DISASTER NURSING LECTURE

TABLE OF CONTENTS

MODULE 1 CONCEPTS OF DISASTER NURSING 1

MODULE 2 THE CORE COMPETENCIES OF NURSES RESPONDING TO 4
MASS CASUALTIES
MODULE 3 HAZARD IDENTIFICATION & VULNERABILITY 6
ASSESSMENT
MODULE 4 DISASTER MANAGEMENT 11
MODULE 5 ETHICO-LEGAL ISSUES IMPACTING DISASTER 14
MODULE 6 MANAGEMENT OF MASS CASUALTY INCIDENTS 16
MODULE 7 INCIDENT HOSPITAL COMMAND SYSTEM 19
MODULE 8 DISASTER TRIAGE SYSTEM 22
MODULE 9 DISASTER TRIAGE PRINCIPLES 25
MODULE 11 WORKING WITH FUNCTIONAL ANNEXES IN DISASTER 27
AND COMMUNICATING WITH MEDIA
MODULE 12 ATTENDING TO THE NEEDS OF VULNERABLE GROUPS 31
AND WORKING WITH EXTERNAL SUPPORT GROUPS
MODULE 13 COMMUNITY DIAGNOSIS ON DISASTER PREVENTION 33
AND PREPAREDNESS
MODULE 14 UNDERSTANDING THE PSYCHOSOCIAL IMPACT OF 35
DISASTER
MODULE 15 COMMON REACTIONS OF DISASTER SURVIVOR 42
MODULE 16 PHASES OF EMOTIONAL RECOVERY 45
MODULE 17 SPECIAL NEED POPULATION 48
MODULE 18 BASIC LIFE SUPPORT 50
MODULE 19 FIRST AID 55
 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING
NUR 1221 DISASTER NURSING LECTURE
A.Y. 2022-2023 SECOND SEMESTER
MODULE 1 CONCEPTS OF DISASTER
NURSING
Topic Outline
1. Concepts of Disaster Nursing
2. The Philippines as a Disaster-Prone Country
3. Types of Disasters
a. Natural
b. Man-made
c. Na-Techs
OVERVIEW
In the global community within which we all live, concern
for the health and well-being of our citizens and for the
sustainability of our environment has not diminished in
any way. In light of recent world events, our concerns have
now expanded to include hazards such as emerging and
reemerging infectious diseases, the ubiquitous fear of
terrorism and the detonation of nuclear weapons, an
increasing awareness of the danger of climate change, and
the devastating health impact of the forces of Mother
Nature on communities affected by natural disasters such
as earthquakes, floods and volcanic eruptions (Veenema,
2013).
In the Philippines, disaster has always been a part and
parcel of the lives of Filipino people. Filipinos learned to
become resilient as catastrophe strike most part of the
country in its two seasons. In this module, we will
determine some of the reasons why the Philippines is
usually hit by untoward incidents, whether man-made or
natural calamities as we navigate through the concepts of
Emergency and Disaster Nursing.
CONCEPTS OF DISASTER NURSING
DEFINITION OF 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”
(United Nations International Strategy for
Disaster Reduction [UNISDR], 2017)
• A sudden, unplanned event that makes it difficult,
or impossible for a facility to carry out essential
activities. During a disaster, the needed resources
are greater than those available
• An event in which the demand for health services
from the event or existing patients, exceeds the
ability of the facility to provide those services.
• A disaster can occur at any level – local, state,
regional, country or multiple countries.
• A disaster is present when need exceeds
resources.
• Any destructive event that disrupts the normal
functioning of a community.
• Disasters have been defined as ecologic
disruptions, or emergencies, of a severity and
magnitude that result in deaths, injuries, illness,
and property damage that cannot be effectively.
Disaster = Need > Resources
• A response need that is greater than the response
available.
Disaster- dis·as·ter n.
a. An occurrence causing widespread destruction
and distress
b. a catastrophe
c. a grave misfortune
D - Destructions
I - Incidents
S - Sufferings
A - Administrative, Financial Failures
S - Sentiments
T - Tragedies
E - Eruption of Communicable diseases
R - Research program and its implementation
Disasters affect the health status of a community in the
following ways:
• Disasters may cause premature deaths, illnesses,
and injuries in the affected community, generally
exceeding the capacity of the local health care
system.
• Disasters may destroy the local health care
infrastructure, which will therefore be unable to
respond to the emergency. Disruption of routine
health care services and prevention initiatives
may lead to long-term consequences in health
outcomes in terms of increased morbidity and
mortality.
• Disasters may create environmental imbalances,
increasing the risk of communicable diseases and
environmental hazards.
• Disasters may affect the psychological,
emotional, and social well-being of the population
in the affected community. Depending on the
specific nature of the disaster, responses may
range from fear, anxiety, and depression to
widespread panic and terror.
• Disasters may cause shortages of food and cause
severe nutritional deficiencies.
• Disasters may cause large population movements
(refugees) creating a burden on other health care
systems and communities. Displaced populations
and their host communities are at increased risk
for communicable diseases and the health
NUR 1221 – EDN TEAM 2022-2023 |1
 consequences of crowded living conditions.
(Noji, 1996)
• Emergency- a sudden, unexpected event
requiring immediate action due to a potential
threat to health, life, property or environment.
• Emergency Management- the care given to
patients with urgent and critical needs.
• Emergency Nursing- is a nursing specialty in
which nurses’ care for patients in the emergency
or critical phase of their illness or injury.
• Emergency Nurse- a nurse specialized in rapid
assessment and treatment when every second
counts, particularly during the initial phase of
acute illness and trauma.
o A nurse that had a specialized education,
training and experience to gain expertise
in assessing and identifying patient
health care problem in crisis situation.
• First Responder- local police, fire & emergency
medical personnel who arrive first on the scene of
an incident & take action to save lives, protect
property, & meet basic human needs.
• Emergency Medical Services (EMS)- is system
encompasses all aspect of emergency care. The
systems are responsible for establishing,
regulating coordinating, and monitoring the
components involved in the provision of
emergency care.
o EMS is created to provide emergency
care to patients as quickly as possible.
• Principles of Emergency Care: “Treat the
potentially life threatening first”
• Goals of Emergency Care:
1. Preserve life
2. Prevent deterioration before definitive
treatment
3. Restore patient to useful living
• Disaster Nursing- the adaptation of professional
nursing knowledge and skills in recognizing and
meeting the needs of disaster victims.
Types of Victims:
1. Direct victims – those killed, injured, or who lost
properties
2. Indirect victim – family, friends, co-workers and
those identified with the victims
3. Hidden victims – crisis workers, police, red cross
volunteers, rescuers, firemen, staff, disaster
managers, hospital workers
THE PHILIPPINES AS A DISASTER-PRONE
COUNTRY
GEOGRAPHICAL
1. Typhoon Corridor: average of 20 typhoons
occur yearly
2. Geographical Location- the country lies within
the Pacific Ring of Fire where 80% of the world’s
earthquake occur.
3. Physical Structure: composed of 7,107 islands/
along shoreline. Rugged terrain, 22 of the
country’s 220 volcanoes are scattered all over the
archipelago is active.
4. Socio-economic status:
a. Population (110 M)
b. Social class ratio
c. Armed conflict, demolition and the so-
called development projects displace
families and communities.
d. The poverty situation of majority of the
Filipinos restricts their capacity to cope
with these hazards, and more so, to
recover rapidly from damages brought by
disasters.
5. Environmental degradation:
• El Niño Phenomenon induces long dry spell
in many parts of the country
• La Niña Phenomenon induces long rain
downpour in many parts of the country
• Global Climate Change
• Destruction of the country’s environment
TYPES OF DISASTERS
• Natural
• Man-made
• Technological
NATURAL DISASTERS
• those caused by natural or environmental forces
• WHO defines natural disaster as the “result of an
ecological disruption or threat that exceeds the
adjustment capacity of the affected community
(Lechat, 1971).
• Example: Earthquake, floods, tornadoes,
hurricane, volcanic eruption, tsunami, and other
geological and meteorological phenomenon.
EARTHQUAKE
• Shaking caused by movements of plates in the
earth’s crust
• Occur along faults – borders between two plates
• Occur most often along the Pacific Ring of Fire
• The primary health concern:
• Injuries arising from structural collapse
• Well known prevention
• strategy is to prevent
• buildings from collapsing
• DUCK, COVER & HOLD – action to do during
earthquake
FLOODS
• Floods may originate very quickly following a
quick rainstorm, a heavy rain, or they may
develop over a short period following an extended
period of rain or quick snow melt
• May involve rivers overflowing, storm
surge/ocean waves, and dams or levees breaking
• Flashfloods = floods that happen very fast
• The primary hazard from flooding is drowning
• Health concerns from flooding is the development
of disease from contaminated water and lack of
hygiene.
NUR 1221 – EDN TEAM 2022-2023|2
 TORNADO
• Rotating funnel-shaped clouds from powerful
thunderstorms which form over land
• Generates stronger winds up to 300 MPH which
form within a short time thus, warnings are harder
to get out in time
• Occur in the United States than anywhere else in
the world
• The primary hazard: risk for injuries from flying
debris
• The high winds and circular nature of a tornado
leads to the elevation and transport of anything
that is not fastened down. Some individuals are
injured while on the ground. Others are lifted into
the air by the tornado and dropped at another
location.
HURRICANE
• Originates from the ocean, gathers strength as it
glides across the water causing tidal surge which
in turn brings flood
• Clouds and winds greater than 75 MPH spin
around the eye
• Follows a loosely defined course, giving time for
safety warnings
• Primary health hazard: risk of drowning from
the storm surge associated with the landfall of the
storm. Secondarily, a hazard exists for injuries
from flying debris due to the high winds.
VOLCANIC ERUPTION
• More than 500 active volcanoes in the world; over
half in the Ring of Fire
• Pressure builds below the earth’s surface
producing eruptions of lava, rock, & volcanic
gases
• Over the 25-year period (1972-1996), there was
an average of 6 eruptions per year, causing an
average of 1017 deaths and 285 injuries
• Health outcomes are associated with volcanic
eruptions:
o Respiratory illnesses from the inhalation
of ash
o For individuals close to the volcano,
some danger exists from lava flows, or
more likely mud flows
TSUNAMIS
• Form as a result of earthquakes, volcanoes, or
landsides under the ocean
• Waves grow taller as they reach the coast
• Four out of Five occur in the Ring of Fire
Some natural signs of Tsunami:
1. A felt earthquake
2. Unusual sea level changes: sudden sea water
retreat or rise.
3. Rumbling sound of approaching waves.
* Stay out of danger areas until “all clear” is issued by
competent authority.
MAN-MADE OR ANTHROPGENIC DISASTERS
• Disasters in which the principal direct causes are
identifiable human actions, deliberate or
otherwise (Jha, 2010).
EXAMPLE OF MAN-MADE DISASTER
• Biological terrorism
• Biochemical terrorism
• Chemical spills
• Radiologic/nuclear events
• Fires
• Blast/explosion
• Transportation accidents
• Armed conflicts
• Act of wars
CLASSIFICATION OF MAN-MADE DISASTERS
1. Complex human emergencies- involve
situations where populations suffer significant
casualties as a result of war, civil strife, or other
political conflict.
o Some disasters are the result of a
combination of forces such as drought,
famine, disease, and political unrest that
displace millions of people from their
homes.
2. Technological disasters- people, property,
community infrastructure & economic welfare are
directly affected by major industrial accidents
(unplanned release of nuclear energy, fires or
explosions from hazardous substances).
3. Disasters not caused by natural hazards but occur
in human settlements
NATURAL & TECHNOLOGICAL DISASTERS
(NA-TECHS)
• a natural disaster or phenomenon may trigger a
secondary disaster, the result of weaknesses in the
human environment
• NA-TECH disaster occurred in Japan (March,
2011) when an earthquake and tsunami caused
damage to the Fukushima Daiichi nuclear reactor,
resulting in wide-scale evacuation, illness, and
long-term population displacement (referred to as
an indirect causality event).
Reference:
Disaster Nursing and Emergency Preparedness for
Chemical, Biological, and Radiological Terrorism
and Other Hazards by Tener Goodwin Veenema 4th
Edition, 2019.
NUR 1221 – EDN TEAM 2022-2023|3
 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING
NUR 1221 DISASTER NURSING LECTURE
A.Y. 2022-2023 SECOND SEMESTER
MODULE 2 THE CORE COMPETENCIES
OF NURSES RESPONDING TO MASS
CASUALTIES
Topic Outline
1. The Core Competencies of Nurses Responding to
Mass Casualty Incidents
a. Core Competencies
b. Core Knowledge Areas
c. Professional Role Development
d. Identification of the most appropriate or
most likely health care role for oneself
during a Mass Casualty Incident
OVERVIEW
As nurses, we are uniquely trained to be able to give back
to our society in times of greatest suffering and it is our
firm belief that nurses, no matter what their chosen
specialty, should be prepared to give back in this way.
We have the compassion and ability to provide care and
emotional and spiritual support to those who have lost
family members and friends and seen their communities
devastated, and we can refer survivors on to other
professionals as needed. It is our duty to give back to
society by using our gifts and skills in times of greatest
need and prepare ourselves for this role (Veenema, 2013).
In this module, we will be discussing our important role as
frontline health worker in delivering care to clients
specifically during disaster and emergency situation.
THE CORE COMPETENCIES OF NURSES
RESPONDING TO MASS CASUALTY INCIDENTS
CORE COMPETENCIES
1. Critical thinking- critical thinking skills include
the ability to identify and define a problem,
recognize assumptions, evaluate arguments, and
apply inductive and deductive reasoning to draw
conclusions from the available information. As
such, emergency management professionals must
continually enhance their critical thinking skills.
• The inherent nature of the disaster condition
mandates that providers are critical thinkers who
can remain calm, rapidly assess situations,
consider options, and enact the emergency
response plan. New problems will need to be
addressed. Time will be of the essence.
• Flexibility, a preparedness to assume
responsibility and risk, and strength of character
are just a few characteristics of the disaster nurse
leader.
• An ability to triage situations as well as patients
and prioritize and delegate limited resources are
also key components of the role. Critical thinking
requires risk taking, not formulaic response.
2. Assessment- the inherent nature of the disaster
condition mandates that providers are critical
thinkers who can remain calm, rapidly assess
situations, consider options, and enact the
emergency response plan. New problems will
need to be addressed. Time will be of the essence.
3. Technical Skills. Technology plays a key role in
the prevention, preparation, and management of
emergencies. Communication, data analysis, and
security are of the utmost importance when it
comes to dealing with emergency preparedness
and prevention, and technology is a prime part of
these solutions.
4. Communication. Communication during and
immediately after a disaster situation is a vital
component of response and recovery. Effective
communication connects first responders, support
systems, and family members with the
communities and individuals immersed in the
disaster.
CORE KNOWLEDGE AREAS
• Health promotion, risk reduction, and disease
prevention
• Health care systems and policy
• Illness and disease management
• Information and health care technologies
PROFESSIONAL ROLE DEVELOPMENT: A
DESCRIPTION OF NURSING ROLES IN MASS
CASUALTY INCIDENTS
Burkle (1984) identified a variety of personal abilities that
are essential to be an effective triage officer during a
disaster:
• Clinically experienced
• Good judgment and leadership
• Calm and cool under stress
• Decisive
• Knowledgeable of available resources
• Sense of humor
• Creative problem solver
• Available
• Experienced and knowledgeable regarding
anticipated casualties
IDENTIFICATION OF THE MOST APPROPRIATE
OR MOST LIKELY HEALTH CARE ROLE FOR
ONESELF DURING A MASS CASUALTY
INCIDENT
NUR 1221 – EDN TEAM 2022-2023 |4
ROLE OF THE PUBLIC HEALTH NURSE IN A • By collaborating with other health and human
DISASTER service professionals, the PHN is accustomed to
• Assess the needs of the community (including being part of a large interdisciplinary framework
special populations) as the event unfolds based on
the information available. Reference:
• Conduct surveillance activities within the health Disaster Nursing and Emergency Preparedness for
department as well as in cooperation with in- Chemical, Biological, and Radiological Terrorism and
hospital infection control practitioners to control Other Hazards by Tener Goodwin Veenema 4th
the spread of communicable disease. Edition, 2019.
• Assure the health and safety of themselves as well
as their fellow responders.
• Maintain communication with local, state, or
federal agencies, assuring the accurate
dissemination of information to colleagues and
the public-at-large.
• Operate points of distribution (POD) mass
prophylaxis centers as needed.
• Provide on-site triage of victims as needed.
• Maintain nursing documentation throughout the
event

ROLE OF THE PUBLIC HEALTH NURSE IN

POINT OF DISTRIBUTION PLANS
• Public health nurses will often be asked to
participate in the implementation of local point of
distribution (POD) plans. Point of distribution
plans are activated (primarily under the direction
of the local county medical director) when large
numbers of the population will require
vaccination or treatment within a short span of
time
• To assist in understanding the PHN’s role in a
biological disaster, a prehospital model of
practice must be defined:
o Follow agency protocol and report to
disaster site or to point of distribution
(POD) center.
o Don appropriate PPE (if needed) before
approaching site if appropriate.
o Familiarize yourself with on-site non-
clinical and clinical responders and
establish yourself as a leader.
o Assess the status of patients at a POD and
triage them accordingly

THE ROLE OF THE PHN ON A

MULTIDISCIPLINARY RESPONSE TEAM
• The importance of the role of the PHN in disaster
planning is demonstrated by their widespread
inclusion on county, regional and state wide
planning committees.
• These committees provide an initial opportunity
for the PHN to share their unique abilities and
experiences with the rest of the first responder
team. It is also a chance for the PHN to learn more
about what the role of other responders in the field
will be.
• The PHN is well prepared to advise on
community resources and make suggestions
regarding program planning.

NUR 1221 – EDN TEAM 2022-2023|5

 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING
NUR 1221 DISASTER NURSING LECTURE
A.Y. 2022-2023 SECOND SEMESTER
MODULE 3 HAZARD IDENTIFICATION &
VULNERABILITY ASSESSMENT
Topic Outline
1. Disaster Planning
2. Data Collection Methods for Disaster Planning
3. Types of Hazard Analysis
4. Disaster Prevention Measures
5. Emergency Management Cycle
6. Evaluation
7. Core Preparedness Activities
OVERVIEW
Disasters have been integral parts of the human experience
since the beginning of time, causing premature death,
impaired quality of life, and altered health status. The
increase in natural disasters, their intensity, the number of
people affected by them, and the human and economic
losses associated with disaster events have placed an
emergency planning and preparedness. Global warming
shifts in climates, sea-level rise, and societal factors may
coalesce to create future calamities. Finally, war, acts of
aggression, and the incidence of terrorist attacks are
reminder of the potentially deadly consequences of man’s
inhumanity toward man. A professional mandate exists
that calls for nurses to participate in the development of
and serve as an integral part of a community’s disaster
preparedness plan. Nurses must participate as full partners
with both the medical community and emergency
management community in all aspects of disaster response
and recovery.
DISASTER PLANNING
• addresses the problems posed by various potential
events, ranging in scale from mass casualty
incidents, such as motor vehicle collisions with
multiple victims, to extensive flooding or
earthquake damage, to armed conflicts and acts of
terrorism
• Nurses participation in all phases is critical to
ensure they are aware and prepared to deal with
different factors
DEFINITION OF TERMS
• Hazards identification- process used to evaluate
if any particular situation, item, thing, etc. may
have the potential to cause harm. This continues
in assessing the risk in the workplace,
environment
• Health Preparedness- medical preparedness and
response capabilities for emergencies, whether
deliberate, accidental, or natural. It serves as a
vital framework for state, local, tribal, and
territorial preparedness programs as they plan,
operationalize, and evaluate their ability to
prepare for, respond to, and recover from public
health emergencies.
• Vulnerability Analysis- is the human dimension
of disasters and is the result of the range of
economic, social, cultural, institutional, political,
and psychological factors that shape people’s
lives and the environment that they live in.
• Risk Assessment- a process to identify potential
hazards and analyze what could happen if a
hazard occurs. (what causes injury or harm, what
preventive or protective measures should be and
what can be eliminated)
ISSUES AND CHALLENGES ON CORE
PREPAREDNESS
1. Anticipate communication problems
2. Address operational issues related to effective
triage, transportation, and evacuation
3. Accommodate the management, security, and
distribution of resources
4. Implement advance warning systems and enhance
effective warning messages
5. Enhance coordination of search and rescue efforts
6. Effective triage of patients
7. Establish plans for the distribution of patients to
hospitals
8. Patient identification and tracking
9. Damage or destruction of healthcare
infrastructures
10. Management of volunteers, donations, and other
organizations
11. Organized improvisational response to disruption
of systems
12. Encouraging overall resistance to planning efforts
According to Auf der Helde (1989) “Interest in disaster
preparedness is proportional to the recency and magnitude
of the last disaster.”
SIX DOMAINS OF PREPAREDNESS
COMMON CHALLENGES TO ADDRESS
PROACTIVELY
• Communication– among organizations and
people is the most crucial and a priority in disaster
planning. Failure may lead to damage to
NUR 1221 – EDN TEAM 2022-2023 |6
 infrastructure, lack of operator familiarity,
increase demands, inadequate supplies, and lack
of integration. Backup communication system
must be planned. Ex. cellphones, texting, social
media.
• Information management– planning should
ensure necessary leadership and accountability to
support the establishment of the interconnected
data systems and analytic capacity. Data sharing
should be included in disaster planning such as
medical and behavioral healthcare, public health,
and social services
• Coordination– important to know geographical
area of jurisdiction to consider how will they
respond in a disaster when entire region is
affected. Leadership responsibilities and
coordination of all rescue sectors should work
hand in hand.
• Advance warning systems and use of
evacuation areas – warnings can be made in
advance before the arrival of a disaster (typhoons,
earthquake, volcanic eruptions, tsunami). The
emergency alert systems can help in public alert
warning.
• Surge management- a comprehensive disaster
plan will account for a sudden unanticipated
“surge” of patients, the effective triage of patients
(prioritization for care and trans- port of patients),
and distribution of patients to hospitals (a
coordinated, even distribution of patients to
several hospitals as opposed to delivering most of
the patients to the closest hospital).
METHODS OF DATA COLLECTION FOR
DISASTER PLANNING
1. HAZARD IDENTIFICATION AND MAPPING
Hazard identification is used to determine which events
are most likely to affect a community and to make
decisions about who or what to protect as the basis of
establishing measures for prevention, mitigation, and
response. Historical data and data from other sources are
collected to identify previous and potential hazards. Data
are then mapped using aerial photography, satellite
imagery, remote sensing, and geographic information
systems.
2. VULNERABILITY ANALYSIS
Vulnerability analysis is used to determine who is most
likely to be affected, the property most likely to be
damaged or destroyed, and the capacity of the community
to deal with the effects of the disaster. Data are collected
regarding the susceptibility of individuals, property, and
the environment to potential hazards in order to develop
prevention strategies. A separate vulnerability analysis
should be conducted for each identified hazard.
3. RISK ASSESSMENT
Risk assessment uses the results of the hazard
identification and vulnerability analysis to determine the
probability of a specified outcome from a given hazard that
affects a community with known vulnerabilities and
coping mechanisms (risk equals hazard times
vulnerability). The probability may be presented as a
numerical range (i.e., 30% to 40% probability) or in
relative terms (i.e., low, moderate, or high risk). Major
objectives of risk assessment include:
• Determining a community’s risk of adverse health
effects due to a specified disaster (i.e., traumatic
deaths and injuries following an earthquake)
• Identifying the major hazards facing the
community and their sources (i.e., earthquakes,
floods, industrial accidents)
• Identifying those sections of the community most
likely to be affected by a particular hazard (i.e.,
individuals living in or near flood plains)
• Determining existing measures and resources that
reduce the impact of a given hazard (i.e., building
codes and regulations for earthquake mitigation)
• Determining areas that require strengthening to
prevent or mitigate the effects of the hazard
Source: Information obtained from Landesman, L. (2001).
Chapter 5: Hazard assessment, vulnerability analysis, risk
assessment and rapid health assessment. In Public health
management of disasters: The practice guide. Washington,
DC: American Public Health Association. The author
gratefully acknowledges Dr. Linda Landesman and the
American Public Health Association for permission to
reproduce this work
TYPES OF HAZARD ANALYSIS
• Natural Events- hurricane, drought, avalanche,
tsunami, wildfire, heat wave, earthquake,
volcanic eruption, landslide, lightning storm
• Technological Events- hazardous material
release, explosion or fire, transportation accident,
building or structure collapse, power or utility
failure, air pollution, dam failure, nuclear power,
communication disruption
• Human Events- economic failures, general
strikes, terrorism ecological, cyber, nuclear,
biological, chemical), sabotage, bombs, hostage
situation, enemy attack, arson, mass panic
• Special Events- mass gatherings, concerts,
sporting events, political gatherings
• Content Hazards- climate change, sea level rise,
deforestation, intensive urbanization, loss of
natural resources
Source from Smith, & Petley, D.N. (2009) Environmental
hazards: Assessing risk and reducing disaster(5th ed0.
New York: NY: Routledge
DISASTER PREVENTION MEASURES
1. Prevention or removal of hazard – ex. closing
down an aging industrial facility that did not pass
the safety standard
2. Containment of the hazard – ex. enforcing strict
building regulations in an earthquake -prone zone,
3. Removal of at-risk populations – ex. evacuation
of people prior to impact of an hazard events,
resettling communities
4. Provision of public information and education –
providing information that can help in health
measures and protection
NUR 1221 – EDN TEAM 2022-2023|7
5. Establishment on early warning system – ex.
using satellite data for information to public
warnings
6. Mitigation of vulnerabilities – ex. sensors to
check food, water, currency, mail for
contamination
7. Reduction of risk posed by some hazards – ex.
relocating a chemical depot away from the
community
8. Enhancement of a local community capacity to
respond– ex. healthcare coordination in the
community such as hospitals, health departments,
clinics, home care agencies
EVALUATING CAPACITY TO RESPOND
• Resource identification is essential in disaster
planning in a community.
• Assembling lists of healthcare facilities, medical,
nursing, and emergency responder groups, public
works, civic organizations, and volunteer
agencies
• Resource availability
• Creativity in identifying and mobilizing human
resources
• Coordination to agencies to avoid chaos
CORE PREPAREDNESS ACTIVITIES
1. Prepare a theoretical foundation for disaster
planning. This should be constructed. A firm
foundation grounded in an understanding of
human behavior.
• Disaster plan must focus first on the local
response and best estimates of what
people are likely to do as opposed to what
planners “want people to do.”.
• Disaster plans that are flexible in design,
and easy to change, will be of greater
value to all personnel involved in a
disaster response.
2. Disaster planning is only as effective as the
assumptions upon which it is based. The
effectiveness of planning is enhanced when it is
based on information that has been empirically
verified by systematic field or research body.
3. Activities must go beyond the routine. Most
disasters cannot be managed merely by
mobilizing more equipment, personnel, and
supplies.
4. Community needs assessment. A community
needs assessment must be conducted to identify
the preexisting prevalence of disease and to
identify those high-risk, high-need patients that
may need to be transported in the event of an
evacuation or whose needs may necessitate the
provision of care in nontraditional sites.
5. Identify leadership and command post. The
process of disaster planning is important to
establishing relationships, identifying leaders and
laying the groundwork for smooth responses.
• Identification of the command post must
also be decided in advance and
communicated to all members of the
organization
6. Design a local response for the first 72 hours.
A plan for the mobilization of local authorities,
personnel, facilities, equipment, and supplies for
the initial postimpact 72-hour period is composed
of the next level of the foundation of the disaster
response.
• Local organizational leaders and
executives from each agency must come
together as a planning group to conduct
the initial assessments (risk, hazard, and
vulnerability), establish a coordinated
process for response, design effective and
complementary communication systems,
and create standard criteria for the
assessment of the scope of damage to the
community
7. Identification and accommodation of
vulnerable populations. A community disaster
plan must accommodate the needs of all people,
including patients residing in hospitals and long-
term care facilities such as nursing homes,
assisted living, psychiatric care facilities, and
rehabilitation centers.
8. State and federal assistance- Groups and
organizations are most helpful when they
understand their own capabilities and limitations,
as well as those of the organizations with which
interactions are anticipated or intended
9. Identification of training and educational
needs, resources, and personal protective
equipment. The disaster plan provides direction
for identifying training needs including mock
drills, acquiring additional resources, and PPE.
10. Plan for the early conduct of damage
assessment. In emergency medical care, response
time is important
• Disaster response is the early conduct of
a proper damage assessment to identify
urgent needs and to determine relief
priorities for an affected population
(Lilibridge, Noji, & Burkle, 1992).
EMERGENCY MANAGEMENT CYCLE
PHASES OF EMERGENCY MANAGEMENT
CYCLE
1. Pre-Impact (Before)
• Advance planning
• Community participation - Mock drill -
Mass education - Safety measures • Time
factor
• Coordination
2. Impact
• Establish emergency communication
• Deploy rescue teams
• Medical support & other life-saving
activities.
• Supply/air dropping of food, drinking
water and essential items
3. Post-Impact
• Medical care
NUR 1221 – EDN TEAM 2022-2023|8
 • Food, clothing and shelter for rescued
people
• Disposal of bodies/animal carcasses,
prevention of epidemics
• Repair and restoration of essential
services/infrastructure
• Estimating loss of life and property
An essential step in disaster planning and preparedness is
the evaluation of the disaster response plan for its
effectiveness and completeness by key personnel involved
in the response. The comprehension of people expected to
execute the plan and their ability to perform duties must be
assessed.
The availability and functioning of any equipment called
for by the disaster plan need to be evaluated and reviewed
on a systematic basis.
Disaster drills may also provide an excellent means of
testing plans for their completeness and effectiveness.
Drills can be staged as large, full-scale exercises, using
mock victims, and requiring vast resources of supplies and
personnel, or they may be limited to a small segment of the
disaster response.
Essential features of all effective disaster drills are the
inclusion of all individuals and agencies likely to be
involved in the disaster response and a critique, with
debriefing, of all participants following the exercise. This
should include representation from all sectors of the
emergency management field, all health care disciplines,
government officials, school officials, and the media.
The critique should consider comments from everyone
involved in the drill. Disaster planners should review all
observations and comments and respond with
modifications of the disaster plan.
Periodic evaluations of disaster plans are essential to
ensure that personnel are adequately familiar with their
roles in disaster situations, as well as to accommodate
changes in population demographics, regional emergency
response operations, hospital renovations and closings,
and other variables.
DISASTERS WITHIN HOSPITALS
• “Internal” disasters refer to incidents that
disrupt the everyday, routine services of the
medical facility and may or may not occur
simultaneously with an external event.
• The sudden large volumes of patients arriving
from an emergency must have a plan in accepting
disaster events or situations. An internal event
threatens the smooth functioning of the hospital,
medical center, or health care facility, or that
presents a potential danger to patients or hospital
personnel (Aghababian et al., 1994).
• Internal disaster plans should be integrated with
the hospital’s overall disaster preparedness
protocol. Training should be mandatory for all
personnel
• United States, the Joint Commission on
Accreditation of Healthcare Organizations
(JCAHO) requires that all hospitals have
comprehensive plans for both internal and
external disasters. They created the International
patient Safety Goals IPSG) to be a guideline in
hospital accreditation. Sources of internal events
include power failures, flood, water loss,
chemical accidents and fumes, radiation
accidents, fire, explosion, violence, bomb threats,
loss of telecommunications (inability to
communicate with staff), and elevator
emergencies.
• “Hospital Incident Management System” and
address the institution’s response to any potential
incident that would disrupt hospital functioning.
The identification of a command post and the
following three phases:
1. Alert phase, during which staff remain
at their regular positions, service
provision is uninterrupted, and faculty
and staff await further instructions from
their supervisors.
2. Response phase, during which
designated staff report to supervisors or
the command post for instructions, the
response plan is activated, and
nonessential services are suspended.
3. Expanded response phase, when
additional personnel are required, off-
duty staff are called in, and existing staff
may be reassigned based on patient’s
needs.
• Internal disaster plans must address all potential
scenarios, including:
o loss of power, including auxiliary power
o loss of medical gases
o loss of water and/or water pressure
o loss of compressed air and vacuum
(suction)
o loss of telecommunications systems.
o loss of information technology systems
o threats to the safety of patients and staff
(violence, terrorism, and bombs)
o toxic exposures involving fumes,
chemicals, or radiation
o immediate evacuation of all patients and
personnel
BIOTERRORISM/ COMMUNICABLE DISEASE
Infectious disease outbreaks create unique challenges to
planners. At what point does outbreak management
become disaster management?
Three Steps in Managing a Communicable disease
Outbreak:
1. Recognition that a potential outbreak is occurring
2. Investigation of the source, mode of transmission,
and risk factors for infection
3. Implementation of appropriate control measures
Note: Assessment of the preparedness and capacity of each
hospital to respond to and treat victims of an infectious
NUR 1221 – EDN TEAM 2022-2023|9
disease outbreak or biological incident must be conducted
as part of disaster planning
HAZARDOUS MATERIALS DISASTER
PLANNING
Every industrialized nation is heavily reliant on chemicals.
it produces, stores, and transports large quantities of toxic
industrial agents.
Clinically, the removal of solid or liquid chemical agents
from exposed individuals is the first step in preventing
serious injury or death. Civilian hazmat teams generally
have basic decontamination plans in place. Few teams are
staffed, trained, and equipped for mass decontamination.
Hospitals need to be prepared to decontaminate patients,
despite plans that call for field decontamination of patients
prior to transport.
Mismanagement of a hazmat incident can turn a contained
accident into a disaster involving the entire community,
disaster planning in victim decontamination and PPE into
the planning process (Levitin & Siegelson, 1996, 2002
PROFESSIONAL NURSING MANDATE
All nurses should have an awareness of the basic life cycle
of disasters, the health consequences associated with the
major events, and a framework to support the necessary
assessment and response efforts.
Caring for patients and the opportunity to save lives is
what professional nursing is all about, and disaster events
provide nurses with an opportunity to do both.
According to the American Nurses Association (ANA),
“the aim of nursing actions is to assist patients, families
and communities to improve, correct or adjust to physical,
emotional, psychosocial, spiritual, cultural, and
environmental conditions for which they seek help.”
Six essential features of professional nursing (ANA, 2010,
pp. 1–3):
• Provision of a caring relationship that facilitates
health and healing.
• Attention to the range of human experiences and
responses to health and illness within the physical
and social environments.
• Integration of objective data with knowledge
gained from an appreciation of the patient or
group’s subjective experience.
• Application of scientific knowledge to the
processes of diagnosis and treatment through the
use of judgment and critical thinking.
• Advancement of professional nursing knowledge
through scholarly inquiry.
• Influence on social and public policy to promote
social justice
EARTHQUAKE PREPAREDNESS
DROP, COVER, AND HOLD ON DURING YOUR
EARTHQUAKE DRILL
• DROP down onto your hands and knees
immediately. This position protects you from
falling but still allows you to move if necessary.
• COVER your head and neck (and your entire
body if possible) underneath a sturdy table or
desk. If there is no shelter nearby, get down near
an interior wall or next to low-lying furniture that
won’t fall on you, and cover your head and neck
with your arms and hands. Try to stay clear of
windows or glass that could shatter or objects that
could fall on you.
• HOLD ON to your shelter (or to your head and
neck) until the shaking stops. Be prepared to move
with your shelter if the shaking shifts it around.
FLOODS PREPAREDNESS
TURN AROUND, DON’T DROWN
Never drive through flooded areas. As little as six inches
of water can cause you to lose control of your vehicle.
1. Make communication plan
2. Stay informed.
3. Inform local authorities about special needs
(bedridden, elderly, or with disability)
4. For homes – check hazard places, turn off
electricity power, prepare emergency kits, food
and water
5. If need to evacuate be prepared
TSUNAMIS
Tsunamis, also known as seismic sea waves, are a series
of enormous waves created by an underwater disturbance
such as an earthquake, landslide, volcanic eruption, or
meteorite. A tsunami can strike anywhere along coastline.
1. Flood waters can pose health risks such as
contaminated water and food
2. Loss of shelter leaves people vulnerable to
exposure to insects, heat, cold.
3. Traumatic injuries is present due to washed debris
(houses, trees, buildings etc.)
4. Surveying and monitoring for infectious people
from water or insect transmitted diseases,
medicine supplies, restoring primary health
services, water, food, shelter, and employment
VOLCANOES
Volcanoes can produce ash, toxic gases, flash floods of hot
water and debris called lahars, lava flows, and fast-moving
flows of hot gases and debris called pyroclastic flows.
Some dangers from volcanoes can be predicted ahead of
time while others may occur with little or no notice after
an eruption. Each volcano and situation is unique.
1. Emergency kit
2. If to evacuate – follow authorities’ instructions,
take only essentials with you a 1 week supply
including meds if you have
3. Keep listen to radio to be updated.
NUR 1221 – EDN TEAM 2022-2023|10
 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING
NUR 1221 DISASTER NURSING LECTURE
A.Y. 2022-2023 SECOND SEMESTER
MODULE 4 DISASTER MANAGEMENT
Topic Outline
1. Introduction to Disaster Management
a. Three Types of Advance Planning
2. Classifications of Disaster
3. Disaster Management Programs
a. Five Basic Phases
b. Essential Elements for Hospital Disaster
Management
c. Leadership Role
OVERVIEW
The purpose of disaster management in any health care
facility is to maintain a safe environment and continue to
provide essential services to the patients during times of
disaster. Disaster management is akin to a feedback loop—
it starts with planning, moves to prevention, mitigation,
and response, and then moves to evaluation and
identification of areas for improvement, and planning
again to implement the required changes. The possibility
exists that in the event of a catastrophic disaster, the
standard of care in the hospital setting may have to be
altered. Advance planning for such a situation can serve to
save the most lives.
INTRODUCTION TO DISASTER MANAGEMENT
• Disaster management of the 21st century goes
beyond incident response and post event
activities. It includes risk assessment, prevention,
mitigation, response, and recovery activities.
• In the hospital setting, the primary purpose for an
emergency management plan is to maintain a safe
environment so that patient care can continue to
be delivered effectively and staff are not exposed
to undue risks during times of emergency or
disaster response.
• Advance planning requires cooperative efforts of
the hospital, community agencies, and local
government officials (Waeckerle, 1991).
THREE TYPES OF ADVANCED PLANNING
1. Strategic planning (all hazards approach)- these
are planning activities that focus on preparing the
organization for any type of threat.
• Strategic planning is done to prepare the
hospital for any type of emergency or
disaster
2. Contingency planning- these are planning
activities related to a site-specific threat that may
occur at any time
• Done after a risk assessment has been
completed and the vulnerabilities of the
organization are identified (Geographic
location, geological features, industries
in the community, demographics of the
population served, and age)
3. Forward planning- these are planning activities
for a known imminent disaster or event
• It focuses on plans for activation of the
existing strategic and possibly the
contingency plans.
CLASSIFICATIONS OF DISASTER
1. Internal Disaster- occurs when there is an event
within the facility that poses a threat to disrupt the
environment of care
• Such events are commonly related to the
physical plant (e.g., loss of utilities or
fire), but can arise from availability of
personnel (e.g., a labor strike)
• The management goal is to maintain a
safe environment for the patients,
continue to provide essential services,
ameliorate the problem, and restore
normal services
2. External Disaster- it becomes a problem for a
facility when the consequences of the event create
a demand for services that tax or exceed the usual
available resources
• This could be the arrival within an hour
of double the number of trauma patients
usually seen over a 24-hour period, the
arrival of victims of a chemical
HAZMAT incident who need
decontamination as well as medical
attention, or a surge of ambulatory
patient “walk-ins” associated with a
reported communicable disease exposure
in the community.
3. Combined External/Internal Disaster - external
disasters can trigger internal disasters for an
organization. (ex. earthquake, severe typhoons
that can create problem also in the hospitals)
• Short staffs because can’t come due to severe
typhoon, or structural damage like roads,
mass casualties but increased patients
because of the disaster event
DISASTER MANAGEMENT PROGRAMS
FIVE BASIC PHASES
1. Preparedness/Risk Assessment: (Pre-Impact)
• Evaluate the facility’s vulnerabilities or
inclination for disasters.
• Issues to consider include weather patterns;
geographic location; expectations related to
public events and gatherings; age, condition,
and location of the facility; and industries in
close proximity to the hospital
2. Mitigation
• These are steps that are taken to lessen the
impact of a disaster should one occur and can
be considered as prevention measures
NUR 1221 – EDN TEAM 2022-2023 |11
 • Ex. installing and maintaining backup
generator power to mitigate the effects of a
power failure or cross training staff to
perform other tasks to maintain services
during a staffing crisis
3. Response
• The actual implementation of the disaster
plan
• These are routinely practiced and are
modified when needed
• This should be continuously monitored and
adjusted depends on current situation
4. Recovery
• The organization and staff need to recover.
Invariably, services have been disrupted and
it takes time to return to routines
5. Evaluation
• This phase of disaster planning and response
receives the least attention.
• It is essential that a formal evaluation be done
to determine what went well (what really
worked) and what problems were identified.
• A specific individual should be charged with
the evaluation and follow-through activities
ESSENTIAL ELEMENTS FOR HOSPITAL
DISASTER MANAGEMENT
The essential elements for any disaster management
system include the following:
• An appropriate infrastructure to support the
disaster response, which includes maintaining
services for preexisting patients as well as the new
arrivals.
• An appropriately trained staff who are competent
to perform their disaster response functional roles
and able and willing to report to work during any
sort of disaster.
• A clearly defined, executable, practiced
emergency response plan.
• A strong foundation of preexisting relationships
with partnering organizations and agencies that
can be called on to provide mutual aid and support
when needed.
1. INFRASTRUCTURE
• During response current patients need to be cared
for at the same time as the new arrivals. It is the
disaster manager’s responsibility to ensure that
this is done
• Assign one individual with the specific
responsibility for directing the care to the
preexisting patients and ensuring for their safety
• Making provisions for rapid procurement during
these times can help to improve the disaster
response
• Staff need to be sure that the environment of care
remains safe and essential services are provided
to all patients and are functional
2. STAFF COMPETENCIES
• Assuring that all levels of staff are competent to
perform during disaster response
• The best method to evaluate competence is direct
observation. This can be accomplished through
drills or during actual response activities
• Emergency preparedness competencies are cross
cutting knowledge, skills, and abilities that all
hospital workers must be able to demonstrate, and
there are additional competencies for hospital
leaders.
3. DISASTER PLAN
• The staff in any health care organization should
be fully conversant with the emergency response
plan.
• Employees should know their emergency
response functional roles, and these should have
been practiced beforehand.
• Each agency needs to have an emergency
response plan that is specific to that agency, and
consistent with the underlying mission of the
organization
4. PREEXISTING RELATIONSHIPS AND
PARTNERSHIPS
• With the decreased surge capacity of most
hospitals (i.e., fewer staffed beds, little or no extra
staff, and so forth) the need to establish mutual aid
agreements, plans to share resources, and ability
and willingness to provide and receive support
from local agencies
• The best method to establish such emergency
response relationships is to plan and drill/exercise
with other organizations and agencies
• Each hospital or health care facility must have a
plan in place that provides for procurement of
local assistance or mutual aid, before reaching out
to the state or government agencies
5. RESPONSE
• It is at this point that the disaster manager must
change leadership styles.
• During disaster response, group decision
making/consensus style management is replaced
with structured and focused direction style
• Staff who have been involved in the planning
process will recognize the need for this style of
leadership and will cooperate.
LEADERSHIP ROLE
• To be effective, disaster managers need to be able
to match the management style with the phase of
disaster operations (Cuny, 2000).
• Such styles usually span a spectrum of varying
degrees of control—directive, supportive,
participative, or achievement-oriented.
• During the non-crisis phase, participative and
achievement-oriented management styles work
best
o Involvement of the staff during disaster
planning activities serves several
functions, staff who are involved in the
planning have a vested interest in seeing
it succeed and are more likely to follow
NUR 1221 – EDN TEAM 2022-2023|12
 the plan and cooperate during times of
crisis than no staff involvement
• During the response phase of a disaster, a more
directive style of leadership is required
o Leader must act quickly and decisively,
and there is usually little time for
extended consultation thus the most
experienced manager should be sought
for the task.
• During the acute phase of a disaster, use of an
incident command structure will assist the
manager with directing disaster operations

• Transitions to the recovery and evaluation

phases, the leader can become less directive and
more supportive. Staff may have been
traumatized by the event and require support from
the leader

NUR 1221 – EDN TEAM 2022-2023|13

 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING
NUR 1221 DISASTER NURSING LECTURE
A.Y. 2022-2023 SECOND SEMESTER
MODULE 5 ETHICO-LEGAL ISSUES
IMPACTING DISASTER
Topic Outline
1. Ethico-Legal Issues: Philippine Laws
2. Patient’s Bill of Rights
3. Informed Consent
4. Documentation/ Information Dissemination
5. Effective Collaboration with Multisectoral Team
OVERVIEW
This module introduces various legal and ethical issues
that may arise during a disaster or major public health
crisis. It will begin with an overview of the legal system
and describe the sources of law and ethical obligations, the
importance of the various levels of government in public
health regulation, and describe the resources that are
available to nurses for legal and ethical advice.
ETHICO-LEGAL ISSUES
PHILIPPINE LAWS
1. R.A. No. 10121– Philippine Disaster Risk
Reduction and Management Act of 2010
2. RA 10344– Risk Reduction and Preparedness
Equipment Protection Act
3. RA 10821- Children’s Emergency Relief and
Protection Act
4. Philippine Environmental Laws
a. RA 8749- Clean Air Act of 1999
b. RA 9211- Tobacco Regulation Act of
2003
c. RA 9003- Ecological Solid Waste
Management of 2000
5. RA 6969- Toxic substances and the hazardous
and nuclear wastes control act
6. RA 9147- Wildlife resources and conservation
and protection act
7. RA 7586- National Integrated Protected Areas
AMERICAN NURSES ASSOCIATION CODE OF
ETHICS FOR NURSES
1. The nurse, in all professional relationships,
practices with compassion and respect for the
inherent dignity, worth, and uniqueness of every
individual, unrestricted by consideration of social
or economic status, personal attributes, or the
nature of health problems.
2. The nurse’s primary commitment is to the patient,
whether an individual, family, group, or
community.
3. The nurse promotes, advocates for, and strives to
protect the health, safety, and rights of the patient.
4. The nurse is responsible and accountable for
individual nursing practice and determines the
appropriate delegation of tasks consistent with the
nurse’s obligation to provide optimum patient
care.
5. The nurse owes the same duties to self as to
others, including the responsibility to preserve
integrity and safety, to maintain competence, and
to continue personal and professional growth.
6. The nurse participates in establishing,
maintaining, and improving health care
environments and conditions of employment
conducive to the provision of quality health care
and consistent with the values of the profession
through individual and collective action.
7. The nurse participates in the advancement of the
profession through contributions to practice,
education, administration, and knowledge
development.
8. The nurse collaborates with other health
professionals and the public in promoting
community, national, and international efforts to
meet health needs.
9. The profession of nursing, as represented by
associations and their members, is responsible for
articulating nursing values, for maintaining the
integrity of the profession and its practice, and for
shaping social policy.
THE RIGHTS OF THE PATIENTS
1. Right to Appropriate Medical Care and Humane
Treatment
2. Right to Informed Consent.
3. Right to Privacy and Confidentiality.
4. Right to Information.
5. The Right to Choose Health Care Provider and
Facility.
6. Right to Self-Determination.
7. Right to Religious Belief.
8. Right to Medical Records.
9. Right to Leave.
10. Right to Refuse Participation in Medical Research
11. Right to Correspondence and to Receive Visitors.
12. Right to Express Grievances.
13. Right to be Informed of His Rights and
Obligations as a Patient.
POLICIES RELATED TO INFORMED CONSENT
The patient has a right to a clear, truthful and substantial
explanation, in a manner and language understandable to
the patient, of all proposed procedures, whether diagnostic,
preventive, curative, rehabilitative or therapeutic, wherein
the person who will perform the said procedure shall
provide his name and credentials to the patient,
possibilities of any risk of mortality or serious side effects,
problems related to recuperation, and probability of
success and reasonable risks involved provided that the
patient will not be subjected to any procedure without his
written informed consent, except in the following cases:
a) In emergency cases, when the patient is at
imminent risk of physical injury, decline of death
NUR 1221 – EDN TEAM 2022-2023 |14
 if treatment is withheld or postponed. In such 3. Community Relations for Public Information
cases, the physician can perform any diagnostic or Officer 4. Triage Officer
treatment procedure as good practice of medicine 4. NDRRM National and Local Council
dictates without such consent. 5. Philippine National Red Cross
b) When the health of the population is dependent on 6. National and Local Health Personnel
the adoption of a mass health program to control 7. DSWD
epidemic 8. Civil Society Organization
c) When the law makes it compulsory for everyone 9. Community Volunteers
to submit a procedure
d) When the patient is either a minor, or legally
incompetent, in which case. a third party consent
is required
e) When disclosure of material information to
patient will jeopardize the success of treatment, in
which case, third party disclosure and consent
shall be in order
f) When the patient waives his right in writing.

Informed consent shall be obtained from a patient

concerned if he is of legal age and of sound mind. In case
the patient is incapable of giving consent and a third party
consent is required. the following persons, in the order of
priority stated hereunder, may give consent:
1. spouse
2. son or daughter of legal age
3. either parent
4. brother or sister of legal age
5. guardian

If a patient is a minor, consent shall be obtained from his

parents or legal guardian. If next of kin, parents or legal
guardians refuse to give consent to a medical or surgical
procedure necessary to save the life or limb of a minor or
a patient incapable of giving consent, courts, upon the
petition of the physician or any person interested in the
welfare of the patient, in a summary proceeding, may issue
an order giving consent.

DOCUMENTATION IN DISASTER
MANAGEMENT
DISASTER AND RISK MANAGEMENT PLAN
1. Incidence response team (IRT)
2. IRT Roles and responsibilities

DISASTER MANAGEMENT RESPONSE

1. Vulnerable groups
2. Health Hazard Report
3. Casualty Report

DISASTER RECOVERY ACTIVITY SUMMARY

1. Population Groups Involving Multiple Regions
requiring special attention
2. Outbreak surveillance report
3. Disaster Risk Reduction and Management Team
report

MULTIDISCIPLINARY COLLABORATIONS
PERSONAL ROLES AND FUNCTIONS FOR
DISASTER PREPAREDNESS AND RESPONSES
PLANS
1. Incident Commander
2. Medical Command Physician

NUR 1221 – EDN TEAM 2022-2023|15

 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING
NUR 1221 DISASTER NURSING LECTURE
A.Y. 2022-2023 SECOND SEMESTER
MODULE 6 MANAGEMENT OF MASS
CASUALTY INCIDENTS
Topic Outline
1. Management of Mass Casualties Concepts and
Principles
a. Mass Casualty Incidents
b. Basic Principles of Nursing during MCI
c. Incident Command System
Considerations
d. MCI Components
e. Assessment in MCI
2. Levels of MCI
3. Mass Casualty Incident Management
OVERVIEW
The purpose of disaster management in any health care
facility is to maintain a safe environment and continue to
provide essential services to the patients during times of
disaster. Disaster management includes preparedness/risk
assessment, prevention, mitigation, response, recovery,
and evaluation activities. Effective planning is the most
important element of disaster management. Disasters at
any level can be the result of events internal to the
institution, external to the facility, or a combination of
both. Regardless of the type of disaster, strong leadership
is required to mobilize and focus the organization’s
energy. The essential elements for successful disaster
management are appropriate system capacities to support
the delivery of services; staff that is competent in their
disaster response roles; a clearly defined, executable, and
practiced disaster plan; and strong preexisting partnerships
with collaborating organizations and agencies. (p.136)
Any event that draws a large number of individuals to the
same location at the same time creates a potential hazard
to health and safety. Multiple variables are present during
a mass gathering that interact to create the potential for
increased illness and injuries to attendees. Mass gatherings
provide difficult settings to plan for or render an
appropriate emergency health care response. The role of
the nurse in the disaster situation demands ingenuity,
flexibility, adaptability, creativity, and an understanding of
the need to expand one’s practice parameters outside
normal health care situations. (p.205)
MANAGEMENT OF MASS CASUALTY
INCIDENTS CONCEPTS AND PRINCIPLES
MASS CASUALTY INCIDENTS
o Mass casualty incident is any incident that
exceeds the responder’s or receiving hospital’s
capability to treat or transport (multiple- casualty
incident)
o A mass casualty incident (MCI) a multiple-
casualty incident) is any incident in which
emergency medical services resources, such as
personnel and equipment, are overwhelmed by
the number and severity of casualties.
o A formal declaration of an MCI is usually made
by an officer or chief of the agency in charge
usually using an incident command system
o The fundamentals of nursing practice during a
disaster, MCI, or special event are essentially the
same.
o Nurses must realize that in stressful circumstances
such as these the demand on their skills may be
greater and the circumstances unusual; therefore,
the nursing fundamentals practiced in other
settings and during smaller crises will still be
applicable.
o Time is an important factor. The longer the delay
in care for a seriously injured patient, the less
chance for recovery.
o The governing principle is to do the greatest good
for the greatest number of casualties.
VULNERABLE GROUPS
1. Young population
2. Older populations
3. PWDs
4. Pregnant women
THE BASIC PRINCIPLES OF NURSING DURING
SPECIAL (EVENTS) CIRCUMSTANCES AND
DISASTER CONDITIONS
• Rapid assessment of the situation and of nursing
care needs.
• Triage and initiation of life-saving measures first.
• The selected use of essential nursing interventions
and the elimination of nonessential nursing
activities.
• Adaptation of necessary nursing skills to disaster
and other emergency situations. The nurse must
use imagination and resourcefulness in dealing
with a lack of supplies, equipment, and personnel.
• Evaluation of the environment and the mitigation
or removal of any health hazards.
• Prevention of further injury or illness.
• Leadership in coordinating patient triage, care,
and transport during times of crisis.
• The teaching, supervision, and utilization of
auxiliary medical personnel and volunteers.
• Provision of understanding, compassion, and
emotional support to all victims and their families
INCIDENT COMMAND SYSTEM
CONSIDERATIONS
• Emergency Medical Services first responders,
triage, ambulance service
NUR 1221 – EDN TEAM 2022-2023 |16
 • Fire and Rescue will perform all initial rescue- • Hospitals: notification to local hospitals in area
related operations, as well as fire suppression and near the location of incident and/or city or
prevention. parishes
• Police Officers will secure and control access to • Triage: patients identified as red, yellow, green,
the scene, to ensure safety and smooth operations. following START Triage guidelines and primary
• Specialized Teams and Public Services– Red injury/service needed
Cross, Medical Reserve Corps, NGO, etc. • Communications:
• Hospitals will have a mass casualty incident o Primary: phone
protocol which they initiate as soon as they are o Secondary: radio
notified of an MCI in their community.
MCI LEVEL 3
COMPONENTS OF MCI • Incident will require multiple regional resources
• Initial Triage and responding agencies. This may require
• Patient Extrication additional resources in adjacent regions.
• Secondary Triage/Medical Treatment • Size: 20-100 patients
• Transportation of Victim • Hospitals: notification to local all regional
• hospitals and/or adjacent regions
ASSESSMENT IN MCI • Triage: patients identified as red, yellow, green,
(Source: Japan Society for Disaster Nursing, 2002) following START Triage guidelines
1. Size and extent of damage • Communications: phone and radio
2. Health needs among people communications, incident command, operational
3. Quality and quantity required for nursing officers, and hospitals
personnel (number, duration, knowledge, special
skill, organization, insurance, etc.) MCI LEVEL 4
4. Type of service required (institutions, shelters, • Incident will require multiple regional resources
regions, etc.) and responding agencies. Incident may require
5. Need for new development for special facility or additional resources in adjacent and/or multiple
equipment regions.
6. Possibility of secondary disasters • Size: 100-1000 patients
7. Organization structure of health care provision, • Hospitals: initial notification to all hospitals
responsible person, leader, possible assistants, nationwide.
counterpart, etc. • Communication: phone and radio
8. Review for health care provider’s health status communications, incident command, operational
9. Daily life pattern and schedule of health care officers, and hospitals
providers at the site
10. Access for information MCI LEVEL 5
11. Transportation access to and from site and mode • Incident will require nationwide resources
and mean of data collection • Size: greater than 1000 patients
12. Detail of health care activities • Hospitals: initial notification to all hospitals
nationwide
LEVELS OF MASS CASUALTY INCIDENTS • Triage: patients identified as red, yellow, green,
MCI LEVEL 1
following START Triage guidelines
• Incident will require local resources and • Communications: phone and radio
responding agencies communications, incident command, operational
• It may require additional resources within the officers, and hospitals
region
• Size: 5 to 10 patients MASS CASULATY INCIDENT MANAGEMENT
• Hospitals: notification to local hospitals in area NURSING ASSESSMENTS IN MCI
near the location of incident • Perform a respiratory, airway assessment
• Triage: patients identified as red, yellow, green, • Perform a cardiovascular assessment, including
following START Triage guidelines and primary vital signs, monitoring for signs of shock
injury/service needed • Perform an integumentary assessment, including
• Communications: a burn assessment
o Primary: phone • Perform a pain assessment
o Secondary: radio • Perform a trauma assessment from head to toe
• Perform a mental status assessment, including a
MCI LEVEL 2
Glasgow Coma Scale
• Incident will require local resources and
• Know the indications for intubation
responding agencies.
• Intravenous (IV) insertion and administration of
• It may require additional resources within the
IV medication
region.
• Emergency medications
• Size: 10 to 20 patients
NUR 1221 – EDN TEAM 2022-2023|17
 • Principles of fluid therapy

NURSING THERAPEUTICS IN MCI

• Concepts of basic first aid
• Triage and transport
• Pain management
• Management of hypovolemia and fluid
replacement
• Suturing (if appropriate based on practice
parameters) and initial wound care
• Blast injuries/dealing with tissue loss
• Eye lavage techniques
• Decontamination of chemical exposures
• Fractures/immobilization of fractures
• Management of hemorrhage
• Stabilization of crush injuries
• Movement of patients with spinal cord injury

In all types of special events and MCIs, the American Red

Cross (Guidelines for Disaster Nursing, 2002) states that
nurses will be expected to exercise great leadership and
discerning judgment in:
1. Assessment and triage of patient’s condition for
priority care.
2. Provision of care, treatment, and health
protection.
3. Appropriate utilization of nursing service
personnel.
4. Detection of changes in the event environment
and organizing activities to modify or eliminate
health hazards.
5. Dealing with mass casualties should it become
necessary.

NUR 1221 – EDN TEAM 2022-2023|18

 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING
NUR 1221 DISASTER NURSING LECTURE
A.Y. 2022-2023 SECOND SEMESTER
MODULE 7 INCIDENT HOSPITAL
COMMAND SYSTEM
Topic Outline
1. Considerations related to disasters according to:
a. Hospital disaster classification
b. Disaster’s magnitude rt to the
agency/community’s ability to respond
c. Levels of Disaster
2. Hospital Incident Command System (HICs)
a. Definition
b. Key Features
c. Examples in the Philippine Setting
d. Incident Command System
OVERVIEW
A clear chain of command and authority and assigns
specific disaster functional roles for staff members. After
each disaster response, an evaluation must be done for the
purpose of identifying what worked and what requires
improvement. Afterward, follow-through activities must
ensure that identified changes are implemented. Disaster
management is akin to a feedback loop—it starts with
planning, moves to prevention, mitigation and response,
and then moves to evaluation and identification of areas
for improvement, and planning again to implement the
required changes. Not every disaster can be prevented;
however, strong leadership and sound disaster
management can serve to mitigate the results of almost any
disaster. The possibility exists that in the event of a
catastrophic disaster, the standard of care in the hospital
setting may have to be altered. Advance planning for such
a situation can serve to save the most lives. (P.136)
CONSIDERATIONS RELATED DISASTERS
ACCORDING TO HOSPITAL DISASTER
CLASSIFICATION
INTERNAL DISASTER
• An internal disaster occurs when there is an event
within the facility that poses a threat to disrupt the
environment of care. Such events are commonly
related to the physical plant (e.g., loss of utilities
or fire), but can arise from availability of
personnel (e.g., a labor strike). Regardless of the
cause, the management goal is to maintain a safe
environment for the patients, continue to provide
essential services, ameliorate the problem, and
restore normal services.
INTERNAL HOSPITAL DISASTER PHASES
1. Alert Phase- the staff remain at their regular
positions, service provision is uninterrupted, and
faculty & staff await further instructions from
their supervisors
2. Response Phase- the designated staff report to
supervisors or the command post for instructions;
the response plan is activated, and nonessential
services are suspended
3. Expanded Response Phase- when additional
personnel are required, off-duty staff are called in,
and existing staff may be reassigned based on
patient needs.
POTENTIAL INTERNAL HOSPITAL DISASTER
SCENARIO:
• Loss of Power including auxiliary power
• Loss of medical gases
• Loss of water and/or water pressure
• Loss of compressed air and vacuum (suction)
• Loss of telecommunications system
• Loss of information technology system
• Threats to safety of patients and staff (violence,
terrorism and bombs)
• Evacuation of patients & staff
• Decreased levels of service provision
• Diversion of ambulances, helicopter transport, &
other patients
• Relocation of patient care areas
EXTERNAL DISASTER
• External Disaster An external disaster becomes a
problem for a facility when the consequences of
the event create a demand for services that tax or
exceed the usual available resources. (p.138)
COMBINED EXTERNAL/INTERNAL DISASTER
• It can trigger internal disasters for an
organization. A severe weather condition like a
snowstorm or a geological event like an
earthquake can create both conditions for a
hospital.
• During severe weather events, staff may not be
able to commute to work, but trauma cases may
increase, and this results in a situation where there
is short staffing with a simultaneous increase in
demand for services.
• An earthquake may cause structural damage to the
hospital, destroy roads and highways, and cause
mass casualties in the community. Such a hospital
would be faced with simultaneous internal and
external disasters.
CLASSIFICATIONS OF DISASTER ACCORDING
TO THE DISASTERS’ MAGNITUDE RELATED
TO THE AGENCY/COMMUNITY’S ABILITY TO
REPSOND
Goolsby and Kulkarni (2006) further classify disasters
according to the magnitude of the disaster in relation to the
ability of the agency or community to respond. Disasters
are classified by the following levels:
NUR 1221 – EDN TEAM 2022-2023 |19
 • Level I: If the organization, agency, or
community can contain the event and respond
effectively utilizing its own resources.
• Level II: If the disaster requires assistance from
external sources, but these can be obtained from
nearby agencies.
• Level III: If the disaster is of a magnitude that
exceeds the capacity of the local community or
region and requires assistance from state-level or
even federal assets. (p.139)
CONSIDERATION RELATED TO THE LEVELS
OF DISASTER
LEVEL I
• The agency must assure that each of its own
employees are competent in basic emergency
preparedness, and there is adequate surge capacity
within its own organization to be prepared to
respond to routine emergencies, some of which
can be expected, such as power outages, weather
events, or other limited events.
• If the organization, agency, or community is able
to contain the event & respond effectively
utilizing its own resources
• Employees and community should be capable.
• HICS is an emergency management system that
is comprised of specific disaster response
functional role positions within a hierarchical
organization chart. Each position has a job
responsibility that clearly d fines the functional
role and the tasks required to fulfill that role. The
use of incident command reduces staff freelancing
and provides management with the level of
control required to manage the disaster
• The HICS document reflects the same basic
principles of command and control, chain of
command, predefined positions, established
reporting and communication relationships, use of
common nomenclature, expandability, and
contractility of the scale of the operation, and span
of control.
HICs TEAM ORGANIZATION

LEVEL II
• The agency must assure that it has adequate
KEY FEATURES OF INCIDENT COMMAND
linkages with other organizations and agencies in
SYSTEM AND HICs
the surrounding community so when needed,
required local support and assets can be readily • Predictable, responsibility-oriented chain of
procured. command. In the HICS system there is ONE
incident commander. This individual has overall
• If the disaster requires assistance from external
responsibility for the management of the incident,
sources, but these can be obtained from nearby
and employees know who reports to them and to
agencies.
whom they report. Direction, requests for
• Linkages with other organizations & agencies in
resources and all information flow in a prescribed
the surrounding community is important.
fashion up or down the chain of command.
• Use of common nomenclature. All agencies
LEVEL III
utilizing ICS use the same titles and functional
• The agency must assure that it has adequate
roles for the command staff positions. Use of
linkages with state- and federal-level
common terminology assists different agencies
organizations, have the ability to know when to
with communicating with each other.
request a higher level of assistance, and know the
• Modular, flexible organization. Only those
communication chain of command for requesting
portions of the system that are needed for the
state and or federal assets
response are activated. It can be expanded or
• If the disaster is of a magnitude that exceeds the
scaled back according to the situation. This is
capacity of the local community or region and
efficient, conserves resources, and makes it
requires assistance from state-level assets
applicable to both large and small events.
• Agency must assure that it has adequate linkages
• Unified command structure. This allows all
with state & federal-level organization
agencies involved in the response to coordinate
efforts by establishing a unified set of incident
HOSPITAL INCIDENT COMMAND SYSTEM
objectives and strategies.
• An emergency management system that is
• Incident Action Plan (IAP). This is a plan that is
composed of specific disaster response functional
developed when multiple agencies are involved in
role positions within a hierarchical organization
the disaster response. It ensures that all agencies
chart o Each position has functions to fulfill
are working toward the same goal. It is what is
Internal Hospital Disaster refers to incidents that
developed when the unified command structure is
disrupt the everyday routine services of the
used.
medical facility and may or may not occur
• Facility Action Plan (FAP). A FAP describes the
simultaneously with an external event.
purpose, goals, and objectives for the hospital’s

NUR 1221 – EDN TEAM 2022-2023|20

 response. All responders in the hospital then work
toward the same goals and objectives.

EXAMPLE OF ICS IN THE PHILIPPINE SETTING

DISASTER RISK REDUCTION MANAGEMENT
FOR HEALTH (DRRM-H)
• The movement of the West Valley Fault, more
commonly known as the “Big One.” The talked
about the activation of the code alerts, with “Code
Red” being the highest among the three, and role
of the hospital personnel should the “Code Red”
be set in motion.
• Important points on the importance of the ICS
organization, with emphasis on the 4Cs
(Command, Control, Communications and
Coordination), 4Ss (Space, Stuff, Staff and
Special) and 3Ts (Triage, Treatment and
Transport).

DOH LAUNCHES ONE HOSPITAL COMMAND

CENTER FOR FASTER AND MORE EFFICIENT
COVID-19 CASE REFERRAL
• The Department of Health (DOH) and the Inter-
agency Task Force on Emerging Infectious
Diseases (IATF-EID), in coordination with the
Department of Interior Local Government
(DILG), Department of Tourism (DOT), Metro
Manila Development Authority (MMDA), and
Bases Conversion and Development Authority
(BCDA), officially launched the One Hospital
Command Center (OHCC)
• The Command Center will house the One
Hospital Command which will facilitate a
comprehensive and coordinated response to the
COVID-19 pandemic by ensuring effective and
efficient health facility referral in Metro Manila.

INCIDENT COMMAND SYSTEM

Incident Command system is the model for the command,
control, and coordination of a response to an emergency.
It provides the means to coordinate the efforts of
individual agencies.
• Who’s in charge?
• What’s our goals?
• What’s my tasks?
• Where do I fit in the organization?
• Whom do I report? Incident Management
• Places one person in charge
• Clarifies objectives
• Guides deployment of personnel & resources
• Organizes personnel & tasks so that IC is not
overwhelmed
• Eases communications & identifies chain of
command
• Limits high risk activities & establishes resources
to provide immediate assistance
• Allows for growth and reduction of organizational
structure

NUR 1221 – EDN TEAM 2022-2023|21

 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING

NUR 1221 DISASTER NURSING LECTURE

A.Y. 2022-2023 SECOND SEMESTER

MODULE 8 DISASTER TRIAGE SYSTEM 6. Allay patient and family anxiety and
Topic Outline enhance public relations.
1. Triage Definitions
2. Triage Systems TRIAGE SYSTEMS
1. Simple Triage and Rapid Treatment (START)
OVERVIEW System
Triage is the first action in any disaster response, and 2. Jump Start
decisions made at this time will have a significant impact 3. Medical Disaster Response (MDR)
on the health outcomes of the affected population. 4. MASS Triage
5. Military Triage
Disaster triage is a difficult and intimidating task. The
presentation of large numbers of traumatic casualties or SIMPLE TRIAGE AND RAPID TREATMENT
persons infected during an epidemic can quickly (START) SYSTEM
overwhelm the health system and the health care personnel • prehospital triage
who must respond. • 15 - 30 second each
• based on the person’s ability to respond:
In a large-scale disaster, mass casualty incident, or verbally, ambulate, respirations, perfusion, and
epidemic, in all likelihood many health care providers will mental status (RPM)
be called on to perform triage at the scene or in the • Only two interventions: open the airway - stop
hospital— including those without previous triage excessive bleeding.
experience.
START PRINCIPLE
Whether in the hospital or at the scene, the triage nurse A. Green (Minor /Walking wounded)
must accurately decide which patients need care, where • All pts who can walk (walking wounded) & are
they should receive it, in what order they should receive asked to move away from the incident area to a
care, and in situations of severely constrained resources, specific location
who should not receive care at all.
B. Red (Immediate)
TRIAGE • Respirations: > 30 cpm
DEFINITIONS • Perfusion (cap. Refill): > 2 secs
• Triage is derived from the French verb “trier” • Mental Status - doesn’t obey commands
which means to sort or to choose
• The sorting of two or more patients based on the C. Yellow (Delayed)
severity of their conditions to establish priorities • Respirations: < 30 cpm
for care based on available resources. • Perfusion: < 2 secs
• The process by which patients are classified • Mental status: obey commands
according to the type and urgency of their
conditions to get the right patient to the right place D. Black (expectant):
at the right time with the right care provider • Dead or dying
• It is used in: • Respirations: not breathing
o Hospital emergency rooms
o Battlefield
o Disaster sites with limited medical
resources
• Objectives of Triage
1. Identify patients requiring immediate
care.
2. Determine the appropriate area for
treatment
3. Facilitate patient flow and avoid
unnecessary congestion.
4. Provide continued assessment and
reassessment of arriving and waiting
patients.
5. Provide information and referrals to
patients and families.
NUR 1221 – EDN TEAM 2022-2023 |22

Triage Tag
START System Algorithm
JUMPSTART TRIAGE
• to assess children less than 8 years of age
• Respirations:
o “Good” if15 - 45 (1 breath/2-4 secs);
critical if < 15 or > 45
• Perfusion (palpate distal pulses): weak or
nonexistent = red
• Mental status: Alert, responds to vocal stimuli,
responds to painful stimuli, unresponsive
• Red if unresponsive/ inappropriate response to
pain
• In young child, who is not breathing on initial
assessment, check for pulse. If there is pulse, give
a brief (5 min) ventilatory trial, if not successful
classify as black; if breathing is restored, classify
as red.
Evaluate infants first
in secondary triage
using the JS
algorithm
MEDICAL DISASTER RESPONSE (MDR)
• Specially trained health providers evaluate pts.
• Permits the triage process to evolve over hours or
even days, maximizing pt. survival & resulting in
a more efficient use of resources
RED: Highest Priority- Patients who need immediate
care and transport ASAP
• Airway and breathing difficulties
• Uncontrolled or severe bleeding
• Decreased level of consciousness
• Severe medical problems
• Shock (hypoperfusion)
• Severe burns
YELLOW: Second highest priority able to wait longer
before transport (45 mins)
• Burns without airway problems
• Major or multiple bone or joint injuries
• Back injuries with or without spinal cord damage
NUR 1221 – EDN TEAM 2022-2023|23
GREEN: Low Priority Walking Wounded able to wait
several hours for transport
• Minor fractures
• Minor soft-tissue injuries

BLACK: Lowest Priority Patients who are already dead or

have little chance for survival
• If resources are limited, treat salvageable patients
before these patients a. Obvious death
• Obviously nonsurvivable injury, such as major
open brain trauma
• Full cardiac Arrest

M.A.S.S. TRIAGE
• M – Move, A – Assess, S – Sort, S – Send
• A disaster triage system that utilizes US military
triage categories with a proven means of handling
large numbers of casualties in a mass casualty
incident (MCI).

MILITARY TRIAGE
• Priority is to get as many soldiers back into action
as possible.
• Those with the least serious wounds may be the
first treatment priority

CIVILIAN TRIAGE
• Priority is to maximize survival of the greatest
number of victims. Those with the most serious
but realistically salvageable injuries are treated
first.

References:
Disaster Nursing and Emergency Preparedness for
Chemical, Biological, and Radiological Terrorism and
Other Hazards by Tener Goodwin Veenema 4th
Edition, 2019.
Disaster Nursing and Emergency Preparedness for
Chemical, Biological, and Radiological Terrorism and
Other Hazards by Tener Goodwin Veenema 2nd
Edition, 2013.

NUR 1221 – EDN TEAM 2022-2023|24

 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING

NUR 1221 DISASTER NURSING LECTURE

A.Y. 2022-2023 SECOND SEMESTER

MODULE 9 DISASTER TRIAGE substances. This may be achieved by chemical

PRINCIPLES reaction, disinfection or physical removal.
Topic Outline • The purpose of decontamination is to make an
1. Triage Principles individual and/or their equipment safe by
2. Decontamination Procedure physically removing toxic substances quickly and
3. Disaster Zones easily.

OVERVIEW DECONTAMINATION METHODS

Triage dates back in history to the French military, which • Physical Removal
used the word to designate a “clearing hospital” for • Chemical Decontamination
wounded soldiers. The U.S. military used triage to • Oxidation
describe a sorting station where injured soldiers were • Hydrolyzing Agent
distributed from the battlefield to distant support hospitals.
PHYSICAL REMOVAL
Following World War II, triage came to mean the process • Remove clothing
used to identify those most likely to return to the battle • Flush with water/aqueous solution
after medical intervention. This process facilitated the • Absorb contaminating agent with absorbent
provision of medical care to soldiers who could fight materials
again. During the Korean and Vietnam conflicts, triage o Rub with flour followed with wet tissues
was further refined to resemble the process that is still used o Spot decontaminations only
today. Disaster triage will always be a difficult and o Scrape bulk agent with wooden sticks
daunting task.
CHEMICAL DECONTAMINATION
The triage nurse must accurately decide which patients Chemical Warfare Agents:
need care, the location of the care, in what order they 1. Nerve agents: e.g. tabun, sarin, soman
should receive care, and in situations of severely 2. Tissue (blood) agents: e.g. cyanidesicants
constrained resources, who should not receive care at all. 3. Vesicants: sulfur mustard and lewisite
4. Pulmonary agents: phosgene and chlorine
Previous triage experience in an emergency department is 5. Riot control agents (tear gas): pepper spray
excellent preparation for disaster triage. In a large-scale
disaster, mass casualty incident, or epidemic in all Chemical Decontamination
likelihood many health care providers will be called on to 1. Water/soap wash
perform triage at the scene of the event, in a community 2. Chemical solution: alkaline solutions of
setting or in the hospital. hypochlorite
3. Oxidation: hypochlorite solutions are universally
DISASTER TRIAGE PRINCIPLES effective in removing organophosphates and
1. Never move a casualty backward (against the mustard agents
flow) 4. Hydrolyzing agents (agents VX and G): alkaline
2. Never hold a critical patient for further care. hypochlorite
3. Salvage life over limb
4. Do not stop treating patients DECONTAMINCATION PROCEDURES
5. Never move patients before triage, except in cases 1. Determine the level of PPE required
of risk due to: 2. Mobilize security personnel and trained staff
a. bad weather 3. Triage and decontaminate
b. impending darkness or darkness has 4. Control access to the decontamination site and
fallen hospital
c. there is continued risk of injury 5. Prepare decontamination area
d. medical facilities are immediately
available TRIAGE ZONES’DESCRIPTION OF ACTIVITIES
e. tactical situations that dictate movement HOT ZONE
• Immediately adjacent to the location of the
DECONTAMINATION incident
• Decontamination is the process of removing • Minimal triage and medical care; activities are
contaminants on an object or area, including limited to:
chemicals, microorganisms or radioactive o airway and hemorrhage control
o administration of antidotes
NUR 1221 – EDN TEAM 2022-2023 |25
 o identification of expectant cases
• All staff are in protective gear in this zone

WARM ZONE
• More than 300 feet from the outer edge of the Hot
Zone, and uphill/upwind from the contamination
area
• Rapid triage takes place to sort victims into
critical, urgent, delayed, or expectant categories
to provide essential stabilization and to
commence decontamination.
• Priority is to commence decontamination
• All staff must wear the appropriate PPE

COLD ZONE
• Adjacent to the Warm Zone, and uphill/upwind
from the contamination area
• Decontaminated patients enter this area where a
more thorough triage is performed; then patients
are directed to treatment areas based on the
severity and nature of illness or injury
• Personnel may wear PPE in case the wind changes
or victims arrive who have been improperly
decontaminated

References:
Disaster Nursing and Emergency Preparedness for
Chemical, Biological, and Radiological Terrorism
and Other Hazards by Tener Goodwin Veenema 4th
Edition, 2019.
Disaster Nursing and Emergency Preparedness for
Chemical, Biological, and Radiological Terrorism
and Other Hazards by Tener Goodwin Veenema
2nd Edition, 2013.

NUR 1221 – EDN TEAM 2022-2023|26

 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING

NUR 1221 DISASTER NURSING LECTURE

A.Y. 2022-2023 SECOND SEMESTER

• The health sector (including public health and

MODULE 11 WORKING WITH
FUNCTIONAL ANNEXES IN DISASTER
AND COMMUNICATING WITH MEDIA
Topic Outline
1. Adopting a Whole-of-Society Approach in
Disasters
2. Introducing ‘The Sphere Handbook’
3. Role of Media in Disaster Response and
Emergency Risk Communication
OVERVIEW
Health emergencies, including disasters, take a heavy toll
on populations around the globe. Human and animal
diseases, chemical, radiological and nuclear accidents, and
natural disasters cause ill-health, disability, loss of lives,
food insecurity, environmental damage, displacement, and
destabilization of trade and economic development, as
well as of societies as whole. Diseases can spread, and they
can do so even more significantly where health systems are
fragile or are faced with newly emerging and re-emerging
diseases, as seen in recent outbreaks of Ebola virus
disease, Zika virus disease, yellow fever, cholera and
COVID-19, affecting entire countries and regions. Thus,
the objective for sustainable disaster response is to
enhance collaboration and coordination between the public
health sector and all other relevant stakeholders and
sectors that may be engaged in and can contribute to
advancing the disaster science.
health-care services) provides critical
epidemiological, clinical, and virological
information that, in turn, informs measures to
reduce spread of the pandemic virus and its
attendant morbidity and mortality.
• The diverse array of non-health sectors must
provide essential operations and services during a
pandemic to mitigate health, economic, and social
impacts.
• Civil society organizations often are well-placed
to raise awareness, communicate accurate
information, counter rumors, provide needed
services, and liaise with the government during an
emergency.
• Families and individuals can help reduce the
spread of pandemic influenza through adoption of
measures, such as covering coughs and sneezes,
hand washing, and the voluntary isolation of
persons with respiratory illness.
ENGAGING GOVERNMENT, BUSINESS, AND
CIVIL SOCIETY AS PLANNING PARTNERS

As multi-sectoral collaboration is critical, crisis

communication is equally important. When crisis strikes,
most people look to the news media for information about
the extent and details of the threats or disasters at hand, for
blow-by-blow accounts of important developments, and,
depending on nature of the calamity, for instructions of
what to do and what not to do. This attention offers crisis
managers and response professionals the opportunity to
communicate information and messages to the directly
affected communities and to the larger national, sometimes
even international, audience as well.

ADOPTING A WHOLE-OF-SOCIETY APPROACH

IN DISASTERS
A whole-of-society approach to disaster preparedness and
management emphasizes the significant roles played by all
sectors of society:
• The national government is the natural leader for
communication and overall coordination efforts.
Central governments should work to put in place
the necessary legislation, policies, and resources
for pandemic preparedness, capacity
development, and anticipated response efforts
across all sectors.
Figure 1. The World Health Organization’s Whole-of-
Society Approach
The best responses to emerging threats are driven by multi-
sector, inclusive approaches that unify the experiences and
resources of government, military, civil society, and the
private sector. Effective preparedness requires
coordination, integrated planning, and the management of
the complex relationships across different sectors—and
between international, national, and local actors. All
relevant stakeholders need to be identified and brought
together to communicate and agree on their roles in
preparedness and response.
NUR 1221 – EDN TEAM 2022-2023|27

Comprehensive, executable national pandemic
preparedness and response plans should be developed to
provide guidance for future pandemic preparedness and
response operations. Once developed, plans should serve
as a guide for the development of lower-level ministerial
plans to support both national disaster preparedness and
response plans and national pandemic preparedness and
response plans.
INTRODUCING ‘THE SPHERE HANDBOOK’
WHAT IS SPHERE?
The Sphere Project, now known as Sphere, was created in
1997 by a group of humanitarian non-governmental
organisations and the Red Cross and Red Crescent
Movement. Its aim was to improve the quality of their
humanitarian responses and to be accountable for their
actions.
The Sphere philosophy is based on two core beliefs:
• People affected by disaster or conflict have the
right to life with dignity and, therefore, the right
to assistance; and
• All possible steps should be taken to alleviate
human suffering arising out of disaster or conflict.
The Humanitarian Charter and Minimum Standards put
these core beliefs into practice. The Protection Principles
inform all humanitarian action, and the Core Humanitarian
Standard contains commitments to support accountability
across all sectors. Together, they form The Sphere
Handbook, which has developed into one of the most
widely referenced humanitarian resources globally.
THE SPHERE HANDBOOK
• The principal users of The Sphere Handbook are
practitioners involved in planning, managing or
implementing a humanitarian response. This
includes staff and volunteers of local, national and
international humanitarian organisations
responding to a crisis, as well as affected people
themselves.
• The Handbook is also used for humanitarian
advocacy to improve the quality and
accountability of assistance and protection in line
with humanitarian principles. It is increasingly
used by governments, donors, military or the
private sector to guide their own actions and allow
them to work constructively with the
humanitarian organisations that apply the
standards.
• The Handbook was first piloted in 1998, with
revised editions published in 2000, 2004, 2011
and now 2018. Each revision process has relied on
sector wide consultations
with individuals, non-
governmental organisations
(NGOs), governments and
United Nations agencies.
The resulting standards and
guidance are informed by
evidence and reflect 20
years of field testing by
practitioners around the
world.
THE HUMANITARIAN CHARTER
• The Humanitarian Charter provides the ethical
and legal backdrop to the Protection Principles,
the Core Humanitarian Standard and the
Minimum Standards that follow in the Handbook.
• It is in part a statement of established legal rights
and obligations, in part a statement of shared
belief.
• In terms of legal rights and obligations, the
Humanitarian Charter summarises the core legal
principles that have most bearing on the welfare
of those affected by disaster or conflict.
• With regard to shared belief, it attempts to capture
a consensus among humanitarian agencies on the
principles which should govern the response to
disaster or conflict, including the roles and
responsibilities of the various actors involved.
• The Humanitarian Charter forms the basis of a
commitment by humanitarian agencies that
endorse Sphere and an invitation to all those who
engage in humanitarian action to adopt the same
principles.
OUR BELIEFS
The Humanitarian Charter expresses our shared conviction
as humanitarian agencies that all people affected by
disaster or conflict have a right to receive protection and
assistance to ensure the basic conditions for life with
dignity. We believe that the principles described in this
Humanitarian Charter are universal, applying to all those
affected by disaster or conflict, wherever they may be, and
to all those who seek to assist them or provide for their
security. These principles are reflected in international law
but derive their force ultimately from the fundamental
moral principle of humanity: that all human beings are
born free and equal in dignity and rights. Based on this
principle, we affirm the primacy of the humanitarian
NUR 1221 – EDN TEAM 2022-2023|28
imperative: that action should be taken to prevent or
alleviate human suffering arising out of disaster or
conflict, and that nothing should override this principle.

OUR ROLE
We acknowledge that it is firstly through their own efforts,
and through the support of community and local
institutions, that the basic needs of people affected by
disaster or conflict are met. We recognise the primary role
and responsibility of the affected state to provide timely
assistance to those affected, to ensure people’s protection
and security and to provide support for their recovery.

COMMON PRINCIPLES, RIGHTS AND DUTIES

• the right to life with dignity
ROLE OF MEDIA IN DISASTER RESPONSE AND
• the right to receive humanitarian assistance
EMERGENCY RISK COMMUNICATION
• the right to protection and security
• In today’s mass society, mass-mediated
emergency response must be an integral part of
PROTECTION PRINCIPLES
effective disaster management—especially in the
The Protection Principles support the rights set out in the
face of bioterrorism, emerging infectious
Humanitarian Charter: the right to life with dignity, the
diseases, or other public health crises.
right to humanitarian assistance and the right to
• Although each emergency situation has its own
protection and security.
unique features and requires different approaches
for dealing with public information and media
relations, this chapter provides a list of general
media guidelines for nurses as crisis managers or
emergency responders in the public and private
sectors.
• Instead of concentrating solely on utilizing the
traditional and new media during emergencies,
prudent preparedness measures include public
education and information before disasters strike.

CRISIS AND EMERGENCY RISK

COMMUNICATION: FEEDING THE MEDIA
• Those involved in crisis response efforts must
The principles articulate the role that all humanitarian provide information to the media or will
actors can play in helping protect people. The roles and otherwise risk hostility on the part of the media
responsibilities of humanitarian actors are, however, that could harm their effectiveness as crisis
secondary to those of the state. The state or other responders.
authorities hold legal responsibility for the welfare of
• If the media are deprived of food in the form of
people within their territory or control and for the safety of
information, they may rely on sources that lack
civilians in armed conflict. Ultimately, it is these
the professional background and judgment that
authorities that have the duty to ensure people’s security
the members of emergency medical services,
and safety through action or restraint. The role of
physicians, nurses, or other responders possess.
humanitarian actors may be to encourage and persuade the
Often the result is that half-truths and rumors
authorities to fulfil their responsibilities and, if they fail to
rather than facts are reported.
do so, assist people in dealing with the consequences.
• It is always important to remember that the media
are not the enemy. Although they can be difficult
The Humanitarian Charter and Protection Principles
and aggressive, they can be a tremendous asset in
directly support the Core Humanitarian Standard.
crisis situations, and so it is best to approach them
Together, these three chapters constitute the principles and
with an open mind. The following outlines core
foundations of the Sphere Standards.
communication principles.

EMERGENCY RISK COMMUNICATION PRINCIPLES

• Don’t over reassure
• Acknowledge that there is a process in place
• Express wishes
• Give people things to do
• Ask more of people

NUR 1221 – EDN TEAM 2022-2023|29

 WHAT THE PUBLIC WILL ASK FIRST: WHAT
DOES THIS MEAN TO ME?
• Are my family and I safe?
• What have you found that may affect me?
• What can I do to protect myself and my family?
• Who caused this?
• Can you fix it?

WHAT THE MEDIA WILL ASK FIRST

• What happened?
• Who is in charge?
• Has this been contained?
• Are victims being helped?
• What can we expect?
• What should we do?
• Why did this happen?
• Did you have forewarning?

JUDGING THE MESSAGE

• Speed counts – marker for preparedness
• Facts – consistency is vital
• Trusted source – can’t fake these

5 KEY ELEMENTS TO BUILD TRUST

1. Expressed empathy
2. Competence
3. Honesty
4. Commitment
5. Accountability

References:
World Health Organization (2020). Multisectoral
Preparedness Coordination Framework: best practices,
case studies and key elements of advancing
multisectoral coordination for health emergency
preparedness and health security.
https://apps.who.int/iris/bitstream/handle/10665/3322
20/9789240006232-eng.pdf
Veneema, T.G. (2008). Disaster nursing and emergency
preparedness for chemical, biological, and radiological
terrorism and other hazards (2nd ed.).
Beyond Pandemics: A whole-of-society approach to
disaster preparedness. (Sept. 2011).
https://resourcecentre.savethechildren.net/pdf/6217.pd
f/
Sphere Association. The Sphere Handbook: Humanitarian
Charter and Minimum Standards in Humanitarian
Response, fourth edition, Geneva, Switzerland, 2018.
www.spherestandards.org/handbook

NUR 1221 – EDN TEAM 2022-2023|30

 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING

NUR 1221 DISASTER NURSING LECTURE

A.Y. 2022-2023 SECOND SEMESTER

MODULE 12 ATTENDING TO THE NEEDS • They have “additional needs before, during, and
OF VULNERABLE GROUPS AND after an incident in functional areas, including but
WORKING WITH EXTERNAL SUPPORT not limited to maintaining independence,
communication, transportation, supervision, and
GROUPS
medical care.
Topic Outline:
1. Vulnerable Populations
a. Different Types of Vulnerable Groups
b. Addressing Needs

OVERVIEW
Preparing and responding to disasters have been high on
the agendas of many countries and local governments. For
example, the Department of Health and local public health
departments are undertaking major emergency planning
initiatives, including extensive training and educational
programs. Several recent governmental policies also
address emergency readiness across the globe. These
efforts, however, often disregard the special needs of
DIFFERENT TYPES OF VULNERABLE GROUPS
vulnerable populations. During and after a catastrophic
Different groups are traditionally recognized as vulnerable
event, vulnerable populations may include individuals
in different contexts. During disasters, several population
with disabilities, pregnant women, children, the elderly,
segments are potentially vulnerable. These include:
prisoners, ethnic minorities, people with language barriers,
1. individuals with physical and mental disabilities
and the impoverished.
2. elderly persons
3. pregnant women
Inadequate preparation for the needs of vulnerable
4. children
populations can lead to catastrophic consequences. The
5. prisoners
disadvantaged could suffer large death tolls, as illustrated
6. economically disadvantaged minorities
by Hurricane Katrina, in which over 1,800 individuals died
7. undocumented workers
because they were unable to evacuate the city. 1 The ill-
8. those with language barriers
stricken elderly, poor, and disabled were the most likely to
die in that notorious disaster. Members of vulnerable
The measure of a country’s greatness should be based on
populations who survive could suffer permanent,
how well it cares for its most vulnerable populations.
debilitating injuries and become unable to work, live
independently, and care for themselves.

VULNERABLE POPULATIONS
• Vulnerable populations, also called “special
needs” populations or “at-risk” populations, are
those that are particularly “at risk of poor
physical, psychological, or social health” after a
disaster.
ADDRESSING THE NEEDS
• The local public health department has the lead
responsibility for planning and caring for persons
with special medical needs. The planning
NUR 1221 – EDN TEAM 2022-2023|31
 assumption used by public health authorities is
that one in six evacuees will need some type of
assistance or accommodation. Although public
health authorities have anticipated the need to
open special needs shelters, the plan has never
been tested.
• Community-based organizations have been active
in the region and have formed a local Voluntary
Organizations Active in Disaster (VOAD).
Member agencies have begun meeting to
coordinate mass care service delivery and other
relief efforts, and [to] identify unmet needs in the Healthy, Resilient, and Sustainable Communities After
community. Disasters calls for actions at multiple levels to facilitate
recovery strategies that optimize community health.

REACHING VULNERABLE AND

MARGINALIZED POPULATIONS With a shared healthy community vision, strategic
The quality of response during a pandemic depends partly planning that prioritizes health, and coordinated
on the ability to meet the specific communication needs of implementation, disaster recovery can result in a
all populations, including those most vulnerable and most communities that are healthier, more livable places for
likely to experience communication gaps. Vulnerability current and future generations to grow and thrive—
refers to individuals, groups, communities, or places where communities that are better prepared for future adversities.
health disparities, differences in treatment access, living
conditions, health literacy, language, immigration status,
risk perceptions, and lack of confidence in the
government’s ability to respond could exacerbate risks for
populations. Evidence for a differential impact from
pandemic influenza includes both higher rates of
underlying health conditions in minority populations,
increasing their risk of influenza-related complications,
and larger socioeconomic, cultural, educational, and
linguistic barriers to adoption of pandemic interventions.

Example of a Guidelines Developed to Safeguard the

Health of Children During Disasters

NUR 1221 – EDN TEAM 2022-2023|32

 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING

NUR 1221 DISASTER NURSING LECTURE

A.Y. 2022-2023 SECOND SEMESTER

MODULE 13 COMMUNITY DIAGNOSIS ON groups of people who are likely to be susceptible,

DISASTER PREVENTION AND the extent/intensity of exposure, and the
PREPAREDNESS geographical distribution.
• Context, including an evaluation of the environment in
Topic Outline:
which the event is taking place:
1. Rapid Risk Assessment Key Features
o health impact, including number of cases, number
2. Elements of an Emergency Rapid Risk
of deaths, number
Assessment leading to Community Diagnosis on
o of hospitalizations and case fatality ratios
Disaster Risk Preparedness
o vulnerability of exposed or potentially exposed
3. Sample Checklist on CDx of Disaster
populations
Preparedness, Response, and Management
o capacity of local and national authorities to
successfully address the risk
OVERVIEW
o impact on the national health care system
Once an acute event is verified, it may then undergo a
o occupational risks to responders
structured rapid risk assessment that will lead to
o WHO’s reputational risk
community diagnoses. The decision to conduct a full and
rigorous risk assessment is context-specific and signals the
DISASTER LANGUAGE
need to document the public health risks of an event, its
likely impact and recommended actions. • Risk- likelihood of harm, loss, disaster
• Hazard- physical impact of disturbance
The main objectives of the risk assessment are to • Exposure- elements affected by hazard
characterize the risk to public health and to recommend the • Vulnerability- capacity of community to prepare,
most effective public health actions– especially to prevent absorb, recover from hazard
amplification of an event into an outbreak. • Risk= Hazard x Exposure x Vulnerability

RAPID RISK ASSESSMENT KEY FEATURES

• The assessment is undertaken as quickly as
possible—ideally within 24 hours of verification.
Nonetheless, the timing may vary by hazard, the
accessibility of the affected areas, and the rate of
onset or evolution of the acute event.
• An absence of verification does not preclude a
risk assessment if other information suggests it is
warranted.
• A multidisciplinary team of disaster response staff
from different levels of the organization will
undertake the risk assessment. The team always
includes at least one team member and input from
an infectious disease specialist or other hazard- DISASTER RISK TRIANGLE
specific expert.
SAMPLE CHECKLIST ON CDX OF DISASTER
ELEMENTS OF AN EMERGENCY RAPID RISK PREPAREDNESS, RESPONSE, AND
ASSESSMENT LEADING TO COMMUNITY MANAGEMENT
DIAGNOSIS ON DISASTER RISK Preparation
PREPAREDNESS Obtain available information on the crisis-
When a public health event is verified, questions are affected population.
developed around the following criteria to determine the Obtain available maps, aerial photos or satellite
level of risk and to characterize it: images, and geographic information system
• Hazard(s): identifying the hazard(s) that could be (GIS) data of the affected area.
causing the event and its potential impact, Obtain demographic, administrative and health
characterizing the hazard(s), ranking potential data.
hazards when one or more is considered a possible Security and Access
cause of the event. Determine the existence of the ongoing natural or
• Exposure (or potential exposure) of individuals human-made hazards.
and populations: the numbers of people known Determine the overall security situation,
or likely to have been exposed, the number or including the presence of armed forces.
NUR 1221 – EDN TEAM 2022-2023|33
 Determine the access that humanitarian Determine the level of IPC standards in health
organizations have to the crisis affected facilities.
population. Determine the status of the existing health
Demographics and social structure information system.
Determine the size of the crisis-affected Data from other relevant sectors
population, disaggregated by sex, age and Nutritional status.
disability. Environmental and WASH conditions.
Identify groups at increased risk, such as women, Food basket and food security.
children, older people, persons with disabilities, Shelter – quality of shelter.
people living with HIV or marginalized groups. Education – health and hygiene education.
Determine the average household size and
estimates of the number of female- and child- References:
headed households. Sphere Association. The Sphere Handbook: Humanitarian
Determine the existing social structure and Charter and Minimum Standards in Humanitarian
gender norms, including positions of authority Response, fourth edition, Geneva, Switzerland, 2018.
and/or influence in the community and the www.spherestandards.org/handbook
household. World Health Organization (June 2017). Emergency
Background health information response framework.
Identify health problems that existed in the crisis- https://www.who.int/publications/i/item/97892415122
affected area before the emergency. 99#:~:text=The%20ERF%20provides%20WHO%20st
Identify pre-existing health problems in the aff,Member%20States%20and%20affected%20comm
country of origin for refugees, or the area of unities.
origin for internally displaced persons.
Identify existing risks to health, such as potential
epidemic diseases.
Identify pre-existing and existing barriers to
healthcare, social norms and beliefs, including
positive and harmful practices.
Identify previous sources of healthcare.
Analyze the various aspects of the health system
and their performance
Mortality rates
Calculate the crude mortality rate
Calculate the age-specific mortality rates (such
as under-five mortality rate)
Calculate cause-specific mortality rates
Calculate proportional mortality rate
Morbidity rates
Determine incidence rates of major health
conditions that have public health
importance.
Determine age- and sex-specific incidence rates
of major health conditions
where possible.
Available resources
Determine the capacity of the MoH of the
country affected by the crisis.
Determine the status of national health facilities,
including total number by type of care provided,
degree of infrastructure damage, and access.
Determine the numbers and skills of available
healthcare staff.
Determine the available health budgets and
financing mechanism.
Determine the capacity and functional status of
existing public health programmed such as
Extended Programme on Immunization.
Determine the availability of standardized
protocols, essential medicines, medical devices
and equipment, and logistics systems.
Determine the status of existing referral systems.

NUR 1221 – EDN TEAM 2022-2023|34

 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING
NUR 1221 DISASTER NURSING LECTURE
A.Y. 2022-2023 SECOND SEMESTER
MODULE 14 UNDERSTANDING THE
PSYCHOSOCIAL IMPACT OF DISASTER
Topic Outline:
1. Understanding the Psychosocial Impact of
Disasters
a. Bioterrorism and Toxic Exposures
b. Community Impact and Resource
Assessment
c. Reducing Resistance to Psychosocial
Intervention
d. Acute Stress Disorder
e. Post-Traumatic Stress Disorder
f. Critical Incident Stress Management
g. Psychological Debriefing
OVERVIEW
The psychosocial impact of a disaster and the resources
that will be needed to respond to the disaster can be
estimated based on data from past experiences with a
variety of natural and man-made disasters. Normal
reactions to abnormal events include a range of distressing
thoughts, emotions, sensations, and behaviors, which
ought not to be characterized as a mental illness. How-
ever, early outreach can set the stage for those at risk for a
psychiatric disorder to accept help in the future, should it
be needed. Children display a variety of reactions that are
normal given the extreme nature of the stressor and their
level of emotional and cognitive maturity. Mental health
responders must be culturally competent and attuned to the
needs of special populations, and they, along with first
responders, disaster workers, and hospital personnel, are
particularly vulnerable to stress- induced symptoms. Work
groups, schools, and entire communities not only react to
a disaster but also serve as a conduit for support and
psychoeducational information. There is no timetable for
grief, and expressions of mourning and bereavement
reflect the characteristics of the person, the loss, and the
disaster.
The mental health response to a disaster must be a well-
coordinated effort that draws on a variety of professionals,
paraprofessionals, and volunteers who have been
prescreened and specially trained for this work. In the
immediate aftermath, the goal of mental health
intervention is to facilitate normal coping, to treat those
with immediate needs, and to begin to identify those at risk
for psychiatric disorders in the ensuing weeks, months, or
years. Although mental health interventions have not been
shown to prevent psychiatric disorders once exposure to a
traumatic event has occurred, re- search continues to
search for strategies that can mitigate harmful effects.
Cognitive behavioral approaches are most likely to be
beneficial, and psychological de- briefing, a somewhat
controversial technique, is now changing in response to
research, particularly regarding time frames and target
populations. Management of the psychosocial effects of
disaster will continue long after the initial impact.
Psychiatric disorders among children may present with
symptoms that differ from those of adults, or may not
present until sometime later. Major depression and PTSD
can be disabling consequences of exposure to disaster
among those of any age group, and thus, early diagnosis
and treatment are critical to the prevention of future
disability.
PSYCHOSOCIAL IMPACT OF DISASTERS
• Disasters, by their very nature, are stressful, life-
altering experiences, and living through such an
experience can cause serious psychological
effects and social disruption.
• Disasters affect every aspect of the life of an
individual, a family, or a community. Depending
on the nature and scope of the disaster, the degree
of disruption can range from:
o mild anxiety and family dysfunction
(e.g., marital discord or parent-child
problems)
o separation anxiety
o posttraumatic stress disorder (PTSD)
o conduct disorders
o addictive behaviors
o severe depression
o suicidality
The most commonly reported disorders:
1. Depression (41%)
2. PTSD (22%–59%)
3. Generalized anxiety disorder (20%– 29%)
4. Substance abuse disorders (14%–22%)
The impact the disaster has on the survivor and/or the
bereaved:
1. The experience of terror or horror when one’s
own life is threatened or one is exposed to
grotesque or disturbing sights.
2. Traumatic bereavement, which occurs when
beloved friends or family members die as a result
of a disaster
3. Disruption of normal living
BIOTERRORISM AND TOXIC EXPOSURES
• Bioterrorism has an entirely different profile from
that of natural disasters or even sudden violent
events, such as bombings and explosions.
• Although bioterrorism is also a man-made
disaster, the effects are more uncertain and occur
over a longer period of time.
o Those exposed to toxic agents in the Gulf
War are still unsure of the long-term
health effects.
NUR 1221 – EDN TEAM 2022-2023|35
 • This creates an environment of continual anxiety,
which, under the right circumstances, can be
exacerbated into a full-blown panic attack.
• The October 2001 anthrax scare was probably
designed to be more of a psychological attack
than a physical one.
• In an editorial by Wessely, Hyams, and
Bartholomew (2001), the authors note that
biologic and chemical weapons are notoriously
ineffective methods of mass destruction but are
much more effective as weapons of terror—by
introducing fear, confusion, and uncertainty into
everyday life.
• Fear of biological warfare can lead to mass
sociogenic illnesses in which common, everyday
symptoms are believed to be signs of a biological
exposure.
Common psychological reactions to bioterrorism
(Holloway, Norwood, Fullerton, Engel, & Ursano,
2002) include:
1. Horror, anger, or panic
2. Magical thinking about microbes and viruses
3. Fear of invisible agents or fear of contagion
4. Attribution of arousal symptoms to infection
5. Anger at terrorists, the government, or both
6. Scapegoating, loss of faith in social institutions
7. Paranoia, social isolation, or demoralization
Interventions by medical personnel to minimize the
potential psychological and social consequences of
suspected or actual biological exposures:
1. Prevention of group panic
2. Careful, rapid medical evaluation and treatment
(to distinguish between hyperarousal,
intoxication, and infection)
3. Avoidance of emotion-based responses (e.g.,
knee-jerk quarantine)
4. Effective communication regarding potential risk
5. Control of symptoms secondary to hyperarousal
(provide reassurance, and if unsuccessful,
consider diazepam-like anxiolytics for acute
relief)
6. Management of anger, fear, or both
7. Management of misattribution of somatic
symptoms
8. Provision of respite as required
9. Restoration of an effective, useful social role (e.g.,
as worker at triage site)
10. Return to usual sources of social support in the
community
COMMUNITY IMPACT AND RESOURCE
ASSESSMENT
A population exposure model to estimate the
psychological impact of mass violence and terrorism and,
the resources that might be needed. The model’s
underlying principle is that individuals who are most
personally, physically, and psychologically exposed to
trauma and the disaster scene are likely to be affected the
most.
POPULATION EXPOSURE MODEL
A. Community victims killed and seriously injured,
bereaved family members, loved ones, close
friends
B. Community victims exposed to the incident and
disaster scene but not injured
C. Bereaved extended family members and friends;
residents in disaster zone whose homes were
destroyed; first responders, rescue and recovery
workers; medical examiner’s office staff; service
providers immediately involved with bereaved
families; obtaining information for body
identification and death notification
D. Mental health and crime victim assistance
providers, clergy, chaplains, emergency health
care providers, government officials, members of
the media
E. Groups that identify with the target-victim group,
businesses with financial impacts, community-at-
large.
Population Exposure Model
REDUCING RESISTANCE TO PSYCHOSOCIAL
INTERVENTION
One major reason that medical professionals are often
reluctant to include mental health professionals on the
team and that victims do not seek psychiatric consultation,
is the concern that emergency mental health intervention
implies that emotional distress is equated with mental
illness. Primary care providers can play an important role
in the assessment of their patients for the presence of
mental disorders and referral for treatment with a specialist
when it is indicated. It is of critical importance, therefore,
that mental health workers are part of the response team
from the outset.
Alexander (1990) has identified four main reasons to
include mental health workers as part of the immediate
medical response:
1. Personal experience of the disaster and its
immediate aftermath may increase the credibility
of mental health counselors in a way that is likely
to facilitate their subsequent work with victims
and responders.
2. Early intervention allows mental health
professionals to be seen as part of the medical
team, rather than as distant and possibly
threatening figures.
3. In the emotionally charged atmosphere of the
postimpact phase of the disaster, a special
NUR 1221 – EDN TEAM 2022-2023|36
 bonding may occur between helper and victim,
which may facilitate subsequent counseling and
treatment.
4. Early intervention provides an opportunity for
“psychological triage” and identification of those
who may be at particular risk for adverse
reactions.
ACUTE STRESS DISORDER
• Although a variety of psychiatric disorders may
be seen in the aftermath of a disaster, within the
first month of a traumatic event, acute stress
disorder (ASD) is the disorder most likely to be
encountered by the disaster response team.
• Those in closest proximity to the event are at
greatest risk.
• Although lack of social supports, history of
childhood traumas, and poor coping skills may
increase likelihood of the disorder, ASD can
develop in a child or an adult having no
predisposing conditions, particularly if the
stressor is extreme.
• According to the Diagnostic and Statistical
Manual of Mental Disorders (text revision;
DSM–IV–TR), 80% of motor vehicle crash
survivors and victims of violent crimes who
initially met the criteria for ASD, were
subsequently diagnosed with PTSD (American
Psychiatric Association, 2000).
DSM V CRITERIA FOR ASD/PTSD
Characteristic of the disorder is the development of
anxiety, dissociation, and other symptoms occurring
within 1 month after the trauma, lasting a minimum of 2
days. If symptoms persist longer than 4 weeks post-
trauma, a diagnosis of PTSD should be considered. In
considering the diagnosis of either PTSD or ASD, the
individual must meet the following criteria:
1. Experienced, witnessed, or been confronted with
an event that involved actual or threatened death
or serious injury, or a threat to the physical
integrity of self or others.
2. Responded with intense fear, helplessness, or
horror.
DISSOCIATIVE SYMPTOMS
Although dissociation may be a feature of PTSD, it is a
hallmark of ASD when a person experiencing a distressing
event (or within 4 weeks of the event has three or more of
the following dissociative symptoms:
1. A subjective sense of numbing, detachment, or
absence of emotional responsiveness
2. A reduction in awareness in his/her surroundings
(e.g., being in a “daze”)
3. Derealization
4. Depersonalization
5. Dissociative amnesia (inability to recall an
important aspect of the trauma)
PTSD SYMPTOM CLUSTERS
In addition, at least one symptom from each of the three
symptom clusters required for PTSD is also present:
1. The traumatic event is persistently reexperienced
(recurrent recollections, images, flashbacks, etc.)
2. Reminders of the trauma are avoided (people,
places, activities, etc.)
3. Hyperarousal in response to stimuli reminiscent
of the trauma (hypervigilance, insomnia,
exaggerated startle response, motor restlessness,
etc.)
If symptoms of despair and hopelessness are sufficiently
severe, an additional diagnosis of major depressive
disorder may be warranted. If the symptom pattern does
not meet criteria for ASD, however, a diagnosis of
adjustment disorder should be considered in lieu of PTSD.
POST-TRAUMATIC STRESS DISORDER
• Posttraumatic stress disorder is a response to a
recognizable, serious stressor that is characterized
by specific behaviors.
• PTSD is a condition that generates waves of
anxiety, anger, aggression, depression, and
suspicion; threatens a person’s sense of self; and
interferes with daily functioning.
• Specific examples of events that place people at
risk for PTSD:
o Rape
o Family violence
o Torture
o Terrorist attacks
o Fire
o Earthquake
o Military combat
• Patients who have experienced a traumatic event
are often frequent users of the health care system,
seeking treatment for the overall emotional and
physical trauma that they experienced.
PTSD DIAGNOSIS CRITERIA
A diagnosis of PTSD requires that several criteria be met.
1. The first criterion relates to the nature of the
traumatic event and the response it evokes: The
person experienced, witnessed, or was confronted
with an event or events that involved actual or
threatened death or serious injury, or a threat to
the physical integrity of self or others. The
person’s response involved intense fear,
helplessness, or horror. In children, this may be
expressed instead by disorganized or agitated
behavior.
2. The second criterion relates to the traumatic event
and the development of symptoms that fall into
the three categories of “reexperiencing the event,”
“avoidance and psychic numbing,” and
“increased arousal.”
3. Finally, the disturbance must cause “clinically
significant distress or impairment in social,
occupational, or other areas of functioning”.
• Unlike other psychiatric disorders, which are
usually linked to psychosocial and biological
causes, PTSD occurs as a result of trauma
experienced by otherwise normal individuals.
PTSD usually appears in the first few months after
NUR 1221 – EDN TEAM 2022-2023|37
 a trauma has been experienced; however, this may
not always be the case. In certain cases, years may
have passed before the disorder appears.
• PTSD’s duration can vary, with symptoms
resolving over time in some individuals and
persisting for many years in others (American
Psychiatric Association, 2000).
o Acute- the the duration of symptoms is
less than 3 months
o Chronic- the duration of symptoms is 3
months or more
o Delayed onset- the onset of symptoms is
at least 6 months after the stressor.
• The diagnosis of PTSD cannot be made unless the
duration of the disturbance is more than 1
month.
PHYSIOLOGICAL RESPONSES IN PTSD
• The physiologic responses of people who have
been severely traumatized include increased
activity of the sympathetic nervous system,
increased plasma catecholamine levels, and
increased urinary epinephrine and norepinephrine
levels.
• People with PTSD may lose the ability to control
their response to stimuli (Loseke, Gelles &
Cavanaugh, 2005). The resulting excessive
arousal can increase overall body metabolism and
trigger emotional reactivity. In this situation,
ASSESSING FOR POST-TRAUMATIC STRESS
DISORDER
1. Physiologic Indicators
• Dilated pupils
• Headaches
• Sleep pattern disturbances
• Tremors
• Elevated blood pressure
• Tachycardia or palpitations
• Diaphoresis with cold, clammy skin
• Hyperventilation
• Dyspnea
• Smothering or choking sensation
• Nausea, vomiting, or diarrhea
• Stomach ulcers
• Dry mouth
• Abdominal pain
• Muscle tension or soreness
• Exhaustion
2. Psychological Indicators
• Anxiety
• Anger
• Depression
• Fears or phobias
• Survivor guilt
• Hypervigilance
• Nightmares or flashbacks
• Intrusive thoughts about the trauma
• Impaired memory
• Dissociative states
• Restlessness or irritability
• Strong startle response
• Substance abuse
DIAGNOSTIC CRITERIA FOR
POSTTRAUMATIC STRESS DISORDER
Source: Diagnostic and Statistical Manual of Mental
Disorders, 5th ed. Washington, DC, American
Psychiatric Association, 2013.
A. Exposure to actual or threatened death, serious
injury, or sexual violence in one (or more) of the
following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred
to others.
3. Learning that the traumatic event(s) occurred to a
close family member or close friend. In cases of
actual or threatened death
of a family member or friend, the event(s) must
have been violent or accidental.
4. Experiencing repeated or extreme exposure to
aversive details of the traumatic event(s) (e.g.,
first responders collecting
human remains; police officers repeatedly
exposed to details of child abuse).
B. Presence of one (or more) of the following intrusion
symptoms associated with the traumatic event(s),
beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing
memories of the traumatic event(s).
2. Recurrent distressing dreams in which the content
and/or affect of the dream are related to the
traumatic event(s).
3. Dissociative reactions (e.g., flashbacks) in which
the individual feels or acts as if the traumatic
event(s) were recurring. (Such
reactions may occur on a continuum, with the
most extreme expression being a complete loss of
awareness of present
surroundings.)
4. Intense or prolonged psychological distress at
exposure to internal or external cues that
symbolize or resemble an aspect of
the traumatic event(s).
5. Marked physiologic reactions to internal or
external cues that symbolize or resemble an
aspect of the traumatic event(s).
C. Persistent avoidance of stimuli associated with the
traumatic event(s), beginning after the traumatic
event(s) occurred, as evidenced by one or both of the
following:
1. Avoidance of or efforts to avoid distressing
memories, thoughts, or feelings about or closely
associated with the traumatic event(s).
2. Avoidance of or efforts to avoid external
reminders (people, places, conversations,
activities, objects, situations) that arouse
distressing memories, thoughts, or feelings about
or closely associated with the traumatic event(s).
NUR 1221 – EDN TEAM 2022-2023|38
D. Negative alterations in cognitions and mood
associated with the traumatic event(s), beginning or
worsening after the traumatic event(s) occurred as
evidenced by two (or more) of the following:
1. Inability to remember an important aspect of the
traumatic event(s) (typically due to dissociative
amnesia and not to other factors such as head
injury, alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or
expectations about oneself, others, or the world
(e.g., “I am bad,” “No one can be trusted,” “The
world is completely dangerous,” “My whole
nervous system is permanently ruined”).
3. Persistent, distorted cognitions about the cause or
consequences of the traumatic event(s) that lead
the individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear,
horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in
significant activities.
6. Feelings of detachment or estrangement from
others.
7. Persistent inability to experience positive
emotions (e.g., inability to experience happiness,
satisfaction, or loving feelings).
E. Marked alterations in arousal and reactivity
associated with the traumatic event(s), beginning or
worsening after the traumatic event(s) occurred, as
evidenced by two (or more) of the following:
1. Irritable behavior and angry outbursts (with little
or no provocation) typically expressed as verbal
or physical aggression toward people or objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or
staying asleep or restless sleep).
F. Duration of the disturbance (criteria B, C, D, and E)
is >1 month.
G. The disturbance causes clinically significant distress or
impairment in social, occupational, or other important
areas of functioning.
H. The disturbance is not attributable to the physiologic
effects of a substance (e.g., medication, alcohol) or
another medical condition.
ETIOLOGY AND PATHOPHYSIOLOGY
• It is hypothesized that in PTSD there is excessive
release of norepinephrine from the locus
coeruleus in response to stress and increased
noradrenergic activity at projection sites in the
hippocampus and amygdala.
• These changes theoretically facilitate the
encoding of fear-based memories.
• Greater sympathetic responses to cues associated
with the traumatic event occur in PTSD, although
pituitary adrenal responses are blunted.
• In addition to fear learning, changes in threat
detection (insula overactivity), executive
function, emotional regulation and contextual
learning have been documented.
TREATMENT: STRESS DISORDERS
• Acute stress reactions are usually self-limited, and
treatment typically involves the short-term use of
benzodiazepines and supportive/ expressive
psychotherapy. The chronic and recurrent nature
of PTSD, however, requires a more complex
approach using drug and behavioral treatments.
• PTSD is highly correlated with peritraumatic
dissociative symptoms and the development of an
acute stress disorder at the time of the trauma.
• The Selective Serotonin Reuptake Inhibitors
(SSRIs) (paroxetine and sertraline are FDA
approved for PTSD), venlafaxine, nefazadone,
and topiramate can all reduce anxiety, symptoms
of intrusion, and avoidance behaviors.
• Hydrocortisone, intranasal oxytocin, and
opiates such as morphine, given shortly after the
acute stress, may have beneficial effects in
preventing the development of PTSD, and
adjunctive naltrexone can be effective when
comorbid alcoholism is present.
• Low dose trazodone and mirtazepine, sedating
antidepressants, are frequently used at night to
help with insomnia.
• Benzodiazepines and SSRIs, however, should not
be given in the early aftermath of trauma.
• Psychotherapeutic strategies for PTSD help the
patient overcome avoidance behaviors and
demoralization and master fear of recurrence of
the trauma
• Therapies that encourage the patient to dismantle
avoidance behaviors through stepwise focusing
on the experience of the traumatic event, such as
trauma-focused cognitive-behavioral therapy,
exposure therapy, and eye movement
desensitization and reprocessing, are the most
effective.
• Debriefing after the traumatic event does not
prevent PTSD and may exacerbate symptoms.
PTSD IN CHILDREN
The clinical presentation of PTSD in children can be
extraordinarily heterogeneous with a bewildering array of
symptoms. Describing children’s responses to trauma
presents four specific symptoms characteristic of
childhood PTSD:
1. Repeatedly perceiving memories of the event
through visualization
2. Engaging in behavioral reenactments and
repetitive play related to the event
3. Fears related to the trauma event, and
4. Pessimistic attitudes reflecting a sense of
hopelessness about the future and life in general.
• The behavioral presentation of a child or
adolescent suffering from PTSD or symptoms of
PTSD may also include problems with
NUR 1221 – EDN TEAM 2022-2023|39
 verbalization, and extremes of disconnections (no
close relationships) or false connections
(perceiving close relationships where none exist)
(van der Kolk, 2001).
• The diagnosis of PTSD cannot be made based
solely on the child’s affective presentation (e.g.,
crying, sadness, expressions of terror) (van der
Kolk, 1999, 2001). The DSM–IV–TR criteria
specify that there must be an indication that the
disturbance causes significant distress in other
spheres of the child’s life, such as social or
educational function.
• PTSD often results in impairment of the child’s
ability to function in social groups or family
situations, including school phobia, decreased
academic performance, withdrawal from normal
activities, and family discord. It is the disturbance
in function that is the hallmark of PTSD, and
differentiates the diagnosis from the more
common reactions to stress and disasters.
• PTSD rarely occurs in isolation. Children with
PTSD may be more likely to have comorbid
conditions because traumatic insults occur in
developmental stages that are particularly
sensitive to disruptions in neurobiological
maturation.
• Developing coping skills, interpersonal relations,
and the achievement of developmental milestones
such as language acquisition, self-regulation,
security, and trust may be disrupted by trauma.
Other related psychological disorders commonly
occurring in children, as well as adults, with
PTSD include depression and feelings of guilt and
hopelessness, disillusionment with authority,
acute stress disorder, and generalized anxiety
disorder. Concomitant diagnoses may include
eating disorders, substance abuse, and problems
with memory and cognition.
• In recent years, a great deal of research has been
aimed at development and testing of reliable
assessment tools. A combination of findings from
structured interviews and questionnaires with
physiological assessments is generally considered
to be the most effective method of diagnosing
PTSD.
• Van der Kolk (2001) suggests that examining
PTSD symptoms rather than diagnoses is more
appropriate for children because many children
who experience posttraumatic symptoms do not
technically earn the PTSD diagnosis.
CRITICAL INCIDENT STRESS MANAGEMENT
• Critical Incident Stress Management (CISM)
as a crisis intervention program to mitigate the
psychological distress among emergency services
personnel and assist them in returning to normal
duties.
• CISM is a comprehensive program that not only
includes psychological debriefing, but also a
variety of other crisis intervention strategies for
emergency services personnel.
CISM STRATEGIES:
1. Pre incident education/mental preparedness
training
2. Individual crisis intervention and on-scene
support
3. Demobilization after large-scale events
4. Defusing
5. Critical Incident Stress Debriefing (CISD)
6. Significant other support services for families and
children
7. Follow-up services and professional referrals
when necessary
PSYCHOLOGICAL DEBRIEFING
• Psychological debriefing is the most well-known
of the CISM interventions, and the most
controversial.
• It has been defined as “a systematic process of
education, emotional expression and cognitive
reorganization accomplished through the
provision of information and meaningful
integration and group support through identifying
shared common experience” (Fullerton, Ursano,
Vance, & Wang, 2000, p. 260).
• This model is typically applied within 24 to 72
hours
• Seven phases of Psychological Debriefing
1. Introduction 5. Symptoms
2. Facts 6. Teaching/ Information
3. Thoughts 7. Reentry
4. Reactions
• CISD has been used primarily for rescuers who
are exposed to traumatic events in the course of
their work.
• Debriefing is most helpful when conducted in a
group setting (rather than with individuals), and
when the members are part of a naturally
occurring group, such as rescue squads, fire
companies, or emergency room/intensive care
unit staffs.
DEFUSING
• Defusing is a crisis intervention procedure that is
similar to debriefing, in which small group
discussion takes place within a few hours (8–10 is
ideal) of the event (Mitchell & Everly, 2000).
• It too is usually conducted in groups
• Three main segments: Introduction, Exploration,
and Information
• This process may also help a group decide
whether further psychological debriefing is
needed.
• Sometimes a defusing is all that is necessary, but
more typically, it reduces psychological discord
and tension so that the team can properly set up a
formal CISD group session.
NUR 1221 – EDN TEAM 2022-2023|40
References:
Brunner, L. S., Suddarth, D. S., Smeltzer, S. C. O., & Bare,
B. G. (2010). Brunner & Suddarth's textbook of
medical-surgical nursing (12th ed.). Philadelphia:
Lippincott Williams & Wilkins.
Jameson J, & Fauci A.S., & Kasper D.L., & Hauser S.L.,
& Longo D.L., & Loscalzo J(Eds.), (2018). Harrison's
Principles of Internal Medicine, 20e. McGraw Hill.
https://accesspharmacy.mhmedical.com/content.aspx?
bookid=2129&sectionid=159213747
Veenema, T. (2013), Disaster Nursing and Emergency
Preparedness, 3rd ed., Springer Pub. Co.: New York

NUR 1221 – EDN TEAM 2022-2023|41

 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING
NUR 1221 DISASTER NURSING LECTURE
A.Y. 2022-2023 SECOND SEMESTER
MODULE 15 COMMON REACTIONS OF
DISASTER SURVIVOR
Topic Outline:
1. Stress Reactions among Children and Youth
2. Resiliency in the Face of Disaster
3. Common Stress Reactions by Disaster Workers
4. Community Reactions and Responses
OVERVIEW
The psychosocial impact of a disaster and the resources
that will be needed to respond to the disaster can be
estimated based on data from past experiences with a
variety of natural and man-made disasters. Normal
reactions to abnormal events include a range of distressing
thoughts, emotions, sensations, and behaviors, which
ought not to be characterized as a mental illness. How-
ever, early outreach can set the stage for those at risk for a
psychiatric disorder to accept help in the future, should it
be needed. Children display a variety of reactions that are
normal given the extreme nature of the stressor and their
level of emotional and cognitive maturity. Mental health
responders must be culturally competent and attuned to the
needs of special populations, and they, along with first
responders, disaster workers, and hospital personnel, are
particularly vulnerable to stress- induced symptoms. Work
groups, schools, and entire communities not only react to
a disaster but also serve as a conduit for support and
psychoeducational information. There is no timetable for
grief, and expressions of mourning and bereavement
reflect the characteristics of the person, the loss, and the
disaster.
The mental health response to a disaster must be a well-
coordinated effort that draws on a variety of professionals,
paraprofessionals, and volunteers who have been
prescreened and specially trained for this work. In the
immediate aftermath, the goal of mental health
intervention is to facilitate normal coping, to treat those
with immediate needs, and to begin to identify those at risk
for psychiatric disorders in the ensuing weeks, months, or
years. Although mental health interventions have not been
shown to prevent psychiatric disorders once exposure to a
traumatic event has occurred, re- search continues to
search for strategies that can mitigate harmful effects.
Cognitive behavioral approaches are most likely to be
beneficial, and psychological de- briefing, a somewhat
controversial technique, is now changing in response to
research, particularly regarding time frames and target
populations. Management of the psychosocial effects of
disaster will continue long after the initial impact.
Psychiatric disorders among children may present with
symptoms that differ from those of adults, or may not
present until sometime later. Major depression and PTSD
can be disabling consequences of exposure to disaster
among those of any age group, and thus, early diagnosis
and treatment are critical to the prevention of future
disability.
STRESS REACTIONS AMONG CHILDREN AND
YOUTH
• General risk factors for stress reactions among
children:
o being female
o being near to the event
o having a physical injury, having a parent/
close family member injured or killed,
o having a parent with significant
psychopathology
o having a family environment that is
depressed and irritable or volatile.
• The personality and temperament of the child are
also associated with risk for psychiatric
symptoms. Children who are intrinsically shy are
at greater risk for trauma-related symptoms, and
those who are chronically depressed are prone to
feelings of guilt (Shaw, 2000).
CHILDREN’S STRESS REACTIONS ACCORDING
TO AGE GROUP
There are also a wide range of emotional and physiological
reactions that children of differing ages may also display
following a disaster:
1. Infants will sense their parents’ anxiety and fear
and will mirror the parent or caregiver’s reaction
to the disaster.
2. Preschool children are extremely dependent on
routine and will react strongly to any disruption in
their daily routine. They may exhibit mild to
extreme helplessness, passivity, and a lack of
responsiveness to things in their environment. A
heightened level of arousal, confusion, and
generalized fear may be present. Other symptoms
of distress include a lack of verbalization, sleep
disturbances, nightmares and night terrors, fears
of separation and clinging to caregivers,
irritability, excessive crying, and neediness.
Somatic complaints may include stomachaches,
headaches, and nondescript pains.
3. School-aged children are more mature, both
cognitively and emotionally, but remain highly
vulnerable to events involving loss and stress.
Whereas younger children may exhibit symptoms
of separation anxiety, school-aged children may
present with more classical symptoms of PTSD,
as well as depressive and anxiety disorders.
4. Adolescents tend to respond to a disaster much
the same as do adults. However, this may also be
accompanied by the awareness of a life unlived, a
sense of a foreshortened future, and the fragility
of life (Shaw, 2000). Adolescents may also
exhibit a decline in academic performance,
NUR 1221 – EDN TEAM 2022-2023|42
 rebellion at home or school, and delinquency, as 3. Confusion
well as somatic complaints and social withdrawal. 4. Slowness of thinking and comprehension
5. Difficulty calculating, setting priorities, making
RESILIENCY IN THE FACE OF DISASTER decisions Poor concentration
• Because not all survivors of a disaster display 6. Limited attention span
symptoms beyond the initial phases of recovery, 7. Loss of objectivity
researchers have become increasingly interested 8. Unable to stop thinking about disaster
in the factors that might promote resiliency in the 9. Blaming
aftermath of a devastating disaster.
• Resiliency is often the most commonly observed D. PHYSICAL
outcome trajectory after exposure to a potential 1. Increased heart/respiratory rate/BP
traumatic event (Bonanno, Rennicke, & Dekel, 2. Upset stomach, nausea, diarrhea
2005). 3. Change in appetite, weight loss or gain
• Characteristics associated with resiliency: 4. Sweating or chills
o family stability 5. Tremor (hands/lips)
o social support 6. Muscle twitching
o and capacity to tolerate stress and 7. “Muffled” hearing
uncertainty. 8. Tunnel vision
• There may be a social cost to self-enhancement, 9. Feeling uncoordinated
further study is needed to understand this 10. Headaches
relationship, as well as the relationship between 11. Soreness in muscles
resiliency and PTSD symptoms and the ability to 12. Lower back pain
function over time and across differing types of 13. “Lump” in the throat
traumatic events (Litz, 2005). 14. Exaggerated startle reaction
15. Fatigue
16. Menstrual cycle changes
COMMON STRESS REACTIONS BY DISASTER 17. Change in sexual desire
WORKERS 18. Decreased resistance to infection
A. PSYCHOLOGICAL 19. Flare-up of allergies and arthritis
1. Denial 20. Hair loss
2. Anxiety and fear
3. Worry about the safety of self or others COMMUNITY REACTIONS AND RESPONSES
4. Anger By addressing the emotional and social needs of disaster
5. Irritability victims, counselors and other disaster workers can
6. Restlessness establish trust and engender a sense of support within the
7. Sadness, grief, depression, moodiness community. Some of the needs that are commonly seen
8. Distressing dreams among disaster survivors, regardless of the type of disaster,
9. Guilt or “survivor guilt” include:
10. Feeling overwhelmed, hopeless 1. Basic survival, personal safety, and the physical
11. Feeling isolated, lost, or abandoned safety of loved ones.
12. Apathy 2. Grieving over loss of loved ones and loss of
valued and meaningful possessions.
B. BEHAVIORAL 3. Concerns about relocation and the related
1. Change in activity isolation or crowded living conditions.
2. Decreased efficiency and effectiveness 4. A need to talk about events and feelings
3. Difficulty communicating associated with the disaster, often repeatedly.
4. Outbursts of anger, frequent arguments 5. A need to feel one is part of the community and
5. Inability to rest or “let down” its recovery efforts.
6. Change in eating habits
7. Change in sleeping patterns THREE STEPS IN SCHOOL-BASED
8. Change in patterns of intimacy, sexuality INTERVENTION
9. Change in job performance Schools provide a key mechanism for reaching children.
10. Periods of crying Teachers and principals are in contact with students
11. Increased use of alcohol, tobacco, and drugs throughout the day, and they are in an excellent position to
12. Social withdrawal/silence disseminate information, allow expression of feelings, and
13. Vigilance about safety of environment screen children for unusual difficulties and make referrals
14. Avoidance of activities or places that trigger when indicated. Professionals can provide guidance about
memories the age-specific strategies that might be used in discussing
15. Proneness to accidents a community-wide disaster.

C. COGNITIVE Community-based consultation in the workplace can also

1. Memory problems be requested when large numbers of employees are
2. Disorientation affected by a disaster. The debriefings consisted primarily
NUR 1221 – EDN TEAM 2022-2023|43
of information about responses to disaster, normal and
traumatic; advice for helping children who have been
exposed to trauma; and practical steps that participants
might take to feel safer.

This type of school-based intervention occurs as soon after

the event as possible, and follows three phases:
1. Preconsultation- identifying the need; preparing
the intervention with school authority.
2. Consultation in class- introduction, open
discussion (fantasy), focused discussion (fact),
free drawing task, drawing or story exploration,
reassurance and redirection, recap, sharing of
common themes, and return to school activities.
3. Postconsultation- debriefing with school
personnel and triage/referrals.

References:
Brunner, L. S., Suddarth, D. S., Smeltzer, S. C. O., & Bare,
B. G. (2010). Brunner & Suddarth's textbook of
medical-surgical nursing (12th ed.). Philadelphia:
Lippincott Williams & Wilkins.
Jameson J, & Fauci A.S., & Kasper D.L., & Hauser S.L.,
& Longo D.L., & Loscalzo J(Eds.), (2018).
Harrison's Principles of Internal Medicine, 20e.
McGraw Hill.
https://accesspharmacy.mhmedical.com/content.asp
x?bookid=2129&sectionid=159213747
Veenema, T. (2013), Disaster Nursing and Emergency
Preparedness, 3rd ed., Springer Pub. Co.: New York

NUR 1221 – EDN TEAM 2022-2023|44

 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING

NUR 1221 DISASTER NURSING LECTURE

A.Y. 2022-2023 SECOND SEMESTER

MODULE 16 PHASES OF EMOTIONAL symptoms are frequent. These psychological impacts have
RECOVERY a significant impact on both the person and the community
Topic Outline: at large.
1. Definition of Terms
2. Psychosocial Impact of Disaster FEAR AND DISTRESS IMMEDIATE RESPONSE
3. Mental and Emotional Phases of a Disaster (PHYSICAL)
4. Common Emotional and Complications Disaster • Fight or flight or freeze
Survivor Experience • Gastrointestinal distress
5. Steps to Build Emotional Well-Being and Gain • Increased heart rate, blood pressure, respiration
Self-Control (Coping Skills)
BEHAVIOR IMMEDIATE RESPONSE
OVERVIEW (COGNITIVE)
Hurricanes, earthquakes, transportation accidents, and • Startle reactions, difficulty expressing oneself
wildfires are all examples of disasters that are unexpected, • Restlessness
sudden, and overpowering. Although there is no overtly • Constant talking
evident evidence of physical injury for many people, there • Slowed reaction
can be an emotional toll. People who have encountered a • Emotional numbing
disaster are more likely to have significant emotional • Self-blame
reactions. Understanding responses to distressing events • Shame
can help you cope effectively with your feelings, thoughts, • Change in awareness of one’s surroundings
and behaviors, and help you along the path to recovery.
PSYCHIATRIC ILLNESS (EMOTIONAL)
DEFINITION OF TERMS • Grief/Sadness
• Mental Health– the ability to process and Fragility
understands information and experiences Feeling vulnerable
• Emotional Health– the ability to express feelings • Hopelessness, emotional pain
which are based on the information you have • Anxiety
processed, or you have learned from the • Shock, Numbness
experienced.
• Fear, Terror
• Coping – it is a conscious or unconscious
• Feeling unreal
strategies used to reduce unpleasant emotions or
• Feeling out of control
to deal with and attempt to overcome problems
and difficulties • Disorientation, Rapid shifting of emotions
• Psychosocial Health– state of mental, emotional,
social, and spiritual well-being (social support,
social integration, environment, social status,
social disruption, bereavement)

PSYCHOSOCIAL IMPACT OF DISASTER

Psychosocial impact is defined as the effect caused by

environmental and/or biological factors on individual’s
social and/or psychological aspects. After disasters and
other traumatic experiences, emotional instability, stress
reactivity, anxiety, trauma, and other psychiatric
NUR 1221 – EDN TEAM 2022-2023|45
MENTAL AND EMOTIONAL PHASES OF A
DISASTER
Disaster Phases
1. PRE-DISASTER PHASE
• Disasters with no warning can cause feelings of
vulnerability and a sense of loss of control or the
loss of the ability to protect yourself and your
family. Disasters with warning can cause guilt or
self-blame for failure to heed warnings. This
phase may last hours, or even minutes, such as
COMMON EMOTIONAL AND COMPLICATIONS
during a terrorist attack, or it may be several
months, such as during typhoon season.
• Feelings of fear and uncertainty define the pre-
disaster phase, and people in this phase may feel
a sense of vulnerability and lack of control to
protect themselves and their families.
2. IMPACT PHASE
• Slow, low-threat disasters have psychological
effects that are different from rapid, dangerous
disasters. Reactions range from shock to panic.
Initial confusion and disbelief are followed by a
focus on self-preservation and family protection.
TO TAKE NOTE:
This is usually the shortest phase.
3. HEROIC PHASE
• Characterized by a high level of activity with a
low level of productivity. There is a sense of
altruism, and community members exhibit
adrenaline-induced rescue behavior. This phase
often passes quickly.
4. HONEYMOON PHASE
• This period generally extends from one week to
six months after the disaster. For survivors, even
with the loss of loved ones and possessions, there
is a strong sense of having shared with others a
dangerous, catastrophic experience and having
lived through it.
• This phase is characterized by community
bonding and optimism and provides an
opportunity for assistance to affected groups.
5. DISILLUSIONMENT PHASE
• Communities and individuals realize the limits of
disaster assistance. Optimism turns to
discouragement and stress continues to take a toll.
Negative reactions, such as physical exhaustion or
substance use, begin to surface. The gap between
need and assistance leads to feelings of
abandonment. This phase can last months and
even years. It is extended by trigger events, such
as the anniversary of the disaster.
• There may be an increased need for relief
services, but those affected by disasters realize the
limits of relief available during the
disillusionment phase
6. RECONSTRUCTION PHASE
• Characterized by an overall feeling of recovery.
Individuals and communities begin to assume
responsibility for rebuilding their lives, and
people adjust to a new normal while continuing to
grieve losses. This phase often begins around the
anniversary of the disaster and may continue
beyond. Following catastrophic events, the
reconstruction phase may last for years.
• This phase is associated with a sense of recovery
as stakeholders take responsibility for rebuilding
their lives, adjust to a “new normal” and continue
to grieve.
DISASTER SURVIVOR EXPERIENCE
• Distress • Mood swings
• Shock • Flashbacks
• Fear • Difficulty making
• Guilt decisions
• Confusion • Problems sleeping
• Anxiety • Difficulty eating
• Depression • Compassion fatigue
• Irritability • Burnout
• Intense or
unpredictable feelings
1. Intense or unpredictable feelings. You may be
anxious, nervous, overwhelmed, or grief-stricken.
You may also feel more irritable or moody than
usual.
2. Changes to thoughts and behavior patterns.
You might have repeated and vivid memories of
the event. These memories may occur for no
apparent reason and may lead to physical
reactions such as rapid heartbeat or sweating. It
may be difficult to concentrate or make decisions.
Sleep and eating patterns also can be disrupted—
some people may overeat and oversleep, while
others experience a loss of sleep and loss of
appetite.
3. Sensitivity to environmental factors. Sirens,
loud noises, burning smells, or other
environmental sensations may stimulate
memories of the disaster creating heightened
anxiety. These “triggers” may be accompanied by
fears that the stressful event will be repeated.
4. Strained interpersonal relationships. Increased
conflict, such as more frequent disagreements
with family members and coworkers, can occur.
You might also become withdrawn, isolated, or
disengaged from your usual social activities.
NUR 1221 – EDN TEAM 2022-2023|46
 STEPS TO BUILD EMOTIONAL WELL-BEING
AND GAIN SELF-CONTROL (COPING SKILLS)
1. Give yourself time to adjust. Anticipate that this will
be a difficult time in your life. Allow yourself to
mourn the losses you have experienced and try to be
patient with changes in your emotional state.
2. Ask for support from people who care about you
and who will listen and empathize with your
situation. Social support is a key component to
disaster recovery. Family and friends can be an
important resource. You can find support and common
ground from those who've also survived the disaster.
You may also want to reach out to others not involved
who may be able to provide greater support and
objectivity.
3. Engage in healthy behaviors to enhance your
ability to cope with excessive stress. Eat well-
balanced meals and get plenty of rest. If you
experience ongoing difficulties with sleep, you may be
able to find some relief through relaxation techniques.
Avoid alcohol and drugs because they can be a
numbing diversion that could detract from as well as
delay active coping and moving forward from the
disaster.
4. Avoid making major life decisions. Switching
careers or jobs and other important decisions tend to
be highly stressful in their own right and even harder
to take on when you're recovering from a disaster.
5. Communicate your experience. Express what you
are feeling in whatever ways feel comfortable to
you—such as talking with family or close friends,
keeping a diary, or engaging in a creative activity (e.g.,
drawing, molding clay, etc.).
6. Find a local support group led by appropriately
trained and experienced professionals. Support
groups are frequently available for survivors. Group
discussion can help you realize that you are not alone
in your reactions and emotions. Support group
meetings can be especially helpful for people with
limited personal support systems.
7. Establish or reestablish routines. This can include
eating meals at regular times, sleeping and waking on
a regular cycle, or following an exercise program.
Build in some positive routines to have something to
look forward to during these distressing times, like
pursuing a hobby, walking through an attractive park
or neighborhood, or reading a good book.

NUR 1221 – EDN TEAM 2022-2023|47

 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING

NUR 1221 DISASTER NURSING LECTURE

A.Y. 2022-2023 SECOND SEMESTER

MODULE 17 SPECIAL NEED POPULATION

Topic Outline:
1. Key Concepts
2. PWDs and Elderly’s Need Accommodation
3. Suggestion Adoption to Respect PWDs
4. Cultural, Ethnic, and Religious Subgroups

OVERVIEW
Employing a functional needs-based perspective addresses
all aspects of an individual’s life (social conditions, mental
health wellness, family separation/unification,
independence, activities of daily living,) and mitigates the
possibility of compounding the victim’s problems in the
wake of the original disaster. The new roles and the
demands of ensuring effective care during a disaster
require a more holistic consideration of the individual’s Photo by: Philippine Association of Speech Pathologist
circumstances and needs.

SPECIAL NEED POPULATION

POPULATION
• Special populations and persons with special
needs are widely used throughout the nation to
describe individuals or groups that are difficult to
reach, or whose key demographic characteristics
make them more vulnerable than others when
disaster strikes
• Many health departments partially define these
groups by the recognition that their needs are not
fully addressed by traditional service providers or
through understanding that fears about comfort or
safety limit access to and use by these groups of Photo by Creative Learning 4 Kidz
the standard resources offered in disaster
preparedness, relief, and recovery DISABILITY AND AGE
• Older people are made vulnerable by disaster in
CULTURAL COMPETENCE
ways not readily apparent
• The ability of service delivery systems to provide
• Helpful to inquire how they have coped with past
quality assistance to clients with diverse values, adversities
beliefs, or traditions, including tailoring delivery
• It is important to be aware of preexisting physical
to meet their social, cultural, and linguistic needs.
limitations and assess the
It is a set of behaviors, attitudes, and policies that
• need to replace lost such as wheelchair, canes,
come together in an agency or among
hearing aids, eyeglasses
professionals enabling them to work effectively in
• Also, to consider their preexisting medical
cross–cultural situations. (DHHS, 2003).
conditions that may need access for medication or
• To bridge the communication barrier, many
supplies
institutions use a simple folding board with the
• Grief from loss must be acknowledge
names of body parts and systems in several
languages, together with pictures, where
ETHICAL AND LEGAL ISSUES
appropriate and useful during emergency
• Individual with a disability to recognize that
situations
emphasis is now to be placed on the person first
• He or she no longer will be seen simply as a
medical condition, but as a human being with
personality, emotions, and desires
• People with disabilities ask neither for pity nor for
charity, but for a voice— the voice in determining
how their lives shall unfold
NUR 1221 – EDN TEAM 2022-2023|48
ACCOMMODATING THE NEEDS OF PEOPLE
WITH DISABILITIES AND ELDERLY
1. PROVIDE GENERAL INFORMATION
• Access to information is the primary problem
faced by people who are deaf or blind, the groups
constituting the majority of those with sensory
disabilities
• Large hospitals, especially those at a distance
from the event receiving patient overflow, should
have on hand material in alternate formats that
provides the same basic information available to
sighted patients
• Ex. Most legally blind persons over the age of 65
have some vision, and for them, the most useful
information format is large print
• In a crisis condition of a disaster, nursing staff still
have a responsibility to build trust with patients,
trust that elicits cooperation and may allow
seniors to accept services without damaging their
pride.
2. METHODS OF COMMUNICATION
• It is important to realize that during times of
emergency or disaster, communication can take
place via formal modality or other technologies
not originally intended to convey critical
emergency messages to the deaf or hard of
hearing community.
• Sign language, interpreters may step in when
emergency events occur
3. EVACUATION DEVICES
• Equipment technology is changing fast and
improving every day. It is a very complex process
to evaluate and decide the appropriate type of
equipment needed
• Ex. wheelchair or any mode of transfer for
mobilization
4. SAFETY ASSURANCE
• Safety Assurance concepts can be built into the
safety tools that already exist in most systems.
Hazard and incident reports, safety committee
meetings and safety audits can include Assurance
concepts that will help you determine if the
actions taken in response to a safety issue actually
corrected a given situation and improved the
system.
5. NEED FOR INCLUSION
• No matter the type or nature of the impending
disaster, the intent for nurses during disaster
planning, especially for widespread emergencies,
is inclusiveness.
• The goal is to assure that every person in a
community can obtain and understand the
information needed to prepare, cope, and recover
when health emergencies strike
SUGGESTIONS TO RESPECT PEOPLE WITH
DISABILITIES
1. Put People First. The person should always come
first. An individual has abilities as well as
disabilities. Focusing on the person emphasizes
the status we share, rather than conditions we
presently do not. Thus, say “the person who has a
disability”, rather than “the disabled person.”
2. Emphasize Action. People with disabilities, even
severe ones, can be quite active. Thus, it is better
to say “Mr. Bright used a wheelchair and
occasionally walked using braces and crutches.”
3. Do Not Sensationalize, Pity or Characterize.
Avoid words like “afflicted,” “crippled,” and
“victim” when referring to a person with a
disability. Also, remember that people are more
than their disabilities
4. Avoid Inappropriate Words. “Handicapped”
has gone the way of “invalid” and “crippled” and
is no longer viewed as an appropriate term to refer
to a person with a disability. “Differently abled”
and “physically challenged” are fad phrases
which have not gained general acceptance among
people with disabilities
Points to Keep in Mind:
• Physical disability does not imply a mental
disability or childishness.
• Different means of communication does not mean
low intellectual ability.
• Disabilities can occur to anyone at any time in
life.
• Some disabilities can be temporary or episodic.
Don’t be afraid to encounter someone with a
disability
CULTURAL, ETHNIC, AND RELIGIOUS
SUBGROUPS
• It is important to be sensitive in roles of the family
members, such as head of the family or decision
maker. If using interpreter or translator, make sure
to look at the person to whom you are talking
instead of the interpreter.
• Be aware of the role of the community as there
may be suspicion and distrust of outsiders
• Attempt to work with community support
providers who have established relationships with
these subgroups
NUR 1221 – EDN TEAM 2022-2023|49
 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING

NUR 1221 DISASTER NURSING LECTURE

A.Y. 2022-2023 SECOND SEMESTER

MODULE 18 BASIC LIFE SUPPORT EMERGENCY CARDIOVASCULAR CARE (ECC)

Topic Outline • ECC includes all responses (pre-hospital or in-
1. Emergency Cardiovascular Care (ECC) hospital) needed to stabilize the victim or patient
a. Components of ECC who develops sudden and often life threatening
2. Emergency Action Principles events affecting the cardiovascular,
3. Chain of Survival cerebrovascular and pulmonary systems.
a. Four Links of Chain Survival • Emergency transportation without life support is
b. AHA Survival Link not Emergency Cardiovascular Care (ECC).
4. Cardiac Arrest
5. Cardiopulmonary Resuscitation (CPR) COMPONENTS OF ECC
6. Defibrillation 1. BLS- it includes recognition of respiratory arrest
7. Rescue Breathing or cardiac arrest, access to EMS systems and
8. Relief of FBAO application of basic CPR
2. ACLS- refers to the attempts to restore
OVERVIEW spontaneous circulation with basic CPR plus
• Cardiovascular diseases are the leading cause of advanced airway management, tracheal
death in the US for both men and women. intubation, defibrillation, and intravenous
• Sudden cardiac death is the major complication of medications.
cardiovascular diseases.
• Ventricular Fibrillation The Expanding Role of BLS
o The most frequent initial rhythm
documented witnessed sudden cardiac
arrest.
o The useless quivering of the heart that
results in no blood flow to the body.
• Early Defibrillation
o The most effective treatment of
Ventricular Fibrillation is Defibrillation.
o Defibrillation, however, is another
intervention with time limited access.
o The probability of successful
defibrillation decreases by
approximately 7-10% for every minute
defibrillation delayed.
• Many victims of other emergencies may also be Critical Time
saved by prompt initiation of access to the EMS
system, CPR and use of AED.
• Trauma, Electrocution, Drowning, Drug
Intoxication, and Pediatric and Neonatal
resuscitation
• Prompt intervention with BLS and ACLS not only
save lives but also help avoid devastating brain
damage that may result in long term suffering and
economic hardship.
• The Community as the “Ultimate Coronary
Care Unit”
o Because the majority of sudden deaths
caused by cardiac arrest occur outside the
hospital, it is then clear that the IMPORTANCE OF BLS
community must be recognized as the • Prevent cardiac arrest
“ultimate coronary care unit.” • Restore cardiorespiratory function
o Public education and training are crucial
• Maintain brain viability
aspects to reduce sudden cardiac death.
GETTING STARTED
• Plan of Action
NUR 1221 – EDN TEAM 2022-2023|50
 • Gathering of Needed Materials CHAIN OF SURVIVAL
• Remember the Initial Response as follows:
1. A – Ask for help
2. I – Intervene
3. D – Do not Further Harm

EMERGENCY ACTION PRINCIPLES • A metaphor to communicate the interdependence

1. Survey the Scene
2. Activate Medical Assistance (AMA) or Transfer
Facility
3. Do a Primary Survey of the Victim
4. Do a Secondary Survey of the Victim
SURVEY THE SCENE
Take time to survey the scene and ask these questions:
1. Is the scene safe?
2. What happened?
3. How many people are injured?
4. Are there bystanders who can help?
5. Then, identify yourself as a trained first aider
ACTIVATE MEDICAL ASSISTANCE (AMA) OR
TRANSFER FACILITY
Call First
• First aider is alone
• 8 yrs. old or older
• Unconscious, infant or child known to beat high
risk for heart problem
Care First
• Unconscious victim less than 8 years old
• Victim of submersion or near drowning
• Victim of arrest associated with trauma
• Victim of Drug overdose
Information to be Remembered in AMA
1. What happened?
2. Location
3. Number of persons injured
4. Extent of injury and first aid given
5. The telephone number from where you're
calling
6. Person who activated the Medical Assistance
must identify him/herself and drop the phone
last
of a community's emergency response to cardiac
arrest.
• This response is composed of Four Links.
1. Early access
2. Early CPR
3. Early defibrillation
4. Early Advanced Care
• If a link is weak or missing, the result will be poor
despite excellence in the rest of the ECC system.
FOUR LINKS OF THE SURVIVAL CHAIN
1. The First Link: Early Access
• Encompasses the event initiated after the patient’s
collapse until the arrival of EMS personnel
prepared to provide care.
• Recognition of early warning signs, such as chest
pain and shortness of breath.
2. The Second Link: Early CPR
• CPR is most effective when started immediately
after the victim collapses.
• Bystander CPR
3. The Third Link: Early Defibrillation
• Most likely to improve survival rates.
4. The Fourth Link: Early Advance care
• Another critical link in management of cardiac
arrest.
• ACLS brings equipment to support ventilation,
establish IV access, administers drugs, controls
arrhythmias and stabilizes the victim for
transport.
2020 AHA SURVIVAL LINK

DO A PRIMARY SURVEY OF THE VICTIM

• Check for consciousness
• Check for circulation
• Check for airway
• Check for breathing • A strong Chain of Survival can improve chances
of survival and recovery for victims of cardiac
DO A SECONDARY SURVEY OF THE VICTIM arrest, stroke and other emergencies.
1. Interview the victim • The six links adult Chain of Survival are:
• Ask the victim’s name 1. Early recognition & Prevention
• Ask what happened 2. Activation of Emergency Response
• Ask the SAMPLE history 3. High Quality CPR
2. Check the Vital Signs 4. Defibrillation
3. Do head to toe examination 5. Post Cardiac Arrest Care
6. Recovery

NUR 1221 – EDN TEAM 2022-2023|51

DENIAL IS THE DEADLY RESPONSE TO A
HEART ATTACK!
Denial on the part of the patient but insists on taking
prompt action:
1. “Call First”- call EMS
2. Be prepared to provide CPR if necessary.

CARDIAC ARREST
• Occurs when the heart stops beating and breathing
ceases abruptly or unexpectedly.
• May occur as the initial and only symptom of
CAD.
• Commonly occurs within the first hour after the • Location: Sternum (2 fingers above the
onset of symptoms. Xyphoid Process)
• Immediately give 30 Chest Compressions
CAUSES OF CARDIAC ARREST: (No ventilation during Pandemic)
1. CAD – most common • Push Hard (Firm)
2. Primary respiratory arrest • Push fast to the beat of “Staying Alive”
3. Direct injury to the heart • Parameters of High Quality CPR
4. Use of drugs 1. Push hard at a depth of 2-2.4 inches (5-
5. Disturbance in heart rhythm 6cm)
2. Push fast at a rate of 100-120
SIGNS AND SYMPTOMS: compressions/min
1. No response 3. Allow full chest recoil
2. No adequate breathing 4. Minimize interruptions to less than 10
3. No signs of circulation, no pulse seconds
5. Avoid excessive ventilation (not use
CARDIOPULMONARY RESUSCITATION (CPR) during Pandemic)
• Is a series of assessments and interventions using
techniques and maneuvers made to bring victims 5. Airway
of cardiac and respiratory arrest back to life.

THE C-A-Bs
• Core concept: Oxygen to the brain
• In order: Compression-Airway-Breathing.
These build on each other
• “You cannot breathe for a patient or to assess
breathing without first opening the airway.”

AHA 2010 Guidelines American Heart Association

• Early CPR improves the likelihood of survival
• Chest compressions are the foundations of CPR. • Position the Victim
• Compressions create blood flow by increasing the • Open the airway
intrathoracic pressure and directly compress the o Obstruction by the tongue and
heart; generate blood flow and oxygen delivery to Epiglottis.
the myocardium and brain. o When a victim is unresponsive, the
tongue and epiglottis can block the
CPR SEQUENCE 2020 upper airway
1. Establish scene safety • Head Tilt – Chin Lift
2. Place mask on your patient (During Pandemic) o Obstruction of the airway is relieved by
• Check for consciousness. Head Tilt - Chin Lift
o Tap the shoulder. Hey, hey are you • Jaw-thrust maneuver
ok? Hey, hey, are you alright? If o Jaw thrust without head tilt. The Jaw is
unconscious SHOUT for help. lifted without lifting the head.
3. Assess for the pulse while checking the breathing. o This is the airway Maneuver of choice for
If the patient has no pulse and breathing. Activate a victim with suspected cervical spine
the EMS and grab an AED. injury.
4. Perform High Quality CPR If you can’t feel the
pulse within 10 seconds, but not more than 10
seconds.

NUR 1221 – EDN TEAM 2022-2023|52

 6. Breathing (this is not used during pandemic)
• Determine absent or inadequate breathing by:
o During Pandemic: just look at the
patient's chest movement. •
• If there is no breathing, give 2 Rescue Breaths
• You may use a bag mask device if there is a
HEPA filter (high efficiency particulate air
filter).
RESCUE BREATHING (POSITIVE PULSE BUT
NO BREATHING)
• Adult: 1 breath every 6 secs.; 10 breaths per min
• Infants and children: 1 breath every 2-3 secs;
20-30 breaths per min
• After 2 minutes of Rescue Breathing, assess the
victim for Pulse and Breathing. If the victim has a
pulse and breathing, position the victim in a
recovery position.
Recovery position

7. Continue CPR
• 30 Compressions: 2 breath (5 Cycles) (2
breath not apply during Pandemic)
• Do this until AED arrives, ALS provider
takes over, or victim starts to move.

DEFIBRILLATION
• As soon as possible connect the victim with an
AED or defibrillator and if indicated deliver a
shock
METHODS OF RESCUE BREATHING:
AUTOMATED ELECTRONIC DEFIBRILLATOR
(AED)
1. Turn on the AED
2. Attach pad to the victim's bare chest
3. Clear the victim
4. Listen to the prompt if shock is needed
5. Press button to deliver shock
6. Start CPR, begin with compression
7. After 2 minutes of High Quality CPR, assess the
victim, if the victim has pulse and breathing
position the victim in a Recovery Position. Mouth-to-Mouth Mouth-to-Stoma
8. If there is no or inadequate breathing but has
pulse, perform RESCUE BREATHING.

SUMMARY FOR ALL AGES

Adult Child Infant
Assessment of Tap the shoulder Tap the sole
unresponsiveness
Pulse check Carotid Carotid/ Brachial
femoral
Compression 2-2.4 in (5-6 2 in 1 ½ in
Mouth-to-Mask Mouth-to-Face shield
depth cm) (5 cm) (4 cm)
Compression to 1 or 2 1 rescuer- 30:2
ventilation rate rescuers 2 rescuers 15:2
30:2
Compression 2 hands in 2 hands in 1 rescuers:
Placement/ the lower the lower 2 finger
technique half of the half of the hand
breastbone breastbone technique
(optional for
patient’s 2 rescuers:
body built) 2 thumb
encircling
technique
Bag Mask Device

NUR 1221 – EDN TEAM 2022-2023|53

 FOREIGN BODY AIRWAY OBSRTUCTION • Reposition and reattempt to ventilate
(FBAO) • Give 5 abdominal thrusts
• Severe or complete airway obstruction is an
emergency that will result in death within minutes Relief/Survive from FBAO, we position the patient on
if not treated. a recovery position
o Intrinsic (tongue)
o Extrinsic (foreign body) ACTIONS AFTER RELIEF OF FBAO
• Classification of FBAO After the obstruction is removed, the rescuer should:
o Partial Obstruction 1. Provide 2 slow breaths
§ Good air exchange 2. Check for signs of circulation. If No Signs of
§ Poor air exchange circulation, perform CPR.
o Complete Obstruction 3. If signs of circulation represent but the victim is
not breathing, continue with RESCUE
SIGNS OF SEVERE OR COMPLETE AIRWAY BREATHING.
OBSTRUCTION: 4. Place the victim in a RECOVERY POSITION
1. Universal choking sign
2. Inability to speak COMMON QUESTIONS ASKED
3. Weak ineffective coughs 1. What happens if I break a rib?
4. High-pitched sounds or no sounds while inhaling 2. What happens if a female is pregnant?
5. Increased difficulty of breathing 3. What do I do if the patient vomits?
6. Bluish Skin Color (cyanosis) 4. Can I get AIDS doing CPR?
5. What do I do if the patient is wearing dentures?
RELIEF OF FOREIGN BODY AIRWAY 6. What do I do if I am alone and I am choking?
OBSRTUCTION (FBAO)
ADULT
Relief of FBAO conscious victim
• Heimlich Maneuver with a standing/sitting victim
• Heimlich maneuver with the victim lying.
• Chest thrust for responsive pregnant woman

Responsive victim of FBAO becomes unresponsive

1. Activate EMS
2. Perform a tongue-jaw lift, then a finger sweep to
remove the object.
3. Open the airway and try to give 2 rescue breaths.
4. Perform Heimlich maneuver up to 5 times.
5. Repeat the sequence of tongue-jaw lift, finger
sweep, attempt to ventilate, and Heimlich
maneuver.

Tongue-jaw Lift and Finger Sweep

• Used to remove a foreign body from the back of
the pharynx

INFANT/CHILDREN
Responsive Infant
• Recognize presence of choking
• Deliver 5 back blows and chest thrust
• Repeat until the object is removed or victim
becomes unresponsive.

Unresponsive infant:
• Open the airway, finger sweep if visible– Attempt
to ventilate
• Reposition the head and attempt to ventilate
• Give 5 back blows and 5 chest thrusts

Responsive child
• Heimlich maneuver

Unresponsive child
• Open the airway, finger sweep if visible
• Attempt to ventilate
NUR 1221 – EDN TEAM 2022-2023|54
 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
DEPARTMENT OF NURSING

NUR 1221 DISASTER NURSING LECTURE

A.Y. 2022-2023 SECOND SEMESTER

MODULE 19 FIRST AID CAUSES OF SHOCK

Topic Outline • Severe bleeding
1. First Aid • Crushing injury
2. Shock • Infection
3. Soft Tissue Injuries • Heart attack
4. Bones, Joint, and Muscle Injury • Perforation
5. Bandaging Technique • Shrapnel and bullet wound
6. Emergency Rescue • Rupture of tubal pregnancies
• Anaphylaxis
FIRST AID • Starvation and diseases
• Is an immediate care given to a person who has
been injured or suddenly taken ill. FACTORS WHICH CONTRIBUTE TO SHOCK
• It includes self-help and homecare medical • P – Pain
assistance is delayed or not available. • R – Rough handling
• I – Improper bandaging
ROLES & RESPONSIBILITIES OF THE FIRST • C - Continuous bleeding
AIDER • E – Exposure to extreme temperature
• Bridge the gap between the victim and the • F – Fatigue
physician.
• It is not intended to compete with nor take the GENERAL SIGNS AND SYMPTOMS OF SHOCK
place of the services of the Physician. EARLY STAGE
• It ends when medical assistance begins. • Face – pale or cyanotic
• Skin – cold clammy
OBJECTIVES OF FIRST AID • Breathing – irregular
• To alleviate suffering• To prevent added or • Pulse – rapid and weak
further injury or danger • Nausea and vomiting
• To prolong life • Weakness
• Thirsty
CHARACTERISTICS OF A GOOD FIRST AIDER
• Gentle – should not cause pain LATE STAGE
• Resourceful – should make the best use of • Apathetic or relative unresponsive
things at hand • Eyes will be sunken with vacant expression
• Observant – should notice all signs • Pupils are dilated
• Tactful – should not alarm a victim • Low blood pressure
• Empathic – should be comforting • Unconsciousness when body temperature falls.
• Respectful – should maintain professional and
caring attitude OBJECTIVES OF FIRST AID FOR SHOCK
1. To improve circulation of the blood.
HINDRANCE IN GIVING FIRST AID: 2. To ensure an adequate supply of oxygen
1. Unfavorable surrounding 3. To maintain normal body temperature.
2. The presence of crowds
3. Pressure from victim or relatives FIRST AID MANAGEMENT OF SHOCK
• P - Proper positioning
TRANSMISSION OF DISEASES • P - Proper body temperature
1. Direct • P - Proper administration of fluid
2. Indirect • P - Proper oxygenation
3. Airborne/ Droplet • P - Proper transfer
4. Vectors
SOFT TISSUE INJURIES
SHOCK Wound is a break in the continuity of tissue the body
• It is a depressed condition of many body either internal or external.
functions due to failure of enough blood to
circulate throughout the body following serious TWO CLASSIFICATIONS OF WOUND
injury. 1. Closed Wound- caused by blunt object which
results in contusion.
NUR 1221 – EDN TEAM 2022-2023|55
 • Contusion/ecchymosis- blood trapped under • C – Care for shock
the surface of the skin • C – Consult

2. Open Wound- Incision, Abrasion, Puncture, SPECIFIC BODY INJURIES

Laceration, Avulsion • Eye Injuries
• Incision- cut in the tissues that are • Chemical Burns
commonly caused by knives, metal edges, • Eye knocked out
broken glass, or other sharp objects • Foreign object
• Abrasion- denuded skin; superficial wounds • Nosebleeds
in which the topmost layer of the skin • Impaled objects
(epidermis) is scraped off • Amputations
• Puncture • Sucking Chest wound
• Laceration- skin tear with irregular edges • Abdominal evisceration
and vein bridging; jagged, irregular, or blunt • Animal bite
breaks or tears in the soft tissues
• Avulsion- tearing away of tissue from BONES, JOINT, AND MUSCLE INJURY
supporting structures; forcible separation of MUSCLE CRAMPS
tissue from the victim’s body • It is the sudden, painful tightening of the muscle.

First Aid for Cramps:

• Stretch out the affected muscle to counteract the
cramp.
• Massage the cramped muscle firmly but gently
• Apply heat (moist heat)
• Get medical help if cramps persist.
Contusion Incision
STRAIN
• It is the sudden, painful tearing of muscle fiber
during exertion.
• S/S: Pain, Swelling, Bruising, Loss of efficient
movement
Abrasion Laceration First Aid for Strain:
• Apply cold compress at once.
• Elevate the limb to reduce swelling.
• Rest the affected part for 24 hours.
• Get medical help

SPRAIN
Puncture Avulsion • It is caused by torn fibers of the ligament.
• S/S: Swelling, bruising
DANGERS OF SOFT TISSUE INJURIES
• Hemorrhage First Aid For Sprain:
• Infection • Apply cold compress at once.
• Shock • Elevate the affected joint
• Physician May Recommend Anti-inflammatory
KINDS OF BLEEDING
1. Arterial DISLOCATION
2. Venous • It is the displacement of a bone from its normal
3. Capillary position at the joint.
• S/S: Pain, Misshapen appearance, Swelling, Loss
FIRST AID MANAGEMENT FOR CLOSED of function
WOUND:
• I – Ice application FRACTURE
• C – Compression • It is a break or disruption in the normal
• E – Elevation continuity of the bone tissue.
• S – Splinting
First Aid for Dislocation Fracture:
• Check the Victim’s Airway, Breathing And
FIRST AID MANAGEMENT FOR OPEN WOUND: Circulation (ABC).
• C – Control bleeding • Prevent infection by covering with sterile
• C – Cover the wound dressing before immobilizing.
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 • Splint or sling the injury in the position, which
you found it.
• Prevent shock
• Get medical help

BANDAGING TECHNIQUE
Photo by Military Medicine
• S – Speed, Snugly Fit
• C – Clean and carefully applied
Triangular Head Bandage
• A – Accurate
• N – Neat
• E – Ends with a square knot.

USE OF TRIANGULAR BANDAGE

OPEN PHASE
• Head (topside)
• Chest; back of chest
• Face; back of the head Photo by Military Medicine

• Arm Sling Triangular Chest Bandage

• Underarm Sling
• Hand/ foot

Head (topside) Chest; back of chest

Photo by Military Medicine

Triangular Arm Sling

Face; back of the head Arm Sling

Photo by Military Medicine

Triangular Foot Bandage

Hand

Underarm Sling

Foot
Photo by Military Medicine
Triangular Hand Bandage

NUR 1221 – EDN TEAM 2022-2023|57

 CRAVAT PHASE • Danger of electrocution
Broad Cravat: • Danger of collapsing walls
• Abdominal Binder - indicated for abdominal
evisceration METHODS OF RESCUE
• Knee bandage • For immediate rescue without assistance, drag or
pull the victim in the direction of the long axis of
his body preferably from shoulder.
• Most of the one-man drags/carries other transfer
methods can be used as methods of rescue.

Photo by Military Medicine
Knee Bandage
Narrow Cravat:
• Forehead; eye
• Ear; cheek; jaw
• Arm; leg
• Elbow; (straight or bent)
• Palm pressure (close)
• Palm bandage (open)
• Shoe on, shoe off
Photo by Military Medicine
Forehead-Eye Cravat
Photo by Military Medicine
Ear-Cheek-Jaw Cravat
Photo by Military Medicine
Leg Cravat
TRANSFER
• Transfer is moving a patient from one place to
another after giving first aid.
SELECTION OF TRANSFER METHOD DEPENDS
ON:
• Nature and severity of Injury
• Size of victim
• Physical capabilities of first aider
• No. of personnel and equipment available
• Nature of evacuation route
• Distance to be covered
• Gender of the victim (last consideration)
POINTERS TO BE OBSERVED DURING
TRANSFER
1. Victim's airway must be maintained open
2. Hemorrhage is controlled.
3. Victim is safely maintained in the correct
position.
4. Regular check of the victim's condition is made.
5. Supporting bandages and dressing remain
effectively applied.
6. The method of transfer is safe, comfortable and
speedy as circumstances permit.
7. The victim's body is moved as one unit
8. The taller the first aider stays at the head side of
the victim.
9. First Aiders must observed ergonomics in lifting
and moving of patient
Photo by Military Medicine
Elbow Cravat METHODS OF TRANSFER
ONE MAN CARRIES/ DRAGS
• Assist to walk
• Carry in arms
• Pack strap carry
• Fireman’s carry
• Fireman’s drag
• Blanket drag
Photo by Military Medicine
• Armpit / shoulder drag
Palm Cravat (Open)

EMERGENCY RESCUE
• Emergency rescue is the rapid movement of
patients from safe place to a place of safety.

INDICATIONS
• Danger of fire or explosion
• Danger of toxic gases or asphyxia due to lack of
oxygen. Photo by Wiki How Photo by Medical Training

• Serious traffic hazards Assist to walk Carry in Arms

• Risk of drowning
NUR 1221 – EDN TEAM 2022-2023|58
 Photo by Wiki How Fireman’s Carry with
Carry by extremities Assistance
Photo by CERT LA Photo by CERT LA
Lover’s Carry Pack Strap Carry THREE MAN CARRIES
• Bearers alongside
• Hammock carry

Photo by CERT LA Photo by CERT LA

Fireman’s Carry Fireman’s Drag

Photo by Anesthesia Key Photo by CERT LA

Photo by CERT LA Photo by CERT LA
Blanket Drag Armpit/ Shoulder Drag
Bearers Alongside Hammock Carry
TWO MAN ASSIST/CARRIES
FOUR/SIX/EIGHT MAN CARRY
• Assist to walk (two man)
• Four-hand-seat
• Hand as a litter
à à
• Chair as a litter
• Carry by extremities
• Fireman’s carry with assistance

Photo by Wiki How Photo by CERT LA

Assist to Walk (two man) Chair as litter

Photos by Wiki How

Four-Hand-Seat

Photos by Wiki How

Hand as a litter
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