Disaster nursing

P H IL IP P IN E D IS A S T E R R IS K R E D U C T IO N M A N A G E M E N T A C T O F 2 01 0

R A 101 21  3 Geographical Areas: Luzon, Visayas, and

P h ilip p in e D R R M A c t o f 201 0 Mindanao
 18 regions (NCR, CAR, Regions I - XIII,
MIMAROPA, BARMM)
P rese n tatio n C o n ten t
 81 provinces
I. General Information
 145 cities
II. Philippine Disaster Risk Profile
 1,489 municipalities
A. Hazards
 2,029 barangays
B. Major Disasters
III. Philippine DRRM System
A. Salient Features II. P h ilip p in e D isa ster R isk P ro file
B. NDRRM Council
C. NDRRM Framework P H IL IP P IN E N A T U R A L D IS A S T E R R IS K IN D E X
D. NDRRM Plan
E. DRRM Thematics Areas  Due to the geographical context of the
F. National Disaster Response Plan Philippines, the country is vulnerable to
G. National Disaster Preparedness Plan numerous natural disasters ranging from
H. Challenges earthquakes, tropical cyclones, and flooding. In
2021, earthquakes occurring in the country had
a 10 risk index points while tropical cyclones had
“T hose w ho w ant to reap the ben efits of this great nation
a 9.5 risk index points.
m ust bea r the fatigue of suppo rting it..”
~ T hom as P aine  The World Risk Index 2022 (released
September) ranked the Philippines first in the
world in risk among 193 countries worldwide
I. G en era l In fo rm atio n (representing 99 percent of global population).
 The country, however, was not included in the
P H IL IP P IN E S top 10 most vulnerable countries to disasters.
 R ep u b lic o f th e P h ilip p in e s (Filipino:
R ep u b lika n g P ilip in as ), located in South East
Asia, an archipelago of around 7,64 0 islands as C lim ato -M eteo ro lo g ica l
of 2016

F IL IP IN O
 F ilip in a (fem in in e)
 Belonging or relating to the Philippines, or to its
people or culture. Known for their love of family
and friends, and their strong sense of
community. Filipinos are hardworking and
resilient, having overcome many challenges in
their history.

P H G o vern m en t A d m in istra tiv e S tru ctu re

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G eo -H yd ro lo g ic al
 Presidential Decree 1566 established the authority,
units concerned, and process required to manage
disasters. PD1566 is aimed at strengthening the
Philippine disaster control capabilify and
establishing the national program on community
disaster preparedness. It likewise created the
N atio n al D isas ter C o o rd in atin g C o u n cil in 1978
chaired by the Secretary of the Department of
National Defense (DND).

R A 1 0 121
 Philippine Disaster Risk Reduction and
Management Act of 2010
 "An act strengthening the Philippine Disaster
Risk Reduction and Management System,
providing for the National Disaster Risk
Reduction and Management Framework and
institutionalizing the National Disaster Risk
B. M ajo r & R ece n t D isa sters in th e P h ilip p in e s Reduction and Management Plan, appropriating
 Typhoon Frank/Fengshen (June 2008) funds therefor and for other purposes"
 Typhoon Ondoy/Ketsana (September 2009)  Enacted on 27 May 2010
 Typhoon Pepeng/Parma (September 2009)
 Typhoon Santi/Mirinae (October 2009)  Under the DRRM Act of 2010, provinces, cities,
 Super Typhoon Juan/Megi (October 2010) and municipalities now play a greater role in
 Typhoon Sendong/Washi (December 2011) building the disaster resilience of communities,
 Typhoon Pablo/Bopha (November 2012) and in institutionalizing measures for reducing
 Earthquake in Central Visayas (October 2013) disaster risks, enhancing disaster preparedness
 Super Typhoon Yolanda/Haian (November 2013) and response capabilities. The DRRM Act
 Typhoon Glenda/Rammasun (July 2014) transforms the Philippines' disaster management
system from disaster relief and response towards
 Typhoon Ruby/Hagupit (December 2014)
disaster risk reduction (DRR).
 Typhoon Lando/Koppu (October 2015)
 Mt. Mayon Volcanic Activity (January 2018) P D 1 566
 Naga Landslides (September 2018)  Assumes that disasters cannot be avoided
 Typhoon Ompong/Mangkhut (September 2018)  Most plans were on the provision of relief goods
 Taal Volcano Eruption (January 2020) & infrastructures like dike & flood control
 Super Typhoon Odette/Rai (December 2021) systems (R eac tiv e)
 Tropical Storm Agaton/Megi (April 2022)  Government response was focused on disaster
 Typhoon Karding/Noru (September 2022) response
 Severe Tropical Storm Paeng/Nalgae (October  Economic expediency was maintained at the
2022) barangay level.

III. P h ilip p in e D R R M S ys tem  Ability to anticipate, respond to and recover from..,

R A 1 0 121
S A L IE N T F E A T U R E S
 Transforms & reforms the way we deal with
disasters
P D 1 566
 that impact of disasters can be reduced
 “Strengthening the Philippine Disaster Control, by addressing the root cause of disaster
Capability and Establishing the National risks
Program on Community Disaster  from disaster response to risk reduction
Preparedness”  emphasis on strengthening peoples’
 Issued on 11 June 1978 capacity to absorb stress

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  P ro activ e an d d ev elo p m en tal approach in (DSWD) as Vice Chairperson for Disaster
managing disaster Response, the Secretary of the Department of
 Establishment of permanent disaster Science and Technology (DOST) as Vice
management offices at all levels of local Chairperson for Disaster Prevention and
government Mitigation, the Director-General of the National
Economic and Development Authority (NEDA)
as Vice Chairperson for Disaster Rehabilitation
P H IL IP P IN E D R R M S Y S T E M and Recovery, and the Administrator of the
Office of Civil Defense (OCD) as the Executive
R A 1 0 121 (D R R M A c t) Director, and 39 members
 the Philippine Disaster Risk Reduction and
Management Act of 2010 R A 1 0 121
transforms the Philippine’s Disaster Risk
Management System from Disaster Relief and
Response to Disaster Risk Reduction (DRR)
 Approved on May 27, 2010
 Repealed PD 1566 enacted in 1978

R A 1 0 121 - D R R M A c t o f 201 0

 The NDRRMC being empowered with policy-

making, coordination, integration, supervision,
monitoring and evaluation functions shall carry
out 17 responsibilities as stipulated in the law.
The NDRRMC Chairperson may call upon other
instrumentalities or entities of the government
and nongovernment and civic organizations for
1. Strengthening the Philippine Disaster assistance in terms of the use of their facilities
Management System and resources for the protection and
2. Providing for the National Disaster Risk Reduction preservation of life and properties in the whole
and Management Framework and range of disaster risk reduction and
3. Institutionalizing the National Disaster Risk management. This authority includes the power
Reduction and Management Plan, Appropriating to call on the reserve force as defined in
funds therefore and for Other Purposes Republic Act No. 7077 to Assist in relief and
rescue during disasters or calamities.
S A L IE N T P R O V IS IO N D R R M
S ec tio n 5 provides for the creation of the N atio n al S ec tio n 8 of the law stipulates that the O ffice o f C iv il
D isa ster R isk R ed u ctio n an d M an ag em en t C o u n cil D efen se (O C D ) shall have the primary mission of
(N D R R M C ) which is formerly known as the N atio n al administering a comprehensive national civil defense
D isa ster C o o rd in atin g C o u n cil but its membership and and disaster risk reduction and management program by
functions have increased to cope with complexities of providing leadership in the continuous development of
disasters at present times. strategic and systematic approaches as well as
o The NDRRMC is headed by the Secretary of the measures to reduce the vulnerabilities and risks to
Department of National Defense (DND) as hazards and manage the consequences of disasters.
Chairperson with the Secretary of the
Department of the Interior and Local  The Administrator of the OCD serves as the
Government (DILG) as Vice Chairperson for Executive Director of the National Council and,
Disaster Preparedness, the Secretary of the as such, shall have the same duties and
Department of Social Welfare and Development privileges of a department undersecretary. All

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 appointees shall be universally acknowledged municipal levels and the barangay captain for
experts in the field of disaster preparedness and the barangay level. The members are the heads
management and of proven honesty and of various offices assigned at the local levels
integrity. The National Council shall utilize the together with the four (4) members from the
services and facilities of the OCD as the CSOs and one (1) private sector representative.
Secretariat of the National Council. The OCD
has 19 functions, duties and responsibilities as The LDRRMCs shall have the following functions:
stipulated in the law.
a) Approve, monitor and evaluate the
 It is further provided for in the law that the
implementation of the local DRRM Plans and
NDRRMC shall establish an Operations Center.
regularly review and test the plan consistent with
This is the 24/7 facility for monitoring and
other national and local planning programs;
coordination. It is where we disseminate
b) Ensure the integration of disaster risk reduction
situation reports, alerts and communications to
and climate change adaptation into local
all Council members and various stakeholders. It
development plans, programs and budgets as a
is also a venue for us to facilitate effective
strategy in sustainable development and poverty
management of the consequences of disasters.
reduction;
S ec tio n 10 provides for the creation of the R eg io n al c) Recommend the implementation of forced or
D isa ster R isk R ed u ctio n an d M an ag em en t C o u n cil preemptive evacuation of local residents, if
(R D R R M C ), formerly known as R eg io n al D isa ster necessary; and,
C o o rd in atin g C o u n cil (R D C C ). RDRRMC coordinates, d) Convene the local council once every three (3)
integrates, supervises, and evaluates the activities of the months or as necessary.
local Disaster Risk Reduction and Management Councils
(LDRRMCs). The RDRRMC is responsible in ensuring
disaster sensitive regional development plans, in case of
emergencies; RDRRMC shall convene the different
regional line agencies and concerned institutions and
authorities.
 Under the law, the RDRRMC shall establish an
operating facility known as the Regional Disaster
Risk Reduction and Management Operations
Center (RDRRMC OpCen) whenever necessary.
The civil defense officers of the OCD who are or Hence, to bring DRRM down to the grassroots,
may be designated as Regional Directors of RA 10121 further provides for the establishment
OCD serves as chairpersons of the RDRRMCs. of the “DRRM Network”, or the replication of the
Its Vice Chairpersons shall be the Regional NDRRMC from the national down to the regional,
Directors of DSWD, the DILG, the DOST, and provincial, city, municipal and barangay levels
the NEDA. The existing regional offices of the
OCD shall serve as secretariat of the RDRRMCs. S ec tio n 12 provides for the L o cal D isas ter R isk
The RDRRMCs are composed of the executives R ed u ctio n an d M an ag em en t O ffice (L D R R M O ). It is
of regional offices and field stations at the also mandated that the local government units shall
regional level of the government agencies. establish an LDRRMO in every province, city, and
municipality, and a Barangay Disaster Risk Reduction
S ec tio n 11 provides for the organization at the L o cal and Management Committee in every barangay. The
G o v ern m en t L ev el. The Provincial, City and Municipal LDRRMOs shall be responsible for setting the direction,
Disaster Risk Reduction and Management Councils are development, implementation and coordination of
mandated to be organized at the local levels. In the case disaster risk management programs within their territorial
of the Barangays, a Barangay Disaster Risk Reduction jurisdiction. The LDRRMOs are permanent offices under
and Management Committee which is mandated to be the office of the governor, city or municipal mayor and
organized and shall operate under the Barangay the punong barangay (barangay captain) in case of the
Development Council (BDC). BDRRMC. The LDRRMOs have twenty-five (25)
 The L o cal D R R M C s shall be chaired by the functions, duties and responsibilities under this law given
local chief executives, the Governor for the that the local government units are the first line of
provincial level, the mayor for the city and defense in every disaster or emergency. Thus, they shall

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act as front liners of all disaster risk reduction and work of other LDRRMCs which are declared under state
management plans, programs, projects and activities. of calamity.
 Of the amount appropriated for LDRRMF, thirty
percent (30%) shall be allocated as Quick
Response Fund (QRF) or stand-by fund for relief
and recovery programs in order that situation
and living conditions of people In communities or
areas stricken by disasters, calamities,
epidemics, or complex emergencies, may be
normalized as quickly as possible. Unexpended
LDRRMF shall accrue to a special trust fund
S ec tio n 12 The L D R R M C s sh all take th e lead in solely for the purpose of supporting disaster risk
preparing for, responding to, and recovering from the reduction and management activities of the
effects of any disaster based on the following criteria: LDRRMCs within the next five (5) years. Any
such amount still not fully utilized after five (5)
years shall revert back to the general fund and
will be available for other social services to be
identified by the local sanggunian.
 Local Disaster Risk Reduction and Management
Fund (LDRRMF). Not less than five percent (5%)
of IRA and estimated revenue from regular
sources shall be set aside as the LDRRMF
 70% will be used to support disaster
risk management activities such as, but
S ec tio n 15 provides for the coordination during not limited to, pre-disaster preparedness
emergencies. The LDRRMCs are mandated to take the programs including training, purchasing
lead in preparing for, responding to and recovering from life-saving rescue equipment, supplies
the effects of any disaster based on the following criteria and medicines, for post-disaster
activities, and for the payment of
premiums on calamity insurance
 30% shall be allocated as Quick
Response Fund (QRF) or stand-by fund
for relief and recovery programs

C riteria on coordin ation durin g em erg encie s

S ec tio n 21 provides for the L o cal D isas ter R isk

R ed u ctio n an d M an ag em en t F u n d (L D R R M F ) which is
not less than five percent (5%) of the estimated revenue
from regular sources shall be set aside as the LDRRMF
to support disaster risk management activities such as,
but not limited to, pre disaster preparedness programs
including training, purchasing life-saving rescue
equipment, supplies and medicines, for post-disaster
activities, and for the payment of premiums on calamity
insurance. The LDRRMC shall monitor and evaluate the
use and disbursement of the LDRRMF based on the.
LDRRMP as incorporated in the local development plans
and annual work and financial plan. Upon the
recommendation of the LDRRMO and approval of the
sanggunian or council concerned, the LDRRMC may
transfer the said fund to support disaster risk reduction
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70% if th e L D R R M F preparedness activities such as, but not limited
to, training of personnel, procurement of
A c tiv ities equipment, and capital expenditures. It can also
Trainings, conferences and emergency meetings be utilized for relief, recovery, reconstruction and
Purchase of life-saving equipment, emergency/disaster other work or services in connection with natural
preparedness, special vehicles, rubber boats and other or human-induced calamities which may occur
equipment.
during the budget year or those that occurred in
Supplies and medicines
the past two (2) years from the budget year.
Insurance premiums
b) The specific amount of the NDRRM Fund and
Warning equipment and services
the appropriate recipient agencies and/or LGUs
Communication equipment and facilities
shall be determined upon approval of the
Rehabilitation (agri, engineering, livestock, fisheries,
fowl, forest and minor forest, coconut, etc) President of the Philippines in accordance with
Emergency field investigation the favorable recommendation of the NDRRMC.
Risk mapping c) Of the amount appropriated for the NDRRM
Other MOOE Fund, thirty percent (30%) shall be allocated as
S U B -T O T A L Quick Response Fund (QRF) or stand-by fund
G RAN D TO TAL for relief and recovery programs in order that
 COA Circular 2012-02, Accounting and reporting situation and living conditions of people in
guidelines of LDRRMF communities or areas stricken by disasters,
 DILG Circular 2012-73, Utilization of LDRRMF calamities, epidemics, or complex emergencies,
 Joint NDRRMC & DILG Memorandum Circular may be normalized as quickly as possible.
2013-01, Allocation and Utilization of LDRRMF d) All departments/agencies and LGUs that are
allocated with DRRM fund shall submit to the
S ec tio n 21 NDRRMC their monthly statements on the
utilization of DRRM funds and make an
A M E N D IN G DILG-DBM JOINT MEMORANDUM accounting thereof in accordance with existing
CIRCULAR NO. 1, (2005) ENTITLED, "GUIDELINES accounting and auditing rules.
ON THE APPROPRIATION AND UTILIZATION OF THE e) All departments, bureaus, offices and agencies
20% OF THE IRA FOR D E V E L O P M E N T P R O JE C T S " of the government are hereby authorized to use
 Joint DILG-DBM Memorandum Circular 2011- a portion of their appropriations to implement
enumerated the projects covered by the 20% projects designed to address DRRM activities in
developm en t fund w hich now include proje cts to accordance with the guidelines to be issued by
add ress and respond to natura l and m an-m ade the NDRRMC in coordination with the DBM.
disaste rs and calam ities.
 Under the guidelines, the 20% IRA can now be Notably, the special provisions for the NDRRM Fund
used for the construction or rehabilitation of under the General Appropriations Act No. 10964,
evacuation centers; purchase or repair of area- provided for the aid, relief and rehabilitation services to
wide calamity related ala rm o r w arn in g sys te m ; communities / areas affected by human-induced and
purchase or repair of appropriate calamity- natural calamities, and repair and reconstruction of
related rescue operations equipment such as permanent structures, including other capital
inflatable boats, breathing apparatus, extraction expenditures for disaster operation, and rehabilitation
tools, fire extinguishers, chainsaws, 2-w ay activities with a total budget amounting to Nineteen
h an d h eld rad io s and the like. Billion Six Hundred Million Pesos (P19.6 B).
 Public Disclosure of fund utilization, Rule 18 of In addition to the NDRRM Fund, the amount of Seven
IRR Billion Six Hundred Million pesos (P7.6B) is used for the
Quick Response Fund of various agencies such as the
S ec tio n 22 provides for the National Disaster Risk Departments of Social Welfare and Development,
Reduction and Management Fund. National Defense, Health, Public Works and Highways,
Education, and Agriculture, as well as National
a) The present Calamity Fund appropriated under Electrification Administration and National Irrigation
the annual General Appropriations Act shall Administration. Release of funds for other agencies in
henceforth be known as the National Disaster need of QRF shall be subject to the submission of a
Risk Reduction and Management Fund favorable recommendation of the NDRRMC and
(NDRRM Fund) and it shall be used for disaster approval of the DBM.
risk reduction or mitigation, prevention and
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S ec tio n 23 of the law also specifies funding of the OCD HOW HAS THE DRRM STRUCTURE CHANGED?
as lead agency to carry out the provisions the Philippine
Disaster Risk Reduction and Management Act of 2010.
The OCD shall be allocated a budget of one billion
pesos (PhP1,000,000,000.00) revolving fund starting
from the effectivity of this Act. The National Council,
through the OCD, shall submit to the Office of the
President, the Senate and the House of Representatives,
within the first quarter of the succeeding year, an annual
report relating to the progress of the implementation of
the NDRRMP.

NDRRM FRAM EW ORK

 The DRRM framework created in June 2011 is
integrated into a National Disaster Risk Reduction P ro h ib ited A c ts
and Management Plan, which is implemented by the  Dereliction of duties which leads to destruction, loss
Office of Civil Defense (OCD), under the Department of lives, critical damage of facilities, and misuse of
of National Defense (DND). It covers 4 DRRM funds;
aspects, namely: prevention and mitigation, o Actually, public as well as private individuals
preparedness, response, and rehabilitation and could commit this act especially medical teams
recovery. or those in the public positions or officials of
government.
 The Secretary of the Department of National  Preventing the entry as well as the distribution of
Defense (DND) chairs the NDRRMC, with the relief goods in disaster-stricken areas, including
administrator of the DND Office of Civil Defense appropriate technology, tools, equipment,
(OCD) as executive director. accessories, disaster teams/experts;
o During a disaster or a calamity, of course, there
R A 1 0 121 - D R R M A c t o f 201 0 will be competition among people in the affected
areas however, that should not be a justification
THE NDRRM FRAM EW ORK
for one (1) to prevent the entry or distribution or
the withholding of the relief goods in disaster-
 Safer, adaptive and resilient Filipino stricken areas.
communities toward sustainable development  Buying for consumption or resale, from disaster relief
agencies any relief goods, equipment, or other
commodities which are intended for distribution to
disaster-affected communities;
o You will notice that most of the prohibited acts
are actually those acts that would create profit
out of the act during a calamity. It should not be
considered as an avenue for taking advantage
or getting some benefits out of it because
everyone is suffering especially in those
disaster-stricken areas.
 Buying for consumption or resale, from the recipient
disaster-affected persons any relief goods,
equipment, or other aid commodities received by
them;
o Another prohibited act in relation to buying for
consumption or resale would be buying from the
victims themselves. The first form would be from
the relief agencies, and the second form would
be from the affected person.

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 Selling of relief goods, equipment, or other aid  Illegal solicitations by persons or organizations
commodities intended for distribution to disaster representing others;
victims; o In other words, you are claiming that you are
o So, instead of distributing it to the victims, one is from this organization, which is not therefore,
selling it to get profit. This is another form of you are lying to others hence you are given
profiteering. funds supposed to be for the disaster victims. It
 Forcibly seizing relief goods, equipment, or other aid is like a false claim.
commodities intended for or consigned to a specific  The deliberate use of false and inflated data in
group of victims or relief agency; support of the request for funding, relief goods,
o The forcible seizure of relief goods intended for equipment, or other aid commodities for emergency
a specific person it is consigned to but without assistance or livelihood projects; and
any justification, the relief goods are seized. o Inflating it would mean the increase of funding
 Diverting or misdelivery of relief goods, equipment, so, there is again the element of profit or taking
or other aid commodities to persons other than the advantage.
rightful recipient or consignee;  Tampering with or stealing hazard monitoring and
o Undoubtedly, the mere act of diverting as well as disaster preparedness equipment including
misdelivery is punishable under this law. paraphernalia.
 Accepting, possessing, using, or disposing of relief o The law does not allow this. We will not be
goods, equipment, or other aid commodities not having a reliable source of data to give to the
intended for nor consigned to him/her; disaster-stricken areas or the persons affected.
o From the giver to the recipient. Accepting,
possessing, using, or disposing of relief goods P E N A L T IE S
that are not intended. There are two (2)
processes, the distribution from the giver side  W h o co u ld b e liab le ?
and then to the recipient or the receiver side. o Individual, corporation, partnership,
 Misrepresenting the source of relief goods, association, or other juridical entity.
equipment, or other aid commodities by; o There is no qualification or there is no
o Covering, replacing, or defacing the labels of the discrimination or advantage to any other
containers to make it appear that the goods, person because an individual or a
equipment, or other aid commodities from corporation can be liable.
another agency or persons;
 The relief goods are coming from the  W h at are th e p en alties ?
UN agencies and then relabelled under o Fine (P50,000.00 – P500,000.00);
the politician’s name. The law does not o The fine will not be less than P50,000.00
allow it. and not more than P500,000.00 if found
o Repacking the goods, equipment, or other aid guilty.
commodities into containers; and o Imprisonment (6 years + 1 day – 12 years;
o Making false verbal claims that the goods, or both); and
equipment, or other aid commodities when its o This is at the discretion of the court.
untampered original containers actually came o Perpetual disqualification and confiscation or
from another agency or persons. forfeiture of objects in favor of the
government.
 It is like claiming. There is also an
o This could be imposed on the public official.
advantage here because the person
In case of conviction, they will not be
(the claimant) would be known to
qualified to occupy government office and all
everyone that he is a philanthropist,
the goods will be confiscated in favor of the
generous, a politician, a political leader,
government.
or an official of the government who
cares for the disaster victims. NOTE:
 Substituting or replacing relief goods, equipment, or
 F u n d in g o f th e O C D
other aid commodities with the same items or
 P1,000,000,000.00 (revolving starting
inferior/cheaper quality;
from effectivity).
o Giving out substandard quality which is not
 The government is really
supposed to be the case because the victim
allocating such a big fund for
should be given the utmost form of the product.
this especially that in the
Abigail marie Finals | Disaster Nursing 8
 Philippines, we have volcanic  As a policy-making body, it is assigned to
eruptions, typhoons, floodings, formulate a national disaster risk reduction and
earthquakes. All these sorts of management (DRRM) framework that provides
calamities including even for a “comprehensive, all hazards, multi-sectoral,
possible tsunamis especially inter-agency and community-based approach to
that we are in the Pacific Ring of disaster risk reduction and management,”
Fire. according to Republic Act 10121, NDRRMC’s
enabling law.
 S u n se t rev iew
 A systematic evaluation by the
congressional oversight committee of
the accomplishments and impact of the
act. As well as the performance and
organizational structure of the
implementing agencies (for remedial
legislation).
 This is done for the possible
determination of remedial
legislation. So if the Act is
insufficient, then it will be
improved.

N D R R M C O U N C IL

M IS S IO N :
 To administer a comprehensive national civil
defense and DRRM program by providing
leadership in the continuous development of
strategic and systematic approaches as well as
measures to reduce the vulnerabilities and risk
to hazards and manage the consequences of
disasters.

E ac h D R R M asp ec t is ass ig n ed to a v ice

ch airp ers o n , as fo llo w s:
 Vice Chairperson for Preparedness – Secretary,
T H E N A T IO N A L D IS A S T E R R IS K R E D U C T IO N A N D Department of the Interior and Local
M A N A G E M E N T C O U N C IL (N D R R M C ) Government (DILG)
 Vice Chairperson for Response – Secretary,
Department of Social Welfare and Development
 is the agency tasked to prepare for, and respond
(DSWD)
to, natural calamities, like typhoons and  Vice Chairperson for Prevention and Mitigation –
earthquakes. It also monitors human-induced Secretary, Department of Science and
emergencies, such as armed conflicts and Technology (DOST)
maritime accidents.  Vice Chairperson for Rehabilitation and
 The NDRRMC uses strategies to mitigate the Recovery – Director-General, National
Economic and Development Authority (NEDA)
impact of disasters and increase the resiliency of
both the national government and local
government units (LGUs) in the face of disasters.

Abigail marie Finals | Disaster Nursing 9

  Secretary, Department of Environment and
Natural Resources (DENR)
 Secretary, Department of Finance (DOF)
 Secretary, Department of Foreign Affairs (DFA)
 Secretary, Department of Health (DOH)
 Secretary, Department of Information and
Communications Technology (DICT)
 Secretary, Department of Justice (DOJ)
 Secretary, Department of Labor and
Employment (DOLE)
 Secretary, Department of Public Works and
Highways (DPWH)
 Secretary, Department of Trade and Industry
(DTI)
 Secretary, Department of Transportation (DOTr)
 Secretary, Department of Tourism (DOT)
 Press Secretary (now the Secretary, Presidential
Communications Operations Office or PCOO)
 The DOTr and the DICT were included in the
council in July 2017 via Executive Order Number
32, following the reorganization of the now
defunct Department of Transportation and
Communications (DOTC).

T h e N D R R M C is also co m p o sed o f th e fo llo w in g :

 Secretary, Office of the Presidential Adviser on
the Peace Process (OPAPP)
 Chairperson, Commission on Higher Education
(CHED)
 Chairperson, Housing and Urban Development
Coordinating Council (HUDCC)
 Chief of Staff, Armed Forces of the Philippines
(AFP)
 Chief, Philippine National Police (PNP)
 Secretary-General, Philippine National Red
Cross (PNRC)
 Commissioner, National Anti-Poverty
Commission – Victims of Disasters and
Calamities Sector (NAPC-VDC)
 Chairperson, National Commission on the Role
of Filipino Women (now the Philippine
Commission on Women or PCW)
 Executive Director, Climate Change Office of the
Climate Change Commission (CCC)
 President, Government Service Insurance
System (GSIS)
 President, Social Security System (SSS)
 President, Philippine Health Insurance
Corporation (PhilHealth)
 President, Union of Local Authorities of the
Philippines (ULAP)
 President, League of Provinces of the
Philippines (LPP)
T h e C ab in et m em b ers b elo w are also p art o f th e  President, League of Cities of the Philippines
NDRRM C: (LCP)
 Executive Secretary, Office of the President  President, League of Municipalities of the
 Secretary, Department of Agriculture (DA) Philippines (LMP)
 Secretary, Department of Budget and  President, Liga ng mga Barangay (LMB)
Management (DBM)  Four (4) representatives from civil society
 Secretary, Department of Education (DepEd) organizations (CSO)
 Secretary, Department of Energy (DOE)  One (1) representative from the private sector

Abigail marie Finals | Disaster Nursing 10

 NDRRM PLAN  These priority areas are not autonomous from the
 To implement all the country’s DRRM targets, the other nor do they have clear start and end points.
NDRRMC formulated the NDRRM Plan, approved The 4 priority areas are NOT seen as a mere cycle
on 7 February 2012. The NDRRM Plan enumerates which starts in prevention and mitigation and ends in
4 priority areas with 4 long term goals, 14 objectives, rehabilitation and recovery. They...
24 outcomes, 56 outputs and 93 activities. a) Mutually reinforce each other and are
 The plan adheres to the principles of good interoperable. This means that whatever we do
governance within the context of poverty alleviation in one aspect will have a direct or indirect effect
and environmental protection. It is about on the activities identified under the other
partnerships, working together and all of aspects. Furthermore, this means that it is
government/community approach– engaging the assumed that the level of preparedness and
participation of CSOs, the private sector and intensity of response activities we conduct are
volunteers in the government’s DRRM programs lessened because proper prevention and
towards complementation of resources and effective mitigation activities have been done already.
delivery of services to the citizenry. b) DO NOT, SHOULD NOT and CANNOT stand
alone. Because they are inter-linked, one cannot
T H E M A T IC A R E A S just focus on one aspect without considering the
others.
4 D R R M T H E M A T IC A R E A S c) Have no clear starting nor ending points
between each of the aspects and overlaps are to
 In accordance with the NDRRMF, through the be expected. There are some areas which are
NDRRMP, the country envisions a “S afe r, ad ap tiv e divided very thinly by gray areas. These are
an d d isas ter resilien t F ilip in o co m m u n ities activities which need to be smoothly integrated
to w ard s su stain a b le d ev elo p m en t.” This will be into two aspects. The overlapping activities were
achieved through the four distinct yet mutually put into the specific aspect which could better
reinforcing priority areas, namely, capture its essence using the lens of that
a) Disaster Prevention and Mitigation; specific DRRM area and to correspond to the
b) Disaster Preparedness; given parameters within which these aspects
c) Disaster Response; and focus on.
d) Disaster Recovery and Rehabilitation.
T h e sig n ifica n t activ ities u n d er th e 4 th em atic area s
Each priority area has its own long term goal, which in clu d e:
when put together will lead to the attainment of the 1. D isa ster P re v en tio n an d M itig atio n
 Early warning systems
country’s over goal/vision in DRRM.
 Flood forecasting and monitoring
 Hazard and risk mappings
 Structural and non-structural interventions

2. D isa ster P re p are d n ess

 Contingency planning
 Prepositioning and stock-piling
 Capacitating and organizing responders
 Training, drills and exercises
 Pre-Disaster Risk Assessment

3. D isa ster R esp o n se

 Rapid Damage Assessment and Needs
Analysis (RDANA)
 Issuance of advisories and situation
reports
 Activation of Response Clusters and
Incident Command System (ICS)
 Mobilization of responders
 Humanitarian assistance (eg relief
distribution)
 Provision of financial assistance
 Management of evacuation centers

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 4. D isa ster R eh ab ilitatio n an d R eco v ery D E C L A R A T IO N O F T H E S T A T E O F C A L A M IT Y
 Post-Disaster Needs Assessment (PDNA)
 Enhancement of policies and plans 1. The N atio n al C o u n cil sh all rec o m m en d to th e
 Reconstruction using “build back better” P resid e n t o f th e P h ilip p in e s the declaration of a
approach cluster of barangays, municipalities, cities, provinces,
 Resettlement
and regions under a state of calamity, and the lifting
 Provision of new sources of livelihood
thereof, based on the criteria set by the National
Council.
2. The President's declaration may w arra n t
N A T IO N A L D IS A S T E R R E S P O N S E P L A N (N D R P )
in tern atio n al h u m an itaria n ass istan ce as deemed
necessary.
T H E N A T IO N A L D IS A S T E R R E S P O N S E P L A N 3. The declaration and lifting of the state of calamity
may also be issued by the lo cal san g g u n ian , upon
 The National Disaster Response Plan (NDRP) is the the recommendation of the LDRRMC, based on the
National Government’s “m u lti-h azard ” res p o n se results of the damage assessment and needs
p lan . Emergency management as defined in the analysis.
NDRRM Act of 2010 (RA 10121), is the organization
and management of resources to address all N A T IO N A L D IS A S T E R P R E P A R E D N E S S P L A N
aspects or phases of the emergency, mitigation of,  The primary goal of preparedness is to avert the loss
preparedness for, response to and recovery from a of lives and assets due to threats and emergencies.
disaster or emergency. It outlines the processes and RA 10121 defines preparedness as the “kn o w led g e
mechanisms to facilitate a coordinated response by an d cap ac ities d ev elo p ed b y g o v ern m en ts,
the national and/or at the local level departments / p ro fess io n al res p o n se an d rec o v ery
agencies. Local government institutions are o rg an izatio n s, co m m u n ities an d in d iv id u als to
responsible for the development and improvement of effectiv ely an ticip ate, resp o n d to , an d rec o v er
local response plans relative to their areas of fro m , th e im p acts o f likely, im m in en t o r cu rren t
responsibility and underlying risks. h azard ev en ts o r co n d itio n s.” While essentially
implementation of preparedness is before any
 The NDRP prescribes the relevant activities on how hazard or any disasters strikes, preparedness
the disaster response shall be conducted as outcomes straddle between pre-disaster, disaster
augmentation or assumption of response functions and post disaster phases based on existing
to the disaster affected local government units definitions.
(LGUs) as a result of these disasters. The contents
of the NDRP also include identifying roles and  The objectives of the National Disaster
responsibilities of organizations / institutions during Preparedness Plan (NDPP) emanates from the
disaster / emergency phase as leads and members National Disaster Risk Reduction and Management
of the Response Cluster. The NDRP is also built on Plan (NDRRMP). The NDPP helps the national and
the understanding that all LGUs have prepared their local governments and other stakeholders contribute
Contingency Plans for Hydro-Met and implemented to the following objectives:
their Local DRRM Plans (LDRRMPs) particularly 1. To increase level of awareness and
preparedness activities that are directly connected to enhanced capacity of communities to
response like prepositioning of key assets and anticipate, avoid, reduce and survive the
resources. At present, the Government’s strategic threats and impacts of all hazards;
action plans have three versions for response plans 2. To fully-equip communities with the
for each possible and perceived disaster. They are necessary skills and capability to face and
NDRPs for: survive hazards and cope with the impacts
a) Hydro-Meteorological Hazards; of disasters;
b) Earthquake and Tsunami; and, 3. To increase Disaster Risk Reduction and
c) Consequence Management for Terrorism- Management (DRRM) and Climate Change
Related Incidents. Adaptation (CCA) capacity of Local DRRM
Councils, Offices and Operation Centers at
all levels;

Abigail marie Finals | Disaster Nursing 12

 4. To develop and implement comprehensive D id Y o u K n o w ?
national and local preparedness and
response policies, plans and systems; and “T he D R R M A ct adop ts and adhe res to principle s &
5. To strengthen partnership and coordination strategies consisten t w ith the inte rnation al standa rds set
among all key players and stakeholders. by the H yogo F ram ew o rk for A ctio n (H F A ). T he H F A is a
com preh ensive, actio n ‐orien ted response to internation al
 Consistent with the NDRRMP and other mandates, concern about the grow ing im p acts of disasters on
the NDPP aims to contribute to the broader vision of ind ivid uals, com m u nitie s & nation al developm en t.”
reducing loss of lives and assets due to hazards and
its potential impacts, by aiming at safe and resilient
communities. National and local public and private S A L IE N T F E A T U R E S
stakeholders need to work together to contribute to
attain this objective, with the government taking the  Coherence with international framework
lead in facilitating synergy of interventions and  Adherence to universal norms, principles, and
ensure that communities are able better to anticipate, standards of humanitarian assistance
cope with, and recover from hazards. Good governance through transparency and
accountability
CHALLENGES  Strengthened institutional mechanism for DRRM
 The Philippines are confronted with various  Integrated, coordinated, multi‐sectoral,
challenges when it comes to implementing DRRM. inter‐agency, and community‐based approach to
First, there is a need for the cooperation and buy-in disaster risk reduction
of the stakeholders. There is a need to correct the
notion that DRRM is only a government concern.
Rather, it requires the whole-of-society approach R A 1 0 121
because the safety of the nation is not only job of the
government but rather it is a shared responsibility. It  Empowerment of local government units (LGUs)
is also important to consider DRRM as a way of life. and civil society organizations (CSOs) as key
DRRM must be part of day to day decision-making. partners in disaster risk reduction
The national and local officials have to prioritize  Integration of the DRRM into the educational
DRRM. Lastly, there is a need for continuous system
development, review and improvement of the  Establishment of the DRRM Fund
country’s DRRM policies, plans and programs in (DRRMF) at the national and local levels
view of the “new normal.” This new normal is the  Providing for provisions on the declaration of a
acknowledgement of the fact that disasters state of calamity, remedial measures, prohibited
nowadays are increasing in terms of scope, acts and penalties
magnitude, frequency and complexities.

Abigail marie Finals | Disaster Nursing 13

 IN C ID E N T A C T IO N P L A N L G U A N D R E G IO N A L D E P A R T M E N T S

DOST
 D O S T as Vice-Chair on Disaster Prevention and
Mitigation, implements Programs, Projects and
Activities in support to the operations of Local DRRM
Councils.
 D O S T provides R&D based solutions to enhance PH
disaster risk reduction and mitigation efforts.

PAG ASA

P H IL IP P IN E A R E A O F R E S P O N S IB IL IT Y (P A R )

 This is the smallest and innermost monitoring

domain, whose boundary is closest to the
Philippine Islands. Tropical Cyclones inside the
PAR warrants the issuance of Severe Weather
Bulletin, the highest level of warning information
issued for tropical cyclones.

T R O P IC A L C Y C L O N E A D V IS O R Y D O M A IN (T C A D )

 This is the "middle domain" located between the

PAR and the tropical cyclone information
domain. The TCAD completely encloses the
PAR but is smaller than the TCID. Disturbances
within the TCAD warrant the issuance of a
Tropical Cyclone Advisory.

T R O P IC A L C Y C L O N E IN F O R M A T IO N D O M A IN (T C ID )

 The TCID is the largest and the outermost

monitoring domain of PAGASA. Tropical
cyclones present inside the TCID are of least
concern for the forecasters but are necessary
enough for monitoring and public awareness
purposes.

Abigail marie Finals | Disaster Nursing 14

 P A G A S A S E V E R E W E A T H E R B U L L E T IN P H IV O L C S E A R T H Q U A K E IN F O R M A T IO N

P H IV O L C S V O L C A N IC E R U P T IO N B U L L E T IN

D IL G
 DILG pursuant to its mandate, has identified sets of
relevant interventions for disaster preparedness that
aim to create an enabling environment for local
government units to further develop their capacities
towards mitigating the adverse impacts of disasters
and climate change.
 As the responsible agency for disaster preparedness,
we see to it that the LGUs down to the barangays
are prepared for any disaster events.

Abigail marie Finals | Disaster Nursing 15

 D efin itio n o f alp h a, b rav o & ch arlie

K E Y A C T IO N S : C H A R L IE

K E Y A C T IO N S : B R A V O

E A R L Y W A R N IN G L E A D S T O E A R L Y A C T IO N

K E Y A C T IO N S : A L P H A

L esso n s fro m P as t T yp h o o n s

Abigail marie Finals | Disaster Nursing 16

 P R O C E S S F O R C A S C A D IN G IN F O R M A T IO N

P R O C E S S F O R R E P O R T IN G (D IL G )

DSWD
 DSWD is the key agency in disaster relief efforts. It
coordinates with local governments and other
stakeholders to ensure that relief operations are
well-organized and effective.
 Disaster Response Operations Monitoring and
Information Center (DROMIC) is a division of the
Disaster Response Assistance and Management
Bureau (DREAMB). It is responsible for the
gathering, curating, consolidation, presentation and
dissemination of information related to all phases of
disaster response.

Abigail marie Finals | Disaster Nursing 17

 NEDA
 NEDA is the country’s socioeconomic planning
agency and vice-chair for disaster rehabilitation and
recovery, has been advocating for proper planning
as a key to guide the recovery efforts and to build
more resilient communities through improved
structures, services, and governance.
 NEDA prepared the Disaster Rehabilitation and
Recovery Planning Guide to provide national
agencies and LGUs a comprehensive guide in
planning and expediting processes for post-disaster
rehabilitation and recovery using a systematic
approach.

PRIMARY SOURCE OF INFORMATION &

RESOURCES

Abigail marie Finals | Disaster Nursing 18

 H E A L T H E M E R G E N C Y M A N A G E M E N T IN D IS A S T E R

 The HEMS mission: To ensure a comprehensive

V IS IO N , M IS S IO N , C O R E V A L U E S
and integrated health sector emergency
management system.
 As the health emergency management arm of
DEPARTMENT OF HEALTH the DOH, the HEMS was institutionalized, by
 The DOH Regional Office, which serves as the head virtue of Executive Order 102, to ensure a
of the health sector in the region, is authorized under comprehensive and integrated Health Sector
P.D. 1566 to undertake all the necessary measures Emergency Management System to prevent or
and to assist the local government units (LGUs) in minimize the loss of lives during emergencies
health emergencies and disasters. Representing the and disasters in collaboration with government,
Department of Health, it is incumbent in its role to business and civil society groups.
coordinate all other health facilities to maximize
CORE VALUES:
resources aimed at the common goal of mitigating
 The HEMS adopts, above all, God-centered and
suffering and decreasing morbidity and mortality in
God-inspired values of commitment, respect for
the affected areas.
life and environment, and leadership and
excellence.
DOH HEMS
LEG AL M AN DATES
 Acts as the DOH Coordinating unit and Operation
Center for all health emergencies and disasters, as
E X E C U T IV E /A D M IN IS T R A T IV E O R D E R S
well as incidents with the potential of becoming an
M IL E S T O N E O F P H IL IP P IN E H E A L T H E M E R G E N Y
emergency, and coordinate the mobilization and M AN AG EM ENT
sharing of resources.

V IS IO N : D O H A d m in istra tiv e O rd er N o . 6-B o f 199 9:

 The Health Emergency Management Staff Institu tio na liza tio n of a H ealth E m e rgency P rep aredn ess
and R espon se P rog ram W ithin the D epartm ent of H ealth
(HEMS) of the Department of Health (DOH) was
created with the vision of becoming Asia’s model  Institutionalized the Health Emergency
in health emergency management systems. Preparedness and Response Program of DOH.
 We are the leader in human resource  Created the “Stop Death” Program as a
development, technical assistance, and health comprehensive, integrated and respon- sive
emergency care, with state-of-the-art equipment emergency/disaster-related, service and
and logistics. Our health emergency policies, research-oriented program.
plans, programs and systems are internationally  Aimed to promote health emergency
acclaimed and benchmarked to guarantee preparedness among the general public and
minimum loss of lives during health emergencies strengthen health sector’s capability to respond
and disasters. to emergency/disaster.
 The program likewise gives advice and policy
directions regarding health emergencies.

E xe cu tiv e O rd er N o . 102 : Institu tio na liza tio n of the

H ealth E m e rgency M an age m en t S taff (H E M S )
 In view of the reengineering of the DOH, the
Disaster Management Unit (DMU) and STOP
DEATH Program were merged.
 The HEMS organizational structure places it
directly under the Office of the Secretary. It has
two divisions: the Preparedness Division and the
Response Division.

M IS S IO N :

Abigail marie Finals | Disaster Nursing 19

 A d m in istrativ e O rd er N o . 182 s. 2001 : A do ption and M em o ran d u m N o . 120 s. 2003 : P ersonn el and
Im plem entation of C ode A lert S ystem for D O H H ospitals A m b ula nce S ervices for E m e rgencie s and D isasters
D uring E m ergen cies and D isasters
A d m in istrativ e O rd er 155 s. 200 4, sec tio n V I
A d m in istrativ e O rd er N o . 168 s. 2004 : N ationa l P olicy Im p lem e n tin g G u id elin es : "T he B asic Life S up port
on H ealth E m ergen cy and D isasters (B LS ) T raining is m and atory to all health w orkers and to
suppo rt com m u nity hea lth resilience build ing .

A d m in istra tiv e O rd er N o . 155 s. 200 4: Im plem enting

G uid eline s for M an aging M ass C asualty Incide nts D O H A O -2 019 -0046 : N ationa l P olicy on D isaster R isk
D uring E m ergen cies and D isasters R edu ction and M an age m en t in H ealth (D R R M -H )

A d m in istra tiv e O rd er N o . 2007 -0018 : N ationa l P olicy A d m in istra tiv e O rd er 2020 -053 : G uarante e equitab le ,
on the M an age m en t of the D ead and M issin g P ersons accessible and quality health services, and to ensure
D uring E m ergen cies and D isasters that essential hea lth services are not disrupte d even
durin g em e rgencies and disaste rs.

A d m in istra tiv e O rd er N o . 200 7-000 9: O peratio nal

F ram ew o rk for the S usta ina ble E stablishm en t of a ROLES
M en tal H ealth P rog ram
R O L E S A N D R E S P O N S IB IL IT IE S O F T H E D O H
A d m in istra tiv e O rd er N o . 200 7-001 7: G uid eline s on R E G IO N A L O F F IC E IN H E A L T H E M E R G E N C Y
the A cceptan ce and P rocessing of F oreign and Local M AN AG EM ENT
D ona tio ns D uring E m ergen cy and D isaster S ituation s
D O H R E G IO N A L O F F IC E in H ealth E m erg en cy
M em o ran d u m C ircu la r, N atio n al D isa ster M an ag em en t B ase d o n th e N atio n al p o licy o n H ealth
C o o rd in atin g C o u n cil, M ay 10, 2007 : E m e rg en cies an d D isa sters (A .O . 168 s. 2004)
Institu tio naliza tion of the C luste r A pp roach in the 1. Serves as the DOH Coordinating Body for the
P hilipp in e D isaster M an age m en t S ystem , D esign ation of health sector in the region.
C luster Lead s and T heir T erm s of R eferen ce at the 2. Provides technical assistance and empowers all
N atio nal, R egion al and P rovin cial Level LGUs in the area on health emergency
management.
O rd er N o . 2008 -002 4: A do ption and Institutio naliza tion 3. Maintains an updated hazard and vulnerability
of an Integ rated C ode A lert S ystem W ithin the H ealth assessment of its catchment areas.
S ecto r
4. Observes all the requirements and standards
(regional emergency plan, etc.) needed to
A d m in istra tiv e O rd er N o . F A E 007 s.199 8: P olicies respond to emergencies and disasters.
and G uid eline s on the T ransfer and R efe rral of P atien ts 5. Maintains an operation center to serve as the
B etw een D O H M etro M anila H ospitals
regional repository of events for the health
sector.
D ep artm en t O rd er N o . 1-J, s. 200 0: R epo rting 6. Identifies and official spokesperson to answer
M echan ism of H ealth E m erg ency M an age m en t S taff
concerns by the public and the media.
(H E M S ) at the C entral O ffice and Its U nits at the
7. Reports to the Central DOH HEMS on all
C enters for H ealth D evelopm ent and D O H H ospitals
emergencies and disasters and any incident with
the potential of becoming an emergency.
A d m in istra tiv e O rd er N o . F A E 007 s.199 8: P olicies
8. Documents all health emergency events and
and G uid eline s on the T ransfer and R efe rral of P atien ts
B etw een D O H M etro M anila H ospitals conducts researches to support policies and
program development.
D ep artm en t O rd er N o . 1-J, s. 200 0: R epo rting
M echan ism of H ealth E m erg ency M an age m en t S taff D O H R E G IO N A L O F F IC E R o les in M an ag in g M ass
(H E M S ) at the C entral O ffice and Its U nits at the C asu a lty In cid en ts D u rin g E m e rg en cies an d
C enters for H ealth D evelopm ent and D O H H ospitals D isas ters (B ased o n A .O . 155 s 200 4)
1. All DOH Regional Offices shall ensure
institutionalization of functional Operations
Centers.

Abigail marie Finals | Disaster Nursing 20

 2. They shall be responsible for monitoring all In cid en t M ed ical C o m m an d er (IM C ) R esp o n sib ilities :
health and health related incidents, coordinate 1. Be knowledgeable in the structure of the
all activities within its region, and regularly Department of Health and how resouces are
update and submit reports to HEMS Central mobilized through adequate networking.
operations Center. 2. Keep abreast of reports on the Mass Casualty
3. They should submit a final report to HEMS two Incident and interagency plans in response to
weeks from the time of the incident of all the MCI, and make necessary recommendations
coordinated events within the region. for the management of victims.
3. Evaluate and report all medical information to
D O H R eg io n al O ffice R o les W h en th e H ealth the Incident Commander and give feedback to
E m e rg en cy P rep ared n ess an d R o sp o n se P ro g ram the Operations Center and the Secretary of
w as In stitu tio n alized (A .O . 6-B s. 1999 ) Health.
1. Provides support and encouragement to all the 4. Know all incoming medical teams arriving to the
activities of the program. All Regional Health scene; assist in the planning activities of the
offices and retained hospitals, being part of the Incident Commander and anticipate
DOH System, should provide medical services requirements, such as scheduling of teams in
and mitigate the sufferings of the victim of the event of a prolonged activity.
disasters and emergencies. 5. Should not hold a press conference on his/her
2. Institutionalizes the program/units in their own to avoid discrepancies in the reporting. The
respective regional health offices and hospitals. IMC is liable for the behaviour of his or her staff
3. Designates adequate personnel for this unit and in the Advance Medical Post. At no instance will
the medical teams. the IMC leave the post without a representative
4. Supports the training activities and requires all until the event is terminated.
personnel to undergo Basic Life Support and
other trainings that will enhance their R O L E S A N D R E S P O N S IB IL IT IE S O F T H E D O H
preparedness capability. R E G IO N A L O F F IC E IN H E A L T H E M E R G E N C Y
5. Knows and links with the communities and M AN AG EM ENT
develops networking relationships with all
government organizations, nongovernment In th e M an ag em en t o f th e D ead an d M issin g P erso n s
organizations, speciality societies, and other (M D M ) D u rin g E m e rg en cies an d D isa sters (A .O . N o .
people’s organizations who are involved with 2007 -0018 )
emergencies or disasters. 1. If two or more provinces are involved, the
concerned Regional Health Director shall lead in
R o les o f th e D O H R eg io n al O ffice D ire cto r the management of the dead, the missing and
the bereaved families
In M ass C asu alty In cid en t (M C I) M an ag em en t (A .O . 2. Similar to that of the National Disaster
155 ) Coordinating Council , a coordinating body shall
1. The DOH Regional Office Director shall be be established under the Regional Disaster
responsible for the implementation and adoption Coordinating Council primarily for MDM.
of the guidelines (“implementing Guidelines for 3. While it is the local health officer of the
Managing Mass Casualty Incidents During concerned LGU who leads/coordinates the five
Emergencies and Disasters “) and shall provide domains of MDM (namely: Search and Recovery,
feedback, suggestions, and policy Identification of the Dead, Final arrangement,
recommendations to the Secretary of Health. Handling the Missing, and Assistance to
2. The highest ranking health official, depending on Bereaved Families), when two or more
the MCI or disaster, in the Disaster Coordinating municipalities are involved, the concerned
Council should be represented in the Command Provincial Health Officer shall lead.
Post, which is the multisectoral unit established 4. Of the five domains of MDM, the one that the
to coordinate the various sectors involved in field local health officer is directly responsible for is
management. At the regional level, this is the the final arrangement of the dead, such as burial
Regional Director who represents the Secretary in collective graves of unidentified bodies
of Health. The health official assigned to the wrapped in individual cadaver bags with
command Post is known as the Incident Medical identification numbers and features.
Commander (IMC).
Abigail marie Finals | Disaster Nursing 21
In th e M an ag em en t o f D o n atio n s (A .O . N o . 200 8-001 7) R esp o n sib ilities o f th e D O H R eg io n al O ffice – H E M
1. During and emergency/disaster, the concerned C o o rd in ato r (D .O . 136 -I s. 200 1)
DOH Regional Office shall oversee the
distribution and utilization of donated items in  Reports directly to his/her DOH Regional Office
the affected areas and afterwards submit a Director and coordinates with the Director of
utilization report to HEMS. HEMS in times of emergencies and disasters.
 Takes the lead in the preparation of the
Emergency Preparedness Plan of the DOH
In th e H ealth E m e rg en cy R ep o rtin g M ech an ism (D .O .
N o . 1-J s. 2003) Regional Office, duly approved by his DOH
Regional Office Director, and in having this
1. The DOH Regional Office Director shall be the
disseminated this to all the DOH Regional Office
overall coordinator for disaster preparedness
staff and regularly tested, evaluated and
and response within the DOH Regional Office
updated.
geographical jurisdiction.
 Prepares the annual work and financial plan and
takes the lead in the implementation of the
In th e C o d e A lert S ys tem D u rin g E m e rg en cy o r
health emergency activities.
D isa ster (A .O . 182 s. 2001 , A O 2008 -002 4)
 Responsible for the organization and
1. The DOH Regional Office Directors shall be
dispatching of teams to respond to emergencies
responsible for the implementation and adoption
and disasters as embodied in the plan. The
of the guideline (“adoption and Implementation
team coming from the DOH Regional Office
of Code Alert System for DOH Hospitals during
should lead in the rapid assessment , monitoring,
Emergencies and Disasters) and provide
social advocacy and other public health activities.
updates, feedback and policy recommendations
to their respective undersecretaries, specific  Makes himself/herself available and accessible
responsibilities for DOH Regional Office are in times of emergencies and disasters; hence
defined in second AO (“Integrated Code Alert must equip himself/herself with the necessary
System for the Health Sector”) means of communication.
 Responsible for the training of DOH Regional
Office members in the region, including the
STAFF
communities, relative to health emergency skills
and management.
HEALTH EM ERG EN CY M AN AG EM ENT STAFF
 Ensures that the necessary drugs, medicines,
supplies and other necessary equipment are
available and properly stocked for emergencies
and disasters.
 Takes the lead in public information and
awareness activities concerning disasters and
emergencies.
 Networks with members of the health sector
responding to emergencies and disasters within
the DOH regional/zonal catchment areas and
E xecutive O rder N o. 102 communities as well as with other agencies
responding to emergencies and disasters.
 Follows the HEARS reporting and coordinates
with the DOH Central Operations Center for all
D O H R eg io n al O ffice – H E M S C o o rd in ato r emergencies and disasters
 The DOH Regional Office –Health Emergency  Fully responsible for the implementation of the
Management (DOH Regional-HEM) Coordinator is memorandum Order, Circular, Administrative
also known as the Regional Health Emergency Order, and Department Order issued by the
Management (RHEM) Coordinator. secretary of Health and the Director of HEM
respectively, especially in extreme emergencies.
 Documents all related activities, including a
Postmortem Evaluation of each event
responded and reports to the Director of the

Abigail marie Finals | Disaster Nursing 22

 DOH Regional Office. With copy furnished to the  Develops research proposals that would aid the
HEMS Director. program in policy direction, program
 Develops research proposals that would aid the implementation and improvement.
service in policy direction, implementation and  Performs all other related activities that may be
improvement. assigned from time to time.
 Submits quarterly reports to the Director of HEM.  In Managing Mass Casualty Incidents During
Emergencies and Disasters (A.O. 155 s. 20014)
R esp o n sib ilities o f R H E M D O H R eg io n al O ffice –  Directly oversees the implementation of
H E M A s sistan t C o o rd in ato r the guidelines (“Managing MCI during
Emergencies and Disasters”) in their
 Assists the HEM Coordinator in all his/her
respective regions.
activities.
 Reports to the DOH Regional Office
 Acts as an Acting Officer on health emergencies
Director and the HEMS Director.
and disasters.
 In Management of the Dead and the Missing
 Acts on behalf of the Coordinator in the latter’s
During Emergencies and Disasters (A.O. No.
absence.
2007-0018)
 Acts as Training Officer in relation to health
 Specific responsibilities will be given by
emergencies and disasters.
the DOH Regional Office Director based
D O H R eg io n al O ffice-H E M C o o rd in ato r’s on the regional context.
R esp o n sib ilities w h en th e H ealth E m e rg en cy  Regarding the Health Emergency Reporting
P rep ared n ess an d R esp o n se P ro g ram w as Mechanism (D.O. 1-J s. 2003)
In stitu tio n alized (A .O ). 6-B s. 199 9)  Duplicating the functions of HEMS as its
units at the DOH Regional Office, The
 Takes the lead in the preparation of the DOH Regional Office – HEM
Emergency Preparedness Plan of the region Coordinator shall report directly to the
and ensures that this Is approved by the DOH Regional Office – Director.
Regional Director, disseminated and regularly
updated. P rep ared n ess D iv isio n F u n ctio n s
 Responsible for the organization and  Maintains an Operation Center to serve as an
alert system to monitor health and health -
dispatching of teams to respond to emergencies
related emergencies.
and disasters where the DOH Regional Office
Team takes charge of the public health aspects  Provides leadership in the mobilization and
of disasters, such as rapid assessment, deployment of health teams in anticipation of or
monitoring and social mobilization. in response to health emergencies.
 Responsible for human resource development in
the region, hospitals and the communities in the  Coordinates and integrates health sector
response to health emergencies.
respective DOH Regional Office catchment
R esp o n se D iv isio n F u n ctio n s
areas.
 Develop plans, policies, programs, standards
 Ensures that the necessary equipment, supplies
and guidelines for the prevention and mitigation
and medicines are properly stocked and of health emergencies.
available for emergencies and disasters.
 Networks with the region. Catchment areas and  Provides leadership in organizing and
the communities. coordinating health sector efforts for health
 Prepares the annual work and financial plan and emergency preparedness.
takes the lead in the implementation of the
 Provides technical assistance, capability building
program’s activities.
and consulting and advisory services to
 Documents all activities and reports to the implementing agencies.
program.
 Coordinated with the Operations Center for all  Conducts or coordinates studies and researches
emergencies and disasters related to health emergencies.
 Submits quarterly reports to the program
Manager of the HEM Program.

Abigail marie Finals | Disaster Nursing 23

 HEALTH EM ERG ENC Y M AN AG EM ENT BUREAU analysis in response, recovery and rehabilitation
phases of disaster.
 Plans and develops policies & guidelines
essential in the implementation & management
of projects, programs and activities relevant to
emergency and disaster response, recovery and
rehabilitation.
 Develops and capacitates human resource of
regional offices, operation centers and local
government units in responding to emergencies
and disasters.
 Monitors and evaluates activities and systems
like EWS, RHA, SPEED and PDANA.

P reve n tio n , M itig atio n & P re p are d n ess D ivis io n

 Develops well-performing managerial human

resources for health emergency management
 Provides technical assistance to ensure the
availability of functional health emergency
preparedness systems (including policies,
planning and capability building activities) at all
G en era l F u n ctio n s levels of the health sector.
 Acts as the DOH Coordinating unit and  Provides technical assistance to ensure delivery
Operation Center for all health emergencies and of appropriate services in time of emergencies
disasters, as well as incidents with the potential and disasters.
of becoming an emergency, and coordinate the
mobilization and sharing of resources.  Develops and implements an overall Monitoring
and Evaluation System and Plan for health
 Provides the communication linkage among emergency management
DOH Central Office and other concerned  Leads in public information and awareness-
agencies, including the hospitals and the raising activities
regions, during emergencies and disasters.

 Maintains updated information of all health O p eratio n C en ter S p ec ific F u n ctio n s

emergencies and disasters (except  Monitors all health and health-related events on
epidemiological investigation reports) and a 24/7 basis, including all national events, mass
provide such information to other offices and gatherings, and international events with
agencies in accordance with existing protocols.
potential impact to the Philippines
 Maintains a database of all health emergency  Monitors all DOH implementation and response
personnel, technical experts, and resource efforts to activation of Code Alerts (White, Blue,
speakers. Together with the National Center for Red)
Health Facilities Development (NCHFD), HEMB  Prepares timely reports as needed by the
maintains a database of capabilities of health situation and properly disseminated to the
facilities.
Secretary of Health, the DOH Executive
Committee and NDRRMC and other concerned
D iv isio n s S p ecific F u n ctio n s offices
 Coordinates all health-related response efforts
R esp o n se , R eco ve ry & R eh ab ilitatio n D ivis io n to major health emergencies and disasters
 Facilitates the issuance of appropriate warnings
 Mobilizes resource of technical experts, health
to the ROs and health facilities in anticipation of
response teams and tangible logistics needed
impending emergencies
locally and internationally.
 Coordinates and monitors the mobilization of
 Manages information through rapid health
technical experts and all types of medical teams
assessment, damage assessment and needs
needed in emergencies and disasters

Abigail marie Finals | Disaster Nursing 24

  Coordinates and monitors the mobilization of all
logistical requirements of the Department of
Health needed in the affected region
 Deploys Emergency Officers to the NDRRMC
Operation Center, as per Office Order/standard
operating procedure, when their Red Alert status
is activated and serve as the official DOH
representative to liaise between the NDRRMC
and DOH OpCen

A d m in istra tiv e U n it
 Maintains proper recording, safekeeping, easy
access, and archiving of all pertinent official
records and documents of the Office.
 Leads in the development of guidelines and
policies pertaining to administrative concerns.
 Renders technical assistance to all staff and
other offices with regards to administrative
concerns.
 Prepares and monitors the processing of all
financial transactions relevant to HEM.
 Assists in the preparation of Annual
Procurement Plan, Operational Plan and Work
and Financial Plan .
 Prepares and monitors monthly Budget
Utilization Report.
 Prepares and monitors monthly Budget
Utilization Report.
 Maintains a working environment conducive to
the productivity of employees through secure
and well-maintained facilities.
 Ensures functionality and safekeeping as well
as preventive maintenance of equipment,
vehicles and other utilities/facilities
 Ensures that all necessary supplies and
materials are readily available at any given time
 Prepares and files all necessary documents for
the compensation and other benefits of all
HEMB personnel

Abigail marie Finals | Disaster Nursing 25

 IN V E N TO R Y O F P R E H O S P ITA L E M E R G E N C Y M E D IC A L S E R V IC E S S Y S T E M (E M S S ) C O M P O N E N TS

on the
E m e rg en cy D isp atc h training and
 involves the immediate identification and prioritizing capability of
of emergency situations, the timely dispatch of the dispatched
personnel
most appropriate resources and full endorsement to
Readily Complete Wide-
the receiving hospital. Dispatch encompasses all available equipment range of
aspects of communication including request basic first for BLS. available
processing, coordination and support, and aid kit in Need to equipment
the have readily in the
documentation and monitoring
community available provision
S p e c ia l ALS of BLS
IN V E N T O R Y O F L O C A L P R E H O S P IT A L E M S e q u ipm e n t/ equipment and ALS
SYSTEM re s o u rc es (desirable interventio
u tilize d /re qu ire d but would ns
depend on
EM S 1 S T T IE R 2 N D T IE R 3 R D T IE R the training
COM PONENT and
EM ERGENCY capability of
D IS P A T C H emergency
Awareness Presence of Presence of personnel)
of the a Unified a
people on Local Hotline Functional
C o m m u n ic a tion E m e rg en cy T ran sp o rt
the Number National
F a c ilitie s  involves transporting the patient to the most
available Hotline
emergency Number appropriate facility and continued provision of care
numbers en route
Barangay Education Complete
Responders among lay range of
and Lay persons EMS IN V E N T O R Y O F L O C A L P R E H O S P IT A L E M S
Persons already personnel SYSTEM
strengthened including a
specialist
(emergency EM S 1S T T IE R 2N D T IE R 3R D T IE R
P e rs o n n el Wide array medicine or COM PONENT
D is p a tch e d of trauma EM ERGENCY
responders surgeon) in TRANSPORT
up to the EMS
presence of team Ambulanc Wide Complete
a general e Type B range of Range of
physician in vehicles Vehicles
the EMS (ideal
team T ran sp o rta tio number of
E x p ec te d 20 minutes 10-15 < 10 n O p tio n s responder
R e s p o n se T im e minutes minutes s vis-a-vis
number of
E m e rg en cy R esp o n se an d C are ambulance
used
 involves arrival of resources at the scene and the
Patient BLS w/ Advanced
timely initiation of appropriate interventions Transport capacity to Life
w/ capacity provide Support
IN V E N T O R Y O F L O C A L P R E H O S P IT A L E M S to provide ALS
SYSTEM BLS (dependin
g on the
S erv ices
training
EM S 1 S T T IE R 2 N D T IE R 3 R D T IE R P ro v id ed en
and
COM PONENT ro u te to
capability
EM ERGENCY H o sp ital
RESPONSE AND of
CARE responder
First Aid Basic Life Advanced s and
and Basic Support and Life ambulance
S e rvic e s type and
Life Advanced Support
p ro vid e d o n -s ite
Support Life Support equipment
(depending

Abigail marie Finals | Disaster Nursing 26

 In ter-F acility R eferral an d T ran sp o rt IN V E N T O R Y O F L O C A L P R E H O S P IT A L E M S
 involves the transport of patient with medical escorts, SYSTEM
if necessary, from one facility to another, as the
patient requires services that are not available in the EM S 1 S T T IE R 2 N D T IE R 3 R D T IE R
COM PONE
referring facility
NT
Shall identify Identified Already have
possible stakeholders a functioning
stakeholders, that could be and effective
including involved in the EMS
potential implementation network
roles and . involving
responsibilitie different
s that could Framework of sectors in its
assist in the the network implementati
effective and including on.
efficient possible roles
implementati and Each of the
S E R V IC E
on of the responsibilities stakeholders
P R O V ID E R
EMS system. of the is functioning
IN V E N T O R Y O F L O C A L P R E H O S P IT A L E M S S AND
stakeholders well
SYSTEM OTHER
Stakeholders are already according to
STAKEHO
with existing recognized their
LDERS
roles on pre- and beginning designated
EM S 1 S T T IE R 2 N D T IE R 3 R D T IE R hospital EMS coordination roles.
COM PONENT will be initially and sharing of
tapped to resources Sharing of
IN T E R -
assist / among them resources,
F A C IL IT Y
provide are done. technical
REFERRAL
resources in expertise,
AND
the provision and capacity
TRANSPORT
of emergency building are
Strengthening Availability Availability medical also being
of existing and of Trauma- services done among
R e fe rra l health strengthening capable stakeholders
N e tw ork facilities of trauma- Facility
receiving
facilities
S u p p o rt F acilities an d S ys tem s
 refer to accessible communication and transport
E xistin g H ealth care D eliv ery S ys tem s facilities
 involves the various levels of health units, e.g.
barangay health stations, rural health units, free L eg al F ram e w o rk
standing clinics, etc., and referral units, i.e. inter-  defines the contractual liabilities of all stakeholders
local health zones (individuals, agencies, and hospitals) as defined in
appropriate policy mechanisms and instruments. It
also involves developing and operationalizing
A v aila b le G ro u p s o f S erv ice P ro v id ers an d procedures and guidelines for policy implementation
S take h o ld ers
 begins with the organizational structure and G o vern an c e
dynamics of the Program Management Committee  system management and supervision at the national
which coordinates the strategies and implementation (or local) level by a council/network/coalition, which
of the National Policy on Violence and Injury may include representation from the government
Prevention, and shall later include healthcare and other stakeholders under the chairmanship of
professionals, accredited EMT / paramedics, an appropriate authority. It will coordinate the
barangay health workers, and volunteer implementation of the EMS system within the
organizations country (or province or city) through standardization,
regulation, accreditation, policy making, monitoring
and evaluation, technical and capability building,
resource sharing and management, and steering
inter-sectoral coordination. Also, it will manage and
Abigail marie Finals | Disaster Nursing 27
 supervise at the local level by the local chief
executive through a fitting office that will overlook
functioning of the EMS system at the grassroots
level.

IN V E N T O R Y O F L O C A L P R E H O S P IT A L E M S
SYSTEM

EM S 1 S T T IE R 2 N D T IE R 3 R D T IE R
COM PONENT
Public Initiated Public Public –
Initiated w/ Private
beginning Partnershi
negotiation p
G o ve rn a n c e
s to forge a
Public-
Private
Partnership
DRRMO is Public Public
available but Safety Safety
will opt to Office Office
create a Public already
Safety Office created
Lead Agency
for the
implementation
of EMS to
address daily
emergencies
Mapping / Province- Province-
clustering of wide / City- wide /
municipalities Wide City-Wide
or barangays (sub-
Scope of
already started station link
Im p lem e n tatio n
for province / to the
city wide national
implementation EMS
system)
Already crafted YES YES
P re s e n ce o f and proposed
S u p p o rtin g – for
P o lic y consultation
and approval
Protocols used Local National
are local Protocol Protocol
protocols from used used
P ro to c o ls u s e d LGUs having
fo r s ys te m the same
im p lem e n tatio n characteristics
with already
existing EMS
system

Abigail marie Finals | Disaster Nursing 28

 IN C ID E N T C O M M A N D S Y S T E M - C o m m a n d a n d C o n tro l in E m erg e n c y R e s p o n s e

T h e In cid en t C o m m an d S ys tem (IC S )  1993 ICS became a national model for command
 standardized approach to the command, control, structures at a fire, crime scene or major incident.
and coordination of emergency response providing a ICS was used in New York at the first attack on the
common hierarchy within which responders from World Trade Center in 1993.
multiple agencies can be effective.  1 March 2004, the Department of Homeland
(F ed eral H ig h w ay A d m in istra tio n O ffice o f Security, in accordance with the passage of
O p eratio n s, U S A 2018 ) Homeland Security Presidential Directive 5 (HSPD-5)
calling for a standardized approach to incident
 standardized management tool designed to allow its management amongst all federal, state, and local
users to adopt an integrated organizational structure agencies, developed the National Incident
flexible enough to meet the demands of small or Management System (NIMS) which integrates ICS.
large emergency or non-emergency situations. Additionally, it was mandated that NIMS (and thus
(N atio n al In cid en t M a n ag e m en t S ys tem , U S A ) ICS) must be utilized to manage emergencies in
order to receive federal funding.
 11 September 2001 HSPD-5 and thus the National
H isto ry o f IC S
Incident Management System came about as a
 1968 The concept was formed to address problems
direct result of the terrorist attacks, which created
of inter-agency responses to wildfires in California
numerous All-Hazard, Mass Casualty, multi-agency
and Arizona.
incidents.
 1970s ICS was fully developed during massive
wildfire suppression efforts in California
(FIRESCOPE) that followed a series of catastrophic In cid en t C o m m an d S ys tem (IC S ) in th e P h ilip p in e s
wildfires, starting with the massive Laguna fire in  In the Philippines, the ICS was adopted as part of
1970. Studies determined that response problems the on-scene disaster response system when the
often related to communication and management Philippine Disaster Risk Reduction and Management
deficiencies rather than lack of resources or failure Act was enacted in 2010.
of tactics.  a standard, on-scene, all-hazard incident
 Weaknesses in incident management were often management concept that can be used by all DRRM
due to: Councils, emergency management and response
o Lack of accountability, including unclear agencies. It is a useful tool that coordinates all the
chain of command and supervision. actions and movements of different groups related to
o Poor communication due to both inefficient disaster risk reduction. (D ep artm en t o f In terio r an d
uses of available communications systems L o cal G o vern m e n t, P h ilip p in e s)
and conflicting codes and terminology.
o Lack of an orderly, systematic planning IC S O v erv iew
process.  ICS consists of a standard management hierarchy
o No effective predefined way to integrate and procedures for managing temporary incident(s)
inter-agency requirements into the of any size. ICS procedures should be pre-
management structure and planning process. established and sanctioned by participating
o “F reela n cin g ” by individuals within the first authorities, and personnel should be well-trained
response team without direction from a team prior to an incident.
leader (IC) and those with specialized skills  ICS includes procedures to select and form
during an incident and without coordination temporary management hierarchies to control funds,
with other first responders personnel, facilities, equipment, and
o Lack of knowledge with common communications. Personnel are assigned according
terminology during an incident.which lead to to established standards and procedures previously
become a vital component of the National sanctioned by participating authorities. ICS is a
Incident Management System (NIMS) in the system designed to be used or applied from the time
US, where it has evolved into use in all- an incident occurs until the requirement for
hazards situations, ranging from active management and operations no longer exist.
shootings to hazmat scenes. In addition, ICS
has acted as a pattern for similar
approaches internationally.

Abigail marie Finals | Disaster Nursing 29

 ICS is interdisciplinary and organizationally flexible  Training exercises
to meet the following management challenges:
o Meets the needs of a jurisdiction to cope
with incidents of any kind or complexity (i.e.
it expands or contracts as needed).
o Allows personnel from a wide variety of
agencies to meld rapidly into a common
management structure with common
terminology.
o Provide logistical and administrative support
to operational staff.
o Be cost effective by avoiding duplication of
efforts, and continuing overhead.
o Provide a unified, centrally authorized
emergency organization.
 ICS includes procedures to select and form
temporary management hierarchies to control funds,
personnel, facilities, equipment, and
communications. Personnel are assigned according
to established standards and procedures previously
sanctioned by participating authorities. ICS is a
system designed to be used or applied from the time IC S K E Y C O N C E P T S
an incident occurs until the requirement for  Unity of Command
management and operations no longer exist.  Common terminology
 Management by objectives
IN C ID E N T S are u n p lan n ed situ atio n s n eces sitatin g a  Flexible and modular organization
res p o n se.  Span of control
 Emergency medical situations (ambulance  Coordination
service)  Incident Action Plans (IAP)
 Hazardous material spills, releases to the air  ICS Forms
(toxic chemicals), releases to a drinking water  Comprehensive resource management
supply  Integrated communications
 Hostage crises or Active Shooter situation.
U N IT Y O F C O M M A N D
 Man-made disasters such as vehicle crashes,
industrial accidents, train derailments, or
 Each individual participating in the operation
structure fires reports to only one supervisor. This eliminates
 Natural disasters such as wildfires, flooding, the potential for individuals to receive conflicting
earthquake or tornado orders from a variety of supervisors, thus
 Public health incidents, such as disease increasing accountability, preventing freelancing,
outbreaks improving the flow of information, helping with
 Search and Rescue operations the coordination of operational efforts, and
 Technological crisis enhancing operational safety. This concept is
 Cyberattack, Cybersecurity Incident, or major fundamental to the ICS chain of command
information security breach. structure.
 Terrorist attacks
 Traffic incidents C O M M O N T E R M IN O L O G Y

 When different organizations are required to

E V E N T S are p lan n ed situ atio n s ap p lied to
em erg e n cy m an ag em e n t an d n o n -em erg en c y work together, the use of common terminology is
m an ag em en t settin g s. an essential element in team cohesion and
 Concerts communications, both internally and with other
 Parades and other ceremonies organizations responding to the incident inorder
top avoid confusion.
 Fairs and other gatherings
An incident command system promotes the use
Abigail marie Finals | Disaster Nursing 30
 of a common terminology and has an associated network of responders. These network qualities
glossary of terms that help bring consistency to allow the ICS flexibility and expertise of a range
position titles, the description of resources and of organizations. But the network aspects of the
how they can be organized, the type and names ICS also create management challenges. One
of incident facilities, and a host of other subjects. study of ICS after-action reports found that ICS
tended to enjoy higher coordination when there
M A N A G E M E N T B Y O B JE C T IV E S was strong pre-existing trust and working
relationships between members, but struggled
 Each individual participating in the operation when authority of the ICS was contested and
reports to only one supervisor. This eliminates when the networks of responders was highly
the potential for individuals to receive conflicting diverse. Coordination on any incident or event is
orders from a variety of supervisors, thus facilitated with the implementation of the
increasing accountability, preventing freelancing, following concepts:
improving the flow of information, helping with
the coordination of operational efforts, and IN C ID E N T A C T IO N P L A N S
enhancing operational safety. This concept is
fundamental to the ICS chain of command  Incident action plans (IAPs) ensures cohesion
structure. amongst anyone involved toward strictly set
goals. These goals are set for specific
F L E X IB L E A N D M O D U L A R O R G A N IZ A T IO N operational periods. They provide supervisors
with direct action plans to communicate incident
 Incident Command structure is organized in objectives to both operational and support
such a way as to expand and contract as personnel. They include measurable, strategic
needed by the incident scope, resources and objectives set for achievement within a time
hazards. Command is established in a top-down frame (also known as an operational period)
fashion, with the most important and which is usually 12 hours but can be any length
authoritative positions established first. For of time. Hazardous material incidents (hazmat)
example, Incident Command is established by must be written,[14] and are prepared by the
the first arriving unit. planning section, but other incident reports can
be both verbal and/or written.
SPAN OF CONTROL
 The consolidated IAP is a very important
component of the ICS that reduces freelancing
 To limit the number of responsibilities and
and ensures a coordinated response. At the
resources being managed by any individual, the
simplest level, all incident action plans must
ICS requires that any single person's span of
have four elements:
control should be between three and seven
 What do we want to do?
individuals, with five being ideal. In other words,
 Who is responsible for doing it?
one manager should have no more than seven
 How do we communicate with each
people working under them at any given time. If
other?
more than seven resources are being managed
 What is the procedure if someone is
by an individual, then that individual is being
injured?
overloaded and the command structure needs to
 The content of the IAP is organized by a number
be expanded by delegating responsibilities (e.g.
of standardized ICS forms that allow for
by defining new sections, divisions, or task
accurate and precise documentation of an
forces). If fewer than three, then the position's
incident.
authority can probably be absorbed by the next
highest rung in the chain of command. IC S F O R M S
C O O R D IN A T IO N
 ICS 201 – Incident Briefing
 ICS 202 – Incident Objectives
 ICS allows a way to coordinate a set of
 ICS 203 – Organization Assignment List
organizations who may otherwise work together
 ICS 204 – Assignment List
sporadically. While much training material
 ICS 205 – Incident Radio Communications Plan
emphasizes the hierarchical aspects of the ICS,
 ICS 205A – Communications List
it can also be seen as an inter-organizational
 ICS 206 – Medical Plan
Abigail marie Finals | Disaster Nursing 31
  ICS 207 – Incident Organization Chart "assigned" categories. Resources can
 ICS 208 – Safety Message/Plan be "out-of-service" for a variety of
 ICS 209 – Incident Summary reasons including: resupplying after a
 ICS 210 – Resource Status Change sortie (most common), shortfall in
 ICS 210 – Resource Status Change staffing, personnel taking a rest,
 ICS 211 – Incident Check-In List damaged or inoperable.
 ICS 213 – General Message
 ICS 214 – Activity Log IN T E G R A T E D C O M M U N IC A T IO N S
 ICS 215 – Operational Planning Worksheet
 ICS 215A – Incident Action Plan Safety Analysis  Developing an integrated voice and data
 ICS 218 – Support Vehicle/Equipment Inventory communications system, including equipment,
 ICS 219 – Resource Status Cards (T-Cards) systems, and protocols, must occur prior to an
 ICS 220 – Air Operations Summary Worksheet incident.
 ICS 221 – Demobilization Check-Out  Effective ICS communications include three
 ICS 225 – Incident Personnel Performance elements:
Rating  M o d es: The "hardware" systems that
transfer information.
C O M P R E H E N S IV E R E S O U R C E M A N A G E M E N T  P la n n in g : Planning for the use of all
available communications resources.
 Comprehensive resource management is a key  N etw o rks : The procedures and
management principle that implies that all assets processes for transferring information
and personnel during an event need to be internally and externally.
tracked and accounted for. It can also include
processes for reimbursement for resources, as
appropriate. Resource management includes
processes for:
 Categorizing resources
 Ordering resources
 Dispatching resources
 Tracking resources
 Recovering resources

 Comprehensive resource management ensures

that visibility is maintained over all resources so
they can be moved quickly to support the
preparation and response to an incident, and
ensuring a graceful demobilization.
 T-Cards (ICS 219, Resource Status Card) are
most commonly used to track these resources. IC S C O M P O S IT IO N
The cards are placed in T-Card racks located at
an Incident Command Post for easy updating
and visual tracking of resource status.
 Comprehensive resource management applies
to the classification of resources by type and
kind, and the categorization of resources by their
status.
 A s sig n ed resources are those that are
working on a field assignment under the
direction of a supervisor.
 A v ailab le resources are those that are
ready for deployment(staged), but have
not been assigned to a field assignment.
 O u t-o f-serv ice resources are those that
are not in either the "available" or

Abigail marie Finals | Disaster Nursing 32

In cid en t co m m an d er (1) media or other organizations seeking
information directly from the incident or event.
 S in g le in cid en t co m m an d er – a single person While less often discussed, the public
commands the incident response and is the information officer is also responsible for
decision-making final authority. ensuring that an incident's command staff are
kept apprised as to what is being said or
reported about an incident. This allows public
questions to be addressed, rumors to be
managed, and ensures that other such public
relations issues are not overlooked.
 L iaiso n o fficer serves as the primary contact
for supporting agencies assisting at an incident.

G en era l S taff

 O p eratio n s sectio n ch ief: Tasked with

directing all actions to meet the incident
objectives.
In cid en t co m m an d er (2)
 P la n n in g sec tio n ch ief: Tasked with the
 U n ified co m m an d – involves two or more collection and display of incident information,
individuals sharing the authority normally held by primarily consisting of the status of all resources
a single incident commander. Unified command and overall status of the incident.
is used on larger incidents usually when multiple  F in an ce/ad m in istratio n sec tio n ch ief: Tasked
agencies or multiple jurisdictions are involved. A with tracking incident-related costs, personnel
Unified command typically includes a command records, requisitions, and administrating
representative from major involved agencies procurement contracts required by Logistics.
and/or jurisdictions with one from that group to  L o g istics sectio n ch ief: Tasked with providing
act as the spokesman, though not designated as all resources, services, and support required by
an Incident Commander. A Unified Command the incident.
acts as a single entity. It is important to note,
200 -L ev el IC S
that in Unified Command the command
representatives will appoint a single operations
 At the ICS 200 level, the function of Information
section chief.
and Intelligence is added to the standard ICS
In cid en t co m m an d er (3) staff as an option. This role is unique in ICS as it
can be arranged in multiple ways based on the
 A rea co m m an d – During multiple-incident judgement of the Incident Commander and
situations, an area command may be needs of the incident. The three possible
established to provide for incident commanders arrangements are:
at separate locations. Generally, an area  Information & intelligence officer, a
commander will be assigned – a single person – position on the command staff.
and the area command will operate as a  Information & intelligence section, a
logistical and administrative support. Area section headed by an information &
commands usually do not include an operations intelligence section chief, a general staff
function. position.
 Information & intelligence branch,
headed by an information & intelligence
C o m m an d S taff branch director, this branch is a part of
the planning section.
 S afe ty o fficer monitors safety conditions and
develops measures for assuring the safety of all 300 -L ev el IC S
assigned personnel
 P u b lic in fo rm atio n o fficer (PIO or IO) serves  At the ICS 300 level, the focus is on entry-level
as the conduit for information to and from management of small-scale, all-hazards
internal and external stakeholders, including the incidents with emphasis on the scalability of ICS.

Abigail marie Finals | Disaster Nursing 33

 It acts as an introduction to the utilization of IC S O R G A N IZ A T IO N A L S T R U C T U R E
more than one agency and the possibility of
numerous operational periods. It also involves
an introduction to the emergency operations
center.

400 -L ev el IC S

 At the ICS 400 level, the focus is on large,

complex incidents. Topics covered include the
characteristics of incident complexity, the
approaches to dividing an incident into
manageable components, the establishment of
an "area command", and the multi-agency
coordination system (MACS).

IC S P erso n n el
 ICS is organized by levels, with the supervisor of
each level holding a unique title (e.g. only a person
in charge of a section is labeled "chief"; a "director"
is exclusively the person in charge of a branch).
Levels (supervising person's title)

IN C ID E N T C O M M A N D E R

 C o m m an d staff m em b er (o fficer) - command staff

 S ec tio n (ch ief) - general staff
 B ran c h (d irecto r)
- D iv isio n (su p erv iso r) – A division is a unit
arranged by geography, along jurisdictional
lines if necessary, and not based on the
makeup of the resources within the division.
- G ro u p (su p erv iso r) – A group is a unit
arranged for a purpose, along agency lines if
necessary, or based on the makeup of the
resources within the group.
 U n it, team , o r fo rce (lead er) – Such as
"communications unit," "medical strike
team," or a "reconnaissance task force."
A strike team is composed of same
resources (four ambulances, for
instance) while a task force is composed
of different types of resources (one
ambulance, two fire trucks, and a police
car, for instance).
 Individual resource. This is the
smallest level within ICS and
usually refers to a single person
or piece of equipment. It can
refer to a piece of equipment
and operator, and less often to
multiple people working together.

Abigail marie Finals | Disaster Nursing 34

 IC S P erso n n el
 Single resources may be organized into teams.
Using standard ICS terminology, the two types of
team configurations are:
o T ask F o rces , which are a combination of
m ixed reso u rces with common
communications operating under the direct
supervision of a Leader.
o S trik e T eam s , which include all sim ila r
res o u rce s with common communications
operating under the direct supervision of a
Leader.

IC S F acilities
 ICS uses a standard set of facility nomenclature. ICS
facilities include: pre-designated incident facilities:
Response operations can form a complex structure
that must be held together by response personnel
working at different and often widely separate
incident facilities. These facilities can include:
o Incident command post (ICP)
o Staging are
o Base
o Camps
o Helibase
o Helispots

Abigail marie Finals | Disaster Nursing 35

 resources. Camps are designated by geographic
location or number. Multiple camps may be used, but not
all incidents will have camps.

H elib a se is the location from which

helicopter-centered air operations are
conducted. Helibases are generally used
on a more long-term basis and include
such services as fueling and maintenance. The helibase
is usually designated by the name of the incident

In cid en t co m m an d p o st (IC P ): The location H elis p o ts are more temporary locations at

where the incident commander operates the incident, where helicopters can safely
during response operations. There is only one land and take off. Multiple helispots may be
ICP for each incident or event, but it may change used.
locations during the event. Every incident or event must
have some form of an incident command post. The ICP
may be located in a vehicle, trailer, tent, or within a  Each facility has unique location, space, equipment,
building. The ICP will be positioned outside of the materials, and supplies requirements that are often
present and potential hazard zone but close enough to difficult to address, particularly at the outset of
the incident to maintain command. The ICP will be response operations. For this reason, responders
designated by the name of the incident should identify, pre-designate and pre-plan the
layout of these facilities, whenever possible.
 On large or multi-level incidents, higher-level support
S tag in g area : Can be a location at or near facilities may be activated. These could include:
an incident scene where tactical response o Emergency operations center (EOC)
resources are stored while they await o Joint information center (JIC)
assignment. Resources in staging area are o Joint operations center (JOC)
under the control status. Staging areas should be o Multiple agency coordination center (MACC)
located close enough to the incident for a timely
response, but far enough away to be out of the E M E R G E N C Y O P E R A T IO N S C E N T E R (E O C ):
immediate impact zone. There may be more than one
staging area at an incident. Staging areas can be  a central command and control facility
collocated with the ICP, bases, camps, helibases, or responsible for carrying out the principles of
helispots. emergency preparedness and emergency
management, or disaster management functions
at a strategic level during an emergency, and
B ase is the location from which primary ensuring the continuity of operation of a
logistics and administrative functions are company, political subdivision or other
coordinated and administered. The base organization. An EOC is responsible for the
may be collocated with the incident strategic overview, or "big picture", of the
command post. There is only one base per incident, and disaster, and does not normally directly control
it is designated by the incident name. The base is field assets, instead making operational
established and managed by the logistics section. The decisions and leaving tactical decisions to lower
resources in the base are always out-of-service. commands. The common functions of all EOC's
is to collect, gather and analyze data; make
decisions that protect life and property, maintain
C am p s : Locations, often temporary, within
continuity of the organization, within the scope of
the general incident area that are equipped
applicable laws; and disseminate those
and staffed to provide sleeping, food, water,
decisions to all concerned agencies and
sanitation, and other services to response
individuals. In most EOC's there is one individual
personnel that are too far away to use base facilities.
in charge, and that is the Emergency Manager.
Other resources may also be kept at a camp to support
incident operations if a base is not accessible to all
Abigail marie Finals | Disaster Nursing 36
JO IN T IN F O R M A T IO N C E N T E R (JIC ): collect, gather and analyze data; make decisions
that protect life and property, maintain continuity
 the facility whereby an incident, agency, or of the government or corporation, within the
jurisdiction can support media representatives. scope of applicable laws; and disseminate those
Often co-located – even permanently designated decisions to all concerned agencies and
– in a community or state EOC the JIC provides individuals.
the location for interface between the media and
the PIO. Most often the JIC also provides both E m e rg en cy O p eratio n s C en ter v s M u ltip le ag en cy
space and technical assets (Internet, telephone, co o rd in atio n cen ter
power) necessary for the media to perform their EOC
duties. A JIC very often becomes the "face" of  a permanently established facility and operation for
an incident as it is where press releases are a political jurisdiction or agency.
made available as well as where many  often, but not always, follow the general ICS
broadcast media outlets interview incident staff. principles but may utilize other structures or
It is not uncommon for a permanently management (such as an emergency support
established JIC to have a window overlooking function (ESF) or hybrid ESF/ICS model) schemas
an EOC and/or a dedicated background showing  For many jurisdictions the EOC is where elected
agency logos or other symbols for televised officials will be located during an emergency and,
interviews. like a MACC, supports but does not command an
incident.
JO IN T O P E R A T IO N S C E N T E R (JO C ): M AC C
 a separate entity with a defined area or mission and
 A JOC is usually pre-established, often operated lifespan
24/7/365, and allows multiple agencies to have a
dedicated facility for assigning staff to interface M u ltiag en cy C o o rd in atio n S ys tem s
and interact with their counterparts from other
agencies. Although frequently called something
other than a JOC, many locations and
jurisdictions have such centers, often where
Federal, state, and/or local agencies (often law
enforcement) meet to exchange strategic Facilities Equipment Personnel
information and develop and implement tactical
plans. Large mass gathering events, such as a
presidential inauguration, will also utilize JOC-
type facilities although they are often not
identified as such or their existence even Procedures Communications
publicized.

M U L T IP L E A G E N C Y C O O R D IN A T IO N C E N T E R A S ys tem . . . N o t a F acility
(M A C C ):

 is a central command and control facility

responsible for the strategic, or "big picture" of a
disaster. A MACC is often used when multiple
incidents are occurring in one area or are
particularly complex for various reasons such as
when scarce resources must be allocated
across multiple requests. Personnel within the
MACC use multi-agency coordination to guide
their operations. The MACC coordinates
activities between multiple agencies and
incidents and does not normally directly control
field assets, but makes strategic decisions and
Coordination Groups/Department
leaves tactical decisions to individual agencies. Operations Centers
The common functions of all MACC's is to
Abigail marie Finals | Disaster Nursing 37
 where as an incident reduces in size command
can be passed down to a less qualified person
(but still qualified to run the now-smaller incident)
to free up highly qualified resources for other
tasks or incidents.
 Other reasons to transfer command include
jurisdictional change if the incident moves
locations or area of responsibility, or normal
turnover of personnel due to extended incidents.
The transfer of command process always
includes a transfer of command briefing, which
may be oral, written, or a combination of both.

C o m m an d v s. C o o rd in atio n

 Direct tactical and operational responsibility for

conducting incident management activities rests
with the Incident Command/Unified Command/
Area Command.
 Coordination and Support of Incident
Command/Area Command rests with the
Emergency Operations Center and other
elements of the multi-agency coordination
system.

S u m m a ry
 Incidents typically begin and end locally and are
managed on a daily basis at the lowest possible
geographical, organizational, and jurisdictional
level.
 However, there are instances in which
successful incident management operations
IC S E q u ip m en t depend on the involvement of multiple
jurisdictions, levels of government, functional
 The "typ e" of resource describes the size or
agencies, and/or emergency responder
capability of a resource. For instance, a 50 kW (for a disciplines.
generator) or a 3-ton (for a truck). Types are  These instances require effective and efficient
designed to be categorized as "Type 1" through coordination across this broad spectrum of
"Type 5" formally, but in live incidents more specific organizations and activities.
information may be used.  NIMS uses a systematic approach to integrate
 The "kin d " of resource describes what the resource the best existing processes and methods into a
unified national framework for incident
is. For instance, generator or a truck. The "type" of management.
resource describes a performance capability for a  This framework forms the basis for
kind of resource for instance, interoperability and compatibility that will, in turn,
 In both type and kind, the objective must be included enable a diverse set of public and private
in the resource request. This is done to widen the organizations to conduct well−integrated and
potential resource response. effective emergency management and incident
response operations.
CO M M AN D TRAN SFER  It does this through a core set of concepts,
principles, procedures, organizational
processes, terminology, and standards
 A role of responsibility can be transferred during requirements applicable to a broad community
an incident for several reasons: As the incident of NIMS users
grows a more qualified person is required to
take over as Incident Commander to handle the
ever-growing needs of the incident, or in reverse

Abigail marie Finals | Disaster Nursing 38

 H O S P IT A L IN C ID E N T C O M M A N D S Y S T E M (H IC S )

M an ag em en t S ys tem an d T o o ls fo r E v en ts 6. Guidance requirements from the NIMS and

accreditation agencies regarding hospital use of
incident command system principles with
O b jectiv es
community partners
 Learn the principal concepts and features of the
7. Management by Objectives in which the problem
Hospital Incident Command System
encountered is evaluated, a plan to remedy the
 Understand the roles and relationships of the
problem identified and implemented, and
Hospital Incident Management Team
resources assigned
 Understand the principles of Incident Action
Planning One of the key focuses of the Joint Commission and the
National Incident Management System is community
T H E B E N E F IT S O F U S IN G H IC S IN C L U D E :
collaboration and coordination. By having one system
and one “language” that we all use helps to achieve this
1. Efficient and coordinated response to
goal.
emergencies;
2. Seamless integration in the Multi-Agency H IC S F E A T U R E S
Coordination System (MACS) with community
response partners; used by fire, law, public  Hospital Incident Management Team Chart
safety, governmental agencies. Provides for
 All hazards approach
community collaboration and coordination.
 In cid en t A c tio n P la n n in g
3. National Incident Management System (NIMS)
 Job Action Sheet
consistence;
 Incident Planning Guides (IPG)
4. Federal preparedness and response grant
 Incident Response Guides (IRG)
consistence; and
5. Accreditation consistence  HICS Forms
 Demobilization and Recovery

H IC S O v erv iew HICS 2014 Revision - The word “hospital” was added to
 Assists in emergency management planning, the Incident Management Team to differentiate between
response, and recovery capabilities for unplanned federal and state Incident Management Teams
and planned events
 Consistent with ICS and the National Incident W H E R E D O I F IN D H IC S IN F O R M A T IO N ?
Management System (NIMS) principles
o Logical management structure  www.emsa.ca.gov/disaster_medical_services_di
o Defined responsibilities vision_hospital_incident_command_system
o Clear reporting channels  www.calhospitalprepare.org
o Common nomenclature  www.hicscenter.org

H IC S IS B A S E D O N F U N D A M E N T A L E L E M E N T S :
B asic In cid en t C o m m an d S tru c tu re
1. Predictable chain of command with a suggested
Incident
span of control
Commander
2. Accountability of position and team function,
including prioritized action checklists
3. Common language for promoting interagency Public Safety
Information Officer
communication Officer

4. A flexible and scalable incident management

Liaison Medical/
system addressing planning and response Officer Technical Specialist(s)

needs of any size hospital with universal

applicability
Operations Planning Logistics Finance/
5. Modular design and adaptability allowing Section Chief Section Section Chief Administration
planning and management of non-emergent Chief Section Chief
incidents or events Modular Organization:
Functional Sections Activated as Needed

Abigail marie Finals | Disaster Nursing 39

 H o sp ital In cid en t C o m m an d S yste m activities within the Hospital Command Center, sets the
 The system is scalable so that more or fewer operational periods, and devises strategies and priorities
positions -depending on the emergency - may be to address those objectives that are communicated in
implemented the Incident Action Plan.

 One of the main aspects of HICS is it’s

Many facilities are not using the CEO as the Incident
sca lab ility
Commander. The CEO needs to remain available to
 Only activate needed positions
 In cid en t C o m m an d er is the one position that is manage the entire hospital (while the IC manages the
always activated. It may be the only position Event). The CEO also needs to be available to liaison
that is activated. with the Governing Board.

P u b lic In fo rm atio n O fficer

C o m m an d
D esc rip tio n /D u ties :
C o m m an d fu n ctio n s  Communicate with internal and external
 M ain tain o v erall m an ag em e n t o f th e in cid en t stakeholders including:
 Sets incident objectives and priorities  Staff
 Devise and approve strategies  Patients, visitors and family
 Ensure mission completion  Media
 Determine information to be released
C o m m an d S ec tio n co n sists o f:  Collaborate with local community officials (Joint
 Incident Commander Information Center) for consistent content
 Command Staff  Obtains Incident Commander approval on
messages
Incident Commander  R ep o rts to : Incident Commander

T h e P u b lic In fo rm atio n O fficer (P IO ) is responsible for

Public Information coordinating information sharing inside and outside the
Safety Officer
Officer hospital. He/she serves as a conduit for information to
internal personnel and external stakeholders, including
the media or other organizations/agencies.
Liaison Officer Medical/
Technical Specialist(s) This is an important position and requires a trained
person in the position.
 Works closely with the Situation Unit Leader
Even if you are not functioning in a command position, it
 Keep staff informed to decrease rumors
is important to have an understanding of what the other
 Works with the JIC – Joint Information Center.
positions, sections are doing Provide a common community message.
Example: Northridge Earthquake boil water
In cid en t C o m m an d er D escrip tio n an d D u ties messages were different.
 Determine scope, magnitude and facility impact
 Activates Hospital Incident Management Team S afety O fficer
(HIMT) down to the Chief level
 Activate and direct Hospital Command Center D esc rip tio n /D u ties :
 G iv e o vera ll strateg ic d irec tio n fo r th e h o sp ital  Ensure safety of staff, patients and visitors
 Initiate and approve the Incident Action Plan  Monitor and have authority over the safety of
 Authorize total facility evacuation if warranted rescue operations and hazardous conditions
 Completes 201 Incident Briefing  Determine safety risks
 The only position always activated  Initiate corrective/protective actions
 Completes the HICS form 215A, Incident Action
T h e In cid en t C o m m an d er is the only position always Plan Safety Analysis
activated in HICS. The Incident Commander is  Has authority to halt any operation that poses
responsible for the management of the incident within immediate threat to life and health
the hospital. The Incident Commander directs all of the  R ep o rts to : Incident Commander

Abigail marie Finals | Disaster Nursing 40

T h e S afe ty O fficer monitors hospital response  For example the Incident Commander might
operations to identify and correct unsafe practices. activate:
He/she institutes measures for assuring the safety of all  Legal Affairs / Risk Management – Infant
assigned personnel. abduction
 Ethicist – who gets the vents during Pan Flu
L iaiso n O fficer
C o m m an d R ev iew
D esc rip tio n /D u ties :
 Hospital contact to external supporting agencies T h e In cid en t C o m m an d er is resp o n s ib le fo r:
and organizations  Overall management of the Incident
 Make facility needs and requests for assistance  Activities the Hospital Command Center
and resources  Continuing as Incident Commander until
 Provides Situation Reports (SitRep) to authority is delegated to another
government partners
 R ep o rts to : Incident Commander T h e C o m m an d S taff co n sists o f:
 Public Information Officer (PIO)
T h e L iaiso n O fficer is the hospital’s primary contact for
 Liaison Officer
external agencies assigned to support the hospital
during incident response. In some cases, a Liaison  Safety Officer
Officer may be assigned to the Hospital Command  Medical/Technical Specialist(s)
Center and a Deputy Liaison Officer or Assistant (or an
Agency Representative) assigned to represent the
S ec tio n s
hospital at the field Incident Command Post or local
emergency operations center

M ed ical/T ech n ica l S p ec ialis t

D esc rip tio n /D u ties :

 Subject matter experts that advise the Incident
Commander and/or assigned section as needed
 May be assigned as technical advisor in the
Hospital Command Center
 May be assigned to advise and oversee specific
hospital operations
 E xa m p le: Decontamination operations during a
chemical exposure situation
 R ep o rts to : Incident Commander  Depending on the event, other General Staff
positions (e.g., Operations, Planning, Logistics, and
M ed ical-T ech n ical S p ec ialis ts are persons with
specialized expertise in areas such as infectious Finance/Administration Section Chiefs) may be
disease, legal affairs, risk management, medical ethics, activated by the Incident Commander. Qualified
etc., who may be asked to provide the HIMT staff with personnel assigned to serve as Section Chiefs
needed insight and recommendations. Medical- receive a briefing, their names are recorded on the
Technical Specialists may be assigned anywhere in the Hospital Incident Management Team chart, and their
HICS structure as needed. appointment is announced as outlined in the
hospital’s Emergency Operations Plan>
 In normal day to day operations we have redundant
E xa m p les In clu d e:
activities through each department--such as staffing,
 Biological  Risk Management
 Infectious Disease  Pediatric Care obtaining resources, budget/financials, etc…
 Chemical  Medical Ethicist HOWEVER, during an incident we don’t want that
 Radiological  Clinical Administration redundancy, so we manage through the functions of
 Legal Affairs  Hospital each section. For example, Logistics handles the
 Medical Staff Administration obtaining of resources for the entire incident,
 The list goes on… Finance handles the budget issues for the entire
incident.
Abigail marie Finals | Disaster Nursing 41
 Command and general staff must continually interact  Security Branch
and share vital information and estimates of current  Business Continuity Branch
and future situation
 These Branches are included in the Operations
O p eratio n s Section because each of these areas provides
services that are essential for supporting the mission
of delivering patient care in the challenging
circumstances of the immediate incident and not
simply routine day-to-day logistical support.
 For example, the facilities personnel in the
Infrastructure Branch are providing for the utility
needs for the incident; security personnel are
maintaining order; and the information technology
and business continuity personnel are keeping the
computerized systems operational for information
sharing and record keeping among various areas of
the hospital. In some internal emergencies (e.g.,
child abduction, water outage, or computer system
failure) the function of one or more of these areas
becomes an essential part of restoring normal
operations.
 H IC S 201 4 R ev isio n - To separate patient and
employee family assistance, a Patient Family
 The Operations Section manages all incident tactical Assistance Branch has been added under the
activities and implements the Incident Action Plan Operations Section to address patient family needs
(IAP). This section is typically the largest due to the during a response, and an Employee Family Care
role of management and coordination of immediate Unit Leader has been included in the Support
resources needed to respond to the incident. Branch within the Logistics Section to assist
 Branches and units are implemented as needed to healthcare staff and clinicians by providing support
maintain a manageable span of control and for their families.
streamline the organizational management. The
number of positions activated depends on situational S tag in g M an ag er
needs and the availability of qualified staff.
M issio n :
O p eratio n s S ec tio n  Organize and manage the deployment of
supplementary resources, including:
O p eratio n s S ec tio n M issio n :  Personnel
 Vehicles
 Manage tactical operations
 Equipment, supplies, and medications
 Direct all tactical resources
 Carry out the mission and Incident Action Plan T h e S tag in g M an ag er works closely with the Logistics
Section to learn what is needed and ensure that the
 Directs all tactical resources requested item(s) are delivered to the correct location as
 Led by the Operations Section Chief soon as possible. In turn, the Logistics Section works to
obtain those needed items and directs their arrival to the
Staging Area as outlined in the Emergency Operations
O p eratio n s S ec tio n are the hands on – “D O E R S ,” with
Plan (EOP) and/or at the request of the Staging
boots on the ground
Manager.
T h e S ec tio n in clu d es : In situations where the number of staged items is too
 Staging Area great or must be kept in separate locations, a team
 Medical Care Branch leader can be assigned to coordinate each type of asset
 Patient Family Assistance Branch being staged (e.g., Personnel Staging Team Leader,
Vehicle Staging Team Leader, Equipment/Supply
 Infrastructure Branch
Staging Team Leader, and Medication Staging Team
 HazMat Branch Leader).

Abigail marie Finals | Disaster Nursing 42

Staging – “read y to p u t to u se” – waiting for In frastru ctu re B ran ch D ire cto r
assignment
M issio n :
The Staging Area can be virtual or physical (i.e.
 Organize and manage services required to
personnel staging area – Cafeteria - physical, paper list
– virtual) sustain and repair the hospital’s infrastructure
operations
D u ties:
M ed ical C are B ran c h D ire cto r  Maintain overall facility operations and operating
M issio n : capacity
 Organize and manage the delivery of  Identify and fixes utility service-delivery failures
emergency, inpatient, outpatient, casualty care,  Assign personnel to address damage and
and clinical support services ongoing monitoring of critical infrastructure
D u ties : S u p erv ises:
 Coordinate acute and continuous care  Power/Lighting Unit Leader
 Work with Logistics and Finance for resource  Water/Sewer Unit Leader
acquisition  HVAC Unit Leader
 Work with Staging Manager for delivery of  Building/Grounds Unit Leader
resources to areas  Medical Gases Unit Leader

T h e M ed ical C are B ran c h is responsible for providing The maintenance of overall hospital facility operations
care to the incident victims, non-incident related arrivals, support activities to meet the medical care needs of the
as well as patients already within the hospital. patients and protect staff. The responsibility for
maintaining facility operations primarily rests with the
S u p erv ises : Infrastructure Branch in the Operations Section.
 Inpatient Unit Leader (all inpatient units)
 Outpatient Unit Leader (all outpatient services) Maintenance of the normal operational capability of the
facility includes power and lighting (Power/Lighting Unit),
 Casualty Care Unit Leader water and sewer (Water/Sewer Unit), heating,
 Behavioral Health Unit Leader ventilation, and air-conditioning (HVAC Unit), medical
 Clinical Support Unit Leader (Lab, Diagnostic gases (Medical Gases Unit), and building/grounds
Imaging, Pharmacy, Morgue, Blood Donor) (Building/Grounds Damage Unit). This branch is
 Patient Registration Unit Leader responsible for maintaining or potentially expanding
operating capacity as well as identifying and fixing utility
service delivery failures.
T h e M ed ical C are B ran c h D irec to r works with the
Logistics Branch to ensure needed personnel,
equipment, medication, and supplies. S ec u rity B ran c h D ire cto r
T h e C asu a lty C are U n it L ead er is often located in the
emergency department but can appoint additional M issio n :
personnel to coordinate triage and treatment activities  Coordinate activities related to internal and
elsewhere on the campus. These activities are external personnel and facility security
conducted in accordance with the hospital’s Emergency D u ties:
Operations Plan (e.g., separation of victims into triage  Implement facility security measures
categories such as Immediate, Delayed, and Minor
treatment areas).  Ensure security and access control of the
Hospital Command Center
Patients arriving at the hospital must be quickly triaged  Liaison with responding law enforcement
to a treatment location for expedited medical care. If  Oversee search and rescue operations
activated, the Triage Unit Leader’s treatment priority S u p erv ises:
(triage category) should be plainly identified on a
 Access Control Unit Leader
patient’s tag or band. A quick but reliable registration
process should be implemented by the Patient  Crowd Control Unit Leader
Registration Unit to avoid delays in medical care and  Traffic Control Unit Leader
facilitate patient tracking. The daily registration process  Search Unit Leader
can be reinstituted once the incident is stabilized and  Law Enforcement Interface Unit Leader
staffing allows.

Abigail marie Finals | Disaster Nursing 43

T h e S ec u rity B ran c h coordinates all activities related to operation of the hospital's information system
patient, staff, and hospital security. A significant number and information technology
of actions should be considered early in an incident:  Supports the Infrastructure and Security
 Secure and restrict access Branches with needed movement or relocation
 Supplemental security staffing to alternate business operation sites.
 Traffic control  Coordinates with Logistics Section
 Personal belongings management Communications Unit Leader, Information
 Evidence collection and chain-of-custody Technology/Information Services Equipment
considerations Unit Leader, and the impacted area(s) to expand
and/or restore business functions and review
technology requirements.
H azM at B ran ch D ire cto r  Maintains and repairs information technology
equipment with logistical support from the IT/IS
Equipment Unit Leader in the Service Branch of
M issio n :
the Logistics Section.
 Organize and direct hazardous material incident
response activities B u sin es s co n tin u ity is an area that is greatly
 Technical and emergency decontamination; and overlooked. Business recovery was once the arena only
facility and equipment decontamination of the IT departments. However, the resumption on
D u ties: “normal” services and recovery of the facility is essential
for community health and facility financial viability. It is
 Oversee hazmat event
very important that business continuity be addressed
 Decontamination of victims, staff, facility during the response phase and managed throughout
 Safe and appropriate use of PPE recovery.
 Clean up operations
 Collaborates with Medical Care Branch Director S u p erv ises:
 IT Systems and Applications Unit Leader
T h e H azM at B ran c h will have the personnel and  Service Continuity Unit Leader
equipment to address agent identification (Detection and
 Records Management Unit Leader
Monitoring Unit), spill response (Spill Response Unit),
victim decontamination (Victim Decontamination Unit),
and decontamination of equipment and the hospital If the IT systems (network) is down, we are very
dependent on IT, including Electronic Medical Records,
and other IT systems.
S u p erv ises:
 Detection and Monitoring Unit Leader
 Spill Response Team Unit Leader P atie n t F am ily A s sis tan ce B ran c h D ire cto r
 Victim Decontamination Unit Leader
 Facility/Equipment Decontamination Unit Leader M issio n :
 Organize and manage assistance for patient
B u sin es s C o n tin u ity B ran ch D irec to r family care needs, including communication,
lodging, food, health care, spiritual, and
M issio n : emotional needs that arise during the incident.
 Ensure business functions are maintained, D u ties:
restored or augmented  Ensure patient family assistance resources
D u ties:  Coordinate external community resource
 Facilitate acquisition and access to essential requests
recovery resources, including business records  Ensure Family reunification, Social Service,
 Coordinate IT services with Logistics Section Cultural and Spiritual needs
 Assist Branches and impacted areas to restore  Communication with law, government and non-
normal operations governmental agencies, and media through the
Liaison Officer and Public Information Officer
T h e fu n ctio n o f th e B u sin es s C o n tin u ity B ran ch is to
assist impacted hospital functions, departments and
When large numbers of patients are received at a
areas to maintain, restore, or augment critical business
hospital the Patient Family Assistance Branch may be
functions, and meet the designated recovery objectives
activated to assist in meeting their needs.
and recovery strategies outlined in the Incident Action
Plan.
Family support should be provided in a secure location
T h e B u sin es s C o n tin u ity B ran c h :
suitable in size to accommodate the number of families
 Ensures the continued effective and efficient
Abigail marie Finals | Disaster Nursing 44
being assisted. Refreshments for their consumption L o g istics
should be obtained from the Food Services Unit Leader
and the availability of phones should be coordinated with
the Communications Unit Leader.

T h e S o cia l S erv ice s U n it L ead er will work with the

families to address their behavioral health needs and
other general support requirements. The Family
Reunification Unit Leader will take the lead in assisting a
family to locate their loved one or friend through the
hospital's patient tracking program (working with the
Planning Section’s Patient Tracking Manager) or the
community’s patient location system

S u p erv ises:
 Social Services Unit Leader
 Family Reunification Unit Leader  Logistics are the “G etters ”
 Logistics works closely with Operations
 Logistics takes care of the “Doers” - they get
The mission of the Social Services Unit Leader is to what is needed and take care of the resources
organize and manage patient social service
requirements during a disaster, by coordinating with
community and government resources.
L o g istics S ec tio n
The Unit addresses:
 Housing, shelters and authorized care sites
 Food and water distribution centers and L o g istics S ec tio n M issio n :
resources  Organize and direct maintenance of the physical
 Clothing distribution centers environment – providing human resources,
 Medical and non-medical transportation material, and services to support the incident
 Pharmacies, including 24 hour availability  Provides support (stuff) to other sections
 Pet and animal shelters  Acquires resources from internal and external
 Translator services, such as ATT
sources
 Child, adult, and dependent day care
 Interface with Faith-based organizations  Through Liaison, links to local Emergency
 Interface with the American Red Cross Operations Center for resource requests
 Led by the Logistics Section Chief
F am ily R eu n ifica tio n U n it L ead er organized and
managed the services and processes required to assist T h e L o g istics S ec tio n provides for all the support
in family reunification. needs of the incident. These responsibilities include
Family unification area, protocols, including: acquiring resources from internal and external sources,
identification, tracking, documentation, and using standard and emergency acquisition procedures
communication. as well as requests to other hospitals, corporate
Resources, cultural and spiritual, interpreter services, partners, and the local emergency operations centers
transportation needs (EOC) or the Regional Hospital Coordination Center
(RHCC) or equivalent.

O p eratio n s S ec tio n R ev iew L O G IS T IC S , O P E R A T IO N S A N D F IN A N C E

T h e O p eratio n s S ec tio n is resp o n s ib le fo r: L o g istics, O p eratio n s an d F in an ce are clo se ly lin ked

 The tactical objectives and organization an d m u st w o rk co llab o ra tiv ely
 All tactical operations  Logistics Section are the “getters”
 Directing all tactical resources  Operations Section are the “doers”
 Operations is led by the O p eratio n s C h ief  Finance Section are the “checkbook”

S co p e an d R esp o n sib ilities o v erlap

 Logistics Supply Unit and Operations’
Infrastructure Branch

Abigail marie Finals | Disaster Nursing 45

  Labor Pool and Credentialing Unit and Staging S u p p o rt B ran c h D ire cto r
Manager– Personnel Tracking Manager
M issio n :
Some actions seem to overlap between the sections but  Manage supplies, facilities, transportation, and
there is a demarcation between them, for example: labor pool. Provide logistical, psychological, and
 Personnel medical support to hospital staff and their
 Logistics (Labor Pool) “gets” more personnel. dependents
 Once cleared for use – Staging in Operations O v ersees :
holds them for deployment
 Employee Health and Well-Being Unit Leader
 Operations decides how to use them
 Planning writes the plan of how they will be Employee Family Care Unit Leader
used and tracks where they ended up Supply Unit Leader
 Finance calculates how much it will cost Transportation Unit Leader
Labor Pool and Credentialing Unit Leader
T h e S ec tio n in clu d es :
 Service Branch  E m p lo ye e H ealth – includes staff
 Support Branch Mental/Behavioral Health
 E m p lo ye e F am ily C are – pet care might be a
team here or a separate Unit
 T h e S erv ice B ran c h is responsible for supporting
 F acility U n it L ead er – maintaining day to day
communication (Communications Unit); information
facility operations (i.e. light bulbs) as opposed to
technology/information services resource needs Infrastructure position deleted
(Information Technology/Information Services [IT/IS]
Equipment Unit); and food services for patients and L o g istics S ec tio n R ev iew
staff (Food Services Unit).
 T h e S u p p o rt B ran ch is responsible for acquiring
T h e L o g istics S ec tio n is resp o n sib le fo r:
needed supplies (Supply Unit); coordinating internal
 Organizing and directing internal and external
and external transportation (Transportation Unit);
resources to support the incident
acquiring and credentialing additional personnel
 Providing support to other sections
(Labor Pool and Credentialing Unit); employee
 Logistics supports the incident resource
health and behavioral health (Employee Health and
requirements
Well-Being Unit); and staff family care (Employee
Family Care Unit).
L o g istics h as tw o b ran ch e s:
 Support
S erv ice B ran ch D irec to r
 Service
M issio n :
 Logistics is led by a Chief who works closely with the
 Organize and manage services to maintain
Operations and Finance Sections
hospital communication, food and water supply
and information technology and systems
O v ersees : P lan n in g S ectio n
 Communications Unit Leader
 IT/IS and Equipment Unit Leader
 Food Services Unit Leader

C o m m u n icatio n s U n it L ead er - Manages

communication hardware, i.e. phones, radios

IT /IS U n it an d E q u ip m en t U n it L ead er -
 Provide computer hardware, software and
infrastructure
 Coordinates closely with Operations Section
Business Continuity Branch, IT Unit
F o o d S erv ices U n it L ead er
 Organize food and water stores and prepare for
rationing during periods of anticipated or actual
shortage

Abigail marie Finals | Disaster Nursing 46

 The Planning Section collects, evaluates, and performed by the Situation Unit Leader unless
disseminates situational information and intelligence assigned to other personnel. Important information
regarding incident operations and assigned may be displayed using tracking boards, chart pads,
resources, conducts planning meetings, and or computer software programs.
prepares the Incident Action Plan for each  T h e D o cu m en tatio n U n it L ead er completes the
operational period. The effectiveness of the Planning Incident Action Plans and other supporting
Section has a direct impact on the availability of documents and archives them based on instructions
information needed for the critical strategic decision- from the Incident Commander or the Emergency
making done by the Incident Commander and the Operations Plan. Assures documentation is in order,
other General Staff positions. key role to the emergency planner.
 The Planning Section personnel are the “Brains”  T h e D em o b ilizatio n U n it L ead er is responsible for
“Thinkers” – they are the keepers of the information, developing demobilization activities (e.g., a
track and document the event. And they do some Demobilization Plan) for approval by the Incident
current/future planning and share information. Commander, presenting the plan to designated
Command Staff and revising the plan as needed
M issio n : once implementation is underway.
 Collect, evaluate, and disseminate incident
action information and intelligence to Incident T h e P la n n in g S ec tio n is res p o n sib le fo r:
Commander  Collecting, evaluating and disseminating incident
 Prepare status report situation information to the Hospital Command
 D ev elo p th e In cid en t A c tio n P la n Center
 Led by the Planning Section Chief  Completing HICS 202 Incident Objectives
 Maintaining status of resource requests
P la n n in g S ec tio n C h ief  Developing the Incident Action Plan (IAP) and
obtaining Incident Commander approval on the
S u p erv ises: IAP
 Resources Unit Leader  Archiving response and recovery documentation
 Personnel Tracking  Assisting with After Action Report development
 Material Tracking
F in an ce S ec tio n
 Situation Unit Leader
 Patient Tracking
 Bed Tracking

 Documentation Unit Leader

 Demobilization Unit Leader

 T h e R eso u rces U n it L ead er tracks the status of

personnel and material resources that are being
utilized in various locations of the hospital.
T h e F in an ce/A d m in istra tio n S ec tio n coordinates
Personnel Tracking and Materiel Tracking Managers
personnel time (Time Unit); orders items and initiates
may be appointed to assist when necessary. contracts (Procurement Unit); arranges personnel-
 T h e S itu atio n U n it L ead er is responsible for writing related payments and Workers’ Compensation
and maintaining situational updates based on (Compensation/Claims Unit); and tracks response and
internal and external events, including those related recovery costs and payment of invoices (Cost Unit).
to patient tracking and bed tracking. These
managers maintain current patient location Activating Finance in beginning of event or in drills plays
an essential role in financial guidance and recovery
assignments/bed capacity and make this information
available to Hospital Incident Management Team
personnel as well as the local emergency operations
centers and other appropriate external agencies
through the Liaison Officer.
Monitoring the media (TV, radio, and print) will also
provide needed situational awareness and should be
Abigail marie Finals | Disaster Nursing 47
F in an ce/A d m in istra tio n S ec tio n C h ief T h e Jo b A c tio n S h ee t (JA S ) is an incident
management tool designed to familiarize the user with
M issio n : critical aspects of the management position he or she is
assuming. Information provided on a JAS includes the
 Monitor the utilization of financial assets and the
position title and mission, to whom the position reports,
accounting for financial expenditures and critical action considerations. These tasks are
 Supervise the documentation of expenditures intended to prompt the Hospital Incident Management
and cost reimbursement Team members to take needed actions related to their
 Coordinates documentation of any incident- roles and responsibilities. The JAS format allows for
specific injuries as a result of the response personnel to document each action taken at specific
times. The JAS also depicts the position within the HIMT
activities
and highlights reporting relationships. HICS 2014
Revision: The JAS have been extensively revised and
T h e F in an ce S ec tio n C h ief keeps track of all the costs include action steps sectioned into time frames.
of an event.
JO B A C T IO N S H E E T F O R M A T
S u p erv ises:
 Time Unit Leader O p eratio n s S ec tio n C h ief
 Procurement Unit Leader
 Compensation/Claims Unit Leader M issio n :
 Cost Unit Leader  Develop and implement strategies and tactics to
 Works closely with Logistics in coordinating carry out the objectives established by the
funding and cost accounting response Incident Commander. Organize, assign, and
supervise the resources of the Staging Area, the
 T im e U n it L ead er– personnel time Medical Care, Infrastructure, Security,
 C o st U n it L ead er– puts together all cost + lost Hazardous Materials (HazMat), Business
revenue (cancelled surgeries) Continuity, and Patient Family Assistance
Branches.

T H E H O S P IT A L IN C ID E N T M A N A G E M E N T T E A M

P u ttin g it all to g eth er: C h o o sin g th e H o sp ital

In cid en t M an ag em en t T eam :
 Incident Commander is the only position that
must be activated
 The Incident Commander activates positions
down to the Chief Level
 Each Section Chief appoints positions under
their section needed to complete the mission,
based on available personnel A c tio n S tep s an d C o n sid era tio n s
 Job Action Sheet provides position action steps
Both the Incident Commander and the Chiefs assign and considerations
positions only as determined by the scope and
magnitude of the incident in keeping with the principle of
scalability, which is important during an emergency. A c tio n s listed b y R esp o n se T im e P erio d s
Im m ed ia te 0 – 2 hours
In term e d iate 2 – 12 hours
Jo b A c tio n S h ee ts
E xte n d ed Beyond 12 hours
S eries o f actio n step s to “p ro m p t” team m em b ers to D em o b ilizatio n / S ys tem
take n eed ed actio n s related to th eir ro les an d R eco v ery
res p o n sib ilities
 One for each position
 Includes title, mission/function and duties
 Can be adjusted to meet hospital needs
 Refers to supporting HICS forms for
the …position

Abigail marie Finals | Disaster Nursing 48

  Are divided in response time periods:
 Immediate: 0 – 2 hours
 Intermediate: 2 – 12 hours
 Extended : Greater than 12
hoursDemobilization/System Recovery
 Standardized to facilitate interagency response
 Customizable for the unique facility needs/roles

You may customize the Job Action Sheets to facility, but

keep title and mission the same

H o sp ital In cid en t A c tio n P la n n in g

K ey to E ffectiv e R esp o n se an d R eco v ery

D o cu m en ts/T o o ls:
 A listing of pertinent HICS forms this position is
 In cid en t actio n p lan n in g is a core concept for a
responsible for using
successful response and recovery from any incident.
 Forms noted in Job Action Sheet action
Developing and utilizing an Incident Action Plan (IAP)
steps
provides the goals, strategies, and tactics to
 Other tools that will help them fulfill their role and
facilitate the Management by Objectives and
responsibilities
ensures understanding of the strategic direction. The
 Hospital plans, policies and procedures
planning process is effective for both smaller, short-
 Technology tools
term incidents and more complicated long-term
 Other adjuncts
incidents and the IAP is scalable (e.g., HICS IAP
Quick Start versus a fully documented IAP). Incident
O p eratio n s C h ief
action planning provides:
o Provides the organization’s strategic
direction
o Maximizes available resources
o Reduces omissions and duplication of
efforts
o Reduces cost
o Gathers and disseminates information
o Improves and enhances communication
o Provides a historical record of the incident

 In cid en t A c tio n P la n n in g is the key to having an

organized, logical, planned out response
JO B A C T IO N S H E E T U S E  The forms used to make up the Incident Action
Planning vary by incident, but a minimum include:
 Job Action Sheets are used continuously 201, 202, 203, 204 & 215A, and the IAP QuickStart
 Actions in all operational periods should may also be used at the beginning of an event or for
be continued and monitored smaller incidents
 Job Action Sheets should transfer to your  HICS forms augment the Incident Action Planning
replacement and actions continued process
 Upon shift change or position change
H O S P IT A L IN C ID E N T A C T IO N P L A N N IN G
JO B A C T IO N S H E E T S E C T IO N R E V IE W
1. Assess the Situation
T h e Jo b A c tio n S h ee ts are : 2. Set the Operational Period
3. Determine Safety Priorities and Incident
 An incident management tool
Objectives
 A series of actions to meet the incident response
4. Determine Branch/Section Objectives
Abigail marie Finals | Disaster Nursing 49
 5. Determine Strategies and Tactics The Operational Period is almost never shorter than 2
6. Determine Needed Resources hours
7. Issue Assignments
8. Implement Actions  Usually the 1st period is 2 hours long. Depends
on how fast things are changing, if the situation
9. Reassess and Adjust Plans
is still not fully assessed.

#3 D eterm in e S afety P rio rities an d In cid en t

A c tio n p lan n in g is what we do on a daily basis: O b jectiv es

 H o m e – plan your day out, critical items you

S afe ty P rio rities :
need to do, take the kids to soccer, MD
appointment. Who is going to do what.  T h e S afe ty O fficer id en tifies S afe ty P rio rities
Evaluate at the end of the day – did you get  Document hazards and potential
everything done. hazards, along with mitigation activities
 W o rk – review all your emails, what do you on the 215A
need to get done now, today. How are you
going to get it done, delegate some of it.
 E xa m p les :
Evaluate at the end of the day – did you get
everything done, what do you have to do first  H azard : Smoke from nearby wildfire
thing tomorrow.  M itig atio n : Close outside air intake
valves
 A s sig n ed P erso n n el: Infrastructure
#1 A s se ss th e S itu atio n Branch Director

T h e In cid en t C o m m an d er co n d u cts th e in itial O B JE C T IV E S A R E N E X T , B U T T H E R E A R E T W O

in cid en t ass ess m en t: T Y P E S O F O B JE C T IV E S
 Type, location, magnitude, possible duration
1. In cid en t O b jectiv es:
 On-going hazards and safety concerns
 Broad, overall focus of the hospital’s response
 Determine initial priorities based on:
1 - Life saving  Documented on the 201 Incident Briefing and
2 - Incid ent stabiliza tio n 202 Incident Objectives
3 - P rop erty preservatio n
2. S ec tio n /B ra n ch O b jectiv es:
 Establishes the Hospital Command Center
 Specific objectives that are developed for each
#2 S et th e O p eratio n al P erio d Branch
 Documented on the 204(s) Assignment List
A n O p eratio n al P erio d is:
 The time period scheduled for execution of IN C ID E N T O B JE C T IV E S :
tactical actions in the Incident Action Plan
 Broad organizational objectives that are
 Set by the Incident Commander
foundational and do not change during response
and recovery; not limited to an operational
T h e O p eratio n al P erio d is u su ally set in h o u rs
period
 Does not have to conform to shift times
 Can be long or short, depending on the intensity
E xa m p les :
of the incident
 Provide adequate care to all patients who
present as a result of the incident
T h e o p eratio n al p erio d is the time period in which
chosen objectives are to be met and identified strategies  Provide for the safety of hospital personnel
and tactics are carried out. This time period is flexible,
may be of various lengths, and is determined by the Initial priorities are based on life safety, incident
Incident Commander according to the needs of the stabilization, and property preservation. To ensure safety
incident. The length of the operational period varies, of patients, staff, and visitors, the Safety Officer
usually between 2 and 24 hours. The operational period assesses the hazards, determines strategies to mitigate
does not need to correspond to hospital shift times and the hazards, and assigns personnel to carry out the
may be shortened or extended based on situational tactics.
response and incident progression. The Incident Commander determines the initial incident

Abigail marie Finals | Disaster Nursing 50

objectives. The incident objectives are documented on strategies, tactical actions, and resources identified to
the HICS 202: Incident Objectives. address the priorities for the operational period and
(Individual sections, branches and units will identify accomplish the incident objectives.
strategies and tactics for their response (HICS 204: Documentation includes:
Assignment List) based on these objectives set by the  Section Chiefs and/or Branch Directors
Incident Commander which is done in Step 4.) complete the HICS 204: Assignment List stating
section/branch/unit-specific incident objectives
The Planning Section Chief initiates the HICS 202:  The HICS 204: Assignment Lists are submitted
Incident Objectives which includes: to the Planning Section and distributed to
 Incident name Command, General Staff, and Documentation
 Operational period date and time Unit Leader as part of the Incident Action Plan
 Incident objectives, as obtained from the
Incident Commander These are the individual Section/Branch objectives just
 Weather and environmental implications for the current Operational Period. What do you need to
 Factors to consider (refer to the HICS 215A: focus on for this time frame.
Incident Action Plan (IAP) Safety Analysis)  Each Section/Branch (Operations, Logistics,
 Incident Commander approval Planning, Finance) will have their own objectives
 These individual incident objectives are
These will last through out the whole event documented on an individual 204 for each
 Usually has to do with Safety, Patient Care, Section/Branch/Unit
Dealing with media and other agencies
 Documented on the HICS 202 Incident
Objectives #5 D eterm in e S tra teg ies an d T actics

S tra teg y d efin ed :

#4 D eterm in e In d iv id u al S ec tio n /B ra n ch O b jectiv es  The general direction selected to accomplish
incident objectives
In d iv id u al S ectio n /B ran c h O b jectiv es  The approach to achieving the objectives
 Specific Branch/Section objectives to achieve T actics d efin ed :
overall Incident Objectives - Steps to take during  Specific actions, sequence of actions,
that Operational Period procedures, tasks, assignments to meet
 Should be tangible and measurable strategies and objectives
 Documented on HICS 204 Assignment List  The “boots on the ground” or “doers”
 Documented in 5b of HICS 204 form
E xa m p le:
 Provide prophylaxis to 50% of on duty direct
patient care staff within 12 hours
 Ensure all critical power plugged into red plugs
within 1 hour

T here can be m ultip le H IC S 204 form s – one for each

S ection and B ranch

Strategies are the general plans or directions selected to

accomplish incident objectives for individual sections.
Tactics are the short-term, specific actions taken to
complete, or satisfy, the incident objectives (e.g., the
directing/deployment of resources during an incident).
The Section Chiefs and Branch Directors document
strategies and tactics on the HICS 204: Assignment List.

Additional incident objectives will be identified by Section Some hospital people may be confused by the use of the
Chiefs and/or Branch Directors to be addressed in the word “tactical” in ICS. The Operations Section is the
specified operational period. These incident objectives boots on the ground, the ones who are mounting the
will comprise a section/branch/unit–specific set of defense and carrying out patient care operations, using
Abigail marie Finals | Disaster Nursing 51
equipment, supplies, and personnel resources to Staff Medical Plan to outline resources for
accomplish the mission. Therefore, the word “tactics” is medical care of injured/ill hospital personnel, as
used for operations, as they are responsible for needed
managing tactical resources, or the boots/troops on the
ground. #7 Issu e A s sig n m en ts

#6 D eterm in e N eed e d R eso u rc es O n ce th e o b jectiv es an d n eed ed reso u rces are

 Available and needed resources to meet the id en tified , assig n m e n ts are issu e d :
objectives must be identified  Hospital Command Center positions are
 Tactical resources may include: activated according to incident needs
 Personnel  Staff are assigned to conduct incident specific
 Equipment operations:
 Supplies  Evacuation
 Pharmaceuticals  Decontamination
 Vehicles  Triage and treatment
 Safety measures
D ocum e nte d in box 5c of H IC S 204 form

The next step is to identify needed resources. Examples

of needed resources include personnel, equipment,
The next step is for the Section Chiefs, Branch Directors,
supplies, pharmaceuticals, and vehicles. Just as in daily
and Unit Leaders to make staff assignments specific to
operations, there are many components to resource
response action (e.g., Triage, Evacuation,
identification, requisition, distribution, and restocking.
Decontamination, Security). This step includes
completion and distribution of the following:
The following must be ensured:
 HICS 204: Assignment List documents specific
 Section Chiefs coordinate with Branch Directors
assignments within each section/branch/unit
and Unit Leaders to determine needed
activated
resources within their specific section
 The Planning Section Chief, or designee
 Logistics Section Chief confers with Operations
(Resource Unit Leader) completes the HICS
Section Chief to coordinate obtaining the
203: Organization Assignment List and
resources
distributes to Command and General Staff,
 Finance/Administration Section Chief confers Branch Directors and Documentation Unit
with Logistics and Operations Section Chiefs to Leader
assure appropriate financial tracking as
individual sections identify resource needs
T H E P L A N N IN G M E E T IN G
Documentation includes:
 HICS 204: Assignment Lists are used to T h e P la n n in g M eetin g is:
document specific resources needed within the  Led by the Planning Section Chief
section/branch/unit  Defines and finalizes operational period
 Logistic Section Communication Unit Leader objectives, strategies, tactics, and resources as
completes the HICS 205A: Communications List determined by each section (Documented on the
to identify communication resources and
designate equipment and channels to be used HICS 204 Assignment List) for the next
within the hospital and for coordination with operational period
internal and external partners
 Logistic Section Employee Health and Well-
Being Unit Leader completes the HICS 206:

Abigail marie Finals | Disaster Nursing 52

T h e P la n n in g M eetin g is co n d u cted after: distributed to the HIMT as needed. The Section Chiefs
 Incident Commander has provided an incident evaluate the response and share the information with the
briefing and determined the Incident Objectives Command and General Staff and make corrective
actions.
and identified the Operational Period (HICS 201)
 Sections have met to discuss their response As an operational period is concluding, the Incident
priorities and identified Section/Branch Action Plan (IAP) process sets off again, beginning with
objectives (HICS 204s) an updated situational assessment/review of the
objectives to direct planning activities within sections and
A t th e en d o f th e P la n n in g M eetin g : identification of continuing activities and objectives for
the next operational period using a new o r rev ised set
 The Section Chiefs submit completed HICS
of forms and documents. The staffing of positions, the
Form 204 Assignment List to the Planning Chief assignment of resources, and other critical information
 The Safety Officer submits completed HICS should be developed for this new operational period
Form 215A Incident Action Plan Safety Analysis (and/or oncoming HIMT). The IAP will serve as the
to the Planning Chief guidance for what is to be done during this next
operational period.
#8 Im p lem e n t A c tio n s

D ire ct, m o n ito r an d ev alu ate resp o n se : In cid en t A c tio n P lan R esp o n sib ilities
 Constant monitoring of strategies and tactics
 Assess the Branch/Section Objectives T h e In cid en t C o m m an d er
 Are the objectives being achieved?  Develops the Incident Briefing (HICS 201)
 Is the strategy/tactics safe?  Provides overall Incident Objectives
 Is the strategy/tactics effective?  Sets the Operational Period
 Develops major strategies (priorities)
E va lu atio n is an o n g o in g p ro ces s th ro u g h o u t  Activates Hospital Incident Management Team
res p o n se an d reco ve ry (Command and General Staff)
 Establishes policy for resource orders
Supervisors meet with their staff for a detailed briefing  Approves initial actions and the Incident Action
on their assignments using the approved Incident Action Plan
Plan (IAP). Staff members are directed to complete their
assignments and to report their activities.
T h e C o m m an d S taff:
 Develops overall incident objectives and
strategy
#9 E v alu ate an d R ev ise P lan s  Determines the operational period
 Approves resource orders and (later)
C o n d u ct a cu rren t situ atio n asse ssm en t demobilization
 Update situation/incident information  Approves the Incident Action Plan (IAP)
 Assess the impact on the hospital
T h e S afe ty O fficer
 Length and duration of incident
 Advises the Incident Commander and Section
 Resource availability
Chiefs on safety issues and measures
 Develops the Safety Plan (HICS 215A)
 Assess the Incident Objectives
 Assure objectives are achieved in a safe and timely  Oversees the safety of operations and tactics
manner  Has responsibility and authority to halt response
 Revise objectives, strategies, tactics and resource activities based on safety concerns
needs for the upcoming operational period
T h e O p eratio n s S ec tio n C h ief
A s th e In cid en t A c tio n P la n (IA P ) is used in the  Determines/assesses areas of operation
response, there is ongoing assessment of the  Advises Incident Commander of activated
effectiveness of strategies and tactics. Plans should be Operations positions and work assignments
continually reassessed and revised. The revision of the  Determines Section/Branch objectives,
plan d o es n o t h av e to w ait in step 9 serv es as th e strategies and tactics, resource requirements
ro ad m ap for the next operational period. Adjustments in
and issues assignments (HICS 204)
assignments, activation of additional branches or units,
and revised safety plans should be documented and

Abigail marie Finals | Disaster Nursing 53

  Communicates needs with Logistics T h e F in an ce/A d m in istra tio n S ec tio n :
 Develops cost analyses to help ensure that the
T h e O p eratio n s S ec tio n : Incident Action Plan (IAP) is within the financial
 Assists with developing strategy limits established by the Incident Commander
 Identifies, assigns, and supervises the resources  Develops contracts, procures, and pays for the
needed to accomplish the incident objectives resources
 Reports costs
T h e P la n n in g S ec tio n C h ief
T h e In cid en t A c tio n P la n
 Completes HICS 202 Incident Objectives
 Provides Hospital Incident Management Team
 Prepares for the Planning Meetings
with direction for the Operational Period
 Gathers information for the Incident
 Uses the elements of Management by
Action Plan (HICS 201, 202, 203, 204s
Objectives
and 215A)
 Developed by Command and General Staff
 Develops demobilization plans
 Essential for effective response and recovery
 Conducts the Planning Meeting
 Coordinates and submits the Incident Action
Plan to the Incident Commander for approval D em o b ilizatio n an d R eco v ery
 Disseminates the Incident Action Plan
 Planning for demobilization should begin early in the
T h e P la n n in g S ec tio n : response. The Planning Section Demobilization Unit
 Provides status reports Leader is tasked with developing preliminary
 Tracks resources and identifies shortages activities (e.g., Demobilization Plan) for when and
 Manages the planning process how demobilization is to occur and revising the plan
 Develops the Incident Action Plan (IAP) as needed once implementation is underway. The
decision to move from response to demobilization
T h e L o g istics S ec tio n C h ief
will be made by the Incident Commander.
 Activates Logistics positions and advises
Incident Commander of work assignments
P rep aratio n fo r D em o b ilizatio n
 Determines Section/Branch objectives,
strategies and tactics, resources and issues
D E M O B IL IZ A T IO N
assignments (HICS 204)
 Communicates with Operations and Finance
 The Demobilization Plan is created by the
 Ensures resources to support Incident Action
Demobilization Unit Leader and approved by the
Plan and develops plans as needed that support
Planning Section Chief and Incident
the Incident Action Plan such as:
Commander
 Communications Plans
 Demobilization begins
 Transportation Plans
 As incident objectives are met
 Follow-on objectives are more focused
T h e L o g istics S ec tio n :
upon recovery and returning to “normal”
 Orders resources
 Assists in the development of the transportation,  The demobilization of resources no
communications, and medical plans longer Needed should occur rapidly and
efficiently
T h e F in an ce/A d m in istra tio n S ec tio n C h ief
 Determines Section/Branch objectives, Depending on the situation, not all areas of the hospital
strategies and tactics, resource requirements will begin demobilization at the same time. Planning
should address not only when the demobilization
and issues assignments (HICS 204)
process is to begin but also how it will be implemented.
 Tracks personnel and materiel costs and
provides cost implications of the Incident When the decision to demobilize has been made, it
Objectives should be communicated by the Planning Chief or
 Ensures the Incident Action Plan is within cost Demobilization Unit Leader to hospital staff and by the
limitations Liaison Officer to appropriate external agencies (e.g.,
EMS, fire, law enforcement, local health department, and
 Advises the Incident Commander on
emergency management). Select information may need
Finance/Admin activated positions to be shared with the patients and their families. The
Public Information Officer (PIO) should also determine
Abigail marie Finals | Disaster Nursing 54
the need to share information with the general public, O rg an izatio n al L earn in g
particularly in situations where hospital operations have
been curtailed and will subsequently be resumed T h e rec o v ery p lan in clu d es p rin cip le s o f
o rg an izatio n al learn in g an d im p ro v em en t:
D E M O B IL IZ A T IO N C O N S ID E R A T IO N S  After Action Report and Improvement Plan
 Evaluate hospital response/recovery operations
 Demobilizing must be a part of the Incident
 Identify strengths, weaknesses, and strategies
Action Plan
to:
 Managing public perception
 Lessen future vulnerability
 Equipment rehabilitation and restocking  Improve ability to respond to future
 Financial restoration incidents
 Addressing hospital personnel concerns  Revise the Emergency Operations Plan

R eco v ery Following the termination of the response, a series of

 Recovery follows response and focuses upon debriefing meetings should be held at various levels to
returning to baseline level of functioning provide involved staff with the chance to share
 The starting point for recovery begins early in information on what worked well and possible
the response improvement options. These comments should be
formally recorded and reflected as part of the After
 Transition from response to recovery is rarely Action Report (AAR) and Corrective Action and
obvious Improvement Plan (IP) process for the incident.
 Recovery may extend over a long time, from
weeks to years P u rp o s e o f th e A fte r A c tio n R ep o rt
 Document exercise and response activities
A hospital’s return to day-to-day operations may be  Identify operational successes and deficiencies
progressive. Planning should take into account that  Analyze findings to determine effectiveness and
ramped-up methods to accommodate medical surge will efficiency of the Emergency Operations Plan
be dismantled as patient care activities allow. Extra  Plan of action for implementing needed
equipment, supplies, and medications will return to the improvements
pre-incident “just-in-time” inventory levels as soon as the
opportunity permits. C o rre ctiv e A c tio n P la n s m ay in clu d e:
 Emergency Operation Plan revision
Recovery efforts will also need to address various other  Develop additional plans, Policies and
personnel issues. The Logistic Section’s Support Branch Procedures
plays an important coordination role for all matters  New equipment, supplies, systems
pertaining to staff and family support.  Identify additional training and exercises
Operations Section Chief will primarily be responsible for
coordination of this activity, along with the Medical Care
and Infrastructure Branches. S ec tio n R ev iew
 Demobilization and Recovery should be planned
The costs associated with a hospital’s response to any early
incident can be significant. This is especially true if
 Demobilization and Recovery is the return to
documentation is not collected properly. From the outset,
the Finance/Administration Section has the responsibility “normal,” or “new-normal”
to track the various costs associated with the response  Demobilization is managed by the Planning
including personnel, patient care, resources, equipment Section
repair and replacement, and hospital repair/operations.  The development of a Demobilization Plan by
the Demobilization Unit Leader
Normally, hospitals enjoy the trust of the communities
they serve. However, this trust may be shaken when
performance during an incident is below public
expectations. In addition, there may be concerns about a
hospital’s capability for providing patient care if there has
been noticeable damage or if the cleanliness and safety
of the hospital has been compromised by the perceived
presence of HazMat or a dangerous pathogen. The
hospital must remain responsive to these issues and
proactive in allaying fears and, if necessary, rebuilding
the public trust.

Abigail marie Finals | Disaster Nursing 55

 S ce n ario s allows the emergency manager to ensure that activities
In cid en t P la n n in g G u id es an d In cid en t R esp o n se within each of the emergency management phases are
G u id es considered during plan development. The IPG should be
viewed as a template, with hospitals carefully
considering the recommended actions for their
T h ere are 16 S ce n ario /In cid en t P lan n in g an d customized plans.
R esp o n se G u id es to assis t in p lan n in g an d train in g :
1. Active Shooter Hospitals may use the IPG in a variety of ways,
2. Chemical Incident including:
3. Earthquake  Develop strategies and actions to reduce the
4. Evacuation, Shelter-in-Place, and Hospital impact of the event or threat
 Assess current plans and identify gaps in
Abandonment
planning
5. Explosive Incident  Develop or customize event-specific response
6. Hostage or Barricade Incident guides for the hospital
7. Infectious Disease
8. Information Technology (IT) Failure These are used in the planning process, not the
9. Mass Casualty Incident response
10. Missing Person
HICS Revision 2014 – The Incident Planning Guides
11. Radiation Incident (IPGs) and Incident Response Guides (IRGs) have been
12. Severe Weather with Warning reformatted and consolidated or expanded for improved
13. Staff Shortage application among hospitals
14. Tornado
15. Utility Failure In cid en t R esp o n se G u id es (IR G s)
16. Wildland Fire  Provides Incident Specific:
o Directions
In cid en t P la n n in g G u id es an d In cid en t R esp o n se o Incident Objectives
G u id es are tools hospitals and healthcare partners may o Management tasks by function and
use to evaluate and improve their level of preparedness.
timeframes
IPGs outline strategic considerations for hospitals to
assess when writing their response plans. IRGs develop o Sample Hospital Incident Management
incident-specific response guides for the hazards that Teams
may impact the hospital. The guides include the  Should compliment:
following: o Emergency Operations Plan and Job Action
 The Incident Scenario Sheets
 The Incident Planning Guide (IPG)  Can be used as documentation
 The Incident Response Guide (IRG)
 A recommended list of Documents and Tools,
including HICS Forms S ec tio n R ev iew
 A recommended Hospital Incident Management
Team (HIMT) Activation Chart for each response In cid en t P la n n in g G u id es an d In cid en t R esp o n se
period G u id es:
 Are incident-specific tools to assist with planning,
training and response/recovery
In cid en t P lan n in g G u id es (IP G s)  Assist in meeting regulatory requirements
 Incident Planning Guides assist hospitals with  Guide Command and General Staff with
evaluating existing plans or writing needed plans decision-making and actions
o They address 16 scenarios  Should be consistent with the hospital
o They are intended to identify actions or Emergency Operations Plan
strategies to prepare for identified hazards  Do not replace the Job Action Sheets
o Assess current plans and identify gaps
o Develop event-specific response guides

T h e In cid en t P lan n in g G u id e (IP G ) identifies potential

actions or strategies the hospital may use in preparing
for the identified hazard. The IPG actions are grouped
into the four phases of emergency management:
mitigation, preparedness, response, and recovery. This

Abigail marie Finals | Disaster Nursing 56

 H IC S F o rm s 203 Organizational Assignmen Resource Unit Leader
t List
204 Assignment List Branch Directors
205 Communications Log Communications Unit Lead
er
206 Staff Medical Plan Support Branch Director
207 Organization Chart Incident Commander
213 Incident Message Form All Positions
 H IC S R ev isio n 201 4 - The HICS Forms have been 214 Operational Log All HIMT Staff
215a Incident Action Plan Safet Safety Officer
revised to be more consistent with those used by the
y Analysis
Federal Emergency Management Agency (FEMA). IAP IAP QuickStart Incident Commander and P
Additionally, there are 3 new HICS Forms available QS lanning
for hospital use: Incident Action Plan (IAP) Quick
Start; the HICS 200: IAP Cover Sheet; and the HICS No. Nam e R e s p o n sib le
221: Demobilization Check-Out. 221 Demobilization Check-Out Demobilization Unit Leader
251 Facility System Status Rep Infrastructure Branch Direct
T H E V A L U E O F U S IN G H IC S F O R M S ort or
252 Section Personnel Time Sh Section Chiefs
eet
 Serve as a road map in response: everyone
acting from the same plan 253 Volunteer Staff Registration Labor Pool and Credentiali
ng Unit Leader
 Serve as foundation for corrective action
254 Disaster Victim / Patient Tr Patient Tracking Manager
 Ensure consistency and compliance with acking
regulatory guidelines 255 Master Patient Evacuation Patient Tracking Manager
 Complies with documentation for FEMA Tracking
reimbursement 256 Procurement Summary Re Procurement Unit Leader
port
257 Resource Accounting Section Chiefs
Having a standardized form used by all responders Record
provides a familiar and consistent method of 258 Hospital Resource Resource Unit Leader
documenting an incident and ease in sharing Directory
information. Local and federal agencies have adopted 259 Hospital Casualty / Fatality Patient Tracking Manager
standardized forms with the use of Federal Emergency Report
Management Agency (FEMA) Incident Command 260 Patient Evacuation Trackin Inpatient Unit Leader Outpa
System (ICS) forms. HICS has modified select FEMA g Form tient Unit Leader, Casualty
ICS forms (2010 edition) to reflect hospital functions. Care Unit Leader
Where possible, HICS has maintained the intent and
layout of the FEMA forms. Not every FEMA ICS form is
applicable to a hospital; in that case, the FEMA form has H IC S F o rm s 200 : In cid en t A c tio n P la n S h eet
not been utilized by HICS. There are additional functions  P u rp o s e: Provides a cover sheet and a
performed by hospitals that are not addressed by FEMA
forms, so additional hospital based forms have been checklist for HICS Forms and other documents
developed to fill those needs. included in the operational period Incident Action
Plan
T h e fo rm s are ess en tials to o ls:  O rig in atio n : Incident Commander or Planning
 They help to document and guide the Incident Section Chief
Action Planning Process
 C o p ies to : Command and General Staff and
 The County Emergency Operations Center is
utilizing similar forms Documentation Unit Leader
 The forms match up with FEMA forms  H elp fu l T ip s: Additions may be made to the
 Necessary for federal reimbursement for an form to meet the organization’s needs
event
H IC S F o rm 201 : In cid en t B rie fin g
H IC S F o rm s  P u rp o s e: Documents initial response
information and actions at start-up
No. Nam e R e s p o n sib le  O rig in atio n : Incident Commander
200 Incident Action Plan Cove Planning Section Chief  C o p ies to : Command Staff, Section Chiefs, and
r Sheet
Documentation Unit Leader
201 Incident Briefing Incident Commander
202 Incident Objectives Section Chiefs

Abigail marie Finals | Disaster Nursing 57

  W h en to C o m p lete: Prior to briefing the current  Used in development of the Incident Action Plan
operational period
 H elp fu l T ip s : Distribute to all staff before initial The order has been changed to begin with what are our
objectives, strategies and tactics, and needed resources,
briefing
followed by who is activated to the Unit to flow with the
Incident Action Plan process.
201 Incident Briefing most significant changes:
 Changed to match the FEMA 201 form The 204 is the only form that looks significantly different
 Designed to provide a summary of the current than the FEMA form in that it addresses the needed
Operational Period information for the Incident Action Plan
 Provides a situational status report and update
to the oncoming Incident Commander

H IC S F o rm 203 : O rg an izatio n A s sig n m e n t L ist

H IC S F o rm 202 : In cid en t O b jectiv es
 P u rp o s e: To document Hospital Command
 P u rp o s e: Defines incident objectives
Center staffing
 In stru ctio n s : Include  O rig in atio n : Planning Section Chief or
 Weather/Environmental Implications designee (Resources Unit Leader)
 General Safety/Safety Messages
 C o p ies to :
 Attachments
 Command Staff and General Staff
 Prepared by Planning Section Chief
 Branch Directors and Agency Staff
 A p p ro v ed b y: Incident Commander
 Documentation Unit Leader

204 Assignment List(s) Previously 204 – Branch

Assignment List
 Documents the objectives, strategies and
tactics, and resources needed for each
Section/Branch for the current operational period

Abigail marie Finals | Disaster Nursing 58

 P ag e 1

P ag e 2

H IC S F o rm 204 : A s sig n m en t L ist

 P u rp o s e: Document branch assignments,
objectives, strategies/tactics and resource needs
 O rig in atio n : Section Chief or Branch Director
 C o p ies to : Command, General Staff and
Documentation Unit Leader
 W h en to co m p lete: At the start of each
operational period

A 204 is filled out by each branch. So if you activated 3 H IC S F o rm 215 A : In cid en t A c tio n P lan S afety
branches in the Operations Section, you should end up A n alys is
with three 204s from the Operations Section.  P u rp o s e: Document hazards and mitigation
For sections like Planning and Finance that don’t have  O rig in atio n : Safety Officer
branches, you would just have one for the whole section
 C o p ies to : Command and General Staff,
204 Assignment List(s) Previously 204 – Branch Sections, and Branches
Assignment List  P rep ared b y: Safety Officer
 Documents the objectives, strategies and  A p p ro v ed b y: Incident Commander
tactics, and resources needed for each  W h en to co m p lete: Prior to safety briefing
Section/Branch for the current operational period during the operations briefing and at transfer of
 Used in development of the Incident Action Plan
roles
The order has been changed to begin with what are our
objectives, strategies and tactics, and needed resources, Initial priorities are based on life safety, incident
followed by who is activated to the Unit to flow with the stabilization, and property preservation. To ensure safety
Incident Action Plan process. of patients, staff, and visitors, the Safety Officer
assesses the hazards, determines strategies to mitigate
The 204 is the only form that looks significantly different the hazards, and assigns personnel to carry out the
than the FEMA form in that it addresses the needed tactics. This information is recorded on the HICS 215A:
information for the Incident Action Plan Incident Action Plan (IAP) Safety Analysis. The Safety
Officer initiates the HICS 215A which includes:
Abigail marie Finals | Disaster Nursing 59
  Incident name
 Operational period date and time
 Identification of hazards (potential and actual)
 Actions to be taken to reduce risk and ensure
safety
 Assignments for mitigation activities listed
 Date prepared
 Time prepared
 Facility name
 Incident Commander approval

HICS 2014 Revision - This form was previously 261 –

Now changed to 215A to conform with new FEMA form
numbering

H IC S F O R M 214: A c tiv ity L o g

 P u rp o s e: Document
H IC S F O R M 213: G en eral M essag e F o rm  Incident issues encountered
 P u rp o s e: Provide standardized message  Decisions made
recording  Notifications conveyed
 In stru ctio n s :  O rig in atio n : Command and General Staff
 R esp o n se req u ired : Indicate a reply was  W h en to co m p lete:
requested and to whom reply addressed  Continuously, from activation through
 P rio rity : Indicate level of urgency demobilization
 M essag e :
 Keep all messages/requests brief, V ery im p o rtan t d o cu m en t
to the point, and very specific  This is where you document the nuts and bolts
of actions you have taken
 Transcribe complete, concise, and
 Should not use yellow pads, scratch pads and
specific content other odds and ends notes
 A c tio n T aken (if any)  Since all documentation should be standard, this
is the form to use
3 typ es o f in fo rm atio n m u st b e d o cu m en ted
1. Assignments made
2. Resources requested
3. Status updates

If they are not documented elsewhere this form, then the

information can be passed on with this form

If a request is made the response can be documented

on this form

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 P ag e 1

H IC S F o rm IA P Q u ick S tart:
 P u rp o s e: A short form combining forms 201, P ag e 2
202, 203, 204 and 215A. May be used in place
of full forms to document initial actions or short
incidents, and can expand to the full forms as
needed.
 O rig in atio n : Incident Commander or Planning
Section Chief

T h e H IC S IA P Q u ick S tart was designed because there

are often limited resources or time to complete multiple
forms or the incident may be small in scope, requiring
less documentation.

T h e H IC S IA P Q u ick S tart was developed to provide a

shorter, more concise documentation tool. As the
incident expands or additional assistance is available,
the information can be expanded onto the full version of
the complementing HICS Form.

H IC S 201 4 R ev isio n – This is a new form

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 S ec tio n R ev iew O P E R A T IO N A L IZ IN G H IC S

T h e H IC S fo rm s:  Assign an individual in charge of implementation

 Provide the Hospital Incident Management  Obtain support from the CEO/senior leadership
Team with documents needed to manage a  Make it high priority for administrators and staff
response  Provide budgets support
 Assist in communication with external agencies  Establish training requirements/competencies
 Assist in communication with hospital staff  Promote integration into the community
 Documents response and recovery response
 Provide training of HICS and Emergency
H IC S D U R IN G O F F H O U R S A N D S M A L L A N D R U R A L Operations Plan
H O S P IT A L S  Exercise the plan and use of HICS

The same principles for large hospitals is used at smaller The application and adaptation of HICS to the individual
hospitals or during off hours, holidays and weekends at hospital requires education and training to produce
all size hospitals proficiency and competency. Once mastered, it provides
 Activate needed Hospital Incident Management an easy-to use framework to manage any incident.
Team members
S ev eral step s are n eces sary to in teg rate H IC S in to
 When not enough staff, it may be necessary to h o sp ital o p eratio n s, in clu d in g :
blend job roles into a single Job Action Sheet  Assign an individual with appropriate authority
 For example, the Incident Commander may and respect within the hospital to be in charge of
assume the role of the Public Information Officer HICS implementation according to an outlined
and even the Liaison Officer. plan
 Obtain support from the hospital’s Chief
Executive Officer (CEO) and other senior
The same HICS principles that make it useful for large administrators
hospitals apply to small hospitals as well. In addition,  Encourage the recognition that HICS
hospitals of all sizes must be able to apply HICS to implementation must be a high priority for both
crises that occur during off hours and on holidays and administrators and staff
weekends.  Provide financial resources and budgets needed
to support emergency management and HICS
Small hospitals will benefit from the use of HICS, but activities
some have found it difficult to make needed adaptations.  Establish training requirements/competencies
The same problem exists for all hospitals operating at that meet established national standards
night, on the weekend, or during holidays. The  Promote hospital integration into the community-
successful use of HICS depends in part on only based response
activating the Hospital Incident Management Team  Provide training of HICS, in addition to training
(HIMT) positions that the situation requires. For a small of the hospital Emergency Operations Plan
hospital, successful adaptation requires the blending of (EOP)
some job roles into single Job Action Sheets (JAS). For
example, staff at Critical Access Hospitals routinely
perform multiple job roles on a daily basis. During an
emergency, those same people will need to assume
more than one position on the HIMT, at least initially.
During nights, weekends, and holidays, hospitals of
medium and large size will likely have to begin to build
their HIMT in a similar fashion.

Some positions are more easily combined than others.

It’s not uncommon for the Incident Commander to
assume the role of the Public Information Officer (PIO)
and even the Liaison Officer. However, some positions,
such as the Safety Officer or Medical- Technical
Specialists, should not be combined with other job
responsibilities unless absolutely necessary.

H IC S 201 4 R ev isio n - A new chapter addressing the

implementation of HICS during off hours and for small
and rural hospitals has been added.

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 B L S -C P R R E S U S C IT A T IO N

P h ys io lo g y o f B rea th in g  P A S S A G E Blood Vessels

 Arteries carry blood away from the heart towards
different organs. Arteries manage transportation of
oxygen, nutrients throughout the body
 Veins collect oxygen-poor blood and return them
back towards the heart
 Capillaries provices blood, nutrients and energy to
cells of organs. Capillaries connect the arteries and
veins

L ife S u p p o rt

B A S IC L IF E S U P P O R T (B L S )

 An emergency procedure that consist of

recognizing respiratory arrest or cardiac arrest
or both and the proper application of CPR to
maintain life until a victim recovers or advanced
P h ys io lo g y o f C ircu la tio n life support is available.
 P U M P Peripheral Circulation is concerned with the
transport of blood, blood flow distribution, exchange A D V A N C E D C A R D IA C L IF E S U P P O R T (A C L S )
between blood and tissue, and storage of blood
(venous system)  The use of special equipment to maintain
o Systemic provides the functional blood breathing and circulation for the victim of cardiac
supply to all body tissue. LV to body parts emergency.
and back to RA
P R O L O N G E D L IF E S U P P O R T
o Pulmonary is the system of transportation
that shunts de-oxygenated blood from the
 For post resuscitative and long term
heart to the lungs to be re-saturated with
resuscitation
oxygen before being dispersed into the
systemic circulation. RV to Lungs and back
to LA C ard io v ascu lar D ise ase s
 P A S S E N G E R Blood runs in a closed system
throught the blood vessels and the four chamber of R isk F acto r fo r C ard io v asc u lar D ise ase s
the heart. F o u r m ain co m p o n en ts: pla sm a, red
1. R isk F acto rs th at can n o t b e ch an g ed :
blo od cells, w hite blo od cells, and pla telets. Blood
 Heredity
has many different functions, including: transporting
 Age
oxygen and nutrients to the lungs and tissues.
 Sex
forming blood clots to prevent excess blood loss.

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 2. R isk F acto rs th at can b e ch an g ed o r
co n tro lled :
 Cigarette smoking
 Hypertension
 Elevated cholesterol/triglyceride level
 Lack of exercise
 Obesity
 Stress
 Diabetes mellitus

H eart A ttac k

W arn in g S ig n als
 Chest discomfort
 Sweating
 Nausea
 Shortness of breathe

C ard iac A rrest

 Condition when circulation ceases and vital organs
are deprived of oxygen

T h ree co n d itio n o f C ard iac A rre st F irst A id M an ag em en t

 Cardio Vascular Collapse 1. Recognize the signal and take action.
 Ventricular Fibrillation 2. Have the patient stop from doing things and
 Cardiac Standstill have the patient sit or lie down in a comfortable
position.
D iag n o sis o f C ard ia c A rre st 3. Have someone call the M.D or ambulance for
help.
 Blood pressure measurement
4. Assist in taking his/her prescribed medicine.
 Taking the pulse on peripheral arteries
 Auscultation of cardiac tones
C ard io p u lm o n a ry R esu sc itatio n
 S ym p to m s o f C ard ia c A rres t
 Is the combination of ch est co m p res sio n s and
 Absence of pulse on carotid arteries –
res cu e b reath in g , given to a victim of card iac
pathognomic symptom
arrest.
 Respiration arrest – may be in 30
seconds after cardiac arrest COUGH CPR
 Enlargement of the pupils – may be in
90 seconds after cardiac arrest  Is a self- initiated CPR, which is possible and is
limited to patient with monitored cardiac arrest
and the arrest was recognized before the patient
losses consciousness.

 C o m p res sio n O n ly C P R

Let's say it's 6:15pm and you're driving home (alone of

course) after an unusually hard day on the job.
You're really tired, and frustrated……
Y O U A R E R E A L L Y S T R E S S E D A N D U P S E T ….
Suddenly you start experiencing severe pain in your
chest that starts to radiate out into your arm and up into
your jaw.
You are only five miles from the hospital nearest your
home.
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Unfortunately you don't know if you'll be able to make it T im e E le m en t
that far
G o ld en H o u r
W HAT TO DO ???
 From moment of injury or illness
You have been trained in cpr, but the guy that conducted
 To definitive treratement
the course did not tell you how to perform it on yourself !!!
 “EMS Platinum Time”
H O W T O S U R V IV E A H E A R T A T T A C K W H E N A L O N E ?
A s se ssm en t an d M an ag em en t
= since many people are alone when they suffer a heart  Every action must have lifesaving purpose
attack, without help, the person whose heart is beating  Organized, detail-oriented, selective, rapid
improperly and who begins to feel faint, has only about
10 seconds left before losing conscious

ANSW ER:
Do not panic, but start coughing repeatedly and very
vigorously.

A deep breath should be taken before each cough, the

cough must be deep and prolonged, as when producing
sputum from deep inside the chest.

A breath and a cough must be repeated about every two

seconds without let-up until help arrives, or until the
heart is felt to be beating normally again.

Tell as many other people as possible about this.

It could save their lives !!! Don't ever think that you are
not prone to heart attack as your age is less than 25 or
30. Nowadays due to the change in the
Life style, heartattack is found among people of all age
groups.

C h ain o f S u rv iv al
Chain of events that must occur in rapid succession to
maximize the chances of survival from sudden cardiac
arrest (SCA). C h ain o f S u rv iv al

1. E A R L Y A C C E S S (E A R L Y A C T IV A T IO N O R E A R L Y
D E T E C T IO N )

 Recognition of cardiac arrest and activation of

the emergency response system.

2. E A R L Y C P R

 Early cardiopulmonary resuscitation (CPR) with

an emphasis on chest compressions.
Bystanders can provide hands-only or
compression-only CPR.

3. E A R L Y D E F IB R IL L A T IO N

 Rapid defibrillation. Defibrillation that occurs in

less than 3 minutes after Sudden Cardiac Arrest.

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 Rapid defibrillation is the only definitive  Food
treatment for Sudden Cardiac Arrest.  Other Foreign Objects (FBAO)

4. E A R L Y A D V A N C E D R E S U S C IT A T IO N (E A R L Y
ACLS)

 Advanced resuscitation by Emergency Medical

Services and other healthcare providers.

5. E A R L Y P O S T C A R D IA C A R R E S T C A R E

 Post–cardiac arrest care is a critical component

of advanced life support. Most deaths occur
during the first 24 hours after cardiac arrest.

6. E A R L Y R E C O V E R Y

 The recovery phase consists of the need for

treatment, surveillance and rehabilitation for
cardiac arrest survivors, including assessment
for anxiety, depression and post-traumatic stress.

R E S C U E B R E A T H IN G

R esp irato ry A rre st

 Is a condition in which breathing stop or is
inadequate.

C A U S E S O F R E S P IR A T O R Y A R R E S T

1. O b stru ctio n
 Anatomical
 Mechanical

2. D ise ase s
 Bronchitis A irw ay M an ag em en t
 Pneumonia  Emergency medical care begins with ensuring an
 COPD and other respiratory illnesses open airway.
o The most common obstruction to a patient’s
O T H E R C A U S E S O F R E S P IR A T O R Y A R R E S T airway is the tongue

 Electrocution M A IN T A IN IN G A N O P E N A IR W A Y
 Circulatory Collapse
 External strangulation  Clearing or preventing obstructions of airways,
 Chest compression often referred to as choking, caused by
 Drowning the tongue, the airways themselves, foreign
bodies or materials from the body itself, such as
 Poisoning
blood or stomach content, the latter resulting
 Suffocation
in aspiration.
C O M M O N C A U S E S O F A IR W A Y O B S T R U C T IO N

 Dentures
 Blood
 Vomitus
 Mucus
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B A S IC A IR W A Y A D JU N C T S N aso p h aryn g ea l A irw ay (N P A )
 Relief of upper airway obstruction in awake,
semicomatose, or lightly anesthetized patients
 Patients who are not adequately treated with OPAs
 Undergoing dental procedures or with oropharyngeal
trauma
 Requiring oropharyngeal or laryngopharyngeal
suctioning

C O N T R A IN D IC A T IO N S :
 Contraindicated on patients with active nasal
bleeding.
 New postoperative rhinoplasty or septoplasty
patients because it can cause tissue trauma or
damage the newly altered structural integrity of
the surgical site. The nasal passages may also
be occluded with surgical packing.
 Signs of basilar skull fractures, facial trauma,
and disruption of the midface, nasopharynx or
roof of the mouth.
O ro p h aryn g e al A irw ay (O P A )
 The patient is unconscious minimally responsive
because it may stimulate gagging, which poses a S U P R A G L O T T IC A IR W A Y D E V IC E S
risk of aspiration.
 Nasopharyngeal airways are preferred for obtunded
patients with intact gag reflexes.

C O N T R A IN D IC A T IO N S :
 Contraindicated on a conscious patient with an
intact gag reflex.
 Patients that can cough.
 If the patient has a foreign body obstructing the
airway.

B A S IC A IR W A Y A D JU N C T S

NPA

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 L aryn g e al M ask A irw ay (L M A ) E so p h ag e al T rach e al A irw ay (E T A )
 Apnea, severe respiratory failure, or impending  Use in emergency situations and difficult airways.
respiratory arrest in which endotracheal intubation  It can be inserted without the need for visualization
cannot be accomplished. (blind insertion) into the oropharynx, and usually
 Certain elective anesthesia cases. enters the esophagus.
 Patients who needs to be intubated or ventilated
immediately before a surgical procedure can be C O N T R A IN D IC A T IO N :
performed.  Obstruction or other abnormality, ingestion of
caustic agents, upper airway foreign body or
C O N T R A IN D IC A T IO N S : mass, lower airway obstruction, height less than
4 feet, and an intact gag reflex.
 Patients with poor pulmonary compliance, high
airway resistance, pharyngeal pathology, risk for
aspiration, and/or airway obstruction below the
larynx. C R IC O T H Y R O ID O T O M Y / C R IC O T H Y R O T O M Y
 Morbidly obese individuals, pregnant women >
14 weeks gestation, individuals at increased risk
for aspiration, patients in which peak inspiratory
pressures may exceed 20 cm H20.

S U P R A G L O T T IC A IR W A Y D E V IC E S

C ric o th yro to m y
 Inability to establish an airway through orotracheal
or nasotracheal intubation.
 Excessive blood in the mouth or nose, massive
facial trauma, or airway obstruction resulting from
angioedema, trauma, burns, or a foreign body.

C O N T R A IN D IC A T IO N S :
 Inability to identify the landmarks.
 Underlying anatomical abnormality.
 Tracheal transection or severe trauma.
 Acute laryngeal disease due to infection or
trauma.
 Small children under 12 years old (a 10–14
gauge catheter over the needle may be used).

S u p p lem e n tal O xyg en

 Always give to patients who are hypoxic
o Some tissues and organs need a constant
supply of oxygen to function normally.
 Never withhold oxygen from any patient who might
benefit from it.

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 Supplemental oxygen equipment
o Become familiar with how oxygen is stored.
o Oxygen cylinders contain compressed gas.
o Liquid oxygen is becoming a more
commonly used alternative.

 S afe ty co n sid eratio n s

o Handle gas cylinders carefully.
o Make sure the correct pressure regulator is
attached.
o A puncture hole in a tank can turn it into a
deadly missile.
o Secure tanks during transport.
o HAZARDS:
 Oxygen does not burn or explode
but it speeds up the combustion
process.
 Keep any sources of fire away.
 Make sure the area is adequately
ventilated.
 Never leave an oxygen cylinder
standing unattended.

Pin-index system
Threaded system

O xyg en D eliv ery D ev ices

 Nasal cannulas
 Nonrebreathing masks
 Bag-mask devices
 Tracheostomy masks
 Continuous Positive Airway Pressure

A b d o m in al T h ru st
 Also called the H eim lich M an eu v er by Dr. Henry
Heimlich

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A B D O M IN A L T H R U S T : A D U L T C H E S T T H R U S T : U N C O N S C IO U S

CHEST THRUST: PREGNANT & OBESE

A B D O M IN A L T H R U S T : C H IL D

R E S C U E B R E A T H IN G
 Is a technique of breathing air into a person’s lungs
to supply him or her with the oxygen needed to
survive.

W A Y S T O V E N T IL A T E T H E L U N G S

 Mouth to Mouth breathing

C H O K IN G : IN F A N T  Mouth to Nose breathing
 Mouth to Mouth and Nose
 Mouth to Stoma
 Mouth to Face Shield RB
 Mouth to Mask RB
 Bag-Mask Device
 Cricothyrotomy

C P R B A R R IE R D E V IC E S

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C P R F ace S h ield C P R M ask BVM

C o n sid eratio n

G astric d isten tio n

- Occurs when artificial ventilation fills the
stomach with air
- Most commonly affects children
- Most likely to occur when you ventilate the
patient too forcefully or too rapidly
- May also occur when the airway is obstructed
- Slight gastric distention is not of concern.
- Severe inflation of the stomach is dangerous.
- Recheck and reposition the airway, apply cricoid
pressure, and perform rescue breathing.

S to m as an d trach e o sto m y tu b es
- Neither the head tilt–chin lift nor the jaw-thrust
maneuver is required.

- If the patient has a tracheostomy tube, ventilate

through the tube with a bag-mask device.

E lem e n ts o f B L S

D en tal ap p lian c es can cau se an airw ay o b stru ctio n B asic L ife S u p p o rt A d v an ced L ife S u p p o rt
- Examples: crown, bridge, dentures, piece of  ECG interpretation  Cardiac monitoring
braces  Use of AED  Intravenous fluids and
- Manually remove the appliance before providing  Oral and epi-pen medications
ventilations. injections  Advanced airway
- Leave well-fitting dentures in place.  Basic airway adjuncts adjuncts
- Loose dentures interfere with the process and
should be removed.
1. C O M P R E S S IO N : Chest compressions to circulate
F acia l b leed in g blood.
- Airway problems can be particularly challenging 2. A IR W A Y : Open airway.
in patients with serious facial bleeding.
3. B R E A T H IN G : Provide artificial respirations by
- Blood supply to the face is rich.
 Injuries can result in severe tissue rescue breathing.
swelling and bleeding into the airway.  Mouth-to-mouth
 Control bleeding with direct pressure,  Mouth-to-nose
and suction as necessary.  Use of mechanical device

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 CAB of CPR S E Q U E N C E IN P E R F O R M IN G C P R A N D R E S C U E
B R E A T H IN G

 Survey the Scene (Universal Precaution)

 Check Responsiveness (AVPU)
 Activate Medical Assistance (AMA) and inform
Transfer Facility
 C-A-B (< 10 seconds)
 Check for Circulation
 Open the Airway
 Check Breathing

W HEN NO T TO STAR T BLS

 If the patient and physician have previously

agreed on do not resuscitate (DNR) orders:
 Can be complicated issue
 Advanced directives expressing
patient’s wishes may be hard to find.
 When in doubt, begin CPR.

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 IL C O R R E S U S C IT A T IO N G U ID E L IN E S 2020 Rate of 10-12 /min 12-20 breaths every 3-5
Ventilation 5-6 seconds seconds (interval)
Counting Breath 1, 2 Breath 1, 2, 3, 4, breath
C o m p o n en ts A d u lt C h ild In fa n t 3, 4, 5,
Recognition Unresponsive breath
No breathing or not normal (i.e. gasping)
No pulse palpated (within 10 seconds for
HCP) IL C O R R E S U S C IT A T IO N G U ID E L IN E S 2020
CPR Sequence C-A-B (Compression-Airway-Breathing) C ard io -P u lm o n ary R esu sc itatio n (C P R )
Opening the Maximum Neutral plus Neutral
Airway head tilt (Jaw position position C o m p o n en ts A d u lt C h ild In fa n t
thrust if Compression Center of Center of Center of
suspected Area chest in chest 1 chest just
head and between finger below the
spine injury) imaginary below the nipple line
Checking for Carotid pulse Brachial line nipple line
Pulse pulse Position of Heel of 1 Heel of 1 2 fingertips
Hands hand on hand while or 2 thumbs
A s s es sin g C o n scio u sn es s center of the other hold
chest and the head
 A lert stack the
 V erbal other hand
 P ainful stimuli
 U nresponsive

 Gently tap shoulder

 “Hey, hey are you okay?” Compression Around100- 120 beats per minute
 Infant tap the base of foot Rate 120 bpm
Compression At least 2 to2 At least 1 At least 1 to
O p en in g th e A irw ay Depth ½ inches ½ to 2 1 ½ inch
inches
 Head tilt–chin lift maneuver
 Jaw-thrust maneuver

A s se ssin g C irc u latio n

 Adult/Child – Carotid Compression to 30:2 30:215:2 (2 30:2
 Infant - Brachial Ventilation Ratio HCP
rescuer)
Chest Wall Allow complete recoil between
Recoil compressionsHCPs rotate every 2 minutes
Chest Uninterrupted only allow minimal
Interruptions interruptions <10 seconds
Untrainedor not Chest Compression OnlyHands Only CPR
proficient
Counting 1, 2, 3, 4, 5... 20, 1, 2, 3, 4, 5, 6, 7, 8, 9, “1”
Number of 5 cycles for 2 minutes
Cycles

IN T E R R U P T IN G C P R
IL C O R R E S U S C IT A T IO N G U ID E L IN E S 2020
R E S C U E B R E A T H S (R B ) o r A rtificia l R esp ira tio n  CPR is an important holding action.
 Patient receives definitive care afterwards:
C o m p o n en ts A d u lt C h ild In fa n t  Defibrillation
Ventilation Mouth to Mouth to Mouth,Mouth to
 Further care at hospital
Mouthwith Mouth and Nose (<8-
vible chest infant) with visible chest  If no ALS available at scene:
rise rise  Provide transport .
Volume of Full, slow Full, slow Gentle,  ALS rendezvous en route to hospital
Ventilation breath regulated slow breath
breath

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  Try not to interrupt CPR for more than a few A U T O M A T E D C P R D E V IC E S
seconds. CPR must be uninterrupted
 Necessary, for example, to move patient
up and down stairs

H A N D S -O N L Y C P R

IL C O R R E S U S C IT A T IO N G U ID E L IN E S 2020
A u to m ated E xtern al D efib rillato r (A E D )

Components Adult Child Infant

Defibrillation Attach AED as soon as available, turn the
AED on and follow device audio (voice)
prompts
Pad Placement High Right - Low Leftjust Center Front
bellow collar bone and Center Back
under the armpit
Chest Uninterrupted, minimize compression
Interruptions interruptions before and after shock
Compressions Resume CPR beginning with
compressions after each shock
Clear Water, breast tissue, hair, implanted
device, medical patch and all hands
C le a r! the patient A u to m ated E xte rn al D efib rillatio n
 If you witness cardiac arrest, begin CPR and apply
the AED as soon as it is available.
 Children
o Safe for children older than 1 year of age
o Apply after first five cycles of CPR.
o For child 1 to 8 years of age, use pediatric-
sized pads and dose-attenuating system.
Abigail marie Finals | Disaster Nursing 74
 Special situations R E C O V E R Y P O S IT IO N
o Pacemaker
o Wet patients
o Transdermal medication patches

 For resuscitative efforts and evaluation to be

effective, the victim must be supine and on a firm,
flat surface. If the victim is lying face down, roll the
victim as a unit so that the head, shoulders, and
torso move simultaneously without twisting.

B L S C P R A lg o rith m

B L S A d u lt A lg o rith m

S afe ty C o n sid eratio n

 Hairy chest
 Medicinal patches
 Covered in water
 Conductive surface
 Flammable supplies
 Implanted pacemakers or defibrillators
 Pediatric patients
 Fully automated AEDs

A L W A Y S m ake su re K E E P H A N D S O F F w h ile
p erfo rm in g

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CPR SEQUENCE

C H IL D C P R

B L S In fan t & C h ild A lg o rith m

IN F A N T C P R

C H IL D C P R
 Causes of child respiratory problems :
o Injury
o Infections
o Foreign body
o Near drowning
o Electrocution
o Poisoning/overdose
o SIDS

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B L S A E D A lg o rith m IN F A N T R E S C U E B R E A T H S

B L S C h o kin g
A d u lt o r C h ild A lg o rith m

B L S R esc u e B rea th in g
A d u lt o r C h ild A lg o rith m

B L S C h o kin g
In fan t A lg o rith m

A D U L T & C H IL D R E S C U E B R E A T H S

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 BLS
S u sp e cted O p io id O v erd o seA lg o rith m

W h en to S T O P C P R
STROKE

C o m p lica tio n s o f C P R
 rib fracture;  retrosternal
 sternal fracture; haematoma, and
 lung contusion,  mediastinal
 lung haemorrhage, haematoma.
pneumothorax,  neurological problems
 haemothorax, (ischemia and
reperfusion),
 vomiting and aspiration
(abdominal distension),
and
 cuts on liver and spleen

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 T R A U M A (S O F T T IS S U E IN J U R IE S , B L E E D IN G & S H O C K , A N D O R T H O P E D IC IN J U R IE S )

S o ft-T issu e In ju rie s (S T I) o Apply dressings and bandages to various

parts of the body.
 Skin varies in thickness.
O b jectiv es
o Thinner in the very young and very old
o Thinner on the eyelids, lips, and ears than
T rau m a
on the scalp, back, soles of feet
 Applies fundamental knowledge to provide basic
o Thin skin is more easily damaged than thick
emergency care and transportation based on
skin.
assessment findings for an acutely injured
 Skin has two principal layers: the epidermis and the
patient.
dermis.
S o ft T issu e T rau m a o Epidermis is the tough, external layer.
 Recognition and management of: o Dermis is the inner layer
 Wounds  Skin covers all the external surfaces of the body.
 Burns  Bodily openings are lined with mucous membranes.
o Mucous membranes secrete a watery
 Electrical
 Chemical substance that lubricates the openings.
 Thermal o These are wet, whereas skin is dry.
 Chemicals in the eye and on the skin  Skin serves many functions.
o Keeps pathogens out
P ath o p h ysio lo g y, ass ess m en t, an d m an ag em en t: o Keeps water in
 W ounds o Assists in temperature regulation
 Avulsions o Nerves in skin report to brain on
 Bite wounds environment and sensations.
 Lacerations  Any break in the skin allows bacteria to enter and
 Puncture wounds raises the possibilities of:
 Incisions o Infection
 B u rn s o Fluid loss
 Electrical o Loss of temperature control
 Chemical
 Thermal
 Radiation
 Crush syndrome
 Recognize bleeding
 Understand how bleeding affects the body
 Bleeding can be external or internal.
 Bleeding can cause weakness, shock, and
death.

T h e A n a to m y an d P h ysio lo g y o f th e S kin

 First line of defense against:

o External forces
P ath o p h ysio lo g y
o Infections
 Relatively tough, but still susceptible to injury.
T h ree typ es o f so ft-tissu e in ju rie s:
o Simple bruises and abrasions to serious
 C lo sed in ju ries
lacerations and amputations
- Damage is beneath skin or mucous
 In all instances you must:
membrane.
o Control bleeding.
- Surface is intact.
o Prevent further contamination to decrease
 O p en in ju ries
the risk of infection.
- Break in surface of skin or mucous
o Protect wounds from further damage.
membrane

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 - Exposes deeper tissues to
contamination
 B u rn s
- Damage results from thermal heat,
frictional heat, toxic chemicals,
electricity, nuclear radiation

P ath o p h ysio lo g y o f clo se d an d o p en in ju ries

 Cessation of bleeding is the primary concern.
 The next wound healing stage is inflammation.
 A new layer of cells is then moved into the
damaged area.
 New blood vessels form.
 Collagen provides stability to the damaged
tissue and joins wound borders.

C lo sed In ju ries

C h ara cteristics o f clo se d in ju rie s

O p en In ju rie s
 History of blunt trauma
 Pain at the site of injury  Protective layer of the skin is damaged.
 Swelling beneath the skin  Wound is contaminated and may become infected.
 Discoloration  F o u r typ es:
o Abrasions
 A co n tu sio n (b ru ise) causes o Lacerations
bleeding beneath the skin but o Avulsions
does not break the skin. o Penetrating wounds
o Caused by blunt
forces  An ab ra sio n is a wound of the superficial layer of
o Buildup of blood the skin.
produces blue or black ecchymosis. o Caused by friction when a body part rubs or
scrapes across a rough or hard surface
 A h em ato m a is
blood collected
within damaged
tissue or in a body
cavity.  An av u lsio n separates various layers of soft tissue
so that they become either completely detached or
 When an area of the body is trapped for longer than hang as a flap.
4 hours, crush syndrome can develop. o Often there is significant bleeding.
o Never remove an avulsion skin flap.
 Compartment syndrome results from the swelling
that occurs whenever tissues are injured.  An am p u tatio n is an injury in which part of the body
is completely severed.
 Severe closed injuries can also damage internal
organs.
o Assess all patients with closed injuries for
more serious hidden injuries.

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 A cru s h in g in ju ry occurs when a great amount of  D eath is often related to hemorrhage or infection.
force is applied to the body.  HCPs can teach children and others preventive
 Extent of damage depends on: actions.
o Amount of force
o Length of time force is applied

 A p en etra tin g w o u n d is an injury resulting from a

sharp, pointed object.
o Can damage structures deep within the
body 1. Assess / Reassess
2. Set Goals
3. Assemble Team
4. Establish and Implement
5. Evaluate

 Stabbings and shootings often result in multiple

p en etra tin g in ju ries .
o Assess the patient carefully to identify all
wounds.
o Count the number of penetrating injuries.
o Determine the type of gun and rounds fired,
and document your care.
o You may have to testify in court.

 A lace ratio n is a jagged cut.

o Caused by a sharp object or blunt force that
tears the tissue

 An in cisio n is a sharp, smooth cut.

S o ft-T issu e In ju rie s

 Soft-tissue injuries are common.
P atien t A s se ssm en t o f C lo sed an d O p en In ju ries
o Simple as a cut or scrape
o Serious as a life-threatening internal injury  More difficult to assess a closed injury
- You can see an open injury.
 Do not be distracted by dramatic open wounds.
o Do not forget airway obstructions.  Consider the possibility of a closed injury when you
 Soft tissues of the body can be injured through a observe:
variety of mechanisms:  Bruising
o Blunt injury  Swelling
o Penetrating injury  Deformity
o Barotrauma  The patient reporting pain
o Burns
 Soft-tissue trauma is the leading form of injury.

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 P A T IE N T A S S E S S M E N T S T E P S  Poor initial general impression
1. Scene size-up  Altered level of consciousness
2. Primary assessment  Dyspnea
3. History taking  Abnormal vital signs
4. Secondary assessment  Shock
5. Reassessment  Severe pain

S C E N E S IZ E -U P H IS T O R Y T A K IN G

S ce n e safety In v estig ate th e ch ief co m p lain t.

 Observe the scene for hazards to yourself, your  Obtain a medical history.
crew, and the patient.  Obtain a SAMPLE history.
 Assess for the potential for violence.  Using OPQRST may provide some
 Assess for environmental hazards. background on isolated extremity
 Take standard precautions. injuries.
 Determine the number of patients.  If the patient is unresponsive, attempt to obtain
 Consider if you need additional resources. the history from other sources.

M ech an ism o f in ju ry/ N atu re o f illn ess T yp ical sig n s o f an o p en in ju ry in clu d e:

 Look for indicators of the MOI as you assess the  Bleeding or Hemorrhage
scene.  Break(s) in the skin
 The MOI may provide indicators of safety threats.  Shock
 If the scene is unsafe, request additional help  Disfigurement or loss of a body part
early.
SECONDARY ASSESSM ENT
P R IM A R Y A S S E S S M E N T
P h ys ica l exa m in atio n s
F o rm a g en era l im p res sio n .  Is the patient in a tripod position?
 Look for indicators to alert you to the  What is the skin’s color and condition?
seriousness of the patient’s condition.  Are there any signs of increased respiratory
 Do not be distracted from looking for more efforts?
serious hidden injuries.  Retractions
 Check for responsiveness using the AVPU scale.  Nasal flaring
 Pursed lip breathing
A irw ay an d b rea th in g  Use of accessory muscles
 Ensure that the patient has a clear and patent  Listen for air movement and breath sounds.
airway.  Assess pulse rate and quality.
 Protect the patient from further spinal injury.  Determine the skin condition, color, and
 Assess the patient for adequate breathing. temperature.
 Inspect and palpate the chest for DCAP-BTLS.  Check the capillary refill time.
 Assess the neurologic system.
C irc u latio n  Assess the musculoskeletal system with a full-
 Assess the patient’s pulse rate and quality. body scan.
 Determine the skin condition, color, and  Assess all anatomic regions.
temperature.
 Check the capillary refill time. V ital sig n s
 You may need to treat for shock.  You must reassess the vital signs to identify how
 If visible significant bleeding is seen, you must quickly the patient’s condition is changing.
begin the steps to control it.  Use appropriate monitoring devices to quantify:
 Oxygenation
 Circulatory status
T ran sp o rt d ecisio n  Blood pressure
 Immediately transport in these cases:

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REASSESSM ENT D E C O M P R E S S IO N S IC K N E S S (D C S )

 Repeat the primary assessment.  also called g en eralized b aro tra u m a or the
 Reassess vital signs and the chief complaint. b en d s, refers to injuries caused by a rapid
 Assess all bandaging frequently. decrease in the pressure that surrounds you, of
 Identify and treat changes in the patient’s either air or water. It occurs most commonly in
condition. scuba or deep-sea divers, although it also can
 Interventions occur during high-altitude or unpressurized air
 Assess and manage all threats to the travel.
patient’s airway, breathing, and  Altitude Sickness
circulation.  Pulmonary Barotrauma
 Expose all wounds, cleanse the wound  The treatment of DCS is with 100 % o xyg en ,
surface, control bleeding, and be followed by recompression in a hyperbaric
prepared to treat for shock. chamber.
 Extremities that are painful, swollen, or
deformed should be splinted. A L T IT U D E S IC K N E S S
 Communication and documentation
 Description of the MOI  the m ild est form being acute mountain sickness
 Position in which you found the patient (AMS), is the harmful effect of high altitude,
 Amount of blood loss caused by rapid exposure to low amounts of
 Location and description of any soft- oxygen at high elevation.
tissue injuries or other wounds  P rim ary –headache
 Size and depth of the injury  G astro in tes tin al: Loss of appetite,
 How you treated the injuries nausea, vomiting, excessive flatulation
 N erv o u s: Fatigue or weakness,
headache with or without dizziness or
E m e rg en cy M ed ical C are fo r C lo sed In ju ries
lightheadedness, insomnia, "pins and
 No special emergency care for small contusions
needles" sensation
 Soft-tissue injuries may look rather dramatic.
 L o co m o to ry: Peripheral edema
o Still focus on airway and breathing first
(swelling of hands, feet, and face)
o You may have to assist ventilations with a
 R esp irato ry : Nose bleeding, shortness
bag-mask device.
of breath upon exertion
 C ard io v ascu lar: Persistent rapid pulse
 Treat closed soft-tissue injury using the R IC E S
Other: General malaise
mnemonic:
 R est
A ltitu d e sick n es sev ere sym p to m s th at m ay in d icate
 Ice
life-th reate n in g altitu d e sick n ess in clu d e:
 C ompression
P u lm o n ary ed em a (fluid C ere b ral ed em a (swelling
 E levation in the lungs) of the brain)
 S plinting
 Symptoms similar to  Headache that does
S ig n s o f d ev elo p in g sh o ck: bronchitis not respond to
 Anxiety or agitation  Persistent dry cough analgesics
 Fever  Unsteady gait
 Changes in mental status
 Shortness of breath  Gradual loss of
 Increased heart rate
even when resting consciousness
 Increased respiratory rate  Increased nausea and
 Diaphoresis vomiting
 Cool or clammy skin  Retinal hemorrhage
 Decreased blood pressure

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 E m e rg en cy M ed ical C are fo r O p en In ju rie s
 Before caring for the patient, follow standard
precautions.
 Wear gloves and eye protection (gown and a mask if
necessary.)
 Make sure the airway is open and administer high-
flow oxygen.
 Control life-threatening bleeding using:
o Direct, even pressure and elevation
o Pressure dressings and/or splints
o Tourniquets
 All open wounds are assumed to be contaminated
and present a risk of infection.
 Often, better control bleeding from an open soft-
tissue wound by splinting the extremity, even if there
is no fracture.

BAR O TRUAM A

 P u lm o n ary b aro trau m a can occur during self-

contained underwater breathing apparatus PNEO M O THO RAX
(SCUBA) diving or free diving. It can happen
during descent (negative pulmonary barotrauma  P n eo m o th o ra x or co llap se d lu n g caused by
or lung squeeze) or during ascent (positive chest trauma, excess pressure on the lungs or a
pulmonary barotrauma is also known as lung disease, such as chronic obstructive
pulmonary overinflation syndrome (POIS). pulmonary disease (COPD), asthma, cystic
fibrosis, tuberculosis or whooping cough

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 IM P A L E D O B JE C T S

 Only remove an impaled object when:

 The object is in the cheek and obstructs
breathing.
 The object is in the chest and interferes
with CPR.

S U C K IN G C H E S T W O U N D (S C W )

 happens when an injury causes a hole to open N E C K IN JU R IE S

in your chest. SCWs are often caused by
stabbing, gunshots, or other injuries that  Open neck injuries can be life threatening.
penetrate the chest. Signs of an SCW include:  Open veins may suck in air and cause cardiac
an opening in the chest, about the size of a coin. arrest.
hissing or sucking sounds when the person  Cover the wound with an occlusive dressing.
inhales and exhales.  Apply pressure but do not compress both carotid
arteries at the same time.

S M A L L -A N IM A L B IT E S

 A small animal’s mouth is

heavily contaminated with
virulent bacteria.
 Wounds may require:
 Antibiotics
 Tetanus prophylaxis
 Suturing
 Bites should be evaluated
by a physician.

A m ajo r co n cern is th e sp re ad o f rab ies .

 Acute, potentially fatal viral infection of the
central nervous system
 Can affect all warm-blooded animals
 Transmitted through biting or licking an open
A B D O M IN A L W O U N D S
wound
 Prevented by a series of special vaccine
 An open wound in the abdominal cavity may
injections
expose internal organs protruding through the
wound, an injury called evisceration.
 Cover the wound with sterile gauze.
 Secure with an occlusive dressing.
 Keep the organs moist and warm.

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E n d em ic S n ak es in P an a y  Mark the leading edge of tenderness/swelling on
1. Acrochordus 19. Pseudorabdion the skin and write the time alongside it.
granulatus (File/Wart) mcnamarae
2. Python reticulatus (Burrowing)N DO NOT
3. Ahaetulla prasina 20. Pseudorabdion
 pick up the snake or try to trap it. NEVER handle
preocularis oxycephalum
(Vine/Whip) (Burrowing)N a venomous snake, not even a dead or
4. Boiga angulata (Cat) 21. Pseudorabdion decapitated head.
5. Boiga cynodonn (Cat) talonuran (Talonuran)*  wait for symptoms to appear if bitten, get
6. Boiga dendrophila 22. Tropidonophis medical help right away.
(Cat) negrosensis (Water)N  apply a tourniquet.
7. Calamaria gervaisi 23. Zaocys luzonensis
 slash the wound with a knife or cut it in any way.
8. Cerberus rynchops (Rat)
(Bockadam) 24. Calliophis calligaster  try to suck out the venom.
9. Chrysopelea paradisi gemianulis (Coral)  apply ice or immerse the wound in water.
(Flying) 25. Hydrophis belcheri  drink alcohol as a painkiller.
10. Cyclocorus lineatus (Sea)  take pain relievers (such as aspirin, ibuprofen,
alcalai (Lined) 26. Hydrophis
naproxen).
11. Dendrelaphis cyanocinctus (Sea)
caudolineatus terrificus 27. Hydrophis elegans  apply electric shock or folk therapies.
(Bronzeback) (Sea)
12. Dendrelaphis pictus 28. Hydrophis inornatus
pictus (Bronzeback) (Sea)
13. Elaphe erythrura 29. Lapemis hardwickii
psephenoura (Rat) (Sea)
14. Gonyosoma 30. Laticauda colubrina
oxycephala (Rat) (Sea Krait)
15. Hologerrhum dermali 31. Ramphotyphlops
(Striped) * braminus (Blind)
16. Lycodon aulicus 32. Rhamphotyphlops
capucinus (Wolf) cumingii (Blind)
17. Oligodon modestum 33. Typhlops castanotus
(Kukri) (Blind/Worm)
18. Psammodynastes 34. Typhlops hypogius
pulverulentus (Viper) (Rubber/Worm)
35. Tropidolaemus wagleri
(Pit Viper)
36. Trimereserus
flavomaculatus (Pit
Viper)

S N A K E B IT E S

 Redness, swelling, bruising, bleeding, or

blistering around the bite. Severe pain and
tenderness at the site of the bite. Nausea,
vomiting, or diarrhea. Labored breathing (in
extreme cases, breathing may stop altogether)
 Stings requires flushing
 Seek medical attention as soon as possible
the area with saltwater.
 Identify or take a photograph of the snake at a
 Scrape tentacles, barbs
distance
or spines with a card.
 Keep calm
 Control bleeding.
 Lay or sit down with the bite in a neutral position
 Apply ice to the site to
of comfort.
reduce pain and
 Remove rings and watches before swelling inflammation.
starts.
 DO NOT use vinegar,
 Wash the bite with soap and water. and never urinate.
 Cover the bite with a clean, dry dressing.

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H U M A N B IT E S  Amount of heat energy possessed by
the object or substance
 The human mouth contains an exceptionally  Duration of exposure
wide range of virulent bacteria and viruses.  The greater the heat energy, the deeper the
 Regard any human bite that has penetrated the wound.
skin as a very serious injury.  Exposure time is an important factor.
 Can result in a serious, spreading infection  People reflexively limit heat energy and
exposure time.
E m e rg en cy treatm e n t:  But cannot if unconscious or trapped
 Apply a dry, sterile dressing.
 Promptly immobilize the area with a splint or B u rn s
bandage.  Account for over 10,000 deaths a year
 Provide transport to the ED.  Among the most serious and painful of all
injuries
B las t (M u ltip le) In ju rie s  A burn occurs when the body receives more
 B las t in ju ries result from explosions that have the radiant energy than it can absorb.
capability to cause multisystem, life-threatening  Sources of this energy include heat,
injuries in single or multiple victims simultaneously. toxic chemicals, and electricity.
 Always perform a complete assessment to
determine whether there are other serious
injuries.

C O M P L IC A T IO N S O F B U R N S

 When a person is burned, the skin that acts as a

barrier is destroyed.
 The victim is now at high risk for:
 Infection
B L A S T IN JU R IE S  Hypothermia
 Hypovolemia
 These types of events present complex triage,  Shock
diagnostic, and management challenges for the  Burns to the airway are of significant importance.
health care provider.  Circumferential burns of the chest can
compromise breathing.
 Circumferential burns of the extremity can lead
to neurovascular compromise and irreversible
damage.

B U R N S E V E R IT Y

B u rn sev erity d ep en d s o n :
 Depth of burn
 Extent of burn
 Critical areas involved
 Face, upper airway, hands, feet,
genitalia
P ath o p h ysio lo g y  Preexisting medical conditions
 Patient younger than 5 or older than 55
P ath o p h ysio lo g y o f b u rn s
 Severity of a thermal wound correlates directly
with:
 Temperature
 Concentration

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D ep th M an ag em en t
 S u p erficial (first-d eg ree ) b u rn s  Remove any chemical from the patient.
- Only the top layer of skin  Always brush dry chemicals off the skin and
 P artial-th ick n ess (seco n d -d eg re e) b u rn s clothing before flushing with water.
- Epidermis and some portion of the  Remove the patient’s clothing.
dermis  For liquid chemicals, immediately begin to flush
the burned area with lots of water.
- Blisters are present.
 Continue flooding the area for 15 to 20 minutes
 F u ll-th ickn ess (th ird -d eg ree) b u rn s after the patient says the burning pain has
- Extend through all skin layers. stopped.
 If the patient’s eye has been burned, hold the
eyelid open while flooding the eye.

E le ctric al B u rn s
 May be the result of contact with high- or low-
voltage electricity
 For electricity to flow, there must be a complete
circuit between the source and the ground.
- Any substance that p reve n ts this circuit
is called an in su lato r.
- Any substance that allo w s a current to
flow is called a co n d u cto r.
 The human body is a good conductor.
E xte n t  The type of electric current, magnitude of current,
 Can be estimated using the rule of 9s and voltage have effects on the seriousness of
 Divides the body into sections, each the burn.
representing approximately 9% of the total body  Your safety is of particular importance.
surface area - Never attempt to remove someone from
 Proportions differ for infants, children, and adults an electrical source unless you are
specially trained to do so.
 A burn injury appears where the electricity
enters and exits the body.
 T w o d an g ers:
1. There may be a
large amount of
deep tissue injury.
2. The patient may
go into cardiac or
respiratory arrest
from the electric
C h em ic al B u rn s shock
 Can occur whenever a toxic substance contacts
the body E L E C T R O C U T IO N
 Generally caused by strong acids or strong
alkalis E le ctric al In ju ries
 The eyes are particularly vulnerable.
 The severity of the burn is directly related to the:
 Type of chemical
 Concentration of the chemical
 Duration of the exposure
 Wear appropriate chemical-resistant gloves and
eye protection.

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 E le ctric al B u rn s M an ag em en t
 First ensure your own safety and the safety of your
M an ag em en t coworkers.
 If indicated, begin CPR on the patient and apply  Prehospital treatment for a patient with suspected
an AED. hydrogen cyanide poisoning includes
decontamination and supportive care.
 Be prepared to defibrillate if necessary.
 Care for any toxic gas exposure includes:
 Give supplemental oxygen and monitor.
 Recognition
 Treat soft-tissue injuries with dry, sterile dressings.
 Identification
 Provide prompt transport.  Supportive treatment

T h erm al B u rn s R ad iatio n B u rn s
 Caused by h eat  Potential threats include:
 Most commonly, they are caused by scalds or  Incidents related to the use and
an open flame. transportation of radioactive isotopes
- A flame burn is very often a deep burn.  Intentionally released radioactivity in
- Hot liquids produce scald injuries. terrorist attacks
 Coming in contact with hot objects produces a  You must determine if there has been a
contact burn. radiation exposure and then whether ongoing
 A steam burn can produce a topical burn. exposure continues to exist.
 A flash burn is produced by an explosion.
- May briefly expose a person to very T h ree typ es o f io n izin g rad ia tio n :
intense heat  A lp h a
- Lightning strikes can cause a flash burn.  Little penetrating energy, easily stopped by
the skin
M an ag em en t
 Stop the burning source, cool the burned area,  B eta
and remove all jewelry.  Greater penetrating power, but blocked by
 Increased exposure time will increase damage to
simple protective clothing
the patient.
 All patients should have a dry dressing applied to:
 Maintain body temperature  G am m a
 Prevent infection  Very penetrating, easily passes through the
 Provide comfort body and solid materials

In h alatio n B u rn s  Most ionizing radiation accidents involve gamma

 Can occur when burning takes place in enclosed radiation, or x-rays.
spaces without ventilation
- U p p er airw ay damage is often
associated with the inhalation of
superhe ated gases.
- L o w er airw ay damage is more often
associated with the inhalation of
chem icals and particulate m atter.
 You may encounter severe upper airway
swelling, requiring intervention immediately.
- Consider requesting ALS backup.
 The combustion process produces a variety of M an ag em en t
toxic gases.  Patients with a radioactive source on their body
 Carbon monoxide intoxication should be must be initially cared for by a HazMat responder.
considered whenever a group of people in the  Irrigate open wounds.
 Notify the emergency department.
same place all report a headache or nausea.
 Identify the radioactive source and the length of
the patient’s exposure to it.
 Limit your duration of exposure.
 Increase your distance from the source.

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  Attempt to place shielding between yourself and C irc u latio n
the sources of gamma radiation.  Assess the pulse rate and quality.
 Determine perfusion based on the patient’s skin
condition, color, temperature, and capillary refill
P atien t A s s es sm en t o f B u rn s time.
 When you are assessing a burn, it is important  Control significant bleeding.
for you to classify the victim’s burns.  Assess for shock.
 Classification involves determining the:
 Source of the burn T ran sp o rt d ecisio n
 Depth of the burn  Consider quickly transporting a patient who has:
 Severity  An airway or breathing problem
 Significant burn injuries
P atie n t asse ssm en t step s  Significant external bleeding
1. Scene size-up  Signs and symptoms of internal
2. Primary assessment bleeding
3. History taking  Consider a rendezvous with ALS providers.
4. Secondary assessment
5. Reassessment H IS T O R Y T A K IN G

S C E N E S IZ E -U P In v estig ate th e ch ief co m p lain t.

 Be alert for signs and symptoms of other injuries
S ce n e safety due to the MOI.
 Observe the scene for hazards and safety  Typical signs of a burn are:
threats.  Pain
 Ensure that the factors that led to the patient’s  Redness
burn injury do not pose a hazard.  Swelling
 Blisters
M ech an ism o f in ju ry/n a tu re o f illn es s  Charring
 Determine the type of burn that has been  Regardless of the type of burn injury, it is
sustained and the MOI. important for you to:
 Stop the burning process.
P R IM A R Y A S S E S S M E N T  Apply dressings to prevent
contamination.
B eg in w ith a rap id sca n .  Treat the patient for shock.

F o rm a g en era l im p res sio n . S A M P L E h isto ry

 Be suspicious of clues that may indicate abuse.  Along with the SAMPLE history, also ask the
 Consider the need for manual spinal stabilization. following questions:
 Check for responsiveness using the AVPU scale.  Are you having any difficulty breathing?
 Are you having any difficulty swallowing?
A irw ay an d b rea th in g  Are you having any pain?
 Ensure that the patient has a clear and patent  Check whether the patient has an emergency
airway. medical identification device.
 Be alert to signs that the patient has inhaled hot
gases or vapors: SECONDARY ASSESSM ENT
 Singed facial hair
 Soot present in and around the airway P h ys ica l exa m in atio n s
 Copious secretions and frequent coughing may  Perform a full-body scan.
indicate a respiratory burn.  Make a rough estimate, using the rule of
 Quickly assess for adequate breathing. nines, of the extent of the burned area.
 Inspect and palpate the chest wall for  Determine the classification of the burn.
DCAP-BTLS.  Determine the severity of the burn.
 Package the patient for transport.

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  Assessment of the respiratory system  To protect the wound from further
involves looking, listening, and feeling. damage
 Assess the patient’s neurologic system.  To prevent further contamination and
 Assess the musculoskeletal system. infection
 Determining an early set of vital signs
will help you to know how your patient is
tolerating his or her injuries.

REASSESSM ENT

 Repeat the primary assessment and reassess

the patient’s vital signs.
 Reassess the chief complaint.
 Reevaluate interventions
 Stop the burning process.
 Assess and treat breathing.
 Support circulation. S terile D res sin g s
 Provide rapid transport.  Most wounds will be covered by:
 Oxygen is mandatory for inhalation  Universal dressings
burns but is also helpful in patients with  Conventional 4″ x 4″ and 4″ x 8″ gauze
smaller burns. pads
 If the patient has signs of hypoperfusion,  Assorted small adhesive-type dressings
treat aggressively for shock and provide and soft self-adherent roller dressings
rapid transport.  Universal dressings are ideal for covering large
 Communication and documentation open wounds.
 Provide hospital personnel with a  Gauze pads are appropriate for smaller wounds.
description of how the burn occurred.  Adhesive-type dressings are useful for minor
 Include the extent of the burns. wounds.
 Amount of body surface area  Occlusive dressings prevent air and liquids from
involved entering (or exiting) the wound.
 Depth of the burn
 Location of the burn B an d ag es
 Document if special areas are involved.  To keep dressings in place during transport, you
can use:
E m e rg en cy M ed ical C are fo r B u rn s  Soft roller bandages
 Stop the burning process.  Rolls of gauze
 Prevent additional injury.  Triangular bandages
 Adhesive tape
 The self-adherent, soft roller bandages are
easiest to use.
 Adhesive tape holds small dressings in place
and helps to secure larger dressings.
 Do not use elastic bandages to secure dressings.
D res sin g an d B an d ag in g - The bandage may become a tourniquet
 All wounds require bandaging. and cause further damage.
- Sometimes splints can help control  Splints are useful in stabilizing broken
bleeding and provide firm support for extremities.
dressing. - Can be used with dressings to help
- There are many different types of control bleeding from soft-tissue injuries
dressings and bandages.  If a wound continues to bleed despite the use of
 Dressings and bandages have three functions: direct pressure, quickly proceed to the use of a
 To control bleeding tourniquet.

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 S u m m a ry: S T I B lee d in g & S h o ck

O b jectiv es
T rau m a
 Applies fundamental knowledge to provide basic
emergency care and transportation based on
assessment findings for an acutely injured
patient.
B lee d in g
 Recognition and management of:
 Bleeding
 Pathophysiology, assessment, and management
of:
 Bleeding

S h o ck an d R esu s citatio n
 Applies a fundamental knowledge of the causes,
pathophysiology, and management of shock,
respiratory failure or arrest, cardiac failure or
arrest, and post-resuscitation management.

P ath o p h ysio lo g y
 Applies fundamental knowledge of the
pathophysiology of respiration and
perfusion to patient assessment and
management.

In tro d u ctio n
 Important to be able to:
o Recognize bleeding
o Understand how bleeding affects the body
 Bleeding can be external or internal.
 Bleeding can cause weakness, shock, and death.
 Shock (hypoperfusion) means a state of collapse
and failure of the cardiovascular system.
o In the early stages, the body attempts to
maintain homeostasis.
o As shock progresses, blood circulation
slows and eventually ceases.
 Shock can occur because of medical or traumatic
events.
o Heart attack
o Severe allergic reaction
o Automobile crash
o Gunshot wound

A n ato m y an d P h ys io lo g y o f th e C ard io v ascu lar

S ys tem
 Functions of the cardiovascular system
 Circulate blood to cells and tissues
 Deliver oxygen and nutrients
 Carry away metabolic waste products

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  T h ree p arts
 Pump (heart)
 Container (blood vessels)
 Fluid (blood and body fluids)

T h e H eart
 The heart is a hollow muscular organ about the size B lo o d V es sels
of a clenched fist.  A rteries
 Has its own regulatory system  Small blood vessels that carry blood away
 Works as two paired pumps from the heart
o Upper chamber (atrium)  A rterio les
o Lower chamber (ventricle)  Smaller vessels that connect the arteries
and capillaries
 C ap illa rie s
 Small tubes that link arterioles and venules
 V en u le s
 Very small, thin-walled vessels that empty
into the veins
 V ein s
 Blood leaves each chamber through a one-way  Blood vessels that carry blood from the
valve. tissues to the heart
 Right side receives oxygen-poor blood from veins
 Left side supplies oxygen-rich blood to arteries

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 B lo o d

 R ed b lo o d cells P ath o p h ysio lo g y an d P erfu sio n

 Responsible for the transportation of oxygen
to the cells and carbon dioxide away from  Blunt trauma can cause injury and significant
the cells to the lungs bleeding that is unseen inside a body cavity or
 W h ite b lo o d cells region.
 Responsible for fighting infection and other  Significant amounts of blood loss cause
diseases hypoperfusion, or shock.
 P la telets o In penetrating trauma, the patient may have
 Responsible for forming clots - depending only a small amount of bleeding that is
on blood stasis, changes in the vessel walls, visible.
and the body’s ability to clot.
 P la sm a
 The largest part of your blood (about 55%),
a light yellow liquid responsible for carrying
water, salts and enzymes towards the cells

A u to n o m ic N erv o u s S yste m
 Constantly adapting to maintain homeostasis and
perfusion
 Monitors the body’s needs
 Adjusts blood flow and vascular tone
 Automatically redirects blood away from other
 Body Cavity protect organs from accidental shocks.
organs to the heart, brain, lungs, and kidneys in an
Permit changes in size and shape of internal organs.
emergency
 Perfusion is the circulation of blood within an organ
or tissue to meet the cells’ needs for oxygen,
nutrients, and waste removal.

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 Some tissues need a constant supply of blood while  Cold
others can survive with very little.  The need for oxygen and waste
 All organs and organ systems are dependent on removal
adequate perfusion to function properly.
o Death of an organ system can quickly lead  Perfusion requires more than just having a
to death of the person. working cardiovascular system.
 The heart requires a constant supply of blood.  Adequate oxygen exchange in the lungs
o Brain and spinal cord may last 4 to 6  Adequate nutrients in the form of
minutes. glucose in the blood
o Kidneys may survive 45 minutes.  Adequate waste removal, primarily
o Skeletal muscles may last 2 hours. through the lungs
o Times are based on a normal body  Mechanisms are in place to help support the
temperature. respiratory and cardiovascular systems when
the need for perfusion of vital organs is
S H O C K (H Y P O P E R F U S IO N ) increased.
 Mechanisms include the autonomic
 refers to a state of collapse and failure of the nervous system and hormones.
cardiovascular system that leads to inadequate
circulation. SHOCK
 Shock is an unseen life threat caused by a
medical disorder or traumatic injury.  can result from bleeding, respiratory failure,
 If the symptoms of shock are not promptly acute allergic reactions, and overwhelming
addressed, the patient will soon die. infection.
 These three parts can be called the “p erfu sio n  Damage occurs because of insufficient perfusion
trian g le.” of organs and tissues.
 When a patient is in shock, one or more  Caused by inadequate function of the heart
of the three parts is not working properly.  A major effect is the backup of blood into the
lungs.
 Resulting buildup of pulmonary fluid is called
pulmonary edema

 Blood pressure is the pressure of blood within

the vessels at any one time.
 S ys to lic: peak arterial pressure
 D ias to lic: pressure in the arteries while
the heart rests between heartbeats
 Blood flow through the capillary beds is
regulated by the capillary sphincters.
 Under the control of the autonomic
nervous system
 Sphincters respond to other stimuli:
 Heat

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 E xtern al B lee d in g  Does not spurt and is easier to manage
 Hemorrhage means b leed in g .
 Examples include nosebleeds and bleeding from C ap illa ry b leed in g
open wounds.  Bleeding from damaged capillary vessels
 Dark red, oozes steadily but slowly
 As a First Responder, you must understand how to
control external bleeding.
C lo ttin g
S IG N IF IC A N C E O F E X T E R N A L B L E E D IN G  Bleeding tends to stop rather quickly, within about
10 minutes.
 With serious external bleeding, it may be difficult o When a person is cut, blood flows rapidly.
to tell the amount of blood loss. o The cut end of the vessel begins to narrow,
 Presentation and assessment of the patient will reducing the amount of bleeding.
direct care and treatment. o Then a clot forms.
 Body will not tolerate a blood loss greater than o Bleeding will not stop if a clot does not form.
20% of blood volume.
 Significant changes in  Despite the efficiency of the
vital signs may occur if system, it may fail in certain
typical adult loses situations.
more than 1 L of blood. o Movement
 Increase in o Medications
heart rate o Removal of bandages
 Increase in o External environment
respiratory o Body temperature
rate o Severe injury
 Decrease in
blood pressure H em o p h ilia
 Patient lacks blood clotting factors.
 How well people compensate for blood loss is  Bleeding may occur spontaneously.
related to how rapidly they bleed.  All injuries, no matter how trivial, are potentially
 An adult can comfortably donate 1 unit serious.
(500 mL) of blood over 15 to 20 minutes.  Patients should be transported immediately.
 If a similar blood loss occurs in a much
shorter time, the person may rapidly In tern al B lee d in g
develop hypovolemic shock.  Bleeding in a cavity or space inside the body
 Consider age and preexisting health.  Can be very serious, yet with no outward signs
o Injury or damage to internal organs
 Serious conditions with bleeding: commonly results in extensive internal
 Significant MOI bleeding.
 Patient has a poor general appearance o Can cause hypovolemic shock
and is calm.  Possible conditions causing internal bleeding:
 Signs and symptoms of shock o Stomach ulcer
 Significant blood loss o Lacerated liver
 Rapid blood loss o Ruptured spleen
 Uncontrollable bleeding o Broken bones, especially the ribs or femur
o Pelvic fracture
C h ara cteristics o f E xte rn al B leed in g
A rterial b leed in g M O I fo r In tern al B leed in g
 Pressure causes blood to spurt and makes  High-energy MOI
bleeding difficult to control.  Internal bleeding is possible whenever the MOI
 Typically brighter red and spurts in time with the suggests that severe forces affected the body.
pulse
o Blunt trauma
V en o u s b leed in g o Penetrating trauma
 Dark red, flows slowly or severely

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 S ig n s o f in ju ry (D C A P -B T L S ) P atie n t A s s es sm e n t fo r E xte rn al an d In tern al
D D efo rm itie s B leed in g
C C o n tu sio n s
A A b ras io n s P atie n t asse ssm en t step s
P P u n ctu re s/p en e tratio n s 1. Scene size-up
B B u rn s 2. Primary assessment
T T en d ern e ss 3. History taking
L L aceratio n s 4. Secondary assessment
S S w ellin g 5. Reassessment

S C E N E S IZ E -U P
N O I fo r In tern al B lee d in g
 Bleeding is not always caused by trauma S ce n e safety
 Be alert to potential hazards.
N o n trau m atic cau se s F req u en t sig n s  At vehicle crashes, ensure the absence of
in clu d e: leaking fuel and energized electrical lines.
 Bleeding ulcers  Abdominal tenderness  In violent incidents, make sure the police are on
 Bleeding from colon  Guarding the scene.
 Ruptured ectopic  Rigidity  Follow standard precautions.
pregnancy  Pain
 Aneurysms  Distention
M ech an ism o f in ju ry/n a tu re o f illn es s
In o ld er p atien ts, sig n s U lce rs o r o th er G I
in clu d e: p ro b lem s m ay cau se :  Determine the NOI or MOI.
 Dizziness  Vomiting of blood  Consider the need for spinal stabilization and
 Faintness  Bloody diarrhea or additional resources.
 Weakness urine  Consider environmental factors such as weather.

P R IM A R Y A S S E S S M E N T
S ig n s an d S ym p to m s o f In tern al B lee d in g
 Pain (most common)  Bleeding from any D o n o t b e d istrac ted fro m id en tifyin g life th reats.
 Swelling in the area of body opening
bleeding  Hematemesis F o rm a g en era l im p res sio n .
 Distention  Melena  Note important indicators of the patient’s
 Bruising  Hemoptysis condition.
 Dyspnea, tachycardia,  Broken ribs, bruises  Be aware of obvious signs of injury.
hypotension over the lower part of
 Determine gender and age.
 Hematoma the chest, or a rigid,
distended abdomen  Assess skin color and the LOC.
 Hypoperfusion
A irw ay an d b rea th in g
L ater sig n s o f h yp o p erfu sio n :  Consider the need for spinal stabilization.
 Tachycardia  Slightly dilated pupils  Ensure a patent airway.
 Weakness, fainting, or  Capillary refill of more  Look for adequate breathing.
dizziness at rest than 2 seconds in  Check for breath sounds.
 Thirst infants and children  Provide high-flow oxygen or assist ventilations
 Nausea and vomiting  Weak, rapid (thready) with a bag-mask device or nonrebreathing mask.
 Cold, moist (clammy) pulse
skin  Decreasing blood
pressure C irc u latio n
 Shallow, rapid
breathing  Altered level of  Assess pulse rate and quality.
 Dull eyes consciousness  Determine skin condition, color, and temperature.
 Check capillary refill time.
 Control external bleeding.
 Treat for shock.

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T ran sp o rt d ecisio n S A M P L E h isto ry
 Assessment of ABCs and life threats will  Ask the patient about blood-thinning medications.
determine the transport priority.  If the patient is unresponsive, obtain history from
 Signs that imply rapid transport: medical alert tags or bystanders.
 Tachycardia or tachypnea  Look for signs and symptoms of shock.
 Low blood pressure  Determine the amount of blood loss.
 Weak pulse
 Clammy skin SECONDARY ASSESSM ENT

 Record vital signs.

 Assess vital signs to observe the
changes that may occur during
treatment.
 A systolic blood pressure of less than
100 mm Hg with a weak, rapid pulse
should suggest the presence of
hypoperfusion.
 Cool, moist skin that is pale or gray is an
important sign.
 Complete a focused assessment of pain.
 Attach appropriate monitoring devices.
 With a critically injured patient or a short
transport time, there may not be time to conduct
a secondary assessment.

P h ys ica l exa m in atio n s

 Should include a systematic full-body scan
 Assess the respiratory system.
 Assess the airway for patency.
H IS T O R Y T A K IN G
 Determine the rate and quality of respirations.
 Look for distended neck veins and a deviated
In v estig ate th e ch ief co m p lain t.
trachea.
 Look for signs and symptoms of other injuries
 Check for paradoxical movement of the chest
due to the MOI and/or NOI.
wall and bilateral breath sounds.
 You may have identified severe bleeding in the
 Assess the cardiovascular, neurologic, and
primary assessment.
musculoskeletal systems.
 Note obvious signs of internal bleeding.
 Determine the level of consciousness.
 Examine pupil size and reactivity.
 Determine if there are any preexisting illnesses.
 Assess motor and sensory response.

A s se ss all an ato m ic reg io n s.

 Check the head for raccoon eyes, Battle’s sign,
and drainage of blood or fluid from the ears or
nose.
 Feel all four quadrants of the abdomen for
tenderness or rigidity.
 Record pulse, motor, and sensory function in all
four extremities.

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REASSESSM ENT  Hold uninterrupted pressure for at least 5
minutes.
 Repeat the primary assessment in areas that
showed abnormal findings. E L E V A T IO N
 Signs and symptoms of internal
bleeding are often slow to present.  Elevate a bleeding extremity by as little as 6"
 Assess interventions and treatments. while applying direct pressure.
 Vital signs show how well your patient is doing  Never elevate an open fracture to control
internally. bleeding.
 In severe cases, assess every 5  Fractures can be elevated after splinting.
minutes.  Splinting helps control bleeding.
 In terv en tio n s
 Provide high-flow oxygen. P R E S S U R E D R E S S IN G
 Provide treatment for shock and
transport rapidly.  Firmly wrap a sterile, self-adhering roller
 Do not delay transport of a patient to bandage around the entire wound.
complete an assessment.  Cover the entire dressing above and below the
 Communication and documentation wound.
 Communicate all relevant information to  Stretch the bandage tight enough to control
the staff at the receiving hospital. bleeding.
 Give an estimate of the amount of blood  You should still be able to palpate a
loss that has occurred. distal pulse.
 Describe the MOI/NOI and the signs  Do not remove a dressing until a physician has
and symptoms. evaluated the patient.
 Document all injuries, the care provided,  Bleeding will almost always stop when the
and the patient’s response. pressure of the dressing exceeds arterial
pressure.
E m erg en cy M ed ical C are fo r E xte rn al B leed in g
 Follow standard precautions.
o Wear gloves, eye protection, and possibly a
mask or gown.
o Make sure the patient has an open airway
and is breathing adequately.
o Provide high-flow oxygen.

 Several methods are available to control external

bleeding.
o Direct, even pressure and elevation
o Pressure dressings and/or splints
o Tourniquets

 It will often be useful to combine these methods.

D IR E C T P R E S S U R E

 Most effective way to control external bleeding

 Pressure stops the flow of blood and permits
normal coagulation to occur.
 Apply pressure with your gloved fingertip or
hand over the top of a sterile dressing.
 Never remove an impaled object from a wound.

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T O U R N IQ U E T  Can usually be controlled by pinching the
nostrils together
 If direct pressure fails, apply a tourniquet above
the level of bleeding. B lee d in g fro m th e n o se o r ears fo llo w in g a h ead
 It should be applied quickly and not released in ju ry:
until a physician is present.  May indicate a skull fracture
 May be difficult to control
O b serv e th e fo llo w in g p rec au tio n s:  Do not attempt to stop blood flow.
 Do not apply a tourniquet directly over any joint.  Loosely cover the bleeding site with a sterile
 Make sure the tourniquet is tightened securely. gauze pad.
 Never use wire, rope, a belt, or any other narrow  Apply light compression with a dressing.
material.
 Use wide padding under the tourniquet.
 Never cover a tourniquet with a bandage.
 Do not loosen the tourniquet after you have
applied it.

C O M B A T A P P L IC A T IO N T O R N IQ U E T (C A T )

E m e rg en cy M ed ical C are fo r In tern al B lee d in g

 Refer for surgery & hospital procedures
 Keep the patient calm, reassured, and as still and
quiet as possible.
 If spinal injury is not suspected, place the patient in
the shock position.
 Provide high-flow oxygen.
 Maintain body temperature.
 Splint the injured extremity.
 Never use a tourniquet to control bleeding from
closed, internal, soft-tissue injuries.

B L E E D IN G F R O M T H E N O S E , E A R S , A N D M O U T H

S ev eral co n d itio n s:
 Skull fracture
 Facial injuries
 Sinusitis, infections, use and abuse of nose
drops, dried or cracked nasal mucosa
 High blood pressure
 Coagulation disorders
 Digital trauma

E p ista xis (n o seb leed )

 is a co m m o n em erg en cy.
 Occasionally it can cause enough blood loss to
send a patient into shock.
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T R E A T IN G H Y P O V O L E M IC S H O C K O rth o p ed ic In ju ries

O b jectiv es

T rau m a
 Applies fundamental knowledge to provide basic
emergency care and transportation based on
assessment findings for an acutely injured
patient.

O rth o p aed ic T rau m a

 Recognition and management of:
 Control all obvious external bleeding.  Open fractures
 Splint any bone and joint injuries.  Closed fractures
 Secure and maintain an airway, and provide  Dislocations
respiratory support.  Amputations
 Transport as rapidly as possible.
 Secure and maintain the airway. P ath o p h ysio lo g y, ass ess m en t, an d m an ag em en t :
 Clear the mouth and throat of obstructions.  Upper and lower extremity orthopaedic trauma
 Open fractures
T R E A T IN G H Y P O V O L E M IC S H O C K  Closed fractures
 Dislocations
 Sprains/strains
 Pelvic fractures
 Amputations/replantation

N o n trau m atic M u scu lo ske letal D iso rd ers

 Anatomy, physiology, pathophysiology,
assessment, and management of:
 Nontraumatic fractures

In tro d u ctio n
 The musculoskeletal system provides:
o Form
o Upright posture
 If necessary, provide ventilations with a bag-mask
o Movement
device.
 Give supplemental oxygen.
 System also protects vital internal organs
 Transport the patient promptly.
o Bones, muscles, tendons, joints, and
ligaments are still at risk

 Musculoskeletal injuries are among the most

common reasons why patients seek medical
attention.
o Often easily identified because of associated
pain, swelling, and deformity
o Often result in short- or long-term disability

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 A n ato m y an d P h ysio lo g y o f th e M u scu lo sk ele tal T h e S keleto n
S ys tem  Gives us our recognizable human form
 T h ree typ es o f m u scle s : skeleta l, sm ooth , and  Protects our vital organs
cardiac  Allows us to move
 Skeletal muscle attaches to  Produces blood cells
the bones and usually  Made up of approximately 206 bones
crosses at least one joint.  The bones of the skeleton provide a framework to
o Forms the major which the muscles and tendons are attached.
muscle mass of the  A joint is formed wherever two bones come into
body contact.
o Called v o lu n tary o Joints are held together in a capsule.
m u scle because it o Joints are lubricated by synovial fluid.
is under direct
voluntary control of
the brain

 All skeletal muscles are

supplied with arteries,
veins, and nerves.
 Skeletal muscle tissue is
directly attached to the
bone by tendons.

 Smooth muscle performs

much of the automatic work
of the body.
o Not under voluntary  The skull protects the brain.
control of the brain
o Contracts and  The thoracic cage protects the
relaxes to control heart, lungs, and great vessels.
the movement of
the contents within tubular structures  The pectoral girdle consists of
two scapulae and two clavicles.
 Cardiac muscle is a specially adapted involuntary
muscle with its own regulatory system.

 The upper extremity extends

from the shoulder to the
fingertips.
o Composed of the arm
(humerus), elbow,
forearm (radius and
ulna), wrist, hand, and
fingers

 The hand contains three sets of

bones:
o Wrist bones (carpals)
o Hand bones (metacarpals)
o Finger bones (phalanges)

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 FRACTURES
 The pelvis supports the body
weight and protects the  Classified as either closed or open
structures within the pelvis:  Your first priority is to determine whether the
the bladder, rectum, and overlying skin is damaged.
female reproductive organs. o Treat any injury that breaks the skin as a
possible open fracture.
 The lower extremity consists  Fractures are described by whether the bone is
of the bones of the thigh, leg, moved from its normal position.
and foot. o A nondisplaced fracture is a simple crack of
the bone.
o A displaced fracture produces actual
deformity, or distortion, of the limb by
 The foot consists of three classes of bones: shortening, rotating, or angulating it.
o Ankle bones
(tarsals)  G reen s tick: An incomplete fracture that passes only
o Foot bones partway through the shaft of a bone
(metatarsals)  C o m m in u ted : A fracture in which the bone is broken
o Toe bones into more than two fragments
(phalanges)  P ath o lo g ic : A fracture of weakened or diseased
bone
 O b liq u e: A fracture in which the bone is broken at
an angle across the bone
M u scu lo skele tal In ju rie s  T ran sv erse : A fracture that occurs straight across
 A fractu re is a broken bone. the bone
o A potential complication is compartment  S p iral: A fracture caused by a twisting force,
syndrome. causing an oblique fracture around the bone and
 A d islo ca tio n is a disruption of a joint in which the through the bone
bone ends are no longer in contact.  In co m p lete : A fracture that does not run completely
 A su b lu xatio n is similar except the disruption of the through the bone
joints is not complete.
 A fractu re -d islo ca tio n is a combination injury at the S u sp e ct if o n e o r m o re o f th e fo llo w in g sig n s are
joint. p res en t:
 A sp ra in is an injury to ligaments, articular capsule,  Deformity  Crepitus
synovial membrane, and tendons crossing the joint.  Tenderness  False motion
 Guarding  Exposed fragments
 A strain is a stretching or tearing of the muscle,
 Swelling  Pain
causing:
 Bruising  Locked joint
 Pain
 Swelling
D IS L O C A T IO N S
 Bruising
 An am p u tatio n is an injury in which an extremity is  Sometimes a dislocated joint will spontaneously
completely severed from the body. reduce before your assessment.
 Injury to bones and joints is often associated with o Confirm the dislocation by taking a patient
injury to the surrounding tissues. history.
o Entire area is known as the zo n e o f in ju ry o A dislocation that does not reduce is a
serious problem.
M ech an ism o f In ju ry  S ig n s an d sym p to m s
 Significant force is generally required to cause o Marked deformity
fractures and dislocations. o Swelling
o Direct blows o Pain that is aggravated by any attempt at
o Indirect forces movement
o Twisting forces o Tenderness on palpation
o High-energy forces o Virtually complete loss of normal joint motion

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 o Numbness or impaired circulation to the limb o Strength of the force that caused the injury
or digit o Injury’s location
o Patient’s overall health
S P R A IN S  To prevent contamination following an open fracture:
o Brush away any debris on the skin
 A sp ra in occurs when a joint is twisted or stretched o Do not enter or probe the site
beyond its normal range of motion.  Long-term disability is one of the most devastating
o Alignment generally returns to a fairly consequences of an orthopaedic injury.
normal position, although there may be  You can help reduce the risk or duration of long-term
some displacement. disability by:
o Severe deformity does not typically occur. o Preventing further injury
 S ig n s an d sym p to m s o Reducing the risk of wound infection
o Point tenderness o Minimizing pain by the use of cold and
o Swelling and ecchymosis analgesia
o Pain o Transporting patients to an appropriate
o Instability of the joint medical facility

S T R A IN A s se ssin g th e S ev erity o f In ju ry
 The Golden Period is critical for life and for
 A strain is an injury to a muscle and/or tendon that
preserving limb viability.
results from a violent muscle contraction or from
o Prolonged hypoperfusion can cause
excessive stretching.
significant damage.
o Often no deformity is present and only minor
o Any suspected open fracture or vascular
swelling is noted at the site of the injury.
injury is a medical emergency.
 Most injuries are not critical.
COM PARTM ENT SYNDROM E
o Use a grading system.

 Most often occurs with a fractured tibia or forearm of

children
 Typically develops within 6 to 12 hours after injury,
as a result of:
o Excessive bleeding
o A severely crushed extremity
o The rapid return of blood to an ischemic limb
 This syndrome is characterized by:
o Pain that is out of proportion to the injury
o Pain on passive stretching of muscles within
the compartment
o Pallor
o Decreased sensation
o Decreased power

A M P U T A T IO N S

 Can occur as a result of trauma or a surgical

intervention
 You must control bleeding and treat for shock.
 Be aware of the victim’s emotional stress.

C o m p lica tio n s O rth o p ed ic In ju ries

 Orthopaedic injuries can also lead to systemic
changes or illnesses.
 The likelihood of having a complication is often
related to the:

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 P atien t A s se ssm en t C irc u latio n
 Determine whether the patient has a pulse, has
P atie n t asse ssm en t step s adequate perfusion, or is bleeding.
1. Scene size-up  If the skin is pale, cool, or clammy and capillary
2. Primary assessment refill time is slow, treat for shock.
3. History taking  Maintain a normal body temperature and
4. Secondary assessment improve perfusion with oxygen.
5. Reassessment  Fractures can break through the skin and cause
external bleeding.
A lw ays lo o k at th e b ig p ictu re.
 Distinguish mild injuries from severe injuries. T ran sp o rt d ecisio n
 Severe injuries may compromise neurovascular  Provide rapid transport if the patient has an
function, which could be limb threatening. airway or breathing problem, or significant
bleeding.
 A patient who has a significant MOI but whose
S C E N E S IZ E -U P condition appears otherwise stable should also
be transported promptly.
S ce n e
safety  Patients with a simple MOI may be further
 Observe the scene for any hazards. assessed.
 Identify the forces associated with the MOI.
 Standard precautions involve gloves, a mask, H IS T O R Y T A K IN G
and a gown.
 Consider that there may be hidden bleeding.  Investigate the chief complaint.
 Evaluate the need for additional support.  Obtain a medical history and be alert for
injury-specific signs and symptoms and
M ech an ism o f in ju ry/n a tu re o f illn es s any pertinent negatives.
 Look for indicators of the MOI.  Obtain a SAMPLE history for all trauma patients.
 Be alert for both primary and secondary injuries.  OPQRST is too lengthy when matters of
 Consider how the MOI produced the injuries ABCs require immediate attention.
expected.
SECONDARY ASSESSM ENT
P R IM A R Y A S S E S S M E N T
M o re d etailed exa m in atio n o f th e p atien t to rev eal
F o cu s o n id en tifyin g an d m an ag in g life th reats. h id d en in ju rie s

F o rm a g en era l im p res sio n . P h ys ica l exa m in atio n s

 Introduce yourself.  If significant trauma has occurred, start with a
 Check for responsiveness using the AVPU scale. full-body scan
 Ask about the chief complaint.  Begin with the head and work systematically
toward the feet.
 Administer high-flow oxygen to all patients
whose LOC is less than alert and oriented.  Assess the musculoskeletal system.
 Perform a rapid scan and ask about the MOI.  When lacerations are present in an extremity,
consider an open fracture.
 If there was significant trauma, the
musculoskeletal injuries may be a lower priority.  Any injury or deformity of the bone may be
associated with vessel or nerve injury.
A irw ay an d b rea th in g
 Evaluate the chief complaint and MOI.
 If a spinal injury is suspected, take the
appropriate precautions and prepare for
stabilization.
 Oxygen may be given to relieve anxiety and
improve perfusion.

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  Suspect internal bleeding.

S p lin tin g
 A sp lin t is a flexible or rigid device that is used to
protect and maintain the position of an injured
extremity.
o Splint all fractures, dislocations, and sprains
before moving the patient, unless he or she
is in immediate danger.
o Splinting reduces pain and makes it easier
to transfer and transport the patient.

 Splinting will help to prevent:

V ital sig n s o Further damage to muscles, the spinal cord,
 Determine a baseline set of vital signs, including: peripheral nerves, and blood vessels
 Pulse rate, rhythm, and quality o Laceration of the skin
 Respiratory rate, rhythm, and quality o Restriction of distal blood flow
 Blood pressure o Excessive bleeding of the tissues
 Skin condition o Increased pain
 Pupil size and reaction to light o Paralysis of extremities

REASSESSM ENT

R ep ea t th e p rim ary asse ssm en t.

 Every 5 minutes for an unstable patient
 Every 15 minutes for a stable patient

In terv en tio n s
 Assess the overall condition, stabilize the ABCs,
and control any serious bleeding.
 In a critically injured patient, secure the patient
to a long backboard and transport.
 If the patient has no life-threatening injuries, take
extra time at the scene to stabilize his or her
condition.
 The main goal is stabilization in the most
comfortable position that allows for maintenance
of good circulation distal to the injury.

C o m m u n icatio n an d d o cu m en tatio n
 Include a description of the problems found
during your assessment. G E N E R A L P R IN C IP L E S O F S P L IN T IN G
 Report problems with the ABCs, open fractures,
and compromised circulation.  Remove clothing from the area.
 Document complete description of injuries and  Note and record the patient’s neurovascular
the MOIs associated with them. status.
 Cover all wounds with a dry, sterile dressing.
E m e rg en cy M ed ical C are  Do not move the patient before splinting an
extremity, unless there is danger.
 Perform a primary assessment.
 Pad all rigid splints.
 Stabilize the patient’s ABCs.
 Maintain manual stabilization.
 Perform a rapid scan or focus on a specific
injury.  If you encounter resistance, splint the limb in its
deformed position.
 Follow standard precautions.

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  Stabilize all suspected spinal injuries in a neutral, R ig id S p lin ts
in-line position.  Made from firm material
 When in doubt, splint.  Applied to the sides, front, and/or back of an injured
extremity
G E N E R A L P R IN C IP L E S O F IN -L IN E T R A C T IO N  Prevent motion at the injury site
S P L IN T IN G  Takes two responders to apply

 Act of pulling on a body structure in the direction

of its normal alignment
 Goals of in-line traction:
 To stabilize the fracture fragments
 To align the limb sufficiently
 To avoid potential neurovascular
compromise
 Imagine where the uninjured limb would lie, and  R ig id sp lin ts
pull gently along the line of that imaginary limb o Can help stabilize fractures
until the injured limb is in approximately that o Reduce pain
position o Prevent further damage to soft-tissue
injuries
 A sp lin t is a supportive device that protects a o Once the splint is applied, monitor
broken bone or injury. A splint keeps the injured part circulation in the distal extremity.
of your body still to help with pain
 Two situations in which you must splint the limb in
the position of deformity:
o When the deformity is severe
o When you encounter resistance or extreme
pain when applying gentle traction to the
fracture of a shaft of a long bone

F o rm ab le S p lin ts
 Most commonly used formable splint is the
precontoured, inflatable, clear plastic air splint
A ir S p lin ts o Comfortable
 Can control internal or external bleeding associated o Provides uniform contact
with severe injuries o Applies firm pressure to a bleeding wound
 Stabilize fractures o Used to stabilize injuries below the elbow or
 Act like a pressure dressing knee
 Commonly referred to as
soft splints or pressure  D raw b acks :
splints o The zipper can stick, clog with dirt, or freeze.
 Once the splint is applied, o Significant changes in the weather affect the
monitor circulation in the pressure of the air in the splint.
distal extremity.
 Use only approved, clean,
or disposable valve stems.

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 5. Slide splint under injured leg.

6. Fasten the ischial strap.

7. Connect loop of ankle hitch to splint

8. Tighten the ratchet so the splint holds the
traction
9. Apply the rest of the straps- avoiding the fracture
site.
10. Assess neurovascular function
T ractio n S p lin ts
 Used primarily to secure and designed to stabilize
femur fractures
o When traction pulls the ankle,
countertraction is applied to the ischium and
groin.
T o ap p ly a S ag e r sp lin t
o Once the splint is applied, monitor
1. Expose the injured extremity and check pulse,
circulation in the distal extremity.
motor, and sensory function.
2. Adjust the thigh strap of the splint.
 Several different types:
3. Estimate the proper splint length.
o Hare splint
4. Fit the ankle pads to the patient’s ankle.
o Sager splint
5. Place the splint along the inner thigh.
o Reel splint
o Kendrick splint

6. Secure the ankle harness.

7. Snug the cable ring against the bottom of the
foot.
8. Pull out the inner shaft of the splint to apply
traction.
 Do not use for any of these conditions:
o Injuries of the upper extremity
o Injuries close to or involving the knee
o Injuries of the hip
o Injuries of the pelvis
9. Secure the limb to the splint.
o Partial amputations or avulsions with bone
10. Secure patient to a long backboard.
separation
11. Check pulse, motor, and sensory function.
o Lower leg, foot, or ankle injury

T o ap p ly a H are sp lin t
1. Expose the injured limb.
2. Measure distance of splint on
uninjured leg- Should be 6-8
inches past ankle.
3. Measure on opposite leg of
fracture as femur fracture side
can be shortened
4. Apply ankle hitch
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 P elv ic B in d er o Splint the joint in whatever position is more
 Used to splint the bony pelvis to reduce hemorrhage comfortable for the patient.
from bone ends, venous disruption, and pain
 Meant to provide temporary stabilization F rac tu res o f th e H u m eru s
o Should be light, made of soft material, easily  Occur either proximally, in the midshaft, or distally at
applied by one person, and should allow the elbow
access to the abdomen, perineum, anus,  Consider applying traction to realign the fracture
and groin fragments before splinting them.
o Splint the arm with a sling and swathe.
H A Z A R D S O F IM P R O P E R S P L IN T IN G

 Compressions of nerves, tissues, and blood

vessels
 Delay in transport of a patient with a life-
threatening injury
 Reduction of distal circulation
 Aggravation of the injury
 Injury to tissue, nerves, blood vessels, or
muscles

T R A N S P O R T A T IO N

 Very few, if any, musculoskeletal injuries justify

the use of excessive speed during transport.
 A patient with a pulseless limb must be
given a higher priority. E lb o w In ju rie s
 If the treatment facility is an hour or  Different types of injuries are difficult to distinguish
more away, transport by helicopter or without x-ray examinations.
immediate ground transportation.  Fracture of the distal humerus
o Common in children
In ju rie s o f th e C lav icle an d S ca p u la o Fracture fragments rotate significantly,
 The clavicle is one of the most commonly fractured producing deformity and causing injuries to
bones in the body. nearby vessels and nerves.
o Occur most often in children
o A patient will report pain in the shoulder and  D islo c atio n o f th e elb o w
will hold the arm across the front of the body. o Typically occurs in athletes
 Fractures of the scapula occur much less frequently o The ulna and radius are most often
because the bone is well protected by many large displaced posteriorly
muscles.  E lb o w jo in t sp ra in
o Almost always the result of a forceful, direct o This diagnosis is often mistakenly applied to
blow to the back an occult, nondisplaced fracture.
o The associated chest injuries pose the  F rac tu re o f o lecran o n p ro cess o f u ln a
greatest threat of long-term disability o Can result from direct or indirect forces
 These fractures can be splinted effectively with a o Often associated with lacerations and
sling and swathe. abrasions
o Patient will be unable to extend the elbow.
D islo c atio n s o f th e S h o u ld er  F rac tu res o f th e rad ia l h ead
 The humeral head most commonly dislocates
o Often missed during diagnosis
anteriorly.
o Generally occurs as a result of a fall on an
 Shoulder dislocations are very painful.
outstretched arm or a direct blow to the
o Stabilization is difficult because any attempt
lateral aspect of the elbow
to bring the arm in toward the chest wall
o Attempts to rotate the elbow or wrist cause
produces pain.
discomfort.

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 C are o f elb o w in ju rie s o Place the patient supine on a backboard.
o All elbow injuries are potentially serious and o Support the affected limb with pillows.
require careful management. o Secure the entire limb to the backboard with
o Always assess distal neurovascular long straps.
functions periodically. o Provide prompt transport.
o Provide prompt transport for all patients with
impaired distal circulation. F rac tu res o f th e P ro x im al F em u r
 Common fractures, especially in elderly
F ractu re s o f th e F o rearm  Break goes through the neck of the femur, the
 Common in people of all age groups interochanteric region, or across the proximal shaft
 Seen most often in children and elderly of the femur
 Usually, both the radius and the ulna break at the  Patients display a certain deformity.
same time. o They lie with the leg externally rotated, and
o Fractures of the distal radius are known as the injured limb is usually shorter than the
Colles fractures. opposite, uninjured limb.
o To stabilize fractures, you can use a padded  Assess the pelvis for any soft-tissue injury and
board, air, vacuum, or pillow splint. bandage appropriately.
 Assess pulses and motor and sensory functions.
In ju rie s o f th e W rist an d H an d  Splint the lower extremity and transport to the
 Must be confirmed by x-ray exams emergency department.
 Dislocations are usually associated with a fracture.
 Any questionable wrist injury should be splinted and F em o ra l S h aft F ractu re s
evaluated in the ED.  Can occur in any part of the shaft, from the hip
 Follow the steps in S kill D rill to splint the hand and region to the femoral condyles just above the knee
wrist. joint
 Large muscles of the thigh spasm in an attempt to
F ractu re s o f th e P elv is “splint” the unstable limb.
 Often results from direct compression in the form of  Fractures may be open.
a heavy blow  There is often significant blood loss.
o Can be caused by indirect forces  Bone fragments may penetrate or press on
o Not all pelvis fractures result from trauma. important nerves and vessels.
 May be accompanied by life-threatening loss of o Carefully and periodically assess the distal
blood neurovascular function.
 Open fractures are quite uncommon.  Cover any wound with a dry, sterile dressing.
 Suspect a fracture of the pelvis in any patient who  These fractures are best stabilized with a traction
has sustained a high-velocity injury and complains of splint.
discomfort in the lower back or abdomen.
 Assess for tenderness. In ju rie s o f K n ee L ig am en ts
 Many different types of injuries occur in this region.
D islo c atio n o f th e H ip o Ligament injuries
 Dislocates only after significant injury o Patella can dislocate.
 Most dislocations are posterior. o Bony elements can fracture.
 Suspect a dislocation in any patient who has been in  When you examine the patient, you will generally
an automobile crash and has a contusion, laceration, find:
or obvious fracture in the knee region. o Swelling
 Posterior dislocation is frequently complicated by o Occasional ecchymosis
injury to the sciatic nerve. o Point tenderness at the injury site
 Distinctive signs o A joint effusion
o Severe pain in the hip  Splint all suspected knee ligament injuries.
o Strong resistance to movement of the joint
o Tenderness on palpation D islo c atio n o f th e K n ee
 Make no attempt to reduce the dislocated hip in the  These are true emergencies that may threaten the
field. limb.
o Splint the dislocation.  Ligaments may be damaged or torn.

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 Direction of dislocation is the position of the tibia  Correct any gross deformity by applying traction.
with respect to the femur.  Before releasing traction, apply a splint.
o Anterior dislocations
o Posterior dislocations F o o t In ju rie s
o Medial dislocations  Can result in the dislocation or fracture of one or
 Complications may include: more of the tarsals, metatarsals, or phalanges of the
o Limb-threatening popliteal artery disruption toes
o Injuries to the nerves  Frequently, the force of injury is transmitted up the
o Joint instability legs to the spine.
 If adequate distal pulses are present, splint the knee  If you suspect a foot dislocation, assess for pulses
and transport promptly. and motor and sensory functions.
 Injuries of the foot are associated with significant
F rac tu res A b o u t th e K n ee swelling but rarely with gross deformity.
 May occur at the distal end of the femur, at the  To splint the foot, apply a rigid padded board splint,
proximal end of the tibia, or in the patella an air splint, or a pillow splint.
o Leave the toes exposed.
M an ag em en t
 If there is an adequate distal pulse and no C o m p artm e n t S yn d ro m e
significant deformity, splint the limb with the  If you have a pediatric patient with a fracture below
knee straight. the elbow or knee, be on the lookout for these
 If there is an adequate pulse and significant signs/symptoms:
deformity, splint the joint in the position of o Extreme pain
deformity. o Decreased pain sensation
 If the pulse is absent below the level of injury, o Pain on stretching of affected muscles
contact medical control. o Decreased power
 Never use a traction splint.  If you suspect the patient has compartment
syndrome, splint the affected limb and transport
D islo c atio n o f th e P ate lla immediately.
 Most commonly occurs in teenagers and young o Reassess neurovascular status frequently
adults in athletic activities during transport.
 Usually, the dislocated patella displaces to the  Must be managed surgically.
lateral side and exhibits a significant deformity.
 Splint the knee in the position in which you find it. A m p u tatio n s
 Surgeons can occasionally reattach amputated parts.
In ju rie s o f th e T ib ia an d F ib u la  Make sure to immobilize the part with bulky
 Tibia (shinbone) is the larger of the two leg bones, compression dressings.
and the fibula is the smaller. o Do not sever any partial amputations.
 Fracture may occur at any place between the knee o Control any bleeding to the stump.
joint and the ankle joint. o If bleeding cannot be controlled, apply a
o Usually, both fracture at the same time. tourniquet.
 Stabilize with a padded, rigid long leg splint or an air  With a complete amputation, wrap the clean part in a
splint. sterile dressing and place it in a plastic bag.
o Put the bag in a cool container filled with ice.
A n kle In ju rie s o The goal is to keep the part cool without
 The ankle is a very commonly injured joint. allowing it to freeze or develop frostbite.
o Range from a simple sprain to severe
fracture-dislocations S tra in s an d S p ra in s
 Any ankle injury that produces pain, swelling, S tra in s
localized tenderness, or the inability to bear weight  Often no deformity is present and only minor
must be evaluated by a physician. swelling is noted.
 Patients may complain of:
M an ag em en t
 Increased sharp pain with passive
 Dress all open wounds. movement
 Assess distal neurovascular function.
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  Severe weakness of the muscle
 Extreme point tenderness
 General treatment is similar to that of fractures
and includes the following:
 Rest; immobilize or splint injured area
 Ice or cold pack over the injury
 Compression with an elastic bandage
 Elevation
 Reduced or protected weight bearing
 Pain management as soon as practical

S p ra in s
 Usually result from a sudden twisting of a joint
beyond its normal range of motion
 Majority involve the ankle or the knee
 Err on the side of caution and treat every sprain
as if it is a fracture.
 Sprains are typically characterized by:
 Pain
 Swelling at the joint
 Discoloration over the injured joint
 Unwillingness to use the limb
 Point tenderness
 General treatment is the same for strains.

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 P S Y C H O L O G IC A L F IR S T -A ID - A C O M M U N IT Y S U P P O R T M O D E L

N o one w ho experie nces a disaste r is untou ched by it.  Support survivors to master the disaster
experience
P syc h o lo g ical F irst-A id
 A set o f skills that helps community residents care D isa ster
for their families, friends, neighbors, and themselves  A disaster is an occurrence that causes human
by providing basic psychological support in the suffering or creates human needs that the victim
aftermath of traumatic events. cannot alleviate without assistance.
 All Disasters Begin Locally.Get Prepared Locally!
A m o d el th at:
 Integrates public health, community, and R esilien ce b u ild in g is anchored in und erstanding
individual psychology. ind ivid ual difference.
 Includes preparedness for communities, work
places, schools, faith communities, and families. C ritic al In cid en t
 Does not rely on direct services by mental health  A natural or man-made event or situation that has
professionals. the potential to temporarily overwhelm the ability to
 Uses skills you probably already have. maintain psychosocial equilibrium.

P syc h o lo g ica l F irst-A id R eso u rces An event may not qualify as a disaster, but has an
 American Red Cross impact on the community. Such as suicides or serious
 American Psychological Association accidents.
 Centers for Disease Control & Prevention (CDC)
 Substance Abuse and Mental Health Services The focus is on the words “tem p o rary ” an d
Administration (SAMHSA) “eq u ilib riu m ”
 National Institute for Mental Health (NIMH)
Symptoms may last longer, or may not emerge
 Minnesota Department of Health (MDH)
 Minnesota Department of Human Services immediately, and even if additional help is needed, that
 Minnesota Hospital Association (MHA) is not necessarily an indication that negative effects of
 National Center for PTSD, Terrorism & Disaster the event are permanent. For extreme cases, such as
Branch PTSD, negative symptoms can be managed with
appropriate support and professional intervention.
This is a list of agencies who have been
instrumental in the development and promotion of
psychological first aid training for behavioral health
and other healthcare professionals.
For more information, each agency has a website.
All agencies listed did develop training specific to
Hurricane Katrina responders.
This training does not require previous knowledge of
psychological principles. It is an entry level training
on understanding disaster and critical event
response.
Minnesota Department of Health is the initiative.
Minnesota Department of Human Services is
responsible for deploying resources in the event of a T o th e T rain er: The number of people affected
disaster. psychologically is larger than the number sustaining
personal harm, damage to home, or loss of possessions.
G u id elin es The size of the “psychological footprint” is larger than the
A n o rm al rea ctio n to an ab n o rm al situ atio n medical footprint. Ex: During the Sept. 11, 2001 terrorist
attack, 3,000 people were killed and 7,500 sought
 Expect and promote normal recovery
medical attention- in fact people all over the world were
 Assume survivors are competent
affected. The term widespread refers to not only larger
 Recognize survivor strengths
numbers, but larger geographical area.
 Promote resiliency

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 T h e M o d el S kills  Connection to disaster recovery
S A F E T Y , F U N C T IO N , A C T IO N : services,medical care, work,
Psychological First Aid for Disaster Survivors school, vital services
OUTCOMES W h at T o D o :
 Keep survivor families intact.
 Reunite separated loved ones.
SAFETY
 Reunite parents with children.
 Restoring physical safety and diminishing the
 Connect survivors to available
physiological stress response. supports.
F U N C T IO N  Connect to disaster relief
 Facilitating psychological function and perceived services, medical care.
sense of safety and control. A C T IO N
A C T IO N W h at S u rv iv o rs N eed :
 Initiating action toward disaster recovery and  Information about the disaster
return to normal activity.  Information about what to do
 Information about resources
 Reduction of uncertainty
SAFETY
EDUCATE W h at T o D o :
W h at S u rv iv o rs N eed :
 Clarify disaster information:
 Safety
 what happened
 Security
 what will happen
 Shelter
 Provide guidance about what to
W h at T o D o : do.
SAFEGUARD
 Remove from harm’s way.  Identify available resources.
 Remove from the scene. W h at S u rv iv o rs N eed :
 Provide safety and security  Planning for recovery
 Provide shelter.  Practical first steps and “do-
 Reduce stressors. able” tasks
W h at S u rv iv o rs N eed :  Support to resume normal
 Basic survival needs activities
W h at T o D o :  Opportunities to help others
 Provide food, water, ice. W h at T o D o :
EM POW ER
S U S T A IN  Provide medical care, alleviate  Set realistic disaster recovery
pain. goals.
 Provide clothing.  Problem solve to meet goals.
 Provide power, light, heat, air  Define simple, concrete tasks.
conditioning.  Identify steps for resuming
 Provide sanitation. normal activities.
F U N C T IO N  Engage able survivors in
W h at S u rv iv o rs N eed : helping tasks.
 Soothing human contact
 Validation that reactions are G en era l G u id elin es
“normal”.
 Tell the truth as it is known, when it is known.
W h at T o D o :
 Explain what is being done to deal with the
 Establish a compassionate
problem.
“presence.”
COM FORT  Listen actively.  Avoid withholding bad news or disturbing
 Comfort, console, soothe, and information.
reassure.  Be forthright about what is not known.
 Apply stress management  Provide practical guidance for citizen protection.
techniques.
 Reassure survivors that their Use very direct language such as “Dead or die” not
reactions are “normal” and
“loss or pass”
expected
Start slow add details as ready
W h at S u rv iv o rs N eed :
CONNECT
 Social supports/keeping family
together
 Reuniting separated loved ones

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 S K IL L S : S tres s  Feeling a lack of involvement or enjoyment in
favorite activities
S tre ss is:  Feeling a sense of emptiness or hopelessness
 Normal about the future
 Productive or destructive
 Acute or chronic C o m m o n E m o tio n al R eac tio n s to T rau m a tic S tre ss
 Cumulative over time in C h ild re n
 Preventable  Anxiety, fear, vulnerability
 Manageable  Fear of reoccurrence
 Fear of being left alone
STRESSORS  Especially if separated from family
during event
 Events or situations that produce physical or  May seem like an exaggerated reaction
psychological reactions to adults
 Stressors can be:  Loss of “Sense of Safety”
 Real or imagined  Depression
 Internal or external  Anger
 Absolute or perceived  Guilt

T h e S tre ss R esp o n se C o m m o n C o g n itiv e R eac tio n s to T rau m atic S tre ss in

 P h ys ica l – Body Reactions A d u lts
 E m o tio n al – Feelings  Difficulty concentrating
 C o g n itiv e – Thinking and decision making  Difficulty with memory
 B eh av io ral – Actions  Intrusive memories
 S p iritu al – Beliefs and values  Recurring dreams or nightmares
 Flashbacks
 Difficulty communicating
C o m m o n P h ys ical R eac tio n s to T rau m a tic S tres s in  Difficulty following complicated instructions
A d u lts
 Elevated heart rate
C o m m o n C o g n itiv e R eac tio n s to T rau m atic S tre ss in
 Elevated blood pressure
C h ild ren
 Elevated blood sugar
 Confusion and disorientation
 Stomach upset, nausea
 Particularly difficult symptom for school-
 Gastrointestinal problems (diarrhea, cramps) age children
 Sleep difficulties  Difficulty concentrating
 With extended stress, suppression of immune  May appear as behavioral problems in
system functioning classroom

C o m m o n P h ys ical R eac tio n s to T rau m a tic S tres s in *N o te th at sch o o l m ay b e p lace w h ere ch ild
C h ild ren fu n ctio n s b est:
 Headaches  Continuing structure, predictability
 Stomachaches  Child may retain a sense of control
 Nausea
 Eating problems C o m m o n B eh av io ral R eactio n s to T rau m atic S tre ss
 Other physical reactions in A d u lts
 Family challenges (physical, emotional abuse)
C o m m o n E m o tio n al R eac tio n s to T rau m a tic S tre ss  Substance abuse
in A d u lts  Being overprotective of family
 Fear and anxiety  Keeping excessively busy
 Sadness and depression  Isolating self from others
 Anger and irritability  Being very alert at times, startling easily
 Feeling numb, withdrawn, or disconnected  Problems getting to sleep or staying asleep

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  Avoiding places, activities, or people that bring A C T IV E L IS T E N IN G
back memories
V erb al S u p p o rt
C o m m o n B eh av io ral R eactio n s to T rau m atic S tre ss  Tone of voice
in C h ild re n  Not too loud
 “Childish” or regressive behavior  Encouraging prompts/head movement
 May not be deliberate acting out  Support personal pacing
 Bedtime problems
 Sleep onset insomnia P h ys ica l C o n tact
 Midnight awakening  Pat on back
 Fear of dark  Hug
 Fear of event reoccurrence during night  Follow lead of person

A C T IV E U N D E R S T A N D IN G
C o m m o n R eac tio n s to T rau m a tic S tre ss –
F aith & S p iritu ality in A d u lts & C h ild ren  Try not to interrupt
 Reliance upon faith  Ask questions to clarify
 Questioning values and beliefs  Occasionally restate a part of the story in your
 Loss of meaning own words to make sure you understand
 Directing anger toward God  Establish sequence
 Cynicism  Avoid “Why?” and “Why not?”
 Avoid “I know how you feel”
Senses have the power to diminish or intensify stress  Avoid evaluation of their experience and their
responses. reactions in the event
Under stress, sensory responses are compromised.  Silence is OK
Also can trigger memories.
A G IT A T IO N

E V E N T IS M O R E T R A U M A T IC W H E N …  Some may become agitated

 Refusal to follow directions
 Event is unexpected  Loss of control
 Many people die, especially children  Become threatening
 Event lasts a long time  This is a reaction to an U N C O M M O N situ atio n ,
 The cause is unknown and has nothing to do with you
 Event is poignant or meaningful  Seek help from security
 Event impacts a large area
T o th e T rain er: Denial defenses are primary in all
F A C T O R S T H A T M A K E T R A U M A T IC E V E N T S L E S S catastrophic situations. Sometimes an innocent word
STRESSFUL… expressed by you may produce an unexpected violent
reaction. You have to be sensitive to the fact that most
 Preparation survivors need to defend themselves FOR A TIME from
 Training the reality of their situation.
 Teamwork, cooperation, camaraderie
*Carefully support them into accepting reality and help
them process the sense of loss by using comforting
S K IL L S : A c tiv e L isten in g skills.
 Eye contact
E m o tio n al/B eh av io ral E sc ala tio n :
 Facial expression
 Answer their questions
 Tone of voice
 Repeat your request in a neutral tone of voice
 Head movement
E le m en ts o f D e-esc ala tio n :
1. In tro d u ce yo u rse lf if th ey d o n o t kn o w yo u
- Ask the person what they would like to
be called
- Don't shorten their name or use their

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 first name without their permission  Extreme stress reactions or grief
- With some cultures, it is important to  Confusion
always address them as "Mr." or "Mrs.",  Inability to concentrate or make decisions
especially if they are older than you
 Haunted by images or memories of the event
2. U se co n cre te q u estio n s to h elp th e p ers o n  Complaining of physical symptoms after
fo cu s reassurance that there are none
- Use closed ended questions
- If the person is not too agitated, briefly Alarm Bells list verbal or non-verbal indicators that more
explain why you are asking the question help is needed than psychological first aid.
F o r exa m p le:
These would be signs that a supervisor should be called,
I'd like to get some basic information from you
so that I can help you better. Where do you or that someone be encouraged to contact a
live? professional.
Take time to explore how this might be handled with the
3. C o m e to an ag ree m en t o n so m eth in g most sensitivity for the community.
- Establishing a point of agreement will
help solidify your relationship and help
gain their trust
- Positive language has more influence R eferrals fo r A d d itio n al C are an d S u p p o rt
than negative language (IM M E D IA T E )
- Active listening will assist you in finding  Disorientation
a point of agreement  Psychotic behavior
 Inability to care for self
4. S p ea k to th e p ers o n w ith res p ect
This is communicated with:  Suicidal/homicidal thoughts, talk, or plans
 Words  Inappropriate anger or reactions to triggers
 Para-verbal Communication  Excessively “flat” emotions
 Non-verbal behavior  Regression
 Use of words like please and thank you  Problematic alcohol or drug use
 Don't make global statements about the  Flashbacks, excessive nightmares, or crying
person's character
 Use “I” statements
 Lavish praise is not believable S E L F -C A R E : A R E Y O U R E A D Y … R E A L L Y ?

B A S IC P R IN C IP L E S …  Evaluate your level of readiness to respond

 Do not assume that because you are
 Privacy experienced you must be ready to respond
 Respect  Give consideration to your physical and
 Non-judging emotional health
 Impartial  If you have recently encountered a major life
stressor it may be better for you and those who
 Equal care for all
need assistance for you to NOT to respond
 Gender, age,ethnicity, religion, political
perspective, and culture
R esilie n ce
YOUR ROLE  Positive adaptation in the face of adversity
 Ordinary--not extraordinary
 A Compassionate Presence  People commonly demonstrate resilience
 The “ru le ” not the exception
B asic P rin cip le o f H elp in g :
W H E N IN D O U B T … R E F E R T O A P R O F E S S IO N A L ! P R O M O T E R E S IL IE N C Y

S p ec ific rea ctio n s th at M A Y in d icate ad d itio n al  Everyone who experiences a disaster is touched
n eed s by it
 We have the ability to “bounce back” after a
 Difficultly thinking clearly or acting logically disaster to a “New Normal”
 Bizarre behavior  Resilience can be fostered
 Lacking awareness of reality
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  One goal of Psychological First-Aid: support P o st-ev en t (R eco v ery)
resiliency in ourselves and others  Monitor health and well-being
 Delayed reactions with increased demand for
T o th e train er: Resilience is the ability to accommodate services seen in general public and emergency
and bounce back after a setback, disappointment, crisis responders (onset >5 wks later)
or major distress. Following a disaster the ability to  Give yourself time to recover
bounce back can be supported and nurtured.  Seek support when needed
Psychological First Aid can nurture resilience.
T o T h e T rain e r: Post-event- realize that your emotional
P E R S O N A L R E S IL IE N C Y P L A N reactions to the event may be delayed up to 5 weeks
after the event so give yourself time to recover and seek
 Focus beyond short-term help from a professional if needed.
 Know your unique stressors and R ed F lag s
 Know unique stressors of the event: extent of
damage, death, current suffering SELF CARE AFTER SUPPORT W ORK
 Demystify/de-stigmatize common reactions
 Select from menu of coping responses  Expect a reintegration period upon returning to
 Monitor on-going internal stress your usual routine
 Pay attention to cues from your family that you
T o th e T rain er: Understand how you react to stress. Do are becoming too involved
you feel it as: Shoulder pain, Headaches, Stomach
problems? Learn to recognize when you reach your
stress limit. Remember what are the common reactions Because people who are drawn to be helpers are
to stress. Use healthy coping skills – what has worked motivated to relieve distress, the rewards can be
for you in the past? Assisting others in physical or somewhat intoxicating, making the work of everyday
emotional pain may start to affect you so you should be relationships appear humdrum and unimportant.
constantly aware of your own reactions. Emotional pain
and anxiety are “contagious” and will affect you so The opposite is true! Family members will let us know
continue to monitor yourself for stress reactions. that we’ve lost touch with our role in the family. What
would this look like? Take a moment to discuss
B u ild in g R esp o n d er R esilien ce symptoms of over involvement on the part of helpers.
Talk about what family members would say. Brainstorm
P re-ev en t positive and negative responses.
 Educate and train
 Build social support systems
 Instill sense of mission and purpose
 Create family communications plan

T o T h e T rain e r: Pre-event – create a family

communications plan ( you will not be able to effectively
respond if you are worried about your won loved ones)
Response – Use the buddy system and monitor your
own and your co-workers emotional well-being

R esp o n se
 If possible deploy as a team or use the buddy
system
 Focus on immediate tasks at hand
 Monitor occupational safety, personal health,
and psychological well-being
 Know your limits
 Activate family communication plans

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