ILOILO DOCTORS COLLEGE
College of Nursing
DISASTER IN NURSING (SKILLS)
The basic principles of disaster nursing
during special (events) circumstances
and MCI’s include the following:
 Rapid assessment of the situation
and of victims immediate nursing
care needs.
 Security of the scene and
assessment of the potential for a
secondary disaster.
 Mass casualty triage and the
initiation of lifesaving measures
first.
 Knowledge of one’s role within
the ICS.
 The selected use of essential
nursing interventions and the
elimination of nonessential
nursing activities.
 Adaptation of necessary nursing
skills to mass casualty situation
and the allocation of scare
resources (the nurse must use of
imagination and resourcefulness
in dealing with a lack of supplies,
equipment and personnel.)
 The potential need for
decontamination
 Ongoing evaluation of the
environment and the mitigation
or removal of any health hazards.
 Prevention of further injury or
illness.
 Leadership in coordinating patient
triage, care and transport during
the times of crisis.
 The teaching, supervision and
utilization of auxiliary medical
personnel and volunteers.
 Provision of understanding,
compassion and emotional
support to all victims and their
families.
 Appreciation of and the
knowledge to keep oneself safe
during the MCI response.
THE DISASTER CONTINUUM
The life cycle of a disaster is
generally referred to as the "disaster
continuum," or "emergency
management cycle." This life cycle is
characterized by three major phases
pre-impact (before), impact (during),
and post-impact (after) -and provide
the foundation for the disaster time
line (Figure 1.2). Specific actions
taken during these three phases,
along with the nature and scope of
the planning, will affect the extent of
the illness, injury, and death that
occurs.
The basic phases or "life cycle" of a
disaster management program
include preparedness, mitigation,
response, recovery, and evaluation
(Kim, Proctor, & Amos, 2002;
Landesman, 2011; Landesman &
Morrow, 2013). There is a degree of
overlap across phases, but each
phase has distinct activities
associated with it.
Preparedness refers to 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. "Warning" (also known as
"forecasting*) refers to monitoring
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events to look for indicators that
predict the location, timing, and
magnitude of future disasters.
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.
Prevention refers to a broad range of
activities, such as attempts to
prevent a disaster from occurring,
and any actions taken to prevent
further disease, disability, or loss of
life. Mitigation usually requires a
significant amount of forethought,
planning, and implementation of
measures before the incident occurs.
Response phase is the actual
implementation of the disaster plan.
Disaster response, or emergency
management, is the organization of
activities used to address the event.
Traditionally, the emergency
management field has organized its
activities in sectors, such as fire,
police, hazardous materials
management (hazmat), and
emergency medical services. The
response phase focuses primarily on
emergency relief: saving lives,
providing first aid, minimizing and
restoring damaged systems such as
communications and transportation,
and providing care and basic life
requirements to victims (food, water,
and shelter).
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 actions focus on stabilizing
and returning the community (or an
organization) 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 inter-ventions.
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 is the phase of disaster
planning and response that often
receives the least attention. FEMA
recognizes the previously mentioned
phases of the disaster life cycle;
however, the importance of response
and recovery evaluation cannot be
underestimated. After a disaster, it is
essential that evaluations be
conducted to determine what
worked, what did not work, and
what specific problems, issues, and
challenges were identified. Future
disaster planning needs to be based
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College of Nursing
on empirical evidence derived from
previous disasters (Auf der Heide,
2006, 2007).
Command
INCIDENT COMMAND SYSTEM
 Sometimes referred to as the
Incident Management
System.
 The purpose of the ICS is to:
- ensure responder and
public safety.
- Achieve incident
management goals.
- Ensure the efficient use of
resources.
 Controls duplication of effort
and freelancing
 Limits the span of control
- One supervisor for three to
seven works.
 Organizational divisions
include sections, branches,
division and groups.
 Roles and responsibilities
- Incident commander (IC)
is in change.
- It is important that you
know who the IC is, where
the command post is
located, and how to
communicate with your
supervisor.
- An IC may turn over
command to someone with
more experience in a
critical area.
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College of Nursing
Finance
- Responsible for
documenting all
expenditures at an incident
for reimbursement.
Logistics
- Responsible for
communicating equipment,
facilities, food and water,
fuel, lighting and medical
equipment/supplies.
Operations
- At a very large incident,
responsible for managing
the tactical operations
usually handle by the IC.
- Supervise the people
working at the scene.
Planning
-
Solves problems as they
arise.
- Develops an incident
action plan.
Command staff
- The safety officer monitors
the scene for conditions or
operations that may
present a hazard.
- The public information
officer (PIO) provides the
media with clear
information.
- The liaison officer relays
information and concerns
among command and the
staff.
COMMUNICATIONS AND
INFORMATION MANAGEMENT
 Communication has historically
been the weak point at most
major incidents.
 It is recommended that
communications be integrated.
- All agencies should be able
to communicate quickly via
radios.
- Communications allow for
accountability and instant
communication.
MASS-CASUALTY INCIDENTS
A mass-casualty incident (MCI) is:
- Any call involving three or
more patients.
- Any situation that requires a
mutual aid response.
- Any incident that has the
potential for one of these
situation.
Bus or train crashes and earthquakes
are examples:
- Other causes, smaller in scope
are more common.
All systems have different protocols for
when to declare an MCI and initiate the
ICS.
- You and your team cannot treat
and transport all injured patients
at the same time.
- Never leave the scene with
patients if there are still other
patients who are sick or
wounded.
If there are multiple patients and not
enough resources to handle them
without.
- Declare an MCI
- Request additional resources.
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College of Nursing
- Initiate the ICS and triage
procedures.
TRIAGE
Triage means to “to sort” patients based
on the severity of their injuries.
- Assessment is brief and patient
condition categories are basic.
- Primary triage is done in the field.
- Secondary triage is done as
patients are brought to the
treatment area.
Four common categories five the order
of treatment and transport.
- Immediate (RED)
- Delayed (YELLOW)
- Minor or minimal (GREEN: hold)
- Expectant (BLACK: likely to die or
dead).
TRIAGE PRECATIONS
Triage Category
RED TAG: first priority (Immediate)
Patients who need immediate care
and transport.
YELLOW TAG: second priority
(Delayed)
Patient whose treatment and
transport can be temporarily delayed.
GREEN TAG: third priority, minimal
(walking wounded)
Patient who required minimal or no
treatment and transport can be
delayed until last.
BLACK TAG: fourth priority(expectant)
Patients who are already dead or have
little chance for survival: treats
salvageable patients before treating
these patient.
TYPICAL INJURIES
Airway and breathing
difficulties
 Uncontrolled or severe bleeding
 Severe medical problems
 Signs of shock (hypoperfusion)
 Severe burns
 Open chest or abdominal
injuries
 Burns without airway problems
 Major or multiple bone or joint
injuries
 Back injuries with or without
spinal cord damage.
 Minor fractures
 Minor soft-tissues injuries
 Obvious death
 Obviously non-survival injury,
such as major open brain and
trauma
 Respiratory arrest (if limited
resources)
 Cardiac arrest
MEDICAL INCIDENT COMMAND
Medical incident command is also known
as the medical (or EMS) branch of the
ICS.
- Primary roles of triage, treatment
and transport of injured people.
Triage Supervisor
- In charge of counting and
prioritizing patient.
- Ensures that every patient
receives initial assessment of his
or her condition.
- Do not begin treatment until all
patient are triaged.
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College of Nursing
Treatment Supervisor
- Locates and sets up the
treatment area with a tier of
each adequate care is given.
- Assists with moving patients
to the transportation area.
Transportation Supervisor
- Coordinates the transportation
and distribution of patients to
appropriate receiving hospitals
- Communicates with the area
hospitals
- Documents and tracks the
number of vehicles transporting,
patients transported, and the
facility destination
Staging supervisor
- Should be assigned when scenes
require response by numerous
emergency vehicles or agencies
- The staging area should be
established away from the scene.
Physicians on scene
- Make difficult triage decisions
- Provide secondary triage
decisions in the treatment sector
- Provide on-scene medical
direction for emts
- Provide care in the treatment
sector as appropriate
Rehabilitation supervisor
- Established an area that provides
protection from the elements and
situation
- Monitors responders for signs of
stress
- Rehabilitation is where a
responder’s needs for rest, fluids,
food, and protection from the
elements are met.
Extrication and special rescue
- Determines the type of
equipment and resources needed
for the situation
- Usually function under the ems
branch of the ics
Morgue supervisor
- Works with area medical
examiners, coroners, disaster
mortuary assistance teams, and
law enforcement agencies to
coordinate removal of bodies and
body parts
- The morgue area should be out
of view of the living patients and
other responders
Mobilization and Deployment
- check in with the finance section
when you arrive.
- Report to your supervisor for an
initial briefing.
- Record keeping allows for
tracking of time spent on the
actual incident for reimbursement
purposes.
- Accountability means keeping
your supervisor advised of your
location, actions and completed
tasks.
- Once the incident has been
stabilized, the IC will determine
which resources are needed and
when to begin demobilization.
EMS Response within the incident
command system
Preparedness
- Involves the decisions made and
basic planning done before an
incident occurs
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College of Nursing
- Involves decisions and planning NATIONAL INCIDENT
about the most likely natural MANAGEMENT SYSTEM
disasters for the area  Major NIMS components
- Your EMS agency should have - ICS
written disaster plans that you - Command and
are regularly trained to carry out. management
Scene size-up - Preparedness
- Make an initial assessment - Resource management
and some preliminary - Communications and
decisions information management
- Driven by three basic  Major NIMS components
questions: - Supporting technologies
o What do I have? - Ongoing management and
o What do I need to do? maintenance
o What resources do I
need?
Establishing command
- Command should be established
by the most senior official.
- Notification to other responders
should go out.
- Necessary resources should be
requested.
- Command must be established
early.
Communication
- If possible, use face-to-face
communications to limit radio
traffic.
- If you communicate via radio, do
not use codes or signals.
- Equipment mist be reliable,
durable, and field-tested.
- Be sure there are backups in
place.

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