ZENAS B.

PALOMA, RN, MN, MAN, EMT-B

DISASTER
A serious disruption of the functioning of a
community or a society causing widespread
human, material, economic or environmental
losses which exceed the ability of the
affected community or society to cope
using its own resources.
-WHO, 1998

DISASTER
Disaster Nursing can be defined as the
adaptation of professional nursing skills in
recognizing and meeting the nursing
physical and emotional needs resulting from
a disaster.
The overall goal of disaster nursing is to
achieve the best possible level of
health for the people and the
community involved in the disaster.

TYPES OF DISASTER
Disasters may be:
Natural
Technological
Those in between or hybrid
Another way to classify disasters is
based on speed of onset:
Rapid onset
Slow Onset

NATURAL DISASTER
1. Geophysical (earthquakes, landslides, tsunamis and
volcanic activity)
2. Hydrological (avalanches and floods)
3. Climatological (extreme temperatures, drought and
wildfires)
4. Meteorological (cyclones and storms/wave surges)
5. Biological (disease epidemics and insect/animal
plagues).
TECHNOLOGICAL DISASTERS:
Conflict and Wars leading to refugees and internal
displacement.
Structure failure and building collapse
Transportation crashes and accidents
Military accidents
Fire disasters
Terrorism
Industrial Incidents
LEVEL OF DISASTER
LEVEL III DISASTER - considered a minor
disaster. These are involves minimal level of
damage.

LEVEL II DISASTER considered a moderate
disaster. The local and community resources
has to be mobilized to manage this situation.

LEVEL I DISASTER considered a massive
disaster. This involves a massive level of
damage with severe impact.
DISASTER MITIGATION
Disaster mitigation refers to an action
or measures that can either prevent the
occurrence of a disaster or reduce the
severity of its effects. (ARC)

Mitigation activities include
awareness, education and disaster
prevention measures.
PHASES OF DISASTER MANAGEMENT
1. Mitigation
and
Prevention
2. Preparedness
3. Response
4. Recovery
PHASES OF DISASTER MANAGEMENT
1. Prevention
Phase
Mitigation activities
actually eliminate or
reduce the probability of
disaster occurrence, or
reduce the effects of
unavoidable disasters.
PHASES OF DISASTER MANAGEMENT
2.Preparedness
Phase
Personal preparedness
Professional
preparedness
Community preparedness


PHASES OF DISASTER MANAGEMENT
3. Response
Phase
The aim of
emergency response
is to provide
immediate
assistance to
maintain life,
improve health and
support the morale
of the affected
population.


PHASES OF DISASTER MANAGEMENT
4. Recovery Phase
During this phase actions
are taken to repair,
rebuilt, or reallocate
damaged homes and
businesses and restore
health and economic
vitality to the community.
Psychological recovery
must be addressed. Both
victims and relief workers
should be offered mental
health activities and
services.



DISASTER MANAGEMENT
Goals of Disaster Management:
Reduce, or avoid, losses from hazards
Assure prompt assistance to victims
Achieve rapid and effective recovery.

TRIAGE SYSTEM
Triage system: The process by which a
clinician assesses a patients clinical
urgency.

Triage: A triage system is the basic
structure in which all incoming
patients are categorized into groups
using a standard urgency rating scale
or structure. Triage is a dynamic
process and is usually done more than
once.

TRIAGE
- Primary Triage: is the initial triage done in
the field, allowing responders to quickly and
accurately categorize the patients
condition and transport needs.
- Based on physiology
How well the patient is able to utilize
their own resources to deal with their
injuries
Patients unable to physiologically
compensate for their injuries are
assigned higher priority.

TRIAGE
- Secondary Triage: is done as patients are
brought to the treatment area.
Goal: to best match patients current and
anticipated needs with available resources.
Incorporates:
A reassessment of physiology
An assessment of physical injuries
Initial treatment and assessment of
patient response
Further knowledge of resource
availability

Secondary Triage cont
Goals is to distinguish between:
Victims needing life-saving
treatment that can only be
provided in a hospital setting.
Victims needing life-saving
treatment initially available on
scene.
Victims with moderate non-life-
threatening injuries, at risk for
delayed complications.
Victims with minor injuries.

TRIAGE CATEGORY
RED TAG
FIRST
PRIORITY
TYPICAL INJURIES
Airway and breathing difficulties
Uncontrolled or severe bleeding
Severe medical problems
Signs of shock
Severe Burns
Open chest or abdominal
injuries
TRIAGE CATEGORY
YELLLOW
TAG
SECOND
PRIORITY
TYPICAL INJURIES
Burns without airway problems
Major or multiple bone or joint
problems.
Back injuries with or without
spinal cord injury.
TRIAGE CATEGORY
GREEN
TAG
THIRD
PRIORITY
TYPICAL INJURIES
Minor fractures
Minor soft-tissue injuries
TRIAGE CATEGORY
BLACK
TAG
FOURTH
PRIORITY
TYPICAL INJURIES
Obvious death
Obviously non-survivable injury,
such as major open brain
trauma
Respiratory arrest (if limited
resources)
Cardiac arrest
TRIAGE
The assignment of degrees
of urgency to wounds or
illnesses to decide the order
of treatment of a large
number of patients or
casualties.

START TRIAGE
Is one of the easiest methods of
triage.
START means (Simple Triage and Rapid
Treatment)
By assessing the following criteria:
1. Ambulation
2. Respiration
3. Pulse
4. Mental Status
START TRIAGE (Steps)
1. Calling out patients at the disaster
site.


START TRIAGE (Steps)
2. Move to the non-ambulatory patient
and check your RPM
Assist respiratory status
Hemodynamic status (Pulse)
Neurologic Status
START TRIAGE (Steps)
3. Check the
RESPIRATORY
None Open the
Airway
Still None? BLACK
Restored? RED
Present?
Above 30 RED
Below 30 Check
Perfusion

START TRIAGE (Steps)
4. Check the
CIRCULATION
No pulse or
Greater than 2
RED
Present or Lesser
than 2 Check
Mental Status

START TRIAGE (Steps)
5. Check MENTAL
STATUS
Can not follow
simple
commands
RED
Can follow
simple
commands -
YELLOW

START TRIAGE SUMMARY
START TRIAGE SUMMARY
JUMP START TRIAGE
To provide aid to children at multi-
casualty disasters, which takes into
consideration the dramatic differences
between adults and children.
Used 1-8 years old.
Weight less than 100lb.
If the victim looks like a child, use
JumpSTART. If the victim looks like a
young adult, use START.

MILITARY VS CIVILIAN TRAIGE
MILITARY CIVILIAN
Priority is to get as many
soldiers back into action
as possible.
Priority is to maximize
survival of the greatest
number
Those with least serious
wound may be the first
treatment priority
Those with most serious
but realistically
salvageable injuries are
treated first
In both models, victims with clearly lethal injuries or
those who are unlikely to survive even with extensive
resource application are treated as the lowest priority.
HOSPITAL OPERATION PLAN
FIRST UNIT
A. Assess the secure the
scene
B. Establish areas as
outlined in the schematic
C. Communicate and direct
incoming units
D. Requests additional
resources
E. Notify hospitals
F. Establish triage unit
coordinator
EMERGENCY
A situation that arises
suddenly and threatens the
life or welfare of a person or a
group of people, as a natural
disaster, medical crisis, or
trauma situation.
EMERGENCY NURSING
Nursing care provided to prevent
imminent severe damage or
death or to avert serious injury.
Require urgent intervention to
prevent a worsening of the
situation, although in some
situations, mitigation may not be
possible and agencies may only
be able to offer palliative care for
the aftermath.

The Father of Modern Medicine
In fifth century BC,
Hippocrates was one of
the first people in the
world to study
healthcare, earning him
the title of "the father of
modern medicine".
Western European concepts
of nursing were first
practiced by male
Catholic monks who
provided for the sick and
ill during the Dark Ages
of Europe.

NURSING
In 17
th
Century Europe, Nursing care was
provided by persons serving punishment. It
was associated with prostitutes, and women
serving time for other crimes.

These persons had a reputation of being drunk
and obnoxious, a view amplified by the
physicians of the time to make themselves
seem more important and able.

FRANCE
By the 1600s the French Sisters of mercy was
one of the first organized nursing orders that
responded to care for epidemic victims.

FRANCE
During the French Revolution (1789), after seeing
the speed with which the carriages of the
French flying artillery maneuvered across the
battlefields, French military surgeon Dominique
Jean Larrey applied the idea of ambulances, or
"flying carriages", for rapid transport of
wounded soldiers to a central place where
medical care was more accessible and effective.
Larrey manned ambulances with trained crews
of drivers, corpsmen and litter-bearers and had
them bring the wounded to centralized field
hospitals, effectively creating a forerunner.
USA
Nurses in the United States Army actually started
during the Revolutionary War when a general
suggested to George Washington that the he
needed female nurses "to attend the sick and
obey the matron's orders. In July 1775, a plan
was submitted to the Second Continental
Congress that provided one nurse for every ten
patients and provided that a matron be allotted
to every hundred sick or wounded"
FLORENCE NIGHTINGALE
It was not until Florence
Nightingale, a well-
educated woman from
a wealthy class family,
became a nurse during
the Crimean War, and
improved it drastically
that people began to
accept nursing as a
respectable profession.
WWII
There were no male nurses in the American military until
years later
Army and Navy nursing was highly attractive and a larger
proportion of nurses volunteered for service higher
than any other occupation in American society

POST WAR CARE
The military nurses returned
home as the nations
experts in blood transfusion
and the application of new
drugs like penicillin. When
the nurses returned home
they used the previously
powerless American Nurses
Association to take control
of the nursing profession

POST WAR CARE
Hospitals became more community sources of help and
information instead of institutions only for the seriously
ill or injured
As more patients arrived to EDs hospitals were forced to
assign increasing numbers of nursing staff to provide
care, even though the role was not clearly defined

PARAMEDICS
At the same time ERs were becoming more recognized,
transport of patients to hospitals for care was also
gaining attention

PARAMEDICS
Community leaders recognized that lessons learned from
WWII and the Korean Conflict about triage, field care
and rapid transport could be translated to civilian
practice
Korea Air ambulance transport was initiated.

ED TRIAGE
1. Identify patients requiring immediate care.
2. Determine the appropriate area for treatment
3. Facilitate flow through the ED and avoid
unnecessary congestion.
4. Provide continued assessment and
reassessment of arriving and waiting
patients.
5. Provide information and referrals to patients
and families.
6. Ease patient and family anxiety and enhance
public relations.
EMERGENCY SITUATION?
Emergent situations are potentially
life-threatening
Urgent situations are serious but not
life-threatening if treatment is delayed
briefly;
Nonemergency situations are not
acute and are considered minor to
moderately severe


HOSPITAL INCIDENT COMMAND SYSTEM (HICS)
System for managing emergent and
non-emergent situations
Provides hospitals with required tools
to address the event
HICS initiated by an internal/external
event
Flexible in scale
Only those positions needed are
activated
Administrative position assumes role
as Incident Commander



STAFF ROLES & RESPONSIBILITIES
Know Staging and Evacuation Plans for
patients.
Evacuation Maps posted in all clinical areas
Horizontal and vertical routes
Be familiar with Evacuation Equipment.
Location
Use
Be familiar with Emergency Codes &
Designations.
Check with Supervisor for updates if role is
not pre-assigned.



EMERGENCY CODES AND DESIGNATION
CODES MEANING
RED
Fire
BLUE
Adult Medical Emergency
WHITE
Pediatric Medical Emergency
AMBER
Infant And Child Abduction
YELLOW
Explosive Device Or Bomb Threat
GRAY
Patient Elopement
SILVER
Persons With Weapon, Hostage Situation
ORANGE
Hazmat Incident, Decontamination Needed
BLACK
Severe Weather Warning
CLEAR
Situation Has Been Resolved