Disaster Nursing

and Emergency
Preparedness
Christian Rodel Perez, MSN, RN
2011

Objectives
Given a scenario involving clients
experiencing disasters, students will
be able to:
Define disasters based on types, stages
and characteristics
Identify Impact of a disaster on health
Describe principles of Disaster planning
Discuss emergency health planning
necessary for disaster preparedness
Utilize the nursing process in the
management of events including: mass
casualty incidents, natural and

It is no accident that 90% of disasters

worldwide are in developing countries.
Poverty and population pressures are
forcing a great number of people to live
in Harms way - flood plains, earthquake
prone areas and unstable slopes and hills.
Their extraordinary vulnerability is
perhaps the single most important cause
of disaster casualties
- Kofi Annan , former UN Sec

Introduction

Introduction
Prematu
re death

Impaired
quality
of life

DISAST
ER

Damage
to
properti
es

Altered
health
status

Risk Profile of
the Philippines
Christian Rodel D. Perez, RN, MSN
2011

Composed of more than

7,100 island.
Philippines geographical

and physical characteristic

expose the country to
hazards and disasters, but
does not necessarily make
it a disaster prone country.

Threats in the Philippines

Threats in the Philippines

Threats in the Philippines

Average of 866 earthquakes per year,

some of them have proved to be
damaging
2 major damaging earthquakes in
recent years
1976 Mindanao earthquake>
around 6,000 people killed> about
USD 400 Million in damage
1990 Luzon earthquake> over
1,283 people killed> 1.3 Million

Threats in the Philippines

220 volcanoes, 22 as
active
June 1991 Mt.
Pinatubo eruption
dubbed as the 2nd largest
volcano eruption of this
century
850 people killed>
around 1.2 Million people

Threats in the Philippines

Threats in the Philippines

Tsunam
i
August 17, 1976
Earthquake & Tsunami
7.8 Magnitude generated
a tsunami as high as 15 ft.
which swept coastal areas
of 5 provinces in Central
and Southern Mindanao
3,792 killed; 9,240
injured; 1,937 missing>
362,136 rendered
homeless> around

Threats in the Philippines

EMERGING
GLOBAL
CONCERNS

Threats in the Philippines

Red Tide Outbreak
From 1983 to 2001, a
total of 42 toxic outbreaks
have resulted in a total of
2,107 paralytic shellfish
poisoning cases with 117
deaths.
In Manila Bay, during the
1992 Pyrodinium red-tide
outbreak, around
outbreak, around 38,500
fisherfolks were displaced
from their

Threats in the Philippines

Rizal Day Bombing
Also referred to as
theDecember 30 bombings,
were a series of bombings that
occurred aroundMetro Manila.
Five locations were bombed
almost simultaneously within
the span of an hour.
Twenty-two (22) fatalities
were reported and around a
hundred more suffered nonfatal injuries.

Threats in the Philippines

PhilSports Stadium Stamped

Also referred as
Wowowee
stampedeor the
ULTRA stampede was
astampedethat
occurred at
thePhilSports Stadium
inPasig City on
February 4, 2006.
It killed 78 people
and injured about

Threats in the Philippines

Threats in the Philippines

Threats in the Philippines

Threats in the Philippines

nking of MV Princess of the Stars

The ferry sent a distress signal
at midday on June 21, 2008
when its engines allegedly
stalled in rough seas
nearSibuyan Island.
Surveillance team confirmed
that the ship has a hole in the
hull.
52 survived the tragedy and
312 bodies were recovered of
825 passengers listed. The
rest were declared missing and
presumed dead.

Threats in the Philippines

Typhoon Ondoy (Ketsana)
Most devastatingtyphoonin
the2009 Pacific typhoon
seasonwith a damage
of$1.09 billion and 747
fatalities.
The damage to property was
estimated to beP6 billion,
including P4.1 billion in
damage to infrastructure, P1.9
billion in damage to schools,
and P882.525 million in
damage to agriculture.

Philippines Disaster Statistics

No of events:
(1980-2010)
No of people killed:
Average killed per year:
No of people affected:
Average affected per
year:
Ecomomic Damage
(US$ X 1,000):
Ecomomic Damage per
year (US$ X 1,000):

363
32,956
1,063

116,212,416
3,748,788
7,417,145
239,263

Source: Emergency Events Database (EM-DAT). Centre for Research

Introduction
Philippines Disaster Statistics
(1980-2010)
Natural Disaster Occurrence Report

Source: Emergency Events Database (EM-DAT). Centre for Research

Introduction
Top 10 Disaster Report Philippines
Killed Disaster Dat
Disast Dat Affected Disaster Date
Cost
er (1980-2010)
e
e
(US$ X
Storm
1991
5,956
Storm
Storm
Storm
Storm
Storm
Storm
Storm
Droug
ht

199
0
200
9
200
8
200
9
199
8
200
6
198
8
199
8

6,159,56
9
4,901,76
3
4,785,46
0
4,478,49
1
3,902,42
4
3,842,40
6
3,250,20
8
2,600,00
0

Earthqua 1990
ke
Storm
2004
Storm

1984

Storm

2006

Mass
2006
mov. wet
Storm

1984

Storm

1987

Storm

1995

Storm

2008

2,412 Flood

199
5
1,619 Storm
200
9
1,399
199
1,399 Storm
0
1,126 Earthqua 199
ke
0
200
1,079 Storm
8
882
Storm
201
882
0
199
644 Storm
5
Storm
198

1,000)
700,30
0
585,37
9
388,50
0
369,60
0
284,69
4
275,74
5
244,00
0
240,50

Key Components of
Disaster Preparedness

Key Components:

Disaster
Ecologic Disruptions, or Emergencies
Varying Severity and Magnitude
Results in Illness, Deaths, Injuries, and
Property Damage
Cannot be managed by routine
procedures.
Requires Extraordinary Efforts beyond
what is needed to respond to
everyday.
* Landesman et al. (2001); Al-Madhari and Zeller (1997)

Categories of Disaster
Natural Disasters
Result of an ecological disruption or threat that
exceeds the adjustment capacity of the affected
community (WHO, 1979)
Man-made Disasters (human generated)
Principal direct causes are identifiable deliberate
human actions or otherwise (Noji, 1996).
Combination or Synergistic Disasters
Also known as NA-TECH. A natural disaster or
phenomena that may triggers a secondary
disaster

Natural Disaster

Man-made Disaster

Man-made Disaster
Three Broad Categories:
Complex Emergencies
Suffering and devastation caused by war, civil
strife, and other political conflicts.
Technologic Disasters
Direct and adverse effect of major industrial
accidents, unplanned release of nuclear energy,
fires or explosions from hazardous materials
Disasters that Occur in Human Settlements
Results of combination of forces like famine,
drought, epidemics, and political unrest.

Disaster Classification
Other categories:
Onset, Impact, Duration
Rapid-onset events short durations but
with a sudden impact (e.g. earthquakes
and tornadoes).
Sudden Impact (e.g. hurricanes and
volcanic eruptions).
Rapid-onset with unanticipated and
prolonged impact (e.g. bioterrorism
attack).
Creeping disasters (e.g. droughts and

Disaster Classification
Other categories:
Internal Disasters
Caused by disruption of normal hospital
function due to injuries or deaths of
hospital personnel or damage to health
care facility.
External Disasters
Exhaustion of health care/ hospital
resources due to large volume of
patients with varying types of injuries

Disaster Epidemiology
Characteristi
cs
Measures

Epidemiology

Disaster
Epidemiology

Health-related
determinants

Adverse health
effects of disasters

Distribution of
states or events

Contributory factors
to the effects of
disaster
Need of disasteraffected populations

Application

Disease
surveillance and
control

Match available
resources to the needs
of disaster-affected
population
Prevent further
adverse effects

Health-Related Effects of
Disaster

Levels of Disaster

Considerations related to
levels of disaster
Level I
Response team should be
competent in basic
emergency preparedness
Adequate surge capacity
to respond to routine
emergencies (power
outages, weather events,
etc.)

Considerations related to
levels of disaster
Level II
Assure adequate
linkages with other
organizations and
agencies in the
surrounding
community.
Local support and
assets should readily
procured.

Considerations related to
levels of disaster
Level III
Assure adequate
linkages between
local and nationallevel organizations.
Knows the
communication
chain of command
for the nationallevel linkages.

Disaster Continuum
Also known as Emergency management
cycle
Provides guide on the time line of a
disaster.
Consist of three phases:
Time
0
(0 24 hours) (24 72 hours)
72 hours

greater than

Disaster Planning
Cyclical process
Composed of phases, often taking place
concurrently, indicative of specific actions,
along with the nature and scope of the
plan.
Aims to reduce the negative impact or
consequences of adverse events

Disaster Management
Cycle

Disaster Management
Cycle

taken from: ert-sar.org.uk. Emergency Response Team Disaster Management Cycle, 2009

Mitigation and
Prevention

Phase 1

Mitigation and
Prevention

All actions taken before a disaster to reduce its

impacts, including preparedness and long-term risk
reduction measures.
Two Main Categories:
1. Structural Mitigation
Activities or Projects which aims to reduce
economic and societal impacts
2. Non-Structural Mitigation
policies and practices which raise awareness
of hazards or encourage developments to
reduce the impact of disasters

Phase 1

Mitigation and
Prevention

Mitigation Strategies:
1. Risk Assessment
Hazard Identification
Vulnerability Analysis.
2. Various mitigation strategies or
measures (Capacities).

Phase 1

Mitigation and
Prevention

Risk Assessment: Hazard

Identification

Industrial chemicals
Transportation
elements
Collections of people in
areas with limited
access
Environmental and
meteorological hazards
Explosions and
terrorism

Phase 1

Mitigation and
Prevention
Understand the
nature of the
threat
Identify variations
of threats in
between
locations

Methods by which
planners identify
which events are
most likely to affect a
community

Frequency of
occurrence of
events/threats
Identify possible
risk factors

Phase 1

Mitigation and
Prevention

Risk Assessment: Vulnerability

Analysis
Vulnerability - Is the extent to which a
communitys structure, services or
Type of
environment
is likely to be
damaged or
Characteristics
Vulnerability
disrupted by the
impact of a hazard.
People lives, health, security, living
Tangible/Material
(easy to see; value
easily determined)

conditions
Property services, physical property loss,
loss of use
Economy loss of products and production,
income
Environment water, soil, air, vegetation,
wildlife
Social structures family and community

Phase 1

Mitigation and
Prevention

Risk Assessment: Vulnerability

Analysis
Vulnerability Analysis methods used to
determine:

Who is most likely to be affected.

What property is most likely to be
damaged or destroyed.
What is the capability of the community
to deal with the effects of the disaster.
Data that were collected will be used to

Phase 1

Mitigation and
Prevention

Mitigation Strategies and Measures

Phase 1

Mitigation and
Prevention

Mitigation Strategies and Measures

(Capacities)
Positive resources and abilities which are
helpful to individuals, families, and
community in mitigating, preparing for,
responding to, and recovering from the
hazard impact.

Phase 1

Mitigation and
Prevention

Risk Assessment
Utilizes the results of the hazard
identification and vulnerability
analysis.
Determines the probability of a
specified outcome from a given hazard
that affects a community with known
vulnerabilities.

Mitigation and
Prevention

Phase 1

Risk Assessment
Risk is a function of the hazards to which a
community is exposed and the
vulnerabilities of that community.
However, that risk is modified by the level of
the local preparedness of the community
at risk. It is expressed by the following
notation: hazard vulnerability

x
________________
Ris=

Level of preparedness

Phase 1

Mitigation and
Prevention

Risk Assessment Benefits:

Prevention or removal of hazards
Removal of at-risk populations from
hazards
Provision of public information and
education
Establishment of early warning
systems
Reduction of risk posed by some
hazards

Preparedness

Phase 2

Preparedness

PREPAREDN
ESS

Phase 2

Preparedness

Disaster Preparedness
A continuous and integrated process
Involves a wide range of activities and
resources taken before the onset of a disaster
from multi-sectoral sources.
Enables successful discharge of emergency
management programs, by which disaster
relief is coordinated and mobilized from
governmental and nongovernmental
organizations to helpless victims of a disaster.
(Disaster Preparedness Training Programme; International
Federation of Red Cross and Red Crescent Societies, IFRCRCS,

Phase 2

Preparedness

Disaster Preparedness Goals:

To achieve a satisfactory level of readiness to
respond to any emergency situation.
Develop programs that will strengthen the
technical and managerial capacity of
governments, organizations, and
communities.
Build response mechanisms and procedures,
rehearsals, developing long-term and short-

Phase 2

Preparedness

Phase 2

Preparedness

Disaster Preparedness Measures:

Preparedness plans
Emergency exercises/training
Warning systems
Emergency communications systems
Evacuations plans and training
Resource inventories
Emergency personnel/contact lists
Mutual aid agreements
Public information/education
*The International Federation of Red Cross and Red Crescent Societies

Phase 2

Preparedness

Disaster Risk Reduction (DRR)

Physical measures to reduce the vulnerability
and exposure of infrastructure to natural
hazards as well and to provide coping and
adaptive infrastructure in case of a disaster
event (IFRCRCS, 2005).
Forms the pillar of disaster preparedness.

Phase 2

Preparedness

Disaster Risk Reduction

Recommendations:

Response

Phase 3

Response

Disaster Response
Act of putting preparedness plans into action
Measures taken to save lives and prevent
further damage in a disaster or emergency
situation.

Phase 3

Response

Phase 3

Response

Phase 3

Response

Disaster Response Activities:

1. Warning
2. Evacuation and Migration
3. Search and Rescue (SAR)
4. Post-disaster Assessment
5. Response and Relief
6. Logistics and Supply
7. Communication and Information Management
8. Survivor Response and Coping
9. Security
10.Emergency Operations Plan
11.Rehabilitation
12.Reconstruction

Response

Phase 3

1. Warning
refers to information concerning the nature
of the danger and imminent disaster threats.
Action: rapidly disseminate warnings to
government officials, institutions and the
population at large in the areas at
immediate risk
Dissemination methods:

Phase 3

Response

2. Evacuation and migration

Involves the relocation of a population from
zones at risk of an imminent disaster to a
safer location.
Primary concern: protection of life,
immediate treatment of injuries.
Measures for effective evacuation:

Phase 3

Response

3. Search and Rescue (SAR)

the process of identifying the location of
disaster victims that may be trapped or
isolated and bringing them to safety and
medical attention.
During Floods:
Locate stranded victims and transfer them
to a safer place or;
Provide them with foods and first aid until
evacuated or returned to their homes.
During Earthquakes:

Phase 3

Response

4. Post-disaster Assessment
The primary objectives:

It determines options for humanitarian assistance, how

best to utilize existing resources, or to develop requests
for further assistance.

Phase 3

Response

5. Response and Relief

Should take place immediately
there should be no delays.
contingency plans should be constructed.
Relief - is the provision on a humanitarian
basis of material aid and emergency medical
care necessary to save and preserve human
lives.

Phase 3

Response

6. Logistics and Supply

Victims
of
Disaster

Victims
of
Disaster

Victims
of
Disaster

Victims
of
Disaster

Phase 3

Response

7. Communication and information

management
Two Aspects to communications in disasters:

Phase 3

Response

8. Survivor response and Coping

Assess victims for existing social coping
mechanism
Provide social services to victims with
special needs to help them adjust with the
trauma and disruption caused by the
disaster.

Response

Phase 3

9. Security
Not always a priority issue after a sudden
onset of disasters.
Civil defense or police departments should
ensure the protection of the human rights
and safety of displaced populations or
refugees.

Phase 3

Response

10.Emergency Operations
Management
Emergency Operations Plan (EOP)
Policies and procedures that sets out the
scope of activities required for community
preparedness and response.
Allows the community to respond to threats
and engages responders in the short-term
recovery.

Phase 3

Response

11. Rehabilitation
Actions taken in the aftermath of disaster to:
Resumption of basic services.
Assist victims in repair of dwellings and
community facilities.
Facilitate revival of economic activities.
Disast
er

Phase 3

Response

12. Reconstruction
is the permanent construction or
replacement of severely damaged physical
structures.
the full restoration of all services and local
infrastructure.
revitalization of the economy (including
agriculture).

Phase 3

Response

Traditional Responses to disaster:

Provisions In-kind

Provisions in cash

Phase 3

Response

Traditional Responses to disaster:

Local Partnerships

Civil Service

Phase 3

Response

Modern Responses to disaster:

Cell Phones
Spatial Devices Social Networking
and Social Media

Recovery

Phase 4

Recovery

Disaster Recovery
Actions taken to return the community to
normal following a disaster.
There is no distinct point at which
immediate relief changes into recovery.
Continues until all systems return to
normal or better.

Phase 4

Recovery

Immediate measures conducted that tends to

overlap with Response. Some activities last
for weeks.

Phase 4

Recovery

Continuity of short-term activities. May carry

on for a number of months or years,
depending on the severity and extent of the

Phase 4

Recovery

Recovery Plan
Designed to spell out major steps for
managing successful recovery.
Involves designation of key partners for
each steps including their roles and
instruction for mobilization.

Phase 4

Recovery
Recovery Plan

Disaster Plan
Evaluation

Disaster Plan
Evaluation
Purposes:
Evaluate the disaster response plan for
effectiveness and completeness.
Assess the comprehension of key
personnel expected to execute the plan
and their ability to perform the assigned
duties.
Ensure availability and functionality of
equipment to be called in during disaster

Disaster Plan
Evaluation
Disaster Drills
Best method to evaluate disaster plans for
effectiveness and effectiveness.
Staging of full-scale or small segment of
disaster response.
Assessment techniques:
a. Table top academic exercises
b. Mock patients
c. Computer simulations
d. Seminar sessions focused on key
personnel or aspects of disaster

Disaster Plan
Evaluation
Essentials of Effective Disaster Drill
Implementation:
Goals and objectives should be clearly
communicated.
The more realistic the exercise, the more
likely it is to be useful in assessing the
strengths and weakness of both the
disaster plan and the responders.
Include all individuals and agencies likely
to be involved in a disaster response, and
a critique, during debriefing of the
participants.

Disaster Plan
Evaluation
Key Points to Disaster Plan
Evaluation:
Any modifications made to a disaster
plan or response procedures must be
communicated to all groups involved.
Evaluate personnel to ensure their
familiarity with their roles in disaster
situation.
Accommodate changes in population
demographics, regional emergency
response operations, hospital

Disaster Plan
Evaluation
Key Points to Disaster Plan
Evaluation:
At a minimum, disaster drills should take
place once every 12 months in the
community, and more frequently in
hospitals.