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DISASTER  American Red Cross: It is an occurrence either

natural or man-made that causes human suffering
THE PHILIPPINE DISASTER AND RISK PROFILE and creates human needs that victims cannot
Philippines alleviate without assistance; causes “paralysis”
 Consists 7107 islands  United Nations: It is a serious destruction of the
 Vulnerable to almost all types of natural hazards functioning of a community. It involves widespread
because of geographical location human, material, economic, or environmental
 Occupies the western segment of ‘Pacific Ring of impacts which exceed the ability of the community
Fire’ - most active part of the Earth characterized by or society to cope using its own resources.
an ocean encircling belt of active volcanoes and
earthquake generators Thus, a disaster may have the following features:
 One of the most disaster-prone country in the world UUUUST
for the past century, third out of 173 countries  Unpredictability
10 countries:  Unfamiliarity
1. Vanuatu  Urgency
2. Tonga  Uncertainty
3. Philippines  Speed
4. Solomon Islands  Threat
5. Guatemala
6. Bangladesh Classification of disaster according to cause:
7. Timor-Leste 1. Natural disaster
8. Costa Rica 2. Human-generated/man-made
9. Cambodia
10. El Salvador Classification of disaster according to onset:
1. Acute or sudden impact events
Nurses need to be ready to participate in: 2. Slow or chronic genesis (creeping disaster)
1. Preparation
2. Response Contributing factors to disaster occurrence and severity:
3. Recovery 1. Human vulnerability resulting from poverty and
Note: First step to be taken by every nurse is to understand social inequality
the basic concepts of disaster and disaster risk towards 2. Environmental degradation resulting from poor land
disaster readiness and risk reduction. use
3. Rapid population growth especially among the poor
CONCEPT OF DISASTER
Disaster = Greek words Dus (bad) + aster (star) When is an event a Disaster?
↓ 1. At least 20% of the population are affected and in
Calamity due to position of star or planet need of emergency assistance.
↓ 2. At least 40% of livelihood are destroyed
Disastro Italian 3. Major roads and bridges are destroyed and
↓ impassable for at least a week
Disastre French 4. Widespread destruction of fishponds, crops, poultry,
↓ livestock, and other agricultural products
Disaster 5. Epidemics

Definitions of Disaster Vulnerability

 An event, in which local emergency mgt measures  Is having the condition determined by social,
were insufficient to cope with a hazard, whether due physical, economic, and environmental factors or
to the lack of time, capacity or resources, resulting in processes which increase the susceptibility of a
unacceptable levels of damage or number of community to the impacts of hazards (UNISDR, 2004)
casualties  A condition susceptible to injury or attack;
 WHO: Any occurrence that causes damage, unprotected from danger; or insufficiency
ecological disruption, loss of human life,  Weakness to cope up
deterioration of health and health services on a  Vulnerability in the community:
scale, sufficient to warrant an extraordinary SPPEL
response from outside the affected community or o Services
area. o People
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o Properties 2. Internal vs External hazards and disasters

o Environment a. Internal: Entry of alpha, beta radiation-
o Livelihood emitting particles into the body; results in
irradiation of critical organs; can enter the
Hazard body by ingesting contaminated water/food
 Is any phenomenon that has the potential to cause or by absorption through wounds
disruption or damage to people and their b. External: Highly penetrating gamma
environment radiation or less penetrating beta that
 It is a natural event while disaster is its consequence. causes burns; produces overall irradiation
 Is perceived natural event which threatens both life and beta burns
and property
 Any phenomenon, which has the potential to cause Natural hazards and disasters
disruption or damage to humans and their 1. Geophysical - A hazard originating from solid earth
environment a. Earthquake
Note: Disaster is the consequence of hazard. b. Volcano
c. Dry mass movement: rock fall, landslide,
Risk: The level of loss or damage that can be predicted from a avalanche, subsidence
particular hazard affecting a particular place at a particular Note: Subsidence is vertical movement of the earth’s
time from the point view of the community surface caused by both natural and human activities,
which makes the ground sink or make the ground
Components of Risk: collapse suddenly.
1. Susceptibility: The factors of the community which 2. Meteorological - A hazard caused by short lived
allows a hazard to cause an emergency (e.g., living in micro to meso-scale extreme weather and
an earthquake prone area) atmospheric condition that last from minute to days
2. Vulnerability: The factors of the community which a. Storm
allows a hazard to cause a disaster (e.g., level of b. Extra tropical, Tropical cyclone
underdevelopment of the community) c. Local storm
3. Hydrological - A hazard caused by the occurrence,
Major risks to be considered: NEST movement, and distribution of surface and
1. Natural risks such as flood, earthquake, cyclones, subsurface freshwater and saltwater
landslides a. Flood: general flood, flash flood, coastal
2. Epidemics caused by infectious diseases flood/storm surge
3. Societal risks caused by social exclusion, extreme b. Wet mass movement: rock fall, avalanche,
poverty, and group violence landslide, subsidence
4. Technological risks caused by chemical, radiological, 4. Climatological - A hazard caused by long lived, meso
other events to macro-scale atmospheric processes ranging from
intra-seasonal to multi decadal climate variability
Note: Hazard vs Risk: Hazard is the cause. Risk is the effect. a. Extreme temperature: heat wave, cold
wave, extreme winter
Coping capacity: Ability of people, organizations, and systems b. Drought
using available skills and resources, to deal with and manage c. Wild fire: forest fire, land fire
conditions such as hazards, emergencies, and disasters 5. Biological - A hazard caused by living organisms and
their toxic substances, or vector-borne diseases that
Emergency: As any occurrence, which requires an immediate they may carry
response (WHO) a. Insect infestation
b. Animal stampede
TYPES OF DISASTER AND HAZARD c. Epidemic viral/ parasitic/fungal/prion
1. Natural vs Technological hazards infectious disease
a. Natural: Forces of nature - Acts of God; COVID-19 Pandemic in the Philippines
humans have limited control; have occurred o July 4, 2022
throughout the history of humankind  3,708,271 reported cases
b. Technological: Caused by human-made  60,592 reported deaths
systems; systems not designed to fail;  5th highest in Southeast Asia
humans had control; point of blame o February 2022 started declining
o May 2022 - “minimal risk case classification”
o June 2022 - 69.4 million fully vaccinated
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 14.3 million received booster shots

Top 10 global natural disasters Tsunamis
TT FAVE DWCL  Means harbor wave and it is caused by the
1. Tornado displacement of a large body of water normally an
2. Tsunami ocean or a large lake
3. Flood
4. Avalanche Floods
5. Vulcanic eruption  Are caused when water overflows from a water body
6. Earthquake
7. Drought Wildfire
8. Wildfire  Is any uncontrolled fire in the countryside or
9. Cyclone wilderness. It is also known as brushfire, bushfire,
10. Landslide forest-fire, desert-fire, grass-fire, hill-fire, peat-fire,
5 common disasters in the Philippines vegetation fire, and veld fire.
DEVTF
1. Drought Drought
2. Earthquake  Is a long period of time in which a certain region
3. Volcanic eruption receives a shortage of water.
4. Typhoon  Lasting 3 years from 1958 to 1961, the great Chinese
5. Fire famine is the worst on record, 15 to 43 million died
as a result.
NATURAL DISASTERS
Cyclone Avalanches
 Is an area closed, circular fluid motion  Is a sudden drop of snow
 Has a low pressure on the outside  The biggest avalanche happened on Mt. Hwascarany
 Center of the storm is called the eye with a death toll of 20,000.
 Has calmest water and lowest pressure
Landslides
Earthquake  A landslide or a landslip is a movement in the ground
 Result of the sudden release of energy from earth’s with a shallow flow of debris
crust that creates seismic wave
 Valdivia, 1960 - Biggest earthquake recorded & Unusual natural disasters:
happened in Chile on May 22, 1960 with 9.5  Firenado: Is a column of smoke and fire caused when
magnitude and killed 6000 people fire gets into a tornado. Also known as fire whirls,
 Central China, 1556 - World’s deadliest recorded fire devils and fire tornadoes.
earthquake; killed 830,000 people  Limnic eruption: Or explosion is also called a lake
 Tangshan, China, 1979 - Another deadly earthquake overturn and is caused by an explosion of gas from
that killed 250,000 people the lake (normally carbon dioxide) erupting and
suffocating people.
Tornado
 is a violently rotating column of air that is touching CONCEPT OF DISASTER RISK
both the ground and a cumulonimbus cloud  Is the product of the possible damage caused by a
hazard due to vulnerability within a community (Dar,
Volcanic eruptions 2014)
 Volcano: An opening in a planet’s surface which  It is the combination of probability of an event to
allows hot magma to escape from below the surface. happen and its negative consequences.
 Volcanic eruptions are measured using volcanic
explosivity index. 3 factors of disaster risk:
 Lahar: Is a type of natural event closely related to a 1. Hazard
volcanic eruption, and involves a large amount of 2. Vulnerability to the hazard
material originating from an eruption of a glaciated 3. Coping capacity
volcano, including mud from the melted ice, rock,
and ash sliding down the side of the volcano at a Concept of Disaster Risk Reduction (DRR)
rapid pace.  Is viewed as concept and practice of reducing
disaster risks through systematic efforts to analyze
and manage the casual factors of different disasters
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 Aims to reduce the damage caused by natural 2. Republic Act No. 1760 (Local Government Code of
hazards like earthquake, droughts, cyclones through 1991)
preventive measures  Transfer of responsibilities from the
 Focuses on the mitigation and preparedness aspects national to the LGUs thereby giving more
of the disaster management powers, authority, responsibilities, and
 The systematic process of using administrative resources of the LGUs
directives, organizations, operational skills, and  Allocation of 5% calamity fund for
capacities to implement strategies, policies, and emergency operation as relief
improved coping capacities in order to lessen the rehabilitation, reconstruction, and other
adverse impacts of hazards and their potential to works of services
cause disasters.
 It aims to avoid, lessen or transfer the adverse DISASTER CONTINUUM
effects of hazard through activities and measures for I. Planning/preparedness prevention warning
prevention (Dat et al., 2014). Nursing Actions:
 It is designed to protect livelihoods and the assets of 1. Participate in the development of community
communities and individuals by mitigation, disaster plans
preparedness, and advocacy (EU, 2005). 2. Participate in community risk assessment
o Elements of hazard analysis for all-
DRR includes: hazards approach
 Reducing exposure to hazards o Hazard mapping
 Lessening vulnerability of people and property o Vulnerability analysis
 Wise management of land and environment 3. Initiate disaster prevention measures
 Improving preparedness for adverse events o Prevention or removal of hazard
o Movement/relocation of at-risk
HEALTH EMERGENCY PREPAREDNESS AND RESPONSE population
PROGRAM o Public awareness campaign
o Establishment of early warning systems
DOH 4. Perform disaster drills and table-top exercises
 One of the agencies comprising the National 5. Identify educational and training needs for
Coordinating Council nurses
o NCC: Lead agency in coordinating, 6. Develop disaster nursing data bases for
integrating, supervising, and implementing notification, mobilization, and triage emergency
disaster-related functions nurse staffing resources
 Secretary of health: Represents the department 7. Develop evaluation plans for all components of
 A.O. No. 6 Bs of 1999: Institutionalization of the disaster nursing response
Health Emergency Preparedness and Response
Program within the DOH II. Response emergency management mitigation
III. Recovery rehabilitation/reconstruction
HEALTH EMERGENCY PREPAREDNESS AND RESPONSE evaluation
PROGRAM
 Designed to a comprehensive, integrated, and METHODS FOR DATA COLLECTION FOR DISASTER PLANNING
responsive emergency, disaster-related service and Hazard Identification and Mapping
research-oriented program with the goal of  Hazard identification is used to determine which
promoting health emergency preparedness among events are most likely to affect a community and to
the general public and strengthening the health make decisions about whom or what to protect as
sector capability and response to emergencies and the basis of establishing measures for prevention,
disaster mitigation, and response.
2 Steps:
LEGAL MANDATE  Historical data and data from other sources are
1. Presidential Decree No. 1566 (1978): Strengthening collected to identify previous and potential hazards.
the Philippine Disaster Control Capability and  Data are then mapped using aerial photography,
establishing the National Program on Community satellite imagery, remote sensing, and geographic
Disaster Preparedness. This created the NDCC, multi- information system.
level organizations and funding for a 2% reserve for
calamities Vulnerability Analysis
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 Vulnerability analysis is used to determine who is

most likely to be affected, the property most likely to
damage or destroyed, and the capacity of the MASS CASUALTY MANAGEMENT
community to deal with the effects of disaster. CRITICAL INCIDENT MANAGEMENT
 Data are collected regarding the susceptibility of Characteristics:
individuals, property, and the environment to  Often random in nature and disrupt normal life
potential hazards in order to develop prevention  Terrorist organizations use opportunity as a tool for
strategies. civil disturbance
 A separate vulnerability analysis should be  A mass casualty is a critical incident
conducted for each identified hazard.
MASS CASUALTY INCIDENT
Risk Assessment  Produces several patients, as few as 10 or as many as
 It uses the results of hazard identification and several hundreds
vulnerability analysis to determine the probability of  Affects local hospitals
a specified outcome from a given hazard that affects  Patients are greater than resources of initial
a community with known vulnerabilities and coping responders
mechanism (risks equal hazard times vulnerability)
Objectives of risk assessment: To determine the Preparation for Mass Casualty
community’s:  Establish guidelines and procedures
SMEAR  Early implementation of Incident Command
1. Sections most likely to be affected by a particular  First five minutes will determine next five hours
hazard (i.e., individuals living near floodplains)
2. Major hazards and their sources (earthquakes, Problems in MCIs
floods, industrial accidents) Most common being:
3. Existing measures and resources that reduce the  Who is in command of the incident
impact of a given hazard (building codes and  Location of the Command Post
regulation for earthquake mitigation)  Lack of communication between agencies leading to
4. Areas that require strengthening to prevent or conflicting priorities and orders
mitigate the effects of the hazard  Perimeter establishment delayed or not done at all
5. Risk of adverse health effects due to a specified  Large crowds of people
disaster (traumatic deaths and injuries after  Media involvement
earthquake)  Political involvement
 Inadequate resources
Disaster prevention measures
1. Prevention or removal of hazard MASS CASUALTY MANAGEMENT
2. Containment of hazard or implementation of Problems in Developing MCM
mitigation strategies  Limited human resources
3. Removal of at-risk population from hazard
 Limited material resources
4. Provision of public information and education
o Facility
5. Establishment of early warning systems
o Transport
6. Mitigation of vulnerabilities
o Communication
7. Reduction of risk posed by hazards
 Poor communication
8. Enhancement of a local community’s capacity to
o Topography
respond
o Isolation
“All hazards and potential dangers should be identified before  Political
an effective disaster response can be planned.”
Mass Casualty Management Approach
DEVELOPING STRATEGIES OR CONTINGENCY PLANS  Training of various level of responders
 Used to mitigate disasters  Incorporates links between field and HC facilities
 In making strategies, focus on vulnerabilities  Command Post
 Multi-sectoral response
Matrix:  Dependent on the availability of large amounts of
Scenario/ Risk
Assessment
Vulnerabilities Strategies Time Frame Person
Responsible
Indicators human and material resources
 Most sophisticated approach includes pre-
established procedures for:
a. Resource mobilization
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b. Field management  Restore order

c. Hospital reception  Prevent target opportunities

Activities at various levels of responses: Functional Systems Approach

 Alerting process (emergency/disaster site/scene)  Three levels of function: strategic, tactical and
 Initial assessment task/operation
 Command/Control/Coordinate  Mgt is strategic (gold)
 Manage info  Team leaders are tactical (silver)
 Search/Rescue  Resources not involved in supervision are
 Field care (mostly health activities) task/operation (bronze)
 Transport/Traffic control
 Facility reception at ER/A & ED Critical Incident Stages
 Hospital MCM and command system Consist of:
 Initial Response
Alerting Process  Incident Control using the Six-Step Response
 Definition: Sequence of activities implemented to  Recovery Stage
achieve the efficient mobilization of adequate
resources Six-Step Response (Incident Control)
 Aim: Is based on the Incident Command System
o Confirm the initial warning ASIESS
o Evaluate extent of problems 1. Assume command (incident commander)
o Ensure that appropriate resources are 2. Situation assessment
informed and mobilized 3. Identify and set perimeters
 Done by incident command manager 4. Establish command post
5. Safety officer and
6. Staging officer

#1 – Assume Command
 The first responder is providing order to the incident
 Prevents independent action and multiple
commands
 Reassures responders that someone is in charge

#2 – Situation Assessment
 Size up of the incident that includes the type of
threat, approximate number of injured, size of
threatened area and possibility of secondary event
 Describe:
o What do you have?
Field Management o What are you doing?
 Encompasses procedures used to organize the o What do you need?
disaster area to facilitate the mgt of victims
 Components: #3 – Identify and Set Perimeters
o Alerting process  Divide the incident into manageable divisions
o Pre-identification of field areas (geographical areas)
o Safety/security  Allows command to provide resources where they
o Command post are needed
o Search and rescue  Critical incidents have three standard perimeters. All
o Field medical care perimeters are divisions
o Evacuation  Expand perimeters based on weather
o Management center (EMC)  Perimeters: hot zone, inner perimeter and outer
perimeter
Initial Response Objectives
As soon as possible: Staging Officer
 Gain control of the scene  Found in exit and entrance (2 SOs)
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The Hot Zone  Coordinate sectors involved in field/scene

 “impact zone”; area in which the incident has management
occurred  Linked with back-up system: provide information
 May be a street corner or spread over a large area and mobilization resources
 Secured by placing responders in positions of  Supervise victim management
controlling ingress and egress Requisite: Radio Communication Network - main criterion to
 DON’T treat in hot zone; cold zone – safe; extrication be effective.
– treat at cold zone Purpose: coordination/communication hub of
 Distance of incident command post from hot zone: people who don’t work routinely (pre-hospital setting)
10-15 meters Location: external boundary of restricted area
(impact zone) close to AMP/ Evacuation Area/
Inner Perimeter (Warm Zone) accessible/easily identified; should accommodate: comm./
 Protects responders in hot zone visuals/maps/boards
 Uniformed personnel only
 Used as decontamination area (sometimes used as Incident Command Process
treatment area and evacuation area for walking  The process will assist the Incident Commander in
wounded) organization of the incident

Outer Perimeter (Cold Zone) Incident Command System

 Provides last line of defense from internal incident  Developed in the 1970’s during the California
acceleration wildfires
 Provides first line of defense from external  Business management practices of planning,
acceleration directing, organizing, coordinating, delegating,
 Secure area for command post, resources and communicating and evaluating
control of the media  Framework necessary to manage resources,
personnel and equipment
Done within 5 minutes:  Designed to be flexible and can be used in large or
Hot zone small incidents
1. Incident commander – scene safety, no. of patients,  Creates a safe environment for all involved
no. of resources needed
2. Call triaging officer – colors (first to go in hot zone) Benefits of Incident Command
3. Enter first aiders; says “load and go” for lifters to  Common terminology
enter  Position Titles and Chain of Command for decision
4. Enter lifters making
5. Once lifted, go cold zone  Responder accountability
6. Assign staging officer, logistics (lahat may dala e.g.,
bandage, c-collar) Single Command
Cold zone  Based on first arriving emergency units
1. Staging officer  Initial Incident Commander begins assessment of
2. PIO incident
3. Safety officer – police, identifies threat  Rescue, Triage, Treatment, Transport
4. Search and rescue group – “sweepers”; goes to
unsafe places for first aiders Basic Command Structure (Single Command)

#4 – Establish Command Post

 Typically begins at first responder’s vehicle
 Incident dynamics will require Incident Commander
to shift to fixed command post
 Must be away from hot zone; located in the cold Indicent
zone/outer perimeter Commander
 The command post will ensure support for field
personnel, create a controlled environment and
improve communications
Rescue/
Triage Treatment Transport
Command Post (CP/ICP)
Extrication
Multi-sectoral control unit to:
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 Also serves as the communication or coordination

hub of pre-hospital care. It is likewise responsible for
providing information to officials and the media
 Headed by the Incident Commander (IC)
Unified Command in large scale disasters:

Incident Command Process

Process is based on:
 Size up
 Setting incident priorities
 Predicting incident course and harm
 Strategic goals and tactical objectives

Size Up
 Rapid mental evaluation of factors influencing an
Unified Command incident
 Incidents that involve jurisdictions or agencies  Must continue throughout incident with ongoing
involved in the decision making and planning process evaluation
 Ensures plan is communicated and supported by all  3 parts: Incident situation, incident cause and
resources assembled incident status

Unified Command Structure Incident Situation

May be one or combination of:
 Biological
 Nuclear
 Fire
 Chemical
 Explosion or natural event

Incident Cause
 Is important because additional or specialized
resources may be needed
 The Incident Commander must determine if the
incident was accidental or intentional

Pre-Identification of Field Areas

 Impact Zone
 Command Post
INCIDENT COMM AND SYSTEM  Collecting Area in unstable location
INC ID ENT
CO M M A ND
 Advance Medical Post Area (3-T Principle)
SAF ET Y OFFIC ER L IA ISON OFF ICE R  Evacuation Area
P UB L IC INFOR M A T ION
OF F ICE R
 VIP & Press Area (Information Officer)
OPE RATIO NS OF FIC ER PLAN N ING OF F IC ER L OG IST IC S OF FICER AD MIN IS TRATIVE O F F IC ER
 Access Roads (Geographical Presentations if
available)
F IEL D M E DIC A L COM M AND ER

 Check Point for Resources (Staging Area)

STAG IN G O F FIC ER ME DIC AL G RO U P TRAN SPO R T G R O U P R ESO UR CE S S ERVICE S UPP O R T TIME
S UP ERVISO R S UPE RVISOR

S ITU ATIO N PR O C UR EMEN T

TREATME NT TEAM TRIAG E TEAM G R O U N D AMBULAN CE C OMMU N IC ATIO N S SU PPLY
LE ADE R LE AD ER
D OC U MEN TATIO N C O MPEN SATIO N

TRE ATMEN T MEMB ER S

IMMED IATE
TRIAG E MEMBERS
AIR AMBU LAN C E

D EMO BILIZATIO N
MEDICAL F AC ILITIES

CO ST
Setting Incident Priorities
TRE ATMEN T MEMB ER S
DE LAYE D
MO RG U E MAN AG ER
FOOD G RO U ND SU PP OR T
 After sizing up the incident, a course of action is
TRE ATMEN T MEMB ER S
MIN O R
determined
 High priority is life safety for the public and
Incident Command Post (ICP) responders
 Serves as the multi-sectoral control unit established  Incident stabilization
to coordinate the various sectors involved in the  Protection of critical systems
field management
Safety
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 Best practice technique to protect victims, Management of Victims

responders and exposed population: immediate/ Search and Rescue
potential risk  Locate victims
Measures:  Remove victims from unsafe locations – collecting
 Direct action: area
o Risk reduction - fire fighting  Assess victim’s status (on-site triage)
o Contain hazardous material  Provide first aid, if necessary (no CPR on-site in MC
o Evacuation of exposed population Event)
 Preventive actions: establish field areas  Transfer victims to AMP thru entry triage (medical
o Primary - impact zone triage)
o Secondary - rescue/ICP/AMP  Under supervision of the CP/ IC/ or
o Tertiary - “buffer zone”; trimedia Commander/Coordinator
Personnel: Fire services; specialized units  May in special situation, require medical personnel
Hazardous Materials and Explosives (bio-nuclear and (trained)
radioactive materials) Experts, etc.  To stabilize/resuscitate/amputate (trapped) victim
Airport Manager/Chemical Plant Expert before extrication
Field Care
Security Measures  Pre-established capabilities/ inventory: pre-planning
 Non-interference of external elements:  Integrated community plan
crowd/traffic control  The “Golden Hour” Principle
Contribute to safety:
 Protect workers from external influence; additional Recent progress in pre-hospital emergency/disaster
stress medicine:
 Free flow: victims/resources Establish AMP with especially skilled/trained -- “disaster field
 Protect general public from risk exposure ensured by medical teams”
police officers /special units (security: airport/  Good triage/stabilization capacity
building/ hospital/ establishments, etc.)  Specifically trained/up-skilled medical teams
 Good (radio) communications between the field
Personnel scene and medical facility
 High ranking officer (government police, fire, health, “Don’t transfer chaos in the scene, to the hospital.”
defense)
o Plant manager/ airport manager/chief Advance Medical Post (AMP)
security, etc. Purpose:
o Fire officer/ police officer skilled in  Reduce loss of life and limb - save as many as
ICS/MCM possible in the context of existing and available
 Identified by name/ position, coordinator/ resources or situation
commander  Victim’s status; chance of survival; resources
 May depend on what type of incident Location:
 Must be familiar with each other’s roles during  50-100 meters from Impact Zone (walking distance)
previous meetings/ drills/ simulation exercises  Direct access to: Evacuation/Road/Command Post
(policy)  Clear Radio-Com Zone… and SAFE (Upwind/Uphill)
 This core group cooperate with volunteer o Tent/building/open/mobile field hospital?
organizations Role:
 Provide “entry” medical triage
Method  Effective stabilization for victims of an MCI/Situation
The communication/coordination hub of the pre-hospital o Intubation, tracheostomy, chest drainage
organization. By constant re-assessment, CP will identify o Shock mgt, analgesia, fracture
needs to increase/decrease resources: immobilization
 Organize timely rotation of rescue workers o Control external bleed and dressing
 Ensure adequate supply of equipment/manpower  Convert red to yellow category as maybe possible
 Ensure welfare/comfort of rescue workers  Organize patient transfer to designated care
 Provide information to system, through an facility/ties.
Information Officer  AMP 3-T principle: Tag – Treat – Transfer
 Re-establish normal operations as soon as possible Personnel:
 Determine termination of field operations  ER. A & ED physicians/nurses (trained and skilled)
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 Support: Anesthetists/ Surgeons/ EMT’s/ Nurses/

Aiders, etc.

C P - Collecting Point near an unstable working area in the

impact zone

Triage
Basis: Color Tag
 Urgency (victim’s status)  Red: First priority; transferred ASAP to tertiary
 Survival (chance or likelihood) facilities in an equipped ambulance with medical
 Care - resource availability and capability escort
Objectives: Quick identification for immediate stabilization  Yellow: Second priority; after evacuation of Red;
for life-saving (measures) and surgery without life-threatening problem
Levels: OMEB  Green: Third priority; ‘walking wounded’ – to AS/
 On-site - ‘where they lie’ OPD
 Medical - at Advance Medical Post  Black: Last priority; to morgue; Forensic services;
 Evacuation - transport Public Health and Psycho-social interventions to
 Before the ER – hospital relatives/kin
On-site T:
Triage Area  Acute
 Headed by a Triage Officer  Non-acute
 To prioritize the management of casualties using Medical T:
RPM (for treatment and transport)  Red
 To report the number of priority tagged victims  Yellow
 To identify temporary mortuary area  Green
 To coordinate with the IC, IMC, Treatment Officer,  Black
Staging Officer Evacuation T - transport:
 Red
 Yellow
 Green
 Black

Treatment Area
 Headed by a Treatment Officer
 To designate an area for the red, yellow, and green
 Tagged victims with their respective medical officers
 To supervise the medical management of victims
 To prioritize transfer of victims to the transport area
 To coordinate with the IMC, Triage Officer,
Transport Officer, Staging Officer

First Aid
Personnel: Volunteers, fire, police staff, special units, EMT’s,
and medical personnel
 11

Location:
 On-site, before moving victim
 At collecting point/area in an unstable environment.
 “Green Area” of AMP
 Ambulance in transit to facility
Action: Primarily to transfer, with consideration of the ABC’s
order of priority

Transfer Organization
Preparation for Transport
 Assess patient’s status: vital signs, ventilation
 Check security of equipment or accessories
 Ensuring efficiency of immobilization measures
 Ensure triage tags: secure and clearly visible
Evacuation Procedures: Regulation
Principles
 Not to overwhelm care facility
 Avoid spontaneous evacuation of unstable patients

Transport Area
 Headed by a Transport Officer
 To supervise the transport of victims
 To identify the ingress and egress of the ambulances
 To provide appropriate type of ambulance to
transport the victims
 To ensure safety of responders and victims upon
loading and dispatch of ambulances
 To coordinate with the IMC, Treatment Officer,
Staging Officer, OpCen, receiving facility

Transfer Organization
Evacuation Procedures: Regulation
Rules
 Victim is in most possible stable condition
 Vehicle is adequately equipped for transfer
 Receiving facility correctly informed and ready
 The best possible vehicle and escort – available
Victim Flow
 “Noria” Principle… Spanish word from Arabic - …
”wheel” WW I Battle of Chemin de Dames, Verdun,
France.
 Conveyor belt’s flow from first aid to the most
sophisticated care level

Establishing a Mass Casualty Management System

 12

 Organizations should function as an extension of

Emergency Medical Service their core business.
 Can provide medical care on individual patient cases  Individuals are responsible for their own safety.
(small scale)  Disaster management planning should focus on
 A very good resource for logistics in terms of trained large-scale events.
personnel, supplies and equipment, and ambulances  Disaster management planning should recognize the
difference between incidents and disasters.
 Disaster management operational arrangements are
additional to and do not replace incident
management operational arrangements.
 Disaster management planning must take account of
the type of physical environment and the structure
DISASTER MANAGEMENT CONTINUUM of the population.
 Disaster management arrangements must recognize
DISASTER EDUCATION the involvement and potential role of non-
 Disaster Risk Reduction government agencies.
 Disaster Risk Reduction & Management
 Disaster Management Continuum Goals of Disaster Management
1. Reduce or avoid losses from hazards
To reduce the overwhelming damages caused by natural 2. Assure prompt assistance to victims
hazards, we should implement an ethic of – Prevention. 3. Achieve rapid and effective recovery

DISASTER RISK REDUCTION Disaster Management Cycle

Includes interdisciplinary efforts: 1. Before a disaster (pre-disaster): Activities which are
1. Disaster management taken to reduce human and property losses caused
2. Disaster mitigation by a potential hazard. E.g., Carrying out awareness
3. Disaster preparedness campaign; Strengthening a weak structures;
Preparation of a disaster management plan
DISASTER MANAGEMENT 2. During a disaster (disaster occurrence): Include
Disaster Risk Management initiatives taken to ensure that the needs and
 Includes all activities, programs, and measures that provisions of victims are met and suffering is
can be taken before, during, and after a disaster minimized. E.g., Emergency response activities
 To avoid disaster, reduce its impact, or recover from 3. After a disaster (post-disaster): Initiatives taken in
its losses response to a disaster with a purpose to achieve
early recovery and rehabilitation of affected
Disaster Management communities, immediately after disaster strikes. E.g.,
A continuous and integrated process of planning, organizing, Response and recovery activities
coordinating, implementing measures which are necessary
for: BEFORE DURING AFTER
 Prevention of danger or threat of any disaster Mitigation Preparedness Response Recovery
 Reduction of risk of any disaster or its severity or  Develop  Stock disaster  Search and  Debris removal
preventive laws and supplies kit rescue to  Precise damage
consequences and regulations identify affected
 Develop mutual assessment
 Capacity – building  Implement aid agreements people
 Infrastructure
 Preparedness to deal with any disaster advanced codes and plans  Assess initial destruction and
and standards  Train response damage reconstruction
 Prompt response to any threatening disaster  Establish zoning personnel and  Provide first-aid  Restore the
situation or disaster requirements concerned and livelihoods
 Assessing the severity or magnitude of effects of any  Buy insurance citizens humanitarian
assistance
 Community
  Prepare shelters
disaster Construct
and backup  Open and
development
barriers
 Evacuation, rescue, and relief facilities manage shelters
 Rehabilitation and reconstruction
Prevention/Mitigation
Principles of Disaster Management  Minimizing the effects of disaster
 Disaster management is the responsibility of all  Mitigation activities eliminate or reduce the
spheres of the government. probability of disaster occurrence, or reduce the
 Disaster management should use resources that effects of unavoidable disasters.
exist for a day-to-day purpose.
 13

UNISDR provided 7 ways to reduce vulnerability and prepare  Vulnerability – Having the conditions which increase
for disaster: AKITISM the susceptibility of a community to the impacts of
1. Adaptability - Recognizing where you and your hazards
family are not able to easily adapt, is the first step in  Exposure - Elements in the environment which
thinking of alternate ways to address them in a hazardous events may occur
disaster situation.  Capacity - The combination of all strengths and
2. Knowledge – Know the ff: hazards in your area, your resources available within a community, society or
vulnerabilities, your risk, and potential risks to your organization that can reduce the level of risk or the
property effect of the disaster
3. Integration - A widespread and strong social Process to develop an HRVA involves 9 steps: GIU AA BIGR
network is very helpful during and after disaster. 1. Getting started
Social media is a great, free tool that you can use.  Gather and compile information and
4. Trust – Before disasters, identify local trusted media knowledge on the community that already
sources that you know you can count on to provide exists
valuable information in the event of an emergency.  It is important to be realistic regarding the
5. Impact Avoidance - Referred to as mitigation and time and energy required
includes taking actions to reduce or eliminate risks of 2. Identify hazards
impact during a disaster  Gather hazard information
6. Subsistence - Gather the items that you and your  Conduct hazard identification workshops
family need to carry you through disaster. and interviews
7. Mobility - Access to transportation in the event of  Select applicable hazards from 57 hazards
evacuation list
Hyogo Framework for Action (HFA) outlines 5 priorities for  Define any unique local hazards
action, and offers guiding principles and practical means for  Provide a progress report to the executive
achieving disaster resilience: DIKRS committee
 Priority Action 1: Ensure that disaster risk reduction 3. Understand community risk and resilience
is a national and local priority with a strong  Describe existing risk reduction measures
institutional basis for implementation.  Gather or generate community maps
 Priority Action 2: Identify, assess and monitor  Identify social and economic, physical and
disaster risks and enhance early warning. environmental vulnerabilities
 Priority Action 3: Use knowledge, innovation and  Identify underlying risk drivers
education to build a culture of safety and resilience  Write hazard scenarios
at all levels. 4. Assess hazard likelihood
 Priority Action 4: Reduce the underlying risk factors  Gather and apply knowledge
 Priority Action 5: Strengthen disaster preparedness  Determine historical likelihood score
effective response at all levels  Understand and document changing
Hazard, Risk, and Vulnerability Analysis (HRVA) likelihood
 Purpose: To help a community make risk-based  Assess future likelihood
choices to address vulnerabilities, mitigate hazards  Conduct a hazard likelihood assessment
and prepare for response to, and recovery from, a workshop
range of hazard events 5. Assess consequences
 Hazards - Any phenomenon that has the potential to  Review consequence categories and rating
cause disruption or damage to people and their system
environment
 Rate and document consequences
 Risk - The probability of harmful consequences or
 Conduct a hazard consequence assessment
expected losses resulting from interactions between
workshop
natural or human induced has and vulnerable
6. Build a risk profile
conditions
 Read about risk matrices
 Disaster Risk – The chance of likelihood of suffering
 Generate risk level
harm and loss as a result of a hazardous event
 Generate risk matrix and consequence
 Element at risk - People, household, community
graph
structures, facilities and services, livelihood, and
 Review hazard priority levels
economic activities
 Optional: Provide a progress report to the
 Disaster risk assessment - A participatory process to
executive committee
assess the hazards, vulnerabilities and capacities of a
 Key deliverable: Rank hazard priorities
community
7. Identify risk reduction strategies
 14

 Review risk reduction measures already in 6. Children playing with fire

place 7. Christmas trees
 Recommend new risk reduction measures 8. Cooking
 Optional: Conduct a risk reduction Fire Safety and Prevention
measures workshop 1. Use the stairs not the elevator.
 Key deliverable: Determine risk reduction 2. Stay low.
strategies 3. Stop. Drop. Roll.
8. Generate and assemble your report 4. Seal off Smoke
 Generate preliminary report 5. Know the way out.
 Assemble companion documents 6. Test smoke alarms.
 Assemble and review final report (draft) The 7 Ways to Prepare for a Home Fire
 Optional: Present the HRVA report to your 1. Install the right number of smoke alarms. Test them
management committee once a month and replace the batteries at least once
 Key deliverable: Generate draft report a year.
9. Review and approve your report 2. Teach children what smoke alarms sound like and
 Obtain feedback from partners what to do when they hear one.
 Determine a maintenance schedule 3. Ensure that all household members know two ways
 Submit report for official approval to escape from every room of your home and know
 Publish and share final report the family meeting spot outside of your home.
 Optional: Provide document feedback 4. Establish a family emergency communications plan
and ensure that all household members know who
 Key deliverable: Submit report for review
to contact if they cannot find one another.
and approval
5. Practice escaping from your home at least twice a
Preparedness
year. Press the smoke alarm test button or yell “Fire”
Disaster Preparedness
to alert everyone that they must get out.
 Covers activities to enhance the ability to predict,
6. Make sure everyone knows how to call 9-1-1
respond to and cope with the effect of a disaster
7. Teach household members to STOP, DROP, and ROLL
 Includes precautionary activities by households,
if their clothes should catch on fire.
communities, and organizations to react
How to use fire extinguisher
appropriately during and following the event
PASS
Fire Preparedness
1. Pull the pin
 Fire outbreak may come by accident but for the most
2. Aim at the base of fire
part, it can be prevented.
3. Squeeze the operating handle
 With proper fire safety habits and a place designed
4. Sweep from side to side
to minimize the spread of fire, people have greater
Fire safety tips from the Philippine National Red Cross
chance of surviving this tragedy.
1. Avoid electrical overloading.
Four things must be present at the same time in order to
2. Unplug all electrical appliances after every use.
produce fire:
3. Check all electrical installations regularly.
 Enough oxygen to sustain combustion
4. Check gas stoves and LPG tanks for leaks.
 Enough heat to raise the material to its ignition 5. Keep children away from flammable liquids, lighters
temperature, and matches.
 Some sort of fuel or combustible material, and 6. Avoid smoking in bed.
 The chemical, exothermic reaction that is fire 7. Ensure you have a pre-fire plan at your residence or
Classification of Fuel: office.
 Class A - wood, paper, cloth, trash, plastics 8. Do not leave lighted mosquito coils unattended.
 Class B - flammable liquids: gasoline, oil, grease, 9. Always take extra precautions while cooking.
acetone; any non-metal in a liquid state, on fire 10. Never leave lighted candles unattended.
 Class C - electrical: energized electrical equipment; 11. Do not throw lighted cigar or cigarette butts on dried
any “plugged in” leaves and garbage.
 Class D - metals: potassium sodium, aluminum, 12. Strictly obey the “no smoking” signs.
magnesium 13. Maintain proper housekeeping to eliminate fire
Eight (8) Most Common Fire Hazards: hazards.
1. Candles 14. Check fire protection gadgets or devices of
2. Smoking appliances and equipment regularly.
3. Electrical and Lighting 15. Be fire safety conscious.
4. Dryers and washer machines The Four Major Natural Causes of Wildfires
5. Lightning 1. Lightning
 15

2. Sparks from rock falls  Keep a battery-powered radio, flash light, and first
3. Spontaneous combustion aid kits. Make sure everyone knows where they are
4. Volcanic eruption kept.
The Man-made (Human-Induced) Causes of Wildfires  Learning first aid is a must.
1. Arson  Avoid keeping heavy objects in high shelves.
2. Discarded cigarettes  Fasten heavy appliances to the floor, and anchor
3. Sparks from equipment heavy furniture to the wall.
4. Ignition of wildland fires via contact with hot rifle –  Discuss earthquake safety in school and at home.
bullet fragments  Conduct earthquake drills in school and at home.
5. Communities experiencing shifting cultivation when  Keep some food and drinking water, good for 3-7
land is cleared quickly and farmed until the soil loses days.
fertility and slash and burn clearing  Have home and school emergency evacuation plan.
6. Forested areas cleared by logging encourage the  Know the responsibilities during emergency.
dominance of flammable grasses What to do DURING an earthquake
7. Campfires  Remain calm; Don’t panic
8. Fireworks  Stay away from buildings, trees, if you’re outside.
9. Yard waste burning Many injuries occur when people enter or leave
10. Vehicles buildings.
Earthquake Preparedness  If indoors, stand against a wall near the center of the
What to expect? The first indication of a damaging building, or get under a sturdy table and make sure
earthquake that one’s head is covered.
may be a gentle shaking.  Stay away from windows and outside doors,
It’s important to take “quake-safe” action at the first cabinets, mirrors, and bookshelves.
indication of ground shaking. For example:  If one is in a high-rise building, make sure to stand
 Wall mounted objects may shake against a column or under a table or a desk. Never
 Suspended ceiling components may pop out use an elevator.
 Door frames may be bent by moving walls & may  If outdoors, stay in an open place and keep away
cause glass to shatter from overhead electric wires and bridges.
 The noise that accompanies an earthquake may  When one is in a moving vehicle, refrain from going
cause considerable emotional stress to bridges, keep away from over passes and stay
Hazard hunt inside the vehicle until the earthquake stops.
 Contrary to popular imagination, an earthquake does  In the event of an earthquake, it is important to
not cause the Earth to open up and swallow people. “DROP, COVER, and HOLD.”
 Anything that can move, fall, or break when the What to do AFTER an earthquake
ground starts to shake is an earthquake hazard if it  Check oneself and nearby people for injury and
can cause physical or emotional harm. provide first aid.
 Nursing students can remove objects in their homes  Turn on the radio or TV for emergency instructions.
that could fall and cause injury during earthquake  Reduce the use of phone lines because it may be
shaking. required for conveying some important messages.
 There will be some hazards in the classroom, home,  Stay out of damaged buildings.
community and health care institutions that nursing  Wear helmets and gloves to protect against
students will not be able to eliminate. shattered glasses and debris.
Prepare and Share Emergency Kits
 Check appliances, electrical lines, water and gas for
Earthquake Simulation and Drill
damage. Do not turn on anything until checked.
 Drop where you are, onto your hands and knees
 Avoid lighting matches, using any open flames, or
 Cover your head and neck with one arm and hand turning on appliances or electrical switches until you
 Hold on until shaking stops are sure that there are no gas leaks.
Earthquake can be destructive but everyone who takes  Check if there are any spilled bleaches, medicines,
appropriate safety precautions can minimize damages, gasoline, and other flammable liquids and clean it
injuries, and other potential quake concerns. There is no up.
effective warning system for earthquakes, which makes
 Anticipate and prepare yourself for aftershocks. This
preliminary precautions even more essential. At the same
could lead to further damages on already weakened
time, knowing what to do and how to behave when a quake
structures.
occurs and what to do after the event is just as important as
Volcanic Eruptions Preparedness
staying safe.
The following are commonly observed that a volcano is about
What to do BEFORE an earthquake
to erupt:
 16

1. Increase in the frequency of volcanic quakes with  Clear heavy ash from flat or low-pitched roofs.
rumbling sounds; occurrence of volcanic tremors;  Avoid running car or truck engines. Driving can stir
2. Increased steaming activity; change in color of steam up volcanic ash that can clog engines and damage it.
emission from white to gray due to entrained ash;  If you have to drive, keep speed down to 35 MPH or
3. Crater glow due to presence of magma at or near the slower.
crater; When outside:
4. Ground swells (or inflation), ground tilt, and ground  Cover mouth and nose
fissuring due to magma intrusion;  Wear goggles
5. Localized landslides, rock falls, and landslides from  Keep skin covered
the summit area which are not attributable to heavy  Clear roofs of ashfall
rains;  Avoid driving
6. Noticeable increase in the extent of drying up of  Go to a designated public shelter if have been told to
vegetation around the volcano upper slopes, evacuate
7. Increase in the temperature of hot openings, wells, Typhoon Preparedness
crater lake near the volcano; Signs of impending typhoon
8. Noticeable variation in the chemical content of  Cumulus clouds – indicates thunderstorm
springs, crater lakes within the vicinity of the  Cirrus clouds – strand-like clouds that form almost
volcano; above 20,000 feet in sky; indicates a change in
9. Drying up of springs / wells around the volcano; and weather
10. Development of new thermal areas and/or  Lenticular clouds – like wave clouds; indicates
reactivation of old presence of strong winds in upper part of
During a volcanic eruption atmosphere; large incoming storm
 Follow the evacuation order issued by authorities  Dark sky – incoming bad weather
and evacuate immediately from the volcano area to  A drop in barometric pressure gauge – indicates rain
avoid flying debris, hot gases, lateral blast, and lava or snow
flow. What to do before and during typhoon
 Be aware of mudflows/landslides-debris-flow. The  Radio or TV
danger from a mudflow increases near stream  Identify safe shelter in area
channels and with prolonged heavy rains. Mudflows
 Keep emergency kit
can move faster than you can walk or run. Look
 Strengthen doors, windows
upstream before crossing a bridge and do not cross
 Conduct mock drills for family and community
the bridge if a mudflow is approaching.
 Do not venture into sea
 Avoid river valleys and low-lying areas.
 Remain indoors until advised
 Remembering to help your neighbors who may
After typhoon
require special assistance – infants, elderly people,
 Do not go out until advised that it is safe
and people with access and functional needs.
 Use recommended rout to return to home
 Protection from falling ash
 Be careful of broken power lines, damaged roads
o If you are unable to evacuate, and to
and house, fallen trees
protect self from falling ash, you should
Flood Preparedness
remain indoors with doors, windows, and
Types of Floods
ventilation closed until ash settles.
 Ice jam - flooding occur when the snow melts at a
o If you have a respiratory ailment, avoid
very fast rate
contact with any amount of ash. Stay
 Coastal floods – associated with cyclonic activities
indoors until local health officials advise it is
like hurricane, tropical cyclones generating a
safe to go outside.
catastrophic flood from rain water which aggravate
 Listen to a battery-powered radio or TV for the latest
wind induced storm and water surges along the
emergency info.
coast
 Wear long-sleeved shirts and long pants.
 Urban flood - as land is converted from agricultural
 Use goggles and wear eyeglasses.
farm to roads and parking lots, it loses its ability to
 Use a dust mask or hold a damp cloth over face to
absorb rainfall
help with breathing.
 Flash floods – occurring within 6 hours post heavy
 Stay away from areas downwind from the volcano to
rain fall; requires rapid localized warning system
avoid volcanic ash.
 River floods – caused by precipitation over a large
 Stay indoors until the ash has settled unless there is
catchment’s area, melting snow or both
a danger of the roof collapsing.
 Close doors, windows, and all ventilation in house.
 17

 Glacial Lake Outburst Flood (GLOF) – melted big  Presentation skills

glaciers resulting to discharge of large volumes of  Patient education
water and debris, causing flood in the downstream  Compassion
Causes of floods  Cultural awareness
 Intense rainfall when river is flowing full  Personal connections
 Cyclone and intense rainfall when El Nino effect is on  Trust
a decline  Active listening
 Synchronization of flood peaks in main rivers or their
tributaries
 Landslides leading to obstruction of flow in river
 Poor natural drainage system
Flood response
 The role of communities and NGOs is vital in search, INTERNATIONAL CLASSIFICATION OF DISEASES, 11TH
rescue, and relief operations REVISION (ICD-11)
 Immediate medical assistance to the affected people International Classification of Diseases (ICD)
and steps for prevention of outbreak of epidemics  Designed to promote international comparability in
after the floods the collection, processing, classification, and
 DM Act 2005: The GOI has constituted National presentation of mortality statistics
Disaster Response Force (NDRF) for the purpose of  Includes providing a format for reporting causes of
specialized response to disasters death on the death certificate. The reported
Tsunami conditions are then translated into medical codes
 One of the most dangerous effect and primary cause through use of the classification structure and the
of an earthquake selection and modification rules contained in the
 Known as tidal waves - giant waves that can cause applicable revision of the ICD, published by the
flood. It happens because of sub ocean faulting of World Health Organization (WHO).
the ocean floor sending seismic waves through water  Started on January 1, 2022
and making huge waves of low amplitude yet long Mortality Statistics
stretch moving at 500-700 mph  Help track the characteristics of those who have
 Tsunami are created by big splashes made in deep died, monitor and make decisions about public
oceans by fault movement, volcanic eruptions, health challenges, determine life expectancy, and
landslide, meteorite impacts… compare death trends
 Tides, wind, storms have nothing to do with tsunami
 Cannot be accurately predicted ICD-11
 Philippines is prone to tsunami  Almost five times as big as the ICD-10
Natural Signs of Impending Tsunami  Created following a decade of development
 Water receding from the coast, exposing the ocean involving over 300 specialists from 55 countries
floors  Following an alpha version in May 2011 and a beta
 Reefs and movement of the fishes draft in May 2012, a stable version of the ICD-11 was
 Create unusual loud roaring sound similar to train or released on June 18, 2018 and officially endorsed by
jet plane all WHO members during the 72nd World Health
 Large earthquake may be felt undersea Assembly on May 25, 2019
 For the ICD-11, the WHO decided to differentiate
COMMUNICATION PLAN between the core of the system and its derived
specialty versions, such as the ICD-O for oncology. As
EFFECTIVE COMMUNICATION such, the collection of all ICD entities is called the
Importance in Nursing Foundation Component. From this common core,
 Essential to collaborating on teams with fellow subsets can be derived. The primary derivative of the
nurses and colleagues from other disciplines Foundation is called the ICD-11 MMS, and it is this
 Essential to patient-centered care system that is commonly referred to and recognized
 Better prepared to address issues as they arise, as "the ICD-11". MMS stands for Mortality and
resulting in better patient outcomes Morbidity Statistics.
 Comes with an implementation package that
Effective Communication Skills includes transition tables from and to ICD10, a
 Written communication translation tool, a coding tool, web services, a
 Nonverbal communication manual, training material, and more. All tools are
 Verbal communication
 18

accessible after self-registration from the  An Act Providing Policies and Prescribing Procedures
Maintenance Platform. on Surveillance and Response to Notifiable Diseases,
 The ICD provides a common language that allows Epidemics, and Health Events of Public Health
health professionals to share standardized Concern, and Appropriating Funds Therefore,
information across the world. The ICD-11 contains Repealing for the Purpose Act No. 3573, Otherwise
around 17 000 unique codes, more than 120 000 Known as the "Law on Reporting of Communicable
codable terms and is now entirely digital. Diseases"
 All Member States are encouraged to follow their  “Mandatory Reporting of Notifiable Diseases and
commitment to move on to ICD-11 documented with Health Events of Public Health Concern Act”
their approval of ICD-11 at the 72nd meeting of the
World Health Assembly in 2019, and use the most Definition of Terms
current version of ICD for recording and reporting  Disease control: Refers to the reduction of disease
mortality and morbidity statistics both nationally and incidence, prevalence, morbidity, or mortality to a
internationally. locally acceptable level
New in ICD-11 2022  Disease response: Refers to the implementation of
 35 countries are using ICD-11. specific activities to control further spread of
 Current implemented uses of ICD-11 include causes infection, outbreaks or epidemics and to prevent
of death, primary care, cancer registration, patient reoccurrence
safety, dermatology, pain documentation,  Disease surveillance: Refers to the ongoing
allergology, reimbursement, clinical documentation, systematic collection, analysis, interpretation, and
data dictionaries for WHO guidelines, digital dissemination of outcome-specific data for use in the
documentation of COVID-19 vaccination status and planning, implementation, and evaluation of public
test results, and more. health practice in terms of epidemics, emergencies,
 French language is now available alongside Arabic, and disasters
Chinese, English, & Spanish. Russian and 20 more  Epidemiologic investigation: Refers to an inquiry to
languages are underway. the incidence, prevalence, extent, source, mode of
 Terminology coding with the coding tool and API transmission, causation of, and other information
 Rare diseases coding pertinent to a disease occurrence
 Support for perinatal and maternal coding
 900 proposals were processed based on input from Notifiable Diseases
early adopters, translators, scientists, clinicians and  A disease that, when diagnosed, requires health
partners. providers (usually by law) to report to state or local
 Grade and stage coding for cancers public health officials
 Clinical Descriptions and Diagnostic Requirements  Of public interest by reason of their contagiousness,
for mental health severity, or frequency

ICD-11 was specifically designed for the following use cases: RA 11332, Section 3
 Certification and reporting of causes of death Public health emergency refers to an occurrence or imminent
 Morbidity coding and reporting including primary threat of an illness or health condition that:
care 3.12.a. Is caused by any of the following: (i) Bioterrorism; (ii)
 Case mix and Diagnosis-Related Grouping (DRG) Appearance of a novel or previously controlled or eradicated
 Assessing and monitoring the safety, efficacy, and infectious agent or biological toxin; (iii) A natural disaster; (iv)
quality of care A chemical attack or accidental release; (v) A nuclear attack or
 Cancer registries accident; or, (vi) An attack or accidental release of radioactive
 Antimicrobial resistance (AMR) materials; and,
 Researching and performing clinical trials and 3.12.b. Poses a high probability of any of the following: (i) A
epidemiological studies large number of deaths in the affected population; (ii) A large
 Assessing functioning number of serious injuries or long-term disabilities in the
 Coding traditional medicine conditions affected population; (iii) Widespread exposure to an
 Interoperability standard in WHO Digital Guidelines infectious or toxic agent that poses a significant risk of
and for Digital Documentation of COVID-19 substantial harm to a large number of people in the affected
Certificates (DDCC) population; (iv) International exposure to an infectious or
 Clinical documentation toxic agent that poses a significant risk to the health of
citizens of other countries; or, (v) Trade and travel restrictions
RA 11332
Section 5.2
 19

The selection and the deletion of diseases and health events business permit and license to operate of the concerned
of public health concern, including the procedure to be facility, institution, agency, corporation, school, or legal entity
followed, shall be governed by DOH Administrative Order No. shall be cancelled.
2018 - 0028 or the “Guidelines for the Inclusion and Delisting
of Diseases, Syndromes, and Health Events in the List of Priority Diseases/Syndromes/Conditions Targeted
Notifiable Diseases, Syndromes and Health Events of Public for Surveillance
Health Concern (NDEPH)” Diseases spread by droplet:
The criteria for inclusion, recommendation, and issuance of I. Bacterial Meningitis
the List of Notifiable Diseases and Health Events of Public  Haemophilus influenzae type b (Hib)
Health Concern for mandatory reporting are any one or more  Streptococcus Pneumonae
of the following: II. Coronavirus disease 2019 (COVID-19)
5.2a. Disease is of international or national concern;  Severe Acute Respiratory Syndrome (SARS)-
5.2b. Disease has epidemic or outbreak potential; associated coronavirus 2 (SARS-COV2)
5.2c. Disease is being eliminated; III. Diphtheria
5.2d. Disease is included in the top ten (10) leading cause of  Corynebacterium Diphtheriae
morbidity and/or mortality in the Philippines; IV. Hand, Foot and Mouth Disease
5.2e. Disease with large number of serious or long-term V. Human Avian Influenza
disabilities in the affected population; VI. Influenza-like Illness (ILI)
5.2f. Disease with large number of deaths in the affected VII. Severe acute respiratory syndrome
population; (SARS)
5.2g. Disease characteristics, prevalence, incidence and/or  SARS-associated coronavirus
mortality is changing and would likely impact public health; VIII. Measles
5.2h. Disease is a priority of the DOH; and  Measles morbillivirus
5.2i. Disease or health event that fulfills either one of the IX. Meningococcal Disease
following surveillance goals:  Neisseria Meningitis
5.2i.i. To monitor and control the spread of disease; and X. Middle East Respiratory Syndrome
5.2i.ii. To monitor the trends of a disease over time. (MERS)
 Middle East respiratory syndrome coronavirus
Epidemics can be detected through the following surveillance (MERS-CoV); and
systems: XI. Pertussis (Whooping Cough)
a. Case-based — routine collection of data, analyzed  Bordetella Pertussis
on a periodic basis.
b. Event-based — reports are received anytime from Airborne diseases:
sources outside the routine reporting system (e.g. I. Anthrax
Media reports).  Bacillus Antracis
c. Laboratory-based — reporting of laboratory results II. Human Avian Influenza
based on criteria (e.g. Influenza surveillance). III. Influenza-like Illness (ILI); and
IV. Measles
Section 10  Measles morbillivirus
10.1 Any person or entity found to have violated Section 9 of
this IRR shall be penalized with a fine of not less than twenty Diseases spread by direct contact:
thousand pesos (P20,000.00) but not more than fifty I. Acute Viral Hepatitis
thousand pesos (P50,000.00) or imprisonment of not less  Hepatittis A virus (HAV)
than one (1) month but not more than six 6) months, or both  Hepatitis B virus (HBV)
such fine and imprisonment, at the discretion of the proper  Hepatitis D virus (HDV)
court. II. Anthrax
10.2 The Professional Regulation Commission shall have the
 Bacillus Anthracis
authority to suspend or revoke the license to practice of any
III. Bacterial Meningitis
medical professional for any violation of this IRR.
 Group B streptococcus
10.3 The Civil Service Commission shall have the authority to
 Escherichia Coli
suspend or revoke the civil service eligibility of a public
 Neisseria Meningitidis
servant who is in violation of this IRR.
IV. Diptheria
10.4 If the offense is committed by a public or private health
 Corynebacterium Diphtheriae
facility, institution, agency, corporation, school, or other
V. Hand-Foot and Mouth Disease
juridical entity duly organized in accordance with law, the
VI. Leptospirosis
chief executive officer, president, general manager, or such
 Leptospira
other officer in charge shall be held liable. In addition, the
 20

VII. Meningococcal Disease 7. Meningococcal Disease

 Neisseria Meningitidis 8. Middle East Respiratory Syndrome (MERS)
VIII. Rabies 9. Paralytic Shellfish Poisoning
 Rabies Virus (RV) 10. Rabies
11. Neonatal Tetanus
Vehicle Borne Disease: 12. Severe Acute Respiratory Syndrome (SARS)
I. Acute Bloody Diarrhea 13. COVID-19
 Campylobacter bacteria Weekly Notifiable (Category II)
 Salmonella bacteria AAAA DD BCLIMN PT
 Shigella species (bacillary dysentery) 1. Acute Bloody Diarrhea
 Entamoeba histolytica (amoebic dysentery) 2. Acute Encephalitis Syndrome
 Enterohaemorrhagic E. coli (EHEC) 3. Acute Hemorrhagic Fever Syndrome
II. Acute Viral Hepatitis 4. Acute Viral Hepatitis
 Hepatitis A virus (HAV) 5. Dengue
 Hepatitis B virus (HBV) 6. Diphtheria
 Hepatitis C virus (HCV) 7. Bacterial Meningitis
 Hepatitis D virus (HDV) 8. Cholera
 Hepatitis E virus (HEV) 9. Leptospirosis
III. Anthrax 10. Influenza-like IIness
 Bacillus anthracis 11. Malaria
IV. Bacterial Meningitis 12. Non-neonatal Tetanus
 E. coli 13. Pertussis
14. Typhoid and Paratyphoid Fever
 Listeria monocytogenes
V. Cholera
Submission of Report to the Local Epidemiology and
 Vibrio cholerae
Surveillance Units
VI. Neonatal Tetanus
Mandatory reporting of notifiable diseases or health events
 Clostridium tetani
of public health concern shall be done by:
VII. Paralytic Shellfish Poisoning
 Submitting the Case Investigation Form (CIF) for
VIII. Typhoid and Paratyphoid fever; and
diseases/syndromes under Category I diseases/
 Salmonella enterica serotype Typhi
syndromes), or
 Salmonella enterica serotype Paratyphi A, B (tartrate
 Case Report Form (CRF) for diseases/syndromes
negative) and C (S. Paratyphi)
under Category II
IX. Poliomyelitis (Acute Flaccid Paralysis)
to the local epidemiology and surveillance unit (LESU).
 Poliovirus
PHILIPPINE INTEGRATED DISEASE SURVEILLANCE AND
Vector-borne diseases:
RESPONSE (PIDSR)
I. Dengue
Disease surveillance is recognized as the cornerstone of
 Dengue Viruses (DENV -1, -2, -3, and -4)
public health decision-making and practice.
II. Acute Encephalitis Syndrome
 Japanese Encephalitis Virus
Surveillance data provide information that can be used for
III. Malaria
priority setting, policy decisions, planning, implementation,
 Plasmodium Parasites (P. falciparum, P. malariae, P. resource mobilization and allocation, prediction, and early
Ovale and P. Vivax) detection of epidemics.
Categories of Notifiable Diseases and Health Events of Public A surveillance system can also be used to monitor, evaluate
Health Concern and improve disease prevention and control programs. Also,
1. Immediately notifiable (Category I) the Surveillance system generates data that is helpful to
2. Weekly notifiable (Category II) Public Health Officials in understanding the existing and
Immediately Notifiable (Category I) emerging
AAA HH MMM PRNS C infectious and non-infectious diseases.
1. Acute Flaccid Paralysis
2. Adverse Event Following Immunization Purpose of the Manual
3. Anthrax
 A general reference for surveillance activities across
4. Hand-Foot-and-Mouth Disease
all levels
5. Human Avian Influenza
6. Measles
 21

 A resource for developing training, supervision and 4. To enhance utilization of disease surveillance data
evaluation of surveillance activities for decision-making policy development, program
 A guide for improving early detection and management, planning, monitoring and evaluation
preparedness activities for improved and timely at all levels.
response
Basic Features of PIDSR
Who should use this manual? 1. Integrated in terms of the use of standard case
 Managers of the communicable disease program, definitions, surveillance core activities (detection,
Expanded Program on Immunization, and registration, reporting, confirmation, analysis,
Environmental Health and Sanitation Program feedback) and resources.
 Members of the epidemic investigation and control 2. Capacity for early detection of epidemics.
team 3. Integrated response to epidemics and other public
 Members of the epidemic management committee health threats.
at all levels 4. Utilizes case-based, laboratory-based and event-
 Health emergency management staff based surveillance approaches to enhance sensitivity
 Medical doctors, nurses and other allied health and specificity of the system.
professionals 5. Strengthens local capacity for surveillance and
 Community health volunteers response. This includes involvement of the
community in disease surveillance activities. The
Integrated Disease Surveillance primary role of the LGU is to provide appropriate
 A process of coordinating, prioritizing, and intervention to emerging diseases, epidemics and
streamlining of multiple disease surveillance systems other public health threats.
into a unified national disease surveillance system 6. Established capacity of laboratories and
that combines core surveillance activities and strengthened involvement in disease surveillance
support functions into a single integrated activity for system.
the purpose of making the system more efficient and 7. Efficient and effective management of surveillance
effective in providing timely, accurate and relevant data (e.g., collection, analysis, interpretation and
information for action dissemination) and use of information for decision-
making, including monitoring and evaluation of
Scope of PIDSR intervention programs at all levels.
 Entire health sector, including public and private, 8. Open lines of communication with established
national agencies and local government units, feedback loop at all levels.
external development agencies, and the community
involved in disease surveillance and response SURVEILLANCE IN POST EXTREME EMERGENCIES AND
activities; DISASTERS (SPEED)
 Routine surveillance of priority diseases and events Surveillance
identified by the Department of Health;  Ongoing, systematic collection, analysis, and
 Routine surveillance complements the Event-based interpretation of health-related data essential to the
surveillance of priority diseases and events. planning, implementation, and evaluation of public
health practice, closely integrated with the timely
Goal and Objectives of PIDSR dissemination of these data to those responsible for
Goal: To support the health sector in reducing morbidity and prevention and control
mortality from diseases of public health importance through  Surveillance, per se, does not include the public
an institutionalized, functional integrated disease surveillance health action(s) resulting from the interpretation of
and response system. the data.
Objectives
1. To continually improve capacities at the national and Aims and Objectives
regional levels to efficiently and effectively manage  Establish health care priorities
national and sub-national surveillance and response  Follow trend and reassess priorities
system.  Detect and respond to epidemics
2. To mobilize and empower LGUs in the establishment  Evaluate program and or effectiveness
and institutionalization of disease surveillance and  Ensure targeting of resources
response system.  Evaluate quality of health care
3. To support health sector capacity development for
sustainable disease surveillance and response Surveillance: General Principle
system.
 22

Design of a Surveillance Reporting Form

 Simple, flexible and accurate Normal to emergency shift… The more that surveillance
system is needed and must be established as soon as
 Standardize for all agencies
possible. And surveillance data must always be link with
 Consistent at all levels of the reporting chain
information management and public health actions.
 Resembles computer data entry format
 No duplication
 Continuous use
Community-based Surveillance
 Include breakdown
“The detection and reporting of diseases from within the
community usually by local people or leaders who have
Analysis and Presentation of Data
received basic instruction on how to recognize certain
 Focus on mortality rate and key morbidity indicators
conditions”
 Follow trends through graphs
 Ensure routine mechanism to provide data to
Background
program managers in comprehensible format
Massive flooding in NCR, Regions III, IVA
↓
Service Needs in an Emergency
Massive displacement and isolation of communities =
diseases
↓
Delayed reporting + Delayed action = Leptospirosis outbreak
post-Ondoy (resulting to 3,389 cases with 249 deaths = one of
the world’s largest documented outbreaks)
Key challenge identified: Need for health information system
during emergencies and disasters that will give timely
information to allow for evidence-based decision-making, and
more focused and targeted response.

Objective of SPEED
 Detect early unusual increase in communicable and
non-communicable health conditions
 Identify the exact location of health events
 Enable identification of appropriate response to
handle the emergency
Support functions that improve surveillance  Monitor health trends to determine effectiveness of
 Setting of standards (e.g. case definitions) intervention
 Training and supervision
 Setting up laboratory support Key Features of SPEED
 Setting up communications  Utilizes syndromic surveillance
 Resource management  Adopts available information and communication
technology (ICT) such as paper-based reporting, text
Health Care Services in Evacuation Center messaging and the Internet for data collection,
analysis, and report generation
 Focuses on the 21 most common health conditions
encountered after a disaster
 23

 Has an Immediate Notification Alert system that 4. In case of reports on morbidity and health services
instantaneously cues the health system where provided, do the data include all illnesses attended
immediate response is most needed and services provided by all sectors?
 Complements the existing routine surveillance 5. Are all the items in the form filled-in?
systems Effects of Incomplete Report
 Only a partial picture of the health situation is
SPEED is Syndromic presented
 Purpose: Detecting unusual cases and clusters of  Lead to non-comparable reports
diseases early to respond rapidly to limit the impact  Can lead to over under-estimation of levels of
and outbreak indicators, especially if the places with missing data
 Data: Are those which describe actions have some particular characteristics
 Building Block: To identify and predict trends/as  Can lead to problems in data analysis, especially if
they are occurring the variables with missing data are important for the
 Characteristic: Quick – flexible and dirty – bias, but understanding of the health situation
they serve to answer immediate questions Important Reminders:
If we are reporting incomplete data, make sure that:
Characteristics of Syndromic Surveillance 1. You indicate the extent and nature of
 Data is routinely collected incompleteness of the data
 It does not rely on physician reporting 2. You do not leave as blank those in a form or report
 Data are immediately computerized with missing data
 It is population based 3. You take into account the missing information when
 Data are categorized by syndrome doing computations
o Not replace routine surveillance
o Not replace the need for laboratories to Accuracy
confirm cases Indicators of the inaccuracy in the data
o No be conducted in isolation Logical Inconsistency:
a. In relation to events which occurred
Desired Characteristic of Data b. In comparison to characteristics of person, place and
CART time
1. Completeness c. Large and sudden changes in numbers reported
2. Accuracy d. Inconsistency with numbers reported for other
3. Reliability related variables
4. Timeliness Reported Data = Truth

Timeliness Reliability
a. Data of Occurrence of event
b. Date of Data Collection, Recording and report
preparation
c. Date of Submission of Report
d. Date of data\Dissemination
e. Date when Data is needed
Effects of timeliness problems
 Submission of incomplete report
 Allocation of certain events to the time period
 Problems lead to domino effect
 Functionality of syndromic surveillance lies largely on Common Factors Affecting the Reliability of the Data
the timeliness of the information reported  Lack of systematic/organized way of generating and
storing data at health facility
Completeness  Duplication and proliferation of forms
5 Areas of Concern:  Definition of concepts not standardized
1. Do the data cover the whole geographic area  Definition of concepts not clearly understood by
supposed to be covered by the report? health staff resulting in different persons having a
2. Do the data cover the whole target population who different definition
should be included in the report?
3. Do the data include the whole time period supposed Descriptive Data Analysis
to be covered by the report?
 24

SPEED has automated analysis, generation of tables, charts to Reporting Flow

improve timeliness 1. Consultations at hospitals, RHUs, BHS, and
 Analysis by person, time (graphs), place (maps) evacuation centers
 Total Number of Cases/age group/day (mun/city) 2. Accomplishment of appropriate standard SPEED
 Total Number of Deaths/age group/day (mun/city) reporting tool
Study of the occurrence and distribution of disease in terms 3. Sending of SPEED data in the SPEED form thru
of: texting/ available modes
 Time 4. Entry of reports into the server
o When does the disease occur commonly or 5. Validation of cases reported via SPEED c/o MHO/
rarely? CHO/ PHO/ CHD/ DOH-HEMS
o Is the frequency of disease at present 6. Data analysis and report generation at all levels
different from the frequency in the past? 7. Dissemination of information to health emergency
 Place managers for action
o Where the rates of disease highest or 8. Action: (1) Immediate interventions
lowest? (2) Further investigation
 Person (3) Intermediate measures
o Who is getting the disease? CHD – Center for Health Development (DOH office in the
region)
DOH-HEMS – Dept of Health – Health Emergency
Management Staff (central Office)

SPEED Website
Allows for descriptive analysis and report-generation: Activation of SPEED (Within the first 24 hours post-disaster)
 Detail of age group affected by which health Mandatory Activation Criteria
conditions in which health facilities during which All the governed health facilities must activate SPEED if:
time frame through tables, line graphs, and maps  There is an official declaration of a State of Calamity
by the Local or National Government with the public
health impact of the emergency/disaster exceeding
capacity of the Local Government to respond; or
 The active evacuation centers are projected to last
for more than 2 days.
OR any two (2) of the following conditions are present:
 Any hazard with public health consequences
affecting a significant population
 Increasing hospital consultations and admissions
related to the disaster
 Disrupted health services and/or response among
the affected population
Key Players  Occurrence of diseases with a potential for an
Players Roles outbreak
Reporters Local health staff/ partners: data  Isolation of the community brought about by
collection and reporting damage to lifelines (roads, bridges,
Data managers MHO/CHO: data validation, data telecommunications, electricity) or a threat to
analysis, report generation and security exists
dissemination
PHO: data validation and analysis, Who activates SPEED?
report generation and dissemination;  Municipal Health Office/City Health Office - upon
LGU monitoring and tech. assistance the declaration of a state of calamity by the Local or
CHD: data validation and analysis, National Government; or
report generation and dissemination;  Provincial Health Office - If the emergency is of
LGU monitoring and tech. assistance provincial concern; or
Program DOH-HEMS: report generation,  Center for Health Development- If the emergency is
manager corresponding action; technical of regional concern; or
assistance to regions  Department of Health Central Office - If the
emergency is of nationwide concern as declared by
 25

the Office of the President or the National Disaster 2. Immediate Notification Alert – message which
Risk Reduction and Management Council (NDRRMC). signals that the threshold for such disease/event
being monitored under SPEED is breached. It should
De-activation of SPEED be sent right after the case was seen.
 When there is an official declaration that the disaster
or emergency is over, or Flow of SPEED Data Collection
 The conditions that warrant SPEED activation no
longer exist

What are the data to be collected?

 21 communicable and non-communicable health
conditions, including injuries (enumerated in SPEED
reporting forms with assigned disease codes)

Where will data be collected?

1. Evacuation Center (EC)
2. Barangay Health Stations (BHS)
3. Health Centers and RHU
4. MHO/CHO
5. Hospitals (H)

What tools will be used for data collection?

Reporting Where to Who will What to collect Syndrome or Diseases Under SPEED
Form collect collect Case Definition
SPEED 1. EC Designated S/SX of the 21  A set of standard criteria for deciding whether a
Form 1 2. RHU SPEED communicable and
person has a particular disease or other health
3. BHS Reporters: non-communicable
4. MHO/CHO doctors, nurses, health conditions related condition (signs, symptoms, laboratory)
midwives, being monitored by  Used to ensure that every case is diagnosed in the
BHWs, or SPEED same way, regardless of when or where it occurred
volunteers from
NGOs
SPEED Hospitals Hospital HEMS Initial diagnosis and Infectious Diseases
Form 2 coordinators, or findings of the 21
their designated communicable and Health Health Main S/SX Possible Cause Notification
SPEED Reporters non-communicable Event Event/ (SPEED Form 1) Alert
in their OPD and diseases and other CODE Disease Threshold
ER non-communicable (SMS (SPEED Form (Phone/SMS)
health conditions Form) 2)
being monitored by FEV Fever Fever -- Unusual
SPEED clusters or
increase
How will SPEED reports be sent? ARI Acute Cough, colds, Common Unusual
respiratory or sore throat, colds, clusters or
1. Voice call or texting via mobile phones infections w/ or w/o Pneumonia, increase
2. Voice call via telephones fever Influenza
3. Via fax machine Increased risk in inadequate shelter, overcrowding, malnutrition, under 1year
4. Two-way radio old (infants), elderly, and rainy season
MEA Suspected Fever with rash Measles, One
5. Via email
Measles German suspected
6. Via hand-carry measles, case
chicken
Types of SPEED reports pox
AHF Acute Fever with Dengue, blood One
1. SPEED Daily Report – list of consults/cases from the
hemorrhagic spontaneous dyscrasias, suspected
logbooks, forms, or records of health centers, BHS, fevers bleeding (i.e. Nutritional case
and ECs. The data collection period is from 8 am to 4 nose bleeding, disorders,
pm. It should then be sent to the MHO/CHO by 5 pm gum bleeding) Meningococcal
disease
everyday.
MEA: Increased risk in overcrowding, malnutrition, population movement, and
Measles immunization coverage <80% in area where case originates
 26

AHF: Increased risk in dengue hemorrhagic fever endemic areas, vector and poor hygiene
breading sites (e.g. flooding), poor vector control AFP: Increased risk of polio when there is disruption of immunization program,
MEN Suspected 12 mos and Bacterial 2 suspected overcrowding of none immune groups, and collapse of sanitary infrastructure
Meningitis over: sudden meningitis, cases of
onset of fever viral meningitis in
Injuries
(>38°C) with meningitis, the same
severe encephalitis week in one
headache and evacuation Health Health Main S/SX Possible Cause Notification
stiff neck center or Event Event/ Alert
<12 mos: fever settlement CODE Disease Threshold
(>38°C) with (Phone/SMS)
bulging WBS Open -- Trauma – due to Unusual clusters
fontanel, or wounds and the disaster or increase
refusal to suckle bruises
Increased risk in overcrowding, and where there are high rates of acute FRS Fractures -- Trauma – due to Unusual clusters
respiratory infections the disaster or increase
LEP Suspected Fever with Leptospira One Fractures, wounds and bruises: Often associated with injuries received from
Leptospirosis headache, suspected direct impact of the disaster
muscle pains case ANB Animal bites Pain, Insects Unusual clusters
and any of the wounds (scorpions), or increase
ff: eye irritation, and dogs, snakes
jaundice, skin bruises
rash, scanty
urination
Increased risk during flooding and contamination of water by rat urine, contact Risk of rabies associated with dog bites; scorpion and snake bites are
with infected domestic and other animals (dogs, pigs, rats), inadequately potentially fatal
treated drinking water sources, poor hygienic conditions in evacuation centers
and immediate environment
AJS Acute Yellow eyes or Viral Hepatitis, A cluster of 3
jaundice skin w/ or w/o Leptospirosis, cases of AJS
syndrome fever Chemical toxins in the same Chronic Diseases
reporting
unit Health Health Main S/SX Possible Cause Notification
Increased risk of viral hepatitis in overcrowding, inadequate quantity and/or Event Event/ Alert
quality of water, poor personal hygiene, poor washing facilities, poor sanitation CODE Disease Threshold
AWD Acute watery 3 or more loose Cholera, Viral/ 1 death or a (Phone/SMS)
diarrhea stools in the bacterial cluster of 5 HBP High Blood BP >140/90 -- Unusual clusters
past 24 hours) gastroenteritis cases in one Pressure or increase
w/ or w/o week
dehydration AAA Acute Difficulty in -- Unusual clusters
ABD Acute bloody Loose stools Amebiasis, A cluster of 5 asthmatic breathing and or increase
diarrhea with visible Salmonellosis, cases in one attack wheezing
blood Shigellosis week KDM Diabetes NB: May be -- Unusual clusters
Increased risk in overcrowding, inadequate quantity and/or quality of water, asymptomatic or increase
poor personal hygiene, poor washing facilities, poor sanitation. Shigella is the Disruption of drug supply due to a disaster may lead to poor control of blood
most common cause of bloody diarrhea pressure, asthma and diabetes and related complications
SDS Skin diseases Infected or Chemical Unusual
allergic rash irritants, clusters
infections or increase Malnutrition
(scabies)
CON Conjunctivitis Eye itchiness, Chemical Unusual Health Health Main S/SX Possible Cause Notification
redness w/ or irritants, clusters Event Event/ Alert
w/o discharge infections or increase CODE Disease Threshold
(trachoma) (Phone/SMS)
Increased risk in overcrowding, inadequate water supply, poor hygienic AMN Acute Visible Severe acute One suspected
conditions in evacuation centers and immediate environment, and exposure to malnutrition wasting w/ or malnutrition case
chemical irritants such as volcanic dust w/o bipedal
TET Tetanus Spasms of neck Clostridium One case of pitting edema
and jaw (lock Tetani suspected Disruption of food supply due to the disaster may lead significant increase in
jaw) tetanus malnutrition among children at risk
AFP Acute flaccid Paralysis of the Poliomyelitis, One case of
paralysis limbs which Neurologic suspected
occurred Disorders, AFP
Health Condition with Immediate Notification Alert
recently in a Electrolyte Health Alert Factor Preventive/
child <15 years imbalance, Vit. Condition Threshold intervention
who is deficiency Fever with One case -Overcrowding -Minimum living
previously rash -Low immunization space
normal coverage -Immunization
TET: Increased risk when there is no safe procedures for traditional births -Health Education
attendants, disruption of immunization program, open wounds due to trauma Fever with One case -Stagnant Water -Destroying breeding
 27

spontaneous -Poor site 3. Using the summarized data, write the total no. of
bleeding environmental -Health education cases and deaths per disease syndrome per age
health condition
group indicated in the form (<5y/o; ≥5y/o)
Suspected One case -History of -Proper education
 Each cases has a 3 letter disease code
Leptospirosis exposure to campaign
contaminated -Proper hygiene and
flood sanitation
water -Prophylaxis
-Exposure to
infected urine/
droplets of rats 4. Indicate the name of the Main Respiratory unit of
Acute Flaccid One Case -Low immunization -ORI
reports at the end of page 1:
Paralysis coverage -Education
-Overcrowding campaign  For SPEED Form 1, write the name of the
-Immediate main RHU, or the RHU/CHO utilized as the
investigation repository of reports;
Suspected 2 suspected -Overcrowding -Minimum living
 For SPEED Form 2, write either the name of
Meningitis cases 1 one space
week -Immunization only the main RHU, or RHU/CHO utilized as the
after advise from repository of reports, the name of the
expert MHO/CHO/PHO for local government or
-Immediate
private hospitals, or the name of the CHD
investigation
Yellow eyes Cluster of 3-5 -Lack of hygiene -Safe water supply for DOH-retained hospitals
or skin w/ or cases in same -Contamination of -Effective sanitation
w/o fever reporting unit food and water -Education campaign
in 1 week
Fever with Increasing -Overcrowding -Education campaign
other S/SX trend for 3 -Poor sanitation -Distribution of
days and hygiene mosquito nets
associated -Immediate
w/ or w/o investigation
fever
How to send Daily Reports via texting
Spasm of One case of -Injuries -First aid
HF X MM/DD/YY POP 0 0 DISEASECODE 0 0 0 0
neck and jaw suspected -Tetanus toxoid  HF – mandatory SPEED keyword
tetanus vaccination  X – health facility code assigned
Acute -1 death of -Poor sanitation -Proper sanitation  MM/DD/YY – consultation date being reported
watery AWD in and hygiene and hygiene  POP 0 0 – population below 5y/o, 5y/o and up
diarrhea patients 5 -Overcrowding -Education campaign
years or older -Water treatment
 DISEASECODE – 3-letter disease code
-A cluster of 5  0 0 – no. of cases and deaths below 5y/o
cases in 1 week  0 0 – no. of cases and deaths 5y/o and up
in patients 5 When SPEED is activated, text official SPEED reports to the
years or older
LIVE Access Code: 23730796
When doing drills, text practice SPEED to the TRAINING
How to fill-out SPEED forms
Access Code: 23737063
1. Summarize the data from:
 Logbook or patient records from health
centers, BHS, and ECs for SPEED Form 1
 Daily consultation records from OPD and ER
from hospitals for SPEED Form 2
2. Complete all the HF identifying and demographic
info
 28

 Row headings
How to send Immediate Notification Alerts via texting  Body
HF X ALERT DISEASECODE 0 0 0 0  Footnote
 HF – mandatory SPEED keyword  Source of data
 X – health facility code assigned
 ALERT – mandatory keyword
 DISEASECODE – 3-letter disease code
 0 0 – no. of cases and deaths below 5y/o
 0 0 – no. of cases and deaths 5y/o and up

Pointers to remember:
 Title should answer: What? When? and Where?
 Rows and columns should be labeled concisely but
clearly
Tips on Safer Terms to Use  Units of measurement used should be given
 Suspect - Health conditions that needs laboratory  If numbers are counts of people, use whole numbers
confirmation (round off)
 Syndromic which are based on the 21 diseases  Use limited number of rows and columns per table
identified.  Totals should be shown if applicable
 Among =< 5 years and below or =>5 years old and  Abbreviations and source of data [if not original]
below should be given in a footnote
 Consultation rather than cases
Graphs and Charts
 Total consultation under SPEED reporting
 Characteristics
Limitation  Rapid grasp of data
 Case fatality rate unless hospital data is use  Visually attractive
 Attack rate unless population is stable  Tells more in less
 Complete details of the consultations reported Parts:
(name, exact age and exact address)  Figure number
 No Zero reporting  Title
 Labels
Tables, Graphs, and Charts  Data
Purposes:  Legends
 Organize, summarize and display data clearly and  Footnote
effectively  Source of data
 Present distributions, trends and relationships in the
data
 Communicate findings

Tables
Characteristics:
 Simple – easy to understand
 Direct – tells you what you should know
 Clear – self explanatory
Parts:
 Table number
 Title
Pointers to remember:
 Column headings
 29

 Title should answer: What? When? and Where? be expressed as a whole

number
 Axis should be labeled clearly
Continuous Quantitative variables Age (ex: 39.5 y/o)
 Use correct presentation for each type of data Quantitative which can take the form of Weight (70.8 kg)
 Contrasting colors/patterns should be used a decimal or a fraction
appropriately
 Abbreviations and source of data [if not original]
should be given in a footnote Charts
 Simplicity is clarity

Graphs

Use: For plotting qualitative data using only one coordinate

Common Types:
 Bar chart - used to compare categories or groups
 Pie chart - used to illustrate the division of the whole
into segments or sections

Use: For plotting quantitative data using a coordinate system

Common Types:
 Histogram - used for presenting frequency
distribution
 Line Graph - used to present more than one set of
data in terms of a frequency distribution

Types of Graphs Commonly Used in Presenting Statistical

Data
Type of Description Example
Variable
Qualitative Cannot be measured; can Sex (male; female)
only be described and Type of place (urban,
counted rural)
Quantitative Can be measured and can Height, weight,
be expressed numerically monthly income
Discrete Quantitative variables Number of children,
Quantitative whose values will always number of hospital
 30

Global warming can be stopped through global and individual

efforts.

When natural hazards result to negative effects like massive

destruction of properties and lives, it becomes a disaster.

Vulnerability to natural hazards depend on many factors such

as wealth, education, governance, technology, age and
gender.

Risk and vulnerability can possibly to be reduced if there is

an adequate means of predicting a hazardous event.

Early warning given to people on probability of hazardous

event will prevent or reduce the occurrence and intensity of
disaster.
Intelligence vs. Information
 Risk communication is the real-time exchange of The effectiveness of a warning depends on the timeliness of
information, advice and opinions between experts or the warning, effective communications and public
officials and people who face a threat (from a information systems to inform the public of the imminent
hazard) to their survival, health or economic or social danger, and the credibility of the sources from which the
wellbeing.
warning comes.
ADDITIONAL Human beings are affected by disasters in all dimensions of
life – physically, psychosocially, spiritually, politically,
Natural hazards are normally occurring events in the planet economically.
earth
Human nature is resilient and most people have the ability to
Hazard vs Disaster recover from a disaster.
 Hazard: less populated area; e.g., Typhoon occurring
in the ocean Generally speaking, disasters are becoming less deadly but
 Disaster: populated area; e.g., Typhoon occurred in more costly.
urban area
Nurses can make a lot of difference amid disasters with
Disaster risk is the product of possible damage caused by a adequate knowledge, skills and positive attitude.
hazard due to vulnerability within a community. There is no such thing as natural disaster, only natural
hazards.
When hazards and vulnerability are not prevented, this
results to disaster. Disaster risk reduction is everyone’s responsibility.
Disaster risk reduction aims to lessen the impacts of hazards Man-Made (Human-Induced) Hazards & Disasters
and their potential to cause disasters.
A man-made hazard is threat having an element of human
Disaster management is an applied science which seeks by intent, negligence or error, or involving a failure. It may
systematic observation and analysis of disasters, to improve eventually lead to man-made disaster. Ex. Crime, arson, war,
measures relating to prevention, emergency response, cyber attack, nuclear explosions, transportation accidents
recovery, and mitigation.
1. Terrorism
The emphasis of disaster management is prevention and loss 2. Technological Disasters
reduction. 3. Transitional human shelters disasters
The two types of hazards and disasters are: (1) natural Terrorism
hazards and disasters, (2) man-made hazards and disasters.
 Comes Latin word “FEAR”
Disasters have become tremendously devastating and  It is the unlawful use of force against persons or
catastrophic as an outcome of climate change -- global property to intimidate or coerce a government,
warming. civilian population, or segment thereof, in the
furtherance of political or social objectives (FBI)
 31

 In Anti-Terrorism Act (ATA) 2020 Sec 4, it is said to Nuclear explosion - most catastrophic man-made disasters
be committed by any person who, w/n or outside occur in modern times:
the Philippines, regardless of the stage of execution
1. Harrisburg Pennsylvania USA
engages in acts intended to cause death or serious
2. Chernobyl Plant Russia (April 25, 1986)
bodily injury to any person, or endangers person’s
life. 31 people died of 3 months radiation poisoning
Acts of terrorism include: 134 emergency workers inflicted of acute radiation sickness
 Development, manufacture, possession, acquisition, 25k rescue workers died of diseases caused by radiation
transportation, supply or use of weapons/explosives
 Or of biological, nuclear, radiological or chemical Cancer afflicts many others
weapons In year 2000, 1800 cases of thyroid cancer in children &
 Dangerous substances, or causing fire, floods or adolescent
explosions
Environmental: Soil, ground water, air, food (crops and
Technological Disasters livestock) are still contaminated today
FROTCH Biological: Referred as poor man’s nuclear bomb as these are
 Fire easy to manufacture, transport and have the ability to kill
 Radioactive spills hundred thousands of people. These are in forms of bacteria
 Oil spills & virus.
 Toxic chemical Chemical disasters are caused by the excessive use and
 Chemical waste misuse of chemicals in industries. These can be:
 Hazardous waste
 Corrosive
Transitional human shelters disasters  Toxic
 Explosive
 Are rapid, post disaster shelters made from materials
that can be upgraded or re-used in more permanent Fire accidents
structures, or that can be relocated from temporary
site to permanent location.  Common
 May occur in any transitional human shelter. The  Loss of life is high in a crowded building
survivors are at risk to develop diseases caused by
Travel accident
insufficient nutrition, poor supply of potable water,
overcrowding, poor sanitation, lack of hygiene and  An accident which involves a number of people
toilet facilities etc. becomes a disaster:
o Air crashes
Impact of Man-Made (Human-Induced) Hazards & Disasters
o Train /vehicle collision
EE CC GG BN PFT o Capsizing of boats /ships

1. Environmental Epidemic
2. Epidemic
3. Chemical disasters  Occurs when a disease attacks a large number of
4. Climate change people at one time
5. Global warming  Most of the diseases are spread after natural
6. Greenhouse gases disasters
7. Biological Pandemic: Is an epidemic of an infectious disease that has
8. Nuclear explosion spread worldwide
9. Pandemic
10. Fire accidents Global warming: Is the gradual increase in the average
11. Travel accident temperature of the earth’s atmosphere & oceans

Climate change: Literally is the climate changing because the

average global temperature is increasing
 32

Greenhouse gases: Absorb heat emitted from the earth 10 deadliest typhoon in the Philippines
surface, increase concentration of these gases cause earth to
1. Thelma
warm by trapping more of their heat:
2. Ike
BNCSM 3. Fhengshen
4. Washie
 Black carbon 5. Durian
 Nitrous oxide 6. Bopha
 Carbon dioxide 7. Trix
 Sulfate 8. Amy
 Methane 9. Nina
More greenhouse gases means a warmer earth… 10. Haiyan (Yolanda)

Causes of climate change & global warming Top 10 Things You Can Do To Reduce Global Warming

1. Natural causes RUB CUP DUG E

 earth’s orbit 1. Reduce, Reuse, Recycle (Reusable grocery bags mean
 sun’s intensity less waste and less demand for plastic.)
 circulation of the ocean & atmosphere 2. Use less Heat and Air Conditioning
 volcanic activities 3. Buy Energy – Efficient Products
2. Man-made 4. Change a Light Bulb
A. Increased greenhouse gas emissions in the 5. Use less Hot Water
atmosphere due to: 6. Plant a Tree
 burning of fossil fuel 7. Drive Less and Drive Smart (Less driving means fewer
 deforestation emissions)
 intensive farming 8. Use the “Off” Switch
B. Growth in consumption exceeds growth in 9. Get a Report Card from Your Utility Company
developing and developed countries 10. Encourage Others to Conserve
C. Increases in fertility, which necessitates
increase in land use , energy intensity, energy Natural hazards versus disasters
use, and carbon emissions Floods earthquakes, volcanic eruptions, hurricanes are types
Main Impacts & Effects of Climate Change & Global of natural hazards
Warming When do they become a disasters?
Global warming is increasing the frequency & intensity of When a typhoon strikes a thickly populated area in the
some types of extreme weather. Philippines, causing massive destruction of properties and
Global warming causes environmental economic, health lives, ….it becomes a disaster
consequences Vulnerability to a natural hazard depends on the following:
Effects of Climate change in the Philippines WEGTAG
1. Increase in the number of tropical cyclone & storms  Wealth
Typhoon Haiyan (Yolanda)- deadliest storm on  Education
record- Nov 8,2013:  Governance
6300 mortality  Technology
2 billion dollars damages
 Age and gender
2. There are regions most vulnerable to sea level rise
Higher sea level contributes to typhoon surge that Prediction and Warning
can rise upwards 15-20 feet displacing many in the
coastal communities  Prediction involves a statement of probability that
3. A rise in mean temperature in nearly all non-urban an event may occur based on scientific observation
areas (1960-1998) and technology
 33

 Early warning is a statement that a high probability Resilience factors

of a hazardous event will occur, based on a
1. Social support - Through social support, one can
prediction or forecast.
find:
Prediction of warning depends on:  Practical help in solving problems
 Sense of being understood & accepted
 Timeliness of the warning
 Sharing of trauma experience
 Effective communications and public information
 Comfort
systems to inform the public of the imminent
 Workable tips about coping
danger.
2. Coping confidence: Those who think that they can
 The credibility of the sources from which the
cope no matter what happens, usually tend to do
warning comes
better after a disaster
Effects of hazards 3. Hope

Primary effects occur as a result of the process itself: Phases of Disaster

Ex. 1. water damage due to flood Pre-Impact Phase

2. collapse of buildings during an earthquake, landslide or  Initial phase of disaster prior to the actual
hurricane occurrence
 This is the period when the emergency preparedness
Secondary effects occur because of the primary effect caused plan is put into effect emergency centers are opened
them by the local civil, detention authority
Ex. .1. Fires ignited as a result of earthquake.  Role of the nurse: To assist in preparing shelters and
emergency aid stations and establishing contact with
2. disruption of electrical power & water service as a other emergency service group
result of earthquake
Impact Phase
3. flooding caused by a landslide into a lake/river
 Occurs when the disaster actually happens. It is a
Tertiary effect are long term effects that are set off as a result time of enduring hardship or injury end of trying to
of a primary event. survive.
 It continues until the threat of further destruction
Ex. 1. loss of habitat caused by flood
has passed and emergency plan is in effect
2. permanent changes in the position of river channel  The nurse is responsible for psychological support to
caused by flood victims in the shelter.

3. crop failure caused by volcanic eruption Recovery begins during the emergency phase & ends with the
return of normal community order of functioning
4. immersion of town under water, ash fall,& mud due to
volcanic eruptions Post Impact Phase

5. food shortage, malnutrition & famine due to drought 4 stages of emotional response: DSAR

Human Impact of Natural Disasters 1. Denial: During this stage the victim may deny the
magnitude of the problem
1. Displaced population: When places are ruined by 2. Strong emotional response: In the 2nd stage the
earthquakes or other powerful forces of nature person is aware of the problem but regards its as
2. Health risks: Severe flooding can result stagnant overwhelming and unbearable
water that allows breeding of water borne 3. Acceptance: During the 3rd stage, the victim begins
microorganism to accept the problems caused by the disaster and
3. Food scarcity: After natural disasters food becomes makes a concentrated effect to solve them
scarce because of destroyed crops and loss of 4. Recovery: The 4th stage represent a recovery from
agricultural supplies the crisis reaction. Victims feel that they are back to
4. Emotional aftershocks: Many people develop PTSD normal
after witnessing devastating events.
 34

ICN (International Council of Nurses) Framework of Disaster Level II: Any nurse who has achieved the Level I competencies
Nursing Competencies and is/aspires to be a designated disaster responder within
an institution, organization or system.
Disaster Nursing: can be defined as “the adaptation of
professional nursing knowledge, skills and attitude in Examples: supervising or head nurse; a nurse designated for
recognizing and meeting the nursing, health and emotional leadership within an organization’s emergency plan; a nurse
needs of disaster victims.” representing the profession on a hospital/agency emergency
planning committee; preparedness/ response nurse
Goals of Disaster Nursing
educators.
1. To meet the immediate basic survival needs of
Level III: Any nurse who has achieved Level I and II
populations affected by disasters (water, food,
competencies and is prepared to respond to a wide range of
shelter, and security)
disasters and emergencies and to serve on a deployable
2. To identify the potential for a secondary disaster
team.
3. To appraise both risks and resources in the
environment Examples: frequent responders to either national or
4. To correct inequalities in access to health care or international disasters, military nurses, nurses conducting
appropriate resources comprehensive disaster nursing research.
5. To empower survivors to participate in and advocate
PC IS AIRL
for their own health and well-being
6. To respect cultural, lingual, and religious diversity in Domain 1: Preparation and Planning (actions taken apart
individuals and families and to apply this principle in from any specific emergency situation to increase readiness
all health promotion activities. and confidence in actions to be taken during an event)
7. To promote the highest achievable quality of life for
survivors. Domain 2: Communication (approaches to conveying and
updating essential information within one’s place of work or
Principles of DN emergency assignment and documenting actions taken, and
decisions made)
1. Rapid assessment of the situation and of nursing
care needs. Domain 3: Incident Management Systems (the structure of
2. Triage and initiation of life-saving measures first. disaster/ emergency responses required by countries/
3. The selected use of essential nursing interventions organizations/ institutions and actions to make them effective
and the elimination of nonessential nursing and efficient)
activities.
4. Adaptation of necessary nursing skills to disaster and Domain 4: Safety and Security (assuring that nurses, their
other emergency situations. colleagues, and patients do not add to the burden of
5. Evaluation of the environment and the mitigation or response by unsafe practices)
removal of any health hazards.
Domain 5: Assessment (gathering data about assigned
6. Prevention for further injury or illness.
patients/families/communities on which to base subsequent
7. Leadership in coordinating patient triage, care, and
nursing actions)
transport during times of crisis
8. The teaching, utilization, and supervision of auxiliary Domain 6: Intervention (clinical or other actions taken in
medical personnel and volunteers response to assessment of patients/families/communities
9. Provision of understanding, compassion, and within the incident management of the disaster event)
emotional support to all victims and their families
Domain 7: Recovery (steps taken to facilitate resumption of
ICN Framework of Disaster Nursing Competencies version pre-event individual/family/ community/ organization
2.0 2019 functioning or moving it to a higher level)

Level I: Any nurse who has completed a program of basic, Domain 8: Law and Ethics (the legal and ethical framework
generalized nursing education and is authorized to practice by for disaster/emergency nursing)
the regulatory agency of his/her country.

Examples: staff nurse in a hospital, clinic, public health center; PRACTICE QUESTIONS
all nurse educators.
 35

The nurse leader informs staff of the local emergency and Answer: A
instructs them to stay at the hospital to prepare for major Call the nursing supervisor to activate the agency disaster
casualties. The staff displays high levels of anxiety and plan. In an external disaster, many people may be brought to
disorganization which is the most appropriate leadership style the emergency department for treatment. The initial nursing
at this time? action must be to activate the disaster plan. Although options
a. Autocratic B, C, and D may be additional measures that the nurse would
b. Democratic take, the initial action would be to activate the disaster plan.
c. Laissez-faire
d. Bureaucratic A nurse cares for clients during a community-wide disaster
drill. Once of the clients asks, "Why are the individuals with
Answer: A black tags not receiving any care?" How should the nurse
This is a situation in which urgent decisions are needed, and respond?
one person provides instructions for that input from the a. To do the greatest good for the greatest number of people,
others (autocratic). This is especially appropriate if the rest of it is necessary to sacrifice some.
the group is not functioning at an appropriate level. Option B b. Not everyone will survive a disaster, so it is best to identify
would be found in shared governance structures when the those people early and move on.
risks are low and there is time for collaboration Option C is c. In a disaster, extensive resources are not used for one
most effective in groups with high levels of professional and person at the expense of many others.
personal maturity and work operation and coordination are d. With black tags, volunteers can identify those who are
not significant. Option D involves rigid use of rules because dying and can give them comfort care.
managing casualties is a highly unpredictable activity
Enforcement of rules is not appropriate. Answer: C
In a disaster, military-style triage is used; this approach
The community health nurse is working with disaster relief identifies the dead or expectant dead with black tags. This
after a tornado. The nurse assists in finding safe housing for practice helps to maintain the goal of triage, which is doing
survivors, providing support to families, organizing the most good for the most people. Precious resources are
counseling, and securing physical care when needed. Which not used for those with overwhelming critical injury or illness,
level of prevention does the nurse exercise? so that they can be allocated to others who have a
a. Primary level of prevention reasonable expectation of survival. Clients are not sacrificed.
b. Secondary level of prevention Telling students to move on after identifying the expectant
c. Tertiary level of prevention dead belittles their feelings and does not provide an adequate
d. Quaternary level of prevention explanation. Clients are not black-tagged to allow volunteers
to give comfort care.
Answer: C A nurse is field-triaging clients after an industrial accident.
Tertiary prevention involves reduction of the amount and Which client condition should the nurse triage with a red tag?
degree of disability, injury, and damage after a crisis. Primary a. Do you need something for pain right now?
prevention means keeping the crisis from occurring, and b. Please stop yelling. I brought dinner as soon as I could.
secondary prevention focuses on reducing the intensity and c. I suggest that you get control of yourself.
duration of a crisis. There is no known quaternary prevention d. You seem upset. I have time to talk if you'd like.
level.
Answer: D
The nurse in the hospital emergency department is notified Clients should be allowed to ventilate their feelings of anger
by emergency medical services that several victims who and despair after a catastrophic event. The nurse establishes
survived a plane crash will be transported to the hospital. rapport through active listening and honest communication
Victims are suffering from cold exposure because the plane and by recognizing cues that the client wishes to talk. Asking
plummeted and was submerged in a local river. What is the whether the client is in pain as the first response closes the
initial action of the nurse? door to open communication and limits the clients options.
a. Call the nursing supervisor to activate the agency disaster Simply telling the client to stop yelling and to gain control
plan. does nothing to promote therapeutic communication.
b. Supply the triage rooms with bottles of sterile water and
normal saline. A hospital responds to a local mass casualty event. Which
c. Call the intensive care unit to request that nurses be sent to action should the nurse supervisor take to prevent staff post-
the emergency department. traumatic stress disorder during a mass casualty event?
d. Call the laundry department, and ask the department to a. Provide water and healthy snacks for energy throughout
send as many warm blankets as possible to the emergency the event.
department. b. Schedule 16-hour shifts to allow for greater rest between
shifts.
 36

c. Encourage counseling upon deactivation of the emergency Answer: B

response plan. Recovery is about returning to the new normal with the goal
d. Assign staff to different roles and units within the medical of reaching a level of organization that is as near the level
facility. before the disaster as is possible. This is often the hardest
part of the disaster. During the recovery period all involved
Answer: A agencies pull together to restore the institutions and properly
To prevent staff post-traumatic stress disorder during a mass rebuild. In the end, all of the nurses and organizations in the
casualty event, the nurses should use available counseling, world can only provide partnerships with the victims of
encourage and support co-workers, monitor each other’s disaster. Ultimately, it is up to the individuals to recover on
stress level and performance, take breaks when needed, talk their own.
about feelings with staff and managers, and drink plenty of
water and eat healthy snacks for energy. Nurses should also Nurses often participate on field assessment teams
keep in touch with family, friends, and significant others, and (surveillance) during a disaster response. These assessments
not work for more than 12 hours per day. Encouraging are crucial to best help:
counseling upon deactivation of the plan, or after the a. encourage good intentions of those giving aid.
emergency response is over, does not prevent stress during b. match available resources to the population's emergency
the casualty event. Assigning staff to unfamiliar roles or units needs.
may increase situational stress and is not an approach to c. separate casualties and allocate treatment.
prevent post-traumatic stress disorder. d. provide compassion and dignity.

A nurse is field-triaging clients after an industrial accident. Answer: B

Which client condition should the nurse triage with a red tag? Assessment is a major nursing role during a disaster. The
a. Dislocated right hip and an open fracture of the right lower acute needs of populations in disaster turn the community
leg assessment into rapid appraisal of a sector or region's
b. Large contusion to the forehead and a bloody nose population, social systems, and geophysical features.
c. Closed fracture of the right clavicle and arm numbness Elements of a rapid needs assessment include determining
d. Multiple fractured ribs and shortness of breath the magnitude of the incident, defining the specific health
needs of the affected population, establishing priorities and
Answer: D objectives for action, identifying existing and potential public
Clients who have an immediate threat to life are given the health problems, evaluating the capacity of the local response
highest priority, are placed in the emergent or class I including resources and logistics, and determining the
category, and are given a red triage tag. The client with external resource needs for priority actions.
multiple rib fractures and shortness of breath most likely has
developed a pneumothorax, which may be fatal if not treated A triage officer quickly assesses the casualties at the scene of
immediately. The client with the hip and leg problem and the a disaster. Depending on the severity of the victims' injuries, a
client with the clavicle fracture would be classified as class II; color-coded tagging system is subsequently used to tag and
these major but stable injuries can wait 30 minutes to 2 hours identify them. In the event of a disaster where responders are
for definitive care. The client with facial wounds would be faced with a large number of victims, the fundamental
considered the walking wounded and classified as nonurgent. principle governing the allocation of resources is to do the
greatest good for the greatest number. Following this
An example of an external disaster is a: principle, which of the following victims will be assigned of
a. Tornado the lowest triage priority?
b. Hurricane A. A 40-year old man who is in full cardiac arrest with
c. plane crash into a hospital parking lot penetrating wounds in the head
d. all of the above B. A 30-year old woman with stable wounds in the abdomen
without manifestations of hemorrhage
Answer: D C. A young man with obstruction in the airway secondary to a
mechanical cause
The recovery phase of a disaster can take a very long time. D. A child with minor burns and abrasions without significant
Nurses need to be aware that despite effective disaster bleeding
preparedness and response efforts:
a. environmental hazards are minimal. Answer: A
b. individuals must ultimately recover on their own. Following the principle of doing the greatest good for the
c. the government provides economic support. greatest number, prioritization of victims are decided based
d. religious organizations must bear the burden of the on the likelihood of survival and consumption of available
community. resources. Therefore, a 40-year old man who is in full cardiac
arrest with penetrating wounds in the head will be tagged
 37

black or expectant and will receive the lowest triage priority.

Although this may sound uncaring, from an ethical Which client should the emergency department triage nurse
standpoint, the expenditure of limited resources on classify as emergent?
individuals with a low chance of survival, and denial of those A. A client with a displaced fracture who is crying
resources to others with serious but treatable conditions, B. A client with a simple laceration and soft tissue injury
cannot be justified. Triaging involves the use of a color-coded C. A client with crushing substernal pain who is short of
tagging system which consist of four colors--red, yellow, breath
green, and black. Each color signifies a different level of D. A client with a temperature of 38.3°C with a productive
priority. Red (Immediate) - 1, Yellow (Delayed) - 2, Green cough
(Minimal) - 3, and Black (Expectant) - 4. Option A - Black (4),
Option D - Green (3), Option B - Yellow (2), Option C - Red (1) Answer: C
A triage method commonly used in the emergency
Nurse Mark is assigned in a disaster-prone province in Bicol department consists of 3 categories: emergent, urgent, and
Region. He is aware that with the increase frequency of nonurgent. The emergent category implies that a condition
disaster happening, he has to respond quickly and efficiently exists that poses an immediate threat to life or limb. An
to assist the population affected by calamities. An earthquake example of a client who fits into this category is the client
has hit provinces in the region and buildings are knocked experiencing crushing substernal pain who is short of breath.
down; people are injured and crying for help. Looters have The urgent category indicates that the client should be
already started grabbing essential resources. What should the treated quickly but that an immediate threat to life does not
community do FIRST? exist at the moment. The client with a displaced fracture who
A. Send in ambulances to transport injured persons to is crying and the client with a temperature of 38.3°C and a
medical facilities productive cough would fit into this category. The nonurgent
B. Send in media personnel to share the event and begin category indicates that the client can generally tolerate
efforts to obtain donations for the injured waiting several hours for health care services without a
C. Send in medical personnel to administer first aid and triage significant risk of clinical deterioration. The client with a
the injured simple laceration and soft tissue injury would fit into this
D. Send in law officials to secure the area and assure the category.
safety of the victims
Which statement below is INCORRECT about the yellow triage
Answer: D tag color in regards to a disaster situation?
Before search and rescue should begin, safety must be A. A survivor with this tag color can have treatment delayed
considered. In some instances, if a criminal action is for an hour or less
suspected, law officials will be among the first to respond to B. A survivor with this tag color is seen after patients with the
secure the area and possibly gather evidence. While the area green tag color
is being checked and then cleared of potential threats, a C. A survivor with this tag color has serious injuries that could
staging area can be set up at or near the site of the incident eventually lead to the compromise of breathing, circulation,
to direct on-site activities. Search and rescue of victims can or mental status, especially if treatment is delayed more than
begin once clearance is given, a disaster triage area is an hour or so
established, and an emergency treatment area is set up to D. A survivor with this tag color has second priority for
provide first aid until transportation for victims to hospitals or treatment of injuries.
health care facilities for treatment can be coordinated.
Answer: B
The emergency department (ED) triage nurse is assessing four It should say: A survivor with this tag color is seen after
victims involved in a motor vehicle collision. Which patient patients with the RED (not green) tag color. Triaging involves
has the highest priority for treatment? the use of a color-coded tagging system which consist of four
A. A patient with no pedal pulses colors--red, yellow, green, and black. Each color signifies a
B. A patient with an open femur fracture different level of priority. Red (Immediate) - 1, Yellow
C. A patient with bleeding facial lacerations (Delayed) - 2, Green (Minimal) - 3, and Black (Expectant) - 4.
D. A patient with paradoxic chest movements
A situation with a large number of casualties, usually more
Answer: D than 100, that significantly overwhelms available emergency
Most immediate deaths from trauma occur because of medical services and resources is called a?
problems with ventilation, so the patient with paradoxic chest A. Natural disaster
movements should be treated first. Face and head fractures B. Man-made disaster
can obstruct the airway, but the patient with facial injuries C. Multiple casualty incident
only has lacerations. The other two patients also need rapid D. Mass casualty incident
intervention but do not have airway or breathing problems.
 38

Answer: D A. A pregnant woman who exclaims, "My baby is not

A mass casualty incident is a situation with a large number of moving."
casualties, usually more than 100, that significantly B. A child who is complaining, "My leg is bleeding so bad, I am
overwhelms available emergency medical services and afraid it is going to fall off!"
resources. Natural disasters include hurricanes, tornadoes, C. A young child standing next to an adult family member
flash floods, blizzards, slow-rising floods, typhoons, who is screaming, "I want my mommy!"
earthquakes, avalanches, epidemics, and volcanic eruptions. D. An older victim who is sitting next to her husband sobbing,
Man-made disasters include war, chemical and biological "My husband is dead. My husband is dead."
terrorism, transportation accidents, food or water
contamination, and building collapse. A multiple casualty Answer: B
incident is one in which there are more than 2 but fewer than Priority nursing care in disaster situations needs to be
100 people injured, they generally strain and may overwhelm delivered to the living and not the dead. The child who is
the available emergency medical services and resources. bleeding badly is the priority. The bleeding could be from an
arterial vessel; if the bleeding is not stopped, the child is at
How is a disaster the same as or different from an risk for shock and death. The pregnant client is the next
emergency? priority, but the absence of fetal movement may or may not
A. A disaster is personal, whereas an emergency is be indicative of fetal demise. The young child is with a family
community-wide. member and is safe at this time. The older victim will need
B. An emergency is personal, whereas a disaster is comfort measures; there is no information indicating she is
community-wide. physically hurt.
C. Both emergencies and disasters are devastating.
D. Both emergencies and disasters are failures resulting in Following an earthquake, patients are triaged by emergency
extensive insurance claims. medical personnel and are transported to the emergency
department (ED). Which patient will the nurse need to assess
Answer: B first?
A disaster is any event that causes a level of destruction, A. A patient with a red tag
death, or injury that affects the abilities of the community to B. A patient with a blue tag
respond to the incident using available resources. C. A patient with a black tag
Emergencies differ from disasters in that the agency, D. A patient with a yellow tag
community, family, or individual can manage an emergency
using their own resources. However, a disaster event may be Answer: A
beyond the ability of the community to respond to and The red tag indicates a patient with a life-threatening injury
recover from the incident using its own resources. Disasters requiring rapid treatment. The other tags indicate patients
frequently require assistance from outside the immediate with less urgent injuries or those who are likely to die.
community.

A 22-year-old patient who experienced a near drowning

accident in a local pool, but now
is awake and breathing spontaneously, is admitted for
observation. Which assessment will
be most important for the nurse to take during the
observation period?
A. Auscultate heart sounds
B. Palpate peripheral pulses
C. Auscultate breath sounds
D. Check pupil reaction to light

Answer: C
Because pulmonary edema is a common complication after
near drowning, the nurse should assess the breath sounds
frequently. The other information also will be obtained by the
nurse, but it is not as pertinent to the patient's admission
diagnosis.

Nurse Clif is the first responder after an earthquake has

destroyed many homes in the community. Which victim
should the nurse attend to first?