NCM 220

DISASTER NURSING
AMIE S. PEREZ, RN
CLINICAL INSTRUCTOR
 COURSE OBJECTIVES
Distinguish different Discuss the different areas of
concept used in disaster focus in emergency and
nursing disaster planning

Determine the steps in

Classify the different kinds preparing for a disaster
of disaster

Acknowledge the different

Differentiate phases of guidelines used in disaster
disaster. and emergency situations
 COURSE OBJECTIVES

Comprehend the different Differentiate the roles and

Philippine Laws that govern functions of the personnels
the disaster management and involved in disaster preparedness
risk reduction. and reponse plan.

Familiarize the process of

documentation in disaster
management
 BASIC
CONCEPTS ON
DISASTER
NCM 220: DISASTER NURSING

SUPPLEMENTAL VIDEOS:
PHILIPPINE COMPILATION OF DISASTER
https://youtu.be/M-o-F6HDuyY
 WHAT IS DISASTER?
UNISDR, 2017 WHO, 2018
“A serious disruption of
the functioning of a
“Any event which
community or a society: significantly impacts
at any scale due to a considerable
hazardous events number of individuals
interacting with in a community or
conditions of exposure, country where
vulnerability and physical and mental
capacity, leading to health, environment,
one or more of the and economy are
following: negatively disrupted
human, material, requiring national or
economic and international
environmental losses
response”
and impacts”
 DISASTER NURSING
Defined as the adaptation of
professional nursing skills in
recognizing and meeting the nursing
physical and emotional needs
resulting from the disaster.
BASIC CONCEPTS ON DISASTER

HEALTH DISASTER
A catastrophic event that results in
casualties that overwhelm the
healthcare resources in that 1
community and may result in a
sudden unanticipated surge of, a
change in standards of care, and a
need to allocate scarce resources
BASIC CONCEPTS ON DISASTER
HAZARD
 a potential threat to humans and their welfare
 present the possibility of the occurrence of a 2
disaster caused by natural phenomena, failure
of man-made sources of energy, or human
activity

RISK
 the actual exposure of something of human 3
value
 often measured as the product of probability
and loss
 RISK For example, an earthquake hazard of the same
magnitude in a sparsely populated village of
Rajasthan and in the densely populated city of
Risk is the probability of harmful
Delhi will cause different levels of damage to
consequences, or expected losses (deaths, human lives, property and economic activities.
injuries, property, livelihoods, economic
activity disrupted or environment damaged)
resulting from interactions between natural or
human-induced hazards and vulnerable
conditions. (UNDP 2004)

Risk is conventionally expressed by

the equation:

RISK = HAZARD X VULNERABILITY

BASIC CONCEPTS ON DISASTER
VULNERABILITY
The characteristics determined by physical, social,
economic and environmental factors or processes 4
which increase the susceptibility of an individual, a
community, assets or systems to the impacts of
hazards (UNDRR Terminology, 2017).

CAPACITY
The combination of all the strengths and resources
available within a community, society or organization
5
that can reduce the level of risk, or the effects of a
disaster
 CLASSIFICATIONS OF DISASTER

NATURAL DISASTER MAN-MADE DISASTER

Caused by natural ANTHROPOGENIC
or environmental forces Human generated

SUPPLEMENTAL VIDEO:
DISASTER RESPONSE IN THE PHILIPPINES
https://youtu.be/feQXpDHIzNU
NATURAL  The result of an ecological disruption
or threat that exceeds the adjustment

DISASTER capacity of the affected community.

( WHO)

 Include earthquakes, floods,

tornadoes, hurricanes, volcanic
eruptions, ice storms, tsunamis, and
other geological or meteorological
phenomena.

 The consequence of the intersection

of a natural hazard and human
activity
MAN MADE  Anthropogenic disasters are those in
which the principal direct causes are

DISASTER identifiable human actions, deliberate

or otherwise.

 Anthropogenic disasters include:

Biological and biochemical terrorism

Chemical spills
Radiological (nuclear) events
Fire
Explosions
Transportation accidents
Armed conflicts
Acts of war
 HOSPITAL CLASSIFICATION OF DISASTER

INTERNAL DISASTER EXTERNAL DISASTER

Cause disruption of normal hospital function Those that do not affect the hospital
due to injuries or deaths of hospital personnel infrastructure but tax hospital resources due
or damage to the facility itself, as with a to numbers of patients or types of injuries
hospital fire, power failure, or chemical spill.
 SUPPLEMENTAL VIDEO:
WORST NATURAL DISASTER IN HUMAN HISTORY
https://youtu.be/dCQS-I22SmA

THE NATURAL DISASTER

 GEOPHYSICAL DISASTER
Originate from the solid earth, include:
● Earthquake (ground movement and tsunami)
● Dry mass movement (rock fall and
landslides)
● Volcanic activity (ash fall, lahar, pyroclastic
flow, and lava flow).
 BIOLOGICAL DISASTER
Biological disasters are caused by the exposure
to living organisms and their toxic substances or
vector borne diseases that they may carry and
include
 epidemics (viral, bacterial, parasitic, fungal,
and prion)
 insect infestation (grasshopper and locust)
 animal accidents
 HYDROLOGICAL DISASTER
Hydrological disasters are caused by the occurrence,
movement, and distribution of surface/subsurface
freshwater and saltwater and include
 Floods - can be coastal, riverine, flash, or ice jam
 Landslides (an avalanche of snow, debris,
mudflow, and rock fall),
 Wave action (rogue wave and seiche)
 CLIMATOLOGICAL DISASTER
Climatological disasters are caused by long
lived, meso- to macro-scale atmospheric
processes ranging from intra seasonal to
multi decadal climate variability and include
 drought
 glacial lake outburst
 wildfire (forest fire, land fire: brush, bush,
or pasture).
 METEOROLOGICAL DISASTER
Meteorological disasters are caused by short-lived,
micro- to meso-scale extreme weather and
atmospheric conditions that last from minutes to
days and include:
 Extreme temperatures (cold wave, heat wave,
and severe winter conditions such as snow/ice
or frost/ freeze)
 Fog
 Storms
 EXTRATERRESTRIAL DISASTER
Extraterrestrial disasters are caused by
asteroids, meteoroids, and comets as they
pass near-earth, enter Earth’s atmosphere,
and/or strike the earth, and by changes in the
interplanetary conditions that affect the
Earth’s magnetosphere, ionosphere, and
thermosphere. Types include:
 impact (airbursts)
 space weather (energetic particles,
geomagnetic storm, and shockwave)
events
 SUPPLEMENTARY VIDEOS:
5 WORST MAN MADE DISASTER
https://youtu.be/71dHj3DNy88

THE MAN-MADE DISASTER

 MAN MADE DISASTER CLASSIFICATION
Situations where Unplanned release A natural and
populations suffer of nuclear energy, human-generated
significant and fires or disaster may trigger
casualties as a explosions from a secondary
result of war, civil hazardous disaster, the result
strife, or substances such as of weaknesses in
other political fuel, chemicals, or the human
conflict. nuclear materials environment

COMPLEX HUMAN TECHNOLOGICAL SYNERGISTIC

EMERGENCIES DISASTER DISASTER
TECHNOLOGICAL DISASTER

INDUSTRIAL ACCIDENTS
include chemical spills, collapse,
explosion, fire, gas leak, poisoning,
radiation, and oil spills.

A chemical spill is an accidental release

occurring during the production,
transportation, or handling of hazardous
chemical substances
TECHNOLOGICAL DISASTER

TRANSPORT ACCIDENTS
include disasters in the:
 AIR (airplanes, helicopters, airships,
and balloons)
 ON THE ROAD (moving vehicles on
roads or tracks)
 ON THE RAIL SYSTEM (train)
 ON THE WATER (sailing boats, ferries,
cruise ships, and other boats).
TECHNOLOGICAL DISASTER
MISCELLANEOUS
ACCIDENTS

Vary from collapse to explosions to

fires

Collapse is an accident involving

the collapse of a building or
structure and can either involve
industrial structures or
domestic/nonindustrial structures
  Combs (2018) defines terrorism
TERRORISM as “an act of violence perpetrated
on innocent civilian
noncombatants in order to evoke
fear in an audience”

TERRORISM is an act composed of

at least four crucial elements:
1) It is an act of violence
2) It has a political motive or goal
3) It is perpetrated against civilian
noncombatants
4) It is staged to be played before an
audience whose reaction of fear
and terror is the desired result.
TYPES OF TERROR VIOLENCE BY FELIKS GROSS

1 2 3 4 5
DYNASTIC FOCUS RANDOM
MASS TERROR ASSASSINATION
RANDOM TERROR TERROR
TACTICAL TERROR

The placing of explosives, Directed solely against

An attack on a head The placing of explosives
for example to where the ruling government as
where people gather to
Terror by a state of state or a ruling destroy whoever happens
significant agents of a part of a ‘broad
elite oppression are likely to revolutionary strategic
to be there
gather plan’
 MARTIN (2017) EIGHT DIFFERENT TERRORISM TYPOLOGIES
NEW STATE DISSIDENT RELIGIOUS
TERRORISM TERRORISM TERRORISM TERRORISM

Characterized by the Committed by Committed by non Motivated by an

threat of mass governments against state movements and absolute belief that an
casualty attacks from perceived enemies groups against otherworldly power
dissident terrorist and can be directed governments, ethno- has sanctioned and
organizations, new externally against national groups, commanded the
and creative adversaries in the religious groups, and application of terrorist
configurations, international domain other perceived violence for the
transnational religious or internally against enemies greater glory of the
solidarity, and domestic enemies” faith
redefined moral
justifications for
political violence
 MARTIN (2017) EIGHT DIFFERENT TERRORISM TYPOLOGIES
CRIMINAL GENDER
IDEOLOGICAL INTERNATIONAL
DISSIDENT SELECTIVE
TERRORISM TERRORISM
TERRORISM TERRORISM
Motivated by political Spills over onto the Solely profit-driven, Directed against an
systems of belief world’s stage and can be some enemy population’s
(ideologies), which combination of profit men or women
champion the self- Targets are selected and politics because of their
perceived inherent because of their value gender.
rights of a particular as symbols of
group or interest in international interests
opposition to another
group or interest

SUPPLEMENTAL VIDEOS:
Hunting For Terrorists In The Philippines
https://youtu.be/hAexuFyGIaU
 CHEMICAL AGENT OF TERRORISM
CHEMICAL AGENTS  Defined as any chemical
substance intended for use in
military operations to kill,
seriously injure, or incapacitate
humans (or animals) through its
toxicological effects

Chemicals excluded from this list are

riot-control agents, chemical
herbicides, and smoke/flame
materials.
 CLASSIFICATIONS OF CHEMICAL AGENTS
INCAPACITATING
TOXIC AGENTS
AGENTS
Producing injury or Producing
death temporary effects

NERVE AGENTS
(anticholinesterases)
STIMULANTS
BLOOD AGENTS
(cyanogens) DEPRESSANTS

BLISTER AGENTS
(vesicants) PSYCHEDELICS

LUNG-DAMAGING AGENTS DELIRIANTS

(choking agents)
BIOLOGICAL AGENTS

Often referred to as BIOTERRORISM

 Center for Disease Control (CDC)
define it as the deliberate release
of viruses, bacteria, or other
germs (agents) used to cause
illness or death in people,
animals, or plants.
 CATEGORIES OF BIOLOGICAL AGENTS

Result in high mortality

Organisms with the rates and Have the Promote public panic
Require special action
highest risk because the potential for major and social disruption
of public health
ease of dissemination public health impact preparedness
or transmission from
person-to-person

CATEGORY A
 CATEGORIES OF BIOLOGICAL AGENTS

Result in moderate Require specific

morbidity and low enhancements of
mortality rates Low mortality rates diagnostic capacity and
Moderately
enhanced disease
Easy to disseminate
surveillance.

CATEGORY B
 CATEGORIES OF BIOLOGICAL AGENTS

Emerging pathogens
that could be Have the potential for
Ease of production and high morbidity and
engineered for mass
dissemination mortality rates Major health impact
dissemination because
of availability

CATEGORY C
 EXAMPLES
Ricin Toxin
Smallpox Brucellosis
Anthrax Epsilon Toxin Nipah virus
Plague Food Safety Threats
Glanders
Hantavirus
Meliodosis Yellow fever virus
Viral hemorrhagic
Psitticosis
fevers Typhus Fever Drug resistant
(filoviruses and Q Fever Tuberculosis
arenaviruses) Staphylococcal Enterotoxin
B, Trichothecenes
Mycotoxin Tick-borne encephalitis
Botulinum toxin
Viral Encephalitis
Tularemia Water Safety Threats

CATEGORY A CATEGORY B CATEGORY C

 RADIOLOGICAL / NUCLEAR DISASTER

Any radiation incident resulting in or

having a potential to result in
exposure and/or contamination of
the workers or the public in excess
of the respective permissible limits
can lead to a nuclear/radiological
emergency
 RADIOLOGICAL AND NUCLEAR DISASTER

FUKUSHIMA DAIICHI
NUCLEAR DISASTER
Following a major earthquake, a
15-metre tsunami disabled the
power supply and cooling of three
Fukushima Daiichi reactors,
causing a nuclear accident
beginning on 11 March 2011
RADIOLOGICAL AND NUCLEAR
DISASTER
CHERNOBYL DISASTER

The Chernobyl accident in 1986 was the result of a

flawed reactor design that was operated with
inadequately trained personnel.
The resulting steam
explosion and fires
released at least 5%
of the radioactive
reactor core into
the environment.
 EXPLOSIVES DISASTER
 Relatively simple to manufacture and
easy to detonate.
 Injure and kill many people and spread
fear over large populations
 Victims of bomb blasts sustain more
body regions injured, have more body
injury severity scores, and require more
surgeries than victims of non explosive
trauma incidents.
 Victims of explosives also have a
higher mortality
Factors influence the number of people injured and the severity of
the injuries in an explosion

The magnitude of the explosion and

Its proximity to people

The collapse of building or structure from

the blast

Promptness of the rescue operation

The caliber and proximity of medical

resources in the vicinity
 FOUR (4) KINDS OF INJURY FROM EXPLOSIONS

PRIMARY SECONDARY TERTIARY QUARTERNARY

occur directly from occur from being struck occur when victims are All other injuries related to the blast
the pressure wave by flying objects from the displaced from a location include burns, inhalational injuries,
of the blast blast and strike other objects or toxic exposures, and traumatic
surfaces injuries from structural collapse.
ACTIVE SHOOTING
Bureau of Investigation (FBI) uses
the term ACTIVE SHOOTER, which it
defines as “an individual actively
engaged in killing or attempting to kill
people in a populated area.”

 gang- or drug related incidents,

 the accidental discharge of a firearm
 family- and intimate partner-related
shootings
TRENDS AND
PATTERN OF
DISASTER
NCM 220: DISASTER NURSING
 GOALS OF DISASTER NURSING
To identify the potential

To meet the immediate

2 for a secondary
disaster.
basic survival needs of
populations affected by
1
disasters
4 To correct inequalities
in access to health care
or appropriate
resources.
To appraise both risks
and resources in the 3
environment.
6 To respect cultural, lingual,
and religious diversity in
individuals and families
and to apply this principle

5 in all health promotion

activities.

To empower survivors
to participate in and
advocate for their own
7 To promote the highest
achievable quality of life
health and well-being. for survivors.
 PRINICIPLES OF DISASTER NURSING
Rapid assessment of
the situation and of Evaluation of the
nursing care needs. environment and the
mitigation or removal of
any health hazards.

Triage and initiation of

life-saving measures Prevention of further injury
first. or illness.

Leadership in coordinating
The selected use of patient triage, care, and
essential nursing transport during times of
interventions and the crisis.
elimination of nonessential
nursing activities. The teaching,
supervision, and utilization
of auxiliary medical
Adaptation of necessary
personnel and volunteers.
nursing skills to disaster
and other emergency
Provision of understanding,
situations.
compassion, and emotional
support to all victims and their
families.
HEALTH EFFECTS OF DISASTER
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.
HEALTH EFFECTS OF DISASTER Disasters may cause
premature deaths, illnesses, Disasters may destroy the
and injuries in the affected local health care

1 community, generally
exceeding the capacity of the
infrastructure, which will
therefore be unable to
respond to the emergency..
2
local health care system.

Disasters may create Disasters may affect the

environmental imbalances,

4
psychological, emotional,

3
increasing the risk of and social well-being of
communicable diseases and the population in the
environmental hazards. affected community.

Disasters may cause large

Disasters may cause

5 6
population movements
shortages of food and
(refugees) creating a
cause severe
burden on other health care
nutritional deficiencies.
systems and communities.

LEVEL
1 2
Local emergency response
personnel and organizations
can contain and effectively
manage the disaster and its
aftermath
LEVEL OF DISASTERS
LEVEL LEVEL
3
Local and regional assets
Regional efforts and aid from the
are overwhelmed; statewide
surrounding communities are sufficient
or federal assistance is
to manage the effects of the disaster.
required.
 PHASES OF DISASTER

PRE IMPACT IMPACT POST IMPACT

 PHASES OF DISASTER
Ricin Toxin
Smallpox Brucellosis
Anthrax Epsilon Toxin Nipah virus
Plague Food Safety Threats
Glanders
Hantavirus
Meliodosis Yellow fever virus
Viral hemorrhagic
Psitticosis
fevers Typhus Fever Drug resistant
(filoviruses and Q Fever Tuberculosis
arenaviruses) Staphylococcal Enterotoxin
B, Trichothecenes
Mycotoxin Tick-borne encephalitis
Botulinum toxin
Viral Encephalitis
Tularemia Water Safety Threats

PRE IMPACT IMPACT POST IMPACT

PHASES OF DISASTER
 PRE-IMPACT
It is the initial phase of disaster, prior
to the actual occurrence.

A warning is given at the sign of the

first possible danger to a community
with the aid of weather networks and
satellite many meteorological
disasters can be predicted.
 PRE-IMPACT
● The earliest possible warning is crucial in
preventing toss of life and minimizing
damage.
● This is the period when the emergency
preparedness plan is put into effect
emergency centers are opened by the local
civil, detention authority.
● Communication is a very important factor
during this phase; disaster personnel will
call on amateur radio operators, radio and
television stations.
 PRE-IMPACT
● The role of the nurse during this
warning phase is to assist in
preparing shelters and emergency
aid stations and establishing
contact with other emergency
service group.
 IMPACT
The impact phase occurs when the disaster
actually happens.

It is a time of enduring hardship or injury end

of trying to survive.

The impact phase may last for several

minutes (e.g. after an earthquake, plane
crash or explosion.) or for days or weeks (eg
in a flood, famine or epidemic).
 IMPACT
Continues until the threat of further
destruction has passed and emergency plan
is in effect.

This is the time when the emergency

operation center is established and put in
operation.

It serves as the center for communication

and other government agencies of health
tears care healthcare providers to staff
shelters.
 IMPACT
● Every shelter has a nurse as a member of
disaster action team.
● The nurse is responsible for
psychological support to victims in the
shelter.
 POST IMPACT
Recovery begins during the emergency phase and ends with the return of
normal community order and functioning.

For persons in the impact area this phase may last a lifetime.
 FOUR STAGES OF EMOTIONAL RESPONSE
2. STRONG EMOTIONAL
3. ACCEPTANCE
RESPONSE
The person is aware of the problem but The victim begins to accept the problems
regards it as overwhelming and caused by the disaster and makes a
unbearable concentrated effect to solve them.

1. DENIAL 4. RECOVERY
During the stage the victims
Victims feel that they are back
may deny the magnitude of the
to normal. A sense of well-being
problem or have not fully
is restored.
registered.
DISASTER MANAGEMENT CYCLE

SUPPLEMENTAL VIDEOS:
Integrated Approach to Disaster Risk
Management: Prevent, Residual risk Prepare,
Respond, Recover
https://youtu.be/xjlPmSXj24Y
DISASTER MANAGEMENT CYCLE
The life cycle of a disaster is generally
referred to as the “disaster continuum,” or
“emergency management cycle.”

The basic phases or “life cycle” of a

disaster management program include
preparedness, mitigation, response,
recovery, and evaluation

There is a degree of overlap across

phases, but each phase has distinct
activities associated with it.
 PREPAREDNESS
The proactive planning efforts
designed to structure the
disaster response prior to its
occurrence.

Disaster planning encompasses

evaluating potential
vulnerabilities (assessment of
risk) and the propensity for a
disaster to occur.
 MITIGATION
Includes measures taken to reduce
the harmful effects of a disaster by
attempting to limit its impact on
human health, community function,
and economic infrastructure.

These are all steps that are taken to

lessen the impact of a disaster
should one occur and can be
considered as prevention measures.
 RESPONSE
The actual implementation of the disaster plan.

Disaster response, or emergency management, is the organization of

activities used to address the event.
 RESPONSE
The response phase focuses
primarily on emergency relief:
 Saving lives
 Providing first aid
 Minimizing and restoring damaged
systems such as communications
and transportation
 Providing care and basic life
requirements to victims (food, water,
and shelter).
 RESPONSE
Disaster response plans are most
successful if they are clear and
specific, simple to understand, use
an incident command system (ICS),
are routinely practiced, and updated
as needed.

Response activities need to be

continually evaluated and adjusted
to the changing situation.
 RECOVERY
Recovery actions focus on stabilizing
and returning the community to
normal (its pre impact or improved
status).

This can range from rebuilding

damaged buildings and repairing
infrastructure to relocating
populations and instituting physical,
behavioral, and mental health
interventions.
 RECOVERY
● Rehabilitation and reconstruction
involve numerous activities to
counter the long-term effects of
the disaster on the community, its
economy, and future
development.
● “Build Back Better” should be the
goal of all recovery actions with a
focus upon resilient and
sustainable communities.
 EVALUATION
Evaluation is the phase of disaster
planning and response that often
receives the least attention.

After a disaster, it is essential that

evaluations be conducted to determine:
● what worked
● what did not work
● what specific problems, issues, and
challenges were identified.
ROLE OF NURSES IN THE DISASTER
 MAJOR ROLES OF NURSE IN THE DISASTER

Determine magnitude of the

1 event

Define health needs of the

2 affected groups

Establish priorities and

3 objectives

Identify actual and potential

4 public health problems
 MAJOR ROLES OF NURSE IN THE DISASTER
Determine resources needed
5 to respond to the needs
identified
Collaborate with other professional
6 disciplines, governmental and non-
governmental agencies

Maintain a unified chain of

7 command

8 Communication
DISASTER TIMELINE AND
NURSING ACTION
DISASTER TIMELINE AND NURSING ACTION
PLANNING/ PREPAREDNESS/
PREVENTION/ WARNING
 RESPONSE
EMERGENCY MANAGEMENT
MITIGATION
 RECOVERY
REHABILITATION
EVALUATION
THANK YOU FOR LISTENING!
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