NCM4225 DISASTER NURSING (PRE-LIM)

DISASTER
Etymology - The word disaster comes from the Latin words dis (bad) and astro/aster (star). In the Middle
Ages, disasters such as floods or fires were blamed on the misalignment of the planets or attributed to the
events written by the stars.

Any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health
and health services on a scale sufficient to warrant an extraordinary response from outside the affected
community or area. (World Health Organization 1995)

A situation or event, which overwhelms local capacity, necessitating a request to the national or
international level for external assistance; an unforeseen and often sudden event that causes great
damage, destruction and human suffering. (United Nations 2008)

A serious disruption of the functioning of a community or society involving widespread human, material,
economic or environmental losses and impacts, which exceeds the ability of the affected community or
society to cope with using its own resources. (United Nations Office for Disaster Risk Reduction 2015)

MAIN TYPES OF DISASTER

I. Natural Disasters
II. Man-Made Disasters
III. Hybrid Disasters

I. Natural Disasters- A natural disaster is a natural process or phenomenon that may cause loss of life,
injury or other health impacts, property damage, loss of livelihoods and services, social and
economic disruption, or environmental damage.

Classification of Natural Disasters

A. Geophysical (i.e. Earthquakes, Landslides and Debris Flow, Tsunamis and Volcanic Activity)
a) EARTHQUAKE A shaking or trembling of the earth that is volcanic or tectonic in origin. (Webster)
Also known as a quake, tremor or temblor is the shaking of the surface of the Earth resulting
from a sudden release of energy in the Earth's lithosphere that creates seismic waves. The
seismicity, or seismic activity, of an area is the frequency, type, and size of earthquakes
experienced over a particular time period.

Anatomy of an Earthquake
 Fault Lines refer to the gap between tectonic plates caused by plate movement. Fractures
in Earth's crust where rocks on either side of the crack have slid past each other.
Sometimes the cracks are tiny, as thin as hair, with barely noticeable movement between
the rock layers
 Focus is the point earthquake begins.
 Epicenter is the point in the ground level directly above the focus.
 Seismic Waves are vibrations rapidly moving from direction of the focus. Waves of energy
that travel through Earth's layers, and are a result of earthquakes, volcanic eruptions,
magma movement, large landslides and large man-made explosions that give out
low-frequency acoustic energy.

Types of Earthquake
 Tectonic earthquakes are produced by sudden movement along faults and plate
boundaries.
 Volcanic earthquakes are induced by rising lava or magma beneath active volcanoes.
 Explosion earthquakes related to volcanic events, and they occur (beneath the crater) with
volcanic explosions. It can also happen during nuclear tests.
 Collapse earthquakes are small earthquakes in underground caverns and mines that are
caused by seismic waves produced from the explosion of rock on the surface.
 Cryoseism -Ice quake or frost quake, is a seismic event caused by a sudden cracking action
in frozen soil or rock saturated with water or ice, or by stresses generated at frozen lakes.
As water drains into the ground, it may eventually freeze and expand under colder
temperatures, putting stress on its surroundings.

Seismometer is an instrument that responds to ground noises and shaking such as caused by
earthquakes, volcanic eruptions, and explosions. They are usually combined with a timing device
and a recording device to form a seismograph. The output of such a device—formerly recorded
on paper (see picture) or film, now recorded and processed digitally—is a seismogram. Such
data is used to locate and characterize earthquakes, and to study the Earth's internal structure.

Measuring the Strength of an Earthquake

1. Magnitude is proportional to the energy released by an earthquake at the focus. It is
calculated from earthquakes recorded by an instrument called seismograph. It is
represented by Arabic Numbers (e.g. 4.8, 9.0).
2. Intensity is the strength of an earthquake as perceived and felt by people in a certain
locality. It is a numerical rating based on the relative effects to people, objects,
environment, and structures in the surrounding. The intensity is generally higher near the
epicenter. It is represented by Roman Numerals (e.g. II, IV, IX). In the Philippines, the
intensity of an earthquake is determined using the PHIVOLCS Earthquake Intensity Scale
(PEIS).

Earthquake-Related Hazards
1. Subsidence- A gradual settling or sudden sinking of the Earth’s surface owing to
subsurface movement of earth materials. Principal causes are aquifer-system compaction,
drainage of organic soils, underground mining, hydrocompaction, natural compaction,
sinkholes, and thawing permafrost.
 2. Seiches - Oscillating waves that produce major fluctuations in the water level. Series of
standing waves in a fully- or partially-enclosed body of water caused by earthquakes or
landslides.
3. Liquefaction - Similar to subsidence but occurs when sediments are saturated with water.
While these events can occur naturally, they are usually aggravated by earthquakes.
4. Tsunamis - Giant waves produced when a fault displaces a large slab of the ocean floor.
Nearly undetectable in the open ocean, but once tsunamis reach shallow waters, wave
height increases dramatically and can reach up to 30 meters.

b) Landslides - Form of mass wasting where large amounts of earth move down a slope under the
influence of gravity. They can have devastating effects especially in heavily populated areas
near hillsides or mountain slopes.

c) Mudslides - Develop when water rapidly accumulates in the ground and results in a surge of
water-saturated rock, earth, and debris. Usually start on steep slopes and can be activated by
natural disasters.

d) Rockslides - A type of landslide caused by rock failure in which part of the bedding plane of
failure passes through compacted rock and material collapses en masse and not in individual
blocks.

e) Volcanic Eruption - A volcano is an opening or rupture in the earth's surface that allows magma
(hot liquid and semi-liquid rock), volcanic ash and gases to escape. A volcanic eruption is when
lava and gas are released from a volcano—sometimes explosively

Volcanic Eruption Hazards

1. Lava flows
2. Pyroclastic flows
3. Lahars
4. Jökulhlaups (glacial outburst floods)
5. Landslides
6. Debris avalanches
7. Volcanic activity also produces hazards that can affect areas far from the volcano, such as
tephra or ash falls, releases of gas and tsunamis.

Pyroclastic Materials
 Magma - Molten rock beneath the surface of the earth.
 Lava - Magma that has erupted onto the surface of the Earth and maintaines its integrity
as a fluid or viscous mass.
 Lahar - A mixture of water and volcanic debris that moves rapidly downstream.
Consistency can range from that pf muddy dishwater to that of wet cement, depending on
the ratio of water to debris.
 Tephras - Volcanic rock fragments irrespective of grain size produced during an explosive
eruption.
 Volcanic ash - Fine-grained material that is ejected during explosive volcanic
eruptions caused by rapid expansion of gases.
 Volcanic Bombs - Large magma blobs.
 Volcanic BLocks - Large pieces of solid rock.
 Lapilli - “Little Rocks”. Rock fragments ejected from a volcano.

B. Hydrological (i.e. Avalanches, Floods and Sinkholes)

a) Avalance - Also called a snow slidem, is a rapid flow of snow down a slope, such as a hill or
mountain. Primarily composed of flowing snow and air, large avalanches have the capability to
 capture and move ice, rocks, and trees. Can be set off spontaneously, by such factors as
increased precipitation or snow pack weakening, or by external means such as humans, animals,
and earthquakes
b) Flood - An overflow of water that submerges land that is usually dry. Climate change increased
rainfall and extreme weather events increases the severity of other causes for flooding,
resulting in more intense floods and increased flood risk.

Contributing Factors to Flooding

i. Daily Tides - High tides that are regular, predictable rise and fall of the currents caused by
the moon and sun’s gravity.
ii. King Tides - Non-scientific term people often use to describe exceptionally high tides.
These higher than normal “spring” tides occur during new or full moon during specific
seasons around the globe.
iii. El Niño causes changing weather patterns and warmer surface waters in the Pacific, which
can lead to increase sea level.
iv. Coastal Storms - Storms can cause an abnormal rise in water levels over and above the
prescribed tide. The rise in water can cause extreme flooding in coastal areas particularly
when storm-driven waves coincide with high tide.

Causes of Floods
 Increased Urbanization
 Bad farming practice
 Deforestation
 Storms
 Ice and snow melting
 Dam and levee failures

Main Types of Floods

 River Flood (Fluvial floods) - caused by excessive rain or melting of snows which causes the
level of water to overflow from a river.
 Flash Floods - Caused by excessive rainfall top of a higher ground (like a hill) which travels
or flow to low lying areas. Usually accompanied by mud or debris that are washed away by
the water (like trees).
 Coastal Floods ( Storm Surge) - brought about bu tropical storms where water is forces
ashore by strong high winds.
 Urban FLoods - drainage system in a city cannot absorb the amount of water brought
about by heavy or excessive rain.

c) Sinkhole - Sudden sinking of the Earth’s surface due to the movement of the earth underneath
most often caused by the removal of water, oil, natural gas, or mineral resources out of the
ground by pumping, fracking, or mining activities.

Karts Topography - Formed from the dissolution of soluble rocks such as limestone, dolomite,
and gypsum; and quartzite given the right conditions.

C. Climatological (i.e. Extreme Temperatures, Thunderstorms and Lightning, Drought and Wildfires, and
Winter and Ice Storms)
a) Climate Change refers to long-term shifts in temperatures and weather patterns. These shifts
may be natural, but since the 1800s, human activities have been the main driver of climate
change, primarily due to the burning of fossil fuels (like coal, oil and gas), which produces
heat-trapping gases.
 i. EL NIÑO “the boy” is the warm phase of the El Niño–Southern Oscillation (ENSO)
associated with a band of warm ocean water that develops in the central and east-central
equatorial Pacific (the area off the Pacific coast of South America).
ii. LA NIÑA “the girl is an oceanic and atmospheric phenomenon that is the colder
counterpart of El Niño, as part of the broader ENSO climate pattern.

b) Heat Wave - Qualitatively, heat wave is a condition of air temperature which becomes fatal to
human body when exposed. Quantitatively, it is defined based on the temperature thresholds
over a region in terms of actual temperature or its departure from normal. Heat waves are
more dangerous when combined with high humidity. The combination of temperature and
humidity is measured by the heat index.

Heat Index - Also known as the apparent temperature, is what the temperature feels like to the
human body when relative humidity is combined with the air temperature.

c) Drought is defined as drier than normal conditions. This means that a drought is "a moisture
deficit relative to the average water availability at a given location and season". A drought can
last for days, months or years.
d) Wildfire, forest fire, bushfire, wildland fire or rural fire is an unplanned, uncontrolled and
unpredictable fire in an area of combustible vegetation.
e) Heavy Rains - Intertropical Convergence Zone, or ITCZ, is a band of low pressure around the
Earth which generally lies near to the equator. The trade winds of the northern and southern
hemispheres come together here, which leads to the development of frequent thunderstorms
and heavy rain.
f) Thunderstorm - An electrical storm or a lightning storm, characterized by the presence of
lightning and its acoustic effect on the Earth's atmosphere, known as thunder. Relatively weak
thunderstorms are sometimes called thundershowers.
g) Tornado - is a violently rotating column of air that is in contact with both the surface of the
Earth and a cumulonimbus cloud or, in rare cases, the base of a cumulus cloud. Tornadoes
develop from severe thunderstorms in warm, moist, unstable air along and ahead of cold fronts.
Such thunderstorms also may generate large hail and damaging winds. When intense
springtime storm systems produce large, persistent areas that support tornado development,
major outbreaks can occur.
h) Hailstorm - Hail is a type of solid rain made up of balls or lumps of ice. Hail forms when a
thunderstorm updraft lifts a water droplet above the freezing level in the atmosphere. The
frozen water droplet then accretes super-cooled water or water vapor, which freezes once it
comes in contact with the frozen droplet. This process causes a hailstone to grow. They
typically last for no more than 15 minutes but can cause injuries to people and damage
buildings, vehicles and crops.
i) Winter storm - An event in which wind coincides with varieties of precipitation that only occur
at freezing temperatures, such as snow, mixed snow and rain, or freezing rain. In temperate
continental climates, these storms are not necessarily restricted to the winter season, but may
occur in the late autumn and early spring as well. A snowstorm with strong winds and other
conditions meeting certain criteria is called a blizzard. Winter storm brings about extreme cold,
freezing rain, sleet, heavy snowfall, ice, and high winds.

D. Meteorological (i.e. Hurricanes, Tornadoes, Cyclones and Tropical Storms/Wave Surges)

a) Tropical Cyclone - A rapidly rotating storm system characterized by a low-pressure center, a
closed low-level atmospheric circulation, strong winds, and a spiral arrangement of
thunderstorms that produce heavy rain and/or squalls. Depending on its location and strength,
a tropical cyclone is referred to by different names, including hurricane (/ˈhʌrɪkən, -keɪn/),
typhoon (/taɪˈfuːn/), tropical storm, cyclonic storm, tropical depression, or simply cyclone
 Typhoon Hazards
i. Storm surge flooding
ii. Inland flooding from heavy rains
iii. Destructive winds
iv. Tornadoes
v. High surf and rip currents - Often simply called a rip (or misleadingly a rip tide), is
a specific kind of water current that can occur near beaches with breaking
waves. Rip currents are powerful, narrow channels of fast-moving water or
localized current that flows away from the shoreline toward the ocean,
perpendicular or at an acute angle to the shoreline. It usually breaks up not far
from shore and is generally 24 meters (80 feet) wide.

b) Storm Surge - Storm flood, tidal surge, or storm tide is a coastal flood or tsunami-like
phenomenon of rising water commonly associated with low-pressure weather systems, such as
cyclones.
c) Squall l is often named for the weather phenomenon that accompanies it, such as rain, hail, or
thunder; a line squall is one associated with a squall line of thunderstorms that is often
hundreds of kilometers long.
d) Derecho - A derecho is a widespread, long-lived wind storm that is associated with a band of
rapidly moving showers or thunderstorms. The word derecho means “straight ahead” in
Spanish.

E. Disease Outbreaks (i.e. Epidemics) - A sudden increase in occurrences of a disease when cases are in
excess of normal expectancy for the location or season. It may affect a small and localized group or
impact upon thousands of people across an entire continent.
a) Common Source - A common-source outbreak is one in which a group of persons are all
exposed to an infectious agent or a toxin from the same source.
b) Propagated or Progressive Epidemics - A propagated outbreak results from transmission from
one person to another. Usually, transmission is by direct person-to-person contact, as with
syphilis.
c) Mixed Epidemics - Some epidemics have features of both common-source epidemics and
propagated epidemics. The pattern of a common-source outbreak followed by secondary
person-to-person spread is not uncommon. These are called mixed epidemics.

Disease Transmission
1. Droplets
2. Airborne
3. Direct Contact
4. Indirect Contact
5. Waterborne
6. Foodborne
7. Vector-borne

Microorganisms that can Cause Diseases

1. Bacteria
2. Protozoa
3. Fungi
4. Algae

Patient Zero - Index case is the first documented patient in a disease epidemic within a population,
or the first documented patient included in an epidemiological study. It can also refer to the first
case of a condition or syndrome (not necessarily contagious) to be described in the medical
literature, whether or not the patient is thought to be the first person affected.
 Types of Disease Outbreaks:
a) Endemic - Greek ἐν, en, "in, within" and δῆμος, demos, "people" Infection is constantly
maintained at a baseline level in a geographic area without external inputs. It is a rapid spread
of disease to a large number of hosts in a given population within a short period of time.
b) Epidemic - Greek ἐπί epi "upon or above" and δῆμος demos "people" Rapid spread of disease
to a large number of hosts in a given population within a short period of time. Affects a large
number of people within a community, population, or region.
c) Pandemic - Greek πᾶν, pan, "all" and δῆμος, demos, "local people" the 'crowd' An epidemic of
an infectious disease that has spread across a large region - multiple continents or worldwide,
affecting a substantial number of individuals. Epidemic that's spread over multiple countries or
continents.

Outbreak of Concern
1. Cholera 10. Yellow fever
2. Dengue fever 11. Viral hemorrhagic fevers (i.e. Ebola virus disease,
3. Influenza Lassa fever, Rift Valley fever, Marburg virus disease)
4. Typhus 12. Coronaviruses
5. Smallpox 13. Severe acute respiratory syndrome
6. Measles 14. Influenza
7. Tuberculosis 15. H5N1 (Avian flu)
8. Leprosy 16. Zika virus
9. Malaria

II. Man-Made or Artificial Disasters - Anthropogenic or Human-instigated disasters are the consequence
of technological or human hazards. Examples include war, social unrest, stampedes, fires, transport
accidents, industrial accidents, conflicts, oil spills, terrorist attacks, nuclear explosions/nuclear
radiation. Man-made disasters have an element of human intent, negligence, or error involving
a failure of a man-made system

Causes:
 Human-Intent
 Human Error
 Failed Systems
 Man-Made Disasters Categories:
1. Violent Conflicts - use of physical force to resolve competing claims or interests
a) Civil Unrest or Civil Disturbance - an incident which disrupts a community and requires
intervention to maintain public safety. (i.e. panic, mass hysteria, demonstrations, riots,
strikes, public nuisances, and criminal activities
b) Terrorism - unlawful use of violence and intimidation, especially against civilians, in the
pursuit of political aims. (i.e. use of use of CBRNE; hijackings, hostage takings, kidnappings,
mass shootings, car bombings, and, frequently, suicide bombings)
2. Technological Disaster - originate from technological or industrial conditions, dangerous
procedures, infrastructure failure or human activity. (i.e. cyber-attacks, urban or structural fire,
arson, explosions, hazmat spills, structure collapse or failure, power failure)
a) Transportation Disasters - driver or pilot related incidents due to fatigue, distractions, and
inattention during transport (i.e. road, railroad, marine, aviation)
b) Environmental Disasters - extreme events or substances in the Earth and its ecological
system that may cause adverse consequences resulted from human manipulation. (i.e.
land degradation, deforestation, desertification, wildland fires, loss of biodiversity, land,
water and air pollution, climate change, sea level rise and ozone depletion)
c) Structural Failure Disasters - begins to occur when the material is stressed to its upper
strength limit causing to rupture or extreme deformations. The ultimate strength of the
material or the system is the limit of the load bearing capacity.

III. Hybrid or Mixed - A man-made disaster combines with the forces of nature as a result of technical
failure or sabotage. It can be a natural phenomenon, where human intervention causes disorder that
leads to big risk events, resulting in a disaster that exceeds the capacity of society to respond to it.

i.e.: Experimental hybrid model used to study flood hazard and vulnerability in West Virginia showing
relations between social and biophysical factors.

Flooding Hazard and Vulnerability. An Interdisciplinary Experimental Approach for the Study of the 2016
West Virginia Floods by Martina Angela Caretta, Rodrigo Fernandez, Nicolas P. Zégre, Jamie Shinn
PHILIPPINE DISASTER AND RISK PROFILE
Philippines (Republic of the Philippines (Filipino: Republika ng Pilipinas)
Historically, the total number of islands in the archipelago was 7,107. In 2016 the National Mapping and
Resource Information Authority of the Philippines discovered more than 500 previously uncharted islands.
In total the archipelago has around 7,640 islands — about 2,000 of which are inhabited

Filipinos (Tagalog: Mga Pilipino) are the people who are citizens of or native to the Philippines. The
majority of Filipinos today come from various Austronesian ethnolinguistic groups, all typically speaking
either Filipino, English, and/or other Philippine languages. Currently, there are more than 185
ethnolinguistic groups in the Philippines; each with its own language, identity, culture, and history.

Administrative Region
3 Geographical Areas: Luzon, Visayas, and Mindanao
18 regions
81 provinces
145 cities
1,489 municipalities
2,029 barangays

Iloilo, officially the Province of Iloilo

(Hiligaynon: Kapuoran sang Iloilo; Kinaray-a: Kapuoran kang Iloilo; Tagalog: Lalawigan ng Iloilo)
5 Congressional Districts
42 Municipalities
2 Cities (one component and one highly urbanized)
1,721 Barangays
2.5 million as of January 2023

Iloilo City, officially the City of Iloilo

(Hiligaynon: Dakbanwa sang Iloilo, Syudad sang Iloilo; Tagalog: Lungsod ng Iloilo)
Lone Congressional District
7 Geographical Districts
180 Barangays
± 457 K population

DISASTER RISK PROFILE

National-level disaster risk profiles provide information on possible losses in future disasters; guide the
placement of infrastructure to minimize new risk; inform urban planning and risk reduction measures; and
guide disaster risk financing efforts, to name a few.

Disaster risk is expressed as the likelihood of loss of life, injury or destruction and damage from a disaster
in a given period of time. (UNDRR Global Assessment Report, 2015)

Disaster risk is widely recognized as the consequence of the interaction between a hazard and the
characteristics that make people and places vulnerable and exposed.
PHILIPPINE NATURAL DISASTER RISK INDEX
Due to the geographical context of the Philippines, the country is vulnerable to numerous natural
disasters ranging from earthquakes, tropical cyclones, and flooding. In 2021, earthquakes occurring in the
country had a 10 risk index points while tropical cyclones had a 9.5 risk index points.

The World Risk Index 2022 (released September) ranked the Philippines first in the world in risk among
193 countries worldwide (representing 99 percent of global population). India and Indonesia ranked
second and third, followed by Colombia and Mexico. (Oct 20, 2022)
(WorldRiskReport published by Bündnis Entwicklung Hilft ISBN 978-3-946785-14-9)

Emergence and progression of disasters are highly dependent on the social conditions of the people,
regions, and countries affected, to accompany the shift from reactive to proactive action.
Disaster risks are not solely shaped by the occurrence, intensity, and duration of extreme natural events,
but that social factors, political conditions, and economic structures are equally responsible for whether
disasters occur in the context of extreme natural events.

Exposure is the extent to which populations in hazard-prone areas are exposed to and burdened by the
impacts of extreme natural events or the negative consequences of climate change

Thus, exposure consists of the aspects of hazardousness, which include the frequency and intensity of
earthquakes, tsunamis, coastal and river floods, cyclones, droughts, and sea-level rise in an area (hazard
zone), and populations (hazard object)

The country, however, was not included in the top 10 most vulnerable countries to disasters.

Vulnerability focuses on the tendency of populations to be vulnerable to damage from extreme natural
events or the negative impacts of climate change.

Author: International Monetary Fund. Asia and Pacific Dept, Publication Date: 06 Feb 2020, eISBN:
9781513529158, ISBN: 9781513529158

As a sphere of economic, political, social, and environmental factors, vulnerability maps the capacities and
dispositions of people, households, and societies and indicates how easily and to what degree they can be
destabilized, damaged, or even destroyed by extreme events.
It is composed of the three dimensions of susceptibility, lack of coping capacities, and lack of adaptive
capacities, which are subdivided into further categories.
The country’s coping capabilities and adaptive capacities scores were 57.81 (very high) and 55.48 (high),
respectively.

Coping capacities is the abilities and measures of societies to counter adverse impacts of natural events
or climate change through direct actions and available resources in the form of formally or informally
organized activities and measures, as well as to reduce damage in the immediate aftermath of an event
and initiate recovery.

Adaptive capacities, in contrast refers to long-term processes and strategies to achieve anticipatory
changes in societal structures and systems to counteract, mitigate, or purposefully avoid future negative
impacts

Destructive Earthquakes in the Philippines

1968 August 02 Casiguran Earthquake Ms: 7.3 Mb: 5.9 (ISC) Killed 270, Injured 261
1973 March 17 Ragay Gulf Earthquake Ms: 7.1 Dead 15; Injured 100
1976 August 17 Moro Gulf Earthquake Mw: 8.1 Dead 4,751, Missing 2,288, Injured 9,926
1983 August 17 Laoag Earthquake Ms: 6.5 Dead 16; Injured 47
1990 February 08 Bohol Earthquake Ms: 6.8 Dead 6; Injured 200; Displaced 46,000
1990 June 14 Panay Earthquake Ms: 6.1 Killed 8; Injured 41
1996 May 27 Bohol Earthquake Ms: 5.6
1999 June 07 Earthquakes in Agusan del Sur Ms: 5.1
2002 March 06 Ms6.8 Palimbang Earthquake Dead 8; Injured 41; Affected 7,684 families

Deadliest Earthquakes in the Philippines

1968 August 02 Casiguran Earthquake Ms: 7.3 Mb: 5.9 (ISC) Killed 270; Injured 261
1976 August 17 Moro Gulf Earthquake Mw: 8.1 Dead 4,751; Missing 2,288; Injured 9,926
1990 July 16 Luzon Earthquake Mw: 7.8 Dead 1,621; Injured 3,513; Missing 321 missing; Displaced
126,035
1994 November 15 Mindoro Earthquake Mw: 7.1 Dead 78
2013 October 15 Bohol Earthquake Mw: 7.2 Dead 222; Missing 8; Injured 976

Deadliest Typhoons in the Philippines

PHASES OF EMERGENCY
I. Mitigation
II. Preparedness
III. Response
IV. Recovery

I. MITIGATION
This phase includes actions taken to prevent or reduce the cause, impact, and consequences of
disasters. Examples of hazard mitigation include:
 Tying down homes with ground anchors to withstand wind damage
 Digging water channels to redirect water and planting vegetation to absorb water
 Constructing levees or permanent barriers to control flooding
 Reinforcing fencing to prevent animal escapes
 Buying insurance policies

II. PREPAREDNESS
This phase includes planning, training, and educational activities for events that cannot be mitigated.
Examples include:
 Developing disaster preparedness plans for what to do, where to go, or who to call for help in a
disaster
 Exercising plans through drills, tabletop exercises, and full-scale exercises
 Creating a supply list of items that are useful in a disaster
 Walking around an infrastructure and identifying possible vulnerabilities to high winds

III. RESPONSE
The response phase occurs in the immediate aftermath of a disaster. During the response phase,
business and other operations do not function normally. Personal safety and wellbeing In an
emergency and the duration of the response phase depend on the level of preparedness. Examples
of response activities include:
 Implementing disaster response plans
 Conducting search and rescue missions
 Taking actions to protect yourself, your family, your pets, and others
 Addressing public perceptions about food safety

IV. During the recovery period, restoration efforts occur concurrently with regular operations and
activities. The recovery period from a disaster can be prolonged. Examples of recovery activities
include:
 Preventing or reducing stress-related illnesses and excessive financial burdens
 Rebuilding damaged structures based on advanced knowledge obtained from the preceding
disaster
 Reducing vulnerability to future disasters
ACTIVITIES PRE-EVENT to POST -DISASTER

EMERGENCY AND DISASTER

The terms emergency and disaster often are used interchangeably. This common use of terms can be
confusing. It is easiest to understand the terms emergency and disaster as being at two ends of a scale, in
which the size of an incident and the resources to deal with the incident are matched to varying degrees.

EMERGENCIES are usually small scale, localized incidents which are resolved quickly using local resources.
However, small-scale emergencies can escalate into disasters when there has been inadequate planning
and wasteful use of resources.

DISASTERS are typically largescale and cross geographic, political, and academic boundaries. Disasters
require a level of response and recovery greater than local communities can provide.

EMERGENCY AND DISASTER Similarities

 Both begin as unexpected occurences with little or no warning
 Both produces negative effects
 Both require immediate response
 Both may well have available personnel and resources that are initially overwhelmed by demand for
their services
 Both have similar goals - save lives, protect property, mitigate impact and hasten recover

EMERGENCY AND DISASTER Differences

 Differing methods of response
 Differing resources available
 Differing impacts

“Disaster is an event that results in large numbers of deaths and injuries; causes extensive damage or
destruction of facilities that provide and sustain human needs; produces an overwhelming demand on
state and local response resources and mechanisms; causes a severe long-term effect on general
economic activity; and severely affects state, local, and private sector capabilities to begin and sustain
response activities.”
FEMA (Federal Emergency Management Agency)

LEVELS OF A DISASTER
Emergency managers further classify emergencies and disasters by size and the type and number of issues
that need to be addressed. This classification involves
 minor emergencies,
 limited and potential emergencies, and
 major disasters.
DISASTER SCALE
I. LEVEL I - EMERGENCY
 Minor incidents that do not interrupt daily operations
 Handled by minimal personnel
II. LEVEL II - SMALL
 Limited or isolated area
 Disruption may be handled within a day
 Outside resources from other locality may be needed
III. LEVEL III - MEDIUM
 Disruption may be handled within 48 hours
 Outside resources from other locality/region are needed
IV. LEVEL IV - MAJOR/LARGE SCALE
 Wide-area disaster
 Outside resources from national/international are needed

DISASTER DECLARATION is a formal statement by a jurisdiction that a disaster or emergency exceeds the
response and/or recovery capabilities. Although a declaration is commonly addressed after a disaster, a
declaration may be made if a disaster is found to be imminent.

EMERGENCY DECLARATION is more limited in scope and without the long-term federal recovery
programs of a Major Disaster Declaration. Generally, federal assistance and funding are provided to meet
a specific emergency need or to help prevent a major disaster from occurring.

STATE OF EMERGENCY is a situation in which a government is empowered to be able to put through

policies that it would normally not be permitted to do, for the safety and protection of its citizens. A
government can declare such a state during a natural disaster, civil unrest, armed conflict, medical
pandemic or epidemic or other biosecurity risk.
Justitium is its equivalent in Roman law—a concept in which the Roman Senate could put forward a final
decree (senatus consultum ultimum) that was not subject to dispute yet helped save lives in times of
strife.
In the Philippines, there are several situations that calls for various levels of government action in the
Philippines. The constitution alludes to these.

Disasters and major emergencies affect people‘s lives in many different aspects – their health, security,
housing, access to food, water and other life commodities. Therefore, it is vital to strengthen the
disaster/emergency preparedness as well as the response to different natural and man-made disasters.
GUIDELINES IN DISASTER AND EMERGENCY SITUATION
Nurses need to be familiar with their role in emergency preparedness and disaster planning as they
frequently have wide-ranging leadership responsibilities for community- and hospital-level disaster
preparedness and response. This chapter discusses the definition of a disaster, either natural or
anthropogenic (caused by humans), disaster preparedness and planning, and the disaster response.

An emergency as the state in which normal procedures are interrupted, and immediate measures
(management) need to be taken to prevent it from becoming a disaster, which is even harder to recover
from. Disaster management is a related term but should not be equated to emergency management.
(WHO)

Emergency management is the organization and management of the resources and responsibilities for
dealing with all humanitarian aspects of emergencies (prevention, preparedness, response, mitigation,
and recovery). The aim is to prevent and reduce the harmful effects of all hazards, including disasters.

DISASTER NURSING TIMELINE

I. DISASTER MITIGATION
Disaster mitigation measures are those that eliminate or reduce the impacts and risks of hazards through
proactive measures taken before an emergency or disaster occurs. It begins with identifying the risks.
Health care leaders need to evaluate potential emergencies or disasters that could impact the demand for
their services and supplies, then develop a plan that will address those needs.
Hospital facility planners and health leaders should address those disasters that are most likely to occur in
their community and geographic area and perform a hazard vulnerability analysis to determine the likely
vulnerabilities that may arise in their facility from those disasters.

Hazard Vulnerability Analysis (HVA) is defined as a systematic approach that:

 identifies all hazards that may affect a community;
 determines the probability of the hazard;
 determines the consequences of the hazard; and
 analyzes the findings to determine what hazards are of priority
(Saunderson Cohen, 2013; Hendrickson & Horowitz, 2016)

The results of an HVA can be used to develop and streamline disaster plans. These plans should be
designed using an interdisciplinary approach, including partners from local police, emergency, and fire
services. HVAs should be conducted on an annual basis, or whenever there are demographic or
infrastructural changes that may impact the potential of a disaster.

II. DISASTER PREPAREDNESS

The goal of disaster preparedness is to plan a response that will decrease the damages and support the
recovery from a disaster (Stopford, 2007). Nurses, with their expertise in primary health care, extensive
experience with interdisciplinary teamwork, and strong collaborative skills are the ideal leaders in disaster
preparedness.

DISASTER PLANNINGN AND PUBLIC HEALTH PREPAREDNESS

The first step in preparing for a disaster is developing a strategic emergency management plan (SEMP)
(Public Safety Canada, 2016) in anticipation not only for those disasters that are most likely to occur in a
specific geographical area, but also those that are unexpected (Saunderson Cohen, 2013).

The SEMP is a broad scope document that guides and informs partners internally and externally on how
to respond to disasters. It includes specific processes for:
 the main goals of the plan and the method for attaining those goals;
 obtaining information on threats; and
 planning standard response to threats.

DISASTER PREPAREDNESS STRATEGIES

1. Determining a command and control plan. When determining a line of command, it is essential to
ensure you have both a command person and a second-in-command, should the situation arise that
the primary commander is unable to fulfill the role. The control plan must also include the
designation of a specific location for the command centre.
2. Identifying the functional roles and responsibilities of internal and external agencies. Internal and
external department need to have a clear understanding of both their roles and responsibilities and
other parties’ roles and responsibilities during a disaster. Contact information of emergency
personnel, along with their roles should be readily available. Additionally, essential service staff
should be defined, thus ensuring that there is consistent emergency staff coverage during the
disaster.
3. Determining a communication system. A standard process of communication must be developed to
address the possibility of system failure. The contingency process should include the use of land lines,
cellphones, and radios as standard communication equipment.
4. Confirming a legal basis for response to include isolation strategies as needed for infection control.
Disaster preparedness must include details for the processes of isolation, infection control, and
allocation of medications such as vaccines, antibiotics, and antiviral agents should they become short
in supply. Additionally, should there be a need for facility lockdown and controlled facility access,
legal and ethical concerns need to be considered when developing this portion of the plan.
5. Developing an infectious disease plan. Standard process needs to address the potential for an
infectious disease outbreak or pandemic. Different illnesses require different levels of isolation and
personal protective equipment (PPE). Disaster preparedness addresses the possibility of high-level
isolation equipment requirements and ensures adequate supplies and equipment are readily
available. Emergency care providers should be familiar with clinical signs of different diseases, and a
surveillance methodology plan should be in place to address possible advancement of the disease
process.
6. Obtaining and maintaining emergency facilities, equipment, and supplies. Emergency preparedness
requires a standard process for obtaining and maintaining emergency equipment and supplies. This
includes a standard maintenance schedule, a tracking schedule of where equipment is located, and
details where to obtain additional equipment and supplies.
7. Providing disaster preparedness training for emergencies. Training may involve
a) educating personnel to understand their role in an emergency;
b) donning and doffing PPE;
c) decontamination procedures; and
d) triage.
Training should occur on a regular basis and should be included in regional orientation for all
personnel. Individual facilities require additional planning on the steps to take if a disaster disrupts
their day-to-day facility operations. This planning is directed at facility leadership and personnel and
provides a standard process for ensuring facilities can continue to provide regular essential services
(Saunderson Cohen, 2013).
Staff may be required to remain in the facility, and if so, they need to be trained to develop a
contingency plan for family emergency planning.

III. DISASTER RESPONSE

The first step in responding to an incident is recognizing the event is occurring and initiating the plans that
were developed in the preparedness phase. External responses may include activities such as
search-and-rescue operations, firefighting, and building shelters for displaced persons.
Nurses need to have a good understanding of the disaster plan, as well as a concrete awareness of the
events surrounding the incident, to provide the best care for their patients.
Efficient internal facility responses to disasters include disaster triage and casualty distribution.
Nursing during a disaster often focuses on providing care to an influx of patients to a care centre, and it
requires an understanding that these patients may have varying degrees of illness and injury as well as
emotional stress from the event. Disaster triage is the process of “doing the greatest good for the greatest
number of casualties” and has been characterized as the “keystone to mass casualty management”
Various disaster triage systems have been designed for use in mass casualty incidents; therefore, it is
important for facilities to determine in advance which system they will use. One method of disaster triage
is the simple triage and rapid transport (START) tool. This system was developed in the 1980s in Orange
County, California, and has been adopted throughout many countries.

CATEGORY DESCRIPTION

Immediate care required. These patients are in a priority treatment category with illness
RED
es or injuries that could result in loss of life or limb.

Urgent care required. This category of patient requires urgent treatment but can wait un
YELLOW
til the red-tagged patients have been stabilized.

Minimal care required. These patients require care but are deemed stable enough to wa
GREEN
it several hours for treatment.

End-of-life care required. Black-tagged patients are deemed to be beyond the ability of
BLACK the care team to provide lifesaving care. They are in a state of impending death or alrea
dy lifeless.

IV. DISASTER RECOVERY

Disaster recovery follows the response phase and is defined by the short-term and long-term actions
required to return the community to a normal state. Short-term recovery includes returning vital life
support systems to an operational state and repatriation of patients.
Establishing a protocol for the safe transport of patients back to their designated facility as soon as
possible helps to alleviate the psychological trauma of family separation. Additionally, it eases the burden
on the alternate care facilities and staff called into action during the disaster (Assid, 2014).
Long-term recovery includes such actions as restoring damaged infrastructure and damaged property, and
providing physical and psychological support for victims, families, and responders (Upton, 2013). Physical
damage is an easily identifiable visual cue of disaster, but it is not always present (Saunderson Cohen,
2013).
Pandemics, bio- and cyber-terrorism are examples of disasters that leave minimal or no visual footprint.
However, the psychological impact may last for years, for both patients and the health care team.
Individuals who experience a traumatic event are at risk of suffering long-term effects, which. may be
physical, emotional, spiritual, or mental.
Characteristics of these responses include:
 emotional reactions to events;
 loss of ability to function;
 feeling overwhelmed; and
 increased use of resources.

Summary
 Disasters are unpredictable and can occur anywhere, at any time. Nursing during a disaster requires
a coordinated effort among professionals throughout the health care, public, and private service
sectors.
 Today’s nurses are faced with the challenges of responding to natural, anthropogenic, and
technological disasters. Strong leadership is required to address the unique set of challenges and
necessary preparation for such events.
 “When a disaster strikes a community—whether a bus accident, a tornado, a hurricane, or terrorist
attack—nurses will be on the front lines helping those who are in need” As the frequency,
magnitude, and variety of disasters, both anthropogenic and natural, continue to escalate, nursing
leaders will need to respond with “awareness, preparedness, political prowess…and most of all,
teamwork on all levels” (Ford, as cited by Goodwin Veenema, 2013, p. xxix).
ICN Disaster Framework of Nursing Competencies 2009
“Nurses, as the largest group of committed health personnel, often working in difficult situations with
limited resources, play vital roles when disasters strike, serving as first responders, triage officers and care
providers, coordinators of care and services, providers of information or education, and counselors.
However, health systems and health care delivery in disaster situations are only successful when nurses
have the fundamental disaster competencies or abilities to rapidly and effectively respond.
The International Council of Nurses and the World Health Organization, in support of Member States and
nurses, recognize the urgent need for acceleration of efforts to build capacities of nurses at all levels to
safeguard populations, limit injuries and deaths, and maintain health system functioning and
community well-being, in the midst of continued health threats and disasters.” (ICN & WHO)

CORE COMPETENCIES
The Steering Committee identified three levels of nurses needing competency in disaster nursing at
increasing levels of complexity. Bear in mind that for any level or any one competency, the nurse begins
as a novice, should move toward proficiency as defined by national or institutional standards, and may
become an expert. Expertise within any one level does not confer automatic ability to perform
competencies at a higher level. The three levels of nurses defined for use in Version 2.0

TO WHOM DO THESE COMPETENCIES APPLY?

Level I: Any nurse who has completed a programme of basic, generalized nursing education and is
authorized to practice by the regulatory agency of his/her country.
 staff nurse in a hospital, clinic, public health centre; all nurse educators.
Level II: Any nurse who has achieved the Level I competencies and is/aspires to be a designated disaster
responder within an institution, organization or system.
 supervising or head nurse; a nurse designated for leadership within an organization's emergency
plan; a nurse representing the profession on a hospital/agency emergency planning committee;
preparedness/ response nurse educators.
Level III: Any nurse who has achieved Level I and II competencies and is prepared to respond to a wide
range of disasters and emergencies and to serve on a deployable team.
 frequent responders to either national or international disasters, military nurses, nurses conducting
comprehensive disaster nursing research.

Note that specific competencies for this level of nurse are not included in Version 2.0 at this time, and
many of the competencies expected at this level are common across many disaster-associated disciplines.

APPLICATION OF COMPETENCIES
Effective nursing practice during any disaster requires clinical competency and the application of
utilitarian principles (“Doing the greatest good for the greatest number with the least amount of harm”).

Impetus for the Development of the Framework of Disaster Nursing Competencies

“Nurses with their technical skills and knowledge of epidemiology, physiology, pharmacology,
cultural-familial structures, and psychosocial issues can assist in disaster preparedness programmes, as
well as during disasters. Nurses, as team members, can play a strategic role cooperating with health and
social disciplines, government bodies, community groups, and non-governmental agencies, including
humanitarian organizations.” - ICN (2006)

Disaster Nursing
Disaster nursing is the adaptation of professional nursing knowledge, skills, and attitude in recognizing
and meeting the physical and emotional needs of disaster victims.

Pioneer Disaster Nursing Practitioner

FLORENCE NIGHTINGALE OM RRC DStJ "The Lady with the Lamp" (12 May 1820-13 August 1910)
1854 Nightingale arrived in Scutari, Turkey, during the Crimean War with a group of 38 nurses to take
charge of a British military hospital. She found injured soldiers festering in unsanitary conditions and set
her charges to work scrubbing the hospital clean.
Nightingale worked tirelessly to develop a rudimentary standard of care for the soldiers. This required
adaptation of previous knowledge and skills in order to provide care to these soldiers. This ability to
adapt is one of the building blocks required for disaster nurses.

COMPETENCE
 knowledge, understanding and judgment;
 a range of skills─cognitive, technical or psychomotor and interpersonal; and
 a range of personal attributes and attitudes”
“COMPETENCE is a level of performance demonstrating the effective application of knowledge, skill and
judgment” - ICN (1997)

Nurses must be able to work internationally, in a variety of settings with nurses and health care providers
from all parts of the world. To assure a global nursing workforce ready to respond in the event of a
disaster, competencies are essential.

NEED FOR COMPETENCE

 facilitate deployment of nurses globally;
 create consistency in the care given;
 facilitate communication;
 build confidence;
 facilitate a more professional approach;
 promote shared aims;
 allow for a unified approach;
 enhance the ability of nurses to work effectively within the organizational structure; and
 assist nurses to function successfully as members of the multidisciplinary team.

Jennings Disaster Nursing Management Model (2004)

CYCLE OF DISASTER MANAGEMENT

ROLES OF THE NURSE

DISASTER MANAGEMENT ROLES OF NURSES
1. Community Assessment
2. Community Diagnosis of Disaster Threat
3. Community Disaster Planning
4. Implement Disaster Plan
5. Evaluate Effectiveness of the Disaster Plan
1. COMMUNITY ASSESSMENT
 Is there a current disaster plan in place?
 Previous disaster experiences?
 How is the local terrain conducive to disaster?
 What are the local industry?
 What personnel are available for disaster interventions?
 What local agencies and organization are available?

2. COMMUNITY DIAGNOSIS OF DISASTER THREATS (RISK)

 The identification of hazards; a review of the technical characteristics of hazards such as their
location, intensity, frequency and probability;
 The analysis of exposure and vulnerability, including the physical, social, health, environmental
and economic dimensions; and
 The evaluation of the effectiveness of prevailing and alternative coping capacities with respect
to likely risk scenarios.

3. COMMUNITY DISASTER PLANNING

Action - Arrange meetings of community members through the development Community Disaster
Preparedness committee or through another civic association for example the Civil Society Networks
in each of the 14 Municipal Corporations and work together to develop a community disaster
preparedness plan in your respective community. Begin with a discussion of the following topics:
 Community warning system. Community members should establish and know their local
warning system. In the event of a disaster, local radio and television stations will provide
information on evacuation routes, temporary shelters, and other emergency procedures.
Depending on the circumstances, any one of three protective actions (shelter-in-place,
prepare-to-evacuate, or evacuate) may be appropriate.
 Neighborhood directory. Create a list of home and work phone numbers and e-mail addresses
for all community members, noting contact information and plans for children and seniors who
may be home alone during emergency situations. Include important phone numbers, such as
the local emergency management office and the non-emergency numbers for the local police
department, local fire department, and ambulance service.
 Members with special needs. Identify members of the community who may need special
assistance during an emergency. These members might include seniors, individuals who are
hearing or mobility impaired, and children who are home alone. Develop a plan to assist them
during an emergency.
 Members with special skills or equipment. Identify members of the community who have
special skills (medical, technical) or equipment that they would be willing to share in the event
of an emergency. Consider CPR and first aid training for community volunteers. To find CPR and
first aid training in your area, contact the ODPM or the Trinidad and Tobago Red Cross Society.
 Caring for pets. Community members should design a plan to treat with their pets in an
emergency.
 Property protection. Community members should have working fire extinguishers and know
how to shut off their utilities such as gas, electricity, and water in the event of an emergency.
House address numbers should be large and well-lighted so emergency personnel can find
homes easily. Consider having a representative from a local utility company or fire department
to speak to your Community Disaster Committee about property protection during a disaster.
 Evacuation procedures. Develop a neighborhood evacuation plan. Contact the local emergency
management office and find out ahead of time what evacuation routes have been designated
for your area. Distribute maps to community members. Become familiar with major and
alternate routes to leave your area before a disaster.
  Local shelters. Provide the location of all county shelters to community members. (Shelters are
often located in public school buildings.) Include their pet policies, if possible. Also, identify any
community members who would be willing to provide shelter to others in an emergency.
 School emergency plans. Find out what your local school district and day care centres plan do in
the event of an emergency. Make sure children know where to meet parents in the event
schools are evacuated or an early release occurs.
 Family emergency plans. Encourage community members to develop family preparedness plans
that cover emergency contact information for family members, predetermined meeting places,
home evacuation procedures, emergency pet care, safe storage of food and water, and
assembling disaster supplies kits.

4. IMPLEMENT DISASTER PLAN

Implementation of the preparedness program includes identifying and assessing resources, writing
plans, developing a system to manage incidents and training employees so they can execute plans.
 Resource Management: Resources needed for responding to emergencies, continuing business
operations and communicating during and after an incident should be identified and assessed.
 Emergency Response Plan: Plans to protect people, property and the environment should be
developed. Plans should include evacuation, sheltering in place and lockdown as well as plans
for other types of threats identified during the risk assessment.
 Crisis Communications Plan: A plan should be established to communicate with employees,
customers, the news media and stakeholders.
 Business Continuity Plan: A business continuity plan that includes recovery strategies to
overcome the disruption of business should be developed.
 Information Technology Plan: A plan to recover computer hardware, connectivity and electronic
data to support critical business processes should be developed.
 Employee Assistance & Support: The business preparedness plan should encourage employees
and their families to develop family preparedness plans. Plans should also be developed to
support the needs of employees following an incident.
 Incident Management: An incident management system is needed to define responsibilities and
coordinate activities before, during and following an incident.
 Training: Persons with a defined role in the preparedness program should be trained to do their
assigned tasks. All employees should be trained so they can take appropriate protective actions
during an emergency.
 Strategic Plan: Strategic planning is an organization's process of defining its strategy
or direction, their vision for the future, identify their organization’s goal and objectives,
and making decisions on allocating its resources to attain strategic goals.
Furthermore, it may also extend to control mechanisms for guiding the implementation of the
strategy.
 Tactical Plan: A tactical plan is a written outline of the specific actions you're going to take to
address a problem or achieve a goal. It could list the tasks that you'll do yourself, and the tasks
you'll assign to employees. Tactical planning is a type of planning that involves breaking down a
long-term strategic plan into smaller and more distinct short-term plans. Companies and teams
frequently use this type of plan when they have long-term goals that extend further than two
or three years. There are several key elements of a tactical plan, including focused goals, steps
to take to reach those goals and a timeline. In this article, we'll explore what tactical planning is,
when to use it, the key elements of a tactical plan and the benefits and disadvantages of this
form of planning.
 Operation Plan: Operational planning is the process of planning strategic goals and objectives to
technical goals and objectives.An operational plan outlines the key objectives and goals of an
organization and how to reach them. It is a well-crafted document that ensures team members
know their responsibilities and have a clear understanding of what needs to be done. Crafting
an operational plan keeps teams on track while guiding them in making crucial decisions about
the organization's long-term strategy.
 Contingency Plan: A contingency plan, also known colloquially as Plan B, is a plan devised for an
outcome other than in the usual plan. It is often used for risk management for an exceptional
risk that, though unlikely, would have catastrophic consequences. It is a course of action
designed to help an organization respond effectively to a significant future incident, event or
situation that may or may not happen.
 Disaster Recovery Plan: A disaster recovery plan (DRP) is a documented, structured approach
that describes how an organization can quickly resume work after an unplanned incident. A
disaster recovery (DR) plan is a formal document created by an organization that
contains detailed instructions on how to respond to unplanned incidents such as natural
disasters, power outages, cyber attacks and any other disruptive events.
5. EVALUATE EFFECTIVENESS OF DISASTER PLAN
Since you never know when a disaster will hit and how it will affect your workplace, the key is to be
prepared. And a first step for that is to evaluate—or reevaluate—your disaster plan.

 Assign priority and responsibility.

Make it clear that management gives the project high priority and support.
Assign one person to coordinate the task force or work group that will evaluate hazards and
prepare plans. Select and appoint the participants. Most organizations try to involve a
wide representation of managers, supervisors, and employees.
Be sure to involve human resources, as well as safety, security, and operations. When a disaster
occurs, employees will come to HR.
Establish goals and timelines for completion of your review and update.

 Evaluate your facility’s challenges and hazards.

Evaluate your situation to determine likely or potential problems. Certain challenges could
face almost all organizations—fires, injuries, medical emergencies, and violence.
Address threats that are specific to your geographic location, including flooding, mudslides,
earthquakes, hurricanes, tornadoes, and other weather-related problems.
Categorize and list threats related to your specific operations, such as dangerous equipment,
dangerous environments (e.g., confined spaces), and hazardous substances.
Consider neighboring facilities and the threats they may pose.
If your buildings are some distance from fire, police, and emergency services, ascertain if
providing extra training and equipment will help employees deal with emergencies until
responders arrive.
After approval, put the plan in writing, and share pertinent parts with employees.

 Delineate steps for avoidance and prevention.

Once threats are identified, think of measures that will prevent or contain them.
Establish new rules or procedures as needed, such as increased security or more vigilance in
enforcement of safety rules.
Determine if more training in areas such as first-aid and CPR, hazardous materials response, or
handling threats of violence may be required.
Devise site-specific preparations for protecting materials, equipment, and data.
Take steps to provide technological or physical protection for IT, including redundant systems
and off-site capabilities.
Meet with local emergency services organizations, including fire and police, and invite them to
do a "walk-through" of your facility to familiarize themselves with the layout and help identify
potential problems.

 Plan for actions during and after a disaster.

Prepare for evacuation
 Install and/or test the emergency alert systems.
 Review evacuation routes and designate assembly sites and reporting procedures.
 Inform employees, contractors, and others who frequent your facilities about the alert
signal and the evacuation plan.
 Detail equipment shutdown procedures and identify employees who will stay to
accomplish them.
Establish a command post. Identify:
 The location (on- and off-site)
 Who will be in charge
 Alternate communication methods including your website and intranet
 Who will deal with police, fire, and hazardous materials responders
 Who will deal with the media
Prepare for ongoing operations
 In your planning, determine ways you will keep the business going after a disaster,
including alternative sources of power, water, utilities, etc.
 Find sources of temporary space, computer capability, phones, and other means needed
to do whatever you normally accomplish.

 Practice your procedures.

Conduct practice drills to ensure that every employee knows what to do. Determine if drills
uncover flaws in your plan.
  Make regular reviews.
Your standing procedures should include annual reviews of your plan. People leave, phone
systems change, partitions are built, and so on. Also note if new technologies, equipment,
hazardous substances, etc. have been introduced.

ROLES OF NURSES IN THE DISASTER NURSING CONTINUUM

I. MITIGATION/PREVENTION
 perform community needs assessments to determine the pre-existing prevalence of disease, the
susceptibility of health facilities and identification of vulnerable populations, such as those with
chronic disease, mental health problems, or disability
 collaborates in developing plans for alternative housing and other interventions designed to reduce
the vulnerability of these populations.
Participation in risk reduction activities in health care facilities to create safe and sustainable
environments for care or identifying alternative sites for care following a disaster is another activity that
requires the expertise of the nurse. Working in partnership with other health care providers and
community leaders, the nurse helps to plan for the evacuation of health facilities and relocation of patients
as required.
Helping to shape public policy that will decrease the consequences or potential effects of a disaster is an
important role because of the nurse’s knowledge of the community and the areas of vulnerability. Working
with policy-makers to identify hazards, the risk such hazards pose to the population, and health
infrastructure to develop solutions that reduce the risk are all part of nursing’s role. Ongoing community
education related to identification and elimination of health and safety risks in the home or community is
another area where nurses bring expertise.

II. PREPAREDNESS
 creation of policy related to response and recovery requires nursing input
 provide assessments of community needs and resources related to health and medical care which
contribute to the planning activities.
 plan activities such as communication, coordination and collaboration, equipment and supply needs,
training, sheltering, first aid stations, and emergency transport all require nursing expertise
 develop and provide training to other nurses and health professionals, as well as the community
 capacity-building through recruitment and maintenance of a ready disaster nursing workforce is also
part of nursing’s role
 involve in leadership roles, planning, participating in, and evaluation of readiness exercises to assure
that the community, and the nursing workforce itself, is prepared in the time of an emergency or
disaster
 collaborate with planners, organizations involved in disaster relief, government agencies, health care
professionals and community groups to develop the preparedness plan is vital
Education in the area of preparedness is essential in order to reduce barriers that hinder response to a
disaster. Health systems and society in general may have a responsibility to provide support and care of
health workers’ dependents if the call to respond is to be heeded. The measures needed must be identified
and planned in advance for maximum security to be ensured.

III. RESPONSE
 providing both physical and mental health care
 manage scarce resources, coordinating care, determining if standards of care must be altered,
making appropriate referrals, triage, assessment, infection control and evaluation are just a few of
the skills a nurse uses in the response phase
 identify individuals with chronic disease or disability is a critical responsibility. With health care
access and mobility limited, these individuals
 continually monitor survivors for signs of mental health issues, must provide care and must make
referrals, as necessary
 advocacy for patients and survivors, teaching, and leadership and management
 monitor responders to assure that mental health or physical care is not needed
 provide onsite training to other nurses and health care workers and volunteers
 work as part of a health care team and collaborate with other responders to provide assistance to as
many survivors as possible
 use skills in epidemiology to identify patterns of illness to detect any threat of communicable disease
or other health hazards
 collect data on injuries and illnesses seen during the disaster, which are later communicated to
epidemiologists for analysis
The sporadic nature of disaster nursing education has resulted in a workforce with limited capability to
respond in the event of a disaster, develop policy, educate or accept leadership roles. Nursing’s inability to
actively participate in a knowledgeable manner throughout the disaster continuum would place the
population at risk. The risk is further increased by hesitancy to respond as a result of a lack of knowledge.

IV. RECOVERY/REHABILITATION
 continue to provide care and support to those with physical and mental health needs
 the injured or ill or those with chronic disease, mental health illness, or disability must be monitored
to reduce the risk of complications
 referrals must be made to appropriate health care providers, government or relief agencies for
housing, food, medications, medical equipment, specialized care, long-term medical or mental
health needs, or financial assistance for meeting the cost of care
 follow up with survivors to assure all needs have been met
 provide leadership in planning and reconstruction activities to assure that patient needs can be met
 identify and advocate for patient needs
 evaluates the disaster plan and champions required changes to improve the management of the
disaster and the disaster’s impact on the population
 provide documentation and evaluating the process while actively participating in follow-up activities
that include community planning and development.

DISASTER MANAGEMENT CONTINUUM

“It does not matter which model is used by a community or county. Some models combine activities
where others separate out activities. What is important to understand is that the process is continuous,
and designed to decrease the harm to populations, infrastructure and development, and build community
resilience.” - WHO,1999

The “disaster management continuum” was selected as the organization structure for several reasons:
 it is a process recognized throughout the world;
 nursing roles are integrated throughout it;
 it provides a consistent way to organize the competences; and
 it enhances the ability to develop educational curriculum that integrates the disaster management
continuum with the competencies.

4 AREAS OF COMPETENCIES
1. MITIGATION/PREVENTION
 measures that eliminate or reduce the impacts and risks of hazards through proactive measures
taken before an emergency or disaster occurs
 vary for different types of disasters

2. PREPAREDNESS
 focuses on preparing equipment and procedures for use when a disaster occurs
 equipment and procedures can be used to reduce vulnerability to disaster, to mitigate the impacts of
a disaster, or to respond more efficiently in an emergency
3. RESPONSE
 commence with Search and Rescue but in all cases the focus will quickly turn to fulfilling the basic
humanitarian needs of the affected population
 assistance may be provided by national or international agencies and organizations

4. REHABILITATION
 starts after the immediate threat to human life has subsided
 immediate goal of the recovery phase is to bring the affected area back to normalcy as quickly as
possible

ORIGINAL SET OF DISASTER NURSING COMPETENCIES ORGANIZED INTO 4 AREAS AND

10 DOMAINS
I. MITIGATION/PREVENTION
1. policy development and planning
2. risk reduction, disease prevention and health promotion vary for different types of disasters
II. PREPAREDNESS
3. ethical practice, legal practice and accountability
4. communication and information sharing
5. education and preparedness
III. RESPONSE
6. care of the community
7. care of individuals and families
8. psychological care
9. care of vulnerable populations
IV. RECOVERY/REHABILITATION
10. long-term recovery of individuals, families and communities.

Consideration was given to maintaining these domains, however in light of similar work done in
various, collaborative health professional areas, and the need for common preparedness
approaches among professions that must work together, a change of course was indicated. 4
Based on that discussion, Version 2.0 is organised into eight domains.

8 DOMAINS DISASTER NURSING COMPETENCIES

Common Resources:

 Core Competencies in Disaster Nursing v2 2019 International Council of Nurses ISBN:

978-92-95099-68-5
 Disaster Nursing and Emergency Preparedness 2nd ed. 2007, T.G. Veenema, PhD, MPH, MS, CPNP
 Wikipedia https://en.wikipedia.org
 Center for Disease Control (CDC) https:www.cdc.gov
 Federal Emergency Management Agency (FEMA) https://www.fema.gov
 Prevention Web https://www.preventionweb.net