LEARNING MATERIAL I: SIGNIFICANCE OF
DISASTER NURSING
According to the International
Classification of Nursing Practice (ICNP)
Catalogue, the disaster nursing is significant to
nursing for several reasons: 1) reflects nursing
leadership and research in disaster nursing; 2)
shows how the nursing process guides nursing
care; and, 3) demonstrates the commitment of
nursing to high quality health care.
Nursing leadership and research in disaster
nursing
Nursing has been a part of the response
to a wide range of natural disasters (e.g., floods,
cyclones, earthquakes, extremes of heat and
cold) and disasters related to human activity
(e.g., industrial explosions, airplane crashes, war,
terrorism) for many years. The multiple types of
patients the disaster nurse may care for and the
environment in which the patient is treated
dictates that the disaster nurse is prepared for a
variety of challenges. The role of the disaster
nurse is multifaceted and includes practice,
education, management, consultation, advocacy
and research. Disaster nurses come from a
variety of specialty nursing areas and all bring a
wealth of expertise of different types and levels
to the people experiencing a disaster.
Interest in clarifying the roles carried out
by disaster nurses, and the competencies they
need to fulfil these roles, has intensified since
the late 1990’s and continues today. Some
attention has been paid to disaster and
emergency skills needed by all nurses (World
Health Organization & International Council
of Nurses, 2009) while others have considered
only individual specialty nurses such as those in
the areas of public health practice, emergency
departments, intensive care units, flight nurses
and nurses involved in military service. Given the
extensive range and specialization of nurses
from around the globe who are involved in the
complexity of the entire spectrum of disaster
health from pre-event planning through
recovery, it is not surprising that there are
multiple perspectives on what nurses need to
know, and how they will apply that knowledge.
Nursing process guides nursing care
Regardless of the precise manner in
which an individual nurse becomes involved in
practice related to disasters and major
emergencies, it is useful for them to use
consistent language to communicate with one
another about the assessments and diagnoses
they make, the interventions they carry out, and
the outcomes of their patients. Capturing data
through the use of a standardized terminology
can be useful to nurse researchers as they seek
to evaluate nursing practice and patient and
family outcomes, through the use of a
standardized clinical data set and thus make the
processes and outcomes of disaster nursing care
more visible.
Commitment of nursing to high quality health
care
Nurses with disaster experiences and
roles (illustrated in figure below) is a way of
continuing communication across the global
nursing profession, establishing consistent
evidence-based practice standards in disaster
nursing.
LEARNING MATERIAL II: CONCEPT OF DISASTER
Disaster Defined: Is a serious disruption of
functioning of a community or society involving
widespread human, material, economic, or
environmental losses and impacts, which exceed
the ability of the affected community or society
to cope using its own resources. Disaster is often
described as a result of combination of: the
exposure to hazard; the condition of
vulnerability that are present; and the
insufficient capacity of measure to reduce or
cope with potential negative consequences.
Disaster impacts may include loss of life, injury,
disease and other negative on human physical,
mental and social well-being, together with
damage to property, destruction of asset, loss of
service, social and economic disruption and
environmental degradation.
Disaster is any occurrence that causes damage,
ecological disruption, loss of human life,
deterioration of health and health services on a
scale, sufficient to warrant an extraordinary
response from outside the affected community
or area (WHO).
Disaster is an occurrence either natural or man-
made that causes human suffering and creates
human needs that victims cannot alleviate
without assistance (American Red Cross).
Disaster is a widespread serious destruction of
the functioning of the community or a society. It
involves widespread human, material,
economic, or environmental impacts which
exceed the ability of the affected community or
society to cope using its own resources (United
Nations).
When Does a Natural Event Become a Hazard?
Natural events like earthquake,
typhoon, volcanic eruptions and others does not
automatically become hazard, much less cause
disaster.
A. The Exposure to Hazard
What is a hazard?
Hazards are the potential for damage to
man and his environment that may result from
the occurrence of natural events such as
eruptions, earthquake, floods, and storm surges.
An event per se does not constitute a hazard. It
is only when man and his environment are
threatened and these events can be considered
hazards. Without a threat to a population, the
eruption of an isolated volcano remains an event
but when volcanic activity occurs close to or right
at the center of a populated area, a mere event
become a hazard.
Hazard is any phenomenon that has the
potential to cause disruption or damage to the
people and their environment. It is a natural
event while disaster is its consequence. A hazard
is perceived natural event which threatens both
life and property. A disaster is a realization of this
hazard (Whittow, J.n.s.)
Hazard may be inevitable but disaster
can be prevented.
Classification of hazards
Natural hazards are those which are cause by
forces in our environment that disrupts human
activity, or that may cause damage or injury to
life and property. Earthquake, floods, and
thunderstorm are examples of natural hazards.
Quasi-natural Hazards are the second
classification of hazards. These hazards which
resulted from natural process and intervention
of human activities.
An example of quasi-natural hazard is smog.
Smog is a type of pollution in the air like haze.
The difference is that smog is a mixture of dust,
smoke, and other dry particles. It is considered
a quasi-natural hazard as it may be the result of
forest fire caused by human in which smoke is
mixed with the air. Haze is also classified as
quasi-natural hazard. Haze is traditionally an
atmospheric phenomenon where dust, smoke
and other dry particles obscure the clarity of the
sky (No condensation). Sources for haze particles
include farming (ploughing in dry weather),
traffic, industry, and wildfires. The latest incident
on haze is that which occurred in September of
2015. The disaster was term as the 2015
Southeast Asian haze. It originated in Indonesia
in cutting and burning plants and trees during
the dry season. The smoke mixed with some dry
particles in the air reached several countries
including the Philippines.
Technological (or man-made) hazards are those
arising from industrial conditions like accidents
and equipment malfunction which may cause
loss of lives of people, animals, and properties.
In the history of technological hazards, the most
recent is that which occurred in the warehouse
wall in Guiguinto, Bulacan in January 2015. This
hazard result in disastrous event as it resulted to
the death of 11 people with several injured and
properties smashed.
Climate and Weather-related Hazards Climate
and weather-related hazards are types of natural
hazards which have direct effect to people’s lives
and properties. The Philippines for instance, has
a tropical rainforest type climate. This type of
climate is characterizing by high temperature
and high atmospheric humidity. However, when
season pertaining to high temperature is
prolonged and became excessive, it is already
called El Nino. This phenomenon can cause
damage to crops and animals and to the people
as well.
Geophysical Hazards Geophysical events are
normal occurrences of forces of the earth.
However, when this event cause destruction to
life and properties, they are already classified as
geophysical hazards. Geophysical hazards have
different categorization. These categories are
made by the Philippine Institute of Volcanology
and Seismology (PHILVOCS) and the Earthquake
and Natural Resources Atlas of the Philippine of
1998. These are the following:
1. Earthquake is the result of sudden slip
on a fault in the earth. As a result, the
ground shaking will be felt. Earthquake
may be due to some natural occurrence
or man-made events. Natural causes of
earthquake include volcanic or magnetic
activity and movement of fault lines.
Man-made causes of earthquake include
mining and man-made explosions.
2. Earthquake-induce landslide. This is the
downslope movement of soil and rock as
a result of earthquake.
3. Tsunamis. This phenomenon may be
associated with earthquake or volcanic
eruption in large sea wave is formed that
may drown people, animals and
properties including huge buildings.
4. Volcanic eruptions. The flow of lahar and
the accent of magma are the two most
distressing effects of volcanic eruptions.
Biological- Biological hazards include viruses,
bacteria, insects, animals, etc., that can cause
adverse health impacts.
Anthropogenic Hazards. Anthropogenic,
or man-made hazards include pollution,
deforestation, mining and climate change.
Generally, anthropogenic hazard is the result of
human act or omission. Burning of waste is an
example of human act leading to smog while the
refusal of using toxic chemicals may lead to
damage of ozone layer. These two combines may
aggravate global warming.
Biological hazards, also known as biohazards,
refer to biological substances that pose a threat
to the health of living organisms, primarily that
of humans. This can include medical waste or
samples of a microorganism, viruses, or toxins
(from a biological source) that can affect human
health.
During the last few decades, biological
emergencies have assumed an increasing
importance: major outbreaks related to new and
re-emerging infectious diseases such as SARS,
influenza (H1N1 and H5N1), cholera, and the
latest is Covid-19.
Natural Hazards Versus Disaster
Floods, earthquake, volcanic eruption,
hurricanes are types of natural hazards. But
when do they become disaster? The main
difference lies on hazards effect on people.
When typhoon strikes a thickly populated area in
the Philippines, causing massive destruction of
properties and lives, it become a disaster.
EXPOSURE AND VULNERABILITY
Elements of risk are the people,
economic activities, and private and public
services potentially threatened by a harmful
event.
B. WHAT IS VULNERABILITY?
Exposure and Vulnerability
Elements of risk are the people,
economic activities, and private and public
services potentially threatened by a harmful
event.
Vulnerability is the characteristic of
community as being susceptible or [prone to
hazard or diseases. Vulnerability is due to several
characteristics or conditions. Some of the
characteristics affecting vulnerability includes
social, economic, and environmental factors.
Vulnerability of some elements is not
permanent. The risk factor may change
depending on how the element cope with
changes in the environment for its own safety.
Vulnerability is having the conditions
determined by physical, social, economic, and
environmental factors or processes which
increase the susceptibility of a community to the
impacts of hazards (United Nation International
Strategy for Disaster Reduction, 2004)
Classification of Vulnerabilities
There are different classification of
vulnerabilities. These are the following:
 Physical Vulnerability.
This pertains to the physical aspect of the
community, the people and the infrastructures.
Physical aspect of the community may pertain to
the location of the community. Those who are
located on low-lying areas are more vulnerable
to flood while those located on mountainous
areas are more vulnerable to landslides.
Physical aspect of the people may pertain to
demographic profile of the people living on a
certain community. For instance, a community
which composes of diverse young, old, and sick
are more vulnerable than other communities.
Physical vulnerability of infrastructure may
pertain to the type of houses, building
compositions or bridges and buildings, and
others.
 Social Vulnerability
Social vulnerability is the incapacity of the
community to survive the hostile effects of
threats of disasters. Social vulnerability may be
due to the principles and beliefs of the people in
a certain locality. It includes aspects related to:
a. awareness of the people to disaster
b. the existence of emergency-
preparedness plan
c. access to basic social services
d. custom and traditions
e. leadership of government officials
f. optimism in life
Example: Even the weather bureau forecasted
the possible occurrence of storm surge, people
refuse to leave the locality because of the
mistrust to the local government, lack of
awareness about storm surge, and the fear of
losing their resources of livelihood.
 Economic Vulnerability
This kind of vulnerability may be associated
with financial status of a person to stay in safer
place and build a safer home. It can be drawn in
that poor people are more vulnerable to the
impact of disaster because of their incapacity to
sustain a better place to stay, live and build a
family. The poor may choose to stay along
coastal areas, squatters, and bridges which make
them more susceptible to disaster.
Countries which are economically progressive
are also more vulnerable to disasters. Economic
instability may result to low standard of
infrastructures, emergency equipment, supplies,
and reliefs.
 Environmental Vulnerability
Even in our environmental and natural
resources are also vulnerable to disasters. For
 instance, our forests are vulnerable to wildfires
brought by some human negligence of by
lightning. Mountains may also erode due to
heavy rains, and the depth of our ocean may be
affected by seiche.
Vulnerability of Exposed Elements
I.Vulnerability of Physical Elements
Physical vulnerability includes those which
are actually built in the environment vulnerable
to disasters. Physical elements include
infrastructure like buildings, houses, roads, and
bridges. One way to reduce vulnerability of
physical elements is to place them in a more
strategic place. For instance, roads may not be
built along the mountainous areas to avoid
erosion or possibility bring damaged by
landslides.
II. Vulnerability of Social Elements
Social vulnerability pertains to the overall
aspect of the society which is a combination of
political, cultural, and personal characteristics.
The behavior of the people in a certain
community has direct influence to social
vulnerability
III. Vulnerability of Environmental
Elements
Environmental vulnerability pertains to the
physical aspect of the environment which may at
risk to the occurrence of disaster. Our forest,
mountains, and seas are also considered as
vulnerable elements of disaster. The earth in its
entirety is in distress due to global warming and
climate change.
IV. Vulnerability of Economic Elements
Economic elements may pertain to small,
medium, and large enterprises that provide job
and manufactured products. These elements are
likewise vulnerable to disaster. In times of
natural calamities, their products may be
damaged, production may be lessened and so
supply will be affected. There are also instances
wherein disaster can lead to loss of job or loss of
the business.
Vulnerability to Hazards and Disaster
There are various factors that influence the
severity of a disaster from natural hazards. Even
within the same region, different people have
different levels of vulnerability to natural
hazards.
Vulnerability to a natural hazard depends on the
following factors:
 Wealth. People living in poverty are
unable to afford adequate housing or
infrastructure. They more likely are
unable to obtain adequate resources
before and after natural hazards strikes.
Thus, they are more vulnerable to the
resulting disaster.
 Education. Education greatly increase
awareness of the people on avoiding or
reducing the impact of natural hazard
and disaster. A better-educated
population will have more professionals
and non-professionals trained to
catastrophic natural hazards
 Governance. Governance can set policy
and establish infrastructure to reduce
vulnerability to hazards. Some
government have more resources
available for resources for disaster risk
reduction program.
 Technology. Advance technology allows
authorities to forecast weather
significantly reducing vulnerability.
C. WHAT IS RISK?
Risk is used interchangeably with hazard.
However, in the field of disaster management,
risk is different from hazard. Risk is the product
of hazard and vulnerability. It is simplified by the
formula:
Hazard x Vulnerability = Risk
The question means that risk is the
product of the probability hazard and the degree
of vulnerability. The increase of either of the two
factors will increase “risk” as the product.
Therefore, a probability of hazard increase, so
does the risk increase. Further, as the degree of
vulnerability increases, so does risk also
increases.
How to deal with risk?
1. Risk Identification
2. Risk Classification
3. Risk Acceptance
4. Risk Avoidance
5. Risk Reduction
6. Risk Transfer
VULNERABITY + HAZARD/CAPACITY=DISASTER
WHAT IS CAPACITY
According to United Nations
International Strategy for Disaster Reduction or
UNISDR (2009), capacity refers to “all strengths,
attributes, and resources available within a
community, organization, or society that be used
to achieved an agreed goal.” These qualities give
space to citizens and communities to cope with,
overcome the adverse effects of, and reduce the
risks of disasters through preparation,
mitigation, and recovery.
The United Nations Development
Program or UNDP (2009) defines capacity
development as the “the process through which
individual, organizations, and societies obtain,
strengthen, and maintain the capabilities to set
and achieve their own development objectives
over time.” Moreover, UNDP (2009) identified a
number of assumptions in developing
sustainable DRR capabilities, which consist of the
following:
 Essential to the success of any DRR
initiative is also ensuring locally
generated, owned, and sustainable
capacity.
 Rather than being concern of any single
agency, professional discipline, or
stakeholder group, the development of
DRR capacity is the concern of an entire
society.
 The development of technical
capabilities associated with professional
discipline or functions—such as
environment management or land-use
management—needs to be combined
with other types of capacity
development that include the
promotion of leadership and other
managerial capabilities and
performance-enhancing measures.
 An enabling environment—i.e., strong
political ownership and commitment at
the highest levels or authority, extensive
participation, transparency, and clear
public accountability—is essential for
translating capacity into performance.
Capacity /coping capacity is the ability of the
people, organizations, and system, using
available skills and resources, to deal with and
manage conditions such as hazards, emergencies
or disasters. These are strength, attributes, and
resources available within the community,
society, or organization that can be used to
achieve the agreed goals.
Disaster Impact
Impact Phase: The impact phase occurs when
the disaster actually happens. It is a time of
enduring hardship or injury end of trying to
survive.
The impact phase may last for several
minutes (e.g. after an earthquake, plane crash or
expulsion) of for days or weeks (e.g. flood famine
or epidemic)
The impact continues until the threat of
further destruction has passed and emergency
plan is in effect. This is the time when emergency
operation is established and put in operation. It
serves as a center for communication and other
government agencies of health care providers to
 staff shelters. Every shelter has a nurse as a
member of disaster action team. The nurse
responsible for psychological support to victims
in the shelter.
Post Impact Phase: Recovery begins during the
emergency phase and ends with the return of
normal community order and functioning. For
person in the impact area this phase may last a
lifetime (e.g. victims of atomic bomb in
Hiroshima). The victims of disaster go through
four stages of emotional response.
1. Denial: During this stage the victim may deny
or may not fully registered the magnitude of the
problem. The victims may appear usually
unconcerned.
2. Strong Emotional Response: in this stage the
person is aware of the problem but regard it as
overwhelming and undesirable. Common
reaction during this stage is trembling, tightening
of muscles, speaking with difficulty, weeping
heightened, sensitivity, recklessness, sadness,
anger and passivity. The victim may want to
retell or relieve the disaster experience over and
over.
3. Acceptance: During the third stage, the victim
begins to accept the problems caused by the
disaster and make a concentrated effort to solve
them. It is important for the victims to take
specific action to help themselves and their
families.
4. Recovery: Victims feel that they are back to
normal. A sense of well-being is restored. Victims
develop a realistic memory of the experience.
E. EFFECTS OF DISASTER ON ONE’S LIFE
I.Psychological effects of Disaster
When a person lives through disaster,
physical mental, and emotional health can be
disturbed. These are normal reactions to
disasters.
Disasters definitely disrupt our daily
activities. Access to electricity or clean water
may be denied. People’s routine may be
disrupted. These changes can have a harmful
effect on psychological health.
Sign and Symptoms of Psychological Effects of
Disasters
1. Fear- This may be characterized by fear
of the dark, of being alone or of some
things.
2. Shock- Any victim of disaster under the
stage of shock may show irregularity in
breathing, nausea, and confusion.
3. Grief- A victim of disaster may show
extreme sadness by crying and sighing
due to the effect of the event.
4. Irritability- A victim of disaster may
display sudden burst of anger. The
person may also get easily frustrated by
small events like noisy surroundings and
lack of basic need like food and water.
Disaster, by their very nature, are stressful,
life-altering experiences, and living through such
experience can cause serious psychological
effects and social disruption. Depending on the
nature and scope of the disaster the degree of
disruption can range from mild anxiety to family
dysfunction (e.g. marital discord or parent-child
relational problems) to separation anxiety,
posttraumatic stress disorder (PTSD),
engagement in high-risk behaviors, addictive
behaviors, severe depression, and even
suicidality.
 30-40% of those who directly experience
the trauma have PTSD. Children are the
most vulnerable. Goldman and Galea
2014.
 After terrorist attack on the World Trade
Center, 25% of New Yorkers reported
increased in alcohol use, 10% increase in
cigarette use, 3% increase marijuana
use. Vlahov et al 2022.
 1 in 6 people (10%-15%) who experience
disaster will suffer mild to moderate
mental disorder. 1 in 30 (3-4%) will be
 emotionally impacted to the degree that
it interferes with their ability to function.
Van Ommeren, Hanna, Weissbecker,
and Ventovogel, 2015
 Hurricane Katrina was a unique in that it
was not only a natural disaster was also
a man-made disaster in the sense that
much of the suffering occurred as a
result of delayed or ineffective rescue.
Of the displaced survivors: 50% met the
criteria of major depressive dis-order,
20% had suicidal ideation, and 14% had
increased substance use. Larraine,
Anastario, and Lawry, 2007
 Hurricane Katrina: A year after the
disaster. A study over 7,000 children
affected by Katrina found out that 50%
have PTSD symptoms and depression. A
year after the study, 41% of the affected
children still have symptoms of PTSD and
depression. Osofsky, Kronenberg,
Brennan, and Hansel, 2009
An environmental disaster can lead to a sense of
mistrust towards the government and business,
leading to a sense of helplessness and
hopelessness.
 Puerto Rico Hurricane Maria in 2017, a
level 5 hurricane with sustained gale
force wind of 155mph and severe
flooding after the Hurricane surge. The
government neglect of the island’s
infrastructure and ongoing poverty lead
to angry outlash. Davila and Rushing,
2017.
On the Responders:
 Those involved in the rescue and
recovery profession to be one of the
groups of highest risk of developing
negative mental health consequences in
response to the event. Neria and Shultz,
2012.
 14 months after the Great EasT Japan
Earthquake of 2011. 10%-20% of the
responders have PTSD. Factors causing
PTSD in Great East Japan Earthquake:
Lack or rest, depression, lack of
communication. Sakuma et.al, 2015
Management of the Psychosocial Impact of
Disaster
The management psychosocial effects
begin with a sound plan to mitigate the adverse
impact of the disaster on the emotional,
cognitive, and behavioral capacity of the
individual. Involvement of mental health
professionals, such as psychiatric nurse
practitioners and clinical nurse specialist, should
begin with the development of community or
agency disaster plan.
1. The Mental Health Response Team
1. Designation of a Mental Health
Coordinator is a crucial first step in the
formulation of a team.
2. Function of Mental Health Coordinator
1. Manage and coordinate the mental
health response from command center;
2. Decide what resources are needed;
3. Activate appropriate mental health
agencies;
4. Assign staff to locations;
5. Monitor field reports regarding the
ongoing needs of victims, workers, and
counselors;
6. Adapt a plan as event unfold.
7. Order demobilization
3. Some of immediate responders
deployed by the Mental Health Coordinator
 Mobile crisis teams
 Case managers
 Professionals; and
 Volunteers who have been preapproved
The deployed team includes: Psychiatrists,
Psychologists, Licensed Clinical Social Workers,
Marriage and Family Therapist, Professional
Clinical Counselor, Nurses with specialty
certification, School Psychologists, and School
Counselors depending on the types or nature of
disaster.
Skills
 Psychiatric nurse and psychiatrist can
1. Identify organic mental disorders caused
by conditions such as head injuries, toxic
exposures, preexisting illnesses,
dehydration, or hyper/hypothermia
 Nurses
1. Have tradition practice in homes, in
school, and other natural settings, they
tend to be readily accepted by members
of the community.
 Paraprofessionals and volunteers
1. They may be indigenous workers known
to the community affected by disaster;
2. May share ethnic or religious
background.
Mental Health Coordinator Responsibility
Following Demobilization Order
1. Conduct a review of the mental health
response both separately and in
conjunction with the entire disaster
response team
2. Review the adequacy of the predisaster
plan in light of the actual response
3. Conduct psychological debriefing to the
workers at demobilization.
Disaster Mental Health Intervention
1. Psychological First Aid is an evidence-
informed approach to assist and support
survivors in the immediate aftermath of
a disaster. The goal is to help survivors to
reduce distress, assist with current
needs, promote adoptive function to
recover normally. Psychological first aid
also identifies those individuals and
families needing additional follow-up
and referral.
People in need of immediate emotional and
practical support dur to a recent disaster benefit
from psychological first aid, which should be
made available by field personnel such as
healthcare workers, educators, or qualified
volunteers.
Other steps to reduce potential psychological
harm
The prevention of re-traumatization- limit the
number of persons with whom victims must
interact in order to receive services. “Telling the
story” can be a source of trauma to some
individual; therefore, forcing someone to tell his
or her story in contraindicated.
Prevention of new victim- limit the number of
people exposed to the sight, the sounds, and the
smells of disaster site, whenever possible. Those
who do not to be at the disaster site should be
discouraged from witnessing any of the horror of
the aftermath.
Prevention of “pathologizing” distress- Avoid
labeling normal reaction as pathological to
prevent symptoms from being interrupted as
interpreted as medical condition or disorder that
requires treatment. Provide anticipatory
guidance about the emotional, cognitive,
behavioral, and physiological survivors are likely
to experience in the coming weeks or months,
normalize these reactions, and help survivors to
regain perspective and self-confidence.
Identification of individuals showing signs of
acute distress- Those who need immediate
medical intervention includes individuals with
obvious and active physiological stress reaction
(exceeding frantic, panicky, or extremely anger)
or individual who are profoundly shut down
(numb)dissociated, disconnected).
2. Crisis Intervention should be considered
as the first line of emergency management for
those potentially affected by large-scale
community disaster. This is a technique used to
assist persons whose coping abilities have been
overwhelmed by stressful event. This include
active listening and problem solving. Active
listening allows the disaster workers to
established a sense of respect and trust and to
better understand the survivor’s situation and
needs. This intervention are meant to “lend”
survivors the strengths needed to decrease their
fear responses (thereby calming themselves) and
access immediate care and support, allowing
them to move to the stage of recovery.
3. Social Support networks can provide
important effective and material aid that
mitigates the adverse effects of disaster trauma.
(van Ommerin, Hanna, Weissbecker and
Ventevogel, 2015). Thus, mobilizing the natural
social support system of family, friends, the
faith-based community, and the coworkers can
be one of the most helpful intervention in the
aftermath of a disaster.
4. Psychosocial Triage is the identification
of individuals that are most at risk for psychiatric
complications and to make referrals for further
mental health evaluation and treatment when
indicated. Psychiatric difficulties seem to follow
a dose-related trajectory—those closest to the
vent are at greater risk.
Factors increasing the risk of ASD (Acute Stress
Disorder) and PTSD (Post Traumatic Stress
Disorder) in someone suffering a sufficient
precipitating event include the following:
 Loss of love one in the event
 Significant injury from the event
 Witnessing of horrendous images
 Dissociation at the time of the traumatic
event
 Development of serious depressive
symptoms within 1-week that last for 1
month of longer
 Numbness, depersonalization, a sense of
reliving the trauma, and motor
restlessness after the event
 Preexisting psychiatric problems
 Previous trauma
 Loss of home or community
 Extended exposure to danger
 Toxic exposure
 Absence of social support, or social
support who were also traumatized and
thus are incapable of adequate
emotional availability (Lubit, 2016,
“Etiolgy”)
5. Mental Health Referrals to the
professionals ought to be made when one or
more of the following symptoms are present.
(DeWolfe, 2000)
 Disorientation-dazed; memory loss;
inability to give date and time, state
where he or she is, recall events of the
past 24 hours, or understand what is
happening.
 Depression- pervasive feeling of
hopelessness and despair, unshakable
feeling of worthlessness and
inadequacy, withdrawal from others,
inability to engage in productive activity.
 Anxiety – constantly on the edge,
restless, agitated, unable to sleep,
frequent frightening nightmares,
flashbacks, intrusive thoughts, obsessive
fear of another disaster, excessive
rumination about the disaster.
 Psychosis- hearing voices, seeing visions,
delusional thinking, excessive
preoccupation of ideas or thoughts,
pronounce pressure of speech (talking
rapidly with little content continuity).
 Inability to care for self- not eating,
bathing, or changing clothes, inability to
manage activity of daily life.
  Suicidal thoughts or plan- expressing
indirect and direct thoughts of harming
self.
 Other behavior of concern- problematic
use of alcohol or drugs, domestic
violence, child abuse, or elder abuse.
F. CHILDREN’S NEED DURING DISASTER AND
OTHER PUBLIC HEALTH EMERGENCIES
Children have physiological differences
that, compared with the adult, have implication
for signs, symptoms, and severity of illness or
injury following a disaster or public health
emergencies.
Pulmonary- Children’s faster respiratory
rates, higher metabolic rate, as well as greater
minute ventilation increase risk of inhaling a
higher dosage or amount of toxic airborne
substance including radioactive gasses (Chung
and Shannon 2005; Gausche-Hill 2009; Save the
Children, 2015).
Sarin, other nerve agents, chlorine, as
well as other gasses, have high vapor densities,
making them heavier than that air and more
concentrated closer to the ground, leaving
infants and small children much more
susceptible than their adult counterpart (Bearer,
1995; Gausche-Hill, 2009).
Oxygen consumption of infant is 6 to
8mL/kg/min compare with 3-4 mL/kg/min in
adults (Chamedies and Hazinski, 1998); children
exposed to noxious chemicals or vapor would
require early oxygenation administration.
When a child is in respiratory distress,
suprasternal, supraclavicular, intercostal, or
substernal retractions result from the child’s
increased work of breathing. Respiratory distress
could result from exposure to biological or
chemical agents, as well as dust and particles
from blasts or collapsed buildings. Kinetic energy
from blast, earthquake or other forces easily
transmitted to underlying cardiac tissues,
resulting in pulmonary and cardiac contusions
leading to pulmonary edema and cardia
arrythmias (Beach, 2010; Gausche -Hill, 2009).
Cardiovascular- A child’s estimated
blood volume is 80 mL/kg, which is larger than an
adult on a milliliter per kilogram basis and this
can result in small amount of blood loss from
trauma decreasing circulation blood volume
leading to shock (Gausche-Hill, 2009). Children
have greater cardiac reserves and catecholamine
responses compared with adults, allow them to
compensate for fluid losses from hemorrhage,
diarrhea, or lack of oral intake. However, when
this system of compensation fails, shock and
cardiopulmonary failure can result quickly in
children exposed in severe trauma, biological or
chemical agents, or in those sustaining kinetic
energy or burn trauma.
Integumentary-The skin of infant and
children are more permeable compared whith
skin of adults (Gausche-Hill, 2009).
They also have less subcutaneous fat
than adults. Infants and children have higher
body-area-to-weight ratio, predisposing them to
greater heat loss through conduction,
convection, radiation, and evaporation
(Gausche-Hill, 2009). Skin permeability and
larger area-to-weight ratio may result in a
greater exposure to absorption of dermal
toxicants (COEH and COID, 2000).
Musculosketal- The long bone of
children continues to grow throughout
childhood and into adolescence. Physical injury
to the growth plate, or physis, can result to
growth arrest and deformity. Such injury could
occur in children sustaining blast injuries or other
traumatic injuries during natural disasters.
Cognitive: - Cognitive development of
the child can be seriously affected by chemical
and hazardous materials producing both short-
and long-term impact. During 2014 to 2016, the
population of Flint, Michigan experienced one of
the worst community contamination of water
supply in the United State. The health effects of
lead exposure in children are known to include
impaired cognition, behavioral disorder, hearing
problems and delayed growth.
PEDIATRIC CARE DURING DISASTER
Pediatric Disaster Triage: - For children’s triage
during a disaster, the most commonly use in the
Jump START System. The JumpSTART Pediatric
Multiple Casualty Incident Triage is a method
that focuses exclusively on the triage of children
during mass casualty event and is modeled after
the Simple Triage And Rapid Treatment program
(Romig, 2002). The JumpSTART triage help
rescuer categorize pediatric patient into
treatment group quickly and accurately (Romig,
2002). The JumpSTART Triage System assesses
the victims’ airways, vital signs, and level of
consciousness categorizing them in the following
groups: minor, delayed, immediate, or deceased.
The assessment is designed to be completed in
less than 60 seconds.
The JumpSTART triage approach is using
a color-coded length-based tape that is designed
to provide the responder with rapid
understanding of what physiological signs and
symptoms should be considered. Once the child
is triage using this method, he or she is assigned
to triage priority from green to black. Green is
delayed priority, yellow is urgent priority, red is
immediate priority, and black is dead.
PsySTART TRIAGE- Developed by Dr.
Merritt Shreiber, is a mental health triage system
that has been tested and commonly used in real-
world events. The tool is best used at regular
intervals (Schreiber, 2010). PsySTART is a very
simple screening that relies on the individual’s
self-report using a checklist scoring system. The
checklist can be used at intervals to assist in
helping direct mental health resources to assist
individuals in reducing mental and behavioral
health sequela such as PTSD, depression, anxiety
and in, in the case of children, developmental
regression.
G. DISASTER NURSING IN SCHOOLS AND OTHER
COMMUNITY CONGREGATE CHILD CARE
SETTINGS
Elementary and Secondary Schools-
Preparedness:
 Readiness and Emergency
Management for Schools (REM)-
Developing of an individualized
comprehensive emergency
management and disaster planning.
Example: vulnerability assessment, Disaster-
safe room during a disaster, protection of
personally identifiable information,
Example: school crisis guide (before, during, and
after the disaster) which include: crisis
prevention activities, identification of crisis
response team with specific roles identified,
research-based violence prevention program
and safety policy in place; clear internal and
external communication avenues; school safety
assessment updated regularly; crisis response
policies and procedure; written plan for
recovery.
Nurses Role:
1. Nursing students may be invited to
collaborate with school nurses to assess
the disaster preparedness level of local
schools. If schools are not prepared, the
nursing students could offer to assist the
school develop or expand their plans as
community health nursing project.
2. Nurses and nursing students can
volunteer to participate in school’s
vulnerability assessments, with one of
their responsibilities being to examine
functional access requirement and how
the schools are meeting the needs of
students living with various disabilities.
 3. Nurses and nursing students can
volunteer their services to any disaster
organization. Nurses who obtain the
appropriate national, state, or local
volunteer training stand ready and help
manage the surge capacity of the
response teams (Veenema et.al., 2016,
p.194).
SOME EFFECTS OF DISASTER
1. Emotional Effects of Disaster
Emotional effect of disasters may be shown
through the acts of victims/survivors or through
the words they utter. Some of the emotional
effects are the following:
1. Feeling of guilt with the thought that had
he/she done something, he/she may not
have lost a member of the family.
2. Feeling of dissatisfaction from the
support coming from the family,
neighbors, friends, or even from the
government.
3. Feeling of bitterness for those who
survived the disaster or to those who
were not actually affected by it.
3. Physical Effects of Disaster
The following are the
manifestation of physical effects of disasters:
1. Physical sickness like headaches, fever,
cough and others
2. Change of appetite
3. Poor sleeping condition
4. Constipation
4. Social Effects of Disaster
Social effects of disaster may be displayed by
children or even adolescents. Some of the social
effects of the disaster are the following:
1. Loss of interest in the activity previously
enjoyed by the victim/survivor. Children
may display loss of interest with his/her
favorite toys or games while adults may
display loss of interest on his/her job or
hobbies.
2. Family may be rebuilt. Even broken
homes come together in times of
disaster. Relative with long-time
arguments may even forget the issue of
the past and immediately come to the
rescue of the relative in need.
3. Circle of friend will expand. A simple
thought of lending a blanket or slippers
in times of disaster is a gesture to start
another friendship which will then
expand the social group.
COVID -19 Social Impact
4. Service sector is not able to provide their
proper service
5. Cancellation or postponement of large
sport and tournaments
6. Avoiding the national and international
travelling and cancellation of services
7. Disruption of the celebration of cultural,
religious and festive events
8. Undue stress among population
9. Social distancing with our peers and
family members
10. Closure od hotel, restaurants and
religious places
11. Closure of places for entertainment such
as movie and play theatres, sports clubs,
gymnasium, swimming pools, and so on.
12. Postponement of examinations
5. Economic Effects of Disaster
Disaster will generally affect the economy of the
country, specifically that of the family. These
effects may be characterized by:
1. Loss of Job
2. Loss of business
3. Damaged bridges, buildings, and roads
4. Forfeiture of investments from other
countries
5. Decline of tourism industry
COVID 19-Economic Impact
6. Slowing the manufacturing of essential
goods
7. Disrupt the supply of chain products
8. Losses in national and international
business
9. Poor cash flow in the market
10. Significant slowing down of the revenue
growth

6. Healthcare Effects of Disaster

COVID 19- Impact on Healthcare
1. Challenges in the diagnosis, quarantine and
treatment of suspected or confirmed Cases
2. High burden of the functioning of the existing
medical system
3. Patients with other disease and health
problems are getting neglected
4. Overload on doctors and other healthcare
professionals, who are at a very risk
5. Overloading of medical shops
6. Requirement of high protection
7. Disruption of medical supply chain

Other Economic Effects of Disaster:

1. Agricultural damage
2. Loss of life
3. Destruction of property
4. Disruption of production
5. Disruption of lifestyle
6. Loss of livelihood
7. Disruption of essential services
8. Disruption of governmental system
9. National economic loss
10. Sociological and psychological after-
effects