BACHELOR OF SCIENCE IN NURSING: NCMO

410: DISASTER NURSING

COURSE MODULE COURSE UNIT WEEK
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NURSES ROLE RESPONSE PHASE TRIAGE

MANAGEMENT OF MASS CASUALTIES

Mass Casualty Management is a multi-sectorial coordination system based on daily utilized
procedures, managed by skilled personnel in order to maximize the use of existing resources;
provide prompt and adapted care to the victims; ensure emergency services and hospital return to
routine operations as soon as possible.

OBJECTIVES
• The application of triage and tagging procedures in the management of mass casualties
• Understand the priorities in triage and tagging, and orders of evacuation

DISASTER TRIAGE

The word triage is derived from the French word trier, which means, “to sort out or choose.”

The Baron Dominique Jean Larrey, who was the Chief Surgeon for Napoleon, is credited with
organizing the first triage system.

“Triage is a process which places the right patient in the right place at the right time to receive the
right level of care” (Rice & Abel, 1992).

Triage is the process of prioritizing which patients are to be treated first and is the cornerstone of
good disaster management in terms of judicious use of resources (Auf der Heide, 2000).
NEED OF THE DISASTER TRIAGE
1. Inadequate resource to meet immediate needs
2. Infrastructure limitations
3. Inadequate hazard preparation
4. Limited transport capabilities
5. Multiple agencies responding
6. Hospital Resources Overwhelmed

AIMS OF TRIAGE
1. To sort patients based on needs for immediate care
2. To recognize futility
3. Medical needs will outstrip the immediately available resources
4. Additional resources will become available given enough time.

PRINCIPLES OF TRIAGE

The main principles of triage are as follows: -

1. Every patient should receive and triaged by appropriate skilled health-care professionals.
2. Triage is a clinic-managerial decision and must involve collaborative planning.
3. The triage process should not cause a delay in the delivery of effective clinical care.

ADVANTAGES OF TRIAGE
1. Helps to bring order and organization to a chaotic scene.
2. It identifies and provides care to those who are in greatest need
3. Helps make the difficult decisions easier
4. Assure that resources are used in the most effective manner
5. May take some of the emotional burden away from those doing triage

There are two types of triage:

1. Simple triage
2. Advanced triage

SIMPLE TRIAGE

Simple triage is used in a scene of mass casualty, in order to sort patients into those who need
critical attention and immediate transport to the hospital and those with less serious injuries.

This step can be started before transportation becomes available.

The categorization of patients based on the severity of their injuries can be aided with the use of
printed triage tags or colored flagging.

S.T.A.R.T. (Simple Triage and Rapid Treatment) is a simple triage system that can be performed by
lightly trained lay and emergency personnel in emergencies.
Triage separates the injured into four groups:
• 0 - The deceased who are beyond help
• 1 - The injured who can be helped by immediate transportation
• 2 - The injured whose transport can be delayed
• 3 - Those with minor injuries, who need help less urgently

ADVANCED TRIAGE

In advanced triage, doctors may decide that some seriously injured people should not receive
advanced care because they are unlikely to survive.

Advanced care will be used on patients with less severe injuries. Because treatment is
intentionally withheld from patients with certain injuries, advanced triage has an ethical
implication.

It is used to divert scarce resources away from patients with little chance of survival in order to
increase the chances of survival of others who are more likely to survive.

Principles of advanced triage is

• “Do the greatest good for the greatest number”
• Preservation of life takes precedence over preservation of limbs.
• Immediate threats to life: HEMORRHAGE.

ADVANCED TRIAGE CATEGORIES

 USING RPM TO CLASSIFY PATIENTS
CATEGORY (COLOR) RPM INDICATORS

R = Respiratory rate > 30;

Critical (RED)
P = Capillary refill > 2 seconds;

M = Doesn’t obey commands

Urgent (YELLOW) R < 30

P < 2 seconds

M = Obeys commands

Expectant: dead or dying (BLACK) R = not breathing

 TRIAGE SYSTEM IN MASS CASUALTY

COURSE MODULE COURSE UNIT WEEK

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NURSES ROLE IN RECOVERY AND REHABILITATION

Republic Act 10121 defines Response as

Disaster Response – the provision of emergency services and public assistance during or
immediately after a disaster in order to save lives, reduce health impacts, ensure public safety and
meet the basic subsistence need of the people affected.
Disaster response is predominantly focused on immediate and short-term needs and is
sometimes called “Disaster relief.”

IRR Rule 2 Section 1:

a. Early Recovery -- multidimensional process of recovery that begins in a humanitarian setting.
It is guided by development principles that seek to build on humanitarian programs and
catalyze sustainable development opportunities. It aims to generate self-sustaining, nationally-
owned, resilient processes for post=crisis recovery. It encompasses the restoration of basic
services, livelihoods, governance, security and rule of law, environment and social dimensions,
including reintegration of displaced populations.
IRR Rule 2 Section 1:
b. Post Disaster Recovery – the restoration and improvement where appropriate, of facilities,
livelihood and living conditions of disaster-affected communities, including efforts to reduce
disaster risk factors, in accordance with the principles of “build back better”
Under Section 3 of Republic Act 10121, rehabilitation is defined as
Rehabilitation – measures that ensure the ability of affecting communities and/or areas to
restore their normal level of functioning by rebuilding livelihood and damaged infrastructure and
increasing the communities’ organizational capacity
NURSES ROLE IN RECOVERY AND REHABILITATION
NATIONAL RISK REDUCTION AND MANAGEMENT PLAN IN RECOVERY AND
REHABILITATION (2021-2028)

RECOVERY
Long term Goal: Provide life preservation and meet the basic subsistence needs of affected
population based on acceptable standards during or immediately after a disaster.
Objectives:
1. To decrease the number of preventable deaths and injuries.
2. To provide basic subsistence needs of affected population.
3. To immediately restore basic social services.
Specific Outcomes
1. : Well-established disaster response and relief operations
2. Adequate and prompt assessment of needs and damages.
3. Integrated and coordinated Search, Rescue and Retrieval (SRR) capacity.
4. Evacuated safely and on time affected communities
5. Temporary shelter and/or structural needs are adequately addressed.
6. Basic social services provided to affected population (whether inside or outside ECs)
7. Basic social services provided to affected population (whether inside or outside ECs).
8. Psychosocial needs of affected population addressed
9. Coordinated and integrated system for early recovery

Long Term Goal of Rehabilitation

Restore and improve facilities, livelihood and living conditions and organizational capacities of
affected communities, and reduced disaster risks in accordance with the “building back better”
principle.
Objectives:
1. To restore people’s means of livelihood and continuity of economic activities and business.
2. To restore shelter and other buildings/installation, to reconstruct infrastructure and other public utilities;
3. To assist in the physical and psychological rehabilitation of persons who suffered from the
effects of disaster.
Rehabilitation outcomes:
1. Damages, Losses and Needs Assessed
2. Economic activities restored and if possible, strengthened or expanded.
3. DRRM and Climate change adaptation (CCA) elements are mainstreamed in human
settlement. This is about the development of disaster-resilient housing designs and
introduction of improved and modernized building systems and programs.
4. Disaster and climate change resilient infrastructure constructed/reconstructed.
5. A psychologically sound, safe and secured citizenry that is protected from the
effects of disasters are able to restore to normal functioning after each disaster

NURSES ROLE IN RECOVERY AND REHABILITATION

Disaster nursing can be defined as “the adaptation of professional nursing knowledge, skills and
attitude in recognizing and meeting the nursing, health and emotional needs of disaster victims.”
GOALS OF THE DISASTER NURSING
The overall goal of disaster nursing is to achieve the best possible level of health for the people and
the community involved in the disaster.

1. To meet the immediate basic survival needs of populations affected by disasters (water, food,
shelter, and security).
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 appropriate resources.
5. To empower survivors to participate in and advocate for their own health and well-being.
6. To respect cultural, lingual, and religious diversity in individuals and families and to apply this
principle in all health promotion activities.
7. To promote the highest achievable quality of life for survivors.

PRINCIPLES OF DISASTER NURSING

1. Rapid assessment of the situation and of nursing care needs.
2. Triage and initiation of life-saving measures first.
3. The selected use of essential nursing interventions and the elimination of nonessential
nursing activities.
4. 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.
5. Evaluation of the environment and the mitigation or removal of any health hazards.
6. Prevention of further injury or illness.
7. Leadership in coordinating patient triage, care, and transport during times of crisis.
8. The teaching, supervision, and utilization of auxiliary medical personnel and volunteers.
9. Provision of understanding, compassion, and emotional support to all victims and their families.

ROLE OF NURSING IN DISASTERS

“Disaster preparedness, including risk assessment and multi-disciplinary management
strategies at all system levels, is critical to the delivery of effective responses to the short, medium,
and long-term health needs of a disaster-stricken population.” (ICN, 2006)

MAJOR ROLES OF NURSE IN DISASTERS

1. Determine magnitude of the event
2. Define health needs of the affected groups
3. Establish priorities and objectives
4. Identify actual and potential public health problems
5. Determine resources needed to respond to the needs identified
6. Collaborate with other professional disciplines, governmental and non-governmental agencies
7. Maintain a unified chain of command
8. Communication

HEALTH EFFECTS OF DISASTERS

The health effects of disasters may be extensive and broad in their distribution across populations.
In addition to causing illness and injury, disasters disrupt access to primary care and preventive
services. Depending on the nature and location of the disaster, its effects on the short- and long-
term health of a population may be difficult to measure.
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.

COURSE MODULE COURSE UNIT WEEK

3 13 15
FUTURE TRENDS AND ISSUES IN DISASTER NURSING

Future trends and issues in disaster nursing practice

Studies: Literature Review

1. (Challenges for Nurses in Disaster Management: A Scoping Review: Published online 2020
Nov 16) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678497/

1. Major barriers facing nurses include the following:

a. Disaster nursing is a new specialty
b. Inadequate level of preparedness
c. Poor formal education
d. Lack of research
e. Ethical and legal issues
f. Issues related to nurses’ roles in disasters.
Educators, researchers, and stakeholders need to make efforts to tackle these issues and
improve disaster nursing.

2. Disaster Preparedness in Philippine Nurses

• Leodoro J. Labrague et al: December 2015Journal of Nursing
Scholarshiphttps://www.researchgate.net/publication/286439635_Disaster_Preparedness_in_
Philippine_Nurses
• Two hundred nurses were invited to participate in the study:

Findings:
1. Three fourths of the respondents (n = 136, 80%) indicated that they were not fully
prepared to respond to disasters,
2. while only 20% (n = 34) acknowledged that they felt they were adequately prepared.
 3.Respondents believed that they could function in the primary roles of educator (n = 107,
62.94%), caregiver (n = 104, 61.17%), and counselor (n = 82, 48.24%).
4. More than half of the respondents (n = 98, 57.7%) were not aware of existing protocols of
disaster management in the workplace.
5. Courses taken in such areas as first aid (n = 79, 46.4%), field triage (n = 43, 25.29%), and
basic cardiac life support (n = 57, 33.53%) were cited as important in preparing for
disasters.
Conclusions:
1. Nurses in the study revealed that they were not sufficiently prepared for disasters nor
were they aware of disaster management protocols in the workplace.
2. Clinical Relevance: Hospital administrators should consider the development and
formulation of disaster management protocols and provide appropriate disaster nursing
education and training.
3. Nursing curricula should incorporate basic principles of disaster management into
nursing courses as a framework for addressing this critical deficit.

3. Development of disaster nursing education and training programs in the past 20 years
(2000– 2019): A systematic review
• Alice Yuen Loke et al: April 2021
• https://www.sciencedirect.com/science/article/abs/pii/S0260691721000666
Findings:
1. Most of the existing programs focused on disaster preparedness and response, especially
on the skills of triage during disaster response, instead of addressing the full spectrum of
disaster management that included mitigation, preparedness, response, and recovery
phases.
2. Multiple approaches and technologies were adopted, including competency-based, all-
hazard, inter- professional, flipped classroom, simulation, tabletop exercises, and virtual
reality ones
Conclusions:
1. This review provides nurse leaders, educators and researchers in nursing with an
understanding of the state-of-art of the existing disaster nursing education and training
programs.
2. More disaster nursing research are necessary to enhance the knowledge, skills and
readiness of the nursing professionals for disaster management in meeting global disaster
challenges.

4. WHO and partners call for urgent investment in nurses 7 April 2020
• https://www.who.int/news/item/07-04-2020-who-and-partners-call-for-urgent-
investment-in- nurses
• The report, by the World Health Organization (WHO) in partnership with the
International Council of Nurses (ICN) and Nursing Now, reveals that today, there are just
under 28 million nurses worldwide. Between 2013 and 2018, nursing numbers
increased by 4.7 million. But this still leaves a global shortfall of 5.9 million - with the
greatest gaps found in countries in Africa, South East Asia and the WHO Eastern
Mediterranean region as well as some parts of Latin America.
 • To equip the world with the nursing workforce it needs, WHO and its partners
recommend that all countries:
a. increase funding to educate and employ more nurses;
b. strengthen capacity to collect, analyze and act on data about the health workforce;
c. monitor nurse mobility and migration and manage it responsibly and ethically;
d. educate and train nurses in the scientific, technological and sociological skills they
need to drive progress in primary health care;
e. establish leadership positions including a government chief nurse and support
leadership development among young nurses;
f. ensure that nurses in primary health care teams work to their full potential, for
example in preventing and managing noncommunicable diseases;
g. improve working conditions including through safe staffing levels, fair salaries, and
respecting rights to occupational health and safety;
h. implement gender-sensitive nursing workforce policies;
i. modernize professional nursing regulation by harmonizing education and practice
standards and using systems that can recognize and process nurses’ credentials
globally; and
j. strengthen the role of nurses in care teams by bringing different sectors (health,
education, immigration, finance and labor) together with nursing stakeholders for
policy dialogue and workforce planning.

ROLE OF NURSES IN DISASTERS

• Disaster preparedness, including risk assessment and multi-disciplinary management strategies at
all system levels, is critical to the delivery of effective responses to the short, medium, and long-
term health needs of a disaster-stricken population. International Council of Nurses (2006)

NURSES’ ROLES IN DISASTERS

1. Determine magnitude of the event
2. Define health needs of the affected groups
3. Establish priorities and objectives
4. Identify actual and potential public health problems
5. Determine resources needed to respond to the needs identified
6. Collaborate with other professional disciplines, governmental and non-governmental agencies
7. Maintain a unified chain of command
8. Communication

COMMUNICATION IS THE KEY FOR SUCCESS

a. Nursing organizations must have a comprehensive and accurate registry for all members
b. Have a structured plan:
c. Collaborate and coordinate with local authorities Have a hotline 24x7
d. Inform nurses where to report and how (keep records)
e. Make sure have a coordinator to prevent chaos
f. Ensure ways to maintain communication between nurses and their families

THE NEED FOR DISASTER NURSING TRAINING COURSE

Background:
• 28 million nurses worldwide (WHO, ICN 2020) NURSES Form the backbone of the health care
system
 • NURSES Are the frontline health care workers who are in direct contact with the public
• NURSES Contribute to health of individuals, families, communities, and the globe
• Schools of nursing offer little or no information on disaster nursing (WHO, 2008)
• Shortage of trained instructors/faculty (WHO, 2008)

TOPICS THAT MUST BE COVERED BY DISASTER NURSING TRAINING COURSE

1. Basic life support
2. System and planning for settings where nurses work
3. Communications (what to report and to whom)
4. Working in the damaged facilities and with damaged equipment
5. Safety of clients and practitioners
6. Working within a team (understand each member’s role and responsibility)
7. Infection control
8. Mental and psychosocial support (WHO, 2006)

WHY BUILDING DISASTER NURSING COURSE

1. Nurses form the largest health care professional group.
2. Nurses are the main health professionals in touch with the community.
3. Shortage in number of structured nursing programs in disaster preparedness.
4. Nurses deal with the physical stresses of a disaster and more importantly the fear, stress
and uncertainties of disaster.
5. Nurses received little training in disaster preparedness, prevention and mitigation.
6. Expected increase in disaster and in numbers of casualties in particular developing countries,

HOW TO PREPARE FOR DISASTER NURSING COURSE?

1. Provide training for future generations of Nurses who might be engaged in disaster.
2. Collaborate with WHO or DRRM representative.
3. Build disaster nursing lectures to train nurses worldwide.
4. Promote partnerships among instructors at schools of nursing in the world in the area of
disaster nursing.
5. Offer up to date evidence based scientific knowledge to enhance faculty training.

New International Council of Nurses (ICN) report aims to improve nurses’ disaster
preparedness, response and recovery (5 November 2019)
• ICN President Annette Kennedy said:
• “When these new competencies are adopted around the world it will mean that all nurses will
be able to contribute effectively in disaster situations to ease the burden on their patients and
communities.

Core Competencies in Disaster Nursing

• The competencies describe what the nurse should be able to do in a given situation, depending
on his or her professional experience.
• The Level 1 competencies are for all registered nurses, including staff nurses in hospitals,
clinics and health centers, and all nurse educators.
• The Level 2 competencies are for any nurse who has achieved the level 1 competencies and is
or aspires to be a designated disaster responder within an institution, organization or system.
• The Level 3 competencies will be developed in the future. These are for nurses who respond to
a wide range of disasters and emergencies and who serve on a deployable team.
The competencies are organized into eight domains:
1. Preparation and planning - actions taken apart from any specific emergency to increase
readiness and confidence in actions to be taken during an event.
2. Communication - approaches to conveying essential information within one’s place of work or
emergency assignment and documenting decisions made.
3. Incident management systems - the structure of disaster/emergency response required by
countries/organizations/institutions and actions to make them effective.
4. Safety and security - assuring that nurses, their colleagues and patients do not add to the
burden of response by unsafe practices.
5. Assessment - gathering data about assigned patients/families/communities on which to base
subsequent nursing actions.
6. Intervention - clinical or other actions taken in response to assessment of
patients/families/communities within the incident management of the disaster event
7. Recovery - any steps taken to facilitate resumption of pre-event
individual/family/community/organization functioning or moving it to a higher level
8. Law and ethics - the legal and ethical framework for disaster/emergency nursing

REFERENCE:https://www.icn.ch/news/new-icn-report-aims-improve-nurses-disaster-preparedness-
response-and-recovery

COURSE MODULE COURSE UNIT WEEK

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INFORMATION TECHNOLOGY IN DISASTER MANAGEMENT

Information and Communication Technologies (ICTs) is a broader term for Information

Technology (IT), which refers to all communication technologies, including the internet, wireless
networks, cell phones, computers, software, middleware, video-conferencing, social networking, and
other media applications and services enabling users to access, retrieve, store, transmit, and manipulate
information in a digital form.( http://aims.fao.org/information-and-communication-technologies-ict)

INFORMATION TECHNOLOGY IN DISASTER MANAGEMENT

ICTs FOR Disaster Management

• https://www.itu.int/en/ITU-D/Emergency-Telecommunications/Pages/ICTs-4-
DM.aspx#:~:text=%E2%80%8B%E2%80%8B%E2%80%8B%E2%80%8B%E2%80%8B,operations

Information and Communication Technologies (ICTs)

• It plays a significant role in disaster prevention, mitigation response and recovery.
• Timely, predictable and effective information is much needed by government agencies
and other humanitarian actors involved in rescue operations and decision-making processes.
ICTs for Disaster Management can be summed up in four principles:
1. MULTI-HAZARD
• Natural hazards include earthquakes, cyclones, floods, mud slides, droughts, tsunamis,
volcanic eruptions, and fires. For all disasters that follow natural hazards, ICTs play a
critical role in facilitating the flow of vital information in a timely manner.
ICTs for Disaster Management can be summed up in four principles:
2. MULTI-HAZARD
• Natural hazards include earthquakes, cyclones, floods, mud slides, droughts, tsunamis,
volcanic eruptions, and fires. For all disasters that follow natural hazards, ICTs play a
critical role in facilitating the flow of vital information in a timely manner.
3. MULTI-TECHNOLOGY
• In mitigating disastrous effects of hazards, International Telecommunications Union (ITU)
promotes the use of different information and communication technologies and networks,
including satellite, radio, mobile networks and the Internet, that can contribute to enhance
capacity and reduce vulnerability of people.
4. MULTI-PHASED
• Telecommunications are critical at all stages of disaster management: mitigation,
preparedness, response and relief, recovery and rehabilitation.
5. MULTI-STAKEHOLDER
• The local community, the government, the private sector, disaster management agencies,
meteorological organizations, civil society, humanitarian agencies and international
organizations should ensure access to ICTs to better coordinate disaster management
activities. Partnerships are the best way to achieve this task.

NEW TECHNOLOGIES FOR DISASTER RELIEF EFFORTS

• https://safetymanagement.eku.edu/blog/when-disaster-strikes-technologys-role-in-disaster-aid-
relief/
1. ROBOTS AND DRONES
• Help locate and transmit information about survivors to emergency personnel
• Used to drop humanitarian aid as well
2. SERVAL PROJECT
• Develop in response to the Haiti Earthquake
• Allows mobile phones to communicate directly with each other even where there is no
network coverage
3. TRILOGY EMERGENCY RELIEF APPLICATION (TERA)
• SMS TEXT SYSTEM designed for two-way communication between disaster affected people
and aid agencies
• Used since the 2010 Haiti Earthquake
4. NASAL FINDER
• Created in response to the 2015 Nepal Earthquake.
• NASA’S SUITCASE-SIZE TOOL that can detect human heartbeats through 30 feet of rubble
and 20 feet of solid concrete.
5. AIRBONRE LADAR IMAGING RESEARCH TEST BED (ALIRT)
• Can produce high-resolution, three-dimensional RENDERING OF TERRAIN AND
INFRASTRUCTURE
• Identifies road travel conditions, helicopter landing zones, and population changes at
displaces person camps.
• Can help and organizations effectively dispatch vital resources, including food, water, tents
and medical supplies.

THE ROLE OF SOCIAL MEDIA IN DISASTER COMMUNICATIONS

1. FEMA (Federal Emergency Management Agency) reported that more than 20 million
hurricane SANDY related TWEETs were posted in the following two weeks.
2. 2.3 million tweets about the Haiti earthquake about the Haiti earthquake between
01/12/10 and 01/12/10
3. 7 million users near Nepal checked in via facebook’s safety check after the April 2015
earthquake.
ONLINE TOOLS AND APPLICATIONS DEVELOPED TO AID IN DISASTER RELIEF
1. MICRO MAPPERS
• Launched in 2013 and used in Nepal Earthquake, the 2013 Hayian and other disasters
• Creates a Map from social media relief updates and sends it to aid agencies the view real
time updates from affected areas.
• Helps organization effectively plan relief efforts before going into disaster zones.
• MICROMAPPERS processed 60000 plus images and tweets from the 2015 Nepal Earthquake
2. GOOGLE PEOPLE FINDER
• Developed in 2010 as a response to the Haiti Earthquake.
• It is an opensource web application that has been launched in over 40 languages.
• It allows individuals to post and search for the status of people affected by disaster.
• More than 7,400 records were searched during the Nepal Earthquake.
3. RED CROSS EMERGENCY APP
• Gives survivors weather updates, safety tips and preparedness information
• The Red Cross credits their app with saving lives in numerous states in the US.

THE FUTURE PREDICTION TECHNOLOGIES

• Emerging technologies to help predict natural disasters include:
1. WILDFIRE PREDICTION
• A computer model developed at the National Center for Atmospheric Research stimulates
how weather drives fires and how fires create their own weather.
• By restarting the model every 12 hours with latest observations like satellite data, scientist
can regularly issue and update forecasts
2. FLOOD PREDICTION
• Using Radio Detection and Ranging (RADAR), highly detailed computer model weather
forecasts and advanced streamflow computer simulations, scientists can provide locally
specific guidance for decision makers during the crucial 1 to 12 hours window.
3. EARTHQUAKE PREDICTION
• THE US geological Survey is developing and EARTHQUAKE EARLY WARNING SYSTEM
using a network of high-quality ground motion sensors.
• SHAKE ALERT an earthquake early warning being tested in California, has been sending
user notifications since 2012.

(JAPAN) INFORMATION TECHNOLOGIES AND DISASTER MANAGEMENT – BENEFITS AND ISSUES

• ScienceDirect: Progress in Disaster Science July 2019 By Mihoko Sakurai et al
• https://www.sciencedirect.com/science/article/pii/S2590061719300122
Introduction – Technology Progress and Disaster Management
1. Information is crucial for effective disaster management. Social media could be used as new
information sources for disaster relief agencies. It enhances situational awareness as well as
two-way communication.
• Ex: Hurricane Sandy in 2012, around 800,000 photos were posted with the hashtag,
#Sandy on Instagram. These photos also showed their geographical locations
• In the Nepal earthquakes in 2015, Digital Humanitarian, which formed a digital volunteer
community, developed various digital tools for disaster management
• More than 3000 volunteers contributed to create a map and 1500 reports were
released showing affected areas and the number of victims on the map. The
information was used extensively by the American Red Cross and the Nepali
government in delivering relief operations.
• The national government recommends developing an ICT (Information and
Communications Technology)- Business Continuity Plan (ICT-BCP) which guides
government officials how to continue ICT facilities after a disaster.
2. Application of Technologies to the Field
• Application of technologies in four stages of disaster management, risk reduction,
preparedness, response and recovery
• The essential roles of information systems as follows; information record, information
exchange, and information process.
a. Application of Technologies to the Field for Risk Reduction
• Monitoring technology for buildings, unmanned aerial vehicles (UAV) and sensor
network systems help local authorities reduce disaster risk.
• A sensor network system has been deployed in a major bridge and road infrastructure.
It reports on vulnerability of infrastructure by monitoring degradation and endurance
• The sensor can detect water-level rise in a river. These systems enable a local authority
to improve prediction of river flooding and real-time situational analysis
• Sensor data requires frequent observation, using open satellite image is increasingly
popular in monitoring land use and change. Recorded information would be useful
when integrating hazard assessments into disaster planning.
• Information systems support information record in disaster risk reduction.
• Recent development of AI technologies would enable disaster managers to analyze
those recorded data and create an alert.
• An AI platform which can detect water rise from social media posts has already been
developed
b. PREPAREDNESS
• Information collected by sensor network systems can strengthen community-based
disaster preparedness as people learn about vulnerable areas.
• Information technologies provide an opportunity for scenario simulation by living-
lab style, and support field exercises prior to a real disaster.
• One example is a Virtual Reality (VR) training system. This system teaches people
how to survive a disaster. Users can learn what a disaster situation looks like visually
and how to evacuate from the office building or schools in an indoor situation
• The system could show how difficult avoiding smoke during evacuation is, and how
people panic under a disaster situation. The VR technology has been adopted by
hospitals. It supports emergency medical training.
• Messenger applications as well as online dashboards help citizens report their
situation and requests.
• Information systems support information exchange in disaster preparedness.
• Information systems also can create a knowledge repository based on the past disaster
experiences
c. RESPONSE
• Information systems play an essential role for information exchange in the initial
response. Once a disaster occurs, local governments need to conduct the following
operations in Japan:
1. Confirming the whereabouts and safety of residents,
2. Establishing and operating evacuation centers,
3. Transporting and managing relief goods,
4. Supporting evacuees and creating evacuee lists, and
5. Issuing disaster victim certificates.
• Information systems enhances situational awareness and decision making. Victims can
report situations around them through social media.
Issues of Information System:
• False information would lead to public sectors responding unnecessarily. Critical
thinking was suggested to protect one from such false SNS messages.
• Human resources are not enough within a local government. IT professionals to local
governments. This may solve an issue on recruiting IT resources in local governments
at the time of emergency.
 • DISAster-information ANAlyzer (DISA ANA) was implemented to make the social
networking services (SNS) information more trustworthy.
d. RECOVERY
• After an initial response, a local government is in charge of supporting residents to get
back to their normal life. The importance of evacuation centers operation and
management.
• Recognizing necessary resources for evacuees, and managing relief goods, are essential
• Information systems can be used for coordinating available resources.
• ISSUES: However, no information systems were employed for connecting supply side
and local authorities. As an example of managing evacuation center operations.
• Sahana is an information sharing system for humanitarian assistance during disasters
and was developed originally by programmers in Sri Lanka just after the 2004 Indian
Ocean earthquake and tsunami.
• The system is based on a free and open software and has been used extensively during
disasters such as the 2010 Earthquake in Haiti. Sahana was introduced to the Japanese
open-source community in 2010.
• The Sahana Japan Team (SJT) was set up and those industrial volunteers developed the
system for Iwate with the help from SJT
• Another essential operation is the issuing of disaster victim certificates. An
information system for processing disaster victim certificates was available during the
west Japan flooding of 2018
• In the line of situational awareness, a “Reconstruction Watcher” that streamed videos
and pictures of areas affected by the Great East Japan Earthquake 2011 was developed.

3. Discussion

• Information systems help people record, exchange, and process disaster-related

information throughout four management stages (Fig 1).
• In risk reduction, sensors, open satellite images and UAVs help local governments record
real-time situation of land, rivers and critical infrastructure. Information from these tools
would show vulnerability and risk.
• In the preparedness phase, the main activity for local authorities is a disaster field exercise.
• Online dashboards and SNS are used as communication mean for exchanging information
during the exercise. A VR training system provides people with simulated experience.
• Once a disaster occurs, gaining situational information becomes essential.
• Citizen-generated information through social media and open digital tools such as Open
Street Map could increase situation awareness yet managing these tools and information
remain as issues to be addressed.
• Data that is generated in the previous stages is essential to recovery operations. However,
the design of information systems may well be carried out independently in every stage/
• For instance, when operating an evacuation center, the following operations are
required:
a. to keep track of the statistics such as the number of victims as well as vulnerable people
to a disaster, which includes the injured, the disabled, elderly, pregnant women,
 children and the others who need assistance, and provide them with necessary care
including medicines and medical support.
b. to keep track of necessary foods and goods and provide the victims with them.
• During the Great East Japan Earthquake in 2011, the above operations were needed, not
only for victims at evacuation centers, but also for the people who stayed in their own
houses around the evacuation centers.5 Accordingly, it was necessary to get the
information on where those victims who needed the support were staying.
• Now that we have tools such SNS, one could keep track of the victims staying at their own
houses around the evacuation centers by mining the SNS messages with the Global
Positioning System (GPS)
• Local governments can create a specific real-time alert that is useful for people living in a
highly vulnerable area, by combining risk and real-time information in the initial response
• Unmanned aerial Vehicle (UAVs) can provide a holistic view for situational awareness
throughout different disaster stages. In doing so, we need a holistic strategy of information
technology use and standards for data sharing among different systems or different
stakeholder.
CONCLUSION
• The use of information technology under a disaster. From local government's perspective,
essential roles of information systems, i.e., information record, exchange and process, are
critical in effective disaster management.
• Information record and exchange are initial functions of information systems prior to a
disaster, while information process and exchange become core to disaster relief operations.
• The necessity of a strategy for effective use of information technology throughout the four
disaster management stages, and the necessity of data standards among different information
systems and stakeholders.
• Collaboration with external institutions and IT professionals is essential. In addition,
developing a holistic IT strategy including how to manage IT resources is necessary
• It requires a long-term perspective whereas disaster management at each stage deals with a
wicked, short-term problem Noticing such a dilemma in practice, we believe the study of
disaster management and information technologies enhances effective disaster management
for local governments, which are in the front line of disaster preparedness and response.

COURSE MODULE COURSE UNIT WEEK

3 15 17
DIRECTION FOR DISASTER NURSING RESEARCH

Nursing research develops knowledge about health and the promotion of health over the full
lifespan, care of persons with health problems and disabilities, and nursing actions to enhance the
ability of individuals to respond effectively to actual or potential health problems.
(https://www.ncbi.nlm.nih.gov/books/NBK218540/)

Directions for Nursing Research and Development

• Richard Ricciardi, Janice B. Griffin Agazio, Roberta P. Lavin, and Patricia Hinton Walke
• DISASTER NURSING AND EMERGENCY PREPAREDNESS BY TEENER GOODWIN VEENEMA
Priority should be given to nursing research that would generate knowledge to guide practice in:
1. Promoting health, well-being, and competency for personal care among all age groups;
2. Preventing health problems throughout the life span that have the potential to reduce
productivity and satisfaction;
3. Decreasing the negative impact of health problems on coping abilities, productivity, and life
satisfaction of individuals and families;
4. Ensuring that the care needs of particularly vulnerable groups are met through appropriate
strategies.
5. Designing and developing health care systems that are cost-effective in meeting the nursing
needs of the population. (https://www.ncbi.nlm.nih.gov/books/NBK218540/))

Purpose of Research in Disaster Nursing

1. To ensure and measure quality of health care throughout the phases of prevention,
preparedness, response, and recovery in the event of a man-made or natural disaster.
2. The capacity to prevent, mitigate, prepare, respond, and recover from disasters will increase
disaster resilience and thus improve our nation’s capacity to confront disasters.
3. Conducting research related to mass casualty events is a distinct challenge, presents many
challenges from a scientific point of view and a legal and ethical nature.
4. To mitigate the degree of injury and damage and prevention of repeated mistakes in the
response to future disasters.
5. Assessment of current strengths and identification of gaps in education, practice, research, and
health policy is an important approach for the future.
6. With the systems focus, using a quality framework, research can focus on the preparedness,
planning efforts, and the necessary provider and client education that have a greater potential to
improve outcomes in a real mass casualty event.

Conducting Nursing Research

• Focused on mass casualty events and disasters is a legitimate and appropriate task for the
Nursing Profession.

Several strengths of the Nursing Profession are Keys to Improved Management of Disasters:
1. Nurses are team players and work effectively in interdisciplinary teams needed in disaster
situations;
2. Nurses have been advocates for primary, secondary, and tertiary prevention, which means that
nurses can play key roles at the forefront in disaster prevention, preparedness, response,
recovery, and evaluation.
3. Nurses historically integrate the psychological, social support, and family-oriented aspects of
care with physiological needs of patients/clients; and
4. Nurses are available and practicing across the spectrum of health care delivery system settings
and can be mobilized rapidly if necessary.
5. Research must be conducted related to the nursing role and the impact of nursing on both the
client (individual and community) and on the health care delivery system.

STRUCTURING A RESEARCH AGENDA

Focusing on three areas:
1. The needs of patient/individual/community (as client),
2. Health care providers, explore the possible roles for nurses in all phases of disaster.
3. The health care delivery system needs for improved planning and response.

Purpose of the Nursing Research Agenda

1. To improve quality of care received in a disaster situation, using an appropriate framework
designed to manage quality improvement.
2. To address outcomes at the client level, the provider level, and the systems level.
 3. Health policy implications and the ethics of individual decision making for individuals and
communities versus governmental decision making.
4. The impact of mass casualty events and disasters on the financial health of health care delivery
systems.

Purpose of the Nursing Research Agenda for the Nursing Profession

1. A need for research related to assessment of the knowledge of practicing nurses about the
communicability of different biological agents and other seldom-used skills.
2. How to use technology to educate practicing nurses through continuing education.
3. Development of curricula (Disaster Nursing) for schools of nursing.

Research in Disaster Nursing

1. Is needed to demonstrate the effectiveness of technological methods of skills training for
disaster events.
- Demonstration of the effectiveness of simulation tools and online training for disasters
is essential for adequate surge capacity, especially when the training is related to
illnesses and injuries that are infrequently or rarely encountered by nurses or the
healthcare system.
2. To explore how nurses with differing knowledge and expertise might be used in a mass
casualty event and man-made or natural disasters.
3. Understanding the capabilities and limitations of untrained volunteers and how to insert
them into the existing structure is critical to a successful response.

Lieutenant Colonel Harriet Werley,

• A pioneer in nursing research, stated that nursing is well positioned to have great influence on
communities and to conduct research on mass casualty events and disasters (Werley,1956).

She identified the following four principles for conducting community-based research on
mass casualty events and disasters, which are still relevant today:
• Identify methods of teaching all citizens the essentials of survival care to reduce the workload
on trained responders at the site through self-aid and buddy-aid.
• Plan for mass casualty events and disasters and train in a purposeful and realistic manner.
• Use resources economically, including supplies and trained personnel in order to do the
greatest good for the greatest number of people.
• Conduct research on the principles of triaging - especially the psychological impact on nurses
during a mass casualty event.

DISASTER NURSING RESEARCH

• By Dean WhiteHead and Paul Arbon (Feb 26, 2019)
• DISASTER%20NURSING/CU%20DISASTER%20NSG/WK%2017%20CU%2015%20Directio
ns%20for%20Disaster%20Nursing%20Research%20and/WhiteheadArbon-2010-
CHAPTER_32_DISASTER_NURSING_RESEARCH.pdf
• There is considerable opportunity and need for research that contributes to the science of
disaster health care and supports the way that we prepare for and respond to the health
aspects of a disaster. The challenge is to develop research approaches that ensure robust
findings and allow us to compare findings across studies, across events, and across societies,
in an effort to improve the quality of the evidence that supports our practice
Objectives:
• Assist nurses in providing leadership in identifying gaps in disaster healthcare practice by
using research to evaluate their practice;
• Identify and explore effective nursing-related research practices and how they might best be
utilized for disaster health research and evaluation of care; and
• Provide existing examples of the use of these various research methodologies.

The Current Situation and the Challenges for Disaster Research in Nursing
1. The general level of understanding of the healthcare aspects of disasters and the roles of nurses
in a disaster remain varied and confused.
2. The lack of evidence-based knowledge among nurses is the pervasive belief in common disaster
myths.
3. Of all the health-related professions, disaster nursing currently is least supported by a body of
research evidence.
4. Disaster education for nurses is in a relatively early stage of development in most countries,
there currently are few recognized competencies for disaster nursing that are either widely
accepted or that have a strong evidence base.
5. However, the ICN is developing disaster nursing competencies, which are designed to support
the development of appropriate education of nurses across fields and levels of practice.

DISASTER-RELATED NURSING RESEARCH

Walker et al 1 categorize the research of mass casualty events and disaster into 3 distinct areas:
• Research related to the education and training, preparedness, and safety of responding
personnel (including mental health);
• Research related to patients at the individual, family unit, and community levels; and
• Research related to health system communication and collaboration during response and
recovery
1. The general level of understanding of the healthcare aspects of disasters and the roles of
nurses in a disaster remain varied and confused.
- Ex: Mitani et al16 surveyed the expectations of Japanese nurses regarding minimum
conditions, information, essential knowledge, and briefing required by nurses responding
to a disaster
2. Research related to patients at the individual, family unit, and community levels
- Ex: They assessed post-earthquake conditions related to health care and access to health
care, as well as housing, food, sanitation, and water.
3. Research related to health system communication and collaboration during response
and recovery
- Ex: O’Boyle et al26 utilized focus groups to develop recommendations on interventions that
would support the ability of nurses to work effectively during a disaster response, and to
facilitate better communication and multidisciplinary collaboration.
- Recommendations included specific measures to improve safety, reduce anxiety, increase
trust in hospitals, and provide physical and emotional support for nurses.

TOWARD A BROADER AND MORE EFFECTIVE RESEARCH AND EVIDENCE BASE FOR DISASTER
NURSING
• Several international collaborations support the development of research and evidence-based
practice in disaster healthcare. These includes:
1. World Association for Disaster and Emergency Medicine (WADEM)
2. International Council of Nurses (ICN), and
3. Cochrane Collaboration
 • These collaborations provide the opportunities to network, draw in resources to support
research, develop strategic plans or priorities, share research findings effectively, and apply
these findings to the education and practice of the healthcare workforce.

DISASTER RESEARCH AWARENESS

According to Whitehead and Arbon, these skills include:
• An understanding of the concepts of effectiveness, safety, and acceptability to ensure that the
intervention being assessed achieves the desired patient outcomes;
• The ability to access and assess the quality and generalizability of any clinical evidence presented.
- This includes access to resources, such as databases and journals, and the capacity to
critically read and interpret published research.
- For most health professionals, both at the undergraduate and postgraduate level, searching
for, understanding, and translating the existing empirical research literature constitute the
initial steps in promoting evidence-based practice and sound practice-change principles;
• The ability to assess the applicability of the findings to the local population follows from the
critical review of the literature.
- Published research studies may have been undertaken in populations with varying
degrees of similarity to the local population of interest.
- Assessing the local applicability of research findings involves determining if the
populations and context are similar enough to warrant changes based on the published
findings, or if further research involving the target population is required;
• The capacity and skills to affect practice changes.
- Nurses working to change practice by applying evidence-based findings require a working
knowledge of research practices and leadership skills to promote acceptance of the
recommended changes.
- Ex: Mitani et al16 surveyed the expectations of Japanese nurses regarding minimum
conditions, information, essential knowledge, and briefing required by nurses responding
to a disaster
Research Frameworks
• Recognized impediments to the successful application of research in the disaster field include:
- A lack of accepted definitions for disaster and the health effects of disasters;
- A lack of conceptual frameworks able to provide a structure for the study of disasters and to
challenge researchers to (re)consider relationships between important variables; and
- A lack of endorsed sets of indicators or data points that can be used in research studies.
Evidence-Based Practice, Practice Development, and Practice Change
• EVIDENCE-BASED PRACTICE
1. EBP has become a driving force for problem-solving and improving clinical practice and
cost- effectiveness of care.
2. Many healthcare organizations have invested heavily in strategies to increase the
likelihood that all clinical practice is evidence-based, wherever possible.
• PRACTICE DEVELOPMENT
1. Practice development as a primary mechanism for creating work environments that
sustain evidence-based, person-centered practice, thus providing both a framework and the
methods for making EBP a reality.
Promoting Action on Research Implementation in Health Services (PARIHS)
• Which acknowledges that successful implementation of evidence into practice is more likely if
a systematic, explicit, and context-specific approach to facilitation is adopted.
• The PARIHS framework proposes that evidence, context, and facilitation are interrelated and
influence the success of evidence utilization in practice.

PARIHS framework includes:

1. Clarifying values and beliefs about the particular development focus;
2. Identifying the existence of these values and beliefs in practice;
3. Identifying the gaps that exist between the espoused and the real values through processes of
inquiry and evaluation;
4. Ensuring that systematic approaches to developing practice are negotiated and action plans put
in place to develop practice; and
5. Ensuring that the model of facilitation that is negotiated with key stakeholders includes a
sustainable commitment to learning from the processes via reflective learning strategies, such
as action learning and supported reflective practice.

Practice Change
- Practice change requires consideration of three key elements: evidence, context, and facilitation.
- For example, where there is little primary research evidence to guide a clinical decision,
clinicians predominantly use their experience and feedback from past patients in determining
how to care for the patient. Clinicians should be wary, however, of changing practice where
insufficient research evidence exists.