NUR 113: DISASTER NURSING

STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR

Session # 1

Materials:
LESSON TITLE: I. Disaster Preparedness: Essentials of
Disaster Planning Book, pen and notebook
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can:

1. Classify the major types of disasters based on their unique

characteristics. References:
2. Describe basic principles of disaster planning. Veenema, T.G. (2019) Disaster Nursing and
3. Differentiate risk assessment, hazard identification, and Emergency Preparedness for Chemical,
vulnerability analysis. Biological, and Radiological Terrorism and other
4. Identify the core preparedness actions. Hazards 4th Edition

SUBJECT ORIENTATION (10 minutes)

The instructor will start by introducing herself to the class and the assigned subject, Disaster Nursing – Lecture. The
course outline will be distributed and discussed accordingly. Listed below are the additional information vital in orientation:

1. Classroom rules and regulations.

2. The calendar of activities (major examinations).
3. Computation of grades specific for this subject.
4. Election for block officers.

MAIN LESSON (35 minutes)

The students will study and read their book about this lesson (Chapter 1 of the book):

DISASTER: “a serious disruption of the functioning of a community or a society at any scale due to hazardous events
interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human,
material, economic and environmental losses and impacts” (United Nations International Strategy for Disaster Reduction
[UNISDR], 2017).

DISASTER NURSING
 The adaptation of professional nursing skills in recognizing & meeting the nursing physical & emotional needs
resulting from a disaster.
 “Nursing practiced in a situation where professional supplies, equipment, physical facilities & utilities are limited or
not available”.
 GOAL: To achieve the best possible level of health for the people & the community involved in the disaster.

Nurses’ Roles in Disaster:

1. Determine magnitude of the event
2. Define health needs of the affected groups
3. Establish priorities & objectives
4. Identify actual & potential public health problems
5. Determine resources needed to respond to the needs identified
6. Collaborate with other professional disciplines, governmental & non-governmental agencies
7. Determine magnitude of the event
8. Define health needs of the affected groups

HEALTH DISASTER: is a catastrophic event that results in casualties that overwhelm the healthcare resources in that
community and may result in a sudden unanticipated surge of patients, a change in standards of care, and a need to
allocate scarce resources.

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TWO BROAD CATEGORIES OF DISASTER:
1. Natural
2. Man-made or anthropogenic

NATURAL DISASTER
Those caused by natural or environmental forces.
WHO defines “natural disaster” as the “result of an ecological disruption or threat that exceeds the adjustment capacity of
the affected community” (Lechat, 1979). Natural disasters include earthquakes, floods, tornadoes, hurricanes, volcanic
eruptions, ice storms, tsunamis, and other geological or meteorological phenomena. Natural disasters are the
consequence of the intersection of a natural hazard and human activity.

MAN-MADE OR ANTHROPOGENIC (Human Generated)

Anthropogenic disasters are those in which the principal direct causes are identifiable human actions, deliberate or
otherwise (Jha, 2010). Anthropogenic disasters include biological and biochemical terrorism, chemical spills, radiological
(nuclear) events, fire, explosions, transportation accidents, armed conflicts, and acts of war.

THREE CATEGORIES OF HUMAN-GENERATED DISASTERS:

1. Complex Emergencies
2. Technological disasters
3. Disasters that are not caused by natural hazards but occur in human settlements

Complex human emergencies involve situations where populations suffer significant casualties as a result of war, civil
strife, or other political conflict.

Technological disasters, large numbers of people, property, community infrastructure, and economic welfare are directly
and adversely affected by major industrial accidents, unplanned release of nuclear energy, and fires or explosions from
hazardous substances such as fuel, chemicals, or nuclear materials.

Natural and human-made disasters trigger each other and the distinctions between the two disaster types may be
blurred. A natural and human-generated disaster may trigger a secondary disaster, the result of weaknesses in the human
environment. An example of this is a chemical plant explosion following an earthquake.

Disasters are frequently categorized based on their:

1. Onset
2. Impact
3. Duration

For example:
- Earthquakes and tornadoes are rapid-onset events—short durations but with a sudden impact on communities.
- Hurricanes and volcanic eruptions have a sudden impact on a community; however, advanced warnings are
issued enabling planners to implement evacuation and early response plans.
- A bioterrorism attack may be sudden and unanticipated and have a rapid and prolonged impact on a community.
- In contrast, droughts and famines have a more gradual onset or chronic genesis, the so- called creeping disasters
and generally have a prolonged onset.

Factors that influence Impact of a Disaster on a Community:

1. Nature of the event
2. Time of day and year
3. Health and age characteristics of the population affected
4. Availability of resources

Classification of disasters in the field of disaster science:

1. Hazards (cause) is a potential threat to humans and their welfare (Smith & Petley, 2009)
2. Disasters
3. Risk-- is the actual exposure of something of human value and is often measured as the product of probability
and loss (Smith & Petley, 2009).

Classification of Disasters in hospital and other health care facilities:

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 1. internal
2. external
External disasters are those that do not affect the hospital infrastructure but tax hospital resources due to numbers of
patients or types of injuries (Burstein, 2014). For example, a tornado that produced numerous injuries and deaths in a
community would be considered an external disaster.

Internal disasters cause disruption of normal hospital function due to injuries or deaths of hospital personnel or damage
to the facility itself, as with a hospital fire, power failure, or chemical spill (Hendrickson & Horowitz, 2016).

HEALTH EFFECTS OF DISASTERS:

 Disasters may cause premature deaths, illnesses, and injuries in the affected community, generally exceeding the
capacity of the local healthcare system.
 Disasters may destroy the local healthcare infrastructure, which therefore will be unable to respond to the
emergency. Disruption of routine health and mental healthcare services and prevention initiatives may lead to
long-term consequences in health outcomes in terms of increased morbidity and mortality.
 Disasters may create environmental imbalances, increasing the risk of communicable diseases and
environmental air, soil, and water hazards.
 Disasters may affect the psychological, emotional, and social well-being of the population in the affected
community. Depending on the specific nature of the disaster, responses may be fear, anxiety, depression,
widespread panic, terror, and exacerbation of preexisting mental health problems. Children, in particular, may be
deeply affected by the impact of a disaster (Save the Children, 2017).
 Disasters may cause shortages of food and cause severe nutritional deficiencies.
 Disasters may cause large population movements (refugees) creating a burden on other healthcare systems and
communities. Displaced populations and their host communities are at increased risk of communicable diseases
and the health consequences of crowded living conditions (Lam, McCarthy, & Brennan, 2015).
 Disaster frameworks for response are increasingly shaped by globalization, changing world dynamics, social
inequality, and sociodemographic trends (Tierney, 2012; WHO, 2016

2 Major Concerns about Role (Dr. Veenema)

1. Personal safety: “Nurses want to know that they’re safe & that their loved ones & patients are safe.”
2. Clinical competence: “They want to know they can deal with emergencies properly—even less common ones
like massive radiation exposure or SARS outbreaks.”

Nurses’ Roles in Disaster:

1. Determine magnitude of the event
2. Define health needs of the affected groups
3. Establish priorities & objectives
4. Identify actual & potential public health problems
5. Determine resources needed to respond to the needs identified
6. Collaborate with other professional disciplines, governmental & non-governmental agencies
7. Determine magnitude of the event
8. Define health needs of the affected groups

THE DISASTER CONTINUUM – life cycle of a disaster management program.

Three Major Phases

1. Preimpact (before)
2. Impact (during)
3. Postimpact (after)
Basic phases or “life cycle” of a disaster management program: (PMPRR)
1. Preparedness refers to the proactive planning efforts designed to structure the disaster response prior to its
occurrence. Disaster planning encompasses evaluating potential vulnerabilities (assessment of risk) and the
propensity for a disaster to occur.
Warning (also known as “forecasting”) refers to monitoring events to look for indicators that predict the location,
timing, and magnitude of future disasters.

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 2. Mitigation includes measures taken to reduce the harmful effects of a disaster by attempting to limit its impact on
human health, community function, and economic infrastructure. These are all steps that are taken to lessen the
impact of a disaster should one occur and can be considered as prevention measures.

Prevention refers to a broad range of activities, such as attempts to prevent a disaster from occurring, and any
actions taken to prevent further disease, disability, or loss of life. Mitigation usually requires a significant amount
of forethought, planning, and implementation of measures before the incident occurs.

3. Response phase is the actual implementation of the disaster plan. Disaster response, or emergency
management, is the organization of activities used to address the event. Traditionally, the emergency
management field has organized its activities in sectors, such as fire, police, hazardous materials management
(hazmat), and emergency medical services. The response phase focuses primarily on emergency relief: saving
lives, providing first aid, minimizing and restoring damaged systems such as communications and transportation,
and providing care and basic life requirements to victims (food, water, and shelter).

4. Recovery actions focus on stabilizing and returning the community (or an organization) to normal (its preimpact
or improved status). This can range from rebuilding damaged buildings and repairing infrastructure to relocating
populations and instituting physical, behavioral, and mental health interventions. Rehabilitation and reconstruction
involve numerous activities. Goal: “Build, Back, Better”

5. Evaluation is the phase of disaster planning and response that often receives the least attention. After a disaster,
it is essential that evaluations be conducted to determine what worked, what did not work and what specific
problems, issues and challenges were identified.

DISASTER PLANNING
 Addressing the problems posed by various potential events.
 Participation by nurses in all phases of disaster planning is critical to ensure that nurses are aware of and
prepared to deal with whatever these numerous other factors may turn out to be.
 Individuals and organizations responsible for disaster plans should consider all possible eventualities from the
sanitation needs to the crowd, psychosocial needs of vulnerable populations, to evacuation procedure.
 Completion of the disaster planning process should result in the production of a comprehensive disaster or
“emergency operations plan”.

DISASTER PLAN- a formal plan of action of coordinating the responsive of health care agency staff in the event of a
disaster.

AIM: to provide prompt & effective medical care to the maximum possible in order to minimize morbidity and mortality.
Objectives:
 To optimally prepare the staff and institutional resources for effective performance in disaster situation.
 To make the community aware of the sequential steps that could be taken at individual and organizational
levels.
Types of Disaster Planning:
1. Agent specific approach – focus their preparedness activities on the most likely threats to occur based on their
geographic location (Hurricanes in Florida)
2. All -hazards approach- conceptual model for disaster preparedness that incorporates disaster management
component that are consistent across all major events to maximize resources, expenditures and planning
efforts.
Nurses’ Roles in Disaster Planning:
1. Personal and professional preparedness
2. Make a personal and family preparedness.
3. Be aware of the disaster plan at the workplace and community.
4. Maintain certification in disaster training and CPR

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 5. Participate in Mock disaster drills.
Problems, Issues and Challenges in Disaster Planning:
1. Anticipate communication problems.
2. Address operational issues related to effective triages, transportation and evacuation.
3. Accommodate the management, security of and distribution of resources at the disaster sides.
4. Implement advanced warning systems and increase the effectiveness of warning messages
5. Enhance coordination of search and response efforts.
6. Effective triage of patients (prioritization for care and transport of patients).
7. Establish plans for the distribution of patients to hospitals in an equitable.
8. Patient identification and tracking.
9. Damage or destruction of the health care infrastructure.
10. Management of volunteers, donations and other large numbers of resources.
11. Organized improvisational response to the disruption of major systems.
12. Encountering overall resistance (apathy) to planning efforts.

HAZARD IDENTIFICATION, VULNERABILITY ANALYSIS,

AND RISK ASSESSMENT

Methods for Data Collection for Disaster Planning:

1. Hazard identification is used to determine which events are most
likely to affect a community and to make decisions about whom or
what to protect.
2. Vulnerability analysis is used to determine who is most likely to
be affected, the property most likely to be damaged or destroyed,
and the capacity of the community to deal with the effects of the
disaster. Data are collected regarding the susceptibility of
individuals, property, and the environment to potential hazards in
order to develop prevention strategies. A separate vulnerability
analysis should be conducted for each identified hazard.

3. Risk assessment uses the results of the hazard identification and

vulnerability analysis to determine the probability of a specified
outcome from a given hazard that affects a community with known
vulnerabilities and coping mechanisms (risk equals hazard times
vulnerability).

Disaster Planning and Public Health Preparedness:

Six Domains:
1. Community resilience
2. Incident management
3. Information management
4. Countermeasure and mitigation
5. Surge management
6. Biosurveillance

EVALUATING CAPACITY TO RESPOND

Resource identification is an essential feature of disaster planning. A community’s capacity to withstand a disaster
is directly related to the type and scope of resources available, the presence of adequate communication systems, the
structural integrity of its buildings and utilities (e.g., water, electricity), and the size and sophistication of its healthcare
system (Burstein, 2014; Cuny, 1998). Resources include both human and physical elements, such as organizations with
specialized personnel and equipment. Disaster preparedness includes assembling lists of healthcare facilities; medical,
nursing, and emergency responder groups; public works and other civic departments; and volunteer agencies, along
with phone numbers and key contact personnel for each.

CORE PREPAREDNESS ACTIVITIES

1. Prepare a theoretical foundation for disaster planning.

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 2. Disaster planning is only as effective as the assumptions upon which it is based.
3. Core preparedness activities must go beyond the routine
4. Have a community needs assessment.
5. Identify leadership and command post.
6. Design a local response for the first 72 hours.
7. Identify and accommodate vulnerable populations.
8. Know about state and federal assistance.
9. Identify training and educational needs, resources, and personal protective equipment (PPE).
10. Plan for the early conduction of damage assessment.

EVALUATION OF A DISASTER PLAN

An essential step in disaster planning and preparedness is the evaluation of the disaster response plan for its
effectiveness and completeness by key personnel involved in the response. The comprehension of people expected to
execute the plan and their ability to perform duties must be assessed. The availability and functioning of any equipment
called for by the disaster plan needs to be evaluated and reviewed on a systematic basis. Several methods may be used
to exercise the disaster plan, the most comprehensive of which would be its full implementation in an actual disaster.
Disaster drills may also provide an excellent means of testing plans for their completeness and effectiveness. Drills can be
staged as large, full-scale exercises, using triaged victims and requiring vast resources of supplies and personnel, or they
may be limited to a small segment of the disaster response, such as drills that assess the effectiveness of
communications protocols or notification procedure.

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice

(For 1-5 items, please refer to the questions in the Rationalization Activity)

RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS)
The instructor will now rationalize the answers to the students and will encourage them to ask questions and to discuss
among their classmates for 10 minutes.

1. It is a catastrophic event that results in casualties that overwhelm the healthcare resources in that community and
may result in a sudden unanticipated surge of patients, a change in standards of care, and a need to allocate
scarce resources?
a. Disaster
b. Health Disaster
c. Pandemic
d. Natural disaster
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. It is a serious disruption of the functioning of a community or a society at any scale due to hazardous events
interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human,
material, economic and environmental losses and impacts
a. Disaster
b. Health Disaster
c. Pandemic
d. Natural disaster
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. Which of the following is not a category in determining disasters?

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 a. Man-made
b. Natural
c. Anthropogenic
d. Supernatural
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. This is a potential threat to humans and their welfare

a. Risk
b. Disaster
c. Hazard
d. Warning
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. It is used to determine which events are most likely to affect a community and to make decisions about whom
or what to protect as the basis of establishing measures for prevention, mitigation, and response.
a. Hazard Identification
b. Vulnerability analysis
c. Risk Assessment
d. Disaster Planning
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

LESSON WRAP-UP (5 minutes)

Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.

You are done with the session! Let’s track your progress.

AL Activity: Minute Paper

Instruction:
1. Reserve a few minutes at the end of class session. Leave enough time to ask the questions, to allow students to
respond, and to collect their responses.
2. Pass out slips of paper on index cards for students to write on. You may also ask students to bring out and write
on a half sheet of paper instead.
3. Collect the responses as or before students leave. One way is to station yourself at the door and collecting
“minute papers” as student file out.
4. Respond to students’ feedback during the next class meeting or as soon as possible.

1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2) What question(s) do you have as we end this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 2

Materials:
LESSON TITLE: I. Disaster Preparedness: Leadership and
Book, pen and notebook
Coordination in Disaster Healthcare System: DRRM in the
Philippine Perspective References:

LEARNING OUTCOMES: Veenema, T.G. (2019) Disaster Nursing and

Emergency Preparedness for Chemical,
Upon completion of this lesson, the nursing student can: Biological, and Radiological Terrorism and
other Hazards 4th Edition
1. Describe DRRM.
2. Familiarize the goals of NDDRM.
3. Describe the Incident management system and its
http://www.ndrrmc.gov.ph/attachments/artic
elements and their relationships with the Health Sector.
4. Discuss the various types of command structures; Incident le/3031/NDRP_Consequence_Management_f
Command Post, Emergency Operations Center, or_Terrorism_related_Incidents.pdf
Emergency Coordination Center.
5. Identify the command structures that could be applicable to
the Health Sector. https://www.slideshare.net/irpex/disaster-risk-
6. Discuss the role of the HEM (Health Emergency reduction-and-management-28415360
Management) developing incident command system
integrating health component.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: Differentiate Natural Disasters from Anthropogenic Disasters and give an example for each.

MAIN LESSON (30 minutes)

DISASTER RISK REDUCTION and MANAGEMENT (DRRM)

It is a systematic process of using administrative decisions, organization and operational skills and capacities to
implement strategies, policies and improved coping capacities of the society and community in order to lessen the
adverse impacts of hazards and the possibility of a disaster.

2 ASSUMPTIONS: disaster risk is endemic & it is within the power of the state to reduce disaster risk (Source: IRR of
RA10121)

DRRMC ORGANIZATIONAL NETWORK

 National Disaster Risk Reduction & Management Council

 12 Regional Disaster Risk Reduction & Management Councils
 80 Provincial Disaster Risk Reduction and Management Councils
 122 City Disaster Risk Reduction and Management Councils
 1,512 Municipal Disaster Risk Reduction and Management Councils
 42,026 Barangay Disaster Risk Reduction and Management Committees

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THE NATIONAL DISASTER RISK REDUCTION MANAGEMENT COUNCIL (NDRRMC)

The National Disaster Risk Reduction and Management Council (NDRRMC), formerly known as the National Disaster
Coordinating Council (NDCC), is a working group of various government, non-government, civil sector and private sector
organizations of the Government of the Republic of the Philippines established by Republic Act 10121 of 2010.

THE NATIONAL DISASTER RESPONSE PLAN

The NDRP is the Government of the Philippines’ “multi-hazard” response plan. Emergency management as defined in the
NDRRM Act of 2010 (RA10121), is the organization and management of resources to address all aspects or phases of
the emergency, mitigation of, preparedness for, response to and recovery from a disaster or emergency

The NDRP is also built on the following understanding:

 All government agencies and instrumentalities have their own respective Disaster Preparedness Plans for
Terrorism related incidents;
 All Local Government Units (LGUs) have prepared their Contingency Plans for Terrorism related incidents and
implemented their Local Disaster Risk Reduction and Management Plans (LDRRMPs) within the DRRM
Framework of Prevention/Mitigation, Preparedness, programs and activities that are directly connected to
response like prepositioning of key assets and resources; and
 The Cluster Approach System and Incident Command System in response operations have been cascaded to all
levels of government both national and local.

National Disaster Risk Reduction and Management Plan 2011-2028.

The NDRRMP sets down the expected outcomes, outputs, key activities, indicators, lead agencies, implementing partners
and timelines under each of the four distinct yet mutually reinforcing thematic areas. The goals of each thematic area lead
to the attainment of the country’s overall DRRM vision, as graphically shown below.

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The NDDRMP goals are to be achieved by 2028 through 14 objectives, 24 outcomes, 56 outputs, and 93 activities. The
24 outcomes, with their respective overall responsible agencies, are summarized below.

COORDINATION AND EMERGENCY AND DISASTER

Challenges in Managing Emergencies related to Coordination and Communication

• No identifiable leader or incident manager

• No basic organizational structure for chain of command and span of control
• No common terminology
• No unified communications system
• No system for allocating resources
• Lack of integration, due to competition
• Lack or loss of resources, due to failures in planning and lack of resource allocation
• Lack of planning, due to absence of commitment
• failures in risk and crisis communications

INCIDENT MANAGEMENT SYSTEM (IMS)

 Is a standardized, all hazards incident management concept.
 It can be composed of several levels
 ICP (INCIDENT COMMAND POST)
 EOC (EMERGENCY OPERATIONS CENTER)
 ECC (EMERGENCY COORDINATION CENTER)
 Allows its users to adopt an integrated organization structure to match the complexities and demands of single
or multiple incidents without hindered by jurisdictional boundaries

Emergency Response Management Systems: Core Principles

• Based on an all-hazards approach
• Modular, scalable or adaptable organization

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 • Support for joint engagement of multiple institutions / organizations in management decisions
• Clear lines of accountability and authority
• Clearly defined roles and responsibilities, consistent with normal roles and supported by training
• Clearly articulated procedures for activation, escalation, and demobilization of emergency capacities.
• Common functional groupings and consistent terminology
• Integrated with stakeholder agencies
• Mechanisms for the involvement of all stakeholders and users of the EOC in its design, operational planning and
evaluation.
• Provision of capacity to manage public communications opportunities as part of the response to emergencies
Core Components of the System
• integrated communications
• modular organization
• unified command structure
• manageable span of control
• consolidated incident action plans
• comprehensive resource management
• pre-designated incident facilities

The essence of the system 5 functions (in many countries)

1. Incident management (manager who coordinates)
2. Operations
3. Planning
4. Logistics
5. Administration and finance

Management: provides overall direction of the response through the establishment of objectives for the system. This
functional area usually includes other activities that are critical to providing adequate management:
– Public Information manages information released to media and public;
– Safety assesses hazardous and unsafe conditions and develops measures to ensure responder safety; and
– Liaison provides coordination with agencies outside the response system. For the purposes of this discussion, the
terms Operations: achieves management’s objectives through directed strategies and developed tactics.
Logistics: supports management and operations with personnel, supplies, communications equipment, and facilities.
Plans/Information: supports management and operations with information processing and the documentation of
prospective plans of actions (also known as action plans, or APs). Critical components include:
Administration/Finance: supports management and operations through tracking of such issues as reimbursement and
regulatory compliance.

Incident Management System (IMS)

The IMS (or Incident Command System) refers to the combination of facilities, equipment, personnel, procedures, and
communications operating within a common organizational structure and designed to aid in the management of
resources during incident response. The MCM Management System emphasizes management rather than command
because no inherent “line authority” exists in a multidisciplinary response by which assets can be commanded.

Levels of command
Level 1: using emergency response plans of the hospitals; developing operational plans to respond to a crisis
Level 2: information sharing; systems: mutual aid

Level 3: there are several command and coordination mechanisms: at the site (Incident Command Post); the Emergency
Operations Centre (EOC) at the local authority level (multi-sectoral). Depending upon the organization of the country (it
size; level of development, resources available) the EOC can be at District level or even at Provincial level

Level 4: in some countries level 3 is assumed by level 4 in this diagram. The notion of Emergency Coordination Centre is
important when the size of the incident justify the activation of national (or provincial in some countries) plans. In some

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particular circumstances the national level has not only a coordination function but also a “managerial function of the
response” (it can be in the case of a pandemic; for managing the international donations, etc.)
Incident Command Post (ICP)
• Site
• tactical resources directly applied to address emergency problems
• responders may come from one agency, or many
• the on-site response is directed by one agency by jurisdiction or agreement
• operates from an ad-hoc site command post
• utilizes standard functions
• Advise incoming units of what’s going on. What does it contain?
• Be part of solution, not the problem. May have to wait for special resources to arrive. Does a problem still exist?
• Do not rush to a scene. Gather info before entering a scene. Is the area safe to be in? If not, make it safe with
your capabilities or wait for trained resource to arrive
• Expect chaos & confusion
• Careless heroics can injure or kill you
• First priority is personal safety, then team safety, then by standers safety and last is patient safety

EOP (Emergency Operation Center) requires much preparatory work, especially a plan describing the core
elements: The plan usually is composed of:
• purpose of the plan
• concept of operations, management structure, roles of personnel and how the components work together
• Activation procedures and levels, and who has authority
• Escalation and de-escalation plan
• Call-out list and notification procedures
• Checklists of the roles and responsibilities of EOC functions
• Checklists of standard operating procedures
• floor plan, with inventory and locations of equipment and supplies
• Electronic information management processes (including a layout plan of phone, fax, data lines, cables, switches
and outlets)
• Communication resources and procedures, especially mobile phones and radios
• Public information and warning processes
• Procedures for engaging levels of government and/or a superior authority/ jurisdiction
• Standard forms and instructions for documenting EOC activities
• Maps of the area of the event
• Guidelines for worker care and safety
• agency and position responsible for maintaining and updating the plan
• Training and exercise schedule to ensure staff and procedures are up-to-date.

Role of Health Emergency Manager in IMS

• Protect response personnel and resources
• Minimize loss of life, disability and suffering
• Protect public health
• Protect civil infrastructure
• Protect environmental and economic assets, including property
• Reduce economic losses

Risk Communication
- purposeful exchange of information about the existence, nature and form severity or acceptability of health risks between
policymakers, health care providers and the public/media aimed at changing behavior and inducing action to
minimize/reduce risks.
- The process of bringing together various stakeholders to come to a common understanding aboutthe risks, their
acceptability, and actions needed to reduce the risks

Risk Communication Activities

Pre Crisis Crisis Post Crisis

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  Development of a  Implementation of the  Impact/summative evaluation
communication plan communication plan  Documentation of lessons
 Fostering alliances/  Process evaluation/monitoring learned
networking  Impact evaluation of  Revision of plans
 Formative evaluation of the immediate effects
Plan  Networking/advocacy
 Revision of plan based on
monitoring results

Nurses’ Responsibility in Risk Communication

• Identifying/ verifying sources of information
• Protecting patients’ rights to privacy and confidentiality
• Advocating for the public’s right to know
• Following institution’s chain of command or flow of communication
• Supporting institution’s official statements about public health risk and safety

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. It is a systematic approach to identifying, assessing and implementing strategies and plans that aims to reduce,
the probability of a hazard event.
a. Disaster risk reduction management
b. Rehabilitation and recovery
c. Disaster prevention
d. Nursing process
ANSWER: ________
RATIO:______________________________________________________________________________________
________________________________________________________________________________________
2. The leading agency for Disaster Prevention and Mitigation.
a. DOST
b. DILG
c. DOH
d. DSWD
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
3. It is the Government of the Philippines’ “multi-hazard” response plan.
a. National Disaster Response Plan (NDRP)
b. National Disaster Risk Reduction Management Council (NDRRMC)
c. Philippine National Red Cross
d. Philippine Disaster Plan (PDP)
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
4. It is the lead agency of Response.
A. DILG
B. DSWD
C. DOH
D. NEDA
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

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Education (Department of Nursing)
 5. It is a purposeful exchange of information about the existence, nature and severity or acceptability of health risk
between policymakers, health care providers AND THE MEDIA.
a. Emergency response
b. Incident Action Plan
c. Incident management system
d. Risk Communication
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
____________________________________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: 3-2-1

Instructions:
1. As an exit ticket at the end of the class period
2. After the lesson, have each student record three things he or she learned from the lesson.
3. Next, have them record two things that they found interesting and that they’d like to learn more about.
4. Then, have students record one question they still have about the material.
5. Review the students’ responses. You can use this information to help develop future lessons and
6. determine if some of the material needs to be taught again.

Three things you learned:

1. ______________________________________
2 ______________________________________
3. ______________________________________
Two things that you’d like to learn more about:
1. ______________________________________
2. ______________________________________
One question you still have:
1. ______________________________________

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Education (Department of Nursing)
 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 3

LESSON TITLE: I. Disaster Preparedness: Understanding

Materials:
the Psychosocial Impact of Disasters
Book, pen and notebook
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can:

1. Identify the psychosocial effects likely to occur in various

types of disasters.
References:
2. Identify the elements of a community impact and resource
assessment. Veenema, T.G. (2019) Disaster Nursing and
3. Describe the normal reactions of children and adults to Emergency Preparedness for Chemical,
disaster. Biological, and Radiological Terrorism and other
4. Formulate strategies that helpers can use to assist children Hazards 4th Edition
and their families in the immediate aftermath of a disaster.
5. Discuss the impact of disaster trauma on first responders
and helpers.
6. Describe community reactions to a large-scale disaster.
7. Describe the manifestations of normal grief and mourning.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: what are the five phases of disaster management?

1. 4.
2. 5.
3.

MAIN LESSON (40 minutes)

Disaster Preparedness: Understanding the Psychosocial Impact of Disasters

Disasters, by their very nature, are stressful, life-altering experiences, and living through such an experience can
cause serious psychological effects and social disruption. Disasters affect every aspect of the life of an individual, family,
and community. Depending on the nature and scope of the disaster, the degree of disruption can range from mild anxiety
and family dysfunction (e.g., marital discord or parent–child relational problems) to separation anxiety, posttraumatic
stress disorder (PTSD), engagement in high-risk behaviors, addictive behaviors, severe depression, and even suicidality

While there are common mental health effects across different types of disasters, each disaster is unique and
many factors can determine a given disaster’s effect on survivors. Natural disasters, such as floods, hurricanes, forest
fires, and tornadoes most often result in property loss and dislocation. When physical injury and loss of life are minimal,
the incidence of psychiatric sequelae may be reduced

The mental health effects of any type of disaster, mass violence, or terror attack are well documented in the
literature to be related to the intensity of exposure to the event. Documented potential indicators of mental health
problems following the event are: sustaining personal injury, death of a loved one due to the disaster, disaster-related
displacement, relocation, and loss of property and personal finances (Neria & Shultz, 2012).

BIOTERRORISM AND TOXIC EXPOSURES

“bioterrorism is an act of human malice intended to injure and kill civilians and is associated with higher rate of
psychiatric morbidity than are ‘Acts of God’”

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Common psychological reactions to bioterrorism

 Horror, anger, or panic

 Magical thinking about microbes and viruses
 Fear of invisible agents or fear of contagion
 Attribution of arousal symptoms to infection
 Anger at terrorists, the government, or both
 Scapegoating, loss of faith in social institutions
 Paranoia, social isolation, or demoralization

The following are recommended interventions to minimize the potential psychological and social consequences
of suspected or actual biological exposures:

1. Provide information on the believed likelihood of such an attack and of possible impact.
2. Communicate what the individual risk is.
3. Clarify that negative health behaviors, which may increase during time of stress (i.e., smoking, unhealthy eating,
excessive drinking), constitute a greater health hazard than the hazards likely to stem from bioterrorism.
4. Emphasize that the only necessary action against terrorism on the individual level is increased vigilance of suspicious
actions, which should be reported to authorities.
5. Clearly communicate the meaning of different levels of warning systems when such warnings are issued
6. When issuing a warning, specify the type of threat, the type of place threatened, and indicate specific actions to be
taken.
7. Make the public aware of steps being taken to prevent bioterrorism without inundating people with unnecessary
information.
8. Provide the public with follow-up information after periods of heightened alert.

NORMAL REACTIONS TO ABNORMAL EVENTS

Normal reactions to stress and bereavement can and do vary— sometimes even among members of the same family.
Factors that affect expressions of stress and bereavement include age, gender, ethnicity, religious background,
personality traits, coping skills, and previous experience with loss, especially traumatic loss. Stress symptoms can occur
due to secondary exposure, meaning that those experiencing distress need not have been present at the site of the
disaster but may have witnessed it secondhand either via media coverage or through retelling of the event by a person
who was present. As these reactions can be quite startling and overwhelming to those who have not experienced them
before, it is helpful for survivors to hear that their experiences are entirely normal, given the tremendous stress to which
they have been exposed.

COMMON REACTIONS OF DISASTER SURVIVORS

Emotional
Shock, feeling numb Cognitive
Fear Confusion
Grief, sadness Indecisiveness
Anger Worry
Guilt, shame Shortened attention span
Feelings of helplessness Trouble concentrating

Interpersonal Physical
Distrust Tension, edginess
Conflict Fatigue, insomnia
Withdrawal Body aches, pain, nausea
Work or school problems Startling easily
Irritability Racing heartbeat
Loss of intimacy Change in appetite
Feeling rejected or abandoned Change in sex drive

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SPECIAL NEEDS POPULATION

Certain populations affected by disasters may be more vulnerable and therefore require special consideration both in
disaster planning and response. In particular, women, older people, children and young people, people with disabilities,
and people marginalized by ethnicity are more vulnerable (Sim & Cui, 2015).

1. Children and Youth - while most children are resilient, many children do experience some significant degree of
distress. Poverty and parents with mental health challenges put children at higher risk for long-term impairments
(McLaughlin et al., 2009).

2. Older Adults - Older adults are particularly vulnerable to loss. Factors such as age and disability affect
vulnerability to a disaster. Both of these vulnerability traits are apparent in the elderly population. They are often
lacking in social supports, may be financially disadvantaged, and are traditionally reluctant to accept offers of
help. Older adults are also more likely to have preexisting medical conditions that may be exacerbated, either
directly because of the emotional and psychological stress, or because of disruptions to their care, such as loss of
medications or needed medical equipment, changes in primary care providers, lack of continuity of care, or lack of
consistency in self-care routines due to relocation.

3. The Seriously Mentally Ill - According to Austin and Godleski (1999), the most psychologically vulnerable people
are those with a prior history of psychiatric disturbances. Although previous psychiatric history does not
significantly raise the risk of PTSD, exacerbations of preexisting chronic mental disorders, such as bipolar and
depressive disorders, are often increased in the aftermath of a disaster. Those with a chronic mental illness are
particularly susceptible to the effects of severe stress, as they may be marginally stable and may lack adequate
social support to buffer the effects of the terror, bereavement, or dislocation.

4. Cultural and Ethnic Groups - Sensitivity to the cultural and ethnic needs of survivors and the bereaved is key
not only in understanding reactions to stress and grief but also in implementing effective interventions. Mental
health outreach teams need to include bilingual, multicultural staff and translators who are able to interact
effectively with survivors and the bereaved.

5. Disaster Relief Personnel - The list of those vulnerable to the psychosocial impact of a disaster does not end
with the survivors and the bereaved. Often victims can include emergency personnel: police officers, firefighters,
military personnel, Red Cross mass care and shelter workers, cleanup and sanitation crews, the press corps,
body handlers, funeral directors, staff at receiving hospitals, and crisis counselors.

COMMON STRESS REACTIONS BY DISASTER WORKERS

Psychological Behavioral
Denial Change in activity level
Anxiety and fear Decreased efficiency and effectiveness
Worry about the safety of self or others Difficulty communicating
Anger Outbursts of anger, frequent arguments, irritability
Irritability and restlessness Inability to rest or “let down”
Sadness, moodiness, grief, depression Change in eating habits
Distressing dreams Change in sleeping patterns
Guilt or “survivor guilt” Change in patterns of intimacy, sexuality
Feeling overwhelmed, hopeless Change in job performance
Feeling isolated, lost, or abandoned Apathy Periods of crying
Increased use of alcohol, tobacco, and drugs
Social withdrawal/silence
Vigilance about safety of environment
Avoidance of activities/places that trigger memories

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Cognitive Physical
Memory problems Increased heart/respiratory rate/blood pressure
Disorientation Upset stomach, nausea, diarrhea
Confusion Change in appetite, change in weight
Slowness of thinking and comprehension Sweating or chills
Difficulty calculating, prioritizing Tremor (hands/lips)
Poor concentration Muscle twitching
Limited attention span “Muffled” hearing
Loss of objectivity Tunnel vision
Unable to stop thinking about disaster Feeling uncoordinated
Blaming Proneness to accidents
Headaches
Muscle soreness, lower back pain
“Lump” in the throat
Exaggerated startle reaction
Fatigue
Menstrual cycle changes
Change in sexual desire
Decreased resistance to infection
COMMUNITY REACTIONS AND RESPONSES

It is important to understand common responses and needs after a disaster, regardless of the type of disaster. It is
important to recognize:

1. Everyone who sees or experiences a disaster is affected by it in some way.

2. It is normal to feel anxious about your own safety and that of your family and close friends.
3. Profound sadness, grief, and anger are normal reactions to an abnormal event.
4. Acknowledging your feelings helps you recover.
5. Focusing on your strengths and abilities helps you heal.
6. Accepting help from community programs and resources is healthy.
7. Everyone has different needs and different ways of coping.
8. It is common to want to strike back at people who have caused great pain.

Large-group preventive techniques for children have been used for some time in California during the aftermath of
community-wide trauma (Eth, 1992). This type of school-based intervention occurs as soon after the event as possible,
and follows three phases:

1. Preconsultation—identifying the need; preparing the intervention with school authorities

2. Consultation in class—introduction, open discussion (fantasy), focused discussion (fact), free drawing task,
drawing or story exploration, reassurance and redirection, recap, sharing of common themes, and return to school
activities
3. Postconsultation—follow-up with school personnel and triage/referrals, as needed

MOURNING, MILESTONES, AND ANNIVERSARIES

The normal process of mourning is often facilitated by the use of rituals, such as funerals, memorials, and events marking
key time intervals, such as anniversaries. It is important to include the community in the services, as well as the
immediate family members. Community-wide ceremonies can serve to mobilize the supportive network of friends,
neighbors, and caring citizens and provide a sense of belonging, remembrance, and letting go.

Websites and social media groups link the bereaved and can also provide special support during important anniversaries
or milestones. Ceremonies or memorials in schools should be developmentally appropriate and involve students in the
planning process. Websites and pages to be created in the aftermath of a disaster serve as a place for people, both
directly and indirectly impacted, to express their condolences and offer support.

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Education (Department of Nursing) 4 of 8
 The phases of the mourning process have much in common with the emotional phases of disaster recovery, and Worden
(1982) has identified specific tasks that need to be accomplished at each phase of mourning for successful resolution:

- Period of shock, or “numbness.” The task is to accept the reality of the loss (as opposed to denying the reality of the
loss).
- Reality, or “yearning,” and “disorganization and despair.” The tasks are to accept the pain of grief (as opposed to not
feeling the pain of the loss) and to adjust to an environment in which the deceased is missing (as opposed to not adapting
to the loss).
- Recovery, or “reorganized behavior.” The task is to reinvest in new relationships (as opposed to not loving).

NORMAL MANIFESTATIONS OF GRIEF

Feelings Behaviors
Sadness Sleep disturbance
Anger Appetite disturbance
Guilt and self-reproach Absentmindedness
Anxiety Social withdrawal
Loneliness Avoiding reminders (of deceased)
Fatigue Dreams of deceased
Helplessness Searching, calling out
Shock (most often after sudden death) Restless overactivity
Yearning (for the deceased person) Crying Treasuring objects
Emancipation Visiting places/carrying objects of remembrance
Relief
Numbness Thoughts
Disbelief
Physical Sensations Confusion
Hollowness in stomach Preoccupation
Tightness in chest Sense of presence
Tightness in throat Hallucination
Oversensitivity to noise
Sense of depersonalization/derealization
Breathlessness, shortness of breath
Weakness in muscles
Lack of energy
Dry mouth

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CHECK FOR UNDERSTANDING (10 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. It is an act of human malice intended to injure and kill civilians and is associated with higher rate of psychiatric
morbidity than are ‘Acts of God’”
a. Disaster
b. Bioterrorism
c. Calamity
d. Natural disaster
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. They are considered to be more vulnerable and therefore require special consideration both in disaster planning
and response?
a. Special needs population
b. Older people
c. Children and youth
d. Ethnic people
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. Who are considered to belong in those who have special needs population?
a. Children and youth
b. Older people
c. Cultural and ethnic people
d. All of the above
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. A disaster survivor started to have trouble sleeping at night days after the disaster. What could be the explanation
for this?
a. It is a normal reaction.
b. It is not a normal reaction to the situation
c. Her sleep deprivation is caused by overstimulation
d. She was just not tired.
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. Which of the following may facilitate the process of mourning for the bereaved?
a. Telling them to move on
b. Acting as if nothing happened
c. Facilitate rituals, ceremonies, or memorials
d. Give them all the space they can have
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: Minute Paper

1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2) What question(s) do you have as we end this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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 NUR 113: DISASTER NURSING

STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR

Session # 4

Materials:
LESSON TITLE: I. Disaster Preparedness: Legal and
Ethical Issue in Disaster Response Book, pen and notebook
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can:

1. Understand the sources of ethical and legal obligations for

References:
nurses and nurse administrators.
2. Discover that legal and ethical obligations may be similar, Veenema, T.G. (2019) Disaster Nursing and
or may change, in the event of a bioterrorist attack or other Emergency Preparedness for Chemical,
public health crisis. Biological, and Radiological Terrorism and other
3. Explore and identify personal beliefs about disaster Hazards 4th Edition
response and consider the impact they may have on
professional values.
4. Be familiar with major legal and ethical issues related to
nurses’ responses in a disaster.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: Give examples of common reactions of disaster survivors and explain

MAIN LESSON (40 minutes)

The students will study and read their book about this lesson (Chapter 1 of the book):

LEGAL AND ETHICAL ISSUE IN DISASTER RESPONSE

Law – are the rules and regulations under which nurses must carry out their professional duties—can come from many
different sources. What most people commonly think of as “law” are what lawyers call “statutes.”

All of these sources of law can affect nurses in many different ways. For example, laws may require them to do some
affirmative act, such as report new cases of certain diseases to the local or state health department. There may be
criminal penalties for those who fail to comply with these requirements. Laws may also give the authority to certain
governmental officers to require nurses to either do or refrain from doing something in a particular circumstance. Law can
also create certain responsibilities for nurses, such as laws that impose civil liability for the failure to provide professionally
adequate care.

Civil liability is when an individual may be required to pay monetary damages to another individual, or in some cases to
the government, for failure to comply with a legal obligation.

Good Samaritan law – is a law that the nurses and other healthcare provider from liabilities for their good deeds during a
sudden emergency, but not always during a disaster.

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RELATIONSHIP BETWEEN ETHICAL AND LEGAL OBLIGATIONS
Ethics – refers to the examination of what it means to live a moral life.
Morality – encompasses the norms people adopt to direct right and wrong conduct

Nurses’ ethical obligations come from many different sources, but one formal source is the professional code of ethics.
The ANA Code of Ethics for Nurses proscribes the ethical obligations of nurses, and expresses the profession’s
commitment to society (ANA, 2015). Studying the potential issues in advance is key to this preparation.

LAW AND ETHICS

Typical disaster-related issues that challenge traditional legal and ethical thinking include the privacy issues of
reporting diseases of epidemic or pandemic proportions, maintaining confidentiality, and issues surrounding a potential
quarantine. Mandatory vaccination, treatment refusal, resource allocation, and duty to treat also legally and ethically
challenge nurses working in disaster situations.
It is important for nurses to think about ethical and legal issues in advance of disasters because sometimes it is
the fear of handling these ethical issues that keep healthcare providers from offering their services during disasters. Public
health events quickly transform resource-rich environments into settings of austerity and as a consequence produce
unique and challenging ethical and legal issues. Healthcare providers are often conflicted between their moral duty to
serve disaster victims and their moral duty to safeguard their own health, as well as their family’s and even their pet’s
health (Rutkow et al., 2017). Research studies reveal that healthcare providers are more likely to respond to disasters
with appropriate knowledge, sense of role importance, and trust in their organizations (Connor, 2014).

Dilemma - is a circumstance in which a person finds himself or herself choosing between two or more actions he or she is
morally required to perform, but the actions are actually incompatible with one another

SPECIFIC ETHICAL AND LEGAL ISSUES

Privacy Issue
Case Example: An outbreak of an infectious disease leads public health officials to believe that a bioterrorist attack has
occurred. To avoid panic of the public, however, the officials have made no public announcement of their suspicions. They
have requested, however, that nurses be on the alert for new cases of the infectious disease and to report them
immediately, along with certain information about the patient. A nurse asks her supervisor if she can legally make such
reports.

Reporting of Diseases
Nurses should already be aware of the reporting requirements of the state and local governments in the areas where they
currently practice. In the event of a public health crisis resulting from a terrorist attack, nurses will need to keep current on
any additional reporting requirements that may be imposed by state and local health authorities. If the reporting is
anonymous, then there is not concern for confidentiality of the individual. Where the reporting requires the naming of a
particular individual, however, this raises both legal and ethical concerns surrounding the privacy and confidentiality of
medical information, which will be discussed in the next section.

Disclosure of Health Information

When health information contains information that would identify the individual, issues are raised concerning both privacy
and confidentiality. Frequently, these two terms are used interchangeably, but there are technical distinctions between the
two.
Privacy - is an individual’s claim to limit access by others to some aspect of his or her life
Confidentiality - is a type of privacy aimed at preserving a special relationship of trust, such as the relationship between
medical care provider and patient.

Examples:
A person who gains access to a patient’s electronic medical record without authorization violates patient privacy but does
not violate confidentiality (Beauchamp & Childress, 2013).
A nurse who discloses to a neighbor or colleague that a particular patient told her or him about past drug abuse violates
confidentiality.

Generally, disclosure of health information could not be made without the consent of the individual. Five exceptions are:

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Education (Department of Nursing) 2 of 7
 1. Disclosure directly to the individual
2. Disclosure to the individual’s immediate family members or representative
3. Disclosure to appropriate federal agencies or authorities pursuant to federal law
4. Disclosure pursuant to a court order to avert a clear danger to an individual or the public’s health
5. Disclosure to identify a deceased individual or to determine the manner or cause of death.
Quarantine, Isolation, and Civil Commitment
Quarantine - is usually considered to be the restriction of the activities of a healthy person who has been exposed to a
communicable disease, usually for the period of time necessary for the disease to reveal itself through physical symptoms
Isolation - is usually defined to mean the separation of a person known to have a communicable disease for the period of
time in which the disease remains communicable.
Civil commitment - is often associated today with proceedings in the mental health system to forcibly confine persons
who are mentally ill and a danger either to themselves or to others. More broadly in public health, civil commitment “is the
confinement (usually in a hospital or other specially designated institution) for the purposes of care and treatment”.

Vaccination
Under their police powers, states have the governmental authority to require citizens to be vaccinated against disease.
The U.S. Supreme Court, early in the last century, upheld the authority of states to compel vaccination, even when an
individual refused to comply with the mandatory vaccination laws (Jacobson v. Massachusetts, 1905). All states currently
have laws that require school children to obtain vaccinations against certain diseases, such as measles, rubella, and
polio, before attending school. In a public health crisis, however, the question may arise whether the state (or local)
government could require an individual to be vaccinated against an infectious agent released into the general population.
The state or local government must have the authority to do so. This may arise from a specific grant of authority by the
state legislature to mandate vaccinations in the wake of a public health crisis, or the authority may be found in more
general grants of authority given specific governmental agencies to protect the public’s health.

Treatment for Disease

The U.S. Supreme Court affirmed the right of adults to select the course of treatment for their disease, including the right
of adults to refuse treatment. This right is not absolute, however. For example, when children are involved, the courts
have consistently upheld the power of the state to step in and require treatment, even in the face of religious objections by
the parents to medical treatment (Prince v. Massachusetts, 1944).

Screening and Testing

Case Example: Because public health officials suspect a “stealth” bioterror attack, they request that hospitals secretly test
all of their new patients for the suspected contagious disease. The patient is to be notified only if he or she tests positively
for the disease, and he or she will be offered standard medical treatment. Reports are to go directly to public health
officials. Can a nurse legally or ethically participate in such a program?

Screening and testing are two related, yet distinct, public health tools. “Testing” usually refers to a medical procedure to
test whether an individual has a disease. “Screening,” on the other hand, might be thought of as testing all the members
of a particular population. Although this distinction is important to public health officials, public health laws often use the
terms interchangeably or make no sharp distinction between the two.

Professional Licensing
Case Example: In the immediate aftermath of the release of a biological agent in a large city, the city’s health
professionals are overwhelmed with the number of people they must treat. Nurses from a nearby city, which is in another
state, offer to help. In addition, it is proposed that nurses carry out duties normally performed solely by physicians. Can
nurses without a current state license “help out” in a public health crisis? Can nurses perform duties and procedures
normally outside the scope of their field?

All states require licenses in order for an individual to engage in the practice of nursing. Most states, in addition, recognize
different types of nurses such as professional nurses, licensed practical nurses, and nurse practitioners.

Nurse licensing laws have two effects. The first is to limit the geographical area in which a nurse may practice to the state
in which he or she holds a license. The second is to define the scope of practice. State statutes make illegal the practice

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Education (Department of Nursing) 3 of 7
of nursing within the state by one not licensed to practice in the state , including the practice by an individual licensed to
practice in another state.

Resource Allocation
Despite preparation, a bioterrorist attack or a disaster involving a large number of casualties or casualties in excess of
personnel and resources will challenge providers to justly allocate resources. In this case, resources might be medical
supplies, antibiotics, antitoxins, pain medications, vaccines, and/or personnel. One aspect of justice in healthcare is the
concept of “distributive justice.” Distributive justice involves such issues as the fair and equitable allocation of scarce
resources.

Triage - is one mechanism for allocating scarce resources in emergency situations. “Triage” is a French word meaning “to
sort.” Emergency room and military personnel use triage to prioritize treatments of wounded persons.

For example, in the military, the practice of triage is to sort the wounded into three groups—the walking wounded, the
seriously wounded, and the fatally wounded. The walking and seriously wounded receive immediate attention, the walking
wounded so that they may be returned to fight in battle, the seriously wounded to save their lives. Those deemed fatally
wounded are given narcotics to be kept comfortable, but their wounds are not treated.

In emergency departments and at disaster sites, the wounded are also sorted into categories according to medical need
and medical utility. Treated first (triage level 1) are those people who have major injuries and will die without immediate
help; second are those whose treatment can be delayed without immediate danger (triage level 2). The third group treated
is those with minor injuries (triage level 3), and the last group is those for whom treatment will not be effective. In
emergency rooms, treatment for those with minor injuries tends to be delayed because the order of treatment is based
only on medical need and medical utility.

Professional Liability
All healthcare professionals, including nurses, are subject to civil liability for providing substandard healthcare. Malpractice
liability is generally a matter of state law, although the law of malpractice liability is very similar in all of the states. A nurse
may be held liable, that is, have to pay monetary damages, for providing professional care that is below the standard
followed by the profession. Absent special legislation, liability for medical professionals continues, even when they are
performing medical care in an emergency situation

Some states have enacted special legislation, often called “Good Samaritan” laws, which may provide immunity from civil
liability for persons when they render care in emergency situations. It is important for nurses to know the Good Samaritan
laws in their own states in order to avoid being held liable for negligence for intending to perform a good deed during an
emergency or disaster. A nurse can be held liable for negligence if he or she deviates from the accepted standard of care,
resulting in injury.

Provision of Adequate Care

Case Example: The local television news carries a story that a rash of human-to-human transmission cases of avian flu
has occurred in the region, resulting in five deaths to date. Nurses and other staff begin calling in “sick.” When contacted
by supervisors, the nurses admit they are afraid to come in to work because of fears of a possible pandemic and the
danger of spreading flu to their families (as healthcare workers they received vaccinations, but their families were not
similarly protected). What legal recourse does a hospital have if staff refuse to work during a public health crisis? What
liability does the institution face if it operates in the absence of adequate staff? What ethical issues does calling in sick
raise for the nurse and the institution?

The relationship between nurses and hospitals legally is the same as between any other employer and employee. Aside
from the exceptions discussed in the following, the relationship is viewed as an “at-will contract.” This means that the
hospital can set the terms and conditions of employment and is free to dismiss an employee for any reason (except as
this right is modified by state or federal statutes, e.g., laws against racial discrimination). Likewise, the employee, here the
nurse, is free to leave the employment to go elsewhere for any reason, and technically without even giving notice,
although custom usually prevails here

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Education (Department of Nursing) 4 of 7
In dealing with staffing requirements during a public health crisis, nurses and nurse administrators will need to seek
advice about the exact legal nature of the relationship between the nurses and the hospital or other employing agency.
Employee policies regarding hours of work and refusals to work should be reviewed, and this is particularly critical if there
is a contract (either individual or a collective union contract) governing the conditions of employment. In addition, legal
advice will be needed concerning any state requirements about mandatory work and the hours of employment.

A second legal issue surrounding staffing is liability for failing to maintain adequate nursing staff during a public health
crisis. Generally, all hospitals may be held civilly liable if they fail to maintain adequate staffing and an individual is injured
as a result of the inadequate staffing (Pozgar, 1999, p. 265). There is no hard-and-fast standard as to what constitutes
adequate staffing, and the courts are likely to allow hospitals a large degree of discretion in determining whether staffing is
adequate, particularly in the event of a public health crisis. Nonetheless, if at some point sufficient numbers of nursing
staff fail to report for work, administrators will need to consider whether the staffing is so insufficient that the quality of care
will suffer.

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. This refers to the examination of what it means to live a moral life.
a. Law
b. Morality
c. Ethics
d. Confidentiality
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. These are the rules and regulations under which nurses must carry out their professional duties
a. Law
b. Morality
c. Ethics
d. Confidentiality
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. It encompasses the norms people adopt to direct right and wrong conduct?
a. Law
b. Morality
c. Ethics
d. Confidentiality
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. This is usually considered to be the restriction of the activities of a healthy person who has been exposed to a
communicable disease?
a. Isolation
b. Quarantine
c. Screening
d. Vaccination
ANSWER: ________

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Education (Department of Nursing) 5 of 7
 RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. A nurse told the physician about the patient’s infidelity to his wife. The nurse violated the patient’s
a. Civil liability
b. Nurse-patient contract
c. Privacy
d. Confidentiality
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: 3-2-1

Instructions:
1. As an exit ticket at the end of the class period
2. After the lesson, have each student record three things he or she learned from the lesson.
3. Next, have them record two things that they found interesting and that they’d like to learn more about.
4. Then, have students record one question they still have about the material.
5. Review the students’ responses. You can use this information to help develop future lessons and
determine if some of the material needs to be taught again.

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Education (Department of Nursing) 6 of 7
Three things you learned:
1. ______________________________________
2 ______________________________________
3. ______________________________________

Two things that you’d like to learn more about:

1. ______________________________________
2. ______________________________________

One question you still have:

1. ______________________________________

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Education (Department of Nursing) 7 of 8
 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session #5

Materials:
Book, pen and notebook
LESSON TITLE: Principles of Emergency Care
LEARNING OUTCOMES: References:
Upon completion of this lesson, the nursing student can: Veenema, T.G. (2019) Disaster Nursing and
Emergency Preparedness for Chemical,
1. Familiarize the common terms used in emergency care Biological, and Radiological Terrorism and other
2. Understand the basic principles in emergency care Hazards 4th Edition
3. Identify the aims of emergency care
4. Be able to intervene in an emergency situation https://www.makrosafe.co.za/blog/principles-
of-emergency-care

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: Differentiate quarantine, isolation and civil commitment.

MAIN LESSON (40 minutes)

Common Terms Used in Emergency Care
 Trauma :Intentional or unintentional wounds/injuries on the human body from particular mechanical mechanism
that exceeds the body’s ability to protect itself from injury
 Emergency Management: traditionally refers to care given to patients with urgent and critical needs
 Triage: process of assessing patients to determine management priorities.
 First Aid: an immediate or emergency treatment given to a person who has been injured before complete
medical and surgical treatment can be secured.
 BLS: level of medical care which is used for patient with illness or injury until full medical care can be given.
 ACLS: Set of clinical interventions for the urgent treatment of cardiac arrest and often life threatening medical
emergencies as well as the knowledge and skills to deploy those interventions.
 Defibrillation: Restoration of normal rhythm to the heart in ventricular or atrial fibrillation
 Disaster: Any catastrophic situation in which the normal patterns of life (or ecosystems) have been disrupted and
extraordinary, emergency interventions are required to save and preserve human lives and/or the environment
 Mass Casualty Incident: situation in which the number of casualties exceeds the number of resources
 Post Traumatic Stress Syndrome: characteristic of symptoms after a psychologically stressful event was out of
range of an normal human experience

Principles of Emergency Care

First aid is the initial emergency care given immediately upon arrival at the scene to an ill or injured person. The first aider
and people who are assisting should continue with assistance until the professional medical assistance takes over the
care of the casualty. Medical professionals may include paramedics, doctors, or ambulance officers. First aiders should
always make notes or fill out a casualty report for any event attended, no matter how minor. Proper records will help you
to recall the incident if you are ever asked about it at a later stage.

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Education (Department of Nursing) 1 of 7
Records may be used in a court, so ensure your reports or notes are legible, accurate, factual, contain all relevant
information and are based on observations rather than opinions.

Treatment

The last step is to actually provide care to the limits of the first aider's training, but never beyond. In some jurisdictions,
you open yourself to liability if you attempt treatment beyond your level of training. Treatment should always be guided by
the 3Ps:

 Preserve life
 Prevent further injury
 Promote recovery

Treatment will obviously depend on the specific situation, but some situations will always require treatment (such as
shock). The level of injury determines the level of treatment required. The principles first, do no harm and life over limb is
essential parts of the practice of first aid. Do nothing that causes unnecessary pain or further injury unless to do otherwise
would result in death.

Aims

Although the 3Ps are outlined above, we will also include two more areas that needs attention when conducting primary
emergency care:

 Protection against further injury.

 Preservation of life.
 Promotion of recovery.
 Prevention of injuries for people at any age.
 Promotion of healthy lifestyles.

Protection against further injury

No injured person should be moved if his or her life is not in danger. If a person is not breathing and has no pulse, his or
her life is in danger. Life threatening situations exist where there is significant risk of loss of life.

Preservation of Life

In order to stay alive, all persons need to have an open airway—a clear passage where air can move in through the
mouth or nose through the pharynx (part of the throat) and down in to the lungs, without obstruction.

Conscious people will maintain their own airway automatically, but those who are unconscious may be unable to maintain
a patent airway, as the part of the brain which automatically controls breathing in normal situations may not be
functioning.

Once the airway has been opened, the first aider would assess to see if the patient is breathing. If there is no breathing, or
the patient is not breathing normally, such as agonal breathing (abnormal pattern of breathing), the first aider would
undertake what is probably the most recognized first aid procedure, called cardiopulmonary resuscitation or CPR, which
involves breathing for the patient, and manually massaging the heart to promote blood flow around the body.

Promoting Recovery

The first aider is also likely to be trained in dealing with injuries such as cuts, grazes or bone fracture. They may be able to
deal with the situation in its entirety (a small adhesive bandage on a paper cut), or may be required to maintain the
condition of something like a broken bone, until the next stage of definitive care (usually an ambulance) arrives.

Prevention of Injuries for people at any Age

The first aider must prevent injuries for all age groups. Age groups are categorised as follow:

1. Infant: For purposes of first aid, an infant is defined as being younger than 1 year of age.
2. Child: A child is categorised as being above 1 year of age
3. Adult: For purposes of first aid, adults are defined as people about age 12 (adolescents) or older.

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Education (Department of Nursing) 2 of 7
You need parental permission to give care to a child or an infant, even if it is an emergency. The only reasons for which
you could give care without permission are if the parent is not present or is injured and unable to respond.

Promoting of Healthy Lifestyles

The upside to living healthy is that there are many different ways to go about doing it. So many ways that there is no
reason why you can't find a plan which suits you well. But no matter which way you decide works best for you, here are
some general guidelines you are probably going to want to adhere to:

 Be a role model.
 Encourage healthy eating
 Encourage physical activity.

TRIAGE

The word triage comes from the French word trier, meaning “to sort.” In the daily routine of the ED, triage is used to sort
patients into groups based on the severity of their health problems and the immediacy with which these problems must be
treated.

 What were the circumstances, precipitating events, location, and time of the injury or illness?
 When did the symptoms appear?
 Was the patient unconscious after the injury or onset of illness?
 How did the patient get to the hospital?
 What was the health status of the patient before the injury or illness?
 Is there a medical or surgical history? A history of admissions to the hospital?
 Is the patient currently taking any medications, especially hormones, insulin, digitalis, anticoagulants?
 Does the patient have any allergies? If so, what are they?
 Does the patient have any bleeding tendencies?
 When was the last meal eaten? (This is important if general anesthesia is to be given or if the patient is
unconscious.)
 Is the patient under a physician’s care? What are the name and location of the physician?
 What was the date of the patient’s most recent tetanus immunization?

ASSESS AND INTERVENE

For the patient with an emergent or urgent health problem, stabilization, provision of critical treatments, and prompt
transfer to the appropriate setting (intensive care unit, operating room, general care unit) are the priorities of emergency
care. Although treatment is initiated in the ED, ongoing definitive treatment of the underlying problem is provided in other
settings, and the sooner the patient is stabilized and moved to that area, the better.

The primary survey focuses on stabilizing life-threatening conditions. The ED staff work collaboratively and follow the
ABCD (airway, breathing, circulation, disability) method:

 Establish a patent airway.

 Provide adequate ventilation, employing resuscitation measures when necessary. (Trauma patients must have
the cervical spine protected and chest injuries assessed first.)
 Evaluate and restore cardiac output by controlling hemorrhage, preventing and treating shock, and maintaining or
restoring effective circulation.
 Determine neurologic disability by assessing neurologic function using the Glasgow Coma Scale.
 After these priorities have been addressed, the ED team proceeds with the secondary survey. This includes
 A complete health history and head-to-toe assessment
 Diagnostic and laboratory testing
 Insertion or application of monitoring devices such as electrocardiogram (ECG) electrodes, arterial lines, or
urinary catheters
 Splinting of suspected fractures
 Cleaning and dressing of wounds
 Performance of other necessary interventions based on the individual patient’s condition

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Education (Department of Nursing) 3 of 7
Once the patient has been assessed, stabilized, and tested, appropriate medical and nursing diagnoses are formulated,
initial important treatment is started, and plans for the proper disposition of the patient are made.

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice

1. During the nursing assessment, which data represent information concerning health beliefs?
a. Family role and relationship patterns
b. Educational level and financial status
c. Promotive, preventive, and restorative health practices
d. Use of prescribed and over-the-counter medications
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. Which assessment data should the nurse include when obtaining a review of body systems
a. Brief statement about what brought the client to the health care provider
b. Client complaints of chest pain, dyspnea, or abdominal pain
c. Information about the client’s sexual performance and preference
d. The client’s name, address, age, and phone number
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. A male client is admitted to the hospital with blunt chest trauma after a motor vehicle accident. The first nursing
priority for this client would be to:
a. Assess the client’ s airway
b. Provide pain relief
c. Encourage deep breathing and coughing
d. Splint the chest wall with a pillow
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. Nurse Kelly is acquiring information from a client in the emergency department. Which is an example of
biographic information that may be obtained during a health history?
a. The chief complaint
b. Past health status
c. History immunizations
d. Location of an advance
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. An anxious 24-year-old college student complains of tingling sensations, palpitations, and chest tightness. Deep,
rapid breathing and carpal spasms are noted. What priority nursing action should you take?
a. Notify the physician immediately.
b. Administer supplemental oxygen.
c. Have the student breathe into a paper bag.
d. Obtain an order for an anxiolytic medication.
ANSWER: ________

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Education (Department of Nursing) 4 of 7
 RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: Minute Paper

1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2) What question(s) do you have as we end this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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Education (Department of Nursing) 5 of 5
 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 6

LESSON TITLE: Scope and Practice of Emergency Materials:

Nursing
Book, pen and notebook
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can: References:

1. Understand the scope and practice of emergency Veenema, T.G. (2019) Disaster Nursing and
nursing. Emergency Preparedness for Chemical,
2. Identify the issues in emergency nursing care. Biological, and Radiological Terrorism and other
3. Remember the ABCs of emergency nursing care. Hazards 4th Edition
4. Conduct a primary survey during emergency nursing
care.
5. Apply the principles of First Aid, Basic Life Support,
and Cardiopulmonary Resuscitation.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the 3Ps that guides the first aider in responding in an emergency situation?

MAIN LESSON (40 minutes)

SCOPE AND PRACTICE OF EMERGENCY NURSING
 The emergency nurse has had specialized education, training, and experience.
 The emergency nurse establishes priorities, monitors and continuously assesses acutely ill and injured patients,
supports and attends to families, supervises allied health personnel, and teaches patients and families within a
time-limited, high-pressured care environment.
 Nursing interventions are accomplished interdependently, in consultation with or under the direction of a licensed
physician.
 Appropriate nursing and medical interventions are anticipated based on assessment data.
 The emergency health care staff members work as a team in performing the highly technical, hands-on skills
required to care for patients in an emergency situation.
 Patients in the ED have a wide variety of actual or potential problems, and their condition may change constantly.
 Although a patient may have several diagnosis at a given time, the focus is on the most life-threatening ones

ISSUES IN EMERGENCY NURSING CARE

 Emergency nursing is demanding because of the diversity of conditions and situations which are unique in the
ER.
 Issues include legal issues, occupational health and safety risks for ED staff, and the challenge of providing
holistic care in the context of a fast-paced, technology-driven environment in which serious illness and death are
confronted on a daily basis.
 The emergency nurse must expand his or her knowledge base to encompass recognizing and treating patients
and anticipate nursing care in the event of a mass casualty incident.
 Legal Issues Includes:
o Actual Consent
o Implied Consent
o Parental Consent

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Education (Department of Nursing) 1 of 7
“Good Samaritan Law”
- Gives legal protection to the rescuer who act in good faith and are not guilty of gross negligence or willful
misconduct.

Focus of Emergency Care

 Preserve or Prolong Life
 Alleviate Suffering
 Do No Further Harm
 Restore to Optimal Function

Golden Rules of Emergency Care

 Do’s
- Obtain Consent
- Think of the Worst
- Respect Victim’s Modesty & Privacy
 Don’ts
- let the patient see his own injury
- Make any unrealistic promises

Guidelines in Giving Emergency Care

A – Ask for help
I – Intervene
D – Do no Further Harm

Stages of Crisis
1. Anxiety and Denial
 encouraged to recognize and talk about their feelings.
 asking questions is encouraged.
 honest answers given
 prolonged denial is not encouraged or supported
2. Remorse and Guilt
 verbalize their feelings
3. Anger
 way of handling anxiety and fear
 allow the anger to be ventilated
4. Grief
 help family members work through their grief
 letting them know that it is normal and acceptable

Core Competencies in Emergency Nursing

 Assessment
 Priority Setting/Critical Thinking Skills
 Knowledge of Emergency Care
 Technical Skills
 Communication

Assess and Intervene

Check for ABCs of life
A – Airway
B – Breathing
C - Circulation

Team Members
 Rescuer  Incident Commander
 Emergency Medical Technician  Support Staff
 Paramedics  Inpatient Unit Staff
 Emergency Medicine Physicians

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Education (Department of Nursing) 2 of 7
 Emergency Action Principle
I. Survey the Scene - Extent of Injury and First Aid
 Is the Scene Safe? given
 What Happened? - Telephone number from where
 Are there any bystanders who can help? you’re calling
 Identify as a trained first aider! IV. Do Secondary Survey
II. Do a Primary Survey Interview the Patient (SAMPLE)
organization of approach so that immediate threats S – Symptoms
to life are rapidly identified and effectively manage. A – Allergies
M – Medication
Primary Survey P – Previous/Present Illness
A - Airway/Cervical Spine L – Last Meal Taken
- Establish Patent Airway E – Events Prior to Accident
- Maintain Alignment Check Vital Signs
- GCS ≤ 8 = Prepare Intubation
B – Breathing V. Triage
- Assess Breath Sounds  comes from the French word ”trier”, meaning to
- Observe for Chest Wall Trauma sort
- Prepare for chest decompression  process of assessing patients to determine
C – Circulation management priorities
- Monitor VS Categories:
- Maintain Vascular Access 1. Emergent - highest priority, conditions are life
- Direct Pressure threatening and need immediate attention
Estimated Blood Pressure - Airway obstruction, sucking
SITE SBP chest wound, shock, unstable
chest and abdominal wounds,
Radial ≥ 80 open fractures of long bones
2. Urgent – have serious health problems but not
Femoral ≥ 70 immediately life threatening ones. Must be seen
within 1 hour
- Maxillofacial wounds without
Carotid ≥ 60 airway compromise, eye
injuries, stable abdominal
D – Disability
wounds without evidence of
- Evaluate LOC
significant hemorrhage,
- Re-evaluate clients LOC
fractures
- Use AVPU mnemonics
3. Non-urgent – patients have episodic illness
E – Exposure
than can be addressed within 24 hours without
- Remove clothing
increased morbidity
- Maintain Privacy
- Upper extremity fractures, minor
- Prevent Hypothermia
burns, sprains, small lacerations
III. Activate Medical Assistance
without significant bleeding,
Information to be Relayed:
behavioral disorders or
- What Happened?
psychological disturbance.
- Number of Persons Injured

FIRST AID
Role of First Aid
 Bridge the Gap Between the Victim and the Physician
 Immediately start giving interventions in pre-hospital setting
Value of First Aid Training
 Self-help
 Health for Others
 Preparation for Disaster
 Safety Awareness

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Education (Department of Nursing) 3 of 7
BASIC LIFE SUPPORT
Artificial Respiration - a way of breathing air to person’s lungs when breathing ceased or stopped function.
Respiratory Arrest - a condition when the respiration or breathing pattern of an individual stops to function, while the
pulse and circulation may continue.
Causes: Choking, Electrocution, strangulation, drowning and suffocation.
Methods:
 mouth to mouth
 mouth to nose
 mouth to stoma
 mouth to mouth and nose
 mouth to barrier device
To perform rescue breathing perform the following steps:
1. Check the mouth for obstructions, lift the neck and tilt the head back.
2. Pinch the nostrils and seal the mouth, and exhale directly into the victim's mouth.
3. Release the nostrils and the seal around the mouth.
4. Watch for the victim's chest to rise by itself.
5. Feel for a pulse on the victim's neck.
6. If the victim's chest does not start to rise on its own, repeat this process from number 1, until professional
help arrives.

When to Stop AR:

 when the patient has spontaneous breathing
 when the first aider is too exhausted to continue
 when another first aider takes over
 when EMS arrives and takes over

Cardiopulmonary Resuscitation (CPR)

Cardiac Arrest - a condition when the persons breathing and circulation/pulse stop at the same time
Causes: Cardiovascular Disease, Heart Attack, MI
Management:
External Chest Compression
- consist of rhythmic application of pressure over the lower portion of the sternum just in between the nipple

Cardiopulmonary Resuscitation = AR + ECC

Goal: Rapid return of pulse, BP and consciousness

Check that the area is safe, then perform the following basic CPR steps:
1. Call 911 or ask someone else to.
2. Lay the person on their back and open their airway.
3. Check for breathing. If they are not breathing, start CPR.
4. Perform 30 chest compressions.
5. Perform two rescue breaths.
6. Repeat until an ambulance or automated external defibrillator (AED) arrives.

When to STOP CPR:

S – SPONTANEOUS BREATH RESTORED
T – TURNED OVER THE MEDICAL SERVICES
O – OPERATOR IS EXHAUSTED TO CONTINUE
P – PHYSICIAN ASSUMES RESPONSIBILITY

COMPLICATIONS OF CPR:
 Rib Fracture
 Sternum Fracture
 Laceration of the liver or spleen
 Pneumothorax, hemothorax

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Education (Department of Nursing) 4 of 6
CHAIN OF SURVIVAL
EARLY ACCESS – early recognition of cardiac arrest, prompt activation of emergency services
EARLY BLS – prevent brain damage, buy time for the arrival of defibrillator
EARLY DEFIBRILLATION - 7-10% decrease per minute without defibrillation
EARLY ACLS – technique that attempts to stabilize patient

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. You are a nurse in the emergency department and it is during the shift that Mr. CT is admitted in the area due to a
fractured skull from a motor accident. You scheduled him for surgery under which classification?
a. Urgent
b. Emergent
c. Required
d. Elective
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. The nurse finds the client unresponsive on the floor of the bathroom. Which action should the nurse implement
first?
a. Check the client for breathing.
b. Assess the carotid artery for a pulse.
c. Shake the client and shout.
d. Call a code via the bathroom call light.
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. The nurse is triaging four clients injured in a train derailment. Which client should receive priority treatment?
a. A 42-year-old with dyspnea and chest asymmetry.
b. A 17-year-oldwith fractured arm.
c. A 4-year-old with facial lacerations.
d. A 30-year-old with blunt abdominal trauma
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. A 56-year-old patient presents in triage with left-sided chest pain, diaphoresis, and dizziness. This patient should
be prioritized into which category?
a. High urgent
b. Urgent
c. Non-urgent
d. Emergent
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. This status is used for any patient who can wait more than 2 hours to be seen without the likelihood of
deterioration in the ED.
a. Emergent
b. Urgent
c. Nonurgent

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Education (Department of Nursing) 5 of 6
 d. Dead
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: 3-2-1

Instructions:
1. As an exit ticket at the end of the class period
2. After the lesson, have each student record three things he or she learned from the lesson.
3. Next, have them record two things that they found interesting and that they’d like to learn more about.
4. Then, have students record one question they still have about the material.
5. Review the students’ responses. You can use this information to help develop future lessons and
1. determine if some of the material needs to be taught again.

Three things you learned:

1. ______________________________________
2 ______________________________________
3. ______________________________________
Two things that you’d like to learn more about:
1. ______________________________________
2. ______________________________________
One question you still have:
1. ______________________________________

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Education (Department of Nursing) 6 of 6
 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 7

LESSON TITLE: II. Emergency and Disaster Management: Materials:

In Hospital Triage System and Disaster Triage
Book, pen and notebook
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can:

1. Define triage.
2. Understand the situations in which each model of disaster References:
triage is used.
3. Discuss how objective disaster triage tools are beneficial Veenema, T.G. (2019) Disaster Nursing and
not only to the victims themselves but also to those tasked Emergency Preparedness for Chemical,
with performing triage. Biological, and Radiological Terrorism and other
4. Explain the criteria for each of the five basic primary Hazards 4th Edition
disaster triage levels.
5. Discuss the differences between primary, secondary, and
tertiary disaster triage.
6. Identify the five key elements of triage tools.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: Enumerate the sequence when conducting a primary survey.

MAIN LESSON (40 minutes)

The students will study and read their book about this lesson (Chapter 22 of the book):

BASIC PRINCIPLES OF DISASTER TRIAGING

“Triage is a process which places the right patient in the right place at the right time to receive the right level of care”
(Rice & Abel, 1992). The word “triage” is derived from the French word trier, which means, “to sort out or choose.”

Triage is the process of prioritizing which patients are to be treated first and is the cornerstone of good disaster
management in terms of judicious use of medical resources.

Personal abilities that are essential to be an effective triage officer during a disaster:
1. Clinically experienced
2. Good judgment and leadership
3. Calm and cool under stress
4. Decisive
5. Knowledgeable of available resources
6. Sense of humor
7. Creative problem solver
8. Available
9. Experienced and knowledgeable regarding anticipated casualties

Most Common Terminologies

Daily triage - is performed by nurses on a routine basis in the ED, often utilizing a standardized approach, augmented by
clinical judgment. The goal is to identify the sickest patients to assess and treat them first, before providing treatment to

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Education (Department of Nursing) 1 of 7
others who are less ill and whose outcome is unlikely to be affected by a longer wait. The highest intensity of care is
provided to the most seriously ill or injured patients, even if those patients have a low probability of survival.

Incident triage - occurs when the ED is stressed by a large number of patients due to an acute incident or an ongoing
medical crisis such as pandemic influenza, but is still able to provide care to all patients utilizing existing agency
resources. Additional resources (on-call staff, alternative care areas) may be used, but disaster plans are not activated
and treatment priorities are not changed. The highest intensity of care is still provided to the most critically ill patients. ED
delays may be longer than usual, but eventually everyone who presents for care is attended to.

Disaster triage - is a general term employed when local EMS and hospital emergency services are overwhelmed to the
point that immediate care cannot be provided to everyone who needs it because sufficient resources are not immediately
available. The terms “multiple casualty/multicasualty” and “mass casualty” triage (both also known as “MCI triage”) are
often used interchangeably with “disaster triage.” The distinction between “multiple” and “mass” casualties is principally in
the number of victims and the degree of restriction of resources.

During a disaster, patients are usually sorted into one of the following categories:
1. Minimal or minor (green)
2. Delayed (yellow)
3. Immediate (red)
4. Deceased (black)
5. Expectant (gray)

Special conditions during triage: Incidents involving chemical, biological, or radioactive agents may be intentional or
unintentional (e.g., a truck crash involving the release of hazardous materials). These triage situations require personal
protective equipment for all responders coming into contact with potentially contaminated patients and decontamination
capabilities both in the field and at receiving facilities. During any disaster, triage personnel must ensure that they
themselves do not become victims. One enters the scene for field triage only when scene safety has been assured.

Population-based Triage:
Main goal of population-based triage is to prevent secondary illness or injury such as disease transmission from infectious
individuals or foodborne illness from contaminated or poorly refrigerated supplies. The messages and directions sent
during population-based triage will depend on the type(s) of illness or injury that is trying to be contained. Depending on
the severity, lethality, and/or transmissibility of the illness or injury being prevented, these events can be very serious and
have a huge impact on a community.

SEIRV CLASSIFICATION:
1. Susceptible individuals—those individuals who are unexposed but susceptible.
2. Exposed individuals—susceptible individuals who have been in contact with the disease and may be infected and
incubating but still noncontagious.
3. Infectious individuals—persons who are symptomatic and contagious.
4. Removed individuals—persons who no longer can pass the disease to others because they have survived and
developed immunity or died from the illness.
5. Vaccinated or on prophylactic antibiotics—persons in this group are a critical resource for the essential workforce

PHASES OF DISASTER TRIAGE: FROM THE FIELD TO THE HOSPITAL

Primary Triage: The goal of primary triage is usually to sort patients into five triage categories: Immediate, Delayed,
Minimal, Expectant, and Dead.

Secondary Triage: Additional information about each patient is obtained through a more thorough physical assessment
and history. This is similar to the traditional trauma secondary survey, in which physiology is reassessed and obvious
injuries are identified. When secondary triage is done in the field, one of the goals is to determine which patients have
conditions that can be temporarily but effectively treated on-scene using available personnel and resources and identify
those whose immediate needs can be met only in a hospital setting.

Tertiary Triage: Hospital personnel determine if the facility can provide appropriate care or if the patient will require
stabilization and transfer to a facility capable of a higher level of care.

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Education (Department of Nursing) 2 of 7
IN-HOSPITAL TRIAGE SYSTEM FOR DAILY OPERATIONS

Typical Data Elements Gathered at ED Triage During Normal Operations

 Name
 Age
 Gender
 Chief complaint (CC)
 History of present illness (HPI)
 Mechanism of injury (MOI)
 Past medical or surgical history (PM/SHx.)
 Allergies to food or medication (Allergies)
 Current medications (Meds)
 Date of last tetanus immunization
 Last menstrual period (for females between the ages of 11 and 60) (LMP)
 Vital signs: temperature, pulse, blood pressure, respiratory rate, oxygen saturation (VS)
 Level of consciousness (LOC)
 Skin vital signs (Skin vitals): temperature, color, moisture
 Visual inspection for obvious injuries
 Height and weight (pediatric patients) (Ht./Wt.)
 Mode of arrival (MOA)
 Private medical provider (PMD)
 Other

Most hospitals utilize a triage system that has three to five categories. The three main categories are emergent (Class 1),
urgent (Class 2), and nonurgent (Class 3). Where four or five levels are used, subcategories are added to either end of
the spectrum.

Three-tier System

Emergent signifies a condition that requires treatment immediately or within 15 to 30 minutes.

Urgent category is assigned to patients with serious illness or injury that must be attended to as soon as possible, but for
whom a wait of up to 2 hours would probably not add to morbidity or mortality.

Nonurgent status is used for any patient who can wait more than 2 hours to be seen without the likelihood of
deterioration.

In a four-tier system, the Emergent category is usually subcategorized to identify those conditions that must be treated
immediately (STAT or 1A) versus rapidly (within a few minutes, 1B). STAT conditions would include cardiac arrest,
respiratory failure/arrest, airway obstruction, shock, and seizure. Conditions classified as 1B would include moderate to
severe respiratory distress, cardiac dysrhythmia with adequate blood pressure, or heavy bleeding without hypotension or
tachycardia.

In a five-tier system, the Nonurgent category is also subcategorized. Conditions that are nonacute, but require the
technology of the ED to diagnose or treat, are categorized as nonurgent ED (Class 3). This would include conditions such
as minor lacerations requiring sutures, or minor musculoskeletal trauma requiring x-rays for diagnosis.

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Education (Department of Nursing) 3 of 7
SALT TRIAGE

CDC-sponsored expert panel developed SALT Triage. It is nonproprietary and meets the model uniform core criteria for
mass casualty triage. SALT stands for Sort-Assess-Lifesaving interventions-Treatment/ transport, which describes the
steps followed when performing SALT triage.

Once any lifesaving interventions are performed, the responders should evaluate the patient and prioritize him or her for
treatment and/or transport.

 Dead: those who are not breathing even after lifesaving interventions have been attempted.
 Immediate: those with difficulty breathing, uncontrolled hemorrhage, absence of peripheral pulses, and/or inability
to follow commands; who are likely to survive given the available resources.
 Expectant: those with difficulty breathing, uncontrolled hemorrhage, absence of peripheral pulses, and/or inability
to follow commands; who are unlikely to survive given the available resources.
 Delayed: those who are alert and follow commands, have palpable peripheral pulses, no signs of respiratory
distress, and all bleeding is controlled, with injuries or an illness that in the opinion of the rescuer is more than
minor.
 Minimal: those who are alert and follow commands, have palpable peripheral pulses, no signs of respiratory
distress, and all bleeding is controlled, with injuries/condition that in the opinion of the rescuer are minor.

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Education (Department of Nursing) 4 of 7
 SIMPLE TRIAGE AND RAPID TREATMENT (START) JumpSTART
The five basic parameters assessed with START are: The JumpSTART Pediatric MCI Triage Tool
 the ability to walk was the first objective tool developed
 the presence or absence of spontaneous specifically for the primary triage of children in
respirations the multicasualty/disaster setting
 the respiratory rate
 an assessment of perfusion
 the ability to obey commands.

These parameters are often referred to as respirations,

perfusion, and mental status (RPM).

THE JOB OF THE TRIAGE OFFICER

The primary responsibility of the triage officer is to ensure that every victim has been found and triaged. Triage officers
and those responders assigned to perform triage do not provide immediate treatment other than to provide lifesaving
interventions such as opening airways and trying to control active bleeding.

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. It is a process which places the right patient in the right place at the right time to receive the right level of care” (
a. Assessment
b. Triage
c. History taking
d. Nursing process
ANSWER: ________

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Education (Department of Nursing) 5 of 7
 RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. It is performed by nurses on a routine basis in the ED, often utilizing a standardized approach, augmented by
clinical judgment.
a. Daily Triage
b. Incident Triage
c. Disaster Triage
d. Population-based Triage
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. It occurs when the ED is stressed by a large number of patients due to an acute incident or an ongoing medical
crisis such as pandemic influenza, but is still able to provide care to all patients utilizing existing agency
resources.
a. Daily Triage
b. Incident Triage
c. Disaster Triage
d. Population-based Triage
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. These are those who have difficulty in breathing, uncontrolled hemorrhage, absence of peripheral pulses, and
inability to follow commands.
a. Minimal
b. Delayed
c. Expectant
d. Immediate
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. This status is used for any patient who can wait more than 2 hours to be seen without the likelihood of
deterioration in the ED.
a. Emergent
b. Urgent
c. Nonurgent
d. Dead
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

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Education (Department of Nursing) 6 of 7
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: 3-2-1

Instructions:
1. As an exit ticket at the end of the class period
2. After the lesson, have each student record three things he or she learned from the lesson.
3. Next, have them record two things that they found interesting and that they’d like to learn more about.
4. Then, have students record one question they still have about the material.
5. Review the students’ responses. You can use this information to help develop future lessons and
1. determine if some of the material needs to be taught again.

Three things you learned: Two things that you’d like to learn more about:
1. ______________________________________ 1. ______________________________________
2 ______________________________________ 2. ______________________________________
3. ______________________________________
One question you still have:
1. ______________________________________

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Education (Department of Nursing) 7 of 7
 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 8

LESSON TITLE: Mass Casualty Incidents: Traumatic Materials:

injury due to Explosives and Blast Incidents
LEARNING OUTCOMES: Book, pen and notebook

Upon completion of this lesson, the nursing student can:

1. Define what traumatic injuries may happen due to References:

blast incidents and explosives Veenema, T.G. (2019) Disaster Nursing and
2. Identify the factors associated with explosives and Emergency Preparedness for Chemical,
blast incidents Biological, and Radiological Terrorism and other
3. Identify the classifications of blast injuries Hazards 4th Edition
4. Determine the appropriate nursing interventions for
patients with traumatic injury due to explosives and
blast effects
5. Understand the rationale behind the managements
for patients with traumatic injury due to explosives and
blast effects

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: Identify and explain the Three-Tier system of Triaging.

1.

2.

3.

MAIN LESSON (40 minutes)

Traumatic Injury Due to Explosives and Blast Effects

Resultant bodily & structural damage following an explosion depends on:
o Type of explosive
o Medium in which the explosion occurred
o Proximity to the explosion’s epicenter
Assist the health care providers to determine what type of injuries & how many casualties to expect following an
explosion
o Total number of casualties = Number of casualties arriving in the first hour x 2

Classifications of Blast Injury

A. Primary Blast Injury
o Unique to HE
o Due to impact of over-pressurization wave with body surfaces
o Commonly involve air-filled organs & air-fluid interfaces (middle ear, lungs, GIT )
 Types of injuries
o Blast lung, TM rupture
o Abdominal hemorrhage & perforation
o Globe rupture

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Education (Department of Nursing) 1 of 7
 Tympanic Membrane Injury
o TM- structure most frequently injured by blast
 TM rupture
 Ossicle dislocation
 Disruption of oval or round window
o Sx: hearing loss, tinnitus, vertigo, bleeding from external canal, mucopurulent
otorrhea
B. Secondary Blast Injury
o Due to flying debris & bomb fragments
o Penetrating ballistic or blunt injuries
o Leading cause of death in military & civilian terrorist attacks except in cases of major building collapse
o Wounds can be grossly contaminated

C. Tertiary Blast Injuries

o Due to persons being thrown into fixed objects by wind of explosions
o Also due to structural collapse & fragmentation of building & vehicles; structural collapse may cause
extensive blunt trauma.
o Crushing injuries, fracture & traumatic amputation
o Closed & open brain injury

D. Quaternary Blast Injuries

o Explosion related injuries or illnesses not due to primary, secondary, or tertiary injuries
o Exacerbations of preexisting conditions (asthma, COPD, CAD, HTN, DM, etc.)
o Burns (chemical & thermal)
o Toxic inhalation
o Radiation exposure
o Asphyxiation (CO, cyanide)

General Considerations
 Confined space vs. open space: increase number of penetrating & primary blast injuries if closed space
 Blast wave reflected by solid surfaces: person next to a wall may sustain a greater primary blast injury
 Detonating a bomb underwater will produce more damage than air detonation because water is incompressible.
 Half of all initial casualties seek medical care over first hour
 Expect upside down triage
 Most severely injured arrive after less injured who bypass EMS & self-transport to closest hospitals
 Initial explosion attracts law enforcement & rescue personnel who will be injured by second explosion

 Open Space
o Potential for shrapnel to travel a large distance (>100m)
o Less primary blast injury
 Enclosed Space
o Increased mortality
o Increased blast pressure
o Complicated rescue
 Structural Collapse
o Increased mortality from primary blast wave as well as from tertiary and quaternary injuries

Management Elements of an Explosion

 Search & Rescue
 Triage
 Initial stabilization
 Definitive medical treatment
 Evacuation

ATLS Primary Survey (Advance Trauma Life Support)

SURVEY IDENTIFICATION AND MANAGEMENT
A. Airway and Cervical Spine Assess and maintain airway patency: assess for foreign bodies and fractures
Immobilization that may lead to obstruction

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Education (Department of Nursing) 2 of 6
 Immobilize cervical spine with an available device
B. Breathing and Ventilation Assess for bilateral chest wall movement; auscultate and visualize chest wall
and lung fields

Identify pneumothorax, flail chest, hemothorax, and open pneumothorax

C. Circulation Consider hypovolemia the cause of hypotension until proven otherwise

Assess LOC, skin color, and pulse for signs of hypovolemia and hypoxia

Identify and control external hemorrhage, identify internal hemorrhage

D. Disability and Neurologic Deficit Assess Glascow Coma Scale, pupil size and reactvity

A decreased LOC may require intubation

E. Exposure and Environmental Control Expose the patient t view all body surfaces for evidence of injury
Cover with warm blankets and use warmed intravenous fluids to maintain
temperature

ATLS Secondary Survey Physical Examination

BODY SYSTEM EXAMINATION
Neurologic Assess LOC, sensory and motor function, and pupillary response

Consult neurosurgery and obtain a head CT if head injury is suspected

Head Examine head and scalp for injury and fractures

Assess vision and pupils. Hemorrhage, penetrating injury, lens dislocation and ocular
entrapment may occur

Contacts should be removed

Maxilofacial Assess for fractures and soft-tissue injury

Place a gastric tube orally in patients with suspected or confirmed facial fractures
Cervical Spine and Neck Maintain spine precautions
Chest Auscultate breath and cardiac sounds

Obtain chest x-ray

Abdomen Unexplained hypotension may be the result of an internal hemorrhage

Peritoneal lavage, ultrasound, abdominal CT may be necessary to rule out injury

Perineum, Rectum, and Assess for contusions, hematomas, lacerations, and bleeding
Vagina
Perform a rectal exam prior to placing a Foley catheter
Musculoskeletal All extremities, pelvic ring, peripheral pulses, and thoracic and lumbar spine should be
assessed

X-rays should be obtained when the patient is stabilized, if necessary

Blast Injuries
SYSTEM INJURY OR CONDITION
Auditory TM rupture, ossicular disruption, cochlear damage, foreign body
Eye, orbit, face Perforated globe, foreign body, fractures
Respiratory Blast lung, hemothorax, pneumothorax, pulmonary contusion and hemorrhage, airway
epithelial damage
Digestive Bowel perforation, hemorrhage, ruptured liver or spleen, sepsis
Circulatory Cardiac contusion, myocardial infarction from air embolism, shock, hypotension, peripheral
vascular injury, air embolism-induced injury
CNS Injury Concussion, closed and open brain injury, stroke, spinal cord injury
Renal Renal contusion, laceration, acute renal failure due to rhabdomyolysis, hypotension, and
hypovolemia
Extremity Injury Traumatic amputation, fractures, crush injuries, compartment syndrome, burns, cuts,

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 3 of 6
 lacerations, acute arterial occlusion, air embolism-induced injury

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. The nurse is caring for a client with a blast injury. Which of the following nursing assessments would be most
appropriate for this client?
a. Assess for vasovagal hypotension
b. Assess the client for confusion
c. Assess for asphyxia
d. Assess for hypervolemia
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. The patient has a blasted lung and injury to his tympanic membrane. This classification of blast injury is:
a. Primary blast injury
b. Secondary blast injury
c. Tertiary blast injury
d. Quarternary blast injury
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. The patient has crushing injuries, fracture, traumatic amputation, and open brain injury This classification of blast
injury is:
a. Primary blast injury
b. Secondary blast injury
c. Tertiary blast injury
d. Quarternary blast injury
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. After a blast incident, the primary responsibility of the responders is to:

a. Search and rescue
b. Conduct survey
c. Raise an alarm
d. Provide medications
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. During initial stabilization, the nurse should keep in mind that

a. Provide first aid in a safe place
b. Alleviate the worries of patients who are panicking
c. Find the patient’s belongings for identification
d. Ask questions to the patient during first aid
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

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Education (Department of Nursing) 4 of 6
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: Muddiest Point:

In today’s session, what was least clear to you?

_________________________________________________________________________________________________

_________________________________________________________________________________________________

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Education (Department of Nursing) 5 of 5
 NUR 113: DISASTER NURSING

STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR

Session # 9

LESSON TITLE: Management of Burns Mass Casualty Materials:

Incident
LEARNING OUTCOMES: Book, pen and notebook

Upon completion of this lesson, the nursing student can: References:

1. Identify main components of a burn disaster plan. Veenema, T.G. (2019) Disaster Nursing and
2. Describe the etiology, basic pathophysiology and initial Emergency Preparedness for Chemical,
management of burn injury. Biological, and Radiological Terrorism and other
3. Accurately compute fluid replacements for burn Hazards 4th Edition
patients.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: Explain briefly the four classifications of blast injury.

MAIN LESSON (40 minutes)

BURNS
- occur when there is an injury to the tissues of the body (primarily the skin) caused by heat, chemicals, electric
current or radiation.

Classification of Burns
1. Superficial Partial-thickness - the epidermis is destroyed or injured and a portion of the dermis may be injured.
The damaged skin may be painful and appear red and dry, as in sunburn, or it may blister.

2. Deep Partial-thickness - involves destruction of the epi-dermis and upper layers of the dermis and injury to deeper
portions of the dermis. The wound is painful, appears red, and exudes fluid.

3. Full-thickness - involves total destruction of epidermis and dermis and, in some cases, underlying tissue as well.
Wound color ranges widely from white to red, brown, or black. The burned area is painless because nerve fibers
are destroyed.

Local Physiologic Alterations

• Loss of protective barriers
• Escape of body fluids
• Lack of temperature control
• Diminished sensory receptors

Extent of Body Surface Area Injured

1. Rule of Nines
The system assigns percentages in multiples of nine to major body surfaces.

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Education (Department of Nursing) 1 of 6
 2. Lund and Browder Method
A more precise method of estimating the extent of a burn is the Lund and Browder method, which recognizes that
the percent-age of TBSA of various anatomic parts, especially the head and legs, and changes with growth. By
dividing the body into very small areas and providing an estimate of the proportion of TBSA accounted for by such
body parts, one can obtain a reliable estimate of the TBSA burned. The initial evaluation is made on the patient’s
arrival at the hospital and is revised on the second and third post-burn days because the demarcation usually is
not clear until then.

3. Palm Method
In patients with scattered burns, a method to estimate the per-centage of burn is the palm method. The size of the
patient’s palm is approximately 1% of TBSA

Burn Triage in Mass Casualty Incidents

Primary triage
o Local disaster triage criteria
o Occurs at the site
Secondary triage
o Occurs in the hospital or burn center
ABA (American Burn Association) triage policy
o All burn patients should be transferred to a burn center within 24 hours of injury

Management of a Mass Casualty Burn Patient

 STOP the burning process
 Manage the AIRWAY, BREATHING, and CIRCULATION
 Begin FLUID RESUSCITATION
 Keep the patient WARM
 EVALUATE for other life-threatening injuries

Management of Burn MCI: Primary Survey: Stop the Burning Process

 Extinguish the flames (stop, drop and roll)
 Irrigate with cool water
 Use of ice or ice water is contraindicated

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Education (Department of Nursing) 2 of 6
Management of Burn MCI: Primary Survey:
Airway, Breathing, Circulation
 Endotracheal intubation:
o Hoarseness
o Stridor
o Excessive use of accessory muscle
o Difficult respirations
o Decreased LOC
 100% oxygen – smoke inhalation
 Two large-bore peripheral IV catheters

Management of Burn MCI: Primary Survey: Fluid Resuscitation

 Fluid resuscitation
o 2nd or 3rd degree burns greater than 10-20% TBSA
o Significant smoke inhalation injury
 Insertion of urine catheter
 Indications:
- Adults with burns involving more than 10% - 20% TBSA
- Children with burns involving more than 10-15% TBSA
- Patients with electrical injury, the elderly, or those with cardiac or pulmonary disease and compromised
response to burn injury
 The amount of fluid should maintain a urinary output of 30 - 50 ml/hr

Successful fluid resuscitation is evidenced by:

- Stable vital signs - Palpable peripheral pulse
- Adequate urine output - Clear sensorium
 Urinary output is the most common and most sensitive assessment parameter for cardiac output and tissue
perfusion

PARKLAND FORMULA
Example: Patient’s weight: 70 kg; % TBSA burn: 80%
1st 24 hours:
4 ml x 70 kg x 50% TBSA = 14,000ml of lactated Ringer’s
 1st 8 hours = 7,000 ml or 875 ml/hour
 2nd 16 hours = 7, 000 ml or 437.5 ml/hour

BROOKE ARMY FORMULA

0.5ml colloid x weight in kg x TBSA (bld, plasma, dextran)
1.5ml electrolytes X weight in kg x TBSA (normal saline)
Non electrolytes – 2000 ml (D5W)

 Day 1 = same as parkland

 Day 2 – ½ colloids, + ½ electrolytes + non electrolytes to run for 24 hours

EVANS
1ml colloid x weight in kg x TBSA (bld, plasma, dextran)
1ml electrolytes X weight in kg x TBSA (normal saline)
Non electrolytes – 2000 ml (D5W)
 Day 1 = same as parkland
 Day 2 – ½ colloids, + ½ electrolytes + non electrolytes to run for 24 hours

 Initial hourly rate:

o 0.25 mL x kg x %TBSA
 Goal: Urine output:
o Adults: 0.5 mL/kg/hr
o Children less than 30 kg: 1 mL/kg/hr
 Rule of thumb:
o Decrease the fluid rate by 10% every hour if goal is met
o Increase the fluid rate by 20% and observe the next hour, if goal is not met

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Education (Department of Nursing) 3 of 6
Adult maintenance fluid requirement: the fluid is titrated down to maintenance rate at 24 hours from the time of injury
30 mL/kg/day (plus an estimate of insensible loss)

Pediatric Maintenance Fluids: 5% dextrose

First 10 kg of body weight: 100 mL/kg over 24 hours
Second 10 kg of body weight: Add 50 mL/kg to above total
Each kg over 20 kg: Add 20 mL/kg to above total

Management of Burn MCI: Primary Survey: Other Considerations

 On-site:
o Keep the patient warm: rescue blankets or dry sheets
o Remove constrictive clothing and jewelry
 Hospital care:
o Keep the room to a minimum of 30 degrees Celsius
o Keep the patient warm: warm blankets in the hospital
o Assess pulses hourly: radial, ulnar posterior tibial, dorsalis pedis

Management of Burn MCI: Secondary Survey

 Accurate history
 Complete examination
 Close re-examination of the burn wound
 Patient Pre transport Checklist (before secondary triage to another healthcare facility)
o Primary and secondary survey are complete
o Patient is hemodynamically stable
o IV fluid resuscitation
o Patient is warm, wrapped in blankets
o ET tube, IV catheters, urine catheters, NG tube are secure and functioning
o Documentation is complete

Burn Wound Care in MCI

 Principles:
o Keep the wound clean, moist, and covered
o May keep the wound covered for transport
o When the patient arrives in the facility, cleanse with soap and warm water
o Remove any debris and loose, dead skin, and pat dry

Pain Control
 Intravenous narcotics are usually sufficient to maintain adequate pain control
 Oral and subcutaneous routes should not be used to treat burns greater than 20% TBSA

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. On assessment, the nurse notes that the client has burns inside the mouth and is wheezing. Several hours later,
the wheezing is no longer heard. What is the nurse’s next action?
a. Documenting the findings
b. Loosening any dressings on the chest
c. Raising the head of the bed
d. Preparing for intubation
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

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Education (Department of Nursing) 4 of 6
 2. A client who is admitted after a thermal burn injury has the following vital signs: blood pressure, 70/40; heart rate,
140 beats/min; respiratory rate, 25/min. He is pale in color and it is difficult to find pedal pulses. Which action will
the nurse take first?
a. Start intravenous fluid line
b. Check the pulses with a Doppler device
c. Obtain a complete blood count
d. Obtain an electrocardiogram
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. What is the priority nursing diagnosis during the first 24 hours for a client with full-thickness chemical burns on the
anterior neck, chest, and all surfaces of the left arm?
a. Risk for ineffective breathing pattern
b. Decreased tissue perfusion
c. Risk for disuse syndrome
d. Disturbed body image
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. When should ambulation be initiated in the client who has sustained a major burn?
a. When all full-thickness areas have been closed with skin grafts
b. When the client’s temperature has remained normal for 24 hours
c. As soon as possible after wound debridement is complete
d. As soon as possible after resolution of the fluid shift
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. Which intervention is most important to use to prevent infection by auto-contamination in the burned client during
the acute phase of recovery?
e. Changing gloves between wound care on different parts of the client’s body.
f. Avoiding sharing equipment such as blood pressure cuffs between clients
g. Using the closed method of burn wound management.
h. Using proper and consistent handwashing
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________

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Education (Department of Nursing) 5 of 6
 RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: Minute Paper

1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2) What question(s) do you have as we end this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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Education (Department of Nursing) 6 of 6
 Nur 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 10

LESSON TITLE: Infectious Disease Emergencies and Materials:

Coronavirus (Covid-19)
Book, pen and notebook
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can: References:

1. Describe the relationships between emergencies and Veenema, T.G. (2019) Disaster Nursing and
infectious diseases. Emergency Preparedness for Chemical,
2. Identify factors contributing to emerging or resurgent Biological, and Radiological Terrorism and other
infections. Hazards 4th Edition
3. List of infectious diseases of high concern.
4. Explain the epidemiological triangle. https://www.cdc.gov
5. Discuss the cause of Covid-19. https://www.who>Diseases
6. Describe the clinical manifestations for Covid- 19.
7. Identify preventive measures for decreasing the
transmission of Covid -19.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the three classifications of burns?

MAIN LESSON (40 minutes)

Infectious Diseases
 A major cause of global morbidity and mortality after causing or associated with large scale public health
emergencies. Ninety deaths are caused by only six diseases.
percent of all infection diseases.
Emergencies
 Are caused by infectious conditions may occur as the primary event, or a secondary
challenge following or worsening another type of emergency.

The emergence or resurgence of an infectious disease requires the convergence of complex factors
that can be:
 genetic and biological
 physical
 ecological,
 Social
 Political
 behavioral in nature.

Infectious Diseases and Emergencies: Infectious diseases that increase in incidence and prevalence, possibly to the
point of epidemic, pandemic, or emergency, can be classified as being in one of three groups:

■ Emerging—infections that have newly appeared in a human population and have not been previously known,
such as SARS or new strains of avian influenza
■ Reemerging or resurging—infections that have been known but demonstrate a marked increase in incidence or
geographical range, such as the enormous surge of Ebola in West Africa

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Education (Department of Nursing) 1 of 8
 ■ Deliberately emerging—natural or bioengineered agents distributed by individuals as a criminal act of
bioterrorism, such as the anthrax cases in the United States in the fall of 2001

Leading Causes of Infection Disease Death according to WHO in 2017

■ Diarrheal disease
■ HIV/AIDS
■ Malaria
■ Childhood diseases, primarily measles
■ Pneumonia
■ Tuberculosis
■ Hepatitis B

EPIDEMIOLOGICAL TRIANGLE

 A model for explaining the organism causing the disease and the condition that allow it to reproduce and spread.

Made up of 3 parts:

1. Agent- the microorganism that actually causes the disease

2. Host- the organism that carries the disease, a human who is susceptible to the disease
3. Environment- factors that support the transmission

FACTORS CONTRIBUTING TO THE SPREAD OF INFECTIOUS DISEASES:

 Microbial adaption and change
 Human susceptibility to infection
 Climate and weather
 Changing ecosystem
 Human demographic and behavior
 International travel and commence

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Education (Department of Nursing) 2 of 8
  Technology and industry
 Breakdown of public health measures
 Poverty and social inequality
 War and famine

Diseases of particular Importance to address in disaster and emergency planning and response activities are
those that are known to be:
1. Highly contagious
2. Have high mortality rate
3. To which there is no or limited human immunity coupled with either a no available treatment or treatment to which
the organism is resistant

6 Conditions of Particular Importance:

1. Cholera
2. Dengue fever
3. HIV
4. Influenza
5. Marburg hemorrhagic fever
6. Smallpox

CLINICAL PROFILE of CHOLERA

Transmission Clinical Symptoms Diagnosis Therapy

Exposure to drinking water or Mild infection, little or mild Symptomatic, with definitive Immediate fluid and
food contaminated by feces gastrointestinal distress diagnosis based on electrolyte
of an infected individual laboratory examination of replacement, with
stool specimen oral rehydration
solution in large
amounts
Direct person-to-person Severe disease (~5% of Intravenous fluid
transmission unlikely cases), profuse, watery and electrolyte
diarrhea, vomiting, leg replacement may
cramps. Intravenous fluid and be needed in
electrolyte replacement may severe cases
be needed in severe cases

Death can occur within hours

if severe disease not treated

CLINICAL PROFILE of DENGUE FEVER

Transmission Clinical Symptoms Diagnosis Therapy
Between • MILD: Principal symptoms are • Clinical symptoms Fever management
people via high fever and at least two of the • Lab tests: early: 1–5 (acetaminophen
mosquitos following: days (virus, viral nucleic only, NO ibuprofen or
• Severe headache with pain acid, antigens) aspirin-containing
behind the eyes • Lab tests: later: after day medications)
• Arthralgia 5 (antibodies) • Fluid management
• Muscle and or bone pain • Differential diagnosis: • Close monitoring
• Rash yellow fever, Japanese for progression to
• Mild bleeding (gums, petechiae) encephalitis, St. Louis warning signs which
• Low white blood cell count encephalitis, Zika and signal severe dengue
• SEVERE: Any of the following West Nile virus
symptoms • During a confirmed
require emergency medical large-scale outbreak,

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Education (Department of Nursing) 3 of 8
 attention. Usually progresses after diagnosis is made
a 2–7-day febrile phase: by clinical signs and
• Severe abdominal pain symptoms
• Red spots on the skin
• Bleeding from nose or gums
(heavy)
• Vomiting blood or black, tarry
stools
• Drowsiness or irritability
• Pale, cold, clammy skin
•Difficulty breathing

CLINICAL PROFILE of HIV/AIDS

Transmission Clinical Symptoms Diagnosis Therapy

Exposure to causal agent • Shortly after initial Identification of antibodies Antiviral medication
(the HIV retrovirus) infection, flu-like through screening test to keep
through blood or semen of symptoms possible confirmed through viral load low and
infected individual (sexual • Impaired immune diagnostic laboratory test support immune
activity or sharing injection response leads to and assessment of viral function
equipment most common vulnerability to load • Treatment
routes) opportunistic infections, • Monitoring of viral load guidelines are
• Maternal infection of fetus which if untreated, may allows for adjustment of regularly updated by
during pregnancy cause death therapy national and
international health
authorities
• Prompt treatment of
Opportunistic
infection, if it occurs
• Use of prophylaxis
during pregnancy/
delivery or
immediately after
occupational
exposure markedly
reduces infection of
newborn or worker

CLINICAL PROFILE of INFLUENZA

Transmission/Isolation Clinical Presentation Diagnosis Therapy
• Transmission between • “Influenza-like” symptoms: • Viral culture Oseltamivir and
persons is due to inhaled • Fever • IFA Zanamivir are both
droplets from infected • Cough • Serologic studies thought to be
individual, once disease is • Sore throat • PCR effective in
in human population • Myalgia treatment and
• Hospitalized patients • Possibly: prevention
are isolated in negative • Pneumonia
pressure rooms to • Severe respiratory disorder, viral
minimize transmission pneumonia
• Atypical presentations:
• Nausea/vomiting
• Diarrhea
• Acute respiratory failure

CLINICAL PROFILE of MARBURG HEMORRHAGIC FEVER

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Education (Department of Nursing) 4 of 8
 Transmission/Isolation Clinical Presentation Diagnosis Therapy

• Human-to-human • Fever • ELISA Supportive Therapy

transmission is possible • Cough • PCR
through bodily fluids, including • Headache • IgG capture ELISA
those of • Conjunctivitis if patient has
the deceased • Petechial rash (primarily truncal) recovered
• Natural reservoir of the • Shock • Viral culture during
disease remains • Liver failure the acute phase
uncertain • Hemorrhaging
• Isolate in negative pressure • Multisystem dysfunction
room
• Universal precautions with N-
95 or HEPA
Mask when giving care

CLINICAL PROFILE of SMALLPOX

Transmission/Isolation Clinical Presentation Diagnosis Therapy

Prolonged, face-to-face • Initial symptoms (2–4 days): Symptomatic, with No specific

contact with the infected • Fever (101–104 degrees) careful attention treatment:
person throughout the • Malaise to distribution and • Supportive
symptomatic period until • Head/body aches appearance of rash therapies only
all scabs have fallen off • Rash stages: • Confirmation with
• Direct contact with bodily • Mouth and tongue (4 days) PCR and viral isolation
fluids or contaminated • Pustular rash, Cover body within
bedding/clothing 24
hours
• Distinguished by bumps in
center of
raised bumps (~10 days):
• Scabbing and resolution (~10
days)

One Health is defined as a collaborative, multisectoral, and transdisciplinary approach—working at the local, regional,
national, and global levels—with the goal of achieving optimal health outcomes recognizing the interconnection between
people, animals, plants, and their shared environment

CORONAVIRUS (COVID -19)

 The abbreviated name for novel coronavirus disease 2019, which is a respiratory illness that spreads from person
to person. The virus that causes Covid -19 is a novel coronavirus which was first identified during an investigation
into an outbreak in Wuhan, China. (CDC)
 Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed Covid 19 cases.
 Symptoms may appear 2-14 days after exposure and include:
Most common symptoms: fever, dry cough, tiredness
Less common symptoms: aches and pain, sore throat, diarrhea, headache, conjunctivitis, loss of taste and smell,
a rash or skin or discoloration of fingers and toes.
Serious symptoms: difficulty of breathing, chest pain, loss of speech or movement

Outcomes:
Symptoms are usually mild and began gradually with some individuals asymptomatic up to 80% of the general
population who are infected recover wit out any need to seek care. Some will develop severe illness (typically in the 2 nd
week of illness). Just as with influenza and other viral infections, older adults and patients with medical problems like
cardiovascular diseases, diabetes, chronic respiratory diseases, and cancer are at increased risk to develop severe

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Education (Department of Nursing) 5 of 8
illness (CDC). Fortunately, it appears that children who are infected with this illness generally present mild symptoms and
severe complications appear.
Seek immediate medical attention if there is severe symptoms. Always call before visiting a doctor or health facility.
People with mild symptoms should manage their symptoms at home.

Some Strategies to Prevent the Spread of Covid 19:

Hand Hygiene: Wash hands with soap and water for at least 20 seconds: before and after contact with clients,
after blowing nose, coughing, or sneezing, after coming from bathroom, before eating, after touching with
contaminated surfaces or equipment and after removing protective personnel protective equipment (PPE).
Facial hygiene: Avoid touching the eyes, nose and mouth. When coughing or sneezing cover with tissue then
throw the tissue in the trash.
Keep it Clean: Clean and disinfect frequently touched objects and surfaces with approved hospital disinfectant
(such as beds, wheelchairs, remote controls, switch)
Monitor Residents and Prepare Yourself: Restrict residents with fever or acute respiratory symptoms to their
room. If they must leave the room for medically necessary procedures, have them wear a face mask.
Sick Restrictions: As with all situations, health care professionals who are ill should stay at home and seek
healthcare advice through the primary healthcare provider.
During a” community spread” Covid 19 event, direct patient care staff will be assessed for illness or fever by
nursing mangers or supervisors before ‘shift start’ time to ensure patent safety. Expect to include a checking of
regular temperature to ensure the clinical staff does not have an active fever.
During a community spread event of Covid 19 visitor access will be restricted by several different measures which
include:
 Posting of warning signs and “Stop” signs outside the facility to describe the current policies for
allowing visitors.
 If visitors are allowed, a screening method that are accounts for the individuals’ exposure risk and if
they are experiencing symptoms of illness.

Diagnosis:
 Most patients with confined Covid 19 have developed fewer symptoms of acute respiratory illness which may
include cough and difficulty of breathing.

Epidemiologic factors that may help guide decisions to whether to test include:
 Any persons, including healthcare workers who have close contact with a laboratory confined Covid 19
patient within 14 days of symptom onset.
 Or a history of travel from affected geographical areas within 14 days of symptom onset.

Precautions for Protection:

Droplet isolation: Recently updated CDC guidelines have downgrades Covid 19 from airborne precautions to now
droplet precautions. However, there are some scenarios that call for the use of airborne precautions.
 Covid 19 patients (Non respiratory Treatments)
During all lower risk (Non respiratory treatments) utilize droplet precautions. This includes the utilization of
surgical masks, eye protection, gowns and gloves for patients suspected or confined to have been
infected by Covid 19.
 Covid 19 (Respiratory treatments)
Respiratory treatments that may lead to aerosolization of viral particles include nebulizers, suctioning,
tracheostomy care and application or adjustment of oxygen masks.
If a patient is suspected or confined Covid 19 and has a respiratory treatment that increase the chances
of aerosolization, it is recommended that staff prioritize the use of N95 mask.
Isolate Precaution for Protection/ Quarantine Room: As most non hospital facilities are likely to have airborne
isolation rooms or negative pressure rooms, it is recommended that the individual should be placed in a single
room with closed door (CDC, WHO).

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Education (Department of Nursing) 6 of 8
CHECK FOR UNDERSTANDING (10 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. What are the common symptoms of Covid 19?
a. A new and continuous cough
b. fever
c. tiredness
d. All of the above
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
2. How is Covid-19 passed on?
a. Through droplets that come from the mouth and nose when sneezes, cough or breathes out.
b. By drinking unclean water
c. In sexual fluids, including semen, vaginal fluids and mucous.
d. All of the above

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. The most effective way for healthcare providers to protect themselves, their family and their patients from
influenza is to:
a. Wear a surgical mask at all times at work.
b. Stay at home if they have respiratory symptoms.
c. Get an annual shot and encourage their family, co-workers and patients to get the flu-vaccine annually.
d. Not to go to work at all.

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. What is the most important hygiene habit to teach young children?

a. Wash hands frequently
b. Use tissue to cover nose when sneezing
c. Take a bath daily
d. Don’t share glass or eating utensil
: ANSWER: ____________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. It is a model for explaining the organism causing the disease and condition that allow it to reproduce and spread.
a. One health
b. Nursing care plan
c. Chain of infection
d. Epidemiological Triangle

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
_________________________________________________________________________________________

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Education (Department of Nursing) 7 of 8
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: Minute Paper

1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2) What question(s) do you have as we end this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 8 of 8
 NUR 113: DISASTER NURSING

STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR

Session # 11

Materials:
LESSON TITLE: Natural Disasters
Book, pen and notebook
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can:
References:
1. Identify the major types of natural/ environmental Veenema, T.G. (2019) Disaster Nursing and
disasters and their physical, social and economic Emergency Preparedness for Chemical,
impact. Biological, and Radiological Terrorism and other
2. Describe the morbidity and mortality commonly Hazards 4th Edition
associated with each type of natural disaster.
3. Understand the implications of advanced warning
signs.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the signs and symptoms of Coronavirus (Covid-19)?

MAIN LESSON (40 minutes)

NATURAL DISASTERS
Types of Natural Disasters:
 Tornadoes
 Hurricanes
 Earthquakes
 Volcanoes
 Floods
 Tsunamis
 Winter storms
 Wildfires

Tornadoes
 Rotating, funnel-shaped clouds from powerful thunderstorms
 Winds up to 300 MPH capable of producing major damage
 More occur in the United States than anywhere else in the world; they occur in every state in America.

Tornado Preparation:
 Listen to local news or Weather Radio report for emergency updates. Watch for signs of a storm, like
darkening skies, lightning flashes or increasing wind.
 If you can hear thunder, you are close enough to be in danger from lightning. If thunder roars, go indoors!
Don't wait for rain. Lightning can strike out of a clear blue sky.
 Avoid electrical equipment and corded telephones. Cordless phones, cell phones and other wireless handheld
devices are safe to use.
 Keep away from windows.

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  If you are driving, try to safely exit the roadway and park. Stay in the vehicle and turn on the emergency
flashers until the heavy rain ends.
 If you are outside and cannot reach a safe building, avoid high ground; water; tall, isolated trees; and metal
objects such as fences or bleachers. Picnic shelters, dugouts and sheds are NOT safe.

Hurricanes
 Massive severe storms occurring in the tropics
 Winds greater than 75 MPH
 Clouds & winds spin around the eye
 Produce heavy rains, high winds, large waves, and spin-off tornadoes
 Hurricanes, cyclones, and typhoons are all the same weather phenomenon; we just use different names for
these storms in different places.
 In the Atlantic and Northeast Pacific, the term “hurricane” is used.
 The same type of disturbance in the Northwest Pacific is called a “typhoon” and
 “cyclones” occur in the South Pacific and Indian Ocean.
 The ingredients for these storms include a
o pre-existing weather disturbance,
o warm tropical oceans,
o moisture, and
o relatively light winds.
 If the right conditions persist long enough, they can combine to produce the violent winds, incredible waves,
torrential rains, and floods we associate with this phenomenon.

STRENGTH: A storm gets a name and is considered a tropical storm at 39 mph (63 kph).
It becomes a hurricane, typhoon, tropical cyclone, or cyclone at 74 mph (119 kph).

Hurricane Preparation
 Listen to a Weather Radio
 Check your disaster supplies. Replace or restock as needed.
 Bring in anything that can be picked up by the wind (bicycles, lawn furniture).
 Close your windows, doors and hurricane shutters. If you do not have hurricane shutters, close and board up
all windows and doors with plywood.
 Turn your refrigerator and freezer to the coldest setting. Keep them closed as much as possible so that food
will last longer if the power goes out.

 Turn off propane tank.

 Unplug small appliances.
 Fill your car’s gas tank.
 Create a hurricane evacuation plan with members of your household. Planning and practicing your evacuation
plan minimize confusion and fear during the event.

 Find out about your community’s hurricane response plan. Plan routes to local shelters, register family
members with special medical needs and make plans for your pets to be cared for.
 Obey evacuation orders. Avoid flooded roads and washed-out bridges.

Damages of Typhoons/Hurricanes
 Storm surge: increase in sea level
o low pressure central area of the storm creating suction
o storm winds piling up water
o tremendous speed of the storm
 Flash floods

Philippine Storm Warning Signals (PAGASA)

 Signal #1: winds of 30–60 km/h (20-35 mph) are expected to occur within 36 hours
 Signal #2: winds of 60–100 km/h (40-65 mph) are expected to occur within 24 hours
 Signal #3: winds of 100–185 km/h, (65-115 mph) are expected to occur within 18 hours.
 Signal #4: winds of at least 185 km/h, (115 mph) are expected to occur within 12 hours.

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 1. PSWS #1
IMPACT OF THE WINDS:
o Twigs & branches of small trees may be broken.
o Banana plants maybe tilted or downed.
o Nipa/Cogon houses may be partially unroofed.
o Light or no damage at all
o Significant damage in rice drops when it is in its flowering stage.

Precautionary Measures:
o Signal may be upgraded to the next higher level.
o Coastal waters may become bigger & higher.
o Listen to the latest severe weather bulletin. (every 6 hours)
o Business is carried out as usual except if flood occur.
o Disaster preparedness: ALERT STATUS.

2. PSWS #2
IMPACT OF THE WINDS:
o Some coconut trees are tilted or broken
o Big trees may be uprooted
o Banana plants fallen/downed.
o Nipa/cogon houses may be partially or totally unroofed.
o Some old galvanized iron roofing may be peeled off.
o Winds bring light to moderate damage

Precautionary Measures:
o Sea & coastal waters are dangerous to small sea crafts
o People travelling by sea & air are cautioned to avoid unnecessary risks.
o Outdoor activities of children should be postponed.
o Secure properties
o Disaster preparedness agencies are in action to alert their communities.

3. PSWS #3
IMPACT OF THE WINDS:
o Coconut trees destroyed.
o Banana plants downed
o Trees may be uprooted.
o Nipa & cogon houses may be destroyed
o Damage to structures of light to medium construction
o Widespread disruption of power & communication services
o Moderate to heavy damage (Agriculture and Industry)

Precautionary Measures:
o Dangerous to the community
o Sea and coastal waters will be very dangerous
o Travel is very risky by sea and air.
o Seek shelter in strong buildings, evacuate low-lying areas
o When the "eye" of the typhoon hit the community do not venture away from the safe shelter
o Classes in all levels: Suspended
o Disaster preparedness & response: agencies are in action with to actual emergency.

4. PSWS #4
IMPACT OF THE WINDS:
o Coco plantation suffer extensive damage.
o Big trees are uprooted.
o Rice/corn suffer severe losses.
o Buildings may be severely damaged.
o Power & communication services are severely disrupted.
o Damage to affected communities can be very heavy.

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 Precautionary Measures:
o Very destructive
o Travels & outdoor activities are cancelled.
o Evacuation should have been completed since it may be too late under this situation.
o Locality is likely to be hit directly by the eye of the typhoon.
o Winds increasing to its strongest
o Disaster coordinating councils and other disaster response agencies are now fully responding to
emergencies & in full readiness to immediately respond to possible calamity.

If you are at risk for typhoon:

 Keep trees trimmed
 Remove any debris or loose items in the yard
 Declog rain gutters & downspouts to prevent flooding
 Install permanent typhoon shutters to protect glass windows and doors
 Close all windows and doors
 Use rope/chain to secure boat to trailer to the ground or house
 Turn off water or electric utilities

Risk of Morbidity and Mortality: Hurricanes and Typhoons

 Drowning
 Electrocution
 Lacerations and punctures from flying debris
 Blunt trauma
 Gastrointestinal and respiratory diseases

What to Do After a Hurricane:

 Continue listening to a Weather Radio or the local news for the latest updates.
 Stay alert for extended rainfall and subsequent flooding even after the hurricane or tropical storm has ended.
 If you evacuated, return home only when officials say it is safe.
 Drive only if necessary and avoid flooded roads and washed -out bridges.
 Keep away from loose or dangling power lines and report them immediately to the power company.
 Stay out of any building that has water around it.
 Inspect your home for damage. Take pictures of damage, both of the building and its contents, for insurance
purposes.
 Use flashlights in the dark. Do NOT use candles.
 Avoid drinking or preparing food with tap water until you are sure it’s not contaminated.
 Check refrigerated food for spoilage. If in doubt, throw it out.
 Wear protective clothing and be cautious when cleaning up to avoid injury.
 Watch animals closely and keep them under your direct control.
 Use the telephone only for emergency calls.

EARTHQUAKES
 Shaking caused by movements of plates in the earth’s crust
 Occur along faults – borders between two plates
 Occur most often along the Ring of Fire

What is the Ring of Fire?

 The Pacific Ring of Fire is an area of frequent earthquakes and volcanic eruptions encircling the basin of the
Pacific Ocean. The Ring of Fire has 452 volcanoes and is home to over 50% of the world's active and dormant
volcanoes. Ninety percent of the world's earthquakes and 81% of the world's largest earthquakes occur along the
Ring of Fire.

Preparing for an Earthquake:

BEFORE AN EARTHQUAKE: Have a disaster plan. Emergency preparedness can save lives.
 Choose a safe place in every room. It’s best to get under a sturdy piece of furniture like a table or a desk where
nothing can fall on you.
 Practice DROP, COVER AND HOLD ON! Drop under something sturdy, hold on, and protect your eyes by
pressing your face against your arm.

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  If you live in an earthquake prone area, bolt tall furniture to the wall and install strong latches to cupboards.
 Prepare a first aid kit for your home. By taking special precautions and checking for hazards before a disaster
strikes, you will be much more likely to stay safe.

DURING AN EARTHQUAKE: DROP, COVER AND HOLD ON!

 Stay indoors until the shaking stops. Stay away from windows.
 If you’re in bed, hold on and stay there, protecting your head with a pillow.
 If you’re outdoors, find a clear spot away from buildings, trees and power lines. Then, drop to the ground.
 If you’re in a car, slow down and drive to a safe place. Stay in the car until the shaking stops.

AFTER THE SHAKING STOPS: Check for injuries.

 Inspect your home for damage.
 Eliminate fire hazards, so turn off the gas if you think its leaking.
 Use the stairs, not the elevator.
 Be on the look-out for fires. Extinguish small fires. Eliminate fire hazards. Turn off gas at the main valve.
 Stay outside. Move away from buildings, trees, streetlights and power lines by at least 10 feet.
 Inspect your home for damage. Use battery-powered lanterns or flashlights. Get everyone out if your home is
unsafe.
 WOF foundation cracks, gas leaks, electrical system and sewage or waterline damage.
 Expect aftershocks. Each time you feel one, DROP, COVER AND HOLD ON.

Risk Morbidity & Mortality

Vary according to the type of housing available, time of day of occurrence, & population density.
Common injuries:
 Cuts, broken bones, crush injuries, blast injuries
 DHN from being trapped in rubble.
 Stress reactions

VOLCANIC ERUPTION
 A volcano is a mountain that opens downward to a pool of molten rock below the surface of the earth. When
pressure builds up, eruptions occur. Gases and rock shoot up through the opening and spill over or fill the air with
lava fragments. Eruptions can cause lateral blasts, lava flows, hot ash flows, mudslides, avalanches, falling ash
and floods. Volcano eruptions have been known to knock down entire forests. An erupting volcano can trigger
tsunamis, flash floods, earthquakes, mudflows and rockfalls.

Gases that may pose health threat:

 Sulfur dioxide (SO2)
 Acid Rain
 Hydrogen sulfide (H2S)
 Carbon dioxide (CO2)
o Air with 5% CO2 causes perceptible increased respiration;
o 6-10% results in shortness of breath, headaches, dizziness, sweating, and general restlessness;
o 10-15% causes impaired coordination and abrupt muscle contractions;
o 20-30% causes loss of consciousness and convulsions;
o over 30% can cause death (Hathaway et. al., 1991).

Volcanic Alert Level Indicative Phenomena Volcano Status

0 Typical background surface activity; deformation & heat flow at Usual dormant or quiescent
low levels state.
1 Departure from typical background surface activity. Signs of volcano unrest.

2 Onset of eruptive activity, accompanied by changes to monitored Minor eruptive activity.

indicators.

3 Increased vigor of ongoing activity & monitored indicators. Significant local eruption in
progress.
4 Significant change to ongoing activity & monitored indicators. Hazardous local eruption in
progress.

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 5 Hazardous large volcanic eruption in progress. Large hazardous eruption
in progress.

Preparing for a Volcanic Eruption:

 Prepare a disaster supplies kit for your home and car.
 Include a first aid kit, canned food and a can opener, bottled water, battery-operated radio, flashlight, protective
clothing, dust mask, goggles and sturdy shoes. Don't forget, know all of your evacuation routes.

DURING A VOLCANO: Follow the evacuation order issued by authorities. Avoid areas downwind and river valleys
downstream of the volcano.
 If your caught indoors, close all windows and doors, put machinery inside a barn, and bring animals inside.
 If you’re trapped outdoors, seek shelter indoors.
 If you’re caught in falling rocks, roll into a ball and protect your head.
 If you’re caught near a stream, be aware of mudflows and move to higher ground.
 Protect yourself when ash falls by wearing long-sleeved shirts and long pants. Use goggles to protect your eyes.
Wear a dust mask and keep car engines off.

AFTER A VOLCANO: Cover your mouth and nose. Volcanic ash can irritate your respiratory system.
 Wear goggles and protect your eyes.
 Keep your skin covered. Clear roofs of ash, because the ash is very heavy and can cause the building to
collapse.

How to Protect Yourself During Ashfall

 Volcanic ash is fine, glassy fragments & particles that can cause severe injury to the lungs, eyes and skin.
 Wear long sleeved shirts and long pants.
 Use goggles, wear eyeglasses instead of contact lenses.
 Use dust mask or hold a damp cloth over your face.
 Keep car and truck engines off.

What to Do After a Volcanic Eruption

 If possible, stay away from volcanic ashfall areas. Volcanic ash health risk to children and persons with
respiratory problems (asthma, COPD).
 Clear roofs of ashfall.
 Avoid driving in heavy ashfall.

FLOODS
 Result from heavy rains
 May involve rivers overflowing, storm surge/ocean waves, & dams or levees breaking
 Most common natural hazard
 Flashfloods = floods that happen very fast

Contributing Factors
 Rainfall intensity & duration (6 hours of heavy rains)
 Topography (Geography)
 Soil conditions and ground cover
 Dam failure
 If living in areas prone to floods, plan to protect your family & property

Flood Preparations
BEFORE A FLOOD: Have a plan and prepare a disaster supplies kit for your home and car.
 Include a first aid kit, canned food, can opener, bottled water, battery-operated radio, flashlight, protective clothing
and written instructions on how to turn off electricity, gas, and water.

DURING A FLOOD: Move to a safe area quickly.

 Move to higher ground, like the highest floor of your home. Avoid areas subject to sudden flooding like low spots
and canyons.
 Avoid already flooded areas. If a flowing stream of water is above your ankles stop, turn around and go the other
way

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  Do not attempt to drive through a flooded road. The depth of the water is not obvious and the road may be
washed away.
 If your car stalls, leave it and seek higher ground. Rapidly rising water may engulf the car, pick it up and sweep it
away.
 Kids should never play around high water, storm drains or viaducts.
 Be cautious at night, because it’s harder to see flood dangers.
 If told to evacuate, do so immediately.
 AFTER THE FLOOD: Always, boil drinking water. Electrical equipment should be checked and dried before used.

Risk of Morbidity & Mortality

 Deaths and injuries because victims fail to evacuate
 Drowning, electrocution, lacerations
 Gastrointestinal diseases
 Water-borne diseases
 Hepatitis A
 Leptospirosis
 Giardiasis - diarrheal disease caused by Giardia lambia parasite- metronidazole

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. What should you do during an earthquake if you are staying outdoors?
a. Lie on the ground and stay there until the shaking stops
b. Stay under cable or power lines
c. Immediately enter a building
d. Stay in a field around trees. Stand there until the shaking stops
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. Which is a possible cause of a flood?

a. Overflows from dams, rivers, and lakes
b. Low tides
c. Converging winds
d. All of the above
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_____

3. What should you do after an earthquake?

a. Never replace damaged gas, water, and electrical lines
b. Enter and stay inside damaged buildings
c. Check for injuries. Give first aid as necessary
d. Install smoke detectors on every level of your home
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_____

4. Which of the following is a good sign of an approaching earthquake?

a. Volcanic eruption
b. Strong winds

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Education (Department of Nursing) 7 of 9
 c. Sunny day
d. Traffic
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_____

5. What should you do during a hurricane evacuation?

a. Walk through floodwaters
b. Unplug home appliances
c. Leave with all your valuables
d. All of the above
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_____

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: 3-2-1

Instructions:
1. As an exit ticket at the end of the class period
2. After the lesson, have each student record three things he or she learned from the lesson.
3. Next, have them record two things that they found interesting and that they’d like to learn more about.
4. Then, have students record one question they still have about the material.
5. Review the students’ responses. You can use this information to help develop future lessons and

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Education (Department of Nursing) 8 of 9
 1. determine if some of the material needs to be taught again.

Three things you learned:

1. ______________________________________
2 ______________________________________
3. ______________________________________

Two things that you’d like to learn more about:

1. ______________________________________
2. ______________________________________

One question you still have:

1. ______________________________________

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 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 12

LESSON TITLE: Natural Disasters: Tsunami, Winter Materials:

storm, Wildfire
Environmental Disasters and Emergencies Book, pen and notebook
LEARNING OUTCOMES: References:
Upon completion of this lesson, the nursing student can:
Veenema, T.G. (2019) Disaster Nursing and
1. Identify other major types of natural/environmental Emergency Preparedness for Chemical,
disasters and their physical, social and economic Biological, and Radiological Terrorism and other
impact. Hazards 4th Edition
2. Understand the implications of advanced warning
signs. https://www.official.gazette.gov.ph
3. Discuss examples of environmental hazards and their
impact on communities. https:// www.epa.gov > about-us> EPA
4. Define Environmental Protection Agency (EPA) and
DENR.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: Differentiate each of the four Philippine Storm Warning Signals by PAGASA:

MAIN LESSON (40 minutes)

TSUNAMIS
 Form as a result of earthquakes, volcanoes, or landsides under the ocean
 Waves grow taller as they reach the coast
 Four out of Five occur in the Ring of Fire
 Over 200,000 people killed in the 12/26/05 Indian Ocean tsunami

Tsunami: Signals
 A recent submarine earthquake
 Sea appears to be boiling
 The water is hot, smells of rotten egg and stings the skin
 Audible thunder or booming sound followed by a roaring or whistling sound
 Water may recede a great distance from the coast
 Animals that run to the higher ground before the water arrives

Tsunami Preparedness
PLAN FOR A TSUNAMI:
 Have a disaster plan.
 Know whether you’re at risk for danger.
 Plan an evacuation route.

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  Prepare a disaster supplies kit for your home and car. Include a first aid kit, canned food and a can opener,
bottled water, battery-operated radio, flashlight, protective clothing and written instructions on how to turn off
electricity, gas, and water.

DURING A TSUNAMI:
 Follow the instructions issued by local authorities.
 You will probably want to evacuate immediately.
 Get to higher ground and as far inland as you can.

AFTER A TSUNAMI:
 Help injured or trapped people.
 Stay out of a building if water remains around it. Tsunami waters can cause buildings to sink, floors to crack, or
walls to collapse.
 When re-entering homes, use extreme caution.
 Check for gas leaks.
 Open windows and doors to help dry things out.
 Look for fire hazards.

Risk of Morbidity and Mortality

 Immediate intervention: rescue survivors and provide medical care
 Drowning
 Broken limbs and head injuries
 GI diseases (from contaminated water and food supplies after the floods)
 Water-borne diseases: cholera, hepatitis A, leptospirosis, typhoid fever

WINTER STORMS
 May include snow, ice storms, sleet, freezing rain, and extremely cold temperatures
 Most deaths occur in automobiles
 Storms may cause widespread power outages

Winter Storm Preparations

 Learn about your area's winter storm risk. Contact your local Red Cross chapter or emergency management
office for your area's winter storm risk and storm history.
 Understand the hazards of wind chill, which combines the cooling effect of wind and cold temperatures on
exposed skin.
 Service vehicles and snow removal equipment before winter storm season.
 Keep your car's gas tank full for emergency use and to keep the fuel line from freezing.

What to do during a winter storm watch?

 Listen to a National Oceanic and Atmospheric Administration (NOAA) Weather Radio, a portable battery-powered
radio (or television), or a smart phone for updated emergency information of watches issued in your area.
 Be aware of changing weather conditions.
 Make sure pets and animals are safe.
 Avoid unnecessary travel.

What to do during a winter storm?

 Listen to a NOAA Weather Radio, a portable battery-powered radio (or television), or a smart phone for updated
emergency information.
 Stay indoors and dress warmly during the storm.
 Wearing layers of loose-fitting, lightweight, warm clothing will keep you warmer than one bulky sweater.
 Listen to a battery powered radio or television for updated emergency information.
 Eat regularly. Food provides the body with energy for producing its own heat.
 Keep the body replenished with fluids to prevent dehydration.
 If you lose electricity, do not use a generator indoors or in an enclosed space.
 Conserve fuel.

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 What to do after a winter storm?
 Continue listening to local radio or television stations or a NOAA Weather Radio for updated information and
instructions.
 Help neighbors who may require special assistance.
 Avoid driving and other travel until conditions have improved.
 Avoid overexertion.
 Follow forecasts and be prepared when venturing outside.

WILDFIRES
 Occur in forests, grasslands, and wooded areas
 Most common causes: lightning and human accidents
 A wildfire also known as a wildland fire, forest fire, vegetation fire, grass fire, peat fire, bushfire (in Australia), or
hill fire is an uncontrolled fire often occurring in wildland areas, but which can also consume houses or agricultural
resources. Wildfires often begin unnoticed, but they spread quickly igniting brush, trees and homes.

Preparing for Wildfires

BEFORE A WILDFIRE:
 Have a disaster plan. Know whether you’re in a wildfire prone area. Plant fire resistant shrubs and trees around
your home.
 Have a garden hose that is long enough to reach around your home. Prepare a disaster supplies kit for your
home and car. Include a first aid kit, canned food and a can opener, bottled water, battery-operated radio,
flashlight, protective clothing and written instructions on how to turn off electricity, gas, and water. Always listen to
the radio and television for the latest information and instructions for your area.
 Include a first aid kit, canned food and a can opener, bottled water, battery-operated radio, flashlight, protective
clothing and written instructions on how to turn off electricity, gas, and water. Always listen to the radio and
television for the latest information and instructions for your area.

DURING A WILDFIRE:
 If you’re advised to evacuate then do so immediately. Wear protective clothing and lock your home. Tell someone
you left and where you are going. Choose a safe route away from fire hazards. Watch for changes in the speed
and direction of fire and smoke.

AFTER A WILDFIRE:
 Stay away from wildfire areas until it is safe.

ENVIRONMENTAL DISASTER
- An environmental emergency or ecologic disruption of a severity and magnitude resulting in deaths, injuries, illness,
and/or property damage that cannot be effectively managed by the application of routine procedures or resources and
results in a need for additional assistance.

Activities must focus on the following:

1. The immediate removal of the hazard from the environment (or if this is not possible, the movement of the
population away from the hazard)
2. Decontamination of exposed individuals
3. The restoration of services to meet the immediate physiological needs of the affected people
4. The prevention of further illness or injury as a result of exposure to the hazard

Factors needed for environmental public health tracking:

 Environmental hazards
 Exposure to environmental hazards
 Health effects potentially related to exposure to environmental hazards

ENVIRONMENTAL HAZARDS AND THEIR IMPACT

1. Air Pollutants: Toxic air pollutants (also known as hazardous air pollutants) are those pollutants that cause
or may cause serious health effects, such as cancer, severe respiratory disease, reproductive effects or birth
defects, or adverse environmental and ecological effects.

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Education (Department of Nursing) 3 of 7
 2. Chemical Spills: The intentional release or accidental leakage or spill of certain chemical substances into the
environment can have devastating consequences on human health. Nurses need to be aware of the
environmental and safety hazards that exist in or near the communities in which they live and work.
3. Mold: are a type of fungal growth that can be found in both indoor and outdoor environments. Molds are
notoriously hardy organisms and can grow in nearly any environment including those that are harsh and do
not typically support life. Molds thrive in warm, damp, and humid conditions and continuously reproduce
through the production of spores. Natural disasters (especially those involving water and/or heat) often
increase mold growth by altering the state of the natural environment.
4. Oil Spills: An oil spill is the release of a liquid petroleum hydrocarbon into the environment, especially the
marine ecosystem, due to human activity, and is a form of pollution.
5. Pesticides: Pesticides are frequently used to control insects, rodents, weeds, microbes, or fungi. Pesticides
pose significant risks to human health and the environment, when people do not follow directions on product
labels or use products irresponsibly. For example, people might use pesticides when they are not really
needed, apply too much, or apply or dispose of them in a manner that could contaminate water or harm
wildlife.
6. Radiation Release and Contamination: Radiological materials and unstable nuclear isotopes are present
and nearly unavoidable in daily life. Background radiation, naturally occurring radiation from the environment,
exists as unstable isotopes suspended in air, radon emitted from the earth’s crust, cosmic radiation from outer
space, isotopes within the human body (potassium and carbon), and infrequent radioactive elements from
nature. This background radiation produces negligible low-level exposure of radiation to humans.

Environmental Protection Agency (EPA)

 It is a lead governmental agency responsible for the protection of human and the environmental health.
Provides technical assistance to support recovery planning of public health infrastructure such as waste water
and treatment works, to ensure that the environment have clean air, land and water.

How EPA protects the environment and Health?

 Superfund Cleanup- the EPA oversees the cleanup of toxic superfund sites and holds polluters financially
responsible.
 Oil spill cleanup – conducts and supervises cleanup efforts (on land and in non -coast guard control waters) for
oil or hazardous chemical oils. Ex. Exxon Valdez, Kalamazoo and Floreffe spills
 Energy efficiency – maintains the ENERGY STAR program, which helps consumers identify the most energy
efficient appliances and equipment that can save money and energy.
 Clean water/ safe drinking water – sets health-based standards, limiting contaminants in drinking water.
It provides the community to deliver safe drinking water and improve water quality. After disasters, The EPA
provides resources to get drinking water and sewage treatments back online quickly.
State/Local Drinking water & Waste water Infrastructure- improve drinking water infrastructure and
upgrade sewage treatment and other municipal wastewater infrastructure.
Sewage rules: to prevent raw sewage from polluting drinking water sources.
Protecting fish and fishing jobs: sets surface water standards and related fishing jobs from toxic pollution.
Beachgoers Protection: protects beachgoers from pollution by establishing minimum national water quality
standards and guidelines for swimming.
 Clean Air and Climate Protection: sets limits on dangerous air pollutants from factories, refineries, power plants,
oil and gas extraction and vehicles. These limits protect public health, prevent asthma attacks, birth defects
respiratory and cardiovascular diseases and cancer.
 Chemical safety: reviews applications for new chemicals to ensure they are safe before they are allowed on the
market.
 Bug repellants: make sure that sprays, repellents, flea collars and other products kill bugs without poisoning
people.
 Pesticides: reviews safety of pesticides sprayed on food crops, golf courses or public rights-of-way.
 Oil and gas disposal: helps guide state in the handling and disposal of oil and gas waste, including toxic waste.
 Hazardous and solid waste regulations: administers safeguards for how hazardous and non-hazardous waste
is generated, transported, treated, stored and disposed.
 Radioactive Materials: prepares for and responds to emergencies involving radioactive materials, deploying
response team to work with agencies at all levels.
 Sustainable communities: supports efforts to revitalize local economies and make communities healthier and
more livable in collaboration with government agencies, NGOs and private sector.

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In the Philippines, EPA is the Department of Environment and Natural Resources (NEDA), is responsible for the
conservation, management and development of the country’s environment and natural resources. It shall ensure
the proper use of these resources and the protection of the environment within the framework of sustainable
development.

10 Priority Programs:
 Clean air
 Clean water
 Solid waste management
 Geohazard
 Ground water assessment and responsible mining
 National greening program
 Intensified forest protection and anti-illegal logging
 Enhanced biodiversity conservation
 scaling up of coastal and marine ecosystems
 improved land and administration and management

Current environmental problems:

 pollution
 global warming
 overpopulation
 waste disposal
 ocean acidification
 loss of biodiversity
 deforestation
 ozone layer depletion
 acid rain
 public health issues

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. All are true about wildfires except:
a. It occurs in forests, grasslands, and wooded areas
b. Controlled fire often occurring wildland areas
c. Most common causes are lightning and human accidents
d. A wildfire also known as a wildland fire
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. After tsunami, the nurse should:

a. Help injured or trapped people
b. Stay inside of a building if water remains around it.
c. When re-entering homes, caution is not needed.
d. Ignore gas leaks.
ANSWER: ________

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 RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
3. Which of the following is an indicator of a tsunami?
a. thunderstorms
b. water receding from a great distance from the coast
c. excessive rain clouds
d. peaceful waves in the shore
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. What should you do during a winter storm if you’re inside a vehicle?

a. Drive slowly
b. Find a warm shelter
c. Keep the headlights on
d. All of the above
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. Oil spill is a man-made disaster that may cause:

a. Nourishment for the earth
b. Destruction of marine ecosystem
c. Wildfire
d. Nourishment for fishes
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

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You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: Minute Paper

1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2) What question(s) do you have as we end this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 13

LESSON TITLE: Mental Health and Psychosocial Support in Materials:

Emergency Settings
Book, pen and notebook
LEARNING OUTCOMES: References:
Upon completion of this lesson, the nursing student can:
Veenema, T.G. (2019) Disaster Nursing and
1. Define MHPSS. Emergency Preparedness for Chemical,
2. Identify problems in emergencies. Biological, and Radiological Terrorism and other
3. State the purpose of MHPSS. Hazards 4th Edition
4. Enumerate the core principles of MHPSS.
5. Discuss the intervention pyramid.
http://icn.ch/IASC_MHPSS_guidelines.pdf
6. Develop an appreciation of the role of the nurse in
providing MHPSS.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the environmental hazards and their impact?

MAIN LESSON (40 minutes)

Background
 The Inter-Agency Standing Committee (IASC) was established in 1992 in response to General Assembly
Resolution 46/182, which called for strengthened coordination of humanitarian assistance.
 The resolution set up the IASC as the primary mechanism for facilitating inter-agency decision-making in
response to complex emergencies and natural disasters. The IASC is formed by the heads of a broad
range of UN and non-UN humanitarian organizations.

Objectives of the Guideline

 These Guidelines seek to:
 enable humanitarian actors to plan, establish and coordinate multi-sectoral responses to protect and
improve people’s mental health and psychosocial well-being in the midst of an emergency.
 facilitate an integrated approach to address the most urgent mental health and psychosocial issues in
emergency situations.

The focus of the guidelines is on implementing minimum responses, which are essential, high-priority responses that
should be implemented as soon as possible in an emergency.
 Minimum responses: first things that ought to be done; the essential first steps that lay the foundation for
the more comprehensive efforts that may be needed (including during the stabilized phase and early
reconstruction)
Participating Organizations
 Action Contre la Faim (ACF)
 InterAction (co-chair), through:
• American Red Cross (ARC)
• Christian Children’s Fund (CCF)

• International Catholic Migration Commission (ICMC)

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 • International Medical Corps (IMC)
• International Rescue Committee (IRC)
• Mercy Corps
• Save the Children USA (SC-USA)
 Inter-Agency Network for Education in Emergencies (INEE)
 International Council of Voluntary Agencies (ICVA), through:
• ActionAid International
• CARE Austria
• HealthNet-TPO
• Médicos del Mundo (MdM-Spain)
• Médecins Sans Frontières Holland (MSF-Holland)
• Oxfam GB
• Refugees Education Trust (RET)
• Save the Children UK (SC-UK)
 International Council of Voluntary Agencies (ICVA), through:
• ActionAid International
• CARE Austria
• HealthNet-TPO
• Médicos del Mundo (MdM-Spain)
• Médecins Sans Frontières Holland (MSF-Holland)
• Oxfam GB
• Refugees Education Trust (RET)
• Save the Children UK (SC-UK)

DEFINITION OF TERMS:

 The term “psychosocial” denotes the inter-connection between psychological and social processes and the fact
that each continually interacts with and influences the other.
 The composite term mental health and psychosocial support (MHPSS) is used to describe any type of local or
outside support that aims to protect or promote psychosocial well-being and/or prevent or treat mental disorder.

Problems in Emergencies
 Predominantly Social Nature:
1. Pre-existing (pre-emergency) social problems (e.g. extreme poverty; belonging to a group that is discriminated against
or marginalized; political oppression);
2. Emergency-induced social problems (e.g. family separation; disruption of social networks; destruction of community
structures, resources and trust; increased gender-based violence); and
3. Humanitarian aid-induced social problems (e.g. undermining of community structures or traditional support
mechanisms).

 Predominantly Psychological Nature

1. Pre-existing problems (eg. severe mental disorder; alcohol abuse);
2. Emergency-induced problems (eg. grief, non-pathological distress; depression and anxiety disorders, including post-
traumatic stress disorder (PTSD)); and
3. Humanitarian aid-related problems (eg. anxiety due to a lack of information about food distribution).

People at Increased Risk

 Elderly people (especially when they have lost family members who were care-givers);
 Extremely poor people;
 Refugees, internally displaced persons (IDPs) and migrants in irregular situations (especially trafficked women and
children without identification papers);
 Those exposed to extremely stressful events/trauma (eg. people who have lost close family members or their entire
livelihoods, rape and torture survivors, witnesses of atrocities, etc.);
 Those with pre-existing, severe physical, neurological or mental disabilities or disorders;
 People in institutions (orphans, elderly people, people with neurological/mental disabilities or disorders);

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 People experiencing severe social stigma (eg. untouchables/dalit, commercial sex workers, people with severe mental
disorders, survivors of sexual violence);
 People at specific risk of human rights violations (eg. political activists, ethnic or linguistic minorities, people in
institutions or detention, people already exposed to human rights violations).

CORE PRINCIPLES:
1. Human rights and equity
2. Participation
 Involvement of local people from the earliest phase of an emergency, in the assessment, design,
implementation, monitoring and evaluation of assistance.
3. Do no harm
 Minimize duplication and gaps in response;
 Design interventions on the basis of sufficient information
 Commit to evaluation, openness to scrutiny and external review;
 Develop cultural sensitivity and competence
 Use evidence-based effective practices; and
 Develop an understanding of, and consistently reflect on, universal human rights, power relations
between outsiders and emergency-affected people, and the value of participatory approaches.
4. Building on available resources and capacities
5. Integrated Support System
6. Multi-layered support

Core Principles
6. Multi-layered supports
Figure 1. Intervention pyramid for mental health and psychosocial
support in
emergencies

Specialized Services
Aim: to develop
competencies at each
level Focused, non-
specialised supports

Community and family

supports

Basic services and security

Level 1: Basic Services and Security

 (Re)establishment of security, adequate governance and services that address basic physical needs (food,
shelter, water, basic health care, control of communicable diseases).
 These basic services should be established in participatory, safe and socially appropriate ways that protect local
people’s dignity, strengthen local social supports and mobilize community networks.

Level 2: Community and Family Supports

 Useful responses in this layer include family tracing and reunification, assisted mourning and communal healing
ceremonies, mass communication on constructive coping methods, supportive parenting programs, formal and
non-formal educational activities, livelihood activities and the activation of social networks, such as through
women’s groups and youth clubs.

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Level 3: Focused, Non-specialized Supports
 Supports necessary for the smaller number of people who additionally require more focused individual, family or
group interventions by trained and supervised workers (but who may not have had years of training in specialized
care).
 For example, survivors of gender-based violence might need a mixture of emotional and livelihood support from
community workers.
 This layer also includes psychological first aid (PFA) and basic mental health care by primary health care workers.
Level 4: Specialized Services
 Include psychological or psychiatric supports for people with severe mental disorders whenever their needs
exceed the capacities of existing primary/general health services.
 Such problems require either
 (a) referral to specialized services if they exist, or
 (b) initiation of longer-term training and supervision of primary/general health care providers.

Matrix of Interventions
1. Emergency Preparedness
 Enable rapid implementation of minimum responses.
2. Minimum Response
 High-priority responses that should be implemented as soon as possible in an emergency.
3. Comprehensive Response
 These interventions are most often implemented during the stabilized phase and early reconstruction
period following an emergency.

Sample Matrix of Interventions

Function/ Emergency Preparedness Minimum Comprehensive
Domain Response Response
4 Human • Map existing human resource 4.1 Identify and recruit • Develop a description of
capacity and training resources, staff and essential worker competencies
resources including within the local population engage volunteers who that is
• Build awareness of need for workers understand local locally relevant
who understand local culture • Institutionalise, monitor and
culture and language 4.2 Enforce staff codes enforce codes of conduct and
• Train all workers on international of conduct ethical
protection standards and and ethical guidelines standards, strengthening them
codes of conduct 4.3 Organise as needed
• Train workers in different sectors on orientation and training • Map the distribution and
how to integrate MHPSS of aid workers in extent of training and
into emergency work following these mental health supervision
guidelines and psychosocial received
• Expand the pool of available support • Scale up training and
emergency workers trained in MHPSS 4.4 Prevent and manage supervision and build
• Encourage educational institutions to problems sustainable capacity
incorporate MHPSS in mental health and by institutionalising training
training into professional programmes psychosocial • Review response to MHPSS
• Expand MHPSS in emergency well-being among staff issues in workers and adhere to
preparation courses worldwide and organisations’ MHPSS policies
• Develop organisational policies and volunteers for staff and volunteers
plans for the prevention
and management of MHPSS problems
in humanitarian workers
• Develop organisational policies to
maximise worker security
and safety in the field

Common Functions Across Domains:

1. Coordination
2. Assessment, Monitoring & Evaluation

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 3. Protection & Human Rights Standards
4. Human Resources
5. Community Mobilization & support
6. Health Services
7. Education
8. Dissemination of Information
9. Food Security & Nutrition
10. Shelter & site planning
11. Water and Sanitation

Timeline in Typhoon Flooding with Evacuees

Timeline MHPSS
Pre-emptive Evacuation Phase Prepare MHPSS teams
Within first 24 hrs of impact Put MHPSS teams on standby
Coordinate deployment
Conduct rapid MHPSS Assessment
25 to 48 hours Deploy MHPSS teams to communities and
evacuation centers to provide PFA
Call cluster coordination meeting
More than 72 hours Provide community and family support
Provide Psychosocial Processing (PSP),
counseling and other focused non-specialized
services
Provide specialized services through referral to
specialists and/or facilities
Establish referral system
Conduct needs assessment
Call cluster coordination meeting

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice:

1. The core principles of MPHSS are the following except:

a. Participation
b. Human rights and equity
c. Incoordination
d. Do No Harm

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 ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. The first intervention pyramid for mental health and psychosocial support in emergency is:
a. Specialized services
b. Basic services and security
c. Community and family support
d. Focused, non-specialized supports
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. In the matrix of interventions, which of the following has the high- priority responses that should be
implemented as soon as possible in emergency?
a. emergency preparedness
b. specialized preparedness
c. minimum responses
d. comprehensive responses

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. All of the following are examples of Pre-emergency social problems in Predominantly Social Nature Problems in
Emergencies, except:
a. extreme poverty
b. political oppression
c. belonging to a group that is discriminated against or marginalized
d. family separation

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. What level of intervention pyramid for mental health and psychosocial support in emergencies includes the
psychosocial first aid and basic mental health care by primary health care workers?
a. Level1: Basic services and security
b. Level 2: Community and family Supports
c. Level 3: Focused: non- specialized Supports
d. Level 4: Specialized services

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________

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 RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: Muddiest Point:

In today’s session, what was least clear to you?

_________________________________________________________________________________________________

_________________________________________________________________________________________________

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 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 14

LESSON TITLE: Restoring Public Health Under Disaster

Conditions: Basic Sanitation, Water, Food Supply and Shelter Materials:
LEARNING OUTCOMES: Book, pen and notebook
Upon completion of this lesson, the nursing student can:

1. Describe the essential functions of public health as they

relate to a disaster.
2. Describe the importance of a clean environment as a References:
foundation for good health.
3. Appraise both risks and resources in the environment to Veenema, T.G. (2019) Disaster Nursing and
meet the basic needs (food, water, shelter and safety for Emergency Preparedness for Chemical,
survival). Biological, and Radiological Terrorism and other
4. Discuss the major health risks in a population affected by Hazards 4th Edition
disaster and identify and prioritize according to prevention /
control of disease, epidemics and other hazards.
5. Describe rapid environment assessment (REA).
6. Describe the Sphere Project Humanitarian Standards for
disaster response.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: Explain at least 5 core principles of MPHSS.

MAIN LESSON (40 minutes)

Basic Public Health Function
The World Health Organization (WHO) defined health as “a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity.” Public health is the profession, discipline and a system for providing
healthcare to communities.

3 Core Functions of Public Health:

1. Assessment
2. Policy development
3. Assurance

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Essential Functions of Public Health as they relate to a Disaster:
1. Monitoring health status to identify and solve community health problems.
2. Diagnose and investigate health problems and health hazards in the community.
3. Inform, educate and empower people about health issues.
4. Mobilize community partnerships and action to identify and solve health problems.
5. Develop policies and plans that support individual and community health efforts.
6. Enforce laws and regulations that protect health and ensure safety.
7. Monitoring health status to identify and solve community health problems.
8. Diagnose and investigate health problems and health hazards in the community.
9. Inform, educate and empower people about health issues.
10. Mobilize community partnerships and action to identify and solve health problems.
11. Develop policies and plans that support individual and community health efforts.
12. Enforce laws and regulations that protect health and ensure safety.
13. Link people to needed personal health services and assure the provision of healthcare when otherwise
unavoidable.
14. Assure competent public and personal health care workforce.
15. Evaluate effectiveness, accessibility and quality personal and population-based health services.
16. Research for new insights and innovative solutions to health care problems.

Health Promotion

“Health Promotion is the process of enabling people to increase control over and to improve their health. (WHO,
1986, 2009). In health promotion, empowerment is a process through which people gain greater control over decisions
and actions affecting their health. Empowerment may be a social, cultural and psychological or political process through
which individuals and social groups are able to express their needs, present their concerns, devise strategies for
involvement in decision making and achieve political, social and cultural action to meet these needs (WHO 2009).

In disaster situations, the use of organized efforts to eliminate hazards and restore environment and its inhabitants to
their optimal level of health becomes more important.

The Goals of Health Promotion in Disaster Nursing are as follows:

 To meet the immediate basic survival needs of populations affected by disasters (water, food, shelter and
security).
 To identify the potential for a secondary disaster.
 To appraise both risks and resources in the environment.
 To correct inequalities in access to health care or appropriate resources.
 To empower survivors to participate an and advocate for their own health and well-being.
 To respect cultural, lingual and religious diversity in individuals and families to apply their principle in all health
promotion activities.
 To promote the highest achievable quality of life survivors.

To achieve these goals, nurse must have a social understanding the basic principle of environmental health methods
of health promotion and disease prevention strategies. They must also maintain competencies in these areas in order to
collaborate with other members of the team who provide health care. It was Florence Nightingale, who was first
illustrated for nurse the importance of understanding environmental principles.

Abraham Maslow is recognized for having established a theory of hierarchy of human needs. Based on his
prioritization, Maslow grouped and ordered and ordered human needs into categories according to their primacy.

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 The nature of environment has a direct impact in a community’s health on the quality of life of its inhabitants.
“Quality of Life” is an individual perception of his or her positions in life in the context of the culture and value
of system where the individual lives and in relation to personal goals, expectations, standards and concerns,
(WHO 2009). Disaster nursing practice also seeks to promote changes in behaviors that will compensate for
disrupted physiological conditions. At the same time, health promotion and disease prevention activities must
occur simultaneously in the immediate outcome of a disaster.

Risks Factors for Infectious Disease Outbreaks from Disaster:

Several risk factors can lead to post disaster disease outbreaks, such as WASH (water, sanitation and
hygiene), alterations in disease vector distributions and issues with housing and shelter problems. Following a
disaster, continuous monitoring of the environment will allow nurses to immediately address potential
hazards.
1. Age
2. Immunosuppressive diseases such as cancer
3. Immunosuppressive medications such as steroids
4. Not getting vaccinated
5. Stress
6. Overcrowding in shelters and camps
7. Malnutrition
8. Exposure to extreme hot and cold temperature
9. Open wounds

Rapid Assessment of Population Health Needs:

Conducting a rapid comprehensive assessment of population health requirements is one of the most
important public health tasks in a disaster. The process consists of the following elements:
1. Data collection for assessment of needs.
2. Identification of available resources that match defined needs.
3. Prevention of further health effects associated with the event.

Initial Data Collection as part of the Rapid Assessment should include the following:
1. An assessment of the current circumstances and quality of life of the victims- location, demographic data,
routes of access, modes of transportation, communication systems, availability of basic services (water,
electricity, communications, sanitation facilities, housing and shelters) and availability of food.

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 2. The scope of the damage- the number of deaths, the number of persons injured, the number who have
disappeared, the number of displaced and their location, the status and capacity of health care facilities,
urgent needs, human and material resources in the immediate area.

Other Data Points for Collection include the Following:

1. The presence of an immediate or potential hazard (eg persistent toxic smoke or potential for chemical leak or
spill.
2. The community’s need for immediate outside assistance
3. The augmentation of existing public health surveillance for ongoing monitoring of health needs.

The Role of the Public Health Nurse Following a Disaster:

 Assessing the affected community for the presence (or absence) of the fundamentals for health-
clean water, safe food, sanitation and shelter.
 Reestablishing the sanitary barriers that protect communities from environmental hazards.
 Detecting changes in the integrity of the environment and organizing activities designed to eliminate
or mitigate existing health hazards.
 Planning for continuous maintenance and monitoring of facilities basic to health regarding proper
waste removal, adequate water and food supplies, shelter and personal safety.
 Responding aggressively to evidence of the transmission of disease to ameliorate the spread of an
epidemic throughout the population.
 Respecting and empowering affected individuals by giving them decision-making rights regarding all
pertinent public health issues.

The Sphere Project:

It was developed in 1997. This project was published a set of standards in core areas of humanitarian
response.
AIM: To improve the quality of humanitarian response in situation of disaster and conflict; and to enhance
The accountability of the humanitarian system to disaster-affected people.

The Sphere Project of 2018

It was published, revised and updated the standards reflecting recent developments in humanitarian
practice in water, sanitation, food, shelter and health based on feedback from practitioners in the field,
research institutes, and experts

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice

1. It is a state of complete physical, mental and social well -being and not merely the absence of disease or infirmity.
a. Hygiene
b. Sanitation
c. Health
d. Infection control

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. The 3 core functions of Public Health are the following, except:

a. Assessment
b. Policy development
c. Assurance

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Education (Department of Nursing) 4 of 6
 d. Assistance

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. It is an individual perception of his/her position in life in the context of the culture and value of system where
the individual lives and in relation to a personal goals, expectations and concerns.
a. Health promotion
b. Health assessment
c. Quality of life
d. Rapid assessment
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
4. The exercise of collecting information in order to measure the damages and identify the basic needs that require
immediate response as a result of a disaster.
a. Quality of life
b. Rapid assessment
c. Health assessment
d. Health promotion

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. Essential functions of the public health as they relate to a disaster are the following, except:
a. Immobilize community partnerships and to identify and solve health problems.
b. Monitoring health status to identify and solve problems.
c. Inform, educate and empower people about health issues.
d. Develop policies and plans that support individual and community health efforts.

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________

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Education (Department of Nursing) 5 of 6
 RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: 3-2-1

Instructions:
1. As an exit ticket at the end of the class period
2. After the lesson, have each student record three things he or she learned from the lesson.
3. Next, have them record two things that they found interesting and that they’d like to learn more about.
4. Then, have students record one question they still have about the material.
5. Review the students’ responses. You can use this information to help develop future lessons and
determine if some of the material needs to be taught again.

Three things you learned:

1. ______________________________________
2 ______________________________________
3. ______________________________________

Two things that you’d like to learn more about:

1. ______________________________________
2. ______________________________________

One question you still have:

1. ______________________________________

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Education (Department of Nursing) 6 of 6
 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 15

LESSON TITLE: Climate Change and Health: The Nurse’s Materials:

Role in Policy and Practice
Book, pen and notebook
LEARNING OUTCOMES: References:
Upon completion of this lesson, the nursing student can:
Veenema, T.G. (2019) Disaster Nursing and
1. Define climate change. Emergency Preparedness for Chemical,
2. Describe the real and potential impacts of climate Biological, and Radiological Terrorism and other
change on human health. Hazards 4th Edition
3. Describe the nurse’s role in mitigation and adaptation
efforts to reduce climate change impacts on human
health.
4. List vulnerable population at most risk poor health
outcome related to climate change.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the 3 elements of Rapid Assessment?

1.
2.
3.

MAIN LESSON (40 minutes)

Climate- is the average weather in a given area.

Climate Change
 It is the global phenomenon of climate transformation characterized by the changes in the usual climate of the
planet (regarding temperature, precipitation and wind) that are especially caused by human activities. As a result
of unbalancing the weather of Earth, sustainability of the planet’s ecosystem under threat, as well as the future of
humankind and the stability of the global economy.
 NASA’s Definition: A broad change of global phenomena created predominantly by burning fossil fuels, which add
heat-trapping gases on Earth’s atmosphere. These phenomena include the increased temperature trends
described by global warming, but also encompass changes such as sea-level rise, ice mass loss in Greenland,
Antarctica.

Overwhelming Evidence that climate change has contributed to:

 Higher average global temperature and sea levels
 Decreased sea and land use levels
 Change in the precipitation patterns
 Increased frequency of extreme weather events: heat waves, droughts, hurricanes and wildfires
 Heavy pollution
 Shifts in animal and plant habitable
Physical Drivers of Climate Change:
 Anthropogenic activity and to a lesser content:

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Education (Department of Nursing) 1 of 6
 - Well mixed Greenhouse gases- carbon dioxide (CO2), methane (CH4), Nitrous oxide (N2O), H2O
- Ozone, stratosphere water vapor form CN4, Contrails, Aerosol Radiation/ cloud Interaction
 Natural origin- changes in solar irradiance, volcanic eruptions, El-Nino Southern Oscillation
Greenhouse gases that human do emit directly in significant quantities are:
1. Carbon dioxide (CO2). Accounts for around three -quarters of the warming impact of current greenhouse-gas
emission. The key source of CO2 is the burning of fossil fuels such as coal, oil, gas.
2. Methane (CH4). Accounts for around 14% of the impact of current human greenhouse-gas emissions. Key
sources include agriculture (especially livestock and rice fields), fossil fuel extraction and the decay of organic
waste in landfill site. Its warming effect is much more potent for each gram of gas release.
3. Nitrous oxide (N2O). Accounts for 8% of the warming impact of current human greenhouse-gas emissions. Key
sources include agriculture (especially nitrogen fertilized soils and livestock waste and industrial processes. It is
even more potent per gram than methane.
4. Fluorinated gases (“F gases”). Account for around 1% of the warming impact. Key sources are industrial
processes.

Human Activity also changes the planet’s temperature:

 Vapor trails from planes
 Soot from fires
 Tropospheric ozone created by indirect pollution

Selected Health Outcomes:

 Extreme weather events
Wildfires, droughts, hurricanes, heavy rainfall, river flooding, landslides, mudslides and soil erosion caused or
exacerbated by climate change will result injuries, fatalities and illness that can result from post disaster water

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Education (Department of Nursing) 2 of 6
 quality and safety issues and waterborne diseases. Mass shelter care requires a coordinated multiagency
response and surge capacity of health care personnel, placing nurses in multiple roles at the front lines of care.
 Thermal extremes (heat and cold)
Heat-related morbidity and mortality will increase (Schmeltz, Petkova, & Gamble, 2016), caused by air pollution
as well as temperature—fall on children, the elderly, the chronically ill, the obese, people with hypertension
(particularly if taking diuretics), and people taking psychiatric medications. In warm, dry regions and become more
severe increasing the risk to children and to adults with respiratory diseases. Nurses can serve on local, state,
and regional adaptation planning bodies for planning related to extreme heat and poor air quality events, identify
those in their practices who are most risk, including those who work outside in extreme heat
 Vectorborne and zoonotic diseases
Climate change has and will continue to expand the habitats of climate-sensitive vectors, increase them
reproduction rate, and thereby increase the prevalence of diseases transmitted by mosquitoes, ticks, and
rodents. Nurses can and do provide essential roles in these communications: as collaborators for developing
agency health alerts and risk-prevention measures, and as public spokespeople during disease outbreaks.
 Food and waterborne diseases
Climate change–related temperature fluctuations can also affect food- and waterborne infectious diseases, such
as gastritis, which can be fatal in children (EPA, 2018), particularly those who already have other compromising
vulnerabilities and/ or illnesses. Lower-lying coastal regions could experience increased flooding, saltwater
infiltration, severe and harmful algae blooms (HAB) such as Red Tides, thus increasing susceptibility to various
other food- and waterborne diseases. (Rossati, 2017). The expected continuation of global warming will lead to
increased risk of several food and waterborne diseases including those caused by Salmonella, Campylobacter,
Vibrio cholerae, Leptospirosis, Giardia, and Cryptosporidium.

Direct and indirect health effects of climate change:

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Education (Department of Nursing) 3 of 6
Vulnerable and Susceptible Populations:
1. Children: They may smaller body mass to surface area ratio and sensitivity to certain exposures such
heatwaves. Their immune and heating regulatory systems are not fully developed and thus are highly susceptible
to extreme weather events, air pollution, food and waterborne diseases, and vectorborne diseases. School nurses
should be alert who have known medical conditions and require intervention during environmental
health alerts.

2. Elderly: Elderly adults, who often live alone and may have preexisting heart or lung conditions, are especially
susceptible to heat-related illnesses, hyperthermia, heat stress, cardiovascular failure, and dehydration, which
can lead to falls and other injuries. Nurses who practice in areas with a high elderly population can protect this
population by identifying at-risk patients and providing them and their caregivers with guidance about stay-
ing well-hydrated, using home air conditioners, and visiting air-conditioned places and cooling centers.

3. Urban poor: Poorer residents of high-density, heat-trapping urban environment soften have less access to
healthcare and “limited adaptive capacities, such as improved building materials, lack of air conditioning or
ability to access cooling centers and their limited ability to relocate to a less stressed environment” (Ebi, Fawcett,
et al., 2016a). Many of these vulnerable populations are located in flood-prone regions which are at risk of
increased precipitation and sea level rise. Nurses must identify patients who live and work in these communities
and ensure they are aware of their vulnerabilities and, together, create health-risk prevention plans.

4. Mental health: Disasters, including climate- and weather-related ones, can induce in people with and without a
history of mental illness alike, trauma, shock, anxiety, depression, complicated grief, posttraumatic stress disorder
(PTSD), and strains on personal relationships (Trombley, Chalupka, & Anderko, 2017). They can also increase
the incidence of alcohol and substance abuse, homicide, suicide, physical abuse, and spousal abuse. Nurses
should be aware of these potential stressors and be prepared to address them in collaboration with mental health
professionals.

The Nurse’s Role in Climate change:

 Educator
 Research consumer
 Health messenger
 Client advocates
 Leaders
 Change agents
 Nurses are vital partners in developing and implementing national and community strategies for protecting
individual and overall community health. Nurses’ advocacy extends to promoting public and policymaker
awareness and preparedness for the fight against the negative health effects of climate change—bringing their
knowledge, skills, and critical thinking to “the greatest global health opportunity of the 21th century”.

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. Which is the name of the gas that is responsible for the warning effect from greenhouse gases?
a. Carbon dioxide (CO2)
b. Methane (CH4)
c. Nitrous Oxide (N2O)
d. All of the above

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

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Education (Department of Nursing) 4 of 6
 2. What is the main man-made greenhouse gas?
a. CO2
b. CH4
c. N2O

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. Things you can do to help decrease global warming include:

a. Keep your air condition on high.
b. Turn off your lights when not using.
c. Keep your freezer door open.
d. Eat more ice cream.

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. The likelihood of which extreme weather event is expected to increase with climate change?
a. Heat waves
b. droughts
c. hurricanes
d. all of the above
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. Certain gases in the atmosphere: water vapor, CO2, methane and nitrous oxide, help maintain the Earth’s
temperature and climate. These are called:
a. Ozone gases
b. Greenhouse gases
c. Solar gases
d. Stomach gases
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

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Education (Department of Nursing) 5 of 6
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: Minute Paper

1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2) What question(s) do you have as we end this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 6 of 6
 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 16

Materials:
LESSON TITLE: Bioterrorism
Book, pen and notebook
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can:
References:
1. Define Bioterrorism Veenema, T.G. (2019) Disaster Nursing and
2. Identify the pathogens used with bioterrorism. Emergency Preparedness for Chemical,
3. Determine the emergency nursing interventions for Biological, and Radiological Terrorism and other
patients who were exposed to biological agents. Hazards 4th Edition
4. Describe the management for person who were
exposed to biological agents

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: List the vulnerable and susceptible populations.

1.
2.
3.
4.

MAIN LESSON (40 minutes)

BIOTERRORISM
The act of biological terrorism (bioterrorism) involves the deliberate use of microbial pathogens or toxins.

Like other threat agents, Bio-Agents can cause disease by inhalation, ingestion, or skin contact. But unlike other agents,
biological agents can also be contagious among people, and between people and animals. Bio-Agents may also incubate
and multiply in the body for days to weeks before symptoms are seen and a person knows they are sick.

For some Bio-Agents, no vaccines are available, so infected people must be quarantined. When left in the
environment, some biological agents can be dormant but potent for periods of weeks to years, depending upon both the
specific agent, and on the environmental conditions.

Pathogens used in Bioterrorism

1. Bacterial Agents
 Single-celled organisms
 Can reproduce
 Antibiotic treatment
2. Viral agents
 Live inside cells
 Need host to reproduce
 Vaccine and antiviral treatments
3. Toxins
 Non-living (can’t reproduce)
 Produced by organisms
 Antidote treatment

Delivery of Bioterrorism Agents

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Education (Department of Nursing) 1 of 4
  Form of delivery, or method of dispersion, effects both agent spread and response. Attacks may be either overt or
covert. In an overt attack, the delivery method is obvious, such as release from an airplane or bomb. While the
use of a bio-agent may not be immediately known, testing can quickly confirm the presence of microorganisms.
But, determination of the name of the bio-agent can several days. For a biotoxin, as with any chemical,
identification is much quicker.
 In a covert attack, the delay in identification of the bio-agent may be even longer because the attack may not be
recognized until after people have become obviously sick, which may take days. Covert attacks may include
contamination of a building or subway HVAC system, food, water, or other surfaces. For contagious agents, the
presence of an infected individual in a large crowd can effectively spread a bio-agent. However, for most
diseases, people are obviously sick, and bed-ridden during the most contagious stages. An unrecognized attack
using a contagious agent with several days delay until symptoms are seen can allow further dispersion of infected
people and spread the agent. In a worst-case-scenario, an epidemic may occur before a biological attack is
recognized.

1. Overt -- Provides notice, creates panic

 aircraft, bombs, missiles
2. Covert -- NO notice; spread may be unchecked for days!
 Spray fine mist (e.g., into HVAC)
 Spread on food, water, surfaces (e.g., mail, vehicles)
 Contagious people and animals

Bio-Agent Dose
• Inhalation of 1 to 500 bacteria or virus can cause sickness and death.
– 100,000 bacteria fit on a pin head
– 400 million virus fit on a pin head
• Inhalation of 0.000002 to 4.8 micro grams of a biotoxin can cause sickness
– A sand grain weighs 170 to 13,000 micrograms

Bio-Agent Detection
Bio-agents are detected through symptoms of infection and through time-consuming tests. Bio-agents cannot be detected
by the human senses, although high amounts of mist or powder can be seen and may be early indications of the presence
of bio-agents (e.g., powder in envelopes). There are some instruments that can rapidly detect an increase of biological
organisms in the air, but these instruments cannot identify the organism. An organism’s ability to cause harm is not
certain until it is identified. Tests for identifying bio-agents typically take days because they require growing the organism
in a culture before it can be identified.

Bio-Agent Indications
• Many patients with same illness at the same time
• Symptoms unusual for age
• Type of infection rare to region
• Dead animals before humans

Bio-Agent Response
• Identify: Bio-Agent(s), source, area affected, population exposed
• Notify local medical facilities
• Isolate and contain affected areas and population
• Treat - provide vaccine or medications to the affected population
• Decontaminate affected areas and population
• Follow-on Treatment - continue medical treatment as appropriate

Bio-Agent Decontamination
• Physical removal-HEPA vacuum
• Liquid decontamination
• Foam decontamination
• Emulsions
• Fumigants

Different approaches for different situations,

and multiple approaches for most situations.

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Education (Department of Nursing) 2 of 4
CHECK FOR UNDERSTANDING (10 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. All but one is correct about Bio-Agent Response:
a. Identify: Bio-Agent(s), source, area affected, population exposed
b. Notify local medical facilities
c. Isolate and contain unaffected areas and population
d. Treat -- provide vaccine or medications to the affected population
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. One advantage of a biological weapon is

a. It is odorless, colorless, and tasteless
b. It has a small attack area
c. It will immediately result in massive cases of human illness
d. It will kill the perpetrator of the release
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. The difference between the cost of biological weapons and other types of weapons is
a. Biological agents cost much more but can impact a much larger area making them cheaper overall
b. Biological agents cost about as much as chemical agents
c. Biological agents are about half the cost of other types of weapons
d. Biological agents are several hundred times less expensive than other weapons
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. Which of the following is the worst-case scenario for a biological release?

a. Particle size 1 to 5 microns
b. Weather pattern includes a thermal inversion
c. Aerosol release
d. All of the above
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. One disadvantage of a biological weapon is that

a. It is not easy to control
b. It is too easy to disperse and may leak prior to delivery
c. It is difficult to use due to International restrictions
d. None of the above
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 3 of 4
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: 3-2-1

Instructions:
1. As an exit ticket at the end of the class period
2. After the lesson, have each student record three things he or she learned from the lesson.
3. Next, have them record two things that they found interesting and that they’d like to learn more about.
4. Then, have students record one question they still have about the material.
5. Review the students’ responses. You can use this information to help develop future lessons and
1. determine if some of the material needs to be taught again.

Three things you learned:

1. ______________________________________
2 ______________________________________
3. ______________________________________

Two things that you’d like to learn more about:

1. ______________________________________
2. ______________________________________

One question you still have:

1. ______________________________________

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 4 of 4
 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 17

Materials:
LESSON TITLE: Disaster Caused by Biological Agents
Book, pen and notebook
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can:
References:
1. Identify causes biological disasters. Veenema, T.G. (2019) Disaster Nursing and
2. Identify the factors associated with biological disasters Emergency Preparedness for Chemical,
3. Determine the emergency nursing interventions for Biological, and Radiological Terrorism and other
patients who were exposed to biological agents. Hazards 4th Edition
4. Describe the managements for person who were
exposed to biological agents

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the three common pathogens used in bioterrorism?

MAIN LESSON (40 minutes)

CDC Classification of Biological Agents

Category A: most deadly microbes known to man; high mortality rates; induce public panic and social disruption; high
infectivity
Category B: moderate morbidity and lower mortality; lower infectivity
Category C: emerging agents, potential future infective threats

Category A
- Anthrax (Bacillus anthracis)
- Botulinum toxin (Clostridium botulinum)
- Plague (Yersinia pestis)
- Smallpox (Variola major)
- Tularemia (Francisella tularensis)
- Hemorrhagic fever viruses
Category B
- Brucellosis
- Epsilon toxin of Clostridium perfringens
- Melioidosis
- Psittacosis
- Q fever
- Ricin toxin
- Staphylococcal enterotoxin B
- Typhus fever
- Viral encephalitis
Category C
- Nipah fever
- Hantavirus

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Education (Department of Nursing) 1 of 6
ANTHRAX
 A zoonotic disease, generally found in herbivores (sheep, goats, and cattle)
 Bacillus anthracis: spore-forming bacterium
 Contact with infected animals or animal products
 Wool sorter’s disease
 Extremely resilient and can remain viable for decades
 Inhalation anthrax
 Last reported case of naturally occurring inhalation anthrax in the US was in 1978
 Anthrax as bioterrorism: late 2001 to early 2002 with 23 identified cases
 High level of resistance to high temperatures and disinfectants
 Secretes powerful exotoxin (anthrax toxin)
 Confirmatory: clinically compatible case of either cutaneous, gastrointestinal, inhalation diseases, confirmed by
isolation of B. anthracis from an affected tissue or site

Inhalation Anthrax
 Inhalation of spores
 Incubation period: 1-6 days, then producing bacteremia
 Signs and symptoms:
Nonspecific:
 Viral URTI
 Severe edema and hemorrhagic mediastinitis
 Respiratory failure
 Septic shock
 Hemorrhagic meningitis
 Death

Cutaneous Anthrax
 Spores enter skin through cuts or abrasions
 Macule or papule, which ulcerates ( 1 - 7 days)
 Black, painless eschar
 Severe local edema
 Painful regional lymphadenopathy

Gastrointestinal Anthrax
Ingested spores in the upper or lower GI, that leads to sepsis.

Upper GI form
 Oral or esophageal ulcers
 Edema; Lymphadenopathy
 Vomiting
Lower GI form
 Vomiting
 Bloody diarrhea
 Acute abdomen
 Ascites

Isolation, Vaccination, and Postexposure Prophylaxis

Universal precaution: contact with suspected patients
Contact isolation: patients with inhalation or cutaneous anthrax
Vaccine: AVA (Anthrax Vaccine Adsorbed)
Post-exposure prophylaxis:
- For those exposed to airspace contaminated with aerosolized B. anthracis
- Ciprofloxacin or doxycycline for 60 days
- 100 days prophylaxis for inhalation exposure that is significant

Treatment:
Cutaneous anthrax: ciprofloxacin or doxycycline, 60 day oral course

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Education (Department of Nursing) 2 of 6
 Inhalation anthrax:
- ciprofloxacin or doxycycline, 60 -day IV course, plus one or two microbials
- Aminoglycoside
- Clindamycin
Multidrug antibiotic regimens
Chest tube drainage: hemorrhagic pleural effusion

BOTULISM
 Caused by Clostridium botulinum (anaerobic bacterium), which produces botulinum toxin; soil contaminant
 Neuroparalytic
 Foodborne illness that can kill rapidly

Four major types:

1. Foodborne botulism: home processed foods
2. Infantile botulism: food contamination through ingestion
3. Wound botulism
4. Intestinal botulism

Pathogenesis
 C. botulinum is widespread in soil, surfaces of foods, and dust
 Killed by boiling at 100 degrees Celsius
 Blocks acetylcholine release from peripheral cholinergic nerve terminals
 The neurotransmitter blockade is irreversible, requiring the growth of new nerve endings for nerve conduction to
resume

Clinical Manifestation
 Cranial nerve palsies; ophthalmoplegia
 Progressive, descending, symmetric weakness or paralysis
 Respiratory failure leading to death
 Foodborne botulism:
- Nausea and vomiting
- Diarrhea leading to constipation in advanced stage
 Infantile botulism:
- Constipation
- Flaccidity (floppy baby)
- Poor suck reflex and feeding
- Poor head control

Isolation, Vaccination, and Postexposure Prophylaxis

- Universal precautions
- Droplet precautions; isolation is not necessary
- C. botulinum antitoxin for laboratory personnel
- Postexposure prophylaxis is not recommended for asymptomatic patients

Treatment
 Ventilatory support: average of 6-8 weeks, but can last to 7 months
 Administration of botulinum antitoxin
 Acts only in unbound toxin and therefore, its efficacy is greatest early in the patient’s clinical course.
 Cathartics and enemas
 For infantile botulism: human derived Botulism Immune Globulin (BIG)

PLAGUE
 Most feared infectious disease in the history of humankind; more than 200 million died during the Black Death
of the Middle Ages
 Yersinia pestis (gram-negative bacteria)
 Plague-infected fleas moved from their natural hosts (rodents) to humans
Transmission:

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Education (Department of Nursing) 3 of 6
  bite of an infected flea
 droplet spread from patients with pneumonic plague

Types of Plague
1. Bubonic Plague
- Bite of an infected flea
- Bacteria migrate to local lymph nodes and multiply
- Signs and symptoms:
 Large, swollen, extremely tender lymph nodes: bubo
 Bacteremia
 Fever, chills, myalgia
 Nausea and vomiting
 Sepsis to shock
 DIC
 Coma and death

2. Septicemic Plague
- Bite of an infected flea
- Signs and symptoms:
 Sepsis
 DIC
 Grangrene
 Necrosis of fingers and toes

3. Pneumonic Plague
- Deadliest form; spread by droplet dispersal from infected patients, or by hematogenous spread
- Infects the lungs; cardinal sign: severe pulmonary involvement
- Signs and symptoms:
 Severe hemorrhagic, necrotizing bronchopneumonia
 Dyspnea and chest pain
 Cough and hemoptysis

Isolation, Vaccination, Postexposure Prophylaxis

 Strict isolation
 Gloves, gowns, masks and eye protection should be worn for at least 48 hours of treatment
 Antibiotic prophylaxis: recommended for contacts of patients infected with plague:
o Doxycycline
o Ciprofloxacin
o Tetracycline
o Sulfonamides
o Chloramphenicol

Treatment
Treatment of choice:
 Streptomycin
 Gentamicin
 Doxycycline
 Ciprofloxacin
 Chloramphenicol

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 4 of 6
Multiple Choice
1. What is the most common naturally occurring form of anthrax?
a. inhalation
b. cutaneous
c. gastrointestinal
d. neurologic
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. Which form of plague can be spread from person to person?

a. Pneumonic
b. Bubonic
c. septicemic
d. foodborne
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. Which of the following forms of anthrax infection causes most fatalities?

a. Cutaneous
b. inhalation
c. gastrointestinal
d. neurologic
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. The deadliest form/ type of plague.

a. Bubonic plague
b. Septicemic plague
c. Pneumonic plague
d. All of the above

ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. Which of the following would be a symptom of botulism?

a. Disfigured nodules on the skin
b. lockjaw
c. flaccid paralysis
d. sepsis

ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

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Education (Department of Nursing) 5 of 6
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: 3-2-1

Instructions:
1. As an exit ticket at the end of the class period
2. After the lesson, have each student record three things he or she learned from the lesson.
3. Next, have them record two things that they found interesting and that they’d like to learn more about.
4. Then, have students record one question they still have about the material.
5. Review the students’ responses. You can use this information to help develop future lessons and
1. determine if some of the material needs to be taught again.

Three things you learned:

1. ______________________________________
2 ______________________________________
3. ______________________________________

Two things that you’d like to learn more about:

1. ______________________________________
2. ______________________________________

One question you still have:

1. ______________________________________

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Education (Department of Nursing) 6 of 6
 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 18

LESSON TITLE: Preparing for Terrorism: Chemical Materials:

Weapons
LEARNING OUTCOMES: Book, pen and notebook

Upon completion of this lesson, the nursing student can:

1. Identify causes chemical disasters. References:

2. Identify the factors associated with chemical disasters Veenema, T.G. (2019) Disaster Nursing and
3. Determine the emergency nursing interventions for Emergency Preparedness for Chemical,
patients who were exposed to chemical agents. Biological, and Radiological Terrorism and other
4. Describe the managements for person who were Hazards 4th Edition
exposed to chemical agents

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the classifications of biological agents.

MAIN LESSON (40 minutes)

Chemical Agents of Concern

Chemical agents vary widely and are categorized by their structure and/or physical effect on victims. Scientists often
categorize hazardous chemicals by the type of chemical or by the effects a chemical would have on people exposed to it.

The categories/types used by the CDC are as follows:

 Biotoxins
 Blister agents/vesicants
 Blood agents
 Caustics (acids)
 Choking/lung/pulmonary agents
 Incapacitating agents
 Long-acting anticoagulants
 Metals
 Nerve agents
 Organic solvents
 Riot control agents/tear gas
 Toxic alcohols
 Vomiting agents

Chem-Agent Effects and Treatment

Health Effects:
 Disorientation
 Dizziness
 Nausea
 Blindness

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Education (Department of Nursing) 1 of 7
  Serious injury
 Immobilization
 Death

Mitigation
1. Minimize exposure:
• Avoid chemical cloud
• Cover face to filter breathing
2. Get medical attention:
• Skin decontamination
• Antidote

Types of Chemical Agents

Chemicals may be either persistent or non-persistent. Persistent chemicals do not evaporate or break down quickly, and
may take days to weeks to become harmless. The rate of their evaporation or breakdown depends on environmental
conditions including temperature, wind, humidity, and surface type. Release of persistent chemicals may require isolation
of the contaminated area until decontamination is complete, and may thereby cause a longer-term disruption. In contrast,
non-persistent chemicals dissipate quickly, and thus represent only a short-term hazard after they are completely
released. Non-persistent chemicals are typically gases and liquids that evaporate quickly. Most of the common industrial
chemicals carried in bulk in the transportation system are non-persistent.

Persistent chemicals
• remain on surfaces without evaporating or breaking down for more than 24 hours
• can remain for days to weeks
Non-persistent chemicals
• quickly evaporate and break down
• carried in bulk on commercial carriers

1. Nerve Agents – disrupt nervous system, causes paralysis, fatal quickly

2. Blister Agents – destroy skin and tissues, cause blindness, may be fatal
3. Choking Agents – lung fills with fluid, cause choking, quick or delayed fatality
4. Blood Agents – interferes with oxygen at the cellular level, fatal quickly
5. Riot-Control Agents – skin and breathing irritations, rarely fatal

Exposure Pathways
This table shows the more common exposure pathways through which people may be be affected by chemical agents. All
types of chemical agents can cause significant symptoms by inhalation, whereas only nerve agents are likely to be
effective through ingestion. Skin contact is the most common pathway for harm from blister agents, but nerve, choking,
and riot-control agents can also cause skin or eye irritations. These exposure pathways point out that emergency workers
need not only respiratory protection, but full body cover suits for protection from the effects of many of these chemical
agents.

++ Typical path + Possible path -- Unlikely path

Pathway
Chemical Agent
Skin or Eye
Inhalation Ingestion
Contact

Nerve ++ + ++

Blister + -- ++

Choking ++ -- +

Blood ++ -- --

Riot-Control ++ -- ++

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Education (Department of Nursing) 2 of 7
Chem-Agent Dose

100% Lethal Air Dose Quantity

Chemical Agent
Domed Stadium Movie Theater Boeing 747-400

Nerve 13 Gallons 2 ½ Cups 1.3 ounces

Blister 338 Gallons 4 Gallons 1 Quart

Choking 780 Gallons 9 Gallons 2.3 Quarts

Blood 520 Gallons 6 Gallons 1.5 Quarts

Riot-Control 1820 Gallons 21 Gallons 5.3 Quarts

This table shows how much of a chemical agent it would take to deliver a lethal dose to people in a domed stadium, a
movie theater, and occupants of a Boeing 747. Nerve agents are the most lethal type of chemical and require the
smallest quantities, followed by blister and blood agents. Notice that hundreds of gallons are needed to reach lethal
doses in a domed stadium, which would be far more difficult to transport unnoticed than the few quarts that would be
needed on an airplane.

Chem-Agent Detection
Chemical threat agents can often be seen, smelled, tasted, or felt. In addition, numerous instruments and even simple
paper tests can be used to detect and identify chemical threats. In a chemical attack, agents are typically dispersed as a
vapor, liquid drops, or a solid aerosol of small particles, all of which may be inhaled and also come into contact with the
skin and eyes. Although many chemical agents have readily available antidotes, some do not have an antidote, and
treatment options are limited.

• Some can be seen

• Some can be smelled
• Some can be tasted
• Most can be felt (e.g. burning sensation, choking)
• All can be detected by appropriate instruments

Chem-Agent Response
• Call in hazmat team
• Identify chemical agent
• Isolate and contain affected area
• Evacuate and shelter-in-place public
• Provide needed medical treatment
• Cleanup contaminated area

CHEMICAL AGENTS

NERVE AGENTS
 Are among the most potent and most deadly of the chemical weapons
 Rapidly lethal and hazardous by any route of exposure
 Lethal in tiny amounts by disrupting the operations of the nervous system
Clinical presentations: (Develop within a matter of minutes after exposure)
 Gasping
 Miosis
 Copious secretions
 Sweating
 Generalized twitching

Cholinergic toxidrome (muscarinic signs and symptoms):

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Education (Department of Nursing) 3 of 7
 DUMBBELSS
 Diarrhea
 Urination
 Miosis
 Bradycardia
 Bronchorhea
 Emesis
 Lacrimation
 Salivation
 Sweating

Nicotinic signs and symptoms:

 Muscle fasciculations
 Tremors
 Weakness

Duration / Mortality:
 Recovery may take several months
 Permanent damage to CNS is possible

Mild inhalation exposure:

Rapid onset of miosis, blurry vision, runny nose, chest tightness, dyspnea, and possible wheezing

Severe inhalation exposure:

Sudden coma, seizures, flaccid paralysis with apnea, miosis, diarrhea, and a victim who is “wet” (lacrimation, salivation,
urination, sweating, copious upper and lower respiratory secretions).

Mild dermal exposure:

Sweating and muscle fasciculations localized to the area of exposure, nausea, vomiting, diarrhea, and possible miosis

Severe dermal exposure:

Sudden coma, seizures, flaccid paralysis with apnea, miosis, diarrhea, a victim who is “wet”

Treatment
 Decontamination
 Endotracheal intubation
 Suctioning
 Prophylactic anticonvulsants
 Anticholinergics (antagonize muscarinic effects)
 Oximes (reactivate the inihibited acetylcholinesterase and reverse paralysis)
 Atropine and pralidoxime

BLOOD AGENTS
 Primary route: inhalation
 Causes red blood cell lysis

Symptoms: weakness, shortness of breath, possible loss of consciousness, respiratory failure, paralysis, death
Long-term effects: kidney damage and neuropathy
Agent Appearance Odor
Arsine Colorless Mild garlic or fishy
Carbon monoxide Colorless Odorless
Cyanides Colorless, pale-blue Bitter almond

Signs and Symptoms:

Low concentration of cyanide, victims will have 10-15 seconds of:
 Gasping
 Tachypnea

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Education (Department of Nursing) 4 of 7
  Tachycardia
 Flushing
 Sweating
 Headache
 Agitation confusion

High concentration of cyanide:

 Bradycardia
 Apnea
 Seizures
 Coma
 Death

Arsine:
 Burning sensation in the chest followed by chest pain
 Nausea and vomiting
 Headache
 Malaise
 Weakness
 Dizziness
 Abdominal pain
 Dyspnea
 Bloody urine
 Jaundice

Treatment
 Cyanide antidote kit:
o amyl nitrate
o sodium nitrate
o sodium thiosulfate (binds with cyanide and is excreted into the urine)
 Circulatory and respiratory support
 Monitor serum electrolytes, BUN, creatinine

The basic emergency response to a chemical threat attack involves immediate response by a trained Hazmat team,
equipped with appropriate protective gear and measurement instrumentation. It is of paramount importance to identify the
chemical agents involved while isolating and containing the affected area. Public protection is afforded by either
evacuation or sheltering depending on the specific circumstances of chemical type, amount, topography, public location
and weather conditions. With the chemical agents identified, appropriate medical treatment can be provided and the right
type of cleanup can commence. Cleanup may include the application of neutralizing chemicals.

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. The nurse should plan to assess soldiers who might have been exposed to nerve gas agents for which
symptoms?
a. Nausea and vomiting
b. Convulsion and loss of consciousness
c. Diarrhea
d. Constipation
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

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Education (Department of Nursing) 5 of 7
 2. A nurse is responding to a biochemical incident, to protect the nurse from exposure to these chemicals, the nurse
must:
a. Handwash
b. Wear mask
c. Wear appropriate PPE
d. Call for emergency backup
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. The best room to use for shelter during a chemical accident or attack is a room with many windows and doors that
can be used as possible escape routes.
a. True
b. False
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. Chemical agents that destroy skin and tissues, cause blindness, may be fatal
a. Blood agents
b. Blister agents
c. Nerve agents
d. Choking agents
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. You work in a large convention center. Approximately 500 people have been attending an all -day computer
software conference. By mid- afternoon, however, more than a hundred attendees have developed complaints of
disorientation, dizziness, and nausea. Some have even left to go to the hospital. What is the most likely causing
these symptoms?
a. Radiation agents
b. Biological agent
c. Chemical agents
d. None of the above
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________

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Education (Department of Nursing) 6 of 7
 RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: Minute Paper

1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2) What question(s) do you have as we end this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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Education (Department of Nursing) 7 of 7
 NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR
Session # 19

Materials:
LESSON TITLE: Preparing for Terrorism: Nuclear
Book, pen and notebook
Radiation Exposure
LEARNING OUTCOMES:
References:
Upon completion of this lesson, the nursing student can:
Veenema, T.G. (2019) Disaster Nursing and
1. Define radiation. Emergency Preparedness for Chemical,
2. Describe the 3 basic types of radiation. Biological, and Radiological Terrorism and other
3. Recognize common types of radiological incidents and Hazards 4th Edition
emergencies.
4. Describe the clinical signs of radiation exposure.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the types of chemical agents?

MAIN LESSON (40 minutes)

RADIATION refers to ionizing radiation— radiation with enough energy to create ion pairs in matter. Ultraviolet light can
do this, as can x-rays, gamma rays, and other kinds of radiation. Visible light is also radiation, but it is not energetic
enough to cause ionizations, so it cannot normally cause problems. By comparison, ionizing radiation can damage our
DNA, causing health effects in sufficiently high doses.

Types of Radiation
1. Alpha Radiation - Alpha radiation can cause a great deal of damage to the living cells it encounters, but has
such a short range in tissue that external alpha radiation cannot penetrate the dead cells of the epidermis to
irradiate the living cells beneath.
2. Beta Radiation - Beta particles are electrons or positrons and are both lighter than alpha particles and possess a
lower electrical charge. This means that they are not nearly as damaging, although they will penetrate up to a
centimeter into tissue.
3. Gamma Radiation - Gamma rays are energetic photons, similar to x-rays. Gamma radiation is much less
damaging than alpha radiation and is about as damaging as beta radiation. Unlike alpha and beta radiation,
gamma radiation will penetrate the whole body, so it will deliver radiation doses to internal organs as well as to
the skin.

Artificial Sources of Radiation

• Medical Equipment
• Radiopharmaceuticals
• Industrial instruments
• Food irradiation facilities
• Nuclear research laboratories
• University research reactors
• Nuclear weapons
• Nuclear power plants

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Education (Department of Nursing) 1 of 5
Measuring Radiation
1. Curie: Amount of material
2. Rem: Absorbed dose
3. Half-Life: Time for decay to ½ the original amount

Clinical signs of Radiation exposure

1. Nausea and vomiting
2. Erythema
3. Blistering, ulcerated tissue, possible necrosis
4. Depression in red and white blood cell count
5. Elevated levels of chromosomal aberrations

Health Effects of Radiation Exposure

1. Prodromal Syndrome
- Patients with prodromal syndrome have likely been exposed to at least 1 Sv (100 rem)
- Patients exhibiting symptoms like vomiting or bloody diarrhea within 30 minutes of exposure
have likely received a lethal dose of radiation
2. Hemotopoietic Syndrome
- Hematopoietic syndrome begins to appear at doses of 3 to 8 Sv (300 to 800 rem)
- This leads to a reduction in blood cell counts as older cells die and are not replaced, it leaves
the patient open to infection and other related problems.
3. Gastrointestinal Syndrome
- Exposure to 10 Sv (1000 rem) or more.
- Radiation exposure in this range sterilizes dividing crypt cells, leading to loss of cells from villi.
4. Cerebrovascular Syndrome
- Exposure to exceptionally high doses of radiation (in excess of 100 Sv or 10,000 rem) will result
in damage to the central nervous system, normally among the most radiation-resistant parts of
the body.
- Usually results in death within several hours to a few days of exposure.

Radiological Incidents and Emergencies

 Traffic accident involving a truck carrying research or medical radioactive isotopes
 Terrorist attack with an RDD (or “dirty bomb”)
 Fire in a hospital or university radioactive waste storage facility
 Unplanned radioactive release from a commercial nuclear power station
 Detonation of a nuclear weapon
 Loss of a radioactive soil-density gauge or well-logging gauge
 Accidental exposure of a maintenance technician to radiation from an industrial linear accelerator
 Radiation burns to the fingers from the beam of an x-ray diffractometer in a soil science laboratory
 Accidental overexposure to an angiography patient from excessive flouoroscopy, resulting in radiation burns to
the skin.
 Spill of radioactive liquids in a research laboratory

Radiation Detection
• Cannot be seen
• Cannot be smelled
• Cannot be tasted
• Cannot be felt
• CAN ONLY BE DETECTED BY INSTRUMENTS

Protection from Radiation

1. Minimize time you are exposed
2. Stay as far away as possible from the source of radiation
3. Use the thickest possible shielding between you and the radiation source.

Indications of a Radiological Event

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Education (Department of Nursing) 2 of 5
 A radiological event, such as a radiological dispersal device otherwise known as a dirty bomb, may be indicated by an
explosive release of a fine powder or solid material. Early symptoms seen in people exposed to high doses of radiation
include skin reddening, hair loss, widespread incidents of nausea, vomiting, headaches, and a weakened immune system.
Depending on the scenario, these acute radiation symptoms may not be seen from a dirty bomb explosion because high
radiation levels may not extend very far, and the people exposed to these levels may be killed by blast effects, as with a
conventional bomb. The effects of lower exposures to radiation include a long-term increase in certain types of cancers.

Radiation Response

General guidelines indicate that a radiological event has occurred when a radiation dose rate of 0.01 rem/hour or
greater is noted. Short term exposures of a few hours to doses around 10 rem/hour may still not have significant human
health effects, however, it is generally recommended that first responders not enter these areas, with the possible
exception of a very short-term rescue.
General dose guidelines for sheltering, evacuating, and relocating the public are much lower than for emergency
response personnel in recognition that people living in the contaminated area will have long-term, continuous exposure to
greater than normal radiation levels. These longer-term doses are calculated over a 24-hour or annual period.

Response to a Radiological Event

• Identify presence of radiation beyond normal background
• Isolate and contain affected area -- mitigate spread of contamination
• Shelter-in-place or evacuate depending on dose rates
• Provide needed immediate medical treatment

Radiological emergency response should be initiated when excessive radiation is measured. The affected area
should be mapped to identify the extent of radiological contamination and to determine the boundaries of the area to
isolate and contained. Isolation includes stopping all traffic that may spread contamination, and preventing spread by
gravity into sewer drains.
Estimated dose rates and doses should be used in making decisions regarding public evacuation or sheltering. Short
term medical treatment can include wound treatment to preclude infections since radiation exposure can compromise the
immune system. Certain drugs can be used if the exact radioactive material has been identified.

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. There has been a radioactive explosion nearby. The emergency room nurse must triage and manage the
decontamination of the clients systematically. Which of the following clients would be decontaminated first?
a. A client with severe injuries.
b. A client with minor injuries.

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 3 of 5
 c. A client with the least injuries.
d. A client with the most injuries.
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. All are true about Radiation Detection except:

a. Cannot be seen
b. Cannot be smelled
c. Can be tasted
d. Cannot be felt
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. All except one are forms of radiation

a. Alpha radiation
b. Beta radiation
c. Gamma radiation
d. Proton radiation
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. When taking care of a patient undergoing radiation therapy, the nurse should
a. Be with the patient all the time
b. Minimize time together with patient
c. Use hazmat
d. Wash hands
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. What clinical manifestation should alert the nurse to possible fatal exposure to radiation?
a. Elevated levels of chromosomal aberrations
b. Redness in the chest
c. Decreased in WBC count
d. Presence of white spots all over the body
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 4 of 5
 RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: 3-2-1

Instructions:
1. As an exit ticket at the end of the class period
2. After the lesson, have each student record three things he or she learned from the lesson.
3. Next, have them record two things that they found interesting and that they’d like to learn more about.
4. Then, have students record one question they still have about the material.
5. Review the students’ responses. You can use this information to help develop future lessons and
1. determine if some of the material needs to be taught again.

Three things you learned:

1. ______________________________________
2 ______________________________________
3. ______________________________________

Two things that you’d like to learn more about:

1. ______________________________________
2. ______________________________________

One question you still have:

1. ______________________________________

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Education (Department of Nursing) 5 of 5