D – DESTRUCTION
PLANNERS TO IMPLEMENT EVACUATION AND
I - INCIDENTS
S – SUFFERINGS
A – ADMINISTRATIVE, FINANTIAL FAILURES
S – SENTIMENTS
T – TRAGEDIES
E – ERUPTION OF COMMUNICABLE DISEASES
R – RESEARCH PROGRAM AND ITS
IMPLEMENTATION
DISASTER
AS ANY OCCURRENCE THAT CAUSES DAMAGE
ECOLOGICAL DISRUPTION, LOSS OF HUMAN
LIFE, DETERIOTATION OF HEALTH AND HEALTH
SERVICES.
IS AN OCCURRENCE, EITHER NATURAL OR
MANMADE THAT CAUSES HUMAN SUFFERING
AND CREATES HUMAN NEEDS THAT VICTIM
CANNOT ALLEVIATE WITHOUT ASSISTANCE. THE
AMERICAN RED CROSS
ARE NOT CONFINED TO A PARTICULAR PART OF
THE WORLD; THEY CAN OCCUR ANYWHERE
AND ANYTIME
HAZARDS
PRESENT THE POSSIBILITY OF THE OCCURRENCE
OF A DISASTER CAUSED BY NATURAL
PHENOMENA (HURRICANE, EARTHQUAKE),
FAILURE OF MANMADE SOURCES OF ENERGY
(NUCLEAR POWER PLANT), OR BY HUMAN
ACTIVITY (WAR)
DISASTERS ARE FREQUENTLY CATEGORIZED
BASED ON THEIR ONSET, IMPACT, AND
DURATION. FOR EXAMPLE, EARTHQUAKES AND
TORNADOES ARE RAPID ONSET EVENTS SHORT
DURATIONS BUT WITH A SUDDEN IMPACT ON
COMMUNITIES, HURRICANES AND VOLCANIC
ERUPTIONS HAVE A SUDDEN IMPACT ON A
COMMUNITY; HOWEVER, FREQUENTLY
ADVANCE WARNINGS ARE ISSUED ENABLING
EARLY RESPONSE PLANS. A BIOTERRORISM
ATTACK MAY BE SUDDEN AND UNANTICIPATED
AND HAVE A SUDDEN AND PROLONGED
IMPACT ON A COMMUNITY.
FACTORS THAT INFLUENCE THE IMPACT OF A
DISASTER ON A COMMUNITY:
 NATURE OF THE EVENT
 TIME OF DAY OR YEAR
 HEALTH AND AGE CHARACTERISTICS OF
THE POPULATION AFFECTED
 THE AVAILABILITY OF RESOURSES
 LOCATION
TYPES OF DISASTER
NATURAL DISASTER – RESULT OF AN
ECOLOGICAL DISRUPTION OR THREAT THAT
EXCEEDS THE ADJUSTMENT CAPACITY OF THE
AFFECTED COMMUNITY.
 TORNADOS, HAILSTORM, TSUNAMI,
EARTHQUAKE, FLOODS,
COMMUNICABLE DISEASE,
HURRICANES, BLIZZARDS, VOLCANIC
ERUPTION, ETC.
MANMADE DISASTER – ARE THOSE IN WHICH
THE PRINCIPAL DIRECT CAUSES ARE
IDENTIFIABLE HUMAN ACTIONS, DELIBERATE
OR OTHERWISE
 FIRE, EXPLOSIONS, TOXIC MATERIALS,
POLLUTION, TERRORIST ATTACK,
TRANSPORTATION ACCIDENTS,
CONVENTIONAL WAR, ETC.
CATEGORIES OF HUMAN GENERATED DISASTER
COMPLEX EMERGENCIES – INVOLVE
SITUATIONS WHERE POPULATIONS SUFFER
SIGNIFICANT CASUALTIES AS A RESULT OF WAR,
CIVIL STRIFE OR OTHER POLITICAL CONFLICT.
TECHNOLOGIC DISASTER – LARGE NUMBERS OF
PEOPLE, PROPERTY, COMMUNITY
INFRASTRUCTURE, AND ECONOMIC WELFARE
ARE DIRECTLY AND ADVERSELY AFFECTED BY
MAJOR INDUSTRIAL ACCIDENTS: EX.
UNPLANNED RELEASE OF NUCLEAR ENERGY,
AND FIRES OR EXPLOSIONS FROM HAZARDOUS
SUBSTANCES SUCH AS FUEL, CHEMICALS OR
NUCLEAR MATERIALS.
SYNERGISTIC DISASTER – A NATURAL DISASTER,
OR PHENOMENON, MAY TRIGGER A
SECONDARY DISASTER, THE RESULT OF
WEAKNESS IN THE HUMAN ENVIRONMENT.
AND EXAMPLE OF THIS IS A CHEMICAL PLANT
EXPLOSION FOLLOWING AN EARTHQUAKE.
PHASES OF DISASTER
PRE-IMPACT PHASE
IT IS THE INITIAL PHASE OF DISASTER, PRIOR TO
THE ACTUAL OCCURRENCE. A WARNING IS
GIVEN AT THE SIGN OF THE FIRST POSSIBLE
DANGER TO A COMMUNITY WITH THE AID OF
WEATHER NETWORKS AND SATELLITE MANY
METEOROLOGICAL DISASTERS CAN BE
PREDICTED.
THE ROLE OF A NURSE DURING THIS WARNING
PHASE IS TO ASSIST IN PREPARING SHELTERS
AND EMERGENCY AID STATION AND
ESTABLIHING CONTACT WITH OTHER
EMERGENCY SERVICE GROUP.
RESPONSIBLE FOR PSYCHOLOGICAL SUPPORT
TO VICTIMS IN THE SHELTERS
POST IMPACT PHASE
RECOVER BEGINS DURING THE EMERGENCY
PHASE ENDS WITH THE RETURN OF NORMAL
COMMUNIT ORDER AND FUNCTIONING. THE
VICTIMS OF DISASTER IN GO THROUGH FOUR
STAGES OF EMOTIONAL RESPONSE:
1. DENIAL – DURING THE STAGE, THE
VICTIMS MAY DENY THE MAGNITUDE
OF THE PROBLEM OR HAVING NOT
FULLY REGISTERED.
2. STRONG EMOTIONAL RESPONSE – THE
PERSON IS AWARE THE PROBLEM BUT
REGARDS IT AS OVERWHELMING AND
UNBEARABLE.
3. ACCEPTANCE – THE VICTIM BEGINS TO
ACCEPT THE PROBLEMS CAUSED BY THE
DISASTER AND MAKES A
CONCENTRATED EFFECT TO SOLVE
THEM
4. RECOVER – RESPRESENT A RECOVERY
FROM THE CRISIS REACTION. VICTIM
FEELS THAT THE ARE BACK TO NORMAL.

IMPACT PHASE

OCCURS WHEN THE DISASTER ACTUALLY

HAPPENS. IT IS TIME OF ENDURING HARDSHIP
OR INJURY END OF TRYING TO SURVIVE.

THIS IS THE TIME WHEN THE EMERGENCY

OPERATION CENTER IS ESTABLISHED AND PUT
IN OPERATION. IT SERVES AS THE CENTER FOR
COMMUNICATION AND OTHER GOVERNMNET
AGENCIES OF HEALTH TEAMS CARE HEALTH
CARE PROVIDERS TO STALLF SHELTER. EVERY
SHELTER HAS A NURSE AS A MEMBER OF
DISASTER ACTION TEAM. THE NURSE IS
FIVE BASIC PHASES OF DISASTER
MANAGEMENT PROGRAM
PREPAREDNESS
REFERS TO THE PROACTIVE PLANNING EFFORTS
DESIGNED TO STRUCTURE THE DISASTER
RESPONSE PRIOR TO ITS OCCURRENCE
DISASTER PLANNING ENCOMPASSES
EVALUATION POTENTIAL VULNERABILITIES
(ASSESSMENT OF RISK) AND THE PROPENSITY
FOR A DISASTER TO OCCUR. WARNING
(FORECASTING) REFERS TO MONITORING
EVENTS TO LOOK FOR INIDCATIORS THAT
PREDICT THE LOCATION, TIMINGM AND
MAGNITUDE OF FUTURE DISASTERS.
ACTIVITIES PRIOR TO DISASTER
 IT IS AN ON-GOING MULTI SECTORAL
ACTIVITY.
 EXAMPLE: PREPAREDNESS PLANS
 EMERGENCY EXERCISES
 TRAINING
 WARNING SYMPTOMS
MITIGATION
IT INCLUDES MEASURES TAKEN TO REDUCE THE
HARMFUL EFFECTS OF A DISASTER BY
ATTEMPTING TO LIMIT ITS IMPACT ON HUMAN
HEALTH, COMMUNITY FUNCTION, AND
ECONOMIC INFRASTRUCTURE.
THESE ARE ALL STEPS THAT ARE TAKEN TO
LESSEN THE IMPACT OF A DISASTER SHOULD
ONE OCCUR AND CAN BE CONSIDERED AS
PREVENTION MEASURES.
PREVENTION REFERS TO A BROAD RANGE OF
ACTIVITIES, SUCH AS ATTEMPTS TO PREVENT A
DISASTER FROM OCCURING AND ANY ACTIONS
TAKEN TO PREVENT FURTHER DISEASE,
DISABILITY, OR LOSS OF LIFE.
MITIGATION USUALLY REQUIRES A SIGNIFICANT
AMOUNT OF FORETHOUGHT, PLANNING, AND
IMPLEMENTATION OF MEASURES BEFORE THE
INCIDENTS OCCURS.
ACTIVITIES THAT REDUCE THE EFFECTS OF
DISASTER
 EX: IMPROVED BUILDING CODES
 REDUCTION AND PROTECTION OF
VULNERABLE POPULATION
 PUBLIC EDUCATION
 FLOOD MITIGATION WORKS
RESPONSE
IS THE ACTUAL IMPLEMENTATION OF THE
DISASTER PLAN
DISASTER RESPONSE, OR EMERGENCY
MANAGEMENT, IS THE ORGANIZATION OF
ACTIVITIES USED TO ADDRESS THE EVENT.
FOCUSES PRIMARILY ON EMERGENCY RELIEF,
SAVING LIVES, PROVIDING FIRST AID,
MINIMIZING AND RESTORING DAMAGED
SYSTEMS, SUCH AS COMMUNICATIONS AND
TRANSPORTATION, AND PROVIDING CARE AND
BASIC LIFE REQUIREMENTS TO VICTIMS.
 ACTIVITIES DURING A DISASTER
 EX. SEARCH, RESCUER AND FIRST AID
 THE MOST COMMON IMMEDIATE
HELPS COMES FROM THE UNINJURED
PERSONS.
FIELD CARE
 MOST INJURED PERSON CONVERGE
SPONTANEOUSLY TO HEALTH
FACILITIES.
 BED AVAILABILITY AND SURGICAL
SERVISES SHOULD BE MAXIMIZED.
 PROVISION MAKES FOR FOOD AND
SHELTER
TRIAGE
IS A RAPIDLY CLASSIFYING THE INJURED ON THE
BASIS OF THEIR INJURIES
IS THE ONLY APPROACH THAT CAN PROVIDE
MAXIMUM BENEFIRST TO THE GREATEST
NUMBER OF INJURED IN A MAJOR DISASTER
SITUATION
TO SORT PATIENTS IN GROUPS BASED ON THE
SEVERITY OF THEIR HEALTH PROBLEM AND THE
IMMEDIACY WITH WHICH THESE PROBLEMS
MUST BE ADDRESSED
EMERGENT
PATIENTS HAVE T HE HIGHEST PRIORITY
WITH LIFE-THREATENING CONDITION
URGENT
PATIENTS WITH SERIOUS HEALTH PROBLEMS
NOT LIFE-THREATENING, MUST BE SEEN IN 1
HOUR
NON-URGENT
EPISODIC ILLNESS THAT CAN BE ADRRESED
WITIN 24 HOURS
AND PERSONNEL TO CARRY OUR PATIENT CARE
ARE CONCENTRATED.
ACTIVITIES CARRIED OUT IN THIS ZONE
INCLUDES:
 ASSESSMENT OF EACH PATIENT
 TREATMENT OF INJURIES
 PREPARATION FOR TRANSPORT
IT SHOULD BE SITUATED DIRECTLY NEXT TO THE
TREATMENT ZONE SO THAT AMBULANCES AND
OTHER VEHICLES CAN LOAD PATIENT AND
LEAVE FOR HOSPITAL, DELIVERING
APPROPRIATE PATIENT CARE.

COLOR CODING SYSTEM TRIAGE MUST BE EQUIPPED WITH THE

FOLLOWING:
RED - INDICATED HIGH PRIORITY TREATMENT
AND TRANSPORT (CHEST WOUNDS, SHOCKS, • WHEELCHAIR
OPEN FRACTURES, 2-3 BURNS)
• STRETCHER
YELLOW – MEDIUM PRIORITY (STABLE
• BACKBOARDS
ABDOMINAL WOUND, EYE AND CNS INJURIES)
• IV POLES
GREEN – AMBULATORY PATIENTS MINIMAL
BURNS, MINOR FRACTURES, MINOR BLEEDING) • SPLINTS, BANDAGES

BLACK – DEAD PATIENTS • EMESIS KIDNEY) BASIN

ORGANIZING AN EFFECTIVE DISASTER SYSTEM • DISASTER TAGS

THE NURSE/HEALTHCARE PROVIDER MUST BE • PENS

FAMILIAR WITH THE PERSONNEL AT THE
• ADHESIVE TAPES
DISASTER SCENE AND THEIR ROLES AND
FUNCTIONS. A DISASTER SCENE IS USUALLY • ORAL AIRWAY
BROKEN UP INTO THREE ZONES
• SCISSORS
DISASTER ZONE
• BLANKET
IT IS THE ACTUAL LOCATION OF THE INCIDENT
FROM WHERE PATIENT IS TO BE REMOVED AS • STETHOSCOPE
SOON AS POSSIBLE. • EMERGENCY TROLLEY WITH
MAJORITY OF DISASTER PERSONNEL ARE SENT EQUIPMENT AND MEDICATIONS
TO THIS ZONE INITIALLY

TRANSPORT ZONE

NURSES SPEND MOST OF THEIR TIME IN THEIR

ZONE DURING A DISASTER, WHERE EQUIPMENT
RECOVERY
FOCUS ON STABILIZING AND RETURNING THE
COMMUNITY (OR AN ORGANIZATION) TO
NORMAL (ITS PREIMPACT STATUS). THIS CAN
RANGE FROM REBUILDING DAMAGED
BUILDINGS AND REPAIRING INFRASTRUCTURE,
TO RELOCATING POPULATIONS AND
INSTITUTING MENTAL HEALTH INTERVENTIONS.
REHABILITATION AND RECONSTRUCTION
INVOLVE NUMBEROUS ACTIVITIES TO COUNTER
THE LONG-TERM EFFECTS OF THE DISASTER ON
THE COMMUNITY AND FUTURE DEVELOPMENT.
ACTIVITIES FOLLOWING A DISASTER
EX. PROVISION OF SUPPLY
 TRANSPORTATION
 STORAGE
 VACCINATION
 NUTRITION
 TEMPORATY HOUSEING
 LONG MEDICAL CARE
 COUNSELLING
EVALUATION
IS THE PHASE OF DISASTER PLANNING AND
RESPONSE THAT OFTEN RECEIVES THE LEAST
ATTENTION. AFTER A DISASTER IT IS ESSENTIAL
THAT EVALUATIONS BE CONDUCTED TO
DETERMINES WHAT WORKED, WHAT DID NOT
WORK, AND WHAT SPECIFIC PROBLEMS, ISSUE,
AND CHALLENGES WERE IDENTIFIED.
FUTURE DISASTER PLANNING NEEDS TO BE
BASED ON EMPIRICAL EVIDENCE DERIVED
FROM THE PREVIOUS DISASTERS
MEDICAL DISASTER
IS A CATASTROPHIC EVENT THAT RESULTS IN
CASUALTIES THAT OVERWHELM THE HEALTH
CARE RESOURCES IN THAT COMMUNITY
HEALTH EFFECTS OF DISASTERS
MAY CAUSE PREMATURE DEASTHS, ILLNESSES,
AND INJURIES IN THE AFFECTED COMMUNITY
MAY DESTROY THE LOCAL HEALTH CARE
INFRASTUCTURE, WHICH WILL THEREFORE BE
UNABLE TO RESPOND TO THE EMERGENCY
MAY CREATE ENVIRONMENTAL IMBALANCES,
INCREASING THE RISK OF COMMUNICABLE
DISEASES AND ENVIRONMENTAL HAZARDS.
MAY AFFECT THE PSYCHOLOGICAL,
EMOTIONAL, AND SOCIAL WELL-BEING OF THE
POPULATION IN THE AFFECTED COMMUNITY
MAY CAUSE SHORTAGES OF FOOD AND CAUSE
SEVERE NUTRITIONAL DEFICIENCIES
MAY CAUSE LARGE POPULATION MOVEMENTS
(REFUGEES) CREATING A BURDEN ON OTHER
HEALTH CARE SYSTEMS AND COMMUNITES.
HOSPITALS AND OTHER HEALTH CARE
FACILITIES MAY FURTHER CLASSIFY DISASTERS
AS EITHER “INTERNAL” OR “EXTERNAL”
EXTERNAL DISASTERS ARE THOSE THAT DO
NOT AFFECT THE HOSPITAL INFRASTUCTURE
BUT DO TAX HOSPITAL RESOURCES DUE TO
NUMBERS OF PATIENTS OR TYPES OF INJURIES
INTERNAL DISASTERS CAUSES DISRUPTION OF
NORMAL HOSPITAL FUNCTION DUE TO INJURIES
OR DEATHS OF HOSPITAL PERSONNEL OR
DAMAGE TO THE PHYSICAL PLANT, AS WITH A
HOSPITAL FIRE, POWER FAILURE, OR CHEMICAL
SPILL
DISASTER NURSING
DEFINE AS AN ADAPTATION OF PROFESSIONAL
NURSING SKILLS IN RECOGNIZING AND
MEETING THE NURSING PHYSICAL AND
EMOTIONAL NEEDS RESULTING FROM THE
DISASTER.
GOALS OF DISASTER NURSING
1. TO MEET THE IMMEDIATE BASIC
SURVIVAL NEEDS OF POPPULATIONS
AFFECTED BY DISASTER
2. TO IDENTIFY THE POTENTIAL FOR A
SECONDARY DISASTER
3. TO APPRAISE BOTH RISKS AND
RESOURCES IN THE ENVIRONMENT
4. TO CORRECT INEQUALITIES IN ACCESS
TO HEALTH CARE OR APPOPRIATE
RESOURCES.
5. TO EMPOWER SURVIVORS TO
PARTICITATE IN AND ADVOCATE FOR
THEIR OWN HEALTH AND WELL-BEING
6. TO RESPECT CULTURAL, LINGUAL,
RELIGIOUS DIVERSITY IN INDIVIDUALS
AND FAMIILIES AND TO APPLY THIS
PRINCIPLE IN ALL HEALTH PROMOTIONS
ACTIVITIES.
7. TO PROMOTE THE HIGHEST
ACHIEVABLE QUALITY OF LIFE FOR
SURVIVOR.
PRINCIPLE OF DISASTER NURSING
 RAPID ASSESSMENT OF THE SITUATION
AND OF NURSING CARE NEEDS
 TRIAGE AND INITATION OF LIFE SAVING
MEASURE FIRST
 THE SELECTED USE OF ESSENTIAL
NURSING INTERVENTIONS AND THE
ELIMINATION OF NONESSENTIAL
NURSING ACTIVITIES
 EVALUATION OF THE ENVIRONMENT
AND THE MITIGATION OR REMOVAL OF
ANY HEALTH HAZARDS.
 PREVENTION OF FURTHER INJURY AND
ILLNESS.
 LEADERSHIP IN COORINATING PATIENT
TRIAGE, CARE AND TRANSPORT DURING
TIMES OF CRISIS.
 THE TEACHING, SUPERVISION, AND
UTILIZATION OF AUXILIARY MEDICAL
PRESONNEL AND VOLUNTEERS.
 PROVISION OF UNDERSTANDING,
COMPASSION AND EMOTIONAL
SUPPORT TO ALL VICTIMS AND THEIR
FAMILIES.
ROLES OF NURSES IN DISASTER
1. DEFINE HEALTH NEEDS OF THE
AFFECTED GROUPS.
2. ESTABLISH PRIORITIES AND OBJECTIVES
3. IDENTIFY ACTUAL AND POTENTIAL
PUBLIC HEALTH PROBLEMS
4. DETERMINE RESOURCES NEEDED TO
RESPOND TO THE NEEDS IDENTIFIED
5. COLLABORATE WITH OTHER
PROFESSIONAL DISCIPLINES,
GOVERNMENT AND NON-
GOVERNMENT AGENCIES.
6. MAINTAIN A UNIFIED CHAIN OF
COMMAND.DIAGNOSE COMMUNITY
DISASTER THREATS
THE NURSING ROLE IN DISASTER
MANAGEMENT
ASSESS THE COMMUNITY
 IS THERE A CURRENT COMMUNITY
DISASTER PLAN IN PLACE?
 PREVIOUS DISASTER EXPERIENCE?
 HOW IS THE LOCAL TERRAIN
CONDUCTIVE TO DISASTER FORMATION
(HURRICANES, TORNADOS, BLIZZARDS)
 WHAT IS LOCAL INDUSTRY?
 WHAT PERSONNEL ARE AVAILABLE FOR
DISASTER INTERVENTION? (NURSES,
DOCTORS)
 WHAT ARE LOCAL AGENCIES AND
ORGANIZATION? (HOSPITAL,
SCHOOL, RED CROSS)
DIAGNOSE COMMUNITY DISASTER THREATS
 DETERMINE ACTUAL AND POTENTIAL
DISASTER THREATS (TOXIC WASTE,
EXPLOSIONS, ROAD ACCIDENT,
 HURRICANES, TORNADOS, FLOODS AND
EARTHQUAKES)

COMMUNITY DISASTER PLANNING

 DEVELOP A DISASTER PLAN TO

PREVENT OR DEAL WITH IDENTIFIED
DISASTER THREATS.
 IDENTIFY A LOCAL COMMUNITY
COMMUNICABLE SYSTEM.
 SET UP OF AN EMERGENCY MEDICAL
SYSTEM AND CHAIN FOR ACTIVATION.

IMPLEMENT DISASTER PLAN

 FOCUS ON PRIMARY PREVENTION

ACTIVITIES TO PREVENT OCCURRENCE
OF MAN-MADE DISASTER.
 PRACTICE USING EQUIPMENT’S,
OBTAINING AND DISTRIBUTING
SUPPLIES.

EVALUATE EFFECTIVENESS OF DISASTER PLAN

 CRITICALLY EVALUATE ALL ASPECTS OF

DISASTER PLAN AND PRACTICAL DRILLS
FOR SPEED, EFFECTIVENESS, GAPS AND
REVISION.
 EVALUATE THE DISASTER IMPACT ON
COMMUNITY AND SURROUNDING
REGIONS.
 EVALUATE RESPONSE OF PERSONNEL
INVOLVED IN DISASTER RELIEF EFFORTS.