Student’s Questionnaire

Disaster Preparedness Survey (Student)

This questionnaire is designed to evaluate your feedback on disaster preparedness and
response. Please answer the questions carefully. The reliability of your results of the study is
important. Thank you for your contribution.

1. Age (specify your age) ______

2. Gender
[ ] Male
[ ] Female

3. Marital status
[ ] Single
[ ] Married
[ ] Divorced/separated
[ ] Widow/widower

4. Do you have children?

[ ] No
[ ] Yes, how many?.............................

5. What year of the university are you currently in?

[ ] 1st Year
[ ] 2nd Year
[ ] 3rd Year
[ ] 4th Year
[ ] 5th Year
Others (specify)..…………
5. Which clinical course are you currently studying?............................................................

6. Check the appropriate column in the likelihood of natural or man-made disasters in the area
you now live in.
Types of disasters Not Likely
possible
a) Major forest fires

1
Student’s Questionnaire
b) Fires in urban areas caused by disasters

c) Infectious disease outbreaks (SARS/Avian Flu,TB) etc.

d) Human stampedes

e) Landslides

f) Major transport incidents (include road, railway, air, sea)

g) Chemical accidents/spills (chemical explosions, oil spill in the
sea, etc.)
h) Extreme weather conditions (Heat or cold waves)

i) Floods

j) Terrorist attacks

k) Refugee displacement influx (Exodus of people)

l) Nuclear incidents/radioactive substances leakage

m) Earthquake

n) Rock falls/debris flows

o) Drought

p) Soil erosion

q) Avalanches

r) War/armed conflict

s) Food poisoning by natural causes

t) Food poisoning by human causes

u) Tsunami

v) Typhoon/hurricane/cyclone

w) Volcanic eruption

x) Other disasters. If none, please leave this area blank.

7. Have you ever had any special courses on disaster preparedness & response given at your
university?
[ ] Yes
[ ] No

2
Student’s Questionnaire

8. Have you ever attended courses on disaster preparedness & response outside of your university?
[ ] Yes
[ ] No

If YES, did you receive any certification?

[ ] Yes
[ ] No

9. If you feel yourself insufficient for disaster preparedness and response, would you consider
taking another course on disaster preparedness and response in the future?
[ ] Yes, I would.
[ ] No, I wouldn’t.
[ ] Undecided.

10. Do you know whether your university has any information on how it can prepare itself for a
disaster? (E.g. know emergency routes, meeting points, emergency telephone numbers, obtaining
emergency food and supplies)?
[ ] Yes.
[ ] No.
[ ] I have no idea if it does or doesn’t.

11. Does your nursing school/institution have a disaster management plan?

[ ] Yes, it does.
[ ] No, it doesn’t.
[ ] I don’t know if it does or doesn’t.

12. Do you think your nursing school/institution needs a structured disaster management plan?
[ ] Yes, it does.
[ ] No, it doesn’t.
[ ] I don’t know if it needs one or not.

13. Do you have any information on how you as a student can prepare yourself for a disaster before
it happens (e.g. know emergency routes, meeting points at your university or school of nursing,
emergency telephone numbers, obtaining emergency food and supplies by your university of school
3
Student’s Questionnaire
of nursing)?
[ ] Yes, I do.
[ ] No, I don’t. ( )

14. In your university/institution disaster plan, do you have a specific delineated role?
a) Yes ( ) Specify……………………….
b) No ( )
c) Not sure ( )

15. During a disaster event, which role(s) do you think you could perform? Please choose all that
apply.
a) Caregiver role ( ) b) Triage role ( ) c) Managerial role ( )
d) None ( ) e) Other……….

16. What do you think the roles of your nursing school/institution are for disaster prevention?
Please write up to three (3) roles or choose letter “4” if you don’t know:
1)
2)
3)
4) I don’t know.

17. Have you personally experienced a disaster in the past?

a) Yes, I was at home during the disaster.
b) Yes, I was at work during the disaster.
c) Yes, I traveled to respond to a disaster.
d) Yes, other (specify)_________________
e) No

The following questions refer to your willingness and availability to report to your
university/institution in the event of a disaster.
18. on a scale of 1 to 5, how willing are you to report to your university/institution as a volunteer in
the event of a disaster, either natural or man-made?
1=Not at all 2=probably not 3=possibly
4=probably 5=definitely

4
Student’s Questionnaire

19. What would you need in order to be available to report to your university/institution to
volunteer in a disaster response?
I. Transport
a) Yes ( ) b) No ( ) c) Maybe ( )

II. Communication equipment (to communicate with family)

a) Yes ( ) b) No ( ) c) Maybe ( )

III. Compensation (to cover time)

a) Yes ( ) b) No ( ) c) Maybe ( )

20. This section will evaluate your skills, knowledge, and preparedness to disaster. Rate the
extent to which you agree or disagree on the items below.
1 – Strongly Disagree ---------- 6 – Strongly Agree
Statements 1 2 3 4 5 6
a. I know the limits of my knowledge, skills and authority as
a health care provider to act in disaster situations, and I
would know when I exceed them
b. I can identify possible indicators of mass exposure
evidenced by a clustering of patients with similar
symptoms
c. I can manage the common symptoms and reactions of
disaster survivors that are of affective, behavioral,
cognitive and physical nature
d. I am familiar with psychological interventions, behavioral
therapy, cognitive strategies, support groups and incident
debriefing for patients who experience emotional or
physical trauma
e. I am able to describe my role in the response phase of a
disaster in the context of my workplace, the general
public, media, and personal contacts
f. I am familiar with the main groups (A, B, C) of biological
weapons (anthrax, plague, botulism, smallpox, etc.), their
signs and symptoms, and effective treatments

5
Student’s Questionnaire
g. I feel confident recognizing differences in health
assessments indicating potential exposure to biological or
chemical agents
h. I feel confident in my abilities as a direct care provider
and first responder in disaster situations
i. I feel confident as a manager or coordinator of a shelter
j. I would feel reasonably confident in my abilities to be a
member of a decontamination team
k. In case of a bioterrorism/biological or chemical attacks, I
know how to perform focused health history and
assessment, specific to the biological or chemical agents
that are used
l. I feel reasonably confident that I can care for patients
independently in a disaster situation
m. I am familiar with the organizational logistics and roles
among local and national agencies in disaster response
situations
n. I would feel confident implementing emergency plans,
evacuation procedures, and similar functions
o. I would feel confident providing patient education on
stress and abnormal functioning related to trauma
p. I would feel confident providing education on coping
skills and training for patients who experience traumatic
situations so they are able to manage themselves
q. I am able to differentiate the signs and symptoms of acute
stress disorder and PTSD
r. I am familiar with what the scope of my role as a
health-care provider in a post-disaster situation would be
s. I participate in peer evaluation of skills on disaster
preparedness and response
t. I am familiar with how to perform focused health
assessment for PTSD
u. I feel confident managing (caring, evaluating) emotional
outcomes for acute stress disorder or PTSD following
disaster or trauma in a multi-disciplinary way such as

6
Student’s Questionnaire
referrals, and follow-ups and I know what to expect in
ensuing months
v. I participate in disaster drills or exercises at my workplace
(clinic, hospital, etc.) on a regular basis
w. I have participated in emergency plan drafting and
emergency planning for disaster situations in my
community
x. I know who to contact (chain of command) in disaster
situations in my community
y. I participate in one of the following educational activities
on a regular basis: continuing education classes, seminars
or conferences dealing with disaster preparedness
z. I read journal articles related to disaster preparedness
aa. I am aware of classes about disaster preparedness and
management that are offered, for example at my
workplace, the university or community
bb. I would be interested in educational classes on disaster
preparedness that relate specifically to my community
situation
cc. I find that the research literature on disaster preparedness
and management is easily accessible
dd. I find that the research literature on disaster preparedness
is understandable
ee. Finding relevant information about disaster preparedness
related to my community needs is an obstacle to my level
of preparedness
ff. I know where to find relevant research or information
related to disaster preparedness and management to fill in
gaps in my knowledge
gg. I have a list of contacts in the medical or health
community in which I practice I know referral contacts in
case of a disaster situation (for example, health
department)
hh. In case of a disaster situation I think that there is sufficient
support from local officials on the county, region or

7
Student’s Questionnaire
government level
ii. I consider myself prepared for the management of
disasters
jj. I participate/have participated in creating new guidelines,
emergency plans, or lobbying for improvements on the
local or national level
kk. I would be considered a key leadership figure in my
community in a disaster situation
ll. I am aware of what the potential risks in my community
are (e.g. earthquake, floods, terror, etc.)
mm. In case of a bioterrorism/ biological or chemical
attacks, I know how to use personal protective equipment
nn. In case of a bioterrorism/biological or chemical attacks I
know how to execute decontamination procedures
oo. In a case of bioterrorism/biological or chemical attacks I
know how to perform isolation procedures so that I
minimize the risks of community exposure
pp. I am familiar with the local emergency response system
for disasters
qq. I am familiar with accepted triage principles used in
disaster situations
rr. I have personal/family emergency plans in place for
disaster situations
ss. I have an agreement with loved ones and family members
on how to execute our personal/family emergency plans

8
Student’s Questionnaire
21. This section will evaluate how confident you are in handling disasters. Rate the level of confidence
from 1 to 5 where 1= no confidence at all, 2= basically no confidence, 3=little confidence, 4= basically
confident and 5= complete confidence
Dimension 1 2 3 4 5
a. Detect the relative harm from the disaster
b. Assess injuries accurately and swiftly
c. Assess the epidemic situation after the disaster, such as
infectious diseases or acute poisoning
d. Recognize vulnerable groups, such as chronic patients or disable
people
e. Assess essential risk factors after the disaster, such as personal
security
f. Acquaintance with common procedures of disaster rescue
g. Triage technique
h. Debridement, hemostasis, bandaging and splinting
i. Lifting
j. Transfer
k. Emergency rescue techniques
l. Intensive care and nursing of critically ill patients
m. Prevention and control of infectious diseases in disaster areas
n. Survey, record, and report epidemic situation in disaster area
o. Initial psychological assessment of disaster victims
p. Recognize common psychiatric and psychological problems after
disaster, such as PTSD, depression, and anxiety
q. Provide basic psychological treatment for disaster victims
r. Referral of victims who need psychiatric and psychological
treatment in the disaster area
s. Adjust one’s own psychological state and adapt to the working
environment quickly
t. Communicate with other team professionals and establish good
cooperation relationship
u. Actively communicate with victims and relatives and establish
good nurse-patient relationship
v. Obey professional ethics with humanitarian and full of empathy
and love

9
Student’s Questionnaire

End

10