Disaster Nursing

○ The effort of the government to bring the

PRELIMS community back to normal
Emergency vs. disaster ○ Recovery is considered successful if normal
● Both are man-made and natural causes but the difference activities of living have returned– markets
between the two is the response that it gets opened, community people are able to go back to
● Both are disruptions in the normal occurrence their jobs
● If someone was able to respond immediately then it is an ○ Preventive and mitigating responses should be
emergency done after the event.
○ When there is preparation and there is still control of ■ Flooding systems should be arranged
the situation ■ Fixing of roads and drainages
● Disaster is any situation where there is a failure in ● The main objective of the cycle is to create disaster
response resiliency
○ No one is capable of responding to the situation
○ No immediate intervention outside the place where the
disaster took place

PHILIPPINE DISASTER AND RISK PROFILE

CONCEPTS
● Emergency- a state in which normal procedures are
suspended and extraordinary measures are taken to
avert a disaster
○ The community still has the ability to respond to
the disruption
● Disaster- an occurrence disrupting the normal conditions
of existence and causing a level of suffering that exceeds
the capacity of adjustment of the affected community
○ The community has reached its limit in
responding to the disaster ● Risk
○ External support should already be asked in - the potential consequences of hazard interacting with a
cases like this community
● Prevention and Mitigation means "lessening or limiting ● Hazard - any potential threat to public safety and/or public
the adverse impacts of hazards and related disasters" health
(UNISDR, 2009) ● Vulnerability - factors that determine the type and severity
● Preparedness is "the knowledge and capacities developed of the consequences (or risks)
by governments, professional response and recovery ○ E.g., lack of resources, manpower, vulnerable
organizations, communities and individuals to effectively groups of people
anticipate, respond to, and recover from the impacts of ● Capacities - abilities to manage the risk of an emergency
likely, imminent or current hazard events or conditions" (determinants of risks or risk modifiers). A combination of
(UNISDR, 2009) all strengths and resources available within a community,
○ Disaster strikes in between preparedness and society, or organization that can reduce the level of risk or
response effects of a disaster, or may also be described as capability
○ Preparedness should not only be done when if in terms of human resources
disasters already come but should be done even ○ Presence of disaster funds and council
before a disaster comes ○ The higher the hazard, the higher the risk, the
● Response is the provision of emergency services and higher vulnerability
public assistance during or immediately after a disaster to ○ The higher the capacity, the lower the
save lives, reduce health impacts, ensure public safety and vulnerability, the lower the risk
meet the basic subsistence needs of the people affected
(UNISDR, 2009).
○ Rescue operation
○ Relief operation
○ Medical mission
○ Creation of temporary shelters
○ These are all done to prevent further increase in
casualties after the event
● Recovery is the restoration, and improvement where
appropriate, of facilities, livelihoods, and living conditions of
disaster-affected communities, including efforts to reduce
THE PHILIPPINE CONTEXT
disaster risk factors (UNISDR, 2009). The activities
involved in this phase are mainly termed rehabilitation and
TRIPLE BURDEN OF DISEASE
reconstruction. UNISDR (2009) commented that this phase
is closely linked to disaster risk reduction and build back
better principles.
○ Rehabilitation and restoration are the main focus
○ Restoration and rehabilitation of damaged
properties
○ Financial assistance
 ● Resource burden on host communities/LGUs especially
for longer term displacement (e.g. Zamboanga siege)

Emergency Phase
● Characterized by need overwhelming available resources
and resulting in increased mortality rates
● Crude Mortality Rate (CMR) or Under Five Mortality
(UFM) is generally used as an indicator of the severity of
an emergency.
○ If too high and the community cannot respond, it
become a disaster

Effects related to Health

● CoVid-19 virus is included in the communicable disease ● Communicable diseases including outbreaks
section ● Nutrition
● These triple burden of diseases do not only affect health ● Water and sanitation
but also the social, psychological aspects of a person ● Reproductive Health including GBV
● Mental Health and Psychosocial Issues
EMERGENCIES AND DISASTERS IN THE PHILIPPINES ● Non-communicable Diseases
● Natural Disasters
○ Typhoons, earthquakes, volcanic eruptions Five most common causes of deaths in the Philippines during
● Man Made emergencies/disasters
○ Biological warfares, terrorisms 1. Diarrheal diseases
● Institutional/ hybrid ● d/t lack of clean water resources
○ Part man-made, part natural 2. Acute Respiratory Tract infections
3. Measles
4. Malnutrition
5. Malaria in endemic areas

● 0.5 = 500 in a billion population

Most Vulnerable Groups

● Women
● Children
● Elderly
● Ethnic, Political, Religious minorities

Top 10 Emergency Priorities

● Initial assessment
● Measles immunisation
● Water and Sanitation
● Food and Nutrition
● Shelter and site planning
● Health care in the Emergency Phase
● Control of communicable diseases and epidemics
● Public Health Surveillance
● Human resources and training
● Coordination

What happens during Emergencies and Disasters

● Disruption to services, loss of supplies, infrastructure,
health workers
● Displacement - keeping people in the system - population
health, primary care, referral
 or system. Examples: supervising or head nurse; a nurse
designated for leadership within an organisation’s
emergency plan; a nurse representing the profession on a
hospital/agency emergency planning committee;
preparedness/ response nurse educators.
○ BSN, RN, with designation within the disaster
response team
● 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. Examples: frequent responders to either
national or international disasters, military nurses, nurses
conducting comprehensive disaster nursing research.
○ Nurses working in disaster response teams
○ Part of a deployable team

The original set of disaster nursing competencies was

● Reduced risk = reduced morbidity and mortality
organised into four areas and 10 domains:
● This is the first draft of the ICN framework (version 1)
Reminders
● An increase in the incidence of communicable diseases
Mitigation/Prevention
tends to occur towards the terminal end of a downward
● Policy development and planning
spiral leading to 'crisis'.
● Risk reduction, disease prevention, and health promotion
● We are conditioned to react when we see people
suffering/dying.
Preparedness
● We tend to ignore/fail to respond effectively to early
● Ethical practice, legal practice and accountability
warning indicators.
● Communication and information sharing
● We need to be sensitized to increase our awareness and
● Education and preparedness
act before the cascade has escalated to the point of crisis.
Response
ICN core Competencies in ● Care of the community
● Care of individuals and families
Disaster Nursing ● Psychological care
Introduction ● Care of vulnerable populations
● Done during or after disasters and emergencies
In 2009, the International Council of Nurses (ICN) and the World
Health Organization (WHO) published the first edition of ICN Recovery/Rehabilitation
Framework of Disaster Nursing Competencies. The two ● Long-term recovery of individuals, families and
organizations stated at that time: communities
● Nurses, as the largest group of committed health ICN Core Competencies In Disaster Nursing Version 2.0 (2019)
personnel, often working in difficult situations with limited ● Nurses were encourage to do more research to improve
resources, play vital roles when disasters strike, serving as the framework
first responders, triage officers and care providers, ● A continuing and advancement of education and
coordinators of care and services, providers of information enhancement of skills are included in the newer version
or education, and counsellors. 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, recognise 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.
○ Disaster nursing is not a part of the old
curriculum but was included to prepare nursing
students to respond to emergencies
○ The second version of the ICN framework was
developed in Geneva

To Whom Do These Competencies Apply?

● Level I: Any nurse who has completed a programme of
basic, generalised nursing education and is authorised
to practice by the regulatory agency of his/her country.
Examples: staff nurse in a hospital, clinic, public health
centre; all nurse educators.
○ Those who have graduated the BSN degree and
have passed the nursing licensure exam giving
the person authority to practice the profession.
● Level II: Any nurse who has achieved the Level I
competencies and is/aspires to be a designated
disaster responder within an institution, organisation
● Level I nurses are assigned to the family level, but for level
II nurses, they are assigned to the institutional level.

● Institutions– hospitals have HEMS (health emergency

management staff) created for disaster management.
○ Within 10 minutes a casualty should already be
brought to the hospital.
● These domains are established to avoid vagueness in job
descriptions depending on the level of the nurse

● Incident management occurs when the disaster or

emergency has already arrived.
○ EMTs are ad hoc groups, meaning they only
arise when there are already disasters and are
dissolved after disasters.
● NDRRMO headed by the president→ DOH→
IATF that will appoint governors→ create
emergency/ disaster groups
● Heads of the EMT will depend on the type of disaster to be Introduction to Incident
addressed. (e.g., infectious diseases, doctors will be
appointed) Command System (ICS)
● To be able to continue being a part of an EMT, there are
competency exams that should be taken to determine if a ● Different disaster and threats have always been
person is still qualified to join the team. surrounding the lives of the Filipinos:
○ Natural calamities due to the country’s
geographical location
○ Human-induced disasters
○ Climate change
● These necessitate an effective and efficient response
management system

Lessons from Past Disasters and Incidents

● Lack of reliable indecent information
● Inadequate communications
● Too many people reporting to one supervisor
● Too many responders
● Too many emergency response organization structures
○ Organizations are usually not coordinated or
organized
● No check-in procedures for responders
● Lack of structure for coordinated planning agencies
 ● Unclear line of authority ● To create coordinated efforts to prevent vagueness of jobs
● Terminology differences between agencies and overlapping of services
● Unclear or unspecified incident objectives ● The governor appoints the incident commander
● Lack of clarity on who’s incharge
○ The current ICS assigns one leader only What is an Incident?
● Confusion rising from catastrophic incidents ● An occurrence, caused by either human or natural
● Political interventions phenomena, that requires response actions to prevent or
minimize loss of life, or damage to property and the
Examples of Past Disasters/ Incidents environment.
● A standard, on-scene, all hazard incident management
Disaster Date
concept that can be used by all DRRMCs member
Ultra or wowowee incident February 2006 agencies and response groups
● It allows its users to adopt an integrated organizational
Tropical storm “Ondoy” September 2009 structure to match the complexities and demands of single
or multiple incidents without being hindered by agency or
Quirino Grandstand Hostage August 2010 jurisdictional boundaries
Taking
Purpose of ICS
The purpose of ICS is to help to ensure:
Institutionalization of ICS
● The safety of responders and others.
● “An act strengthening the PDDRMS, providing for the
● The achievement of tactical objectives.
NDRRM framework and institutionalizing the NDRRM plan,
● The efficient use of resources.
appropriating funds therefore and for other purposes”
● Section 9 (g): OCD shall establish SOP for coordination
Benefits of ICS
● Rule 7 (h), IRR: OCD shall establish ICS
● Provides accountability and a planning process
● Provides logistical and administrative support to
operational staff
● Is cost effective by avoiding duplication of efforts
● Meets the needs of incidents of any kind or size
● Allows personnel from a variety of agencies to meld rapidly
into a common management structure

● After the disaster, the group will be dissolved and people

who are part of the team will go back to their former jobs

Incidents/Events managed by ICS

● Natural disasters: typhoons, floods, tornadoes,
earthquakes, volcanic eruption, tsunami
● Human and animal disease outbreaks .
● Search and rescue operations
● Hazardous materials incidents
ICS Instructor Development ● Distribution of humanitarian assistance
● Planned events - fiestas, parades, sport events,
conferences, concerts, etc.
● Terrorist incidents
● Hostage-taking
● Car accidents

Countries using ICS

Fully implemented:
● United States
● Canada
● Australia
● New Zealand
● Mexico
NDRRMC Memorandum Circular No. 4
● Signed by C, NDRRMC/ Secretary, DND last March 28, Countries using ICS (In Transition)
2012
● Authorized the use of ICS as an On-Scene Disaster
Response and Management Mechanism under the
Philippine DRRM System
○ ICS are created once disasters and emergencies
appear
○ Cities and municipalities have different ICS
○ IMT- incident management team, a byproduct of
ICS which is responsible in coordinating ad Principles and Features of ICS
spearheading disaster responses 1. Primary ICS Management Functions
2. Management by Objectives
Executive Order No. 82 3. Unity of Command and Chain of Command
● Signed by President Benigno Aquino III 4. Organizational Flexibility
● Section 4D: “As soon as an incident is declared as 5. Span of Control
approaching crisis level, the responding Crisis Manager 6. Common Terminology
activates the Incident Command System (ICS) and calls on 7. Accountability
the designated Incident Commander (IC)..."
 8. Integrated Communications ● Hierarchy of command
9. Resources Management
10. Use of Incident Action Plan and Forms Organizational Flexibility
● ICS organization is flexible and modular
Primary ICS management Functions ● Organization develops in a top-down fashion, beginning
with the incident Commander (IC)
● IC establishes organization based on incident size,
complexity, & specific hazards
● "Form follows function". (only functions/ positions
necessary for the incident will be filled or activated)

Incident Complexity and Resource Needs

● Command is headed by the incident commander

Management by Objectives

Large Disaster: All Units Activated

● The incident commanders to be assigned will depend on

the crisis present e.g., for health crisis, doctors will be
assigned ● The heads or section chiefs are responsible for the
delegation of responsibilities assigned to the unit
Understand Policy and Direction
● understand the legal mandate/orders/directives of Span of Control
Responsible Official (person in charge) inn affected area ICS span of control for any supervisor:
● In cities and municipalities, the mayors will be the one to ● Is between 3 to 7 subordinates
spearhead the response teams ● Optimally does not exceed 5 subordinates.
● To promote simple communication between the managers
Establish Incident Objectives and the subordinates
● Establish SMART objectives ● This is to prevent confusion and difficulty in management
● Examples: ○ Different units have different responsibilities and
○ Search all structures for casualties by 1400H. this may create confusion to the head
○ Clear all roads with debris in six (6) hours.

Select Appropriate Strategy

● Strategy describes the general method/s that should be
used either singly or in combination
● Example:
○ Objective: Clear all roads from debris in 6 hours
○ Strategy #1: Use heavy equipment
○ Strategy #2: Mobilize all volunteers

Perform Tactical Direction ● IMPORTANT: Do not combine functions for one

● Tactical direction describes the specific action that must be organizational unit
accomplished within the selected strategy
● Example:
○ Objective: Clear all roads from debris in 6 hours
○ Strategy: Mobilize all the volunteers
○ Tactics: Equip 50 volunteers with shovels in the
area.

Unity of Command and Chain of Command Common Terminology

● Chain of Command: orderly ranking of management The use of common terminology applies to:
positions in line of authority a. Organizational Elements - All ICS major functions and
● Unity of Command: Establishes a clear line of supervision, functional units are named and defined. Terminology for
every individual has a designated supervisor each organizational element is standard consistent.
 ● To prevent confusion in communication ● Used to communicate response goals, operational
b. Resource Descriptions -Major resources personnel, major objectives and support activities throughout the ICS
equipment, and supply items are given common names organization.
and are listed by type and kind with respect to their ● Developed for each operational period (typically 12 to 24
capabilities. hours) to provide all incoming supervisory personnel with
c. Incident Facilities -Facilities used during the response are appropriate direction.
named according to common terminology ● May be oral or written.
d. Position Titles - All ICS managers and supervisors are
referred to by standardized ICS titles such as Officer, Chief, Who is in-charge?
Supervisor or Leader. The Responsible Official and the Incident Commander

All ICS communications should use clear text (that is, plain Responsible Official
language). Do not use radio codes, agency-specific codes, ● Chairs the NDRRMC (Governor, Mayor, etc)
acronyms, or other jargon. ● Provides overall policy direction and strategic objectives
● Ensures availability of resources
The following examples demonstrate the difference between jargon ● Serves as link to higher authorities
and clear text: ● Delegates authority to IC
Jargon: "Railroad Streer Command for Engine 44, you're 10-1."
Clear Text: "Railroad Street Command from Engine 44, you are Incident Commander
unreadable. ● Takes policy direction from Responsible Official
● Establishes incident objectives
Jargon: "OPSEC from Div. A. I have you 10-4" ● Provides overall leadership for on-scene response
Clear Text: "Operations Section Chief Ramos from Division Alpha. operations
You are coming in clear." ● Ensures incident safety
● Maintains liaison with participating response agencies
Accountability ● Whoever will be assigned in the IC will be the prerogative
● Check-in - All responders, regardless of agency affiliation, of the Mayor or Governor
must check-in to the incident and receive an assignment, ● Liaison- communication or cooperation which facilitates a
following the procedures established by the IC. close working relationship between people or organizations
○ Once assignment is given there will
establishment of responsibilities
● Incident Action Plan - Response operations must be
directed and coordinated as outlined in the IAP.
● Unity of command - Each individual involved in incident
operations is assigned to only one supervisor.
● Span of control - Supervisors must be able to effectively
manage their subordinates and the resources
● Resource Tracking - supervisors must record and report
resource status changes as they occur.
○ Makes sure that a unit does not run out of
resources

Integrated Communications Command and Coordination

Integrated communications are facilitated through ● Command - Incident Commander commands on-scene
● Development and use of a common communications plan. operations and reports to Responsible Official
● Interoperability of communication equipment, procedures, ● Coordination - Responsible Official, through the DRRMC
and systems. and EOC, coordinates with other agencies for the following:
● Communications networks that may be required: ○ Making policy decisions
a. Command Net ○ Establishing priorities
b. Tactical Nets ○ Resolving critical resource issues
c. Support Nets ○ Mobilizing and tracking resources
d. Ground-to-Air ○ Collecting, analyzing, and disseminating
e. Air-to-Air information
● EOC- emergency operations center, serves as the
communication center of all the groups
○ Coordinates all the information of all the units
present
○ This is just beside the ICS office to allow prompt
and swift reporting of incidents

Resource Management
● A Resource is any personnel, team, equipment, aircraft,
supplies and facilities available to support management
and response activities.
● Resource Management includes processes for:
○ Categorizing
○ Ordering
○ Dispatching
○ Tracking
○ Recovering
● ICS is only activated by the NDRRMC
○ Reimbursing resources (as appropriate)
ICS in Action
Incident Action Plan and ICS Forms
 MIDTERMS
UN Office for Disaster Risk
Reduction
Disaster Preparedness and Prevention Initiative (DPPI)
Overview of the Disasters Problem
● Disasters affect millions, cause big losses, hinder the
achievement of MDGs.
● Main problem is awareness and political commitment - risk
is not factored in.
● Knowledge, tools and policy frameworks are readily
available.
● Climate change makes a bad situation worse, adds to the
urgency.

Basic Patterns 1995-2004

● 2,500 million people affected
● 890,000 dead
● US$ 570 billion losses
● Most disasters are weather- or climate-related

Disasters afflict poor people and countries most, and are a

development issue
 ● Other partnerships and supporting groups

UNISDR Secretariat Objectives

● Obtain commitment from public authorities
● Increase public awareness
● Stimulate inter-disciplinary and multi-sector partnerships
● Foster better understanding and knowledge of the causes
of disasters

What Does ISDR Do?

● Advocate for, promote and support disaster risk reduction
● Promote and monitor the implementation of the Hyogo
Framework
If there is a vulnerability, there is a risk
● Develop reliable guidance and information resources on
disaster risk reduction
The Reasons for Rising Risk ● Coordinate action among ISDR partners and the United
Increased exposure and vulnerability Nations especially
● More people and poor people in risky and unsustainable ● Support and guide Governments and their partners in
situations. countries
● Unsafe development: floodplain settlement, coastal
exploitation, mega-city growth, unsafe houses, wetland Hyogo Framework for Action (HFA) 2005 - 2015
destruction, river channelling, deforestation, soil erosion ● "Building the Resilience of Nations and Communities
and fertility decline to Disasters"
● Climate change is starting to play a role. ● Ratified in January 2005 by over 4000 representatives of
DRR - An Agenda in Progress governments, non-governmental organisations (NGOs),
● 1989- IDNDR 1990-1999 Promotion of disaster reduction, academic institutions, and the private sector gathered in
technical and scientific buy-in Kobe, Japan, at the second World Conference on Disaster
● 1994- Yokohama Strategy and Plan of Action First blueprint Reduction (WCDR).
for disaster reduction policy guidance (social & community ● Adopted by 168 states as a 'Framework for Action'
orientation)
● 2000- International Strategy for Disaster Reduction (ISDR) What is the HFA?
Increased public commitment, linked to sustainable ● The Hyogo Framework for Action (HFA) is the key
development, enlarged networking and partnerships instrument for
● 2002– Johannesburg Plan of Implementation - WSSD New ● implementing disaster risk reduction, adopted by 168
section on "An integrated, multi-hazard, inclusive approach Member States of the United Nations
to address vulnerability, risk assessment and disaster ● Its overarching goal is to build resilience of nations and
management." communities to disasters, by achieving substantive
● 2005- WCDR - Hyogo Framework for Action 2005-2015 reduction of disaster losses by 2015
Building the Resilience of Nations and Communities to ● in lives, and in the social, economic, and environmental
Disasters assets of communities and countries
● 2006- World Bank Global Facility for Disaster Reduction
2006-2016 HFA - Cross Cutting Issues
● 2007- Global Platform The ISDR Movement ● Multi hazard approach
● Gender perspective and cultural diversity
United Nations International Strategy for Disaster Risk ● Community and volunteers participation
Reduction (UNISDR) System ● Capacity development and technology transfer
● Launched in 2000 by UN General Assembly Resolution
A/54/219 as successor of the International Decade on HFA: Strategic Goals
Natural Disaster Reduction - IDNDR, 1990-1999' 1. Integration of disaster risk reduction into sustainable
UNISDR system aims to: development policies and planning
● Build disaster resilient communities by promoting increased 2. Development and strengthening of institutions,
awareness of the importance of disaster reduction as an mechanisms and capacities to build resilience to hazards
integral component of sustainable development 3. Systematic incorporation of risk reduction approaches into
● Reduce human, social, economic and environmental losses the implementation of emergency preparedness, response
due to natural hazards and related technological and and recovery programmes
environmental disasters.
Disaster Preparedness and Prevention Initiative (DPPI)
The ISDR system 1. Governance
● The objective: To reduce disaster risk, worldwide, focusing ● Ensure that disaster risk reduction is a national and local
on nations and communities; priority with strong institutional basis for implementation
● The instrument: Hyogo Framework for Action 2005-2015 2. Risk Identification
● The vehicle: ISDR system ● Identify, assess and monitor disaster risks and enhance
early warning
United Nations International Strategy for Disaster Risk 3. Knowledge
Reduction (UNISDR) ● Use knowledge, innovation and education to build a culture
● "Strategy was established by UN General Assembly in of safety and resilience at all levels
2000, along with a small Secretariat and Inter-Agency Task 4. Reduce Risk Factors
Force ● Mainstreaming in various sectors (environment, health,
● Has grown into global multi-stakeholder mechanism social support, insurance and risk transfer, critical
Now comprises: infrastructure and construction, etc.)
● Global Platform for Disaster Risk Reduction 5. Preparedness
● Secretariat with regional outreach units ● Strengthen disaster preparedness for effective response at
● Regional and sub/regional meetings and organisations all levels
● National Platforms for Disaster Risk Reduction
● Monitoring process and Global Assessment Report
HFA Disaster Risk and Development Focus
HFA - Priority One Examples of Key Terminology Endorsed in A/RES/ 71/ 276
● 'Ensure DAR is a national and local priority with strong ● Disaster- A serious disruption of the functioning of a
institutional basis' community or a society at any scale due to hazardous
● DRR institutional mechanisms (national platforms) events interacting with conditions of exposure, vulnerability
● DRR part of development policies and planning, sector and capacity, leading to one or more of the following:
wise and multi-sector human, material, economic and environmental losses and
● Legislation to support DRR impacts.
● Decentralisation of responsibilities and resources ● Disaster Risk- The potential loss of life, injury, or
● Foster political commitment destroyed or damaged assets which could occur to a
● Community participation system, society or a community in a specific period of time,
HFA - Priority Five determined probabilistically as a function of hazard,
● 'Strengthen disaster preparedness for affective exposure, vulnerability and capacity.
response at all levels' ● Exposure- The situation of people, infrastructure, housing,
● Disaster management capacities: policy, technical and production capacities and other tangible human assets
institutional located in hazard-prone areas.
● Dialogue, coordination and information exchange ● Hazard- A process, phenomenon or human activity that
● Regional approaches to disasters response with risk may cause loss of life, injury or other health impacts,
reduction focus property damage, social and economic disruption or
● Review and exercise preparedness and contingency plans environmental degradation.
● Emergency funds ● Mitigation- The lessening or minimizing of the adverse
○ State of calamity is issued to be able for the impacts of a hazardous event.
funds to be released in times of emergency ● Prevention- Activities and measures to avoid existing and
○ A set aside fund form the general allocated funds new disaster risks.
● Voluntarism and participation ● Resilience- The ability of a system, community or society
exposed to hazards to resist, absorb, accommodate, adapt
Hyogo Framework Action to, transform and recover from the effects of a hazard in a
timely and efficient manner, including through the
preservation and restoration of its essential basic structures
and functions through risk management.
● Underlying Disaster Risk Drivers- Processes or
conditions, often development-related, that influence the
level of disaster risk by increasing levels of exposure and
vulnerability or reducing capacity
● Vulnerability- The conditions determined by physical,
social, economic and environmental factors or processes
which increase the susceptibility of an individual, a
community, assets or systems to the impacts of hazards.

Sendai Framework Monitoring: An Overview (2015-2030)

● Global Sendai Framework Targets
● Linkage of Sendai Framework and SDG indicator systems
● Custom and REgional Targets and Indicators

Two Questions about the HFA Seven Global Targets of the Sendai Framework: Areas of
● The Hyogo Framework is voluntary. It says where action is Focus
needed but it does not bind Governments or anyone to do ● Mortality- reduced mortality
anything. Is this lack of legal status a fatal weakness - or a ● People affected
brilliant strength? ● Economic loss
● In your country, how can you use the Hyogo Framework to ● Critical infrastructure and services
achieve the goals of your organisation? ● Disaster risk reduction strategies
● International cooperation
● Early warning and risk information
The HFA has only continued up until 2015, Sendai framework is
now currently used Sendai Framework Monitoring at a glance: 7 Global Targets
● Global Target A: substantially reduce global disaster
An Overview of Terminology for Disaster Risk Reduction Sendai mortality by 2030
Framework Monitoring Global Risk Assessment Framework ● Global Target B: substantially reduce the number of
affected people globally by 2030
Agenda ● Global Target C: reduce direct disaster economic loss in
● Work of the OIEWG on terminology and indicators for drr relation to global GDP (gross domestic product- primary
● Sendai framework monitoring indicator of economic activities)
● Global risk assessment framework ● Global Target D: substantially reduce disaster damage to
critical infrastructure and disruption of basic services
OIEWG on Indicators and terminology Related to DRR ● Global Target E: substantially increase the number of
● The open-ended intergovernmental expert working countries with national and local disaster risk reduction
(OIEWG) group on indicators and terminology relating to strategies by 2020
disaster risk reduction (A/71/644) was established by the ● Global Target F: substantially enhance international
UNGA in it's A/RES/69/284 and endorsed by the UNGA in cooperation to developing countries
A/RES/71/276. ● Global Target G: substantially increase the availability of
● The report presents recommended indicators to monitor the and access to multi-hazard early warning systems and
global targets of the Sendai Framework, the follow-up to disaster risk information and assessments to the people by
and operationalization of the indicators and recommended 2030
terminology relating to disaster risk reduction.
Linkage of Sendai Framework and SDG indicator Systems

Nursing Triage
INTRODUCTION
● The word triage is derived from the French word 'trier'
which means "to sort". Emergency triage is a subspecialty
of emergency nursing which specifically requires
● Sustainable development goals (SDGs) connected to the comprehensive educational preparation. During the
sendai framework: disaster, the goal is to maximize the no. of survivors by
○ 1- no poverty sorting treatable from untreatable victims.
○ 11- sustainable cities and communities
○ 13- climate action Triage
● Triage is a process which places the right patient in the
right place at the right time to receive the right level of care.

Need of Disaster Triage

● Inadequate resources to meet immediate needs.
● Infrastructure limitations.
● Limited transport capabilities.
● Hospital resources overwhelmed.

Aims of Triage
● To sort patients based on needs for immediate care.
● To recognize futility (lack of purpose).
● Medical needs will outstrip the immediately available
resources.
Custom and Regional Targets and Indicators ● Additional resources will become available, if given enough
time.
Custom Target and Indicators ● To ensure that all people requiring emergency care are
● Nationally identified targets and indicators that are appropriately categorized according to their clinical
especially related to the four priorities of the Sendai condition.
Framework
● Member States can measure their progress by creating Advantages of Triage
indicators or selecting from a proposed menu, as relevant ● Triage helps to bring order & organization to a chaotic
to their own context scene.
● These targets and indicators provide a mechanism for ● It identifies & provides care to those who are in greatest
monitoring the national strategies for disaster risk reduction need.
● Dedicated indicators for also available for local ● Triage helps to make difficult decisions easier.
governments to help assess their progress on DRR ○ As priority is done, decisions are made easier
● It assures that resources are used in the most effective
Regional Target and Indicators manner.
● Support regional IGOs to coordinate regional reporting of ● It may take some of the emotional burden away from those
the Sendai framework implementation in their respective doing triage.
regions;
● Provide a common platform for monitoring frameworks of Triage Team
regional DRR strategies; ● Triage team leader: co-ordinator
● Enable regional entities to showcase their success in DRR ● Clinical triage officer
in alignment with other global agendas especially in ● Head nurse, matron: chief organiser
regional events such as sustainable development forums, ● Nursing staff
climate outlook forums and DRR platforms. ● Follow-up medical groups

Global Risk Assessment Framework (GRAF)

Intent
● GRAF aims to strengthen the capacity of UN member
states to generate, disseminate and apply risk information
in development and humanitarian contexts reflective of the Types of Triage
increasingly systemic and interconnected nature of risks.
GRAF will facilitate access and use of systemic risk Simple Triage
information to support more resilient development and ● Simple triage is used in scenes of mass casualty, in order
humanitarian action, and public and private investment to sort patients into those who need critical attention &
immediate transport to hospital and those with less serious
 injuries. This step can be started before transportation
fractures
becomes available.
● S.T.A.R.T. –Simple triage & Rapid Treatment and White First aid and home Mild cut or trauma
immediate transport to hospital and those with less serious care are sufficient
injuries. This step can be started before transportation
becomes available. ● Colors are placed to inform other members of the
○ It is a simple triage system that can be performed healthcare team of the needed care to be provided for the
by lightly trained lay & emergency personnel in patient
emergencies.
○ Triage is done at the scene of the incident and Emergency Severity Index (ESI) Triage Scale
first aid treatment is done ● The Emergency Severity Index is a 5 level tool for use in
emergency department triage. Experienced ER nurses use
Triage separates injured into 4 groups the ESI to rate patients acuity on a scale of 1-5
● 0 – The injured who are beyond help ● LEVEL 1 - immediate life saving intervention is required.
● 1 – The injured who can be helped by immediate Example, cardiac and respiratory arrest
transportation ● LEVEL 2 – High risk situation is required (Confused,
● 2 – The injured whose transport can be delayed lethargic, disoriented, severe pain or distress, hypo or
● 3 – Those with minor injuries, who need help less urgently. hyperglycemia)
● LEVEL 3 – Multiple Resources are required. Example-
Advanced Triage chest pain, GI Bleeding
● In this, doctors may decide that some seriously injured ● LEVEL 4- It includes patients with less serious conditions.
people should not receive advanced care because they are Example - vomiting, diarrhea etc.
unlikely to survive. Advanced care will be used on patients ● LEVEL 5 - No resources are needed, example - minor cut
with less severe injuries. or burn
○ Triage done in the hospital with the involvement
of the different health professionals Emergency Severity Index (SVI)

Australasian Triage
● Triage level 1 – Immediately life threatening or
resuscitation
○ People admitted under this level require
immediate treatment of patients. Any delay in the
treatment can lead to patients' death. It includes
conditions such as cardiac arrest, severe shock,
decreased respiratory status, large area burn,
multi system or cervical trauma etc.
● Triage level 2 – Imminently life threatening or Emergency
(emergency major)
○ People admitted under this level require
immediate treatment of patients within 10-15
minutes of patient’s arrival. It includes conditions
such as head injury, severe allergic reaction, GI
bleeding, sexual assault etc.
● Triage level 3- Potentially life threatening / Time critical or
Urgent people admitted under this level requires immediate
treatment of patients within 30 minutes of patient's arrival. It
includes conditions such as mild head injury, moderate
trauma, history of seizure, any abuse, mild to moderate
asthma attacks etc.
● Triage level 4 – Potentially life serious / Situational urgency
or semi urgent
○ People admitted under this level require
immediate treatment of patients within 1 hour of
patient’s arrival. It includes conditions such as Role of Triage Nurse
vomiting, diarrhea, fever, minor trauma. ● Taking patient blood sample, cleaning and bandaging
● Triage level 5- Less / Non Urgent people admitted under wounds
this level requires immediate treatment of patients within 2 ● Administration of medications and maintaining proper
hours of the patient's arrival. It includes conditions such as supplies of medical equipment.
sore-throat, minor symptoms, abdominal pains etc. ● Documentation of the procedure
● Referral of the patient, if required
● Providing education and conducting triage training program
Classification of Triage according to Color Coding for staff
● Taking patient blood sample, cleaning and bandaging
Color Treatment Required Condition wounds

Black Palliative care is Cardiac arrest, septic

required shock MASS CASUALTY INCIDENT
Mass Casualty Incident (MCI)
Red Immediately steps to Respiratory insufficiency, Definition
be taken to save life hemorrhage ● An incident which produces multiple casualties such that
emergency services, medical personnel and referral
Yellow Patients are kept under Minor amputations, flesh systems within the normal catchment area cannot provide
observation wounds adequate and timely response and care without
unacceptable mortality and/or morbidity.
Green Within several hours Minor tissue injury,
● Strategy should be in place to maximize saving lives
 ● Principle of utilitarianism– the greatest good for the ● CFR, EMT, EMT-I, EMT-CC, EMT-P
greatest number, should be applied because not every ● How many patients are you taught to treat at one time?
person can be saved ● People with minor injuries can help because we need to
increase our resources
EMS GOAL
● To save the largest number of people of a multiple casualty What Changes When You Have An MCI?
incident ● What are my resources?
● Who is a Patient?
How do you start? ● Which Patient do I treat first?
● Command ● Who can be salvaged?
● Safety ● Who gets transported first?
● Triage ● Who needs a Trauma/Specialty Center?
● Staging ● Who can help care for others?
● Communication
● Treatment Time is very Important
THE GOLDEN HOUR
Communication ● “The critical trauma patient has only 60 minutes from the
● Obstacles time of injury to reach definitive surgical care, or the odds
○ Terrain- far-flung areas of a successful recovery diminish dramatically”
○ Different Frequencies ● Mortality increases the longer the patient waits
○ Overloaded channels
● Hospital Time Management
○ Medical Control ● Arrival of resources
○ Patient Routing ● Distribution of resources
○ Transportation Officer ● Effective patient treatment
○ Staging Officer
Scene Management
Things to Remember Command
● Maintain strict radio procedures ● Who is in Charge?
○ Every hospital has HEMS which has a radio line ● Who is in charge of what?
that is open 24/7 ● Who is going to do what?
● Enroute communications must be limited to urgent matters ● Who else needs to be here?
only Safety
● Transport patients in adequate vehicles ● Is there a hazard or threat?
● Transport patients with adequate escort staff ● Should I be here?
● Maintain a log of all Patients (PCR) ● Am I protected?
● What should I worry about?
Assessment
● What is going on?
● How big is this, how many people?
● What do I need?
● How does what I do affect others?
● What are they doing that can affect me?
Communications
● Who needs to know?
○ Make sure that the hospital knows how many
casualties are enroute to prepare healthcare
personnel, equipment, and services
● What do they need to know?
● The presence of resources are limited and is outweighed ● Does Command & Ops know?
by the number of casualties ● Do the other players know?
Triage
● Who is doing it?
○ The nurses does the triage
● Where are they doing it?
● What are they finding?
Treatment
● What the typical EMS provider comes “preloaded” with…
● How to organize?
● How much can we do?
Transport
● Who is doing it?
● From where are they doing it?
● Where are the patients going?
● How many patients are going where?
● The aim is to balance the gathered resources to those who ○ To prepare hospitals for the surge of casualties
are in need
● If unable to provide enough resources, nearby areas can Triage
be contacted and send additional resources to the affected ● “Large scale triage is the hardest job anyone in pre-hospital
area care will ever do.” AJ Heightman
But How is EMS Trained? When do we triage
● BLS, ALS ● When casualties exceed the number of skilled rescuers
● CPR, ACLS, PALS
● PHTLS, BTLS
How Often Should You Triage?
● Primary
○ On scene
● Secondary
○ Time of transport (when patient is being
transported)

Triage Protocol (START) Simple Triage And Rapid Treatment

Primary Triage
● Airway
● Breathing

Primary Triage
● Circulation

Triage Tags

Primary Triage
● Mental status
 ● If burn > 20% and/or inhalation injury, this is severe.
● All others can be triaged again at hospital

Triage Decision Table

● Benefit-to-Resource Ratio
● Based on Age & Total Burn Size

FINALS
THE PHILIPPINE DISASTER RISK
REDUCTION AND MANAGEMENT
ACT OF 2010
Why do we need to have a new law?
VICTIMS
● Female, 30's, walking PD 1566 RA 10121
● Female, teens, walking, pale, complaining of severe
● Assumes that Transforms & reforms the way
abdominal pain
disasters cannot be we deal with disasters
● Male, teens, walking, confused avoided ● That impact of
● Male, teens, you open airway, does not breathe ● Most plans were on disasters can be
● Male, 20's, unconscious, breathing, RR 36, radial pulse the provision of relief reduced by
absent goods & infra like addressing the root
● Male, 20's, holding left ankle, cannot walk, RR 20, CRT I, dike & flood control cause of disaster
responds to instructions systems (reactive) risks
● Government ● From disaster
Burn MCI response was response to risk
Bali Nightclub 2002 focused on disaster reduction
● Over 200 killed response ● Emphasis on
● Additional 250 injured ● Focuses on the strengthening
● All burn beds filled in Australia disaster response peoples’ capacity to
absorb stress
● Proactive and
EMS Considerations developmental
● Scene safety first approach in
○ May require decontamination managing disaster
○ Scene may be a crime scene ● Focuses on
● Designate field commander prevention and
○ Where to go may be different? mitigation
● Terrorism commonly has secondary devices targeting
Ability to anticipate, respond to and recover from..,
rescuers e.g., bombs
○ Always check if the scene is safe, the life of the
rescuer is the utmost priority
RA 10121 or the Phil Disaster Risk Reduction and Management
● Stage vehicles uphill and upwind
Act of 2010 (DRRM Act)
● Is a new law which transforms the Phils'. Disaster
Disposition From Scene
management system from disaster relief and response
● Severe: to burn center
towards disaster risk reduction (DRR)
● Moderate: local care facilities
● Ratified on May 27, 2010
● Minor: any care facility
● It repealed PD 1566 which was enacted in 1978.
Where to take them?
An Act
● International classification
1. Strengthening the Philippine Disaster Management System
○ Type A: resuscitation only
2. Providing for the National Disaster Risk Reduction and
○ Type B: first 48 hours
Management Framework and
○ Type C: everything
3. Institutionalizing the National Disaster Risk Reduction and
○ In the Philippines, only levels 2 and 3 hospitals
Management Plan, Appropriating funds therefore and for
have burn centers
Other Purposes
● What this means in WI
○ Two Type C
The NDRRM Framework
○ Level 2 hospitals are Type B
Safer, adaptive and resilient Filipino communities toward sustainable
development
What Does This Really Mean?
 ● The National DRRM Framework is a conceptual paradigm
on how the “whole of society” can work towards ‘Safer,
adaptive and disaster-resilient Filipino communities
towards sustainable development’
● It ensures DRRM process to be comprehensive and
integrated; all-hazards coverage; involve all sectors; and
have maximum impact on communities
● It emphasizes that resources invested in disaster
prevention, mitigation, preparedness and climate change
adaptation will be more effective towards attaining the
above stated vision
● It also highlights the need for effective and coordinated
humanitarian assistance and disaster response to save
lives and protect the more vulnerable groups
● Further, it illustrates the importance of identifying the risk
Legal Framework
factors and understanding how their interplay can translate
into disasters if left unabated or unmanaged

Philippine DRRM Milestones

The New DRM Law

● NDCC became National Disaster Risk Reduction and
Management Council or NDRRMC
● Formulation of a National Disaster Risk Reduction and
Management Framework and the National Disaster Risk
Reduction Plan
● Framework for Climate Change Adaptation and Disaster
● Local government autonomy- gives more powers to the Risk Reduction and Management
local government in terms of deciding on how to address ● RDCC (regional) ,PDCC (provincial) ,C/MDCC (city/
disasters municipality) into Local Disaster Risk Reduction and
● Adoption of the cluster approach- regional, provincial, Management Councils
municipal levels were created ● OCD directors as Chair of the Regional Disaster Risk
○ If the disaster only has affected the municipal Reduction & Management Council with Regional DSWD,
level, then the head of the municipality and their DILG, DOST, and NEDA as V-Chairs except Mindanao
team will make the decision where the Regional Gov acts as Chair and OCD as
secretariat of the RDRRMC
The National Disaster Risk Reduction and Management Council ● BDCC (barangay) integrated with the Barangay
The NDRRM Council Development Council
● Creation of the Local Disaster Risk Reduction and
Management Office
○ Should already have offices in the local levels
● Accreditation, mobilization and protection of Disaster
Volunteers & National Service Reserve Corp, CSO’s and
the Private Sector
● Integration of Disaster Risk Reduction Education into
school curricula & SK Programs as well as Mandatory
Training for Public Sector Employees

Sec 21 of RA 10121
● Local Disaster Risk Reduction and Management Fund
(LDRRMF).Not less than five percent (5%) of IRA (internal
revenue allocation) and estimated revenue from regular
sources shall be set aside as the LDRRMF
○ IRA- is funds from the national government that is
provided to local governments for disaster
● DND- chairperson
response
● DILG- vice chair for disaster preparedness
● 70% will be used to support disaster risk management
● DSWD- vice chair for disaster response
activities such as, but not limited to, pre-disaster
● NEDA- vice chair for disaster rehabilitation and recovery
preparedness programs including training, purchasing life-
● DOST- vice chair for prevention and mitigation
saving rescue equipment, supplies and medicines, for post-
● OCD- secretariat
disaster activities, and for the payment of premiums on
calamity insurance
How has the DRRM Structure Changed?
● 30% shall be allocated as Quick Response Fund (QRF) or
stand-by fund for relief and recovery programs

Quick Response Fund (QRF) or Stand-by Fund for Relief and

Recovery Programs (30%)
 Declaration of State of Calamity
70% of the LDRRMF 1. The National Council shall recommend to the President
of the Philippines the declaration of a cluster of
barangays, municipalities, cities, provinces, and regions
under a state of calamity, and the lifting thereof, based on
the criteria set by the National Council.
2. The President's declaration may warrant international
humanitarian assistance as deemed necessary.
3. The declaration and lifting of the state of calamity may also
be issued by the local sanggunian, upon the
recommendation of the LDRRMC, based on the results of
the damage assessment and needs analysis.
● Once there is declaration of the state of calamity, the LGU
now has the authority to utilize the disaster risk reduction
fund.

Prohibited Acts such as:

● Preventing the entry / distribution of relief goods and
AMENDING DILG-DBM JOINT MEMORANDUM CIRCULAR NO. 1,
disaster teams/ experts in disaster-stricken areas
(2005) ENTITLED, "GUIDELINES ON THE APPROPRIATION AND
● Buying, for consumption or resale, from disaster relief
UTILIZATION OF THE 20% OF THE IRA FOR DEVELOPMENT
agencies any relief goods, equipment or other aid
PROJECTS''
commodities intended for distribution to disaster affected
● Joint DILG-DBM Memorandum Circular 2011- enumerated
communities
the projects covered by the 20% development fund which
● Buying, for consumption or resale, from the recipient
now include projects to address and respond to
disaster affected persons any relief goods, equipment or
natural and man-made disasters and calamities.
other aid commodities received by them
● Under the guidelines, the 20% IRA can now be used for the
● Selling of relief goods, equipment or other aid commodities
construction or rehabilitation of evacuation centers;
intended for distribution to disaster victims
purchase or repair of area-wide calamity related alarm or
● Forcibly seizing of relief goods
warning system; purchase or repair of appropriate
● Diverting/ misdelivery of relief goods
calamity-related rescue operations equipment such as
● Repacking of relief goods, equipment and other aid
inflatable boats, breathing apparatus, extraction tools, fire
● Substitution of relief goods
extinguishers, chainsaws, 2-way handheld radios and the
● Illegal solicitations by persons/ organizations
like.
● Deliberate use of false or inflated data
Public Disclosure of fund utilization, Rule 18 of IRR
● Tampering with or stealing hazard monitoring and disaster
preparedness equipment and paraphernalia
LOCAL GOVERNMENT AUTONOMY
Penal Clause
Local Disaster Risk Reduction and Management Office
● Violators of those prohibited acts shall suffer a fine of not
less than PhP 50,00.00 or any amount not to exceed PhP
500,000.00 or imprisonment of not less than 6 years and 1
day or not more than 12 years or BOTH

● Gives authority to the local government units for decision-

making (devolution)
● Decentralization

Coordination During Emergencies

● The LDRRMCs shall take the lead in preparing for,
responding to, and recovering from the effects of any
disaster based on the following criteria: