NCM 121: DISASTER NURSING

NCM 121: Disaster Nursing Lecture PRE LIM
2 UNITS LECTURE-TOTAL= 36 HOURS
SCHEDULE OF EXAMINATION
1. Prelim Exam: Feb 20-25
2. Midterm: March 27-April 1
3. End term (graduating) May 4-6, (Non-
grad) May 22-27
LESSON 1: DISASTER RISK PROFILE
What is Disaster Nursing?
- Disaster nursing refers to a situation in
which health professional, usually a
registered nurse or nurse practitioner,
responds toa a crisis by volunteering with
an aid organization or volunteer responder
organization.

PRELIM TOPIC OUTLINE What is the purpose od disaster nursing to our

profession?
The Philippine Disaster Risk Profile - The main goal of education and training in
A. Concept & Types of Disasters disaster nursing is to prepare nurses
1. Natural vs. Technological physically and psychologically to respond
2. Internal vs. External Disaster to disasters. The aim of the current review
B. Natural Disaster was to evaluate how prepared nurses are
1. Geophysical to deal with disasters in terms of their
2. Meteorological knowledge, skill competencies, and
3. Hydrological psychological outlook.
4. Climatological
5. Biological What is a Disaster?
C. Man-made Disasters - A disaster is a result of a natural or
1. Terrorism manmade causes that leads to sudden
2. Technological disruption or normal life, casing severe
3. Transitional Human Shelters damage to life and property to an extent
D. Trends & Patterns of Disasters that available social and economic
1. Phases of a Disaster protection mechanisms are inadequate to
• Pre-disaster cope.
• Warning
• Social & Physical Impact Disaster Nursing
• Emergency - Disasters are classified as per origin, into
• Isolation natural and man-made disasters.
• Rescue - As per severity disasters are classified as
• Remedy minor or major.
• Recovery
Natural and Manmade Disasters
ICN Framework of Disaster Nursing
Competencies

A. Prevention & Mitigation

1. Risk Reduction, Disease Prevention &
Health Promotion
2. policy Development & Planning
B. Preparedness Competencies
1. Ethical Practice, Legal Practice &
Accountability
2. Communication & Information Sharing
3. Education & Preparedness The WHO defines “natural disasters” as the “result
C. Response Competencies of an ecological disruption or threat that exceeds
1. Care of Community the adjustment capacity of the affected
2. Care of Individuals & Families community”
3. Psychological Care
4. Care of Vulnerable Population Natural disasters can be broadly classified into
D. Recovery/Rehabilitation Competencies categories including
1. Long Term Individual, Family & Community 1. Geophysical
Recovery 2. Hydrological
3. Meteorological- typhoon
4. Climatological

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5. Biological- Bioterrorism like COVID-19 or
anthrax

Natural Disasters

Biological Geophysical Hydrological Meteorological Climatological

a. Epidemic a. Earthquake a. Flood a. Storm a. Extreme

ᴥ Viral b. Volcano ᴥ General flood ᴥ Tropical cyclones temperature
infectious c. Mass ᴥ Flash flood ᴥ Extra-tropical ᴥ Heat wave
disease movement ᴥ Storm surge/ cyclone ᴥ Cold wave
ᴥ Bacterial (dry) coastal flood ᴥ Local storm ᴥ Extreme
infectious ᴥ Rockfall b. Mass movement winter
diseases ᴥ Landslide ᴥ Rockfall condition
ᴥ Parasitic ᴥ Avalanche ᴥ Landslide b. Drought
infectious ᴥ Subsidence ᴥ Avalanche c. Wildfire
disease ᴥ Subsidence ᴥ Forest fire
ᴥ Fungal ᴥ Land fire
infectious Hydro-Meteorological
disease Disasters used in
ᴥ Prion this publication
infectious Hydro-
disease Meteorological Hydro-
b. Insect Meteorological
infestation
c. Animal
Stampede

Natural disasters
1. Meteorological
o Floods, cyclone, hurricane, typhoon,
snowstorm, thunderstorm, droughts, Philippine Disaster & Risk Profile
hot/cold waves
2. Geological • Due to its geographical location, the
o Earthquake, volcanic eruptions, Philippines is exposed to high incidents of
landslides, tsunami, debris/ mudflows hazards such as tropical storms, tsunamis,
3. Environmental/Biological earthquakes, volcanic eruptions, landslides,
o Global warming, climate change, ozone and droughts.
depletion, solar flare, epidemic, plagues • Tropical storms or typhoons accompanied by
Manmade Disasters heavy rain and/or strong winds result in
floods and storm surges.
1. Technological • The country is also situated along a highly
o Transport accidents, structure failures, seismic area lying along the Pacific Ring of
explosions, fires Fire where two major tectonic plates
2. Industrial (Philippine Sea and Eurasian) meet and is
o Chemical spills, radiation, poisoning, gas highly prone to earthquakes and volcanic
leaks eruptions. This explains the existence of
3. Warfare more or less 300 volcanoes of which 22 are
o War, terrorism, internal conflicts, civil classified is active, and the several
unrest occurrences of earthquakes and tsunamis all
year round.
Disaster Risk Profile of the Philippines: Natural • While being prone to hazards, its
Calamities geographical location also endows it with
abundant natural resources and some of the
Harold James E. Doroteo world's greatest biodiversity.
Ms. Janice Montes Padagdag

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Earthquakes
• Since it lies along the Pacific Ring of Fire, the
country has frequent seismic and volcanic
activities. Very big statistic of earthquakes of
smaller magnitude occurs very regularly due
to the meeting of major tectonic plates in the
region.
• Within the past two decades (1990- 2010),
five destructive earthquakes were recorded,
and human casualty included 15 deaths and
119 persons injured. Damage to the economy
was estimated to reach PhP 207 million. The
1990 Luzon earthquake, the Moro Gulf
Tsunami, and the collapse of the Ruby Tower
were the most devastating ever recorded.
Volcanic Eruptions
• There are 53 active volcanoes (out of the
300+ total) in the archipelago. Philippine plate
and several smaller micro-plates are sub
ducting along the Philippine trench to the east,
and the Luzon, Sulu, and several other small
trenches to the west.
• The currently active volcanoes are found in
the several corresponding volcanic arcs,
which can be simplified into two major north-
south trending arcs: the Luzon and Mindanao
volcanic arcs. The volcanoes are produced at
the junction of the Philippines tectonic plate
and the Eurasian plate.
Typhoons / Tropical Cyclones
• The climate of the Philippines is tropical and
is strongly affected by monsoon (rain-bearing)
winds, which blow from the southwest from
approximately May to October and from the
northeast from November to February,
although there are considerable variations in
the frequency and amount of precipitation
across the archipelago.
• From June to December typhoons often strike
the archipelago. Most of these storms come
from the southeast, with their frequency
generally increasing from south to north.
• On average, about 20 typhoons occur
annually, with the months of June to
November averaging approximately 3
typhoon strikes per month. Luzon is
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significantly more at risk than more southern
areas.
• Typhoons are heaviest in Samar, Leyte,
eastern Quezon province, and the Batanes
Islands, and when accompanied by floods or
high winds they may cause great loss of life
and property. Mindanao is generally free from
typhoons.
Flooding
• A review of the high impact tropical cyclones
in the Philippines indicate that majority of the
victims were affected by inland flooding and
landslides. The torrential rain can result in
flooding in overflowing rivers, saturated soil,
low-lying areas, and poor drainage. The most
number of deaths and economic losses come
from this type of hazard.
• Environmental concerns such as
deforestation are worsening the risk of floods
and landslides. The uncontrolled urban
growth, poor land use, the decrease in the
number of protected forests and riverbanks,
poor waste disposal and housing have
clogged waterways and increased the risk of
floods.
LESSON 2: DIASTER CONTINUUM
Phases of Disaster
The life cycle of a disaster is generally referred to
as the "disaster continuum" or "emergency
management cycle."
This cycle is characterized by 3 major phases.
1. Pre-impact
2. Impact
3. Post-impact
PRE-IMPACT
• Prepare and mitigate. Mitigate to lessen
casualties.
• It is the initial phase of disaster, prior to the
actual occurrence. A warning is given at the
sign of the first possible danger to a
community with the aid of weather networks
and satellite many meteorological disasters
can be predicted.
• The earliest possible warning is crucial in
preventing toss of life and minimizing
damage.
• Forecasting is not 100 accurate
• This is the period when the emergency
preparedness plan is put into effect
emergency centers are opened by the local
civil, detention authority. Communication is
a very important factor during this phase;
disaster personnel will call on amateur radio
operators, radio and television stations.
• The role of the nurse during this warning
phase is to assist in preparing shelters and
emergency aid stations and establishing
contact with other emergency service group.
• Train nurses, prepare evacuation areas
IMPACT
• Most important is rescue
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• Shortest phase of the disaster
• 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 explosion.) or for days or weeks (eg
in a flood, famine or epidemic).
• The impact phase continues until the threat
of further destruction has passed and
emergency plan is in effect.
• This is the time when the emergency
operation center is established and put in
operation. It serves as the center for
communication and other government
agencies of health tears care healthcare
providers to staff shelters.
• Every shelter has a nurse as a member of
disaster action team. The nurse is
responsible for psychological support to
victims in the shelter.
Nursing Actions
1. Activate disaster response plan
2. Mitigate all ongoing hazards
3. Activate all ongoing agency disaster plans
4. Establish need for mutual aid relationship
5. Integrate local and national government
resources
6. On going triage & provision nursing care
7. Evaluate public health needs of the affected
population.
8. Establish safe shelter & the delivery of
adequate food & water supply
9. Provide sanitation needs & waste removal
POST-IMPACT
• Recovery begins during the emergency
phase and ends with the return of normal
community order and functioning.
• For persons in the impact area this phase
may last a lifetime
• (e.g. - victims of the atomic bomb of
Hiroshima).
Nursing Actions
1. Continue provision of nursing & medical
2. care
3. Continue disease surveillance
4. Monitor the safety of the food & water supply
5. Withdraw from disaster scene
6. Restore public health infrastructure
7. Re-triage & transport of patients to
appropriate levels of care facilities
8. Reunite family members
9. Monitor long term physical health outcomes
of survivors
10. Provide counseling & debriefing for staff.
11. Provide staff with adequate time off for rest
12. Evaluate disaster nursing response actions
13. Revise original disaster preparedness plan
Disaster Continuum
Mitigation/Preparedness
Mitigation
• To prevent future emergencies and take
steps to minimize their effects
• The“mitigation”phase occurs before
disaster takes place. Here, an organization
will take steps to protect people and
property, while also decreasing risks and
consequences from a given disaster
situation. The organization’s main goal is to
reduce vulnerability to disaster impacts
(such as property damage, injuries and
loss of life).
• Early warning, training
Preparedness
• To take actions ahead if time to be ready
for an emergency
• Preparedness also occurs before a
disaster takes place. Here, an organization
attempts to understand how a disaster
might affect overall productivity and the
bottom line. The organization will also
provide appropriate education while putting
preparedness measures into place.
Response
• To protect people and property in the wake
of an emergency, disaster or crisis
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• The “response” phase occurs in the
immediate aftermath of a disaster.
Organizations must focus their attention on
addressing immediate threats to people,
property and business. Occupant safety
and wellbeing largely depends on its
preparedness levels before disaster
strikes.
Recovery
• To rebuild after a disaster in an effort to
return operations back to normal
• The “recovery” phase takes place after a
disaster. This phase is the restoration of an
organization following any impacts from a
disaster. By this time, the organization has
achieved at least some degree of physical,
environmental, economic and social stability.
Evaluation
• A phase of a disaster planning that often
receives the least attention
• After a disaster, it is important that
evaluations be conducted to determine what
worked, what did not work and what specific
problems, issues and challenges were
identified.
Key Elements of Disaster
1. Hazards
2. Vulnerability
3. Capacity
4. Risk
Disasters result from the combination of hazards,
conditions of vulnerability and insufficient capacity
or measures to reduce the potential negative
consequences of risk.
Hazards
• Hazards are defined as “Phenomena that
pose a threat to people, structures, or
economic assets and which may cause a
disaster. They could be either manmade or
naturally occurring in our environment.”
• Hazard is a potentially damaging physical
event, phenomenon or human activity that
may cause the loss of life or injury, property
damage, social and economic disruption or
environmental degradation.
Vulnerability
• Vulnerability is the condition determined by
physical (e.g., elderly), social, economic and
environmental factors (e.g., below sea level)
or processes, which increase the
susceptibility of a community to the impact of
hazards.
Capacity
• Capacity is the combination of all the
strengths and resources available within a
community, society or organization that can
reduce the level of risk, or the effects of a
disaster. Capacity may include physical,
institutional, social or economic means as
well as skilled personal or collective
attributes such as 'leadership' and
'management.' Capacity may also be
described as capability.
• e.g., capacity to cope, capacity to rescue
people
Risk
• Risk is the probability of harmful
consequences, or expected losses
(deaths, injuries, property, livelihoods,
economic activity disrupted or environment
damaged) resulting from interactions
between natural or human-induced
hazards and vulnerable conditions.
Hazard Identification
• Hazard identification is used to determine
which events are more likely to affect a
community & to make decisions about
whom or what to protect as the basis of
establishing measures for prevention,
mitigation & response
Vulnerability Analysis
• Vulnerability analysis is used to determine
who is most likely to be affected, the
property most likely to be damaged or
destroyed and the capacity of the
community to deal with the effects of
disaster.
Risk Assessment
• Risk assessment uses the results of the
hazard identification & vulnerability
analysis to determine the probability of a
specified outcome from a given hazard that
affects a community with known
vulnerabilities & coping mechanism.
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LESSON 3: ICN CORE COMPETENCIES IN
DISASTER NURSING VERSION 2.0
CORE COMPETENCIES IN DISASTER
NURSING
I. Preparation & Planning
1. Maintains a general personal, family and
professional preparedness plan
2. Participates with other disciplines in
drills/exercises in the workplace.
3. Maintains up-to-date knowledge of
available emergency resources, plans,
policies and procedures
4. Describes approaches to accommodate
vulnerable populations during an
emergency or disaster response
5. Communicates roles and responsibilities of
nurses to others involved in planning,
preparation, response and recovery
6. Includes actions relevant to needs of
vulnerable populations in emergency
plans.
II. Communication
1. Uses disaster terminology correctly in
communication with all responders and
receivers
2. Communicates disaster-related priority
information promptly to designated
individuals.
3. Demonstrates basic crisis communication
skills during emergency/disaster events.
4. Uses available multi-lingual resources to
provide clear communication with disaster-
effected populations
5. Adapts documentation of essential
assessment and intervention information to
the resources and scale of emergency
6. Plans for adaptable emergency/disaster
communications systems.
7. Includes emergency communication
expectations in all orientation of nurses to
a workplace
8. Collaborates with disaster leadership
team(s) to develop event-specific media
message.
9. Develops guidance on critical
documentation to be maintained during
disaster or emergency.
III. Incident Management
1. Describes the national structure for
response to an emergency or disaster
2. Uses the specific disaster plan including
chain of command for his/ her place of
education or employment in an event,
exercise or drill
3. Contributes observations and experiences
to post-event evaluation
4. Maintains professional practice within
licensed scope of practice when assigned
to an inter-professional team or an
unfamiliar location
5. Participates in development of
organizational incident plan consistent
with national standards
6. Participates with others in post-event
(actual or exercise) evaluation
7. Develops action plans for improvement in
nursing practice based on event
assessment
8. Includes emergency planning guidance
when reassigning staff or including
unfamiliar colleagues or volunteers
IV. Safety & Security
1. Maintains safety for self and others
throughout disaster/emergency event in
both usual or austere environment(s)
2. Adapts basic infection control practices to
the available resources
3. Applies regular assessment of self and
colleagues during disaster event to identify
need for physical or psychological support
4. Uses PPE as directed through the chain of
command in a disaster/emergency event
5. Reports possible risks to personal or
others’ safety and security
6. Implements materials that support nursing
decision- making that maintains safety
during disaster/emergency events
7. Provides timely alternative infection control
practices applicable within limited
resources
8. Collaborates with others to facilitate
nurses’ access to medical and/or mental
health treatment, and other support
services as needed
9. Explains the levels/ differences in PPE and
indications for use to nurses and others
10. Creates an action plan to address and
correct/eliminate risks to personal or
others’ safety and security
V. Assessment
1. Reports symptoms or events that might
indicate the onset of an emergency in
assigned patients/families/ communities
2. Performs rapid physical and mental health
assessment of each assigned
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patient/family/community based on 12. Guides implementation of nursing
principles of triage and type of emergency/ reassignments within an organization’s
disaster event emergency plan
3. Maintains ongoing assessment of assigned 13. Guides nursing participation in surge
patient/ family/ community for needed activities when required by event
changes in care in response to the evolving 14. Adheres to protocol for management of
disaster event
large numbers of deceased in respectful
4. Assures that all nurses have up-to-date
information on potential emergency events manner
and the process for reporting them if
observed VII. Recovery
5. Develops event-specific guidance on rapid
physical and mental health assessment of 1. Assists an organization to maintain or
individual patients/families/communities resume functioning during and post event
based on available information 2. Assists assigned patients resume
6. Includes principles of disaster/emergency functioning during and post event
triage in all assessment courses taught in 3. Makes referrals for ongoing physical and
basic and continuing education programs mental health needs as patients are
7. Identifies event-specific vulnerable discharged from care
population(s) and actions needed to 4. Participates in transition de-briefing to
protect them. identify personal needs for ongoing
assistance
VI. Intervention 5. Communicates nursing roles,
responsibilities and needs to leadership
throughout the recovery phase
1. Implements basic first aid as needed by
6. Maintains up-to-date referral resource lists
individuals in immediate vicinity
and adds event-
2. Isolates individuals/families/clusters at risk 7. specific modifications as needed
of spreading communicable condition(s) to
others VIII. Law & Ethics
3. Participates in contamination assessment
or decontamination of individuals when 1. Practices within the applicable nursing and
directed through the chain of command emergency-specific laws, policies and
4. Engages patients, their family members or procedures
assigned volunteers, within their abilities, 2. Applies institutional or national disaster
to extend resources during events ethical framework in care of
5. Provides patient care based on priority individuals/families/communities
needs and available resources 3. Demonstrates understanding of ethical
practice during disaster response that is
6. Participates in surge capacity activities as
based on utilitarian principles
assigned (e.g. mass immunization)
4. Participates in development of emergency-
7. Adheres to protocol for management of specific policy and procedure guidance
large numbers of deceased in respectful for nurses within the
manner organization/institution
8. Assures that emergency plans and 5. Participates in the development of
institutional policy include the expectation disaster/emergency frameworks for
that basic first aid can be administered by allocation of resources (e.g. staff, supplies,
all nurses medications)
9. Includes organizationally specific guidance 6. Develops guidance and support for
on implementation of isolation in an nurses expected to a utilitarian principles
emergency in practice during emergency and disaster
response
10. Describes the range of CBRNE exposures
and the exposure- related decontamination
methods to be used
11. Plans for expanded patient, patient’s family
or volunteer participation in extending
resources in emergency/disaster plan

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 NCM 121: DISASTER NURSING
NCM 121: DN Lecture MIDTERM
LESSON 1: TRIAGE
Disaster Management
3. Combined External/Internal Disaster
CLASSIFICATIONS OF DISASTER
1. Internal Disaster
- Occurs when there is an event within an
organization or facility that poses a threat
to disrupt the environment of care.
- Affecting the FACILITY that conducts
planning or rescue effort like Barangay
center, that is affected, or it can be in the
HOSPITAL. Affecting facility attending the
rescue.
- Example: If you have incompetent staff or
nurse, it is an internal disaster because it
can affect the process.
a) Loss of utilities
b) Fire
2. External Disaster
- An external disaster becomes a problem
for a facility when the consequences of
the event create a demand for services
that tax or exceed the usual available
resources.
- Its about external forces that affects the
services of a certain facility.
- Example: There is a typhoon and the nurse
cannot arrive in the hospital
- There are many circumstances that are
external to the health organization that can
trigger an internal disaster as well.
- A severe weather condition like typhoon or
a geological event like an earthquake can
create both conditions, by making it
impossible for the staff to travel safely
to work, while leading multiple
individuals who have experience event
related trauma seek care.
- Example: Any calamity making it unsafe for
the nurse to travel, because they are the
one who responds and when they cannot
arrive, there will be internal disaster.
Levels of Disaster
LEVEL 1: If the organization, agency, or
community is able to contain the event &
respond effectively utilizing its own resources.
Sometimes encounter technical problems like
brownout, but they can resolve it on their own
like having generator
LEVEL 2: If the disaster requires assistance
from external sources, but these can be obtain
from nearby agencies.
Example: In Bacolod, CL and RMCI, CL cannot
cater the needs of the patient needs so they
ask help from RMCI. Another, for a rescue,
when they have no helicopter, they ask another
facility from another nearby facility.
LEVEL 3: If the disaster is of a magnitude that
exceeds the capacity of the local community or
region & requires assistance from the national
government.
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Example: The Barangay cannot supply
everything due to lack of supply so they ask
help from the national government.
DISASTER MANAGEMENT PROCESS
There are 5 basic phases to a disaster
management program, and each phase has
specific activities associated with it.
THIS IS ABOUT FACILITY AND STAFF
Basic Facility: Barangay health Center
1. Preparedness / Risk Assessment
- Evaluate the facility’s vulnerabilities or
propensity for disasters. Issue to consider
includes:
a) Weather patterns- there is a
typhoon
b) Equipment of the facility- typhoon
arrived
c) Competencies of the staff- staff
doesn’t know how to CPR
- Example: Barangay Health Center and
Hospital, what are the vulnerabilities,
supply.
- Early warning from PAGASA, ask for
budget in National Government, Train staff
to handle or apply first aids through
seminars.
- We are planning in the preparedness
phase.
2. Mitigation
- These are steps that are taken to lessen
the impact of a disaster should one occur
and can be considered prevention
measures.
o Installing & maintaining backup
generator power to mitigate the effects of
a power failure Example: Brownout, so
the facility will be having hard time
responding without electricity, so prepare
the generator beforehand.
o Cross training staff to perform other task
to maintain services during a staffing
crisis that is due to a weather emergency.
Cross training like training the staff to do
workloads in another special area.
Example in staff: Rescue operation, one
can do CPR and one can do bandaging,
one staff does not know how to do
bandaging so they must undergo
Bandaging or being trained to do a lot of
things. Even though you are short
staffed, everyone can do the needed
things.
3. Response
- Phase of the actual implementation of the
disaster plan.
- The best response plans use an incident
command system, are relatively simple,
are routinely practiced and modified when
improvements are needed.
- Response activities needed to be
continually monitored & adjusted to the
changing situation. Consider that plan
needs development as you respond.
Example: You noticed that there is full o
supply in another barangay while the other
lacks, so next time you change the plan.
- It is at this point that the disaster manager
must change leadership styles.
- During disaster response, group decision
making/consensus style management is
replaced with structured & focused
direction style.
- The most common framework to achieve
this in the hospital setting is the Hospital
Incident Command System (HICS)
- Rescue people, apply bandaging skills,
swim to rescue drowning people.
4. Recovery
- Once the incident is over, the organization
and the staff need to recover.
- Invariably, services have been disrupted
and it takes time to return to routines.
Routines are disrupted ssso it takes time to
recover or go back to that routine.
- Are the staffs okay after the typhoon?
Staffs also need to recovery physically and
psychologically.
- PFA for victims and the staffs
5. Evaluation
- Often this phase of disaster planning &
response receives the least attention.
- After the disaster, employees and the
community are anxious to return to usual
operations.
- During the RESPONSE, you are already
observing what to evaluate or change after
the disaster in preparation for the next one.
TRIAGE
- “Triage” is a process which places the
right patient in the right place at a right
time to receive the right level of care.”
- The word “triage” is derived from a French
word trier which means to sort out or
choose.
- DONE during the RESPONSE phase
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Different countries-different triaging. During the
pandemic, TRIAGING is different, it is specialized.
Primary Triage
- Field disaster triage protocols, aimed at
maximizing the outcome for the greatest
possible number of victims, are usually
utilized only for the initial gross sorting of
patient in the field.
- The goal of primary triage is to sort
patients into five triage categories:
1) Immediate - RED
2) Delayed - YELLOW
3) Minimal - GREEN
4) Expectant - GRAY
5) Deceased - BLACK
Secondary Triage
- Maybe performed on- scene if transport is
delayed for any reason. The 1st triaging to
you is DELAYED, but the triage officer can
go back to you again and asses you, doing
triage again if your triage level changed.
- Additional information about the patient is
obtained through a more thorough physical
assessment & history (when available).
- The hospital you were delivered to.
Tertiary Triage
- May then become necessary if the
hospitals’ resources become
overwhelmed. Example: There is lack of
respirator, so there will be triaging again
who will receive the respirator
- In this step, the hospital personnel
determines if the facility can provide
appropriate care or if the patient will
require stabilization & transfer to a facility
capable of a higher level of care.
DAILY TRIAGE (STANDARD)
- Performed by nurses on a routine basis in
the ED, often utilizing a standardized
approach, augmented by clinical
judgement.
- The goal is to identify the sickest patients
to assess & treat them first, before
providing treatment to others who are less
ill & whose outcome is unlikely to be
affected by a longer wait
- SICKEST patient will be attended first
INCIDENT TRIAGE
- Occurs when the ED is stressed by a large
number of patients due to an acute
incident or an ongoing medical crisis such
as pandemic influenza, but is still able to
provide care to all patient utilizing existing
agency resources.
- Additional resources (on call staff,
alternative care areas) may be used, but
disaster plans are not activated & treatment
priorities are not changed.
- Example: COVID 19 triaging, specialized
because you need to be swabbed first to
sort you if you are infected or not. 1st sorting
is Infected or Not infected.
DISASTER TRIAGE (Mass Casualty Incident)
- A general term employed when local
EMS and hospital emergency services are
overwhelmed to the point that immediate
care cannot be provided to everyone who
needs it because sufficient resources are
not immediately available.
- The terms “multiple
casualty/multicausality” and “mass
casualty” triage (both also known as MCI
triage) are often used interchangeably with
“disaster triage”
- If the resources are already exhausted they
have to change to MCI triage or disaster
triage.
IMMEDIATE
- These are patients with uncompensated
physiology & injuries that are life-
threatening but probably amenable to
rapid interventions that do not require
consumptions of an inordinate amount of
resources.
- This patient may die or sustain significant
morbidity unless they receive rapid care in
both the field and the hospital.
▪ Patients with poorly controlled
external bleeding, moderate burns,
penetrating trauma, altered mental
status, early shock, respiratory
distress (not failure)
- Grabe siya pero more or less may chance
of survival.
- Example: fully awake but with profuse
bleeding especially if it external which can
be easily controlled.
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- Example: Palpatory V/S
- If more than 30% of the body surface
considered immediate because it can lead
to hypovolemic shock
DELAYED
- These are patients with compensated
physiology but a significant potential
for deterioration or morbidity if there are
long delays before definitive care can be
provided.
- If sufficient resources are available, many
of these patients can be temporarily treated
& stabilized in the field
- Possible spine or head injuries without
neurological deficits, significant bleeding
controlled with pressure dressings,
orthopedic injuries with signs of
neurovascular compromise that improve
after basic splinting.
MINIMAL OR MINOR
- These are patients who are
physiologically well compensated
(Normal V/S) and likely to remain so for an
extended period of time.
- These patient only require basic
immediate care and can probably wait for
a considerable period of time for
definitive care with minimal risk of
deterioration.
- Minor lacerations, burns, & other soft tissue
or orthopedic injuries without significant
bleeding or neurovascular compromise
(Color-pulse-movement-sensation).
- Patients with mild to moderate
psychological stress reaction related to
incident.
EXPECTANT
- These are patients who are still alive but
due to their injuries and/ or medical
condition are unlikely to survive given
the available resources.
- Patients with agonal respirations, massive
head injuries, dismemberment, extensive
burns, crush injuries, critical penetration
trauma, multiple life-threatening injuries
- In mass radiation exposure events
(example mass nuclear radiation), patient
with vomiting/diarrhea soon after exposure
may be classified as expectant.
- Patient designated as expectant should
be evaluated regularly, you can transfer
the patient to immediate.
DECEASED
- These patients are those with no
detectable vital signs, typically identified
as victim not breathing on their own.
- Patients in the deceased category include
those who are not breathing even after
performing simple airway- opening
maneuvers.
START (Simple Triage and Rapid Transport)
- The Simple Triage And Rapid Treatment
(START) system was developed to allow
first responders to triage multiple
victims in 30 seconds or less, based on
three primary observations:
1) Respiration
2) Perfusion
3) Mental Status
- The START system is designed to assist
rescuers to find the most seriously
injured patients.
- As more rescue personnel arrive on the
scene, the patients will be re-triaged for
further evaluation, treatment, stabilization,
and transportation. This system allows first
responders to open blocked airways and
stop severe bleeding quickly.
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START ALGORITHM

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Triage Tags
For triage process to be effective, the findings from
the triage needs to be communicated.
This is typically done through triage tags that are
attached to the patient.
Job of Triage of the Triage Officer
- The primary responsibility of the triage
officer is to ensure that every victim has
been found & triaged (START). NO CPR
- Triage officers oversee triage, not implying
on the rank.
- Are responders assigned to perform triage,
and DO NOT provide immediate treatment
other than to provide live- saving
interventions such as opening the airway
or trying to control active bleeding
LESSON 2: ROLES OF LEADERSHIP
Strong leadership is critical in disaster situations
when “patient surge” challenges a hospital’s
capacity to respond and normally acceptable
patterns of care are interrupted
Most leaders and managers have developed a
leadership style which serves them well during
times of non disaster operations. Such styles
usually span a spectrum of varying degrees of
control.
Such styles usually span a spectrum of varying
degrees of control.
1. Directive
2. Supportive
3. Participative
4. Achievement oriented
1. Disaster Planning Phase
- A leader that is participative and
achievement oriented
2. Response Phase
- A more directive style of leadership is
required.
- At this time, the leader must act quickly and
decisively, and there is usually little time for
extended consultation.
- Example: There is a typhoon, you must
appoint someone who will rescue to act
quickly.
3. Recovery and Evaluation Phase
- Supportive style of leadership because
you staffs are tired.
- Leadership that is more collaborative and
participatory is more effective.
LESSON 3: PSYCH
MANAGEMENT OF PSYCHOSOCIAL EFFECTS
- Management of psychosocial effects
begins with a sound plan to mitigate the
adverse impact of the disaster on the
emotional, cognitive, & behavioral capacity
of the individual.
Mental Health Response Team
- Designation of a mental health coordinator
is a crucial first step in the formulation of a
team. This is the person who will manage
the command center, decide what
resources is needed, activate appropriate
mental health agencies & assign staff to
locations such as neighborhood centers,
Red Cross shelters, schools, hospitals,
etc.
- Psychiatric nurses & psychiatrist are
particularly well suited as members of the
medical team, as they can also be alert to
organic mental disorders caused by
conditions such as head injuries, toxic
exposures, pre-existing illnesses.
Critical Incident Stress Management
- Is a crisis intervention program to mitigate
the psychosocial distress among
emergency services personnel & assist
them in returning to normal duties
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STRESS AND DISASTERS HOW LONG DO THESE THOUGHTS AND
FEELINGS LAST?
WHAT IS A “DISASTER”?
- Wide - scale emergency events that have - Most people exposed to disasters recover
a severe impact on a community fully from the psychological affects within
one year.
DISASTERS - The most intense reactions will lessen
1. Traumatize large populations of people at over the first few weeks.
once. - If they persist over 4-6 weeks or are so
2. Can result in epidemics of survivor guilt and bad, they impair functioning then
other psychological symptoms. professional help is needed.
3. Create chaotic environment.
4. Multiple stressors FACTORS THAT MAY INDICATE THAT
PROFESSIONAL HELP IS NEEDED “3 Rs”
IMPACT OF DISASTERS
REACTIONS – Severe confusion, impaired
For a community – depletion of resources and thinking, distress that can’t be calmed, expressed
slow recovery thoughts of self-harm or harm to others

For people – RISK – Those that lost a loved one, were injured,
• Everyone who experiences a disaster is believed they were going to die, or saw death of
affected in some way – Even the helpers! others, extreme community destruction
• People pull together
• Stress and grief are common reactions to RESILIENCY- Lack good coping skills, has no
uncommon situations family support, has experienced other recent
traumas prior to the disaster.
REACTIONS
• Some people will have severe reactions CHILDREN AND ELDERS (VULNERABLE
following a disaster event POPULATION) CAN BE PARTICULARY
• Most people recover without professional SENSITIVE
treatment
• Survivors often to do not seek or accept 1. To changes in their routine.
help, especially from helpers from outside 2. Separation from familiar environments
the community 3. Separation from familiar people
4. Watch for delayed reactions of several
COMMON REACTIONS TO DISASTER STRESS hours to a few days.

PSYCHOLOGICAL FIRST AID (PFA)

Is an approach that:
1. Eases suffering of disaster survivors: both
physical and emotional
2. Improves survivors’ short-term functioning.
3. Promotes emotional recovery after a
disaster event.

THE GOAL OF PFA

Is to promote an environment of:
Behavioral and emotional sometimes will go 1. Safety
together 2. Calm
Physical- tiredness 3. Connectiveness
Cognitive- Confused 4. Self-reliance
5. Hope

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CORE ACTIONS OF PFA
1. Help self-care.
2. Connect with survivors.
3. Safety and comfort
4. Stabilization
5. Info gathering
6. Offer practical assistance
7. Connect with social supports
8. Info on coping
9. Link to collaborative services
MAKE A CONNECTION WITH SURVIVORS
1. Make the first move
2. Intro self and ask permission to talk
3. Ask about their immediate needs
4. Present with an air of patience,
compassion, and calm
5. Respect their privacy by finding a quiet
place to talk
6. Don’t approach too closely or touch them if
you are not familiar with their cultural
background or personal preferences
7. Protect their confidentiality by sharing their
info appropriately
OFFER SAFETY AND COMFORT
1. Make sure the environment is safe
2. Help survivors meet their basic immediate
needs
3. Offer physical comforts (food, water,
blanket, bathroom)
4. Ask about their needs for eye glasses,
medications, hearing aids
5. Protect them from additional trauma and
trauma reminders (sights and sounds of
danger, destruction or suffering)
SEEK IMMEDIATE PROFESSIONAL HELP IF:
1. The person states a desire to harm
themselves or others
2. The person shows signs of shock:
a) Clammy ashen skin
b) Rapid breathing and pulse
c) Nausea /vomiting
d) Faintness, dizziness
e) Extreme agitation
STABILIZATION Calm and Orient Survivors
1. Use a calm and soothing voice.
2. Give realistic reassurance.
a) What you are feeling is
understandable.
b) We are here to help.
3. Calming techniques include:
A- Cool washcloth to forehead
B- Stretching, head roll
C- Clench and release fists
D- Focus on slow deep breaths
4. Provide repeated, simple and accurate
information
A- Rumors and the unknown increase
stress
INFORMATION GATHERING
1. Gather information for identification of their
needs
2. Find out the nature and severity of the
disaster
o Those that have been injured or
witnessed injury or death are at
greater risk for a severe and
prolonged distress reaction.
3. Ask “What are your immediate concerns?
4. Listen carefully to identify their physical,
medical, emotional needs.
5. Don’t give simple reassurances like
“Everything will be ok”
6. Listen in a patient and caring way.
7. Don’t pry or force people to share their
stories
a) Some people want to talk, and some
don’t.
b) Be patient and come back a little later
if the survivor is not ready to talk.
OFFER PRACTICAL ASSISTANCE
1. Meet immediate physical needs if possible.
2. Clarify what they have told you about their
needs and concerns.
o “So, I heard you say that you are
most worried about….”
3. Help them problem solve and develop an
action plan for next steps
4. Assist them in accomplishing those steps
by:
o Connecting them with internal or
external resources
o Communicating their needs to
appropriate members of your team
or community
CONNECTION WITH SOCIAL SUPPORTS
1. Very important to recovery
2. Help survivors contact their family, friends,
clergy.
3. Sometimes they are reluctant to reach out
to loved ones.
o Don’t want to be a burden.
o Embarrassed or feel guilty about
needing help.
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4. Help them to work through these concerns
5. Assist them to contact a support person
they trust when they are ready
Provide Information on Coping
“It’s normal to feel this way…..”
Common Stress Reactions Following Disaster
Events
Behavioral/Emotional
1. Disorientation/numbness
2. Grief
3. Feeling anxious and fearful
4. Despair/hopelessness
5. Feelings of guilt
6. Feelings of anger
7. Isolation/withdrawal
Physical/Cognitive
1. Headaches, stomach aches
2. Difficulty sleeping/eating
3. Exhaustion
4. Bad dreams
5. Intrusive thoughts/images
6. Difficulty concentrating, remembering,
making decisions
7. Reach out for spiritual support
8. Warm bath or shower
9. Make a list of recovery actions
10. Maintain a healthy routine
a) Rest
b) Eat well
c) Drink fluids
d) Exercise
e) Avoid drugs, alcohol, or binge eating
f) Set a small goal for each day related to
recovery actions and check off list
when done
Link to Collaborative Services
Help survivors connect to services related to their
needs
1. Medical
2. Financial
3. Spiritual
4. Recovery/replacement assistance
5. related to loss.
6. Remember that for most people, PFA is
enough
7. Recognize those who need professional
help with stress by using the “3 Rs”
PRACTICING PSYCHOLOGICAL FIRST AID

DO’S AND DON’TS

EXPLAIN THAT THESE FEELINGS ARE
NORMAL BODY LANGUAGE

DO SAY
1. “You are not going crazy”
2. “These kinds of reactions are normal after
going through
3. something like this”
4. “I have some suggestions for techniques to
help you feel
5. more calm. Would you like to hear them?”
DON’T SAY
1. “You should be feeling better tomorrow”
2. “Cheer up”
3. “Maybe you better see a doctor”
4. “What you need is…..”
5. “I know what it is like”
Coping Techniques To Suggest
1. Deep slow breaths
2. Focus on inhale/exhale
3. Write in a journal
4. Talk to friends/loved ones
5. Stretch exercises
6. Listen to music
DO
• Sit facing the person or beside.
• Give eye contact.
• Show attention by leaning forward.
DON’T
• Sit back with folded arms.
• Look around distractedly while person is
talking.
• Leave while they are talking to you.
WHAT TO SAY
DO SAY
• Can we talk about what happened?
• This must be difficult for you.
• Is there anything I can do for you.
• right now?
• Its normal to feel this way after something
like that.
• I am here to help you if I can.
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WHAT NOT TO SAY
• I know what you are going through.
• Don’t feel so bad.
• You are strong and will get through
• this.
• Don’t cry, cheer up.
• It’s God’s will.
• It could have been worse.
Care of the Pregnant Woman Following a
Disaster
PREGNANCY DURING DISASTER CONDITION
- When disaster occurs, challenges arise in
meeting the physical, emotional & mental
health needs of the pregnant woman.
- During disaster, all normal physical needs
of the pregnant women are present but
health care & birthing environments are
altered, creating challenges for delivery of
safe, obstetrical healthcare.
WHAT ARE CRITICAL ISSUES FOR
PRENATAL CARE?
First Trimester: (before 13 weeks)
- First trimester laboratory testing: blood
type, Rh type, antibody screen, Hct, Hgb,
platelets, rubella, urine screen/culture, pap
smear
Second Trimester: (13 – 26 weeks)
- Prenatal visit every 4 weeks, assessment
of blood pressure, fundal height.
- Consider ultrasound if available.
- Assessment for diabetes with glucose
challenge test (26-28 weeks)
Third Trimester
- Prenatal visit every 2 weeks from 28 until
36 weeks
- Assessment of Bp, fundal height, weight
gain.
- Prenatal visits every week after 36 weeks
Complications of Pregnancy
Eclampsia
- About 10% of pregnant women across the
world experience hypertension
- Hypertension in pregnancy has been
classified into
4 types
1. Preeclampsia /eclampsia
2. Chronic hypertension
3. Chronic hypertension with superimposed
4. preeclampsia
5. Gestational hypertension
HELLP SYNDROME (Hemolysis, Elevated Liver
enzyme, Low Platelet count)
- is a life threatening syndrome affecting
about 25% of women with PIH
Diabetes Mellitus
- Gestational diabetes impacts 3-5% of
pregnant women.
- The goal in managing gestational diabetes
is to normalize blood glucose.
- Treatment includes diet & medication:
Eating complex carbohydrates instead of
simple sugars, if the blood glucose is still
not controlled by diet, insulin maybe
prescribe.
- Second trimester complication include
painless dilation of the cervix from 18-21
weeks and can be indicative of
“incompetent cervix.
Bleeding Disorders in Pregnancy
CHILDBIRTH DURING DISASTER
1. During disaster, supplies, equipment that
are normally used during labor & delivery
may not be available.
2. In these situations, healthcare workers will
need to use whatever available to
accomplish the necessary task.
3. Required equipment & treatments along
with their potential substitutes include:
a) Fetal monitor substitutes:
Fetoscope, stethoscope and hand
on the abdomen should be used
b) Fluids: Oral fluids & light fluids
should be given
c) Pain control & emotional
support: Human presence
NOTE!
Study and Review about
Bioterrorism- release a virus to kill a population.
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RLE 121: Disaster Nursing 6. Check the circulation for 10 seconds
• Palpate carotid artery while counting. 1, 2,
LESSON 1: ADULT CARDIOPULMONARY 3, 4, 5, 6, 7, 8, 9, 10.
RESUSCITATION (CPR)

1. Survey the scene

• Check if the scene is safe for the victim &
the rescuer

7. Locate the compression site.

• Locate the compression site. Place your
hands on the breastbone in the center of
the chest. (One heel of one hand over the
other)

2. Introduce self is victim has companion.

• I found one (1) victim lying on the ground,
presumed unconscious. (Introduced self) I
am _________, a trained first aider I can
help.

3. Check for responsiveness

• Check responsiveness by tapping the
shoulders and at the same time, check for
absent or abnormal breathing (no
breathing or only gasping) by observing the
rise and fall of the chest. Sir, are you okay?
3x.
• The victim is unresponsive and has no
breathing OR NO NORMAL BREATHING.
4. Activate the emergency response system
• Instruct bystander to, “Activate the
emergency response system and report
back to me while I assess the victim.
5. Place patient on his or her back on a firm
surface.
8. Start chest compression.
• Press down at least 2 inches (5 cm) and
allow the chest to recoil in every
compression.
• Perform 5 cycles (30 compressions and 2
ventilations.
• 1st cycle – 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11,
12, 13, 14, 15, 16, 17, 18, 19, 20, 1, 2, 3, 4,
5, 6, 7, 8, 9, & 1 then give 2 ventilation
• Perform 5 cycles

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11. IF WITH PULSE AND BREATHING

• Place in a recovery position

9. Check for breathing and pulse for 10

seconds
• Check for breathing and pulse for 10
seconds by counting 1, 2, 3, 4, 5, 6, 7,
8, 9, 10.

10. IF NO PULSE, NO BREATHING continue

CPR.
• Resume CPR
• 30 compression /2 rescue breaths after
5 cycles

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2015 AHA Guidelines Update
Lesson 2: PEDIATRIC BASIC LIFE SUPPORT
DRS CAB
Adults Chain of Survival
5. Call for help D-anger (Always check your scene)
6. Chest compression
7. ? R-esponse (Quickly check to see if the person has
8. Transport any injuries or needs medical assistance,
9. Hospital CHILDREN with respiratory distress often assume
a position that maintains airway patency and
Children Chain of Survival optimizes ventilation. CPR harder-faster-deeper)
1. Survey Scene? Trained healthcare providers must be able to
2. Chest compression determine pulse,check for pulses. If unable to
3. Call for help assume cardiac arrest.
4. Transport
5. Defib? CPR is better than without

Cardiopulmonary Arrest in Children CPR at all.

Pulse Check
Simultaneously assess victims’ breathing.
Look for the rise and fall of the patient’s chest

Major Causes of Death in Infants and Children

1. Respiratory Failure
2. Sudden Infant Death Syndrome
3. Sepsis
4. Neurologic Disease
5. Drowning C-irculation/ompression

Resuscitation Science

CPR is the best treatment for cardiac arrest in the

absence of AED or until the arrival of AED and
advanced cardiovascular life support.

An artificial method of sustaining life.

When initiated within 4 minutes, the survival rate is

increased to 43% but when initiated within 4-8
minutes the survival rate decreases to less than
10%.

CPR must be started as soon as the heart ceases

to beat or when abnormal breathing is seen. Any
delay in CPR reduces the chances of survival. In
addition, the brain cells begin to die after 4-6
minutes WITHOUT OXYGEN.

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FOR INFANTS: EXCESSIVE VENTILATIONS AND
INTERRUPTIONS, ALLOW ENOUGH CHEST
Landmark: RECOIL

STERNUM just 2 fingers placed below the A-irway

intermammary line with the use INCIRCLING
THUMB/TWO FINGER TECHNIQUE.

Depth: 1/3 the depth of the chest or about 4cm

(1.5 inches).

Compression Rate: 100-120 compressions per

minute.

Quality:
PUSH HARD AND FAST,
AVOID EXCESSIVE VENTILATIONS AND
INTERRUPTIONS ALLOW ENOUGH CHEST
RECOIL B-reathing

FOR CHILD:

Landmark: Healthcare providers should compress

the lower half of the sternum

Depth: Atleast 1/3 of the depth; approximately 5

cm (2inches) with the use of the heel of 1 or 2
hands.

Compression rate: atleast 100-120

compressions oer minute

Quality: PUSH HARD AND FAST, AVOID

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Pulse check (<10sec)

Simultaneouslyassess victims’ breathing. rise and

fall
When using BVM:

Squeeze bag until a visible chest wall rise is noted.

Look for the AGONAL or GASPING isnot breathing

at all of the patient’s chest. .

Appropriate BVM depends on victim’s AGE

Rescue Breathing

Provide 1 breath every 3 to 5 seconds

(12 12cycles then do another pulse check.

one...two...three...one...BLOW!

Complete until 12 cycles then do another pulse

check

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Lesson 3: BANDAGING
Dressings
• are pads placed directly on the wound to
absorb blood and other fluids and to
prevent infection.
• porous dressingsallow better air
circulation. to promote healing process.
• Larger dressings cover very large wounds
and even multiple wounds in one body
area.
An occlusive dressing is a bandage or dressing
that closes a wound or damaged area of the
body. It prevents the injury from being exposed to
air or water.
A bandage is any material that is used to wrap or
cover any part of the body.
• These are used to hold dressings in place,
• apply pressure to control bleeding, protect
a wound from dirt or infection,
• provides support to an injured limb or
body part.
• Any bandage applied snugly to create
pressure on a wound or an injury is called
a pressure bandage.
Bandages are of dofferent types
o Adhesive compresses are available in assorted
sizes and come with a small pad of non-stick
gauze on a strip of adhesive tape which is directly
applied to minor wounds.
o Bandage compresses are thick gauze
dressings attached to a bandage that is tied in
place. Bandage compresses are specially
designed to help control severe bleeding and
usually come in sterile packages.
Roller bandages are usually made of gauze or
gauze-like material.
generally is wrapped around the body part. It can
be tied or taped into place.
A roller bandage may also be used to hold a
dressing in place, secure a splint or control
external bleeding.
Elastic roller bandages, are designed to keep
continuous pressure on a body part.
Triangular Bandages are pieces of cloth that are
cut into triangles. These can be used as slings to
cover large areas. Folded into a cravat, it can be
used just like a roller bandage. It usually measures
40”x40”x56”.
General bandaging guidelines:
• Use a dressing that is large enough to
extend at least one inch beyond the edge
of the wound.
• If body tissue or organs exposed, cover
the wound with a dressing that will not
stick, such as plastic wrap or moistened
gauze. Then secure the dressing with a
bandage or adhesive tapes.
o If the bandage is over a joint, splint
and makes a bulky dressing so the
joint remains immobilized.
o If there is no movement of a wound
over the joint, there should be
improved healing and reduced
scarring.
o Check for feeling, warmth and
color in the area below the injury
site. Observe fingers and toes
before and after applying the
bandage.
• A bandage should be snug, but not so tight
as to interfere with circulation, either at the
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time of application or later if swelling 3. Place the left end over across the right end;
occurs. wrap the left end of the loop to tie another half
knot.
- Do not cover fingers or toes. By keeping these
4. Pull both ends to tighten.
parts uncovered, you will be able to see if the
bandage is too tight. If fingers or toes feel cool to
the touch or seem to look pale or blue, the
bandage may be too tight and should be loosened
slightly.
Apply additional dressings and a supplementary
bandage if blood soaks through the first covering.
Do not remove the blood-soaked bandages and
dressings. Disturbing them may disrupt the
formation of a clot and restart the bleeding

• Bandaging techniques depends upon:

a. Size and location of the wound.
b. Your first aid skills.
c. Materials at hand

SQUARE KNOT
1. Grab one end of the bandage pointed on the
left, pull it to the opposite side (right side) to
loosen the knot.
2. Hold the knot, pull it to the right. The knot
should slip from the bandage thus to untying the
knot.

A square knot (or reef knot) is used to tie the ends

of a triangular bandage. It is easy and quick to tie
and untie.

It is formed by tying a left-handed overhand knot

and then a right_x0002_handed overhand knot, or
vice versa. A common mnemonic for this
procedure is "right over left, left over right, makes
a knot both tidy and tight."

Tying and Untying of a Square Knot

1. Hold both ends of the bandage.
2. Place the right end over the left end, wrap the Folding a Triangular Bandage into a Cravat
right end around the left end on the loop to
1.Bring the point (apex) of the triangular bandage
make a half knot.
to the middle of the base.

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Bandaging Technique

1. Triangular Bandage 2. Roller Bandage

· Open Phase · Spiral

- Head (topside) - Open
- Face; back of the - Closed
head - Spiral reverse
- Chest; back of chest · Figure of eight
- Hand; foot · Recurrent with spiral
turns

· Cravat Phase
2.Then fold lengthwise along the middle. - Forehead; eye - Ear;
cheek; jaw
- Shoulder; hip
- Arm; leg
- Elbow; knee (straight;
bent)
- Palm pressure
bandage
- Palm bandage of open
hand

3. To make a fold again and againuntil you obtain

the desired width.

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Bandaging Techniques-Using a Triangular

Bandage

Wound at the Head Top Side

1. Place a dressing over the injury.

2. Hold the base of the bandage and folding it
inward for about 2 inches wide, twice.
3. Place the middle part of the base just above
the eyebrow of the patient. Exposing the folds
outward.
Wound at the Forehead or Eye

1. Place a dressing over the injury.

2. With a T-Bandage folded in a cravat, place the
center of the bandage over the injury.
3. Wrap the bandage around the head with the
ends running through the side on the contour of the
head.

4. Wrap the bandage around the head running

through the side, to the back of the head and back
to the forehead. Make a square knot.
5. Hold the top of the head and pull the apex to
create a firm
hold of the dressing.
5. Fold the apex upward and tuck all loose ends.
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4. Bring back both sides to the front.
5. Tie square knot over the injury for additional
pressure.
· -If managing an injury on the eye, do not put
pressure over the eye.
· -Tie square knot on the temple of the affected
side
Wound at Ear, Cheek or Jaw
1. Place a dressing on the injury.
2. With a T-Bandage folded in a cravat, place the
center of the bandage over the injury across the
patient’s face.
3. Wrap the bandage around the face with one end
running on the top of the head and the other end
under the chin.
4. When the bandage meets at the opposite side
of the injury, twist it so that one end will run through
the forehead and the other through the back of the
head.
5. Tie a square knot just above the injury.
Wound at Chest
1. Place a dressing over the injury.
2. Place the bandage over the injury with the apex
resting on the shoulder of the
affected side and the base resting across the
patient’s waist.
3. Fold the sides outward towards the body,
enough to cover the injury.
4. Fold the base upward about 2 inches until the
mid-rib.
5. Bring both ends to the back/front and tie a
square knot at the middle.
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-Ask the patient to inhale and hold breath for a
while and quickly secure the knot.
6. Connect the longer end to the apex and tie a
square knot.
-When managing an injury on the back and your
patient is female make sure the longer end passes
across in between the breast.
7. Tuck all loose ends.
Dislocation at the Shoulder/Hips
1. Cover the injury with a dressing.
2. With a T-bandage folded in a cravat, place one
end on the unaffected side. Bring the longer end
over the affected side to cover the injury.
3. Bring the longer end towards the joint, twist the
bandage to make it comfortable for the patient,
bring it towards the shoulder, spread out to cover
the injury again.
4. Bring the moving end through the underarm or
hip of the opposite/unaffected side then to the
front.
5. Tie a square knot in front.
Wound at Arm/Leg
1. Cover the injury with a dressing
2. With a T-bandage folded in a cravat, place the
bandage over the injury along the limb.
-If the injury is on the forearm, place one end on
the hand.
-If the injury is on the upper arm, place one end
on the shoulder.
-If the injury is on the thigh, place the end near
the hip.
-If the injury is on the lower leg, place the end
near the ankle.
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3. Press on the injury and grab the longer end of
the bandage and fold it across the arm.
4. Wrap the injured part with the bandage using
spiral turns.
5. Fold the shorter end of the bandage over the
injury. Proceed with wrapping the longer part of the
bandage until consumed.
6. Make a square knot to secure the bandage.
Tuck all loose ends.
Dislocated Elbow/Knee (Bent)
1. Place a dressing over the injury.
2. With a T-bandage in a cravat, place the middle
part over the injured elbow/knee.
3. Bring both ends towards the opposite side.
4. Twist both ends so that the bandage will take the
contour of the joint.
5. Wrap one end towards the upper part and make
a spiral turn; make spiral turns on the lower part
with the other end.
6. Bring both ends on the opposite side of the
elbow (antecubital fossa) or back of the knee
(popliteal fossa) and tie a square knot.
Wound along the Palm
1. Cover the injury with a bandage. Make a cravat.
2. Place the bandage diagonally over the injury
3. Wrap the palm with part of the bandage near the
thumb by running it through the backside of the
hand and over the injury and rest it between the
thumb and the index finger.
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4. Hold the part of the bandage near the wrist and
wrap the hand by running the bandage under the
backside of the hand, in between the thumb and
index finger, over the injury, through the wrist and
diagonally over the injury /palm resting the end
near the pinky finger.
5. Hold the end near the thumb and run it through
the backside of the hand to the side of the wrist
and over the injury/palm and back to the thumb.
6. Tie a square knot at the backside of the hand.
Burned Hand/Foot
1. Cover the injury with dressing. If the fingers or
toes also sustained burns, place gauze pads in
between the digits.
2. Place the bandage spread out on your arm with
the middle of the base on your palm and the apex
on your upper arm.
3. Place the injured hand or foot on your hand with
the base of
the bandage at the wrist or ankle of the patient.
4. From the apex, fold the bandage towards the
patient covering the injury.
5. Fold the sides neatly one after the other towards
the sides of the hand/foot of the patient and cross
the ends to the opposite sides.
6. Grab both ends, cross it over the opposite sides;
bring the ends under the interchange, making sure
the base is securely sealed. Bring the ends over
again and tie a square knot.
7. Fold the apex towards the digits and tuck neatly.
Bandaging Techniques-Using a Roller
Bandage
General Guidelines
1. Use the appropriate size of a bandage
2. Do not apply bandage unrolled
3. Always start with the distal part towards the
midline
4. When overlapping, cover ½ to ¾ of the first layer
5. Do not pull the bandage while applying
6. Make sure all the application are snug; not too
tight and not to lose
7. Ensure wrinkle-free application without folds
Anchoring
1. Hold the elastic roller bandage with your
dominant hand.
2. Place the free end of the bandage on an angle
with the roll facing upward. Use the other hand to
hold the free end.
3. Wrap the bandage around with sufficient
overlapping.
4. Fold back the tip of the first layer then turn the
bandage around to overlap the folding.
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Tying without Adhesive Tape, Retainers or
Clips
Essentially elastic roller bandage comes with metal
clips used to secure the end. In a case where metal
clips adhesive tape and retainers are not available.
Follow the procedure.
1. Provide enough length to secure the bandage
with a knot.
2. Bring the end of the bandage away from the
patient’s injury.
3. Using your thumb, make a loop and bring the
end back towards the opposite side passing under
and across the injury.
4. Secure a square knot.
Close Spiral
1. Anchor the elastic roller bandage on the distal
part of the injury. Refer to previous slides for
proper anchoring.
2. Wrap the injured area upward towards the
patient’s midline.
3. Ensure that there are no spaces in between
overlapping layers.
4. Secure the end properly. Refer to previous
slides for proper locking.
Open Spiral
1. Anchor the elastic roller bandage on the distal
part of the injury. Refer to previous slides for
proper anchoring.
2. Wrap the injured area upward towards the
patient’s midline.
3. Provide at least an inch gap in between
turns/layers.
4. Secure the end properly. Refer to previous
slides for proper locking.
Figure of Eight
1. Anchor the elastic roller bandage on the distal
part of the injury.
2. Bring the bandage up diagonally and across the
joint.
3. Wrap the bandage around the limb above the
joint.
4. Bring the bandage down across the joint
diagonally so that it crosses the upward portion.
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5. Take the bandage behind the injury and up
diagonally across the joint again. Overlapping 2/3
of the previous upward wrap.
First Aid for an Abrasion or Minor Cut
1. Cleaning a Wound
-Clean it by rinsing under warm running tap
water for about 5 minutes.
-Pat the wound dry using a gauze swab.

2. Apply Antiseptic Solution if available

-Use Povidone Iodine or a triple antibiotic
ointment or cream.
-Ensure that the person has a known allergies
or sensitivities to these medicines.
6. Take the bandage behind the injury and down
again diagonally overlapping 2/3 of the previous
downward wrap.
7. Continue alternate upward and downward
diagonal wraps until the joint is sufficiently
supported.
8. Apply circular wrap above the joint.
9. Secure the end properly.

3. Cover the Wound

-Cover the wound with a sterile dressing a
bandage or with adhesive bandage.

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Application of an Occlusive Dressing on a
Wound
1. Use a dressing that is large enough. This is
not too pulled or sucked into the chest
cavity.
2. Tape the dressing in place. You may tape
the dressing down on all four sides, or you
may create a flutter valve, a one-way that
allows air to leave but not return, by tapping
only three sides of the dressing.
3. Carefully observe after placement of the
occlusive dressing.
Technique for Stabilization of an Impaled
Object
1. Do not remove the object.
2. Use bulky dressings to stabilize the object.
3. Control bleeding by bandaging the dressing
in place around the object.
4. Wash your hands immediately after giving
care.
LESSON 4: EARTHQUAKE DRILL
Earthquake drill
Because earthquakes strike without
warning, life-protecting actions must be taken
immediately at the first indication of ground
shaking. There will not be time to think through
what to do. Therefore, of all earthquake
preparedness measures, earthquake drills are the
most important. Their purpose is to help students
(and staff) learn how to REACT immediately and
appropriately.
How to manage people
Vital in schools or environment with high buildings.
In mountains, prone to landslide
Effective earthquake drills simulate
(1) actions to be taken during an actual
earthquake and
(2) actions to be taken after the ground shaking
stops. Building evacuation following an
earthquake is imperative due to potential danger
of fires or explosions.
This section will help you determine:
• What dangers to expect during an
earthquake.
• What quake-safe actions to take during
an
• earthquake.
• How to conduct classroom drills.
• How to develop procedures for evacuating
the school building after an earthquake.
• How to practice and evaluate the
effectiveness of your earthquake drills.
Learn What to Expect During an Earthquake
The first indication of a damaging earthquake may
be a gentle shaking. You may notice the swaying
of hanging plants and light fixtures, or hear objects
wobbling on shelves. Or, you may be jarred first by
a violent jolt (similar to a sonic boom). Or, you may
hear a low (and perhaps very loud) rumbling noise.
A second or two later, you’ll really feel the shaking;
and, by this time, you’ll find it very difficult to move
from one place to another
It’s important to take “quake-safe” action at the
first indication of ground shaking. Don’t wait until
you are certain an earthquake is occurring. As the
ground shaking grows stronger, danger
increases.
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For example:
• - Free-standing cabinets and bookshelves
are likely to topple. Wall-mounted objects
(such as clocks and artwork) may shake
loose and fly across the room).
• - Suspended ceiling components may pop
out, bringing light fixtures, mechanical
diffusers, sprinkler heads, and other
components down with them.
HOW TO CONDUCT AN EARTHQUAKE DRILL
IN SCHOOL?
OBJECTIVES : should have provision.
1. To ensure the safety of parents, students,
teachers, and staff during and after a
damaging earthquake.
2. To help school administrators and their
disaster action groups to design a specific
response plan of the school for earthquake.
3. To test various elements of the response
plan designed by the School Disaster
Management Committee (SMDC)
4. To train teachers, school staff and student
on how to practice proper action and
response during earthquakes.
STAGE 1: PLANNING/ORGANIZING THE
EARTHQUAKE DRILL
• The BOF will check the Fire Extinguishers
if expired or not, will check the sprinklers,cz
and the fire exits of the school or building.
A. Form a School Disaster Management
Committee
MEMBERS OF THE SDMC SHOULD
EVALUATE THE SCHOOL
1. Have the following information available
yearly.
2. Acquire the most recent school ground lay out
or plan/ map.
3. Obtain a building lay out/floor plan for each
building.
B. Members of the SDMC should conduct
Building Watching Exercise
1. Observe hazardous areas and practices
within the school premises.
2. Suggest correction or improvement of current
set up.
3. Assess the structural integrity of the school
building.
STAGE 2: DEVELOPING THE SCHOOL
EARTHQUAKE EVACUATION PLAN
After identifying the safe and unsafe spots,
the next step is to develop the School
Earthquake Evacuation Plan
1. The School Earthquake Evaluation Plan
2. Determine if there is sufficient open spaces for
all.
3. Consider number of students.
4. Each class should have a assigned specific
evacuation site.
5. Determine the flow of traffic.
6. Indicate by arrows, the flow of student
evacuation.
7. Prepare final evacuation route and orient all
the teachers school staff about this.
8. Prepare Earthquake Survival Kits.
9. Prepare First Aid Kit
STAGE 3: ORIENTATION PRIOR TO THE
CONDUCT OF EARTHQUAKE DRILL
A.Prepare the students a week before the
scheduled earthquake drill. For each class,
instruct the homeroom adviser to do the
following
1. Allot a specific time for lecture
2. Conduct a classroom observation activity.
• Draw floor plan of classroom
• Identify the safe spot in the classroom
• Identify dangerous spots
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• When dangerous areas have been
identified, ask the students what to do to
correct it.
3. Introduce to the student the suggested
evacuation route.
4. Introduce to the student the assigned open
space.
5. Assigne somebody who will be in charge of
making sure that the door is open during
shaking.
B. THE MAIN CONCERN DURING AN
ONGOING SHAKING IS HOW TO PROTECT
ONESELF
1. Give specific instruction on what to do during
an earthquake
⚫ Introduce duck, cover and hold
➢ Take cover
➢ Watch out for falling objects
➢ Keep calm, do not panic
2. Give specific instruction about what to do as
soon as the shaking stops
⚫ Be alert
⚫ Listen to teachers instruction
⚫ Walk out of the classroom in orderly manner
⚫ While walking along corridor to the nearest
exit of the building, be alert for falling debris
⚫ Don’t talk, don’t go back, don’t
bring things
⚫ Don’t run, don’t push
⚫ Quietly proceed to the
evacuation area
⚫ Never go back to the building
3. For the teachers, make sure all students are
accounted for once in the designed evacuation
area
STAGE 4: ACTUAL CONDUCT OF
EARTHQUAKE DRILL
1. Prior to the scheduled drill, inform
neighborhood regarding the drill.
2. Identify and assign observers.
3. For the actual drill.
Assumption
⚫ 1 minute strong shaking signified by 1 minute
siren or bell
⚫ Person should not stand
⚫Building may have damage but no collapse.
⚫No immediate assistance is available.
⚫Possible injuries, fear, panic among students
and teachers.
➢Give instructions/ reiterate the what to do’s
➢Once the siren is heard.
➢Participant should perform one minute duck,
cover and hold
➢ After the one minute siren, student should
proceed to designated area
➢ Teacher should make a head count
4. While the drill is ongoing, observers
should take note on the performance of the
teachers and students
5. Observers will give there comment
6. To be effective, earthquake drill should be
done regularly
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• Is the siren loud enough to be heard by all the
drill participants?
PHASES OF AN EARTHQUAKE DRILL
Yes/No If no, please
PHASE 1: ALARM elaborate________________________________
A pre-arranged signal such as siren/bell should _
be known to all. During the drill, the siren/bell
• Did the drill participants practice the “Duck, Hold
indicates earthquake/shaking. Students and
and Cover” technique
teachers will be alerted by the signal.
during the alarm phase (while the siren is being
sounded)? Yes/ No
PHASE 2: RESPONSE
While the siren/bell is ongoing, everyone should If No, please
move away from window, glass or light fixtures. In elaborate________________________________
this phase every one should perform “duck, cover _______
and hold” under desk, tables orchairs. Remain in
3. Did the drill participants evacuate during the
this position until shaking stops
Alarm Phase or waited for

the siren to stop before evacuating? Yes/No If no

PHASE 3: EVACUATION please
Once the “shaking” stops, teachers and
students should evacuate the school building and elaborate________________________________
proceed using pre-determined routes to go to __________________
identified evacuation area. 4. Did the drill participants follow their designated
evacuation area?
PHASE 4: ASSEMBLY Yes/No If No, please
At the designated evacuation area, student must elaborate___________________________
be grouped together according to the class where
they belong 5. Did drill participants (A) run, (B) walk casually
or (C) or walk faster
than the normal during the evacuation phase?
PHASE 5: HEAD COUNT Please specify A,B, C
Teachers should check and make sure all
6. Did the drill participants bring bring any first aid
students are all accounted for.
kit or any item
noticeable during evacuation phase? Yes/No If
PHASE 6: EVALUATION No please
An evaluation of the drill must be conducted to elaborate________________________________
identify problems encountered during the drill and
_______________
how this can be corrected in the future
earthquake drills. 7. Did the drill participants conduct the head
count during the head

EARTHQUAKE DRILL EVALUATION FORM: count phase? Yes/No If No please

elaborate_____________
Place of drill__________________
Date______________________ 8. Is the evacuation area big enough to
accommodate the evacuees?
Time evacuation Started_________ Time
Evacuation Ended_______ Yes/No If No please
elaborate___________________________
Evaluator:____________________ Location
During the drill______
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9. Any other problems observed during the drill
that might need to be
addressed? Please
elaborate________________________________
10. How long did it take for all the drill participants
to vacate the
building and time to reach the designated
area__________________
11. Did the drill participants (A) stay in evacuation
area, (B) move to
other place, ( C ) went back to the building
without instruction?
Please specify A, B, C
12. Observed number of drill participants
(estimate will do)__________
13. Any untoward incident observed during the
drill?____________________________________
______________
INCIDENT COMMAND SYSTEM (ICS)
• is a management system used to organize
emergency
• response and designed to offer scalable
response to
• incidents of any magnitude.
• is designed to grow and shrink along with
the incident ,
• allowing more resources to be smoothly
added when required or released when no
longer needed.
• provides a way of coordinating the efforts
of agencies and
• resources as they work together toward
safely responding ,
• controlling and mitigating and emergency
incident.
• ensures that efforts are coordinated to
efficiently provide emergency services and
aid to victims of disasters.
• Operations of all kinds must have a
system and an organization to be
successful.
• used for all hazards and has been proven
effective for responding to all types of
incident.
• (Hazardous materials, Fire , Mass
Casualty Incidents,Natural Disasters, Pest
Eradication Programs, Planned Events ,
Epidemics, Accidents, Crime Related and
Terrorism.)
• ICS is implemented at the early stages of
incident.
Guiding Principles
• vital component of disaster management
at all DCC levels
• tool for command, control and
coordination response.
• on scene management concept.
• means of determining resources at
operational level.
• observes unity and chain of command.
• organization is flexible and modular.
• span of control should be from 5-7 teams.
• should an event require the activation of
the Disaster Operation Center /
Emergency Operations Center, the ICS
must be integrated with it.
In the event of emergency, the following steps
should be followed:
• H- Hazard Identification
• E- Evaluate Response
• A- Assemble Work Zone
• R- Run the Incident
• T- Terminate the incident
Key Players:
• Incident Commander
• Safety
• Information
• Liaison
• Planning
• Operations
• Logistics
• Finance and Admin

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Who should be the Incident Commander?

• rapid / slow onset of natural disaster

o LCE Local Chief Executive or
designated officer.
• rapid onset natural disaster
a. two or more barangay - Mayor
b. two or more Municipalities-
Governor
Man-made/Technological – First on scene
responder

-transfer of command will be triggered when there

is a threat to life, environment and properties.
-absence of LCE, trained IC personnel takes
place.
-LCE assumes symbolic IC, if not qualified;
designated representative of agency concerned
acts as IC.

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