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Care of Clients in Cellular Aberrations,

Acute Biologic Crisis (ABC), Emergency and Disaster Nursing
(NCM106)
Emergency and Disaster II

Disaster Nursing and Emergency Preparedness
Risk Profile of the Philippine
Composed of more than 7,100 islands
Philippine Geographic and Physical characteristics expose the country to
hazards and disaster, but does not necessarily make it a disaster prone
country
o Air > 20 feet
o Sea > 200 nautical miles

Threats in the Philippines
Typhoons
Average of 20 typhoons a year, half of these are destructive
About 500 people are killed each year
4 Billion worth of properties are lost

Earthquake & Volcanic Eruptions
Occupies the western ring of the Pacific Ocean (Western segment of the Pacific Ring of Fire), a most
active part of the earth that is characterized by an ocean encircling belt of active volcanoes and
earthquake generators (faults)
Earthquakes:
o Average of 866 earthquakes per year, some of them have proved damaging
o 2 Major Damaging Earthquakes in recent years
1976 Mindanao earthquake around 6000 people died. 5,400 million damage
1990 Luzon Earthquake over 1,283 killed, 2 3M people affected;
Volcanic Eruptions
o 220 volcanoes, 22 as active
o June 1991 Mount Pinatubo eruption dubbed as the 2
nd
largest volcanic eruption of the
century
o 850 people killed > around 12 million people affected > PHP 10.6 Billion of cost of damage

Tsunami
August 17, 1976 Earthquake and Tsunami
7.8 Magnitude generated a tsunami as high as 15 ft which swept coastal areas of 5 provinces in Central
and Southern Mindanao
Magindanao
o 3,792 Killed; 9,240 injured; 1,937 missing, >362,136 rendered homeless, around Php 247 M cost of damage
Landslide
February 17, 2006 Barangay Guinsaugon Landslide
o Wiped out entire village around 480
154 Dead
28 Injured
968 Missing
410 Survivors

Floods
PHP 76 Billion in damage out of the PHP 111.46 Billion total damage from natural disaster, 1990
2005
Average of 750 people are killed
November and December 2004 Landslides / Flashfloods (In the aftermath of 4 weather disturbances)
LOOKY
HERE
Topics Discussed Here Are:
1. Threats in the Philippines
2. Key Components of
Disaster Preparedness
a. Definition and
Classification
System for
Disasters
b. Disaster
Epidemiology
c. Disaster
Planning
d. Nursing Care
During
Disasters
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Top 10 Disaster Reports in the
Philippines
o Around 3 7 Million
Emerging Global Concerns
Terrorism
Global Warming

Red Tide Outbreaks
- From 1983 2001, a total of 42 toxic out breaks have resulted in a total of 2107 paralytic shellfish
poisoning cases with 117 deaths
- In Manila Bay during 1992 Pyrodinium Red Tide outbreak

Rizal Day Bombing
Also referred to as the December 30 bombing, were a series of bombing that occurred around Metro Manila
5 Locations were bombed almost simultaneously within the span of an hour
22 fatalities were reported and around a hundred more suffered non-fatal injuries

Philippine Sports Stadium Stampede
Also referred as Wowowee Stampede or the ULTRA Stampede was a stampede that occurred at the
Philippine Sports Stadium in Pasig City on February 4, 2006
76 People were killed, and 400 were injured

Oil Spill
The Sinking of MT Solar at Lingayen Point, Guimaras Island
Last August 11, 2006, it has resulted in the spillage of 200,000 liters of industrial fuel oil, the largest oil
spill in the country affecting 3 provinces and 38 municipalities with 3,357 families or 16,785 persons
affected, the largest oil spill in the country

Typhoon Milenyo (Xangsane)
Which occurred on September 28, 2006 affecting 9 regions in Luzon and Visayas
184 Dead; 536 Injured; 47 Missing
Affected population 826,725 families

Typhoon Paeng (Cimarron)
Occurred

Sinking of MV Princess of the Stars
June 21, 2008 (Sibuyan Island)
52 survived
312 Bodies recovered
825 passengers listed
5 Toxic pesticide and other poisonous substances
were retrieved 3 months after

Typhoon Ondoy (Ketsana)
2009; most devastating typhoon, Pacific Typhoon Season
With a damage of 1.09 Billion and 747 fatalities
The damage to property was

Philippine Disaster Statistics (1980 2010)
Number of Events 363
Number of People Killed 32,956
Average Killed Per Year 1,063
Number of People Affected 116,212,416
Average Affected Per Year 3,748,788
Economic Damage (US$ x 1,000) 7,417,145
Economic Damage Per Year (US$ x 1,000) 239,263
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Definition and Classification System for Disasters
Ecologic Disruptions or Emergencies
Varying Severity and Magnitude
Results in Illness, Deaths, Injuries and Property Damage
Cannot be managed by routine procedures
Requires Extraordinary Efforts beyond what is needed to
respond to everyday

Categories of Disaster
Natural Disasters
o Result of an ecological disruption or threat that exceeds the adjustment capacity of the affected
community (WHO, 1979)
o Examples of Natural Disasters are:
Earthquakes
Floods
Tornadoes
Hurricanes
Volcanic Eruptions
Tsunami
Geological
Meteorological
Phenomena
Man-Made Disasters (Human Generated)
o Principal direct causes are identifiable deliberate human actions or otherwise (Noji, 1996)
o Examples of Man-made Disasters are:
Biological and
Biochemical Terrorism
Chemical Spills
Radiologic (Nuclear
Spills)
Fires
Explosions
Transportation Accidents
Armed Conflicts
Acts of War
o Three Broad Categories
1. Complex Emergencies Suffering and devastation caused by war, civil strife and other
political conflicts
2. Technologic Disasters Direct and adverse effect of major industrial accidents,
unplanned release of nuclear energy, fires or explosions from hazardous materials
3. Disasters that Occur in Human Settlements Results of combination of forces like
famine, drought, epidemics and political unrest
Combination or Synergistic Disasters
o Also known as NA-TECH
o A Natural disaster or phenomena that may trigger a secondary disaster

OTHER CATEGORIES
Onset, Impact, Duration
Rapid-Onset Events Short durations but with a sudden impact (e.g. Earthquakes and Tornadoes)
Sudden Impact (e.g. Hurricanes and Volcanic Eruptions)
Rapid-Onset with Unanticipated and Prolonged Impact (e.g. Bioterrorism Attack)
Creeping Disasters (e.g. Droughts and Famines)
Internal Disasters
^ Caused by disruption of normal hospital function due to injuries or deaths of hospital personnel or damage
to health care facility
External Disasters
^ Exhaustion of health care / hospital resources due to large volumes of patients with varying types of
injuries being admitted
o Internal and External Frequently used in hospitals and health care facilities


Key Components of Disaster
Preparedness
Definition and classification system
for disasters (Onset, Duration, Effect
and Reactive Period)
Disaster epidemiology and measures
of health consequences
Essentials of Disaster Management
Planning
Nursing Care During Disasters

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Disaster Epidemiology
Characteristics Epidemiology Disaster Epidemiology
Measures Health-related determinants
Distribution of states or events
Adverse health effects of disasters
Contributory factors to the effects of disaster
Need of disaster affected populations
Application Disease surveillance and control Match available resources to the needs of
disaster affected populations
Prevent further adverse effects
Evaluate program effectiveness

Health-Related Effects of Disaster
Premature Deaths, Illness and Injuries Exceeds capacity of local health care system
Destruction of local health care infrastructure Disables the health care unit to respond to emergencies
Environmental Imbalances Increased risk of communicable diseases
Environmental Hazards
Affects psychological, emotional and social well-being of
the population
Disrupts the adaptation and normal coping
Shortage of food and Water Severe nutritional deficiencies
Large Population Movement (Refugee) Health consequences of crowded living conditions

Disaster Management Planning

Considerations Related to Levels of Disaster
Level I
Response team should be competent in basic emergency preparedness
Adequate surge capacity to respond to routine emergencies (Power outages, weather events, etc.)
Level II
Assure adequate linkages with other organizations and agencies in the surrounding community
Local support and assets should readily be procured
Level III
Assure adequate linkages between local and national level organizations
Knows the communication chain of command for the national level linkages

Disaster Continuum
Also known as Emergency Management Cycle (EMC)
Provides guide on the time line of a disaster
Consists of three phases
o Pre-impact
o Impact
o Post-Impact







Level I Local emergency response personnel and organizations can
contain and effectively manage the disaster and its aftermath
Level II Regional efforts and aid from surrounding communities are
sufficient to manage effects of the disaster
Level III Local and regional assets are overwhelmed; statewide assistance
is required


Notes:
The time-line provides guide on what
specific actions to take during the
occurrence of a specific phase of a
disaster
These phases were accompanied with
specific actions and disaster
management programs. The first 24
hours after impact is critical because it
is the time when disaster casualties
come to hospitals (first hour) and few
that were rescued from the site of
impact
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Disaster Planning
Cyclical process
Composed of phases, often taking place concurrently, indicative of specific actions, along with the nature
and scope of the plan
Aims to reduce the negative impact or consequences of adverse events

Disaster Management Cycle
Mitigation
o Measures put in place to minimize the
results from a disaster
o Risk Assessment, Prevention Measures
Preparedness
o Planning how to respond
o Forecasting, Preparedness Plans,
Communications Management
Response
o Initial actions taken as the event takes place.
It involves efforts to minimize the hazards
created by a disaster
o Evacuations, Search and Rescue, Emergency
Relief
Recovery
o Returning the community to normal (pre-disaster state)
o Rehabilitation and Reconstruction

PHASE I: Mitigation and Prevention
O All actions taken before a disaster to reduce its impacts, including preparedness and long-term risk
reduction measures
O Two Main Categories
o Structural Mitigation
- Activities or Projects which aims to reduce economic and societal impacts
o Non-Structural Mitigation
- Policies and Practices which raise awareness of hazards or encourage developments to
reduce the impact of disasters
O Mitigation Strategies
1. Risk Assessment
Hazard Identification
Vulnerability Analysis
2. Various mitigation strategies or measures (Capacities)

RISK ASSESSMENT: HAZARD IDENTIFICATION



O Industrial chemicals
O Transportation elements
O Collections of people in areas with limited access
O Environmental and meteorological hazards
O Explosions and Terrorism










Notes
The ideal is for communities to be prepared at all times for all types of hazards. In practical terms however, this is not possible
Preparedness for one hazard or disaster may increase your risk to another. For example, structures designed to withstand hurricane force winds may incur or cause greater damage if there is
an earthquake. The more logical solution would be to adapt best practices as much as possible for the most likely scenario
A crucial first step in mitigation is deciding which hazards have the greatest potential to affect the community, which is called: Hazard Identification
First you have to identify the nature of the threat and its variation in between locations. Also determine which threat is frequently occurring on a specific location, as well as presence of
risk factors, to be able to have effective identification of the hazard
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RISK ASSESSMENT: VULNERABILITY ANALYSIS
Vulnerability Is the extent to which a communitys structure, services or environment is likely to be
damaged or disrupted by the impact of a hazard
Type of Vulnerability Characteristics
Tangible / Material
(Easy to see; value easily determined)
O People Lives, health, security, living conditions
O Property Services, physical property loss, loss of use
O Economy Loss of products and production income
O Environment Water, soil, air, vegetation, wildlife
Intangible / Abstract
(Difficult to see; value difficult to determine)
O Social Structures Family and Community relationships
O Cultural Practices Religious and agricultural
O Cohesion Disruption of normal life
O Motivation Will to recover; government response
Vulnerability Analysis Methods used to determine:
o WHO Is most likely to be affected
o WHAT Property is most likely to be damaged or destroyed
o WHAT Is the capability of the community to deal with the effects of the disaster
Data that were collected will be used to develop prevention strategies

Mitigation Strategies and Measures
Adjusting normal development programs to
reduce losses
Plant crops that are resistant to locations prone to calamities
Economic diversification Introduce other economic activities that are less vulnerable when
the primary source of income is threatened
Developing disaster resistant economic activities Match the type of economic enterprise to the placement location
considering the presence of hazards

Mitigation Strategies and Measures (Capacities)
Positive resources and abilities which are helpful to individuals, families, and community in mitigating,
preparing for, responding to, and recovering from the hazard impact
Risk Assessment:
- Utilizes the results of the hazard identification and vulnerability analysis
- Determines the probability of a specified outcome from a given hazard that affects a community
with known vulnerabilities
- Risk is a function of the hazards to which a community is exposed and the vulnerabilities of that
community. However, that risk is modified by the level of the local preparedness of the
community at risk. It is expressed by the following notation
Risk Assessment Benefits:
- Prevention or removal of hazards
- Removal of at-risk populations from hazards
- Provision of public information and education
- Establishment of early warning systems
- Reduction of risk posed by some hazards
- Enhanced of a local communitys capacity to respond during disasters

PHASE II: Preparedness
Preparedness
Preparedness is a continuous cycle of planning, organizing, training, equipping, exercising, evaluation and
improvement activities to ensure effective coordination and the enhancement of capabilities to prevent,
protect against, respond to, recover from, and mitigate the effects of natural disasters, acts of terrorism and
other man-made disasters
DISASTER PREPAREDNESS
A continuous and integrated process
Involves a wide range of activities and resources taken before the onset of a disaster from multi-sectoral
sources

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Enables successful discharge of emergency management programs, by which disaster relief is coordinated
and mobilized from governmental and nongovernmental organizations to helpless victims of a disaster
GOALS:
o To achieve a satisfactory level of readiness to respond to any emergency situation
o Develop programs that will strengthen the technical and managerial capacity of governments,
organizations, and communities
o Build response mechanisms and procedures, rehearsals, developing long-term and short-term
strategies, public education and building early warning systems

KEY POINTS:
E Disaster Mitigation and Preparedness go hand-in-hand
o Disaster preparedness for example includes implementation of mitigation measures to ensure that
existing that infrastructure can withstand the forces of disasters or that people can respond in
their communities and at the same time protect themselves
E Mitigation is important, but preparedness is DOUBLE important
o In local circumstances and because of historical proneness to disasters, mitigation is important,
but preparedness is doubly important
E Involves the preparation of people and essential service providers
o Consideration must be given to the manner in which the formal responders (Police and Fire
Services, Emergency Medical Services personnel and the Military) prepare to respond to
disasters. For example, the personnel in these response agencies may have to learn the use of new
equipment methods for diseases
E Requires global, national, community and individual inputs
o According to the International Federation of Red Cross and Red Crescent Societies (IFRCRCS,
2005), Disaster Preparedness incorporates all activities that will enhance the efficiency,
effectiveness and impact of disaster emergency response mechanisms in the local community and
throughout the country

DISASTER PREPAREDNESS MEASURES:
+ Preparedness plans
+ Emergency exercises/training
+ Warning systems
+ Emergency communications systems
+ Evacuation plans and training
+ Resource inventories
+ Emergency personnel/contact lists
+ Mutual aid agreements
+ Public Information/education

Disaster Risk Reduction (DRR)
Physical measures to reduce the vulnerability and exposure of infrastructure to natural hazards as well and
to provide coping and adaptive infrastructure in case of a disaster event (IFRCRCS, 2005)
Forms the pillars of disaster preparedness
Recommendations:
o Policy planning and capacity building in disaster management
o Physical prevention; example, building sea-walls against storm surge or flood shelters during
flood events
o Capacity building at institutional and systemic level in disaster preparedness

PHASE III: Response
Act of putting preparedness plans into action
Measures taken to save lives and prevent further damage in a disaster or emergency situation

AIMS OF DISASTER RESPONSE:
1. Support Morale
o In situations of civil or international conflict, ensure protection and assistance of the civilian
population
2. Provide Immediate Assistance
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o Re-establish self-sufficiency and essential services as quickly as possible, with special attention to
those whose needs are greatest: the most vulnerable and underprivileged
3. Maintain Life
o Ensure the survival of the maximum possible number of victims, keeping them in the best possible
health in the circumstances
4. Improve Health
o Provide adequate supply of basic needs. Ensure reduction of health-related threats in relocation
sites

Disaster Response Activities
1. Warning
- Refers to information concerning the nature of the danger and imminent disaster threats
- Action: Rapidly disseminate warnings to government officials, institutions and the population at
large in the areas at immediate risk
- Dissemination Methods: Radio, Television, Written Press, Telephone/Cell-phones
2. Evacuation and Migration
- Involves the relocation of a population from zones at risk of imminent disaster to a safer location
- Primary Concern: Protection of life, immediate treatment of injuries
- Measures for effective evacuation:
Timely and accurate warning system
Clear identification of escape routes
Established policy for evacuation procedures
Public education program (Evacuation plan awareness)
3. Search and Rescue (SAR)
- The process of identifying the location of disaster victims that may be trapped or isolated and
bringing them to safety and medical attention
- During Floods:
- Located stranded victims and transfer them to a safer place or;
- Provide them with foods and first aid until evacuated or returned to their homes
- During Earthquakes
- Locate trapped and or injured victims
4. Post-disaster Assessment
- The primary objectives:
Provide a clear, concise picture of the post-disaster situation
To identify relief needs
To develop strategies for recovery
- It determines options for humanitarian assistance, how best to utilize existing resources, or to
develop requests for further assistance
5. Response and Relief
- Should take place immediately
- There should be no delays
- Contingency plans should be constructed
- Relief Is the provision on a humanitarian basis of material aid and emergency medical care
necessary to save and preserve human life
Enables families to meet their basic needs for medical and health care, shelter, clothing, water
and food (including the means to prepare food).
Relief supplies or services are typically provided, free of charge, in the days and weeks
immediately following a sudden disaster
6. Logistics and Supply



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7. Communication and Information Management
- Two Aspects to Communications in Disasters:
1. Communication Equipments:
Radios, Telephones, Wireless devices
Supporting Systems: Satellites, Transmission Lines
2. Information Management System:
Protocol of communication
Information Dissemination and interpretation
- All of the above activities are dependent on communication. There are two aspects to communications in disasters. One is the equipment that
is essential for information flow, such as radios, telephones and their supporting systems of repeaters, satellites and transmission lines.
- The other is information management: the protocol of knowing who communicates what information to whom, what priority is given to it,
and how it is disseminated and interpreted
8. Survivor Response and Coping
- Assess victims for existing social coping mechanism
- Provide social services to victims with special needs to hep hem adjust with the trauma and
disruption caused by the disaster
- ACTIVE PARTICIPATION OF VICTIMS == HEALTH RECOVERY!
9. Security
- Not always a priority issue after a sudden onset of disasters
- Civil defense or police departments should ensure the protection of the human rights and safety of
displaced populations or refugees
10. Emergency Operations Plan
- Emergency Operations Plan (EOP)
- Policies and procedures that sets out the scope of activities required for community preparedness
and response
- Allows the community to respond to threats and engages responders in the short-term recovery
- Must be flexible (adjustable in real and potential emergencies)
11. Rehabilitation
- Actions taken in the aftermath of disaster to:
> Resumption of basic services
> Assist victims in repair of dwellings and community facilities
> Facilitate revival of economic activities
- Rehabilitation focuses on enabling the affected populations (Families and local Communities) to resume more-or-less normal (pre-disaster)
patterns of life
- It may be considered as transitional phase between:
i. Immediate relief and
ii. More major, long-term reconstruction and the pursuit of ongoing development
12. Reconstruction
- Is the permanent construction or replacement of severely damaged physical structures
- The full restoration of all services and local infrastructure
- Revitalization of the economy (Including agriculture)
- Reconstruction must be fully integrated into ongoing long-term development plans, taking account of future disaster risks. It must also
consider the possibilities of reducing those risks by the incorporation of appropriate mitigation measures

Traditional Responses to Disaster
* Provisions in-kind
* Provisions in cash
* Local Partnerships
* Civil Service

Modern Responses to Disaster:
* Cell Phones
* Spatial Devices
* Social Networking
* Social Media
PHASE IV: Recovery
Actions taken to return the community to normal following a disaster
There is no distinct point at which immediate relief changes into recovery
Continues until all systems return to normal or better
Short Term Recovery Long Term Recovery
Restore interrupted utility services
Clear roads
Fix of demolish severely damaged buildings
Complete redevelopment of damaged areas
Improve the status of community better than its
pre-disaster state
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Provide foods and shelter to displaced victims Develop new mitigation strategies

Recovery Plan
Designed to spell out major steps for managing successful recovery
Involves designation of key partners for each steps including their roles and instruction for mobilization
- Gathering Basic Information
- Organizing Recovery
- Mobilizing Resources for Recovery
- Administering Recovery
- Regulating Recovery
- Coordinating Recovery Activities
- Evaluating Recovery

Disaster Plan Evaluation (Plan, Personal Property and Equipment)
Purposes:
Evaluate the disaster response plan for effectiveness and completeness
Assess the comprehension of key personnel expected to execute the plan and their ability to perform the
assigned duties
Ensure availability and functionality of equipment to be called in during disaster events

Disaster Drills
Best method to evaluate disaster plans for effectiveness
Staging of full-scale or small segment of disaster response
Assessment techniques:
o Table top academic exercises
o Mock patients
o Computer simulations
o Seminar sessions focused on key personnel or aspects of disaster
Essentials of Effective Disaster Drill Implementation:
o Goals and Objectives should be clearly communicated
o The more realistic the exercise, the more likely it is to be useful in assessing the strengths and
weakness of both the disaster plan and the responders
o Include all individuals and agencies likely to be involved in a disaster response, and a critique
during debriefing of the participants
Key Points to Disaster Plan Evaluation:
o Any modifications made to a disaster plan or response procedures must be communicated to all
groups involved
o Evaluate personnel to ensure their familiarity with their roles in disaster situation
o Accommodate changes in population demographics, regional emergency response operations,
hospital renovations and other variables
o At a minimum, disaster drills should take place once every 12 months in the community, and more
frequently in hospitals