ICN CORE COMPETENCIES Discussion:
IN DISASTER NURSING Level II Nurses: Disaster Nurse Responder
Discussion:
Competency
✓ Needed for us to serve as a defining
capability that distinguishes a particular
practice to other.
✓ A way of regulation
Level of Nurses in Disaster Nursing
GENERAL PROFESSIONAL NURSE
Level I: any nurse who has
• completed a program of basic, generalized
nursing education; and
• Authorized to practice by the regulatory
agency of his/her country.
Examples of Level I include staff nurses in
hospitals, clinics, public health centers; all nurse
educators.
Discussion:
Level 1 Nurses: General Practitioners
✓ Who have finished the general nursing
education
✓ Allowed to practice nursing profession by
the regulatory agency
ADVANCED OR SPECIALIZED NURSE
Level II: any nurse who has achieved the Level
I competencies and is or aspires to be a
designated disaster responder within an
institution, organization or system.
Examples of Level II include supervising or
head nurses; nurses designated for leadership
within an organization’s emergency plan; nurses
representing the profession on an institution or
agency emergency planning committee,
preparedness/response nurse educators.
✓ Has all the necessary qualifications of the
Level 1 Nurse
✓ Aspires to be a designated Disaster Nurse
Responder
Level III: Any nurse who has achieved Level I
and II competencies and is prepared to respond
to a wide range of disasters and emergencies
and to serve on a deployable team.
Examples:
 Frequent responders to either national or
international disasters,
 military nurses,
 Nurses conducting comprehensive
disaster nursing research.
Discussion:
Level III Nurses: Disaster Nurse Educator/
Disaster Nursing Researcher
✓ Has all the necessary qualifications of the
Level 1 and Level II Nurse
✓ Deployable as a team whenever a disaster
may strike anytime
✓ Responds to a large or wide range of disaster
(national/international disasters)
✓ Travels a lot for humanitarian reasons (e.g.
military nurses)
Military Nurses:
✓ Have all the logistics
✓ Very mobile because of their assets
✓ They are in actual service of the country
CORE COMPETENCIES IN DISASTER
NURSING
Domain 1: Preparation and Planning
GENERAL PROFESSIONAL NURSE:
• General preparedness
• Drill participation
• Updated knowledge on emergency
resources, plans, policies and procedure
• Knowledge on approaches to protect the
vulnerable
Thus, refers to the nurses basic functional
knowledge and skills in area of:
• Preparation
• Drill execution
• Policies and procedure, and resources
• Care of the vulnerable/patients during
emergency or disaster response.
Discussion:
Core Competencies for General Nurses:
✓ General and basic knowledge of disaster
preparedness
✓ Drill participation
✓ Updated knowledge on emergency
resources, plans, policies and procedure
✓ Knowledge on approaches to protect the
vulnerable clients
ADVANCED OR SPECIALIZED NURSE
• All the knowledge General Professional
Nurse
• Disciplines in planning emergency
drills/exercises at the institution or
community level
• Plans nursing improvement actions based
on evaluation
• Communicates roles and responsibilities
of nurses to others
• Actions relevant to needs of vulnerable
populations in emergency plans
Discussion:
Core Competencies for Advanced or Specialized
Nurses:
✓ All the knowledge General Professional
Nurse
✓ Planning
a) For emergency drills
b) Improvement and evaluation of
emergency drills
c) Announced/Unannounced in
anticipation of actual disaster
✓ Communication
a) Coordination of nurses to other
allied health team members and
external agencies/organizations.
✓ Makes a specialized action plan for the
most vulnerable population/clients
✓ Formulates the plan on how to execute
the drill
Thus, carry the responsibility on planning to
improve disaster or emergency response.
Preparation and Planning, Execution, And
Post-Execution Of A Disaster Drill Or
Exercise
Domain 1: Preparation and Planning
Important aspect of Domain 1 is the preparation
and planning of disaster drill.
• General Professional Nurse is in the
ground executing and observing the
disaster drill. The Advance or specialized
nurse formulates the disaster drill/exercise
plan.
How Are Emergency Exercises are Plan and
Done?
Divided into 4 Phases:
a. pre-planning phase
b. Planning Phase
c. Exercising Phase; and
d. Post-exercise Phase

A. Pre-Planning Goals
1. Review the emergency response plan;
2. Conduct needs assessment
3. Assess capability
4. Define scope of and select the type of the
drill
5. Gain support from management and staff
6. Coordinate with external emergencies
B. Planning Goals
1. Determine expected action
2. List major detailed events
3. Write narrative
4. Determine exercise objectives
5. Establish exercise planning team and
subordinate units
6. Write messages
7. Develop the master scenario event list
8. Finalize exercise enhancement
9. Develop evaluation format
C. Exercising Goals
1. Preparation
2. Conduction
3. Recovery
D. Post-Exercise Goals
1. Conduct post-exercise meeting
2. Write the after-action report
3. Conduct follow-up activities
PHASE I: PRE-PLANNING
 STEP 1: Review The Emergency
Response Plan
a) Review what you have
Discussion:
While reviewing the plan, you have to answer the
following questions:
a) What hazards/emergency are addressed
by the plan?
b) What emergency responses are listed in
the plan?
c) What resources or materials are used?
d) Which staff members are involved in the
plan?
e) What training is necessary for them to
carry it out?
f) What is necessary to apply the plan to
reality?
 STEP 2: Conduct Needs Assessment
a) Determine what needs to be done
Discussion:
Conduct Needs Assessment
✓ Appraisal of the Hospital Actual Current
State Hospital Emergency Preparedness
✓ Evaluation of the Hospital’s Current
State Emergency Preparedness
➢ Helps determine if:
a) exercises are needed
b) In what areas should be applied
c) Who should be involved
d) What emergency function should be
tested
e) What type of exercise should be
done, if any
 STEP 3: Assess Capability To
Conduct An Exercise
a) Consider what can be done
Discussion:
Capability Assessment
✓ Is necessary to determine or consider what
can be done
✓ Resources available are inventoried for
the drill or exercise conduction
✓ This includes an honest assessment of
availability of the following:
a) Funding
b) Personnel
c) Skills
d) Facilities
e) Time
f) Support
Any deficiencies must be considered in the
planning of the exercise
✓ They may lead to leveling expectations
on what can be accomplished
✓ Adjustment in the scope of and the type
of exercise/drill to be used
 STEP 4: Define Exercise Scope And
Type
a) Decide what will be done.
Discussion:
Decision-Making on what will be done
✓ E.g. Type of emergency/exercise drill
✓ Based on the needs assessment and
capability assessment, the
emergency/exercise drill scope and type
can be determined.
Emergency/Exercise Drill Scope
✓ Pertains to the limit of and the
emergency/exercise drill
5 Exercise/Emergency Drill Scope Elements
✓ Each elements isolate a particular
consideration in planning and exercise:
1) Type of Emergency (what hazard
or emergency will be prepared for)
2) Location (where will the exercise be
done)
3) Functions (What emergency
respond function/operation tested)
4) Participants (Who will be
involved)
5) Exercise Type (Which particular
type will be used)
 STEP 5: Gain Support From
Management And Staff
a) Involve and inform the staff
Discussion:
Involvement of the staff and management
✓ It is important to gain support from the
management by:
1) Prepare an Exercise Directive
Memo (containing details of the
exercise)
Exercise Directive Memorandum
✓ Includes the information of the following:
1) What exercise is to be done (Exercise
Type)
2) What is expected from the exercise
for the emergency drill (Objectives of
the Exercise/Emergency Drill)
3) Why is it being done (Purpose)
4) Who will be involved (Participants in
the exercise/emergency drill)
5) Where it will be done (Location)
6) When it will be scheduled (Date and
Time)
7) Who is in charge (Exercise Director
and the Planning Team)
8) How the Directive read and
approved by the Hospital Director
along with the statement of the
support for the activity
9) Send it to the hospital staff
− serves to inform and to gain
support from the administration
− announce plan to conduct an
exercise
− gains support from the rest
facility staff.
  STEP 6: Coordinate With External PHASE II: PLANNING
Agencies  STEP 1. Establish Exercise Planning
a) Work with others Team And Subordinate Units
Discussion: a) FORM THE TEAM.
Coordination of the Hospital and the External b) Exercise design team.
Agencies c) Exercise control team
✓ It is beneficial to work with the external d) Physical arrangement team
agencies e) Simulators team
✓ Takes part to the disaster response f) Victim actor’s team.
1) Emergency exercises g) Exercise evaluation team.
2) Provide opportunity to share h) Documentation team.
expertise, resources and i) Emergency medical service
manpower team.
✓ Leads to the development of a system for a j) Food and refreshments team.
more coordinated response in case of a
true emergency
✓ Example of such agency includes the
following but not limited to:
a) Other Hospital /Health Facilities
b) Provincial/City Health Officer
c) Local Government Units
d) Fire Department
e) Law Enforcement Agencies
f) Media
Discussion:
Exercise Planning Team
✓ In charge of the exercise for the emergency
drill, from the design to the execution of
the drill.
✓ Members may do the required tasks
themselves or oversee various specialized
subordinate teams
Specialized Subordinate Teams
a) Exercise Design Team
− Plans the exercise
1. How it will be done
2. What scenario will be used
(including assumptions,
artificialities, simulations, time
table)
3. Who are the expected
participants and volunteers
4. And all other matters pertaining
to how the exercise is conducted
b) Exercise Control Team
− Operates during all or part of the
actual exercise performance phase
− Ensures exercise purpose and
objectives are achieved in a realistic
manner
c) Logistic Team
− Gathers all supplies, materials,
equipment, services and facilities
required in the implementation of
the exercise/emergency drill.
d) Physical Arrangement Team
− In charge of the venue and other
facility arrangement
Continuation of Discussion:
e) Simulators Team
− Responsible for acting as a various
agencies that may interact
− Sends messages to the hospital for
health facility during an exercise
f) Victim Actor’s Team
− Identifies the victim’s play
− Orients them in to their assigned
rooms
− Deploys them to the assigned areas
g) Exercise Evaluation Team
− Review all exercising evaluation
tools
− Develop new tools based on the
objectives
− Identify and orient evaluators on the
tools to be used
− Reproduces and distribute the tools
− Deploys evaluators to assigned areas
− Collate all evaluation findings
− Develop the final evaluation report
with recommendation
h) Documentation Team
− Ensures adequate documentation of
the exercise (e.g. pictures videos,
notes) from pre-planning, planning,
execution and post execution/post
incident.
i) Emergency Medical Service Team
− Provides emergency medical service
during the conduct of the exercise
− Ensures all participants, victims,
simulators, evaluators, observers
and bystanders are safe during the
conduct of exercise
j) Food and Refreshment Team
− In charge providing nourishment
during the entire process.
 realistic for the
 STEP 2. Determine Exercise exercise.
Objectives
a) Set the Goals Task- Oriented The objective should
Simple Objective focus on a behavior or
procedure. With
1. Standards 2. Conditions respect to exercise
(Within 5 minutes) (after the hospital design, each
fire notice is given), objective should
focus on an individual
emergency function.
3. Who 4. Specific
(Participants) Action
the (members of the Will (complete  STEP 3. Write Exercise Narrative
emergency operations notification a) Set the Scene
team) procedures to local
fire authorities.) Discussion:
Narrative
SMART Objectives: ✓ Brief description of simulative events that
Simple A good objective led up to when the exercise begins
should be simply and ✓ Sets the mood of the exercise
clearly phrased. It ✓ Provides information that the participants
should be brief and will need during the exercise
easy to understand. ✓ Work the capture the participants’
attention
Measurable The objective should ✓ Motivate them to actively involve.
set the level of
performance, so that
the results are  STEP 4. List major and Detailed
observable, and it can Events
be that when a) Develop the Story
the objective is Discussion:
achieved, that is Major Events
reportable. ✓ Potential large problems resulting an from
an emergency
Achievable The objective should
not be too difficult to Detailed Events
achieve. Achieving it ✓ Most specific problems that requires
should be within the participants to respond with expected
resources that the actions to fulfill exercise objectives
organization is able to ✓ Provide unity to an exercise
commit to an exercise ✓ Link simulated events to actions that
Realistic The objective should participants perform to meet exercise
present a realistic objectives
expectation for the
situation. Even
though an objective
might be achievable,
it might not be
  STEP 5. Determine Expected Actions
a) What Participants SHOULD DO

Sample Related Scenario, Major Event,  STEP 6. Write Messages

Detailed Event And Expected Action. a) What Participants ARE TOLD
Who sends what to whom, via how, and
with what effect?
Narrative Major Detailed Expected
Message Who sends the message?
Scenario Event Event Action
source (who) (must be a credible source)
Earthquak Hospital Operatin Activatio
Transmission How the message is
e structura g room n of
method transmitted? (must be a
l gas pipe operating
(how) credible means of
damage leak room
transmission)
evacuatio
Message What information is
n
content (what) conveyed? (Does this
procedure
message contain the
within 5
information needed by the
minutes
recipient to make a
decision?)
Discussion: Recipient (to Who should receive the
Expected Actions whom) message? (Who would
✓ Actions/Decisions that should be credibly receive it, and
demonstrated by the participants to who would ultimately need
display competence in the exercise to fulfill to receive it to take
exercise objectives action?)
✓ Use to evaluate whether there was an All of these variables will influence the
appropriate response to an emergency action taken (to what effect).
situation

To determine whether an action is appropriate

for a given event:
a) One must simply GO BACK to the
emergency response plan.
b) Examples are given on the above
mentioned tables.
Discussion: Discussion:
Messages The output of the design process, are put
✓ Communicate detailed events to together in a master scenario events list:
participants ✓ Chart of controllers and simulators
✓ Meant to evoke expected actions from the reference in order the exercise remains in
participants to meet exercise objectives track.
✓ 5 Main Variables of Messages: ✓ Overall Guide of the exercise
1) Who ✓ It leads the following:
2) How a) Events or messages
3) What b) Time they are to be released
4) Whom c) Expected actions of the
5) Effect participants
✓ It is best to use the method of
transmission that would likely to be Organizers should still remain FLEXIBLE and
used in the actual emergency: appropriately adjust to participants’ responses
1) Landlines and exercises situations as it develops.
2) Cellphones
3) Videos GOAL:
4) Persons ✓ Accomplish the objectives
5) Facts ✓ NOT being overly strict on following the
✓ Keep messages REALISTIC time schedule
✓ Message is successful, if it is able to
motivate the expected action.  STEP 8. Finalize Exercise
Enhancements
Examples are given on the above mentioned a) Make the Exercise Believable
tables. Discussion:
Exercise Enhancements
✓ Tools, materials and strategies that are
used to add the realism of the exercise
✓ Examples given:
 STEP 7. Develop Master Scenario
1) Use of real equipment and actual
Events List
locations
a) Make an Overall Guide
2) Use of simulated victims with
convincing mock injuries
3) Use of actual equipment
available in the emergency
operation center during the real
emergency
✓ NEED NOT require a lot of money and
energy
✓ It NEEDS: Creativity and
Resourcefulness

 STEP 9. Develop Evaluation Format

a) Assess the Exercise
Discussion: PHASE III: EXERCISE (The Drill)
Evaluation Format
✓ Refers the assessment form of the a) Preparation (Set the stage)
exercise drill
b) Conduction (Monitor the action)
In order for evaluation goals to be met: c) Recovery (Return to normal state)
✓ Systematic and methodological
approach must be given to evaluation
planning and conduction: 1. STEP 1: Preparation
a) Determining structure of evaluation a) Set the stage
team
Discussion:
b) Objective to be measured Several tasks should be accomplished:
c) Observation methods and recording 1) Last minute briefing should occur with
forms to be used the staff members and participants prior
d) Criteria to determine if an exercise to exercise
has been successful must be based on 2) Safety precautions should be
the: implemented:
1. Listed objectives a) Notification alerts should be
2. Expected actions raised to those affected by the
exercise
Expected Actions b) PPEs should be used when
✓ Pertinent evaluation measures can be necessary
developed. c) Briefing on the potential actions
on the event of circumstances
Samples of Evaluation Tools: should occur
1) Data collector’s observation logs d) Call-off procedures should be
2) Observation checklist reiterated in the event of a real
3) Problem logs emergency
4) Evaluator checklist 3) Final system check should be ensured on
5) Narrative summary the importance systems and materials:
a) Computers
Addition to these tools, more information can be b) Projectors
obtained through the conduction of post- c) Radios
exercise debriefing and evaluation team d) Communication devices
meetings. e) Equipment prone to breakdowns
4) Those involved must be properly
FINAL OUTPUT of the entire evaluation positioned such as:
process: a) Simulated casualties
✓ The After Action Report b) Props and equipment
− Used for the implementing c) Exercise staff members
improvements to the emergency d) Participants
response plan and emergency e) Evaluators/observers
management program.
✓ Once all are CLEAR, exercise directors
can signal the exercise to begin.

2. STEP 2: Conduction
a) Monitor the action
Discussion:
During the Actual Exercise/Emergency Drill:
✓ Facilitator/Controller assumes
responsibility for ensuring the exercise
follows the plan that is directed towards
the objectives, this includes:
a) Presenting the players read the
exercise narrative
b) Announcing the first event of the
scenario
c) Stimulating player responses
without assuming control of play
d) Managing how the flow and pace of
the exercise through the use of
messages
Special Consideration in Conducting
Exercise:
a) Fostering realism
b) Maintaining valid timelines
c) Sustaining actions
d) Keeping safety, a common concern
e) Being open to capitalize problem
situations
3. STEP 3: Recovery
a) Return to normal state
Discussion:
At the End of the Exercise/Emergency Drill:
✓ There must be provisions for system
recovery and return to normal operation:
a) Mobilization and cleaning of
exercise sites
b) Return of emergency equipment
c) Proper discharge of participants
from the exercise
d) Return to regular posting
PHASE IV: POST-EXERCISE
a) Conduct Post Exercise Meeting
b) Write the After-Action Report
c) Conduct Follow-up Activities
1. STEP 1: Conduct Post-Exercise
Meetings
a) Debrief the participants
Discussion:
2 Types of Post Exercise Meetings:
1) Hot Debriefing
✓ Conducted immediately after the
exercise
✓ Also called as “Player’s
Debriefing”
2) Cold Debriefing
✓ Can be conducted some days
after the exercise
✓ Usually for evaluation team
the meetings
❖ In either case, they involve giving
feedbacks, critiques, and suggestions
regarding the activity
2. STEP 2: Write After-Action Report
a) Make a written evaluation
Discussion:
After Action Report:
✓ Final output of the evaluation team
✓ Documents the effectiveness of the exercise
✓ Improves the emergency response plan
✓ Improves how the emergency response
plan is implemented
✓ Serve as basis for future exercises
✓ Must be distributed to the Chief Executive
of the institution and its participant’s
department for other affected units
 3. STEP 3: Conduct Follow-up Activities
a) Apply the Learning

Discussion:
Recommendation of the After- Action Report:
✓ Reviewed by:
a) the Chief Executive
b) Emergency Management Program
Committee
c) Other Key Decision Making Units
✓ This may translate to:
a) Changing of policies
b) Resource acquisitions or
allocations
c) Personnel training
d) Decision to conduct further
exercise

Exercise Follow-Up Strategies:

a) Clearly assigning tasks and
schedules
b) Designating responsibly to each
recommended improvements
c) Establish a monitoring plan to
track the progress of the
recommendations and
implementations
d) Completing the cycle by
incorporating the testing of noted
improvement indicators into
succeeding exercises

❖ In the end, the recommendation, the

exercise itself, are useless if no efforts
are placed in the implementation.