Disaster Nursing | NCM 0120
MODULE 5 TERM
Documentation in Disaster Management
“If it’s not documented, it might as well not exist.”
Documentation plays a crucial role in the times of disasters.
Proper documentation can help the team to recall the important details
or events during all stages of disasters. Disaster or emergency
management documentation can take place in many forms. Some
communities or organizations use hand held devices to record on-site
field emergency observations, while others depend on a central
emergency operations center or a surveillance logbook. Regardless of the
communication method, vital information must be documented as
soon as practical during or immediately after an incident. Remember, the
recording of details of plans and evaluation of programs before, during
and after disasters will help in improving the vulnerability and resilience
of the communities.
DISASTER AND RISK MANAGEMENT
PLAN (INCIDENT RESPONSE TEAM)
A disaster and risk management plan is a preventative
plan tailored to reduce the harmful effects of a risk or disaster in an
organization or community. One of the significant concerns is
identification of the point persons who will be responsible for doing a
specific task in an emergency. In this lesson, we will stress on the
importance of organizing an Incident Response Team which is an
essential element of a disaster management plan and properly
documenting plans and interventions for an incident.
DEFINITION OF TERMS
Critical incident refers to a sudden, unexpected occurrence that
puts a person’s or community’s safety at risk. This term is often
used interchangeably with RISK, HAZARD and ISSUE (depending on
the organization).
DEFINITION
Potential (or likelihood) for something bad to happen.
Risk
High or low
A situation which resulted due to lack or inappropriate
Issue
mitigation efforts to limit a given risk.
An object or situation that has the potential to harm a
Hazard
person, the environment or cause damage to property.
Any unplanned event resulting in, or having a potential
Incident
for injury, ill health, damage or other loss.
OTHER IMPORTANT TERMS
An action taken to control the risk and reduce the
Corrective
likelihood and/or severity of injury or illness following
action
an incident occurring or a hazard present.
Any physical or mental damage to the body caused by
Injury
exposure to a hazard.
An incident that could have resulted in an injury or
Near miss illness to people, danger to health, and / or damage to
property or the environment.
An incident for which you are legally required to notify
Notifiable
the concerned agency/office; Incidents involving injury
incident
(in office or on property of the agency).
EXAMPLE: Fire Injury due to lack of protective mechanism on a
certain company in which the company is aware of.
Issue: Lack or inappropriate mitigation effort from the company.
Incident/Disaster: Injury that occurred to the employee which is said
to be notifiable as it involves injury in the workplace.
EXAMPLES OF NOTIFIABLE INCIDENTS
§ Vehicular accidents
§ Biohazard accidents
§ Use of seclusion or restraint
§ Abuse (alleged abuse by staff)
§ Neglect (alleged neglect by staff)
§ Sexual assault
§ Medication errors (if staff are involved)
§ Communicable disease (primary ® HCP reports to agency)
§ Aggression or violence
§ Use and unauthorized possession of weapons
G.M.M.E. | A.J.E.F. | T.A.M.M. – MARILAG
§ Unauthorized use/ possession of substances
§ Suicide or attempted suicide
§ Wandering or elopement from agency activity
Incident Response Team
• An incident response team, also known as neighbourhood
emergency response team (NERT), is a group of people
who prepare for (KSA) and respond to any emergency incident,
such as a natural disaster or an interruption of usual
operations.
• This team is often composed of specific members designated
before an incident occurs, although under certain

circumstances the team may be an ad hoc group of willing
volunteers.
• Members of an incident response team should ideally be
trained and prepared to perform the tasks required by the
specific situation (i.e., how to perform CPR, ambulate, or
transport patient, etc.).
• As the size of an incident grows, and as more resources are
drawn into the event, the command of the situation may shift
through several phases.
• Ideally, the team has already created a process or set of
measures (PROTOCOL) to follow in order to limit the
incident's negative effects. Moreover, the members of the
team are usually skilled to train the members of the
community or organization on disaster preparedness for the
hazards that may impact their area e.g., basic disaster response
skills, such as fire safety, light search and rescue, team
organization, and disaster medical operations.
• Tasks and Protocols should be properly documented. =
document including the members of the response team,
specific responsibilities and tasks of specific member,
algorithm or set of actions in which this team should follow in
responding to an emergency ® beneficial to team (ensures
efficiency and speed), as well as to victims
BASIC COMPOSITION OF THE INCIDENT RESPONSE TEAM
1) NERT Leader/IRT leader
• Generally, the first NERT team member arriving on the
scene becomes team leader, and is the designated
Incident Commander (IC) until the arrival of someone
more competent. = head of the team
• Makes the initial assessment of the scene and determines
the appropriate course of action for team members.
• Assumes role of Safety Officer until assigned to another
team member.
• Assigns team member roles if not already assigned.
• Designates triage area, treatment area, morgue, and
vehicle traffic routes.
• Coordinates and directs team operations.
• Determines logistical needs (water, food, medical
supplies, transportation, equipment, and so on).
• Determines ways to meet those needs through team
members or citizen volunteers on the scene.
• Collects and writes reports on the operation and
victims. ® does the final report
• Communicates and coordinates with the incident
commander, local authorities, and other NERT team
leaders.
2) Safety Officer
• Checks team members prior to deployment to ensure
they are safe and equipped for the operation. = reminds
everyone that safety is important
Disaster Nursing | NCM 0120
• Determines safe or unsafe working environments.
• Ensures team accountability.
• Supervises operations (when possible) where team
members and victims are at direct physical risk.
• Alerts team members when unsafe conditions arise. (i.e.,
tsunami alert)
3) Fire Suppression Team
• Work under the supervision of the Team Leader to
suppress small fires in designated work areas or as
needed.
• When not accomplishing their primary mission, assist the
search and rescue team or triage team.
• Assist in evacuation and transport as needed.
• Assist in the triage or treatment area as needed, other
duties as assigned; communicate with Team Leader.
4) Search and Rescue Team
• Work under the supervision of the Team Leader,
searching for and providing rescue of victims as is
prudent under the conditions.
• When not accomplishing their primary mission, assist the
Fire Suppression Team.
• Assist in the triage or treatment area as needed; other
duties as assigned; communicate with Team Leader.
5) Medical Triage Team
• Work under the supervision of the Team Leader,
providing START triage for victims found at the scene.
• Marking victims with category of injury per the standard
operating procedures. = emergent, urgent, non-urgent
• When not accomplishing their primary mission, assist the
Fire Suppression Team if needed, assist the Search and
Rescue Team if needed, / assist in the Treatment Area if
needed, other duties as assigned; communicate with
Team Leader.
6) Medical Treatment Team
• Work under the supervision of the Team Leader,
providing medical treatment to victims within the scope
of their training.
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• This task is normally accomplished in the Treatment Area;
however, it may take place in the affected area as well.
• When not accomplishing their primary mission, assist the
Fire Suppression Team as needed, assist the Medical
Triage Team as needed; other duties as assigned;
communicate with the Team Leader.
7) Community Relations for Public Information Officer
• Assembles information which can be given to media.
• Releases information only as directed or approved.
• Provides local information to neighbourhood residents.
• Escorts news media if in staging area.
 Disaster Nursing | NCM 0120

8) Staging Area Gatekeeper • Prioritization:

• Unofficial role used to control and direct access to the “L” = Life (people)
staging area. *priority
• May function as de facto security. “I” = Incident Stabilization
• Directs people to appropriate section. *to avoid further aggravation of hazard
o people reporting incidents: to PLANS; may “P” = Property (potential)
request additional details *potential loss of property
o people volunteering donate equipment or “R” = Routine
supplies *disruption of routine
o representatives from responding agencies
7) Plan things
o people needing assistance
• Plan to focus your team response in chaos.
• Document plans and protocols.
BASIC PRINCIPLES
• Sets priorities and directs the response.
Lifted from Fire Operations Guide of San Francisco Fire department, October 2019
• Assigns responsibility and monitors task completion.
1) Single Point Command
• Reflects changing conditions (update during event).
• Someone is in charge at each level; each member reports
to only 1 supervisor = 1 leader who gives instruction to
Task Force Response Plan Outline
avoid confusion and duplication of tasks
1. Collect and assess information before acting to the whole
2) Manageable span of Control response. Develop a strategy to respond to conditions.
• Each team should be given a manageable span of control. o address incidents by priority (LIPR)
Team should have adequate number of members. = 1 o response shall be within the scope of NERT training
function only (own task in which span is manageable) o plan is based on available resources
3) Modular organization o be aware that the response could last for days
• At its smallest, every incident has a command function – 2. Determine the resources needed based on actual incidents and
someone is in charge! current information.
• As the incident warrants and resources are available, the 3. List personnel assignments at each level.
Task Force Leader can expand the organizational structure 4. Keep a map in Planning of the neighborhood noting activity.
by delegating responsibility for other functional 5. Communications plan.
components. = leader assist a certain person to do a o determine who authorizes messages; the means for
certain task (i.e., fire team helping other teams) getting information
6. Weather.
4) Common terminology o plan for conditions that may affect response
• Avoid using codes and obscure acronyms. = use terms 7. Create Safety messages for team members.
which are universally acceptable and known to the whole 8. Set objectives, timeline… (SMART)
team to avoid confusion among the members 9. Disseminate Plan.
5) Integrated communication
• Communications networks are structured so that multiple 8) Decision-making
groups and agencies can send messages to one another. • Consensus is considered, but the leader has final

G.M.M.E. | A.J.E.F. | T.A.M.M. – MARILAG

= leader should know to whom he/she should decision. Chain of command is in effect during a
communicate response.
• Communications networks are structured like the overall • All participants must understand decisions made and
organization. agree to support them.
• Networks are separated to avoid an overload of message • Decisions are based on the information and resources
traffic. available at the time.

6) Prioritize things 9) Create Safety messages for team members

• Incidents are ranked by priority. • List any known hazards.
• The highest priority incidents should be the first ones • Remind the team about precautions to take.
addressed.
• NERT responds based on available information and
resources.

10) Record everything
• If you didn’t write it down, it didn’t happen!
o Use NERT forms if available; any piece of paper
can become a form if you know what
information it should contain.
• Record all NERT activities as soon as possible.
• At the end of response, TFL reviews documentation.
• Don’t get hung up on forms – recording information is the
goal.
• Use anything if you don’t have forms. = forms should not
take much of the time
• Keep at least one set as a guide.
• Document: information of the incident, decisions
made, actions taken, supplies and equipment
donated or purchased, names of NERTs and accurate
time in/out, any injuries to NERT volunteers
• Do not record speculation, record only FACTS…
• ***Documentation of the plans and
responsibilities of specific members will also aid in
providing better and timely response in a critical
incident.
QUESTION: Which is/are true about the Incident Response Team leader?
a. Generally, comes last at the scene to monitor interventions…
= comes first
b. Initially, assumes role of safety officer…
c. Delegates task of writing reports on the operations and victims
= final report should be checked and written by the leader
d. Communicates to local authorities…
QUESTION: Which should be part of your document or written report?
a. Record decisions made and actions taken that are essential for
triaging = documentation serve as protection of team
members and whole organization if there are problems
b. Any injuries to the members/volunteers and victims
Disaster Nursing | NCM 0120
DOCUMENTATION OF DISASTER
MANAGEMENT RESPONSE
Documentation of an emergency incident is a critical part of an
emergency plan. Visual, audio, and written recordings should be made,
detailing each step of the emergency response in order to provide a clear
understanding of the events that occurred. Information and lessons
learned from previous incidents can be used to prepare a more functional
emergency plan for the future.
VULNERABLE GROUPS AND POPULATION GROUPS
REQUIRING SPECIAL ATTENTION
Highly Vulnerable Population
• refers to members of the community with a higher probability
of being exposed to disaster who also face barriers to
anticipate, cope with, resist or recover from the event.
• During a crisis, some people in the general population
(members of community) may be more severely affected than
others, putting them at a higher risk of bad consequences.
• It is critical, from a public health standpoint and as part of
disaster response strategy planning, to identify these groups
in advance so that their needs may be addressed within the
larger framework of post-disaster mental health response.
WHO ARE THE VULNERABLE MEMBERS?
Several agencies have identified a number of potentially
vulnerable groups that may require or benefit from specific post-disaster
interventions. Issues affecting each of these groups (accessed from
https://www.paho.org/disasters) are discussed in this chapter. These
groups are as follows:
§ People with pre-existing mental/other disorders =
physical ability and mental/psychosocial disability
§ Children and adolescents = children have
medical/physical vulnerabilities
§ Gender-based vulnerability (women) = breastfeeding
mothers, pregnant women→reality is that in certain
communities, women are given less opportunities, and less
voice to the society
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§ Older persons = fragile in their health aspect, and
vulnerable in their functionality in the community
§ Homeless persons = exposed to effects of disaster more
§ Indigenous peoples = members of ethnic minorities →
given less prioritization in healthcare delivery and accessibility
of healthcare
§ People living in temporary shelters = foster families,
taking care of certain institutions, prisons, evacuation centers
→ risk for having endemic diseases caused by lack of supply
of clean water & safe food, etc.

The documentation of the existence and needs of the highly
vulnerable members of the community will help in improving the
inclusivity of plans and appropriate allocation of resources (including the
special needs of vulnerable portion of the society). = clear
documentation of numbers of children, disabled persons, homeless →
somehow have an idea on sources that community needs to address their
special needs
MODELS FOR UNDERSTANDING VULNERABILITY
When considering highly vulnerable populations, two models
maybe used. These models, medical and functional, are derived from a
disability- focused approach. To be most effective, however, a balanced
use of both methodologies may be employed. = no model better than
the other → work side by side (complement each other)
1) Medical Model
• derived from disease, trauma or health conditions
that disrupt what is considered to be "normal"
functionality.
• This emphasized the physical, mental and social
aspects of health. = consider the wellness
• In the members of the vulnerable groups, it
may include:
o People with pre-existing mental/other
disorders
o Children and adolescent
o Older persons
2) Functional Model
• also known as Social Model
• considers the social and political environment
• In the members of the vulnerable groups, it
may include:
o Women
o Homeless = financial and lifestyle
o Indigenous = social norms and cultural
beliefs → may also be used in Medical
Model
o Living in shelters
Disaster Nursing | NCM 0120
UNDERSTANDING VULNERABILITY
SYSTEMATICALLY AS A BASIS FOR INTERVENTION
By understanding vulnerability systematically, it is also
possible to identify points of intervention. Once such approach considers
the “ecosystem” that compromises various levels from the individual to
the broader society. This includes:
Microlevel
• includes individuals, families and communities = elderly
→ age caused him to be vulnerable; gender, family
dynamics, economic status, health risk, family history
• vulnerability may result from interaction of individual’s and
family’s factors
Mesolevel
• includes organizations that operate to reduce impact of
disasters
• e.g. healthcare agencies, EMS, health care team = may be
accessible or not to certain families; very important in
reducing vulnerability
Exo-level
• focuses on policy = non-structural that affect person’s
vulnerability; laws (i.e. protects right of children during
emergencies → RA 10821: Children’s Emergency Relief
and Protection Act)
Macrolevel
• encompasses historical, cultural and geographical factors
= larger community →economic and political
environment in community
QUESTION: Who are considered the vulnerable members of the society?
a. Older persons = medical conditions
b. Homeless
c. People with pre-existing mental/other disorders = exacerbate
during disasters and have less access to medications
G.M.M.E. | A.J.E.F. | T.A.M.M. – MARILAG

Health Hazard Report
• is the documentation that is used to indicate hazards that need
to be addressed in order to avoid incidents. Properly filled
hazard report forms can aid in the prevention of accidents and
the reduction of the total recordable incident rate. = job of
company nurse
• All reports should include as much detail as possible,
such as who was involved, what happened, where and
when the event occurred, and the event's cause.
• When images and videos are available, they should be
included as well. = include interventions done upon
implication of health hazards
PROPER PROCESSING OF HAZARD REPORTS
1. Keep track of when and where the hazard was reported.
= know the details
2. Using words, photos, and notes, describe the hazard.
3. Determine the severity of the damage and the level of medical
care required.
4. Create a corrective action plan reduce the risk of hazard.
5. Implement control measures for accident prevention. = need
to be properly documented
Example
Note: It is important to document who implemented it including name
and signature, and date & time.
Disaster Nursing | NCM 0120
Casualty Report
• The original term (casualty) meant a seriously injured patient.
It was predominantly a military word, a general term for the
accidents of service: after a battle the dead, the wounded,
and the sick lumped together as “casualties”. = number of
people who were affected by the disaster → those who died,
were injured, displaced and lost their home
• The term “casual” has its origin from the workhouse “casual”
who was not one of the unemployable permanents, but the
irregular and unexpected caller who needed temporary
help.(Accessed on Ell B. Casuals and casualties. Medical
idioticon. Lancet1972;i:1113.). Various forms may be used
depending on the organization.
• Importance:
o give an idea on the magnitude of a certain
disaster/situation
o serve as guide on planning and what resources
needed on certain locality
Example (used in the army)
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MT. PINATUBO
CASUALTIES: 17 DEAD, 2 MISSING. AFFECTED POPULATION: 130,502
FAMILIES (649,265 PERSONS). EVACUATED: 4,371 FAMILIES (24,982
PERSONS). PROVINCES BATAAN, BULACAN, PAMPANGA, TARLAC, AND
ZAMBALES AFFECTED.

DISASTER RECOVERY
ACTIVITY SUMMARY
After a disaster, many significant damages can occur, including
illness, potential disease outbreaks, death, displaced populations and
crowded shelters, short and long-term psychological effects, significant
damage to buildings and other structures, and devastating financial loss.
Surveillance
• is the ongoing, systematic collection, analysis, and
interpretation of injuries, illnesses, and deaths for planning,
implementation, and evaluation of public health practice.
= not only recording but also involve analysis of gathered data
• In this lesson, you'll learn about the purpose and relevance of
surveillance, especially as it applies to preventing or
minimizing catastrophe-related injuries, illnesses, and deaths,
as well as some of the most prevalent public health disaster
surveillance difficulties.
To respond appropriately and effectively to disasters,
government and health officials must have timely and accurate
information. One way to gather such information is through disaster
surveillance. In simple terms, disaster epidemiology is the use of
epidemiology to measure the short- and long-term health effects of
disasters and to predict the consequences of future disasters.
Disaster Surveillance
• is an epidemiology tool that assesses health effects, monitors
the effectiveness of relief efforts, responds to public concerns
and media inquiries, and assists in planning for future
disasters.
• Disaster surveillance systems provide information and
feedback from the data you collect. That information and
feedback provides the basis on which interventions are
planned as well as insights into future disasters.
PURPOSES OF DISASTER SURVEILLANCE
As part of the healthcare team, you might be called on to help
answer questions, such as which problems are occurring, where and why
they are occurring, who is impacted, and what problems are causing the
most injury, illness, or death. Disaster surveillance is one method by
which you answer these questions. Here are potential objectives of a
public health disaster surveillance system:
§ Follow disease trends for early detection and control = COVID-
19 Pandemic → daily collection of data who are affected to be
aware of the increasing trend → act in a timely manner and
manage it appropriately
§ Estimate the magnitude of a health problem = determine
severity and have an idea who were injured
§ Monitor a population’s health priority health needs
= respiratory illnesses, diarrhea
Disaster Nursing | NCM 0120
§ Ensure resources are targeted to the most vulnerable
= determine who really needs it and determine which locality
needs it the most
§ Evaluate the coverage and effectiveness of program
§ Identify research needs and evaluating control strategies
= source of research topic that would help in future programs
Note: You should promptly analyze and disseminate your findings
because health and other government officials need your results to take
action. In fact, this is the primary purpose of surveillance: to provide
timely, accurate, and relevant information to drive decisions and
interventions during a disaster. = guide concerned agencies with their
interventions
SURVEILLANCE METHODS
1) Active surveillance
• Employs staff members to regularly contact heath
care providers or the population to seek information
about health conditions for a limited time period
(usually weeks or months). Those that do
surveillance will be communicating with health care
providers/health care agencies and asking for
census
• Advantage: More accurate than passive
surveillance because you are really communicating
with the concerned agencies.
• Provides the most accurate and timely information,
but is expensive.
2) Passive surveillance
• A system in which a health jurisdiction regularly
receives reports from hospitals, clinics, public
health units, or other sources.
• A relatively inexpensive strategy that can cover
large areas.
• Disadvantage: less accurate because you do not
know which data are not collected or submitted.
INDICATORS
Two indicators often define disaster-related
G.M.M.E. | A.J.E.F. | T.A.M.M. – MARILAG
surveillance: morbidity and mortality.
1) Morbidity
• refers to the state of being ill or diseased or the
incidence of illness in a population.
• Morbidity Surveillance
o Morbidity surveillance in a disaster
measures the disease state of an
individual or the incidence of illness in a
population. Disaster-related morbidity
surveillance helps you detect disease
outbreaks and track disease trends, as
well as inform decisions about action
 Disaster Nursing | NCM 0120

items, such as allocating resources, Community

targeting interventions to meet specific Health Workers)
needs, and planning for future disasters. § Burial shroud
2) Mortality distribution
• refers to incidence of death in a population. § Graveyards
• Mortality rate is the most important indicator of § Camp
serious stress affecting a displaced population (how administration
severe is the disaster’s effect). Note: During disasters, we cannot sometimes rely on these sources of
• Mortality Surveillance information because they may not be available; we have to more
o As stated, the mortality, or death rate, is resourceful on how we can acquire these data.
the most important indicator by which to
Source: https://www.cdc.gov/nceh/hsb/disaster/Facilitator_Guide.pdf
measure the effect of a disaster on a
population. Important mortality data to RATES COMMONLY USED IN PUBLIC HEALTH AND
collect include demographic EPIDEMIOLOGY
EXPRESSED
characteristics, time and location of
PER
death, and cause and manner of death. MEASURE NUMERATOR DENOMINATOR NUMBER
AT RISK
MEASURES OF MORBIDITY
SOURCES OF
SURVEILLANCE INDICATORS Incidence Number of new Population at the Variable:
INFORMATION 10n where n
Morbidity Incidence rate § Outpatient and rate cases of a specific start of the time
= 2, 3, 4, 5,
§ Number of new cases admission condition per period 6
of disease during records, shelters, given time
specified time interval refugee camp period
over summed person- clinics Attack rate Number of new Population at the Variable:
10n where n
years of observation or § Laboratories cases of a specific start of the
= 2, 3, 4, 5,
average population § Feeding condition per epidemic period 6
during time interval center(s) records epidemic period
§ Community Secondary Number of new Size of contact Variable:
Prevalence rate attack cases of a specific population at risk 10n where n
health worker = 2, 3, 4, 5,
§ Number of current period condition among
records 6
cases (new and pre- contacts of
existing/old) over a known patients
specified period of Point Number of Estimated Variable:
time/ Average or mid- prevalence current cases of a population at 10n where n
= 2, 3, 4, 5,
interval population specific condition same point in 6
Age/sex-specific at a given time time
morbidity rate Period Number of old Estimated mid- Variable:
10n where n
prevalence cases plus new interval
Proportional morbidity = 2, 3, 4, 5,
cases of a specific population 6

G.M.M.E. | A.J.E.F. | T.A.M.M. – MARILAG

rate condition
Mortality Crude mortality rate § Hospital death identified in a
registers given time
Age-specific mortality interval
§ Religious
rate MEASURES OF MORTALITY
leaders or
Cause-specific mortality centers (e.g., Crude death Total number of Estimated mid- 1,000 or
100,000
rate deaths in a given interval
churches or
Case Fatality Rate time interval population
mosques)
§ Community Cause- Number of Estimated mid- 100,000

reporters specific deaths from a interval

(including death rate specific cause in a population
given time
interval
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Proportionat Number of Total number of 100 or Thus, while disaster-related morbidity and mortality
1,000
e mortality deaths from a deaths from all surveillance has many uses, it is important to take into account that data
specific cause in a causes in the must be collected rapidly under poor conditions and be pulled
given time same time together quickly in a logical format while potentially being
interval interval hindered by forces beyond your control. The purpose of surveillance is
Case-fatality Number of Number of new 100 to provide timely data which will you disseminate to the concerned
rate deaths from a cases of that agencies to help them plan interventions or program. Data will no longer
specific condition condition in the be useful anymore if it is not timely disseminated (ex. data from last year).
in a given time same time
interval interval QUESTION: In a disaster setting, what does mortality measure?
Neonatal Number of Number of live 1,000 a. The number of deaths in a population
mortality deaths among births in the b. The incidence of illness in a population = Morbidity
rate the <28 days of same time c. The prevalence of illness and death in a population
age in a given interval d. The number of people affected by the disaster in a population
time interval
Infant Number of Number of live 1,000 QUESTION: Which of the following is not a surveillance indicator for
mortality deaths among births in the morbidity?
rate the <1 year of same time a. Proportional morbidity rate
age in a given interval b. Case Fatality Rate (CFR) = measures the number of deaths for
time interval a specific disease
Maternal Number of Number of live 100,000 c. Incidence rate = new cases
mortality deaths from births in the d. Prevalence rate = new and old cases
rate pregnancy- same time
related causes in interval STEPS FOR DESIGNING AND CONDUCTING A
a given time DISASTER SURVEILLANCE SYSTEM
interval Lifted from Source: https://www.cdc.gov/nceh/hsb/disaster/Facilitator_Guide.pdf

Attack rate – people who were affected at the start of the pandemic The following steps are important in establishing a strong,
Secondary attack rate – rate of infectiousness of the disease based on disaster-situation surveillance system. While some slight variations
the number of contacts who were also infected by the certain condition. might occur, take the following steps to develop a disaster
surveillance system:
CHALLENGES Determine
data
Although we have discussed many of the benefits of Establish
Determine
sources Analyze Dissemi-
variables
conducting disaster surveillance; you may encounter challenges while in objectives
to survey
and
collect
data nate data

the field. The following describes some difficulties in implementing data

public health disaster surveillance and steps you can take to

overcome those difficulties which includes: a) Establish objectives
§ Missing baseline data (d/t affectation of the • The Objectives of Surveillance – Inputs and
computers/systems/infrastructures, ex. during a flood or fire) Outputs in Field Epidemiology Manual states
that objectives may include (establish what is your

G.M.M.E. | A.J.E.F. | T.A.M.M. – MARILAG

§ Difficulty obtaining denominator data (whole population or
number of people affected with a certain illness; people are main objective to determine what data are you
displaced during a disaster) going to collect):
§ Damaged healthcare infrastructure which keeps the data o assessing public health status to inform
(records section of a hospital) actions to control disease occurrence
§ Lack of standardized data collection and reporting (d/t lack of o defining public health priorities to inform
official forms; it is important to define terms) policy and planning
§ Competing priorities (attention will not only be focused on a o evaluating programs to inform
certain area; some will focus on provision of medical intervention decisions, or
treatment/rehabilitation of infrastructure/assigned on o initiating a research agenda to inform
collecting data for outbreak surveillance) follow-up activities and mitigation efforts.

b) Determine variables
• After you have developed the objectives, you will
need an operational definition of the health
problem or condition for surveillance. This definition
is necessary for accurate recognition and counting
of the problem or condition. The operational
definition consists of one or more criteria and is
known as the case definition for surveillance. A case
definition is a set of standard criteria for classifying
whether a person has a particular disease,
syndrome, or other health condition. A case
definition must be simple, clearly defined,
understandable, and must be practical for use in a
disaster setting. Categorize a case using one of
the following methods:
§ Clinical case – a clinical syndrome generally
compatible with the disease, as described in
the clinical description. A general clinical
impression that this is a case of disease. ex. A
person with the signs and symptoms of a
certain disease (cough and colds).
§ Epidemiologic case – a case in which a) the
patient has had contact with one or more
persons who either have or have had the
disease or have been exposed to an infection
point source (i.e., a single source of infection,
such as an event leading to a food borne-
disease outbreak to which all confirmed case-
patients were exposed) and b) plausible
transmission of the agent by the usual modes
of transmission. A case may be considered
epidemiologically linked to a laboratory-
confirmed case if at least one case in the chain
of transmission is laboratory-confirmed. ex. A
person was exposed to a patient with COVID-
19.
§ Laboratory case – a case that is confirmed by
one or more of the laboratory methods listed in
the case definition under laboratory criteria for
diagnosis. ex. A person with signs and
symptoms, and a positive COVID-19 RT-PCR
test.
Some case definitions require laboratory
confirmation, while others rely on multiple signs or symptoms
for a condition where no laboratory test is readily available.
When developing a case definition, the elements can
include the degree of certainty in the diagnosis:
§ Suspected – indicative clinical picture without
being a confirmed or probable case
(equivalent to clinical case)
Disaster Nursing | NCM 0120
§ Probable – clear clinical picture, or linked
epidemiologically to a confirmed case
(equivalent to epidemiological case)
§ Confirmed – verified by laboratory analysis
(equivalent to laboratory case)
c) Determine data sources and data collection
• The surveillance system's goals will aid in the
selection of possible data sources.
• Data from medical and death records from
healthcare providers and medical facilities
will typically be used in non-disaster situations.
• Consider using non-traditional sources of
information, such as humanitarian relief
organizations, civil defense organizations,
evacuation centers, religious groups, or police, if
traditional information channels are
damaged, lacking or not available. Some
localities have computerized systems wherein you
can retrieve data. However, during disasters with
power outage, you won’t be able to retrieve these
data. You have to widen your scope and be
resourceful on how to collect data.
• When determining data source, you also have to
determine what system you will be using:
traditional data collection or make a new system?
This depend on the needs and situation of the
locality. (traditional: documents or do a survey in
the area).
d) Analyze data
• Analyze the surveillance data by person (age
group, gender, economic status), place with
highest morbidity & mortality (highest cases of
COVID-19: determine and analyze what factor in
that locality makes them more prone), and time
(month/season with highest incidence;
epidemics: is there an increase in the trend which
denotes a secondary attack rate?).
• Epi curves are frequently used to generate a
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visual display of the onset of health concerns
related with the event. The time trend,
distribution, pattern of spread, and magnitude
of the health concern are all represented by a
curve.
o Date of onset of illness can be
minutes, days, weeks, months, or years
depending on the disease you are
studying. Usually based on the
incubation period
§ ex. Disease A has an incubation
period of 12 days.
§ Formula: Incubation period / 4

§ 12 days / 4 = 3 days interval
§ x-axis (date of onset of illness):
1 | 4 | 7 | 10 | 13
Example: Cases of E. coli O157:H7 by Date of Onset,
Epps, Louisiana, February, 2012
QUESTION: The incubation period for infection with E. coli
O1257:H7 is usually 3–4 days. What will be the interval for
your x axis? 4 days / 4 = 1 day interval (x-axis: 1 | 2 | 3 | 4)
Determining a Title
An epi curve should have a title that describes it, including
the type of illness, the place where the outbreak occurred,
and the time period.
ü Cases of [insert illness name] by date of onset,
[insert location and time period]
e) Disseminate the data
• At all levels, decision-makers, stakeholders, and
partners must work together. They must be able to
comprehend your data in order to act on the
recommendations that your data supports. You
may use graphs or figures for rapid data review
and comprehension.
CONSIDERATIONS FOR DESIGNING OR USING
EXISTING SURVEILLANCE METHODS
1) Pre-existing Information
• preferred method or course of action is to maximize
the use of preexisting surveillance data for
"baseline" information and modify established,
epidemiologic surveillance systems for disaster
settings. In a certain locality, they use logbook for
recording the number of diseases.
2) Syndromic surveillance
• integrates signs and symptoms, primary complaints
or presumptive diagnoses, or other characteristics of
the disease, rather than specific clinical or laboratory
diagnostic criteria
• You will consider a patient to have the disease with
signs and symptoms even without laboratory criteria
• Can be used for places without laboratories but are
not accurate because some diseases might have the
same manifestations.
Disaster Nursing | NCM 0120
3) Sentinel surveillance
• occurs when data are gathered from a limited
number of sites (Manila and 1 place each from
LuzViMin) and is an alternative to population-based
surveillance and national surveillance (very large
population). Although sentinel surveillance is
extremely useful for detecting large public health
problems, it might not capture rare events, such
as the early emergence of a new disease
4) Ad hoc surveillance
• in a disaster setting you have the opportunity to
develop and employ a supplemental or ad hoc
surveillance system (new system) in which medical
relief workers take part. A supplemental or ad hoc
surveillance system will be useful for areas hit by
a disaster that lack a preexisting surveillance
infrastructure.
Note: Whether you design a new system or modify an existing system,
when collecting health data (timely manner), use generally recognized
and accepted data collection forms. There is a prescribed form for data
collection for every national organization.
QUESTION: _______________ integrates signs and symptoms,
primary complaints or presumptive diagnoses, or other characteristics of
the disease, rather than specific clinical or laboratory diagnostic criteria.
a. Sentinel surveillance = limited number of sites
b. Syndromic surveillance
c. Ad hoc surveillance = supplemental/new system
d. Mortality surveillance
Philippine Integrated Disease
Surveillance
and Response (PIDSR)
Philippine Department of Health has adopted an
integrated approach to surveillance of priority communicable diseases
and conditions. This approach aims at coordinating and streamlining
all surveillance activities and ensuring timely provision of
G.M.M.E. | A.J.E.F. | T.A.M.M. – MARILAG
surveillance information for action. (Lifted from Manual of Procedures for
Philippine Integrated Disease Surveillance and Response (PIDSR) 3rd Edition.)
Republic Act 3573 (Law of Reporting of Communicable
Diseases – An Act providing for the prevention and suppression
of dangerous communicable diseases...) [November 26, 1929];
requires all individuals and health facilities to report notifiable diseases
to local and national health authorities. COVID-19 pandemic:
institutions are required to report data and individuals are encouraged
and required to report if they have signs and symptoms.
 Disaster Nursing | NCM 0120

The priority diseases/syndromes/conditions targeted

for surveillance were selected based on one or more of the
following categories:
§ Epidemic-prone diseases (dengue, malaria)
§ Diseases targeted for eradication and elimination (polio)
§ Other diseases of public health importance as determined
by the DOHMCPCREID (Department of Health
Management Committee on Prevention and Control of
Emerging and Reemerging Infectious Diseases) or those
required by the IHR (International Health Regulations).
This is where COVID-19 is under because it is a new disease and
not included in the list.
In the current system, official forms are tailored. These include:
§ Weekly Notifiable Diseases Report Summary Page
§ Case Investigation form
§ Case Report forms
All hospitals/clinics shall be required to fill up a Notifiable
Disease Report Register (NDRR). The NDRR is a record of all PIDSR
Weekly Notifiable Disease Reports prepared or submitted to the health
office. However, in case of emergencies, these can be amended to be
submitted daily (ex. daily reports on cases of COVID-19).
Figures and tables are Lifted from Manual of Procedures for Philippine Integrated Disease
Surveillance and Response (PIDSR) 3rd Edition.

SAMPLE SCENARIO
On April 18th, a radiation contamination incident occurred at a
nuclear fuel processing plant in Eastern Europe. Due to human error, one
of the reactors at the plant underwent a partial nuclear meltdown. The
tank temperature rapidly increased, causing the uranium fuel rods to
melt and spill into the containment systems. Reactor temperature rose
precipitously. Then a chemical explosion released dried radioactive waste
into the air, creating a radioactive cloud reaching over 525 kilometers.
Although no immediate casualties occurred as a result of the explosion,
the rapid spread of the radioactive cloud resulted in the long-term
contamination of a more than 800-square kilometer area. The
International Nuclear Event Scale (INES) rated the accident a Level 6
(serious accident) that would likely require a long-term disaster response
effort.

What are the initial steps in setting up surveillance for the

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radiological event? The prime minister scheduled a meeting on the ff.
agencies which are concerned with the event and assigned a special team
who will have to do surveillance, and the team planned and defined the
variables which they would like to collect.

Describe the considerations to help you determine whether you

CESU (City Epidemiology and Surveillance Unit) or MESU (Municipal
Epidemiology and Surveillance Unit) then to PESU (Provincial
Epidemiology and Surveillance Unit) then to RESU (Regional
Epidemiology and Surveillance Unit) & NEC (National Epidemiology
Center).
need to design and set up a new surveillance system, or modify
a preexisting system. The community established a new team who
will be responsible for data surveillance. The community did active
surveillance.
What types of data would you collect as part of your
surveillance? Describe why. Aside from the age and gender, they also
 Disaster Nursing | NCM 0120

collected the signs and symptoms after the chemical explosion. They
would like to acquire the direct effects of the nuclear explosion, and its
chronic effects especially with chronic diseases.

Traditional (passive) systems were disrupted and many persons

needed care outside typical acute care settings. How then do
you collect morbidity and mortality data? Since they had difficulty
during the disaster, they used data from evacuation centers, temporary
hospitals and shelters to compute for morbidity and mortality.

KEY POINTS
§ An incident response team, also known as
neighborhood emergency response team (NERT), is a
group of people who prepare for and respond to any
emergency incident. The team is composed of a leader and
members who have common goals and coordinated actions.
§ Highly vulnerable population refers to members of the
community with a higher probability of being exposed to
disaster who also face barriers to anticipate, cope with, resist or
recover from the event. The medical and functional
models help in the identification of the vulnerable members
of the society.
§ Health hazard reports and casualty reports are examples
of ways on documenting risk and effects of an incident
respectively.
§ Surveillance is the ongoing, systematic collection, analysis,
and interpretation of injuries, illnesses, and deaths, for the use
in planning, implementation, and evaluation of public health
practice. Similarly, disaster surveillance is an epidemiology
tool that assesses health effects, monitors relief effort
effectiveness, responds to public concerns and media
inquiries, and assists in planning for future disasters. Data
derived from disaster surveillance activities provide timely,
accurate, and relevant information that drives decisions and
interventions during a disaster. The two indicators of disaster
surveillance are morbidity and mortality.

G.M.M.E. | A.J.E.F. | T.A.M.M. – MARILAG