DISASTER MANAGEMENT: A BRIEF The Philippine Archipelago occupies the

OVERVIEW western rim of the Pacific Ocean (Western

Segment of the Pacific Ring of Fire), a
PHILIPPINE SITUATION & GLOBAL most active part of the earth that is
TRENDS characterized by an ocean-encircling belt
of active volcanoes and earthquake
FACT generators (fault lines).
• The Philippines is listed among the most
disaster prone countries in the world. HAZARDS IN THE PHILIPPINES

TOP 10 NATURAL DISASTERS: What is a HAZARD?

NUMBER KILLED ●​ A phenomenon that poses threat to
the people, structure or economic
assets and which may cause a
Disaster Date Number
Type Killed disaster. It could be natural or
human-made.
Earthquake: 16-Aug-1976 6,000 ●​ Is a dangerous phenomenon,
Moro Gulf, substance , human activity, or
caused condition that may cause loss of
tsunami
life, injury or other health impacts,
Wind Storm : 5-Nov-1991 5,956 property damages, loss of
TS Uring livelihood, and services, social and
economic disruption or
Earthquake : 16-Jul-1990 2,412 environmental damages.
Baguio
●​ Could be a potentially damaging
Wind Storm : 29-Nov-2004 1,619 phenomenon.
T Unding, ●​ It could be natural or man made.
TD Violeta,
TD Winnie,
ST Yoyong

Wind Storm : 13-Oct-1970 1,551

ST Sening

Wind Storm : 1-Sep-1984 1,399

T Nitang EXPOSURE
●​ The degree to which the elements
Wind Storm : 30-Nov-2006 1,399
T Reming at risk are likely to experience
hazard events of different
Volcanic 31-Jan-1911 1,335 magnitude.
Eruption :
Taal VULNERABILITY
Slides : Bgy 17-Feb-2006 1,126 ●​ Is the characteristics and
Guinsaugon, circumstances of a community,
S Leyte system or asset that make it
susceptible to the damaging
Wind Storm : 3-Nov-1984 1,079 effects of a hazard.
T Undang
Vulnerability has been related to the ●​ Cyclones in other areas of the
following factors: world.
●​ They can be classified into the
Social Integration same meteorological phenomenon
●​ Ethnicity in the sense that all have the same
●​ Age type of structure as a tropical
●​ Gender cyclone.
●​ Location
●​ Status
CATEGORY SUSTAINED
●​ Wealth WINDS
●​ Income
●​ Education Super typhoon ≥185 km/h ≥100
●​ Family type (STY) knots

Typhoon (TY) 118–184 km/h

Psychological and Physiological 64–99 knots
●​ Disability
●​ Coping Style Severe tropical 89–117 km/h
●​ Individual's perception storm (STS) 48–63 knots
●​ Lifestyle
Tropical storm 62–88 km/h 34–47
●​ Agility (TS) knots
●​ Mobility
●​ Experience Tropical ≤61 km/h
Depression ≤33 knots
CAPACITY
●​ Is the combination of all strengths TSUNAMI
and resources available within the ●​ A tsunami is a series of ocean
community, society or organization waves that sends surges of water,
that can reduce the level of risk or sometimes reaching heights of
effects of a disaster. over 100 feet (30.5 meters), onto
RISK land. These walls of water can
●​ Is the combination of Probability of cause widespread destruction
an event to happen and its when they crash ashore.
negative consequences.
●​ R = HAZARD x VULNERABILITY What causes a Tsunami?
●​ These awe-inspiring waves are
CAPACITY typically caused by large, undersea
earthquakes at tectonic plate
NATURAL HAZARDS boundaries. When the ocean floor
at a plate boundary rises or falls
TYPHOON suddenly, it displaces the water
●​ Typhoons, or tropical cyclones, above it and launches the rolling
have various names depending on waves that will become a tsunami.
their birth places in the world. ●​ Most tsunamis–about 80
●​ Typhoons are called in the western percent–happen within the Pacific
north Pacific and Asia (Japan). Ocean’s “Ring of Fire,” a
●​ Hurricanes in north and central geologically active area where
America.
 tectonic shifts make volcanoes and LANDSLIDES
earthquakes common. ●​ A landslide is the mass movement
of rock, soil, and debris down a
EARTHQUAKE slope due to gravity. It occurs when
●​ Earthquake, any sudden shaking the driving force is greater than the
of the ground caused by the resisting force. It is a natural
passage of seismic waves through process that occurs in steep
Earth’s rocks. Seismic waves are slopes. The movement may range
produced when some form of from very slow to rapid. It can
energy stored in Earth’s crust is affect areas both near and far from
suddenly released, usually when the source.
masses of rock straining against Landslide materials may include:
one another suddenly fracture and ●​ Soil
“slip.” ●​ Debris
●​ Rock
VOLCANIC ERUPTION ●​ Garbage
●​ Volcanic eruption, an eruption of
molten rock, hot rock fragments, CLIMATIC VARIABILITIES
and hot gases through a volcano, ●​ La Niña
which is a vent in a planet’s or ●​ La Niña
satellite’s crust. Volcanic eruptions
can cause disastrous loss of life MAN-MADE HAZARDS
and property. ●​ Fire
●​ Volcanic eruptions have captured ●​ Pollution (Solid waste, Air, Water,
the imagination of people over and Thermal)
millennia, and they feature in ●​ Industrial (Radioactive Fallout, Gas
several mythologies as well as Leaks)
works of fiction. These eruptions ●​ Sea and Air accidents
also play a role in climate change, ●​ Terrorist-Initiated incidents
with expelled gases such as ●​ Civil Strife
carbon dioxide contributing to
global warming, while ash, dust, NATURE OF DISASTERS
and gases such as sulfur dioxide
can drive global temperatures What is a DISASTER?
down. ●​ Natural or man-made events
wherein communities experience
severe danger and incur loss of
lives and properties causing
disruption in its social structure and
prevention of the fulfillment of all or
some of the affected community’s
essential functions.
●​ Serious disruption of the
functioning of a community/society.
●​ Exceeds ability to cope using own
resources.
Why are Disaster Impacts increasing? ●​ Located along the typhoon belt in
●​ Increased in population the Pacific making it vulnerable to
●​ Climate change typhoons and tsunamis.
●​ Increased vulnerability ●​ Average of 20 typhoons yearly (7
●​ Demographic changes are destructive).
●​ Increased concentration of assets
●​ Environmental degradation MITIGATION
●​ Poverty ●​ Refers to the measures aimed at
●​ Rapid urbanization and unplanned minimizing the impact of a natural
development or man-made disaster on a nation
or community in terms of
casualties and damages. It also
refers to measures designed to
prevent natural phenomena from
causing or resulting in disasters or
other related emergency situations.
​ Know how safe your house or
school is.
​ School ordinance on safety of
students.
​ Know if you are insured, just in
EFFECTS OF DISASTER case.
●​ Loss of life
●​ Damage to and Destruction of SEISMIC
Property and Crops The Philippines, given its location
●​ Disruption of Production and on the earth, is prone to various types of
Essential Services Natural Disasters.
●​ Disruption of Lifestyle
●​ Loss of Livelihood, Jobs Fact:
●​ Damage to Infrastructure The Philippine Archipelago has a
●​ Disruption of Normal Government complex tectonic setting with several
●​ Economic Loss trenches and many active faults.
●​ Sociological and Psychological
After-effects Historical Seismicity
●​ Diversion of Funds from The PHIVOLCS earthquake and
Development and Subsistence catalogue seismicity maps shows so far,
Affecting Satisfactory Recovery seven (7) historically and instrumentally
recorded destructive earthquakes
ATMOSPHERIC (Intensity VII-IX in the adapted Rossi-
●​ The country is considered one of Forel scale) have affected Baguio City for
the most disaster-prone. It ranks the past 356 years (1645-2001). This
12th among 200 countries most roughly translates into a return period of at
at-risk for tropical cyclones, floods, least one destructive earthquake (Intensity
earthquakes, and landslides in the VII to IX) for every 50 years.
2009 Mortality Risk Index of the In addition, there were four very
UN International Strategy for destructive earthquakes during the
Disaster Reduction. 356-year period for a return period of at
least one very destructive earthquake ●​ Do we have an institutionalized
(Intensity VIII to IX) for every 89 years. In warning system?
comparison, regional probabilistic seismic ●​ Are there identified evacuation
hazard calculations by Thenhaus (1994) areas within the premises of the
yielded annual probability rates of Ms: institution?
●​ 6.4 to <7.0 (1 in 23 years)
●​ 7.0 to <7.3 (1 in 62 years) PREPAREDNESS CYCLE
●​ Ms <8.2 (1 in 166 years) 72-Hour Survival Kit
●​ Food
PREPAREDNESS ●​ Clothing
●​ Refers to pre-disaster actions and ●​ Communications
measures being undertaken to ●​ Documents
avert or minimize loss of lives and ●​ Medicines
properties, such as, but not limited ●​ Other Essential Needs
to, community organizing, training, ●​ Emergency Money
planning, equipping, stockpiling,
hazard mapping and public RESPONSE
information and education ●​ Refers to any concerted effort by
initiatives. two or more agencies, public or
​ Have contingency plans. private, to provide emergency
​ Conduct and/or participate in drills. assistance or relief to persons who
​ Inventory of resources. are victims of disasters or
calamities, and in the restoration of
Make a Difference essential public activities and
●​ Changing attitudes facilities.
●​ Knowing hazards ​ Help disseminate warnings/info
●​ Doing something to minimize the using full range of media
hazards. ​ Extend service(s) to those in need
in the community.
CRITICAL CONCERNS ​ Be a volunteer.
●​ Does your institution have an
existing Disaster Response Team / REHABILITATION
Safety Committee? ●​ Refers to the process by which the
-​ If yes, is it functional? affected communities/areas or
●​ Do we conduct emergency / damaged public infrastructures are
disaster drills regularly? restored to their normal level or
●​ Do we have an Emergency their actual condition prior to the
Response Plan? occurrence of the disaster or
●​ Do we have a Preparedness / calamity.
Contingency Plan in the event of ​ Extend assistance to the
any disaster? community as an individual or as a
●​ Are there personnel / employees group.
trained in first aid, fire fighting or ​ Undertake clean-up operations.
rescue?
●​ Does the institution have any
rescue equipment and other DISASTER NURSING
emergency paraphernalia?
What is Disaster? ●​ Earthquakes and events
●​ Is a result of vast ecological associated with high winds tend to
breakdown in the relation between exhibit more injuries than deaths.
humans and their environment, a ●​ The risk of injury and death is
serious or sudden event on such a much higher in developing
scale that the stricken community countries – at least 10 times higher
needs extraordinary efforts to cope because of little preparedness,
with outside help or international poorer infrastructure.
aid.
○​ Nurses are the main health Knowing the patterns of mortality and
professionals in touch with injuries associated with particular
the community. They have disasters can be most beneficial when
exceptional knowledge of providing training. This can result in
the most vulnerable effective preparedness and ensure better
populations, and this outcomes. It is important to bring this to
information can be the attention of nurses in developing
immediately used in a countries especially that their countries
disaster. Nursing are at higher risk for disasters and
recognizes the physical and casualties.
the psychosocial impact of
disasters on the well - Displacement of Disaster Victims
being of individuals, ●​ Mass Shelters
families and communities. ●​ Shelter management:
Nurses deal not only with ●​ Organized team (chain)
the physical stresses of a ●​ Sleeping area and necessities
disaster, but potentially ●​ Water and food handling
more importantly the fear, ●​ Sanitation (toilets, showers,..)
dangers, stress and ●​ Special care to children and elderly
uncertainties of disasters. ●​ Health services (physical, mental)
○​ Nurses in disasters provide
support and help the public Disaster and Health
in regaining confidence in ●​ In a major disaster water treatment
rebuilding their lives and plants, storage & pumping
living through hard times. facilities, & distribution lines could
Understanding and finding be damaged, interrupted or
a meaning to suffering contaminated.
helps in healing and in ●​ Communicable diseases outbreak
reducing impact on physical due to:
health. ❖​ Changes affecting vector
populations (increase
Patterns of Mortality and Injury vector)
●​ Disaster events that involve water ❖​ Flooded sewer systems
are the most significant in terms of ❖​ The destruction of the
mortality health care infrastructure
●​ Floods, storm surges, and ❖​ The interruption of normal
tsunamis all have a higher health services geared
proportion of deaths relative to towards communicable
injuries. diseases
 ❖​ Injuries from the event are, nurses can assist in making
❖​ Environmental exposure links.
after the event (no shelter) ●​ In case of loss, people need to
❖​ Malnutrition after the event mourn:
(feeding the population ○​ Give them space
affected) ○​ Find family friends or local
❖​ Excess NCD mortality healers to encourage and
following a disaster support them
❖​ Mental health (disaster ○​ Most are back to normal
syndrome) within 2 weeks
○​ About1% to 3%, may need
●​ Infection control is an important additional help
strategy in eliminating infectious
diseases (e.g. cholera, etc.). Everyone has a role identity in family and
Nurses receive training in infection community; when they lose everything
control during their undergraduate and are then taken care of with
or as part of continuing education. emergency assistance, they may be
Public education about preventive turned into passive receivers and lose that
strategies in times where water is role identity. We can help them recover
contaminated can be a their sense of purpose and worth along
determinant factor in eliminating with helping them express and process
any epidemic. the losses.

●​ Disaster consequences range ROLE OF NURSING IN DISASTERS

between short and long-term. Disaster preparedness, including
Effective assessment can establish risk assessment and multi-disciplinary
the base for appropriate actions. management strategies at all system
This can serve well in lessening levels, is critical to the delivery of effective
the burden of disaster and responses to the short, medium, and
enhancement of coping. Nursing long-term health needs of a
education acknowledges mental disaster-stricken population. (ICN, 2006)
wellness by itself as an outcome ,
however, it is also looked at as the NURSES’ ROLES IN DISASTERS
key for physical well being. ●​ Determine magnitude of the event
●​ Define health needs of the affected
Mental Wellness groups
●​ Little attention is paid to the ●​ Establish priorities and objectives
children ●​ Identify actual and potential public
●​ Listen attentively to children health problems
without denying their feelings ●​ Determine resources needed to
●​ Give easy-to-understand answers respond to the needs identified
to their questions ●​ Collaborate with other professional
●​ In the shelter, create an disciplines, governmental and
environment in which children can non-governmental agencies
feel safe and secure (e.g. play ●​ Maintain a unified chain of
area) command
●​ In any major disaster, people want ●​ Communication
to know where their loved ones
COMMUNICATION IS A SUCCESS KEY ●​ Ethical and legal issues, and
●​ Nursing organizations must have a decision making;
comprehensive and accurate ●​ Care principles;
registry for all members. ●​ Nursing care;
●​ Have a structured plan. ●​ Needs assessment and planning;
●​ Collaborate and coordinate with ●​ Safety and security;
local authorities. ●​ Communication and interpersonal
●​ Have a hotline 24x7 relationships;
●​ Inform nurses where to report and ●​ Public health; and
how (keep records). ●​ Health care systems and policies
●​ Make sure to have a coordinator to in emergency situations
prevent chaos.
●​ Ensure ways to maintain THE PHASES OF DISASTER
communication between nurses
and their families. Nursing can contribute to prevention,
●​ Nursing organizations have the mitigation, preparedness, response, and
responsibility of coordinating with recovery. Nurses work systematically by
the officials in having a clear gathering data, planning according to
understanding of nurses' roles priorities to target all who might benefit,
during disasters and taking all working skillfully to promote health of the
measures to speed nurses’ community, and evaluating the outcomes.
involvement in crisis times.
●​ Nurses can integrate into an ●​ MITIGATION
existing team or lead one if there is ○​ Lessen the impact of a
not yet one on site. And document disaster before it strikes.
what they do for continuity with ​ Activities that reduce or
each patient, or record where the eliminate a hazard.
injured are sent. ○​ Prevention
○​ Risk reduction
THE NEED FOR DISASTER NURSING EXAMPLES: Immunization programs and
TRAINING Public Education
●​ 11 million nurses world wide
●​ Form the backbone of the health Nurses can save lives and reduce the
care system. public's fear and assist in mitigation
●​ Are the frontline health care measures such as equipped shelters.
workers who are in direct contact Nurses play key roles in disaster
with the public. preparedness. Nurses can help in
●​ Contribute to the health of initiating or updating emergency plans at
individuals, families, communities, their work settings as well as being
and the globe. knowledgeable about the disasters that
●​ Schools of nursing offer little or no their areas are vulnerable to. Nurses can
information on disaster nursing inform the public about the shelters
(WHO, 2008). available in the area and the importance
●​ Shortage of trained of having an emergency family plan
instructors/faculty (WHO, 2008). especially when there are family members
who have special health needs.
CORE COMPETENCIES IN DISASTER
NURSING TRAINING
 ●​ PREPAREDNESS
○​ Activities undertaken to ●​ RECOVERY
handle a disaster when it ○​ Getting a community back
strikes to its pre-disaster status.
○​ o Activities that are taken to ​ Activities undertaken by a
build capacity and identify community and its
resources that may be used components after an
​ Know evacuation shelters emergency or disaster to
​ Emergency communication restore minimum services
plan and move towards
​ Preventive measures to long-term restoration.
prevent spread of disease ●​ Debris Removal
​ Public Education ●​ Care and Shelter
●​ Damage
Nurses play a key role as preventionists in Assessments
assisting in maintenance of proper ●​ Funding Assistance
sanitation measures, proper control of
vector populations, and control of PHILIPPINE DISASTER MANAGEMENT
infectious disease through public SYSTEM
education.
DISASTER MANAGEMENT LAW
●​ RESPONSE ●​ RA 10121 National Disaster Risk
○​ Search and rescue, Reduction Management Council
clearing debris, and feeding
and sheltering victims (and Disaster legislation in the Philippines
responders if necessary). dates back in 1978, primarily reactive
approach to disasters, focusing
​ Activities a hospital,
heavily on preparedness and response.
healthcare system, or
Other relevant legislation for
public health agency take
mainstreaming of disaster risk reduction
immediately before, during,
into development includes land-use
and after a disaster or
controls and building codes. However,
emergency occurs
building codes are not strictly enforced
❖​ Head and chest injuries
and zoning ordinances which are reported
and fractures are common
to have been relaxed over time.
in earthquake victims.
Nurses possess clinical
With the approval of the DRRM (Republic
skills that can save lives
Act No. 10121) expect that there would be
when they assist in
a paradigm shift emphasizing disaster
searching and retrieving
management to a disaster risk
trapped individuals. Also
management approach, with much greater
the injury rate is high for
importance given to reducing risk. The RA
first responders, and
was approved on 27 May 2010, and the
nurses can play a major
Implementing Rules and Regulations was
role in protecting the rescue
crafted by the Task Force RA 10121
teams. In fact all rescue
headed by the OCD.
teams should have at least
one nurse.
Risk Reduction and Management

PD 1566
June 11, 1978

●​ 8th Congress (‘89-’92)

●​ 9th Congress (‘92-’95)
●​ 10th Congress (‘95-’98)
●​ 11th Congress (‘98-2001)
●​ 12th Congress (2001-2004)
●​ 13th Congress (2004-2007)
●​ 14th Congress (2007-2010)

RA No. 10121
May 27, 2010
(21 years in the making;
7 congresses;
4 administrations)

DRRMC Organizational Network

In the following order

●​ Identify, characterize, and assess
threats.
●​ Assess the vulnerability of critical
assets to specific threats.
●​ Determine the risk (i.e. the
expected consequences of specific
types of attacks on specific
assets).
●​ Identify ways to reduce those risks.
●​ Prioritize risk reduction measures THE PHILIPPINE DISASTER RISK
based on a strategy. REDUCTION AND MANAGEMENT
SYSTEM MAY 27, 2010
●​ An Act Strengthening The
Philippine Disaster Risk Reduction
 and Management System, ●​ The state of readiness for
providing for the National Disaster PDRRMC, MDRRMC and
Risk Reduction and Management CDRRMC is greatly determines the
Framework, and Institutionalizing extent to which potential casualties
the Disaster Risk Reduction and and damages can be reduced.
Management Plan, appropriating
funds therefore and for other
purposes (DRRM Act 2010).

DISASTER RISK REDUCTION

●​ The law which transforms the
Philippines’ Disaster Management
System from Disaster Relief and
Response towards Disaster Risk
Reduction.

PARADIGM SHIFT

DISASTER RISK REDUCTION GUIDING

PRINCIPLES

●​ Institutional not personality

oriented.
●​ Permanent solution not temporary
or palliative.
●​ Preemptive evacuation is better
than rescue.

R.A. 10121
The enactment of the Philippine Disaster
Risk Reduction and Management Act of
2010 (also known as Republic Act 10121),
aims to achieve a paradigm shift from
reactive to proactive approach in disaster
risk reduction and management.

●​ One of the main objectives of

Disaster Preparedness it to
“Enhance the community with the
necessary skills to cope with the
negative impacts of a disaster”. MANAGEMENT OF MASS CASUALTY
INCIDENCE
 ●​ Concentrate on salvageable
Mass Casualty Incident patients
●​ The key to effective emergency ●​ Heroic resuscitative efforts are not
care is to call for plenty of help appropriate
early. “It’s better to call too many ○​ Takes too much time
rescuers than too few.” ○​ Require equipment that can
●​ Effective management of MCI be used for salvageable
consists of getting enough help, patients
positioning vehicles properly, 2. Resources Management
giving appropriate emergency ●​ Determine resources early.
medical care, transporting patients ●​ Be prepared for possible delays in
efficiently, and providing follow up resource allocation & response.
care at receiving facilities. ●​ Early notification of medical
facilities is critical.
Mass Casualty Incident (MCI) ●​ Regional lead hospitals make
●​ Multiple Casualty Incident, Multiple necessary arrangements with
Casualty Situation also refers to neighboring hospitals.
Mass Casualty Incident which ●​ Normally the Level I trauma center.
typically involves three or more ●​ Command hospitals coordinate
patients. transportation decisions.
○​ is any event where the
needs of a large number of 3. Don’t Relocate the Disaster
victims disrupt the normal ●​ Field triage and patient
capabilities of the local transportation prioritization at the
health service. scene is important for casualty
distribution.
Basic Mass Casualty Incident (MCI) ●​ Work through the Command
management Hospital to determine medical
●​ Disaster triage is similar to military facilities capabilities.
triage which goal or objective is ●​ Preplan for alternate facilities and
“the greatest good for the greatest their capabilities.
number of injured”

Goal of MCI Management

1. Greatest Good RAPID ASSESSMENT TEAM
●​ Responders practice scarce
resource management. Incident Commander
○​ You do not have enough ●​ The time and extent of the
providers, equipment, damage;
vehicles, or the time to ●​ The potential continuing danger
provide the normal level of from the disaster;
pre-hospital care. ●​ The estimated number of
●​ Available personnel must salvage casualties and exposed victims;
the most patients they can while and
waiting for additional resources. ●​ The resources needed for
response.
 ●​ Receives authority from the RO ○​ Decisions regarding the
●​ Sets incident objectives management of the mass
●​ Leads the tactical incident casualty incident are made
response in collaboration by the
representatives of the EMS,
A security team protects restricted areas the fire service, and law
limiting any further danger from the enforcement.
disaster and to provide crowd control in ○​ Incidents that involve
order to ensure the safety of responders jurisdictions or agencies
and victims. involved in the decision
making and planning
The search and rescue team’s priority is process
to locate and evacuate victims from the ○​ Ensures the plan is
impact zone and transfer them to the communicated and
medical post after assessing their status. supported by all resources
assembled.
A medical post should be established as ○​ Includes determination of
close as possible to the impact zone while objectives.
again maintaining a safe distance. ○​ Selection of strategies
○​ Control of joint operations
The Incident Management System ○​ Maximum use of resources
●​ Hierarchical structure that
commands, controls and ●​ Single Command System
coordinates an effective ○​ This applies when one
emergency response among all the agency is given the
agencies and organizations in a authority to manage all
disaster. emergency response
●​ Designed to organize people and resources.
resources and to allocate ○​ Based on first arriving
necessary services to the emergency units.
population in need. ○​ Initial incident manager
●​ Flexible in scaling-up or begins assessment of
scaling-down the level of response incident.
to meet needs that arise in ○​ Rescue, triage, treatment,
different circumstances without any transport.
loss of compatibility with the other
entities involved. The person in charge
●​ The incident manager/ incident
Advantages of Incident Management commander should be stationed in
System a safe area near or at the area
1.​ Prevents chaos where patients will be loaded for
2.​ Prevents individualism transport.
3.​ Prevents injury and further damage ●​ He should establish the different
4.​ Prevents prolongation of the EMS sectors.
incident
INCIDENT COMMAND SYSTEM
Who is in charge of the IMS? ORGANIZATION
●​ Unified Method
 TRIAGE
●​ Purpose
○​ Technique for assigning
treatment priorities.
The Seven Sectors in the IMS ○​ Separates MCI victims into
1.​ Mobile Command Sector– easily identifiable groups.
considered the headquarters or ○​ Determine required
command post for incident resources for treatment,
management. transportation and definitive
2.​ Supply Sector- responsible for care.
distributing the medical materials ○​ Prioritization of patient
and equipment necessary to distribution and
render care. transportation.
3.​ Extrication Sector- responsible for ●​ Evaluation and categorization of
freeing patients from wreckage and the sick or wounded
managing them at the incident site. ●​ Commonly used in crowded
4.​ Triage Sector- performs a system emergency rooms and walk-in
used for sorting patients to clinics to determine which patients
determine the order in which they should be seen and treated
will receive medical care or immediately.
transportation to definitive care. ●​ Prioritize the use of space or
5.​ Treatment Sector- a sector with a equipment, such as operating
designated area away from the rooms, in a crowded medical
incident where treatment and on facility.
going assessment of patients is ●​ In mass casualty situations, triage
done is used to decide who is most
6.​ Staging Sector- this is where a urgently in need of transportation
staging officer monitors, to a hospital for care (generally,
inventories, and directs those who have a chance of
7.​ available ambulances to the survival but who would die without
treatment sector at the request of immediate treatment) and whose
the transportation sector officer injuries are less severe and must
8.​ Transportation Sector- wait for medical care.
transportation sector officer
ensures that ambulances are START (Simple Triage And Rapid
accessible and does not occur Treatment)
without the direction of the EMS
incident manager. The categories in START are:
●​ The deceased, who are beyond
EMS INCIDENT COMMAND help.
●​ The injured who could be helped
First unit on the scene by immediate transportation.
●​ Initial size up ●​ The injured with less severe
●​ Take command injuries whose transport can be
●​ Request resources delayed.
●​ Assign sectors as needed ●​ Those with minor injuries not
●​ Transfer command higher requiring urgent care.
 Example:
Color-coding Scheme ●​ obstruction/damage to airway
●​ Red tags - (immediate) ●​ breathing disturbance
●​ Yellow tags - (observation) (RR = 30/min or RR<10/min)
●​ Green tags - (wait) ●​ Circulation disturbance
●​ White tags - (dismiss) (HR = 100/ min or weak pulses)
●​ Black tags - (expectant) ●​ Altered level of consciousness
●​ External bleeding with CVS
Triaging collapse
●​ Triaging is done if there are more
victims than health responders. YELLOW TAG
●​ Reverse Triaging is done during 2nd priority: Urgent- needs to be treated
Search and Rescue stage where within 4-6 hours; Transport after Red
the priority is to get as much Cases
people out of danger with the least
effort. Example:
●​ Major burns: involving hands, feet
or face (excluding respiratory
tract); complicated by major soft
tissue trauma
●​ Spinal injuries; long bone or pelvic
fractures
●​ Environmental injuries (heat/cold
exposure)

GREEN TAG
3rd priority: Requires minor treatment or
can be delayed, Transport after Red and
Yellow

COLOR TAGGING Example:

●​ Minor injuries not threatened by
Ideally, the following information ABC instability
should be contained in the patients ●​ Minor fractures
Color Tag: ●​ Minor soft tissue injuries
●​ Patient’s sequence number ●​ Minor burns
●​ Name of patient
●​ Injuries Identified BLACK TAG
●​ Previous interventions given at the Last priority: Expectant- Dead or
scene Non-salvageable given the available
resources; Lowest transport priority.
RED TAG
1st priority: Life-threatening- needs to be Example:
treated within 1-3 hours; Transport ●​ Injuries so severe that survival
Immediately. cannot be expected even under
the most ideal conditions;
 obviously mortal wounds where ●​ Right after triage is done
death is certain. ●​ Basic first aid
●​ Death or moribund state. ●​ Stabilizing the victims
●​ Constantly re-triage to monitor
IDEAL TRIAGE SYSTEM victim’s condition

Should be SIMPLE Transportation

●​ Does not require advanced ●​ Red category are transported to a
assessment skills designated hospital by an
●​ Does not rely on specific diagnosis ambulance.
●​ Should be easy to perform ●​ Patient’s condition are carefully
●​ Should provide for rapid and monitored.
simple life saving interventions ●​ Victims with minor injuries are
●​ Should be easy to teach and learn transferred by non-medical
transport after all acute victims
Triage Ribbon Concept have been evacuated.
●​ Universal colors are used System
depends on advanced assessment COLOR-CODED ALERT SYSTEMS
and specific injuries to classify and Alert Mode is called with any of the
prioritize patient. following conditions:
●​ A strong possibility of a military
Benefits operations (i.e. coup attempt).
●​ Identifies patients who require ●​ Any planned mass action or
rapid medical care to save life and demonstration within the area.
limb by separating out the minor ●​ Forecasted typhoons, the path of
injuries, reduces the urgent burden which may affect the area.
on medical facilities and ●​ National or local elections or
organizations. plebiscites.
●​ Provides a rational distribution of ●​ National holidays or celebrations
casualties. (i.e. new year’s eve, holy week,
etc.).
●​ Other conditions which may be
Problems declared as disasters by the chief
●​ Some triage systems rely on of hospital or other appropriate
specific injuries and physical authority.
findings in order to categorize
patients. S.T.A.R.T.—Simple Triage and Rapid
●​ In depth assessment requires Treatment
more than may be available in the ●​ Remember RPM (Respiration,
beginning of the MCI. Perfusion, Mental Status)

GEOGRAPHY OF DISASTER POST IMPACT, RECOVERY,

RECONSTRUCTION, REHABILITATION
CARDINAL RULE OF TRIAGE Critical Incident Stress Management
“TO DO THE GREATEST GOOD
FOR THE GREATEST NUMBER” CRITICAL INCIDENT
●​ Any emergency situation that
Treatment involves potential or actual
 physical or psychological harm CISD is not any form of:
which occurs during the conducting ●​ Psychotherapy
of someone’s day to day activities ●​ Professional counseling
(e.g. pt. assault, pt. suicide, a ●​ A treatment or cure for PTSD
global pandemic) ●​ A critique of the incident
●​ Investigative tool
DEBRIEFING ●​ An organizational problem solving
●​ A technique used to help a person process
emotionally process a critical ●​ Stand – alone process
incident with the intention of
helping them deal with the Critical Incident Stress Debriefing
potential impact of the incident on (CISD)
their functioning at work and at ●​ Is a more structured, seven phase
home. group crisis intervention process
used to facilitate psychological
Critical Incidents closure and recovery.
●​ Are important, often stressful, -Mitchell and Everly, 2016
events which have the potential to ●​ Is an intervention which assists
overwhelm one’s usual coping victim survivors to deal positively
mechanisms resulting in with the emotional effects of critical
psychological distress and an incidents, provide education about
impairment of normal individual, as current and anticipated stress
well as collective, adaptive responses and stress management
functioning. techniques.
●​ Three (3) basic types of critical -DSWD Administrative
incidents: order no. 72, series of 2003
○​ Emergencies
○​ Disasters Rationale for CISD
○​ Catastrophes ●​ Lower tension and mitigate a small
group’s reaction to a traumatic
event.
CRITICAL INCIDENT ●​ Facilitation of normal recovery
MANAGEMENT PROGRAM processes of normal people within
●​ Critical Incident Management a small group who are having
(CISM) is defined as a normal reactions to an abnormal
comprehensive, integrative, event.
multicomponent crisis intervention ●​ Identification of people within a
program. group who might be in need of
additional individual support or in
Seven (7) Core Components: some cases, a referral for
●​ Pre – Crisis Preparation professional psychotherapy.
●​ Demobilization and staff consult ●​ Used to educate, normalize
●​ Defusing reactions and hopefully prevent
●​ CISD PTSD from occurring.
●​ Individual stress intervention
●​ Family CISM Who Conducts CISD?
●​ Follow up referral ●​ CISD Team
●​ Provider/Debriefer
 ●​ Mental Health Professional ○​ Who arrived first?
●​ Team Leader What Happened?
●​ Door Keeper ○​ Who came in next?
Can you tell me
Who can participate in CISD? what happened?
●​ Small, homogenous groups who ○​ Where were you
have experienced the same when the incident
traumatic experience. occurred?
●​ Small group who completed its ○​ What were you
mission. doing?
●​ 6 to 8 members ○​ How did you first
know something
When to conduct CISD? was wrong?
●​ 24 to 72 hours after the traumatic
event III.​ Thought Phase
●​ 3 to 7 weeks after the disaster ●​ Describe their cognitive
reactions concerning the
Where to conduct CISD? incident and to transition to
●​ Reasonably comfortable emotional reactions.
●​ Afford privacy ●​ Sample
●​ Accessible Questions/Statements:
○​ I’d like you to
How long does the CISD take place? describe what your
●​ 1 – 3 hours depending on primary first thoughts were
factors: in response to what
○​ The number of people in happened.
the group. ○​ What were your
○​ The intensity of the thoughts when you
traumatic event. saw what was
happening?
○​ What was going
I.​ Introduction through your head?
●​ Introduce yourself What was the first
●​ Let the participants thought you had
introduce themselves when you went off
●​ Describe the process autopilot?
●​ Explain the purpose ○​ When you had
●​ Lay out basic guidelines finally a chance to
●​ Clarify expectations think about this
situation, what
II.​ Fact Phase entered your mind?
●​ Describe the traumatic ○​ Is there some
event from each thought that keeps
participant’s perspective on recurring after this
a cognitive level. event?
●​ Focus on facts
●​ Sample Questions: IV.​ Reaction or Feeling Phase
 ●​ Help people identify the ○​ Could it be that you
most traumatic part of the experienced it?
experience.
●​ Help them recognize strong VI.​ Teaching or Educational Phase
emotions that accompany ●​ Provide explanations and
their experience guidance regarding stress
●​ Help them normalize and and stress management.
legitimize feelings ●​ Alert the person to a future
●​ Sample Questions: anxiety.
○​ What was the worst ●​ After self care such as
part of the exercise, structure, time,
experience for you share feelings with others,
personally? journals , quiet time etc.
○​ When this Example in a robbery setting:
happened, how did ●​ “Which door did he come in
you feel? and how will you react
○​ What was it like for when hear the door slam?
you? Since the robbery occurred
○​ What did you feel at Thursday at 11:00, how
that time? might respond next
○​ What are your Thursday at 11:00?
feelings now?
VII.​ Reentry Phase
V.​ Symptom Phase ●​ A time to answer and
●​ Transitions to cognitive summarize what was
from feeling domain. occurred.
●​ Briefly describe the ●​ It’s the time when
cognitive, physical, psychological closure is
behavioral, emotional, likely to occur
spiritual and other signs of ●​ It should end only when the
signals of distress the majority has returned to the
participants were or are cognitive domain
experiencing.
●​ Sample Questions:
○​ What physical and Example:
physiological ●​ “What has emerged from
reactions have you this group tonight seems to
noticed? be a theme of frustration
○​ Have you and loss of control”
experienced any ●​ “A common question that
signs of distress arises from incidents such
since this as this is, “why did this
happened? incident affect me when so
○​ What are some of many others have not been
the stress affected? From listening to
responses you’ve the group today, the answer
experienced? that has emerged seems
clear”.
 ●​ Poor self care
●​ Easily startled/angered
●​ Physical symptoms
●​ Appetite/sleep changes
●​ Relationship problems
●​ Problems at work
●​ Being susceptible to future
traumas

Stressor
●​ Any stimuli that seems to demand
FIRST RESPONDERS & PUBLIC a response from us.
HEALTH WORKERS ●​ Can be positive (win the lottery) or
negative (death of a loved ones).
Traditional Responders ●​ Can be cumulative (add up
●​ Police together).
●​ Firefighters ●​ Stressors are specific to
●​ Search and Rescue Personnel individuals.
●​ Emergency and Paramedical
Teams CRITICAL INCIDENT STRESS
DISORDERS
Non-Traditional Responders
●​ Truck Drivers Acute Stress Disorder (ASD)
●​ Heavy equipment operations Responders may display a variety of
●​ Laborers and carpenters symptoms of ASD to include:
●​ Nurse and Physicians ●​ Severe anxiety
●​ Laboratory Personnel & Ancillary ●​ Dissociation
Hospital Staff ●​ Develops dissociative symptoms
●​ Decrease in emotional
Why Debrief? responsiveness
●​ To help ●​ May feel guilty about pursuing
●​ To try to reduce or eliminate usual life tasks
burnout, compassion fatigue, and ●​ Difficulty concentrating
re-traumatization. ●​ Feel detached from their body
●​ To address existing trauma which ●​ Experience the world as unreal or
may have occurred in the course of dreamlike
work activities. ●​ Dissociative amnesia
●​ To refer people to help when
needed. 1.​ Beginning of CID

Common Trauma Response 2.​ Retelling of Incident

●​ Shock ●​ Have the participants tell
●​ Anger the whole story about what
●​ Anxiety happened. This should be
●​ Withdrawing/avoidance roughly chronological, but it
●​ Depression is more important to led
●​ Negativity each person have their full
●​ Addictive behavior say in what happened.
 Keep it to just the facts, making everyone safer and
we’ll discuss feelings and learning from past
potential courses of action incidents.
later.
●​ Even if you know what 6.​ Suggestions for the Person
happened, let them tell it. ●​ Any self – care plans?
How they see it is more ●​ Sometimes the symptoms
important than your take time to kick in. what is
recollection or even what their plan if this starts to
really happened. happen.
●​ Leave the door open for
3.​ Feelings Check-in them to come to you later
●​ Next, we ask for people’s on.
feelings, both during the ●​ Ask if you can check in with
incident and since. All them later on.
feelings are valid, keep ●​ What are they doing to take
them talking. care of themselves now?
●​ Validation is key here:
○​ “That’s sounds TIPS FOR THE DEBRIEFER
really scary” ●​ Only do debriefings under the
○​ “I’d probably feel the supervision of a clinician, so you
same way” have somewhere to bring
●​ Your experience is helpful, questions/problems.
but it is better for them to ●​ Do your first debriefings with
do most of the talking. Be someone more experience.
careful about sharing your ●​ No debriefing is perfect, and no
stories. two are the same.
●​ Remember, you are helping to
4.​ Changes since the Incident create a safer and trauma
●​ If the incident didn’t just –informed workplace for you and
happen, ask them if they your co-workers.
are aware of any
differences they have
noticed since the incident.
○​ Work
○​ Medical
○​ Emotional
○​ Spiritual
○​ Self care
○​ Appetite/sleep

5.​ Suggestions for the Workplace

●​ What could have been
done differently or could be
done differently to avoid
such an incident in the
future? This isn’t about
placing blame, it is about