THREATS TO SAFETY, LOSS OF TELECOMMUNICATIONS AND
HOSPITAL INCIDENT COMMAND SYSTEM
9.4 NCM 120: Disaster Nursing
Mr. Mark Angelo T. Cristino, MAN, RN • June 16, 2022
THREATS TO SAFETY
Threats to safety refers to the presence or impending
danger that poses an imminent threat or injury or harm
to humans. This includes acts of violence, environmental
and health threats, and involuntary population
displacement.
Violence refers to the use of physical force so as to
injure, abuse, damage, or destroy. It is the intentional use
of physical force or power, threatened or actual, against
oneself, another person, or against a group or
community, that either results in or has a high likelihood
of resulting in injury, death, psychological harm,
maldevelopment or deprivation (WHO). Acts of violence
includes terrorism and destroying properties.
TYPES OF VIOLENCE
There are four types of violence, namely: physical
violence, sexual violence, psychological violence, and
neglect.
1. PHYSICAL VIOLENCE
• The intentional use of physical force, used with
the potential for causing harm, injury, disability
or death.
• This includes, but is not limited to: scratching,
pushing, shoving, grabbing, biting, choking,
shaking, slapping, punching, hitting, burning, use
of a weapon, and use of restraint or one’s body
against another person.
• This type of violence does not only lead to
physical harm, but can also have severe negative
psychological effects – for example, if a child is
frequently a victim of physical violence at home,
he or she can suffer from mental health problems
and be traumatized as a consequence of this
victimization.
2. SEXUAL VIOLENCE
• Involves a sexual act being committed or
attempted against a victim who has not freely
given consent, or who is unable to consent or
refuse.
• This includes, but is not limited to: forced,
alcohol/drug-facilitated or unwanted penetration,
sexual touching, or non-contact acts of a sexual
nature.
• A perpetrator forcing or coercing a victim to
engage in sexual acts with a third party also
qualifies as sexual violence.
• This type of violence can also lead to physical
harm, and in most cases has severe negative
psychological effects too.
3. PSYCHOLOGICAL VIOLENCE (also referred to as
EMOTIONAL or MENTAL ABUSE)
• Includes verbal and non-verbal communication
used with the intent to harm another person
mentally or emotionally, or to exert control over
another person.
• The impact of psychological violence can be just
as significant as that of other, more physical
forms of violence, as the perpetrator subjects the
victim to behavior which may result in some form
of psychological trauma, such as anxiety,
depression or post-traumatic stress disorder.
• This not only leads to mental health problems,
but also to severe physical problems, such as
psychosomatic disorders.
4. NEGLECT
• Also described as deprivation, is a type of abuse
which occurs when someone has the
responsibility to provide care for an individual
who is unable to care for him- or herself, but fails
to do so, therefore depriving them of adequate
care.
• Neglect may include the failure to provide
sufficient supervision, nourishment, or medical
care, or the failure to fulfill other needs for which
the victim cannot provide themselves.
• Neglect can lead to many long-term side effects
such as: physical injuries, low self-esteem,
attention disorders, violent behavior, physical and
psychological illness, and can even result death.
ENVIRONMENTAL HEALTH THREATS
Environmental & Health Threats are specific
environmental issues that can impede or hinder human
health and wellness. These include issues such as:
1. Chemical Safety
2. Air Pollution
3. Climate Change and Natural Disasters
4. Diseases Caused by Microbes
5. Lack of Access to Health Care
6. Infrastructure Issues
7. Poor Water Quality
8. Global Environmental Issues
INVOLUNTARY POPULATION DISPLACEMENT
Involuntary population displacement is the forced
displacement (also forced migration) or an involuntary or
coerced movement of a person or people away from their
home or home region. A distinction is often made
between conflict-induced and disaster-induced
displacement.
• Conflict-induced displacement is typically
referred to as caused by humans
• Disaster-induced displacement causes
typically underlay displacement caused by
disasters.
The definitions of these concepts are useful, but the lines
between them may be blurred in practice because
conflicts may arise due to disputes over natural resources
and human activity may trigger natural disasters such as
landslides.
Refugees are persons who flee their country due to
"well-founded fear" of persecution due to reasons of race,
religion, nationality, membership of a particular social
group or political opinion, and who are outside of their
country of nationality or permanent residence and due to
this fear are unable or unwilling to return to it.
Internally displaced persons (IDPs) are defined as
“persons or groups of persons who have been forced or
obliged to flee or to leave their homes or places of
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 THREATS TO SAFETY, LOSS OF TELECOMMUNICATIONS AND
HOSPITAL INCIDENT COMMAND SYSTEM
9.4 NCM 120: Disaster Nursing
Mr. Mark Angelo T. Cristino, MAN, RN • June 16, 2022
habitual residence, in particular as a result of or in order
to avoid the effects of armed conflict, situations of
generalized violence, violations of human rights or natural
or human-made disasters, and who have not crossed an
internationally recognized State border.
LOSS OF TELECOMMUNICATIONS
The interruption of external and internal
communications seriously threatens any disaster plan and
is in itself a disaster. The personal mobile phones of
medical personnel on call became the primary mode of
external communication, and messengers on foot
maintained internal communication between
departments. Walkie-talkies were of limited use owing to
the size of the institution. A limited number of operational
cellular phones were used to maintain external
communication while batteries lasted; a private company
that was able to maintain services during the disaster lent
new cellular telephones during the evacuation.
MOST IMPORTANT FACTORS IN THE
SOLUTION OF INTERNAL DISASTERS OF THIS
MAGNITUDE
COORDINATION OF HUMAN RESPONSE
• Crisis training that includes such elements as
communication, coordination with other healthcare
professionals, and strong leadership is essential during
a crisis.
• Also, human response from the community is a
decisive factor in rapid adaptation to unexpected
adverse conditions and it is critical to the successful
implementation of any disaster plan. Without the help
of hundreds of volunteers, it would have been
impossible to carry hundreds of patients down the
stairs of the hospital in darkness. The community
should be invited to participate in disaster planning.
ELECTRICITY
• Electrical power is vital in today’s healthcare system,
which depends on advanced technology. To prevent
widespread internal electrical loss, it is imperative that
hospitals take the necessary measures to preserve
electrical power at all times
COMMUNICATIONS
• Hospitals should have battery-operated internal and
external communication systems readily available in
the event of a communication outage. Cellular
telephones are useful but may be limited by weather
conditions and battery life.
PROTECTION OF ESSENTIAL SERVICES
• Critical services such as pharmacy, laboratories (e.g.,
microbiology), blood bank, and central supply rooms
should be in safer places than the ground floors in
areas at risk of flooding or better protected physically
in areas of high seismic activity or other threats,
including terrorism.
• In the event a hospital becomes isolated, these
services are essential to maintain continuity of care.
Therefore, these services should be prepared for
challenging situations.
PATIENT VENTILATION
• Alternative modes of ventilation and monitoring, with
contingency plans in the event of complete power
failure, should be available.
• A military or a mass-casualty approach to any similar
event may be necessary if a plan is not in place or does
not work or if the team responding to the crisis is
overwhelmed.
• Planning the response to mass-casualty ventilation
needs in conjunction with the respiratory therapy
department is recommended.
WATER AND OTHER ESSENTIAL SUPPLIES
• Maintenance of protected water supply; water
purifiers; emergency food supplies; emergency kits
with batteries, flashlights, battery-operated lamps,
and two-way radios; reflecting devices or emergency
lights in stairways and corridors; telephones in
elevators; and lists of telephone numbers of
personnel, essential internal services, and outside
facility emergency services (e.g., police, National
Guard) is critical.
PATIENT-LOGGING SYSTEM
• A non-electronic emergency system for the
identification of incoming or outgoing patients should
be readily available
PATIENT-LOGGING SYSTEM
• Effective design and system for vertical evacuation of
patients could help to reduce evacuation time,
personnel requirements, potential injuries, or deaths.
• This includes updated engineering and architectural
design of stairwells, as well as special evacuation
equipment, such as the Evacu-Trac or EvacChair.
MEDIA COMMUNICATION
• The media’s report of a disaster could be of help, be
distracting, or create panic.
• Therefore, these organizations should also review
their performances and role during any crisis.
• They should organize and develop plans to respond
during disasters in a more responsible and effective
way.
• At the same time, the hospital should establish a
system for communicating information through the
media in a manner most likely to create a productive
response.
Although the recovery phase is not a major concern
during an emergency like this, proper planning is essential
for a rapid recovery and return to baseline function.
Finally, rapid adaptation to unexpected adverse
conditions is critical to the successful implementation of
any disaster contingency plan.
HOSPITAL INCIDENT COMMAND SYSTEM
Hospital Incident Command System (HICS) is an
emergency management system that consists of specific
disaster response functional role positions within a
hierarchical organization chart. This is not a disaster plan,
but a disaster management model for emergency
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 THREATS TO SAFETY, LOSS OF TELECOMMUNICATIONS AND
HOSPITAL INCIDENT COMMAND SYSTEM
9.4 NCM 120: Disaster Nursing
Mr. Mark Angelo T. Cristino, MAN, RN • June 16, 2022
response. Common in the US as this was developed by
the California Emergency Medical Services Authority and
San Mateo County Medical Services Agency. HICS
Template also supported by other documents. Used by
several states in the US. Need to study this system to
provide a uniform way of identifying the functional role
positions and their responsibilities in emergency or
disaster situations.
KEY FEATURES OF HICS
1. Predictable, responsibility-oriented chain of
command. One Incident Commander – has overall
responsibility for the management of the incident,
whom employees or staff report to.
2. Use of common nomenclature. Same titles,
functional roles for staff positions, etc.
3. Modular, flexible organization. Only portions of
the system needed for response are activated.
4. Unified command structures. Allow all agencies
involved in response to coordinate efforts,
establishing a unified set of objectives and strategies.
5. Incident action plan (IAP). Developed when
multiple agencies are involved in the response.
Ensures all agencies or sections are working towards
the same goal.
6. Facility Action Plan (FAP). Describes the purpose,
goals and objectives for the hospital’s response.
7. Unity of command. Each person reports only to one
individual.
8. Manageable span of control. Each manager
controls a defined amount of resources which is
limited to what one can realistically manage. (Ex. 5-7
staff managed)
9. Use of Job Action Sheets (JAS). Defines the staff
and specific functional role during the disaster
response. (Ex. What a Nurse is to function as during
disaster)
SPECIFIC HICS FUNCTIONAL ROLES:
COMMAND POSITIONS
1. Incident Commander (IC)
• Mission is to organize and direct the operations of the
incident. Selected based on experience on disaster
management, knowledge of the organization and
nature of the incident.
• IC establishes emergency operations center, initiates
a meeting to develop initial IAP.
• IC acts more as a director than a participant and
manages on a macro level rather than micro level.
2. Safety & Security Officer
• Ensures the safety of the staff, facility and
environment during a disaster operation
• Has the final authority to make decisions as they
relate to safety and hazardous conditions
3. Liaison Officer
• Serves as a contact for external agencies.
• During disasters, hospitals are likely to face multiple
local or state authorities where this officer is used
best in establishing linkages and coordinates with
other agencies.
• All communications from the hospital are coursed
through this officer in order to prevent duplication of
requests or conflicts.
4. Public Information Officer
• Responsible for providing information to the news,
media and general public.
• Communicates with the use of media platforms (social
media, radio, television)
5. Medical/Technical Specialists
• Positions provide guidance on a variety of special
situations. (Specialist in biological & infectious
diseases, legal affairs, chemical or radiological risk
management, clinical staff, pediatric care, clinic or
hospital administration and medical ethics)
SPECIFIC HICS FUNCTIONAL ROLES: STAFF
POSITIONS
1. Planning Section Chief
• Responsible for collecting and distributing information
within the organization that is required for planning
and development of the Internal Action Plan.
2. Operation Section Chief
• Mission is to direct the actual activities related to the
patient care activities during the response. (Activities
to do and persons involved)
• Includes clinical (medical & nursing staff) and axillary
services.
3. Logistics Section Chief
• Responsible for ensuring that all resources and
support required by the other sections are readily
available.
• Responsibilities include maintenance of the
environment, procurement of supplies, equipment
and food.
4. Finance/Administrative Section Chief
• Responsible for monitoring the utilization of assets,
and authorizing the acquisition of resources essential
for the emergency’s response.
• Monitors resources of the hospital and authorizes
approval of requests.
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