UNIQUE NEEDS OF CHILDREN DURING DISASTERS AND OTHER PUBLIC HEALTH EMERGENCIES

Physiologic Considerations in Pediatric Care

A. Pulmonary System
 Children have faster Respiratory Rate, higher metabolic rate as well as greater minute
ventilation increase their risk of inhaling a higher dosage or amount of toxic airborne substances
including radioactive gases.
 Oxygen consumption in infants is 6 to 8 mL/kg/minute compared to 3 to 4 mL/kg/min in adults
hence they may require early oxygen administration following exposure to noxious chemicals.
 Tachypnea—nonspecific sign of respiratory distress observed in pediatrics exposed to toxic
gases
 Infants and young children have cartilaginous and thus compliant chest walls. This anatomical
fugure has both medical and trauma implications. When a child is in respiratory distress,
substernal, supraclavicular, infraclavicular, intercostal or substernal retractions result from the
child’s increased work of breathing.
B. Cardiovascular
 Child’s estimate blood volume is 80 mL/kg, which is larger than adult on a millimeter per
kilogram basis and this can result in small amount of blood loss from trauma decreasing
circulating blood volume leading to shock.
 Children have greater cardiac reserves than adult allowing to compensate for fluid losses from
hemorrhage, diarrhea, or lack of oral intake. However, when this fails, shock and
cardiopulmonary failure results quickly. (severe trauma, burn, biological/chemical trauma)
 Tachycardia- non specific sign of cardiopulmonary distress
 Delayed capillary refill time- important indicator of cardiopulmonary compromise during early
stage of shock
 In compensated shock- children’s vital sign will remain within their age range or slightly
elevated.
 Hypotension is not observed until the child lost 20%-25% of his or her circulating blood volume
and is a sign of decompensated shock.
 Fluid replacement mjust be done quick and aggressively to prevent shock.
C. Integumentary
 They have thinner and more permeable skin than adults, hence they have greater exposure to
and absorption of dermal toxicants.
 They have less subcutaneous fats than adult.
 They have higher body area-to-weight ratio predisposing them to greater heat loss through
conduction, convection, radiation and evaporation.
 They have higher risk for hypothermia because of an immature thermoregulatory system and
higher surface area-to mass ration.
 Infants less than 6 months old do not have fine motor coordination to shiver and are unable to
keep themselves warm; nonshivering thermogenesis occurs where brown fat is broken down to
produce warmth.
 Access to heating sources such as heat lamps, blankets, and intravenous fluid warmers will be
needed to prevent hypothermia in pediatric population.
D. Musculoskeletal
 Physical injury to yhe growth plate may lead to growth arrest or deformity.
 Young bpnes are compliant, therefor affording less protection to underlying body organs (lungs,
heart, liver, brain) when external forces are applied. This may lead to significant internal injuries.
 Along with large size of organs among children, their proximity in the abdominal compartment
and injured to several organs can occur from a single penetrating or blunt force.
E. Cognitive
 Young children are unlikely to recognize danger or to protect themselves from it.
 The confusion and disruption present during a disaster may cause extreme levels of fear and
anxiety in children and may be magnified when they see their parents experiencing the same
levels of fear.
F. Nutritional Requirements
 Children have a greater growth rate and subsequent higher protein and calorie requirements
when compared with adults.
 Protein-energy malnutrition may occur in complex emergency where there is inadequate food
source.
 Protein-energy malnutrition—marasmus, kwashiorkor, marasmic-kwashiorkor.
 Diagnosed when child’s arm circumferenc is less than the 5 th percentile or less than 80% of the
reference standard.
 They have greater risk to secondary infections and complications leading to death.
 G. Immunologic
 They are susceptible to infection due to their undeveloped immune system.
 Sepsis may be encountered in children and infants exposed to biologic agents.
 The thyroid gland is also sensitive to the carcinogenic effects of radiation exposure.

Pediatric Disaster Triage

 A higher proportion of children involved in disaster would occur if the event included predominantly
pediatric setting (e.g. school, school bus, children’s hospitaljuvenile detention center)
 Pediatric equipment, supplies and medications must be brought by the Rescue officers.
 JumpStart Pediatric Multiple Casualty Incident Triage
 Method used in mass casualty incidents and is modeled after the Simple Triage and Rapid
Treatment (START)
 It assesses the victim’s airway, vital signs and level of consciousness categiorizing them in:
Minor, delayed, immediate, deceased
 It is designed to be completed in 60 seconds.
 SAVE- Secondary Assessment of Victim Endpoint
 Developed to direct limited resources to the subgroup of patients expected to derive the most
benefit from their application.
 It assesses survivability in relation to injuries and, on the basis of trauma statistics, applies this
information to describe the relationship between expected benefits and consumed resources.
 SMART Triage Tape- incorporates a JumpSTART-like triage approach using a color coded length-
based tape that is designed to provide the responders with a rapid understanding of what
physiological signs and symptoms should be considered.
 SALT- Sort Assess Life-Saving Intervensions Treatment and Transport.
 Inclusive of both adults and children
 Not yet universally accepted despite being endorsed by CDC.
 TRAIN- Triage by Resource Allocation for IN-patient
 Hospital triage system designed as a proactive assessment of patients in the hospital either by
building proactive assessment if patients in the hospital either by building the tool in to the
hospital electronic records or a quick paper-based assessment based on the utilization of
equipment, medication, and respiratory and medical support.
 It uses simple scoring scale that evaluates the patient’s transportation needs based on the
following criteria: transportation option, life support, mobility, nutrition and pharmacy.
 PsySTART triage—Developed by Sr. Merritt Shreiber
 A mental health triage system to assist with the identification of children and adults who are at
the greatest risk for adverse outcomes.
 It uses individual’s self-report using a checklist scoring system

Primary Survey of the Pediatric Trauma Patients

Component Actions
Airway/ cervical spine  Assess for airway patency – check for loose teeth, vomitus or other obstructions
 Suspect cervical spine injury with multiple trauma—maintain neutral alignment
during assessment. Evaluate effectiveness of cervical immobilization and other
equipment used to immobilize spine
 THE USE OF RIGID C-COLLARS IS NOW CONSIDERED A POTENTIAL DANGEROUS
PRACTICE. EVP NOW ENCOURAGES SPINAL STABILIZATION WITHOUT USE OF RIGID
BACKBOARDS OR RIGID COLLARS.
Breathing  Auscultate breath sounds in the axillae and throughout the chest area for presence
and equality.
 Assess for chest contusions, penetrating wounds, abrasions, or paradoxical
movements.

Circulation  Assess apical pulse for rate, rhythm and quality; compare apical pulse with
peripheral pulse for equality and quality.
 Evaluate capillary refill
 Check for skin color and temperature
 Note for open wounds and uncontrolled bleeding;applyu direct pressure or
torniquet as necessary.
Disability (neurologic)  Assess for level of consciousness and orientation to person and place, and time for
older children
 In younger child, assess for alertness, ability to interact with environment, and
ability to follow commands.
 Check pupils for reactivity, size and equality
Expose  Remove clothing to allow visual inspection of the body.
 Secondary Survey of the Pediatric Trauma Patients
Component Actions
Head, eye, ear and  Assess scalp for lacerations or open wounds; palpate for step-off defects, depressions,
nose hematomas, and pain
 Reassess pupil for size, equality and reactivity, and extraocular movements; ask child if
he or she can see
 Assess ears and nose for rhinorrhea or otorrhea
 Observe for raccoon eyes (bruising around the eyes); or Battle’s sign (bruising over the
mastoid process)
 Palpate forehead, orbits maxilla, and mandible for crepitus, deformities, step-off
defects, pain and stability, evaluate malocclusion by asking child to open and close
mouth; note for open wounds.
 Inspect for loose, broken or chipped teeth as well as oral lacerations.
 Check orthodontic appliances for stability
 Evaluate facial symmetry by asking child to smile, grimace, and open and close mouth.
 Do not remove impaled objects or foreign objects.

Neck  Open cervical collar and reassess anterior neck for jugular vein distention and tracheal
deviation; note for bruising, edema, open wounds, pain and crepitus.
 Check for hoarseness or changes in voice by asking child to speak.
Chest  Obtain respiratory rate, breath sounds in anterior lobes for equality. Palpate chest wall
and sternum for pain, tenderness and crepitus.
 Observe inspiration and expiration for symmetry or paradoxic movement; note use of
accessory muscles.
 Reassess apical heart rate, rhythm and clarity
Abdomen, pelvis,  Observe abdomen for bruising and distention; auscultate bowel sounds briefly in all four
genitourinary quadrants; palpate abdomen gently for tenderness; assess pelvis for tenderness and
stability.
 Palpate bladder for distention and tenderness; check urinary meatus for signs of injury
or bleeding; not priapism and genital trauma such as lacerations or foreign body
 Have rectal sphincter tone assessed usually by physicians.
Musculoskeletal  Assess extremities for deformities, swelling, lacerations or other injuries. Palpate distal
pulse for equality, rate, rhythm, and compare to central pulse.
 Ask child to wiggle toes and fingers; evaluate strength through hand grips and foot
flexion and extension.
Back  Logroll as a unit to inspect the back; maintain spinal alignment during examination;
observe for bruising and open wounds; palpate each vertebral body for tenderness,
pain, deformity and stability; assess flank area for bruising and tenderness.

Pediatric Care during Public Health Emergencies

A. Exposure to Nuclear and Radiologic Agents

 Prehospital Treatment
 Dose rate meters—devise that can detect radioactive contamination
 Pediatric advance life support always take precedence over radiation issues. It is better to have
dirty patient who is alive than to have a dead clean patient.
 Removal of contaminated clothing results in the elimination of 90% of the contamination.
 PPE’s must be worn by health care providers in entering a highly contaminated area. Respirators
must be worn.
 Surface decontamination can be undertaken in the absence of physical injuries; in the presence
of life-threatening injuries, such injuries are stabilize prior to decontamination.
 Separate facilities for decontamination must be available for male and female.
 Young children and infants should remain to their parents or caregivers, while older children can
be decontaminated in a designated area based on their gender.
 Contaminated items are placed in labeled plastic bags and properly disposed or held for law
enforcement purposes.
 Open wounds should be covered until decontamination is completed.
 Emergency Department Treatment
 Before the patient arrive at the ER, area for decontamination and treatment should be prepared
to prevent spread of contamination.
 Triage should include radiological survey to assess the dose rate, documentation of prodromal
symptoms and collection of tissue sample for biodosimetry.
 Children should be given age- appropriate explanation of what is happening to them and what
they will feel.
 Definitive Treatment
 1. Should children be exposed to the detonation of a nuclear weapon or the release of
radioactive material from a nuclear reactor and iodine is a byproduct of the release,
potassium iodide (KI) or iodate would be administered to prevent radioiodine from
accumulating in the thyroid gland. KI should be administered immediately or at least within
8 hours postexposure
2. KI should be administered with caution in children and adolescents with a known or
reported allergy to iodide, as severe allergic reactions have been reported
3. In newborns, KI administration has been linked with transient decreases in thyroxine along
with increases in thyroid-stimulating hormone (AAP, 2003). Therefore, newborns who
receive KI should have ongoing monitoring of their thyroid function by measuring thyroid-
stimulating hormone activity 2 to 4 weeks postadministration of a single KI dose or for
longer periods than when one KI dose is administered.
4. Because both radioiodine and KI are secreted into human breast milk, lactating women who
receive KI should not breastfeed their infants because of the risk of additional exposure to
radioiodine from breast milk.
5. Public health officials will determine when it is safe to resume breastfeeding and when it is
safe to consume produce and milk following a radiological exposure.
6. KI is prepared in tablets, making it easier to store. Infants and children may not be able to
swallow tablets, When dissolved in water, the fluid is too salty to drink. To disguise the salty
taste of the K1, the tablet can be crushed and mixed with raspberry syrup, low-fat chocolate
milk, orange juice, or flat soda.
7. Crush one 130-ms KI. tablets into small pieces; add four teaspoons of water to the crushed
tablet to dissolve it; then aad four teaspoons of one of the aforementioned fluids to the
mixture making 130 mg per four teaspoons of solution.
8. The recommended daily dose for Kl in children 4 to 18 years of age is four teaspoonfuls: for
children 1 month through 3 years of age, two teaspoonfuls; and for newborns and infants
less than I month of age, one teaspoonful; 18 years of age weighing 150 or more pounds.
eight teaspoons.
9. This daily dosing should continue until the risk of exposure has passed or until other
measures, such as evacuation, sheltering, and control of the food and milk supply, have
been implemented successfully.
10. For children exposed to cesium-137 and thallium, Prussian blue is administered. Prussian
blue enhances the excretion of these agents in the stool, thereby decreasing radiation
exposure
11. The dosage for Prussian blue is 3 to 10 g/d by mouth (0.21-0.32 g/kg/d)
12. Following exposure to plutonium, curium and americium chelation with pentetate calcium
trisodium (CaDTPA), pentetale zinc trisodium (Zn-DTPA), or dimercapto propane-1-sulfonit
acid (MIPS) can be administered
13. Ca-DTPA and Zn-DTPA chelate with metals and are excreted in the urine. These medications
are administered by inhalation or intravenous routes at a dosage of 14 mg/kg IV, up to a
maximum of 1 g.
14. Children are one of the groups at high risk of psychological effects following terrorist attacks
and subsequent exposure to radiation. Counseling should be in place to help children cope
with life situation and its long-term effects.
B. Exposure to Biologic Agents

Biologic Agents of Concern by Category

Category A Anthrax Bacillus anthracis
Smallpox Variola major
Tularemia Francisella tularenis
Plague Yersinia pestis
Viral hemorrhagic fevers Ebola, Marburg,
Lassa
Botulinum Clostridium botulinum toxi
Category B Q fever Coxiella burneti
Brucellosis Brucella species
Glanders Burkholderia mallei
Melioidosis Burkholderia pseudomallei
Viral encephalitis alphaviruses
Typhus Rickettsia prowazekit
Biotoxins ricin, staphylococcal enterotoxin B
Psittacosis Chlamydia psittaci
Food safety threats Salmonella
Water safety threats Vibrio cholerae
Category C Emerging threat agents Nipah and hantavirus
Multidrug-resistant tuberculosis
 Tick-borne encephalitis
Tick-borne hemorrhagic fever virus
Yellow fever

Definitive Treatment
1. Anthrax
 Anthrax
 Cutaneous Anthrax
Signs and Symptoms
 Initial painless papulovesicular lesion surrounded by massive interstitial edema.
 Eschar develops within 2-5 days
 Systemic symptoms include fever, and leukocytosis
 Bacteremia may developed if delayed treatment.

Diagnosis

 Serum polymerase chain reaction and skin biopsy

 Systemic (inhalation) anthrax

Signs and Symptoms
 Fever
 Myalgia
 Fatigue
 Headache
 Malaise
 Nonproductive cough for 2-3 days, severe respiratory distress, cyanosis, chest pain, diaphoresis,
shock and death over 24-36 hours.

Treatment

 Hospitalization—monitor electrolyte and hematological status

 Administer intravenous antibiotics
 Initial treatment—Ciprofloxacin or doxycycline IV therapy
 Oral therapy—initiated once improvement is noted. One or two antimicrobial agents including
either ciprofloxacin or doxycycline for the first 7-10 days.
 Remaining days until 60 days—Amoxicillin is administered for the completion of the remaining
60 days of therapy.
2. Botulism
 Usually tied to a common food source but if no identifiable food source or event, it may be a case of
intentional release of possible inhaled botulism toxin.
 Trivalent Equine botulinum antitoxin—prevent advancement of symptoms but does not reverse the
disease in children with symptoms.
 Botulism Immune Globulin Intravenous (human)—administered for infantile botulism.

C. Exposure to chemical agents

 Prehospital Treatment
1. Upon arrival at the scene of a chemical release, EMS, in conjunction with hazardous materials
teams, assess the situation and identify potentially exposed individuals.
2. Based on their findings, skin decontamination may be warranted. As in radiological exposures,
males and females are decontaminated separately, and young children would stay with their
mothers, while older children go through same-gender decontamination.
3. In chemical exposures, EMS personnel will wear special protective equipment that covers their
entire bodies, and their faces may not be visible through their masks. The EMS and hospital
emergency responders in decontamination events can stay in protective gear for limited periods
of time before requiring rest, rehydration, and rehab, increasing the need for manpower.
4. Young children may become frightened and uncooperative at the sight of such heavily dressed,
anonymous emergency care providers-_having their clothes cut from their bodies and removed
by strangers, then being cleansed with sufficient amounts of warmed water to completely rinse
the victims after removal of clothing. Solutions such as 0.5% sodium hypochlorite (dilute bleach)
should be avoided as they are known to irritate the skin.
5. In addition, the use of soap increases the risk of injury associated with slips, falls, and not being
able to hold on to slippery infants or small children.
6. Additional safety measures may be required such as placing infants and very young children in
plastic laundry baskets or store carts to move them safely through a decontamination station.
 7. It should be anticipated that although adults may understand the given situation, children are
likely to become inconsolable and this will affect how quickly decontamination can be
performed. As in any situation where there is a predominance of children, additional healthcare
providers will be needed to assist children through the decontamination process. Words of
encouragement and praise ("You are doing a great job") will be much appreciated.
8. As with adults decontamination is completed before the initiation of pediatric advanced life
support protocols. The decision to initiate decontamination is an important one and the process
requires specialty-trained personnel an adequate manpower.
9. Water is the preferred decontaminant and water-based decontamination should be delivered at
a low pressure (50-60 PSI), high volume, tepid temperature, and with a duration of no longer 3
minutes to ensure thorough soaking.
 Treatment
1. For Malathione/ Sevin exposure
- pralidoxime chloride
-Diazepam—if convulsion occurs
- Atropine—for Sevin exposure

2. For Vesicant such as mustard or lewsite producing erythema, burning and vesication
followed by desquamation of skin:
-- wash skin with soap and water solution
---Adsorbent powder can be applied on skin to absorb mustard then remove with moist
cloth
--- Prepare intubation set and mechanical ventilator for children exposed to mustard
--- eye exposure requires copious flushing with water or normal saline. Thorough eye
examination should be made. Corneal lesions are treated with antibiotics and mydriatic-
cycloplegic medication; petroleum jelly applied to eyelids will prevent them from adhering
together.

GROWTH AND DEVELOPMENTAL/ COGNITIVE CONSIDERATIONS AMONG PEDIATRICS DURING DISASTER AND
EMERGENCY

Stages of Response to Trauma or Disaster in Children

Stage 1: Occurs immediately after a disaster or traumatic event

 Reaction of fright, disbelief, denial, grief, and feelings of relief if loved onnes have not been harmed.
 Altruism may be displayed, and this will sometimes help the child develop resilience or be a marker of
resilience in the child.

Stage 2: can occur from a few days after the disaster to several weeks posttraumatic even or disaster.

 Initial reaction leads to regression among many young children and manifest inn behaviors that
represent anxiety, depression, sadness, fear, hostility, and aggressive behaviors, apathy, withdrawal,
and sleep disturbance.

Stage 3: Occurs when the child continuous to have abnormal coping behaviors longer than one month post
event. Children who experienced long term distress are at risk for PTSD or delinquent behavior later on in life

 Long term behavior escalates from stage 2. These children will need psychosocial counseling from a
mental health specialist.

Children’s unique Needs in Disaster

1. Children may experience long-lasting effects such as academic failure, PTSD, depression, anxiety,
bereavement, and other behavioral problems such as delinquency and substance abuse
2. Children are more susceptible to chemical, biological, radiological, and nuclear threats and require
different medications, dosages, and delivery systems than adults.
3. During disasters, young children may not be able to escape danger, identify themselves, and make
critical decisions.
4. Children are dependent on adults for care, shelter, transportation, and protection from predators.
5. Children are often away from parents, in the care of schools, child care providers, Head Start, or other
child congregate care environments, which must be prepared to ensure children's safety.
6. Children must be expeditiously reunited with their legal guardians if separated from them during a
disaster.
7. Children in disaster shelters require age-appropriate supplies such as diapers, cribs, baby formula, and
food.
Nursing considerations during disaster preparedness based on the Psychosocial and Cognitive Development by
age Group

1. Infant (0-1 year old)

 Keep an emergency stock of the following items: diapers, formula, bottles, water for mixing formulas,
wipes, blankets, age-appropriate clothing, and toys.
 Create a way to transfer infants to a safe place in the event of a weather-related disaster or earthquake.
 Identify each infant by using a wrist or ankle band, or in an equally effective manner.
2. Toddler (1-3 years old)
 Keep an emergency stock of the following items: diapers, formula, bottles, water for mixing
formulas, wipes, blankets, age-appropriate clothing, and toys.
 Ensure that each child has on closed-toe shoes.
 Identify each child with a wrist or ankle band, or in an equally effective
 manner.
 Assess for risk factors of PTSD and provide mental health counseling for those at risk
3. Preschool (3-6 years old)
 Keep an emergency stock of coloring books, reading books, crayons, markers, flash cards, and
board games.
 Be consistent with behavior modification, as some children will act out during stressful events.
 Allow children to socialize and play in groups and create songs, dances, and other games that
can be played without props.
 Assess for risk factors of PTSD and provide mental health counseling for
 those at risk.
4. School-aged (6-12 years old)
 Give older school children tasks and small jobs that they can be responsible for during the
sheltering process.
 Allow children to socialize and play in groups and create songs, dances, and other games that
can be played without props.
 Be consistent with behavior modification, as some children will act out during stressful events.
 Assess for risk factors of PTSD and provide mental health counseling for those at risk.

Global Disaster and Complex Human Emergencies

2015 UN Landmark Agreements

 In 2015, several landmark UN agreements were adopted by the international community which include
the Sendai Framework for Disaster Risk Reduction and the Paris Climate Agreement.
 Sendai Framework for Disaster Risk Reduction 2015-2030
 Endorsed by the UN General Assembly and adopted by 187 countries at the 3 rd world
Conference for Disaster Risk Reduction in Sendai, Japan.
 It puts health at the center of global disaster risk reduction policy and advocates for action to
reduce disaster risk for the next 15 years.
 It is voluntary, nonbinding agreement with seven global targets, aimed at reduction of disaster
risk and losses in lives, livelihood, and health.
 It recognizes that by reducing and managing conditions of hazard, exposure and vulnerability-
while building the capacities of communities and countries for prevention, preparedness,
response and recovery-losses and impacts from disasters can be effectively alleviated.
 National health and care system can be strengthened by promoting and enhancing training
capacities in the field of disaster medicine and by supporting and training community health
groups in disaster risk-reduction approaches in health programs.
 Global targets of SFFDRR:
1. Substantially reduce global disaster mortality by 2030, aiming to lower the average per
100,000 global mortality rates in the decade 2020-2030 compared to the period 2005-2015
2. Substantially reduce the number of affected globally by 2030, aiming to lower the average
per 100,000 global mortality rate in the decade 2020-2030 compared to the period 2005-
2015
3. Reduce direct disaster economic loss in relation to global GDP by 2030
 4. Substantially reduce disaster damage to critical infrastructure and disruption of basic
services, among them health and education facilities, including through developing their
resilience by 2030
5. Substantially increase the number of countries with national and local disaster risk reduction
strategies by 2020
6. Substantially enhance international cooperation to developing countries through adequate
and sustainable support to complement their national actions for implementation of the
present Framework by 2030
7. Substantially increase the availability of and access to multihazard early warning systems
and disaster information and assessment to people by 2030.
 The Sustainable Development Goals (SGD)
 Represent 17 aspirational “global goals” with 169 targets between them, including: the universal
call to action to end poverty, protect the planet from climate change, and ensure that all people
enjoy peace and prosperity.
 Target 3.d of the health goal is to “strengthen the capacity of all countries in particular the
developing countries, for early risk reduction and management of national and global health
risk.
 Paris Climate Change Agreement
 Aims to achieve legally binding and universal agreement on climate and keeping global warming
below 2C.

Roles and Responsibilities of Nurses in Implementing the Sendai Framework

1. With their technical skills and knowledge in epidemiology, physiology and pharmacology, cultural-
familial structures, and psychosocial issues, nurses can actively contribute in disaster preparedness
programs as well as during disasters.
2. Nurses can advocate for significant strategic and leadership role in coordinating and leading health and
social disciplines, governmental bodies, community groups and nongovernmental agencies, including
humanitarian organizations.
3. Promoting and conducting nursing and health research on disaster reduction, preparedness and
mitigation, response, and recovery.

The WHO Disaster Risk Management for Health Fact Sheets

 These advocacy materials are an introduction for health workers engaged in disaster risk management
and for multisectoral partners to consider how to integrate health into disaster risk-management
strategies.
 The overview places disaster risk management in the context of multisectoral action and focuses on the
generic elements of disaster management including potential hazard, vulnerabilities of a population and
capacities that apply across the various health domains.
The WHO thematic Platform for Health-EDRM Research group

 Established in September 2016 which aims to coordinate activity, promote information sharing, develop
partnerships, provide technical advice, and facilitate the generation of robust and scientific health
research to promote the implementation of Sendai Framework and related global agenda.

WHO Collaborating Center for Disaster Risk management for Health

 First established in 2007. Its mandate is to promote nursing and health research on disaster risk
reduction, preparedness, mitigation, response and recovery from the disaster and similar life-
threatening afflictions in the mid to long term ; delineate the roles and competencies of nursing
professionals involved in various phases of disaster; carry out a leading role in development of an
effective national, regional and global network system for nursing and other health professionals
involved in health emergency.

WHO Collaborating Center for Public Health Nursing and Midwifery

 Established in 2016. Its remit is to support WHO in generating evidence and defining frameworks of
practice for nurses and midwives that prevent avoidable illnesses, protect health, and promote
wellbeing and resilience.

NATURAL DISASTERS

 Worldwide, most natural disasters are similar; they are limited in scale and duration and are usually
managed by local, regional or national resources.
 The severity of damage is affected by population density in disaster prone areas, local building codes,
community preparedness, sophistication of communication system, and use of public safety
announcement and education on how to respond correctly to the first sign of danger.

Cyclones, Hurricanes, and Typhoons

Cyclones- large-scale storm characterized by low pressure in the center surrounded by circular wind motion.

Hurricanes- Severe storms arising in the Atlantic waters

Typhoon- Severe storm developing in the Pacific Ocean and the China Seas.

Environmental Effects:

 Storm surge
 Flooding
 Landslide
 Erosion
 Deforestation
 Loss of plant and animal life

Severe Weather Watches and Warnings

Flood Watch: High flow or overflow of water from a river is possible in the given time period. It can
also apply to heavy runoff or drainage of water into low-lying areas. These watches are generally
issued for flooding that is expected to occur at least 6 hours after heavy rains have ended.

Flood Warning: Flooding conditions are actually occurring or are imminent in the warning area.

Flash Flood Watch: Flash flooding is possible in or close to the watch area. Flash flood watches are
generally issued for flooding that is expected to occur within 6 hours after heavy rains have ended.
Flash Flood Warning: Flash flooding is actually occurring or imminent in the warning area. It can be
issued as a result of torrential rains, a dam failure, or an ice jam.

Tornado Watch: Conditions are conducive to the development of tornadoes in and close to the watch
area.

Tornado Warning: A tornado has actually been sighted by spotters or indicated on radar and is
occurring or imminent in the warning area.

Severe Thunderstorm Watch: Conditions are conducive to the development of severe thunderstorms
 in and close to the watch area.

Severe Thunderstorm Warning: A severe thunderstorm has actually been observed by spotters or
indicated on radar and is occurring or imminent in the warning area.

Tropical Storm Watch: Tropical storm conditions with sustained winds from 39 to 73 mph are
possible in the watch area within the next 36 hours.

Tropical Storm Warning: Tropical storm conditions are expected in the warning area within the next
24 hours.

Hurricane Watch: Hurricane conditions (sustained winds greater than 73 mph) are possible in the
watch area within 36 hours.

Hurricane Warning: Hurricane conditions are expected in the warning area in 24 hours or less.

Drought

 Results in sparse rain and may trigger crisis in arid and semiarid areas because rain is sparce and irrgualr.
 Factors leading to Desertification:
1. Overcultivation
2. Deforestation
3. Overgrazing
4. Unskilled irrigation
 Public Health Implications
1. Compromise quality and quantity of potable water
2. Compromised food and nutrition
3. Diminished living conditions
4. Recreational risks
5. Mental and behavioral health
6. Vulnerable populations
7. Increased Disease Incidence (infectious, chronic and vector borne)
 Environmental Effects
1. Fire (wildfire)
2. Depletion of water sources—water shortage
3. Deterioration of soil
4. Loss of plants and animals

Earthquake

 Most destructive and frightening force of nature.

 Sudden, rapid shaking of the earth caused by the breaking and shifting of rock beneath the earth’s
surface.
 Richter Scale- used as an indication of force of an earthquake, measures the magnitude and intensity or
energy released by the quake. This value is calculated based on data recording from a single observation
point for events anywhere on earth, but it does not address the possible damaging effects of the
earthquake.

 Environmental Impact
1. Landslide
2. Liquefaction
3. Tsunami
4. Avalanche

Epidemics

 An outbreak or occurrence of one specific disease from a single source in a group, population,
community or geographical area, in excess of the usual or expected level.
 It exists when new cases exceed the prevalence of a disease
 An epidemic or threat of an epidemic can become an emergency if the following characteristics are
present:
1. Risk of introduction to and spread of the disease in the population
2. Large number of cases reasonably expected to occur
3. Disease involved of such severity as to lead to serious disability or death
4. Risk of social or economic disruption resulting from the presence of the disease
 5. Inability of authorities to cope adequately with the situation because of insufficient technical or
professional personnel, organizational experience, and necessary supplies or equipment
6. Risk for international transmission.

Flood

 Prolonged rainfall over several days can cause a river or stream to overflow and sloof surrounding areas.
 Global statistics show that floods are the most frequently recorded destructive events accounting over
40% of the world’s disaster each year.
 Health Impacts of Flooding:
1. Infectious disease morbidity exacerbated by crowded living conditions and compromised personal
hygiene, contamination of water sources and compromised personal hygiene.
2. Waterborne Diseases (E.coli infection, shigella, hepatitis A, Leptospirosis)
3. Food shortage---malnutrition
4. Mental stress
5. Injuries

Heat Wave

 Temperature that hover 10F or more above the average high temperatures for the region and the last
for several weeks are defined as extreme heat.
 Heat waves- result in adverse health effects in cities more than in rural areas. During period of sustained
environmental heat-particularly during summer-the number of deaths classified as heat related and
attributed to other causes (Cardiovascular, cerebrovascular, respiratory) increases.

Adult Heat Wave Safety Tips

1. Slow Down
2. Dress for Summer
3. Put less fuel in your inner fires
4. Drink plenty of water, nonalcoholic, decaffeinated fluids.
5. Spend more time in cool areas
6. Don’t get too much sun
7. Do not take salt tablets unless specified by physician.

Tsunamis

 Series of waves usually generated by large earthquakes under or near the ocean, occue when a body of
water is rapidly displaced on a massive scale.
 They are describe based on their wavelength (feet, miles), period (minutes or hours it takes for one
wavelength to pass a fixed point), speed (mph) and height
 Tsunami warnings:
1. Recent submarine earthquake occurs
2. The sea appears to be boiling, as large quantity of gas rise to the surface
3. The water is hot, smells like rotten eggs or stings the skin
4. There is an audible thunder or booming sound followed by a roaring or whistling sound
5. The water may recede a great distance from the coast
6. Red light may be visible near the horizon and, as the wave approaches, the top of the wave may
glow red.

Volcanic Eruption

 When pressure from gases within the molten rocks become too great, an eruption occur.
 Eruption can be quiet of explosive
 There may be lava flow, flattened landscape, poisonous gases and flying rock and ash
 Volcanic ash can be abrasive, acidic, gritty, gassy and odorous
 Volcanic ask can cause lung damage, and can also damage machineries.
 May be accompanied by other natural hazards such as earthquake, mudflows, flash floods, rockfall,
landslide, acid rain, fire and tsunamis.
 Activities for When a Volcano Erupts
1. Collaborate with emergency management specialists as needed.
2. Follow the evacuation order issued by authorities and evacuate immediately from the volcano
area to avoid flying debris, hot gases, lateral blast, and lava flow.
3. Be aware of mudflows. The danger from a mudflow
4. increases near stream channels and with prolonged heavy rains. Mudflows can move faster than
you can walk or run.
5. Look upstream before crossing a bridge, and do not cross the bridge if a mudflow is
approaching.
6. Avoid river valleys and low-lying areas.
 Protection From Falling Ash
1. Listen to a battery-powered radio or television for the latest emergency information.
2. Individuals with a respiratory ailment should avoid contact with any amount of ash.
3. Wear long-sleeved shirts and long pants.
4. Use goggles and wear eyeglasses instead of contact lenses.
5. Use a dust mask or hold a damp cloth over your face to help with breathing.
6. Stay away from areas downwind from the volcano to avoid volcanic ash.
7. Stay indoors until the ash has settled unless there is a danger of the roof collapsing.
8. Close doors, windows, and all ventilation in the house (chimney vents, furnaces, air
conditioners, fans, and other vents).
9. Clear heavy ash from flat or low-pitched roofs and rain gutters.
10. Avoid running car or truck engines. Driving can stir uP volcanic ash that can clog engines,
damage moving part and stall vehicles.
11. Avoid driving in heavy ash fall unless absolutely required.
12. If you have to drive, keep speed down to 35 mph or slower.