NCM 121 Lec Week 3

Marie Grace Anne M. Reynoso, RN, MPH

Disaster Preparedness
✓ Leadership and Coordination in Disaster
1

✓ Essentials of Disaster Planning

2

✓ Hospital and Emergency Department

3
Preparedness
4
✓ Emergency Health Services in Disasters and
5

Public Health Emergencies

6

✓ Emergency Medical Consequence Planning for

7

Special Events, Mass Gatherings and Mass

Casualty Incidents
✓ agency tasked to prepare for, and
respond to, natural calamities, like
typhoons and earthquakes.
✓ also monitors human-induced
emergencies, such as armed
conflicts and maritime accidents.
✓ uses strategies to mitigate the
impact of disasters and increase the
resiliency of both the national
government and local government
units in the face of disasters.
The Cabinet members below are also part of the NDRRMC:
✓ Executive Secretary, Office of the President
✓ Secretary, Department of Agriculture (DA)
✓ Secretary, Department of Budget and Management (DBM)
✓ Secretary, Department of Education (DepEd)
✓ Secretary, Department of Energy (DOE)
✓ Secretary, Department of Environment and Natural Resources
(DENR)
✓ Secretary, Department of Finance (DOF)
✓ Secretary, Department of Foreign Affairs (DFA)
✓ Secretary, Department of Health (DOH)
✓ Secretary, Department of Information and Communications
Technology (DICT)
✓ Secretary, Department of Justice (DOJ)
✓ Secretary, Department of Labor and Employment (DOLE)
✓ Secretary, Department of Public Works and Highways (DPWH)
✓ Secretary, Department of Trade and Industry (DTI)
✓ Secretary, Department of Transportation (DOTr)
✓ Secretary, Department of Tourism (DOT)
✓ Press Secretary (now the Secretary, Presidential
Communications Operations Office or PCOO)
Disaster Preparedness
✓ Leadership and Coordination in Disaster
1

✓ Essentials of Disaster Planning

2

✓ Hospital and Emergency Department

3
Preparedness
4
✓ Emergency Health Services in Disasters and
5

Public Health Emergencies

6

✓ Emergency Medical Consequence Planning for

7

Special Events, Mass Gatherings and Mass

Casualty Incidents
✓ The disaster planning continuum is broad in
scope and must address collaboration across all
agencies and organization.

✓ Participation by nurses in all phases of disaster

planning is critical to ensure that nurses are
aware of and prepared to deal with whatever
these numerous other factors may turn out to
be.
✓ Agent-specific approach– focused preparedness
activities on the most likely threats to occur
based on their geographic location

✓ All-hazards approach – a conceptual model

for disaster preparedness that incorporates
disaster management components that are
consistent across all types of disaster events
to maximize resources, expenditures, and planning
efforts
Attention should be addressed on the following in
disaster planning:

1. Anticipate community problem

2. Address operational issues r/t effectively triage,
transportation and evacuation
3. Accommodate the management, security of, and
distribution of resources at the disaster site
4. Implement advanced warning systems and increase
the effectiveness of warning messages
5. Enhance coordination of search and rescue efforts
6. Effective triage of patients (prioritization for care
and transport of patients)
Attention should be addressed on the following in
disaster planning:

7. Establish plans for the distribution of patients to

hospitals in an equitable fashion
8. Patient identification and tracking
9. Damage or destruction of the healthcare
infrastructure
10. Management of volunteers, donations, and other
large numbers of resources
11. Organized improvisational response to the
disruption of major systems
12. Encountering overall resistance (apathy) to planning
efforts
1. Communication
2. Information Management
3. Coordination
4. Advanced warning systems and the use of evacuation
5. Surge management
6. Patient evacuation and tracking
7. Family reunification
1.Hazard Identification and Mapping
-which events are most likely to affect a community

2.Vulnerability Analysis
-who is most likely to be affected, the property
most likely to be damaged, and the capacity of the community to
deal with disaster’s effects
3.Risk Assessment
- determine community’s risk of adverse health effects
-identify major hazards facing the community and their
sources
-identify those sections of the community most likely to
be affected by a particular hazard
-determine existing measures and resources
-determine areas that require strengthening prevention/
mitigating effects of hazard
1. Prepare a theoretical foundation for disaster
planning
2. Disaster planning is only as effective as the
assumptions upon which it is based.
3. Core preparedness activities must go beyond the
routine.
4. Have a community needs assessment.
5. Identify leadership and command post (ICS –
incident command post)
6. Design a local response for the first 72 hours.
7. Identify and accommodate vulnerable populations.
8. Know about state and government assistance
9. Identify training and educational needs, resources
and personal protective equipment (PPE)
10. Plan for the early conduction of damage
assessment.
 Disaster Drill Computer simulation
Mock Patient Exercises

Table-top Exercises Seminar sessions

 must address all potential scenarios, including:

1. Loss of power, including auxiliary power

2. Loss of oxygen and other medical gases
3. Loss of compressed air and vacuum (suction)
4. Loss of water, stem and/or water pressure
5. Loss of telecommunication systems
6. Loss of information technology systems
7. Threats to the safety of patients and staff (violence, terrorism
and bombs)
8. Toxic exposures (fumes, chemicals or radiation)
9. Immediate evacuation of all patients and personnel
 As every nurse has the potential to be involved in a disaster at
some point in his/her personal or professional life, disaster nursing is “everyone’s
subspecialty”.

It is imperative that all nurses acquire a minimum knowledge base and

set of skills to enable them to plan for and respond to a disaster
in a timely and appropriate manner.

Nurses are better prepared to keep themselves, their colleagues, their

parents, and families, and ultimately their communities safe.
Disaster Preparedness
✓ Leadership and Coordination in Disaster
1

✓ Essentials of Disaster Planning

2

✓ Hospital and Emergency Department

3
Preparedness
4
✓ Emergency Health Services in Disasters and
5

Public Health Emergencies

6

✓ Emergency Medical Consequence Planning for

7

Special Events, Mass Gatherings and Mass

Casualty Incidents
Hospital emergency preparedness is critical
to maintaining the integrity of the healthcare
system during a disaster.
The hospital’s emergency management committee
should consist of a broad cross section of
hospital departments, including clinical, support,
operational, and financial units.
During incidents, healthcare leaders must impact
judgment based on the best available data, which
are often incomplete, incorrect, or both
Remain cognizant of the time-sensitive nature of
the issue at hand
Ensure that a well-defined command structure is initiated and
remains intact throughout the incident’s duration
Hospitals must make sustained efforts, either structural
or nonstructural, to lessen the likelihood and impact of
hazards.
Structural efforts include those that the hospital
performs through the construction or alteration of
the physical environment through engineered solutions

Nonstructural efforts are those that the hospital

undertakes by modifying behaviors or processes such
as regulatory measures, staff awareness and
educational programs.
Preparedness efforts range from developing a
resource inventory and conducting institution-wide
emergency management training, drills, and exercises
to leading an institution emergency management
committee.
Include those measures taken when an emergency
incident occurs and may involve care for patients,
staff and visitors:
✓ To limit injuries, loss of life, and damage to
the physical environment
The primary goal is to restore core services and
normal operations.
From a hospital planning perspective, the institution’s
recovery actions and implementation activities for
its core financial, human resources, and support
services should also be addressed.
Disaster Preparedness
✓ Leadership and Coordination in Disaster
1

✓ Essentials of Disaster Planning

2

✓ Hospital and Emergency Department

3
Preparedness
4
✓ Emergency Health Services in Disasters and
5

Public Health Emergencies

6

✓ Emergency Medical Consequence Planning for

7

Special Events, Mass Gatherings and Mass

Casualty Incidents
Constitute a critical element of
the medical response to
disasters and planning is a key
component of community
disaster preparedness

3 basic medical functions:

✓ Evacuation
✓ Stabilization
✓ redistribution

EHS fundamental components:

✓ Prehospital EMS
✓ EDs
✓ Alternate source of
emergency care
 ’
Basic Life Support (BLS) Providers
✓ Basic Emergency Medical Technician (EMT-B)
✓ Advanced Emergency Medical Technicians (EMT-A)
✓ Can administer oxygen and provide extrication, immobilization and
bleeding control
✓ Assist patient in taking their own medication

Advanced Life Support (ALS) Providers

✓ EMT-A, Paramedics (EMT-P)
✓ Can perform more advanced skills, including intubation, needle
thoracostomy, defibrillation, and cardiac pacing while administering a
wide variety of pharmacotherapy, including ACLS medication
EDs received undifferentiated, unscheduled patients and they evaluate
and provide initial diagnosis and management of the patients’ presenting condition.

EDs have differing diagnostic and treatment capabilities due to a

number of factors including staff capacity, community structure,
availability of specialized care, and inpatient capability-related
resources.

Although essential to ED functions, certain types of consult services

and support staff may be irregularly or entirely unavailable
Can come in various forms – freestanding EDs, urgent care centers, physician
offices)

✓ Freestanding EDs (FSED) – not attached to the hospital, but without

immediate access to consultative services

✓ Urgent care centers – provide care for minor illnesses and injuries,
commonly available in many communities

✓ Physician offices – integrated physician practices already evaluate and

care for acutely ill patients on site. Can provide laboratory,
radiographic, or even cardiac stress testing.
EHS typically differentiates between a mass casualty incident and a disaster

Any influx of patients from a Disaster as a natural or

single incident that exceeds the human-induced phenomenon
capacity of the EHS system that results in the destruction or
can be considered a MCI. dysfunction of the available
response infrastructure to meet
A bus accident in a small the community’s need for
town may quickly become a healthcare.
MCI if the responding EMS
agency or local ED resources Paralytic disaster has the
are overwhelmed. potential to eliminate the EHS’s
ability to respond to any
call for services
 ’
✓ It is estimated that the EHS system in a MCI will face a sudden surge of 5-10x
the usual number of patients
✓ First wave of the influx will present in 2 ways:
a. One group of 1st-wave patients will be cared for by EMS when they
respond to the scene of the incident and will be transported to health
facilities
b. 2nd group of 1st wave patients will directly present to Eds by foot, personal
vehicle, or nonmedical public transport
✓ Second wave of patients will usually follow. They are usually more sick or injured
than the first wave of “walking wounded”
✓ Overall, the majority of patients will arrive via means other than EMS, and the
majority of patients will arrive not be critically ill.
✓ System survey

✓ Resource availability: 3 types of EHS resources that are critical to

responding to any sort of MCI or disaster – facilities, personnel and

materials

✓ Communication and Coordination

1. Individuals calling 911 for assistance – proper distribution of EMS
resources must be considered as all patients probably do not need an
EMS response immediately. Alternative transport mechanisms should
also be considered.
2. Patients presenting to the ED for care – operations within the ED
can be modified to improve the efficiency of care and handle the
increased volume

Consider the issue of patient decontamination.

Disaster Preparedness
✓ Leadership and Coordination in Disaster
1

✓ Essentials of Disaster Planning

2

✓ Hospital and Emergency Department

3
Preparedness
4
✓ Emergency Health Services in Disasters and
5

Public Health Emergencies

6

✓ Emergency Medical Consequence Planning for

7

Special Events, Mass Gatherings and Mass

Casualty Incidents
An event “attended by a sufficient
number of people to strain the
planning and response of the host
community, where it is being held”

The definition is purposefully not

linked to the size of the gathering
or the number of people because
each community has a different
capacity to manage crows of people.
1. Emergency medical consequence planning to enable the delivery of
medical and nursing services during the event
2. A detailed written emergency response plan for rapid action during
emergency incidents (including urgent treatment and evacuation) and
surge capacity for MCIs
3. Associated plans including a communication plan, logistics plan and
transport plan
 1. Strategic Planning – focus on preparing the organization for any type
of threat or event
2. Contingency Planning – related to a site-specific threat that may occur
at any time
3. Forward Planning – activities for a known imminent event, example, rock
concert

Summary information gathering must include identifying: a) what type of event

will be held; b) where it will be held; c) why it is being held; d) who is
sponsoring the event; and e) who is expected to attend
1. Evaluate and stabilize injury and illness in participants, support staff
and spectators involved in the event.
2. Preserve the capacity of the local public health and acute medical care
systems to serve their local constituents
3. Respond to extraordinary or catastrophic events through the
utilization of the Incident Command Post

Nurses must, as members of the on-site healthcare team, be prepared to

deal with routine minor injuries, respond to sudden cardiac arrest,
psychiatric emergency, or precipitous birth.
1. Weather
2. Event Type
3. Event Duration
4. Crowd Mood
5. Crowd Density
6. Attendance
7. Age
8. Alcohol and Drug Use
1. Heat-related illnesses: heat stroke, heat exhaustion,
heat cramps, sunburn, heat rash (commonly
referred to as “prickly heat”)
✓ The longer the duration of the event, the greater the number of individuals who
will seek care.
✓ The event plan must include provisions for drinking water and sanitation
facilities, adequate power supply, and rubbish disposal.
✓ In the event that an MG should decompensate into an MCI, every healthcare
provider must be aware of the entire site layout, location of all escape routes,
how to activate the emergency operations plan, and their roles within the plan.
✓ Crowd refers to a number of people co-located in a specific place for a
measurable time period, frequently with common goals and displaying common
behaviors.
✓ Crowd characteristics:
- size: a large group of people
-density: people co-located in a particular area
-time: individuals who come together in a specific location of a specific purpose
-collectivity: crowd members share a social identity, including common goals
and interests
-novelty: individuals act in a socially coherent manner
✓ One of the most significant biomedical issues of concern at many MGs and is
related to other crown behaviors such as “moshing” and stampedes that result in
increased rates of injuries and illness
✓ Alcohol, drug use and dehydration can be expected to be higher among
spectators at outdoor sporting events.
✓ Careful selection of the location of patient treatment areas is paramount in
increasing their effectiveness. Placement of medical and first aid stations should
be such that the stations are easily accessible within a reasonable time by all.
✓ The event size and site layout will determine the number of aid stations needed.
✓ All aid stations should be clearly marked with signs.
✓ Location and directions to aid stations should be listed in the event program
and announced over the public address system during the event.
✓ Aid stations should have tables and sufficient room for equipment, supplies and
personnel.
✓ Ambulance areas should be within easy access of the medical treatment
stations.
✓ All healthcare providers should be aware of the plans for transportation and
know where transport vehicles will be located.
✓ Considerations as to what roads are available for ambulance traffic as well as
what physical obstructions may be encountered must be part of the overall
planning process.
✓ COMMUNICATION - Good communication is essential for the successful
operation of any large healthcare activity.
✓ STAFFING - Medical and nurse staffing at MGs require consideration of
expertise levels and types.
✓ DOCUMENTATION - A brief written record should be generated for all
presentations including the most trivial such as multi-patient record, standard
and detailed medical record, patient encounter forms, clinical records and other
documentation.
✓ Rapid assessment of the situation and of victims’ immediate nursing care
needs
✓ Security of the scene and assessment of the potential for a secondary
disaster
✓ Mass casualty triage and the initiation of lifesaving measures first
✓ Knowledge of one’s role within the ICS
✓ Selected use of essential nursing interventions and the elimination of non-
essential nursing activities
✓ Adaptation of necessary nursing skills to a mass casualty situation and allocation
of scarce resources
✓ Potential need for decontamination
✓ Ongoing environmental evaluation and hazard mitigation
✓ Prevention of further injury or illness
✓ Leadership in coordinating triage, care, and transport
✓ Teaching, supervision, and utilization of auxiliary medical personnel & volunteers
✓ Provision of understanding, compassion and emotional support to victims
✓ Appreciation of and knowledge to keep oneself safe during the MCI response
✓ Perform a respiratory, airway assessment
✓ Perform a cardiovascular assessment,
including v/s, monitoring for signs of shock
✓ Perform an integumentary assessment,
including a burn assessment
✓ Perform a pain assessment
✓ Perform a trauma assessment from head to
toe
✓ Perform a mental status assessment,
including a Glasgow Coma Scale
✓ Know the indications for intubation
✓ Know IV insertion and IV med administration
✓ Know emergency medications
✓ Know the principles of fluid therapy
✓ Concepts of basic first aid
✓ Disaster triage and transport
✓ Pain management
✓ Management of hypovolemia and fluid
replacement
✓ Suturing (if appropriate based on practice
parameters) and initial wound care
✓ Blast injuries/dealing with tissue loss
✓ Eye lavage techniques
✓ Chemical and radiation exposure
decontamination
✓ Fractures/Immobilization
✓ Hemorrhage management
✓ Crush injuries stabilization
✓ Movement of patients with spinal cord injury
1. Prepare any core preparedness activity as a group that you learned from this
lesson.