Disaster nursing
UN STRATEGIES ON DISASTER RISK REDUCTION
WORLD CONFERENCE FOR DISASTER RISK
REDUCTION
Sendai Framework Monitoring
Hyogo Framework of Action
Global Risk Assessment Framework
OIEWG on Indicators and Terminology Related to
DRR
 The open-ended intergovernmental expert working
(OIEWG) group on indicators and terminology
relating to disaster risk reduction (A/71/644) was
established by the UNGA in it’s A/RES/69/284 and
endorsed by the UNGA in A/RES/71/276.
 The report presents recommended indicators to
monitor the global targets of the Sendai Framework,
the follow-up to and operationalization of the
indicators and recommended terminology relating to
disaster risk reduction.
Examples of Key Terminology Endorsed in
A/RES/71/276
Disaster
 A serious disruption of the functioning of a
community or a society at any scale due to
hazardous events interacting with conditions of
exposure, vulnerability and capacity, leading to
one or more of the following: human, material,
economic and environmental losses and
impacts.
Disaster Risk
 The potential loss of life, injury, or destroyed or
damaged assets which could occur to a system,
society or a community in a specific period of
time, determined probabilistically as a function of
hazard, exposure, vulnerability and capacity.
Exposure
 The situation of people, infrastructure, housing,
production capacities and other tangible human
assets located in hazard-prone areas.
Hazard
 A process, phenomenon or human activity that
may cause loss of life, injury or other health
impacts, property damage, social and economic
disruption or environmental degradation.
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Mitigation
 The lessening or minimizing of the adverse
impacts of a hazardous event.
Prevention
 Activities and measures to avoid existing and
new disaster risks.
Resilience
 The ability of a system, community or society
exposed to hazards to resist, absorb,
accommodate, adapt to, transform and recover
from the effects of a hazard in a timely and
efficient manner, including through the
preservation and restoration of its essential
basic structures and functions through risk
management.
Underlying Disaster Risk Drivers
 Processes or conditions, often development-
related, that influence the level of disaster risk
by increasing levels of exposure and
vulnerability or reducing capacity.
Vulnerability
 The conditions determined by physical, social,
economic and environmental factors or
processes which increase the susceptibility of an
individual, a community, assets or systems to
the impacts of hazards.
The World Conference on Disaster Risk Reduction
 A series of United Nations conferences focusing on
disaster and climate risk management in the context
of sustainable development.
 Convened three times, with each edition to date
having been hosted by Japan:
o Yokohama in 1994
o Hyogo in 2005
o Sendai in 2015
 As requested by the United Nations General
Assembly (UNGA), the United Nations Office for
Disaster Risk Reduction (UNISDR) served as the
coordinating body for the Second and Third UN
World Conference on Disaster Reduction in 2005
and 2015.
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 United Nations
International Strategy for Disaster Reduction
 Aims at increasing public awareness to understand
risk, vulnerability and disaster reduction globally.
o Adopted during the July 1999 IDNDR
Programme Forum, in Geneva, and ratified
by the United Nations’ Economic and Social
Council (ECOSOC) and General Assembly
during the second meeting of its
Commission on Sustainable Development.
More than 20 speakers at the CSD spoke in
favour of the Strategy and the proposed
institutional arrangements in November
1999, and a resolution to that effect was
adopted.
 Summary of the International Strategy (July 1999
IDNDR Programme forum):
o While hazards are inevitable, and the
elimination of all risk is impossible, there are
many technical measures, traditional
practices, and public experience that can
reduce the extent or severity of economic
and social disasters. Hazards and
emergency requirements are a part of living
with nature, but human behavior can be
changed.
o In the words of the Secretary General,
“We must, above all, shift from a culture of
reaction to a culture of prevention.
Prevention is not only more humane than
cure; it is also much cheaper… Above all, let
us not forget that disaster prevention is a
moral imperative, no less than reducing the
risks of war”.
VISION
 To enable all communities to become resilient to
the effects of natural, technological and
environmental hazards, reducing the compound
risks they pose to social and economic
vulnerabilities within modern societies.
 To proceed from protection against hazards to
the management of risk through the integration
of risk prevention into sustainable development.
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GOALS
1. Increase public awareness of the risks that
natural, technological and environmental
hazards pose to modern societies.
2. Obtain commitment by public authorities to
reduce risks to people, their livelihoods, social
and economic infrastructure, and environmental
resources.
3. Engage public participation at all levels of
implementation to create disaster-resistant
communities through increased partnership and
expanded risk reduction networks at all levels.
4. Reduce the economic and social losses of
disasters as measured, for example, by Gross
Domestic Product.
OBJECTIVES
1. Stimulate research and application, provide
knowledge, convey experience, build capabilities
and allocate necessary resources for reducing
or preventing severe and recurrent impacts of
hazards, for those people most vulnerable.
2. Increase opportunities for organizations and
multi-disciplinary relationships to foster more
scientific and technical contributions to the
public decision-making process in matters of
hazard, risk and disaster prevention.
3. Develop a more proactive interface between
management of natural resources and risk
reduction practices.
4. Form a global community dedicated to making
risk and disaster prevention a public value.
5. Link risk prevention and economic
competitiveness issues to enhance opportunities
for greater economic partnerships.
6. Complete comprehensives risk assessments
and integrate them within development plans.
7. Develop and apply risk reduction strategies and
mitigation measures with supporting
arrangements and resources for disaster
prevention at all levels of activity.
8. Identify and engage designated authorities,
professionals drawn from the widest possible
range of expertise, and community leaders to
develop increased partnership activities.
9. Establish risk monitoring capabilities, and early
warning systems as integrated processes, with
particular attention being given to emerging
hazards with global implications such as those
related to climate variation and change, at all
levels of responsibility.
10. Develop sustained programs of public
information and institutionalized educational
components pertaining to hazards and their
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 effects, risk management practices and disaster
prevention activities, for all ages.
11. Establish internationally and professionally
agreed standards / methodologies for the
analysis and expression of the souci-economic
impacts of disasters on societies.
12. Seek innovative funding mechanisms dedicated
to sustained risk and disaster prevention
activities.
IMPLEMENTATION
 Conduct a national audit or assessment process
of existing functions necessary for a
comprehensive and integrated national strategy
of hazard, risk and disaster prevention,
projected over 5-10 and 20 year time periods.
 Conduct dynamic risk analysis with specific
consideration of demographics, urban growth,
and the interaction or compound relationships
between natural, technological and
environmental factors.
 Build, or where existing, strengthen
regional/sub-regional, national and international
approaches, and collaborative organizational
arrangements that can increase hazard, risk and
disaster prevention capabilities and activities.
 Establish coordination mechanisms for greater
coherence and improved effectiveness of
combined hazard, risk and disaster prevention
strategies at all levels of responsibility.
 Promote and encourage know-how transfer
through partnership and among countries with
particular attention given in the transfer of
experience amongst those countries most
exposed to risks.
 Establish national, regional/sub-regional, and
global information exchanges, facilities, or
websites dedicated to hazard, risk and disaster
prevention, linked by agreed communication
standards and protocols to facilitate interchange.
 Link efforts of hazard, risk and disaster
prevention more closely with the Agenda 21
implementation process for enhanced synergy
with environmental and sustainable
development issues.
 Focus multi-year risk reduction strategies on
urban concentration and mega-city
environments.
 Institute comprehensive application of land-use
planning and programmes in hazard prone-
environments.
 Develop and apply standard forms of statistical
recording of risk factors, disaster occurrences
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and their consequences to enable more
consistent comparisons.
 Undertake periodic reviews of accomplishments
in hazard, risk and disaster reduction efforts at
all levels of engagement and responsibility.
 Study the feasibility of specific alternative
funding and resource allocation modalities that
can ensure continued commitment to sustained
risk and disaster prevention strategies
UN Office for Disaster Risk Reduction
 (formerly UNISDR) is part of the United Nations
Secretariat and it supports the implementation &
review of the Sendai Framework for Disaster Risk
Reduction adopted by the Third UN World
Conference on Disaster Risk Reduction on 18 March
2015 in Sendai, Japan. The Sendai Framework is a
15-year voluntary people-centred approach to
disaster risk reduction, succeeding the 2005-2015
framework.
 UNDRR’s vision is anchored on the four priorities for
action set out in the Sendai Framework.
 UNDRR coordinates international efforts in Disaster
Risk Reduction (DRR) and it reports on the
implementation of the Sendai Framework for
Disaster Risk Reduction. It convenes the biennial
Global Platform on Disaster Risk Reduction.
 1 May 2019, the UNDrR officially changed its
acronym to UNDRR (from UNISDR) to better reflect
its name. The former acronym had not been
changed since the office was called the International
Strategy for Disaster Risk Reduction
Post-Disaster : Disaster Management and Post-
disaster Stage: Response & Recovery
Linking to the Goals of Sustainable Development
1994 First World Conference on Natural Disasters in
Yokohama
 The First World Conference on Natural Disasters
(Yokohama, Japan - May 23 to 27, 1994)
 adopted the Yokohama Strategy for a Safer World:
Guidelines for Natural Disaster Prevention,
Preparedness and Mitigation and its Plan of Action,
endorsed by the UNGA in 1994.
 Main outcome of the mid-term review of the
International Decade of Natural Disaster Reduction
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 (IDNDR) and established 10 principles for its
strategy, a plan of action and a follow-up.
10 Principles of theYokohama Strategy for a Safer
World
1. Risk assessment is a required step for the
adoption of adequate and successful disaster
reduction policies and measures.
2. Disaster prevention and preparedness are of
primary importance in reducing the need for
disaster relief.
3. Disaster prevention and preparedness should be
considered integral aspects of development
policy and planning at national, regional,
bilateral, multilateral and international levels.
4. The development and strengthening of
capacities to prevent, reduce and mitigate
disasters is a top priority area to be addressed
during the Decade so as to provide a strong
basis for follow-up activities to the Decade.
5. Early warnings of impending disasters and their
effective dissemination using
telecommunications, including broadcast
services, are key factors to successful disaster
prevention and preparedness.
6. Preventive measures are most effective when
they involve participation at all levels, from the
local community through the national
government to the regional and international
level.
7. Vulnerability can be reduced by the application
of proper design and patterns of development
focused on target groups, by appropriate
education and training of the whole community.
8. The international community accepts the need to
share the necessary technology to prevent,
reduce and mitigate disaster; this should be
made freely available and in a timely manner as
an integral part of technical cooperation.
9. Environmental protection as a component of
sustainable development consistent with poverty
alleviation is imperative in the prevention and
mitigation of natural disasters.
10. Each country bears the primary responsibility for
protecting its people, infrastructure, and other
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national assets from the impact of natural
disasters. The international community should
demonstrate strong political determination
required to mobilize adequate and make efficient
use of existing resources, including financial,
scientific and technological means, in the field of
natural disaster reduction, bearing in mind the
needs of the developing countries, particularly
the least developed countries.
2005 Second World Conference on Disaster
Reduction in Kobe
 The Second World Conference on Disaster
Reduction conference was held in Kobe, Japan from
18 to 22 January 2005. This conference took on
particular poignancy, as it came almost 10 years to
the day after the Great Hanshin earthquake in Kobe
and less than a month after the 2004 Indian Ocean
tsunami. Japan's long history of severe natural
disasters, prominence in international humanitarian
aid and development and its scientific achievements
in monitoring dangerous natural phenomena also
made it a suitable conference venue.
 The upcoming conference had not garnered much
attention, but due to the 26 December, Indian Ocean
tsunami, the attendance grew dramatically and the
international media focused on the event. Japan's
Emperor Akihito opened the conference and
welcomed 4,000 participants from around the world.
 The World Conference adopted plans to put in place
an International Early Warning Programme (IEWP),
which had first been proposed at the Second
International Conference on Early Warning in 2003
in Bonn, Germany.
 The goal of the World Conference was to find ways
to reduce the toll of disasters through preparation,
and ultimately to reduce human casualties. Due to
the proximity to the devastating Indian Ocean
tsunami, developing a global tsunami warning
system was high on the agenda.
OTHER TOPICS INCLUDED:
 pledges to reduce disaster damage
 healthcare after disaster
 early warning systems
 safe building standards
 agree upon cost-effective preventative
countermeasures
 a global database on relief and reconstruction
and a centre on water hazards
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 HYOGO FRAMEWORK FOR ACTION 2005-2015
Building the Resilience of Nations and Communities
to Disasters
I. Preamble
 The World Conference on Disaster Reduction was
held from 18 to 22 January 2005 in Kobe, Hyogo,
Japan, and adopted the present Framework for
Action 2005-2015: Building the Resilience of Nations
and Communities to Disasters (here after referred to
as the “Framework for Action”). The Conference
provided a unique opportunity to promote a strategic
and systematic approach to reducing vulnerabilities1
and risks to hazards. It underscored the need for,
and identified ways of, building the resilience of
nations and communities to disasters.
CHALLENGES POSED BY DISASTERS
 Disaster loss is on the rise with grave consequences
for the survival, dignity and livelihood of individuals,
particularly the poor, and hard-won development
gains. Disaster risk is increasingly of global concern
and its impact and actions in one region can have an
impact on risks in another, and vice versa.
 In the past two decades, on average more
than 200 million people have been affected
every year by disasters.
 This, compounded by increasing
vulnerabilities related to changing
demographic, technological and socio-
economic conditions, unplanned urbanization,
development within high-risk zones, under-
development, environmental degradation,
climate variability, climate change, geological
hazards, competition for scarce resources,
and the impact of epidemics such as
HIV/AIDS, points to a future where disasters
could increasingly threaten the world’s
economy, and its population and the
sustainable development of developing
countries.
 Disaster risk arises when hazards interact with
physical, social, economic and environmental
vulnerabilities.
 Events of hydrometeorological origin
constitute the large majority of disasters.
Despite the growing understanding and
acceptance of the importance of disaster risk
reduction and increased disaster response
capacities, disasters and in particular the
management and reduction of risk continue to
pose a global challenge.
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 There is now international acknowledgement that
efforts to reduce disaster risks must be
systematically integrated into policies, plans and
programmes for sustainable development and
poverty reduction, and supported through bilateral,
regional and international cooperation, including
partnerships.
 Sustainable development, poverty reduction,
good governance and disaster risk reduction
are mutually supportive objectives, and in
order to meet the challenges ahead,
accelerated efforts must be made to build the
necessary capacities at the community and
national levels to manage and reduce risk.
 Such an approach is to be recognized as an
important element for the achievement of
internationally agreed development goals,
including those contained in the Millennium
Declaration.
 The importance of promoting disaster risk reduction
efforts on the international and regional levels as
well as the national and local levels has been
recognized in the past few years in a number of key
multilateral frameworks and declarations.
THE YOKOHAMA STRATEGY:
lessons learned and gaps identified
 The Yokohama Strategy for a Safer World:
Guidelines for Natural Disaster Prevention,
Preparedness and Mitigation and its Plan of Action
(“Yokohama Strategy”), adopted in 1994, provides
landmark guidance on reducing disaster risk and the
impacts of disasters.
The review of progress made in implementing the
Yokohama Strategy identifies major challenges for
the coming years in ensuring more systematic action
to address disaster risks in the context of
sustainable development and in building resilience
through enhanced national and local capabilities to
manage and reduce risk.
 The review stresses the importance of disaster risk
reduction being underpinned by a more pro-active
approach to informing, motivating and involving
people in all aspects of disaster risk reduction in
their own local communities. It also highlights the
scarcity of resources allocated specifically from
development budgets for the realization of risk
reduction objectives, either at the national or the
regional level or through international cooperation
and financial mechanisms, while noting the
significant potential to better exploit existing
resources and established practices for more
effective disaster risk reduction.
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 Specific gaps and challenges are identified in the
following five main areas:
a) Governance: organizational, legal and policy
frameworks;
b) Risk identification, assessment, monitoring
and early warning;
c) Knowledge management and education;
d) Reducing underlying risk factors;
e) Preparedness for effective response and
recovery.
 These are the key areas for developing a relevant
framework for action for the decade 2005–2015.
II. World Conference on Disaster Reduction:
Objectives, expected outcome and strategic goals
A. Objectives convened by the General Assembly
a) To conclude and report on the review of the
Yokohama Strategy and its Plan of Action, with
a view to updating the guiding framework on
disaster reduction for the twenty-first century;
b) To identify specific activities aimed at ensuring
the implementation of relevant provisions of the
Johannesburg Plan of Implementation of the
World Summit on Sustainable Development on
vulnerability, risk assessment and disaster
management;
c) To share good practices and lessons learned to
further disaster reduction within the context of
attaining sustainable development, and to
identify gaps and challenges;
d) To increase awareness of the importance of
disaster reduction policies, thereby facilitating
and promoting the implementation of those
policies;
e) To increase the reliability and availability of
appropriate disaster-related information to the
public and disaster management agencies in all
regions, as set out in relevant provisions of the
Johannesburg Plan of Implementation.
 The realization of this outcome will require the
full commitment and involvement of all actors
concerned, including governments, regional and
international organizations, civil society including
volunteers, the private sector and the scientific
community.
B. Strategic Goals, the Conference resolved to adopt
a) The more effective integration of disaster risk
considerations into sustainable development
policies, planning and programming at all levels,
with a special emphasis on disaster prevention,
mitigation, preparedness and vulnerability
reduction;
b) The development and strengthening of
institutions, mechanisms and capacities at all
levels, in particular at the community level, that
can systematically contribute to building
resilience to hazards;
c) The systematic incorporation of risk reduction
approaches into the design and implementation
of emergency preparedness, response and
recovery programmes in the reconstruction of
affected communities.
How do we respond, recover and rebuild to disaster in
order to decrease risk and increase our resiliency in
transforming our society to one that is sustainable in the
long-term?
Note: Key factors influencing resilience and
decreasing disaster risk

B. Expected Outcomes
 Taking these objectives into account, and
drawing on the conclusions of the review of the
Yokohama Strategy, States and other actors
participating at the World Conference on
Disaster Reduction (hereinafter referred to as
“the Conference”) resolve to pursue the
following expected outcome for the next 10
years:
 The substantial reduction of disaster
losses, in lives and in the social,
economic and environmental assets of
communities and countries.
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Source: Turnbull et al., 2013

 Adopted by 168 Governments at the World
Conference on Disaster Reduction, held in Kobe,
Hyogo Prefecture, Japan, 18-22 January 2005
The HFA identified five separate priorities for action
 Ensure that disaster risk reduction (DRR) is a
national and local priority with a strong
institutional basis for implementation;
The Disaster Risk Management Model for SD from CGSS
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 Identify, assess and monitor disaster risks and
enhance early warning;
 Use knowledge, innovation and education to
build a culture of safety and resilience at all
levels;
 Reduce underlying risk factors;
 Strengthen disaster preparedness for effective
response at all levels.
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What we DO NOT want DRM & Sustainable Development
 Actions taken in the aftermath of a disaster to:
o Reconstruct same as before
Sustainability
o Rebuilding the pre-existing vulnerabilities
 Systems science:
o Community in same state as before the
o “A set of conditions and trends in a given
disaster
system that can continue indefinitely.”
 Dictionary:
o “The ability to endure”

“Sustainable DEVELOPMENT”
means …
 “A managed process of continuous innovation and
systemic changein the direction of sustainability.”
o i.e. Creating systems that can endure (i.e.
What WE WANT resilient, transformative, flourishing)

SUSTAINABILITY IS…
 a set of conditions and trends in a given system
that can continue indefinitely.

Principles Disaster Recovery and Rehabilitation

Recovery and rehabilitation is most effective:

 when communities and stakeholders recognize
that it is a long-term process;
 when activities are integrated with risk
management and sustainable development;
 when conducted with the participation of all Sustainability is not about the Earth.
affected stakeholders; The Earth is Fine.
 when services are provided in a timely, fair and
flexible manner. Sustainability is about the Survival of Humanity (the
human species) going forward- our children’s and their
children’s future
Disaster Response & Recovery Areas
This is what is at risk!
Governance, Leadership, Infrastructure
Decision-making
Health & sanitation Waste management Different observers highlight different aspects—
Mental health Mortality management economics, corporations, climate change,
Public safely transportation pandemics, communication technology, terrorism,
Communications Business vitality civil society, governance, culture, and so on—all
Emergency medical care Education & training introduced by the modifier “global”. Indeed, each is
Food security Children welfare a critical issue in its own right. But rather than
(procurement, distribution) independent, these factors or variables are separate
expressions of a larger process, the formation of a
Housing Public services & utiliies
unitary global system.
Environmental Infrastructure
management

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4 Basic System Conditions for Sustainability as the inability to continue production for some time
Nature: or permanently due to loss of assets (Mechler, 2004).
 Living within the Earth’s physical and biological
limits; UN CONFERENCE ON SUSTAINABLE
DEVELOPMENT
Economy;
 Maintaining a vital, prosperous economy;

Society:
 Supporting social stability, equity, and
development;

Human Wellbeing:
 Making individual opportunity, fulfillment, and Official Negotiations
happiness possible.  3rd Preparatory Committee Meeting (13-15
June) to agree the last version of the draft
SOME BASIC PRINCIPLES: AN ORGANIZATION, difficulty of reaching a consensus the
COMMUNITY, OR SOCIETY WILL BE SUSTAINABLE PrepCom invited Brazil to conduct
IF IT… “preconference informal consultations in its
1. understands its own systems, and the systems capacity as host country”.
in which it is embedded;  UN SUMMIT -HEADS OF STATE (20/22 June):
2. understands and accounts for limits and system Plenary and adoption of the outcome document
dynamics;
3. looks for and responds to long-term systemic
trends that affect its ability to achieve its goals;
4. changes internally to meet and take advantage
of external conditions and trends;
5. is resilient enough to withstand short-term
shocks;
6. does not undermine the conditions of its own
existence;

Hazard, exposure and vulnerability drive direct risk

in Disaster Risk Management Analysis

Figure shows the common understanding that

(direct) risk is a function of hazard, exposure and
vulnerability
Direct risk is the likelihood of direct losses, which
are the immediate impact of the disaster; such as
physical damage caused by flood waters.
Indirect risk relates to indirect losses, which are the
consequences which flow from the direct loss; such

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 Sustainable Development Dialogues
Outcomes
1. “The future we want” Outcome Document
2. 700 Voluntary Commitments
“THE FUTURE WE WANT” OUTCOME DOCUMENT
 53 pages, 283 paragraphs;
 6 sections:
I. Our common vision;
II. Renewing political commitment;
III. Green economy in the context of sustainable
development and poverty eradication;
IV. Institutional framework for sustainable
development;
V. Framework for action and follow-up
VI. Means of implementation.
1.4.2. “The future we want” Outcome Document
SECTION I: our common vision
 Recognizing that poverty eradication, changing
unsustainable and promoting sustainable
patterns of consumption and production, and
protecting and managing the natural resource
base of economic and social development are
the overarching objectives of and essential
requirements for sustainable development
1.4.4. “The future we want” Outcome Document
SECTION III: Green economy
 There are “different approaches” and tools
available to achieve SD  Green economy is
one of the important tools,
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 Guidance on green economy policies:
 Reference to Rio Principles and past
action plans
 national sovereignty over natural
resources;
 participation by all relevant stakeholders;
 sustained and inclusive growth;
Sustainable Consumption and
Production;
 international cooperation on finance;
 indigenous peoples and non-market
approaches;
 poverty eradication (social protection
floors).
1.4.7. “The future we want”
B. SUSTAINABLE DEVELOPMENT GOALS (SDGS)
 Still firmly committed to MDGs but also
recognize utility of a set of SDGs (based on
Agenda 21 and the JPOI, Rio Principles);
 SDGs focused on priority areas selected on the
Outcome Document;
 established an intergovernmental process on
SDGs  working group will be constituted, to
submit a proposal for SDGs to the UNGA;
 need to assess targets and indicators for
SDGs.
1.4.8. “The future we want” Outcome Document
VI. MEANS OF IMPLEMENTATION
A. FINANCE: need for significant mobilization of
resources for SD  established an
intergovernmental process to propose a SD
financing strategy.
B. TECHNOLOGY: importance of access by all
countries to environmentally sound techn.
(included technology trasfer to developing
countries)
C. CAPACITY BUILDING: need for enhanced
capacity building for SD  UN agencies invited
to share knowledge and support cooperation
D. TRADE: international trade as engine for SD 
need of rule-based, open, trading system
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Each of the 17 Goals and 169 Targets represent our
attempt to maintain or achieve certain system conditions
that we think are required for sustainability.
Disaster risk reduction references in goals and
targets
Goal 1. End poverty in all its forms everywhere
 1.5 By 2030 build the resilience of the poor and
those in vulnerable situations, and reduce their
exposure and vulnerability to climate-related
extreme events and other economic, social and
environmental shocks and disasters
Goal 2. End hunger, achieve food security and
improved nutrition, and promote sustainable
agriculture
 By 2030 ensure sustainable food production
systems and implement resilient agricultural
practices that increase productivity and
production, that help maintain ecosystems, that
strengthen capacity for adaptation to climate
change, extreme weather, drought, flooding and
other disasters, and that progressively improve
land and soil quality
Goal 3. Ensure healthy lives and promote well-being
for all at all ages
 3.d Strengthen the capacity of all countries,
particularly developing countries, for early
warning, risk reduction, and management of
national and global health risks
Goal 4. Ensure inclusive and equitable quality
education and promote life-long learning
opportunities for all
 4.a Build and upgrade education facilities that
are child, disability and gender sensitive and
provide safe, non-violent, inclusive and effective
learning environments for all
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Goal 6. Ensure availability and sustainable
management of water and sanitation for all
 By 2020 protect and restore water-related
ecosystems, including mountains, forests,
wetlands, rivers, aquifers and lakes
Goal 9. Build resilient infrastructure, promote
inclusive and sustainable industrialization and foster
innovation
 9.1 Develop quality, reliable, sustainable and
resilient infrastructure, including regional and
trans-border infrastructure, to support economic
development and human well-being, with a
focus on affordable and equitable access for all
 9.a Facilitate sustainable and resilient
infrastructure development in developing
countries through enhanced financial,
technological and technical support to African
countries, LDCs, LLDCs and SIDS
Goal 11. Make cities and human settlements
inclusive, safe, resilient and sustainable
 11.4 Strengthen efforts to protect and safeguard
the world’s cultural and natural heritage
 11.5 By 2030 significantly reduce the number of
deaths and the number of affected people and
decrease by% the economic losses relative to
GDP caused by disasters, including water-
related disasters, with the focus on protecting
the poor and people in vulnerable situations
 11.6 By 2030, reduce the adverse per capita
environmental impact of cities, including by
paying special attention to air quality, municipal
and other waste management
 11.b By 2020, increase by x% the number of
cities and human settlements adopting and
implementing integrated policies and plans
towards inclusion, resource efficiency, mitigation
and adaptation to climate change, resilience to
disasters, develop and implement in line with the
forthcoming Hyogo Framework holistic disaster
risk management at all levels
 11.c Support least developed countries,
including through financial and technical
assistance, for sustainable and resilient
buildings utilizing local materials
Goal 13. Take urgent action to combat climate
change and its impacts*
 13.1 Strengthen resilience and adaptive
capacity to climate related hazards and natural
disasters in all countries
 13.2 Integrate climate change measures into
national policies, strategies, and planning
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  13.3 Improve education, awareness raising and
human and institutional capacity on climate
change mitigation, adaptation, impact reduction,
and early warning
Goal 14. Conserve and sustainably use the oceans,
seas and marine resources for sustainable
development
 14.2 By 2020, sustainably manage and protect
marine and coastal ecosystems to avoid
significant adverse impacts, including by
strengthening their resilience, and take action for
their restoration, to achieve healthy and
productive oceans
Goal 15. Protect, restore and promote sustainable
use of terrestrial ecosystems, sustainably manage
forests, combat desertification, and halt and reverse
land degradation and halt biodiversity loss
 15.1 By 2020 ensure conservation, restoration
and sustainable use of terrestrial and inland
freshwater ecosystems and their services, in
particular forests, wetlands, mountains and
drylands, in line with obligations under
international agreements
 15.3 By 2020, combat desertification, and
restore degraded land and soil, including land
affected by desertification, drought and floods,
and strive to achieve a land-degradation neutral
world
Sendai Framework for Disaster Risk Reduction
2015–2030
 The Sendai Framework for Disaster Risk Reduction
(2015–2030) is an international document that was
adopted by the United Nations (UN) member states
between 14 and 18 March 2015 at the World
Conference on Disaster Risk Reduction held in
Sendai, Japan, and endorsed by the UNGA in June
2015. It is the successor agreement to the Hyogo
Framework for Action (2005–2015), which had been
the most encompassing international accord to date
on disaster risk reduction.
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SENDAI FRAMEWORK MONITORING: AN
OVERVIEW
 Global Sendai Framework Targets
 Linkage of Sendai Framework and SDG
indicator systems
 Custom and Regional Targets and Indicators
PRIORITY AREAS
1. Understanding disaster risk;
2. Strengthening disaster risk governance to
manage disaster risk;
3. Investing in disaster risk reduction for resilience;
4. Enhancing disaster preparedness for effective
response, and to "Building Back Better" in
recovery, rehabilitation and reconstruction.
Substantially reduce global
Global Target A:
disaster mortality by 2030
Substantially reduce the number
Global Target B: of affected people globally by
2030
Reduce direct disaster economic
Global Target C:
loss in relation to global GDP
Substantially reduce disaster
Global Target D: damage to critical infrastructure
and disruption of basic services
Substantially increase the number
of countries with national and
Global Target E
local disaster risk reduction
strategies by 2020
Substantially enhance
Global Target F: international cooperation to
developing countries
Substantially increase the
availability of and access to multi-
hazard early warning systems and
Global Target G:
disaster risk information and
assessments to the people by
2030
Sendai Framework
a) Substantially reduce global disaster mortality by
2030, aiming to lower the average per 100,000
global mortality rate in the decade 2020–2030
compared to the period 2005– 2015;
b) Substantially reduce the number of affected
people globally by 2030, aiming to lower the
average global figure per 100,000 in the decade
2020–2030 compared to the period 2005–2015;
c) Reduce direct disaster economic loss in relation
to global gross domestic product (GDP) by 2030;
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 d) Substantially reduce disaster damage to critical
infrastructure and disruption of basic services,
among them health and educational facilities,
including through developing their resilience by
2030;
e) Substantially increase the number of countries
with national and local disaster risk reduction
strategies by 2020;
f) Substantially enhance international cooperation
to developing countries through adequate and
sustainable support to complement their national
actions for implementation of the present
Framework by 2030;
g) Substantially increase the availability of and
access to multi-hazard early warning systems
and disaster risk information and assessments
to people by 2030.

Sendai Framework for DRR 2015–2030 Global Goals

SEVEN TARGETS TO ACHIEVE BY 2030

SUBSTANTIALLY REDUCE
a. Global disaster mortality
b. Number of affected people
c. Economic loss in relation to GDP
d. Damage to critical infrastructure and services
disruption

SUBSTANTIALLY INCREASE
e. Number of countries with national and local DRR
strategies by 2020
f. International cooperation to developing countries
g. Availability and access to early warning systems
and DRR information

Development
 The Sendai document emerged from three years
of talks, assisted by the United Nations
International Strategy for Disaster Reduction,
during which UN member states, NGOs, and
other stakeholders made calls for an improved
version of the existing Hyogo Framework, with a
set of common standards, a comprehensive
framework with achievable targets, and a
legally-based instrument for disaster risk
reduction.

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 Hazard Risk Vulnerability Assessment (HRVA)

Objective  The following factors are often considered:

 Discuss methods of conducting a hazard  Known risk
vulnerability analysis (HVA)  Historical data
 Identify how the HVA is applicable to  Manufacturer or vendor statistics
preparedness and evacuation
 Practice effective training techniques in Historical Data
conducting a HVA  Natural events
 Hazardous material releases
The HVA and the Relationship to Evacuation  Technological accidents
 The HVA is a tool used to evaluate the potential  Infrastructure problems
risks for a facility
 It is not an evaluation of the potential for Risk Assessment
evacuation  The risk of an event is assessed based on:
 However, risks identified in the process may  Threat to life and/or health
focus the organization toward the need to  Disruption of services
mitigate and prepare for circumstances that  Damage for failure possibilities
could include evacuation  Loss of community trust
 Financial impact and legal issues
THE PURPOSE OF HVA
Preparedness
 The purpose is a prioritization process that will
 Preparedness of the organization’s ability to
 result in a risk assessment for “all hazards”
manage risks, can include items such as:
The tool includes consideration of multiple
 Status of current plans
factors
 Training
 The focus is on organization planning and
 Insurance
resources and /or the determine that no action
 Back up systems
may be required. This is an organization
 Community resources
decision
Models
Is This Required?
 There are a number of models for an HVA.
 The Joint Commission, previously called the
 Two well known models are from
Joint Commission of Accreditation of Healthcare
 American Society of Healthcare
Organizations (JCAHO), requests an HVA for
 Engineering (ASHE)
organizations to determine the focus of their
Kaiser Foundation
emergency planning
 Both models can be adjusted to fit the
 There is no specific tool nor method defined
organization
 Security organizations and other vendors also
HVA Categories for Evaluation market HVA tools
 There are categories considered in a formal
process of assessing an HVA
Medical Center HVA Model
 Most HVA tools include an assessment of the
following factors:
❒ ASHE Model 2001
o Probability that an event will occur
 Human Events
o The risk of disruption to the organization
associated with the event scored as high,  Natural Events
moderate or low or a similar description.  Technological Events
o The level of preparedness
❒ Kaiser Foundation Model 2001
 Human Events
PROBABILITY OF OCCURRENCE
 Natural Events
 The probability may be based on statistics and  Technological Events
objective information but also may be intuitive  Hazmat Events
and highly subjective.

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Natural Events
 Risks common to the area or geography of the
region, for example: storms, earthquakes, floods,
and tornadoes, and other natural causes of
damage
 The impact may be able to be mitigated or may
result in a partial or complete evacuation
Mitigation Plans for Regions
 Other models use sophisticated software to
determine the hazards by cities, counties or
regional areas
 Are used for the development of mitigation plans
for multi-jurisdictions
WHY IS THIS IMPORTANT TO WORKER WELL-
BEING?
 Preparedness efforts, plans and resources are
directly related to the organization’s HVA
 Engineering controls may occur as a result of
HVA thus reducing risk for the work force
 Safety factors are considered
 Process promotes understanding of current
resources that may not have been known
beyond the “expert”
Evacuation Implications
 When a risk is identified in the HVA that would
potentially result in an evacuation, the
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organization should focus on issues that could
impact the need to evacuate or to mitigate the
risk. Examples:
 Routes
 Locations
 Personal Protective Equipment (PPE)
 Communication to employees with
special needs
 Special situations - management of
family on site
WHAT DOES IT ALL MEAN?
 HVA tools, used to prioritize specific and overall
relative risks, are based on mathematical
formulas that are either embedded in the
document or managed manually
 The factors considered in the assessment
includes the assumption that the risk occurs at
the worst possible time and with a full patient
census
SUMMARY: WHAT IS THE GREATEST RISK?
 The HVA process helps an organization
prioritize in the order of criticality
 The efforts to decrease the consequences of a
possible event can be focused upon. This
includes evacuation.
Examples of HVA Tools
o American Society for Healthcare Engineering of
the American Hospital Association
o Kaiser Permanente’s interactive HVA tool
available at:
o Emergency Management Program Guidebook
Published by VHA Center for Engineering &
Occupational Safety and Health, St. Louis, MO
vaww.ceosh.med.va.gov
o For review of an HVA sample go to: Click HVA
under index link
HRVA － Hazard, Risk and Vulnerability Assessment
 provides the foundation within a continuous
emergency planning cycle needed to maintain an
effective emergency plan.
 It comes from evolving national and international
standards in the field of emergency management.
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 HRVA Step #1
 Select the emergency events from Lists A and B that
you feel could possibly have application for your
emergency plan. Only omit those you’re certain don’t
have application (e.g., a tsunami would not apply if
you are not near an ocean).

 HRVA may seem complicated, but in practice, it

simply involves any person or group following the
six-step procedure.
HRVA Step #2
 Assess the “probability of occurrence” (based on a
projected timeline and available historical data and
current expertise), which will result in a rating of
Frequent, Probable, Occasional, Remote or
Improbable.

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HRVA Step #3 Recovery components of emergency management.
 Determine the “probable severity of damage” if the
emergency took place, which will result in a rating of
Catastrophic, Critical, Marginal or Negligible.

HRVA
 This emergency planning tool is a good visionary
approach, but is not without its faults. Users can fall
HRVA Step #4
victim to subjectivity as they attempt to assess
 Determine the “vulnerability level” by finding the
vulnerabilities objectively. Success depends greatly
combination of ratings you gave in Steps 2 and 3,
on the effort and open-mindedness of those who
and noting the vulnerability of Low, Medium or High.
choose to use it. It can be used effectively to
determine reasonable allocation of resources, and
as a continuous process to ensure that necessary
actions are being taken to maintain an effective
emergency plan.
 An HRVA can also be used for various non-
emergency events (e.g., wedding, vacation, reunion)
to help plan for and carry out planning activities.

HRVA Step #5
 Prioritize the vulnerability levels from highest to
lowest (If you don’t have any High vulnerability
events, then start your list with the Medium and Low
events).

HRVA Step #6
 In sequential order (1st, 2nd, 3rd), transfer the list
from Step 5 so that resources and priority of actions
can be identified, allocated, and tracked in
accordance with the proactive: Prevention/Mitigation,
Preparedness, and the reactive: Response and

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 P.A.C.E. PLAN
P. A. C. E. Plan
 PACE is a methodology developed by the US
Military to help build resilient communication plans
for organizations that need to ensure
communications regardless of the situation. PACE is
an acronym for Primary, Alternate, Contingency, and
Emergency.
P Primary
A Alternate
C Contingency
E Emergency
PRIMARY PLAN
 “main, prime, chief importance, principal” (Merriam-
Webster)
 Primary: The main form of communication.
 The best and intended method of communicatn
between parties.
ALTERNATE PLAN
 “every other, be used instead, substitute” (Merriam-
Webster)
 Alternate: If the primary fails, this is your secondary
form of communication.
 Common but less-optimal method of but is capable
of accomplishing the task. Often monitored
concurrently with primary means.
CONTINGENCY PLAN
 “may but is not certain or possible to occur,
something liable to happen or eventual as an
adjunct or result of something else” (Merriam-
Webster)
 Contingency: Tertiary method of communication.
 Method will not be as fast/ easy/ inexpensive/
convenient as the first two methods but is capable of
accomplishing the task. Often (but undesirably) the
receiver rarely monitors this method.
EMERGENCY PLAN
 ”unforseen cicumstance that need immediate action,
urgenct need” (Merriam-Webster)
 Emergency: If all else fails, this is the worst case
option. It is usually ugly, but will get a message
across.
 method of last resort and typically has significant
Delays, costs, and/or impacts. Often only monitored
when the other means fail.
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P. A. C. E. Example
Primary: Sending short codes or texts from GPS
tracking devices
Alternate: Use of digital cellular communication
with use of data to using landlines if
available.
Contingency: Use of voice calls when the data
network is down.
Emergency: Use of Hi Frequency (HF) radios which
is not reliant on any cellular network.
The PACE Plan System
 The PACE plan system is expressed as a list
showing the order of communication precedence;
primary, alternate, contingency, and emergency.
 The plan designates the order in which
organizations plan to move through available
communications systems until contact can be
established..
 In the general plan, it is important to understand the
order in which you would plan to use various
communication systems and the agreed-upon
method between groups.
METHODOLOGY
 The method requires the author to determine the
different parties that need to communicate and
then determine, if possible, the best four forms of
communication between each of those parties.
 PACE also designates the order in which an
element will move through available
communications systems until contact can be
established with the desired distant element(s).
 Ideally, each method will be completely separate
and independent of the other systems of
communication. For each method, the receiver
must first sense which one the sender is using and
then respond.
 Once an organization has agreed upon the
general plan, detailed operational planning must
follow. In the detailed plan, you can then designate
the radio channel or talk group to be used if using
radios, the satellite phone numbers to be called.
When you know what systems will be used the
PACE Plan ensures everyone agrees on which
systems to monitor and in the correct order as the
higher level of communications fail.
 Emergency Management and Communications
Managers should coordinate the development of
PACE plans for the many different functions and
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 departments within your organization to ensure
that Incident Command and clinical staff can
maintain critical communication links. Plans must
reflect the training, equipment status, and true
capabilities of the organization. If a clinical team
has a disaster plan but team members are
untrained, lack the proper equipment or contact
information they will not be effective in an
emergency.
 Departmental PACE plans should be coordinated
with Emergency Management and the
Communications Team. It is critical that individual
departments nest their plan within the larger
Emergency Plan and with the coordination of the
organization’s communications team to ensure
that the resources are in place to execute the plan
and reduce unnecessary duplication of assets.

CONCLUSION
 Developing comprehensive PACE plans will not
ensure perfect communications in a disaster, but
helps to clear some of the fog and friction found in
every emergency situation.
 The most important part of the PACE plan is the
act of planning itself.
 P.A.C.E. planning is about mitigating risk by
developing 3 back up plans. If the Primary plan
doesn’t work, go to the Alternate. If the Alternate
doesn’t work, do the Contingency Plan. If that fails,
then accomplish you mission with the Emergency
plan. P.A.C.E. Planning isn’t rocket science, but it
is a simple and effective tool you can use to
ensure that you accomplish your mission and get
the job done.

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 EMERGENCY DRILLS
INTRODUCTION
 Emergency drills are an important part of workplace
safety. By practising emergency procedures, you
can ensure that your employees know what to do in
the event of a real emergency. This topic will discuss
the importance of workplace emergency drills and
exercises and provide tips for planning and
conducting a successful drill or exercise.
Emergency Drill
 An emergency drill is a procedure carried out to
practice how a building or organization would
respond to an unexpected event. Emergency drills
are designed to test the response of individuals and
groups to a simulated crisis, such as a fire, severe
weather event, or terrorist attack. The goal of an
emergency drill is to ensure that everyone knows
what to do in the event of an actual emergency.
 Emergency drills should be conducted regularly, and
participants should be given clear instructions on
what to do in the event of an emergency. The drill
should be designed to test the response of
individuals and groups to a simulated crisis, such as
a fire, severe weather event, or terrorist attack. The
goal of an emergency drill is to ensure that everyone
knows what to do in the event of an actual
emergency.
WHAT IS THE IMPORTANCE?
 Emergency drills are important because they
help employees to be prepared for a real
emergency. In the event of an actual emergency,
it is important that employees know what to do
and where to go. By practising emergency
procedures in a drill, employees can become
familiar with the steps they need to take to stay
safe.
DESIGNING AN EMERGENCY DRILL
 A well-designed mock emergency drill can help
your organization assess its readiness and
identify areas that need improvement. But not all
mock drills are created equal. To be effective, a
mock drill should be based on a realistic
scenario that has the potential to occur in your
community.
How to Conduct a Successful E-Drill?
1. Choose a scenario that is relevant to your
community. A mock emergency drill should be
based on a realistic scenario that has the
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potential to occur in your community. For
example, if you live in an area that is susceptible
to wildfires, choose a wildfire-related scenario
for your drill. If you live in a coastal community,
choose a hurricane-related scenario.
2. Make sure the scenario is achievable. The goal
of a mock emergency drill is to test your
organization’s readiness, not to see how well it
can respond to an impossible situation. Choose
a challenging but achievable scenario, and
ensure all participants understand the
parameters of the drill.
3. Involve as many people as possible. A mock
emergency drill is an opportunity to test your
organization’s response plan, but it’s also an
opportunity to educate and engage your
community. Invite first responders, local officials,
media, and the general public to participate in
the drill. The more people you involve, the more
realistic the experience will be.
4. Debrief after the drill. Once the drill is over, take
some time to debrief all of the participants.
Discuss what went well and what could be
improved upon. Use the feedback to revise your
organization’s emergency response plan.
Emergency Drills
 Evacuation and shelter-in-place drills are
scheduled throughout the year to ensure the
readiness of the campus community in
responding to any type of crisis that requires
building occupants to evacuate a building or to
seek protective shelter inside of a building.
Evacuation and sheltering-in-place are the
inverse of one another. You evacuate a building
when the conditions inside the building present a
hazard to human life, health or safety. If the
conditions outside of a building presented a
hazard to human life, health or safety, one would
reverse the evacuation steps and shelter inside
a building.
1. Emergency Evacuation drills include alarm
activation to ensure fire protection and reliability,
along with an orderly, disciplined evacuation,
followed by a thorough inspection of the building to
immediately rectify any code related issues. Finally,
an on-site discussion is held with students, staff and
faculty to evaluate and improve, when necessary,
the performance and efficacy of these drills.
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2. Shelter-in-place drills are a tactical response to a
possible chemical, biological, radiological, nuclear or
natural disaster. They are designed to provide a
place of refuge for people and to give them a level of
physical, emotional and mental comfort. During a
shelter-in-place drill, building occupants are directed
to pre-designated “shelter areas” within a building.
Types of Emergency Drills
 Many types of emergency drills can be
conducted in the workplace. Some of the most
common include fire drills, earthquake drills, and
tornado drills. It is important for employers to
choose the right type of drill for their workplace
based on the hazards present.
❒ Fire drills
 are one of the most common types of
emergency drills conducted in the
workplace. They are designed to ensure
that everyone in the building knows what
to do in the event of a fire. The drill
should include evacuating the building,
using the stairs, and assembling in a
designated area.
❒ Earthquake drills
 are another common type of emergency
drill conducted in the workplace. These
drills are designed to ensure that
everyone in the building knows what to
do during an earthquake. The drill should
include evacuating the building, using the
stairs, and assembling in a designated
area.
❒ Tornado drills
 are another common type of emergency
drill conducted in the workplace. These
drills are designed to ensure that
everyone in the building knows what to
do during a tornado. The drill should
include evacuating the building, using the
stairs, and assembling in a designated
area.
Factors To Consider In Workplace Emergency Drills
 It is important for employers to choose the right type
of emergency drill for their workplace. The type of
drill should be based on the hazards present in the
workplace. By conducting the proper type of drill,
employers can ensure that their employees are
prepared in the event of an emergency.
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 An effective workplace emergency drill should be
based on a well-developed plan that considers your
workplace’s specific needs. It should be designed to
test your emergency procedures’ effectiveness and
allow employees to practice their roles in an
emergency situation.
 When developing your workplace emergency drill
plan, there are several factors that you need to
consider:
o The type of emergencies that could occur in
your workplace
o The location of your workplace
o The number of employees in your workplace
o The ability of your employees to evacuate
the premises safely
o The availability of emergency services
 When developing your workplace emergency drill
plan, it is important to keep the following points in
mind:
o All employees should clearly state and
understand the purpose of the drill.
o The drill should be conducted at a time
when employees are not expecting it.
o Employees should be given enough time to
evacuate the premises safely.
o The drill should be conducted in a realistic
manner and as close to a real emergency
situation as possible.
 When conducting a workplace emergency drill, it is
important to debrief your employees afterwards. This
will allow you to identify any areas where
improvements can be made. It will also provide
employees with the opportunity to raise any
concerns they may have about the drill or the
emergency procedures.
 Simulating a real event is necessary to polish your
disaster plans. “An organization that fails to plan,
is planning to fail”.
 Use tabletop exercises to evaluate your evacuation
procedures with your emergency team. You can test
for potential glitches and find unaddressed
complications by running hypothetical scenarios.
 “Work through the process of what an event will
entail and what resources you need to bring to bear.
Anticipate how people are going to go evacuate,
where they should go, and how you’re going to
communicate this to them.”
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 Teachers:
 Bring everyone indoors
 Ensure exterior doors are locked
 Increase situational awareness
 Take attendance
 Business as usual inside the
classroom

LOCKDOWN
Locks, Lights, Out of Sight
 Lockdown is activated when there is a threat
inside the school building. Creates a time barrier

Students:
 Immediately move away from the theat
 Get to a safe area-classroom or away from the
school
 Stay out of sight
 Maintain silence

Teachers:
 Immediately bring students in to the classroom
LOCKOUT
 Lock the classroom door
Secure the Perimeter
 Cover interior windows, lights out
 Lockout is activated when there is an unsafe
situation outside the school building. Designated  Move away from sight
personnel are assigned to secure the exterior  Maintain silence
doors to the building.  Wait for First Responders to open
the door
Students:  Take attendance, account for
 Return and remain inside the school building students
 Business as usual inside the classroom

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TEAM RESPONSE EVACUATE! TO THE ANNOUNCED LOCATION
Activate School Emergency Team (SET) Students:
 Team response is activated when there is a  Bring your phone
medical emergency or some non threatening  Leave your stuff behind
incident that requires staff to control movement  Follow instructions
inside the school
Teacher:
Students:  Lead evacuation to location
 Immediately return to their classrooms  Take attendance
 Notify if missing, extra or injured students
Teachers:
 Return to classrooms HOLD! IN YOUR CLASSROOM. CLEAR THE HALLS
 Take attendance, account for students Students:
 Increased situational awareness  Remain in the classroom until the “All Clear” is
 Business as usual inside classroom announced

DUCK- COVER- HOLD ON Teacher:

Earthquake
Students:
 Get under a desk, table or hard surface
 Stay away from windows and other objects that
could fall
 Wait for evacuation instructions from teacher
Teacher:
 Get under a desk, table or hard surface
 Stay away from windows and other objects that
could fall
 Assess the damage, determine if it is safe to
evacuate
 Grab emergency attendance roster and
emergency supplies
 Take roll, account for students
 Close and lock classroom door
 Business as usual
 Take attendance
CONCLUSION
 Emergency drills are an important part of
workplace safety. By knowing what type of drill to
conduct and how to execute it effectively, you can
minimize the risk of injury or death in the event of
a real emergency. Make sure your workplace is
prepared for any potential emergency by
conducting regular drills with your team. If you’re
not sure where to start, our guide on emergency
drills will help get you started. Stay safe!

SHELTER-IN-PLACE
Remain in doors
 air contaminate or threat requiring staff and
community to remain in doors

Students:
 Follow the instructions of teacher
 Be ready to move

Teachers:
 Cancel outside activities
 Move students to interior
rooms
 Seal windows door if
necessary
 Take attendance, account
for students

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 MEDICAL TRAUMA- PATIENT ASSESSMENT

VITAL SIGNS  Solicit any signs of systemic infection or

Objective
Vital Signs
 Enhances the First Responder's ability to take
the vital signs of the patient which includes the
temperature, pulse, respiratory rate, perfusion
and the mental status of the patient. This lesson
provides the knowledge and skills to properly
perform the initial assessment.
 Vitals or VS is used to measure the body’s basic
functions.
 These measurements are taken to help assess the
general physical health of a person, give clues to
possible diseases, and show progress toward
recovery.
 The normal ranges for a person’s vital signs vary
with age, weight, gender, and overall health.
5 primary vital signs (5VS)
 Body Temperature
 Pulse Rate/Heart Rate (HR)
 Breathing Rate/Respiratory Rate (RR)
 Blood Pressure (BP)
 Pulse Oximetry (SpO2)
6th, 7th & 8th Vital Signs
 Level of Consciousness
 Pupillary Reaction
 Pain
 Skin Condition
 Capillary Refill
 Glasgow Coma Scale (GCS)
 Blood Glucose Level (CBG)
inflammation in the presence of fever, or elevated
significantly above the individual's normal
temperature.
NORMAL BODY TEMPERATURE
 Measured in degree Celsius or Centigrade (ºC)
and degree Fahrenheit (ºF)
 Varies on gender, recent activity, food and fluid
consumption, time of day, and, in women, the
stage of the menstrual cycle.
 36.5 degrees C (or Celsius) or 97.8 degrees F
(or Fahrenheit) to 37.2 degrees C or 99
degrees F for a healthy adult.
MEASUREMENT TEMPERATURE
 Thermometer is a device that measures
temperature or a temperature gradient.
Body Temperature Site
 Oral (Mouth) 36.8 °C (98.2 °F)
 Rectal (Rectum) 37.5 °C (99.5 °F)
 Axillary (Armpit) 36.5 °C (97.7 °F)
 Tympanic (Ear) 37.5 °C (99.5 °F)
 Temporal (Forehead) 36.5 °C (97.7 °F)
Temp Abnormalities
 Hypothermia is the condition of having an
abnormally low body temperature, typically one
that is dangerously low. <36.5°C
 Hyperthermia is the condition of having a body
temperature greatly above normal. >37.2°C

Additional Vital Signs

 Height & Weight
 Outlook (Mental Status)
 Urinary Output
 Capnograph
 Mean Arterial Pressure (MAP) HEART RATE
 Pulse Rate or Heart Rate (HR) is the rate at which
the heart beats while pumping blood through the
BODY TEMPERATURE
arteries. Its rate is usually measured either at the
 Indication of core body temperature is normally wrist or the ankle and is recorded as beats per
tightly controlled (thermoregulation) as it affects the minute.
rate of chemical reactions.
 Establish a baseline for the individual's normal body
temperature for the site and measuring conditions.

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 PULSE RATE Pulse Abnormalities
 Pulsus alterans strong pulse followed by a
Normal Heart Rate(beats per minute) weak pulse over and over (progressive systolic
Newborn (0-3 m) 100-150 bpm heart failure).
 Pulsus bigeminus gallop rhythm (hoofbeats).
Infant (3-6 m) 90-120 bpm
 Pulsus bisferiens 2 pulse to each beat instead
Infant (6-12 m) 80-120 bpm
of 1 (aortic valve disease).
Children (1-10) 70-130 bpm
 Pulsus tardus er parvus or anacrotic pulse
Children (>10)Adult 60-100 bpm slow than normal tactile pulse (stiff aortic valve).
Trained Athletes 40-60 bpm  Pulsus paradoxus cannot be detected at radial
artery during respiration cause by exaggerated
Strength of Pulse decrease in BP during inspiration (cardiac or
0 Absent respiratory condition)
1 Barely palpable  Tachycardia elevated resting heart rate
2 Easily palpable  Bradycardia decreased resting heart rate
3 Full  Pulsatile intrinsic physiology of systole and
4 Aneurysmal or Bounding pulse diastole
 Collapsing pulse (hyperdynamic circulation)
MEASUREMENT & SITE PR
 Palpate on pulses counting 1 minute
 Auscultate directly on the chest RESPIRATION RATE
 RR is the number of breaths (inhalation-exhalation
cycles) taken within a minute.
 Eupnea normal RR
 Tachypnea increased RR
 Bradypnea lower-than-normal RR

NORMAL RESPIRATORY RATE

Age Group Age Breaths per

minute
Newborn 0-6 weeks 30-60 cycles per
minute
Infant 6 weeks to 6 25-40 cpm
months
Toddler 1 to 3 years 20-30 cpm
Young Children 3 to 6 years 20-25 cpm
Older Children 10 to 14 years 15-20 cpm
Young Adult 14 to 18 years
Palpable Site Adult 18 years and 12-20 cpm
above
 Temporal (forehead)  Apical (chest)
 Facial (lower jaw)  Femoral (inner thigh)
MEASUREMENT RR
 Carotid (neck)  Popliteal (behind the
 Axillary (armpit) knee)  Human respiration rate is measured when a
 Brachial (arm)  Tibialis posterior person is at rest and involves counting the
 Radial (lateral wrist) (ankle) number of breaths for one minute by counting
 Dorsalis pedis (top of how many times the chest rises.
 Ulnar (medial wrist)
foot)

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RR Abnormalities Age Diastole Systole
 Apnea cessation of breathing Infant 65 mmHg 95 mmHg
 Dyspnea difficulty or discomfort during Child 65 mmHg 100 mmHg
breathing Adult 60-80 mmHg 90-120 mmHg
 Hyperpnea increased depth in breathing
 Tachypnea abnormal rapid Diastole Systole
 Hypopnea overly shallow breathing or low Ventricles of Fill with blood Left ventricle
respiratory rate the heart contract
 Bradypnea abnormally slow Blood Vessels Relaxed Contracted
 Orthopnea shortness of breath (lying flat)
 Platypnea shortness of breath (breathlessness)
BP MEASUREMENT
relieved by lying down, worsen when sitting or
standing up  Arterial pressure is most commonly measured
via a sphygmomanometer, which historically
 Biot’s respiration quick and shallow
used the height of a column of mercury to reflect
inspirations followed by periods of apnea
the circulating pressure or a dial in an aneroid.

BLOOD PRESSURE POINTS

 Cheyne-Stokes respiration progressive deep
and sometimes faster breathing, followed by a
gradual decrease that results in a temporary
stop in breathing or apnea
 Kussmaul breathing hyperventilation tend to
be rapid and relatively shallow
 Listen with the stethoscope to the brachial
artery at the antecubital area of the elbow and
slowly releases the pressure in the cuff.
 “Whooshing" or pounding (1st Korotkoff
sound) – systolic blood pressure. Further
release cuff pressure until no sound can be
heard (5th Korotkoff sound) – diastolic arterial
pressure.

\
BLOOD PRESSURE
 BP is the pressure exerted by circulating blood upon
the walls of blood vessels.
 Refers to the arterial pressure in the systemic
circulation.
 Blood pressure is usually expressed in terms of
the systolic (maximum) pressure
over diastolic (minimum) pressure.
 Measured in millimeters of mercury (mm Hg).
BP Abnormalities
NORMAL BLOOD PRESSURE
Category Systolic, mm Diastolic, mm
 Systole is the part of the cardiac
Hg Hg
cycle when the ventricles contract.
Hypotension <90 < 60
 120 mmHg
Desired 90-119 60-79
Prehypertension 120-139 80-89
 Diastole is the part of the cardiac Stage 1
140-159 90-99
cycle when the heart refills with hypertension
blood following systole contraction. Stage 2
160-179 100-109
 80 mmHg hypertension
Hypertensive
≥ 180 ≥ 110
emergency
Isolated systolic
≥ 140 < 90
hypertension

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  Hypotension is the abnormally low blood
pressure, which is considered too low only if
noticeable symptoms are present. Low Blood
Pressure.
 Orthostatic hypotension is also called
postural hypotension results from a
sudden change in body position. Usually
standing up from suddenly from a
seated or lying position.
 Neurologic syncope is an inappropriate
drop of blood pressure while standing
up.
 Hypertension is a pathological increase in
blood pressure. High Blood Pressure.
 Essential hypertension (primary
hypertension or idiopathic hypertension)
is the form of hypertension that by
definition, has no identifiable cause.
 Secondary hypertension (inessential
hypertension) is caused by unidentified
secondary cause
 Hypertensive crisis is severely elevated
blood pressure (equal to or greater than
a systolic 180 or diastolic of 110)
 Hypertensive urgency no organ
damage
 Hypertensive emergency direct
organ damage
 Gestational hypertension or Pre-
eclampsia
 Hypertension in children
OXYGEN SATURATION
 Pulse Ox is a non-invasive method for monitoring a
person's O2 saturation (SpO2 or Saturation of
peripheral oxygen).
PULSE OXYMETRY
 a sensor device is placed on a thin part of the
patient's body, usually a fingertip or earlobe, or
in the case of an infant, across a foot. The
device passes two wavelengths of light through
the body part to a photodetector.
Abigail marie
Abnormalities in O2 Saturation
 Hypoxemia is normally low level of oxygen in
the blood. More specifically, it is oxygen
deficiency in arterial blood.
 Hypoxia, hypoxiation or anoxemia is a
condition in which the body or a region of the
body is deprived of adequate oxygen supply.
Pulse Ox Limitations
 A falsely high or falsely low reading will occur
when hemoglobin binds to something other than
oxygen:
 Hemoglobin has a higher affinity to
carbon monoxide than oxygen, and a
high reading may occur despite the
patient actually being hypoxemic. In
cases of carbon monoxide poisoning,
this inaccuracy may delay the
recognition of hypoxia (low blood
oxygen level).
 Cyanide poisoning gives a high
reading, because it reduces oxygen
extraction from arterial blood. In this
case, the reading is not false, as arterial
blood oxygen is indeed high in early
cyanide poisoning.
 Methemoglobinemia characteristically
causes pulse oximetry readings in the
mid-80s.
LEVEL OF CONSCIOUSNESS
 Individual’s awareness and understanding of what is
happening in his or her surroundings
o Conscious (sensing, perceiving, and
choosing)
o Preconscious (memories that we can
access)
o Unconscious ( memories that we can not
access)
o Non-conscious ( bodily functions without
sensation)
o Subconscious ( “inner child,” self image
formed in early childhood).
Midterms | Disaster Nursing 27
 Pupil Reaction Abnormalities
 Anisocoria or unequal pupils
 Sluggish or slow reaction
 Non-reactive

PAIN ASSESSMENT
 Assessed according to multidimensional approach,
determine the following:
o Chronicity
PUPILLARY RESPONSE
o Severity
 Physiological involuntary response of the pupil of the o Quality
eyes to light o Contributing/associated factors
 Important in assessing underlying neurological o Location/distribution or etiology of pain, if
cause identifiable
o Perfusion o Mechanism of injury, if applicable
o Oxygenation o Barriers to pain assessment
o Condition
Pain Assessment Tool
NORMAL PUPILLARY RESPONSE
 Onset of the event. When the pain started
 The pupils are normally round and of
 Provocation or paliation. Any movement,
approximately equal size (Isocoria).
pressure or other external factors make it worse.
 In the absence of any light, the pupils will
 Quality of the pain. Description of the pain.
become fully relaxed and dilated.
 Radiation or region. Where the pain moves to
 Shone the pupils react briskly, simultaneous and
another area
equal to light.
 Severity. The pain score on a scale 0 to 10.
 Time (history). How long the condition has been
going on and how it has changed since onset

Pupils - Equal, Round & Reactive to Light and

Accomodation (PERRLA)

PUPIL SIZE MEASUREMENT

 Dim the ambient light and ask the patient to
fixate a distant target. Using a penlight,
illuminate the right eye from the right side and
the left from the left side.

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 SKIN CONDITION
 Assessment of skin color includes patient’s skin
color, temperature, and condition. While evaluating
the skin, continue to look for bleeding.
 Skin color depends on blood circulating in the
vessels of the skin. Skin color also depends on the
kind and amount of pigment in the skin.
NORMAL SKIN COLOR
 Lightly pigmented individuals normally has a
pink color.
GLASGOW COMA SCALE
 GCS is a neurological scale that give a reliable,
objective way of recording the conscious state of a
person for initial as well as subsequent assessment.
 Published in 1974 by Graham Teasdale and Bryan J.
Jennett, professors of neurosurgery at the University
of Glasgow's Institute of Neurological Sciences at
the city's Southern General Hospital, Scotland.
ELEMENTS OF GCS
 EVM 456

SKIN CONDITIONS

Color Emotion Condition

Red Angry
Pink to Red Aroused or Hot and Flushing
Excited
White Anxious, Cold or Pale and
Fear Clammy
Blue Cold or Extreme
Pale and Dry
Fear GCS INTERPRETATION
Green Severe Anxiety  Generally, brain injury is classified as:
Cold and
or Disgust  Severe, with GCS < 8–9
Clammy
Yellow Extreme Fear  Moderate, GCS 8 or 9–12 (controversial)
 Minor, GCS ≥ 13
COLORED POEM  Movement:
 “When I'm born I'm black, when I grow up I'm
black, when I'm in the sun I'm black, when I'm
sick I'm black, when I die I'm black, and you...
when you're born (points to white man) you're
pink, when you grow up you're white, when
you're cold you're blue, when you're sick you're
blue, when you die you're green and you dare
call me colored”

CAPILLARY REFILL
 Nail Blach Test or Capillary Refill Test (CRT) is a
rapid test used for assessing the blood flow through
peripheral tissues.
 It's a quick test performed on the nail beds as an
indicator of tissue perfusion (the amount of blood
flow to tissue) and dehydration.
BLOOD GLUCOSE LEVEL
ASSESSING SKIN CONDITION  A mean of checking the blood sugar or glucose level
at any one time.
 Skin touching with the wrist or the back of the
 Glucose meter or glucometer is used to determine
hand.
the approximate concentration of glucose in the
 Skin turgor
blood.
 Capillary refill is the ability of the circulatory
system to restore blood to refill the capillaries.

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Abnormal Blood Glucose Level  Onset, Provocation, Quality, Radiation,
Severity and Time
Blood Glucose Excellent Good Acceptable Poor
Level
Befor mmol/L 4.0 – 6.0 6.1 – 8.1 – 10.0 >10.0
e 8.0
meals
mg/dL 72 – 109 110 - 145 – 180 >180
144
After mmol/L 5.0 – 7.0 7.1 – 10.1 – >13
meals 10.0 13.0
mg/dL 90 – 126 127 – 181 – 234 >235
180

 Hypoglycemia, low blood sugar or glucose,

is when blood sugar decreases to below
normal.
 Hyperglycemia, or high blood sugar is a
condition in which an excessive amount of
glucose circulates in the blood plasma.

HISTORY TAKING

Objective
History Taking
 Enhances the First Responder's ability to
effectively communicate with the patient and
garner important information that determines the
mechanism of injury or nature of illness of the
patient. This lesson provides the knowledge and
skills to properly perform the initial assessment.

Components
 Determining the chief complaint
 Mechanism of injury/nature of illness
 Associated signs and symptoms
 Investigation of the chief complaint
 Past medical history
 Pertinent negatives

Patient History
 Px Hx are pertinent information obtained in order to
formulate a diagnosis of the patient and utilized as
basis for providing medical care to the patient.

Components of Px Hx
 Signs and symptoms
 Sign is something you see in a patient
 Symptom is what patient tell you how they
feel
 Chief Complaint is usually the symptom that is
bothering the patient the most.
 OPQRST Questions

Abigail marie Midterms | Disaster Nursing 30

 EMERGENCY ACTION PRINCIPLE II. Primary Assessment

Objective Primary assessment for all patient situations

Patient Assessment 1. Level of consciousness or LOC (AVPU)
 Enhances the First Responder's ability to 2. ABCs
evaluate a scene for potential hazards, to 3. Identifying life threats
determine the number of patients, whether 4. Determine Mechanism or Injury (MOI) or Nature
additional help is necessary, and to evaluate the of Illness (NOI)
mechanism of injury or nature of illness. 5. Assessment of vital functions
 This lesson provides the knowledge and skills to 6. Initial general impression (GI)
properly perform the initial assessment. In this
session, the student will learn about forming a 1. LEVEL OF CONSCIOUSNESS
general impression, determining
responsiveness, and assessing the airway, Painful stimulus
breathing, and circulation. Students will discuss o Pinch earlobe
how to determine priorities of patient care. o Press down on bone above eye
 This lesson also teaches the knowledge and o Pinch neck muscle
skills required to continue the assessment and
management of the ill or injured patient. Mental status oriented to:
o Person
EMERGENCY ACTION PRINCIPLE (EAP) o Place
1. Scene-Size Up o Time
2. Primary Assessment o Event
3. Interventions
4. Secondary Assessment 2. ABC
5. Reassessment

I. Scene-Size Up
 Quick assessment of the scene and surroundings
 Scene management
o Impact of the environment
o Addressing hazards
o Violence
o Need for additional or specialized resources
o Standard precautions (BSI PPE)
o Multiple patient situations (Triage/MCI)
SAFETY FIRST
 Make sure safety is priority before entering the
scene. Never become a victim.
 Look for potential hazards.
 When parking a unit, park it in a place that will
offer great safety.
 Talk to law enforcement before entering the
scene, especially if it is a crime scene.
 Assess the safety of the patient(s) and
bystanders. Move bystanders if necessary.
 Wear proper PPE and follow BSI techniques.
 Evaluate the need for additional resources.
Contact dispatch if need more help.
 When there are multiple patients, call for help
and begin triage before beginning patient care.
3. IDENTIFY LIFE THREATS
 Perform rapid scan
 Determine need for C-Spine Immobilization
 Transport decision (Pre-Hospital Care Strategies)
 “Load and Go”
 “Stay and Play” (“Treat and Run”)
 “Scoop and Run”
Transport Decision
❒ “Load and Go”
 The process of packaging a patient and
loading them onto an ambulance to be
taken to hospital.
 Criteria: Under the following
circumstances a patient must always be
a load and go:
 Altered Level of Consciousness.
 Any compromise to the Airway.

Abigail marie Midterms | Disaster Nursing 31

  Any compromise to the
Breathing.
 Any compromise to the
Circulation.

 Life threatening injury is found

 Continue life support
 Stabilize any major injuries as quickly as
possible
 Administer Oxygen
 Load patient into stretcher or any means EMS Phases
of transport 1. Detection
 Transport to medical facility 2. Reporting
3. Response
❒ “Stay and Play” 4. On-Scene Care
 The approach of pre-hospital trauma 5. Care in Transit
care in which the patient receives 6. Transfer to Definitive Care
treatment and/or stabilization on scene
before being transported to the hospital.
 Research found effective in treating out-
of-hospital cardiac arrest (OHCA), in
which immediate care is delivered on site
rather than during transport to the
emergency department (ED). (Westafer
et. al., JAMA 2020 Sep 15)
 On-scene resuscitation for OHCA
increases survival rate, is dismal and
transport may interrupt or reduce the
quality of chest compressions.
 EMS agencies should compare their
protocols and outcomes with those of EMS Phases: 1. Detection
high-performing systems, paying  The first vital aspect in the case of an
particular attention to intra-arrest emergency is the detection of the problem, the
transport. extent of the problem, and identifying ways in
which people on site can protect themselves
from any danger around them. This role is
usually undertaken by civilians who are often the
first responders in such situations.

EMS Phases: 2. Reporting

❒ “Scoop and Run”
 Patient is transported as fast as possible
to the hospital without trying to stabilize
him at the scene.
 Administering only Basic Life Support
(BLS) at the trauma site before rushing
patients to a hospital while they are still
in their “platinum minutes”
 After the first responders have identified the
problem and taken measures to protect
themselves and others, they will call in for
professional help, explain the situation, and
provide their location after which an emergency
medical dispatch is sent to the scene.
EMS Phases: 3. Response
 Calling for help is not the end of the first
responders’ duty. While awaiting professional
help, the civilians are required to try to the most
of their ability to administer first aid to those that
need it.

Abigail marie Midterms | Disaster Nursing 32

EMS Phases: 4. On-Scene Care 4. DETERMINE MOI AND NOI
 This is usually the first role performed by the  Nature of Illness is the cause or what affects the
professional medics. The Emergency Medical sickness.
Services (EMS) staff on arrival provide as much  Mechanism of Injury or how the traumatic injury
medical care as they possibly can on the scene. occur.

EMS Phases: 5. Care in Transport NOI: Medical

 When a patient needs much more specialized  Determine history of the patient
care than can be offered on the scene, EMS  Similarities of NOI and MOI
staff transport them to the hospital. While in  Talk with bystanders and family members
transit, the EMS staff continue to utilize the  Use senses to check for clues
medical equipment attached to their mode of
transport to help the patient and administer as
much medical care as possible. MOI: Trauma
 Injuries that can potentially lead to serious
EMS Phases: 6. Transfer to Definitive Care outcomes.
 This usually is the stage at which emergency  Easily injured areas: brain, spinal cord and eyes
medical personnel conclude their roles. At this
 Factors to evaluate
point, the patient is already at the hospital  Amount of force applied to the body
whereby they can receive the appropriate
 Length of time the force was applied
medical care, personalized to their needs. The
 Areas of the body that are involved
EMS staff hand the patient over to the doctors
and await the next dispatch.
6. GENERAL IMPRESSION
 How ill the patient is.
 The Golden Period is the time from injury to
 Specific information:
definitive care.
 Location
 Treatment of shock and traumatic injuries
 Gender
should occur.
 Age (rough)
 Aim to assess, stabilize, package, and begin
 Level of distress
transport within 10 minutes (“Platinum 10”).
 Gestalt of GI:
 Behavior
 Breathing
 Appearance of the skin

IV. Secondary Assessment

MEDICAL
o History Taking
o Focused assessment of pain
o Assessment of vital signs (VS)
o Detailed Physical examination

TRAUMA
o Performing a rapid full-body scan (RTA) or
o Head-to-Toe Examination
o Focused assessment of pain
o Assessment of vital signs (VS)
o Detailed Physical examination

HISTORY TAKING
 SAMPLE History
 OPQRST

Abigail marie Midterms | Disaster Nursing 33

 RTA Boxing DCAP-BTLS 5. Reassessment
 Reassess patients and monitor condition while
waiting for professional help, en route or in transit

Category Minutes Interval

Critical or Emergency Every 5 minutes or necessary
Urgent or Non-critical Every 10 minutes
Emergent or Non-Urgent Every 15 to 30 minutes

Special Challenges
 Silence
 Overly-talkative
 Multiple symptoms
 Anxiety
FOCUSED ASSESSMENT ON PAIN  Anger and hostility
 Intoxication
 Crying
 Depression
 Confused
 Limited cognitive
abilities
 Language barriers
 Hearing problems
 Visual impairments

EMERGENCY ACTION PRINCIPLE

1. Scene Size-Up
2. Primary Assessment
3. Interventions
4. Secondary Assessment
5. Reassessment

Physical Assessment: MEDICAL

1. Scene Size-Up
a. Scene Safety
b. Nature of Illness
c. Number of Patients
d. Require Additional Help
e. C-Spine Stabilization

2. Primary Assessment
a. General Impression
b. Responsiveness/Level of
Consciousness
c. CAB
Vital Signs d. Chief Complaint/Apparent Life Threats
e. Patient Priority/Patient Transport Priority
Detailed Physical Exam
3. Secondary Assessment
 Individual body parts examined for signs of illness or a. Focused History
injury i. Signs and Symptoms
 Performed for: ii. Allergies
o Trauma with significant MOI iii. Medications
o Unresponsive medical patients iv. Past Pertinent History
o Not all patients require a detailed PE v. Last Oral Intake
vi. Events Leading to Present
Illness

b. Focused Physical Examination

i. IPPA

Abigail marie Midterms | Disaster Nursing 34

 c. Baseline Vital Signs

4. Reassessment

Physical Assessment: TRAUMA

1. Scene Size-Up
a. Scene Safety
b. Mechanism of Injury
c. Number of Patients
d. Require Additional Help
e. C-Spine Stabilization

2. Primary Assessment
a. General Impression
b. Responsiveness/Level of
Consciousness
c. Apparent Life Threats
d. CAB
e. Patient Priority/Patient Transport Priority

3. Secondary Assessment
a. Focused Physical Examination or Rapid
Trauma Assessment

b. Detailed Physical Examination

i. Head
ii. Neck
iii. Chest
iv. Abdomen/Pelvis
v. Extremities
vi. Posterior

4. Reassessment

Abigail marie Midterms | Disaster Nursing 35

 TRAUMA OVERVIEW

Trauma Objectives: Newton’s Law of Motion

 In every action there is an equal and opposite
Soft Tissue Injuries reaction.
 Reviews the cardiovascular system and teaches
the management of soft tissue injuries and
burns. Techniques of dressing and bandaging
wounds will also be taught in this lesson.

Bleeding
 Describes the care of the patient with internal
and external bleeding. Techniques of dressing
and bandaging wounds will also be taught in this
lesson.
MECHANISM OF INJURY
Recognition and Care for Shock  Easily injured areas:
 Reviews the cardiovascular system, teaches o Brain
how to recognize the signs and symptoms of o spinal cord
shock, and the management and care for shock. o eyes

Muscle and Bone Injuries  Factors to evaluate

 Reviews the anatomy of and injuries to the
musculoskeletal system. Presents information
about injuries of the skeletal system. Reviews
the anatomy of the nervous system and the
skeletal system.
o Amount of force applied to the body
o Length of time the force was applied
o Areas of the body that are involved

Head and Spinal Injuries

 Reviews the anatomy of and injuries to nervous
system. Presents information about injuries of
the nervous system. Reviews the anatomy of the
nervous system and the skeletal system.
Discusses injuries to the spine and head,
including the mechanism of injury, signs and
symptoms of injury, and assessment.

Chest and Abdomen Injuries

 Reviews the anatomy of and injuries to
anatomical systems within the chest (thorax)
and abdomen. Presents information particularly
about injuries of the cardiovascular, respiratory,
digestive, endocrine, urinary and reproductive
system. Reviews the anatomy of the nervous
system and the skeletal system. Discusses
injuries to the chest and abdomen, including the
mechanism of injury, signs and symptoms of
injury, and assessment particular to internal
bleeding.

Abigail marie Midterms | Disaster Nursing 36

 Trauma Classification by type of force applied
 Blunt Trauma (blunt injury, non-penetrating or
blunt force trauma) physical trauma by a blunt
force
 Contusion
 Abrasions
 Lacerations
 Bone fractures

 Penetrating Trauma pierces the skin and

enters a tissue of the body, creating an opening.
 Puncture and penetration

Bleeding

ASSESSMENT

FALL

BLOOD VESSELS

Trauma Classification to the Parts of the Body

 Polytrauma
 Head injuries
 Chest trauma CHARACTERISTICS OF EXTERNAL BLEEDING
 Abdominal trauma
 Extremity trauma

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 Bandages and Dressings Shock Position

Bandages Dressings
 Adhesive  Non-adherent
 Fabric Tape  Sterile gauze
 Field bandage  ABD dressing
 Roller bandage  Roller gauze
 Triangular  Oval eye
 Vasilinized gauze
 Telfa pad
 Adaptic pads
 Xeroform gauze

Bleeding Control

Soft-Tissue Injuries

ABRASION

LACERATION

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PENETRATING FRACTURE

CONTUSION

AVULSION AMPUTATION

SPRAIN (LIGAMENT)

BLAST

STRAIN (MUSCLES)

DISLOCATION

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BURN Head and Spine Injuries

Immobilize and Splint

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CRANIAL INJURY Concussion vs. Contusion

Concussion
 Mildtraumatic brain injury (a simple disturbance)
in brain function with no resulting brain damage
 There is no actual interference within
the structure of the brain.
 Main symptoms are headaches and dizziness.

INTRACRANIAL HEMORRHAGE

EPIDURAL

Contusion
 Deep bruising to the brain tissue which can
cause haemorrhaging, the evidence of which
can be found in the spinal fluid.
 Symptoms of blurred vision, disorientation,
unsteadiness whilst walking, vomiting and
slurred speech, which can ultimately develop
into a coma.

SUBDURAL

INTRACEREBRAL

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 LIFTING, MOVING AND POSITIONING PATIENTS

Objective  "We will move in that specific direction when I

 Provides students with knowledge of body say, 'Move.'"
mechanics, lifting and carrying techniques, and  "We will stop moving when I say, 'Stop.'"
principles of moving patients.  "We will lower when I say, 'Lower.'"

Body Mechanics Lifting

 Body Mechanics is the proper use of the body to  In lifting:
prevent injury and to facilitate lifting and moving. o Shoulder girdle
 To move patients without injury, you need to learn aligned over
proper techniques. pelvis.
 Correct body mechanics, grips, and devices are o Hands held close
important to legs.
o Force goes
Manual Handling Considerations essentially
straight down
spinal column.
o Very little strain
occurs.

Lifting rules to prevent injuries

 Position your feet properly on a firm, level
surface and positioned shoulder-width apart.
 Use your legs, not your back to do the lifting.
 DO NOT compensate when lifting with one hand.
AVOID leaning to either side. Keep your back
straight and locked.
 Keep the weight close to the body, or as close
as possible. This allows you to use your legs
❒ Object rather than your back while lifting. The farther
 What is the weight? the weight is from your body, the greater your
 Do you require additional help in lifting? chance of injury.
 Keep your back straight. Flex your knees and
❒ Limitations lean from the hips, not the waist. If you are
 Physical characteristics of each person? walking backward down stairs, ask a helper to
 Physical limitations both you and steady your back.
partner?
 Similar strength and height can lift and
carry together more easily.
❒ Communications
 Make a plan.
 Communicate plan for lifting and
carrying.
 Continue communicate during the
process to make the move comfortable
for the patient and safe for the EMTs.

COMMUNICATE
 "We will lift when I say, 'Lift.'"
 "We will stop lifting when I say, 'Stop.'"

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 Power Whatyamacallit? NON-URGENT MOVES
 The required treatment can only be performed if
patient is moved.
 Factors at scene cause patient decline.

EMERGENCY MOVES
 The scene is hazardous.
 Care of life-threatening conditions requires Patient-Carrying Devices
repositioning.
 You must reach your patient. WHEELED STRETCHER/COT

SCOOP STRETCHER/ORTHOPEDIC STRETCHER

FLEXIBLE STRETCHERS

 Fabric or Evac Sheet

URGENT MOVES
 The required treatment can only be performed if
patient is moved.
 SKED Stretcher
 Factors at scene cause patient decline.

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 Vacuum Mattress or VacMat RECOVERY POSITION

 Reeves Stretcher

Geriatric Considerations

PORTABLE STRETCHER

 Folding Stretcher Kyphosis Spondylosis

Bariatric Considerations

STOKES OR BASKET STRETCHER/LITTER

Medical Restraints
ANATOMICAL POSITIONS  Apply restraint to each extremity.
 Assess circulation after restraints are applied.

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 MCI- TRIAGE
MCI Triage and Operations
General Learning Objectives
Triage
Provide nursing students with instruction about:
 different types of triage.
 method of conducting a verbal interview to
assess a patient's health status
 how to offer recommendations for treatment and
referral.
Knowledge of operational roles and responsibilities of
the Nurse to ensure patient, public, and personnel safety
in an event of a Mass Casualty Incident (MCI).
Principles of START Triage
 Risks and responsibilities of emergency
response
 Risks and responsibilities of transport
SAVE
 Safe patient evacuation
 Criteria for utilizing air medical response
Etymology of the word Triage
 The French word “trier”, the origin of the word
“triage”, was originally applied to a process of
sorting, probably around 1792, by Baron
Dominique Jean Larrey, Surgeon in Chief to
Napoleon's Imperial Guard.
 Larrey was credited with designing a flying
ambulance: the Ambulance Volante.
Background of Triage
 Used by first responders to quickly classify victims
during a mass casualty incident (MCI) based on the
severity of their injury
 Unlike standard medical triage, MCI triage is more
utilitarian (i.e. the greatest good for the greatest
number of people)
 Multiple triage systems exist, however evidence
regarding their effectiveness is lacking.
 In an effort to update and standardize MCI triage,
the Model Uniform Core Criteria (MUCC) were
created as a national guideline for MCI triage
o These criteria have been endorsed by all
major national shareholders, including
NAEMSP, ACEP, ACS, NAEMT, NASEMSO,
AMA, CDC, and others.
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o Currently, the SALT triage system is the only
one that meets the Model Uniform Core
Criteria
Mass Casualty Incident (MCI)
 A mass casualty incident (often shortened to MCI
and sometimes called a multiple-casualty
incident or multiple-casualty situation) is any
incident in which emergency medical services
resources, such as personnel and equipment, are
overwhelmed by the number and severity
of casualties.
 Mass Casualty Incident (MCI) defined as an
incident where the number of patients (or the rate of
their arrival to a medical facility) overwhelms local
resources (and the ability to immediately supplement
them).
MCI vs MCS
 Mass Casualty Incidents are distinguished from
Multiple Casualty Situations by available resources:
o with Mass Casualties, resources for each
patient are limited,
o whereas with Multiple Casualties, full
resources can be brought to bear on each
individual patient.
CAUSES OF MCI
 Radiation exposure (disaster)
 Dirty bomb
 Bioterrorism
 Chemical weapons
 Mass shooting
 Natural Disaster (e.g. Hurricane, Earthquake,
Tornado, Tsunami, etc)
 Unintentional large-scale incident (e.g. building
collapse, train derailment, etc)
 Major pandemic
 Explosions
MASS CASUALTY INCIDENT (MCI)
Boston Marathon
bombings
April 16, 2013
Midterms | Disaster Nursing 45
 Principles: Triage Classification Triage Classification: Deceased
 Minor (GREEN)  Priority 0: No Priority, Expectant, Morgue,
 Delayed (YELLOW) Unsalvageable
 Immediate (RED)  Color Code Black
 Deceased (BLACK)  Symbol Ankh or Cross

3R’s Action
 Retreat
 Severely injured likey to die of injuries
 Reassess
 In life-threatening medical crisis that they are
 Radio
unlikely to survive given the care available
 Treatment is usually palliative, such as being given
Triage Classification: MINOR painkillers, to reduce suffering.
 Priority 3: Low Priority, Walking Wounded, Non-
Urgent, Dismissed SALT Triage
 Color Code Green
 Sort, Assess, Life-saving interventions, Treatment
 Symbol Ambulance Marked X
and/or Transport
 Product of a CDC Sponsored working group to
propose a standardized triage method. The
guideline, entitled SALT triage, was developed
 Relatively low priority. Capable of walking.
based on the best available science and consensus
 These patients are conscious and breathing with
opinion.
only relatively minor injuries.
 Usually called upon to assist in treatment,
evacuation or other tasks.
 Are not evacuated until all immediate and delayed
have been evacuated

Triage Classification: Delayed

 Priority 2: Medium Priority, Emergent,
Stable,Observation
 Color Code Yellow
 Symbol Turtle

 Currently in stable condition but require medical

assistance and placed under observation.
 Medical evacuation is delayed until all immediates
have been transported.
Triage Classification: Immediate
 Priority 1: High Priority, Urgent, Critical, Cannot
Wait
 Color Code Red
 Symbol Rabbit
 Require immediate life-saving treatment to survive
 Have a chance of survival if transferred immediatelty
to definitve care
START System
 Simple Triage and Rapid Treatment
 A triage method used by first responders to quickly
classify victims during a mass casualty incident (MCI)
based on the severity of their injury.
 The method was developed in 1983 by the staff
members of Hoag Hospital and Newport Beach Fire
Department in California, and is currently widely
used in the United States.

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 START Rapid Assessment
 Yes Respirations
 30/min (bpm) - IMMEDIATE (RED)
 < 30/min (bpm) - check Perfusion
 Radial Pulse Absent OR Capillary Refill > 2
seconds - IMMEDIATE (RED)
 Control Bleeding - IMMEDIATE (RED)
 Radial Pulse Present OR Capillary Refill < 2
seconds - Check Mental Status
 Unable to follow simple command -
IMMEDIATE (RED)
 Follows Simple Command - DELAYED
(YELLOW)

STEPS:  No Respirations
1. Make sure you are safe. Your Personal Safety is  Reposition or Open the Airway
utmost priority.  No Repiration - DECEASED (BLACK)
2. Speak loudly and ask people to stand up and walk  Respirations - IMMEDIATE (RED)
towards you.
3. Guide ambulatory patient. Those Able to walk
JumpSTART
relocate to a certain area
 The JumpSTART Pediatric Triage MCI triage tool
 Minor (Green)
(usually shortened to JumpSTART) is a variation of
4. Non-ambulatory patients are then assessed
the START triage system.
 Delayed (Yellow)
 Specific for triaging children in disasters.
 Red (Immediate)
 JumpSTART was created in 1995 and modified in
 Deceased / Expectant / Unsalvageable
2001 by Dr. Lou Romig, a pediatric emergency and
(Black)
disaster physician working at Miami Children's
Hospital.

Rapid Assessment

1. Able to walk relocate to a certain area

 Minor (Green)

2. Non-ambulatory patients are then assessed

 Delayed (Yellow)
 Red (Immediate)
 Deceased / Expectant / Unsalvageable
(Black)

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  No Respirations Three categories:
 Reposition or Open the Airway  Those who will die regardless of care
 Respirations - IMMEDIATE (RED)  Those who will survive whether or not they
 No Repiration - Check Pulse receive care
 No Pulse - DECEASED (BLACK)  Those who will benefit from limited immediate
 Yes Pulse - 5 Rescue Breaths field interventions
 Still No Respirations -
DECEASED (BLACK) Triage
 Respirations - IMMEDIATE (RED)

 Yes Respirations
 < 15 or > 45/min (bpm) - IMMEDIATE (RED)
 15-45/min (bpm) - check Perfusion
 Pulse Absent OR Capillary Refill Time
(CRT) > 2 seconds - IMMEDIATE (RED)
 Control Bleeding - IMMEDIATE (RED)
 Pulse Present OR CRT < 2 seconds -
Check Mental Status
 Inappropriate - IMMEDIATE (RED)
 Appropriate - DELAYED (YELLOW

Combined START-JumpSTART Triage Algorithm

SAVE
 Secondary Assessment of Victim Endpoint
 Applies after patients have been triaged with
START/jumpStart
 Designed for appropriation of limited resources for
most gain in immediate on-scene care situations

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 Emergency Triage
TRIAGE QUICK TEST
1. A 14-year-old male with a broken arm walking
around the scene.
MINOR
o This patient is walking around the scene with
what appears to be an isolated extremity injury.
This would be a green status as “walking
wounded.”
2. A 36-year-old man is unresponsive with brain
matter showing.
DECEASED
o This patient is deceased and therefore given
black status. This is a non-survivable wound.
3. A responsive 34-year-old female has pale, moist
skin and respirations of 32/minute.
IMMEDIATE
o Rapid respiration and signs of shock place this
patient in the red category.
4. An unresponsive male patient has snoring
respirations. His breathing improves when you
open his airway.
IMMEDIATE
o If a patient with airway problems responds to
minimal interventions, then he is placed in the
red category
5. A 66-year-old male patient is sitting on the
ground. His eyes are open, but he can't answer
or follow directions.
IMMEDIATE
o The patient can’t follow instructions and has an
altered mental status, which places him in the
red category.
6. A 50-year-old man has bilateral fractured femurs.
He has a faint radial pulse and a respiratory rate
of 24.
IMMEDIATE
o The patient falls into the red category because
of the signs of shock (faint radial pulse).
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7. A 57-year-old female has a deformed tibia and
fibula. She is oriented with respirations of 20 and
a pulse of about 100.
DELAYED
o This patient does not fall into the walking
wounded category and doesn’t have outward
signs of shock, elevated respirations or an
altered mental status. This makes her yellow.
8. A 16-year-old female who is ambulatory and says
she is "OK."
MINOR
o Walking wouned is green. Remember that
secondary triage will catch any hidden injuries.
9. A 42-year-old woman with no obvious injuries
and without a carotid pulse.
DECEASED
o Resuscitation isn’t performed in a multiple
casualty situation. This patient is deceased.
10. A 19-year-old male with 2nd and 3rd degree
burns over about 80 percent of his body.
Respirations 24 and pulse about 120.
DELAYED
o This patient is critical (and may not survive). The
patient doesn’t fit the criteria for green or red.
While it seems contradictory, yellow is a spot
that meets the triage criteria and doesn’t take
the resources for a more salvageable red tagged
patient.
Limitations and Considerations
 Critical patients are vulnerable.
 Trauma measures are problematic.
 Categories do not differentiate among injury
severities and survival probabilities, and are invalid
based on categorical definitions and evacuation
priorities
 Protocol doesn’t change to consider or address the
size of incident, resources, and injury severities and
prioritization within its categories whether it is 30,
300, 3,000
 Resulting in inconsistent tagging and
prioritizing/ordering of casualties and substantial
overtriage
Midterms | Disaster Nursing 49
REMEMBER DURING TRIAGE
Manage scene before managing the patient.
 How many patients?
 How many ambulances do I need to call in?
 What information needed so that it can be
integrated to the scene more smoothly?
 Where to enter from?
 Which hospital to send the patients?
 Which medical facility is appropriate to receive
the patients?
Look at those quiet patients before looking at the
noisy ones.
 Noisy patients already triaged themselves with a
patent airway, still perfusing and conscious
mental status.
 “As long as a patient shouts he/she is still alive.”
 Assess the quiet first and before moving with the
noisy ones.
Triage Tagging
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TELEPHONE TRIAGE
 The process of managing a patient’s call to the office
to determine the urgency of the medical issue, the
level of provider who should respond, the
appropriate location for the patient to be seen (if
necessary), and the timing of appointment
scheduling.
Triage Nurse
 A nursing professional that helps patients determine
what type of care they need over the phone. They
often provide a cursory assessment of the patients
and help them decide if they need to seek
emergency treatment, make an appointment with a
doctor, or treat themselves at home.
 Crisis hotlines
 Physician offices
 Trauma centers
 Hospitals
 Outpatient care facilities
 Poison control centers
 Unlike nurses who get to assess their patients
physically, telephone triage nurses don’t have that
type of luxury.
 Educate patients about managing their
symptoms
 Gather all the necessary information about
your patients, such as their height, weight,
and age
 Schedule consultations and refer to
specialists
 Provide support to medical response teams
when they are bringing patients to hospitals
 Assess the severity of the patient’s health
condition
TELEPHONE TRIAGE
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 Triaging Calls
1. Gather the Right Information
o Name and basic demographics
o Brief medical history
o Description of the illness
o Chief complaint
2. Ask Relevant Questions
o life-threatening emergency or urgent problem
o follow-up questions should detect less urgent
issues and mild symptoms
3. Confirm Understanding
o repeat a brief synopsis back to the patient to
confirm that they heard everything correctly
4. Use Verbal Cues
o listen closely to the caller’s tone of voice, level
of concern, and level of anxiety while they
speak
5. When in Doubt, See the Patient
o don’t be held accountable for turning a patient
away if they had a severe problem
6. Give Instructions for Call-Backs
o encourage to call back if the condition gets
worse
7. Document Telephone Interactions
o “if it’s not recorded, it wasn’t done”
o advice is provided. Documentation should include
TRIAGE SYSTEM
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Patient Safety Strategy
 Utilize written policies and protocols for office and
clinical staff to follow when triaging calls and
providing advice. Conduct periodic chart audits to
ensure that policies and protocols are followed.
Review the guidelines annually and revise as
circumstances warrant.
 Train staff regarding questions to ask the caller and
when to refer a call to the physician immediately.
The physician will then know that if he or she is
summoned to take a call, the patient has an urgent
or emergent need.
 Practice Telephone Triage Scenarios. Help your
newest triagers improve their skills by practicing
telephone triage scenarios before they get on the
line with real patients. Choose a range of scenarios,
and go over the possible outcomes of each call. This
practice will help your triage team be more confident
and composed when they need to make decisions in
real time.
 Instruct staff members to follow the advice protocols
and check with the doctor first if there is any doubt
about proper instructions or advice. Failure to do so
may be considered the practice of medicine and
practicing beyond their scope of practice.
 Require that staff members refer calls directly to the
physician if a patient calls a second time with a
complaint that was not resolved by previous
telephone advice.
 Require an in-person examination if a patient calls a
third time with a complaint that was not resolved by
previous telephone advice.
 Document all calls in which medical information or
the date, time, patient’s name, name of caller as well
as his or her relationship to the patient, complaints,
concerns, questions, and the advice given.
 Document critical negative information that helped
determine the advice provided. i.e.: “Mother stated
the child has no fever, no lethargy, or neck stiffness,
has a good appetite and is taking fluids.”
 Document the reasoning behind any deviations from
the written protocols.
 End all calls by providing patient instructions on
when to call back or seek emergency care if
symptoms worsen or persist.
 If your hospital is having trouble keeping up with the
pace of phone calls, it may be time to hire a medical
call center. This will ensure you have the bandwidth
to thoroughly speak with all callers and reduce the
chance of triage error.
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 GO BAG

Grab and Go Kit

 After an emergency, you may need to survive on
your own for several days.
 Being prepared means having your own food, water
and other supplies to last for several days.
 A disaster supplies kit is a collection of basic items
your household may need in the event of an
emergency.

TIP:
 Rotate items annually.
 Making sure the clothes you have stored still fit!
Foods are still edible and far from the date of
expiration.
 Equipments or items are still in maximum
working conditions

How should I store my kit?

 Store these items in something that is portable
and easily carried, like a backpack or
tub/suitcase with wheels.
 Keep this kit in a designated place and have it
ready in case you have to leave your home
quickly.
 Make sure all family members know where the
kit is kept.

What other places should I have a kit?

Work
 Be prepared to shelter at work for at least 24
hours. Your work kit should include food, water
and other necessities like medicines, as well as
comfortable walking shoes, stored in a “grab and
go” case.
Car
 In case you get stranded, keep a kit of
emergency supplies in your car.

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 FIRE SAFETY

Fire Safety & Prevention  Make sure all power strips and extension cords
are tested and approved by a laboratory such as
Objectives UL (Underwriter’s Laboratories)
 To educate participants on how to avoid fires  Electrical Connections and Electrical Faults
and fire related injuries. have been the top cause of fires in Metro Manila
with an average of 53.85% of the total number of
 To create awareness of fire deaths and injuries
fires yearly. What are the general causes of
and their common causes.
Electrical fires?
 To inform participants of their personal
 Use of substandard materials
responsibility toward fire safety and injury
 Wrong Installation Practices
prevention.
 Malpractice in actual use
 Improper maintenance Practices
INTRODUCTION
 BFP NHQ 2023 January-February 1,984 fire UNATTENDED COOKING OR CANDLES
incidents (GMA News 2023 March 2, BFP Spokes
 Never leave an open stove or lit candle
SUPT. A. Atienza )
unattended. Unlike other causes, unattended
 Most common cause is electrical ignition
cooking/candles involves the presence of active
 About 500 LGU no fire trucks and active fire stations.
fire. Leaving it unattended can lead to serious
accidents.
MOST COMMON CAUSE
1. Electrical Connections 6. Flammable Chemicals COOKING FIRES
2. Cooking Fire 7. Combustible Gases  Cooking is usually associated with Gas. We
3. Open Pit Flames 8. Arson know that Fire and Gas, if not controlled properly,
is not a good.
4. Candles 9. Fireworks
 Pay attention to what you’re cooking.
5. Cigarettes 10. Ignition Sparks  If you leave the room, turn off the stove.
 Don’t cook if you’re sleepy or if you’re impaired.
Faulty Electrical Connections / Electrical  Keep flammable items away from heat sources.
Overloading  Clean your stovetop frequently to avoid grease
build up.
Electrical ignition
 which is related to the use of appliances, old CANDLES
wiring and extension wires as well as poor Unattended candles are a leading fire cause.
maintenance of electrical wiring.
Candle safety tips:
Poor/Damaged Wire Quality.  Use flameless candles.
 Electrical Overloading occurs when the current  When you leave the room, blow out the candle.
being passed through the wires exceed the  Keep anything that could burn at least a foot
capacity limit the wires can handle; this can heat away
up the wires and melt, leading to fire.  Don’t set the candles on anything combustible.
 Fires can start when the candle burns
ELECTRICAL SAFETY down to the base.
 Do not overload electrical sockets.
 Do not run cords under rugs or furniture. GREASE FIRES
 They can become worn, overheat, and  Always have the matching lid nearby!
cause a fire.  If you have a small grease fire you can
 Avoid putting cords against walls or across smother it with the lid.
doorways.
 Use power strips equipped with overload NEVER PUT WATER ON A GREASE FIRE
protection. Nearly half of all home fires originate in the kitchen

Abigail marie Midterms | Disaster Nursing 53

SMOKING Fire Calls Causes
 Cigarettes can smolder for hours.
 Don’t smoke inside. Nick’s Lechon, UI Phinma
 Discard smoking materials in a fire safe o Gas Vapor
container.
Molo Boulevard
 Use a proper, heavy ashtray which won’t tip
o Faulty Wire Connection (Tapping)
easily. Don’t improvise!
 Don’t smoke in bed.
McDonalds Marymart
 Don’t smoke if you’re tired, taking medications,
o Grease
or if you’ve been drinking or are otherwise
impaired.
Veterans Village
 After a party, check indoor and outdoor furniture
o Candle
and cushions for smoldering cigarette butts.

FIRE (Sunog, Apoy, Kalayo)

FLAMMABLE CHEMICALS

ELEMENTS IN FIRE SAFETY

Some chemicals can ignite and explode if not stored
properly
FIRE TETRAHEDRON
 Fuel
 The fire triangle was changed to a fire tetrahedron to
 Solvents
reflect this fourth element. A tetrahedron can be
 Cleaning agents
described as a pyramid which is a solid having four
 Thinners
plane faces. Essentially all four elements must be
 Adhesives
present for fire to occur, fuel, heat, oxygen, and a
 Paints
chemical chain reaction.
 Other liquids (alcohol, acetone, celluloids etc.)

 Make sure to always store flammable liquids in

their approved containers.
 Seal them properly and place them in the proper
location with the moderate temperature
indicated in its packaging.

FLAMMABLES
 Flammable gas - flammable range in air at
20 °C and a standard pressure of 101.3 kPa.
 Flammable liquid - flash point of not more than
93 °C.
 Flammable solids - readily combustible, or may
cause or contribute to fire through friction.

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 ACTIVE FIRE PROTECTION
 Active fire protection (AFP) is an integral part of fire
protection. AFP is characterized by items and/or
systems, which require a certain amount of motion
and response in order to work, contrary to passive
fire protection.
 All AFP systems are required to be installed and
maintained in accordance with strict guidelines in
order to maintain compliance with the local building
code and the fire code.
 AFP works alongside modern architectural designs
and construction materials and fire safety education
to prevent, retard, and suppress structural fires.
EXAMPLE OF HEAT TRANSFER
PASSIVE FIRE PROTECTION
 Passive fire protection (PFP) is components or
systems of a building or structure that slows or
impedes the spread of the effects of fire or smoke
without system activation, and usually without
movement.
 Contain a fire to the compartment of fire origin
 Slow a fire from spreading from the compartment of
fire origin
 Slow the heating of structural members
 Prevent the spread of fire through intentional
openings (e.g., doors, HVAC ducts) in fire rated
FIRE PROTECTION
assemblies by the use of a fire rated closure (e.g.,
fire door, fire damper)
ACTIVE (AFP)
 Prevent the spread of fire through penetrations (e.g.,
 Manual
holes in fire walls through which building systems
 Fire Blanket
such as plumbing pipes or electrical cables pass) in
 Fire Extinguisher
fire rated assemblies by the use of fire stops
 Standpipe

 Automatic Escape Routes

 Sprinkler system
 Gaseous clean agent
 Foam suppresion system
 Expansion (low, Medium, High)
 Electronically controlled
PASSIVE (AFP)
 Fire-resistance rated walls
 Fire-resistant glass
 Fire-resistance rated floors
 Occupancy separation
 Closures (fire dampers)
 Firestops
 Grease ducts
 Cable coating
 Spray fireproofing
 Fireproof cladding
 Enclosures
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 When the smoke alarm sounds, you may only have
seconds or minutes to escape safely.
 Have a meeting place for everyone to gather outside.
 Plan two ways out, in case one way is filled with
smoke or fire.
 Know your escape routes and practice them.
Fire Drills
 A simulation of evacuation that helps prepare
participants for an emergency situation
FIRE CODE of the Philippines
 The Implementing Rules and Regulations (IRR) of
RA 9514, or the Fire Code of the Philippines, serves
as the framework that guides the BFP in the
implementation of the law to ensure public safety
and to promote economic development through the
prevention and suppression of all kinds of
destructive fires.
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 DepEd Memo Fire & Earthquake Drills
 DepEd Order No. 53, s. 2022 - Mandatory
Unannounced Earthquake and Fire Drills in Schools,
requiring all public elementary and secondary
schools to conduct unannounced earthquake and
fire drills every first and third week of every month.
(Office of the Undersecretary for Operations
(OUOPS)
SMOKE ALARMS/DETECTORS
 An electronic fire-protection device that
automatically senses the presence of smoke, as
a key indication of fire, and sounds a warning
 Ionization
 Photoelectric
 combination
SMOKE
 Carbon monoxide (CO) Poisoning caused by
inhaling combustion fumes. CO replaces the
oxygen (O2) in red blood cells preventing O2
from reaching your tissues and organs.
 Breathing smoke can kill you!
 Smoke is toxic.
 If you must escape through smoke,
 Get Low and Go under the smoke.
CARBON MONOXIDE (CO) POISONING
 High levels of CO can be fatal, causing death
within minutes.

ALARM PLACEMENT AND MAINTENANCE

 Make sure you can hear the alarm in every
place in your home.
 They should be loud enough to wake you from
sleep.
 Check once a month.
 Change batteries once a year.
 Replace every 10 years.

Fire Alarms Detectors

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SPRINKLER SYSTEM
 An active fire protection method, consisting of a
water supply system providing adequate
pressure and flowrate to a water distribution
piping system, to which fire sprinklers are
connected.
A. Dry pipe systems
 Dry pipe valve (a specialized type of check
valve)
B. Wet pipe sprinkler systems
 Automatic sprinklers and automatic alarm
check valve
EXTINGUISHING FIRE
FIRE CONTROL MEASURES
 Cooling
 Smothering
 Starving
 Interrupting the Chain Reaction
Cooling:
 limiting temperature by increasing the rate at which
heat is lost from the burning material
COOLING THE FIRE
 One of the most common methods of
extinguishing a fire is by cooling with water.
 The rate at which heat is lost from the fire may
be greater than the rate of heat production and
the fire will die away.
 When water is applied, it undergoes changes as
it absorbs heat from the fire:
 Its temperature will rise
 It may evaporate (boil)
 It may react chemically with the burning
material
 The properties of a good cooling agent are
therefore:
 High specific heat capacity (thermal
capacity)
 High latent heat of vaporisation
 High heat of decomposition
 Water is a good cooling agent because of its
high thermal capacity and latent heat of
vaporisation. This, combined with the fact it is
available in large quantities, makes it by far the
most widely useful fire extinguishing agent.
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Smothering:
 limiting oxygen by preventing air from reaching the
seat of the fire to allow the combustion process to
reduce the oxygen content in the confined
atmosphere until it extinguishes itself
SMOTHERING THE FIRE
 If the oxygen supply to the burning material can
be sufficiently reduced, burning will cease.
Prevent fresh air from reaching the seat of the
fire, allowing the combustion to reduce the
oxygen content in the confined atmosphere until
it extinguishes itself, for example by:
 Snuffing out candles
 Smothering a pan with a fire blanket
 Wrapping a person in a fire blanket
 Applying a blanket of foam over the
burning surface, thus separating the fuel
from the air
 Smothering can also be achieved by removing
the oxygen in the atmosphere, thus
extinguishing the fire, for example, by:
 Introducing carbon dioxide (CO2) to the
immediate vicinity of the fire
 Introducing an inert gas to the
immediate vicinity of the fire, such as
through systems installed to protect
computer server rooms
Starving:
 limiting fuel by removing potential fuel from the
vicinity of the fire, removing the fire from the mass of
combustible materials or by dividing the burning
material into smaller fires that can be extinguished
more easily
STARVING THE FIRE
 In some cases, a fire can be extinguished simply
by removing the fuel source. This may be
accomplished in a number of ways, such as
stopping the flow of liquid or gaseous fuel,
removing solid fuel in the path of the fire or
allowing the fire to burn until all of the fuel is
consumed.
 Fires can be starved of fuel by removing
potential fuel from the vicinity of the fire, for
example:
 Back burning forestry fires
 Draining fuel from burning oil tanks
 Removing cargo from a ship's hold
 Creating firebreaks in peat, heathland
and forest fires
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  Removing vehicles in the proximity of
the fire
 Creating firebreaks in thatch roofs
 Removing tyres not affected by the fire
from a tyre dump

Interrupting:
 inhibiting the chemical chain reaction by applying
extinguishing media to the fire that inhibit the
chemical chain reaction at the molecular level)

INTERRUPTING THE FIRE

 Dry powder, Bromochlorodifluoromethane (BCF)
and other halon extinguishers work by releasing
atoms that interrupt the chemical chain reaction.
They also create an inert gas barrier.

Parts of a Fire Extinguishers

Fire Extinguishers
 A fire extinguisher is a handheld active fire
protection device usually filled with a dry or wet
chemical used to extinguish or control small fires,
often in emergencies.
 It is not intended for use on an out-of-control fire that
could endanger the user (i.e., no escape route,
smoke, explosion hazard, etc.), or otherwise
requires resources, and/or expertise of a fire brigade.

Classification Fire Extinguishers

Other Types of Extinguishers

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 7. Make sure it is full, this can be done by just lifting the
extinguisher or you can weigh it

MOUNTING
1. Extinguisher Cabinet: mounted to the surface of
the wall, semi-recessed into the wall, or fully-
recessed into the wall. Can include a break-front
panel that has proven to be a deterrent to theft and FIREXT (FE)
tampering as to access the extinguisher requires
actually breaking the panel which would produce
sounds and possibly alert individuals nearby that
someone is tampering.
2. Hanger: specifically designed for the type of
extinguisher being mounted, which typically comes
with the extinguisher.
3. Bracket: a strap-type bracket that helps ensure that
the extinguisher does not become dislodged.
4. Signage and location visible from near and far away,
from different angles, and that signs protrude 90°
from the mounting wall making them highly visible
from both sides, especially if the cabinet is recessed
into the wall.
5. No permeant structure, an open door, or anything
piled that obstructs the view of the sign. Fire is FAST!
6. These signs are often made of corrosion resistant  There is little time to escape. It only takes
materials so they can be used in indoor and outdoor minutes for thick black smoke to fill your home
areas. Select models come with glow in the dark
properties so the extinguisher can be identified in Fire is DEADLY!
dark areas, at night, or in blackout situations.s  Smoke and toxic gases kill more people than
flames do
MAINTENANCE
1. Perform a monthly fire extinguisher inspection. Fire is DARK!
2. Confirm the extinguisher is visible, unobstructed,  Fire isn’t bright, it’s pitch black. Fire starts bright,
and in its designated location. but quicly produces black smoke and complete
3. Make sure everyone can easily access the fire darkness
extinguisher.
4. Verify the locking pin is intact and the tamper seal is Smoke is POISONOUS
unbroken.  Get low to the ground and go under the smoke
5. Ensure the pressure gauge is in the operable range to your exit to escape through smoke. GET LOW
or position. AND GO!
6. Examine the extinguisher for obvious physical
damage, corrosion, leakage, or clogged nozzle.

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Fire is HOT! o Being on the ground floor and near an exit will
 Heat is more threatening than flames. Room make your escape easier.
temperature can rise to over 1,000˚F (537.778˚C)
at eye level
American Sign Language (ASL)
Fire can be SILENT!
 If there is a fire, pull the fire alarm on your way
to nofity everyone inside, the fire department
and the neighbors

Fight Fire with Fire!

 PASS Please House Emergency
 Use fire extinguisher on small firesonly

Fire Fighting is for Fire Fighters!

 When in doubt, get out!

Danger Call

Fire Nurse Disabled

Hurt/Pain Help Firefighter

Fire Safety for PWDs

 Have smoke alarms on every level of your home,
inside bedrooms and outside sleeping areas.
Interconnect your alarms, so when one sounds, they
all sound.
 If you are deaf or hard of hearing, use smoke alarms (tap wrist) Stuck/Trapped Victim
with a vibrating pad, flashing light or strobe light. PARAMEDIC
These accessories start when your alarm sounds.
 Test your alarms every month.
 Plan your escape around your activities
o Know two ways out of every room.
o If possible, live near an exit.
o You’ll be safest on the ground floor if you live
in an apartment building.
o If you live in a multistory home, sleep on the
first floor.

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