NCMC410: DISASTER NURSING

PRELIMINARIES |
Week One to Five

Week 1: a. Hurricane, Typhoon

b. Tornado
Disaster c. Earthquake
An event which cause a level of destruction, death or injury that d. Flood
affects the abilities of the community to respond using available e. Volcanic eruption
resources (Famorca 2013) f. Tsunami
Any destructive events that disrupt the normal functioning of a g. Wildfire
community. h. Drought, etc.
W.H.O i. Other geological/meteorological phenomena
B. Man-made/Human Generated - the principal direct
defines disaster as “any occurrence that causes damage,
cause are identifiable human actions.
ecological disruption, loss of human life, deterioration of health
a. Biological and Biochemical
and health services on a scale sufficient to warrant an
extraordinary response from outside the affected community or b. Terrorism
area.” c. Chemical Spills

Disaster Nursing THREATS IN PHILIPPINES

“The adaptation of professional nursing knowledge, skills and ● TYPHOONS
attitude in recognizing and meeting the nursing, health and ○ Average of 20 typhoons a year, half of these
emotional needs of disaster victims” are destructive.
● EARTHQUAKE AND VOLCANIC ERUPTIONS
CONCEPTS OF DISASTER The Philippine Archipelago occupies the
D- disruption of function of a large number of people western ring of the pacific ocean (western segment of
I- impact involves human, material, monetary and ecological the pacific ring of fire). Most active part of the earth is
losses characterized by an ocean-encircling belt of active
S- sudden devastation and unexpected event volcanoes and earthquake generators (faults).
A- affect different levels of society: household level, community ○ Average of 866 earthquakes per year, some of
level of provincial level them have proved to be damaging.
S- safe keeping measures is the utmost concern ■ 1976 Mindanao Earthquake - around
T- total damages to life, limb and property is appalling 6,000 people killed; around 400 USD
E- exceeds the capacity of a neighborhood or general public to million in damage
manage by means of its own resources ■ 1990 Luzon Earthquake - over 1,283
R- recovery takes months or years people killed; 1.3 Million (400 USD
million) in damage.
MAJOR EFFECTS OF DISASTER ○ 220 volcanoes, 22 active
■ June 1991 Mt. Pinatubo Eruption -
1. Premature Death
dubbed as the 2nd largest volcano
2. Impaired Quality of Life
eruption in the century.
3. Altered Health Status
■ 850 people killed; around 1.2 million
4. Damage to Properties
people affected; php 10.6 billion cost
of damage
KEY COMPONENTS OF DISASTER ● TSUNAMI
PREPAREDNESS ○ August 17, 1976 Earthquake and Tsunami
1. Definition and classification system for disasters ■ 7.8 Magnitude generated a tsunami
(onset, duration, effect and reactive period) high as 16ft, which swept coastal
2. Disaster epidemiology and measures of health area of 5 provinces in Central and
consequences Southern Mindanao
3. Essential of Disaster Management Planning ■ 3,792 killed, 9240 injured, 1937
4. Nursing Care during Disasters. missing, 362,136 homeless rendered;
around 247 million cost of damage.
Types of Disaster ● LANDSLIDES
○ February 17, 2006 Brgy. Guinsaugon landslide
A. Natural/Environmental - result of ecological disruption
wiped out an entire village of around 480 has:
or threat that exceeds the adjustment capacity of a
community (WHO 2013)
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The Great
 154 dead, 28 injured, 968 missing, 410 Disaster Classification:
survivors
ONSET, IMPACT, DURATION
● FLOODS
A. Rapid-onset Events
○ PHP 76 billion in damage out of the PHP
a. Short duration but with a sudden impact (e.g
111.46 billion total damages from natural
earthquake)
disasters 1990-2005
B. Sudden impact
○ Average of 750 killed per year
a. E.g hurricanes and volcanic eruptions
● RED TIDE OUTBREAK
C. Rapid Onset
○ From 1983 to 2001, a total of 42 toxic
a. With unanticipated and prolonged impact (e.g
outbreaks have resulted in a total of 2,107
bioterrorism attack)
paralytic shellfish poisoning case with 117
D. Creeping Disasters
deaths.
a. E.g droughts and famines
○ In manila bay, during the 1992 pyrodinium
Other Categories
red-tide outbreak around 38,500 fisherfolk
A. Internal Disasters - caused by disruption of normal
were displaced from their livelihood.
hospital function due to injuries or deaths of hospital
Estimated economic losses for displaced
personnel or damage to health care facilities.
fisherfolk was PHP 3.4 billion
B. External Disasters - Exhaustion of health care/hospital
● RIZAL DAY BOMBING
resources due to large volume of patients with
○ Also referred to as the December 30
varying types of injuries being admitted.
bombings, were a series of bombing that
occurred around Metro Manila
Disaster Continuum also known as Emergency
○ Five locations were bombed almost
Management Cycle
simultaneously within the span of an hour
○ Twenty-two (22) fatalities were reported and Provides a guide on the timeline of a disaster. Consist of three
around a hundred more suffered non-fatal phases
injuries
Phases of Disaster
Major Disaster in the Philippines 1. Pre-impact | 0-24 hours
1. Typhoon (YOLANDA, PABLO AND URING, ONDOY, the initial phase of disaster, prior to the actual
HABAGAT) occurrence.
2. EARTHQUAKE (1976 MINDANAO, 1990 LUZON, 2013 A warning is given at the sign of the first possible
BOHOL) danger to a community with the aid of weather
3. VOLCANIC ERUPTION (1991 MT PINATUBO) networks and satellites. Many meteorological disasters
can be predicted.
Disasters in the World The earliest possible warning is crucial in preventing
loss of life and minimizing damage. This is the period
1. Hurricane (Harvey and Irmaa 2017, Katrina 2005)
when the emergency preparedness plan is put into
effect, emergency centers are opened by the local civil
Characteristics of Disaster detention authority.
1. Frequency Communication is a very important factor during this
2. Predictability phase; disaster personnel will call on amateur radio
3. Preventability operators, radio and television stations.
4. Imminence a. Role of the nurse during this warning phase
5. Scope i. Assist in preparing shelters and
6. Intensity emergency aid stations
ii. Establishing contact with other
Three Broad Categories emergency service groups.
2. Impact | 24-74 hours
1. Complex Emergencies
The impact phase occurs when the disaster actually
a. Suffering and devastation caused by war, civil
happens. It is a time of enduring hardship or injury
strife, and other political conflicts
end of trying to survive. The impact phase may last for
2. Technologic Disasters
several minutes (e.g. after an earthquake, plane crash
a. Direct and adverse effects of major industrial
or explosion.) or for days or weeks (eg in a flood,
accidents, unplanned release of nuclear
famine or epidemic).
energy, fires or explosions from hazardous
The impact phase continues until the threat of further
materials
destruction has passed and emergency plan is in effect.
3. Disaster that occur in human settlements
This is the time when the emergency operation center
a. Results of a combination of forces like
is established and put in operation. It serves as the
famine, drought, epidemics and political
center for communication and other government
unrest.
agencies of healthcare providers to staff shelters.

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The Great
 Every shelter has a nurse as a member of disaster 3. To appraise both risks and resources in the
action team. The nurse is responsible for psychological environment
support to victims in the shelter. 4. To correct inequalities in access to health care or
3. Post-impact | more than 74 hours appropriate resources.
Recovery begins during the emergency phase and ends 5. To empower survivors to participate in and advocate for
with the return of normal community order and their own health and well-being.
functioning. For persons in the impact area this phase 6. To respect cultural, lingual, and religious diversity in
may last a lifetime. individuals and families and to apply this principle in
Four Stages of Emotional Response all health promotion activities.
1. Denial 7. To promote the highest achievable quality of life for
a. During the stage the victims may survivors.
deny the magnitude of the problem
or have not fully registered. The Principles of Disaster Nursing
victims may appear usually
1. Rapid assessment of the situation and of nursing care
unconcerned.
needs.
2. Strong Emotional Response
2. Triage and initiation of life-saving measures first.
a. In the second stage, the person is
3. The selected use of essential nursing interventions and
aware of the problem but regards it
the elimination of nonessential nursing activities.
as overwhelming and unbearable.
4. Adaptation of necessary nursing skills to disaster and
Common reactions during this stage
other emergency situations.
are trembling, tightening of
The nurse must use imagination and resourcefulness in
muscles, speaking with difficulty,
dealing with a lack of supplies, equipment, and
weeping heightened sensitivity,
personnel.
restlessness, sadness, anger and
5. Evaluation of the environment and the mitigation or
passivity. The victim may want to
removal of any health hazards.
retell or relieve the disaster
6. Prevention of further injury or illness.
experience over and over.
7. Leadership in coordinating patient triage, care, and
3. Acceptance
transport during times of crisis.
a. During the third stage, the victim
8. The teaching, supervision, and utilization of auxiliary
begins to accept the problems caused
medical personnel and volunteers.
by the disaster and makes a
9. Provision of understanding, compassion, and emotional
concentrated effect to solve them. It
support to all victims and their families.
is important for victims to take
specific action to help themselves
and their families. LEVEL 1 RESUSCITATION
4. Recovery
a. The fourth stage represents a LEVEL 2 EMERGENT
recovery from the crisis reaction.
Victims feel that they are back to LEVEL 3 URGENT
normal. A sense of well-being is
LEVEL 4 LESS URGENT
restored. Victims develop the
realistic memory of the experience.
LEVEL 5 NON-URGENT

**From week 1 pptx** (DISASTER CONTINUUM)

1. Planning/Preparedness/Prevention – 0 hours
2. Response Emergency – 0-24 hours
Management Mitigation – 24-72 hours Week 2
3. Recovery Rehabilitation Evaluation – greater than 74
hours Levels of Disaster
Level 1
Local emergency response personnel and organizations
Goals of Disaster Nursing can contain and effectively manage the disaster and its
aftermath
The overall goal of disaster nursing is to achieve the best
possible level of health for the people and the community
Level 2
involved in the disaster. Regional efforts and aid from surrounding
communities are sufficient to manage effects of the disaster
1. To meet the immediate basic survival needs of
populations affected by disasters (water, food, shelter, Level 3
and security). Local and regional assets are overwhelmed; statewide
2. To identify the potential for a secondary disaster. assistance is required

Prepared by: Ron Samuel Sicat, SN

The Great
 ○ • Returning the community to normal
Considerations related to levels of disaster (pre-disaster state).
○ Rehabilitation and Reconstruction
● Level I
○ Response team should be competent in basic
emergency preparedness
○ Adequate surge capacity to respond to routine
emergencies (power outages, weather events,
etc.)
● Level II
○ Assure adequate linkages with other
organizations and agencies in the
surrounding community.
○ Local support and assets should be readily
procured.
● Level III
○ Assure adequate linkages between local and
national-level organizations.
○ Knows the communication chain of command
for the national-level linkages.

Disaster Planning PHASE 1: Mitigation and Prevention

All actions taken before a disaster to reduce its impacts,
Cyclical process
including preparedness and long-term risk reduction measures.
Composed of phases, often taking place concurrently, indicative
of specific actions, along with the nature and scope of the plan.
Two Main Categories
Aims to reduce the negative impact or consequences of adverse
1. Structural Mitigation
events
a. Activities or Projects which aims to reduce
economic and societal impacts
National Disaster Risk Reduction and
2. Non-structural Mitigation
Management Plan 2011-2028
a. policies and practices which raise awareness
of hazards or encourage developments to
reduce the impact of disasters

Mitigation Strategies
1. Risk Assessment
a. Hazard Identification
b. Vulnerability Analysis.
2. Various mitigation strategies or measures (capacities).

Risk Assessment: Hazard Identification

Disaster Management Cycle

● Mitigation
○ Measures put in place to minimize the results
from a disaster. ● Industrial chemicals
○ Risk Assessment, Prevention Measures ● Transportation elements
● Preparedness ● Collections of people in areas with limited
○ Planning how to respond. access
○ Forecasting, Preparedness Plans, ● Environmental and meteorological hazards
Communications Management ● Explosions and terrorism
● Response
○ Initial actions taken as the event takes place.
It involves efforts to minimize the hazards
created by a disaster.
○ Evacuations, Search and Rescue, Emergency
Relief
● Recovery

Prepared by: Ron Samuel Sicat, SN

The Great
 preparing for, responding to, and recovering from the
hazard impact.

Risk Assessment
● Utilizes the results of the hazard identification and
vulnerability analysis.
● Determines the probability of a specified outcome from
a given hazard that affects a community with known
vulnerabilities
● Risk is a function of the hazards to which a community
is exposed and the vulnerabilities of that community.
However, that risk is modified by the level of the local
preparedness of the community at risk. It is expressed
by the following notation:

Risk Assessment: Vulnerability Analysis

Vulnerability - Is the extent to which a community’s structure,
services or environment is likely to be damaged or disrupted by
the impact of a hazard.

Type of Vulnerability Characteristics Risk Assessment Benefits:

Tangible/Material People – lives, health, security, living ● Prevention or removal of hazards
(easy to see; value conditions Property – services, ● Removal of at-risk populations from hazards
easily determined) physical property loss, loss of use ● Provision of public information and education
Economy – loss of products and ● Establishment of early warning systems
production, income Environment – ● Reduction of risk posed by some hazards
water, soil, air, vegetation, wildlife
● Enhancement of a local community’s capacity to
● respond during disasters.
Intangible/Abstract Social structures – family and
(difficult to see; community relationships Cultural
value difficult to practices – religious and agricultural PHASE 2: Preparedness
determine Cohesion – disruption of normal life
Motivation – will to recover;
government response

Vulnerability Analysis is a method used to determine:

● Who is most likely to be affected.
● What property is most likely to be damaged or
destroyed.
● What is the capability of the community to deal with
the effects of the disaster.
Data that were collected will be used to develop prevention
strategies

Mitigation Strategies and Measures

● A continuous and integrated process

● Involves a wide range of activities and resources taken
before the onset of a disaster from multi-sectoral
sources.
● Enables successful discharge of emergency
management programs, by which disaster relief is
coordinated and mobilized from governmental and
Mitigation Strategies and Measures (Capacities) nongovernmental organizations to helpless victims of a
disaster.
● Positive resources and abilities which are helpful to
individuals, families, and community in mitigating,

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Disaster Preparedness Goals:
● To achieve a satisfactory level of readiness to respond
to any emergency situation.
● Develop programs that will strengthen the technical
and managerial capacity of governments, organizations,
and communities.
● Build response mechanisms and procedures, rehearsals,
developing long-term and short-term strategies, public
education and building early warning systems.

Disaster Preparedness Measures:

● Preparedness plans
● Emergency Exercises/training
● Warning systems
● Emergency communications systems Disaster Response Activities:
● Evacuations plans and training 1. Warning
● Resource inventories 2. Evacuation and Migration
● Emergencypersonnel/contact lists ƒMutual aid 3. Search and Rescue (SAR)
agreements 4. Post-disaster Assessment
● Public information/education 5. Response and Relief
6. Logistics and Supply
Disaster Risk Reduction (DRR) 7. Communication and Information Management
● Physical measures to reduce the vulnerability and 8. Survivor Response and Coping
exposure of infrastructure to natural hazards as well 9. Security
and to provide coping and adaptive infrastructure in 10. Emergency Operations Plan
case of a disaster event (IFRCRCS, 2005). 11. Rehabilitation
● Forms the pillar of disaster preparedness. 12. Reconstruction

Disaster Risk Reduction Recommendations: 1. Warning

1. Policy, planning and capacity building in disaster refers to information concerning the nature of the danger and
management imminent disaster threats.
2. Physical prevention; example, building sea-walls ● Action: rapidly disseminate warnings to government
against storm surge or flood shelters during flood officials, institutions and the population at large in the
events. areas at immediate risk
3. Capacity building at institutional and systemic level in ● Dissemination methods:
disaster preparedness. ○ Radio
○ Television
○ Written press
PHASE 3: Response ○ telephone/cell phones
Disaster Response
● Act of putting preparedness plans into action 2. Evacuation and Migration
● Measures taken to save lives and prevent further Involves the relocation of a population from zones at risk of an
damage in a disaster or emergency situation. imminent disaster to a safer location.
● Primary concern: protection of life, immediate
treatment of injuries.

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The Great
 ● Measures for effective evacuation: b. Supporting systems: satellites, transmission
lines
2. Information Management System
a. Protocol of communication
b. Information dissemination and interpretation
8. Survivor response and Coping
Assess victims for existing social coping mechanism
Provide social services to victims with special needs to help
them adjust with the trauma and disruption caused by the
3. Search and Rescue (SAR)
disaster.
the process of identifying the location of disaster victims that
may be trapped or isolated and bringing them to safety and
medical attention.
● During Floods:
○ Locate stranded victims and transfer them to
a safer place or;
○ Provide them with foods and first aid until
they are evacuated or returned to their
homes.
● During Earthquakes:
○ Locate trapped and/or injured victims.
9. Security
4. Post-Disaster Assessment
Not always a priority issue after a sudden onset of disasters.
Primary Objectives Civil defense or police departments should ensure the protection
● Provide a clear, concise picture of the post-disaster of the human rights and safety of displaced populations or
situation refugees.
● To identify relief needs
● To develop strategies for recovery 10, Emergency Operations Management
It determines options for humanitarian assistance, how best to
Emergency Operations Plan (EOP)
utilize existing resources, or to develop requests for further
● Policies and procedures that sets out the scope of
assistance.
activities required for community preparedness and
response.
5. Response and Relief
● Allows the community to respond to threats and
● Should take place immediately engages responders in the short-term recovery.
● there should be no delays. ● Must be flexible (adjustable in real and potential
● contingency plans should be constructed. emergencies).

**Relief - is the provision on a humanitarian basis of material 11. Rehabilitation

aid and emergency medical care necessary to save and preserve
Actions taken in the aftermath of disaster to:
human lives
● Resumption of basic services.
● Assist victims in repair of dwellings and community
6. Logistics and Supply
facilities.
● Facilitate revival of economic activities.

12. Reconstruction
● is the permanent construction or replacement
of severely damaged physical structures.
● the full restoration of all services and local
infrastructure.
7. Communication and information ● revitalization of the economy (including
management agriculture).
Two aspects to communication in disasters
1. Communication Equipments
a. Radios, telephones, Wireless devices Traditional Responses to Disaster
1. Provision In-kind

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 2. Provision in-cash Recovery Plan
3. Local Partnerships
4. Civil Service

Modern Responses to Disaster

1. Cell phones
2. Spatial Devices
3. Social Networking

PHASE 4: Disaster Recovery

● Actions taken to return the community to normal

following a disaster.
● There is no distinct point at which immediate relief
changes into recovery.
● Continues until all systems return to normal or better.
Disaster Plan Evaluation
Plan
Personnel
Equipment

Purposes:
1. Evaluate the disaster response plan for effectiveness
and completeness.
2. Assess the comprehension of key personnel expected to
execute the plan and their ability to perform the
assigned duties.
Short Term Recovery 3. Ensure availability and functionality of equipment to
● Restore interrupted utility services be called in during disaster events
● Clear roads
● Fix or demolish severely damaged buildings Disaster Drills
● Provide foods and shelter to displaced victims 1. Best method to evaluate disaster plans for effectiveness
and effectiveness.
Immediate measures conducted that tends to overlap with 2. Staging of full-scale or small segment of disaster
Response. Some activities last for weeks. response.
3. Assessment techniques:
Long Term Recovery a. Table top academic exercises
● Complete redevelopment of damaged areas b. Mock patients
● Improve the status of community better than its pre c. Computer simulations
disaster state. d. Seminar sessions focused on key personnel or
● Develop new mitigation strategies aspects of disaster

Continuity of short-term activities. May carry on for a
number of months or years, depending on the severity
and extent of the damage sustained.
● Designed to spell out major steps for managing
successful recovery.
● Involves designation of key partners for each step
including their roles and instruction for mobilization.
Essentials of Effective Disaster Drill
Implementation
● Goals and objectives should be clearly communicated.
● The more realistic the exercise, the more likely it is to
be useful in assessing the strengths and weaknesses of
both the disaster plan and the responders.
● Include all individuals and agencies likely to be
involved in a disaster response, and a critique, during
debriefing of the participants.

Key points to Disaster Plan Evaluation

● Any modifications made to a disaster plan or response
procedures must be communicated to all groups
involved.
● Evaluate personnel to ensure their familiarity with
their roles in disaster situation.

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 ● Accommodate changes in population demographics, Nonmaleficence
regional emergency response operations, hospital
Do no harm
renovations, and other variables.
● Requires that no harm be caused to an individual,
● At a minimum, disaster drills should take place once
either unintentionally or deliberately
every 12 months in the community, and more
● This principle requires nurses to protect individuals
frequently in hospitals.
who are unable to protect themselves

According to the ANA code of ethics for nurses

A nurse’s duty to care is an ethical component of the
Week 3 nurse-patient relationship that can be inferred from Provision 2
of the ANA Code of Ethics for Nurses with Interpretive
Ethical Principles used in Disaster Nursing Statements which states that :
● “The nurse’s primary commitment is to the patient.”
However, nurses not only have an ethical obligation to
Moral
care for others but also to care for themselves.
● An individual’s own code for acceptable behavior
● Provision 5 of the Code states that the nurse owes the
● They arise from an individual’s conscience
same duty to self as to others.
● They act as a guide for individual behavior
● They are Learned
Beneficence
Ethics Do Good
● Ethics is the study of values in human conduct or the ● This principle means “doing good” for others (The
study of right conduct. Good Samaritan Law)
● Ethics offers a critical, rational, defensible, systematic ● Nurses need to assist clients in meeting all their needs
and intellectual approach to determining what is right • Biological • Psychological • Social
or best in a difficult situation. ● Article 25 of Human Rights
● Ethics deals with the “rightness” or “wrongness” of ○ Everyone has the right to a standard of living
human behavior adequate for the health and wellbeing of
himself and of his family, including food,
Two major classifications of ethical principles clothing, housing and medical care and
and ethical thought necessary social services, and the right to
security in the event of unemployment,
1. Deontology (Duty)
sickness, disability, widowhood, old age or
a. is the ethical school of thought that requires
other lack of livelihood in circumstances
that both the means and the end goal must
beyond his control.
be moral and ethical.
2. Utilitarianism
ANA Code of Ethics for Nurses
a. a school of ethical thought states that the end
● During the times of pandemics or natural catastrophes,
goal justifies the means even when the means
nurses and other health care providers must decide
are not moral.
how much high quality care they can provide to others
while also taking care of themselves.
ETHICAL PRINCIPLES
1. Autonomy Guidance for Establishing Crisis Standards of Care for use in
2. Nonmaleficence Disaster Situations: A Letter Report. (ANA, 2017) it says:
3. Beneficence
4. Justice A Protocol designed to protect medical professionals operating
5. Fidelity in extreme conditions and scarcities, and to ensure that the
6. Confidentiality public receives the most adequate medical services possible in
7. Veracity the situation.
8. Accountability
Justice
Autonomy Every individual must be treated equally
• The freedom to make decisions about oneself ● This requires nurses to be nonjudgmental
● Article 7 of HUMAN RIGHTS
Limits of Autonomy in making health care decisions ○ All are equal before the law and are entitled
Autonomy is limited: without any discrimination to equal
● when its exercise causes harm to someone else or may protection of the law
harm the patient. ● Article 21 of HUMAN RIGHTS
● When harm to others is sufficiently grave, it overrides ○ Everyone has the right of equal access to
the principle of autonomy. public service in his country

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Fidelity Ethical Dilemmas
● Occur when a problem exists between ethical principles
The promise to fulfill all commitments
● Deciding in favor of one principle usually violates
● Loyalty
another
● The basis of accountability
● Both sides have “goodness” and “badness” associated
● Includes the professionals faithfulness or loyalty to
with them
agreements & responsibilities accepted as part of the
practice of the profession
Why call an Ethics Consultant?
● This ethical principle is the foundation of the
Ethics Consultant can help:
nurse-patient relationship.
● Discover and understand the issues
● Fidelity comes into play when we uphold our
● Serves as a forum for sharing of concerns and
commitment to provide adequate pain control, when
questions
we provide quality of care, comfort and support when
● Identifies possible treatment, solutions, alternatives
needed, when we represent the interests of our clients
● Provides guidance to the staff, patient, and family
and we tell the truth.
members
● Resolves conflicts
Confidentiality
Anything stated to nurses or healthcare providers by patients Using the Nursing Process
must remain confidential
Assessment
● The only times this principle may be violated are:
Planning
○ If patients may indicate harm to themselves
Implementation
or others
Evaluation
○ If the patient gives permission for the
;)
information to be shared

Approach to Ethical Dilemma

Veracity
Truthfulness
● Nurses need to be truthful to their clients
● Veracity is an important component of building
trusting relationships

Accountability
Individuals need to be responsible for their own actions
Nurses are accountable to themselves and to their colleagues

Principle of Impartiality
It makes no discrimination as to nationality, race, religious
beliefs, class or political opinions.
It endeavors to relieve the suffering of individuals, being guided
Ethical Decision Making Process
solely by their needs, and to give priority to the most urgent
cases of distress ● Describe the problem
● Gather the facts
FUNDAMENTALS OF PRINCIPLE OF ● Clarify values
IMPARTIALITY ● Note reactions
● Identify ethical Principles
1. Non-discrimination is the refusal to apply distinctions of an
● Clarify legal rules
adverse nature to human beings
● Explore options and alternatives
2. Does not exclude differences in the treatment given to people
● Decide on a recommendation
placed in different situations on the basis of sex or age,
● Develop an action plan
nationality, race, religious beliefs, class or political opinions.
● Evaluate the plan
3. All those in need shall be helped, yet to treat everyone the
same way without taking into account much they are suffering,
Salient Points: ANA, 2017
or how urgent their needs are.
Nurses must be professionally and personally prepared.
4. The only priority that can be set in dealing with those who
Registered nurses need to be aware of the ethical situations they
require help must be based on need.
may encounter, especially in times of scarce resources and
5. The order in which available aid is shared out must
supplies when they may face unimaginable patient care
correspond to the urgency of the distress it is intended to
decisions.
relieve.
They need to advocate for systems and protocols that protect
6. The most important elements of all aspects of the protection
their ethical obligations as nurses, as well as ensure equity and
of the human being: human rights law, humanitarian law,
fairness in disaster medical care planning.
refugee law.

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Provision 8 of the Code obligates nurses to always “stress
human rights protection under all conditions, with particular
attention to:
● preserving the human rights of vulnerable groups such
as women,children, the elderly, prisoners, refugees and
socially stigmatized groups.”
UNIVERSAL DECLARATION OF HUMAN RIGHTS
ARTICLE 1
All human beings are born free and equal in dignity and rights.
They are endowed with reason and conscience and should act
towards one another in a spirit of brotherhood.
(2) No one shall be held guilty of any penal offence on account
of any act or omission which did not constitute a penal offence,
under national or international law, at the time when it was
committed. Nor shall a heavier penalty be imposed than the one
that was applicable at the time the penal offence was
committed.
ARTICLE 12
No one shall be subjected to arbitrary interference with his
privacy, family, home or correspondence, nor to attacks upon his
honor and reputation. Everyone has the right to the protection
of the law against such interference or attacks.

ARTICLE 2
ARTICLE 13
Everyone is entitled to all the rights and freedoms set forth in
(1) Everyone has the right to freedom of movement and
this Declaration, without distinction of any kind, such as race,
residence within the borders of each state.
color, sex, language, religion, political or other opinion, national
or social origin, property, birth or other status. Furthermore, no
(2) Everyone has the right to leave any country, including his
distinction shall be made on the basis of the political,
own, and to return to his country.
jurisdictional or international status of the country or territory
to which a person belongs, whether it be independent, trust,
ARTICLE 14
non-self-governing or under any other limitation of sovereignty.
(1) Everyone has the right to seek and to enjoy in other countries
asylum from persecution.
ARTICLE 3
Everyone has the right to life, liberty and security of a person.
(2) This right may not be invoked in the case of prosecutions
genuinely arising from non-political crimes or from acts
ARTICLE 4
contrary to the purposes and principles of the United Nations.
No one shall be held in slavery or servitude; slavery and the
slave trade shall be prohibited in all their forms.
ARTICLE 15
(1) Everyone has the right to a nationality.
ARTICLE 5
No one shall be subjected to torture or to cruel, inhuman or
(2) No one shall be arbitrarily deprived of his nationality nor
degrading treatment or punishment.
denied the right to change his nationality

ARTICLE 6
ARTICLE 16
Everyone has the right to recognition everywhere as a person
(1) Men and women of full age, without any limitation due to
before the law
race, nationality or religion, have the right to marry and to
found a family. They are entitled to equal rights as to marriage,
ARTICLE 7
during marriage and at its dissolution.
All are equal before the law and are entitled without any
discrimination to equal protection of the law. All are entitled to
(2) Marriage shall be entered into only with the free and full
equal protection against any discrimination in violation of this
consent of the intending spouses.
Declaration and against any incitement to such discrimination.

(3) The family is the natural and fundamental group unit of

ARTICLE 8
Everyone has the right to an effective remedy by the competent
national tribunals for acts violating the fundamental rights
granted him by the constitution or by law.
ARTICLE 9
No one shall be subjected to arbitrary arrest, detention or exile
ARTICLE 10
Everyone is entitled in full equality to a fair and public hearing
by an independent and impartial tribunal, in the determination
of his rights and obligations and of any criminal charge against
him
ARTICLE 11
(1) Everyone charged with a penal offence has the right to be
presumed innocent until proved guilty according to law in a
public trial at which he has had all the guarantees necessary for
his defense.
society and is entitled to protection by society and the State.
ARTICLE 17
(1) Everyone has the right to own property alone as well as in
association with others.
(2) No one shall be arbitrarily deprived of his property
ARTICLE 18
Everyone has the right to freedom of thought, conscience and
religion; this right includes freedom to change his religion or
belief, and freedom, either alone or in community with others
and in public or private, to manifest his religion or belief in
teaching, practice, worship and observance.
ARTICLE 19
Everyone has the right to freedom of opinion and expression;
this right includes freedom to hold opinions without

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interference and to seek, receive and impart information and
ideas through any media and regardless of frontiers.
ARTICLE 20
(1) Everyone has the right to freedom of peaceful assembly and
association.
(2) No one may be compelled to belong to an association.
ARTICLE 21
(1) Everyone has the right to take part in the government of his
country, directly or through freely chosen representatives.
(2) Everyone has the right of equal access to public service in his
country
(3) The will of the people shall be the basis of the authority of
government; this will shall be expressed in periodic and genuine
elections which shall be by universal and equal suffrage and
shall be held by secret vote or by equivalent free voting
procedures
ARTICLE 22
Everyone, as a member of society, has the right to social security
and is entitled to realization, through national effort and
international co-operation and in accordance with the
organization and resources of each State, of the economic, social
and cultural rights indispensable for his dignity and the free
development of his personality
ARTICLE 23
(1) Everyone has the right to work, to free choice of employment,
to just and favorable conditions of work and to protection
against unemployment.
(2) Everyone, without any discrimination, has the right to equal
pay for equal work.
(3) Everyone who works has the right to just and favorable
remuneration ensuring for himself and his family an existence
worthy of human dignity, and supplemented, if necessary, by
other means of social protection.
(4) Everyone has the right to form and to join trade unions for
the protection of his interests.
ARTICLE 24
Everyone has the right to rest and leisure, including reasonable
limitation of working hours and periodic holidays with pay.
ARTICLE 25
(1) Everyone has the right to a standard of living adequate for
the health and well-being of himself and of his family,
including food, clothing, housing and medical care and
necessary social services, and the right to security in the event
of unemployment, sickness, disability, widowhood, old age or
other lack of livelihood in circumstances beyond his control.
(2) Motherhood and childhood are entitled to special care and
assistance. All children, whether born in or out of wedlock, shall
enjoy the same social protection.
ARTICLE 26
(1) Everyone has the right to education. Education shall be free,
at least in the elementary and fundamental stages. Elementary
education shall be compulsory. Technical and professional
education shall be made generally available and higher
education shall be equally accessible to all on the basis of merit.
(2) Education shall be directed to the full development of the
human personality and to the strengthening of respect for
human rights and fundamental freedoms. It shall promote
understanding, tolerance and friendship among all nations,
racial or religious groups, and shall further the activities of the
United Nations for the maintenance of peace.
(3) Parents have a prior right to choose the kind of education
that shall be given to their children.
ARTICLE 27
(1) Everyone has the right freely to participate in the cultural
life of the community, to enjoy the arts and to share in
scientific advancement and its benefits
(2) Everyone has the right to the protection of the moral and
material interests resulting from any scientific, literary or
artistic production of which he is the author.
ARTICLE 28
Everyone is entitled to a social and international order in which
the rights and freedoms set forth in this Declaration can be
fully realized.
ARTICLE 29
(1) Everyone has duties to the community in which alone the
free and full development of his personality is possible.
(2) In the exercise of his rights and freedoms, everyone shall be
subject only to such limitations as are determined by law solely
for the purpose of securing due recognition and respect for the
rights and freedoms of others and of meeting the just
requirements of morality, public order and the general welfare
in a democratic society.
(3) These rights and freedoms may in no case be exercised
contrary to the purposes and principles of theUnited Nations
ARTICLE 30
Nothing in this Declaration may be interpreted as implying for
any State, group or person any right to engage in any activity or
to perform any act aimed at the destruction of any of the rights
and freedoms set forth herein
WEEK 4 AND 5
NURSES ROLE IN DISASTER NURSING
Disasters are catastrophic events that often result in extensive
property damage and loss of life. Extreme devastation can occur
from both man-made and natural disasters.
Nurses play a major role in responding to disasters to help
ensure the best possible outcomes. They usually have a desire to
help, but they don't always know where to start. If inadequately
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prepared, a nurse can be more of a hindrance than a help in
disaster relief efforts. The best time to prepare for a disaster is
before it occurs.
Nurses serve as an essential resource and can hold a wide range
of responsibilities related to disaster preparedness and response
a. Institution/Community disaster response written plan
familiarization
b. Task delineation and delegation in the event of a disaster
Developing an understanding of the disaster preparedness and
response plans, operational protocols, and security measures can
help nurses understand what their employers expect of them.
● Provide direct care as by working in local health units.
● Manage communications and media.
● Coordinate various activities in disaster management.
● Participate in planning, policy writing, or research.
Disaster management framework
Hyogo Framework for Action (HFA)
A 10-year plan to make the world safer from natural hazards
(2005-2015).
It was adopted by 168 Member States of the United Nations in
2005 at the World Disaster Reduction Conference in Kobe, Japan.

c. PROPER Use of materials and equipment during drills (i.e. The first plan to explain, describe and detail the work that is
PPEs, fire escape, fire extinguisher, emergency routes, required from all different sectors to reduce disaster losses.
communication devices.)
Nurses who volunteer and become involved with an organized
Substantially reduce disaster losses by 2015.
disaster response system are better prepared when disaster
● Loss of lives
strikes.
● Loss of social functions
● Loss of environmental and economic assets
d. Identification of agencies (GOs and NGOs) and their
roles/responsibilities in disaster risk reduction and management
Assisting during a disaster.
Five priorities for action
Collaboration of the nurse and NGO’s may be assigned
at a variety of tasks during a disaster such as
delivering first aid and medication, assessing the state
of victims, and monitoring mental health needs.

e. Disaster drills and evaluation of drills

f. Participate in continuing education on disaster risk reduction
and management.
Educating consumers and the community gives them the
knowledge they need to make it safely through a disaster and
help others. Knowledge can also do much to alleviate fear and
anxiety.
g. Preparing self and family
Some nurses have family members who rely on them. Personal
National Incident Management System (NIMS)
preparation with an emergency plan and basic emergency
supplies can help to ensure their families' safety while easing
the nurse's worries “a consistent nationwide approach for federal, state, tribal, and
Other things to consider include arranging a meeting place if local governments to work effectively and efficiently together to
separated, ensuring reliable communication, and compiling prepare for, prevent, respond to, and recover from domestic
important paperwork. incidents, regardless of cause, size, or complexity.” -HSPD5

Nurses may encounter challenges such as: A structured framework built on the foundation of existing
systems. Integrates best practices developed over the years. •
● Balancing professional and personal obligations,
sometimes even if the nurse has prepared at home. Developed by Homeland Security at the request of the President
● Dealing with restrictions to volunteering that depend – Homeland Security Presidential Directive—5 (HSPD-5)
upon training and immunizations.
● Working with limited resources and supplies.
● Facing potential security and safety threats such as
violence or infectious disease.
● Dealing with legal implications related to practicing
outside of the nurse's specialty area.
● Having to work in uncontrolled physical environments.
● Struggling with life-and-death situations and difficult
ethical decisions.

Nurse’s Role in Disaster Management

● Identify and characterize disaster events.
● First responder to the scene.
● Member of rapid needs assessment team.

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Works together with National Response Plan (NRP) to improve
nation’s incident management capabilities and overall
efficiency.
NIMS template enables national, regional, local, and tribal
governments, as well as private sector and NGO’s to work
effectively
NIMS Components
Designed to work together in a flexible, systematic manner to
provide the national framework for incident management
Preparedness
● Planning
● Training and Exercises
● Standards and Certification
● Mutual Aid
● Information and Publications
Command and Management
● designed to enable effective and efficient incident
management and coordination by providing a flexible,
standardized incident management structure.
NIMS standard incident command structures
are based on three key organizational systems:
A. The Incident command system
B. Multi-agency Coordination (MAC) System
C. Public Information Systems
● System that will identify available resources at all
jurisdictional levels to enable timely and unimpeded
access to resources needed to prepare for, respond to,
or recover from an incident.
Resource Management
● Identify and type resources
● Certify and credential personnel
● Inventory, acquire, mobilize, track and recover
resources from all sources.
NIMS describes the requirements necessary for a standardized
framework for communications.
Provides a common operating picture to all command and
coordination sites.
Communication and Information Management
• Utilizes concepts of communications:
Supporting Technologies
● Oversees and coordinates the ongoing development of
incident management related technology, including
strategic research and development.
● Use of technology will enable emergency response
personnel to continuously refine and implement NIMS
against rapidly evolving crisis situations.
Ongoing Management and Maintenance
National Integration Center
• provides strategic direction, oversight, and coordination of
NIMS .
• supports both routine maintenance and the continuous
refinement of NIMS and its components.
• It provides guidance and support to jurisdictions and
emergency management/response personnel and their affiliated
organizations as they adopt NIMS system
1. Incident Command system
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 2. Multiagency Coordinating System c. When possible, minimize use of abbreviations,
3. Public Information System acronyms or confusing terminology to
improve communication.
Incident Command System 3. Module/Scalable Organization
Developed in response to a series of fires in Southern California a. A modular organization develops from the
in the early 1970s by an interagency effort called FIRESCOPE. top-down at any incident.
(Firefighting Resources of California Organized for Potential i. All incidents regardless of size or
Emergencies) complexity will have an incident
commander
Weaknesses in incident management that lead to the b. The organization can expand/shrink according
development of ICS: to the needs of the situation.
● Too many people reporting to one supervisor c. Only activate what you need.
● Different emergency response organizational structure 4. Integrated Communications
● Lack of reliable incident information
a. Integrated communications is a system
● Inadequate and incompatible communications
characterized by the use of:
● Lack of structure for coordinated planning among
i. standard operating procedures,
agencies (departments)
ii. common communications plan
● Unclear lines of authority
iii. common equipment
● Terminology differences among agencies (departments)
iv. common terminology.
● Unclear or unspecified incident objectives.
b. Several communication technologies may be
established, depending on the size and
ICS Defined as:
complexity of the organization and the
A standardized, on-scene, allhazard incident management
incident.
concept. (FEMA).
5. Unified Command Structure
Systematic tool used for the command, control, and
coordination of emergency response. (United States Federal a. A unified command allows all departments or
Highway Administration.) groups with responsibility for the incident, to
manage an incident by establishing a
ICS is based on proven management characteristics, namely: common set of incident objectives and
strategies.
b. Unified command does not mean losing or
giving up agency (departmental) authority,
responsibility, or accountability, it simply
provides for a coordinated response.
6. Consolidated Action PLan
a. Consolidated AP’s describe response goals,
operational objectives, and support activities.
b. Goals and objectives are always prepared
around a timeframe called an operational
period.
c. The Incident Commander determines the
length of the operational period based on the
complexity and size of the incident
d. Operational periods can be of various lengths.
1. Manageable Span of Control
i. should be no longer than 24 hours.
a. A manageable span of control is defined as ii. Twelve-hour operational periods are
the number of individuals one supervisor can common for large-scale incidents. \
manage effectively. iii. At the beginning of an incident the
b. The number of subordinates one supervisor time frame is often short, 2 - 4
can manage effectively is usually 3-7, the hours.
optimum is 5. 7. Pre-designed Command Centers
2. Common Terminology
a. Pre-designated command centers are placed
a. Common terminology is essential in any strategically appropriate for the risk and
system, especially when diverse groups are hazards.
involved in the response. i. • Ideally have two; a primary and a
i. • Multiple company departments backup.
and/or locations ii. Determine location once you have
b. Also critical when it is not an activity you done a hazard analysis.
perform on a “regular” basis. 8. Comprehensive Resource Management
a. Comprehensive resource management allows
an organization to:
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 i. Maximize resource use.
ii. Consolidate control of single
resources.
iii. Reduce the communications load.
iv. Provide accountability.
v. Ensure personnel safety

Incident Command and Staff

Incident Command is responsible for overall management of the
incident.

Types of Incident Command according to

function
1. Single Incident Command
2. Unified Command

Single Incident Command

Designated during:
• incident occurring within a single jurisdiction
• there is no jurisdictional or functional agency
overlap.
The designated IC will develop the incident objectives on which
subsequent incident action planning will be based.
Designated when in multijurisdictional or multiagency incident
management.

Enables multiple agencies to:

● coordinate, plan, and interact effectively.
● jointly provide management direction through a
common set of incident objectives and strategies .
● maintains the authority, responsibility, and
accountability of each participating agency.

Unified Command
Enables multiple agencies to:
● coordinate, plan, and interact effectively.
● jointly provide management direction through a
common set of incident objectives and strategies .
Multi-Agency Coordination System
● maintains the authority, responsibility, and
accountability of each participating agency. process that allows all levels of government and all disciplines
to work together more efficiently and effectively.
Advantages of Using Unified Command
Primary Functions:
1. Single Incident management objectives
2. Improves coordination and Information flow ● Coordinate activities above the field level
3. Consistent understanding of joint priorities and ● To prioritize the incident demands for critical or
restrictions. competing resources
4. Preserves authority in each participating agency. ● Assist the coordination of the operations in the field.
5. Combined efforts produce optimum performance.
MAC System Elements
● PErsonnel
Basic ICS Commanding Staff and General Staff ● Equipment
● Procedures
● Facilities

Personnel
includes:
● Agency administrators/ Executives
● Appointed agency representatives
● Supporting agency representatives

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 ● NGOs, and the private sector Components:
Facilities are needed to house system activities of the MAC
group.
May include locations for:
● Communication/ Dispatch center
● Emergency Operations Center (EOC)
● City Hall
● Virtual Locations

Equipment
To accomplish system activities, equipment (such as computers
and phones) must be identified and procured.

Procedures
Procedures that prescribe the activities and functionality of
MACS includes:
● Processes
● Protocols
● Agreements
● business practices
Public Information Officer
advises the IC/UC on all public information matters relating to
the management of the incident.

Responsibilities of Public Information Officer:

● Identify key information that needs to be
communicated to the public.
● Craft key information messages that are clear and
easily understood by all.
● Prioritize messages to ensure timely delivery of
information without overwhelming the audience.
● Verify accuracy of information through appropriate
channels.
● Disseminate messages using the most effective means
available.

Public Information Joint Information System

● provides the mechanism to organize, integrate, and
● The processes, procedures, and systems to
coordinate information across multiple jurisdictions
communicate timely and accurately.
and/or disciplines with NGOs and the private sector
● Accessible information on the incident’s cause and its
● central location that facilitates operation of the Joint
size.
Information System
● Current situation of the public, responders, and
● site where Public Information performs their critical
additional stakeholders (both directly affected and
emergency information functions, crisis
indirectly affected).
communications, and public affairs functions

Philippine Disaster Management System

RA 10121: Philippine Risk Reduction and
Management Act of 2010

“An Act strengthening the Philippine Disaster Risk Reduction

and Management System, providing for the national disaster
risk reduction and management framework and
institutionalizing the national disaster risk reduction and
management plan, appropriating fund therefor and for other
purposes.”

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Republic Act 10121, Sec. 5
The present National Disaster Coordinating Council or NDCC
shall henceforth be known as the National Disaster Risk
Reduction and Management Council
NDRRMC - NATIONAL LEVEL
RDMMC - REGIONAL LEVEL
LDRRMC - LOCAL LEVEL (Provincial, City, Municipal, Barangay)
National Council
Act No. 7077: Authority of NDRRMC Chairperson
“..call upon other instrumentalities or entities of the
government and nongovernment and civic organizations for
assistance in terms of the use of their facilities and resources
for the protection and preservation of life and properties in the
whole range of disaster risk reduction and management. This
authority includes the power to call on the reserve force.”
-Republic
Regional Council
Functions
● Coordinate, integrate, supervise, and evaluate the
● activities of the LDRRMCs.
● Ensure disaster sensitive regional development plans
● in case of emergencies shall convene the different
regional line agencies and concerned institutions and
authorities.
● Establish an operating facility to be known as the
Regional Disaster Risk Reduction and Management
Operations Center (RDRRMOC)whenever necessary
Local Council
Function:
● responsible for setting the direction, development,
implementation and coordination of disaster risk
management programs within their territorial
jurisdiction
Issues of Disaster Management in the
Philippines
● Disasters are being dealt within manners that are
ad-hoc and response-oriented.
● Information on disaster risk is lacking and
measurement of socio- economic impact of disasters is
inadequate. Issues of Disaster Management in the
Philippines Study on Comprehensive Disaster Risk
Management for East Asia and the Pacific Region,
World Bank (2005)
● NDCC members and LGUs have limited risk reduction
capacities.
● Efforts by donors, multilateral and civil society are
poorly coordinated and generated little effects.
● Government bears majority of the cost of disasters
Recommendations
Philippines should develop a national framework for a
comprehensive disaster risk management that should:
1. provide for political leadership and policy support at
the highest levels.
2. Facilitate the active engagements and implementation
of all relevant stakeholders at the national, local, and
household levels.
3. Incorporate the three essential steps of integrated risk
management, which include risk identification, risk
reduction and risk sharing.
Current Initiatives:
NDRRMC has adopted the guiding principles in disaster risk
reduction management in 2005 (Hyogo Framework of Action).
The Government of the Philippines adopts an all-hazards,
comprehensive, inter-agency/ multi-sectoral, community-based
approach in the context of the UNMDGs (poverty alleviation,
environmental sustainability and sustainable development).
NDCC Four – Point Action Plan on Disaster
Preparedness:
1. Upgrading the forecasting and warning capability of
PAGASA and PHIVOLCS which are the warning
agencies for Met-Hydro and Geological hazards.
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 2. Public information campaign on disaster preparedness.
3. Capacity building for local government units in
identified vulnerable areas.
4. Mechanisms for government and private sector
partnership in relief and rehabilitation
Standard of Care
It refers to the level of attentiveness and care that a certain
person owes to another person under the circumstances. This
generally refers to professionals, such as doctors, paramedics,
lawyers, and others
PROFESSIONAL STANDARD OF CARE
● A professional standard of care applies to anyone in a
professional role offering services to a client, patient,
or customer.
● Professionals govern themselves by a professional
standard of care that, if violated, can subject them to
lawsuits for malpractice.
MEDICAL STANDARD OF CARE
● The medical standard of care is the standard required
of doctors and other medical personnel.
● refers to the idea that a doctor/nurse possessing the
same knowledge and skills as any other doctor/nurse
owes his patients the best possible treatment and care
he can provide.
● If there is a reasonable treatment option available and
he does not pursue it, and the patient suffers as a
result, then he may be subject to a lawsuit for
neglecting him under the medical standard of care.
MEDICAL MALPRACTICE
● A form of negligence.
● Medical malpractice translates to mean that a doctor
either did something wrong, or did not exercise
reasonable care when treating a patient
GUIDELINES FOR CRISIS STANDARDS OF CARE
DURING DISASTERS
● June 2013
● American College of Emergency Physicians
● ACEP Disaster Preparedness and Response Committee
I. Background and Terminology
A. The Institute of Medicine defined
B. “Crisis Standard of Care” (CSC) to be a
“substantial change in the usual health care
operations and the level of care it is possible
to deliver… justified by specific
circumstances… and formally declared by a
state government in recognition that crisis
operations will be in effect for a sustained
period.”
Guidelines for crisis standards of care during
disaster
● A pandemic or other catastrophic disaster may strain
medical resources
● a shift in care that was previously focused on the
individual patient to that which is focused on doing
the most good for the greatest number.
● to allocate scarce resources to save as many lives as
possible.
Goals of community dealing with a catastrophic
disaster
1. To minimize death and serious illness by distributing
finite resources (personnel, supplies, hospital beds and
space, medications, and treatment) to those who have
the greatest opportunity to benefit;
2. To maximize appropriate care for the largest, number
of patients;
3. To maximize self-care by the public by using media to
deliver public health messages; GOALS OF A
COMMUNITY DEALING WITH A CATASTROPHIC
DISASTER WILL BE :
4. To delineate which health care facilities should provide
what level of care based on the capacities and
capabilities of the facility;
5. To provide a legal framework for developing triage
decisions;
6. To engage the public and build trust in the community
by being inclusive, transparent, open, and honest about
the limited resources and the resulting crisis standard.
II. Liability Issues
A. Many practitioners have expressed concern
about liability issues.
B. if a provider injures someone in the course of
performing some public health action,
emergency workers, particularly those
working as volunteers may receive immunity.
C. Disaster Act or similar legislation that
provides liability protection for health care
providers and disaster responders.
D. It is important for providers to understand
the liability protection afforded to disaster
responders in their state.
E. Other actions to increase surge capability
1. Obtain an executive order from local
and state governments to facilitate
lower staff-to-patient ratios.
2. Decrease the number of routine care
activities (frequency of vital signs
being taken) that are performed
3. Decrease documentation of care.
4. Decrease stringent rules about
privacy and confidentiality to
facilitate transfer of information
between health care providers.
5. Cancel elective procedures and
appointments.
6. Use areas of the hospital not
normally used for patient care.
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 7. Consider performing low-risk births
at home, rather than at hospitals.
8. Within reasonable standards and
with appropriate training, consider
increasing the scope of practice of
midlevel providers, nurses,
physicians, dentists, pharmacists,
physical therapists, etc. Again, the
level of care provided by these
practitioners should meet the
“reasonable” standard, given the
limited resources at hand.
Conversely, physicians may need to
be flexible and perform secretarial,
transportation, or administrative
duties.
9. Mass fatality plans – note that there
is no urgent or imminent need for a
dead body to be disposed to one of
four final dispositions within 24
hours (cremation, burial,
refrigeration or embalming), as it
has been demonstrated that these
bodies are NOT an immediate
infection control hazard. There is
time to properly respect the cultural
and religious beliefs of the affected
population.
III. Planning
A. Advance planning is crucial in anticipating,
the health care needs and resource shortfalls
that will occur and to identify policy and
operational adjustments that will be needed.
B. Efforts should be made to eliminate scarcity
prior to having to implement allocation
guidelines by performing and acting upon
hazard vulnerability analyses in a fair and
transparent process.
C. At the hospital and institutional level,
develop a plan to expand staff capacity,
including contingency plans for staff
absences, and the use of volunteers. Ensure
that a plan for managing volunteers is in
place.
D. Develop a strategy to acquire additional
equipment/ supplies if needed, and streamline
a process whereby your hospital would get
access to the Strategic National Stockpile.
E. Develop a communication process so the
community understands the rationale behind
resource allocation.
F. Plan to restrict visitors and limit hospital
entry to a few key entrances and plan for
increased security needs.
G. At the local hospital level, initiate discussions
of the process of allocation of scarce
resources. It is important for hospital
administrators to meet with the hospital
ethics committee to establish guidance for
scarce resource allocation. The Michigan plan
actually outlines inclusion and exclusion
criteria for mechanical ventilation (in the
event that there are limited quantities of
ventilators).
H. Note that palliative care in the aftermath of a
disaster is an ethical imperative (and is
recognized as a core institutional competency
by the Joint Commission and the National
Quality Forum).
I. Palliative care stress the importance of
patient care in four key areas:
1. Physical symptom management
(pain, dyspnea, nausea, etc.);
2. Psychological symptom management
(anxiety, depression, agitation);
3. Support for family and close
persons; and
4. Spiritual support
Allocation of ventilators and critical care
in Colorado, according to the Department of Public Health’s
written guidance, during a pandemic of catastrophic proportions,
ventilators should not to be offered to those with metastatic
malignant disease, a terminal illness, or those who have
advanced immunocompromise.
The Sequential Organ Failure Assessment (SOFA) score may also
be used to help triage who warrants critical care or ventilatory
management.
The SOFA score is dependent upon six variables and patients can
receive a total score of 24 (6 categories with a total of 4 points
for each category, and a higher score indicates greater severity
of illness):
1. PaO2/FiO2 ratio,
2. Bilirubin,
3. Hypotension,
4. Glasgow Coma Score,
5. Creatinine,
6. Platelet count.
The sequential Organ Failure Assessment
(SOFA Score)
● Black – those with SOFA score > 11 will be managed
medically andprovided only palliative care
● Red – those with SOFA score </= 7 or single organ
failure – have the highest priority for care
● Yellow – those with SOFA score 8-11 – have the second
highest priority for care
● Green – those without any organ failure – may be
discharged
ALL LAWS
RA 10121 PHILIPPINE DISASTER REDUCTION AND
MANAGEMENT ACT
The Act mandates the establishment of a Disaster Risk
Reduction and Management Office (DRRMO) in every province,
city and municipality, and a Barangay Disaster Risk Reduction
and Management Committee (BDRRMC) in every barangay.
Provides for the calamity fund to be used in support of disaster
risk reduction or mitigation, prevention, and preparedness
activities for the potential occurrence of disasters and not just
for response, relief, and rehabilitation efforts.
Prepared by: Ron Samuel Sicat, SN
The Great

WHY WAS R. A. 10121 IMPLEMENTED?
● To prevent the loss of lives during disasters natural or
man made
● To reduce the loss of structures
● To prepare the people for the upcoming Typhoons,
Earthquakes, Landslides etc.
Act No. 7077: Authority of NDRRMC Chairperson
“..call upon other instrumentalities or entities of the
government and nongovernment and civic organizations for
assistance in terms of the use of their facilities and resources
for the protection and preservation of life and properties in the
whole range of disaster risk reduction and management. This
authority includes the power to call on the reserve force.”
-Republic
Executive Order 137 s.1999: National Disaster
Consciousness Month (JULY)
The whole month of July of every year is hereby declared as
National Disaster Consciousness Month to be collectively
observed by all Filipinos throughout the country through the
conduct of fitting activities for the occasion.
RA 9173 Philippine Nursing Act of 2002
The bills provide that RA 9173 must be amended to achieve the
vision of the Philippine professional nursing care to be the best
for the Filipino and the choice of the world by 2030.
RA 10871 Basic Life Support Training in School
Act
An Act Requiring Basic Education Students to Undergo
Age-Appropriate Basic Life Support Training, otherwise known as
the Basic Life Support Training in Schools Act.
United Nations Declaration on human rights in
1948
Human rights in the Philippines are protected by the
Constitution of the Philippines, to make sure that persons in the
Philippines are able to live peacefully and with dignity, safe
from the abuse of any individuals or institutions, including the
state.
Ra 9372: Human Security Act of 2007
1. The Human Security Act (HSA) of 2007 is an act to
secure the State and to protect the people from acts of
“Terrorism”.
2. It condemns terrorism as inimical and dangerous to
national security and to the welfare of the people,
thereby making terrorism a crime against the Filipino
people, Humanity and the Law of the nations.
RA10168: Terrorism Financing Prevention and
Suppression Act of 2012
TF Suppression Act
It is the policy of the State to protect life, liberty, and property
from acts of terrorism and to condemn terrorism and those who
support and finance it and to recognize it as inimical and
dangerous to national security and the welfare of the people,
and to make the financing of terrorism a crime against the
Filipino people, against humanity, and against the law of
nations.
Standards of Care during Disaster
It refers to the level of attentiveness and care that a certain
person owes to another person under the circumstances. This
generally refers to professionals, such as doctors, paramedics,
lawyers, and others
Code of Conduct for International Red Cross
and Red Crescent Movement and NGOs in
Disaster Relief in 1992 (Steering Committee for
Humanitarian Response)
● Agreed upon by 7 International Humanitarian
Agencies: IFRC, ICRC, Caritas International,
International Save the Children, Lutheran World
Federation, Oxfam and World Council of Churches;
● Seeks to guard the standards of behavior of
International Humanitarian Agency and Humanitarian
Aid workers as well as to maintain the high standards
of independence, effectiveness and impact to
humanitarian activities;
IATF Guidelines (Inter Agency Task Force for the
Management of Emerging Infectious Disease)
RESOLUTION NO. 134, Series of 2021, August 19, 2021
WHEREAS, Section 15 Article II of the 1987
Constitution states that the State shall protect and promote the
right to health of the people and instill health consciousness
among them;
WHEREAS, Section 2(b) of Executive Order No. 168
(s.2014) mandates the Inter-Agency Task Force for the
Management of Emerging Infectious Diseases (IATF) to prevent
and/or minimize the entry of suspected or confirmed patients
with emerging infectious diseases into the country;
WHEREAS, the continued implementation of proactive
measures and restrictions must be put in place to slow down the
surge in COVID-19 cases, stop further spread of variants, buy
time for the health system to cope, and to protect more lives;
09996904331 G-CASH: 👍 digits na lang as thank you :*
Prepared by: Ron Samuel Sicat, SN
The Great