NCM 121: Disaster Nursing & o Geological: Earthquakes,
tsunamis, volcanic eruptions,
Emergency Preparedness
landslides.
o Biological: Epidemics, pest
I. Basic Concepts and Definitions
infections.
Disaster: A serious disruption of the
2. Man-Made (Technological /
functioning of a community causing
Human-Induced) Disasters:
widespread human, material,
o Caused by human error,
economic, or environmental losses
negligence, or malfunction of
which exceeds the ability of the
technological structures.
affected community to cope using its
o Examples: Industrial pollution,
own resources. (Formula: Disaster =
nuclear accidents, oil spills,
Hazard + Vulnerability)
transport accidents,
Emergency: A state in which normal
deforestation, structural
procedures are suspended, and extra-
collapses, wars/civil strife.
ordinary measures are taken to avert a
III. The Disaster Management Cycle
disaster.
Disaster management aims to reduce
Hazard: A dangerous condition or
potential losses, assure prompt assistance,
event that threatens or has the
and achieve rapid recovery.
potential for causing injury to life or
1. Mitigation (Prevention): Minimizing
damage to property/environment.
the effects of disaster before it strikes.
Vulnerability: The extent to which a
(Examples: building codes, zoning,
community, structure, or geographic
vulnerability analyses, public
area is likely to be damaged.
education).
Predisposition to suffer damage (can
2. Preparedness: Planning how to
be physical or socio-economic).
respond. (Examples: disaster plans,
Capacity: Resources, means, and
emergency exercises/drills, early
strengths in communities that enable
warning systems).
them to cope with, withstand, prepare
3. Response: Efforts to minimize the
for, prevent, mitigate, or recover from
hazards created by a disaster
a disaster.
immediately after it occurs.
Risk: Probability of harmful
(Examples: search and rescue,
consequences or expected losses
emergency relief, triage).
resulting from interactions between
4. Recovery (Rehabilitation &
hazards and vulnerable conditions.
Reconstruction): Returning the
DISASTER Acronym:
community to normal. (Examples:
D - Destructions
temporary housing, medical care,
I - Incidents
grants, rebuilding).
S - Sufferings
IV. OVERVIEW OF DISASTER NURSING
A - Administrative, Financial Failures
(Detailed Concept)
S - Sentiments
Definition: Disaster nursing is the
T - Tragedies
systematic adaptation of professional nursing
E - Eruption of Communicable diseases
knowledge, skills, and attitudes to recognize
R - Research programme and its
and meet the health, emotional, and survival
implementation
needs of disaster-affected populations. It
II. Types of Disasters
requires shifting from the traditional "patient-
1. Natural Disasters: Caused by
centered" standard of care to a "population-
natural phenomena.
centered" standard of care (doing the
o Hydro-meteorological: Cyclones,
greatest good for the greatest number of
typhoons, floods, droughts,
people with limited resources).
storm surges.
Core Paradigms & Ethical Shifts:
Utilitarian Framework: In normal Education & Training: Teaching
nursing, maximum resources are used basic first aid, CPR, and emergency
to save one critically ill patient. In a preparedness to the community.
disaster (Mass Casualty Incident), Facilitating disaster drills (earthquake,
resources are allocated to save the fire, mass casualty) within healthcare
maximum number of people. Some facilities.
patients who would normally receive Personal & Family Preparedness:
intensive care may be classified as A nurse cannot effectively respond if
"expectant" (black tag) if their injuries their own family is in danger. Creating
require too many resources and their personal "go-bags" and family
survival chances are low. communication plans is a professional
Adaptability & Resourcefulness: duty.
Nurses must operate in austere Stockpiling: Ensuring adequate
environments (no electricity, limited ward/hospital supplies of emergency
water, lack of sterile supplies). medications, IV fluids, and triage tags.
Improvisation (e.g., using alternative 2. During Disaster (Response / Impact
materials for splints or bandages) Phase)
without compromising basic patient Triage (e.g., START Method -
safety is a critical skill. Simple Triage and Rapid
Vulnerable Populations: Disaster Treatment): Rapidly categorizing
nursing places heavy emphasis on patients based on respiration,
identifying and protecting those at perfusion, and mental status
highest risk: the elderly, pediatric (Red=Immediate, Yellow=Delayed,
populations, pregnant women, the Green=Minor,
disabled, and those with chronic Black=Expectant/Deceased).
illnesses who lose access to their daily Direct Clinical Care: Managing
medications. trauma (hemorrhage control, airway
Major Goals: management, splinting), administering
1. Prevent or mitigate the loss of life and medications, and providing life-saving
property. interventions in chaotic environments.
2. Meet basic survival needs (water, Infection Control: Maintaining strict
sanitation, food, shelter). sanitation protocols to prevent
3. Prevent secondary complications (e.g., secondary outbreaks in cramped
outbreaks of waterborne diseases like evacuation centers or overwhelmed
Cholera or Leptospirosis after floods). hospitals.
4. Provide Psychological First Aid (PFA) Psychological First Aid (PFA):
and promote community resilience. Providing immediate emotional
V. ROLE OF NURSES IN DISASTERS (By support to victims experiencing acute
Phase) stress reactions. Listening, comforting,
A nurse's role is not limited to treating and connecting them to information
trauma in the emergency room; it spans the and family.
entire disaster management cycle. Coordination & Leadership: Acting
1. Pre-Disaster (Preparedness & as a liaison within the Incident
Mitigation) Command System (ICS). Directing
Community Risk Assessment: volunteers, allocating staff, and
Identifying local hazards (e.g., fault communicating with other emergency
lines, flood-prone areas) and responders.
vulnerable demographics. 3. Post-Disaster (Recovery &
Policy and Planning: Participating in Rehabilitation)
the development of hospital disaster Epidemiological Surveillance:
plans and community evacuation Monitoring evacuation centers for
protocols. signs of communicable disease
outbreaks (e.g., diarrhea, measles, alternate care sites (tents,
respiratory infections). gymnasiums), requiring
Long-Term Care Management: Re- extreme adaptability in
establishing care for patients with maintaining sterile techniques.
chronic diseases (diabetes, o Psychosocial Toll: The
hypertension) whose treatments were constant threat of aftershocks
interrupted. causes extreme psychological
Psychosocial Support: Identifying distress for both patients and
signs of Post-Traumatic Stress Disorder healthcare workers,
(PTSD), depression, or severe anxiety emphasizing the critical need
in survivors and referring them for for continuous Psychological
psychiatric care. First Aid.
Debriefing & Evaluation: B. The Pandemic (Biological Hazard)
Participating in post-incident reviews Context: A global, prolonged
(After Action Reports) to evaluate the biological disaster challenging
effectiveness of the disaster response healthcare systems on an
and identify areas for improvement in unprecedented scale.
future plans. Nursing Implications &
Community Rebuilding: Advocating Reflections:
for safer health infrastructures and o Chronic vs. Acute Disaster:
better public health policies. Unlike an earthquake which is a
VI. REFLECTION ON RECENT PHILIPPINE sudden impact, the pandemic
& GLOBAL EVENTS was a prolonged disaster. This
Applying disaster nursing concepts to recent highlighted the issue of nurse
real-world scenarios highlights the dynamic burnout, moral injury, and
and evolving nature of the profession. fatigue. Resilience and self-
A. 2025 Mindanao & Cebu Earthquakes care became paramount nursing
(Geological Hazards) concepts.
Context: Massive seismic events o Infection Control as Primary
causing infrastructure collapse, power Defense: Proper donning and
outages, and immediate mass doffing of PPE, quarantine
casualties. protocols, and isolation nursing
Nursing Implications & became the core focus.
Reflections: o Crisis Standards of Care:
o Surge Capacity & MCI: Nurses faced severe ethical
Hospitals were immediately dilemmas regarding the
overwhelmed. Nurses had to allocation of scarce resources
rapidly activate surge capacity (e.g., ventilators, ICU beds),
plans, moving non-critical reinforcing the shift from
patients out to make room for individual-centered to
acute trauma cases. population-centered care.
o Crush Syndrome: Nurses had o Telehealth & Innovation: The
to be highly vigilant for crush disaster forced a rapid
injuries and compartment adaptation to remote nursing
syndrome, requiring aggressive care, telephone triage, and
IV fluid resuscitation to prevent digital health monitoring to
acute kidney injury from minimize exposure.
rhabdomyolysis. C. Regional Conflicts (Human-Induced /
o Field Hospitals & Austere Complex Emergencies)
Care: With structural damage Context: Geopolitical tensions, armed
to primary hospitals, nurses had conflict, and internal displacements
to set up and operate in
(e.g., resulting in Internally Displaced rainfall. Definite threat of
Persons - IDPs). flooding. Action: Prepare for
Nursing Implications & possible evacuation.
Reflections: o 🔴 Red (Flood Level 3 -
o Vulnerability in Evacuation Evacuation): >30 mm/hr
Centers: IDPs fleeing conflict rainfall. Serious flooding
often live in cramped, expected. Action: Immediate
unsanitary conditions. Nurses evacuation advised; emergency
play a crucial role in preventing measures activated.
communicable diseases (WASH - Other Relevant Laws:
Water, Sanitation, and Hygiene o RA 10821: Children’s
protocols) and addressing Emergency Relief and Protection
severe malnutrition. Act
o Trauma Care: Responding to o RA 8749: Philippine Clean Air
blast injuries, gunshot wounds, Act
and complex trauma specific to o RA 9003: Ecological Solid Waste
warfare. Management Act
o Medical Neutrality & Ethics: VIII. Incident Command System (ICS)
Operating under international Definition: A standardized, on-scene,
humanitarian law (Geneva all-risk incident management concept.
Conventions). Nurses must treat It is highly flexible, allowing personnel
all wounded individuals from multiple agencies to meld into a
impartially, regardless of their common management structure.
political or military affiliations, Span of Control: Pertains to the
often while working in highly number of individuals one supervisor
insecure environments. can manage effectively. The ideal ratio
o Generational Trauma: is 1 supervisor to 5 reporting
Recognizing that conflict causes elements (acceptable range is 3 to
deep, long-lasting psychological 7).
wounds. Mental health nursing 5 Major Management Functions:
becomes a primary focus in the 1. Command: Sets incident
recovery phase for conflict- objectives/priorities and has
affected populations. overall responsibility.
VII. Philippine Context & Legal 2. Operations: Conducts tactical
Framework operations to carry out the plan.
RA 10121 (Philippine Disaster Risk Directs all tactical resources.
Reduction and Management Act of 3. Planning: Prepares the Incident
2010): Shifts the country's focus from Action Plan, collects/evaluates
reactive disaster response to proactive information, and maintains
disaster risk reduction. It mainstreams resource status.
climate change and disaster risk 4. Logistics: Provides support,
reduction into local development resources, and services needed
plans. to meet objectives (food, fuel,
Local Flood Early Warning System lodging).
(LFEWS): 5. Finance/Administration:
o 🟡 Yellow (Flood Level 1 - Monitors costs related to the
Standby): 7.5 - 15 mm/hr incident, procurement, and time
rainfall. Possible flooding in low- recording.
lying areas. Action: Be alert and IX. Hospital and Emergency
monitor updates. Preparedness
o 🟠 Orange (Flood Level 2 - Hazard Vulnerability Analysis
Preparation): 15 - 30 mm/hr (HVA): Identifying potential
emergencies that could affect the I - Incidents
facility. S - Sufferings
Surge Capacity: The ability to rapidly A - Administrative, Financial Failures
expand operations to manage a S - Sentiments
sudden, massive influx of patients. T - Tragedies
Triage: The process of sorting E - Eruption of Communicable diseases
patients based on the severity of their R - Research programme and its
injuries to prioritize treatment and implementation
transport, ensuring doing the greatest II. Types of Disasters
good for the greatest number. 1. Natural Disasters: Caused by
Alternate Care Sites: Designated natural phenomena.
areas used when the main hospital is o Hydro-meteorological: Cyclones,
overwhelmed or compromised. typhoons, floods, droughts,
🚨 Comprehensive Reviewer: Disaster storm surges.
Nursing & Emergency Preparedness o Geological: Earthquakes,
This reviewer is synthesized from your tsunamis, volcanic eruptions,
course materials, covering disaster concepts, landslides.
nursing roles, Philippine laws, and o Biological: Epidemics, pest
management systems. infections.
I. Basic Concepts and Definitions 2. Man-Made (Technological /
Disaster: A serious disruption of the Human-Induced) Disasters:
functioning of a community causing o Caused by human error,
widespread human, material, negligence, or malfunction of
economic, or environmental losses technological structures.
which exceeds the ability of the o Examples: Industrial pollution,
affected community to cope using its nuclear accidents, oil spills,
own resources. (Formula: Disaster = transport accidents,
Hazard + Vulnerability) deforestation, structural
Emergency: A state in which normal collapses, wars/civil strife.
procedures are suspended and extra- III. The Disaster Management Cycle
ordinary measures are taken to avert a Disaster management aims to reduce
disaster. potential losses, assure prompt assistance,
Hazard: A dangerous condition or and achieve rapid recovery.
event that threatens or has the 1. Mitigation (Prevention): Minimizing
potential for causing injury to life or the effects of disaster before it strikes.
damage to property/environment. (Examples: building codes, zoning,
Vulnerability: The extent to which a vulnerability analyses, public
community, structure, or geographic education).
area is likely to be damaged. 2. Preparedness: Planning how to
Predisposition to suffer damage (can respond. (Examples: disaster plans,
be physical or socio-economic). emergency exercises/drills, early
Capacity: Resources, means, and warning systems).
strengths in communities that enable 3. Response: Efforts to minimize the
them to cope with, withstand, prepare hazards created by a disaster
for, prevent, mitigate, or recover from immediately after it occurs.
a disaster. (Examples: search and rescue,
Risk: Probability of harmful emergency relief, triage).
consequences or expected losses 4. Recovery (Rehabilitation &
resulting from interactions between Reconstruction): Returning the
hazards and vulnerable conditions. community to normal. (Examples:
DISASTER Acronym: temporary housing, medical care,
D - Destructions grants, rebuilding).
IV. OVERVIEW OF DISASTER NURSING A nurse's role is not limited to treating
(Detailed Concept) trauma in the emergency room; it spans the
Definition: Disaster nursing is the entire disaster management cycle.
systematic adaptation of professional nursing 1. Pre-Disaster (Preparedness &
knowledge, skills, and attitudes to recognize Mitigation)
and meet the health, emotional, and survival Community Risk Assessment:
needs of disaster-affected populations. It Identifying local hazards (e.g., fault
requires shifting from the traditional "patient- lines, flood-prone areas) and
centered" standard of care to a "population- vulnerable demographics.
centered" standard of care (doing the Policy and Planning: Participating in
greatest good for the greatest number of the development of hospital disaster
people with limited resources). plans and community evacuation
Core Paradigms & Ethical Shifts: protocols.
Utilitarian Framework: In normal Education & Training: Teaching
nursing, maximum resources are used basic first aid, CPR, and emergency
to save one critically ill patient. In a preparedness to the community.
disaster (Mass Casualty Incident), Facilitating disaster drills (earthquake,
resources are allocated to save the fire, mass casualty) within healthcare
maximum number of people. Some facilities.
patients who would normally receive Personal & Family Preparedness:
intensive care may be classified as A nurse cannot effectively respond if
"expectant" (black tag) if their injuries their own family is in danger. Creating
require too many resources and their personal "go-bags" and family
survival chances are low. communication plans is a professional
Adaptability & Resourcefulness: duty.
Nurses must operate in austere Stockpiling: Ensuring adequate
environments (no electricity, limited ward/hospital supplies of emergency
water, lack of sterile supplies). medications, IV fluids, and triage tags.
Improvisation (e.g., using alternative 2. During Disaster (Response / Impact
materials for splints or bandages) Phase)
without compromising basic patient Triage (e.g., START Method -
safety is a critical skill. Simple Triage and Rapid
Vulnerable Populations: Disaster Treatment): Rapidly categorizing
nursing places heavy emphasis on patients based on respiration,
identifying and protecting those at perfusion, and mental status
highest risk: the elderly, pediatric (Red=Immediate, Yellow=Delayed,
populations, pregnant women, the Green=Minor,
disabled, and those with chronic Black=Expectant/Deceased).
illnesses who lose access to their daily Direct Clinical Care: Managing
medications. trauma (hemorrhage control, airway
Major Goals: management, splinting), administering
1. Prevent or mitigate the loss of life and medications, and providing life-saving
property. interventions in chaotic environments.
2. Meet basic survival needs (water, Infection Control: Maintaining strict
sanitation, food, shelter). sanitation protocols to prevent
3. Prevent secondary complications (e.g., secondary outbreaks in cramped
outbreaks of waterborne diseases like evacuation centers or overwhelmed
Cholera or Leptospirosis after floods). hospitals.
4. Provide Psychological First Aid (PFA) Psychological First Aid (PFA):
and promote community resilience. Providing immediate emotional
V. ROLE OF NURSES IN DISASTERS (By support to victims experiencing acute
Phase) stress reactions. Listening, comforting,
and connecting them to information patients out to make room for
and family. acute trauma cases.
Coordination & Leadership: Acting o Crush Syndrome: Nurses had
as a liaison within the Incident to be highly vigilant for crush
Command System (ICS). Directing injuries and compartment
volunteers, allocating staff, and syndrome, requiring aggressive
communicating with other emergency IV fluid resuscitation to prevent
responders. acute kidney injury from
3. Post-Disaster (Recovery & rhabdomyolysis.
Rehabilitation) o Field Hospitals & Austere
Epidemiological Surveillance: Care: With structural damage
Monitoring evacuation centers for to primary hospitals, nurses had
signs of communicable disease to set up and operate in
outbreaks (e.g., diarrhea, measles, alternate care sites (tents,
respiratory infections). gymnasiums), requiring
Long-Term Care Management: Re- extreme adaptability in
establishing care for patients with maintaining sterile techniques.
chronic diseases (diabetes, o Psychosocial Toll: The
hypertension) whose treatments were constant threat of aftershocks
interrupted. causes extreme psychological
Psychosocial Support: Identifying distress for both patients and
signs of Post-Traumatic Stress Disorder healthcare workers,
(PTSD), depression, or severe anxiety emphasizing the critical need
in survivors and referring them for for continuous Psychological
psychiatric care. First Aid.
Debriefing & Evaluation: B. The Pandemic (Biological Hazard)
Participating in post-incident reviews Context: A global, prolonged
(After Action Reports) to evaluate the biological disaster challenging
effectiveness of the disaster response healthcare systems on an
and identify areas for improvement in unprecedented scale.
future plans. Nursing Implications &
Community Rebuilding: Advocating Reflections:
for safer health infrastructures and o Chronic vs. Acute Disaster:
better public health policies. Unlike an earthquake which is a
VI. REFLECTION ON RECENT PHILIPPINE sudden impact, the pandemic
& GLOBAL EVENTS was a prolonged disaster. This
Applying disaster nursing concepts to recent highlighted the issue of nurse
real-world scenarios highlights the dynamic burnout, moral injury, and
and evolving nature of the profession. fatigue. Resilience and self-
A. 2025 Mindanao & Cebu Earthquakes care became paramount nursing
(Geological Hazards) concepts.
Context: Massive seismic events o Infection Control as Primary
causing infrastructure collapse, power Defense: Proper donning and
outages, and immediate mass doffing of PPE, quarantine
casualties. protocols, and isolation nursing
Nursing Implications & became the core focus.
Reflections: o Crisis Standards of Care:
o Surge Capacity & MCI: Nurses faced severe ethical
Hospitals were immediately dilemmas regarding the
overwhelmed. Nurses had to allocation of scarce resources
rapidly activate surge capacity (e.g., ventilators, ICU beds),
plans, moving non-critical reinforcing the shift from
individual-centered to climate change and disaster risk
population-centered care. reduction into local development
o Telehealth & Innovation: The plans.
disaster forced a rapid Local Flood Early Warning System
adaptation to remote nursing (LFEWS):
care, telephone triage, and o 🟡 Yellow (Flood Level 1 -
digital health monitoring to Standby): 7.5 - 15 mm/hr
minimize exposure. rainfall. Possible flooding in low-
C. Regional Conflicts (Human-Induced / lying areas. Action: Be alert and
Complex Emergencies) monitor updates.
Context: Geopolitical tensions, armed o 🟠 Orange (Flood Level 2 -
conflict, and internal displacements Preparation): 15 - 30 mm/hr
(e.g., resulting in Internally Displaced rainfall. Definite threat of
Persons - IDPs). flooding. Action: Prepare for
Nursing Implications & possible evacuation.
Reflections: o 🔴 Red (Flood Level 3 -
o Vulnerability in Evacuation Evacuation): >30 mm/hr
Centers: IDPs fleeing conflict rainfall. Serious flooding
often live in cramped, expected. Action: Immediate
unsanitary conditions. Nurses evacuation advised; emergency
play a crucial role in preventing measures activated.
communicable diseases (WASH - Other Relevant Laws:
Water, Sanitation, and Hygiene o RA 10821: Children’s
protocols) and addressing Emergency Relief and Protection
severe malnutrition. Act
o Trauma Care: Responding to o RA 8749: Philippine Clean Air
blast injuries, gunshot wounds, Act
and complex trauma specific to o RA 9003: Ecological Solid Waste
warfare. Management Act
o Medical Neutrality & Ethics: VIII. Incident Command System (ICS)
Operating under international Definition: A standardized, on-scene,
humanitarian law (Geneva all-risk incident management concept.
Conventions). Nurses must treat It is highly flexible, allowing personnel
all wounded individuals from multiple agencies to meld into a
impartially, regardless of their common management structure.
political or military affiliations, Span of Control: Pertains to the
often while working in highly number of individuals one supervisor
insecure environments. can manage effectively. The ideal ratio
o Generational Trauma: is 1 supervisor to 5 reporting
Recognizing that conflict causes elements (acceptable range is 3 to
deep, long-lasting psychological 7).
wounds. Mental health nursing
becomes a primary focus in the 5 Major Management Functions:
recovery phase for conflict- 1. Command: Sets incident
affected populations. objectives/priorities and has
VII. Philippine Context & Legal overall responsibility.
Framework 2. Operations: Conducts tactical
RA 10121 (Philippine Disaster Risk operations to carry out the plan.
Reduction and Management Act of Directs all tactical resources.
2010): Shifts the country's focus from 3. Planning: Prepares the Incident
reactive disaster response to proactive Action Plan, collects/evaluates
disaster risk reduction. It mainstreams
information, and maintains
resource status.
4. Logistics: Provides support,
resources, and services needed
to meet objectives (food, fuel,
lodging).
5. Finance/Administration:
Monitors costs related to the
incident, procurement, and time
recording.
IX. Hospital and Emergency
Preparedness
Hazard Vulnerability Analysis
(HVA): Identifying potential
emergencies that could affect the
facility.
Surge Capacity: The ability to rapidly
expand operations to manage a
sudden, massive influx of patients.
Triage: The process of sorting
patients based on the severity of their
injuries to prioritize treatment and
transport, ensuring doing the greatest
good for the greatest number.
Alternate Care Sites: Designated
areas used when the main hospital is
overwhelmed or compromised.