Disaster Lecture Prelim Finals

Disaster Nursing - Lec
ESSENTIALS OF
The WHO defined natural disasters as
the “result of an ecological disruption
or threat that exceeds the adjustment
DISASTER PLANNING capacity of the affected community”
Introduction to Disaster Hospitals facilities also described

disasters as “internal or external”
• Disasters have been integral
parts of human experience • External – those that do not
causing premature death, affect the infrastructure but tax
impaired quality of life, and hospital resources
altered health status. • Internal – cause disruption of
• Approximately 1 disaster per normal hospital function due to
week that needs international injuries or deaths of personnel
attention occurs somewhere or damage to the physical
worldwide. plant, hospital fire, or power
• Nurses constitute the largest failure
sector of health care workers Types of Natural Disaster
and will be in the frontlines of
Geological
any emergency response.
Landslide
Disaster
• described as an outward and
• Any destructive event that downward slope movement of
disrupts the normal functioning
an ambulance including rock,
of a community.
• Also defined as ecologic soil, artificial materials, or a
disruptions, or emergencies, of combination of these
a severity and magnitude that
Earthquakes
results in death, injuries, and
property damage that cannot • result of a sudden release of
be effectively managed using energy in the Earth’s crust that
routine procedures and
create seismic waves
resources and that require
outside assistance. • caused by slippage within
• Noji (1997) describes disasters geological faults
quite simply, as “events that • Seismic focus – underground
require extraordinary efforts point of origin of the
beyond those needed to earthquake
respond to everyday • Epicenter – point directly
emergencies.”
above the focus on the surface
May be classified into 2 broad • Usually, the secondary event
categories that they trigger, such as
building collapse, tsunamis,
Natural – typhoons, earthquakes, and volcanic eruptions, that
volcanic eruptions cause death
Man-made – chemical spills, nuclear
events, fire, explosions, transportation
accidents, armed conflicts
Disaster Nursing – Lec
Sinkholes covers land used by humans,

such as a village, city or other
• When natural erosion, human
inhabited areas.
mining or underground
excavation makes the ground Tsunami
too weak to support the
• Also known as a seismic sea
structures built on it, the ground
wave or tidal wave, is a series of
can collapse and produce a
waves in a water body caused
sinkhole. For example, the 2010
by the large volume of water,
Guatemala City sinkhole,
generally in an ocean or a
which killed fifteen people, was
large lake
caused when heavy rainfall
from Tropical Storm Agatha,
diverted by leaking pipes into a
Meteorological Disasters
pumice bedrock, led to the
sudden collapse of the ground Tropical cyclone
beneath a factory building
• Typhoon, cyclone, cyclonic
Volcanic Eruptions storm and hurricane are
different names for the same
• One hazard is the volcanic
phenomenon: a tropical storm
eruption itself, with the force of
that forms over an ocean
the explosion and falling rocks
able to cause harm Blizzard
• Lava may also be released
• Are severe winter storms
during the eruption of a
characterized by heavy snow
volcano; as it leaves the
and strong winds
volcano, it can destroy
buildings, plants and animals Hailstorms
due to its extreme heat • Precipitations in the form of ice
• In addition, volcanic ash may that does not melt before it hits
form a cloud (generally after the ground. Hailstorms usually
cooling) and settle thickly in measure between 5 and 150
nearby locations mm (1/4 and 6 in) in diameter
Cold waves
Hydrological • Specifically, as used by the US
Is a violent, sudden and destructive National Weather Service, a
change either in the quality of Earth’s cold wave is a rapid fall in
water or in the distribution or temperature within a 24-hour
movement of water on land below period, requiring substantially
the surface or in the atmosphere. increased protection to
agriculture, industry,
Flood
commerce and social activities
• An overflow of water that
‘submerges’ on land
• A flood is not considered
significant unless the water
Heat waves waves in a water body caused

by the large volume of water,
• Heat wave is a period of
generally in an ocean or a
unusually and excessive hot
large lake
weather
Drought
Biological Disasters
• is the unusual dryness of soil
caused by levels of rainfall Are natural scenarios involving
significantly below average disease, disability or death on a large
over a prolonged period. scale among humans, animals and
• Hot and dry winds, shortage of plants due to microorganisms like
water, high temperatures and bacteria, or viruses or toxins
consequent evaporation of
moisture from the ground can Disasters are frequently categorized
also contribute to conditions of based on their onset, impact, and
drought. Drought result in crop duration.
failure and shortage of water.
Earthquakes and tornadoes – rapid-
Thunderstorms onset events
• Severe storms, dust clouds and A bioterrorism attack may be sudden

volcanic eruptions can and unanticipated and have a rapid
generate lightning. Apart from and prolonged impact on a
the damage typically
community
associated with storms, such as
winds, hail and flooding, the Drought and famines – gradual onset
lightning itself can damage or chronic genesis
buildings, ignite fires and kill by
direct contact.
Tornado Terms
• Hazard - is a potential threat to

• Violent and dangerous rotating
column of air that is in contact humans and their welfare.
with both the surface of the Present the possibility of the
Earth and a cumulonimbus occurrence of a disaster
cloud, or, in rare cases, the caused by natural
base of a cumulus cloud. It is phenomena, man-made
also referred to as a twister or a sources, or human activity
cyclone
• Risk - is the actual exposure of
• Typically take the form of a
something of human value and
visible condensation funnel,
is often measured as the
the narrow end of which
product of probability and loss.
touches the Earth and is often
Possibility and Probability
encircled by a cloud of debris
• Vulnerability - the degree of
and dust.
susceptibility and resilience of
Storm Surge the community and
environment to the hazards.
• Also known as a seismic sea
• Susceptibility – being likely to
wave or tidal wave, is a series of
be influenced
• Resilience – the capacity of a Technological Disasters

community or a person to
• Is a catastrophic event that is
recover quickly from a disaster
caused by either human error
event
in controlling technology or a
• Health disaster - a catastrophic
malfunction of a technology
event that results in casualties
system
that overwhelm the healthcare
• Disasters caused by
resources in that community
technology involve the failure
and may result in a sudden
or breakdown of systems,
unanticipated surge of
equipment and engineering
patients
standards that harms people
• Disaster epidemiology- is the
and the environment
measurement of the adverse
• Technology disasters includes
health effects of natural and
structural collapse, such as
human-generated disasters
bridges, mines and buildings.
and the factors that contribute
to those effects, with the Transitional Human Shelters
overall objective of assessing
Is any of a range of shelter options
the needs of disaster-affected
that help people affected by conflict
populations, matching
or natural disasters who have lost or
available resources to needs,
abandoned their housing until they
preventing further adverse
can return to or recover acceptable
health effects, evaluating
permanent accommodation.
program effectiveness, and
planning for contingencies Transitional means:
1. Upgraded into part of a

Man-made Disaster permanent house
2. Reused for another purpose
Terrorism
3. Relocated from a temporary
• Terrorist organizations or site to a permanent location
affiliates may seek to acquire, 4. Resold, to generate income to
build, and use weapons of aid with recovery
mass destruction. 5. Recycled for reconstruction
Conventional terrorist attacks,
Trends and Patterns of Disasters
including those by lone actors
employing explosives and • Flooding is the most common
armed attacks, present a natural disaster since 1990.
continued risk to the nation. From 1990 to 2019, a total of
• Cyberattacks can have 9,924 natural disasters
catastrophic consequences occurred globally, of which 42
and may also have cascading percent were floods.
effects such as power grid or • In 2005, the world experienced
financial system failures. the largest amount of natural
disasters that left a death toll of
more than 90,000 after 442
incidents with another 160
million people in need of

immediate assistance.
• The resulting cost of addressing
damage caused by natural
disasters has risen from US$50
billion per year in the 1980s to
US$ 200 billion per year in the
last decade.
ICN FRAMEWORK FOR

major gap in disaster and
emergency response.
• The Asia Pacific Emergency
DISASTER NURSING and Disaster Nursing Network
(APEDNN) was established -
COMPETENCIES mission is to promote nursing's
ability to reduce the impact of
emergencies and disasters on
In 2009, the International Council Of
the health of communities
Nurses (ICN) and the World Health
(WHO Regional Office for the
Organization (WHO) published the
Western Pacific, 2007).
first edition of the ICN framework of
• Experiences demonstrated the
Disaster Nursing Competencies. lack of disaster and
The International Council of Nurses emergency preparedness,
and the World Health Organization, in including the need for trained
support of the Member States and volunteers, communication
systems, collaboration among
nurses, recognize the urgent need for
organizations, and education
acceleration of efforts to build
of the population in disaster
capacities of nurses at all levels to
preparedness.
safeguard populations, limit injuries • As the disaster situation
and deaths, and maintain health transitions to the long-term
system functioning and community recovery phase, nurses take on
well – being, in the midst of continued the role of managing the
health threats and disasters. ongoing health threats to
individuals, families, and the
The ICN expects that disaster nursing
community, as well as the
competencies for the generalist
continuing care needs of those
nurse will help clarify the role of the
with injuries, illnesses, chronic
nurse in disasters and assist in the disease, and disability.
development of disaster training and • The Iranian earthquake of 2003
education. was powerful, killing more than
Role of Nurses 43 000 people, injuring 20 000,
and leaving more than 60 000
• Disaster nursing requires the people homeless.
application of basic nursing • A study was designed to
knowledge and skills in difficult investigate the experiences of
environments with scarce 13 RN during the disaster relief
resources and changing efforts.
conditions. • It revealed that the nurses were
• Nurses must work ill-prepared. Nurses arriving first
collaboratively with other at the disaster expressed
health professionals, disaster confusion and disappointment
responders, non-governmental with the absence of protocols.
organizations, and They were left to work in the
governments. dark.
• WHO views nurses and • The study found a need for
midwives as essential in disaster protocols, teamwork,
responds, but considers their experienced nursing team
lack of disaster training as a
leaders, and education in Why need a set of competencies?

disaster nursing
• Create consistency in the
• While mental health issues are
care given;
a major concern, many nurses
• Facilitate deployment of
lack sufficient knowledge to
nurses globally:
recognize the potential for
• Promote shared aims;
mental health consequences
• Enhance the ability of nurses
in a disaster.
to work effectively within the
• Many of the workers have
organizational structure and
never been exposed to the
as a member of the
suffering and devastation of a
multidisciplinary team
disaster. They tend to work long
hours and get little rest. They Mitigation means to reduce the severity
may also be dealing with an of the human and material damage
unfamiliar culture and political caused by the disaster. Prevention is to
tensions. ensure that human action or natural
phenomena do not result in disaster or
Ethical issues and cultural
emergency.
competency
Prevention / Mitigation
• Disasters require nurses to
Competencies
make difficult, ethical
choices in the face of • process designed to prevent or
scarce resources focus from minimize the risks related to
individual to sudden shift of disaster
focus from individual to • Technological solutions - e.g.
community care. flame-retardant roofing’s or
• RNs who become so sprinkler systems in homes in
involved in the mechanics fire-prone areas, structural
of the disaster response can changes in infrastructure, or
easily disregard respect, engineering solutions such as
dignity, and cultural norms. the building of dams to control
• RNs must strive to be water flow.
culturally competent in • Legislations - prohibits building
order to provide the in flood-prone areas,
required care and requirements for
assistance as effectively as immunizations, safety codes,
possible within the building codes to make
circumstances of the buildings safer, and public
disaster. education.
Competence Prevention / Mitigation
• Used to describe the • Nurse's role in prevention and
knowledge that enables a mitigation begins with
practitioner to perform identifying risks both at the
activities consistently in a community and individual
safe manner. level.
• RN also collaborates on
developing plans to reduce
identified risk, and assists in the
development of surveillance • may last a few days to several

systems related to disease weeks depending on the
outbreaks. magnitude of the disaster.
• Helping to shape public policy • Managing scarce resources,
that will decrease the coordinating care,
consequences or potential determining if standards of
effects of a disaster is an
care must be altered, making
important role because of the
appropriate referrals, triage,
nurse's knowledge of the
assessment, infection control,
community and the areas of
and evaluation are just a few of
vulnerability
the skills a nurse uses
Preparedness • Post-Traumatic Stress Disorder,
• perhaps the most critical depression, and anxiety are
phase in the disaster frequently seen in the
management continuum aftermath of a disaster
• The International Strategy
Recovery/Rehabilitation
for Disaster Reduction (ISDR)
defines it as "activities and • Once immediate needs are
measures taken in advance met, the recovery phase can
to ensure effective response begin
to the impact of hazards, • restoring vital services,
including the issuance of rebuilding infrastructure and
timely and effective early housing, and meeting the
warnings and the temporary
needs of the population while
evacuation of people and
assisting them to restore their
property from threatened
lives
locations"
• Capacity-building through • Without the health care
recruitment and infrastructure, the community
maintenance of a ready will struggle to survive.
disaster nursing workforce is Temporary medical services
also part of nursing's role. must be transitioned back to
• Collaboration with planners, permanent facilities.
organizations involved in
disaster relief, government
The competencies were organized
agencies, health care
professionals, and under four areas:
community groups to 1. Mitigation/prevention
develop the preparedness competencies,
plan is vital. 2. Preparedness competencies;
Response 3. Response competencies;
4. Recovery/rehabilitation
• encompasses the immediate
competencies.
action taken in the face of a
disaster “Starve your distractions feed your
• includes the mobilization of focus”
responders to the disaster area
the community such as mass

immunization and medication
administration programs.
• Works with the community to
strengthen the health care
system's ability to respond to
and recover from a disaster.
Prevention/Mitigation Competencies 2. Policy Development and Planning
1. Risk Reduction, Disease Prevention • Describes the phases of the
and Health Promotion disaster management
1.1 Risk Reduction and Disease continuum:
Prevention. o Prevention / mitigation,
preparedness, response,
• Using epidemiological data o and recovery /
evaluates the risks and effects rehabilitation.
of specific disasters on the • Describes the role of
community and the population government and organizations
and determines the in disaster planning and
implications for nursing. response
• Identifies challenges to the • Understands the community
health care system and works disaster plan and how it relates
with the multidisciplinary team to the national and
to mitigate the challenges. international response plans.
• Identifies vulnerable • Participates in disaster
populations and coordinates planning and policy
activities to reduce risk. development.
• Understands the principles and • Contributes to the
process of isolation, development, evaluation, and
quarantine, containment and modification of the community
decontamination and assists in disaster plan.
developing a plan for • Participates politically and
implementation in the legislatively in the
community. development of policies
1.2 Health Promotion related to disaster
preparedness and response.
• Participates in community
education activities related to 3. Ethical Practice, Legal Practice,
disaster preparedness. and Accountability
• Assesses the community to 3.1 Ethical Practice
determine pre-existing health
issues, the prevalence of • Collaborates with others to
disease, chronic illness and identify and address ethical
disability, and the health care challenges
resources in the community • Applies the national approved
• Participates in planning to ethical framework to support
meet the health care needs of
decision - making and 4. Communication and Information

prioritizing Sharing
• Practices in accordance with
• Describes the chain of
the cultural, social, and spiritual
command and the nurse's role
beliefs of individuals and
within the system.
communities.
• Describes the principles of crisis
• Protects the rights, values, and
communication in crisis
dignity of individuals and
intervention and risk
communities
management.
• Understands one's own
• Identifies and communicates
personal beliefs and how those
important information
beliefs impact disaster
immediately to appropriate
response.
authorities.
• Describes how security issues
• Maintains records and
and ethics may conflict
documentation and provides
3.2 Legal Practice reports as required.
• Practices in accordance with 5. Education and Preparedness

local, state, national, and
• Maintains knowledge in areas
international applicable laws.
relevant to disaster and
• Understands how laws and
disaster nursing
regulations specific to disaster
• Participates in drills in the
impact nursing practices and
workplace and community
disaster survivors.
• Facilitates research in disaster
• Understands the legal
• Develops and maintains a
implications of disasters and
personal and family
emergency events
preparedness plan.
o Roles and responsibilities
• Evaluates community
of volunteers
readiness and takes actions to
o Abandonment of
increase readiness where
patients
needed
o Adaptation of standards
• Takes on a leadership role in
of care
the development and
3.3 Accountability implementation of training
programs for nurses and other
• Accepts accountability and
health care providers.
responsibility for one's own
actions. 6. Care of Communities
• Delegates to others in
• Describes the phases of
accordance with professional
community response to
practice, applicable laws and
disaster and the implications
regulations, and the disaster
for nursing interventions.
situation.
• Participates in preventive
• Advocates for the provision of
strategies such as mass
safe and appropriate care.
immunization activities
• Recognizes symptoms of • Assists in developing recovery

communicable disease and strategies that improve the
takes measures to reduce quality of life for the
exposure to survivors community.
• Determines need for
decontamination, isolation or
quarantine and takes
appropriate action.
• Applies accepted triage
principles when establishing
care based on the disaster
situation and available
resources
• Works with appropriate
individuals and agencies to
assist survivors in reconnecting
with family members and loved
ones
• Understands the psychological
impact of disasters on adults,
children, families, vulnerable
populations and communities.
• Describes vulnerable
populations at risk as a result of
a disaster
7. Long-term Care Needs
7.1 Individual and Family Recovery
• Develops plans to meet short-

and long-term physical and
psychological nursing needs of
survivors
• Serves as an advocate for
survivors in meeting long term
need
• Identifies the changing needs
of survivors and revises the plan
of care as required
7.2 Community Recovery
• Assists the community in

transitioning from the response
phase of the
disaster/emergency through
recovery and rehabilitation to
normal functions
THE DISASTER
• Prevention - refers to a broad
range of activities, such as
attempts to prevent a disaster
CONTINUUM from occurring, and any
actions taken to prevent
Disaster Continuum - also referred to further disease, disability, or loss
as the life cycle/emergency of
management cycle of a disaster. • Response phase - is the actual
implementation of the disaster
plan.
3 phases: preimpact (before), impact o Disaster response, or
(during), and postimpact (after) emergency
• The basic phases of a disaster management, is the
management program include organization of activities
preparedness, mitigation, used to address the
response, recovery, and event
evaluation. o focuses primarily on
emergency relief: saving
Degree of overlaps present across lives, providing first aid,
phases, but each phase has distinct minimizing and restoring
activities associated with damaged systems such
• Preparedness - refers to the as communications and
proactive planning efforts transportation, and
designed to structure the providing care and
disaster response prior to its basic life requirements to
occurrence. victims
o encompasses • Recovery-actions focus on
evaluating potential stabilizing and returning the
vulnerabilities community to normal.
(assessment of risk) and o This can range from
the propensity for a rebuilding damaged
disaster to occur. buildings and repairing
• Warning - refers to monitoring infrastructure to
events to look for indicators relocating populations
that predict the location, and instituting physical,
timing, and magnitude of behavioral, and mental
future disasters. health interventions.
• Mitigation includes measures o "Build Back Better"
taken to reduce the harmful should be the goal of all
effects of a disaster by recovery action to
attempting to limit its impact produce resilient and
on human health, community sustainable communities
function, and economic o Evaluation - After a
infrastructure. disaster, it is essential that
evaluations be
conducted to determine
what worked, what did • Historical data and data from

not work, and what other sources are collected to
specific problems, issues, identify previous and potential
and challenges were hazards. Data are then
identified. (empirical mapped using aerial
evidence must be used photography, satellite imagery,
based on previous remote sensing, and
disasters) geographic information
systems
Hazard Identification, Vulnerability

Disaster stages – the time frame for a
Analysis, and Risk Assessment
disaster is a principal factor in
innovating methods for the Vulnerability Analysis
management of the disaster.
• is used to determine who is
most likely to be affected, the
property most likely to be
damaged or destroyed, and
the capacity of the community
to deal with the effects of the
Pre – impact phase – there is enough disaster.
for investigating choices, inventing • Data is collected regarding the
ways to prevent or mitigate disasters, susceptibility of individuals,
and training communities on the property, and the environment
methods. Strategic planners and to potential hazards in order to
leaders are involved in this phase. develop prevention strategies.
They will make the needed large – A separate vulnerability
scale decisions and policy shifts analysis should be conducted
intended to change people’s for each identified hazard
perceptions of risk.
Hazard Identification, Vulnerability
Hazard identification, Vulnerability Analysis, and Risk Assessment
analysis, and Risk Assessment
Risk Assessment
• Are three cornerstone methods
• uses the results of the hazard
of data collection for disaster
identification and vulnerability
planning
analysis to determine the
Hazard identification and mapping probability of a specified
outcome from a given hazard
• is used to determine which
that affects a community with
events are most likely to affect
known vulnerabilities and
a community and to make
coping mechanisms
decisions about whom or what
to protect as the basis of risk equals hazard times vulnerability
establishing measures for
prevention, mitigation, and
response.
Hazard Identification, Vulnerability prevent or mitigate future

Analysis, and Assessment Risk disasters.
Risk Assessment Includes: Post-impact Phase
• Determining a community's risk • includes two subphases, the

of adverse health effects due early and late phases.
to a specified disaster (i.e., o In the early phase, there
traumatic deaths and injuries is a need to restore pre
following an earthquake) impact norm.
• Identifying the major hazards o In the late phase, there is
facing the community and a need to set new norms
their sources (i.e., earthquakes, to prevent or mitigate
floods, industrial accidents) future disasters.
• Identifying those sections of the
Disasters within Hospitals and
community most likely to be
Healthcare Settings
affected by a particular
hazard (i.e., individuals living in • "Internal" disasters refer to
or near floodplains) incidents that disrupt the
everyday, routine services of a
Assessment Includes:
medical facility and may or
• Determining existing measures may not occur simultaneously
and resources that reduce the with an external event.
impact of a given hazard (i.e., • In general, an internal event
building codes and regulations can be defined as any event
for earthquake mitigation) that threatens the smooth
• Determining areas that require functioning of the hospital,
strengthening to prevent or medical center, or healthcare
mitigate the effects of the facility, or that presents a
hazard potential danger to patients or
hospital personnel.
Impact Phase
Name some internal hospital events
• includes the period that is
that you can think of that might
immediately before, during,
cause a disaster
and after the event.
• Policymakers and operation Critical functions during hospital
leaders are involved and are disasters include:
under strong time pressure to
• Communicating during
deal with the effects of
emergency conditions
disasters.
• Managing resources and
Post-impact Phase assets during emergency
conditions
• includes two subphases, the
• Managing safety and security
early and late phases.
during emergency conditions
• In the early phase, there is a
• Defining and managing staff
need to restore pre impact
roles and responsibilities during
norm. In the late phase, there is
emergency conditions
a need to set new norms to
• Managing utilities during Involves 3 phases - alert, response,

emergency situations and expanded response phase
• Managing clinical activities
• Alert phase, during which staff
during emergency conditions
remain at their regular
• Hospitals are dependent upon
positions, service provision is
the infrastructure of the
uninterrupted, and faculty and
community where they are
staff await further instructions
located and must be able to
from their supervisors.
survive and sustain operations
• Response phase, during which
in the event of a loss of this
designated staff report to
essential infrastructure.
supervisors or the command
• Unplanned and planned
post for instructions, the
disruptions to infrastructure can
response plan is activated, and
disrupt the ability of the hospital
nonessential services are
to remain functional and
suspended.
create a dangerous
• Expanded response phase,
environment for patients and
when additional personnel are
staff.
required, off-duty staff are
• Any event that may result in the
called in, and existing staff may
disruption of electrical power,
be reassigned based on
water, steam, cooling, sewer,
patient needs.
oxygen, and suction systems
must be accounted for in the Pandemics
hospital's internal disaster plan.
• The need for widespread
• Internal disasters or system
quarantine for the purposes of
support failures can result in a
disease control (e.g., measles
myriad of responses, such as
epidemic) would rapidly
evacuation of patients and
overwhelm the existing
staff; decreased levels of
healthcare system and create
service provision; diversion of
significant staffing issues.
ambulances, helicopter
• Staff may refuse to come to
transport, and other patients;
work fearing exposure of
and relocation of patient care
themselves and their families to
areas.
the disease.
• Internal disaster plans are
based on a "Hospital Incident
Management System" and
address the institution's
response to any potential
incident that would disrupt
hospital functioning.
BASIC LIFE SUPPORT

Protecting yourself. Your personal
safety is the highest priority!
DISASTER Age groups
• Infant: <1 yr. old

Sudden Cardiac Arrest • Child: 1 yr. old until onset of
• Sudden cardiac arrest (SCA) puberty
can happen with little or no • Adult: Onset of puberty and
warning above
• Ventricular fibrillation occurs BLS Assessment
• Blood flow with oxygen it
1st STEP
carries stops
• Brain cell death starts Assess Scene
Cardiopulmonary Resuscitation • Pause and assess scene for
(CPR) safety
• If unsafe, or if it becomes
• CPR is the immediate
unsafe at any time, GET OUT!
treatment for a suspected
cardiac arrest 2nd STEP
• 2 Main Tasks:
• Check for response
o Chest compressions
• Tap or squeeze shoulder and
o Rescue breaths
ask loudly, "Are you all, right?"
CPR alone is NOT enough • For an infant, tap the foot
• If alone, shout for help!
Chain of Survival (Out – of – hospital
cardiac arrest) 3rd STEP
• Check Breathing and Pulse

• Look at face/chest for normal
breathing. If unsure, assume
not normal
• Weak, irregular gasping,
snorting, or gurgling is NOT
Chain of Survival (In – hospital normal
cardiac arrest) • Take at least 5 and no longer
than 10 seconds to check
breathing/pulse
4th STEP
Provide Indicated Care.
• If not already done, activate

emergency response protocol
Chain of Survival
and get AED
• Survival is higher when the
1. No response, with normal
LINKS ARE STRONG
breathing and pulse? Place in the
recovery position
2. No response with breathing Cycles of CPR: (x5 cycles approx. 2

absent and pulse present? Begin minutes)
rescue breathing
Counting chest compressions: 1 to 20
3. No response with no breathing then 1 to 9 then (the cycle) (give 5
and pulse absent? Begin CPR cycles approx. 2 minutes)
REPEAT 😊 Switching of roles: every 2 minutes
1. No response Normal breathing Chest compression to ventilation ratio

With pulse for single rescuers = 30:2
2. No response No normal
For child 2 or more rescuers = 15:2
breathing With pulse
3. No response no breathing no For infant 2 or more rescuers = 15:2
pulse and using encircling thumb
technique
High – Quality CPR skills? Narrow the
gap between perfect skills and what Knowledge check
you can perform What are the rate and depth for
1. Begin CPR compressions within chest compressions on an adult?
10 seconds of determining a) A rate of 60-80 compressions per
cardiac arrest minute and a depth of about 1
2. Compress hard, at least 2 inch
inches for adult, and at least b) A rate of 80-100 compressions per
1/3 depth of chest for minute and a depth of about 1
children/infants inch.
3. Compress fast, at a rate of 100 c) C. A rate of 120-140 compressions
to 120 times per minute per minute and a depth of about
4. Minimize interruptions to 2 inches.
compressions d) A rate of 100-120 compressions per
5. Allow for complete chests minute and a depth of at least 2-
recoil - allowing the chest to 2.4 inches.
return to normal position after
chest compressions Rescue Breaths
6. Avoid excessive air on rescue • Inhaled air - 21 %
breaths • Exhaled air - 16% to 17% and
7. Give effective rescue breaths can support someone's
with visible chest rise. breathing
Chest compressions • When giving breaths, avoid
blowing too hard or too long.
• Infant: about 1 ½ inches, 2
finger technique, encircling
thumb technique
• Child: about 2 inches, 1 or 2
hand technique
• Adult: at least 2-2.4 inches
Maneuvers in opening airway Automated External Defibrillator

(AED) – a small, portable,
• Head tilt chin lift
computerized device that is simple to
• Jaw thrust
operate.
Caring for Respiratory Arrest – a
• Push power button
person in respiratory arrest has
• AED provides voice instructions
stopped breathing but still has a
to guide attachment and use
beating heart.
automatically
• Without immediate o Analyzes heart rhythm
intervention, can quickly o Determines if shock is
progress to cardiac arrest needed
• Reassess pulse every 2 minutes, o Operator pushes button
taking no longer than 10 to deliver shock when
seconds prompted by AED
• If pulse is absent and tissue
Early Defibrillation
signs indicate poor perfusion,
or you are unsure, perform CPR The most effective way to end
• If opioid overdose is suspected, fibrillation is defibrillation
consider the use of naloxone.
• Each minute in cardiac arrest,
Caring for Respiratory Arrest chance of survival declines by
10%
For adult
• After as few as 10 minutes,
• Provide 1 high – quality survival is unlikely
rescue breath
Children and Infants
• Every 5-6 seconds or 10-12
breaths per minute (total of Steps for using an AED on a child or
20 – 24 breaths for 2 minutes infant are similar to an adult
of care)
• For smaller children and infants:
For child and infants o Place one pad on the
center of the chest just
• Provide 1 high – quality rescue
below the collarbones
breath
o Attach second pad on
• Every 2 – 3 seconds or 20 – 30
center of the back
breaths per minute (total of 40
between the shoulder
– 60 breaths for 2 minutes of
blades
care)
• If AED specifically equipped for
Performs CPR if pulse rate is ≤ 60 beats use on a child or infant not
per minute and with these signs: available, an AED configured
for an adult can be used
• Signs of poor blood perfusion
include the following: pale,
mottled, or bluish skin, weak
pulse, cool extremity
temperature.
Adult Child Infant

Location Center of the Lower half of Tips of two fingers
chest breastbone, just on the
above point breastbone just
where ribs meet. below the nipple
line where ribs
meet.
Depth At least 2-2.4 At least 1/3 the At least 1/3 the
inches depth of the depth of the
chest, or about 2 chest, or about 1
inches. ½ inches.
Rate At least 100 – 120 At least 100 – 120 At least 100 – 120
compressions per compressions per compressions per
minute minute minute
Ratio 30:2 1 rescuer – 30:2 1 rescuer – 30:2
2 rescuer – 15:2 2 rescuer – 15:2
(encircling thumb
technique)
Work as a team – an effective team Choking - Mild versus severe

approach can significantly improve obstruction
care provided.
• Clearly defined roles especially

during calamities and disasters
• Clear and effective
communication
• Multiple treatment actions
occur at the same time
• High-quality CPR by allowing
team members to switch when
tired
• Minimizes overall interruption
times
Advanced Airways - An advanced

airway device may be inserted into
throat during a resuscitation to
protect and maintain an open airway
Once in place, not necessary to

pause compressions for breaths
• Provide continuous
compressions at a rate of 100 to
120 per minute
• Regardless of age, provide
single breath every 6 seconds,
or 10 times per minute
DISASTER TRIAGE
• Incident triage - occurs when
the ED is stressed by a large
number of patients due to an
"Triage is a process which places the
acute incident or an ongoing
right patient in the right place at the
medical crisis such as
right time to receive the right level of
pandemic influenza but is still
care"
able to provide care to all
Accurate triage provides responders patients utilizing existing
with the opportunity to do the agency resources. Same
greatest good for the greatest tagging as the daily triage
number of casualties (with the least
amount of harm), and is the • Disaster triage is a general term
cornerstone of good disaster medical employed when local EMS and
resource management hospital emergency services
are overwhelmed to the point
• used to decide who will get the
that immediate care cannot
resources that are available
be provided to everyone who
and who will not.
needs it because sufficient
• may have a significant impact
resources are not immediately
not only on the individual
available.
victims but also on the health
• Resource management
outcomes of the entire affected
becomes the driving force for
population
the provision of care.
• Its overall success may be
highly dependent on the Categories:
competence, experience, and
Minimal or minor, Green -
composure of the nurse,
physiologically well compensated
working in close concert with
and likely to remain so for an
the rest of the emergency care
extended period of time. AKA
team
Walking wounded
Subtle Differences:
• (e.g. minor lacerations, burns,
• Daily triage is performed by or other soft tissue or
nurses on a routine basis in the orthopedic injuries without
ED, often utilizing a significant bleeding or
standardized approach, neurovascular compromise
augmented by clinical and pts with mild to moderate
judgment. The highest intensity psychological stress reactions.)
of care is provided to the most
Delayed, yellow - compensated
seriously ill or injured patients,
physiology but a significant potential
even if those patients have a
for deterioration or morbidity if there
low probability of survival.
are long delays before definitive care
can be provided.
• (e.g. physiologically stable

patients with possible spine or
head injuries without acute
neurological deficits, Having an objective triage tool that

significant bleeding controlled dictates that patients meeting
with pressure dressings or certain criteria be tagged as
tourniquets, and orthopedic Deceased or Expectant may help
injuries with signs of protect triage officers from some of
neurovascular compromise the emotional trauma
that improve after basic
Special conditions during triage:
splinting.)
• Triage during special
Immediate, Red life-threatening
conditions does not change
but probably amenable to rapid
the sorting process so much as
interventions that do not require
the circumstances in which it
consumption of an inordinate
must be performed.
amount of resources.
• Protecting responders can
• may die or sustain significant cause delays and these delays
morbidity unless they receive may result in the deterioration
rapid care in both the field and of patients who might have
the hospital. been less seriously affected if
• (e.g. poorly controlled external more rapid care had been
bleeding, moderate burns, or possible.
penetrating trauma without
A 45-year-old woman with vital signs
other critical injuries, altered
PR 132, RR 28, BP 90/60, sats of 92%.
mental status, early shock, and
She has a massively bleeding
respiratory distress (but not
laceration at the right arm and has a
failure).
tracheal deviation as per x-ray
Deceased, Black –
Ans. RED
• (e.g. no detectable vital signs,
considered dead without the
attempt of resuscitation, not
breathing even after
performing simple airway-
opening maneuvers.)
Expectant, Gray - who is still alive but

due to their injuries and/or medical
condition is unlikely to survive given
the available resources.
• (e.g. agonal respirations,

massive head injuries,
dismemberment, extensive
burns, crush injuries, critical
penetrating trauma, or multiple
life-threatening injuries.)
PHASES OF DISASTER
that can be temporarily but
effectively treated on-scene
and identify those whose
TRIAGE: immediate needs can be met
only in a hospital setting
From the Field to the Hospital • effective use of ground and air
• Prehospital care providers are transport resources often
trained and well-practiced in requires that several patients
triaging individual injured or ill be placed in each transport
patients to appropriate unit. (different triage category
hospitals based on their needs in one plane to be sent for the
for specialized care. same facility)
• Field disaster triage protocols, Tertiary triage
aimed at maximizing the
outcome for the greatest • hospital personnel determine if
possible number of victims are the facility can provide
usually utilized only for the initial appropriate care or if the
gross sorting of patients in the patient will require stabilization
field. - "primary triage" and transfer to a facility
• The goal of primary triage is sort capable of a higher level of
patients into five triage care.
categories: Immediate, Functional role in
Staff
Delayed, Minimal, Expectant, Triage
and Dead. Emergency Triage officer
physician
Primary Triage Evaluates patient
• Physiology is the focus rather and reports findings
Emergency
to offer, supervises
than the identification of nurse (1)
clerk, nursing aid,
specific injuries. and transporters
• Each time a provider assesses a Emergency Records all
patient is an opportunity to nurse (2) assessments
reevaluate their triage Applies
Nurse’s
prioritization. prenumbered
aide/clerk
identification band
Secondary Triage Moves patient from
triage area to
• may be performed on-scene if Transporter
assigned area in the
the transport is delayed for any ED
reason or at the hospital itself.
• additional information about
Staff Complement of a Typical
each patient is obtained
Disaster Triage Team
through a more thorough
physical assessment and • In some facilities, a senior level
history (obvious injuries are ED registered nurse may be
identified.) designated as the triage officer
• one of the goals is to determine • No "first come, first serve basis",
which patients have conditions especially for minor patients
SALT Triage (sort, assess, life-saving likely to survive given the available
interventions, treatment and/or resources.
transport triage)
Expectant: those with difficulty
• Formulated by a CDC- breathing, uncontrolled hemorrhage,
sponsored expert panel absence of peripheral pulses, and/or
• It uses an all-hazards approach inability to follow commands; who are
that is intended to be used for unlikely to survive given the available
any age patient in any type of resources.
event
Delayed: those who are alert and
Steps follow commands, have palpable
peripheral pulses, no signs of
1. Global sorting 2 voice
respiratory distress, and all bleeding is
commands (walk and wave)
controlled, with injuries or an illness
2. Individual Assessment
that in the opinion of the rescuer is
3. Treatment or Transport
more than minor.
Dead: those who are not breathing
Minimal: those who are alert and
even after lifesaving interventions
follow commands, have palpable
have been attempted.
peripheral pulses, no signs of
Immediate: those with difficulty respiratory distress, and all bleeding is
breathing, uncontrolled hemorrhage, controlled, with injuries/conditions
absence of peripheral pulses, and/or that in the opinion of the rescuer are
inability to follow commands; who are minor
Salt Triage (sort, assess, life – saving interventions, treatment and/or transport
triage)
Step 1 – sort (Global sorting)
• Walk assess third (3)

• Waves/purposeful movement assess second (2)
• Still/obvious life threat assess first (1)
Step 2 – assess (individual assessment)
LSI • Obeys
commands
• Control major or makes
hemorrhage purposeful
• Open airway movement?
(if child, • Has
consider 2 peripheral M
rescue → Breathing pulse? All
Minor I
breaths) ↓ Yes • Not in injuries →
N
→ → Yes
• Chest No respiratory Yes only? I
↓
decompression DEAD distress? M
• Auto injector • Major ↓ no A
antidotes hemorrhage L
Delayed
is
controlled?
↓ Any no
Likely to survive
given current Yes Immediate
resources →
↓ No
Expectant
Simple Triage and Rapid Treatment • are assessed in a sequential

(START) fashion for each patient
• terminated immediately upon
• commonly used adult MCI
the identification of a critical
primary triage tool developed
threshold criterion
by the Newport Beach Fire and
Marine Department and Hoag Simple Triage and Rapid Treatment
Hospital in California (first (START)
published in 1983 and revised in
• 1’st action upon entering the
1994)
scene - is to make an
• It was devised for use only for
announcement stating:"
adults, with an arbitrary lower
Anyone who can hear my
application limit of a patient
voice should get up and walk
weight of 100 pounds.
to a designated point, where
Simple Triage and Rapid Treatment they will be met by a rescuer at
(START) the first possible opportunity."
• All victims able to walk alone or
• The 5 basic parameters
with minimal assistance are
assessed with START are (a) the
designated as Minor. - all vital
ability to walk, (b) the presence
physiological functions
or absence of spontaneous
adequate
respirations, (c) the respiratory
• very important that a clinician
rate, (d) an assessment of
assess all Minor patients as
perfusion, and (e) the ability to
soon as possible in secondary
obey commands.
triage or as part of any
• These parameters are often
reassessment of primary triage.
referred to as respirations,
• Responders work on victim per
perfusion, and mental status
victim on a grid pattern rather
(RPM).
than trying to go to the
obviously sickest patients first.
primary triage of children in the

multicasualty/disaster setting.
• Dr. Romig recognized that there
were several decision thresholds
for START that were not
appropriate for pediatric
physiology.
• JumpSTART addresses the unique
physiology of children while
paralleling the structure and
procedures of START
JumpSTART differs in several key ways

from START:
1. JumpSTART- used for "all victims

who appear to be children".
Simple Triage and Rapid Treatment START - used for "all victims who
(START) appear to be young adults or
older."
Emergent
R P M REMEMBER: (a victim is
(respirations) (Pulse) (Mobility) considered to be child if there
> 30 >2 “Can do” is absence of secondary sex
(-)
characteristics)
Urgent
R P M 2. All children who probably are
(respirations) (Pulse) (Mobility) not able to walk unassisted
<30 <2 “Can do”
under normal circumstances
(+)
should be assessed using
JumpSTART.
3. Any child who is carried to the
designated location when the
walk command is given should
be individually assessed first
when sufficient personnel
become available to attend to
the patients in that area
4. In adults, apnea more often
follows cardiac arrest, while in
children cardiac arrest more
often follows hypoxia/apnea.
Because children primarily
sustain respiratory failure/ arrest
JumpSTART before their hearts stop, there
may be a short time period
• JumpSTART Pediatric MCI Triage
where a child may be apneic
Tool was the first objective tool
but still have detectable
developed specifically for the
circulation
• It is theoretically possible not developmentally or

that an apneic child who behaviorally capable or are
still has a perfusing rhythm just scared. Therefore, the AVPU
may be salvageable if (alert, voice, pain,
spontaneous ventilation unresponsive) scale is used as
can be reestablished (i.e., an indicator of mental status
"window of salvageability"). rather than simply the ability to
Therefore, five rescue obey commands
breaths should be provided • Care should be taken not to
to apneic children who spend more than 15 to 20
have a detectable pulse. seconds trying to feel a
5. Because a slow respiratory rate pulse.
has more dire implications than • The final assessment is that
tachypnea in a child, of mental status, Because
JumpSTART adds a low obeying commands is
respiratory rate as a critical dependent on both
threshold cognition and behavior, it is
6. Young children may be unable not a universally
or unwilling to obey simple appropriate gauge of
commands because they are pediatric mental status.
Emotional phases of Disasters and governmental agencies

towards rebuilding their lives:
Phase 1, Pre-Disaster
partly because many promises
• characterized by fear and are made to them at this stage.
uncertainty. • often easier to recruit
• may be as short as hours, or volunteers as many people
even minutes, such as during a look for ways to help
terrorist attack, or it may be as physically, and not just donate
long as several months, such as material goods or money.
during a hurricane season or a
Phase 5, Disillusionment
pandemic.
• reality sets in
Phase 2, Impact
• Governments put
• Characterized by a range of conditions on the assistance
intense emotional reactions. they will give, insurance
• Degree of destruction is companies find reasons not
directly proportional to the to pay out, media and
psycho-social effects organizations begin to go
home, and more.
Phase 3, Heroic
• This phase can last from
• characterized by a shell- several months to up to a
shocked community with couple of years.
emergency needs for food, • survivors begin to
water, and shelter. experience a strong sense
• Grief and loss are strong at this of anger, resentment,
stage, but so too are emotions bitterness, and deep
of altruism. disappointment if they now
• E.g. when first-responders, such begin to experience delays,
as Search and Rescue teams, failures, and/or unfulfilled
toiled long hours to rescue and hopes or promises of aid.
assist survivors even though
Phase 6, Reconstruction
their own homes had been
demolished in the disasters. • Lasting for several years
following the disaster, this is the
Phase 4, Honeymoon
long-term phase of disaster
• a few days after the disaster to recovery
about three to six months • not supremely interesting to the
onward media (unless anniversary of
• Survivors - and their loved ones- the event)
feel relief at survival, and often
there is still an emotional "high"
of "I survived. That is what
matters. The rest we can deal
with."
• Survivors experience high
expectations about the help
that they will get from official
GENERAL
10. Make sure your home heating
sources are clean and in
working order. Never pour
PREPAREDNESS IN water on grease fires.
DISASTERS Earthquake Preparedness
1. Prepare your home

Fire Preparedness 2. Identify safe places in each
room of the house
Fires require three key elements: a
3. Locate safe places outdoors
heat source, fuel, and oxygen.
4. If inside, drop, cover, and hold
1. Install the right number of 5. If outdoors, Move into the
smoke alarms (if feasible). Test open, away from buildings,
them once a month and street lights, poles, and utility
replace the batteries at least wires.
once a year. 6. If in a moving vehicle, Stop
2. Teach children what smoke quickly and stay in the vehicle.
alarms sound like and what to 7. After an earthquake, be
do when they hear one. prepared for aftershocks.
3. Ensure that all household
members know two ways to
escape from Every room of
your home and know the
family meeting spot outside of
your home.
4. Establish a family emergency
communications plan and
ensure that all household
members know who to contact
if they cannot find one another
5. Practice escaping from your Volcanic Eruption Preparedness
home at least twice a year
1. Use an N-95 disposable
6. Teach household members to
respirator masks
STOP, DROP and ROLL if their
2. If you are told to evacuate,
clothes catch on fire.
then prepare to leave the
7. DO keep items that can catch
area,
on fire at least three feet away
3. Listen for disaster sirens and
from anything that gets hot
warning signals.
8. DON'T ever smoke in bed,
4. Review your emergency plan
when drowsy or medicated, or
and gather your emergency
if anyone in the home is using
supplies: Be sure to pack at
oxygen.
least a 1-week supply of
9. DO use flashlights when the
prescription medications.
power is out, not candles.
5. Fill your vehicle's gas tank.
DON'T leave a burning candle
6. Put livestock in an enclosed
unattended, even for a minute.
area. Plan ahead to take pets
with you, but be aware that • A flood warning means

many emergency shelters flooding is already
cannot accept animals occurring or will occur
7. Fill your clean water containers. soon - and you should be
8. Fill sinks and bathtubs with prepared to evacuate
water as an extra supply for at a moment's notice
washing.
9. Disconnect appliances to
Creating a Personal Disaster Plan
reduce the likelihood of
electrical shock when power is 1. Learn about the natural
restored. disasters that could occur in
your community
2. Talk with each member of
Flood Preparedness
your household about
1. Prepare your family well in potential emergencies and
advance of severe weather. how to respond to each.
2. Bring in outdoor furniture and 3. Identify two meeting places:
move important indoor items one near home and one
to the highest possible floor. away from the neighborhood.
This will help protect them 4. Pick a friend or relative who
from flood damage. lives out of the area for
3. Disconnect electrical household members to call to
appliances say they are okay
4. If instructed, turn off your gas 5. Draw a floor plan of your
and electricity at the main home. Mark two escape
switch or valve. routes from each room.
5. Move immediately to higher 6. Post emergency telephone
ground or stay on high ground numbers by telephones.
6. Turn Around, Don't Drown! Just 7. Insurance policies
6 inches of moving water can 8. CASH IS KINGI
knock you down and 1 foot of 9. Have a personal
water can sweep your vehicle communications backup
away. plan.
7. Make a flood emergency 10. People with special needs:
plan and an emergency those who don't have
preparedness kit. vehicles, hearing impaired,
8. If floodwaters rise around your mobility impaired, special
car but the water is not dietary needs, and those who
moving, you should abandon live in an apartment building
the car and move to higher
ground. Do not leave the car
and enter moving water.
9. Know the difference:
• A flood watch means a
flood is possible in your
area.
Disaster Supply Kits 11. Wrench or pliers (to turn off

utilities)
• You and your family may need
12. Manual can opener (for food)
to survive on your own for 3
13. Local maps
days or more.
14. Cell phone with chargers and a
• Emergency kit should be kept
backup battery
in a designated place and be
ready to "grab and go". All Patterns of Survival
family members should know
1. Look for other survivors
where it Is kept
2. Scavenge anything you can-
• Additional supplies for up to 2
cloth, fabric, sheets of plastic
weeks should be prepared
3. Delegate survival tasks
• Change the stored water and
4. Find drinkable water (streams
food supplies every 6 months,
or rivers, coconut)
so be sure to write the date
5. Create a shelter
when you store it on all
6. Build a fire
containers. Assess kit every
7. Create a rescue signal,
year for any changes.
8. First aid
• Because you will also need
9. Think of defense.
water for sanitary purposes
10. Wait for help.
and, possibly, for cooking, you
should store at least 1 gallon of
water per person per day
• Containers for water should be
rinsed with a diluted bleach
solution (1 part bleach to 10
parts water) before use.
Disaster Supply Kits (list)
1. Water (one gallon per person

per day for several days, for
drinking and sanitation)
2. Food (at least a several-day
supply of non-perishable food)
3. Battery-powered
4. Flashlight
5. First aid kit
6. Extra batteries
7. Whistle (to signal for help)
8. Dust mask (to help filter PACE planning
contaminated air)
• stands for Primary, Alternate,
9. Plastic sheeting and duct tape
Contingency, and Emergency
(to shelter in place)
• layers of redundancy to ensure
10. Moist towelettes, garbage
essential capabilities are
bags and plastic ties (for
available at all times under any
personal sanitation)
circumstances,
• You first have to assess

experience and knowledge,
critical capabilities, local
terrain and wealthier, and
emergency assistance
availability
EMERGENCY MEDICAL
for, respond to, and recover
from the effect of all hazards.
• A mass casualty incident will
CONSEQUENCE, usually be declared by the first
arriving unit at the scene of the
PLANNING AND MASS incident
CASUALTY INCIDENT
Scene Assessment (METHANE
method)
Mass Gatherings and Special Events • M -Mass incident declared

• E – Exact location
• Nurses and other healthcare
• T – Type of incident
professionals worldwide are
• H – Hazard present
frequently called on to provide
• A – Access and egress
healthcare for large groups of
• N – Number of casualties and
people attending major public
severity
events.
• E – Emergency services
• According to the WHO, an MG
required
is an event “attended by a
sufficient number of people to
strain the planning and Forward planning for a major event
response resources of the host involving potentially large number of
community, state/provinces, people
nation, or region where it is
being held”. Who are the critical collaborators in a
• Emergency medical mass gathering?
consequence planning and The intent is to provide a timely
management involves response throughout the venue,
establishing in advance a maintaining the “chain of survival”
“normal” expected and a
planned rapid expansion in
case MCI occurs
• In the event MCI occurs,
responders must be able to
secure the safety of the scene,
control crowds, delineate Goal of Emergency Care at Mass
access and evacuation routes, Gatherings and Special Events
coordinate, collaborate, and • Evaluate and stabilize injury
communicate across services, and illness in participants,
and rapidly identify the support staff, and spectators
potential for the secondary involved in the event,
event consistent with the standard of
• Emergency management – the medical care in the
organized analysis, planning, surrounding local community
decision making, and • Preserve the capacity of the
assignment of available local public health and acute
resources to mitigate, prepare
Nursing Care of Clients with Life Threatening Conditions/Acutely Ill/Multi-Organ
Problems/High Acuity and Emergency Situation, Acute and Chronic - Lec
medical care systems to serve • Blast injuries / dealing with

their local constituents tissue loss
• Eye lavage techniques
Examination of health care usage
• Decontamination of chemical
data from previous events provides
and radiation exposure
valuable information in preplanning
• Fractures / immobilization of
services for future events and for
fractures
predicting PPRs
• Management of hemorrhage
• Stabilization of crush injuries
• Movement of patients with
Domains for Mass Gathering
spinal cord injury
Police officers will secure and control

access to the scene, to ensure safety
and smooth operations
• Psychosocial (individual Community Emergency Response

behaviors, collective social Teams, or CERT, are civilians trained in
dynamic and culture) basic emergency response and used
• Biomedical (aggregate, to assist in disasters
spectator age, pre-event
health status of attendees, Hazmat teams are responsible for
physical activity levels of cleaning up and neutralizing any
participants and spectators, hazardous materials at the scene.
physiology of response to
Sometimes these will be specialized
extremes of heat or cold, and
extent of substance use in the CBRNE (chemical, biological,
attendees), and; radiological, nuclear and high-yield
• Environmental (bounded vs. explosive teams)
unbounded venue; time-
focused vs. extended; seated Ideally, once an MCI has been
vs. mobile; local weather, declared, a well-coordinated flow of
crowd density; type of event; events will occur, using three
outdoor weather exposure vs. separate phases: triage, treatment,
indoor controlled climate) and transportation
Nursing Therapeutics and Core The first-arriving crew will conduct

Competencies triage: red, yellow, green, black
• Concepts of basic first aid and When responding to a chemical,

hemodynamic stabilization biological or radiological incident,
• Disaster triage and transport the first-arriving crew must establish
• Pain management safety zones prior to entering the
• Management of hypovolemia scene
and fluid replacement
• Suturing (if appropriate based
on practice parameter) and
initial wound care
Nursing Care of Clients with Life Threatening Conditions/Acutely Ill/Multi-Organ
Problems/High Acuity and Emergency Situation, Acute and Chronic - Lec
Safety zones:
• The hot zone: the

contaminated area
• The warm zone: the area where
HazMat specialists will
decontaminate patients and
fellow responders
• The cold case: the safe zone,
where any personnel who are
not specially trained in HazMat
and do not have chemical or
biological protection gear
must remain at all times.
Depending on the
contaminant, the cold zone
should be roughly 200-300
yards from the incident, uphill
and upwind. It should also be at
least 50 years uphill and
upwind from the warm zones.
LEGAL AND ETHICAL

• Resource allocation
A dilemma is a circumstance in which
ISSUES IN DISASTERS a person finds himself or herself

choosing between two or more
Equality means each individual or group actions he or she is morally required
of people is given the same resources or to perform, but the actions are
opportunities. Equity recognizes that actually incompatible with one
each person has different circumstances another
and allocates the exact resources and
Case example: An outbreak of an
opportunities needed to reach an equal
infectious disease leads public health
outcome.
officials to believe that a bioterrorist
• LGU may also exercise public attack has occurred. To avoid panic
health regulatory powers, but of the public, however, the officials
because local governments have made no public
are considered "creations of announcement of their suspicions.
the state," their powers are, in They have requested, however, that
most states, limited to those nurses be on the alert for new cases
powers specifically granted by of the infectious disease and to report
the national government. them immediately, along with certain
• the division of responsibility information about the patient. A
would be based on what nurse asks her supervisor if she can
makes the most sense in terms legally make such reports.
of the optimum functioning of
• Do nurses have an obligation
the public health system.
to care for patients with highly
• Nursing professionals must work
communicable diseases when
with the legal professionals on
that care will put nurses at risk
the hospital's staff when
for contracting the disease? No
questions arise concerning the
• How much risk a professional is
proper course of conduct in a
obligated to assume?
particular circumstance.
Case Example: Because public
Can the legal obligations be less
health officials suspect a "stealth
stringent than what is required
bioterror attack, they request that
ethically of the nurse? Yes
hospitals secretly test all of their new
These are some legal and ethical patients for the suspected
issues faced by nurses during contagious disease. The patient is to
disasters: be notified only if he or she tests
• Privacy issues of reporting positively for the disease, and he or
diseases of epidemic or she will be offered standard medical
pandemic proportions treatment. Reports are to go directly
• Maintaining confidentiality to public health officials. Can a nurse
• Issues surrounding a potential legally or ethically participate in such
quarantine a program? No
• Mandatory vaccination
• Treatment refusal
Resource Allocation and recovering from the

impact of disasters;
• Distributive justice-involves
such issues as the fair and Section 5. National Disaster Risk
equitable allocation of scarce Reduction and Management
resources Council. - The present National
• Utilitarian theory, "that we ought Disaster Coordinating Council or
always produce the maximal NDCC shall henceforth be known
balance of positive value over as the National Disaster Risk
disvalue Reduction and Management
• is it ethically justifiable to treat a Council, hereinafter referred to as
nurse with minor injuries is it the NDRRMC or the National
ethically justifiable to treat a Council.
nurse with minor injuries in
The National Council shall be headed
disasters???
by the Secretary of the Department
Philippine Disaster Risk Reduction and of National Defense (DND) as
Management Act of 2010 (RA 10121) Chairperson with the
• An Act Strengthening the • Sec of DILG - Vice Chairperson

Philippine Disaster Risk for Disaster Preparedness
Reduction and Management • Sec of the DSWD - Vice
System, Providing for The Chairperson for Disaster
National Disaster Risk Response
Reduction and Management • Sec of the DOST - Vice
Framework and Chairperson for Disaster
Institutionalizing the National Prevention and Mitigation
Disaster Risk Reduction and • Director-General of National
Management Plan, Economic and Development
Appropriating Funds Therefor Authority (NEDA)- Vice
and For Other Purposes. Chairperson for Disaster
Rehabilitation and Recovery.
It shall be the policy of the State to:
Section 7. Authority of the NDRRMC
1. Adopt a disaster risk reduction
Chairperson. - The Chairperson of the
and management approach
NDRRMC may call upon other
that is holistic, comprehensive,
instrumentalities or entities of the
integrated, and proactive in
government and nongovernment
lessening the socioeconomic
and civic organizations for assistance
and environmental impacts of
in terms of the use of their facilities
disasters
and resources for the protection and
2. Implement a comprehensive
preservation of life and properties in
National Disaster Risk
the whole range of disaster risk
Reduction and Management
reduction and management. This
Plan
authority includes the power to call
3. Recognize and strengthen the
on the reserve force as defined in
capacities of LGUs and
Republic Act No. 7077 to assist in relief
communities in mitigating and
and rescue during disasters or
preparing for, responding to,
calamities.
Section 12. Local Disaster Risk b) The city/municipal DRRMCs, If

Reduction and Management Office two (2) or more barangays are
(LDRRMO). - (a) There shall be affected;
established an LDRRMO in every c) The provincial DRRMC, if two (2)
province, city, and municipality, and or more cities/municipalities
a Barangay Disaster Risk Reduction are affected;
and Management Committee d) The regional DRRMC, if two (2)
(BDRRMC) in every barangay which or more provinces are
shall be responsible for setting the affected; and
direction, development, e) The NDRRMC, if two (2) or more
implementation, and coordination of regions are affected.
disaster risk management programs
Section 16. Declaration of State of
within their territorial jurisdiction.
Calamity. - The National Council shall
Section 14. Integration of Disaster Risk recommend to the President of the
Reduction Education into the School Philippines the declaration of a
Curricula and Sangguniang cluster of barangays, municipalities,
Kabataan (SK) Program and cities, provinces, and regions under a
Mandatory Training for the Public state of calamity, and the lifting
Sector Employees. - The DepED, the thereof, based on the criteria set by
CHED, the Technical Education and the National Council. The President's
Skills Development Authority (TESDA), declaration may warrant
in coordination with the OCD, the international humanitarian assistance
National Youth Commission (NYC), as deemed necessary. The
the DOST, the DENR, the DILG-BFP, the declaration and lifting of the state of
DOH, the DSWD and other relevant calamity may also be issued by the
agencies, shall integrate disaster risk local sanggunian, upon the
reduction and management recommendation of the LDRRMC,
education in the school curricula of based on the results of the damage
secondary and tertiary level of assessment and needs analysis
education, including the National
Section 17. Remedial Measures. - The
Service Training Program (NSTP),
declaration of a state of calamity
whether private or public, including
shall make mandatory the Immediate
formal and nonformal, technical-
undertaking of the following remedial
vocational, indigenous learning, and
measures by the member-agencies
out-of-school youth courses and
concerned as defined in this Act:
programs.
(a) Imposition of price ceiling on
Section 15. Coordination During
basic necessities and prime
Emergencies. - The LDRRMCS shall
commodities by the President
take the lead in preparing for,
upon the recommendation of
responding to, and recovering from
the implementing agency as
the effects of any disaster based on
provided for under Republic
the following criteria:
Act No. 7581, otherwise
a) The BDC, if a barangay is known as the "Price Act", or
affected; the National Price
Coordinating Council;
(b) Monitoring, prevention and other aid commodities

control by the Local Price received by them;
Coordination Council of (e) Selling of relief goods,
overpricing/profiteering and equipment or other aid
hoarding of prime commodities which are
commodities, medicines and intended for distribution to
petroleum products, disaster victims;
(c) Programming/reprogrammin (f) Diverting or misdelivery of
g of funds for the repair and relief goods, equipment or
safety upgrading of public other aid commodities to
infrastructures and facilities; persons other than the rightful
and recipient or consignee;
(d) Granting of no-interest loans (g) Accepting, possessing, using
by government financing or or disposing relief goods,
lending institutions to the most equipment or other aid
affected section of the commodities not intended for
population through their nor consigned to him/her;
cooperatives or people's (h) Misrepresenting the source of
organizations. relief goods, equipment or
other aid commodities
Section 19. Prohibited Acts.
(i) Substituting or replacing relief
(a) Dereliction (abandonment) goods, equipment or other
of duties which leads to aid commodities with the
destruction, loss of lives, same items or
critical damage of facilities inferior/cheaper quality;
and misuse of funds; (j) Illegal solicitations by persons
(b) Preventing the entry and or organizations representing
distribution of relief goods in others as defined in the
disaster-stricken areas, standards and guidelines set
including appropriate by the NDRRMC;
technology, tools, (k) Deliberate use of false at
equipment, accessories, inflated data in support of the
disaster teams/experts; request for funding, relief
(c) Buying, for consumption or goods, equipment or other
resale, from disaster relief aid commodities for
agencies any relief goods, emergency assistance or
equipment or other and livelihood projects; and
commodities which are (l) Tampering with or stealing
intended for distribution to hazard monitoring and
disaster affected disaster preparedness
communities; equipment and
(d) Buying, for consumption or paraphernalia.
resale, from the recipient
Section 20. Penal Clause. - Any
disaster affected persons any
individual, corporation, partnership,
relief goods, equipment or
association, or other juridical entity
that commits any of the prohibited
acts provided for in Section 19 of this

Act shall be prosecuted and upon
conviction shall suffer a fine of not less
than Fifty thousand pesos
(Php50,000.00) or any amount not to
exceed Five hundred thousand pesos
(php500,000.00) or imprisonment of
not less than six (6) years and one (1)
day or more than twelve (12) years, or
both, at the discretion of the court,
including perpetual disqualification
from public office if the offender is a
public officer, and confiscation or
forfeiture in favor of the government
of the objects and the
instrumentalities used in committing
any of herein prohibited acts.
LEGAL AND ETHICAL

Section 4. Prohibited Acts.
The government risk reduction and
ISSUES IN DISASTERS preparedness equipment,

accessories and other vital facility
Risk Reduction and Preparedness items, or parts thereof shall, at all
Equipment Protection Act (RA 10344) times, be protected and it shall be
unlawful for any person to commit
AN ACT PENALIZING THE any of the following acts:
UNAUTHORIZED TAKING, STEALING,
KEEPING OR TAMPERING OF (a) Steal, or take, or possess any of
GOVERNMENT RISK REDUCTION AND the equipment, or any part thereof;
PREPAREDNESS EQUIPMENT, (b) Sell or buy stolen equipment or
ACCESSORIES AND SIMILAR FACILITIES any part thereof;
Section 2. Declaration of Policy. (c) Tamper, dismantle, or disassemble
all government agencies are equipment or any part thereof;
mandated to institute measures to (d) Attempt to commit any of the
ensure the safety of its citizens and abovementioned prohibited acts;
their properties through the and
installation of data and information
(e) Benefit from the proceeds or fruits
gathering devices and the network of
of any of the abovementioned
national and local authorities to
prohibited acts knowing that the
disseminate risk reduction warning
proceeds or fruits are derived from
and advice.
the commission of said prohibited
Section 3. List of Government Risk acts.
Reduction and Preparedness
Section 6. Penalties.
Equipment and Other Vital Facility
Items. The following penalties are hereby
imposed:
The (DOST) shall, in coordination with
the (PAGASA), (PHIVOLCS), and • penalty of imprisonment of not
(NDRRMC), provide a list of all less than twelve (12) years but
government risk reduction and not more than fifteen (15) years
preparedness equipment, or;
accessories, and other vital facility • a fine of not less than one
items such as but not limited to, million pesos (P1,000,000.00)
radars, weather forecasting but not more than Three million
equipment, flood monitoring pesos (P3,000,000.00),
instruments, seismographs, tsunami • or both imprisonment and fine
warning systems, and automated at the discretion of the court
weather systems. shall be imposed upon any
person found guilty of stealing
Improvement of equipment of
or unauthorized taking or
PAGASA: Pres. Gloria Macapagal
possession without authority or
Arroyo
selling or buying with intent to
gain of any stolen government
risk reduction and Protection of Children Against Abuse,

preparedness equipment, Exploitation and Discrimination Act;
accessories and other vital
(i) Orphans or Orphaned Children -
facility items, or parts thereof;
refer to children who do not have a
Section 7. Penalty for Government family and relatives who can assume
Officers or Employees. responsibility for their care;
Any government officer or employee (k) Separated Children - refer to

who shall assist in the commission of children separated from both
any of the prohibited acts parents, or from their previous legal or
enumerated in Section 4 of this Act usual primary caregiver, but not
shall suffer the same penalty imposed necessarily from other relatives. As a
upon the person who committed the result, this may include children
prohibited act. In addition, after due accompanied by other family
notice and hearing, they shall be members;
administratively dismissed from the
(n) Unaccompanied Children - refer
service and all their benefits from the
to children who have been
government, shall be forfeited. They
separated from both parents and
shall likewise be perpetually
other relatives, and who are not being
disqualified from holding any public
cared for by an adult who, by law or
office.
custom, is responsible for doing so.
SEC. 4. Comprehensive Emergency

"Children's Emergency Relief and Program for Children. - (DSWD) shall
Protection Act" [REPUBLIC ACT NO. formulate a Comprehensive
10821] Emergency Program for Children
• AN ACT MANDATING THE • The Program shall be used as

PROVISION OF EMERGENCY the basis for handling disasters
RELIEF AND PROTECTION FOR and other emergency
• CHILDREN BEFORE, DURING, situations to protect children,
AND AFTER DISASTERS AND pregnant and lactating
OTHER EMERGENCY SITUATIONS mothers, and support their
immediate recovery.
SEC. 3. Definition of Terms. - For the
purposes of this Act, the following The Program shall be gender-sensitive
shall refer to: and have the following components:
(a) Child - refers to a person below (b) Establishment of Transitional

eighteen (18) years of age or those Shelters for Orphaned, Separated,
over but are unable to fully take care and Unaccompanied Children. - The
of themselves or protect themselves NHA shall, in coordination with the
from abuse, neglect, cruelty, DSWD, the (DENR), (DPWH), (DILG),
exploitation or discrimination and LGUS of the areas declared
because of a physical or mental under a state of calamity,
disability or condition as defined in immediately establish an option for
Republic Act No. 7610 or the Special transitional shelters, prioritizing
vulnerable and marginalized groups
including orphaned, separated, and SEC. 8. Training of Emergency

unaccompanied children, and Responders on Child Protection. - The
pregnant and lactating mothers. NDRRMC shall promote and conduct
a child-responsive training program
(c) Assurance for Immediate Delivery
for all responders in the calamity area
of Basic Necessities and Services. -
such as community and barangay
shall give priority to the specific
leaders, community members, school
health and nutrition needs of
personnel and other rescuers.
pregnant women, lactating mothers,
newborn babies, children under five SEC. 9. Data Gathering, Monitoring,
(5) years old and children with and Reporting The report shall include
special needs. a specific section on pregnant
women and children under five (5)
(d) Upon the declaration of a
years of age as a strategy to address
national and local state of calamity,
the post-disaster nutrition needs of
the PNP and the DSWD, with the
children under age five (5) and
assistance of the AFP operating units
pregnant women.
in the area and local councils against
trafficking and violence against Philippine Clean Air Act (RA 8749)
women and their children.
AN ACT PROVIDING FOR A
Children shall be given priority during COMPREHENSIVE AIR POLLUTION
evacuation as a result of a disaster or CONTROL POLICY AND FOR OTHER
other emergency situation. PURPOSES
SEC. 5. Evacuation Centers. recognizes the principle that

"polluters must pay".
When a school or child development
center is used as an evacuation Section 7. Integrated Air Quality
center, gymnasiums, learning and Improvement Framework.
activity centers, auditoriums and
within six (6) months after the
other open spaces shall be utilized
effectivity of this Act, establish, with
first. Classrooms shall only be used as
the participation of LGUs, NGOs, POs,
a last resort.
the academe and other concerned
SEC. 6. Orphaned, Unaccompanied, entities from the private sector,
or Separated Children. formulate and implement the
Integrated Air Quality Improvement
Those whose families or relatives
Framework for a comprehensive air
cannot be found or assessed to be
pollution management and control
incapable of providing proper care
program.
and protection shall be placed in a
licensed or accredited residential Section 9. Airsheds
care facility or with a foster family in
To effectively carry out the
accordance with Article 140 of the
formulated action plans, a Governing
Child and Youth Welfare Code, or a
Board is hereby created, hereinafter
community-based center. A
referred to as the Board.
registered social worker shall provide
the needed case management and
intervention.
DENR Secretary-Chairman Section 21. Pollution from Motor

Vehicles
The members shall be as follows:
b) The Department, in collaboration
a) Provincial Governors from
with the DOTC, DTI and LGUs, shall
areas belonging to the airshed;
develop an action plan for the
b) City/Municipal Mayors from
control and management of air
areas belonging to the airshed;
pollution from motor vehicles
c) A representative from each
consistent with the Integrated Air
concerned government
Quality Framework. The DOTC shall
agency;
enforce compliance with the
d) Representatives from people's
emission standards for motor vehicles
organizations;
set by the Department. The DOTC
e) Representatives from non-
may deputize other law enforcement
government organizations, and
agencies and LGUs for this purpose.
f) Representatives from the
private sector. Section 33. Radioactive Emissions.
Section 20. Ban on Incineration. All projects which will involve the use
of atomic and/or nuclear energy,
- Incineration, hereby defined as the
and will entail release and emission of
burning of municipal, biomedical
radioactive substances into the
and hazardous waste, which process
environment, incident to the
emits poisonous and toxic fumes is
establishment or possession of
hereby prohibited;
nuclear energy facilities and
• Provided, however, that the radioactive materials, handling,
prohibition shall not apply to transport, production, storage, and
traditional small-scale method use of radioactive materials, shall be
of community/neighborhood regulated in the interest of public
sanitation "siga", traditional, health and welfare by the Philippine
agricultural, cultural, health, Nuclear Research Institute (PNRI), in
and food preparation and coordination with Department and
crematoria; other appropriate government
• Provided, Further, that existing agencies.
incinerators dealing with a
Tobacco Regulation Act of 2003.
biomedical waste shall be out
Republic Act No. 9211
within three (3) years after the
effectivity of this Act; Provided, AN ACT REGULATING THE
Finally, that in the interim, such PACKAGING, USE, SALE, DISTRIBUTION
units shall be limited to the AND ADVERTISEMENTS OF TOBACCO
burning of pathological and PRODUCTS AND FOR OTHER
infectious wastes, and subject PURPOSES
to close monitoring by the
Department. (DENR)
SECTION 3. Purpose. It is the main within the same room that has been
thrust of this Act to: designated as a nonsmoking area.
• Inform the public of the health SECTION 9. Minimum Age Sales. -

risks associated with cigarette Under this Act, it shall be unlawful:
smoking and tobacco use;
a. For any retailer of tobacco
• Regulate and subsequently
products to sell or distribute tobacco
ban all tobacco
products to any minor; b. For any
advertisements and
person to purchase cigarettes or
sponsorships;
tobacco products from a minor; c.
• Protect the youth from being
For a minor to sell or buy cigarettes or
initiated to cigarette smoking
any tobacco product; and d. For a
and tobacco use by
minor to smoke cigarettes or any
prohibiting the sale of tobacco
other tobacco products.
products to minors;
• Regulate the labeling of SECTION 10. Sale of Tobacco Products
tobacco products; Within School Perimeters. The sale or
distribution of tobacco products is
SECTION 5. Smoking Ban in Public
prohibited within one hundred (100)
Places.
meters from any point of the
Smoking shall be absolutely perimeter of a school, public
prohibited in the following public playground or other facility
places: frequented particularly by minors.
a. Centers of youth activity

b. Elevators and stairwells;
"Toxic Substances and Hazardous
c. Locations in which fire hazards
and Nuclear Wastes Control Act of
are present
1990."- RA 6969
d. Within the buildings and
premises of public and private AN ACT TO CONTROL TOXIC
hospitals SUBSTANCES AND HAZARDOUS AND
e. Public conveyances and NUCLEAR WASTES, PROVIDING
public facilities including PENALTIES FOR VIOLATIONS THEREOF,
airport and ship terminals and AND FOR OTHER PURPOSES
train and bus stations,
SECTION 4. Objectives. — The
restaurants and conference
objectives of this Act are:
halls, except for separate
smoking areas; and To monitor and regulate the
f. Food preparation areas. importation, manufacture,
processing, handling, storage,
SECTION 6. Designated Smoking and
transportation, sale, distribution, use
Nonsmoking Areas.
and disposal of chemical substances
Such areas may include a and mixtures that present
designated smoking area within the unreasonable risk or injury to health or
building, which may be in an open to the environment in accordance
space or separate area with proper with national policies and
ventilation, but shall not be located international commitments;
SECTION 5. Definition. imported, manufactured,

processed or distributed in
h) Hazardous wastes are hereby
violation of this Act or
defined as substances that are
implementing rules and
without any safe commercial,
regulations or orders;
industrial, agricultural or economic
b) Failure or refusal to submit
usage and are shipped, transported
reports, notices or other
or brought from the country of origin
information, access to records
for dumping or disposal into or in
as required by this Act, or
transit through any part of the territory
permit inspection of
of the Philippines.
establishment where
i) Nuclear wastes are hazardous chemicals are manufactured,
wastes made radioactive by processed, stored or otherwise
exposure to the radiation incidental held;
to the production or utilization of c) Failure or refusal to comply with
nuclear fuels but does not include the premanufacture and pre-
nuclear fuel, or radioisotopes which importation requirements; and
have reached the final stage of d) Cause, aid or facilitate, directly
fabrication so as to be usable for any or indirectly, in the storage,
scientific, medical, agricultural, importation, or bringing into
commercial, or industrial purpose. Philippine territory, including its
maritime economic zones,
SECTION 6. Functions, Powers and
even in transit, either by means
Responsibilities of the DENR
of land, air or sea
• To keep an updated inventory transportation or otherwise
of chemicals that are presently keeping in storage any amount
being manufactured or used of hazardous and nuclear
• To require chemical wastes in any part of the
substances and mixtures that Philippines.
present unreasonable risk or
"Ecological Solid Waste Management
injury to health or to the
Act of 2000." RA 9003
environment to be tested
before they are manufactured AN ACT PROVIDING FOR AN
or imported for the first time; ECOLOGICAL SOLID WASTE
• To confiscate or impound MANAGEMENT PROGRAM, CREATING
chemicals found not falling THE NECESSARY INSTITUTIONAL
within the standard set by the MECHANISMS AND INCENTIVES,
rules and regulations and the DECLARING CERTAIN ACTS
said acts cannot be enjoined PROHIBITED AND PROVIDING
except after the chemicals PENALTIES, APPROPRIATING FUNDS
have been impounded; THEREFOR, AND FOR OTHER
SECTION 13. Prohibited Acts. The • One of the salient features or

following acts and omissions shall be provisions of the law is the
considered unlawful: recycling program.
• DTI - Coding system for
a) Knowingly use a chemical
packaging materials as well as
substance or mixture which is
products-waste recycling and o Causing or permitting the

reuse; is mandated to have this collection of nonsegregated or
coding system for packaging unsorted waste???
materials and products. o The manufacturing,
Specifically, this includes distribution, or use of non-
waste, recycling, and reuse. environmentally acceptable
• Notice on the packaging of materials.
grocery items? It will always
have a recycle symbol .
• Prohibition of non- "Wildlife Resources Conservation and
environmentally acceptable Protection Act.” Republic Act No.
products and their use; 9147"
o RA 9003 also prohibits AN ACT PROVIDING FOR THE
non environmentally CONSERVATION AND PROTECTION
acceptable products OF WILDLIFE RESOURCES AND THEIR
and even their use. HABITATS, APPROPRIATING FUNDS
• Recycling markets THEREFORE AND FOR OTHER
development; and Moreover, PURPOSES
there should be a market that
would encourage recycling. SECTION 4. Jurisdiction of the
• Lastly, establishment of MRF in Department of Environment and
every Barangay/Cluster. Natural Resources and the
o Also the establishment of Department of Agriculture.
Materials Recovery DENR shall have jurisdiction over all
Facility (MRF) in every terrestrial plant and animal species
barangay cluster.
Department of Agriculture (DA) shall
Waste Management Facilities have jurisdiction over all declared
o Prohibition against the use of aquatic critical habitats, and all
open dumps for solid waste aquatic resources
o Environmental compliance SECTION 5. Definition of Terms
certificate requirement in case
of operation of a new solid (f) “Critically endangered species”
waste facility; refers to a species or subspecies that
o Establishment of criteria for is facing extremely high risk of
siting, establishing and extinction in the wild in the immediate
operating a sanitary landfill; future;
and (h) "Endangered species” refers to
Prohibited Acts species or subspecies that is not
critically endangered but whose
o Littering of waste in public survival in the wild is unlikely if the
places; causal factors continue operating;
o Also open burning of solid
waste (s) “Threatened species” a general
term to denote species or subspecies
considered as critically endangered,
endangered, vulnerable or other
accepted categories of wildlife indigenous cultural

whose population is at risk of communities;
extinction; (ii) when the wildlife is afflicted
with an incurable
(w) "Vulnerable species” refers to
communicable disease;
species or subspecies that is not
(iii) when it is deemed
critically endangered nor
necessary to put an end to
endangered but is under threat from
the misery suffered by the
adverse factors throughout their
wildlife;
range and is likely to move to the
(iv) when it is done to prevent
endangered category in the near
imminent danger to the life
future;
or limb of a human being;
SECTION 24. Conservation Breeding and
or Propagation of Threatened (v) when the wildlife is killed or
Species. - destroyed after it has been
used in authorized research
Conservation breeding or
or experiments.
propagation of threatened species
shall be encouraged in order to SECTION 24. Conservation Breeding
enhance its population in its natural or Propagation of Threatened
habitat. It shall be done Species. -
simultaneously with the rehabilitation
Conservation breeding or
and/or protection of the habitat
propagation of threatened species
where the captive-bred or
shall be encouraged in order to
propagated species shall be
enhance its population in its natural
released, reintroduced or restocked.
habitat. It shall be done
Commercial breeding or simultaneously with the rehabilitation
propagation of threatened species and/or protection of the habitat
may be allowed provided that the where the captive-bred or
following minimum requirements are propagated species shall be
met by the applicant, to wit: released, reintroduced or restocked.
(a) Proven effective breeding and Commercial breeding or

captive management techniques of propagation of threatened species
the species; and may be allowed provided that the
following minimum requirements are
(b) Commitment to undertake
met by the applicant, to wit:
commercial breeding, simultaneous
with conservation breeding. (a) Proven effective breeding and
captive management techniques of
SECTION 27. Illegal Acts.
the species, and
(a) killing and destroying wildlife
(b) Commitment to undertake
species, except in the
commercial breeding, simultaneous
following instances; with conservation breeding.
(i) when it is done as part of the
religious rituals of
established tribal groups or
SECTION 27. Illegal Acts. SECTION 2. Declaration of Policy -
(b) inflicting injury which cripples there is hereby established a National

and/or impairs the reproductive Integrated Protected Areas System
system of wildlife species; (NIPAS), which shall encompass
outstandingly remarkable areas and
(c) effecting any of the following acts
biologically important public lands
in critical habitat(s):
that are habitats of rare and
i. dumping of waste products endangered species of plants and
detrimental to wildlife; animals, biogeographic zones and
ii. squatting or otherwise related ecosystems, whether
occupying any portion of terrestrial, wetland or marine, all of
the critical habitat; which shall be designated as
iii. mineral exploration and/or "protected areas”.
extraction;
SECTION 4. Definition of Terms
iv. burning;
v. (vi)logging; and 1. "National Integrated Protected
vi. (vii) quarrying Areas System (NIPAS)" is the
classification and administration of all
(d) introduction, reintroduction or
designated protected areas to
restocking of wildlife resources;
maintain essential ecological
(e) trading of wildlife; processes and life-support systems, to
preserve genetic diversity, to ensure
(f) collecting, hunting or possessing
sustainable use of resources found
wildlife, their byproducts and
therein, and to maintain their natural
derivatives;
conditions to the greatest extent
(g) gathering or destroying of active possible;
nests, nest trees, host plants and the
2. "Protected Area" refers to identified
like;
portions of land and water set aside
(h) maltreating and/or inflicting other by reason of their unique physical
injuries and biological significance,
managed to enhance biological
(i) transporting of wildlife.
diversity and protected against
destructive human exploitation;
"National Integrated Protected Areas
System Act of 1992". REPUBLIC ACT
NO. 7586
AN ACT PROVIDING FOR THE

ESTABLISHMENT AND MANAGEMENT
OF NATIONAL INTEGRATED
PROTECTED AREAS SYSTEM, DEFINING
ITS SCOPE AND COVERAGE, AND FOR
OTHER PURPOSES
GUIDELINES IN
The orange rainfall advisory is raised
in areas where rainfall is between
15 mm and 30 mm within one hour.
DISASTER AND Flooding is a definite threat in
communities under the orange alert.
EMERGENCY A red rainfall advisory is issued when
SITUATIONS
downpours constitute an
emergency. This is raised when
observed rainfall is more than 30 mm
PAGASA Rainfall Warning System
within one hour or if rainfall has
stands for Philippine Atmospheric, continued for the past three hours
Geophysical and Astronomical and is more than 65 mm.
Services Administration
When PAGASA raises a Red warning,
• national institution dedicated communities should be prepared to
to providing flood and typhoon respond. It means serious flooding is
warnings, public weather seen and that residents should be
forecasts and advisories, ready to evacuate to safety
meteorological, astronomical,
climatological, and other
specialized information and Tropical Cyclone warning icons
services primarily for the Wind signal: 1
protection of life and property
and in support of economic, Wind threat:
productivity, and sustainable • Strong winds
development. • Beaufort 6-7
• created on December 8, 1972, • 39-61 km/h
by virtue of Presidential Decree (22-33 kt. 10.8-17.1 m/s)
No. 78 reorganizing the
Philippine Weather Bureau into Warning Lead Time (hours before
PAGASA. onset of wind threat): 36 hours
The flood alerts Potential impacts
Under the heavy rainfall warning • Houses of poor construction

system, a yellow rainfall advisory is (e.g., wood frame, bamboo,
raised when the expected rainfall makeshift, old dilapidates
amount is between 7.5 mm and structures, and other structures
15 mm within one hour and likely to made of light materials will
continue. suffer minimal to minor
damage.
• Communities given this • Some banana and similar
advisory are advised to be plants are tilted, while twigs of
aware of the weather small trees and shrubs may be
condition and warned that damaged. Larger trees may
flooding may be possible in sway with the wind, rice crops,
low-lying areas. especially those in flowering
and ripening stages, may suffer blow over, with twigs and
some damage. branches of frail trees broken.
• Minimal disruption to public Considerable damage is likely
transportation to rice and other similar crops.
especially those in flowering
and ripening stages
The Beaufort scale is a method of
Wind signal: 3
estimating wind speed based on the
general condition of the surface of a Wind threat:
large body of water with respect to
• storm – force winds
wind waves and swell. This scale
• Beaufort 10 -11
allows sailors to estimate the wind
• 89 – 117 km/h
speed just by observing the state of
(48-63 kt. 24.5-32.6 m/s)
the sea surface.
Warning Lead Time (hours before
Wind signal: 2
onset of wind threat): 18 hours
Wind threat:
Potential impacts
• Gale – force winds
• Makeshift or old, dilapidated
• Beaufort 8-9
structures, and other structures
• 52-88 km/h
made of light materials may
• (34-47 kt. 17.2 – 24.4 m/s)
suffer substantial damage.
Warning Lead Time (hours before Houses of poor or average
onset of wind threat): 24 hours construction will have
considerable roof damage,
Potential impacts
some blown. out windows,
• Minor to moderate damage and/or partial wall damage.
may occur to makeshift or old Well-constructed houses les.
dilapidated structures, and reinforced CHB/pre-cast
other structures made of light concrete, reinforced concrete
materials. Houses of poor and moment frame) may suffer
average construction (e.g. minimal to minor roof damage.
unreinforced CHB/masonry, • Warehouses and other building
moved timber-CHB) may in industrial parks may suffer
receive minor roof damage minor to moderate damage.
• Unsecured, exposed • Unsecured, exposed outdoor
lightweight items may become items of light to moderate
projectiles which may cause weight may become
additional damage. projectiles, causing additional
• Some electrical wires may be damage or injuries
blown down, resulting in local • Many areas may suffer power
power outages. outages with numerous
• Minor to moderate disruption downed power lines and posts.
to public transportation. Minimal to minor disruption in
• Most banana and similar plants telecommunications and
are titled, with some stooped or potable water supply
downed. Some small trees
• Moderate to significant proportion of blown-out

disruption to public windows due to swaying.
transportation, • Considerable airborne debris
• Some small trees, most banana will be generated and may
and similar plants, and a few cause damage injury, and
large trees are downed or possible fatalities
broken. Rice and other similar • Near total loss of power supply
crops, especially those in and telecommunications due
flowering and ripening stages to numerous downed power
may suffer heavy damage. lines. poles, and cellular towers.
Diminished availability of
Wind signal: 4
potable water supply is also
Wind threat: likely.
• Significant to severe disruption
• Typhoon – force winds
to public transportation.
• Beaufort 12
• Significant damage to banana
• 118 – 184 km/h
and similar plants. Most small
(64-99 kt. 32.7-51.2 m/s)
trees and some large trees will
Warning Lead Time (hours before be broken defoliated, or
onset of wind threat): 12 hours uprooted. Almost total
damage to rice and other
Potential impacts
crops.
• Severe damage will occur to
Wind signal: 5
makeshift or old, dilapidated
structures, and other structures Wind threat:
made of light materials. Houses
• Typhoon-force winds
of poor or average
• Beaufort 12
construction may receive
• 185 km/h or higher (100 kt or
major damage, including
higher, 51.3 m/s or higher)
complete roof failure and
possible wall collapse: a few Warning Lead Time (hours before
may suffer severe damage. onset of wind threat): 12 hours
Most well-constructed houses
Potential impacts
may suffer minor to moderate
roof damage with some houses • Severe to catastrophic
experiencing major roof failure: damage is expected to houses
blown out windows are also of poor or average
likely construction, makeshift or old,
• Failure of aluminum and steel dilapidated structures, and
roofs and coverings may occur other structures made of light
in buildings at industrial parks. materials. Well constructed
• Some glass in most high-rise houses may suffer substantial
office buildings may be blown roof and wall failure or
out: a few of these buildings damage.
may have minor to moderate • Many industrial buildings will be
damage and higher destroyed, with only few
receiving partial roof and wall Flood Bulletin

damage.
Flood forecast issued by the
• Most windows will be blown out
respective river basin centers like
in high-rise office buildings:
Pampanga, Agno, Bicol Cagayan
Moderate structural damage is
and Cagayan De Oro, prepared
possible due to swaying
twice daily during flood watch Water
Extensive damage will be
level is monitored based on the
caused by airborne debris.
assessment levels (Alert. Alarm and
People, pets, and livestock
Critical) which means 40% 60% and
exposed to the wind are at
100% of the river is full respectively.
great risk of injury or death
• Electricity potable water Flood Warning Level
supply, and
telecommunications will be
unavailable for prolonged
periods due to significant
General classification of structures
disruption in infrastructure
(From United Nations Disaster Relief
• Prolonged significant to severe
Organization UNDRO)
disruption to public
transportation, High – risk structures
• Vast majority of the trees will be
Consist of old and densely built – up
broken, defoliated, or
residential areas having light material
uprooted. Banana and similar
structures and organic roof materials,
plants will be extensively
squatter/slum areas, zone of mixed
damaged. Few trees, plants,
development, poor quality housing,
and crops will survive.
warehouses, old, dilapidated
Flood advisory structures, etc.
Non-Telemetered River Basin Medium – risk structures
A General Flood Advisory is simplified consist of older parts of city/town
flood bulletin issued for non- centers, timber structures/G.I. roofs
telemetered river basins whenever and generally belong to the middle-
there is a significant amount of rainfall income group
recorded based on past current
Low risk structures
observation and the forecast rainfall
from the numerical weather consist of concrete/framed
prediction models, satellite-based structures, low-density
information and estimates from population/housing and usually the
radar. It is issued to the public on a modern part of the city/town
regional basis through NDRRMC at
Earthquake and Volcanic eruption
7:00am and 7:00pm
Warning System
Telemetered River Basin
• The Philippine Institute of
River Basins with fully automatic data Volcanology and Seismology
transmission equipped with a (PHIVOLCS) is a service institute
telecommunication system. of the Department of Science
and Technology (DOST) that is • Description: Felt by many

principally mandated to people indoors especially in
mitigate disasters that may upper floors of buildings.
arise from volcanic eruptions, Vibration is felt like one passing
earthquakes, tsunamis and of a light truck. Dizziness and
other related geotectonic nausea are experienced by
phenomena. some people. Hanging objects
• At present, PHIVOLCS operates swing moderately. Still water in
108 (as of December 2020) containers oscillates
seismic monitoring stations all moderately.
over the Philippines. These
Intensity scale: 4
stations are equipped with
seismometers that detect and • Shaking: Moderately Strong
record earthquakes. Data is • Description: Felt generally by
sent to the PHIVOLCS Data people indoors and by some
Receiving Center (DRC) to people outdoors. Light sleepers
determine earthquake are awakened. Vibration is felt
parameters such as like a passing of heavy truck.
magnitude, depth of focus, Hanging objects swing
and epicenter. Together with considerably. Dinner, plates,
reported felt intensities in the glasses, windows and doors
area (if any), earthquake rattle. Floors and walls of wood
information is released once framed buildings creak.
these data are determined. Standing motor cars may rock
slightly. Liquids in containers are
PHILVOCS Earthquake Intensity Scale
slightly disturbed. Water in
(PEIS)
containers oscillate strongly.
Intensity scale: 1 Rumbling sound may
sometimes be heard.
• Shaking: Scarcely perceptible
• Description: Perceptible to Intensity scale: 5
people under favorable
• Shaking: Strong
circumstances. Delicately
• Description: Generally felt by
balanced objects are
most people indoors and
disturbed slightly. Still Water in
outdoors. Many sleeping
containers oscillates slowly.
people are awakened. Some
Intensity scale: 2 are frightened, some run
outdoors. Strong shaking and
• Shaking: Slightly felt
rocking felt throughout
• Description: Felt by few
building. Hanging objects
individuals at rest indoors.
swing violently. Dining utensils
Hanging objects swing slightly.
clatter and clink; some are
Still Water in containers
broken. Small, light and
oscillates noticeably.
unstable objects may fall or
Intensity scale: 3 overturn. Liquids spill from filled
open containers. Standing
• Shaking: Weak
vehicles rock noticeably.
Shaking of leaves and twigs of Intensity scale: 8

trees are noticeable.
• Shaking: Very Destructive
Intensity scale: 6 • Description: People are
panicky. People find it difficult
• Shaking: Very Strong
to stand even outdoors. Many
• Description: Many people are
well-built buildings are
frightened; many runs
considerably damaged.
outdoors. Some people lose
Concrete dikes and
their balance. motorists feel like
foundation of bridges are
driving in flat tires. Heavy
destroyed by ground settling or
objects or furniture move or
toppling. Railway tracks are
may be shifted. Small church
bent or broken. Tombstones
bells may ring. Wall plaster may
may be displaced, twisted or
crack. Very old or poorly built
overturned. Utility posts, towers
houses and man-made
and monuments mat tilt or
structures are slightly damaged
topple. Water and sewer pipes
though well-built structures are
may be bent, twisted or
not affected. Limited rockfalls
broken. Liquefaction and
and rolling boulders occur in
lateral spreading cause man-
hilly to mountainous areas and
made structure to sink, tilt or
escarpments. Trees are
topple. Numerous landslides
noticeably shaken.
and rockfalls occur in
Intensity scale: 7 mountainous and hilly areas.
Boulders are thrown out from
• Shaking: Destructive
their positions particularly near
• Description: Most people are
the epicenter. Fissures and
frightened and run outdoors.
faults rapture may be
People find it difficult to stand in
observed. Trees are violently
upper floors. Heavy objects
shaken. Water splash or stop
and furniture overturn or
over dikes or banks of rivers.
topple. Big church bells may
ring. Old or poorly-built Intensity scale: 9
structures suffer considerable
• Shaking: Devastating
damage. Some well-built
• Description: People are forcibly
structures are slightly
thrown to ground. Many cry
damaged. Some cracks may
and shake with fear. Most
appear on dikes, fish ponds,
buildings are totally damaged.
road surface, or concrete
bridges and elevated
hollow block walls. Limited
concrete structures are
liquefaction, lateral spreading
toppled or destroyed.
and landslides are observed.
Numerous utility posts, towers
Trees are shaken strongly.
and monument are tilted,
(Liquefaction is a process by
toppled or broken. Water
which loose saturated sand
sewer pipes are bent, twisted
lose strength during an
or broken. Landslides and
earthquake and behave like
liquefaction with lateral
liquid).
spreading and sand boils are 1,000 tonnes/day, average

widespread. the ground is water temperature <35°C and
distorted into undulations. Trees acidity pH2.5, General
are shaken very violently with stationary or deflationary
some toppled or broken. trends in ground deformation
Boulders are commonly thrown • Interpretation: Quiescence; no
out. River water splashes major eruption in foreseeable
violently on slops over dikes future, but steam-driven and
and banks. gas eruptions can occur
without warning.
Intensity scale: 10
• Recommendation: Permanent
• Shaking: Completely habitation on Taal Volcano
Devastating Island (TV) must not be
• Description: Practically all allowed.
man-made structures are • Step down criteria: none
destroyed. Massive landslides
Alert level – step up: 1 (unrest)
and liquefaction, large scale
subsidence and uplifting of • Monitoring criteria: Abnormal
land forms and many ground parameters: Moderate level of
fissures are observed. Changes seismic activity with some felt
in river courses and destructive events; Main Crater Lake gas
seiches in large lakes occur. (diffuse CO2) emission >1,000
Many trees are toppled, tonnes/day, slight increases in
broken and uprooted. fumarole and/or Main Crater
Lake temperatures and acidity,
West valley fault
Slight and/or localized
The WVF is approximately 100-km and inflationary ground
transects portions of Quezon City, deformation changes in TVI.
Marikina City, Pasig City, Makati City, • Interpretation: Hydrothermal or
Taguig City, Muntinlupa City, and the tectonic activity beneath the
provinces of Bulacan, Rizal, Laguna, volcano may be occurring
and Cavite. This fault can generate steam-driven, gas or
an earthquake with a magnitude of hydrothermal explosions can
7.2 that may result to a very occur without warning.
destructive ground shaking, with • Recommendation: Entry into
intensity VIII on the PEIS, in Metro the TVI Main Crater, the Daang
Manila and nearby provinces. Kastila fissure area and the Mt.
Tabaro eruption site must not
Alert levels for taal volcano
be allowed.
(PHILVOCS)
• Step down criteria: Alert Level 1
Alert level: 0 (normal) monitoring criteria have been
in decline for at least one (1)
• Monitoring criteria:
month before lowering to Alert
Background parameters:
Level O. (step down: 1 low –
Volcanic earthquakes typically
level unrest)
<5/day, Main Crater Lake gas
(diffuse CO2) emission within
Alert level – step up: 2 (Increasing earthquakes, Occurrence of

Unrest) swarms of volcano tectonic
and/or hybrid earthquakes,
• Monitoring criteria: Increasing
Elevating SO2 flux: Significant
changes in parameters:
changes in Main Crater Lake
Elevated level of seismic
temperature and/or acidity
activity with some felt events in
Accelerating increase in
TVI and Taal Caldera (TC)
ground inflation, rapid increase
Occurrence of earthquake
in ground tilt in TVI: Precursory
swarms and low frequency
phreatic or weak
events Sustained increases in
phreatomagmatic eruptions
inflationary ground
commence.
deformation including ground
• Interpretation: Magmatic or
tilt in TVI; Slight positive
explosive phreatomagmatic
microgravity changes in TVI
eruption is imminent,
and TC Increasing fumarole
precursory eruptive activity
temperature and acidity and
may be taking place and
upwelling in the Main Crater
generating ashfall ballistics
Lake Significant increases in
and/or short lava flows.
CO2 emission, instrumental
• Recommendation: TVI Taal
detection of airborne SO2 >500
Lake and pre-defined
tonnes/day.
lakeshore communities of
• Interpretation: Shallow
Batangas facing the active
hydrothermal unrest and/or
vent must be evacuated.
deep-seated magmatic
intrusion may be occurring,
monitoring criteria have been
bringing higher chances of
in decline for at least two (2)
steam driven, gas or
weeks before lowering to Alert
hydrothermal explosions.
Level 2. (Step down: 3
• Recommendation: Entry into
Decreased tendency towards
TVI must not be allowed.
hazardous eruption)
Communities in pre-defined
areas of the highest hazard Alert level: 4 (Hazardous eruption
must ready for possible imminent)
evacuation,
• Monitoring criteria:
Accelerating changes or
monitoring criteria have been
abrupt decline in parameters:
in decline for one (1) month
Rapidly intensifying volcanic
before lowering to Alert Level 1
earthquakes, continuous
(step down: decreased unrest)
volcanic tremor, frequent felt
Alert level: 3 (Intensified unrest/ earthquakes, Profuse
magmatic unrest) degassing or ash explosions
along existing or new vents and
• Monitoring criteria: Intensifying
fissures Elevated and/or
changes in parameters
sudden drop in SO2 tunc
Sudden increase or decline in
Accelerating increase or
seismic activity, Perceptible
reversal of ground deformation impacting lakeside

patterns and ground fissuring communities and ashfall
Explosive eruption or lava impacting farther areas
effusion with or without • Interpretation: Plinian/
volcanic lightning commence Sublinian/ Violent eruption is
• Interpretation: Strong taking place Extreme life-
phreatomagmatic or threatening hazards of base
magmatic eruption is taking surges/PDCs volcanic Tsunami,
place, which may or may not thick tephra fall/ashfall,
lead to violently explosive fissuring lahars and landslides
eruption. Widespread ashfall could impact communities
and ballistics lava flows and around the lake and
minor pyroclastic density downwind of the eruption
currents (PDCs) on TVI may be plume.
generated • Recommendation: Additional
• Recommendation: areas for evacuation should be
Communities in predetermined considered based on
worst-case or scenario-based prevailing conditions
volcanic hazards zones must • Step down criteria: Alert Level 5
be evacuated conditions have ceased for at
• Step down criteria: Alert Level 4 least 24 hours before lowering
monitoring criteria have been to Alert Level 4
in decline for two (2) weeks
Bureau of Fire Protection (BFP)
before lowering 10 Alert Level 3
(step down: 4 – decreased • is responsible for ensuring
tendency towards highly public safety through the
hazardous eruption) prevention or suppression of all
destructive fires on buildings,
Alert level: 5 (Highly hazardous
houses, and other similar
eruption in progress)
structures, forests, and land
• Monitoring criteria: Violently transportation vehicles and
explosive magmatic eruption equipment, ships/vessels
ongoing: Continuous intense docked at piers, wharves, or
seismic activity, including anchored at major seaports,
explosion type volcanic petroleum industry installations.
earthquakes and strong felt • It is also responsible for the
events Sustained tolleruption enforcement of the Fire Code
column with expansive of the Philippines (PD 1185) and
umbrella cloud accompanied other related laws, conducting
by loud booming sounds and investigations involving fire
volcanic lightning: Generation incidents and causes thereof
of PDCs/base surges and including the filing of
volcanic tsunami that transport appropriate complaints/cases.
across Taal Lake and lakeshore
towns, Ground fissuring and
large particle tephra fall
Force Speed Description Specifications for use at sea
(mph) (knots) Specifications for use on land
0 0-1 0-1 Calm Sea like a mirror.
Calm; smoke rises vertically.
1 1-3 1-3 Light Air Ripples with the appearance of scales are formed, but without foam
crests.
Direction of wind shown by smoke drift, but not by wind vanes.
2 4-7 4-6 Light Breeze Small wavelets, still short, but more pronounced. Crests have a glassy
appearance and do not break.
Wind felt on face; leaves rustle; ordinary vanes moved by wind.
3 8-12 7-10 Gentle Large wavelets. Crests begin to break. Foam of glassy appearance.
Breeze Perhaps scattered white horses.
Leaves and small twigs in constant motion; wind extends light flag.
4 13-18 11-16 Moderate Small waves, becoming larger; fairly frequent white horses.
Breeze
Raises dust and loose paper; small branches are moved.
5 19-24 17-21 Fresh Moderate waves, taking a more pronounced long form; many white
Breeze horses are formed.
Small trees in leaf begin to sway; crested wavelets form on inland

waters.
6 25-31 22-27 Strong Large waves begin to form; the white foam crests are more extensive
Breeze everywhere.
Large branches in motion; whistling heard in telegraph wires; umbrellas

used with difficulty.
7 32-38 28-33 Near Gale Sea heaps up and white foam from breaking waves begins to be blown
in streaks along the direction of the wind.
Whole trees in motion; inconvenience felt when walking against the

wind.
8 39-46 34-40 Gale Moderately high waves of greater length; edges of crests begin to break
into spindrift. The foam is blown in well-marked streaks along the
direction of the wind.
Breaks twigs off trees; generally impedes progress.
9 47-54 41-47 Severe Gale High waves. Dense streaks of foam along the direction of the wind.
Crests of waves begin to topple, tumble and roll over. Spray may affect
visibility
Slight structural damage occurs (chimney-pots and slates removed)
10 55-63 48-55 Storm Very high waves with long overhanging crests. The resulting foam, in
great patches, is blown in dense white streaks along the direction of the
wind. On the whole the surface of the sea takes on a white appearance.
The tumbling of the sea becomes heavy and shock-like. Visibility
affected.
Seldom experienced inland; trees uprooted; considerable structural

damage occurs.
11 64-72 56-63 Violent Exceptionally high waves (small and medium-size ships might be for a
Storm time lost to view behind the waves). The sea is completely covered with
long white patches of foam lying along the direction of the wind.
Everywhere the edges of the wave crests are blown into froth. Visibility
affected.
Very rarely experienced; accompanied by wide-spread damage.
12 72-83 64-71 Hurricane The air is filled with foam and spray. Sea completely white with driving
spray; visibility very seriously affected.
see Saffir-Simpson Hurricane Scale

CARE OF PREGNANT
contractions and causes the
mucus plug to form
• Human choriogonadotropin
WOMAN AND (HCG) rises early in pregnancy.
Levels are measured to
NEWBORN IN A confirm pregnancy and
monitored after a pregnancy
DISASTER •
loss or hydatidiform mole
Circulatory changes occur
When disasters strike resource-poor because the expectant
nations, women are often the most mother's blood volume
affected. They represent the majority increases by 3.0 L with an
of the poor, the most malnourished, additional 3.5 L of water in the
and the least educated, and they amniotic fluid, the fetus, and
account for more than 75% of the placenta
displaced persons. • Women should eat a
balanced diet, avoiding
Nursing care includes a review of the
processed, high salt, and high
course of normal and complicated
sugar foods.
pregnancy, childbirth, and
• Use the opportunity to discuss
postpartum/newborn care and
myths as a teachable
implications for care management
moment. Weight gain will
during disaster.
change the woman's center
Pregnancy is a natural but complex of gravity. Advise the mother
state of health. During pregnancy, a to wear flat shoes and focus
woman's body experiences many on maintaining good posture
changes to support the growth and when standing
development of a baby. • Advise resting and sleeping in
a side-lying position when
• Hormone levels increase
reclining, as supine position will
significantly causing nausea
decrease circulation to the
and vomiting-eat small
mother because of the baby's
frequent meals, avoiding
weight.
odorous and spicy foods
• During a disaster, all the
• Estrogen is essential for
normal physical needs of
maturation of the fetus's lungs,
pregnant women are present
liver, and major organs.
but healthcare and birthing
Estrogen regulates
environments are altered,
progesterone production and
creating increased challenges
maintains pregnancy. Later in
for the delivery of safe,
pregnancy, it stimulates fetal
obstetrical healthcare.
cortisol. Without estrogen, a
• all communities should
pregnancy would miscarry
consider the special needs of
• Progesterone creates a
women giving birth. Nurses
nutrient-rich environment in
must be able to create a
the uterus, necessary for fetal
clean, safe environment for
development. It also prevents
the pregnant woman as well During the Second Trimester (from 13
as provide for a safe delivery. to 26 weeks)
• the first 8 weeks of pregnancy
• Prenatal visits every 4 weeks.
are critical so it is important for
• Assess blood pressure, fundal
women to have access to
height, weight gain, and
healthcare information
address concerns. Consider
• Pregnancy prevention
ultrasound, if available, for
requires access to
confirming due date.
contraception and this can be
Screening for diabetes with
a problem when access to
glucose challenge test (26-28
care has been interrupted.
weeks)
• Mass vaccination or
prophylaxis must consider the During the Third Trimester (from 24
special circumstance of weeks to term [greater than 37
pregnancy; live attenuated weeks])
vaccines such as varicella and
Prenatal visits every 2 weeks from 28
measles, mumps, and rubella
until 36 weeks. Assess blood pressure,
(MMR) are contraindicated in
fundal height, weight gain, and
pregnant women.
address concerns. Prenatal visits
• Influenza vaccine is
every week after 36 weeks.
recommended for all women
who are pregnant during the Seek emergency obstetric care for
influenza season. the following:
• Pregnant women should avoid
• Preterm (less than 37 weeks)
children with rashes and adults
contractions
with shingles in order to
• Contractions every 10 minutes
minimize the potential
or more (cramping)
exposure to varicella
• Pelvic pressure
• Consider giving a copy of
• Low, dull backache
prenatal records to patients if
• Abdominal cramps with or
care is likely to be episodic or
without diarrhea Regular
the woman is likely to be
painful uterine contractions at
transient.
term (increasing in frequency
and duration)
• Vaginal bleeding and/or
LABORATORY
severe abdominal pain
During the First Trimester (before 13 • Leakage of fluid (obvious or
weeks) suspected ruptured
membranes)
First trimester laboratory testing:
• Decreased fetal movement
blood type, Rh type, antibody screen,
Hct, Hgb, platelets, rubella, RPR, urine Complications of pregnancy
screen/culture, Hgb electrophoresis,
PIH: used to be called
PPD, chlamydia/GC, pap smear, and
"preeclampsia." PIH can lead to
HIV.
toxemia or seizures. If PIH does not
respond to treatment and the mother
is near term, consider delivering the • risk of adverse outcomes
baby. Delivery usually resolves PIH because of the sudden and
prolonged loss of medical
HELLP (Hemolysis, Elevated Liver
support; disruption of normal
enzymes and Low Platelets): It can
rest and maternal and infant
lead to liver failure, hepatic coma,
bonding; and increased risk of
and disseminated intravascular
trauma, disease, and
coagulation (DIC).
exposure to civil unrest and
GDM: Fasting BG in pregnancy should violence
be 60 to 80 mg/dL and approximately
110 mg/dL 90 minutes after a meal.
Breastfeeding and infant nutrition
First tri bleeding/cramping
• Promoting breastfeeding is
Can lead to miscarriage. A
always best for mothers and
miscarriage can be nature's way of
babies, and never more
addressing a pregnancy with a
important than during a
genetic problem. Continued
disaster
bleeding may require a surgical
• Both the infant and new
dilatation and curettage (D&C)
mother must never receive
Second tri contaminated fluid.
• It is essential that all sources of
painless dilation of the cervix from 18
nutrition and supplies not be
to 21 weeks of pregnancy and can
contaminated. If a mother is
be indicative of an "incompetent
too sick to feed her baby,
cervix."
ready-to-feed formulas can
Third tri be used, if available.
• RELACTATION IS POSSIBLE!
preterm labor signs and symptoms
may include contractions or
cramping. Limited activity, bed rest,
and hydration should be used to stop
the contractions.
• Sexual intercourse advisable?

No, because seminal fluid
contains prostaglandin that
can induce labor
Postpartum management in disasters
• Unless the mother or baby is

critically ill, it is best to keep the
mother and baby together.
• if evacuation is required, keep
the mother and baby together
• Crisis situations and
emergencies place
postpartum women at greater

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Disaster Nursing - Lec

Introduction to Disaster Hospitals facilities also described

Sinkholes covers land used by humans,

Heat waves waves in a water body caused

• Severe storms, dust clouds and A bioterrorism attack may be sudden

• Hazard - is a potential threat to

• Resilience – the capacity of a Technological Disasters

1. Upgraded into part of a

million people in need of

ICN FRAMEWORK FOR

leaders, and education in Why need a set of competencies?

development of surveillance • may last a few days to several

the community such as mass

decision - making and 4. Communication and Information

• Practices in accordance with 5. Education and Preparedness

• Recognizes symptoms of • Assists in developing recovery

7. Long-term Care Needs

7.1 Individual and Family Recovery

• Develops plans to meet short-

7.2 Community Recovery

• Assists the community in

what worked, what did • Historical data and data from

Hazard Identification, Vulnerability

Hazard Identification, Vulnerability prevent or mitigate future

Risk Assessment Includes: Post-impact Phase

• Determining a community's risk • includes two subphases, the

• Managing utilities during Involves 3 phases - alert, response,

BASIC LIFE SUPPORT

DISASTER Age groups

• Infant: <1 yr. old

• Check Breathing and Pulse

Provide Indicated Care.

• If not already done, activate

2. No response with breathing Cycles of CPR: (x5 cycles approx. 2

REPEAT 😊 Switching of roles: every 2 minutes

1. No response Normal breathing Chest compression to ventilation ratio

Maneuvers in opening airway Automated External Defibrillator

Adult Child Infant

Work as a team – an effective team Choking - Mild versus severe

• Clearly defined roles especially

Advanced Airways - An advanced

Once in place, not necessary to

• (e.g. physiologically stable

neurological deficits, Having an objective triage tool that

Expectant, Gray - who is still alive but

• (e.g. agonal respirations,

Step 1 – sort (Global sorting)

• Walk assess third (3)

Step 2 – assess (individual assessment)

Simple Triage and Rapid Treatment • are assessed in a sequential

primary triage of children in the

JumpSTART differs in several key ways

1. JumpSTART- used for "all victims

• It is theoretically possible not developmentally or

Emotional phases of Disasters and governmental agencies

DISASTERS Earthquake Preparedness

1. Prepare your home

with you, but be aware that • A flood warning means

Disaster Supply Kits 11. Wrench or pliers (to turn off

Disaster Supply Kits (list)