DISASTER NURSING (Topic 1)

JOHN RAFAEL V. GAURANA, MAN, RN, CHRP®

HROD/HRDD Manager / Asst. Chief Nurse / Training Officer
Nueva Ecija Medical Center Inc.

DISASTER DISASTER
NURSING → Is a sudden disruption or event that interrupts the functioning of a
community.

DISASTER NURSING
→ Requires the adaptation of nursing knowledge and skills to
recognize and meet the health and emotional needs of individuals
during such times of crises known as disasters.
→ Nursing responsibilities include:
- Serve on the frontline in providing care during a disaster or
health crisis.
- Must utilize innovative thinking, lead effective coordination
efforts, and clearly communicate the needs of their patients as
well as their own personal needs
- Preparing for and managing patients harmed by the effects of
all disasters, including:
1. Natural disasters
2. Outbreaks
3. Epidemics
4. Pandemics
5. As well as injuries and illnesses that can occur as a result
from attacks of terrorism (biologic, chemical, and nuclear
or radiation incidents)
DISASTER Terrorism
PLANNING → The unlawful, systematic use of violence or threats of violence
against people in order to coerce or intimidate.
Natural Disasters
→ Caused by environmental forces including storms, floods, fires,
earthquakes, and similar forces of nature 5828 that result in
significant damage or loss of life.

Federal, State, and Local Responses to Disasters

→ Many resources are available at the federal, state, and local levels
to assist in the management of disasters, mass casualty incidents,
public health crises, and emergencies.
→ Mass Casualty Incident (MCI)
- Defined as any incident that causes a large number of
casualties to the extent that necessary resources become too
scarce.
- Sustainability Planning
 When local communities must be prepared to act in
isolation and provide competent care for up to 5 days
 before federal or other state resources may become
available.
 When resources to care for casualties become scarce,
“the greatest good for the greatest number of patients”
becomes the mode of operation.
→ Disasters are categorized by type based upon anticipated use of
resources and incident duration. A list of local resources with
specific instructions about how and when to contact these agencies
or organizations should be readily available to local disaster
planning committees and frequently reviewed by those
committees for necessary updates.
→ A disaster response strategy cannot succeed without appropriate
physical assets and staff trained and prepared to carry out the plan.
→ Assets such as:
- Increased security
- Stockpiles of equipment and medications
- Planning
- Drills
- Training
→ Successful execution of a response plan is based on:
- Knowledge
- Confidence
- Readiness

Federal Agencies
→ Agencies at National Level.
National Disaster Risk Reduction and Management Council
(NDRRMC) (www. ndrrmc.gov.ph)
- Formerly known as the National Disaster Coordinating
Council (NDCC).
- A working group of various government, non-government,
civil sector and private sector organizations of the Government
of the Republic of the Philippines established on June 11, 1978
by Presidential Decree 1566.
- The council is responsible for ensuring the protection and
welfare of the people during disasters or emergencies.
- The NDRRMC plans and leads the guiding activities in the
field of communication, warning signals, emergency,
transportation, evacuation, rescue, engineering, health and
rehabilitation, public education and auxiliary services such as
firefighting and the police in the country.
- Member Agencies
1. Office of the President (OP)
a. Office of the Presidential Adviser on the Peace
Progress (OPAPP)
b. Presidential Communications Operations Office
(PCOO)
 Philippine Information Agency (PIA)
 c. National Anti-Poverty Commission (NAPC)
d. Philippine Commission on Women (PCW)
e. Commission on Higher Education (CHED)
2. Office of the Vice President (OVP)
a. Office of the Vice President’s Disaster Operations
Center (OVP-DOC)
3. Department of National Defense (DND)
a. Armed Forces of the Philippines (AFP)
b. Office of Civil Defense (OCD)
4. Department of Science and Technology (DOST)
a. Philippine Atmospheric, Geophysical and
Astronomical Services Administration (PAGASA)
b. Philippine Institute of Volcanology and Seismology
(PHIVOLCS)
5. Department of Information and Communications
Technology (DICT)
6. Department of Interior and Local Government (DILG)
a. Philippine National Police (PNP)
b. Bureau of Fire Protection (BFP)
7. Department of Social Welfare and Development (DSWD)
8. National Economic and Development Authority (NEDA)
9. Department of Public Works and Highways (DPWH)
10. Department of Health (DOH)
a. Philippine Health Insurance Corporation (PhilHealth)
11. Department of Budget and Management (DBM)
12. Department of Labor and Employment (DOLE)
13. Department of Finance (DOF)
14. Department of Trade and Industry (DTI)
15. Department of Transportation (DOTr)
a. Philippine Coast Guard (PCG)
16. Department of Environment and Natural Resources
(DENR)
a. National Mapping and Resource Information
Authority (NAMRIA)
b. Mines and Geosciences Bureau (MGB)
17. Department of Agriculture (DA)
18. Department of Education (DepEd)
19. Department of Energy (DOE)
20. Department of Foreign Affairs (DFA)
21. Department of Justice (DOJ)
22. Department of Tourism (DOT)
23. Philippine Red Cross (PRC)
24. Department of Human Settlements and Urban
Development (DHSUD)
25. Government Service Insurance System (GSIS)
26. Union of Local Authorities of the Philippines (ULAP)
27. League of Provinces of the Philippines (LPP)
28. League of Cities of the Philippines (LCP)
29. League of Municipalities of the Philippines (LMP)
 30. Liga ng mga Barangay sa Pilipinas (LBP)
31. Philippines Social Security System (SSS)
32. Philippine Space Agency (PhilSA)
State Agencies
→ Agencies at Regional Level.
- According of Republic Act 10121, various local governments
throughout the country should establish Local DRRM Offices
at the regional, provincial, municipal, city and barangay levels.
- As functional arms of the local governments, these Offices are
responsible to create a Local Disaster Risk Reduction and
Management Plan according to the Framework of the
NDRRMC covering 4 aspects including disaster preparedness,
response, prevention and mitigation, and rehabilitation and
recovery.
Local Agencies
→ Agencies within the Local Government Unit.

COVID-19 Considerations
→ In response to the coronavirus disease 2019 (COVID-19)
pandemic, the Department of Health (DOH) has provided an
abundance of education addressing safety measures to combat the
virus and precautions for populations at risk and offered
regulatory guidance. These important regulations have informed
government decisions enacted to ensure the safety of individuals
during the pandemic (IATF – Inter-Agency Task Force for the
Management of Emerging Infectious Diseases)
→ In addition to these measures, the Food and Drug Administration
(FDA) accelerated the review of diagnostic tests to mitigate the
spread of the virus. The FDA was responsible for ensuring that
testing methods would provide both accurate and reliable results.
Congress enacted an Emergency Use Authorization (EUA) that
relaxed regulations and ultimately increased the availability of
tests. The FDA then revised their standard procedures to allow for
laboratory testing prior to FDA validation assessment, an
unprecedented policy change that also allowed for increased
testing capabilities.
THE INCIDENT The Incident Command System (ICS)
COMMAND → Is a federally mandated command structure that coordinates
SYSTEM personnel, facilities, equipment, and communication in any
emergency situation.
→ It is the center of operations for organization, planning, and
transport of patients in the event of a specific local MCI.
→ Successful incident management requires:
- Equipment compatibility
- Effective communication
- Adequate distribution of resources
- Clear differentiation of members’ roles
 → The ICS ensures that any hazardous substances used during an
MCI are identified promptly and that appropriate personal
protective equipment (PPE) is distributed.
→ PPE describes the use of equipment beyond standard precautions
and may include different levels of protection, depending on the
nature of the suspected biologic, chemical, or radiologic event.

Hospital Incident Command System (HICS)

→ A modification of the ICS that is used by both hospitals and law
enforcement agencies.
→ The HICS incident commander is the hospital emergency
preparedness coordinator who oversees and coordinates all efforts
surrounding the event.
→ The HICS team includes:
- Safety officer
> Is an individual responsible for ensuring compliance
with occupational health and safety (OHS) guidelines
in a workplace. They play a crucial role in promoting
a safe working environment by advising on safety
measures, conducting risk assessments, and enforcing
preventative measures.
- Public information officer
> A figure who communicates timely information about
their organization with members of the public.
- Liaison officer
> A person who liaises between two or more
organizations to communicate and coordinate their
activities on a matter of mutual concern.
- Operations chief
> An executive in charge of the daily operations of an
organization, (i.e., personnel, resources, and logistics).
- Logistics chief
> Prioritizes and validates resource requests, oversees
ordering and tracking of resources.
- Planning chief
> Organizes briefing meetings, provides key advice on
objectives, and anticipates future needs.
- Finance chief
> In charge of a hospital's financial operations. Duties
include managing budgets, establishing policy,
financial decision-making, controlling margins and
debt, and making decisions about hospital assets and
resources.
→ Each team member has a specific responsibility and
communicates directly back to the incident commander.
Hospital Emergency Preparedness Plans
→ Health care facilities are required by the Joint Commission to
create a plan for emergency preparedness and to practice this plan
with all employees at least twice a year.
→ Before the basic emergency operations plan (EOP) can be
developed, the planning committee of the health care facility
evaluates characteristics of the community to identify the likely
types of natural and man-made disasters that might occur.
→ This hazard vulnerability analysis process is the responsibility of
the local health care facility and its safety committee, safety
officer, or emergency department (ED) manager.
→ This information can be gathered by questioning local law
enforcement, fire departments, and emergency medical systems
and assessing the patterns of local train traffic, automobile traffic,
and flood, earthquake, tornado, or hurricane activity.
→ Consideration is also given to possible MCIs that could arise
because of the community’s proximity to chemical plants, nuclear
facilities, or military bases.
→ Federal, judicial, or financial buildings, schools, and any places
where large groups of people gather can be considered high-risk
areas.
→ The goal of each health care institution is to remain self-sufficient
to provide and sustain core services without the support of external
assistance for at least 96 hours from the inception of the incident.
Ideally, this self-sufficiency should last for 7 days.
→ The committee might also outline how staff would triage and
assign priority to patients when resources are limited (e.g., when
ventilators are in short supply).
→ Multiple factors influence a facility’s ability to respond effectively
to a sudden influx of patients who are injured or sick, and the
committee must anticipate various scenarios to improve its
preparedness.

COVID-19 Considerations
→ As the incidence of COVID-19 cases continued to rise at a rapid
pace during the early phases of this pandemic, political leaders
began to encourage physical distancing among individuals to slow
the rate of transmission; this practice became known as social
distancing.
→ The goal of social distancing was to attempt to flatten the curve of
new infections, thereby avoiding a surge of demand on the health
care system.
→ However, the effects of social distancing were not enough to
decrease the burden experienced by many hospitals in key
geographic areas.
→ Hospitals in these areas reported shortages of key equipment
needed to care for patients who were critically ill, including
ventilators and PPE for medical staff.
 → Insufficient PPE (e.g., respirators, face shields, gowns, hand and
equipment sanitizer) for frontline health care workers resulted not
only in exposures to severe acute respiratory syndrome
coronavirus 2 (SARSCoV-2), but also in the deaths of health care
workers from COVID-19.
→ In response to these shortages, health care providers made pleas to
government officials to try to secure adequate PPE for their
frontline workers.
→ The shortage of critical medical supplies became a global crisis.
→ A crucial role for the government is to coordinate efforts to ensure
that areas that have been impacted the most are receiving needed
equipment and supplies.
→ As health care facilities continued to care for the growing number
of patients hospitalized and critically ill with COVID-19,
government officials worked to secure essential equipment needed
to care for patients and ensure the safety of their workforce.

Components of the Emergency Operations Plan (EOP)

→ The main goal is the protection of the community.
→ The EOP should be integrated with local, state, and federal
government plans and coordinated with the private sector and
volunteers.
→ Essential components of the EOP include the following:
- Activation Response
▪ The EOP activation response of a health care facility
defines where, how, and when the response is initiated.
- Internal/External Communication Plan
▪ Communication is critical for all parties involved,
including communication to and from the prehospital
arena.
- Plan for Coordinated Patient Care
▪ A response is planned for organized patient care into
and out of the facility, including transfers from within
the hospital to other facilities.
▪ The site of the disaster can determine where the greater
number of patients may self-refer.
- Security plans
▪ A coordinated security plan involving facility and
community agencies is key to the control of an
otherwise chaotic situation.
- Identification of External Resources
▪ Resources outside the facility are identified, including
local, state, and federal resources and information
about how to activate these resources.
- Plan for people management and traffic flow
▪ “People management” includes strategies to manage
the patients, the public, the media, and the personnel.
 ▪ Specific areas are assigned, and a designated person is
delegated to manage each of these groups.
- Data management strategy
▪ A data management plan for every aspect of the
disaster will save time at every step.
▪ A backup system for documenting, tracking, and
staffing is developed if the facility utilizes an
electronic health record.
- Demobilization response
▪ Deactivation of the response is as important as
activation; resources should not be unnecessarily
exhausted.
▪ The person who decides when the facility resumes
daily activities is clearly identified.
▪ Any possible residual effects of a disaster must be
considered before this decision is made.
- After action report or corrective plan
▪ Facilities often see increased volumes of patients 3
months or more after an incident.
▪ Postincident response must include a critique and a
debriefing for all parties involved, immediately and
again at a later date.
- Plan for practice drills
▪ Practice drills that include community participation
allow for troubleshooting any issues before a reallife
incident occurs.
- Anticipated resources
▪ Food and water must be available for staff, families,
and others who may be at the facility for an extended
period.
- MCI planning
▪ MCI planning includes such issues as planning for
mass fatalities and morgue readiness.
- Education plan for all of the above
▪ A strong education plan for all personnel regarding
each step of the plan allows for improved readiness and
additional input for fine-tuning the EOP.

COVID-19 Considerations
→ In response to the COVID-19 pandemic, the DOH provided
evidencebased guidance for maintaining the EOP for all health
care facilities, which provided guidance for staff, patients, and
visitors.
→ The guidelines were developed to minimize the spread of the virus
within the community and to ensure all hospital staff were trained,
equipped, and capable of executing these mitigation practices.
Identifying Patients and Documenting Patient Information
→ Patient tracking is a critical component of casualty management.
→ Disaster tags, which are numbered and include triage priority,
name, address, age, location and description of injuries, and
treatments or medications given, are used to communicate patient
information.
→ The tag should be securely placed on the patient and remain with
the patient at all times. The tag number and the patient’s name, if
known, are recorded in a disaster log.
→ The log is used by the command center to track patients, assign
beds, and provide families with information.

Triage
→ The sorting of patients to determine the priority of their health care
needs and the proper site for treatment.
→ In nondisaster situations, health care workers assign a high priority
and allocate the most resources to those who are the most critically
ill.
→ When health care providers are faced with a large number of
casualties, the fundamental principle guiding resource allocation
is to “do the greatest good for the greatest number of people”.
→ Decisions are based on the likelihood of survival and consumption
of available resources.
→ Therefore, this same patient, and others with conditions associated
with a high mortality rate, will be assigned as a low triage priority
in a disaster situation, even if the person is conscious.
→ Although this may sound uncaring, from an ethical standpoint the
expenditure of limited resources on people with a low chance of
survival, and denial of those resources to others with serious but
treatable conditions, cannot be justified.
→ The triage officer rapidly assesses those injured at the disaster
scene.
→ Patients are immediately tagged and transported or given
lifesaving interventions.
→ One person performs the initial triage while other EMS personnel
perform immediate lifesaving measures (e.g., intubation) and
transport patients.
Triage Categories During a Mass Casualty Incident

→ It is important that an experienced ED provider is positioned at the

entrance to provide primary triage at the acute care facility.
→ Traffic control within the facility is one of the most important
components of managing the disaster and resources.
→ The triage area may be outside the entry or just at the door of the
ED.
→ This facilitates the triage of all patients—those arriving by
medical transport and those who walk into the ED.
→ Some patients who have already been seen in the field may be
reclassified in the triage area based on their current presentation.
→ Triage categories separate patients according to the severity of
injury.
→ A common triage method is the use of a special color-coded
tagging system so that the triage category is immediately obvious.
→
→ This system consists of four colors: red, yellow, green, and black.