Ateneo de Zamboanga University

College of Nursing
2nd Semester S.Y. 2025-2026
NCM 121
MODULE HANDOUT 3

DISASTER MANAGEMENT CONTINUUM

DISASTER MANAGEMENT CONTINUUM - PRE-IMPACT PHASE

"Disasters are not natural; they result from failures of development which increase
vulnerability to hazards." - UNDRR, reflecting the fundamental principle that
vulnerability, not the hazard itself, creates disaster risk.

INTRODUCTION TO DISASTER MANAGEMENT CONTINUUM

Definition: The Disaster Management Continuum is an integrated model that views disaster
management as a continuous cycle of activities occurring before, during, and after a disaster. It
emphasizes that effective disaster risk reduction requires sustained, coordinated efforts across all
phases rather than merely responding to emergencies.

The Four Key Phases:

1. Pre-Impact Phase: Prevention, Mitigation, Preparedness

2. Impact Phase: Emergency Response

3. Post-Impact Phase: Recovery, Rehabilitation

4. Reconstruction Phase: Building Back Better

PRE-IMPACT PHASE: PREVENTION & MITIGATION

Prevention: Measures to avoid the occurrence of a disaster (e.g., land-use planning to avoid
floodplains).

Mitigation: Measures to reduce the severity or impact of unavoidable disasters (e.g., building
earthquake-resistant structures, early warning systems).

Core Principle: "An ounce of prevention is worth a pound of cure." Investments in pre-impact
activities save lives, reduce suffering, and are far more cost-effective than post-disaster responses.

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III. Global Frameworks for Disaster Risk Reduction

A. United Nations International Strategy for Disaster Reduction (UNISDR)

Establishment: 1999 (Following the International Decade for Natural Disaster Reduction)

Evolution: Became the UN Office for Disaster Risk Reduction (UNDRR) in 2019, but the
strategic approach remains "UNISDR."

Primary Mandate: To serve as the focal point in the UN system for coordinating disaster risk
reduction and ensuring implementation of international frameworks.

Key Functions:

1. Policy Coordination: Align UN agencies, governments, and stakeholders

2. Monitoring & Reporting: Track global progress in DRR

3. Advocacy & Awareness: Promote cultural shift from reactive to proactive disaster
management

4. Platform Provision: Convene global platforms (Global Platform for DRR)

5. Guidance Development: Create standards, terminology, and best practices

Key Publications:

• Global Assessment Report on Disaster Risk Reduction (GAR)

• Terminology on Disaster Risk Reduction

• Sendai Framework Monitor guidance

B. Hyogo Framework for Action (HFA) 2005-2015

Full Title: "Hyogo Framework for Action 2005-2015: Building the Resilience of Nations and
Communities to Disasters"

Adopted: 2005 at the World Conference on Disaster Reduction in Kobe, Hyogo, Japan

Historical Context: Developed in response to the devastating 2004 Indian Ocean tsunami

Three Strategic Goals:

1. Integration: Effectively integrate DRR into sustainable development policies

2. Capacity Building: Develop and strengthen institutions, mechanisms, and capacities

3. Knowledge Incorporation: Systematically incorporate risk reduction into emergency

preparedness, response, and recovery

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 Five Priorities for Action:

Priority Focus Area Key Actions

1 Governance Ensure DRR is a national/local priority with strong institutional basis
2 Risk Assessment Identify, assess, and monitor disaster risks and enhance early warning
3 Knowledge
Management Use knowledge, innovation, and education to build a culture of safety
4 Risk Reduction Reduce underlying risk factors
5 Preparedness Strengthen disaster preparedness for effective response at all levels

Legacy: First globally accepted framework linking DRR with sustainable development. Provided
foundation for Sendai Framework.

Transition: Succeeded by the Sendai Framework for Disaster Risk Reduction 2015-2030

HAZARD, RISK, AND VULNERABILITY ANALYSIS (HRVA)

Core Concepts & Definitions

Hazard: A potentially damaging physical event, phenomenon, or human activity that may
cause loss of life, injury, property damage, or environmental degradation.

Vulnerability: The conditions determined by physical, social, economic, and environmental

factors or processes that increase the susceptibility of a community to the impact of
hazards.

Risk: The probability of harmful consequences or expected losses resulting from

interactions between hazards and vulnerable conditions.

The Risk Equation:

RISK = HAZARD × VULNERABILITY

CAPACITY
Where Capacity = resources and abilities to cope with, resist, and recover

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HRVA METHODOLOGIES

HRVA can be approached through two complementary lenses:

1. HAZARD-FOCUSED APPROACH

Definition: Starts with identifying and analyzing potential hazards, then assesses their potential
impact on the community.

Steps:

1. Hazard Identification: List all possible hazards

2. Hazard Profiling: For each hazard, determine:

o Frequency/Probability

o Magnitude/Intensity

o Speed of Onset

o Duration

o Spatial Extent

o Predictability

3. Impact Analysis: Potential consequences on:

o Human (death, injury, illness)

o Economic (property damage, business interruption)

o Environmental (pollution, ecosystem damage)

o Social (displacement, trauma)

Tools & Techniques:

• Historical data analysis

• Scientific modeling (seismic, hydrological, meteorological)

• Hazard maps

• Scenario development

• Checklists and matrices

Advantages:

• Scientifically rigorous

• Good for technical planning

• Useful for early warning systems

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 • Facilitates engineering solutions

Limitations:

• May overlook social dimensions of risk

• Can be resource-intensive

• May not capture compound or cascading hazards

2. SITE-SPECIFIC (or COMMUNITY-BASED) APPROACH

Definition: Starts with understanding the community and its vulnerabilities, then identifies which
hazards pose the greatest risk to that specific community.

Steps:

1. Community Profiling: Understand demographic, socio-economic, and physical

characteristics

2. Vulnerability Analysis: Assess:

o Physical Vulnerability: Location, building quality, infrastructure

o Social Vulnerability: Age, gender, disability, poverty, marginalization

o Economic Vulnerability: Livelihoods, insurance, savings

o Environmental Vulnerability: Ecosystem degradation, resource depletion

3. Capacity Assessment: Identify existing strengths and resources

4. Participatory Risk Assessment: Engage community members in identifying and prioritizing

risks

Tools & Techniques:

• Community mapping

• Transect walks

• Focus group discussions

• Seasonal calendars

• Vulnerability matrices

• Capacity inventory

• Participatory Rural Appraisal (PRA) methods

Advantages:

• Empowers communities

• Identifies social dimensions of risk

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 • More holistic understanding

• Builds local ownership of solutions

• Identifies local capacities

Limitations:

• May lack technical precision

• Time-consuming

• Requires skilled facilitation

• May miss low-probability/high-impact hazards

Comparative Analysis: Hazard vs. Site-Specific Approaches

Aspect Hazard-Focused Site-Specific

Starting Point Physical hazard Community context

Primary Focus Hazard characteristics Community vulnerability

Methodology Technical/scientific Participatory/qualitative

Key Output Hazard maps, probability estimates Vulnerability maps, community action plans

Stakeholders Experts, scientists Community members, local leaders

Best Used For Infrastructure planning, engineering Social programming, community mobilization
solutions

PRACTICAL APPLICATIONS IN NURSING & HEALTHCARE

Role of Nurses in Pre-Impact Phase

1. Risk Communication:

o Translate technical hazard information into actionable advice

o Develop culturally appropriate health messages

o Conduct community education sessions

2. Vulnerability Mapping:

o Identify at-risk populations (elderly, disabled, pregnant women)

o Map health facilities and their capacities

o Document special medical needs in the community

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 3. Capacity Building:

o Train community health workers in basic emergency care

o Conduct disaster drills in healthcare facilities

o Develop emergency protocols and standard operating procedures

4. Surveillance Systems:

o Participate in early warning systems

o Monitor disease patterns that may indicate emerging risks

o Report unusual health events

Integration with Health Systems

Primary Prevention Examples:

• Immunization campaigns before outbreak seasons

• Vector control in epidemic-prone areas

• Nutrition programs to reduce baseline vulnerability

Mitigation Examples in Healthcare:

• Structural retrofitting of health facilities

• Developing redundant systems (backup power, water)

• Stockpiling essential medicines and supplies

• Cross-training staff for surge capacity

Case Study Examples

Example 1: Flood Mitigation

• Hazard: Annual monsoon flooding

• Vulnerability: Low-lying communities, poor housing, dependence on agriculture

• Mitigation Measures: Raised homesteads, community flood shelters, early warning

systems, floating gardens

• Nursing Role: Training community volunteers in waterborne disease prevention,

prepositioning oral rehydration supplies

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Example 2: Earthquake Preparedness

• Hazard: Seismic activity in the region

• Vulnerability: Poor building standards, mountainous terrain limiting access

• Mitigation Measures: Retrofitting schools and health facilities, community emergency

funds, search and rescue training

• Nursing Role: Developing emergency medical teams, training in crush injury management,
community first aid training

CHALLENGES & FUTURE DIRECTIONS

Current Challenges:

1. Funding: Pre-impact activities often underfunded compared to response

2. Data Gaps: Incomplete hazard and vulnerability data in many regions

3. Coordination: Fragmented efforts across sectors and agencies

4. Climate Change: Increasing frequency and intensity of hazards

5. Urbanization: Growing populations in high-risk areas

Emerging Approaches:

1. Nature-Based Solutions: Using ecosystems for risk reduction (mangroves for storm
protection)

2. Technology Integration: GIS, remote sensing, AI for better risk assessment

3. One Health Approach: Integrating human, animal, and environmental health

4. Green-Gray Infrastructure: Combining engineered and natural solutions

5. Risk-Informed Development: Mainstreaming DRR into all development planning

Summary:

Prevention is Paramount: The most effective disaster management happens before disasters
strike.

1. Global Frameworks Provide Guidance: UNISDR/UNDRR and the Hyogo/Sendai

Frameworks offer essential roadmaps for coordinated action.

2. HRVA is Foundational: Understanding hazards, vulnerabilities, and capacities is the

scientific basis for effective prevention.

3. Dual Approach Needed: Both hazard-focused (technical) and site-specific (participatory)

methods provide complementary insights.

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 4. Nurses are Key Actors: From risk communication to capacity building, nurses play critical
roles across the pre-impact phase.

5. Integration is Essential: Disaster risk reduction must be integrated into health systems,
development planning, and climate adaptation.

Recommended Resources

1. UNDRR Website: [Link]

2. Sendai Framework Monitor: [Link]

3. PreventionWeb: knowledge platform for DRR

4. WHO Emergency Framework: Health Emergency and Disaster Risk Management

Framework

5. ICN Disaster Nursing Competencies: International Council of Nurses guidelines

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DISASTER MANAGEMENT CONTINUUM & SPECIFIC HAZARD PREPAREDNESS

GENERAL PREPAREDNESS PRINCIPLES

The Universal Preparedness Checklist

Regardless of the hazard type, every household and organization should:

1. DEVELOP A COMMUNICATION PLAN:

o Establish out-of-town contacts

o Identify meeting places (near home and outside neighborhood)

o Ensure all family members know emergency numbers

2. PREPARE AN EMERGENCY KIT ("GO-BAG"):

o Water: 1 gallon/person/day for at least 3 days

o Food: Non-perishable, 3-day supply

o Medications: 7-day supply + prescriptions

o First Aid Kit: Comprehensive, regularly checked

o Tools: Flashlight, batteries, radio (battery/solar/hand-crank), multi-tool

o Documents: Copies of IDs, insurance, bank records in waterproof container

o Other: Cash, sanitation supplies, clothing, blankets

3. SECURE YOUR ENVIRONMENT:

o Know how to shut off utilities (gas, water, electricity)

o Secure heavy furniture and appliances

o Keep emergency exits clear

4. STAY INFORMED:

o Know local warning systems (sirens, alerts)

o Monitor weather and emergency broadcasts

o Understand community evacuation routes

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SPECIFIC HAZARD PREPAREDNESS

1. FIRE PREPAREDNESS

Before:

• Install and maintain smoke alarms on every level

• Practice "Stop, Drop, and Roll" and crawling under smoke

• Plan two escape routes from each room

• Keep fire extinguishers (ABC type) accessible; know PASS technique:

o Pull the pin

o Aim low at base of fire

o Squeeze handle

o Sweep side to side

During:

• GET OUT, STAY OUT, CALL FOR HELP

• Test doors for heat before opening

• Use stairs, not elevators

• If trapped: seal doors/vents with wet cloth, signal from window

Home Fire Safety Inspection Checklist:

• Matches/lighters stored out of children's reach

• Electrical cords not frayed or under rugs

• Space heaters 3 feet from combustibles

• Chimney cleaned annually

• Cooking area clear of flammable items

2. EARTHQUAKE PREPAREDNESS

Before:

• Secure your space: Anchor heavy furniture, appliances, and overhead items

• Practice "Drop, Cover, and Hold On":

o DROP to hands and knees

o COVER head/neck under sturdy furniture

o HOLD ON until shaking stops

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 • Structural safety: Know if your building is retrofitted; consider earthquake insurance

During:

• If indoors: Stay inside; avoid doorways (not safer); stay away from windows

• If in bed: Stay there, cover head with pillow

• If outdoors: Move to open area away from buildings, trees, power lines

• If driving: Pull over, set parking brake, stay in vehicle

After:

• Expect aftershocks

• Check for injuries and damage

• If you smell gas, evacuate immediately and report

• Use phone only for emergencies

3. VOLCANIC ERUPTION PREPAREDNESS

Before:

• Know your community's warning system and evacuation zones

• Prepare for ashfall:

o Seal windows and doors

o Cover machinery/air intakes

o Have N95 masks, goggles, long-sleeved clothing

• Protect water sources from contamination

During Eruption:

• If indoors: Close all windows/doors; place damp towels at thresholds

• If outdoors: Seek shelter immediately; use mask/goggles; avoid low-lying areas (lahar risk)

• If evacuation ordered: Leave immediately; follow designated routes

Special Considerations:

• Lahars (volcanic mudflows): Move to high ground immediately

• Pyroclastic flows: Unsurvivable; evacuation before they occur is critical

• Ash cleanup: Use protective gear; do not wash ash into storm drains

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4. FLOOD PREPAREDNESS

Before:

• Know if you're in a floodplain

• Elevate electrical systems, furnace, water heater

• Install check valves in sewer lines

• Prepare sandbags for doorways

During Flood Watch/Warning:

• Move valuables to higher levels

• Fill containers with clean drinking water

• Prepare to evacuate if advised

During Flooding:

• Never walk or drive through floodwaters:

o 6 inches of moving water can knock you down

o 12 inches can carry away a car

• Avoid electrical equipment in wet areas

• If trapped, move to highest level; signal for help

After:

• Wait for "all clear" before returning

• Beware of structural damage, contaminated water, electrical hazards

• Document damage for insurance

5. TORNADO PREPAREDNESS

Before:

• Identify shelter location:

o Best: Underground storm cellar/basement

o Next best: Small interior room on lowest floor (bathroom, closet)

• Know the difference:

o Watch: Conditions favorable for tornadoes

o Warning: Tornado sighted or indicated by radar; TAKE SHELTER NOW

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During:

• In a structure: Go to pre-identified shelter; cover with mattress/blankets

• In a vehicle: Do NOT try to outrun; either:

o Get to sturdy shelter

o If no shelter: Lie flat in low ditch, cover head

• In open country: Lie flat in low area

After:

• Watch for broken glass, downed power lines, structural damage

• Check on neighbors, especially elderly/disabled

6. TYPHOONS/CYCLONES/HURRICANES PREPAREDNESS

(All are the same phenomenon with different regional names)

Before Season:

• Strengthen roof, windows (storm shutters), doors

• Clear gutters and drains

• Trim trees away from structures

• Know your evacuation zone and route

When Watch/Warning Issued:

• 36-48 hours before: Secure outdoor items; review plan; check supplies

• 24-36 hours before: Fill vehicle gas tank; install storm shutters

• 18-24 hours before: Bring pets inside; charge devices

• 6-18 hours before: Stay indoors; avoid windows

During:

• Stay in interior room, closet, or hallway on lowest level

• NEVER use candles; flashlights only

• Beware the "eye": Storm temporarily calms, but will resume with winds from opposite
direction

Special Wind-Related Dangers:

• Flying debris is the greatest cause of injury

• Water hazards: Storm surge (deadliest threat) and flooding

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 • Post-storm hazards: Downed power lines, contaminated water

7. TSUNAMI PREPAREDNESS

Before:

• Know if you live/work in a tsunami zone

• Learn community warning systems and evacuation routes

• Practice vertical evacuation (to upper floors) if inland evacuation impossible

Natural Warning Signs (May occur before official warnings):

• Strong, long-lasting earthquake

• Sudden rise or fall of ocean

• Loud "roaring" sound from ocean

During Tsunami Warning:

• EVACUATE IMMEDIATELY to high ground or inland

• Do not wait to see the wave

• If you cannot evacuate, go to upper floors of reinforced concrete building (at least 3rd floor)

After:

• Wait for official "all clear" - multiple waves may occur

• Stay away from damaged areas and floodwaters

• Be prepared for aftershocks

SPECIAL POPULATION CONSIDERATIONS

For Persons with Disabilities:

• Create a support network

• Tag mobility equipment with instructions

• Keep extra medication, batteries for devices

• Consider service animal needs in evacuation plans

For Children:

• Include comfort items in go-bag

• Teach them basic emergency information

• Practice drills regularly

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For Elderly:

• Simplify emergency kits (easy-open containers)

• Plan for medication refrigeration needs

• Arrange transportation assistance

PSYCHOLOGICAL PREPAREDNESS

1. Normalize Stress Reactions: Understand that fear, anxiety, and confusion are normal

2. Develop Coping Strategies: Deep breathing, mindfulness, maintaining routines when

possible

3. Build Community Connections: Social support is a key resilience factor

4. Post-Disaster: Recognize signs of trauma and seek professional help if needed

Key Takeaways

1. Disaster management is continuous - Recovery leads back to mitigation

2. General preparedness is foundational - Communication plan, emergency kit, family drills

3. Know your specific risks - Tailor preparations to local hazards

4. Practice regularly - Skills degrade without reinforcement

5. Community resilience is built through shared preparation and mutual aid

Remember: The goal of preparedness is not to eliminate fear, but to build confidence in your
ability to respond effectively when disaster strikes.

Prepared based on guidelines from FEMA, Red Cross, WHO, and UN Office for Disaster Risk
Reduction. Local protocols may vary - always follow instructions from local authorities.

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EMERGENCY COMMUNICATION PLANS

"Effective emergency communication isn't about predicting disasters—it's about preparing people.
The most sophisticated system fails without practiced, clear communication at both institutional
and family levels."

UNIVERSAL EMERGENCY CODE SYSTEM

PURPOSE: A Universal Emergency Code System is a standardized, color-coded communication

protocol used primarily in healthcare facilities (hospitals, clinics, nursing homes) to quickly and
discreetly alert staff to various emergencies without alarming patients or visitors.

Key Objectives:

• Ensure rapid, appropriate staff response

• Minimize patient and visitor panic

• Standardize communication across departments

• Enhance safety and security

2. STANDARD COLOR CODES (U.S. SYSTEM)

• Below is the most commonly adopted system (Note: Colors can vary slightly by
state/facility; always verify local protocols).

CODE EMERGENCY TYPE MEANING & RESPONSE

COLOR

Code Blue Cardiac/Medical Adult cardiac or respiratory arrest - Activate

Emergency emergency response team, bring crash cart,
begin CPR if trained

Code Pediatric Emergency Child/infant medical emergency - Pediatric

White response team to location

Code Pink Infant/Child Abduction Missing child/infant - Lockdown exits, search

designated areas, check identification

Code Child Abduction Child abduction (alternative to Pink in some

Purple facilities)

Code Red Fire Fire or smoke sighted - RACE protocol:

Rescue, Alarm, Contain, Extinguish/Evacuate

Code Bomb Threat Suspicious package or bomb threat -

Yellow Evacuate as directed, do not touch
suspicious items

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 Code Gray Severe Weather Tornado, hurricane, etc. - Move to designated
safe zones, away from windows

Code Active Shooter/Armed Person with weapon - Run-Hide-Fight

Silver Person protocol

Code Hazardous Material Spill Chemical/biohazard release - Evacuate area,

Orange seal off if trained

Code Evacuation Partial or full facility evacuation - Evacuate as

Green per emergency plan

Code Bomb Threat (Alternative for bomb threat in some facilities)

Black

Code Severe Weather (Alternative for severe weather)

Brown

3. RESPONSE PROTOCOLS FOR HEALTHCARE STAFF

General Response Principles:

1. Stay Calm: Your composure affects others

2. Listen Carefully: Note location and code specifics

3. Follow Facility Protocols: Each facility has specific response algorithms

4. Know Your Role: Clinical vs. non-clinical staff have different responsibilities

Specific Staff Actions:

For Clinical Staff:

• Code Blue/White: Immediately go to location if part of response team; otherwise, continue

patient care, clear corridors

• Code Red: Know fire extinguisher locations, evacuation routes, and patient evacuation
priorities

• All Codes: Secure medications and patient records as appropriate

For Non-Clinical Staff:

• Direct visitors away from emergency area

• Secure important documents/areas

• Assist with traffic control or lockdown procedures as trained

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 4. PATIENT & VISITOR COMMUNICATION

What to Tell Patients/Visitors During Codes:

• Use general language: "We are conducting a safety drill" or "We have a situation we're
managing"

• Provide clear instructions: "Please return to your room" or "Follow me to a safe area"

• Reassure without giving false information: "Our staff is trained for this; please follow
instructions"

PREPARING A FAMILY COMMUNICATION PLAN

1. WHY EVERY FAMILY NEEDS A COMMUNICATION PLAN

Statistics:

• 40% of families have no emergency plan (FEMA)

• Cell networks fail or become overloaded during major disasters

• Children may be at school, adults at work when disaster strikes

Benefits:

• Reduces anxiety and confusion during emergencies

• Ensures quicker reunification

• Provides clear roles and responsibilities

2. 4-STEP FAMILY COMMUNICATION PLAN DEVELOPMENT

STEP 1: COLLECT CRITICAL INFORMATION

Create a Family Emergency Contact Card for each member (wallet-sized, laminated):

INFORMATION TYPE WHAT TO INCLUDE EXAMPLE

Out-of-Area Contact Name, phone, email, relationship "Aunt Jane, Phoenix: (555) 123-4567"

Local Emergency 3 local friends/relatives "Neighbor Mr. Smith: (555) 987-6543"

Contacts

Medical Information Allergies, medications, doctors "John: Penicillin allergy, Insulin dependent"

Meeting Places Neighborhood and regional "Home, Oak Street Park, Grandma's house
locations (50 mi away)"

School/Work Contacts Direct numbers, evacuation "Maple Elementary: (555) 222-1111, Evac:
plans Community Center"

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STEP 2: ESTABLISH COMMUNICATION METHODS

Primary Method: Text Messaging

• Works even with weak signals when calls fail

• Use simple, clear language: "Safe at school. Going to community center. Love."

• Create group chats for family members

Secondary Method: Social Media

• Use platforms like Facebook "Safety Check" or dedicated family groups

• Designate one platform as primary (e.g., "We'll all check Facebook Messenger")

Tertiary Method: Emergency Apps

• FEMA App: Alerts, maps, meeting locations

• Red Cross Emergency App: First aid, shelter locations

• Life360 or Find My Friends: Location sharing (with privacy considerations)

Last Resort: Landlines & Payphones

• Landlines often work when cell towers fail

• Know locations of payphones in your area

STEP 3: DESIGNATE RESPONSIBILITIES

FAMILY MEMBER PRIMARY RESPONSIBILITY BACKUP RESPONSIBILITY

Parent/Guardian 1 Contact children's schools Contact out-of-area relative

Parent/Guardian 2 Contact workplaces Gather important documents

Teen (if applicable) Contact younger siblings Check social media for updates

All Members Send "I'm safe" text Check in every 2 hours until reunited

STEP 4: PRACTICE & MAINTAIN THE PLAN

Quarterly Practice Drills:

1. Simulation: "It's 2 PM on a Tuesday. An earthquake has hit. What do you do?"

2. Communication Test: Everyone sends a test text to the group chat

3. Meeting Place Drill: Go to your designated neighborhood meeting place

4. Document Check: Verify everyone has current contact cards

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Semi-Annual Updates:

• Update phone numbers, medical information

• Replace batteries in emergency radios/flashlights

• Review school/work emergency procedures

• Adjust for family changes (new jobs, schools, medical conditions)

3. SPECIAL CONSIDERATIONS

For Families with Children:

• Practice what to say when calling emergency contacts: "Hello, this is Sarah. I'm safe at
school."

• Teach children how to dial important numbers

• Include comforting items in communication kit (family photo, small toy)

For Families with Elderly Members:

• Large-print contact lists

• Medical alert systems with family notification

• Regular check-in schedules

For Families with Pets:

• Include pet information in contact cards

• Designate who retrieves pets

• Identify pet-friendly shelters/hotels

For Non-Traditional/Divorced Families:

• Clear custody/contact protocols during emergencies

• Shared digital documents accessible to all caregivers

• Respect court orders while ensuring child safety

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4. EMERGENCY COMMUNICATION KIT CHECKLIST

Every home and car should have:

ITEM QUANTITY NOTES

Fully charged power bank 2 Rotate charging monthly

Battery-powered radio 1 NOAA weather radio preferred

Extra batteries Set for each device Check expiration dates

Pre-paid phone cards 2 Php 10 minimum on each

Whistle 1 per person For signaling if trapped

Notepad & waterproof pen 1 each For leaving messages

Laminated contact cards 3 per person Home, car, backpack/purse

Local maps 2 Marked with meeting places

Cash (small bills) 100 minimum ATMs may not work

Charging cables 1 per device type USB, lightning, etc.

INTEGRATING BOTH SYSTEMS

Bridging Professional & Personal Preparedness

As a Healthcare Professional:

1. Know your facility's codes and teach your family what they mean

2. Have a backup plan for when you're required to stay at work during emergencies

3. Prepare your family for your potential extended absence during crises

As a Family Member:

1. Understand that healthcare workers may be delayed during emergencies

2. Include hospital/facility contact information in your family plan

3. Practice scenarios where a healthcare worker family member is unavailable

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Sample Integrated Emergency Scenario

Situation: Major earthquake during school/work hours

Healthcare Worker Response:

• Hear "Code Yellow" (structural damage assessment) and "Code Green" (possible
evacuation)

• Report to assigned emergency station

• Send pre-written text: "At hospital, will be late. Safe. Check group chat."

Family Response:

• Children follow school evacuation to predetermined location

• Other adult collects children if possible

• All send texts to group chat and out-of-area contact

• Follow family reunification plan if separated >24 hours

SUMMARY

1. Universal Emergency Codes save lives through rapid, discreet communication in

healthcare settings

2. Every family needs a written, practiced communication plan—not just an idea

3. Text messaging is more reliable than calls during network congestion

4. Out-of-area contacts are crucial when local networks fail

5. Practice transforms plans from paper to instinct

6. Healthcare professionals must bridge workplace and home preparedness

ACTION ITEMS FOR THIS WEEK

1. Create your Family Emergency Contact Cards (use template provided)

2. Identify your out-of-area contact and confirm they're willing

3. Download one emergency app to your phone

4. Hold a 15-minute family meeting to discuss communication basics

5. Locate the emergency code chart at your workplace/clinical site

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Online Resources:

• [Link]/make-a-plan

• [Link]/get-help/how-to-prepare-for-emergencies

• FEMA App: [Link]/mobile-app

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PERSONAL & HOME DISASTER SURVIVAL PREPAREDNESS PLANNING

WHY PREPARE?

Disasters strike without warning—earthquakes, floods, typhoons, fires, or pandemics.

Preparedness saves lives, reduces injury, and minimizes property damage.
REMEMBER: Preparedness is not paranoia—it's practical responsibility. The most expensive
preparedness item you'll ever buy is the one you need but don't have during a disaster. Start small,
build consistently, and practice regularly.

"The best time to prepare was yesterday. The second-best time is today."

Core Philosophy: The 3P's of Preparedness

1. Proactive – Act before disaster strikes

2. Practical – Focus on realistic, actionable steps

3. Personalized – Tailor to your specific needs and context

ASSEMBLING EMERGENCY KITS

A layered approach ensures readiness for different scenarios.

1 CORE PRINCIPLES FOR ALL KITS

• Accessibility: Store where easily reachable (not buried in garage)

• Maintenance: Check every 6 months; rotate consumables

• Customization: Adapt for medical needs, infants, elderly, pets

• Portability: Consider weight and mobility constraints

2 THREE-TIER KIT SYSTEM

TIER 1: GO-BAG / 72-HOUR KIT (Immediate evacuation)

For each person; kept near exits/car

ESSENTIALS:

☐ Water (1 gallon/person/day × 3 days)

☐ Non-perishable food (energy bars, canned goods, manual can opener)

☐ First aid kit + personal medications (7-day supply)

☐ Multipurpose tool (Swiss Army style)

☐ Flashlight + extra batteries (or hand-crank)

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☐ Battery-powered/ hand-crank radio

☐ Whistle

☐ N95 masks (2 per person)

☐ Copies of important documents in waterproof bag

☐ Local maps + emergency contact list

☐ Cash (small denominations) + coins

☐ Phone charger + power bank

☐ Personal hygiene items

☐ Emergency blanket

☐ Change of clothes + sturdy shoes

☐ Note: Keep under 20% of body weight for carrying

TIER 2: HOME SHELTER KIT (2-week sustainment) For sheltering in place during prolonged
disruption

ADD TO TIER 1:

☐ Water (14 gallons/person minimum)

☐ Food supply for 2 weeks (canned, dried, ready-to-eat)

☐ Water purification (tablets/filter/bleach)

☐ Cooking supplies (camp stove + fuel, mess kits)

☐ Sanitation: Portable toilet, garbage bags, disinfectant

☐ Lighting: Lanterns, candles, matches in waterproof container

☐ Communication: Two-way radios, extra batteries

☐ Tools: Wrench for turning off utilities, duct tape, plastic sheeting

☐ Comfort items: Books, games, comfort foods

☐ Pet supplies (food, carrier, leash)

TIER 3: VEHICLE KIT

SPECIFIC ADDITIONS:

☐ Reflective triangles/road flares

☐ Jumper cables + tire repair kit

☐ Warm clothing/blankets

26 | P a g e
☐ Cat litter/sand for traction

☐ Shovel + ice scraper

☐ Paper maps (if GPS fails)

3 SPECIAL CONSIDERATIONS KITS

Population Additional Items

Infants Formula, diapers, wipes, pacifiers, baby medicines

Elderly Extra medications (30-day supply), glasses, hearing aid batteries

Pets Carrier, leash, vaccination records, 2-week food/water

Medical Needs Oxygen tanks, glucose monitor, nebulizer, backup power

Disabilities Wheelchair batteries, communication devices, service animal supplies

LEARNING PREPAREDNESS SKILLS

Knowledge and practice transform supplies into survival capability.

SURVIVAL SKILLS HIERARCHY

LEVEL 1: FOUNDATIONAL SKILLS (All household members)

1. Emergency Communication Protocol

o Designate out-of-area contact (local lines may fail)

o Master text messaging (uses less bandwidth than calls)

o Learn emergency broadcast system codes

o Establish meeting places: ① Near home ② Outside neighborhood

2. Utility Management

o Gas: Locate shut-off valve; use wrench; DO NOT turn back on yourself

o Water: Know main shut-off; store pre-shut-off water in tubs

o Electricity: Circuit breaker operation; safe generator use (outside only!)

3. Basic First Aid & CPR

o Stop severe bleeding (tourniquet application)

o Treat for shock (elevate legs, keep warm)

o Heimlich maneuver

o Take a certified course – skills degrade without practice

27 | P a g e
 4. Fire Safety

o PASS technique (Pull, Aim, Squeeze, Sweep) for extinguishers

o Stop, Drop, and Roll

o Crawl under smoke (cleaner air near floor)

o Fire escape planning with 2 exits per room

LEVEL 2: INTERMEDIATE SKILLS (At least 2 adults)

1. Water Procurement & Purification

o Collection: Rainwater, water heater, toilet tank (not bowl)

o Purification: Boiling (1+ minute rolling), chemical (bleach: 8 drops/gal), filtration

o Storage: Food-grade containers; replace every 6 months

2. Emergency Food Preparation

o Cooking without power (camp stove, solar oven, fireplace)

o Safe food handling without refrigeration

o Identifying edible wild foods (location-specific knowledge)

3. Shelter & Warmth

o Temporary shelter construction

o Insulation techniques

o Safe indoor heating (ventilation to prevent CO poisoning)

4. Basic Search & Light Rescue

o Triage principles (Simple Triage and Rapid Treatment - START)

o Lifting techniques to prevent injury

o Creating makeshift splints and stretchers

LEVEL 3: ADVANCED SKILLS (Specialists in household/community)

1. Advanced Medical

o Wound suturing, infection management

o Dental emergency handling

o Managing chronic conditions without professional care

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 2. Technical Skills

o Ham radio operation (requires license)

o Small engine repair (generators, pumps)

o Basic structural assessment for safety

3. Security & Community Organization

o Neighborhood Watch coordination

o Conflict de-escalation

o Resource pooling and barter systems

B.2 PRACTICE DRILL SCHEDULE

Frequency Activity Goal

Monthly Check smoke/CO alarms; test flashlights Equipment reliability

Quarterly Practice fire/earthquake drills; review escape routes Response automation

Biannually Update contacts; rotate food/water; check medications Supply freshness

Annually Full-scale family drill (no power/water for 24h if safe) System validation

Every 2 Years Renew CPR/first aid certification Skill currency

INTEGRATED DISASTER PLAN DEVELOPMENT

1. Create Your Household Disaster Plan

1. Risk Assessment: What disasters are most likely in your area?

2. Communication Tree: Who contacts whom? Include school/work plans.

3. Home Hazard Hunt: Secure heavy furniture, water heater, hazardous materials.

4. Document Safeguarding: Digital scans in cloud + waterproof hard copies:

o IDs, passports, birth certificates

o Insurance policies

o Medical records

o Property deeds

o Pet vaccination records

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2 Scenario-Specific Considerations

Disaster Type Special Preparations

Earthquake "Drop, Cover, Hold On" training; structural reinforcement knowledge

Flood Elevate utilities; sandbag techniques; evacuation route alternatives

Typhoon/Hurricane Storm shutter installation; post-storm water safety awareness

Wildfire Defensible space creation; "Go Bag" in car always

Pandemic Extended medication supply; hygiene station at home entry

MAINTAINING PREPAREDNESS MINDSET

1 Overcoming Common Barriers

• "Too expensive": Build gradually; focus on water first; DIY where possible

• "Too time-consuming": 15-minute weekly increments; involve whole family

• "It won't happen to me": Review local disaster history; probability ≠ immunity

2 The Preparedness Cycle

ASSESS → PLAN → ACQUIRE → PRACTICE → REVIEW

↑___________________________________|

3 Community Integration

• Know your neighbors' skills and vulnerabilities

• Participate in community emergency response teams

• Share resources responsibly during actual emergencies

RESOURCES & NEXT STEPS

Immediate Actions (This Week)

1. Create family contact cards for all members

2. Identify two meeting places

3. Buy one extra gallon of water per person

4. Locate utility shut-offs

5. Schedule a first aid/CPR course

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30-Day Preparedness Challenge

• Week 1: Assemble Go-Bags

• Week 2: Build 3-day water supply

• Week 3: Conduct home hazard hunt

• Week 4: Practice fire/earthquake drill

Recommended Resources

• FEMA: [Link]

• Red Cross: [Link]/get-help/how-to-prepare-for-emergencies

• Local: Emergency management office website

• Apps: FEMA, Red Cross Emergency, Weather Alerts

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SURVIVAL PATTERNS & STAYING ALIVE

Survival Psychology & Priorities

The Rule of 3's (Human Survival Limits):

• 3 Minutes without air

• 3 Hours without shelter in extreme conditions

• 3 Days without water

• 3 Weeks without food

• 3 Months without hope (psychological resilience)

Primary Survival Priorities: Protection → Location → Water → Food

A. FINDING FAST SOLUTIONS NATURALLY

1. The Survival Mindset

S.T.O.P. Principle:

• Stop: Sit down, don't panic

• Think: Assess your situation, resources, and options

• Observe: Survey your environment for dangers and resources

• Plan: Develop and implement your survival strategy

2. Immediate Action Steps

• Shelter First: Before darkness falls or weather worsens

• Water Procurement: Begin immediately (collect rain, dew, find sources)

• Fire Creation: Critical for warmth, water purification, signaling

• Resource Assessment: Inventory what you have (gear, clothing, tools)

3. Improvisation Techniques

• The "MacGyver" Mindset: See multiple uses for every item

• Natural Cordage: Inner bark, roots, plant fibers, animal sinew

• Natural Containers: Bark, leaves, shells, animal bladders/stomachs

• Emergency Tools: Sharp rocks as knives, sticks as digging tools

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B. FOOD AND WATER PROCUREMENT

1. WATER: The Critical Priority

Finding Water Sources:

• Natural Indicators:

o Animal tracks converging

o Bird flight patterns at dawn/dusk

o Lush, green vegetation

o Valleys/low ground

o Rock crevices

Collection Methods:

• Rain: Tarps, leaves, bark containers

• Dew: Wipe with cloth, squeeze into container

• Transpiration Bag: Clear plastic bag over leafy branch

• Solar Still: Dig hole, place container, cover with plastic, weight center

Purification Methods (in order of effectiveness):

1. Boiling (1 minute at rolling boil, 3 minutes at altitude)

2. Chemical Treatment (iodine tablets: 30 minutes; chlorine: 4 hours)

3. Solar Disinfection (PET bottles in sun for 6 hours)

4. Filtration (improvised sand/charcoal filters)

2. FOOD: Calorie Procurement

Universal Edibility Test (ONLY if desperate):

1. Separate plant into parts

2. Smell for bitterness/almond scent (cyanide)

3. Touch to skin, wait 15 minutes

4. Touch to lips, wait 15 minutes

5. Small taste, wait 3 hours

6. Larger taste, wait 8 hours

7. Eat small portion, wait 8 hours

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Safe Universal Foods:

• Grasses: Young shoots (boil to improve digestion)

• Acorns: Leach tannins by boiling/soaking

• Cattails: Every part edible (roots, shoots, pollen)

• Insects: Remove legs/wings, cook thoroughly

• Earthworms: Purge in clean water, cook

Trapping Methods (Energy efficient):

• Figure-4 Deadfall: For small mammals/birds

• Snare Traps: Loop wire/cord on game trails

• Fish Traps: Basket weirs in streams

Hunting/Fishing Improvisation:

• Spearfishing: Sharpened, fire-hardened stick

• Gorge Hook: Small sharp bone/wood sliver

• Throwing Stick: For birds/small game

C. SIGNALS

1. The Rule of Three

ALL international distress signals use patterns of THREE:

• Three fires (triangle formation)

• Three whistle blasts

• Three gunshots

• Three flashes of light/mirror

2. Visual Signals

Ground-to-Air Signals:

• Smoke: Green vegetation for white smoke; rubber/plastic for black

• Signal Mirrors: Flash at aircraft/vehicles (even improvised: CD, tin can)

• Signal Fires: Three in triangle (25m apart) or straight line

• Ground Markings: Use contrasting materials (rocks, logs, clothing)

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Common Ground-to-Air Symbols:

X = Unable to proceed

→ = Proceeding this direction

Y = Yes/affirmative

N = No/negative

F = Need food/water

II = Need medical supplies

LL = All is well

3. Auditory Signals

• Whistle: Carry always (sound travels farther than voice)

• Gunshots: Three spaced evenly

• Improvised: Bang rocks, sticks, metal

4. Night Signals

• Flashlight: Three flashes, pause, repeat

• Chemical Lights: Wave in patterns

• Fire Tending: Keep signal fires ready to ignite

D. NAVIGATION

1. Basic Principles

Navigation Without Compass:

• Sun: Rises east, sets west (varies by season/latitude)

• Shadow Stick Method:

1. Place stick vertically in ground

2. Mark shadow tip in morning

3. Mark shadow tip in afternoon

4. Line between marks = east-west line

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 • Stars:

o Northern Hemisphere: Find Polaris (end of Little Dipper handle)

o Southern Hemisphere: Southern Cross points south

2. Natural Navigation Cues

Plant Indicators:

• Trees: Moss often thicker on north side (but not always reliable)

• Flowers: Many follow the sun (heliotropism)

Environmental Clues:

• Snow: Melts faster on south-facing slopes

• Wind Patterns: Learn prevailing winds in your region

• Animal Behavior: Migratory patterns, nest orientations

3. Route Finding & Pace Counting

• Handrails: Follow rivers, ridges, shorelines

• Aiming Off: Deliberately miss target to know which way to turn

• Pace Counting: Know your paces per 100m (average: 60-65 paces)

4. Navigation Tools

• Improvised Compass: Magnetize needle on water (leaf)

• Watch Compass: Analog watch, point hour hand at sun, bisect angle between hour hand
and 12:00 = south (north in southern hemisphere)

• Mapping: Sketch maps with landmarks

E. SPECIAL NEEDS

1. Medical Emergencies

Basic Survival First Aid:

• Stop Bleeding: Direct pressure, elevation, pressure points

• Clean Wounds: Boiled water, honey (antibacterial)

• Splints: Use available materials (sticks, clothing)

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 • Hypothermia:

o Remove wet clothing

o Skin-to-skin contact

o Warm core first (chest, neck, groin)

Natural Medicine:

• Willow Bark: Natural aspirin (salicin)

• Plantain: Poultice for wounds/bites

• Pine Needle Tea: Vitamin C prevention

2. Extreme Environments

Desert Survival:

• Conserve Moisture: Breathe through nose, limit talking

• Travel at Night: Avoid heat exhaustion

• Clothing: Light-colored, loose, cover head/neck

Cold Weather:

• Layering: Base (wicking), middle (insulating), outer (wind/water)

• Snow Shelter: Quinzhee, snow trench, igloo

• Fire: Reflector wall to direct heat

Jungle/Tropical:

• Avoid Leeches: Salt, heat, tobacco juice

• Water Abundant: Purification critical

• Shelter: Elevate above ground

3. Psychological Survival

Combatting Panic & Despair:

• Routine: Maintain daily structure

• Goals: Set small, achievable objectives

• Hope: Focus on reasons to survive

• Mental Exercises: Plan future, recall pleasant memories

4. Special Populations

Children:

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 • Assign age-appropriate tasks

• Maintain routine/schedule

• Distract from fear with games/stories

Elderly/Disabled:

• Conserve energy, delegate tasks

• Special attention to temperature regulation

• Modified shelters for accessibility

Groups:

• Leadership: Clear chain of command

• Roles: Assign based on skills/abilities

• Communication: Regular check-ins

SURVIVAL KIT ESSENTIALS (The 10 C's)

1. Cutting tool (knife)

2. Combustion device (lighter/ferro rod)

3. Cover (tarp/emergency blanket)

4. Container (metal bottle)

5. Cordage (paracord)

6. Cotton (bandana)

7. Candle (emergency)

8. Compass

9. Cloth sail needle

10. Cargo tape

CLOSING PRINCIPLES

1. Adaptability is Survival: The most versatile organism survives

2. Knowledge Weighs Nothing: Skills > Gear

3. Plan for the Worst, Hope for the Best: Preparedness prevents panic

4. The Will to Live is the ultimate survival tool

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Remember: Survival is not about heroic acts, but about consistent, intelligent choices that keep
you alive long enough to be rescued or self-rescue.

"Survival is not about being fearless. It's about making a decision: Is this going to kill me? If not, then
I can deal with it." – Anonymous

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PACE PLANNING & SHELTER STRATEGIES

I. PACE Planning: A Systematic Approach to Communication & Action

PACE is an acronym for Primary, Alternate, Contingency, Emergency - a military-derived planning

methodology that ensures operational continuity through redundant systems. It provides multiple
predetermined options for accomplishing critical tasks when normal methods fail.

Core Philosophy: "One is none, two is one." Never rely on a single point of failure.

B. The Four Tiers of PACE

1. PRIMARY (P)

• Definition: Your first-choice, preferred method of communication or action.

• Characteristics:

o Most reliable under normal conditions

o Easiest to use

o Highest bandwidth/capability

o Least resource-intensive

• Examples:

o Communication: Cellular phone call

o Transportation: Personal vehicle on main roads

o Power: Grid electricity

o Water: Municipal water supply

o Rendezvous: Main meeting location

2. ALTERNATE (A)

• Definition: Your second-choice method, used when Primary fails but conditions are still
relatively normal.

• Characteristics:

o Slightly less convenient than Primary

o Requires some adaptation

o Should be pre-tested and familiar

40 | P a g e
 • Examples:

o Communication: Text messaging or internet-based apps (WhatsApp, Signal)

o Transportation: Alternative route using secondary roads

o Power: Home generator

o Water: Stored water containers

o Rendezvous: Secondary meeting location

3. CONTINGENCY (C)

• Definition: A backup method for use when both Primary and Alternate fail, often during
deteriorating conditions.

• Characteristics:

o Lower-tech, more robust solutions

o May require special skills/equipment

o Assumes some infrastructure disruption

o Often involves manual or analog methods

• Examples:

o Communication: GMRS/FRS radios or ham radio (with license)

o Transportation: Bicycle or on foot via predetermined trails

o Power: Solar panels with battery bank

o Water: Water purification from local sources (streams, rainwater)

o Rendezvous: Rally point with hidden cache

4. EMERGENCY (E)

• Definition: Last-resort methods when all other systems have failed or during extreme crisis.

• Characteristics:

o Low-tech, high-reliability

o May be slow or limited in capability

o Focuses on basic survival needs

o Often involves improvisation

41 | P a g e
 • Examples:

o Communication: Whistle signals, signal mirrors, written notes carried by runner

o Transportation: On foot using compass and map (no trails)

o Power: Hand-crank devices, candles

o Water: Emergency stills, dew collection

o Rendezvous: "If all else fails" location with 72-hour wait period

C. Applying PACE to Different Domains

Domain Primary Alternate Contingency Emergency

Communications Smartphone + Satellite GMRS/FRS radio Signal mirror,

cell messenger whistle

Navigation GPS smartphone Dedicated GPS Topographic map + Celestial

app unit compass navigation

Water Municipal tap Stored water (30 Water filter + local Solar still,
gal) source rainwater catch

Food Grocery stores Pantry stocks (3 Garden + Foraging,

months) preservation trapping

Medical Hospital/Clinic Telemedicine Comprehensive Improvised care

first aid kit + herbal

Security Police response Neighborhood Home security Personal

watch system defense plan

D. PACE Planning Best Practices

1. Test All Elements: Regularly practice using Alternate, Contingency, and Emergency
methods.

2. Maintain Redundancy: Each tier should have its own independent power sources, if
applicable.

3. Document Clearly: Create a written PACE plan that all family/group members understand.

4. Consider Dependencies: Identify single points of failure that could break multiple PACE
levels.

5. Regularly Update: Review and revise plans quarterly or when circumstances change.

42 | P a g e
II. Shelter in Place vs. Bugging Out: The Critical Decision Matrix

A. Fundamental Concepts

Shelter in Place (Bugging In)

• Definition: Remaining in your current location (home, workplace) and fortifying it to

weather a crisis.

• Core Principle: Your prepared home is your strongest asset; moving exposes you to
unknown risks.

• Advantages:

o Familiar environment with all your resources

o Established community connections

o Defensible position you know intimately

o No travel risks or exposure

o Can maintain semblance of normalcy

Bugging Out (Evacuation)

• Definition: Deliberately leaving your current location for a predetermined safer location.

• Core Principle: When the threat at your location outweighs the risks of travel.

• Advantages:

o Can escape imminent, localized danger

o Move toward better resources/support

o Tactical flexibility and mobility

o May reach more secure long-term location

B. Decision Factors: Stay or Go?

SCENARIOS FAVORING SHELTER IN PLACE:

1. Your home is structurally sound and in a safe location

2. You have adequate supplies for the expected duration (rule of thumb: 2 weeks minimum)

3. The threat is widespread (pandemic, economic collapse, nuclear fallout) - traveling won't
help

4. Local infrastructure remains functional enough for basic needs

5. You have vulnerable members (elderly, disabled, infants) for whom travel is hazardous

6. No specific, localized threat is directly targeting your location

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SCENARIOS REQUIRING BUGGING OUT:

1. Immediate physical threat (fire, flood, hurricane, chemical spill) heading toward you

2. Home becomes unsafe/uninhabitable (structural damage, contamination, occupation)

3. Resources exhausted with no hope of replenishment

4. Civil unrest/military conflict making your neighborhood a battleground

5. Medical emergency requiring facilities you can't access locally

6. Government/mandatory evacuation order

C. Implementation Strategies

Shelter in Place: Layered Defense Plan

1. Perimeter Security:

o Reinforced doors/windows

o Motion-activated lighting

o Natural barriers (thorny plants)

o "Grey man" principle - don't look like a target

2. Resource Management:

o Water: 1-2 gallons per person per day (14-day minimum)

o Food: Calorie-dense, rotation-based system

o Energy: Multiple redundant systems (grid → generator → solar → battery)

o Waste: Sanitation plan when plumbing fails

3. Community Integration:

o Establish trusted neighbor network

o Develop skill-sharing arrangements

o Create mutual defense agreements (carefully vetted)

4. Daily Routine Maintenance:

o Security watches/patrols

o Resource inventory and rationing

o Skill practice and training

o Information gathering (radio monitoring)

44 | P a g e
Bugging Out: The Three-Location Strategy

1. Initial Rally Point (IRP):

o Location: 5-15 minutes from home

o Purpose: Immediate safety, group assembly, situation assessment

o Contents: Minimal - grab-and-go bags only

2. Safe Area/Forward Base:

o Location: Several hours to 1 day travel

o Purpose: Temporary shelter, longer assessment, resupply if cached

o Contents: Pre-positioned cache (food, water, fuel, supplies)

3. Final Destination/Bug-Out Location (BOL):

o Location: Secure, sustainable, long-term viable

o Purpose: Survive extended crisis, rebuild if necessary

o Contents: Fully stocked retreat or trusted friend/family location

D. The Bug-Out Bag (BOB) & Get-Home Bag (GHB)

• Bug-Out Bag: 72-hour sustainment for reaching your BOL

• Get-Home Bag: Resources to get from workplace/commute to home

BOB Essential Categories:

1. Water (Filtration + containers + purification tablets)

2. Food (High-calorie, no-cook options + cooking method)

3. Shelter (Tarp, sleeping bag, bivy, insulation)

4. Security (Based on personal philosophy and legality)

5. Health (Trauma kit + routine medications + hygiene)

6. Navigation (Map, compass, GPS with extra batteries)

7. Communication (PACE-compliant systems)

8. Tools (Multi-tool, knife, cordage, duct tape, flashlight)

9. Documents (Copies of IDs, maps, contacts, cash)

10. Special Needs (Glasses, baby formula, pet supplies, etc.)

Weight Guideline: ≤ 25% of your body weight for extended mobility.

45 | P a g e
E. Integrated Decision Matrix

Factor Weight Shelter In Place Bug Out

Home structural integrity High If intact If compromised

Supply levels High ≥14 days <72 hours

Local threat level Critical If high If escaping threat

Travel route safety Medium If unsafe If safe

Group capability Medium If limited mobility If mobile

Weather conditions Medium If severe If favorable

Time of day Low Night Daylight preferred

Decision Rule: When 3+ factors favor one option OR any Critical/High factor decisively favors one
option, choose that course.

SYNTHESIS: Integrating PACE with Shelter Decisions

A. PACE-Applied Shelter Planning

• Primary: Shelter in place at primary residence

• Alternate: Shelter in place at nearby family/friend's home

• Contingency: Bug out to predetermined secondary location

• Emergency: Bug out to wilderness/improvised shelter

B. Critical Pre-Crisis Actions

1. Conduct a "Stay-or-Go" drill quarterly with household members

2. Establish clear decision triggers (e.g., "If municipal water stops, we execute 72-hour
assessment")

3. Create multiple cache points along potential bug-out routes

4. Develop communication protocols using PACE methodology

5. Practice low-profile living to avoid becoming a target

C. Mindset Principles

1. OODA Loop Integration: Observe → Orient → Decide → Act faster than the threat

2. Flexibility Over Rigidity: Have a plan, but be ready to adapt

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 3. Security Through Obscurity: Don't advertise your preparedness

4. Community Is Force Multiplier: The right neighbors are better than any gear

5. Skill > Stuff: Knowledge and practice trump equipment alone

RECOMMENDED PRACTICE EXERCISES

1. PACE Drill: This Saturday, communicate with household members using only your
Contingency methods.

2. Bug-Out Simulation: With full packs, walk your primary bug-out route for 3 miles.

3. Shelter-in-Place Test: Turn off main power/water for 24 hours using only prepared
resources.

4. Decision Game: Watch news of a distant disaster and discuss: "Would we stay or go?
Why?"

5. Gear Audit: Weigh and evaluate every item in your BOB. Remove 3 non-essentials.

Final Wisdom: "Plans are worthless, but planning is everything." - Dwight D. Eisenhower. The value
is in the thought process, relationships built, and skills developed during preparation, not in rigid
adherence to any specific plan when reality inevitably diverges from expectation.

Remember: The goal is not to survive the apocalypse, but to confidently handle the disruptions life
actually brings—storms, job loss, power outages, civil unrest—while maintaining your family's
safety and dignity.

47 | P a g e
IMPACT RESPONSE - DISASTER TRIAGE SYSTEMS

Triage is a French word meaning "to sort." In disaster medicine, it is the process of rapidly
classifying victims based on the severity of their injuries and their likelihood of survival to
prioritize treatment and transport when resources are overwhelmed.

Core Principle: "Do the Greatest Good for the Greatest Number."

• Shifts focus from individual-based care to population-based resource allocation.

• Decisions are based on medical urgency and resource availability.

Key Triage Metaphor: Not "first come, first served," but "worst first, if salvageable."

SIMPLE TRIAGE AND RAPID TRANSPORT (START)

Developed in the 1980s in Orange County, California, for adult and older pediatric victims. It is the
most widely used primary triage system for mass casualty incidents (MCIs).

A. The START Algorithm: 60-Second Assessment

The system evaluates 3 Critical Parameters in this order:

Step 1: AMBULATION? ("Walking Wounded")

• Instruct all who can walk to move to a designated "Green/Minor" area.

• Rationale: Those who can walk are generally not in immediate life-threatening danger.

Step 2: BREATHING?

• Assess non-ambulatory victims.

• If NOT breathing: Open airway (head-tilt/chin-lift). If still not breathing

→ BLACK/Deceased.

• If BREATHING: Assess rate.

o If >30 breaths/min → RED/Immediate (indicates shock or respiratory distress).

Step 3: PERFUSION? (Circulation)

• Assess radial pulse OR capillary refill.

• If NO radial pulse OR capillary refill >2 seconds → RED/Immediate (indicates poor

perfusion/shock).

Step 4: MENTAL STATUS?

• Assess ability to follow simple commands ("Open your eyes," "Squeeze my hand").

• If UNABLE to follow commands → RED/Immediate (indicates significant neurological

insult or shock).

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Step 5: If all the above are within normal limits → YELLOW/Delayed.

B. START Triage Categories & Tags

Color Category Priority Description Clinical Examples

RED Immediate 1st Life-threatening but Airway obstruction, tension

salvageable injuries pneumothorax,
with rapid uncontrolled hemorrhage,
intervention. shock.

YELLOW Delayed 2nd Significant injuries Open fractures without

but stable for a period major bleeding, large
without immediate lacerations, stable
care. abdominal injuries.

GREEN Walking 3rd Minor injuries Minor lacerations, sprains,

Wounded/Minor requiring minimal or contusions, anxiety.
delayed care.

BLACK Deceased/Expectant Last Deceased or Non-survivable injuries

unsalvageable given (e.g., massive head trauma,
current resources. severe burns >95%), apneic
after airway maneuver.

Tag Placement: Tag is secured to the victim's wrist or ankle (leaving chest/airway clear) and
initialed by the triage officer.

JumpSTART: Pediatric Disaster Triage

Developed by Dr. Lou Romig (2002). Adapts START for children aged 1 year to 8 years (or up to
puberty). Recognizes key physiological differences in children.

A. Critical Physiological Differences in Children

1. Airway: Smaller, more easily obstructed.

2. Breathing: Higher normal respiratory rate; diaphragmatic breathers.

3. Circulation: Strong compensatory mechanisms; hypotension is a LATE and

OMINOUS sign.

4. Mental Status: Varies with age; harder to assess via commands.

49 | P a g e
B. The JumpSTART Algorithm: Key Modifications from START

Step 1: AMBULATION?

• Same as START. Exception: A walking child who then lies down should be reassessed
immediately.

Step 2: BREATHING?

• If NOT breathing: Open airway. If still not breathing → check for a pulse.

o If NO pulse → BLACK.

o If PULSE present → Give 5 rescue breaths. If still not breathing → BLACK. If

breathing resumes → RED.

Step 3: BREATHING RATE?

• If <15 or >45 breaths/min → RED.

• Note the different thresholds vs. adult START (>30).

Step 4: PERFUSION?

• Assess pulse (central preferred: brachial/femoral) OR capillary refill.

• If NO palpable central pulse → RED.

• Capillary refill >2 sec → RED.

Step 5: MENTAL STATUS?

• Uses the AVPU Pediatric Scale:

o Alert

o Responds to Voice

o Responds to Painful stimuli

o Unresponsive

• If "P" or "U" → RED.

Step 6: If all parameters are normal → YELLOW/Delayed.

C. JumpSTART Mnemonic & Special Considerations

JumpSTART Atypical Triage Guidelines (JSATG) for Special Needs Children:

• Children with obvious physical/developmental disabilities or technology dependence

(tracheostomy, ventilator) are triaged based on their baseline, not against standard
pediatric norms.

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 Infants (<1 year): No formalized JumpSTART protocol. Rely on clinical judgment, respiratory rate
(<60 or >10), and perfusion. Often triaged as a higher priority when in doubt.

IV. COMPARISON CHART: START vs. JumpSTART

Assessment START (Adult/Older Peds) JumpSTART (Age 1-8)

Parameter

Breathing Apneic? → Open airway. If remains Apneic + Pulse? → Give 5 rescue breaths. If
apneic → BLACK. remains apneic → BLACK.

Respiratory Rate >30/min → RED <15 or >45/min → RED

Perfusion No radial pulse OR cap refill >2 sec → No central pulse OR cap refill >2 sec → RED
RED

Mental Status Unable to follow simple commands → AVPU = "P" or "U" → RED
RED

V. TRIAGE TAG & COMMUNICATION

Components of a Triage Tag:

1. Triage Number (unique identifier)

2. Color-Coded Section (tear-off strips for tracking priorities)

3. Victim Details (location found, injuries, vital signs)

4. Treatment Given (medications, interventions)

5. Transport Priority & Destination

Triage Officer Role: Clear, authoritative, rapid decision-making. Wears high-visibility vest (e.g.,
"TRIAGE"). Does NOT provide treatment.

VI. CLINICAL PEARLS

1. Triage is Dynamic: Re-triage (Secondary Triage) is mandatory as victims' conditions and

resource availability change.

2. The "Platinum 10 Minutes": Goal is to complete primary triage of all victims within the first
10 minutes of the triage team's arrival.

3. Ethical Tension: The BLACK/Expectant category is the most difficult. It is a resource-

based decision, not a medical judgment of certain death in all settings.

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 4. Practice is Essential: Cognitive recall degrades under stress. Regular drills using moulage
(simulated victims) are critical for proficiency.

5. Know Your System: Be familiar with your local MCI plan, triage tag type, and pediatric
receiving facilities.

VII. PRACTICE SCENARIOS (For Self-Study)

Victim 1: Adolescent male, ambulatory, clutching arm. Respiratory rate 22, strong radial pulse,
alert and oriented.

• Triage Category: ________

Victim 2: 4-year-old female, non-ambulatory, found next to a parent. Breathing rate 8/min after
airway opening, weak brachial pulse, responsive only to pain.

• Triage Category: ________

Victim 3: Adult male, pinned under debris, apneic. After jaw-thrust maneuver, he begins breathing
at a rate of 40/min.

• Triage Category: ________

*(Answers: 1=GREEN, 2=RED, 3=RED)*

Remember: Triage is a system of organized compassion. Its disciplined application saves the
maximum number of lives in the chaotic window following a disaster.

References: START Triage, JumpSTART Triage, AHRQ, FEMA IS-200/800 courses.

Handout designed for educational use. Always follow your institution's official protocols.

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MASS CASUALTY INCIDENT (MCI) MANAGEMENT & PATIENT ASSESSMENT

I. DEFINITION AND FUNDAMENTALS OF MASS CASUALTY INCIDENTS (MCI)

A. Definition

A Mass Casualty Incident (MCI) is an event that generates more patients than available resources
can manage using routine procedures. It requires a shift from individual-focused
care to population-based care.

B. Key Principles

1. Greatest Good for the Greatest Number: Prioritize care based on survivability, not first-
come, first-served

2. Resource-Based Triage: Available resources dictate treatment priorities

3. Reverse Triage: Most critical patients may be treated last if resources are insufficient

C. Common MCI Types

• Transportation accidents (bus/train/plane crashes)

• Structural collapses

• Natural disasters

• Terrorist attacks/active shooter events

• Industrial/chemical incidents

• Natural gas explosions

II. SCENE SIZE-UP & INITIAL RESPONSE

A. The 5 Components of Scene Size-Up

1. Scene Safety

o BSI/PPE (including ballistic protection if indicated)

o Identify hazards: structural, chemical, electrical, biological

o Hot/Warm/Cold zone identification

o Establish safe entry/exit routes

2. Mechanism of Injury/Nature of Illness

o Determine type and force of energy transfer

o Consider blast physics in explosions (primary, secondary, tertiary effects)

o Evaluate for CBRNE (Chemical, Biological, Radiological, Nuclear, Explosive)

indicators

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 3. Number of Patients

o Initial estimation vs. continuous reassessment

o Consider hidden/entrapped victims

4. Additional Resources Needed

o Activate MCI plan immediately

o Request additional ambulances, personnel, specialized teams

o Consider mutual aid, disaster response teams

5. Incident Command System (ICS)

o Establish command post

o Implement unified command structure

o Designate treatment sectors (Triage, Treatment, Transport, Morgue)

B. Initial Actions of First Arriving Unit

1. Establish incident command

2. Declare MCI

3. Request additional resources

4. Initiate triage

5. Designate treatment areas

6. Establish staging areas

III. PATIENT ASSESSMENT & IDENTIFICATION IN MCI

A. START Triage System (Simple Triage and Rapid Treatment)

30-Second Assessment Per Patient

Step 1: Global Sorting (Ambulatory Patients)

• "If you can hear me and can walk, come to this area"

• Tag GREEN (Minor/Delayed)

• Exception: Obvious severe injury or distress

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Step 2: Non-Ambulatory Patients - Assess 3 Critical Functions:

1. Respiratory Status

o Apneic → Open airway → Still apneic? = BLACK (Deceased/Expectant)

o Breathing → Check rate

▪ 30/min = RED (Immediate)

▪ <30/min → Proceed to step 2

2. Perfusion (Radial Pulse/Capillary Refill)

o No radial pulse or capillary refill >2 sec = RED (Immediate)

o Present → Proceed to step 3

3. Mental Status (AVPU)

o Unable to follow simple commands = RED (Immediate)

o Alert, or responsive to Verbal/Pain stimuli = YELLOW (Delayed)

Triage Tag Colors:

• RED (Priority 1/Immediate): Life-threatening but treatable injuries

• YELLOW (Priority 2/Delayed): Serious but not immediately life-threatening

• GREEN (Priority 3/Minor): "Walking wounded"

• BLACK (Priority 4/Deceased/Expectant): Dead or nonsurvivable injuries

B. JumpSTART Triage for Pediatric Patients (<8 years or <100 lbs)

• Modified START system for children

• Key differences:

o Apnea → 5 rescue breaths → Still apneic = BLACK

o Respiratory rate cutoff: <15 or >45 = RED

o Uses brachial pulse instead of radial

o Altered mental status uses pediatric AVPU

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IV. RAPID PATIENT ASSESSMENT IN MCI

A. Obtaining Patient History (AMPLE)

Modified for MCI conditions:

• A - Allergies (if known/available)

• M - Medications (brief, focused)

• P - Past medical history (pertinent only: cardiac, respiratory, diabetes)

• L - Last oral intake (relevant for surgery timing)

• E - Events leading to injury (critical for hidden injuries)

B. Rapid Trauma Assessment (DCAP-BTLS)

60-90 second head-to-toe assessment:

1. Head

• Deformities

• Contusions

• Abrasions

• Punctures/Penetrations

• Burns

• Tenderness

• Lacerations

• Swelling

2. Neck

• DCAP-BTLS

• Jugular vein distention (JVD)

• Tracheal deviation

• C-spine stabilization maintained

3. Chest

• DCAP-BTLS

• Symmetrical expansion

• Paradoxical movement

• Breath sounds (quick bilateral check)

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 • Subcutaneous emphysema

4. Abdomen

• DCAP-BTLS

• Distension

• Rigidity/guarding

• Tenderness

5. Pelvis

• Stability check (gentle compression)

• DCAP-BTLS

6. Extremities

• DCAP-BTLS

• Distal pulse/motor/sensory (quick check)

• Obvious deformities

7. Posterior

• Quick log-roll if possible/safe

• DCAP-BTLS of back/buttocks

V. RAPID MEDICAL ASSESSMENT FOR MEDICAL MCIs

A. Primary Medical Survey

1. General Impression

o Age, sex, position, activity

o Obvious distress, skin color

2. Mental Status (AVPU)

o A - Alert

o V - Responsive to Verbal stimuli

o P - Responsive to Painful stimuli

o U – Unresponsive

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 3. Airway & Breathing

o Patency, sounds, rate, effort

o Oxygen saturation if available

4. Circulation

o Pulse (rate, rhythm, quality)

o Skin (color, temperature, condition)

o Major bleeding

B. OPQRST for Symptom Analysis

• Onset (sudden/gradual)

• Provocation/Palliation

• Quality (describe the pain)

• Radiation/Region

• Severity (1-10 scale)

• Time (duration)

VI. ON-GOING ASSESSMENT IN MCI

A. Purpose

• Detect changes in patient condition

• Evaluate effectiveness of interventions

• Reassign triage categories as needed

B. Frequency

• RED tags: Every 5-10 minutes

• YELLOW tags: Every 15-20 minutes

• GREEN tags: Every 30-60 minutes

• Adjust based on resources and patient load

C. Components

1. Repeat primary assessment:

o Mental status

o Airway and breathing

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 o Circulation

2. Reassess vital signs:

o Respiratory rate and quality

o Pulse rate and quality

o Skin condition

o Blood pressure (if resources allow)

3. Recheck interventions:

o Bandages/dressings

o Splints

o Oxygen delivery

o Position

4. Reassess patient priorities:

o Upgrade/downgrade triage category as needed

o Document changes

VII. DOCUMENTATION & COMMUNICATION IN MCI

A. Triage Tag System

1. Information Recorded:

o Triage category/color

o Injuries identified

o Vital signs (if taken)

o Interventions performed

o Unique identifier number

2. Triage Tag Parts:

o Perforated sections for tracking

o Treatment section

o Transportation section

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B. Verbal Reporting (MIST Format)

• Mechanism of injury

• Injuries identified

• Signs/vital signs

• Treatment given

C. Sector Communication

• Treatment Officer to Transport Officer

• Transport Officer to Receiving Facilities

• Use runners or radios as available

VIII. SPECIAL CONSIDERATIONS

A. Pediatric Considerations

• Anatomical and physiological differences

• Psychological needs (separate pediatric treatment area if possible)

• Family reunification considerations

B. Geriatric Considerations

• Altered physiology and medication use

• Increased vulnerability

• Comorbid conditions

C. Psychological First Aid

• Calm, reassuring presence

• Simple, clear communication

• Normalize reactions

• Connect with support systems

D. Provider Safety & Stress Management

• Rotate personnel from high-stress areas

• Implement rehabilitation sector

• Critical Incident Stress Management (CISM)

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KEY TAKEAWAYS

1. Your safety comes first - you cannot help others if you become a victim

2. Think population, not individual - MCI requires different mindset

3. Triage is dynamic - reassessment is critical

4. Communication saves lives - use ICS structure

5. Document minimally but effectively - triage tags are your primary tool

6. Flexibility is essential - adapt to changing conditions

QUICK REFERENCE GUIDES

START Triage Decision Tree

[Walk → GREEN; Not walk → Check breathing → etc.]

MCI Treatment Area Layout Diagram

[Triage → Red/Yellow/Green/Black areas → Transport → Staging]

Common MCI Supplies Checklist

• Triage tags (100+)

• PPE (gloves, masks, eye protection)

• Basic airway adjuncts

• Hemorrhage control supplies

• Blankets/tarps

• Marking tape/cones

• Clipboard/incident forms

Remember: In MCI response, perfection is the enemy of good. Making reasonable decisions
quickly with available information saves more lives than delayed perfect decisions.

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 PATIENT HANDLING & EMERGENCY MANAGEMENT

RESCUER STAGING & SCENE SAFETY

Principles of Safe Response

• ALWAYS begin with scene safety: Assess for hazards before approaching (traffic, fire,
electricity, violence, chemicals, BSI risks)

• Incident Command System (ICS): Establish clear roles and leadership

• Staging Areas:

o Cold Zone: Safe area for equipment and command

o Warm Zone: Area where PPE is required

o Hot Zone: Immediate danger area (requires specialized training/equipment)

The 5 Components of Every Scene Size-Up

1. Scene Safety - Can I safely enter?

2. Mechanism of Injury/Nature of Illness - What happened?

3. Number of Patients - How many need help?

4. Additional Resources Needed - Do I need backup/special equipment?

5. C-Spine Considerations - Is spinal immobilization needed?

BODY SUBSTANCE ISOLATION (BSI) & UNIVERSAL PRECAUTIONS

Core Principle: Treat ALL blood and body fluids as potentially infectious for bloodborne pathogens
(HIV, Hepatitis B/C).

Standard Precautions Hierarchy

1. Engineering Controls - Sharps containers, safer medical devices

2. Work Practice Controls - No recapping needles, proper hand hygiene

3. Personal Protective Equipment (PPE) - Last line of defense

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PPE Selection Guide

Exposure Risk Minimum PPE Required

Basic Patient Contact (no fluids expected) Gloves

Potential Splash/Spray (bleeding, vomiting, Gloves + Face Shield/Goggles + Mask +

suctioning) Gown

Airborne Pathogens (TB, COVID-19, measles) N95/PAPR + Full PPE

Heavy Contamination (major trauma, childbirth) Double gloves, fluid-resistant gown, boot
covers

PPE Donning & Doffing Sequence

DONNING (Put On):

1. Perform hand hygiene

2. Gown

3. Mask/N95

4. Eye protection

5. Gloves (cuff over gown sleeve)

DOFFING (Take Off):

1. Gloves (outside touches only)

2. Hand hygiene

3. Gown (unfold, roll outside-in)

4. Eye protection

5. Mask/N95 (by straps only)

6. FINAL HAND HYGIENE

SAFE PATIENT LIFTING & MOVING

Biomechanics of Lifting

• Keep loads close to body (doubling distance quadruples spinal stress)

• Bend at knees, not waist

• Use leg muscles, not back

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 • Avoid twisting while lifting

• Team lifts anything >35 lbs or awkward

PATIENT MOVEMENT TECHNIQUES

Emergency Moves (Immediate danger present):

• Clothes Drag - Grasp clothing at shoulders

• Blanket Drag - Roll patient onto blanket

• Armpit-Forearm Drag - From behind patient

Urgent Moves (Unstable patient requiring rapid movement):

• Rapid Extrication (see below)

Non-Urgent Moves (Stable patient):

• Direct Ground Lift - 3-4 rescuers

• Extremity Lift - For seated patients

• Draw Sheet Method - For bed transfers

• Log Roll - For spinal motion restriction

Equipment-Based Moves

• Stretcher Operations: Always use at least 2 people

• Stair Chair: Use for narrow spaces, patient must be seated

• Scoop Stretcher: For lifting from ground, opens laterally

RAPID EXTRICATION TECHNIQUE

Indications for Rapid Extrication

1. Scene unsafe and cannot be made safe

2. Patient condition requires immediate transport

3. Patient blocks access to more critically injured

4. Patient in cardiac/respiratory arrest

Rapid Extrication: 3-Rescuer Technique

Preparation:

• Apply C-collar if immediately available

• Position backboard adjacent to patient

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STEP-BY-STEP:

Position 1: Vehicle/Scene Side

1. Rescuer 1: At patient's head, manual in-line stabilization

2. Rescuer 2: At patient's torso

3. Rescuer 3: At patient's legs/feet

Commands & Actions:

• "Ready to rotate on my command. READY... NOW"

• All rescuers rotate patient as unit toward themselves (45-90°)

• "Ready for board. READY... SLIDE"

• Rescuer 3 slides backboard behind patient

• "Ready to lower. READY... LOWER"

• Patient lowered onto backboard

• "SECURE" - Immediately apply straps

Total Time Goal: Less than 60 seconds from decision to secured on board

KENDRICK EXTRICATION DEVICE (KED)

Indications for KED Use

• Vehicle entrapment with suspected spinal injury

• Sitting patients requiring full spinal immobilization

• Limited space where backboard won't fit

KED Application: 7 Steps

1. Manual Stabilization - Maintain head/neck alignment

2. Size & Position - Ensure proper KED size, position behind patient

3. Apply Torso Straps - Snug but not restrictive to breathing

4. Apply Leg Straps - For stability during rotation

5. Secure Head - Pad as needed, apply head flaps

6. Rotate Patient - As unit onto long board

7. Secure to Long Board - Complete immobilization

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 KED Tips

• Pad all voids (especially behind head and lumbar area)

• Can place under clothing for better strap placement

• DO NOT use KED as lifting device alone - always transfer to long board

DRESSING & BANDAGING

Principles of Wound Management

• BSI FIRST - Always glove up

• Control hemorrhage before cleaning

• Never remove impaled objects (stabilize in place)

• Cover all open wounds with sterile dressing

Dressing Types & Uses

Dressing Type Primary Use Key Feature

Occlusive Chest wounds, abdominal evisceration Air-tight (petroleum gauze,

plastic)

Pressure Bleeding control Bulk dressing + pressure

Adhesive Small lacerations Sterile, self-adhering

Burn Thermal injuries Non-stick, moist

Hemostatic Severe hemorrhage Promotes clotting

Bandaging Techniques

Triangular Bandage Applications:

• Sling & Swathe - Arm support

• Cravat - Multiple uses (head, extremities)

• Improvised - Use clothing if needed

Roller Bandage Rules:

1. Start distal, move proximal

2. Overlap by 1/2 bandage width

3. Check distal circulation after application

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 4. Secure with tape or clips (never pins over wound)

Special Wound Considerations

• Amputations: Treat patient first, retrieve part, keep cool (NOT directly on ice)

• Evisceration: Cover with moist sterile dressing, then occlusive layer

• Chest Wounds: 3-sided occlusive dressing (taped on 3 sides)

STABILIZATION & RESTRAINTS

Principles of Patient Restraint

• Last resort after verbal de-escalation fails

• Never punitive - only for safety

• Requires continuous monitoring

• Documentation is critical

Indications for Restraints

1. Patient poses danger to self/others

2. Medical necessity (removing life-saving equipment)

3. NOT for staff convenience

Types of Restraints

Medical/Surgical:

• Soft Restraints - For confused patients

• Limb Holders - IV protection

• Posey Vests - Fall prevention

Emergency/Behavioral:

• 4-Point Restraints - Requires multiple trained staff

• EMT "Hog-Tie" - Avoid (positional asphyxia risk)

Safe Application Protocol

4-Person Technique:

1. Team leader directs all actions

2. Each limb controlled by one rescuer

3. Apply one restraint at a time

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 4. Secure to solid part of stretcher/bed frame

5. Check circulation every 15 minutes

6. Document reason, time, assessments

Critical Safety Points

• NEVER restrain prone or face-down

• ALWAYS maintain airway access

• CONTINUOUS visual monitoring required

• REASSESS need frequently

• RELEASE at earliest safe opportunity

SUMMARY: The Safety Mantra

"BSI, SCENE SAFE, HELP, C-SPINE"

1. BSI - Protect yourself first

2. SCENE SAFE - No dead heroes

3. HELP - Call for resources early

4. C-SPINE - When in doubt, immobilize

Patient Safety = Rescuer Safety = Quality Care

Practical Skills Checklist

• Proper PPE donning/doffing

• 3-person lift demonstration

• Rapid extrication in <60 seconds

• KED application

• Pressure dressing application

• 4-point restraint with team

Remember: These skills require PRACTICE. Regular review and simulation training are essential for
competency.

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POST-IMPACT: RECOVERY, RECONSTRUCTION, REHABILITATION

The Three R's of Post-Disaster Phases

A. Recovery

• Definition: Immediate stabilization following impact

• Timeframe: Hours to days post-event

• Key Objectives:

o Restore basic services and infrastructure

o Address immediate medical and psychological needs

o Establish temporary shelter and food security

o Conduct initial damage assessments

B. Reconstruction

• Definition: Rebuilding physical and social infrastructure

• Timeframe: Weeks to years

• Key Objectives:

o Repair or replace damaged physical structures

o Restore economic systems and livelihoods

o Rebuild community institutions and social networks

o Implement mitigation measures for future events

C. Rehabilitation

• Definition: Restoring individuals and communities to optimal functioning

• Timeframe: Months to years, often overlapping reconstruction

• Key Objectives:

o Psychological and emotional recovery

o Social reintegration and community cohesion

o Long-term health and wellness support

o Capacity building for future resilience

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 II. CRITICAL INCIDENT STRESS DEBRIEFING (CISD)

A. Definition & Purpose

• CISD: A structured, small-group psychological intervention conducted by trained

facilitators

• Primary Goal: Mitigate acute stress symptoms and prevent long-term psychological trauma

• Best Timing: 24-72 hours post-incident (after immediate physical needs are met)

• Duration: 2-3 hours in a single session

B. The 7-Phase CISD Model (Mitchell Model)

Phase Purpose Key Activities

1. Introduction Establish safety, guidelines, and rapport • Facilitator introduction

• Explain purpose and process
• Set ground rules (confidentiality, respect)
• Manage expectations

2. Fact Begin cognitive processing through • Participants describe what happened

objective details • Focus on sensory facts (saw, heard,
smelled)
• Avoid emotional content at this stage

3. Thought Transition to subjective experience • "What was your first thought?"

• Connect facts to cognitive processing
• Normalize thought patterns

4. Reaction Express emotional content • "What was/worst part for you?"

• Encourage emotional expression
• Validate all reactions as normal

5. Symptom Identify stress reactions • Describe physical/emotional symptoms

during and after
• Educate about stress response
• Normalize symptoms

6. Teaching Psychoeducation and coping strategies • Explain common stress reactions

• Teach coping techniques
• Provide resources for additional help

7. Re-entry Summarize and prepare for return • Clarify unanswered questions

• Review key points and resources
• Plan for immediate future
• Formal closure

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C. Important Considerations & Limitations

• Not psychotherapy or counseling

• Not mandatory – participants should choose to attend

• Not appropriate for everyone (contraindicated for those with acute psychosis or severe
dissociation)

• Should be conducted by trained facilitators only

• Recent evidence suggests psychological first aid may be more effective for immediate
response

III. SUPPORTIVE COMMUNICATION SKILLS

A. Core Principles

1. Safety First: Ensure physical and psychological safety

2. Calm Presence: Model calm, composed behavior

3. Non-judgmental Stance: Accept all reactions without criticism

4. Empathic Connection: Demonstrate genuine concern and understanding

B. Essential Communication Techniques

1. Active Listening

• SOLER Technique:

o S: Sit squarely (open posture)

o O: Open posture (non-defensive)

o L: Lean slightly forward

o E: Eye contact (culturally appropriate)

o R: Relaxed demeanor

• Verbal Components:

o Minimal encouragers ("Go on," "I see")

o Paraphrasing ("So what you're saying is...")

o Reflection of feeling ("You sound frightened")

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2. Trauma-Informed Questioning

• Use Open-ended Questions:

o "How are you managing right now?"

o "What has this been like for you?"

o "What do you need most at this moment?"

• Avoid:

o "Why" questions (can sound accusatory)

o Leading questions

o Pressuring for details before readiness

3. Validation & Normalization

• Validate: "Your reaction makes sense given what you've been through"

• Normalize: "Many people experience similar feelings after events like this"

• Avoid: False reassurance ("Everything will be fine")

4. Crisis Communication Do's and Don'ts

DO DON'T

Speak calmly and clearly Use jargon or technical terms

Acknowledge uncertainty when it exists Make promises you can't keep

Repeat important information Minimize or dismiss concerns

Offer practical help Say "I know how you feel"

Respect cultural practices Force physical contact

IV. ASSISTED COPING TECHNIQUES

A. Immediate Grounding Techniques

• 5-4-3-2-1 Sensory Grounding:

o Identify: 5 things you can SEE

o Identify: 4 things you can FEEL/TOUCH

o Identify: 3 things you can HEAR

o Identify: 2 things you can SMELL

o Identify: 1 thing you can TASTE

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 • Breathing Exercises:

o Box Breathing: Inhale (4 sec) → Hold (4 sec) → Exhale (4 sec) → Hold (4 sec)

o Diaphragmatic Breathing: Hand on belly, breathe deeply into abdomen

o Paced Breathing: 5-6 breaths per minute pattern

B. Cognitive Techniques

• Thought Stopping: Visualize a stop sign when intrusive thoughts begin

• Cognitive Reframing: Help identify and challenge catastrophic thinking

• Containment Imagery: Visualize placing distressing thoughts in a container to address

later

C. Behavioral Techniques

• Maintain Routines: Reinforce normal daily patterns where possible

• Problem-Solving Approach: Break overwhelming problems into manageable steps

• Social Connection: Facilitate contact with support systems

• Self-Care Planning: Help develop realistic self-care strategies

D. Techniques for Specific Populations

Population Special Considerations Adapted Techniques

Children Concrete thinking, limited vocabulary Play-based expression, drawing, simple

breathing games

Elderly Possible sensory/cognitive limitations Gentle pacing, connection to routine,

reminiscence of past coping

Cultural Varied expressions of distress, help- Cultural brokers, respect for traditional
Minorities seeking behaviors healing practices

First Professional detachment, stigma about Peer support, normalize reactions as

Responders help-seeking occupational hazard

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V. COMMON EMERGENCY STRESS REACTIONS

A. Cognitive Reactions

• Confusion, disorientation

• Difficulty concentrating

• Memory problems

• Intrusive thoughts or images

• Nightmares

• Difficulty making decisions

B. Emotional Reactions

• Shock, numbness

• Fear, anxiety, panic

• Grief, sadness, depression

• Anger, irritability, resentment

• Guilt, self-blame

• Emotional numbing or flattening

C. Physical Reactions

• Fatigue, exhaustion

• Hyperarousal (jumpiness, startle response)

• Sleep disturbances

• Gastrointestinal problems

• Headaches, muscle tension

• Worsening of pre-existing conditions

D. Behavioral Reactions

• Social withdrawal/isolation

• Increased substance use

• Changes in appetite

• Avoidance of reminders

• Hypervigilance

• Restlessness or pacing

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 E. Timeline of Normal Stress Reactions

Timeframe Common Reactions Intervention Focus

Impact (0-48 hrs) Shock, denial, confusion, numbness Safety, basic needs,
psychological first aid

Acute (2 days-2 weeks) Emotional waves, anxiety, sleep problems, Psychoeducation,

intrusive thoughts normalization, coping skills

Intermediate (2 weeks- Grief, anger, mood swings, relationship strain Support groups, individual
3 months) counseling if needed

Long-term (3+ months) Integration, meaning-making, potential PTSD Professional treatment if

symptoms persist

VI. WHEN TO REFER FOR PROFESSIONAL HELP

Red Flags Requiring Immediate Referral:

• Suicidal or homicidal thoughts

• Complete inability to function

• Severe dissociation (losing time, out-of-body experiences)

• Psychotic symptoms (hallucinations, delusions)

• Inability to care for self or dependents

• Symptoms worsening after 4-6 weeks

Signs of Developing PTSD:

• Symptoms persisting beyond one month

• Significant impairment in daily functioning

• Avoidance behaviors increasing over time

• Hyperarousal interfering with sleep and relationships

• Flashbacks or severe intrusive memories

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VII. PRACTICAL GUIDELINES FOR HELPERS

A. Self-Care for Responders

1. Monitor your own stress levels

2. Use the buddy system – check in with colleagues

3. Maintain boundaries between work and personal life

4. Engage in regular debriefing with your team

5. Recognize signs of burnout or compassion fatigue

B. Creating a Supportive Environment

• Ensure physical safety and privacy

• Provide practical assistance before psychological intervention

• Respect autonomy – offer choices whenever possible

• Connect people to their natural support systems

• Follow up when appropriate

C. Cultural Competence in Crisis Response

• Ask respectfully about cultural practices and preferences

• Engage community leaders and cultural brokers

• Be aware of culturally-specific expressions of distress

• Respect differences in help-seeking behaviors

• Adapt interventions to be culturally appropriate

VIII. RESOURCES & FOLLOW-UP

Essential Information to Provide:

• Local mental health crisis hotlines

• Community support services

• Online resources (reputable websites)

• Printed materials on stress management

• Information on when and how to seek further help

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Follow-Up Considerations:

• Schedule check-ins for high-risk individuals

• Provide information about anniversary reactions

• Educate about delayed stress responses

• Encourage development of long-term support networks

SUMMARY KEY POINTS

1. Post-impact phases (Recovery, Reconstruction, Rehabilitation) require different

interventions

2. CISD is a specific, structured intervention with defined phases and protocols

3. Supportive communication is foundational – focus on listening, validating, and

normalizing

4. Coping techniques should be simple, practical, and tailored to the individual

5. Stress reactions are normal responses to abnormal events – pathologize only when
persistent and impairing

6. Know your limits – recognize when professional referral is needed

7. Helper self-care is not optional – it's essential for effective, sustainable helping

"The goal of post-impact intervention is not to help people forget what happened, but to help
them remember without being overwhelmed by the memory."

This handout is for educational purposes. Always follow your organization's protocols and consult
with mental health professionals when in doubt.

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PSYCHOLOGICAL FIRST AID (PFA) IN CRISIS RESPONSE

I. INTRODUCTION TO PSYCHOLOGICAL FIRST AID (PFA)

Psychological First Aid (PFA) is an evidence-informed modular approach to help children,

adolescents, adults, and families in the immediate aftermath of disaster and terrorism. It is
designed to:

• Reduce initial distress

• Foster short- and long-term adaptive functioning

• Provide humane, supportive, and practical assistance

Key Principles: PFA is NOT professional counseling or debriefing. It is:

• Supportive: Provides comfort and consolation

• Practical: Addresses immediate needs

• Non-intrusive: Respects privacy and autonomy

• Culturally informed: Adapts to diverse backgrounds

• Based on resilience: Focuses on strengths and coping

Who Needs PFA?

Individuals experiencing acute stress reactions after:

• Natural disasters (earthquakes, floods, typhoons)

• Acts of terrorism or violence

• Serious accidents or fires

• Sudden loss or traumatic events

• Community crises or pandemics

II. THE ROLE OF THE PSYCHOLOGICAL FIRST AIDER IN A CRISIS: Core Responsibilities and
Mindset

Primary Goals:

1. Create Safety: Help people feel physically and emotionally safe

2. Calm and Orient: Reduce physiological arousal and confusion

3. Connect: Foster social support and access to resources

4. Empower: Promote self-efficacy and coping skills

5. Provide Hope: Reinforce realistic optimism about recovery

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Essential Qualities of an Effective First Aider:

• Calm Presence: Maintain composure despite chaos

• Active Listener: Give full attention without judgment

• Compassionate: Show genuine care and concern

• Respectful: Honor cultural, religious, and personal differences

• Patient: Allow people to process at their own pace

• Observant: Notice both verbal and non-verbal cues

The 5-Phase Action Framework (LAPP Model)

Phase 1: LOOK (Assessment)

• Check for safety: Ensure physical environment is secure

• Identify urgent needs: Medical emergencies, separation from loved ones

• Observe reactions: Notice signs of shock, dissociation, or extreme distress

• Determine vulnerability factors:

o Children and elderly

o Those with pre-existing mental health conditions

o People with disabilities

o Those who have experienced multiple losses

Phase 2: APPROACH (Initial Contact)

• Introduce yourself clearly and state your role

• Ask permission before assisting: "May I sit with you?" "Would it be okay if I help?"

• Use appropriate non-verbal communication:

o Maintain appropriate eye contact (varies by culture)

o Use open, non-threatening body posture

o Match your tone to the person's emotional state

o Respect personal space boundaries

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Phase 3: PRIORITIZE (Triage Needs)

• Immediate attention required:

o Life-threatening medical conditions

o Severe agitation or disorientation

o Suicidal or homicidal thoughts

o Unaccompanied children

• Secondary needs:

o Information about loved ones

o Basic necessities (food, water, shelter)

o Emotional support and comfort

Phase 4: PROVIDE (Core Actions)

Action 1: Ensure Safety and Comfort

• Address immediate physical needs

• Provide practical assistance (blanket, water, etc.)

• Help reunite families when possible

Action 2: Stabilize (if needed)

• For those who are emotionally overwhelmed or dissociating:

o Use grounding techniques

o Speak in simple, calm tones

o Help regulate breathing

Action 3: Gather Information

• Ask simple, focused questions:

o "What is your most pressing need right now?"

o "Who are you with?"

o "Do you have any medical conditions I should know about?"

Action 4: Provide Practical Assistance

• Help problem-solve immediate concerns

• Connect to available resources

• Assist with making phone calls or locating information

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Action 5: Connect with Social Supports

• Help contact family or friends

• Facilitate connection with others in similar situations

• Identify community resources

Action 6: Provide Coping Information

• Normalize stress reactions

• Share basic information about trauma responses

• Discuss healthy vs. unhealthy coping strategies

Action 7: Link with Collaborative Services

• Provide information about next steps

• Make appropriate referrals

• Ensure continuity of care

Phase 5: LINK (Follow-up)

• Provide written information about available services

• Schedule follow-up contact if appropriate

• Document interventions (maintaining confidentiality)

III. FEAR MANAGEMENT STRATEGIES IN CRISIS SITUATIONS

Understanding Fear in Crisis

Fear is a normal, adaptive response to threat characterized by:

• Physiological arousal (increased heart rate, rapid breathing)

• Cognitive distortions (catastrophic thinking, tunnel vision)

• Behavioral responses (fight, flight, or freeze)

Immediate Fear Management Techniques

1. Grounding Techniques (5-4-3-2-1 Method)

Guide the person to:

• Name 5 things they can see

• Identify 4 things they can feel/touch

• Notice 3 things they can hear

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 • Detect 2 things they can smell

• Recognize 1 thing they can taste

2. Breathing Regulation

• Box Breathing: Inhale for 4 counts, hold for 4, exhale for 4, hold for 4

• Paced Breathing: Guide to slow, diaphragmatic breathing

• Counting Breaths: Focus on counting inhalations/exhalations

3. Cognitive Anchoring

• Help person focus on present reality: "Right now, in this moment, you are safe"

• Use orienting statements: "Today is [date], we are at [location]"

• Encourage focus on immediate, manageable tasks

4. Containment Strategies

• For overwhelming emotions: Imagine placing feelings in a "mental container" to address

later

• Create psychological distance: "Let's set that worry aside for now and focus on..."

Communication Strategies for Fear Reduction

Verbal Techniques:

• Use calm, firm, reassuring tone

• Provide accurate, concise information (uncertainty fuels fear)

• Avoid minimizing ("Don't worry") or catastrophizing

• Use simple, concrete language

• Repeat important information (stress impairs processing)

• Frame positively when possible: "Here's what we're doing to help" vs. "Everything is
terrible"

Non-Verbal Techniques:

• Maintain steady eye contact (if culturally appropriate)

• Use open, relaxed body posture

• Match breathing patterns to help regulate theirs

• Use appropriate, calming touch (if culturally appropriate and with permission)

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Managing Specific Fear Responses

For Panic Attacks:

• Speak slowly and calmly

• Guide through grounding exercises

• Encourage slow breathing

• Stay present until symptoms subside

For Dissociation (Shutting Down):

• Use gentle orientation to present reality

• Ask simple, factual questions

• Encourage mild physical movement (wiggling toes, stretching fingers)

• Avoid overwhelming with too much stimulation

For Agitation or Anger:

• Maintain safe distance

• Acknowledge feelings without judgment: "I can see you're really upset"

• Offer choices to restore sense of control

• Set clear, calm limits if needed for safety

Special Considerations for Different Populations

Children:

• Use age-appropriate language

• Provide physical comfort (if appropriate and with caregiver present)

• Use play or drawing to express feelings

• Maintain routines when possible

• Reassure about caregiver safety

Elderly:

• Speak clearly and face-to-face

• Check hearing aids or glasses are available

• Address concerns about medications or medical equipment

• Be aware of mobility limitations

• Connect with family or caregivers quickly

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Persons with Disabilities:

• Address the person directly, not just their companion

• Ask about specific needs or accommodations

• Ensure communication methods are accessible

• Be patient with different response times

Cultural Considerations:

• Respect different expressions of distress

• Understand cultural norms around eye contact, touch, and personal space

• Be aware of stigma around mental health in some cultures

• Use culturally appropriate metaphors and examples

IV. SELF-CARE FOR PSYCHOLOGICAL FIRST AIDERS

Vicarious Trauma Prevention

• Monitor your own stress signals: Irritability, fatigue, difficulty concentrating

• Practice regular grounding techniques during and after providing aid

• Maintain boundaries: You are a helper, not a rescuer

• Use buddy system for mutual support

• Implement regular debriefing with team members

Practical Self-Care Strategies

• Hydrate, nourish, rest – even in brief moments

• Take micro-breaks when possible (60 seconds of deep breathing)

• Practice compartmentalization: Acknowledge emotions, then consciously set them aside

temporarily

• Engage in positive self-talk: "I am helping in the ways I can"

• Seek support after difficult interventions

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V. WHEN TO REFER FOR PROFESSIONAL HELP

Red Flags Requiring Immediate Referral:

• Expressions of intent to harm self or others

• Severe dissociation or inability to care for basic needs

• Acute psychotic symptoms (hallucinations, delusions)

• Complete social withdrawal or mutism

• Inability to be consoled or stabilized

Referral Process:

1. Normalize the referral: "Many people benefit from extra support after something like this"

2. Provide specific information: Names, locations, contact details

3. Offer to facilitate connection: "Would you like me to help you make that call?"

4. Follow up when possible

VI. SUMMARY OF KEY POINTS

1. PFA is about doing no harm while providing practical, compassionate support

2. Your calm presence is your most powerful tool

3. Safety, calm, connection, efficacy, and hope are your guiding principles

4. Listen more than you speak – presence often speaks louder than words

5. Know your limits – PFA is first aid, not long-term treatment

6. Care for yourself to sustainably care for others

7. Every person's recovery path is unique – respect individual differences

8. Simple interventions (a glass of water, accurate information, a listening ear) can have
profound effects

Remember: In crisis situations, you are not expected to have all the answers or fix everything. Your
role is to provide humane, stabilizing support during the initial aftermath, helping people access
their own resilience and connect to appropriate resources for longer-term recovery.

"Psychological First Aid is not about taking away the pain, but about being a compassionate witness
to it, and helping people bear it until they can begin their own healing journey."

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PUBLIC HEALTH & DISASTER MANAGEMENT

I. Public Health Interventions (Wheel of Public Health Interventions)

Public health interventions are population-based actions designed to promote health and prevent
disease, injury, and premature death.

Core Intervention Categories:

1. Surveillance

o Definition: Systematic collection, analysis, and interpretation of health data

o Examples: Disease reporting systems, syndromic surveillance, vital statistics

monitoring

o Application: COVID-19 tracking, influenza monitoring, injury surveillance

2. Disease Investigation

o Purpose: Identify source, transmission patterns, and risk factors

o Steps: Case identification, contact tracing, source investigation

o Tools: Epidemiological curves, geographic mapping, laboratory testing

3. Outreach

o Definition: Locating populations of interest and providing services

o Strategies: Mobile clinics, street outreach, community screening events

o Target groups: Homeless populations, migrant workers, high-risk communities

4. Screening

o Purpose: Early detection of asymptomatic disease

o Criteria: Condition must have significant burden, detectable preclinically, and

available treatment

o Examples: Mammography, newborn screening, hypertension screening

5. Case Finding

o Active approach: Systematic search for undiagnosed cases

o Methods: Household surveys, workplace screening, school-based programs

o Difference from screening: Targets high-risk groups rather than general population

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 6. Referral and Follow-up

o Process: Connecting individuals with needed services

o Components: Assessment, linkage, monitoring, documentation

o Barriers: Transportation, cost, stigma, system fragmentation

7. Case Management

o Definition: Coordinated approach to service delivery for complex cases

o Elements: Comprehensive assessment, care planning, service coordination,

monitoring

o Models: HIV/AIDS case management, tuberculosis DOT, maternal-child health

home visiting

8. Delegated Functions

o Concept: Task shifting to trained non-professionals

o Examples: Community health workers administering immunizations, lay

counselors providing basic mental health support

o Requirements: Clear protocols, training, supervision, quality assurance

9. Health Teaching

o Principles: Learner-centered, culturally appropriate, evidence-based

o Methods: Individual counseling, group education, peer education, digital platforms

o Evaluation: Knowledge gain, behavior change, health outcomes

10. Counseling

o Therapeutic communication: Active listening, motivational interviewing

o Applications: Smoking cessation, nutrition counseling, risk reduction

o Settings: Clinical encounters, hotlines, community centers

11. Consultation

o Purpose: Provide expert advice to other providers or organizations

o Areas: Infection control, program planning, policy development

o Process: Needs assessment, recommendation development, implementation

support

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 12. Collaboration

o Interdisciplinary approach: Working across sectors and disciplines

o Partners: Healthcare providers, social services, education, housing

o Structures: Memoranda of understanding, regular meetings, shared goals

13. Coalition Building

o Definition: Formal alliance of organizations around common goals

o Stages: Formation, implementation, maintenance, outcomes

o Examples: Tobacco control coalitions, injury prevention networks

14. Community Organizing

o Empowerment approach: Building community capacity for self-advocacy

o Models: COPAR (Community Organizing Participatory Action Research), asset-

based community development

o Outcomes: Policy change, improved services, community ownership

15. Advocacy

o Levels: Individual, community, systems, policy

o Strategies: Media campaigns, legislative testimony, stakeholder engagement

o Ethical considerations: Representation, transparency, accountability

16. Social Marketing

o Application of commercial marketing principles: Product, price, place, promotion

o Campaign examples: Handwashing promotion, vaccination uptake, physical

activity

o Evaluation: Reach, recall, behavior change, social norm shifts

17. Policy Development

o Process: Problem identification, policy formulation, adoption, implementation,

evaluation

o Types: Legislative, regulatory, organizational, fiscal

o Examples: Smoke-free laws, soda taxes, school nutrition standards

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II. GUIDELINES IN DISASTER AND EMERGENCY SITUATIONS

A. Mental Health and Psychosocial Support (MHPSS) in Emergency Settings

Key Principles:

1. Do No Harm: Ensure interventions don't exacerbate trauma

2. Human Rights & Dignity: Respect cultural, religious, and social norms

3. Participation: Involve affected communities in planning and implementation

4. Integrated Approach: Coordinate with health, protection, and other sectors

5. Building on Existing Resources: Strengthen local capacities

Intervention Pyramid (IASC Guidelines):

Level 1: Basic Services & Security

• Safe shelter and basic needs

• Family reunification

• Clear information about services

• Community mobilization

Level 2: Community & Family Support

• Psychological first aid (PFA)

• Community support activities

• Strengthening social networks

• Child-friendly spaces

Level 3: Focused Support

• Basic mental health care by trained providers

• Psychological interventions for specific groups

• Support for caregivers and service providers

Level 4: Specialized Services

• Treatment for severe mental disorders

• Specialized trauma-focused therapies

• Inpatient psychiatric care

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Psychological First Aid (PFA) Core Actions:

1. Look (Check for safety, obvious distress)

2. Listen (Approach, ask needs, listen actively)

3. Link (Connect to practical help, social support, information)

Special Populations:

• Children: Maintain routines, play-based interventions, school-based support

• Elderly: Address mobility issues, medication continuity, social isolation

• Persons with Disabilities: Ensure accessibility, communication support

• First Responders: Rotate duties, buddy system, post-debriefing

B. Infant and Young Child Feeding in Emergencies (IYCF-E)

Critical Objectives:

1. Protect, promote, and support breastfeeding

2. Ensure timely, safe, and appropriate complementary feeding

3. Minimize risks of artificial feeding

4. Provide supportive feeding environment

Operational Guidance:

1. For Breastfeeding Infants (0-6 months):

• Immediate action: Support exclusive breastfeeding

• Mothers separated from infants: Express milk, facilitate reunification

• Wet nursing: Considered when mother unavailable, with informed consent

• Donor milk: Only through established human milk banks with screening

2. For Non-Breastfed Infants:

• Priority: Relactation support (helping mother restart breastfeeding)

• If artificial feeding necessary: Ready-to-use infant formula (RTIF) preferred

• Never distribute infant formula without: Assessment, instruction, monitoring

• Minimum package: Cup/utensils, fuel, clean water, hygiene items, feeding instruction

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3. For Young Children (6-24 months):

• Continue breastfeeding alongside complementary foods

• Complementary foods: Age-appropriate, culturally acceptable, nutrient-dense

• Micronutrient supplementation: As needed (vitamin A, iron, zinc)

• Feeding during illness: Continue feeding, increase fluids

Code of Marketing Violations to Monitor:

• Donations of breastmilk substitutes, bottles, teats

• Promotional materials targeting caregivers

• Health workers receiving incentives from formula companies

Key Infrastructure Needed:

• Baby-Friendly Spaces: Private, safe areas for feeding and counseling

• Trained personnel: At least one IYCF-E counselor per 1,000 population

• Monitoring systems: For breastfeeding rates, formula use, malnutrition

C. PAGASA RAINFALL WARNING SYSTEM (PHILIPPINES)

Color-Coded Warning System:

Yellow Warning (Heavy Rain)

• Rainfall: 7.5-15 mm per hour, expected to continue

• Impact: Possible flooding in low-lying areas

• Advisory: Monitor weather, prepare for possible evacuation

• Actions: Secure outdoor items, check drainage

Orange Warning (Intense Rain)

• Rainfall: 15-30 mm per hour, expected to continue

• Impact: Flooding is threatening

• Advisory: Prepare for evacuation

• Actions: Move to higher ground, monitor evacuation advisories

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Red Warning (Torrential Rain)

• Rainfall: >30 mm per hour, expected to continue

• Impact: Serious flooding expected

• Advisory: Evacuate immediately

• Actions: Evacuate to designated centers, avoid travel

Specialized Warnings:

Thunderstorm Warning:

• Issued when thunderstorms affecting specific areas

• Duration: Usually 1-2 hours

• Associated hazards: Lightning, gusty winds, possible tornadoes

Gale Warning:

• Strong winds associated with tropical cyclones or monsoon

• Sea travel risky for small vessels

Communication Channels:

1. PAGASA website and social media

2. Radio and television broadcasts

3. Local government unit (LGU) warning systems

4. Text alerts (in coordination with telcos)

D. Flood and Earthquake Warning Systems

1. Flood Warning Systems:

Types of Flood Warnings:

• Flash Flood Warnings: Sudden, violent floods within 6 hours

• River Flood Warnings: River overflow expected within 12-48 hours

• Urban Flood Warnings: Inundation in populated areas

• Coastal Flood Warnings: Storm surge or high tide flooding

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Philippine Flood Early Warning System Components:

• Monitoring: River gauges, rain gauges, weather radar

• Forecasting: Hydrological models, rainfall-runoff analysis

• Warning Dissemination: LGU networks, community volunteers, media

• Community Response: Evacuation plans, drills, safe zones

Community-Based Early Warning Indicators:

• Environmental cues: Cloud patterns, animal behavior, water color/odor

• River monitoring: Stick gauges painted with alert levels

• Rainfall measurement: Community rain gauges with agreed thresholds

2. Earthquake Warning Systems:

Types of Earthquake Information:

• Earthquake Information: Magnitude, location, depth (issued after quake)

• Tsunami Alert: Based on earthquake parameters and sea level monitoring

• Early Earthquake Warning: Seconds to minutes warning before shaking arrives

PHILIPPINE EARTHQUAKE AND TSUNAMI ALERT LEVELS:

Earthquake Intensity Scale (PEIS):

• I-X scale describing felt effects and damage

• Used for rapid damage assessment

Tsunami Alert System (PHIVOLCS):

• Tsunami Information: No destructive tsunami threat

• Tsunami Advisory: Minor sea level changes possible

• Tsunami Watch: Potential threat, stay alert for updates

• Tsunami Warning: Destructive waves expected, evacuate immediately

Drop, Cover, and Hold On Protocol:

1. DROP to the ground

2. COVER under sturdy furniture, protect head and neck

3. HOLD ON until shaking stops

4. AFTER: Check for injuries, exit if unsafe, prepare for aftershocks

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Integrated Warning Communication Flow:

National Agencies (PAGASA/PHIVOLCS)

Regional/Provincial Disaster Offices

City/Municipal DRRMO

Barangay Disaster Brigades

Community/Household Level

Public Health Priorities in Early Warning Response:

1. Pre-positioning: Emergency supplies in strategic locations

2. Vulnerable population registry: For prioritized evacuation assistance

3. Health facility preparedness: Emergency power, water supply, staff deployment

4. Disease surveillance: Early detection of outbreaks post-disaster

5. Water, sanitation, hygiene: Immediate provision to prevent disease

III. Public Health Nurse's Role Across Disaster Phases

Pre-Disaster (Preparedness):

• Community risk assessment and mapping

• Vulnerability analysis of special populations

• Health education on disaster preparedness

• Stockpiling of emergency health supplies

• Training of community health volunteers

• Participation in simulation exercises

During Disaster (Response):

• Triage and emergency medical care

• Management of evacuation centers

• Disease surveillance and outbreak investigation

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 • Mental health first aid and psychosocial support

• Nutrition assessment and feeding program implementation

• Environmental health monitoring

Post-Disaster (Recovery):

• Continuity of care for chronic conditions

• Rehabilitation services coordination

• Psychosocial support programs

• Health system recovery assessment

• Lessons learned documentation

• Community resilience building

IV. Key Resources and References

1. WHO Emergency Response Framework

2. SPHERE Humanitarian Charter and Minimum Standards

3. IASC Guidelines on Mental Health and Psychosocial Support

4. Operational Guidance on Infant and Young Child Feeding in Emergencies

5. Philippine DRRM Act of 2010 (RA 10121)

6. PAGASA and PHIVOLCS Official Websites and Apps

7. Department of Health National Disaster Risk Reduction and Management in Health

Manual

Prepared by: EDWIN R. ABU, RN, MN, LPT

NCM 121 INSTRUCTOR

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