DISASTER NURSING: DISASTER TYPES, PHASES, management,

AND the EMERGENCY HEALTH SERVICES

PRELIMS PERIOD
LESSON OUTLINE o Assessing the needs of disaster-
affected populations
I. INTRODUCTION TO DISASTER o Matching available resources to needs
II. TYPES OF DISASTER o Preventing further adverse health
III. ENVIRONMENTAL DISASTERS AND effects
EMERGENCIES o Evaluating program effectiveness
IV. BIOLOGICAL AND CHEMICAL o Planning for contingencies
TERRORISM: A UNIQUE THREAT DISASTER NURSING
V. DISASTER MANAGEMENT
• It can be defined as the adaptation of
CONTINUUM professional nursing skill in recognizing
VI. EMERGENCY HEALTH SERVICES the nursing, physical, and emotional needs
VII. DISASTER OVERVIEW: THE resulting from a disaster.
PHILIPPINES
1. NATURAL DISASTERS
• These are caused by natural or
DISASTER environmental force.
• Defined as “a serious disruption of the • As the “result of an ecological disruption or
functioning of a community or a society at threat that exceeds the adjustment
any scale due to hazardous events capacity of the affected community”.
interacting with conditions of exposure, • Natural disasters include: earthquake,
vulnerability and capacity, leading to one or floods, tornadoes, hurricanes, volcanic
more of the following: human, material, eruptions, ice storms, tsunamis, and other
economic and environmental losses and geological, hydrological, and
impacts” meteorological phenomena.
• Ecological disruption or an emergency,
of a severity and magnitude that result in
death, injuries, illnesses, and property
damage.
• A Health disaster is a catastrophic even
that results in casualties that overwhelm TYPES OF NATURAL DISASTER
the healthcare resources in a community. A. GEOLOGICAL
• Can be natural or man-made, also known • Geology: studies the physical components
as anthropogenic. and formation of the planet. This includes
• Disasters are frequently categorized by how the Earth formed and changed over
onset, impact, and duration several billion years, how its core and
• Hospitals and other healthcare facilities mantle affects the surface of the planet,
divide or classify disasters into two: how rocks are formed, and the chemical
o External – does not affect hospital composition of minerals.
infrastructure but tax hospital resources • A geological disaster occurs anytime a
due to number of patients or type of geological hazard manifests and impacts
injuries. human lives and properties. It is a subtype
o Internal – cause disruption of normal of natural hazards.
hospital function due to injuries or • Examples of geological disasters are
deaths of hospital personnel or damage earthquakes, tsunamis caused by
to the facility itself such as a hospital geological forces, volcanic eruptions, and
fire. landslides.
• 2 Types of Disaster:
1. Natural Disaster B. HYDROLOGICAL
2. Man-made Disaster • Defined as unexpected and violent
changes in quantity, distribution and move
DISASTER EPIDEMIOLOGY patterns of water on earth that can result to
• Measurement of the adverse health destruction.
effects of natural and human-generated • Examples are floods, limnic eruptions and
disasters and factors that contribute to tsunami.
those effects. • Hydrological hazards, and other causative
• Overall objective includes: factors and could be exasperated by global
climate change.

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Disaster Nursing: Disaster Types, Phases, Management, and the Emergency Health Services

• A hazard caused by the occurrence,

movement, and distribution of surface and
subsurface freshwater and salt water.

F. SPACE DISASTER
• Astronomical phenomena might be
responsible for ending life either on Earth
C. METEOROLOGICAL or elsewhere. There are several
• Meteorological disasters are caused by astronomical events that may play a role in
extreme weather such as rain, drought, shortening the lifetime of a life-bearing
snow, extreme heat or cold, ice, or wind. planet or moon.
• Violent, sudden and damaging alteration in • Examples:
the atmosphere associated with, created o Asteroid impact
by, or touching the earth’s atmosphere, o Nearby supernovas
particularly the weather-forming
processes.
• Examples of weather disasters embrace
blizzard, cyclones, droughts, hailstorms,
heat waves, hurricanes, floods (caused by
rain) and tornadoes.
• A hazard caused by short-lived, micro- to 2. MAN-MADE DISASTER
meso-scale extreme and atmospheric
conditions that last from minutes to days. • Human-generated
• Man-made disasters have an element of
human intent, negligence, or error
involving a failure of a man-made system,
as opposed to natural disasters resulting
from natural hazards. Such as man-made
disasters are crime, arson, civil disorder,
terrorism, war, biological/chemical threat,
D. FIRES cyber-attacks, etc.
• Fire is rapid, self-sustaining oxidation
process accompanied by the evolution of
heat and light in varying intensities.
• Fire is believed to be based on three
elements being present: fuel, heat and
oxygen. TYPES OF MAN-MADE DISASTER
• Fire disaster can occur above the ground A. COMPLEX EMERGENCIES
(in tall buildings on planes), on the ground, • Deep social crisis in which large numbers
and below the ground (in mines). of people die from war, displacement and
hunger owing to man made disaster.
• Humanitarian crisis with a break down in
authority due to internal and external
conflicts that requires international
response.
• Characteristics of Complex
E. HEALTH Emergencies:
• Public health emergencies can arise o Violence and Massive displacement
from a wide range of causes, including o Administrative, economic, political
outbreaks of contagious, life-threatening collapse
disease, natural disasters, as well as o Exploitation and worsening of existing
chemical contamination of the environment difference in civil society (economic,
and the release of radiation. social, etc.)
• In emergencies, large numbers of people o Dispute over legitimacy of authority
may require medical attention, health care (government or rebels)
systems may be over-stretched, and public
order may be threatened.

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B. TECHNOLOGICAL DISASTERS stagnant atmospheric conditions and poor

• Is an event caused by a malfunction of a air quality (FEMA, 2006b).
technological structure and/or some • Adverse health outcomes associated with
human error in controlling or handling the high environmental temperatures include
technology. heatstroke, heat exhaustion, heat syncope,
• Technology disasters include structural and heat cramps.
collapse, such as bridges, mines and • Heatstroke is the most serious of these
building, but also industrial accidents, conditions and is characterized by rapid
chemical or nuclear explosions.
progression of lethargy, confusion, and
C. DISASTER IN HUMAN SETTLEMENTS unconsciousness; it is often fatal despite
medical care directed at lowering body
• More than a billion people live in marginal
and informal settlements, many without temperature.
access to basic services, and very • Heat Syncope and Heat Cramps are
frequently in high-risk areas. usually related to physical exertion during
• Their vulnerability to disaster events is hot weather
often compounded by a lack of
infrastructure, environmental degradation, PREVENTION
and increasing challenges exacerbated by ➢ Basic behavioral and environmental
climate change and sea level rise. measures are essential for preventing
• If there is so much technology for heat-related illness and death. Personal
prediction and prevention, why do prevention strategies should include
governments/donors continue to struggle
increasing time spent in air-conditioned
with losses in the same communities,
disaster after disaster? Evidence in the environments, intake of nonalcoholic
scientific community leads us believe the beverages, and incorporation of cool baths
answer to this question lies in the process into a daily routine.
of how human settlements are established ➢ Sun exposure should be minimized, and
and the underlying factors that encourage light, loose, cotton clothing should be worn.
the population within those communities to
establish in high-risk areas. Nurses and other health care providers can
assist in preventing heat-related illnesses and
ADDITIONAL INFORMATION ON deaths by disseminating community
NATURAL DISASTER prevention messages to persons at high risk
(e.g., the elderly and persons with preexisting
HEAT WAVE medical conditions) using a variety of
• Mortality and morbidity rise when daytime communication techniques.
temperatures remain unusually high
several days in a row and nighttime CYCLONES, HURRICANES, AND
temperatures do not drop significantly. TYPHOONS
• Deaths occur more commonly during heat • Cyclones are large-scale storms
waves where there is little cooling at night characterized by low pressure in the center
and taper off to baseline levels if a heat surrounded by circular wind motion.
wave is sustained (Federal Emergency • A hurricane is a tropical storm with winds
Management Agency [FEMA], 2006b). that have reached a constant speed of 74
miles per hour or more. Hurricane winds
RISK OF MORBIDITY AND MORTALITY blow in a large spiral around a relatively
• Heat kills by pushing the human body calm center known as the eye. The eye is
beyond its limits. generally 20 to 30 miles wide, and the
• The heat index (HI) is the temperature the storm may extend outward 400 miles.
body feels when heat and humidity are
combined. A distinctive characteristic of hurricanes is the
• Most heat disorders occur because the increase in sea level, often referred to as storm
victim has been overexposed to heat or surge.
has over-exercised for his or her age and
physical condition. Other conditions that • The increase in sea level is the result of the
can induce heat-related illnesses include low-pressure central area of the storm
creating suction, the storm winds piling up
water, and the tremendous speed of the

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storm. Rare storm surges have risen as organic and nutrient content. This leaves
much as 14 meters above normal sea the soil exposed to the eroding forces of
level. the sun and wind. The subsoil that is left
can become so hard that it no longer
RISK OF MORBIDITY AND MORTALITY absorbs rain.
• Deaths and injuries from hurricanes occur
because victims fail to evacuate the RISK OF MORBIDITY AND MORTALITY
affected area or take shelter, do not take • Morbidity and mortality can result from
precautions in securing their property, and diarrheal disease, respiratory disease, and
do not follow guidelines on food and water malnutrition.
safety or injury prevention during recovery • Mortality exceeding a baseline rate of one
(FEMA, 2006f). death per 10,000 people per day is the
index of concern.
Nurses need to be familiar with the commonly
used definitions for severe weather watches EARTHQUAKE
and storm warnings in order to assist with • An earthquake, generally considered to be
timely evacuation or finding shelter for affected the most destructive and frightening of all
populations forces of nature, is a sudden, rapid shaking
of the Earth caused by the breaking and
• Morbidity during and after the storm itself shifting of rock beneath the Earth’s
results from drowning, electrocution, surface.
lacerations, or punctures from flying debris, • This shaking can cause buildings and
and blunt trauma or bone fractures from bridges to collapse; disrupt gas, electric,
falling trees or other objects. and phone service; and sometimes trigger
• Heart attacks and stress-related landslides, avalanches, flash floods, fires,
disorders can arise during the storm or its andhuge, destructive ocean waves
aftermath. (tsunamis).
• Gastrointestinal, respiratory, vector-borne
disease, and skin disease as well as RISK OF MORBIDITY AND MORTALITY
accidental pediatric poisoning can all occur • Deaths and injuries from earthquakes vary
during the period immediately following a according to the type of housing available,
storm. time of day of occurrence, and population
• Injuries from improper use of chain saws or density. Common injuries include cuts,
other power equipment, disrupted wildlife broken bones, crush injuries, and
(e.g., bites from animals, snakes, or dehydration from being trapped in the
insects), and fires are common. rubble. Stress reactions are also common.

DROUGHT PREVENTION/MITIGATION
• Drought affects more people than any ➢ Mitigation involves developing and
other environmental hazard, yet it is implementing strategies for reducing
perhaps the most complex and least losses from earthquakes by incorporating
understood of this type of event. principles of seismic safety into public and
• Drought is often seen as the result of too private decisions regarding the setting,
little rain and is often synonymous with design, and construction of structures (i.e.,
famine. updating building and zoning codes and
ordinances to enhance seismic safety),
and regarding buildings’ nonstructural
Fluctuation in rainfall alone does not cause a
elements, contents, and furnishings.
famine.

• The ecosystem changes leading to EPIDEMICS

desertification are all attributed to human • An epidemic is an outbreak or occurrence
of one specific disease from a single
activities, such as overcultivation,
source in a group, population, community,
deforestation, overgrazing, and unskilled
or geographic area, in excess of the usual
irrigation. Each of these activities is or expected level. An epidemic exists when
exacerbated by increasing human new cases exceed the prevalence of a
population size. The first three activities disease.
strip the soil of vegetation and deplete its

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• An acute outbreak—a sharp increase of such as from excessive rainfall or sudden

new cases that affect a significant group— release of water from a dam, is the cause
is generally considered an epidemic of most flood-related deaths.
(Merrill & Timmereck, 2006). • Many victims become trapped in their cars
and drown when attempting to drive
The spread of infectious disease depends on through rising or swiftly moving water.
preexisting levels of the disease, ecological Other deaths have been caused by
changes resulting from disaster, population wading, bicycling, or other recreational
displacement, changes in density of population, activities in flooded areas.
disruption of public utilities, interruption of basic • Injured and frightened animals, hazardous
waste contamination, molds and mildew,
public health services, and compromises to
and dislodging of graves pose additional
sanitation and hygiene.
risks in the period following a flood (FEMA,
2006d).
• Not every characteristic need be present,
and each must be assessed with regard to • Food shortages that are due to water-
its relative importance locally: damaged stocks may occur because of
o Risk of introduction to and spread of the flooding and sea surges.
disease in the population. • The stress and exertion required for
o Large number of cases may reasonably cleanup following a flood also cause
be expected to occur. significant morbidity (mental and physical)
o Disease involved is of such severity as and mortality (e.g., myocardial infarction).
to lead to serious disability or death. Fires, explosions from gas leaks, downed
o Risk of social or economic disruption live wires, and debris can all cause
resulting from the presence of the significant injury.
disease.
o Inability of authorities to cope TORNADO
adequately with the situation because • Tornadoes are rapidly whirling, funnel
of insufficient technical or professional shaped air spirals that emerge from a
personnel, organizational experience, violent thunderstorm and reach the ground.
and necessary supplies or equipment Tornadoes can have a wind velocity of up
(e.g., drugs, vaccines, laboratory to 200 miles per hour and generate
diagnostic materials, vector control sufficient force to destroy even massive
materials). buildings.
o Risk of international transmission. • The extent of damage depends on updrafts
within the tornado funnel, the tornado’s
FLOOD atmospheric pressure (which is often lower
• Prolonged rainfall over several days can than the surrounding barometric pressure),
cause a river or stream to overflow and and the effects of flying debris.
flood surrounding areas. A flash flood
from a broken dam or levee or after intense RISK OF MORBIDITY AND MORTALITY
rainfall of 1 inch (or more) per hour often • Certain geographic areas are at greater
catches people unprepared. risk because of recurrent weather patterns;
• Except for flash floods, flooding directly tornadoes most frequently occur in the
causes few deaths. Instead, widespread midwestern and southeastern states.
and long-lasting detrimental effects include • Injuries from tornadoes occur from flying
damage to homes and mass debris or people being thrown by the high
homelessness, disruption of winds (e.g.,head injuries, soft tissue injury,
communications and health care systems, secondary wound infection).
and heavy loss • Stress-related disorders are more
of business, common, as is disease related to loss of
livestock, crops, utilities, potable water, or shelter.
and grain,
particularly in PREVENTION/MITIGATION
densely ➢ Because tornadoes can occur so quickly,
populated, low- communities should develop redundant
lying areas. warning systems (e.g., media alerts and
automated telephone warnings), establish
RISK OF MORBIDITY AND MORTALITY protective shelters to reduce tornado-
• Flood-related morbidity and mortality vary related injuries, and practice tornado
from country to country. Flash flooding, shelter drills.

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• Submarine landslides and volcanic

In the event of a tornado, the residents should eruptions beneath the sea or on small
take shelter in a basement, if possible, away islands can also be responsible for
from windows, while protecting their heads tsunami, but their effects are usually limited
to smaller areas.
THUNDERSTORMS • Tsunami waves can be described by their:
• A thunderstorm is formed from a ○ Wavelength - measured in feet or miles
combination of moisture, rapidly rising ○ Period - minutes or hours it takes one
warm air, and a force capable of lifting air wavelength to pass a fixed point
such as a warm and cold front, a sea ○ Speed - miles per hour
breeze, or a mountain. All thunderstorms ○ Height
contain lightning.
• Thus, it is possible for several Tsunamis may travel long distances,
thunderstorms to affect one location in the increasing in height abruptly when they reach
course of a few hours. shallow water, causing great devastation far
• Thunderstorms can bring heavy rains away from the source.
(which can cause flash flooding), strong
winds, hail, lightning, and tornadoes. • Any of the following events may signal an
Severe thunderstorms can cause approaching tsunami:
extensive damage to homes and property ○ A recent submarine earthquake.
(FEMA, 2006f). ○ The sea appears to be boiling, as large
quantities of gas rise to the surface of
Lightning is a major threat during a the water.
thunderstorm. ○ The water is hot, smells of rotten eggs,
or stings the skin.
• Lightning is an electrical discharge that ○ There is an audible thunder or booming
results from the buildup of positive and sound followed by a roaring or whistling
negative charges within a thunderstorm. sound.
When the buildup becomes strong enough, ○ The water may recede a great distance
lightning appears as a bolt. from the coast.
○ Red light might be visible near the
RISK OF MORBIDITY AND MORTALITY horizon and, as the wave approaches,
• Morbidity is reduced if, when caught the top of the wave may glow red.
outdoors, individuals avoid natural
lightning rods such as tall, isolated trees RISK OF MORBIDITY AND MORTALITY
in an open area or on top of a hill and • Immediate aftermath of a tsunami
metal objects such as wire fences, golf ○ First health interventions:
clubs, and metal tools. ▪ Rescue survivors
▪ Provide medical care for any
It is a myth that lightning never strikes twice in injuries.
the same place. In fact, lightning will strike • For people caught by waves:
several times in the same place in the course ○ The force of the water pushes people
into debris resulting in the broadest
of one discharge (FEMA, 2006f).
range of injuries, such as broken limbs
and head injuries
TSUNAMI
Most deaths from tsunamis are related to
drowning.

• Floods that accompany a tsunami result in

potential health risks from contaminated
water and food supplies.
• Loss of shelter leaves people vulnerable to
exposure to:
○ Insects
• Tsunamis, a series of waves usually ○ Heat
generated by large earthquakes under or ○ Other environmental hazards
near the ocean occur when a body of water • Tsunamis have long-lasting effects and
is rapidly displaced on a massive scale. recovery, necessitates long-term
surveillance of infectious and water- or

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insect-transmitted diseases, an infusion of

medical supplies and medical personnel, Winter storm - Indicates that severe
and the provision of mental health and watch winter weather may affect
social support services. your area.
• Potential waterborne diseases that
follow tsunamis include: Winter storm - Indicates that severe
○ Cholera warning winter weather conditions
○ Diarrheal or fecal-oral diseases such are definitely on the way
as:
▪ Amebiasis - Emergency
▪ Cryptosporidiosis preparedness plans
▪ Cyclosporiasis should be activated.
▪ Giardiasis
▪ Hepatitis A and E Blizzard - Means that large
▪ Leptospirosis warning amounts of falling or
▪ Parasitic infections blowing snow
▪ Rotavirus
▪ Shigellosis - Sustained winds of at
▪ Typhoid fever least 35 miles per hour are
• Animal-or mosquito-borne illness such expected for several
as: hours.
▪ Plague
▪ Rabies RISK OF MORBIDITY AND MORTALITY
▪ Malaria • Keys to safe winter driving:
▪ Japanese encephalitis ○ Preparing vehicles for the winter
▪ Dengue fever with a potentially fatal season
complication: Dengue hemorrhagic ○ Knowing how to react if stranded or lost
shock syndrome on the road
• Wound associated infections and
• Morbidity and mortality associated with
diseases such as tetanus winter storms:
○ Frostbite and hypothermia
WINTER OR ICE STORMS ○ Carbon monoxide poisoning
• A major winter storm can be lethal. ○ Blunt trauma from falling objects
• Winter storms bring ice, snow, cold ○ Penetrating trauma from the use of
temperatures, and often dangerous driving mechanical snow blowers
conditions. ○ Cardiovascular events usually
associated with snow removal.

Transportation accidents are the leading

cause of death during winter storms.

FROSTBITE HYPOTHERMIA

- a severe reaction to - when the body

• Nurses need to be familiar with winter cold exposure that can temperature drops to
storm warning messages, such as the permanently damage less than 90 ◦F.
following: its victims.
Wind chill - Calculation of how cold it Symptoms: Symptoms:
feels outside when the a. Loss of feeling a. Uncontrollable
effects of temperature and b. Light or pale shivering
wind speed are combined. appearance in: b. Slow speech
○ Fingers c. Memory lapses
On November 1, 2001, the ○ Toes d. Frequent
National Weather Service ○ Nose stumbling
implemented a ○ Earlobes e. Drowsiness
replacement wind chill f. Exhaustion
temperature index for the
2001/2002 winter season.

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PREVENTION/MITIGATION RISK OF MORBIDITY AND MORTALITY

➢ Winter storm preparation activities should • Morbidity and mortality associated with
include the following: wildfires:
○ Collecting winter clothing and ○ Burns
supplies such as: ○ Inhalation injuries
▪ Extra blankets ○ Respiratory complications
▪ Warm coats and clothes ○ Stress-related cardiovascular events
▪ Water-resistant boots, hats, and ▪ Exhaustion and myocardial
mittens infarction while fighting or fleeing
○ Assembling a disaster supplies kit the fire
containing:
▪ First aid kit PREVENTION/MITIGATION
▪ Battery powered weather radio ➢ Prevention efforts include encouraging
▪ Flashlight people to do the following:
▪ Extra batteries o Build fires away from nearby trees or
○ Stocking canned food, a nonelectric bushes.
can opener, and bottled water. ▪ Ash and cinders lighter than air float
○ Winterizing vehicles, keeping gas tanks and may be blown into areas with
full, and assembling a disaster supply heavy fuel load, starting wildfires.
car kit. ▪ Be prepared to extinguish the fire
○ Ensuring an adequate supply of any quickly and completely.
medications needed during and ▪ If the fire becomes threatening,
immediately following the storm. someone will need to extinguish it
immediately.
WILDFIRES o Never leave a fire (even a cigarette)
• More and more people are making their burning unattended.
homes in ▪ Fire can quickly spread out of
woodland control.
settings in or o Find out whether the area where
near forests, rural people live is at risk for wildfire and
areas, or remote develop a family wildfire evacuation
mountain sites. plan (FEMA, 2006c).
• As residential
areas expand Natural and environmental disasters result in
into relatively untouched wildlands, people significant losses, physical destruction of
living in these communities are dwellings, social and economic disruption,
increasingly threatened by forest fires. human pain and suffering, and significant injury
and loss of life
3 DIFFERENT CLASSES OF
WILDFIRES Nurses should be familiar with the types and
consequences of frequently occurring natural
Surface fire - The most common type disasters in order to contribute to public health
- burns along the floor of a efforts to prevent, mitigate, and recover from
forest, moving slowly and these events.
killing or damaging trees.
ENVIRONMENTAL DISASTERS AND
Ground fire - Usually started by EMERGENCIES
lightning and burns on or
below the forest floor in ENVIRONMENTAL EMERGENCIES
the humus layer down to
the mineral soil. • An environmental emergency is a
sudden threat to the public health or to the
Crown fires - Spread rapidly by wind well-being of the environment arising from
and move quickly by the release or potential release of oil,
jumping along the tops of radioactive materials, or hazardous
trees. chemicals into the air, land, or water.
• These emergencies may occur from
transportation accidents, events at
chemical facilities or other facilities using or
manufacturing chemicals, or as a result of
natural or man-made disaster events

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(Environmental Protection Agency [EPA],

2003b). consequences on 8,000 people and
human health. injured at least
150,000.
ENVIRONMENTAL DISASTERS
• An environmental disaster is defined as OIL SPILLS CASE STUDY:
an environmental emergency or ecologic EXXON VALDEZ
disruption of a severity and magnitude With billions of gallons
resulting in deaths, injuries, illness, and/or of oil being constantly On March 24, 1989,
property damage that cannot be effectively transported shortly after
managed by the application of routine and stored throughout midnight, an
procedures or resources and that result in the country and accident involving
a need for additional assistance. transported across the the supertanker
seas, the potential for vessel, the Exxon
HEALTH PROMOTION AND DISEASE oil spills is significant, Valdez, resulted in a
PREVENTION ACTIVITIES and the effects of spill of 11 million
1. The immediate removal of the hazard spilled oil can pose gallons (260,000
from the environment (or if this is not serious threats to the barrels) oF crude oil
possible, the movement of the environment. into the waters of
population away from the hazard). Prince William
2. Decontamination of exposed Sound, Alaska.
individuals.
3. The restoration of services to meet POLLUTANTS / CASE STUDY:
the immediate physiological needs of RELEASE OF ARAL SEA
the affected people. TOXINS
4. The prevention of further illness or (Pesticides)
injury as a result of exposure to the The Aral Sea area in
hazard. Central Asia has
Pesticides are been encountering
frequently used to one of the world’s
ENVIRONMENTAL PUBLIC HEALTH
control insects, greatest
TRACKING rodents, weeds, environmental
• Protecting communities through integrated microbes, or fungi. In disasters for more
environmental public health surveillance addition, they help than 17 years. The 5
o Environmental hazards. farmers provide an million people living
o Exposure to environmental hazards. affordable and in this neglected and
o Health effects potentially related to plentiful food virtually unknown
exposure to environmental hazards. supply. part of the world
• The goal of environmental public health were suffering not
tracking is to protect communities by only from an
providing information to federal, state, and environmental
local agencies. catastrophe that had
• Public health tracking monitors known no easy solutions
environmental hazards along with the but also from a litany
mechanism of action that may create the of
potential for disaster. health problems
(Small, van der
EXAMPLES OF ENVIRONMENTAL Meer, & Upshur,
HAZARDS AND THEIR IMPACT 2001).

OUTDOOR AIR CASE STUDY:

CHEMICAL SPILLS CASE STUDY: TOXICS WORLD TRADE
BHOPAL (Air Pollutants) CENTER
The intentional
release or accidental The release of toxic Toxic air pollutants, Following the
leakage or spill of gases at Union also known as explosion at the
certain chemical Carbide’s pesticide hazardous air World Trade Center
substances into the plant in Bhopal in pollutants, are those (WTC) on
environment can have 1984, the worst pollutants that cause September 11,
devastating industrial disaster or may cause cancer 2001, various public
on record, killed or other serious health health concerns

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effects, such as arose regarding the

reproductive effects or air quality. Nurses must become educated regarding the
birth defects, or Researchers be- environmental hazards in their communities
adverse lieve that the and must become advocates for public policy
environmental and explosion may limiting toxic agent use and proponents of
ecological effects. account for adverse research on the health effects of these
health effects in the environmental agents.
workers and
residents in the BIOLOGICAL AND CHEMICAL
environment around TERRORISM: A UNIQUE THREAT
the WTC.
CHEMICAL TERRORISM AND
BROWNFIELDS CASE STUDY: BIOTERRORISM
LOVE CANAL
• The deliberate creation and exploitation of
Brownfields are fear through violence or the threat of
environmental The Love Canal, a
violence in the pursuit of political change”
disasters neighborhood in the
characterized by southeast LaSalle (Hoffman, 1998).
abandoned or district of the city of • The use of chemical or biological agents as
underutilized Niagara Falls, New the main element of a terrorist attack or
industrial and York, takes its name threat would be referred to as chemical
commercial sites that from the failed plan terrorism and bioterrorism.
are, or are perceived of 19th-century • Chemical agents are those chemical
to be, chemically, entrepreneur, compounds synthesized artificially and
physically, or William T. Love. include the many toxic chemicals that may
biologically From 1942 through be available to terrorists.
contaminated. 1953, the Love
• Everything from chlorine gas to the highly
Canal Landfill was
potent nerve agents (i.e.,
used principally by
Hooker Chemical, organophosphate compounds) are
one of the many considered in this category.
chemical plants
located along the We can distill its essence in the following way:
Niagara River, as a Chemical weapons utilize the toxic nature of
municipal and selected substances to cause death or injury.
chemical disposal
site. Nearly 21,000 • These chemical warfare (CW) agents may
tons (42 million cause injury via the respiratory route,
pounds) of what through the skin, or by ingestion.
would later be • Biological agents are those pathogens
identified by used deliberately to infect persons, as well
independent as toxins normally derived from plants or
scientists as toxic animals. (The inclusion of toxins in the
chemicals were biological category is somewhat arbitrary,
dumped at the site.
but we do so for ease of convention.)

In biological warfare (BW), infectious disease

• Environmental emergencies involving
the release, or threatened release, of oil, is the name of the game.
radioactive materials, or hazardous
WHY WOULD TERRORISTS USE
chemicals potentially may affect
communities and the surrounding CHEMICAL OR BIOLOGICAL AGENTS?
environment. 1. Causing large-scale death and
disruption, these agents, when used
Nurses must work to create an environment effectively, are indeed capable of inflicting
that promotes and sustains health for all its enormous casualties and causing massive
citizens. Increases in scientific knowledge disruption to society.
regarding the development of toxic chemicals 2. Terrorists are most likely to be motivated to
and advances in technology must be balanced use chemical or biological agents for the
by the wisdom restricting their transport and use. following reason: By virtue of their novel

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and fearsome qualities, the use of such • A chemical terrorist attack may include
unconventional agents greatly affect the small or large numbers of casualties, and,
targeted population (Falkenrath, Newman, depending on the agent used, victims may
& Thayer, 1998). require special decontamination
3. Many terrorist groups usually rely on a measures.
political base for funding and other • Delivery of chemical agents include the
support, using chemical or biological following:
agents might offend the moral sensibilities a. Nerve agents (e.g., sarin)
of their supporters (Gurr & Cole, 2000). b. Tissue (blood) agents (e.g., cyanide)
4. Groups that are waning in influence and, c. Lung irritants (e.g., chlorine gas)
feeling they have nothing else to lose, may d. Vesicants (i.e., blister agents such as
employ such weapons in a last desperate mustard or lewisite)
act (Hurwitz, 1982). e. Psychoincapacitants (e.g., BZ, LSD)
f. Pesticides
DISINFORMATION OR HOAXES
• The mere threat of an attack using NERVE AGENTS
dangerous chemical or biological materials • Nerve agents include the chemicals tabun,
can cause great anxiety and disorder, if not sarin, soman, and VX.
outright panic, in any society. • These toxic organophosphate compounds
o Following the attack on the Tokyo all operate on the same basic principle—
subway in 1995, for example, the they inhibit acetylcholinesterase (AChE).
numbers of psychosomatic victims and
worried well far exceeded the actual Consequently, increased levels of acetylcholine,
number of victims. an essential neurotransmitter, bring about
o Prior to the few real cases of anthrax in respiratory and cardiovascular crises that
letters in the fall of 2001, the United can quickly lead to death.
States experienced a rash of anthrax
TISSUE (BLOOD) AGENTS
hoaxes.
• The so-called tissue (blood) agents,
WHAT ARE THE REAL RISKS OF includes cyanide in its various forms.
• Cyanide blocks the enzyme cytochrome
CHEMICAL TERRORISM OR
oxidase, shutting down the energy
BIOTERRORISM?
transport (ATP) system.
• Wider availability of information for
• In the form of a salt (e.g., sodium cyanide),
producing.
200 to 300 mg of cyanide are necessary to
• Increased attention being paid to the
cause death in most adults (Lovejoy &
effects of chemical and biological agents
Linden, 1994).
point toward an increasing likelihood of
• Solutions containing a cyanide salt can be
future attacks involving CB terrorism.
made to evolve hydrogen cyanide vapor,
capable of causing death within minutes.
The true threat of super terrorism is not a • Because of its widespread use in the
Hiroshima-like disaster, but a widespread mining and other industries, bulk supplies
panic caused by a relatively small CBW incident of potassium or sodium cyanide salts are
involving a few dozen fatalities” (Sprinzak, ubiquitous.
2000).
• As an adulterant, cyanide salts could be
• Hospital staff and other health care employed to poison food or beverages.
workers will be hard pressed to cope with • But to utilize this compound as a mass
so many injured people of all ages, casualty weapon would probably demand
undoubtedly bringing enormous difficulties the production of hydrogen cyanide (HCN)
for a health care facility. gas.

CHEMICAL TERRORISM LUNG IRRITANTS

• Attack the respiratory system, causing
• In nearly all respects, chemical terrorism is tightness in the airways, hypoxia, and in
essentially a hazardous materials more severe cases, pulmonary edema
(Hazmat) event. (Urbanetti, 1997).
• Are generally self-limiting.

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• Most known lung irritants require high specific instances such as an attack with
volatilities or a gaseous form to cause anthrax spores, generally do not require
injury to the alveolar spaces of the lungs. special decontamination (as would be
• This also means that large concentrations involved in a chemical incident), and despite
widespread fears of epidemics—the gift that
or enclosed spaces are necessary to
keeps on giving—most traditional BW
cause death or injury to many individuals.
agents are noncontagious.
PSYCHOINCAPACITANTS • The notion of bioterrorism has a
particularly frightening and intimidating
• Psychotropic compounds such as the
aura for most people and may also
belladonna drug BZ (3-quinuclidinyl
possess an apocalyptic mystique for both
benzilate) or the hallucinogen LSD terrorists and the public.
(lysergic acid diethylamide) have been • BW is essentially an infectious disease
considered by militaries for use in combat problem, or public health in reverse.
and for sabotage. • Bioterrorists may choose among the
• Because of its potency, BZ could present following categories of pathogens:
the terrorist with an agent for o Bacterial agents (including rickettsial
contaminating food or water. organisms)
• Aerosol dispersion is also possible, o Viral agents
perhaps via solvent, but this may be o Toxins (derived from plants or animals)
technically problematic for improvised o Parasites (less likely)
attacks.
BIOTERRORISM AND DELIVERY OF
Effects on individuals would include delirium,
BW AGENTS
• Infectious agents and toxins are most
hallucinations, and general mental confusion for
efficiently delivered via aerosol, in particles
at least 24 hours.
ranging from about 1 micron to 10 microns.
• Higher doses could be lethal, especially • Particles larger than 10 microns are much
from complications that are due to its more apt to be caught in the fine hairs of
anticholinergic activity (e.g., hyperthermia). the upper respiratory tract and brought out
by the ciliary elevator.
CHALLENGES POSED BY A CHEMICAL
SABOTAGE (FOOD AND WATER
TERRORIST
CONTAMINATION) THREATS
• Past experience is any indicator, confusion
• Scenarios for bioterrorist attack remains
will reign during the early stages of a
the contamination of food or beverages.
chemical terrorist event.
o For example, botulinum toxin may not
• Great anxiety is to be expected, whether have the effectiveness once thought in
from dealing with the nature of the aerosolized form, but it could be an
casualties themselves or loved ones who extremely potent food or beverage
are looking for answers and updates. contaminant.
• In cases of large numbers of serious
chemical casualties, it may reach the point CHALLENGES POSED BY
that limitations of personnel, time, BIOTERRORISM
equipment, and space do not permit the
• Casualties from aerosolized toxins might
degree of medical intervention usually
present themselves within several hours,
called for on any other given day.
as compared with several days for most
• Many people will present themselves to
pathogenic microbes.
emergency wards out of a justifiable
• Unlikely to be noticed.
concern for their health.
• Several pathogens require rapid treatment,
or most victims will die without prompt
BIOTERRORISM treatment.
• The act of biological terrorism • One of the major concerns will be how to
(bioterrorism) involves the deliberate use treat those who have been exposed, while
of microbial pathogens or toxins. managing others who are not at risk of
developing illness (the worried well).
The effects from bioterrorism may not be fully • It might be easy for some to ascribe biblical
known until many hours or days after the event. portents to a bioterrorist release of an
infectious agent.
• In biological casualties, these are
infections or intoxications that, except in

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SUMMARY ON BIOTERRORISM AND PREPAREDNESS

CHEMICAL TERRORISM • Planning how to respond.
1. Terrorist attack using chemical or • Examples: preparedness plans;
biological weapons is an alarming emergency exercises/training; warning
prospect, all the more so after the tragedy systems.
of 9/11. a. Trainings and Drills
2. Although the likelihood of a large-scale b. Warning and Evacuation
chemical or biological terrorist attack is not c. Planning of Disaster Response
as great as some media reports would
have us believe, there are at least some RESPONSE
terrorist groups and individuals who could • Initial actions taken as the event takes
attempt to attack civilians with CB agents. place. It involves efforts to minimize the
This makes preparing for such an event hazards created by a disaster.
essential. • Examples: evacuation; search and rescue;
3. In general, one can consider a chemical emergency relief.
release or attack to be a “lights and sirens” a. Rescue
affair, that is, rapid response and b. Relief
(hopefully) expeditious treatment of
casualties. RECOVERY
a. In a bioterrorist event, however, • Returning the community to normal.
people would be unlikely to know that Ideally, the affected area should be put in
they were exposed to an infectious a condition equal to or better than it was
agent or toxin until the first symptoms before the disaster took place.
appear, at the very least several hours • Examples: temporary housing; grants;
following the event. medical care
It is, therefore, incumbent on every health care
DISASTER RESPONSE
provider to understand all aspects of this threat
and to train and prepare for an event all hope (POST-DISASTER)
will never occur.

DISASTER MANAGEMENT CONTINUUM

DISASTER MANAGEMENT CYCLE

MITIGATION BEFORE A DISASTER

• Measures put in place to minimize the • Mitigation
results from a disaster. ○ Develop preventive laws and
• Examples: building codes and zoning; regulations
vulnerability analyses; public education. ○ Implement advanced codes and
a. Hazard Assessment standards
b. Vulnerability Analysis ○ Establish zoning requirements
c. Risk Assessment ○ Construct barriers
d. Risk Analysis
e. Prevention: Structural Method and • Preparedness
Non-structural Method o Stock disaster supply kit

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o Develop mutual aid agreements and • The likelihood of a hazard causing harm
plans.
o Train response personnel and
concerned citizens
o Prepare shelters and backup facilities

DURING A DISASTER
• Response
o Search and rescue to identify affected
people
o Assess initial damage
o Provide first-aid and humanitarian
assistance
o Open and manage shelters MITIGATION PHASE: THE
CORNERSTONE METHODS OF DATA
AFTER A DISASTER COLLECTION
• Recovery
o Debris removal 1. Hazard Assessment/ Hazard Identification
o Precise damage assessment and analysis
o Infrastructure destruction and 2. Vulnerability Analysis
reconstruction 3. Risk Assessment
o Restore the livelihoods 4. Risk Analysis
o Community development
HAZARD ASSESSMENT/ HAZARD
MITIGATION PHASE IDENTIFICATION AND ANALYSIS
• The method by which planners identify
• The first step in effective disaster which events are most likely to affect a
management requires advanced
community
identification of potential problems for the
institution or community involved. •
• Serves as the foundation for decision
HAZARD (CAUSE) making for prevention, preparedness, and
• A potential threat to humans and their response.
welfare. • Historical data and data from other sources
• It presents the possibility of the occurrence are collected to identify previous and
of a disaster caused by natural phenomena potential hazards.
(hurricane, earthquake), failure of man- • Data are then mapped using aerial
made sources of energy (nuclear power photography, satellite imagery, remote
plant) or human activity (war). sensing, and geographic information
• Hazards may include: systems.
o Chemicals used by local industries
o Transportation elements
o Subways, airports and railroad stations
o Collection of large groups of people in
areas with limited access
o Skyscrapers, nursing homes or sports
stadium
o Environmental and meteorological
▪ Presence of fault lines and seismic
zones, blizzards, ice storms,
tornadoes, hurricanes wildfires and
heat waves
o Technological and accidental hazards
(dam failures)
o Terrorist organizations
o Cyberattacks

RISK VULNERABILITY ANALYSIS

• The actual exposure of something of • Is used to determine who is most likely to
human value and is often measured as the be affected, the property most likely to be
product of probability and cause.

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damaged or destroyed, and the capacity of PREVENTION

the community to deal with the effects of
• A broad range of activities such as
the disaster
attempts to prevent a disaster from
• Data are collected regarding the
occurring, and any actions taken to prevent
susceptibility of individuals, property and
further disease, disability or loss of life.
the environment to potential hazards in
• Structural mitigation – construction
order to develop prevention strategies.
projects which reduce economic and social
• Should be conducted for each hazard
impacts (i.e., dams, windbreaks, terracing
identified and regularly updated to
and hazard resistant buildings)
accommodate population shifts and
• Non-structural mitigation – policies and
changes in the environment.
practices which raise awareness of
• Vulnerability = (Exposure) +
hazards or encourage developments to
(Resistance) + (Resilience)
reduce the impact of disasters
o Exposure: at risk property and
population
o Resistance: measures taken to
prevent, avoid or reduce loss;
o Resilience: ability to recover prior state
or achieve desired post-disaster state.

• Non- structural Mitigation includes:

VULNERABLE GROUP o Reviewing building codes.
• Those who are capable of being physically o Vulnerability analysis updates.
or emotionally wounded, open to attack or o Zoning and land-use management and
damage. planning. Reviewing of building use
• Women, children, elderly, PWDs, mentally regulations and safety codes.
challenged, displaced population Implementing preventative health
measures
RISK ASSESSMENT o Political intervention and commitment
• A calculation or model of risk, in which a public awareness
comprehensive inventory is created
including all existing and potential dangers, PREPAREDNESS
the population most likely to be affected by • The proactive planning efforts designed to
each danger and a prediction of the health structure the disaster response prior to its
consequences. occurrence.

RISK ANALYSIS WARNING (FORECASTING)

• Uses the elements of hazard analysis and • Monitoring events to look for indicators
vulnerability analysis to identify groups of that predict the location, timing and
people at particular risk of injury or death magnitude of future disasters. (typhoon
from each individual hazard. signals)

DISASTER PLANNING
• Must address collaboration across
agencies and organizations, advanced
preparations as well as needs
assessments, event management and
recovery efforts.

2 TYPES OF DISASTER PLANS:

1. Agent-specific approach
a. Focused their activities on the most
likely threats to occur based on their

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geographic location (frequent Typhoon 6 DOMAINS OF PREPAREDNESS:

in Leyte). 1. Community Resilience
2. Incident Management
2. All-hazards approach 3. Information Management
a. Incorporates disaster management 4. Countermeasures and Mitigation
components that are consistent across 5. Surge Management
all major type of disaster events to 6. Biosurveillance
maximize resources, expenditures, and
planning efforts. DISASTER RISK REDUCTION (DRR)
• It forms the action plan to be implemented
Participation by nurses in all phases of Disaster before, during and after disasters.
Planning is critical to ensure that nurses are • The IFRCRCS (International Federation
aware of and prepared to deal with whatever of Red Cross and Red Crescent
these numerous other factors may turn out to be. Societies) defines risk reduction as
They must consider all possible eventualities physical measures to reduce the
– from the sanitation needs of crowds at mass vulnerability and exposure of infrastructure
gatherings, to the physiological needs of to natural hazards as well and to provide
vulnerable populations, to evacuation coping and adaptive infrastructure in case
procedures for buildings and geographic areas. of a disaster event.
• Policy, planning and capacity building in
PREPAREDNESS MEASURES disaster management
INCLUDE: • Physical prevention; example, building
sea- walls against storm surge or flood
1. Preparedness plans
shelters during flood events.
2. Emergency exercises/training
3. Warning systems • Capacity building at institutional and
4. Emergency communications systems systemic level in disaster preparedness.
5. Evacuations plans and training • Continued provision of food, potable water
6. Resource inventories Emergency and health care.
7. Personnel/contact list.
8. Mutual aid agreements
9. Public information/education

• Develop and test warning systems

regularly and plan measures to be taken
during a disaster alert period to minimize
potential loss of life and physical damage.
• Educate and train officials and the
population at risk to respond to the
disaster.
• Train first aid and emergency response EMERGENCY OPERATION PLAN
teams. • EOP allows the community to respond to
• Establish emergency response policies, threats.
standards, organizational arrangements • Engages responders in the short- term
and operational plans to be followed by recovery.
emergency workers and other response • Must be flexible to be valuable in real and
entities after a disaster. potential emergencies.
• It doesn’t include the administrative plan,
the mitigation strategy, the long-term

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recovery or the Standard Operational settings in support of pre- and post-

procedures. disaster recovery healthcare planning.
• Adequate planning should address each
of these domains in advance in order to COORDINATION
eliminate common challenges associated • It is important to consider how they will
with disaster situations. respond to a scenario in which the entire
region is impacted.
COMMUNICATION • It should include identification of
• Failure of communication system may opportunities to strengthen the regional
occur as a result of damage to the coordination required to ensure effective
infrastructure caused by the disaster, as medical and public health response to
well as lack of operator familiarity, large-scale multijurisdictional disaster.
excessive demands, inadequate supplies
and lack of integration with other ADVANCED WARNING SYSTEMS AND
communications providers and THE USE OF EVACUATION
technologies. • Warnings are becoming much more useful
to society as lead time and reliability are
improved and as people devise ways to
respond successfully.

SURGE MANAGEMENT
• A comprehensive disaster plan will
account for a sudden unanticipated “surge”
of patients, the effective triage of patients
(prioritization for care and transport of
patients) and distribution of patients to
hospitals (a coordinated , even distribution
of patients to several hospitals as opposed
to delivering most of the patients to the
closest hospital).

PATIENT EVACUATION AND TRACKING

• It is a major challenge because of lack of
interoperable registration systems, a
shelter, and hospital communication
systems that do not interface with other
hospitals or county health department.
• Family reunification has persisted as a
major challenge to meaningful recovery
initiatives.

EMERGENCY HEALTH SERVICES

EMERGENCY HEALTH SERVICES

SYSTEM
• The EHS system is a complex
combination of various providers and
facilities that provide three basic medical
functions:
o Evacuation
o Stabilization
o Redistribution

EHS COMPONENTS
1. The emergency medical services (EMS)
system
INFORMATION MANAGEMENT 2. Emergency Departments (ED)
• The disaster plans should be designed to 3. Alternate sources of emergency care.
facilitate data sharing and portability of
individual health records across healthcare

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EMERGENCY MEDICAL SERVICES

(EMS) SYSTEM
• The EMS system traditionally includes all
services from the receipt of emergency
requests for assistance to the transport of
patients to EDs.
• EMS dispatchers receive the call for
assistance and, in response, send
appropriate resources to the patient
• Patients flow within the emergency health
care system

HOSPITAL EMERGENCY DEPARTMENT

• EDs receive undifferentiated, unscheduled
patients and can evaluate and provide
initial management of disease.
• The hospital’s ED and inpatient capabilities
may range from providing basic care to
administering specialized, advanced
interventions such as trauma, stroke, and
cardiac care.

• The Medical Priority Dispatch System ALTERNATIVE SOURCES OF

(MPDS) is an example of a commonly used EMERGENCY CARE
triage system specifically designed to 1. Communities with urgent care centers
abstract caller information through a • Provide care for minor illnesses and
question-driven protocol and direct injuries
appropriate resources based on that 2. Physician offices
information. 3. Satellite EDs
• Pre-existing healthcare facilities that
2 LEVELS OF EMS PROVIDERS: can be activated in the event of a
1. Basic Life Support (BLS) disaster to provide emergency.
2. Advanced Life Support (ALS)

BASIC LIFE SUPPORT (BLS)

• Providers can provide extrication,
immobilization, and bleeding control, while
assisting a patient in taking their own
medication (nitroglycerin, for example) or
administering oxygen.

ADVANCED LIFE SUPPORT (ALS) STANDARD OPERATION OF EHS

• Providers can perform a number of skills, • Entry to EHS in the United States occurs
including intubation, needle thoracostomy, most often when individual patients
defibrillation, and cardiac pacing, while request assistance through the 911 system
administering a wide variety of or by presenting directly to EDs or urgent
pharmacotherapy, including advanced care centers.
cardiac life support medications.

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• Once in the care of EMS, patients are HOW TO PREVENT OR OVERCOME

transported to EDs for further evaluation PROBLEMS AND INEFFICIENCIES
and treatment.
WITHIN THE SYSTEM?
• Initial care may be provided on-site or
• Cooperation and integration among the
enroute to the ED, where patients are
groups interacting within the EHS system,
screened, evaluated, and treated for
such as fire and police departments,
unstable, or potentially dangerous
conditions. • Cooperation within organizations, such as
between housekeeping and nursing or
• Patients presenting to EDs with limited
between different nursing units
capabilities or urgent care centers may
also be transported to other sites for • Turf battles must be eliminated
additional or specialized care.
CURRENT STATE OF EHS
For example: • Today, many would consider that the EHS
• A patient suffering a blast injury may system operates in disaster mode on a
initially receive temporizing care in a daily basis. The system is stretched such
smaller local or rural ED without trauma that it lacks the flexibility to handle a
services and then be transported to a sudden increase in patient volume.
regional trauma center for admission and • EDs are routinely overwhelmed with
more definitive therapy “boarders”- patient who cannot leave the
ED because of inpatient beds (exit blocks).
• Output limitations, or exit blocks, cause
“entry blocks,” which progressively limit
the EHS’s ability to function and to respond
to the demands placed on it
• The etiology and impact of this boarding
situation may be understood by applying
the input-throughput-output conceptual
model of EHS system crowding (Asplin et
al., 2003).

• If patients are unable to exit the EHS

system, problems can develop as bed
space and resources required for new,
acutely ill patients are diverted to caring for
stabilized and admitted patients.
• This “exit block” can then cause an “entry
block,” limiting the ability of EHS to respond
to the disaster. • Inability to manage throughput and output,
• Patients exit the EHS system by being and hospitals’ inability to recruit capacity
discharged to home, admitted to inpatient due to system pressures, is a dangerous
units (including observation units), or condition at any time. It is particularly
admitted to skilled nursing facilities. problematic when responding to a disaster,
when input increases dramatically and
output is more limited by transportation and
resource limitations.
• The difficult circumstance on EHS system
operations:
o Staff Shortage
o Financial Stressors
• With the current recognized challenge will
improve disaster response and provides
opportunities for emergency managers to
use their preparations to address current
challenges as they prepare for potential
disasters by:
o Integrating disaster technology

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o Terminology PATIENT ACCESS TO EHS DURING A

o Actions into routine operations
DISASTER
MAJOR EHS CONCEPTS ASSOCIATED • When such a disaster occurs, the EHS
system will immediately experience a large
WITH DISASTERS
influx of patients accessing the system.
• The first wave of the influx will present in
EMERGENCY HEALTH SERVICES two ways.
DIFFERENTIATES… o One group of first-wave patients will
be cared for by EMS when they
1. A Mass Casualty Incident (MCI) respond to the scene of the incident
• Any influx of patients from a single and will be transported to health
incident that exceeds the capacity of facilities.
the EHS system can be considered an o The second group of first-wave
MCI patients will directly present to EDs by
foot, personal vehicle, or nonmedical
2. A Disaster public transport such as bus or taxicab.
• As a natural or man-made • For EMS, the ED is the typical destination.
phenomenon that results in the However, requiring that all patients from a
destruction or dysfunction of the disaster go to an ED is an inefficient use of
available response infrastructure to a community’s available resources.
meet the community’s need for health • To prevent unnecessarily clogging EDs,
care some disaster plans employ alternate
• “Paralytic” disaster - type of disaster resources for the healthier patients,
that has the potential to eliminate the reserving EDs as primary resources for
EHS’s ability to respond to any call for critically ill patients.
services • The proper distribution of patients is
• A “Catastrophe” considered a disaster required to ensure that specialized
in which the community and hospital interventions can be delivered to patients
are overwhelmed and isolated for 3 or requiring those services
more days
THREE MAJOR CHALLENGES EXIST
RESOURCES FOR THE EHS SYSTEM REGARDING PATIENTS PRESENTING
• Three types of EHS system resources are
FOR CONCERNS UNRELATED TO THE
critical to responding to any sort of MCI: DISASTER.
1. To ensure that ill patients continue to
1. FACILITIES access care.
a. Health facilities serve as the location 2. To accurately triage these requests for
for patient care and shelter. assistance to provide care to patients in an
b. Facilities are not immune to being optimal time frame at the optimal site.
impacted by disasters. Planners must 3. In the event of a chemical, biological, or
consider the likelihood and potential infectious exposure, it is critical to
impact of the degradation or loss of segregate potentially contaminated
health facilities in any disaster plan and patients from non-contaminated patients.
consider alternate facilities to render
care.
MAJOR EHS ISSUES
2. PERSONNEL
a. Staffing shortages already exist. SYSTEM SURVEY
b. Planners must remain cognizant that it • Planners must assess the current state of
is rarely possible for the same the EHS system. Must know the exact
personnel to work for the duration of a capabilities of each component.
disaster, and relief schedules should be • For the EMS dispatch system:
incorporated into planning. o How is dispatch performed and how
can it be used to make triage
decisions?
3. MATERIALS • For EMS:
a. If supplies and medications are lost or o How many ambulances and EMS
exhausted because of the nature of the providers exist?
disaster, EHS cannot be provided. o How many can be requested from
surrounding regions?

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o How are the destinations of EMS o Supplies:

patients determined? ▪ Medical supplies, food, and critical
• For EDs: nonmedical supplies, such as
o How many can handle major trauma? gasoline and electricity, must all be
o Minor trauma? maintained in preparation for
o Intensive care patients? disaster.
o How can a massive influx of patients be ▪ Funding must be available for
handled? appropriate disaster planning.
o What alternate sites for care exist? ▪ During the disaster, EHS system
o What transportation resources are components will have to purchase
available for distributing treated supplies and pay staff.
patients efficiently to maintain ED ▪ After the disaster, funds will be
inflow and outflow? needed to recover.
o What alternate shelter sources exist?
o What preparations for mass COMMUNICATION AND
decontamination are in place? COORDINATION
• The components of the EHS system are
RESOURCES AVAILABILITY not integrated and do not share information
• Ensuring the availability of human and resources well.
resources—administrative, physician, • Communication is limited because of
nursing, and support staff. technical considerations as these
o Planners must be careful to identify splintered agencies use different radio
each individual’s primary reporting site. frequencies that may not be compatible
o Staff may also be functionally lost if with each other.
they become exhausted from a • The disaster itself can also complicate the
prolonged event. This requires secure poor preexisting communication and
areas for personnel to sleep, relax, coordination systems.
bathe, and eat between extended • One issue that can impede communication
shifts. and coordination is the interagency
o Staff may be lost if they are unable to conflicts and turf battles that may occur.
physically get to work. EMS agencies, police and fire
o Staff may be lost if they refuse to report departments, hospitals, and others have
to work. some overlap in their roles and duties to
o Factors such as better communication, minimize conflict include training and
providing means of transportation, staff technology.
and family prophylaxis, appropriate day
care, and so on, that increase the HOW TO DEAL WITH THE INFLUX
likelihood that staff will report to work. • During a disaster, the EHS system will face
o These factors must be directly a huge surge in patients. Depending on the
addressed to ensure sufficient human type of disaster, the surge will have
resources exist throughout the EHS different patterns.
system. • EHS system, is to work with media outlets
• The availability of Capital Resources in advance of the disaster to ensure that an
o For the EMS system: appropriate and accurate message is
▪ Planners must know and address relayed to the local population.
mutual aid issues, additional
ambulances, communications SOURCES OF INFLUX
equipment, and maintenance • Individuals calling 911 for assistance
facilities can be deployed o The available resources and incoming
throughout the region. demands should be actively monitored
▪ In other areas, mutual aid compacts to ensure access and distribution of
must be in place to allow for the patients to the best possible care.
immediate recruitment of as many • Patients presenting to the ED for care
additional EMS units as are needed o To deal with the influx, operations
o For the EDs: within the ED can be modified to
▪ Bed space is a significant issue. improve the efficiency of care and
▪ Many hospitals have closed and the handle the increased volume.
remaining EDs are at or exceed
capacity. Satellite EDs and
alternate care sites must be
considered and developed.

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WAYS IN WHICH DISASTER AFFECTS • An average of 20 typhoons per year with

THE HEALTH STATUS OF A eight or nine making a landfall and causes
COMMUNITY extensive damage.
• The country lacks natural barriers and
1. May cause premature deaths, illnesses,
there is nothing buffering the islands and
and injuries, which exceed the capacity of
the sea.
the local healthcare system.
2. May destroy local healthcare VOLCANOES
infrastructure, which renders it unable to • The Philippines is home to 300 volcanoes
respond to emergency. of which 22 are active, and 5 are highly
3. Disrupts routine health and mental active: Taal, Mayon, Bulusan, Kanlaon,
healthcare services and prevention and Hibok-Hibok.
initiatives which can increase morbidity
• In 2018, Mount Mayon erupted and
and mortality.
projected lava and volcanic ash 10 meters
4. May create environmental imbalances,
(32 feet) into the air, with approx. 20,000
increasing the risk for communicable
local residents evacuated.
diseases to spread and hazards in the
• In 2013, Mt. Mayon killed 5 and injured 7
environment.
individuals
5. May affect the psychological, emotional,
and social well-being of the population in EARTHQUAKES
the affected community. It can include fear, • It is similar to volcanic risk; the hazard is
anxiety, depression, widespread panic, the tectonic plate boundary.
terror, exacerbation of preexisting mental
• Average of 20 earthquakes each day, most
health problems, and deeply affects
measure 4.5 magnitude or less
children.
• Most common seismic activity in the
6. May cause shortages of food and cause
country except Palawan region.
severe nutritional deficiencies.
• 12 destructive earthquakes were already
7. May cause large population movements
recorded by the PAG-ASA from 1968-
(refugees) creating a burden on the
2017.
healthcare systems. It can increase the
transmission of communicable diseases FLOODS
and the health consequences.
• Moonsoon rains can be vary damaging;
8. Disaster frameworks for response are
annual rainfall in the country is expected
increasingly shaped by globalization,
from 1 meter to 4 meters.
changing world dynamics, social
• Moonsoon has been exacerbated by urban
inequality, and sociodemographic trends.
developments and puts the country at high
DISASTER OVERVIEW: THE risk for sea level rise along the coast.
PHILIPPINES TSUNAMIS
• The Philippines has increased vulnerability • Increased risk in the country due to it being
to natural hazards an archipelago with significant seismic
o Position in Ring of Fire between the activities.
Eurasian and Pacific plates. • Tsunamis are not deemed as a high-risk
o Most vulnerable to typhoons; the most hazard.
destructive and most common, but
LANDSLIDES
flood, volcanic eruptions, landslides,
• Often initiated by other significant weather
earthquakes, droughts, and tsunamis
events.
also pose a risk.
• Most of the regions are vulnerable to
TYPHOONS landslide except for Palawan region.
• Ten deadliest are: Haiyan, Thelma, Ike, • Most common in the mountainous regions
Fengshen, Washi, Durian, Bopha, Trix, and inland areas which impact the rural
Amy, and Nina from 1947 to 2014 population most heavily.
• Typhoon Haiyan (Yolanda) resulted in
more than 6,300 lost lives, over 4 million
DROUGHTS
displaced, and a damage of 2 billion dollars • The country endures conditions related to
in 2013. El Nino, including prolonged drought

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conditions from postponements in Masarayao, Leyte as the epicenter, with a

seasonal moonsoons. depth of 6.49 kilometers.
• Droughts result in lack of clean drinking • Around 371,680 lived within the 15
water, water scarcity, reduced hydro- kilometers.
power generation, an increase in • As of 19th July, nearly 1,000 aftershocks
waterborne disease, and loss of income. had occurred, including several over 4.0
magnitude and a 5.8 magnitude quake on
RECENT HISTORY OF NATURAL July 10.
DISASTERS • 3 deaths and 448 injured were reported.

MAYON VOLCANO ERUPTION – EARTHQUAKES – FEBRUARY TO

JANUARY 2018 MARCH 2017
• January 15, 2018 – Mayon Volcano • February 10, 2017 – a 6.7 magnitude
produced rockfall and ashfall in 29 villages earthquake with a depth of 10 kilometers
of Camalig and Guinobatan. and epicenter near Surigao City caused
loss of lives and damage to properties in
• Permanent and extended danger zone was
the Caraga region, particularly Surigao del
issued by PHIVOLCS, resulting in
Norte.
evacuation of 25 villages.
• March 5, 2017 – a 5.9 magnitude
• February 19, 2018 – 90,000 people n 6
earthquake near San Francisco
municipalities and 2 cities of Albay have
Municipality occurred, affecting 10,691
been affected; 62,000 people evacuated in
families, or 53,455 people, in 82 barangays
57 centers, with level 4 alert over the area.
in the same province.
TROPICAL CYCLONE TEMBIN – • 8 people reported dead and 249 sustained
DECEMBER 2017 injuries due to the initial 6.7 magnitude
• December 22, 2017 – Tembin (Vinta) earthquake as well as the second one.
disrupted several provinces in Mindanao
with more than 170 people killed, and
FLOOD AND LANDSLIDES – JANUARY
affected northern and central parts of the 2017
island. • January 16, 2017 – over 63,000 people
were displaced due to flash floods in
• According to Disaster Response
Northern Mindanao and Visayas
Operations Monitoring and Information
Center (DROMIC) issued by the DSWD, at • 48,000 people were inside the 115
least 313,498 people were affected in 998 evacuation centers
barangays.
TYPHOON HAIMA – OCTOBER 2016
TROPICAL STORM KAI – DECEMBER • October 19, 2016 – the typhoon made
landfall in Cagayan as a category 4.
2017
• December 16, 2017 – Urduja or Kai made • 8 deaths in all males, including 2 minors
landfall in San Policarpio, Eastern Samar. and infant were recorded. These all
Two months of rain fell over the island in 48 occurred from landslides in Caraga.
hours, resulting in severe flooding. • 2 people were reported missing.
• Northern Samar Province, Tacloban and • A total of 53,433 people were displaced in
Ormoc cities declared a state of calamity, CAR, Regions 1, 2, 3, 4-A and 5, according
with the National Disaster Risk to the DSWD.
Reduction and Management Council
FLOODS AND LANDSLIDES – AUGUST
(NDRRMC) activated national response.
2016
• A total of 435,220 families were affected in
• August 13-14, 2016 – heavy rains and
2,454 barangays with 14 dead.
flooding due to southwest monsoon with
• Around 1 million US dollars of damage
low Pa weather front forced 260,000
were sustained on national roads, and
people to flee their homes.
around 720,00 US dollars in agricultural
• The monsoon affected 6 regions, mostly in
crops.
Luzon, Rizal, and Northern parts.
EARTHQUAKES – JULY 2017 • Close to 18,000 people were housed in 77
• July 6, 2017 – a 6.5 magnitude earthquake designated evacuation centers.
struck three kilometers north-northeast of

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• August 17, 2016 – Dagupan declared a • Half million people were displaced and
state of calamity. more than 27,000 were sheltered in 108
evacuation centers.
TYPHOON MELOR – DECEMBER 2015
• December 16, 2015 – Melor made a TYPHOON HAIYAN – NOVEMBER 2013
landfall in Batag Island, Northern Samar, • November 8, 2013 – Haiyan or Yolanda
across Southern Luzon and made other 5 landed in Guiuan of Eastern Samar.
landfalls. • 4.3 million people were affected in 36
• It has 150 kph (93.2 mph) speed and gusts provinces.
of up to 185 kph (114 mph), and brough • The government accepted the offer of UN
heavy rainfall in its 300 km diameter. international assistance.
• More than 73,000 people from 5 regions • Affected people rose to 14 million across 9
were evacuated. regions, including 4 million people
• There were 41 confirmed deaths and over displaced.
199,850 houses were damaged. • Humanitarian partners presented on
• Most damages were in Oriental Mindoro, December 10 the Strategic Response
Northern Samar, and Sorsogon. Plan (SRP), which requested 791 million
• 99 classrooms and 35 health facilities were US dollars to complement the
damaged. government’s response and recovery
efforts.
TYPHOON KOPPU – OCTOBER 2015 • It was the deadliest event of 2013 in the
• October 14, 2015 – Typhoon Koppu Asia-Pacific, killing more than 6,000
(Lando) killed 46 people, injured 82, and people.
displaced 5 people.
• More than half million people were TYPHOON NARI – OCTOBER 2013
evacuated, 108,700 were in 424 • October 12, 2013 – Typhoon Nari (Santi)
evacuation centers. hit northern of the country, killing 13 people
• Three weeks was all it took for the recovery and affecting more than 200,000.
operations. • More than 43,000 (or 9,000 families) were
displaced.
TYPHOON HAGUPIT – DECEMBER 2014 • More than 16,500 homes were damaged
• December 6, 2014 – Typhoon Hagupit • Bulacan province suffered extensive
(Ruby) made its landfall in the Eastern damage from flooding, with several villages
Samar as category 2 with maximum submerged and farms were destroyed.
sustained winds of 175 kph and gusts of up
to 210 kph.
• It made a second landfall in the morning of
December 7 in Cataingan municipality,
Masbate.
o It weakened into a tropical storm and
moved towards Batangas, with
moderate to heavy rain.
• On December 9, 1.7 million people were in
5,193 evacuation centers.

TYPHOON RAMMASUN – JULY 2014

• July 15, 2014 – it made landfall in Lapu-
lapu, Albay. It crossed the NCR the next
morning and affected Metro Manila with
strong winds and heavy rain, causing
power outages and interrupting
telecommunications.
• It killed 100 people, destroyed more than
100,000 houses, and damaged 400,000
others.

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