DISASTER NURSING (RLE) ● May 23, 2017- Marawi Siege

PRELIM - a battle erupted between the Philippine troops and militants

PHILIPPINE DISASTER PROFILE in Marawi City and the event also known as the Marawi
- The Philippines ranked 3rd Siege.
highest among 171 countries PH NATIONAL POLICIES
in terms of disaster risk ● RA No. 10121
according to the 2016 World - “PH Disaster Risk Reduction and Management Act of 2010”
Risk Report. - To strengthen disaster management
- The Philippines is ● NDRRMP (National Disaster Risk Reduction and
vulnerable to emergencies and Management Plan)
disasters because of its location - 2011-2018 plan for a safer, adaptive, and disaster-resilient
and archipelagic nature. Filipino community towards sustainable development.
- 20 Tropical Cyclones enter ● Memorandum Order No. 23, s. 2014, National Disaster
the Philippine Area of Response Plan (NDRP) for hydro-meteorological
Responsibility every year. ● NDCC MC No. 12, s. 2008, Institutionalization of the Cluster
- Intertropical Convergence Approach in the Philippine Disaster Management System
Zone (ITCZ) - Suicide (e.g ni-jump sa bridge) - wait for 5 years for
- There are 352 volcanoes in the Philippines, 22 are active confirmation of death
and 27 are potentially active. - Missing (e.g. landslide/flood) - wait 1 year to confirm death
- 20 earthquakes are recorded per day. and ayha maminyo utro
- 90 destructive earthquakes and 40 tsunamis were recorded 4 THEMATIC AREAS
in the past 400 years. ● Disaster Prevention and Mitigation
TIMELINE OF PH DISASTER
● July 16, 1990- Central
Luzon Killer (quake: 7.7
Richter scale)
● June 1991- Mt. Pinatubo
eruption (century's 2nd
largest volcanic
eruption)
● Nov 5, 1991- Ormoc city
(worst flash flood)
● December 1987 - Worst
Sea Accident: M/V Dona
Paz
● Disaster Preparedness
● July 2, 1993- Bocaue
Pagoda Tragedy (Worst
festival tragedy)
● April 1995- Armed
conflict/ IPIL MASSACRE
(worst terrorist attack)
● March 18, 1996- OZONE
DISCO FIRE
● 2005 BOHOL MASS
POISONING
● Feb 2006- Guinsaugon
Landslide (worst landslide)
● Disaster Response
● Nov 2009- MAGUINDANAO
MASSACRE
● 2011 "Sendong"
● 2012 TY Pablo
● October 15, 2013- Bohol
Earthquake
● November 8, 2013,
- Typhoon Yolanda,
international code name
Haiyan, made landfall in the
central Philippine island’s
region. The 600 km-diameter
typhoon Yolanda crossed the
Philippine archipelago, bringing widespread devastation in
its path.
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 ● Disaster Recovery and Rehabilitation ● Natural disasters reflect a lack of control over the
environment,
● Technological disasters reflect a loss of control of what was
once under control (Baum et al. 1983)…Because this disaster
was a failure of a human-made dam, the flood that resulted
was less predictable than naturally caused floods.
EXTERNAL VS INTERNAL DISASTER
● An external disaster is an event that impacts a facility when
demand for services goes beyond available resources.
● An internal disaster is an event that happens within the
facility that poses a threat to interrupt the environment of
care.
METEOROLOGICAL DISASTER
- Caused by extreme weather such as rain, drought, snow,
MAJOR LIFELINES
extreme heat or cold, ice, or wind. Examples of weather
● water supply
disasters embrace blizzard, cyclones, droughts, hailstorms,
● transportation
heat waves, hurricanes, floods (caused by rain) and
● financial and economic (e.g. business)
tornadoes
● communications (report situations)
- floods, wildfires, heat waves, and droughts
● infrastructures (e.g roads and bridges)
- Meteorological: relating to weather conditions (such as
● electricity
cyclones and storms)
DISASTER
United Nations International Strategy for Disaster Risk GEOPHYSICAL DISASTER
Reduction (UNISDR) ● include all the geological disasters as well as: Cyclones.
- serious disruption of the functioning of atommunity or a Lightning storms. Drought. Earthquakes Tsunamis.
society at any scale due to hazardous events interacting with Volcanoes. Landslides and other mass movements.
conditions of exposure, vulnerability and capacity, leading to ● Floods (including glacial lake outburst floods and landslide
one or more of the following: human, materials, economic, dam failures)
and environmental losses and impacts CLIMATOLOGICAL DISASTER
- an ecological disruption, or emergency, of a severity and ● climatological disasters as events that are brought about by
magnitude that results in death, injuries, illness and drastic fluctuations of climate states and variabilities. ... This
property damage that cannot be effectively managed using includes natural phenomena like disasters and their weaker
routine procedures or resources and that require outside counterparts.
assistance ● Climate, by definition, is the weather conditions that are
- LEVEL OF RESPONSE; barangay, municipality, province, typical to an area or region
regional, national ● Climatological: relating to the climate (such as droughts and
- Local administrative authorities CANNOT COPE with the wildfires)
impact or the scale of the hazard; and Event is managed HYDROLOGICAL DISASTER
● There are three types: floods; volcanic eruptions, and
from outside the affected communities
tsunamis,
- An event, natural or man-made, sudden or progressive,
● Floods, landslides, tsunamis, storms, heat waves, cold spells,
which impacts with such severity that the affected
droughts and waterborne disease outbreaks
community has to respond by taking exceptional measure
● The impacts and costs of these events are exacerbated by
HEALTH DISASTER
Institute of Medicine (IOM) & Al-Madhari & Keller, 1997 such factors as unplanned urbanization and degradation of
- catastrophic event that results in casualties that overwhelm ecosystem services.
the health care resources in the community BIOLOGICAL DISASTER
- sudden unanticipated surge of patient ● Biological are natural scenarios involving disease, disability
- change of standard of care or death on a large scale among humans, animals and plants
- need to allocate scarce resources due to microorganisms like bacteria, virus or toxins.
RESPONSIBILITIES ● Malaria, Dengue fever. Meningitis, influenza. Pest
● Health infestations. Zoonoses - HIV, H5N1 virus (Bird flu), H1N1
● Nutrition in Disaster (Swine Flu), the plague, Anthrax, Cholera, Leptospirosis.
● Water and Sanitation MAN-MADE/ ANTHROPOGENIC
● Mental health & Psychosocial services (human generated)
TYPES OF DISASTER ● an element of human intent, negligence, or error involving a
NATURAL DISASTER failure of a man-made system, as opposed to natural
- cause by natural or environmental forces result of an disasters resulting from natural hazards.
ecological disruption or threat that exceeds the adjustment ● Man-made disasters are crime, arson, civil disorder,
capacity of the affected community terrorism, war, biological/chemical threat, cyber-attacks,
- Earthquakes, Floods, Tornados, Hurricanes, Volcanic etc.
eruption, Tsunami, and other geological or meteorological TERRORISM
phenomenon ● Use of force or violence against persons or property in
violation of the criminal laws for purposes of intimidation,
NATURAL VS TECHNOLOGICAL DISASTERS coercion, or ransom.
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● Terrorists often use threats to create fear among the public ● Examples: staff nurses in hospitals, clinics, public health
to try to convince citizens that their government is centers; all nurse educators
powerless to prevent terrorism and to get immediate Level II:
publicity for their causes. ● Any nurse who has achieved the Level I competencies and
TECHNOLOGICAL DISASTER is/aspires to be a designated disaster responder within an
● Like natural disasters, technological disasters are caused by institution, organization or system.
events that can be intense and sudden. ● Examples:
● Examples include bridge collapses, dam failures, and ○ supervising or head nurse;
industrial, maritime, and aviation accidents ○ a nurse designated for leadership within an
5 WORST MAN-MADE DISASTER IN HISTORY organization’s emergency plan;
1. Bhopal Gas Tragedy, India: ○ a nurse representing the profession on a
2. Deepwater Horizon Oil Spill, Gulf of Mexico: hospital/agency emergency planning committee;
3. Chernobyl Meltdown, Ukraine: ○ preparedness/response
4. Fukushima Meltdown, Japan: ○ nurse educators
5. Global Warming, Third Planet from the Sun - e.g clinical instructors
PHASES OF DISASTER - go through training
1. Threat
- they can make decision-making
- Pre disaster
Level III:
- Warning
● Any nurse who has achieved Level I and II competencies
2. Impact (inventory)
and is prepared to respond to a wide range of disasters
- Start of disaster (Days 1-3)
and emergencies and to serve on a deployable team.
- Immediately characterized by great dysfunction, intense
● Examples:
overwhelming emotions, or shock
○ frequent responders to either national or
3. Heroic
international disasters,
- Prior to impact up to 1 week afterwards
○ military nurses,
- People working together to save each other/ priorities-
○ nurses conducting comprehensive disaster nursing
concern for survival
research.
4. Honeymoon (community cohesion)
○ Note that specific competencies for this level of nurse
- Remedy Phase: 2 wks – 2 mos
are not included in Version 2.0 at this time, and many
- Victims buoyed & supported by promises of help from
of the competencies expected at this level are
GO’s & NGO’s
common across many disaster-associated disciplines.
5. Disillusionment
● Retrieval of deaths
- Several months to over a year
- natural disaster - NBI
- Unexpected delays and failure; frustration from
- crime - PNP (e.g during marawi)
bureaucratic confusion
- dead bodies - BFP
- Rebuilding their own lives
AREAS: ORIGINAL SET OF DISASTER NURSING
- Solving own individual problems COMPETENCIES
6. Reconstruction (new beginning) Mitigation/prevention
- Several years ● policy
- Characterized by coordinated individual & community development and
effort to rebuild & establish normalcy. planning
Lec 2nd Day - review of planning
ICN FRAMEWORK OF DISASTER NURSING COMPETENCIES ● risk reduction,
Competency ● disease prevention and health promotion
- The capability to apply or use a set of related knowledge,
skills, and abilities required to successfully perform Preparedness
"critical work functions" or tasks in a defined work setting ● ethical practice,
- ex: return demonstration legal practice and
accountability
LEVELS OF NURSES NEEDING COMPETENCY IN DISASTER ● communication
NURSING and information
A NOVICE, should move toward proficiency as defined by sharing
national or institutional standards, and may become an expert. ● education and preparedness
EXPERTISE within any one level does not confer automatic
ability to perform competencies at a higher level. Response (honeymoon phase)
● care of the
LEVELS OF NURSES DEFINED FOR USE IN VERSION 2.0 community
Level I:
● care of individuals
● Any nurse who has completed a programme of basic,
and families
generalized nursing education and is authorized to
● psychological care
practice by the regulatory agency of his/her country.
● care of vulnerable
populations
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Recovery/rehabilitation
all nurse educators. nurses; nurses designated for
● long-term leadership within an
recovery of organization’s emergency
individuals, plan; nurses representing the
families and profession on an institution
communities. or agency emergency
planning committee,
8 DOMAINS
preparedness/response
Domain 1
nurse educators.
● Preparation and planning
● actions taken apart from any specific emergency to Domain 1: Preparation and Planning
increase readiness and confidence in actions to be
taken during an event I.1.1 Maintains a general II.1.1 Participates with other
Domain 2 personal, family and disciplines in planning
professional preparedness emergency drills/exercises at
● Communication
plan the institution or community
● approaches to conveying essential information within level at least annually
one’s place of work or emergency assignment and
documenting decisions made I.1.2 Participates with other II.1.2 Plans nursing
- includes the 6 Major Lifelines disciplines in drills/exercises improvement actions based
Domain 3 in the workplace on results of drill/exercise
evaluation
● Incident management systems
● the structure of disaster/emergency response I.1.3 Maintains up-to-date II.1.3 Communicates roles
required by countries/organizations/institutions and knowledge of available and responsibilities of nurses
actions to make them effective emergency resources, plans, to others involved in
- one command (ex: Dean, Teamleader) policies and procedures planning, preparation,
Domain 4 response and recovery
● Safety and Security I.1.4 Describes approaches to II.1.4 Includes actions
● assuring that nurses, their colleagues and patients do accommodate vulnerable relevant to needs of
not add to the burden of response by unsafe practices populations during an vulnerable populations in
Domain 5 emergency or disaster emergency plans
● Assessment response
● gathering data about assigned II.1.5 Incorporates Level I
core competencies in
patients/families/communities on which to base
Disaster Nursing in any basic
subsequent nursing actions nursing education
Domain 6 programme or refresher
● Intervention course
● clinical or other actions taken in response to
assessment of patients/families/communities within Domain 2: Communication
the incident management of the disaster event I.2.1 Uses disaster II.2.1 Plans for adaptable
Domain 7 terminology correctly in emergency/disaster
● Recovery communication with all communications systems
● any steps taken to facilitate resumption of pre-event responders and receivers
individual/family/community/organization
I.2.2 Communicates disaster- II.2.2 Includes emergency
functioning or moving it to a higher level
related priority communication expectations
Domain 8 information promptly to in all orientation of nurses to
● Law and Ethics designated individuals a workplace
● the legal and ethical framework for
disaster/emergency nursing
ICN CORE COMPETENCIES IN I.2.3 Demonstrates basic II.2.3 Collaborates with
DISASTER NURSING crisis communication skills disaster leadership team(s)
during emergency/disaster to develop event-specific
GENERAL PROFESSIONAL ADVANCED OR SPECIALIZED events media messages
NURSE NURSE

Level I: Level II: I.2.4 Uses available multi- II.2.4 Develops guidance on
any nurse who has any nurse who has achieved lingual resources 8 to provide critical documentation to be
completed a programme of the Level I competencies and clear communication with maintained during disaster or
basic, generalized nursing is or aspires to be a disaster-affected populations emergency
education and is authorized designated disaster
to practice by the regulatory responder within an I.2.5 Adapts documentation
agency of his/her country. institution, organization or of essential assessment and
system. intervention information to
Examples of Level I include the resources and scale of
staff nurses in hospitals, Examples of Level II include emergency
clinics, public health centers; supervising or head

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 Domain 3: Incident Management patient/family/ community assessment of individual
based on principles of triage patients/families/communiti
I.3.1 Describes the national II.3.1 Participates in and type of es based on available
structure for response to an development of emergency/disaster event information
emergency or disaster organizational incident plan
consistent with national I.5.3 Maintains ongoing II.5.3 Includes principles of
standards assessment of assigned disaster/emergency triage in
patient/family/community all assessment courses
I.3.2 Uses the specific II.3.2 Participates with others for needed changes in care in taught in basic and
disaster plan including chain in post-event (actual or response to the evolving continuing education
of command for his/her exercise) evaluation disaster event programmes
place of education or
employment in an event, II.5.4 Identifies event-specific
exercise or drill vulnerable population(s) and
actions needed to protect
them
I.3.3 Contributes II.3.3 Develops action plans
observations and for improvement in nursing Domain 6: Intervention
experiences to post-event practice based on event
evaluation assessment I.6.1 Implements basic first II.6.1 Assures that emergency
aid as needed by individuals plans and institutional policy
in immediate vicinity include the expectation that
I.3.4 Maintains professional II.3.4 Includes emergency basic first aid can be
practice within licensed planning guidance when administered by all nurses
scope of practice when reassigning staff or including
assigned to an inter- unfamiliar colleagues or I.6.2 Isolates II.6.2 Includes
professional team or an volunteers individuals/families/clusters organizationally specific
unfamiliar location at risk of spreading guidance on implementation
communicable condition(s) of isolation in an emergency
Domain 4: Safety and Security to others

I.4.1 Maintains safety for self II.4.1 Implements materials I.6.3 Participates in II.6.3 Describes the range of
and others throughout that support nursing contamination assessment or CBRNE10 exposures and the
disaster/ emergency event in decision- making that decontamination of exposure-related
both usual or austere maintains safety during individuals when directed decontamination methods to
environment(s) disaster/ emergency events through the chain of be used
command
I.4.2 Adapts basic infection II.4.2 Provides timely
control practices to the alternative infection control I.6.4 Engages patients, their II.6.4 Plans for expanded
available resources practices applicable within family members or assigned patient, patient’s family, or
limited resources volunteers, within their volunteer participation in
abilities, to extend resources extending resources in
I.4.3. Applies regular II.4.3 Collaborates with during events emergency/disaster plan
assessment of self and others to facilitate nurses’
colleagues during disaster access to medical and/or I.6.5 Provides patient care II.6.5 Guides implementation
event to identify need for mental health treatment, based on priority needs and of nursing reassignments
physical or psychological and other support services as available resources within an organization’s
support needed emergency plan

I.4.4 Uses PPE9 as directed II.4.4 Explains the I.6.6 Participates in surge II.6.6 Guides nursing
through the chain of levels/differences in PPE and capacity activities as assigned participation in surge
command in a indications for use to nurses (e.g. mass immunization) activities when required by
disaster/emergency event and others event

I.4.5 Reports possible risks to II.4.5 Creates an action plan I.6.7 Adheres to protocol for
personal or others’ safety to address and management of large
and security correct/eliminate risks to numbers of deceased in
personal or others’ safety respectful manner
and security
Domain 7: Recovery
Domain 5: Assessment
I.7.1 Assists an organisation II.7.1 Communicates nursing
I.5.1 Reports symptoms or II.5.1 Assures that all nurses to maintain or resume roles, responsibilities and
events that might indicate have up-to-date information functioning during and post needs to leadership
the onset of an emergency in on potential emergency event throughout the recovery
assigned patients/ events and the process for phase
families/communities reporting them if observed
I.7.2 Assists assigned II.7.2 Maintains up-to-date
I.5.2 Performs rapid physical II.5.2 Develops event-specific patients/families/communiti referral resource lists and
and mental health guidance on rapid physical es to maintain or resume adds event-specific
assessment of each assigned and mental health functioning during and post modifications as needed

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 event emergency- specific laws, specific policy and procedure
policies and procedures guidance for nurses within
I.7.3 Makes referrals for the organization/institution
ongoing physical and mental
health needs as patients are I.8.2. Applies institutional or II.8.2 Participates in the
discharged from care national disaster ethical development of disaster/
framework in care of emergency frameworks for
I.7.4 Participates in transition individuals/families/ allocation of resources (e.g.
de-briefing to identify communities staff, supplies, medications)
personal needs for ongoing
assistance I.8.3 Demonstrates II.8.3 Develops guidance and
understanding of ethical support for nurses expected
Domain 8: Law and Ethics practice during disaster to apply utilitarian principles
response that is based on in practice during emergency
I.8.1 Practices within the II.8.1 Participates in utilitarian principles and disaster response
applicable nursing and development of emergency-

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 DISASTER NURSING (RLE)
PRELIM
GUIDELINES IN GIVING EMERGENCY CARE ● Do provide comfort and emotional support
GETTING STARTED ● Do respect the victim's modesty and physical privacy
1. Plan your action ● Do be as calm and as direct as possible
2. Gather needed materials ● Do care for the most serious injuries first
3. Remember the initial response as follows: ● Do assist the victim with their prescription medication
- Ask for help
- Intervene
- Do no further harm
4. Instruction to helpers
EMERGENCY ACTION PRINCIPLES
1. Survey the Scene
a. Scene Safety
b. Mechanism of injury and nature of illness.
c. Determine the number of patients and
additional resources.
2. Activate Medical Assistance (AMA) or Arrange Transfer
Facility
3. Do a Primary Survey of the Victim
● Check for Consciousness
● Check for Airway
● Do keep onlookers away from the injured person
● Do handle the victim to a minimum
● Do loosen tight clothing

2. What not to DO:

● Do not let the victim see his own injury
● Check for Breathing ● Do not leave the victim alone except to get help
● Check for Circulation ● Do not assume that the victim's obvious injuries are the
4. Do A Secondary Survey of the Victim only ones
A. Interview the victim: ● Do not make any unrealistic promises
- ask the victim's name ● Do not trust the judgment of a confused victim and
- ask what happen require them to make decision
- ask SAMPLE history:
S - Signs/Symptoms
A - Allergies
M - Medication
P - Past medical history
L - Last oral intake
E - Events leading to episode
B. Check Vital Signs
C. Determine Skin Appearance
- for dark colored skin client check the conjunctiva
D. Do Head to Toe Examination
D - Deformity
C - Contusion
A - Abrasion
P - Puncture
B - Burn RLE: 2ND DAY
T - Tenderness SOFT TISSUE INJURIES
L - Laceration Wound
S - Swelling - Is a break in the continuity of a tissue of the body
5. Referral to advance medical authority either internal or external.
GOLDEN RULES IN GIVING EMERGENCY CARE Two Classification of Wounds
1. What to DO: 1. Closed Wound
● Do obtain consent, when possible - Involves the underlying tissue without break/damage in
- implied consent (introduce sel) the skin or
● Do think the worst Causes
- overthink the situations - Blunt objects result in contusion or bruises.
● Do remember to identify yourself to the victim - Application of external forces such as motor vehicle
accidents and falls.
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Signs and Symptoms Dangers
- Pain and Tenderness - Hemorrhage
- Swelling - Infection
- Discoloration - Shock
- Hematoma Kinds of Bleeding
- Uncontrolled restlessness - Arterial Bleeding
- Thirst - Venous Bleeding
- Vomiting or cough up blood - Capillary Bleeding
- Blood in the urine and feces First Aid Management Wound with Severe Bleeding (4Cs)
- Sign of bid. Along mouth, nose, ear canal 1. Control Bleeding
First Aid Management 2. Cover the wound
- Ice application 3. Care for Shock
- Compression 4. Consult or refer to M.D.
- Elevation
- Splinting First Aid Management Wound with Bleeding (NOT severe)
1. Clean the wound with soap and water
2. Open Wound 2. Apply mild Antiseptics.
- A break in the skin or mucous membrane or the protective 3. Cover the wound with dressing and bandage.
skin layer is damaged.
Classification of Open Wound Specific Body Injuries
- Puncture A. Blows to the eye/s
- Abrasion B. Eye/s knocked out
C. Foreign object
D. Nose Bleeds
E. Impaled Objects
F. Amputation
G. Sucking Chest Wound
H. Abdominal Injuries
- avulsion
- dehiscence
BANDAGE PROCEDURES
Use of Triangular Bandage
Open Phase
- Laceration 1. Hand (Topside)
2. Hand/Fost
3. Face; Back of the hand
4. Cheat, Back of Dada
5.
Cravat Phase
1. Forehead/Eye
- Avulsion 2. Shoulder/bicep
3. Palm Pressure
4. Elbow/Knees/
5. Ears/Cheek/Jaw
6. Arm/Leg
7. Palm Bandage (Open Wound)

- Incision - clean cut wound