DISASTER NURSING

NCM 120

DR. MARIA LYRMA E. MORALES

2nd Sem. 2022-2023

 INDIVIDUAL ACTIVITY 1
DISASTER
Develop a creative presentation of
different situations that you consider a
disaster, give details.

*Rubric will be available…


CATEGORY
Knowledge
Identifies key facts and concepts in
with regards to the issue or topic
RUBRIC- CR EATI VE PRESENTATION
LEVEL 4 LEVEL 3 LEVEL 2 LEVEL 1
Demonstrates thorough Demonstrates sufficient Demonstrates some knowledge Demonstrates limited knowledge
knowledge and understanding on knowledge and understanding on and understanding on the and understanding on the
the concepts or topic the concepts or topic concepts or topic concepts or topic

Thinking/Inquiry
Provides information that reflects Collects information that Collects information that Collects information that Has difficulty distinguishing
an understanding of the issue or represents all relevant points represents most relevant points represents few relevant points between facts and locates
topic and reflects understanding. and reflects understanding. and reflects understanding. information of limited usefulness

Excellent analysis to support the Excellent analysis and data to Very good analysis and data to Some good analysis and data to Limited analysis and data to
topic support these support these support these support these

Totally interesting and persuasive Totally interesting and Persuasive and interesting in all Persuasive and interesting in some Limited interest and
persuasive key parts key parts persuasiveness

Communication
Summarize information collected Summarizes information Summarizes information Summarizes information Summarizes information
presented it in any form in an thoroughly in an excellent considerably in an semi-organize thoroughly in a limited manner thoroughly in an topsy- turby
excellent manner manner manner manner

Application
Presents information in an effective Information presented in a highly Information presented with some Information presented with some Little evidence of creativity and
way using information technology. and original manner and is highly creativity and original but with creativity and originality but lacks originality with limited
effective considerable effectiveness effectiveness. effectiveness.
Disaster Nursing
-A serious disruption of the functioning of a
society, causing widespread human, material, or
environmental losses which exceed the ability
of the affected society to cope using only its
own resources.
-The World Health Organization (WHO) defines
disaster as "a situation where people’s normal
means of support for life with dignity have
failed as a result of natural or human-made
catastrophe."
-WHO also considers the "disaster affected
people/population" as "all people whose life or
health are threatened by disaster, whether
displaced or in their home area."
 Disaster as “any
occurrence that causes
damage ecological
disruption, loss of human
life, deterioration of
health and health
services.
•Disaster are not
confined to a particular
part of the world; they
can occur any where and
any time
 Disaster nursing Disaster
nursing can be defined as ''a
adaptation of professional
nursing skills in recognizing and
meeting the nursing physical
and emotional needs resulting
from the disaster.''
 TYPES OF DISASTER
1. Natural Disaster –
tornados, hailstorms,
tsunami, floods,
Earthquakes,
communicable disease
etc.
2. Man-Made Disaster- fires,
explosions, toxic
materials, pollution,
terrorist attack,
transportation accidents
etc.
 Individual Activity 2: What’s your
point?

Watch this disaster video-

https://youtu.be/GgtFkaLeSnk

Sharing of ideas, insights and

feelings about the presentation
individually.

After watching the video…

Group Activity 1: Group students
into 5 students.

 Brainstorm with your

groupmates:

 Construct the goals of disaster

nursing then convey it to the
people in the community thru a
poster, to let them be aware so
that they can participate when
there are activities on the matter.
 RUBRIC- POSTER

CRITERIA
CATEGORY 15 points 10 points 7 points 4 points SCORE
Content-Accuracy flow of All facts in 80-89% of the facts in 70-79% of th e facts in Fewer than 50% of the
information the the posterCRITERIA
are the are facts in the poster are
poster are accurate.
CATEGORY 15 points 10 points poster 7 points 4 points
accurate. accurate. accurate.
SCORE
Content-Accuracy flow All facts in the 80-89% of the 70-79% of the Fewer
than 50% of of information
Graphics/ Pictures Graphics go well Graphic poster s go well withareGraphics
facts
go in the facts in
well with Graphicsdo not go
the poster the facts in the accurate. poster are are accurate. poster are
with the text and the accurate. but there are the text, but there are with the accompanying
text,
there is a good mix text or appear to be
accurate.
of text and graphics. so ny that they too few and th e leaflet randomly chosen..
Graphics/ Pictures Graphics
ma go Graphics go well Graphics go well Graphics do not
from the text. seems “text-h eavy”.
well with the with the text, with the text, but go with the
distract
text and there but there are so there are too few accompanying
is a good mix many that they and the leaflet text or appear to of text and
distract from the seems “text- be randomly
graphics. text. heavy”.
Attractiveness And The poster The poster has Thechosen..
poster has well- The poster’s formatting
Organization has attractiv e formatting organized rmation. and organization of
exceptionally and well-organized info material are confusing
attractive formatting
Attractiveness And informa tion.
The poster has The poster has The poster has The to the reader
andposter’s
well-
Organization exceptionally attractive well-organized
organized
formatting and attractive formatting and information. organization
information. of
formatting and well-organized

Neatness/Creativity Exceptionally neat, Very

material neat, Neat,70% complete, Untidy,50%
Effort/Completeness complete complet 80% haphazardly below
and are e, effort fully complete
done
well-organized information. and
diligently done confusing to the
information.
effortlessly done

reader
Total:----
 A. Concept and Types of Disaster
 Natural vs. Technological
 Internal
 External Disaster

B. Natural Disasters
 Geophysical
 Meteorological
 Hydrological
 Climatological
 Biological

C. Man-made Disasters
 Terrorism
 Technological
 Transitional human shelters
 A.1. Natural disasters is a major adverse event resulting from natural
processes of the Earth; examples include firestorms, dust storms, floods,
hurricanes, tornadoes, volcanic eruptions, earthquakes, tsunamis, storms,
and other geologic processes.
2. Technological disaster is an event caused by a malfunction of a
technological structure and/or some human error in controlling or
handling the technology. Victims of technological disasters tend to feel
anger toward people who were responsible for accidents that may have
been prevented.

B.Internal disasters are events that occur within the walls of the hospital
itself, such as an active shooter, power outage, or radiation exposure.

C. External disasters occur at locations separate

from the
hospital, such as transportation incidents or industrial accidents.
 HURRICANES

 The primary health hazard from hurricanes or cyclones

lies in the risk of drowning from the storm surge
associated with the landfall of the storm. Most deaths
associated with hurricanes are drowning deaths.

 Secondarily, a hazard exists for injuries from flying

debris due to the high winds.

 Nurses can be instrumental in providing direct

emergency care to drowning and head injuries.
 TORNADOE
S
The primary hazard from a health perspective in a
tornado is the risk for injuries from flying debris. The
high winds and circular nature of a tornado leads to
the elevation and transport of anything that is not
fastened down. Most victims of tornadoes are affected
by head and chest trauma due to being struck by debris
or from a structural collapse. Some individuals are
injured while on the ground. Others are lifted into the
air by the tornado and dropped at another location.
 FLOODS

 Floods may originate very quickly

following a quick rain storm, or they may
develop over a short period following an
extended period of rain or quick snow
melt
 The primary hazard from flooding is
drowning
 Longer term health concerns from
flooding is the development of disease
from contaminated water and lack of
hygiene.
 EARTHQUAKES

 A significant global concern

 The primary health concern:
 Injuries arising from structural collapse
 Most injuries occur amongst individuals
trapped at the time of the earthquake
 Well known prevention strategy is to prevent
buildings from collapsing
 There is a recognized need to develop better
rescue strategies for retrieving individuals from
collapsed buildings
 VOLCANOES

 Rare, but can be catastrophic when they occur

 Over the 25 year period (1972-1996), there was an
average of 6 eruptions per year, causing an average
of 1017 deaths and 285 injuries
 Health outcomes are associated with volcanic
eruptions:
•Respiratory illnesses from the inhalation of
ash
•For individuals close to the volcano, some
danger exists from lava flows, or more likely
mud flows
 Components of Disaster Debris
 Building Debris
 Household Debris
 Vegetative Debris
 Problem Waste Streams

 Severe injuries can be caused by

disaster debris.
 Clean up of debris is the authorities
responsibility but nurses can assume the
role of educators by increasing public’s
awareness to hazards of debris and
precautionary measures to protect their
own and their families safety.
 Nurses also a major role in long term
mitigation such as with land minds or
rebuilding.
Patterns of Mortality and Injury
-Knowing the patterns of mortality and injuries associated with particular disasters can
be most beneficial when providing training. This can result in effective preparedness
and ensure better outcomes. It is important to bring this to the attention of nurses in
developing counties especially that their countries at higher risk for disasters and
causalities.

 Disaster events that involve water are the most significant in terms of
mortality
 Floods, storm surges, and tsunamis all have a higher proportion of deaths
relative to injuries
 Earthquakes and events associated with high winds tend to exhibit more
injuries than deaths
 The risk of injury and death is much higher in developing countries – at least 10
times higher because of little preparedness, poorer infrastructure.
 Displacement of Disaster Victims
 Mass Shelters
 Shelter management:
•Organized team (chain)
•Sleeping area and necessities
•Water and food handling
•Sanitation (toilets, showers,..)
•Special care to children and
elderly
•Health services (physical,
mental)
Disaster and Health
- Infection control is an important strategy in eliminating
infectious diseases (e.g. cholera, etc.). Nurses receive training in
infection control during their undergraduate or as part of
continuing education. Public education about preventive
strategies in times where water is contaminated can be a
determinant factor in eliminating any epidemic.

In a major disaster water treatment plants,

storage & pumping facilities, & distribution lines
could be damaged, interrupted or contaminated.
 Communicable diseases outbreak due to:
 Changes affecting vector populations
(increase
vector),
 Flooded sewer systems,
 The destruction of the health care
infrastructure, and
 The interruption of normal health services geared
towards communicable diseases
 MENTAL WELLNESS
 Little attention is paid to the children
 Listen attentively to children without denying their
feelings
 Give easy-to-understand answers to their questions
 In the shelter, create an environment in which
children can feel safe and secure (e.g. play area)
-In any major disaster, people want to know where
their loved ones are, nurses can assist in making links.
-In case of loss, people need to mourn:
• Give them space,
• Find family friends or local healers to
encourage and support them
• Most are back to normal within 2 weeks
• About1% to 3%, may need additional help
 Goals of the Disaster Nursing
• To meet the immediate basic survival
needs of populations affected by
disasters.
• To identify the potential for a
secondary disaster.
• To appraise both risks and
resources in
the environment.
• To correct inequalities in access to
health care or appropriate resources.
• To empower survivors to participate in
and advocate for their own health and
well being.
• To respect cultural, lingual, and
religious diversity in individuals and
families and to apply this principle in all
health promotion activities.
• To promote the highest achievable
quality of life for survivors.
 Principles of Disaster Nursing
• Rapid assessment of the situation and
of nursing care needs.
• Triage and initiation of life-saving
measures first.
• The selected use of essential nursing
interventions and the elimination of
nonessential nursing activities.
• Evaluation of the environment and the
mitigation or removal of any health
hazards.
• Prevention of further injury or illness.
• Leadership in coordinating patient
triage, care, and transport during times
of crisis.
• The teaching, supervision, and
utilization of auxiliary medical personnel
and volunteers.
• Provision of understanding, compassion
and emotional support to all victims and
their families.
MIDTERM:
Group Activity 1: Group students into
5 students.

 Meeting of minds: Research

different health effects of disasters.
 Based on your researches develop an
infographics that we will be given to
the community residents to let them
be mindful on the health effects of
the disaster, in that matter they will
be cooperative in all the activities of
the community to mitigate its effects.
 RUBRIC- INFOGRAPHICS

CRITERIA
CATEGORY 10 points 8 points 6 points SCORE
Graphics/ Pictures 4 points
Graphics go well with the Graphics go well with the Graphics go well with the Graphics do not go with
Representations text and there is a good mix text, but there are so text, but there are too the accompanying text or
CRITERIA
CATEGORY 10 points 8 points 6 points 4 points
of text and graphics. many that they SCORE distract few and the leaflet seems appear to be randomly
from the text.
Graphics/ Pictures Graphics go well Graphics go well Graphics “text-heavy”.
go well Graphics do not
Representations with the text and with the text, but with the text, but go with
chosen.
the there is a good mix there are so there are too
accompanying
Content-Accuracy All facts in ofthe leaflet are 90-99% of the text facts in
andthe
many80-89%
that they of theand
few facts in the Fewer than 80% of the
the text or appear to
accurate. graphics.
leaflet are accurate. leaflet are accurate.
distract from the leaflet
facts in the leaflet are
seems be randomly accurate.
text.

Spelling and Proofreading No spelling errors. No more than 1 spelling No more than 3 spelling Several spelling errors in
“text-heavy”.

error. chosen. errors. the leaflet.

Attractiveness And The infographics has
Content-Accuracy All factsThe infographics
in the 90-99% hasof The
of the 80-89% the Fewerinfographics
than 80% leaflet has The infographics
are facts in the facts in the of the facts in the accurate.
Organization exceptionally attractive attractive formatting leaflet
and well-organized
are leaflet are leaflet are
formatting and
formatting well- well-organized information.
accurate. organization of material
and
organized information. information. accurate. are confusing to
accurate.
the
reader
Sources Careful and accurate
Spelling and records No Careful
spelling errors. andNo more than 1 accurate
No more than 3andSeveralaccurate Sources are
spelling
are kept to document
Proofreading
the records Careful are kept not
spelling
are
error.
kept to
source of 95-100% of the document theto source records of document thedocumented source of accurately oron many facts
are not kept
spelling errors.
facts and graphics in the 85-94% of the facts and 75-84% of the errors facts andin theand graphics.
infographics graphics in the graphics leaflet. in
Attractiveness And The infographics The infographics The infographics The infographics
Organization has the infographics
exceptionally has attractive has well- formatting and
attractive formatting
infographics and organized organization of
formatting and well-organized information.
material are well-organized information. confusing to
the
information. Total:----
reader

Sources Careful and Careful and Careful and Sources are

 Health Effects of Disasters
• Disasters may cause premature
deaths, illnesses, and injuries.
• Disasters may destroy the local health
care infrastructure.
• Disasters may affect the
psychological, emotional, and social
well being of the population.
• Disasters may cause shortages of
food and cause severe nutritional
deficiencies.
• Disasters may create large
population
movements.
• Disasters may create
environmental
imbalances.
 DISASTER MANAGEMENT CYCLE

1. RESPONSE
The response phase is the actual implementation of the disaster plan. Response
activities need to be continually monitored and adjusted to the changing situation.
• A hospital, healthcare system, or public health agency take immediately during,
and after a disaster or emergency occurs.

2. RECOVERY
Once the incident is over, the organization and staff needs to recover. Invariably,
services have been disrupted and it takes time to return to routines.
•Activities undertaken by a community and its components after an emergency or
disaster to restore minimum services and move towards long-term restoration.
• Debris Removal
• Care and Shelter
• Damage Assessments
3. Evaluation/ Development
Often this phase of disaster planning and response receives the least attention.
After a disaster, employees and the community are anxious to return to usual
operations. It is essential that a formal evaluation be done to determine what went
well (what really worked) and what problems were identified. A specific individual
should be charged with the evaluation and follow-through activities.

4. Mitigation
These are steps that are taken to lessen the impact of a disaster should one occur
and can be considered as prevention and risk reduction measures. Examples of
mitigation activities include installing and maintaining backup generator power to
mitigate the effects of a power failure or cross training staff to perform other tasks
to maintain services during a disaster

5. Preparedness/Risk assessment
Evaluate the facility’s vulnerabilities or propensity for disasters. Issues to consider
include: weather patterns; geographic location; expectations related to public
events and gatherings; age, condition, and location of the facility; and industries in
close proximity to the hospital (e.g., nuclear power plant or chemical factory)
THE DISASTER CONTINUUM
-The life cycle of a disaster is generally referred to as the disaster
continuum, or emergency management cycle.

-This life cycle is characterized by three major phases, preimpact (before), impact
(during), and post-impact (after), and provide the foundation for the disaster time
line.

-Specific actions taken during these three phases, along with the nature and scope
of the planning, will affect the extent of the illness, injury, and death that occurs.
The five basic phases of a disaster management program include preparedness,
mitigation, response, recovery, and evaluation (Kim & Proctor, 2002; Landesman,
2001).

- There is a degree of overlap across phases, but each phase has distinct
activities associated with it.
 Preparedness refers to the proactive planning efforts designed to
structure the disaster response prior to its occurrence. Disaster
planning encompasses evaluating potential vulnerabilities (assessment
of risk) and the propensity for a disaster to occur.

Warning (also known as forecasting) refers to monitoring events to look

for indicators that predict the location, timing, and magnitude of future
disasters.
 ICN Framework of Disaster
Nursing Competencies

MITIGATION
Activities that reduce or eliminate a
hazard
Prevention
Risk reduction

Examples
Immunization
programs
Public
education
 MITIGATION
Permanent reduction of the risk of disaster

“Primary” Mitigation:
• reducing the PRESENCE of the Hazard
• reducing Vulnerability “Secondary” Mitigation:
reducing the EFFECTS of the Hazard
(Preparedness)
Mitigation
- includes measures taken to reduce the harmful effects of a disaster by
attempting to limit its impact on human health, community function, and
economic infrastructure.
These are all steps that are taken to lessen the impact of a disaster should one
occur and can be considered as prevention measures.

Prevention
- refers to a broad range of activities, such as attempts to prevent a disaster from
occurring, and any actions taken to prevent further disease, disability, or
loss of life. Mitigation usually requires a significant amount of forethought,
planning, and implementation of measures before the incident occurs.
 Principal Objectives Of Mitigation
 Save lives
 Reduce economic disruption
 Decrease vulnerability/increase capacity
 Decrease chance/level of conflict

RISK REDUCTION
 Physical Planning Measures
 Decentralization of elements at risk
 Control of population density
 Design of services and roads
 Land use regulation
 Economic Measures

 Diversification of economic activity

 Economic incentives (grants loans,
taxes)
 Insurance
PREPAREDNESS

Activities that are taken to build capacity and

identify resources that may be used
 Know evacuation shelters
 Emergency communication plan
 Preventive measures to prevent spread of
disease
 Public Education

Preparedness
• ethical practice, legal practice and
accountability
• communication and information sharing
• education and preparedness
 GENERAL PREPAREDNESS- SAMPLE
Table: The four phases of disaster management
Disaster Management
- refers to managing disaster response in the country (Table ). India has been
traditionally vulnerable to the natural disasters on the account of its unique geo-climatic
conditions. About 60%
Mitigation: of the landmass
Preventing is proneany
- Includes to activities
earthquakes
thatofcan
various intensities;
prevent or reduce
over 40future
million hectares is
emergencies or prone to floods; about 8% of the total area
the chance of occurrence of an emergency, is prone toor
cyclonesminimizing
and 69% their
of theeffects
area is susceptible
reduce the
to drought.
damaging Table:
effects
The offour unavoidable
phases of
disaster management emergencies.
- Mitigation activities take place before and after
emergencies.
- This can be done by revised zoning, land use
management, etc.

Preparedness: Preparing - Includes plans or preparations for disaster and to help

to handle an emergency response and rescue operations.
- Evacuation plans and stocking food and water are
both examples of preparedness.
- Preparedness activities take place before an
emergency occurs.
 Midterm Activity 2: Develop mitigating plans of your
desired disaster. Be specific.

* Why do these plans important when there is a disaster? When

should this be done?
Response: Responding - Includes actions which are to be taken to save lives
safely to an emergency and prevent further property damage. Response is
putting your preparedness plans into action.
- Seeking shelter from a tornado or turning off gas
valves in
an earthquake are both response activities.
- Response activities take place during an emergency.

Recovery Recovering - Includes actions need to be taken to return to a

from an emergency normal or an even safer situation following an
emergency and one should also consider things
which would mitigate the effects of future
disasters.
- Recovery includes getting financial assistance to
help pay
for the repairs.
- Recovery activities take place after a disaster.
Midterm Activity 3:
Formulate response actions of your
desired disaster. Be specific.

• Why do these response actions

important when there is a disaster?
• When are you going to respond when
there is a disaster?
National Disaster Management Authority (NDMA) is an agency of the Ministry of Home Affairs and is responsible
for framing policies, laying down guidelines and coordinating with the State Disaster Management Authorities (SDMAs)
to ensure a holistic and distributed approach to disaster management.

FLOODS
Floods occur when land that is usually dry is submerged by large amounts of water. Sudden submergence or inundation of
land area with water is called as flood. The occurrence of floods can be due to both natural and human causes.
1. Anthropogenic causes of floods include: Clearing of forests: Lack of vegetation cover to hold the soil together on
slopes causes erosion and deposition in river beds making them shallow, flooding occurs when these rivers
overflow. Also bare slopes increase surface runoff and volume of water flowing into the rivers.
2. Urban development: The clearing of land for development of residential, commercial and industrial complexes
have rapidly increased built-up areas. These concrete pavements and roads prevent infiltration of rainwater into the
ground coupled with lack of vegetation cover to intercept the rain water results in increased runoff flowing into the
rivers resulting in flooding.
3. Improper farming and other land use practices: The combination of absence of forest cover on one hand, and
inappropriate farming and land-use practices on the other have aggravated the flood devastation. There are hardly
any forests left in the catchment area of the rivers. It is well known fact that the forest areas are characterized by high
infiltration capacity.
4. Enhanced Green house effect: Various human activities resulting in increased green house effect and causing global
warming are leading to various climate changes such as higher rainfall in short duration, melting of more ice etc. All
these have lead to increased incidences of floods.
Natural causes of floods:
1.Excessive rainfall: Floods occur when rainwater is unable to seep into the ground quickly enough or rivers
overflow their banks because river channels cannot contain excess water. It is common in tropical areas.

2.Storm Surges: It occurs when strong winds raise the waves in the ocean to exceptionally high levels,
causing them to crash into the coast and flood the land. It is common in coastal areas with low-lying relief.

3. Melting Snow: Melting of snow in spring releases large amount of water into the rivers, causing
them to overflow their banks. It is common in places with cool temperate climate.

4. Global Atmospheric processes: Abnormal weather phenomenon such as El Nino (warming of

surface ocean waters at Southeastern part of Pacific Ocean).

5.Earthquakes: Earthquakes can bring about landslides or trigger tsunamis. When landslides occur, loosened
soil, rocks, mud debris etc. may be deposited in rivers causing overflowing of these rivers. Tsunamis triggered
by strong undersea earthquakes can flood and devastate coastal settlements
Impact of floods:
1. Loss of life: Floods mostly strike people unprepared, leading to loss of lives in drowning. Along with
livestock and other life forms. Impact is higher in flood plain areas which are densly populated,
2. Damage to infrastructure and property: Flood cause huge losses to homes, roads, power supply and
other infrastructure.
3. Spread of Diseases: After flood water recedes, shallow stagnant water may cover areas over a considerable
period of times. This may result in outbreak of water borne diseases. Moreover homeless flood victims are
housed in temporary shelters which are mostly overcrowded and with poor sanitation conditions which may
turn situation worse.
4. Loss of natural habitat: Trees, vegetation and other natural habitats may get destroyed leading to loss of
biodiversity.

Mitigation of floods
Floods can be mitigated by structural, water control and non-structural measures such as:

Structural methods include building dams, reservoirs, and retarding basins, channel management and
embankments.

Water control methods: include increasing forest and vegetation cover, watershed management, flood
proofing and catchment modifications. Schemes of drainage and flood protection,

Non-structural methods: flood forecasting, flood warning and emergency preparedness systems, flood
insurance, public information and education, and flood relief
RESPONSE
The response phase is the actual implementation of the disaster plan. Disaster response, or
emergency management, is the organization of activities used to address the event.
Traditionally, the emergency management field has organized its activities in sectors, such
as fire, police, hazardous materials management (hazmat), and emergency medical
services.

The response phase focuses primarily on emergency relief: saving lives, providing first
aid, minimizing and restoring damaged systems such as communications and
transportation, and providing care and basic life requirements to victims (food, water, and
shelter).
Disaster response plans are most successful if they are clear and specific, simple to
understand, use an incident command system, are routinely practiced, and updated as
needed. Response activities need to be continually evaluated and adjusted to the
changing situation. Recovery actions focus.

Recovery actions focus on stabilizing and returning the community (or an organization)
to normal (its preimpact status). This can range from rebuilding damaged buildings and
repairing infrastructure, to relocating populations and instituting mental health
interventions.

Rehabilitation and reconstruction involve numerous activities to counter the long-term

effects of the disaster on the community and future development.
RECOVERY

Activities undertaken by a
community and its components
after an emergency or disaster to
restore minimum services and
move towards long-term
restoration.
Debris Removal
Care and Shelter
Damage Assessments
Funding Assistance
TYPES OF DISASTER PLANNING
- The two major types of disaster plans are those that take the agent-
specific approach and those that use the all-hazards approach.
- Communities that embrace the agent-specific approach focus their
preparedness activities on the most likely threats to occur based on their
geographic location (e.g., hurricanes in Florida).
- The all-hazards approach is a conceptual model for disaster preparedness
that incorporates disaster management components that are consistent
across all major types of disaster events to maximize resources,
expenditures, and planning efforts. It has been
observed that despite their differences many disasters share
similarities because certain challenges and similar tasks occur
repeatedly and predictably.
CHALLENGES TO DISASTER PLANNING
Problems, issues, and challenges are commonly encountered across several types of
disasters. Frequently,these issues and challenges can be effectively addressed in core
preparedness activities and include the following:
1. Communication problems.
2. Triage, transportation, and evacuation problems.
3. Leadership issues.
4. The management, security of, and distribution of resources at the disaster site.
5. Advance warning systems and the effectiveness of warning messages.
6. Coordination of search and rescue efforts.
7. Media issues. 8. Effective triage of patients (prioritization for care and transport of patients).
8. Distribution of patients to hospitals in an equitable fashion.
9. Patient identification and tracking.
10. Damage or destruction of the health care infrastructure.
11. Management of volunteers, donations, and other large numbers of resources.
12. Organized improvisational response to the disruption of major systems.
13. Finally, encountering overall resistance (apathy) to planning efforts. Auf der Heide states, “Interest in
disaster preparedness is proportional to the regency and magnitude of the last disaster” (1989).
What is Triage?

French verb “trier” means to sort

Assigns priorities when resources
limited
Do the best for the greatest number
of
patients

Triage aims to:

• To sort patients based on needs for
immediate care
• To recognize futility
• Assumption: Medical needs will
outstrip the immediately available
resources
• Additional resources will become
available given enough time
Why is Disaster Triage needed?

 Inadequate resource to meet

immediate needs
 Infrastructure limitations
 Inadequate hazard preparation
 Limited transport capabilities
 Multiple agencies responding
 Hospital Resources
Overwhelmed
 ASSIGNMENT: Submit this on Wednesday:

MAKE A DISASTER MANAGEMENT PROCESS/CYCLE

OF YOUR CHOSEN DISASTER, DISCUSS BRIEFY EACH
PROCESS WHY YOU HAVE TO DO SUCH AND
DETERMINE THE ACTIVITIES OF EACH
PROCESS/CYCLE.
Who decides in triage?

 Nurses don’t act for legal fears of being

blamed for deaths, and lack of clarity on
where they fit in the command structure
 Nurses function to the level of their
training and experience.
 If nurses they are the most trained
personnel the site, they are in charge.
Advantages of Triage

 Helps to bring order and organization to a chaotic scene.

 It identifies and provides care to those who are in greatest need
 Helps make the difficult decisions easier
 Assure that resources are used in the most effective manner
 May take some of the emotional burden away from those doing
triage

How Does Triage Manage Resources?

 By preventing the use of excessive resources on patients who

are likely to die no matter what we do for them
 By preventing the use of excessive resources on patients who have
minor injuries and require little to no treatment
 By focusing resources on those patients with severe injuries and
high survivability rates
Role of nursing in disasters

Disaster preparedness, including risk

assessment and multi-disciplinary
management strategies at all system levels, is
critical to the delivery of effective responses
to the short, medium, and
long-term health needs of a disaster-
stricken population.

International Council of Nurses (2020)

 Nurses’ roles in disasters
 Determine magnitude of the event
 Define health needs of the affected
groups
 Establish priorities and objectives
 Identify actual and potential public
health problems
 Determine resources needed to
respond to the needs identified
 Collaborate with other professional
disciplines, governmental and non-
governmental agencies
 Maintain a unified chain of command
 Communication
ADVANCED TRIAGE CATEGORIES

CLASS I (EMERGENT) RED IMMEDIATE

–Victims with serious injuries that are life threatening but has a high probability of
survival if they received immediate care. – They require immediate surgery or other
life-saving intervention, and have first priority for surgical teams or transport to
advanced facilities; they “cannot wait” but are likely to survive with immediate
treatment. “Critical; life threatening—compromised airway, shock, hemorrhage”

CLASS II (URGENT) YELLOW DELAYED

–Victims who are seriously injured and whose life is not immediately threatened;
and can delay transport and treatment for 2 hours. – Their condition is stable for
the moment but requires watching by trained persons and frequent re-triage, will
need hospital care (and would receive immediate priority care under “normal”
circumstances). “Major illness or injury;—open fracture, chest wound”
 CLASS III (NON-URGENT) GREEN MINIMAL
– “Walking wounded,” the casualty requires medical attention when all higher
priority patients have been evacuated, and may not require monitoring. –
Patients/victims whose care and transport may be delayed 2 hours or more. “minor
injuries; walking wounded—closed fracture, sprain, strain”

CLASS IV (EXPECTANT) BLACK EXPECTANT

- They are so severely injured that they will die of their injuries, possibly in hours or
days (large-body burns, severe trauma, lethal radiation dose), or in life-threatening
medical crisis that they are unlikely to survive given the care available (cardiac
arrest, septic shock, severe head or chest wounds); They should be taken to a
holding area and given painkillers as required to reduce suffering. “Dead or
expected to die—massive head injury, extensive full-thickness burns”
Organizing an effective Disaster System The nurse must be familiar with the
personnel at the disaster scene and their roles and functions. A disaster scene is
usually broken up into three zones-
1. Disaster zone
2. Treatment zone
3. Transport zone
 1.Disaster zone:
• It is the actual location of the incident from where patient are to be removed as
soon as possible. Majority of disaster personnel are sent to this zone initially.

2.Treatment zone:
•Nurses spend most of their time in their zone during a disaster, where equipment
and personnel to carry out patient care are concentrated. Activities carried out in
this zone includes. - Assessment of each patient - Treatment of injuries -
Preparation for transport.

3.Transportation zone:
•It should be situated directly next to the treatment zone so that ambulances and
other vehicles can load patient and leave for hospitals. delivering appropriate
patient care:
*Triage area must be equipped with the following
•Wheelchairs • Stretchers • Backboards • IV poles • Splints, bandages • Emesis
basins • Disaster tags • Pens • Adhesive tape • Oral airway • Scissors • Blankets •
Stethoscope • Emergency trolley with equipment
 MAJOR ROLES OF NURSE IN DISASTER
1. Define health needs of the affected
groups
2. Establish priorities and objectives
3.Identify actual and potential public
health problems
4.Determine resources needed to
respond to the needs identified
5.Collaborate with other professional
disciplines, governmental and non-
governmental agencies
6.Maintain a unified chain of
command
MIDTERM
Group Activity 3: Group students
into 5 students.

 Get-together: Based on
your knowledge on the
disaster management
process, design and
construct your group’s
disaster management plan in
preparation for a disaster that
may come. Focus on the
processes.
- Mitigation/Preparedness
- Response
- Relief
- Rehabilitation/Reconstruction
 RUBRIC- DISATER MANAGEMENT PLAN

CRITERIA
CATEGOR Excellent 4 Adequate 3 Developing 2 Needs SCORE
Y Improvement
Content 25% *Appropriate *Most details support *Few details support *No 1details to support
CRITERIA
details support main idea main idea main idea
CATEGORY main idea Excellent 4 Adequate 3 Developing 2
*Accurate information *Lacking accurate Needs
* Information is not
SCORE
*Accurate and for almost all subject information & accurate & no phases
Improvement 1
Content 25%detailed information
*Appropriate details matter & most
*Most details phases
support *Few details phases *No details toavailable
moresupport support
& allsupport
phasesmain idea
available available main idea available main idea
main idea
Focus 25% Main*Accurate
idea andis detailed
clearly Main idea *Accurate Main idea not
information clearly
*Lacking accurateNo idea,
appropriate to topic is stated;
* Information evacuation
is not information & all main plan or
with evacuation plan appropriate to topic for almost all subject information & more
plan but lacking steps evacuation
accurate & no phases phases available
and steps with evacuation matter plan & most phases phases available steps
Visual Appeal 25% Overall design is and steps available Lack of sloppy
pleasing Overall
available
mostly pleasingdesign is harmonious design in appearance Project
Focus 25% Main idea is clearly Main idea is Main idea not clearly No main idea,
Mechanics Words are legible
evacuation and
appropriate toMosttopicwords are legible
appropriate to topicpresentation hasplan or
stated; evacuation plan Distractive elements
25% pertinent
steps to topic and pertinent to topic Presentation make
with evacuation plan with evacuation
is illegible and ineffective illustration
plan but lacking steps and
steps and steps confusing
Visual Appeal 25% Overall design is Overall design is mostly Lack of Total:---
harmonious Project has sloppy
-
pleasing pleasing
design in
presentation appearance
Mechanics Words are legible and Most words are legible Presentation is illegible Distractive elements
25% pertinent to topic and pertinent to topic and confusing make illustration
ineffective
Disaster Management Continuum
A) Pre-Impact
1. Prevention/Mitigation
- United Nations International Strategy for Disaster Reduction (UNISDR) HYOGO -
- Framework for Action on Disaster Reduction Hazard, Risk and Vulnerability
Analysis (HRVA)
 - Hazard Focus
 - Site specific

2. Preparedness
- General preparedness
 Fire Preparedness
 Earthquake
 Preparedness
 Volcanic Eruptions
 Floods, Tornadoes, Typhoons, Cyclones and Tsunami Preparedness
The Hyogo Framework
- is a global blueprint for disaster risk reduction efforts during the next decade. Its goal is
to substantially reduce disaster losses by 2025 - in lives, and in the social, economic, and environmental
assets of communities and countries.
The Hyogo Framework
- -Why is a
is global blueprint for
HOGO framework for action
disaster risk reduction efforts during the next decade. Its goal
important?
is to substantially
- assists the efforts reduce disaster
of nations andlosses by 2015 - to
communities in become
lives, andmore
in theresilient
social, economic, and
to, and cope
environmental
better with the assets of communities
hazards andtheir
that threaten countries.
development gains. Collaboration is at the heart of
the Hyogo Framework: disasters can affect everyone, and are therefore everybody's business.
- The Hyogo Framework assists the efforts of nations and communities to become more resilient to,
This and cope better
brochure withwhat
outlines the hazards that threaten
is the Hyogo their development
Framework gains.
for Action, its Collaboration
strategic goalsisand
at the
the
heart of the
five priorities for Hyogo
action:Framework: disasters can affect everyone, and are therefore everybody's
 Make business.
disaster risk reduction (DRR) a priority.
 Know the risks and take action.
 Build understanding and awareness.
 Reduce risk.
 Be prepared and ready to act.
 What is the Hyogo Framework for Action?
In January 2005, 168 Governments adopted a 10-year plan to make the world safer from natural hazards at the
World Conference on Disaster Reduction, held in Kobe, Hyogo, Japan. The Hyogo Framework is a global
blueprint for disaster risk reduction efforts during the next decade. Its goal is to substantially reduce disaster
losses by 2025 - in lives, and in the social, economic, and environmental assets of communities and countries.
The Framework offers guiding principles, priorities for action, and practical means for achieving disaster
resilience for vulnerable communities.

1. Ensure that disaster risk reduction is national and a local priority with
a institutional basis a strong fo
Strong national and local commitment is required to save lives andimplementation.
livelihoods threatened by natural hazards.
Natural hazards must be taken into account in public and private sector decision-making in the same way that
environmental and social impact assessments are currently required. Countries must therefore develop or
modify policies, laws, and organizational arrangements, as well as plans, programmes, and projects, to
integrate disaster risk reduction. They must also allocate sufficient resources to support and
maintain them. This includes: Creating effective, multi-sector national platforms to provide policy guidance
and to coordinate activities; Integrating disaster risk reduction into development policies and planning,
such as Poverty Reduction Strategies; and, Ensuring community participation, so that local needs are met.
2.Identify, assess, and monitor disaster risks - and enhance early warning. To
reduce their vulnerability to natural hazards, countries and communities must know the risks that they face, and take
actions based on that knowledge. Understanding risk requires investment in scientific, technical, and institutional
capabilities to observe, record, research, analyse, forecast, model and map natural hazards. Tools need to be
developed and disseminated: statistical information about disaster events, risk maps, disaster vulnerability and risk
indicators are essential. Most importantly, countries need to use this knowledge to develop effective early warning
systems, appropriately adapted to the unique circumstances of the people at risk. Early warning is widely accepted
as a crucial component of disaster risk reduction. When effective early warning systems provide information about a
hazard to a vulnerable population, and plans are in place to take action, thousands of lives can be saved.

3. Use knowledge, innovation, and education to build a culture of safety and resilience at all
levels.
Disasters can be reduced substantially if people are well informed about measures they can take to reduce
vulnerability - and if they are motivated to act. Key activities to increase awareness of disaster prevention
include: Providing relevant information on disaster risks and means of protection,
especially for citizens in high-risk areas; Strengthening networks and promoting dialogue and cooperation among
disaster experts, technical and scientific specialists, planners and other stakeholders; Including disaster risk reduction
subject matter in formal, non-formal, and informal education and training activities; Developing or
strengthening community-based disaster risk management programmes; and, Working with the media in disaster
risk reduction awareness activities.
4. Reduce the underlying risk factors.
Vulnerability to natural hazards is increased in many ways, for example:
Locating communities in hazard-prone areas, such as flood plains; Destroying forests and wetlands, thereby
harming the capacity of the environment to withstand hazards; Building public facilities and housing unable
to withstand the impacts of hazards; and, Not having social and financial safety mechanisms in place.
Countries can build resilience to disasters by investing in simple, well-known measures to reduce risk and
vulnerability. Disasters can be reduced by applying relevant building standards to protect critical infrastructure, such
as schools, hospitals and homes. Vulnerable buildings can be retrofitted to a higher degree of safety. Protecting
precious ecosystems, such as coral reefs and mangrove forests,
allow them to act as natural storm barriers. Effective insurance and micro-finance initiatives can help to transfer
risks and provide additional resources.

5. Strengthen disaster preparedness for effective response at all levels.

Being prepared, including conducting risk assessments, before investing in development at all levels of society will
enable people to become more resilient to natural hazards. Preparedness involves many types of activities, including:
The development and regular testing of contingency plans; The establishment of emergency funds to support
preparedness, response and recovery activities;
The development of coordinated regional approaches for effective disaster response; and, Continuous dialogue
between response agencies, planners and policy-makers, and development organizations.
Regular disaster preparedness exercises, including evacuation drills, also are key to ensuring rapid and effective
disaster response. Effective preparedness plans and organization also help to cope with the many small and medium-
sized disasters that repeatedly occur in so many communities. Natural hazards cannot be prevented, but it is possible
to reduce their impacts by reducing the vulnerability of people and their livelihoods.
2. Preparedness
- General preparedness
 Fire Preparedness
 Earthquake
 Preparedness
 Volcanic Eruptions
 Floods, Tornadoes, Typhoons, Cyclones and Tsunami Preparedness

10 Steps to Disaster Preparedness

 Assess your risk – both internally and externally.
 Assess your critical business functions.
 Prepare your supply chain.
 Back-up your data.
 Create an emergency management plan.
 Create a crisis communications plan.
 Assemble emergency supplies.
 Plan for an alternate location.
 Fire Preparedness
Top Tips for Fire Safety
 Install smoke alarms on every level of your home, inside bedrooms and outside sleeping areas.
 Test smoke alarms every month. ...
 Talk with all family members about a fire escape plan and practice the plan twice a year.
 If a fire occurs in your home, GET OUT, STAY OUT and CALL FOR HELP.

Earthquake preparedness
Staying Safe Outdoors
 Find a clear spot and drop to the ground. ...
 Try to get as far away from buildings, power lines, trees, and streetlights as possible.
 If you're in a vehicle, pull over to a clear location and stop. ...
 Stay inside with your seatbelt fastened until the shaking stops.
Volcanic eruption preparedness
Preparing for a volcanic eruption
 Comply with your local
government's mandatory
evacuations, especially if you are
within the
designated danger zone.
 Prepare for evacuation if you live
in the following: ...
 Find out where local evacuation
centers are located.
 Prepare a go-bag filled with
essentials.

Flood preparedness
 Listen to a weather radio for
updated information.
 If time permits, move valuable
possessions to upper floors or safe
ground.
To ensure your family's safety and survival, here's a typhoon preparedness checklist:
 Listen to news on the upcoming typhoon.
 Prepare the basic needs like food, water, flash light, radio, medicines, etc…
 Stay at home or in a safe place.
 If you really have to leave your home, avoid areas that are prone to flooding or landslides.
 Watch out also for flying objects and debris.

Preparedness Planning:
Critical Elements:
 Emergency Plan: Perform a risk assessment before developing an emergency plan. Use an all-
hazards approach to focus on capabilities critical to preparedness for a spectrum of emergencies
(Emergency Operations Plan: EOP)
 Policies & Procedures: Develop and implement policies and procedures based on the Risk
Assessment and Emergency Plan
 Communications Plan: Develop and maintain an emergency preparedness communication plan that
complies with both federal and state law
 Train and Test: Develop and maintain a training and testing program that includes annual training
in emergency preparedness policies and procedures.
 Communication Plan
- Universal Emergency Code System
- Preparing Family Communication Plan

Personal and Home Disaster Survival

a.- Preparedness Planning:
 Assembling Emergency Kit
 Learning Preparedness Skills
 Patterns of Survival (Staying Alive):
 Finding Fast Solutions Naturally
 Food and Water Procurement
 Signals
 Navigation
 Special Needs
b. PACE Planning:
 Primary, Alternate Contingency, Emergency
 Shelter in Place or Bugging Out

B. Impact Response
1. Disaster Triage Categories
Simple Triage and Rapid Transport (START) Immediate/Emergent (Class I) Tagged as RED
Delayed/ Urgent (Class II) Tagged as YELLOW Minimal/Non-Urgent (Class III) Tagged as GREEN
Expectant (Class IV) Tagged as BLACK Jump START (Children)

2.Mass Casualty Incident (MCI) Patient

Assessment and Identification Scene
Size UP
Obtaining Patient History
Physical Examination
Medical History
Rapid Trauma
Assessment
On-going
Assessment
3. Patient handling/Rapid Extrication Technique
Rescuer Staging
Body Substance Isolation
(BSI)/Universal
Precautions including
Personal Protective
Equipment (PPE)
Safe patient Lifting and moving
Extrication
Use of Kendric Extrication
Device (KED)
Dressing and Bandaging
Stabilization Restraints
Rescuer Staging
Procedures for staging Units and Apparatus at Emergency Scenes
This procedure defines the responsibilities of the Staging Sector Officer. Level II staging is
implemented by Command and should be utilized for all greater alarm incidents, first alarm
medical or hazardous materials incidents, or other incidents in which Command desires to
centralize resources, or simply park apparatus in a central, unobstructed location.

Level II staging - will require all responding companies to report to the central staging
location. Implementation of Level II staging automatically requires the implementation of a
"Staging Sector" Officer.

Command should request a separate radio channel and may designate a Staging Sector
Officer. Where an officer is not designated, the first company to arrive at the designated
staging location will automatically become the staging officer.
Staging involves two levels:

LEVEL I and LEVEL II - STAGING

Level I Staging is automatically in effect for all incidents with three or more companies responding.
During any multi-company response, companies should continue responding to the scene until a company
reports on the scene. In situations where the simultaneous arrival of first due companies is possible, the
affected officers shall utilize radio communications to coordinate activities and eliminate confusion. It
will be the ongoing responsibility of Dispatch to confirm the arrival of the first on-scene unit.

Once a company announces arrival on the scene, Level I Staging will be implemented in the
following manner:

For Fires, Hazardous Materials, & Special Operations Incidents The first arriving engine
company will respond directly to the scene and initiate appropriate operations.
Vehicle extrication
- is the process of removing a vehicle from
around a person who has been involved in a
motor vehicle collision, when conventional
means of exit are impossible or inadvisable. A
delicate approach is needed to minimize
injury to the victim during the extrication

- Hydraulic rescue tools are used by emergency

rescue personnel to assist in the extrication of
victims involved in vehicle accidents, as well
as other rescues in small spaces. These tools
include cutters, spreaders, and rams
DRESSING and BANDAGING
First Aid: Bandaging
Covering a break in the skin helps to control bleeding and protect against infection. Dressings are pads of
gauze or cloth that can be placed directly against the wound to absorb blood and other fluids. Cloth
bandages cover dressings and hold them in place.

Step 1. Dress the wound

 Put on gloves or use other protection to avoid contact with the victim's blood.
 Clean the wound with mild soap and water.
 Apply a small layer of topical antibiotic if desired.
 Place a clean dressing over the entire wound. Gauze dressings let in air for faster healing. Nonstick
dressings have a special surface that won't cling to the wound.
 If blood soaks through the dressing, place another dressing over the first one.
Step 2. Cover the bandage
 Wrap roller gauze or cloth strips over the dressing and around the wound several times.
 Extend the bandage at least an inch beyond both sides of the dressing.
 Don't wrap the bandage so tight that it interferes with blood flow to healthy tissue.

Step 3. Secure the bandage

 Tie or tape the bandage in place.
 Don't secure the bandage so tight that fingers or toes become pale or blue.

Step 4. Check circulation

 Check circulation in the area below the bandage after several minutes and again after several
hours.
 If circulation is poor, the skin may look pale or blue or feel cold.
 Signs of poor circulation also include numbness and tingling.
 If circulation is reduced, loosen the bandage immediately.
 If symptoms continue, seek medical attention.
PROTECTIVE RESTRAINS or
STABILIZATION RESTRAINS
-protective stabilization formerly
referred to as physical restraint and
medical immobilization equipment use
of protective stabilization or medical
immobilization when treating patients
and individuals with special health care
needs. Immobilization of a person for
proper delivery of safe, quality care.
C. Post Impact: Recovery, Reconstruction,
Rehabilitation

CRITICAL INCIDENT STRESS

DEBRIEFING
Critical incident stress management is an adaptive,
short-term psychological helping-process that focuses
solely on an immediate and identifiable problem. It can
include pre-incident preparedness to acute crisis
management to post-crisis follow-up.

CISD is an intervention conducted by trained mental

health professionals, in either group or individual
format. CISD encourages traumatized
individuals to share their thoughts and feelings
about the critical incident, with the goal of
making sense of the trauma.
A Critical Incident Stress Debriefing has three
main objectives. They are:
1) the mitigation of the impact of a traumatic
incident,
2) the facilitation of the normal recovery processes
3) a restoration of adaptive functions in
psychologically healthy people who are
distressed by an unusually disturbing event.

Why is it important to debrief?

A debrief can allow people to discuss and record
what worked well and what worked not so well.
It can generate ideas for a better event next time and
help create a plan for similar events.
 MIDTERM ACTIVITY 4 -
Doing What Matters in Times
of a Disaster.

Make a diagram that

illustrates the ways and
techniques that help you
manage your stress during a
disaster. Explain.
 MAKING A DIAGRAM - RUBRIC
CRITERIA
CATEGORY Excellent 4 Adequate 3 Developing 2 Needs SCORE
Improvement 1

Diagram Content *Appropriate details *Most details support *Few details support *No details to support
support main idea main idea main idea main idea
*Accurate and detailed *Accurate information *Lacking accurate * Information is not
information & what for almost all subject information & what accurate & what did not
worked very well matter & what worked worked not so well work
well

Diagram Focus Main idea is clearly Main idea is appropriate Main idea not No main idea, evacuation
appropriate to topic with to topic with evacuation clearly plan or steps
evacuation plan and plan and steps stated; evacuation plan
steps but lacking steps

Diagram design Overall design is pleasing Overall design is mostly Lack of Project has sloppy
pleasing harmonious appearance
design in presentation
Diagram coherence Words are legible and Most words are legible Presentation is illegible Distractive elements make
and impact excellent and very good pertinent and has a good impact illustration ineffective and
impact pertinent to topic to topic confusing has no impact at all.

Total:----
Psychological First Aid (PFA)
- is an evidence-informed approach that is built on the concept of human resilience. PFA aims to
reduce stress symptoms and assist in a healthy recovery following a traumatic event, natural disaster,
public health emergency, or even a personal crisis.

Emotional distress is not always as visible as a physical injury, but is just as painful and
debilitating.
After going through a life altering experience it is common to be effected emotionally.
- Everybody who experiences a disaster is touched by it
- Reactions manifest differently at different periods of time during and after the incident.

Some common stress reactions include:

Confusion Fear Feelings of hopelessness and helplessness Sleep problems
physical pain anxiety Anger Grief Shock Aggressiveness Withdrawal
Guilt Shaken religious faith Loss of confidence in self or others.
While Physical First Aid is used to reduce physical discomfort due to a bodily injury, Psychological First
Aid is a strategy to reduce the painful range of emotions and responses experienced by people exposed to
high stress

Goal of Psychological First Aid

The goal of Psychological First Aid is to create and sustain an environment of:
1) Safety
2) Calm & Comfort
3) Connectedness
4) Self-Empowerment, and
5) Hope

Psychological First Aid addresses basic needs and reduces psychological distress by providing a caring
comforting presence, and education on common stress reactions. It empowers the individual by
supporting strengths and encouraging existing coping skills. It also provides connections to natural
support networks, and referrals to professional services when needed.
Psychological first aid (PFA) is one of the vital tools in delivering psychological interventions
to those who have undergone or experienced traumatic events. Traumatic experiences during
calamities, outbreaks of infections, and war can induce a significant amount of stress in the
absence of early and effective intervention provided by trained professional.

PFA is critical in ensuring the psychological recovery of people affected by disasters. PFA is a
group of skills applied to limit distress and maladaptive behaviors that could negatively impact
the rehabilitation of people from a traumatic experience
Public health interventions
- Interventions are actions that public health nurses take
on behalf of individuals/families, communities, and
systems, to improve or protect health status (Minnesota
Department of Health, 2021, p. 1).

- Public health interventions are population-based if they

consider all levels of practice. The three inner rings of
the model represent this concept. The inner rings of the
model are systems-focused, community-focused, and
individual/family-focused.

- A population-based approach considers intervening

at all possible levels of practice. Interventions may
be directed at the entire population within a
community, the systems that affect the health of
those populations, and/or the individuals and
families within those populations known to be at
risk.
1.Systems-focused population-based practice: Changes organizations, policies, laws, and power structures.
The focus is not directly on individuals and communities but on the systems that impact health. Changing
systems often impacts population health in a more effective and lasting way than requiring change from
every individual in a community.

2.Community-focused population-based practice: Changes community norms, attitudes, awareness,

practices, and behaviors. This practice level is directed at entire populations within the community or
occasionally toward target groups within those populations. Community-focused practice is measured in
terms of what proportion of the population actually changes.

3.Individual/family-focused population-based practice: Changes knowledge, attitudes, beliefs, practices,

and behaviors of individuals and families. This practice level is directed at individuals, alone or as part
of a family, class, or group. Individuals receive services because they are identified as belonging to a
population at risk.
 Guidelines in Disaster and Emergency Situations

IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings

The Inter-Agency Standing Committee (IASC) issues these Guidelines to enable humanitarian actors to
plan, establish and coordinate a set of minimum multi-sectoral responses to protect and improve people's
mental health and psychosocial well-being in the midst of an emergency.

Populations affected by emergencies frequently experience enormous suffering. Humanitarian actors are
increasingly active to protect and improve people's mental health and psychosocial well-being during
and after emergencies. A significant gap, however, has been the absence of a multi-sectoral, inter-
agency framework that enables effective coordination, identifies useful practices, flags potentially
harmful practices and clarifies how different approaches to mental health and psychosocial support
complement one another.

The Guidelines offer essential advice on how to facilitate an integrated approach to address the
most urgent mental health and psychosocial issues in emergency situations.
 Infant and Young Child Feeding During Emergency and Disaster Situation

Infant and Young Child Feeding in Emergencies

The Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE) was first
produced by the Interagency Working Group on Infant and Young Child Feeding in Emergencies in
2021. This Working Group included members of the IFE Core Group; an inter- agency collaboration
concerned with the development of training materials and related policy guidance on infant and young
child feeding in emergencies.
AIMS
The OG-IFE aims to provide concise, practical guidance on how to ensure appropriate infant and young
child feeding in emergencies.
SCOPE
The OG-IFE applies to emergency preparedness, response and recovery worldwide to minimize infant
and young child morbidity and/or mortality risks associated with feeding practices and to maximize
child nutrition, health and development. Target populations The target populations for interventions are
infants and young children aged under two years old (0- 23 months) and pregnant and lactating women
(PLW).
 PAGASA Rainfall Warning System

RAINFALL WARNING
RAINFALL WARNING
Community AWARENESS
Community AWARENESS
FLOODING is POSSIBLE in low-lying areas
ADVISORY FLOODING is POSSIBLE
and nearinriver channels
ADVISORY low-lying areas
and near river channels
Community
Community PREPAREDNESS
PREPAREDNESS
FLOODING
FLOODING is is THREATHENING
THREATHENING in low-lying
ALERT areas
in low-lying areas
ALERT and near
and near river river channels
channels
Community
Community
RESPONSE RESPONSE
SEVERE
SEVERE FLOODING is EXPECTED
EMERGENCY
FLOODING is EXPECTED
EMERGENCY Take necessary precautionary
Take necessary
measures
precautionary measures
 THUNDERSTORM WARNINGS
• This will be issued when there is an
indication that a thunderstorm is
threatening a specific area(s) within the
next 2 hours.
Thunderstorm THUNDERSTORM WARNINGS
•Updates will be issued as frequent as
Advisory •This will be issued when
there is an indication that a
necessary
• This will
thunderstorm be disseminated
is threatening a via SMS, Social
specific area(s) within the next
Thunderstorm 2 hours. Media, website
Advisory •Updates will be issued as
•Thisaswill
frequent inform the public that TSTM
necessary
•This will be disseminated via
SMS,formation is likely within the next twelve
Social Media, website

Thunderstorm (12) hours.

•This will inform the public
Watch •This
that TSTM is ismore
formation likely general than a warning.

Thunderstorm
• This
within the next
will be disseminated thru Social
twelve
hours.
(12)

Watch Media,
•This is morewebsite
general than a
warning.
Thunderstorm ••This
Issued when TSTM is less likely within the
will be disseminated
Information next twelve (12) hours.
thru Social Media, website

• •Issued
Thiswhenwill
TSTM isbe disseminated thru Twitter,
Thunderstorm
less likely within the next
Information
Facebook, website
twelve (12) hours.
•This will be disseminated
thru Twitter, Facebook,
website
Disaster Management and Risk Reduction:
Philippine Laws
 FINAL ACTIVITY 1

Evaluate and critique RA 10121?

Note:
 Does this law effective?
 In what way?
 What are the downside of this law?
 As a nurse what can you do to help impose
this law?
Philippine Environmental Laws
 Documentation in Disaster Management

Disaster and Risk Management Plan

1. Incident Response Team (IRT)
The incident response team is the heart and soul of the incident response system and must have a clearly
defined scope of responsibilities. The members of the business as a whole must know that they have an
incident response system in place and a team that supports it.

An incident response team is composed of a cross section of various business groups, made up of professionals
who come to the rescue when an emergency arises. This team, by default, will have authority to make
command decisions based on the best interests of the business. A successful team will include technical
personnel, management personnel, and legal and communication experts. The team will have various
ownership roles within the confines of the incident response system.

2. IRT Roles and Responsibilities

When you compile your team, you will need to look at the following roles and assign people to fill them:

1. Management 3. Legal support 5. Interface to the security committee

2. Technical team 4. Communications 6. Security officer
The incident response team must be ready to respond to an incident the moment it occurs. In order
to facilitate this, you must create a high-level decision matrix. The following categories make up
that decision matrix:

1. Owner: makes the decisions and owns the process

2. Helpers: team members who help out on a process
3. Advisors: team members who advise on a process
4. Implementers: person or persons doing the work
5. Updaters: part of the team that is updated with the status and actions from other team
members
 FINAL ACTIVITY 2

If you become a nurse senator and given a

chance to make a law, what would it be?

Note:
1. What is the law about
2. What is the purpose and the benefits of the
law
3. How will you implement the law?
NDRRMC Situational Reports on Preparedness Measures and Effects
PAGASA-DOST Weather Forecast

What weather does PAGASA use?

The pressure, temperature, dew point temperature, wind direction
and speed are observed at selected levels in the atmosphere using
radiosondes which record these data by tracking helium-filled
balloons attached to transmitters.

PAG ASA
To enhance PAGASA’s weather data gathering capabilities, radar
dopplers, automatic rain gauges (ARG) and automatic weather
stations (AWS) were installed throughout the country.
These ARGs and AWSs are automated version of the
traditional weather station that measurements of
parameters such enables
as barometric pressure,
pressure, air temperature,
atmosphericrelative humidity, wind speed and
direction from remote areas using meteorological sensors
attached to rechargeable batteries powered by solar panels. With the
use of mobile technology, these stations report through the
telecommunication networks.
Center for Research on the Epidemiology of Disasters (CRED)
The Centre for Research on the Epidemiology of Disasters (CRED)
- has been active for over 40 years in the fields of international disaster and conflict health
studies, with activities linking relief, rehabilitation and development. The
promotes research, training and technical expertise on humanitarian Centre
particularly in public health and epidemiology. emergencies,

CRED's research scope includes two main axes: natural disasters and crisis situations caused
by civil strife, conflict or others. CRED studies broader aspects of humanitarian crises and
emergencies, such as socio-economic, gender and environmental issues, with a strong focus on the special
needs of vulnerable groups such as women and children.

By providing a wealth of data on health issues arising from disasters and conflict, CRED seeks to
improve needs-based preparedness and responses to humanitarian emergencies.
Bureau of Quarantine
BUREAU OF QUARANTINE

1. What is the purpose of Bureau of Quarantine?

BOQ is mandated to ensure security against the introduction and spread of
infectious diseases, emerging diseases and public health emergencies of
international concern (PHEIC).

To prevent international spread of diseases of global impact with minimum

interference to international travel and trade through: Effective surveillance and
control measures on infectious diseases and other health concerns with global impact
through local and international networking.

2. Who is the head of the Bureau of Quarantine?

Ferdinand s. Salcedo MD, MPH, CESO IV Director IV
3. What is Philippine quarantine law?
This quarantine certificate/clearance (Pratique) shall be a prerequisite to customs clearance.
(c) After compliance with the quarantine laws and regulations, all vessels or aircraft leaving
any seaport or airport of the Philippines shall secure quarantine outgoing clearance.

4. What is Rep Act No 9271?

9271. An act strengthening the regulatory capacity of the Department of Health in
Quarantine and International Health Surveillance, repealing for the purpose Republic Act
No. 123 of 1947, as amended. RA - 12th Congress.
Entrepreneurial
Opportunities

- are usually defined as situations where

products and services can be sold at a
price greater than the cost of their
production. An 'entrepreneurial
opportunity', thus, is a situation where
entrepreneurs can take action to make a
profit.
The three main types of entrepreneur opportunities include:
1. franchises
2. developing new operations within an existing organization
3. forming a completely new one

What are examples of opportunities?

There are many types of opportunities you can post, depending on what you need or are
looking to do, such as:
4. Get help on projects.
5. Propose working groups.
6. Get testers for new ideas or products.
7. Create a team to work on an idea you have.
8. Share your expertise or best practices in a particular field.

Why opportunities is important to an entrepreneur?

These are people who start businesses to exploit a potential opportunity. They are likely
to grow their business faster, employ more people, and introduce innovation that could
help fill important gaps in the market, while boosting productivity in the economy.
 Final Activity 3
In a creative presentation
answer this:

What do you think are

the 5 businesses
common in the country
having small capital
explain each.
Examples of Entrepreneurial Opportunities
 Final Activity 4

If given a chance that you will

become a nurse entrepreneur, what
business would you start and why?

Note: *Design a plan includes:

 write the purpose of your business
 describe the process on how you
go about it
 project the cost
 EMERGENCY NURSING

Scope and practice of emergency nursing:

-Emergency management – refers to urgent
and critical care needs; however the EN has
increasingly been used for no-urgent
problems and emergency management has
broadened to include the concepts that an
emergency is whatever the patient or family
considers it to be.

-The emergency nurse has special training,

education, experience, and expertise in
assessing and identifying health care
problems and situations.
Types of Emergency
A. Bioterrorism
B. Chemical emergencies
C. Mass casualties
D. Natural disasters
E. Outbreaks
F. Radiation
G. Terrorism
Airway Obstruction
When the ability to breathe is disrupted:
 Oxygen delivery to tissues and cells is compromised.
 Vital organs may not function normally.
 Brain tissue will begin to die within 4 to 6 minutes.
Oxygen reaches body tissues and cells through breathing and
circulation.
 During inhalation, oxygen moves from the
atmosphere into the lungs.
 Oxygen-enriched blood is pumped through the body by
the heart.
You must be able to locate the parts of the respiratory system and
understand how the system works.
Respiratory and cardiovascular systems work together.
 Ensure a constant supply of oxygen and nutrients are
delivered to cells
 Remove carbon dioxide and waste products
Eventually all cells will die if deprived of oxygen.
Factors affecting pulmonary ventilation
Maintaining a patent airway is critical.
 Intrinsic factors:
Infections
Allergic reactions
Unresponsiveness
(tongue
obstruction)
 Extrinsic factors:
Trauma
Foreign body
Factors affecting respiration
 External factors:
Decreased atmospheric pressure at high
altitudes
 Internal factors:
Pneumonia
COPD
Circulatory compromise
Trauma emergencies typically obstruct blood flow to individual cells
and tissue:
• Pulmonary embolism
• Tension pneumothorax
• Open pneumothorax
• Hemothorax
• Hemopneumothorax
Other causes include:
• Blood loss
• Anemia
• Hypovolemic shock
• Vasodilatory shock
 PATIENT ASSESSMENT:
 Recognizing adequate breathing
• Between 12 and 20 breaths/min
• Regular pattern of inhalation and exhalation
• Bilateral clear and equal lung sounds
• Regular, equal chest rise and fall
• Adequate depth (tidal volume)
 Recognizing abnormal breathing
• Fewer than 12 breaths/min
• More than 20 breaths/min
• Irregular rhythm
• Diminished, absent, or noisy
auscultated breath sounds
• Reduced flow of expired air
at nose and mouth
• Unequal or inadequate chest
expansion
• Increased effort of breathing
• Shallow depth
• Skin that is pale, cyanotic,
 A patient may appear to be breathing after the heart has stopped.
--Called agonal respirations
 Cheyne-Stokes respirations are often seen in stroke and head injury patients.

Assessment of respiration (cont’d)

• Skin color and level of consciousness are excellent indicators of
respiration.
• Also consider oxygenation. Pulse oximetry is the method to assess
 Emergency medical care begins with ensuring an open
airway.
 Rapidly assess whether an unconscious patient has an open
airway and is breathing adequately.
• Position the patient correctly.
• Supine position is most effective.
 Unconscious patients should be moved as a unit.
• Most common airway obstruction is the tongue.
 Other causes of airway obstruction:
• Dentures
• Blood
• Vomitus
• Mucus
• Food
• Other foreign objects
 Maneuver will open the airway in most patients
 For patients who have not sustained or are not suspected of having sustained
trauma
 Follow these steps:
• With patient supine, position yourself beside patient’s head.
• Place heel of one hand on forehead, apply firm backward pressure with palm.
• Place fingertips of other hand under lower jaw.
• Lift chin upward, with entire lower jaw.
 If you suspect a cervical spine injury, use this maneuver.
 Follow these steps:
• Kneel above the patient’s head.
• Place your fingers behind the angles of the lower jaw.
• Move the jaw upward.
• Use your thumbs to help position the jaw.
 Use the look, listen, and feel technique to assess whether breathing has
returned.
 With complete airway obstruction, there will be no movement of air.
• Chest wall movement alone does not indicate that adequate breathing is
present.
 Prevents obstruction by the tongue and allows for
passage of air and oxygen to the lungs
 Oropharyngeal airways
• Keep tongue from blocking upper airway.
• Make it easier to suction oropharynx if necessary.
 Indications include:
• Unresponsive patients with a gag reflex
• Apneic patients being ventilated with a bag-
mask device
 Contraindications include:
• Conscious patients
• Any patient who has an intact gag reflex
Nasopharyngeal airways Used
with a patient who:
Is unresponsive or has an altered LOC Has
intact gag reflex
Is unable to maintain his or her own airway
spontaneously
Indications:
Semiconscious or unconscious patients with an intact
gag reflex
Patients who will not tolerate an oropharyngeal
airway
Contraindications:
Severe head injury with blood in the nose
History of fractured nasal bone
You must keep the airway clear to ventilate
properly.
Portable, hand-operated, and fixed
equipment is essential for resuscitation.
To operate the suction unit:
• Check the unit for proper assembly of all its parts.
• Test the suctioning unit to ensure vacuum pressure of more than 300 mm Hg.
• Select and attach the appropriate suction catheter to the tubing.
Never suction the mouth or nose for more than 15 seconds at one time for adult patients, 10 seconds
for children, and
5 seconds for infants.
Suctioning can result in hypoxia.
When patients have secretions or vomitus that cannot be suctioned easily:
• Remove the catheter from the patient’s mouth.
• Log roll the patient to the side.
• Clear the mouth carefully with a gloved finger.
If the patient produces frothy secretions as quickly as you can suction them:
• Suction the airway for 15 seconds (less in infants and children).
• Ventilate for 2 minutes.
• Continue this alternating pattern until all secretions have been cleared.
Use the recovery position.
Used to help maintain a clear airway in an unconscious patient who is not injured and is
breathing on his or her own
Take the following steps:
Roll the patient onto the left side so that the head, shoulder, and torso move at the
same time without twisting.
Place the patient’s extended left arm and right hand under his or her cheek.
Not appropriate for patients with suspected spinal injuries
Application of Oxygen
• Non-rebreathing masks
• Bag-mask devices
• Nasal cannulas
 Preferred way to give oxygen in the prehospital setting To
patients who are breathing adequately but are suspected of
having hypoxia
 Combination mask and reservoir bag system
 Make sure the reservoir bag is full before placing the
mask on the patient.
 Adjust the flow rate so the bag does not collapse when
the patient inhales.
• Usually 10 to 15 L/min
 When oxygen therapy is discontinued, remove the mask.
 Patients with tracheostomies do not breathe through their
mouth and nose.
Continuous Positive Airway Pressure (CPAP)
CPAP is a noninvasive method of providing ventilatory support
for patients in respiratory distress or suffering from sleep
apnea.
Noninvasive ventilatory support for respiratory distress
• Many people diagnosed with obstructive sleep apnea
wear a CPAP unit at night.
• Becoming widely used at the EMT level
Mechanism
• Increases pressure in the lungs
• Opens collapsed alveoli
• Pushes more oxygen across the alveolar membrane
• Forces interstitial fluid back into the pulmonary
circulation
• Therapy is delivered through a face mask held to the
head with a strapping system.
• Use caution with patients with potentially low blood
Indications
Patient is alert and able to follow commands.
Patient displays obvious signs of moderate to severe respiratory distress. Patient
is breathing rapidly.
Pulse oximetry reading is less than 90%.
Contraindications
Patient in respiratory arrest
Signs and symptoms of pneumothorax or chest trauma
Patient who has a tracheostomy
Active gastrointestinal bleeding or vomiting
Patient is unable to follow verbal commands.
Complications
Some patients may find CPAP claustrophobic.
Possibility of causing a pneumothorax
Can lower a patient’s blood pressure
If the patient shows signs of deterioration,
remove CPAP and begin positive-pressure
ventilation using a bag-mask device.
HEMORRHAGE

Hemorrhage is the medical

term for bleeding. It most often
refers to excessive bleeding.

Hemorrhage is bleeding from a

damaged blood vessel. Many
things can cause hemorrhage
inside and outside the body.
Types of hemorrhage range from
minor, such as a bruise, to major,
such as bleeding in the brain.
 CLASSIFICATION OF HEMORRHAGE

1. Depending on the SOURCE OF BLEEDING

a. External hemorrhage: when the bleeding is revealed and
seen outside e.g. epistaxis
b. Internal hemorrhage: bleeding is concealed and not
seen outside. E.g. intracranial hematoma

2. Depending on the NATURE OF BLEEDING VESSEL

a. Arterial hemorrhage- bright red in color. Blood emitted
as a jet with each heartbeat.
b. Venous hemorrhage- dark red in color. Blood flow is
steady.
c. Capillary hemorrhage- bright red in color. Generalized
ooze of blood instead of blood flow.
3. Depending upon TIME OF HEMORRHAGE
A. Primary hemorrhage- occurs at the time of
trauma or surgery
B. Reactionary hemorrhage- occurs within 24
hours of trauma or operation
C. Secondary hemorrhage- occurs after 7-14
days of trauma or operation

4. Depending upon VOLUME OF BLOOD GAS

a. Mild hemorrhage: Blood loss ≤ 500ml
b. Moderate hemorrhage: Blood loss 500-
1000ml.
c. Severe hemorrhage: Blood loss ≥ 1L.
5. Depending upon SPEED OF BLOOD LOSS
a. Acute hemorrhage- massive bleeding in
short span of time.
b.Chronic hemorrhage- slow bleeding small in
quantity for long time.

6. Depending upon PERCENTAGE OF BLOOD

LOSS
a. Class 1: Up to 15%.
b. Class II: Between 15-30%
c. Class III: Between 30-40%
d. Class IV: More than 40%
 ETIOLOGY

1. Trauma
2. Infections
3. Congenital malformations
4. Surgical intervention
(intraoperative/postoperative)
5. Due to systemic disease (viral
infection, scurvy, allergy)
6. Abnormalities in clotting factor
(hemophilia A, multiple
myeloma)
7. Abnormalities in platelets (leukemias,
thrombocytopenia)
 METHODS IN STOPPING BLEEDING
1. Mechanical methods 4. Thermal agents
 Pressure -Cautery
 Hemostat -Cryosurgery
 Sutures and ligation -Lasers

2. Local agents
 Adrenaline
 Thrombin
 Surgicel
 Oxycel
 Surgical Fibrillar
 Gelatine Sponge
 Microfibrillar Collagen
 Bone Wax
 Ostene

3. Systemic Agents
 Whole blood
 Platelet Rich Plasma
 Frozen Plasma
 Cryoprecipitate
 Injuries Prone to Hemorrhage

Vascular Solid Organ Bones

Aorta Spleen Pelvis

Vena Cava Liver Femur

Quickly Rule Out

Blood Loss
Chest – CXR / FAST
Abdomen - FAST
Pelvis – X-ray
Femur – exam / X-ray

The 3 primary areas to look for blood loss are the chest, abdomen and
pelvis.
SHOCK
-is an inadequate tissue
perfusion resulting from
failure of one or more of
following:
The heart – pump failure
Blood volume
 Arterial resistance
vessels
 Capacity of venous
beds
 Classifications:

1. Hypovolemic shock – occurs when significant amount of blood is lost

from intravascular space resulting from hemorrhage, burns, or fluid shifts
2. Cardiogenic shock – failure of heart as a pump from MI, serious
cardiac dysrhythmias
3.Septic shock – result of bacteria and their release of their products in the
blood
4.Neurogenic shock – from decreased sympathetic control of blood vessels
from defect of vasomotor center of brain stem or blood vessels such as in brain
injury, depressant actions of drugs, anesthesia, hypoxia
Hypoglycemic shock – from lack of glucose or insulin reaction
Spinal shock - occurs in persons with spinal cord injury
5.Anaphylactic shock – massive vasodilatation, pooling of blood I
peripheral blood vessels, and increased capillary permeability from
systemic anaphylaxis from release of vasodilator substance such as
histamine
 Confounding Factors In Response
To Hemorrhage
 Patients age
 Pre-existing disease / meds
 Severity of injury
 Access to care
 Duration of shock
 Amount prehospital fluid
 Presence of hypothermia

Of all of these confounders, duration of shock is

the most important predictor of survival which of
course is related to access to care.

Someone who is severely injured within minutes

of a trauma center with prompt access to care has a
much higher likelihood of survival than the person
with a less severe injury but who has delayed access
to care.
 Pathophysiology of Hemorrhagic
Shock
Cardiac output which is defined as

=
Heart Stroke the volume of blood pumped by
Rate X Volume
Cardiac Output
(L/min)
the heart per minute, is
determined by multiplying the
(beats/ (cc/beat) heart rate by the stroke volume.
min) Stroke volume, the amount of
blood pumped with each
cardiac contraction, is
classically determined by the
following:
Preload (volume of venous
return to the heart)
Myocardial contractility

Afterload (systemic or peripheral

vascular resistance) The
resistance of forward flow of
Myocardial Afterload blood.
Preload
contractility Hemorrhagic shock primarily
affects the PRELOAD

CARDIAC OUTPUT
Sympathetic Nervous System
Uncontrolled hemorrhagic
shock initially leads to
hypotension (decrease in
mean arterial pressure
Heart rate [MAP]) due to an acute
Contractility decrease in cardiac output.
Vasoconstricti
o n The intrinsic response to
hemorrhagic shock is
stimulation of the sympathetic
nervous system via the
baroreceptor reflex which
results in an increase in heart
rate in an attempt to preserve
cardiac output.
 Sympathetic Nervous System

Progressive Vasoconstriction:
 Skin
 Muscle
 Splanchnic Bed

Sympathetic Nervous System stimulation as a result of

response to blood loss are compensatory in nature.

They result in progressive vasoconstriction of

cutaneous, muscle and visceral (splanchnic)
circulation which preserves blood flow to the heart
and brain.

This is why the skin is often cold and clammy in

shock.

The skin, muscle and gut are sacrificed to preserve

blood flow to the heart and brain.
 Important Hormones in Shock

Catecholamines: Epinephrine & Norepinephrine

• Increased heart rate & contractility
• Vasoconstriction & narrowed pulse
pressure
Renin-Angiotensin Axis: Aldosterone and ADH
• Water & sodium conservation &
vasoconstriction
• Increase in blood volume and blood
pressure
• Decreased urine output

Classic Signs & Symptoms of Shock

 Changing mentation
 Tachycardia
 Cool, clammy, skin
 Prolonged capillary refill
 Narrowed pulse pressure
 Decreased urine output
 Hypotension
 Normal Vitals do not
r/o Occult Hypo Perfusion

 Early IV fluid and or physiologic compensation can lead a clinician to think that the patient is
stable.

 It is important to remember that the presence of normal vital signs does not rule out the presence
of occult hypoperfusion.

 Realize that occult hypoperfusion is not readily observed with vital signs or physical exam.
 INTERNAL HEMORRHAGE CONTROL
1. Hematoma
- Pocket of blood between muscle and fascia

2. Unexplained Shock is BEST attributed to

abdominal trauma

General Management
 Immobilization
 Stabilization
 Elevation

3. Epistaxis: Nose Bleed

Causes: Trauma, Hypertension Treatment:
Lean forward, pinch nostrils

4. Hemoptysis 7. Diverticulitis
5. Esophageal Varices 8. Chronic hemorrhage
6. Melena - Anemia
 EXTERNAL HEMORRHAGE CONTROL

 External Hemorrhage
- Direct pressure and pressure dressing

General management
• Direct pressure
• Elevation
• Ice
• Pressure points
• Constricting band
• Tourniquet
-May use BP cuff by inflating the cuff 20-
30mmHg above
- Lactic acid and electrolytes
 GENERAL INTERVENTIONS
 Administer O2 to maintain PaO2 at 80-100 mmHg
 Fluid resuscitation: Lactated Ringer’s , Fresh whole blood if massive blood loss, platelets
and cor\agulation factors
 Insert indwelling urinary catherter: record urinary q15 to 30 min: reveals adequacy of
kidney and visceral perfusion’
 Maintain pt. on supine position with legs elevate
 ECG monitoring
 Monitor vital signs, and laboratory data
 Maintain normothermia

Pharmacologic interventions
 Inotropic in cardiogenic shock: Isoproterenol, digoxin, dobutamine
 Vasopressors: Dopamine, Norepinephrine
 Antibiotics – broad spectrum for septic shock
 WOUND
-injury of any tissues in the body,
especially that caused by physical
means and with interruption of
continuity

-Wound healing is a natural and

spontaneous phenomena.

-When tissue has been disrupted so

severely that it cannot heal
naturally
*dead tissue and foreign bodies
must
be removed
*infection treated
*and the tissue must be held in
CLASSIFICATION OF WOUNDS
1. Intentional vs Unintentional
Intentional wound: occur during therapy. For example: operation or venipuncture
Unintentional wound: occur accidentally. Example: fracture in arm in the road traffic accident

2. Open vs Closed
Open wound: the mucous membrane or skin surface is broken Closed
wound: the tissue are traumatized without a break in the skin.

3. Degree of contamination
Clean wounds: are uninfected wounds in which minimal inflammation exist, are primarily closed
wounds.
Clean-contaminated wound: are surgical wounds in which the respiratory. Alimentary, genital, or
urinary tract has been entered. There is no evidence of infection.
4. Depth of the wound
Partial thickness: the wound involves dermis and epidermis
Full thickness: involving the dermis, epidermis, subcutaneous tissue, and possibly muscle and bone.
WOUND HEALING
 Primary Intention
- skin edges are approximated (closed)
as in a surgical wound
- inflammation subsides within 24
hours (redness, warmth, edema)
- resurfaces within 4 to 7 days

 Secondary Intention: tissue loss

- Burn, pressure ulcer, severe
lacerations
- Wound left open
- Scar tissue forms
 WOUND HEALING
1. Inflammatory Response
- Serum and RBCs form fibrin network
- Increases blood flow with scab in 3 to 5
days

2. Proliferation Phase: 3-24 days

- Granulation tissue fills wound
- Resurfacing by epithelization

3. Remodeling: more than 1 year

-collagen scar reorganizes and increases in
strength
- Fewer melanocytes(pigment), lighter in
color
 Complications of wound healing

1.Hemorrhage: some escape of

blood from a wound is normal, but
persistent bleeding is abnormal

2.Hematoma: localized collection of

blood underneath the skin, and may
appear as reddish blue swelling.

3. Infection
RISK ASSESSMENT

 Alterations in mobility
 Level of incontinence
 Nutritional status
 Alteration in sensation or response to
discomfort
 Co-morbid conditions
 Medications that delay healing
 Decreased blood flow to lower extremities when
ulceration is present
ASSESSMENT & DOCUMENTATION
 Location
 Stage and size
 Periwound
 Undermining
 Exudate
 Color of the wound bed
 Necrotic tissue
 Granulation tissue
 Effectiveness of tissue
STAGES OF PRESSURE ULCER
STAGES OF PRESSURE ULCER
Activity 1: Picture Analysis

Choose a picture and explain what

the picture mean to you and why?
Activity 2 - Reminiscing
Write a traumatic experience which you have encountered in your life and
include your feelings and emotions during those unforgettable event.
 WHAT IS TRAUMA?

A traumatic event is one in which a person

experiences (witnesses or is confronted
with):
 Actual or threatened death
 Serious injury
 Threat to the physical integrity of self or
another
Responses to a traumatic event may include
 Intense fear
 Helplessness
 Horror
 Attachment
What is Trauma?
“Prolonged exposure to repetitive or severe events
such as child abuse, is likely to cause the most
severe and lasting effects.”

“Traumatization can also occur from neglect, which

is the absence of essential physical or emotional
care, soothing and restorative experiences from
significant others, particularly in children.”

(International Society for the Study of Trauma

and Dissociation, 2009)