NCM 121: DISASTER NURSING

NCM 121: Disaster Nursing Lecture - Disaster nursing refers to a situation in

2 UNITS LECTURE-TOTAL= 36 HOURS which health professional, usually a
registered nurse or nurse practitioner,
SCHEDULE OF EXAMINATION responds toa a crisis by volunteering with
1. Prelim Exam: Feb 20-25 an aid organization or volunteer responder
2. Midterm: March 27-April 1 organization.
3. End term (graduating) May 4-6, (Non-
grad) May 22-27 What is the purpose od disaster nursing to our
profession?
PRELIM TOPIC OUTLINE - The main goal of education and training in
disaster nursing is to prepare nurses
The Philippine Disaster Risk Profile physically and psychologically to respond
A. Concept & Types of Disasters to disasters. The aim of the current review
1. Natural vs. Technological was to evaluate how prepared nurses are
2. Internal vs. External Disaster to deal with disasters in terms of their
B. Natural Disaster knowledge, skill competencies, and
1. Geophysical psychological outlook.
2. Meteorological
3. Hydrological What is a Disaster?
4. Climatological - A disaster is a result of a natural or
5. Biological manmade causes that leads to sudden
C. Man-made Disasters disruption or normal life, casing severe
1. Terrorism damage to life and property to an extent
2. Technological that available social and economic
3. Transitional Human Shelters protection mechanisms are inadequate to
D. Trends & Patterns of Disasters cope.
1. Phases of a Disaster
• Pre-disaster Disaster Nursing
• Warning - Disasters are classified as per origin, into
• Social & Physical Impact natural and man-made disasters.
• Emergency - As per severity disasters are classified as
• Isolation minor or major.
• Rescue
• Remedy Natural and Manmade Disasters
• Recovery

ICN Framework of Disaster Nursing

Competencies

A. Prevention & Mitigation

1. Risk Reduction, Disease Prevention &
Health Promotion
2. policy Development & Planning
B. Preparedness Competencies
1. Ethical Practice, Legal Practice &
Accountability The WHO defines “natural disasters” as the “result
2. Communication & Information Sharing of an ecological disruption or threat that exceeds
3. Education & Preparedness the adjustment capacity of the affected
C. Response Competencies community”
1. Care of Community
2. Care of Individuals & Families Natural disasters can be broadly classified into
3. Psychological Care categories including
4. Care of Vulnerable Population 1. Geophysical
D. Recovery/Rehabilitation Competencies 2. Hydrological
1. Long Term Individual, Family & Community 3. Meteorological- typhoon
Recovery 4. Climatological
5. Biological- Bioterrorism like COVID-19 or
LESSON 1: DISASTER RISK PROFILE anthrax
What is Disaster Nursing?
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Natural Disasters

Biological Geophysical Hydrological Meteorological Climatological

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

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

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

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Earthquakes • There are 53 active volcanoes (out of the
300+ total) in the archipelago. Philippine plate
and several smaller micro-plates are sub
ducting along the Philippine trench to the east,
and the Luzon, Sulu, and several other small
trenches to the west.

• Since it lies along the Pacific Ring of Fire, the

country has frequent seismic and volcanic
activities. Very big statistic of earthquakes of
smaller magnitude occurs very regularly due • The currently active volcanoes are found in
to the meeting of major tectonic plates in the the several corresponding volcanic arcs,
region. which can be simplified into two major north-
south trending arcs: the Luzon and Mindanao
volcanic arcs. The volcanoes are produced at
the junction of the Philippines tectonic plate
and the Eurasian plate.

Typhoons / Tropical Cyclones

• Within the past two decades (1990- 2010),

five destructive earthquakes were recorded,
and human casualty included 15 deaths and
119 persons injured. Damage to the economy
was estimated to reach PhP 207 million. The
1990 Luzon earthquake, the Moro Gulf
Tsunami, and the collapse of the Ruby Tower
were the most devastating ever recorded.
• The climate of the Philippines is tropical and
is strongly affected by monsoon (rain-bearing)
Volcanic Eruptions winds, which blow from the southwest from
approximately May to October and from the
northeast from November to February,
although there are considerable variations in
the frequency and amount of precipitation
across the archipelago.
• From June to December typhoons often strike
the archipelago. Most of these storms come
from the southeast, with their frequency
generally increasing from south to north.
• On average, about 20 typhoons occur
annually, with the months of June to
November averaging approximately 3
typhoon strikes per month. Luzon is

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significantly more at risk than more southern
areas.

LESSON 2: DIASTER CONTINUUM

• Typhoons are heaviest in Samar, Leyte,
eastern Quezon province, and the Batanes
Islands, and when accompanied by floods or Phases of Disaster
high winds they may cause great loss of life
and property. Mindanao is generally free from The life cycle of a disaster is generally referred to
typhoons. as the "disaster continuum" or "emergency
management cycle."
Flooding
This cycle is characterized by 3 major phases.
1. Pre-impact
2. Impact
3. Post-impact

PRE-IMPACT
• Prepare and mitigate. Mitigate to lessen
casualties.
• It is the initial phase of disaster, prior to the
actual occurrence. A warning is given at the
• A review of the high impact tropical cyclones sign of the first possible danger to a
in the Philippines indicate that majority of the community with the aid of weather networks
victims were affected by inland flooding and and satellite many meteorological disasters
landslides. The torrential rain can result in can be predicted.
flooding in overflowing rivers, saturated soil, • The earliest possible warning is crucial in
low-lying areas, and poor drainage. The most preventing toss of life and minimizing
number of deaths and economic losses come damage.
from this type of hazard. • Forecasting is not 100 accurate
• Environmental concerns such as • This is the period when the emergency
deforestation are worsening the risk of floods preparedness plan is put into effect
and landslides. The uncontrolled urban emergency centers are opened by the local
growth, poor land use, the decrease in the civil, detention authority. Communication is
number of protected forests and riverbanks, a very important factor during this phase;
poor waste disposal and housing have disaster personnel will call on amateur radio
clogged waterways and increased the risk of operators, radio and television stations.
floods. • The role of the nurse during this warning
phase is to assist in preparing shelters and
emergency aid stations and establishing
contact with other emergency service group.
• Train nurses, prepare evacuation areas

IMPACT
• Most important is rescue

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• Shortest phase of the disaster 9. Monitor long term physical health outcomes
• The impact phase occurs when the disaster of survivors
actually happens. It is a time of enduring 10. Provide counseling & debriefing for staff.
hardship or injury end of trying to survive. 11. Provide staff with adequate time off for rest
• The impact phase may last for several 12. Evaluate disaster nursing response actions
minutes (e.g. after an earthquake, plane 13. Revise original disaster preparedness plan
crash or explosion.) or for days or weeks (eg
in a flood, famine or epidemic). Disaster Continuum
• The impact phase continues until the threat
of further destruction has passed and
emergency plan is in effect.
• This is the time when the emergency
operation center is established and put in
operation. It serves as the center for
communication and other government
agencies of health tears care healthcare
providers to staff shelters.
• Every shelter has a nurse as a member of
disaster action team. The nurse is
responsible for psychological support to
victims in the shelter.

Nursing Actions
1. Activate disaster response plan
2. Mitigate all ongoing hazards
3. Activate all ongoing agency disaster plans Mitigation/Preparedness
4. Establish need for mutual aid relationship
5. Integrate local and national government Mitigation
resources • To prevent future emergencies and take
6. On going triage & provision nursing care steps to minimize their effects
7. Evaluate public health needs of the affected • The“mitigation”phase occurs before
population. disaster takes place. Here, an organization
8. Establish safe shelter & the delivery of will take steps to protect people and
adequate food & water supply property, while also decreasing risks and
9. Provide sanitation needs & waste removal consequences from a given disaster
situation. The organization’s main goal is to
POST-IMPACT reduce vulnerability to disaster impacts
• Recovery begins during the emergency (such as property damage, injuries and
phase and ends with the return of normal loss of life).
community order and functioning. • Early warning, training
• For persons in the impact area this phase
may last a lifetime Preparedness
• (e.g. - victims of the atomic bomb of • To take actions ahead if time to be ready
Hiroshima). for an emergency
• Preparedness also occurs before a
Nursing Actions disaster takes place. Here, an organization
1. Continue provision of nursing & medical attempts to understand how a disaster
2. care might affect overall productivity and the
3. Continue disease surveillance bottom line. The organization will also
4. Monitor the safety of the food & water supply provide appropriate education while putting
5. Withdraw from disaster scene preparedness measures into place.
6. Restore public health infrastructure
7. Re-triage & transport of patients to Response
appropriate levels of care facilities • To protect people and property in the wake
8. Reunite family members of an emergency, disaster or crisis
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• The “response” phase occurs in the Vulnerability
immediate aftermath of a disaster. • Vulnerability is the condition determined by
Organizations must focus their attention on physical (e.g., elderly), social, economic and
addressing immediate threats to people, environmental factors (e.g., below sea level)
property and business. Occupant safety or processes, which increase the
and wellbeing largely depends on its susceptibility of a community to the impact of
preparedness levels before disaster hazards.
strikes.

Recovery Capacity
• To rebuild after a disaster in an effort to • Capacity is the combination of all the
return operations back to normal strengths and resources available within a
• The “recovery” phase takes place after a community, society or organization that can
disaster. This phase is the restoration of an reduce the level of risk, or the effects of a
organization following any impacts from a disaster. Capacity may include physical,
disaster. By this time, the organization has institutional, social or economic means as
achieved at least some degree of physical, well as skilled personal or collective
environmental, economic and social stability. attributes such as 'leadership' and
'management.' Capacity may also be
Evaluation described as capability.
• A phase of a disaster planning that often • e.g., capacity to cope, capacity to rescue
receives the least attention people
• After a disaster, it is important that
evaluations be conducted to determine what Risk
worked, what did not work and what specific • Risk is the probability of harmful
problems, issues and challenges were consequences, or expected losses
identified. (deaths, injuries, property, livelihoods,
economic activity disrupted or environment
Key Elements of Disaster damaged) resulting from interactions
1. Hazards between natural or human-induced
2. Vulnerability hazards and vulnerable conditions.
3. Capacity
4. Risk Hazard Identification
• Hazard identification is used to determine
Disasters result from the combination of hazards, which events are more likely to affect a
conditions of vulnerability and insufficient capacity community & to make decisions about
or measures to reduce the potential negative whom or what to protect as the basis of
consequences of risk. establishing measures for prevention,
mitigation & response
Hazards
Vulnerability Analysis
• Vulnerability analysis is used to determine
who is most likely to be affected, the
property most likely to be damaged or
• Hazards are defined as “Phenomena that destroyed and the capacity of the
pose a threat to people, structures, or community to deal with the effects of
economic assets and which may cause a disaster.
disaster. They could be either manmade or
naturally occurring in our environment.” Risk Assessment
• Hazard is a potentially damaging physical • Risk assessment uses the results of the
event, phenomenon or human activity that hazard identification & vulnerability
may cause the loss of life or injury, property analysis to determine the probability of a
damage, social and economic disruption or specified outcome from a given hazard that
environmental degradation. affects a community with known
vulnerabilities & coping mechanism.

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NCM 121: Disaster Nursing RLE 6. Check the circulation for 10 seconds
• Palpate carotid artery while counting. 1, 2,
LESSON 1: ADULT CARDIOPULMONARY 3, 4, 5, 6, 7, 8, 9, 10.
RESUSCITATION (CPR)

1. Survey the scene

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

7. Locate the compression site.

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

2. Introduce self is victim has companion.

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

3. Check for responsiveness

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

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11. IF WITH PULSE AND BREATHING

• Place in a recovery position

9. Check for breathing and pulse for 10

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

10. IF NO PULSE, NO BREATHING continue

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

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