Disaster Nursing

PRELIMS is closely linked to disaster risk reduction and build back

better principles.
Emergency vs. disaster ○ Rehabilitation and restoration are the main focus
● Both are man-made and natural causes but the difference ○ Restoration and rehabilitation of damaged
between the two is the response that it gets properties
● Both are disruptions in the normal occurrence ○ Financial assistance
● If someone was able to respond immediately then it is an ○ The effort of the government to bring the
emergency community back to normal
○ When there is preparation and there is still control of ○ Recovery is considered successful if normal
the situation activities of living have returned– markets
● Disaster is any situation where there is a failure in opened, community people are able to go back to
response their jobs
○ No one is capable of responding to the situation ○ Preventive and mitigating responses should be
○ No immediate intervention outside the place where the done after the event.
disaster took place ■ Flooding systems should be arranged
■ Fixing of roads and drainages
PHILIPPINE DISASTER AND RISK PROFILE ● The main objective of the cycle is to create disaster
resiliency
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
○ External support should already be asked in
cases like this
● Prevention and Mitigation means "lessening or limiting
the adverse impacts of hazards and related disasters"
(UNISDR, 2009)
● Preparedness is "the knowledge and capacities developed ● Risk - the potential consequences of hazard interacting
by governments, professional response and recovery with a community
organizations, communities and individuals to effectively ● Hazard - any potential threat to public safety and/or public
anticipate, respond to, and recover from the impacts of health
likely, imminent or current hazard events or conditions" ● Vulnerability - factors that determine the type and severity
(UNISDR, 2009) of the consequences (or risks)
○ Disaster strikes in between preparedness and ○ E.g., lack of resources, manpower, vulnerable
response groups of people
○ Preparedness should not only be done when ● Capacities - abilities to manage the risk of an emergency
disasters already come but should be done even (determinants of risks or risk modifiers). A combination of
before a disaster comes all strengths and resources available within a community,
● Response is the provision of emergency services and society, or organization that can reduce the level of risk or
public assistance during or immediately after a disaster to effects of a disaster, or may also be described as capability
save lives, reduce health impacts, ensure public safety and if in terms of human resources
meet the basic subsistence needs of the people affected ○ Presence of disaster funds and council
(UNISDR, 2009). ○ The higher the hazard, the higher the risk, the
○ Rescue operation higher vulnerability
○ Relief operation ○ The higher the capacity, the lower the
○ Medical mission vulnerability, the lower the risk
○ 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
disaster risk factors (UNISDR, 2009). The activities
involved in this phase are mainly termed rehabilitation and
reconstruction. UNISDR (2009) commented that this phase
THE PHILIPPINE CONTEXT What happens during Emergencies and Disasters
● Disruption to services, loss of supplies, infrastructure,
TRIPLE BURDEN OF DISEASE health workers
● Displacement - keeping people in the system - population
health, primary care, referral
● 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
● CoVid-19 virus is included in the communicable disease become a disaster
section
● These triple burden of diseases do not only affect health Effects related to Health
but also the social, psychological aspects of a person ● Communicable diseases including outbreaks
● Nutrition
EMERGENCIES AND DISASTERS IN THE PHILIPPINES ● Water and sanitation
● Natural Disasters ● Reproductive Health including GBV
○ Typhoons, earthquakes, volcanic eruptions ● Mental Health and Psychosocial Issues
● Man Made ● Non-communicable Diseases
○ Biological warfares, terrorisms
● Institutional/ hybrid Five most common causes of deaths in the Philippines during
○ Part man-made, part natural emergencies/disasters
1. Diarrheal diseases
● d/t lack of clean water resources
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
 ○ 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
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
● Reduced risk = reduced morbidity and mortality range of disasters and emergencies and to serve on a
deployable team. Examples: frequent responders to either
Reminders national or international disasters, military nurses, nurses
● An increase in the incidence of communicable diseases conducting comprehensive disaster nursing research.
tends to occur towards the terminal end of a downward ○ Nurses working in disaster response teams
spiral leading to 'crisis'. ○ Part of a deployable team
● We are conditioned to react when we see people
suffering/dying. The original set of disaster nursing competencies was
● We tend to ignore/fail to respond effectively to early organised into four areas and 10 domains:
warning indicators. ● This is the first draft of the ICN framework (version 1)
● We need to be sensitized to increase our awareness and
act before the cascade has escalated to the point of crisis. Mitigation/Prevention
● Policy development and planning
● Risk reduction, disease prevention, and health promotion
ICN core Competencies in Disaster
Nursing Preparedness
Introduction ● Ethical practice, legal practice and accountability
● Communication and information sharing
In 2009, the International Council of Nurses (ICN) and the World ● Education and preparedness
Health Organization (WHO) published the first edition of ICN
Framework of Disaster Nursing Competencies. The two Response
organizations stated at that time: ● Care of the community
● Nurses, as the largest group of committed health ● Care of individuals and families
personnel, often working in difficult situations with limited ● Psychological care
resources, play vital roles when disasters strike, serving as ● Care of vulnerable populations
first responders, triage officers and care providers, ● Done during or after disasters and emergencies
coordinators of care and services, providers of information
or education, and counsellors. However, health systems Recovery/Rehabilitation
and health care delivery in disaster situations are only ● Long-term recovery of individuals, families and
successful when nurses have the fundamental disaster communities
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 ICN Core Competencies In Disaster Nursing Version 2.0 (2019)
curriculum but was included to prepare nursing ● Nurses were encourage to do more research to improve
students to respond to emergencies the framework
○ The second version of the ICN framework was ● A continuing and advancement of education and
developed in Geneva enhancement of skills are included in the newer version

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.
● 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
addressed. (e.g., infectious diseases, doctors will be Introduction to Incident Command
appointed)
● To be able to continue being a part of an EMT, there are System (ICS)
competency exams that should be taken to determine if a
person is still qualified to join the team. ● Different disaster and threats have always been
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 ○ IMT- incident management team, a byproduct of
○ Organizations are usually not coordinated or ICS which is responsible in coordinating ad
organized spearheading disaster responses
● No check-in procedures for responders
● Lack of structure for coordinated planning agencies Executive Order No. 82
● Unclear line of authority ● Signed by President Benigno Aquino III
● Terminology differences between agencies ● Section 4D: “As soon as an incident is declared as
● Unclear or unspecified incident objectives approaching crisis level, the responding Crisis Manager
● Lack of clarity on who’s incharge activates the Incident Command System (ICS) and calls on
○ The current ICS assigns one leader only the designated Incident Commander (IC)..."
● Confusion rising from catastrophic incidents ● To create coordinated efforts to prevent vagueness of jobs
● Political interventions and overlapping of services
● The governor appoints the incident commander
Examples of Past Disasters/ Incidents
What is an Incident?
Disaster Date
● An occurrence, caused by either human or natural
Ultra or wowowee incident February 2006 phenomena, that requires response actions to prevent or
minimize loss of life, or damage to property and the
Tropical storm “Ondoy” September 2009 environment.
● A standard, on-scene, all hazard incident management
Quirino Grandstand Hostage August 2010 concept that can be used by all DRRMCs member
Taking agencies and response groups
● It allows its users to adopt an integrated organizational
Institutionalization of ICS structure to match the complexities and demands of single
● “An act strengthening the PDDRMS, providing for the or multiple incidents without being hindered by agency or
NDRRM framework and institutionalizing the NDRRM plan, jurisdictional boundaries
appropriating funds therefore and for other purposes”
● Section 9 (g): OCD shall establish SOP for coordination Purpose of ICS
● Rule 7 (h), IRR: OCD shall establish ICS The purpose of ICS is to help to ensure:
● The safety of responders and others.
● The achievement of tactical objectives.
● The efficient use of resources.

Benefits of 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
ICS Instructor Development
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
● Distribution of humanitarian assistance
● Planned events - fiestas, parades, sport events,
conferences, concerts, etc.
● Terrorist incidents
● Hostage-taking
● Car accidents

NDRRMC Memorandum Circular No. 4 Countries using ICS

● Signed by C, NDRRMC/ Secretary, DND last March 28, Fully implemented:
2012 ● United States
● Authorized the use of ICS as an On-Scene Disaster ● Canada
Response and Management Mechanism under the ● Australia
Philippine DRRM System ● New Zealand
○ ICS are created once disasters and emergencies ● Mexico
appear
○ Cities and municipalities have different ICS
Countries using ICS (In Transition) 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

Principles and Features of ICS
● Tactical direction describes the specific action that must be
1. Primary ICS Management Functions
accomplished within the selected strategy
2. Management by Objectives
● Example:
3. Unity of Command and Chain of Command
○ Objective: Clear all roads from debris in 6 hours
4. Organizational Flexibility
○ Strategy: Mobilize all the volunteers
5. Span of Control
○ Tactics: Equip 50 volunteers with shovels in the
6. Common Terminology
area.
7. Accountability
8. Integrated Communications
Unity of Command and Chain of Command
9. Resources Management
● Chain of Command: orderly ranking of management
10. Use of Incident Action Plan and Forms
positions in line of authority
● Unity of Command: Establishes a clear line of supervision,
Primary ICS management Functions
every individual has a designated supervisor
● Hierarchy of command

Organizational Flexibility
● ICS organization is flexible and modular
● 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

Understand Policy and Direction

● understand the legal mandate/orders/directives of
Responsible Official (person in charge) inn affected area
● In cities and municipalities, the mayors will be the one to
spearhead the response teams ● The heads or section chiefs are responsible for the
delegation of responsibilities assigned to the unit
Establish Incident Objectives
● Establish SMART objectives Span of Control
● Examples: ICS span of control for any supervisor:
○ Search all structures for casualties by 1400H. ● Is between 3 to 7 subordinates
○ Clear all roads with debris in six (6) hours. ● Optimally does not exceed 5 subordinates.
● To promote simple communication between the managers
and the subordinates
 ● This is to prevent confusion and difficulty in management ○ Makes sure that a unit does not run out of
○ Different units have different responsibilities and resources
this may create confusion to the head
Integrated Communications
Integrated communications are facilitated through
● Development and use of a common communications plan.
● Interoperability of communication equipment, procedures,
and systems.
● Communications networks that may be required:
a. Command Net
b. Tactical Nets
c. Support Nets
d. Ground-to-Air
e. Air-to-Air
● IMPORTANT: Do not combine functions for one ● EOC- emergency operations center, serves as the
organizational unit 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
Common Terminology ● A Resource is any personnel, team, equipment, aircraft,
The use of common terminology applies to: supplies and facilities available to support management
a. Organizational Elements - All ICS major functions and and response activities.
functional units are named and defined. Terminology for ● Resource Management includes processes for:
each organizational element is standard consistent. ○ Categorizing
● To prevent confusion in communication ○ Ordering
b. Resource Descriptions -Major resources personnel, major ○ Dispatching
equipment, and supply items are given common names ○ Tracking
and are listed by type and kind with respect to their ○ Recovering
capabilities. ○ Reimbursing resources (as appropriate)
c. Incident Facilities -Facilities used during the response are
named according to common terminology Incident Action Plan and ICS Forms
d. Position Titles - All ICS managers and supervisors are ● Used to communicate response goals, operational
referred to by standardized ICS titles such as Officer, Chief, objectives and support activities throughout the ICS
Supervisor or Leader. organization.
● Developed for each operational period (typically 12 to 24
All ICS communications should use clear text (that is, plain hours) to provide all incoming supervisory personnel with
language). Do not use radio codes, agency-specific codes, appropriate direction.
acronyms, or other jargon. ● May be oral or written.

The following examples demonstrate the difference between jargon Who is in-charge?
and clear text: The Responsible Official and the Incident Commander
Jargon: "Railroad Streer Command for Engine 44, you're 10-1."
Clear Text: "Railroad Street Command from Engine 44, you are Responsible Official
unreadable. ● Chairs the NDRRMC (Governor, Mayor, etc)
● Provides overall policy direction and strategic objectives
Jargon: "OPSEC from Div. A. I have you 10-4" ● Ensures availability of resources
Clear Text: "Operations Section Chief Ramos from Division Alpha. ● Serves as link to higher authorities
You are coming in clear." ● Delegates authority to IC

Accountability Incident Commander

● Check-in - All responders, regardless of agency affiliation, ● Takes policy direction from Responsible Official
must check-in to the incident and receive an assignment, ● Establishes incident objectives
following the procedures established by the IC. ● Provides overall leadership for on-scene response
○ Once assignment is given there will operations
establishment of responsibilities ● Ensures incident safety
● Incident Action Plan - Response operations must be ● Maintains liaison with participating response agencies
directed and coordinated as outlined in the IAP. ● Whoever will be assigned in the IC will be the prerogative
● Unity of command - Each individual involved in incident of the Mayor or Governor
operations is assigned to only one supervisor. ● Liaison- communication or cooperation which facilitates a
● Span of control - Supervisors must be able to effectively close working relationship between people or organizations
manage their subordinates and the resources
● Resource Tracking - supervisors must record and report
resource status changes as they occur.
Command and Coordination
● Command - Incident Commander commands on-scene
operations and reports to Responsible Official
● Coordination - Responsible Official, through the DRRMC
and EOC, coordinates with other agencies for the following:
○ Making policy decisions
○ Establishing priorities
○ Resolving critical resource issues
○ Mobilizing and tracking resources
○ Collecting, analyzing, and disseminating
information

● ICS is only activated by the NDRRMC

ICS in Action
 ● 2002– Johannesburg Plan of Implementation - WSSD New
section on "An integrated, multi-hazard, inclusive approach

MIDTERMS
to address vulnerability, risk assessment and disaster
management."
● 2005- WCDR - Hyogo Framework for Action 2005-2015
UN Office for Disaster Risk Reduction Building the Resilience of Nations and Communities to
Disasters
Disaster Preparedness and Prevention Initiative (DPPI) ● 2006- World Bank Global Facility for Disaster Reduction
Overview of the Disasters Problem 2006-2016
● Disasters affect millions, cause big losses, hinder the ● 2007- Global Platform The ISDR Movement
achievement of MDGs.
● Main problem is awareness and political commitment - risk United Nations International Strategy for Disaster Risk
is not factored in. Reduction (UNISDR) System
● Knowledge, tools and policy frameworks are readily ● Launched in 2000 by UN General Assembly Resolution
available. A/54/219 as successor of the International Decade on
● Climate change makes a bad situation worse, adds to the Natural Disaster Reduction - IDNDR, 1990-1999'
urgency. UNISDR system aims to:
● Build disaster resilient communities by promoting increased
Basic Patterns 1995-2004 awareness of the importance of disaster reduction as an
● 2,500 million people affected integral component of sustainable development
● 890,000 dead ● Reduce human, social, economic and environmental losses
● US$ 570 billion losses due to natural hazards and related technological and
● Most disasters are weather- or climate-related environmental disasters.

The ISDR system

● The objective: To reduce disaster risk, worldwide, focusing
on nations and communities;
● The instrument: Hyogo Framework for Action 2005-2015
● The vehicle: ISDR system

United Nations International Strategy for Disaster Risk

Reduction (UNISDR)
Disasters afflict poor people and countries most, and are a ● "Strategy was established by UN General Assembly in
development issue 2000, along with a small Secretariat and Inter-Agency Task
Force
● Has grown into global multi-stakeholder mechanism
Now comprises:
● Global Platform for Disaster Risk Reduction
● Secretariat with regional outreach units
● Regional and sub/regional meetings and organisations
● National Platforms for Disaster Risk Reduction
● Monitoring process and Global Assessment Report
● Other partnerships and supporting groups

UNISDR Secretariat Objectives

● Obtain commitment from public authorities
If there is a vulnerability, there is a risk ● Increase public awareness
● Stimulate inter-disciplinary and multi-sector partnerships
The Reasons for Rising Risk ● Foster better understanding and knowledge of the causes
Increased exposure and vulnerability of disasters
● More people and poor people in risky and unsustainable
situations. What Does ISDR Do?
● Unsafe development: floodplain settlement, coastal ● Advocate for, promote and support disaster risk reduction
exploitation, mega-city growth, unsafe houses, wetland ● Promote and monitor the implementation of the Hyogo
destruction, river channelling, deforestation, soil erosion Framework
and fertility decline ● Develop reliable guidance and information resources on
● Climate change is starting to play a role. disaster risk reduction
DRR - An Agenda in Progress ● Coordinate action among ISDR partners and the United
● 1989- IDNDR 1990-1999 Promotion of disaster reduction, Nations especially
technical and scientific buy-in ● Support and guide Governments and their partners in
● 1994- Yokohama Strategy and Plan of Action First blueprint countries
for disaster reduction policy guidance (social & community
orientation) Hyogo Framework for Action (HFA) 2005 - 2015
● 2000- International Strategy for Disaster Reduction (ISDR) ● "Building the Resilience of Nations and Communities
Increased public commitment, linked to sustainable to Disasters"
development, enlarged networking and partnerships ● Ratified in January 2005 by over 4000 representatives of
governments, non-governmental organisations (NGOs),
 academic institutions, and the private sector gathered in ● Regional approaches to disasters response with risk
Kobe, Japan, at the second World Conference on Disaster reduction focus
Reduction (WCDR). ● Review and exercise preparedness and contingency plans
● Adopted by 168 states as a 'Framework for Action' ● Emergency funds
○ State of calamity is issued to be able for the
What is the HFA? funds to be released in times of emergency
● The Hyogo Framework for Action (HFA) is the key ○ A set aside fund form the general allocated funds
instrument for ● Voluntarism and participation
● implementing disaster risk reduction, adopted by 168
Member States of the United Nations Hyogo Framework Action
● Its overarching goal is to build resilience of nations and
communities to disasters, by achieving substantive
reduction of disaster losses by 2015
● in lives, and in the social, economic, and environmental
assets of communities and countries

HFA - Cross Cutting Issues

● Multi hazard approach
● Gender perspective and cultural diversity
● Community and volunteers participation
● Capacity development and technology transfer

HFA: Strategic Goals

1. Integration of disaster risk reduction into sustainable
development policies and planning
2. Development and strengthening of institutions,
mechanisms and capacities to build resilience to hazards Two Questions about the HFA
3. Systematic incorporation of risk reduction approaches into ● The Hyogo Framework is voluntary. It says where action is
the implementation of emergency preparedness, response needed but it does not bind Governments or anyone to do
and recovery programmes anything. Is this lack of legal status a fatal weakness - or a
brilliant strength?
Disaster Preparedness and Prevention Initiative (DPPI) ● In your country, how can you use the Hyogo Framework to
1. Governance achieve the goals of your organisation?
● Ensure that disaster risk reduction is a national and local
priority with strong institutional basis for implementation
The HFA has only continued up until 2015, Sendai framework is
2. Risk Identification
now currently used
● Identify, assess and monitor disaster risks and enhance
early warning
3. Knowledge An Overview of Terminology for Disaster Risk Reduction Sendai
● Use knowledge, innovation and education to build a culture Framework Monitoring Global Risk Assessment Framework
of safety and resilience at all levels
4. Reduce Risk Factors Agenda
● Mainstreaming in various sectors (environment, health, ● Work of the OIEWG on terminology and indicators for drr
social support, insurance and risk transfer, critical ● Sendai framework monitoring
infrastructure and construction, etc.) ● Global risk assessment framework
5. Preparedness
● Strengthen disaster preparedness for effective response at OIEWG on Indicators and terminology Related to DRR
all levels ● The open-ended intergovernmental expert working
(OIEWG) group on indicators and terminology relating to
HFA Disaster Risk and Development Focus disaster risk reduction (A/71/644) was established by the
HFA - Priority One UNGA in it's A/RES/69/284 and endorsed by the UNGA in
● 'Ensure DAR is a national and local priority with strong A/RES/71/276.
institutional basis' ● The report presents recommended indicators to monitor the
● DRR institutional mechanisms (national platforms) global targets of the Sendai Framework, the follow-up to
● DRR part of development policies and planning, sector and operationalization of the indicators and recommended
wise and multi-sector terminology relating to disaster risk reduction.
● Legislation to support DRR
● Decentralisation of responsibilities and resources Examples of Key Terminology Endorsed in A/RES/ 71/ 276
● Foster political commitment ● Disaster- A serious disruption of the functioning of a
● Community participation community or a society at any scale due to hazardous
HFA - Priority Five events interacting with conditions of exposure, vulnerability
● 'Strengthen disaster preparedness for affective and capacity, leading to one or more of the following:
response at all levels' human, material, economic and environmental losses and
● Disaster management capacities: policy, technical and impacts.
institutional ● Disaster Risk- The potential loss of life, injury, or
● Dialogue, coordination and information exchange destroyed or damaged assets which could occur to a
system, society or a community in a specific period of time,
 determined probabilistically as a function of hazard, Linkage of Sendai Framework and SDG indicator Systems
exposure, vulnerability and capacity.
● Exposure- The situation of people, infrastructure, housing,
production capacities and other tangible human assets
located in hazard-prone areas.
● Hazard- A process, phenomenon or human activity that
may cause loss of life, injury or other health impacts,
property damage, social and economic disruption or
environmental degradation.
● Mitigation- The lessening or minimizing of the adverse
impacts of a hazardous event.
● Prevention- Activities and measures to avoid existing and
new disaster risks.
● Resilience- The ability of a system, community or society
exposed to hazards to resist, absorb, accommodate, adapt ● Sustainable development goals (SDGs) connected to the
to, transform and recover from the effects of a hazard in a sendai framework:
timely and efficient manner, including through the ○ 1- no poverty
preservation and restoration of its essential basic structures ○ 11- sustainable cities and communities
and functions through risk management. ○ 13- climate action
● 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
Custom and Regional Targets and Indicators
Seven Global Targets of the Sendai Framework: Areas of
Focus Custom Target and Indicators
● Mortality- reduced mortality ● Nationally identified targets and indicators that are
● People affected especially related to the four priorities of the Sendai
● Economic loss Framework
● Critical infrastructure and services ● Member States can measure their progress by creating
● Disaster risk reduction strategies indicators or selecting from a proposed menu, as relevant
● International cooperation to their own context
● Early warning and risk information ● These targets and indicators provide a mechanism for
monitoring the national strategies for disaster risk reduction
Sendai Framework Monitoring at a glance: 7 Global Targets ● Dedicated indicators for also available for local
● Global Target A: substantially reduce global disaster governments to help assess their progress on DRR
mortality by 2030
● Global Target B: substantially reduce the number of Regional Target and Indicators
affected people globally by 2030 ● Support regional IGOs to coordinate regional reporting of
● Global Target C: reduce direct disaster economic loss in the Sendai framework implementation in their respective
relation to global GDP (gross domestic product- primary regions;
indicator of economic activities) ● Provide a common platform for monitoring frameworks of
● Global Target D: substantially reduce disaster damage to regional DRR strategies;
critical infrastructure and disruption of basic services ● Enable regional entities to showcase their success in DRR
● Global Target E: substantially increase the number of in alignment with other global agendas especially in
countries with national and local disaster risk reduction regional events such as sustainable development forums,
strategies by 2020 climate outlook forums and DRR platforms.
● Global Target F: substantially enhance international
cooperation to developing countries Global Risk Assessment Framework (GRAF)
● Global Target G: substantially increase the availability of Intent
and access to multi-hazard early warning systems and ● GRAF aims to strengthen the capacity of UN member
disaster risk information and assessments to the people by states to generate, disseminate and apply risk information
2030 in development and humanitarian contexts reflective of the
increasingly systemic and interconnected nature of risks.
GRAF will facilitate access and use of systemic risk
information to support more resilient development and
humanitarian action, and public and private investment
 Simple Triage
● Simple triage is used in scenes of mass casualty, in order
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
becomes available.
● S.T.A.R.T. –Simple triage & Rapid Treatment and
immediate transport to hospital and those with less serious
injuries. This step can be started before transportation
becomes available.
○ It is a simple triage system that can be performed
Nursing Triage by lightly trained lay & emergency personnel in
emergencies.
INTRODUCTION ○ Triage is done at the scene of the incident and
● The word triage is derived from the French word 'trier' first aid treatment is done
which means "to sort". Emergency triage is a subspecialty
of emergency nursing which specifically requires Triage separates injured into 4 groups
comprehensive educational preparation. During the ● 0 – The injured who are beyond help
disaster, the goal is to maximize the no. of survivors by ● 1 – The injured who can be helped by immediate
sorting treatable from untreatable victims. transportation
● 2 – The injured whose transport can be delayed
Triage ● 3 – Those with minor injuries, who need help less urgently.
● Triage is a process which places the right patient in the
right place at the right time to receive the right level of care. Advanced Triage
● In this, doctors may decide that some seriously injured
Need of Disaster Triage people should not receive advanced care because they are
● Inadequate resources to meet immediate needs. unlikely to survive. Advanced care will be used on patients
● Infrastructure limitations. with less severe injuries.
● Limited transport capabilities. ○ Triage done in the hospital with the involvement
● Hospital resources overwhelmed. of the different health professionals

Aims of Triage Australasian Triage

● To sort patients based on needs for immediate care. ● Triage level 1 – Immediately life threatening or
● To recognize futility (lack of purpose). resuscitation
● Medical needs will outstrip the immediately available ○ People admitted under this level require
resources. immediate treatment of patients. Any delay in the
● Additional resources will become available, if given enough treatment can lead to patients' death. It includes
time. conditions such as cardiac arrest, severe shock,
● To ensure that all people requiring emergency care are decreased respiratory status, large area burn,
appropriately categorized according to their clinical multi system or cervical trauma etc.
condition. ● Triage level 2 – Imminently life threatening or Emergency
(emergency major)
Advantages of Triage ○ People admitted under this level require
● Triage helps to bring order & organization to a chaotic immediate treatment of patients within 10-15
scene. minutes of patient’s arrival. It includes conditions
● It identifies & provides care to those who are in greatest such as head injury, severe allergic reaction, GI
need. bleeding, sexual assault etc.
● Triage helps to make difficult decisions easier. ● Triage level 3- Potentially life threatening / Time critical or
○ As priority is done, decisions are made easier Urgent people admitted under this level requires immediate
● It assures that resources are used in the most effective treatment of patients within 30 minutes of patient's arrival. It
manner. includes conditions such as mild head injury, moderate
● It may take some of the emotional burden away from those trauma, history of seizure, any abuse, mild to moderate
doing triage. asthma attacks etc.
● Triage level 4 – Potentially life serious / Situational urgency
Triage Team or semi urgent
● Triage team leader: co-ordinator ○ People admitted under this level require
● Clinical triage officer immediate treatment of patients within 1 hour of
● Head nurse, matron: chief organiser patient’s arrival. It includes conditions such as
● Nursing staff vomiting, diarrhea, fever, minor trauma.
● Follow-up medical groups ● Triage level 5- Less / Non Urgent people admitted under
this level requires immediate treatment of patients within 2
hours of the patient's arrival. It includes conditions such as
sore-throat, minor symptoms, abdominal pains etc.

Types of Triage Classification of Triage according to Color Coding

 ● Referral of the patient, if required
Color Treatment Required Condition
● Providing education and conducting triage training program
Black Palliative care is Cardiac arrest, septic for staff
required shock ● Taking patient blood sample, cleaning and bandaging
wounds
Red Immediately steps to Respiratory insufficiency,
be taken to save life hemorrhage MASS CASUALTY INCIDENT
Yellow Patients are kept under Minor amputations, flesh Mass Casualty Incident (MCI)
observation wounds Definition
● An incident which produces multiple casualties such that
Green Within several hours Minor tissue injury, emergency services, medical personnel and referral
fractures systems within the normal catchment area cannot provide
adequate and timely response and care without
White First aid and home Mild cut or trauma unacceptable mortality and/or morbidity.
care are sufficient ● Strategy should be in place to maximize saving lives
● Colors are placed to inform other members of the ● Principle of utilitarianism– the greatest good for the
healthcare team of the needed care to be provided for the greatest number, should be applied because not every
patient person can be saved

Emergency Severity Index (ESI) Triage Scale EMS GOAL

● The Emergency Severity Index is a 5 level tool for use in ● To save the largest number of people of a multiple casualty
emergency department triage. Experienced ER nurses use incident
the ESI to rate patients acuity on a scale of 1-5
● LEVEL 1 - immediate life saving intervention is required. How do you start?
Example, cardiac and respiratory arrest ● Command
● LEVEL 2 – High risk situation is required (Confused, ● Safety
lethargic, disoriented, severe pain or distress, hypo or ● Triage
hyperglycemia) ● Staging
● LEVEL 3 – Multiple Resources are required. Example- ● Communication
chest pain, GI Bleeding ● Treatment
● LEVEL 4- It includes patients with less serious conditions.
Example - vomiting, diarrhea etc. Communication
● LEVEL 5 - No resources are needed, example - minor cut ● Obstacles
or burn ○ Terrain- far-flung areas
○ Different Frequencies
Emergency Severity Index (SVI) ○ Overloaded channels
● Hospital
○ Medical Control
○ Patient Routing
○ Transportation Officer
○ Staging Officer

Things to Remember
● Maintain strict radio procedures
○ Every hospital has HEMS which has a radio line
that is open 24/7
● Enroute communications must be limited to urgent matters
only
● Transport patients in adequate vehicles
● Transport patients with adequate escort staff
● Maintain a log of all Patients (PCR)

Role of Triage Nurse

● Taking patient blood sample, cleaning and bandaging
wounds
● The presence of resources are limited and is outweighed
● Administration of medications and maintaining proper
by the number of casualties
supplies of medical equipment.
● Documentation of the procedure
 ○ Make sure that the hospital knows how many
casualties are enroute to prepare healthcare
personnel, equipment, and services
● What do they need to know?
● Does Command & Ops know?
● 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
● The aim is to balance the gathered resources to those who ● What the typical EMS provider comes “preloaded” with…
are in need ● How to organize?
● If unable to provide enough resources, nearby areas can ● How much can we do?
be contacted and send additional resources to the affected Transport
area ● Who is doing it?
● From where are they doing it?
But How is EMS Trained? ● Where are the patients going?
● BLS, ALS ● How many patients are going where?
● CPR, ACLS, PALS ○ To prepare hospitals for the surge of casualties
● PHTLS, BTLS
● CFR, EMT, EMT-I, EMT-CC, EMT-P Triage
● How many patients are you taught to treat at one time? ● “Large scale triage is the hardest job anyone in pre-hospital
● People with minor injuries can help because we need to care will ever do.” AJ Heightman
increase our resources
When do we triage
What Changes When You Have An MCI? ● When casualties exceed the number of skilled rescuers
● What are my resources?
● Who is a Patient?
● Which Patient do I treat first?
● Who can be salvaged?
● Who gets transported first?
● Who needs a Trauma/Specialty Center?
● Who can help care for others?
How Often Should You Triage?
Time is very Important ● Primary
THE GOLDEN HOUR ○ On scene
● “The critical trauma patient has only 60 minutes from the ● Secondary
time of injury to reach definitive surgical care, or the odds ○ Time of transport (when patient is being
of a successful recovery diminish dramatically” transported)
● Mortality increases the longer the patient waits
Triage Protocol (START) Simple Triage And Rapid Treatment
Time Management
● Arrival of resources
● Distribution of resources
● Effective patient treatment

Scene Management
Command
● Who is in Charge?
● Who is in charge of what?
● Who is going to do what?
● Who else needs to be here?
Safety
● Is there a hazard or threat?
● Should I be here?
● 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?
 Primary Triage
● Circulation

Primary Triage
● Mental status

Triage Tags

VICTIMS
● Female, 30's, walking
● Female, teens, walking, pale, complaining of severe
abdominal pain
● Male, teens, walking, confused
● Male, teens, you open airway, does not breathe
● Male, 20's, unconscious, breathing, RR 36, radial pulse
absent
● Male, 20's, holding left ankle, cannot walk, RR 20, CRT I,
responds to instructions

Burn MCI
Primary Triage
Bali Nightclub 2002
● Airway
● Over 200 killed
● Breathing
● Additional 250 injured
● All burn beds filled in Australia

EMS Considerations
● Scene safety first
○ May require decontamination
○ Scene may be a crime scene
● Designate field commander
○ Where to go may be different?
● Terrorism commonly has secondary devices targeting
rescuers e.g., bombs
○ Always check if the scene is safe, the life of the
rescuer is the utmost priority
● Stage vehicles uphill and upwind

Disposition From Scene

● Severe: to burn center
● Moderate: local care facilities
● Minor: any care facility

Where to take them?

 ● International classification RA 10121 or the Phil Disaster Risk Reduction and Management
○ Type A: resuscitation only Act of 2010 (DRRM Act)
○ Type B: first 48 hours ● Is a new law which transforms the Phils'. Disaster
○ Type C: everything management system from disaster relief and response
○ In the Philippines, only levels 2 and 3 hospitals towards disaster risk reduction (DRR)
have burn centers ● Ratified on May 27, 2010
● What this means in WI ● It repealed PD 1566 which was enacted in 1978.
○ Two Type C
○ Level 2 hospitals are Type B An Act
1. Strengthening the Philippine Disaster Management System
What Does This Really Mean? 2. Providing for the National Disaster Risk Reduction and
● If burn > 20% and/or inhalation injury, this is severe. Management Framework and
● All others can be triaged again at hospital 3. Institutionalizing the National Disaster Risk Reduction and
Management Plan, Appropriating funds therefore and for
Triage Decision Table Other Purposes
● Benefit-to-Resource Ratio
● Based on Age & Total Burn Size The NDRRM Framework
Safer, adaptive and resilient Filipino communities toward sustainable
development

● The National DRRM Framework is a conceptual paradigm

on how the “whole of society” can work towards ‘Safer,
adaptive and disaster-resilient Filipino communities

FINALS ●
towards sustainable development’
It ensures DRRM process to be comprehensive and
THE PHILIPPINE DISASTER RISK REDUCTION integrated; all-hazards coverage; involve all sectors; and
have maximum impact on communities
AND MANAGEMENT ACT OF 2010 ● It emphasizes that resources invested in disaster
Why do we need to have a new law? prevention, mitigation, preparedness and climate change
adaptation will be more effective towards attaining the
PD 1566 RA 10121
above stated vision
● It also highlights the need for effective and coordinated
● Assumes that Transforms & reforms the way
disasters cannot be we deal with disasters humanitarian assistance and disaster response to save
avoided ● That impact of lives and protect the more vulnerable groups
● Most plans were on disasters can be ● Further, it illustrates the importance of identifying the risk
the provision of relief reduced by factors and understanding how their interplay can translate
goods & infra like addressing the root into disasters if left unabated or unmanaged
dike & flood control cause of disaster
systems (reactive) risks Philippine DRRM Milestones
● Government ● From disaster
response was response to risk
focused on disaster reduction
response ● Emphasis on
● Focuses on the strengthening
disaster response peoples’ capacity to
absorb stress
● Proactive and
developmental
approach in
managing disaster
● Focuses on
prevention and
mitigation ● Local government autonomy- gives more powers to the
local government in terms of deciding on how to address
Ability to anticipate, respond to and recover from.., disasters
● Adoption of the cluster approach- regional, provincial,
municipal levels were created
 ○ If the disaster only has affected the municipal where the Regional Gov acts as Chair and OCD as
level, then the head of the municipality and their secretariat of the RDRRMC
team will make the decision ● BDCC (barangay) integrated with the Barangay
Development Council
The National Disaster Risk Reduction and Management Council ● Creation of the Local Disaster Risk Reduction and
The NDRRM Council 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
● DOST- vice chair for prevention and mitigation life-saving rescue equipment, supplies and medicines, for
● OCD- secretariat post-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%)

Legal Framework
70% of the LDRRMF

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 AMENDING DILG-DBM JOINT MEMORANDUM CIRCULAR NO. 1,
Risk Reduction and Management (2005) ENTITLED, "GUIDELINES ON THE APPROPRIATION AND
● RDCC (regional) ,PDCC (provincial) ,C/MDCC (city/ UTILIZATION OF THE 20% OF THE IRA FOR DEVELOPMENT
municipality) into Local Disaster Risk Reduction and PROJECTS''
Management Councils ● Joint DILG-DBM Memorandum Circular 2011- enumerated
● OCD directors as Chair of the Regional Disaster Risk the projects covered by the 20% development fund which
Reduction & Management Council with Regional DSWD, now include projects to address and respond to
DILG, DOST, and NEDA as V-Chairs except Mindanao natural and man-made disasters and calamities.
 ● 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:

Declaration of State of Calamity

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
disaster teams/ experts in disaster-stricken areas
● Buying, for consumption or resale, from disaster relief
agencies any relief goods, equipment or other aid
commodities intended for distribution to disaster affected
communities
● Buying, for consumption or resale, from the recipient
disaster affected persons any relief goods, equipment or
other aid commodities received by them