Disaster Management

and Response

Maria Theresa C. Belcina Jr, PhD, RN

Theresa A. Guino-o, PhD RN
Theorose June Q. Bustillo, PhD RN (Facilitators)
 Disaster Management
a process of effectively preparing for and responding
to disasters
involves strategically organizing resources to lessen
the harm that disasters cause
involves a systematic approach to managing the
responsibilities of disaster prevention, preparedness,
response, and recovery
 AIMS OF DISASTER MANAGEMENT

• reduce (avoid, if possible) the

potential losses from hazards
• assure prompt and
appropriate assistance to
victims when necessary
• achieve rapid and durable
recovery
 ELEMENTS OF DISASTER
MANAGEMENT
Disaster preparedness
planning
*vulnerability and risk
assessment
Disaster response
* disaster assessment
Rehabilitation &
reconstruction
Disaster mitigation
The Disaster-Management Cycle (FEMA)
 Phases of Disaster Management
Prevention/Mitigation/Risk Reduction – identify community
risk factors and to develop and implement programs to prevent
disasters from occurring

Preparedness – involvement of hospitals, police, rescue

personnel, government offices and media; community must
have an adequate warning system

Response – implementation of plans based on the severity or

extent of the disaster

Recovery – repair, rebuilding, or reallocation of damaged

homes and business, health & economy
DISASTER RESPONSE

the set of activities

implemented after the
impact of a disaster in
order to
• assess the needs
• reduce the suffering
• limit the spread and the
consequences of the
disaster
• open the way to
rehabilitation
 Disaster Plan
a pre-defined set of instructions that guides community’s
emergency responders what to do in specific
emergencies
- minimizes the difficulties of a large scale MCI

Characteristics of a good disaster plan:

- address the events that are conceivable for a
particular location
- well publicized (responders should be familiar with the
plan)
- realistic (based on availability of resources)
- rehearsed
 Disaster Triage
• a process which places the right patient in the right place
at the right time to receive the right level of care (Rice &
Abel,1992)
• process of prioritizing which patients are to be treated first
and is the cornerstone of good disaster management in
terms of judicious use of medical resources (Auf der
Heide,2000).
• the process of quickly assessing MCI patients and
assigning each a priority for receiving treatment
Nurses and triage
Accurate triage allows disaster nurses and other
responders to do the greatest good for the greatest
number of afflicted
Performing triage during a disaster presents unique
challenges
Its overall success may be highly dependent on the
competence, experience, and composure of the
nurse, working in close concert with the rest of the
emergency care team
 How different from Daily triage

performed by nurses on a routine basis in the ED

often utilizing a standardized approach, augmented by
clinical judgment
Goal is to identify the sickest patients to assess and treat them first,
before providing treatment to others who are less ill and whose
outcome is unlikely to be affected by a longer wait.
The highest intensity of care is provided to the most seriously ill or
injured patients, even if those patients have a low probability of
survival.
 How different from Incident Triage
ED is stressed by a large number of patients due to an acute incident
or an ongoing medical crisis such as pandemic influenza, but is still
able to provide care to all patients utilizing existing agency resources

Additional resources (on-call staff, alternative care areas) may be used,

but disaster plans are not activated and treatment priorities are not
changed

The highest intensity of care is still provided to the most critically ill
patients. ED delays may be longer than usual, but eventually everyone
who presents for care is attended to
Triage System in Disaster
paradigm shift in fundamentaltriage philosophy from
“do the best for each patient, regardless of what it
takes” to “do the greatest good for the greatest
number” (Auf der Heide, 2000)
Resource management becomes the linchpin driving
the provision of care
Goal shifts to identifying and prioritizing injured or ill
patients who have a good chance of survival with
immediate interventions that do not consume
extraordinary resources (Auf der Heide, 2000)
HISTORY of TRIAGE
TIMELINE:

• 1790s - French transported wounded soldiers from battle

• American Civil War – Clara Barton; established the
American Red Cross
• Early 1900s – non-military ambulance services in
American cities as transport services only
• WW I – volunteers joined battlefield ambulance corps
• After WW II – smaller communities with ambulance
services; emergency care offered along with
transport to the hospital; Fire dept was responsible for
transport
HISTORY of TRIAGE
• 1960s – development of the modern EMS system
• Korean War & Vietnam War – specialized emergency
medical centers for the treatment of trauma injuries
• 1966 – National Highway Safety Act; US Dept of
Transportation charged with developing EMS standards
and assist states to upgrade the quality of their prehospital
emergency care
• 1970 – National Registry of Emergency Medical
Technicians; to establish professional standards
• 1973 – Congress passed the National Emergency
Medical Service Systems Act; cornerstone of an effort to
implement and improve the EMS system
 Triage Algorithm
The various versions and combinations of the most frequently used systems
throughout the United States include:
Simple Triage and Rapid Treatment (START) which uses four basic assessments: ability
to walk, respirations, circulation, and mental status to assess individuals > 8 years of
age.
JumpSTART Pediatric Triage Algorithm which uses the same assessments as START with
pediatric (individuals < 8 years of age) vital sign parameters plus the A (alert) V (verbal)
P (pain) U (unresponsive) assessment.
Emergency Severity Index (ESI) used for individuals of all ages in emergency
rooms/departments by experienced triage providers to evaluate both patient acuity
(pulse, respiration and SaO2) and resources needed.
Sort, Assess, Life Saving Interventions, Treatment and/or Transport (SALT) which uses
similar assessments to START (ability to move, respirations, pulse, and mental status)
but also considers resources and presence of hemorrhage for individuals > 8 years of
age.
Source: A review of the literature on the validity of mass casualty triage systems with a focus on chemical
exposureshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187211/
 Types of Disaster Triage
PRIMARY TRIAGE – providing care according
to the seriousness of the illness or injury;
keeping in mind that spending a lot of time to
save one life may prevent a number of other
patients from receiving the treatment that they
need

Goal : to afford the greatest number of people

the greatest chance of survival
Classification of Patients
Priority 1: Treatable Life-Threatening Illness or
Injuries
Priority 2: Serious but not Life-Threatening
Illness or Injuries
Priority 3: “Walking Wounded”
Priority 4: Dead or Fatally Injured
STaRT TRIAGE
Simple Treatment and Rapid Transport

- rapid primary triage

- acronym RPM
R – respiration
P – pulse
M – mental status
- to be completed in 30 seconds
- begin by asking all patients who can walk and get
up( Green Tag)
- focus attention on remaining patients
STaRT TRIAGE- R

1. Assessing Respiration (breathing)

Priority 0 patient (black tag) – patient is not

breathing
Priority 1 patient (red tag) – patient starts
breathing after the airway is opened or
breathing is > 30 times/min
Priority 2 patient (yellow tag) - patient
breathing < 30 times/min
STaRT TRIAGE- P
2. Assessing Radial Pulse
Priority 0 patient (black tag) – patient is
unresponsive, not breathing, no pulse
Priority 1 patient (red tag) – patient is
breathing but has no pulse
- if breathing and has a pulse, proceed to
assessing mental status
STaRT TRIAGE- M

Assessing LOC (mental status)

Priority 1 patient (red tag) – patient has
altered mental status
Priority 2 patient (yellow tag) - patient is alert

Re-triage Priority 3 patients

Secondary Triage and Treatment

patients are gathered into a TRIAGE SECTOR

under the direction of the triage officer

the place where patients are sorted and separated

according to the acuity of their illnesses or injuries
before they are transported to a treatment sector or
hospital
Secondary Triage and Treatment
TREATMENT SECTOR should have a
treatment officer
- necessary to re-categorize a patient whose
condition has deteriorated or improved or who
has been incorrectly triaged to a higher or lower
priority group than was medically warranted
SALT Triage
Sort
Assess
Lifesaving Interventions
Treatment/Transport
TRIAGE CATEGORIES
• Immediate category. These casualties require
immediate life-saving treatment.
• Urgent category. These casualties require
significant intervention as soon as possible.
• Delayed category. These patients will require
medical intervention, but not with any urgency.
• Expectant category
 Healthcare Disaster-Response Competencies
(1) Recognize a potential critical event and implement initial actions;
(2) Apply the principles of critical event management;
(3) Demonstrate critical event safety principles;
(4) Understand the institutional emergency operations plan;
(5) Demonstrate effective critical event communications;
(6) Understand the incident command system and your role in it;
(7)Demonstrate the knowledge and skills needed to fulfill your role during
a critical event.
source: Healthcare worker competencies for disaster training
https://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-6-19
If the emotional needs of the affected persons are
not given attention, their recovery and that of their
communities will not be satisfactorily achieved.

Interventions and recovery programs after a disaster

must be balanced, and should gear towards a
sustainable development.

Perlas (2011) asserts that when a balanced

sustainable development is pursued, people can rise
above the pain and anguish of human-made (as well
as natural) disasters.
Ladrido-Ignacio (2011) emphasized, to survive is not
simply to remain alive. Rather, it is to sustain a sense
of well-being, acquire a sense of empowerment, and
take control over their situation.

Through PSP, the affected population can

experience healing, better coping and take control
over their difficult situation.
Thank you
for listening