NUR 113: DISASTER NURSING
STUDENT ACTIVITY SHEET
BS NURSING / FOURTH YEAR
Session # 1
LESSON TITLE: I. Disaster Preparedness: Essentials of
Disaster Planning
Materials:
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.
2. Describe basic principles of disaster planning.
3. Differentiate risk assessment, hazard identification, and
vulnerability analysis.
4. Identify the core preparedness actions.
References:
Veenema, T.G. (2019) Disaster Nursing and
Emergency Preparedness for Chemical,
Biological, and Radiological Terrorism and other
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.
2.
3.
4.
Classroom rules and regulations.
The calendar of activities (major examinations).
Computation of grades specific for this subject.
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.
3.
4.
5.
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7.
8.
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10.
Disaster planning is only as effective as the assumptions upon which it is based.
Core preparedness activities must go beyond the routine
Have a community needs assessment.
Identify leadership and command post.
Design a local response for the first 72 hours.
Identify and accommodate vulnerable populations.
Know about state and federal assistance.
Identify training and educational needs, resources, and personal protective equipment (PPE).
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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