Acute Biologic Crisis (ABC), Emergency and Disaster Nursing (NCM106) Emergency and Disaster II
Disaster Nursing and Emergency Preparedness Risk Profile of the Philippine Composed of more than 7,100 islands Philippine Geographic and Physical characteristics expose the country to hazards and disaster, but does not necessarily make it a disaster prone country o Air > 20 feet o Sea > 200 nautical miles
Threats in the Philippines Typhoons Average of 20 typhoons a year, half of these are destructive About 500 people are killed each year 4 Billion worth of properties are lost
Earthquake & Volcanic Eruptions Occupies the western ring of the Pacific Ocean (Western segment of the Pacific Ring of Fire), a most active part of the earth that is characterized by an ocean encircling belt of active volcanoes and earthquake generators (faults) Earthquakes: o Average of 866 earthquakes per year, some of them have proved damaging o 2 Major Damaging Earthquakes in recent years 1976 Mindanao earthquake around 6000 people died. 5,400 million damage 1990 Luzon Earthquake over 1,283 killed, 2 3M people affected; Volcanic Eruptions o 220 volcanoes, 22 as active o June 1991 Mount Pinatubo eruption dubbed as the 2 nd largest volcanic eruption of the century o 850 people killed > around 12 million people affected > PHP 10.6 Billion of cost of damage
Tsunami August 17, 1976 Earthquake and Tsunami 7.8 Magnitude generated a tsunami as high as 15 ft which swept coastal areas of 5 provinces in Central and Southern Mindanao Magindanao o 3,792 Killed; 9,240 injured; 1,937 missing, >362,136 rendered homeless, around Php 247 M cost of damage Landslide February 17, 2006 Barangay Guinsaugon Landslide o Wiped out entire village around 480 154 Dead 28 Injured 968 Missing 410 Survivors
Floods PHP 76 Billion in damage out of the PHP 111.46 Billion total damage from natural disaster, 1990 2005 Average of 750 people are killed November and December 2004 Landslides / Flashfloods (In the aftermath of 4 weather disturbances) LOOKY HERE Topics Discussed Here Are: 1. Threats in the Philippines 2. Key Components of Disaster Preparedness a. Definition and Classification System for Disasters b. Disaster Epidemiology c. Disaster Planning d. Nursing Care During Disasters jcmendiola_Achievers2013
Top 10 Disaster Reports in the Philippines o Around 3 7 Million Emerging Global Concerns Terrorism Global Warming
Red Tide Outbreaks - From 1983 2001, a total of 42 toxic out breaks have resulted in a total of 2107 paralytic shellfish poisoning cases with 117 deaths - In Manila Bay during 1992 Pyrodinium Red Tide outbreak
Rizal Day Bombing Also referred to as the December 30 bombing, were a series of bombing that occurred around Metro Manila 5 Locations were bombed almost simultaneously within the span of an hour 22 fatalities were reported and around a hundred more suffered non-fatal injuries
Philippine Sports Stadium Stampede Also referred as Wowowee Stampede or the ULTRA Stampede was a stampede that occurred at the Philippine Sports Stadium in Pasig City on February 4, 2006 76 People were killed, and 400 were injured
Oil Spill The Sinking of MT Solar at Lingayen Point, Guimaras Island Last August 11, 2006, it has resulted in the spillage of 200,000 liters of industrial fuel oil, the largest oil spill in the country affecting 3 provinces and 38 municipalities with 3,357 families or 16,785 persons affected, the largest oil spill in the country
Typhoon Milenyo (Xangsane) Which occurred on September 28, 2006 affecting 9 regions in Luzon and Visayas 184 Dead; 536 Injured; 47 Missing Affected population 826,725 families
Typhoon Paeng (Cimarron) Occurred
Sinking of MV Princess of the Stars June 21, 2008 (Sibuyan Island) 52 survived 312 Bodies recovered 825 passengers listed 5 Toxic pesticide and other poisonous substances were retrieved 3 months after
Typhoon Ondoy (Ketsana) 2009; most devastating typhoon, Pacific Typhoon Season With a damage of 1.09 Billion and 747 fatalities The damage to property was
Philippine Disaster Statistics (1980 2010) Number of Events 363 Number of People Killed 32,956 Average Killed Per Year 1,063 Number of People Affected 116,212,416 Average Affected Per Year 3,748,788 Economic Damage (US$ x 1,000) 7,417,145 Economic Damage Per Year (US$ x 1,000) 239,263 jcmendiola_Achievers2013 Definition and Classification System for Disasters Ecologic Disruptions or Emergencies Varying Severity and Magnitude Results in Illness, Deaths, Injuries and Property Damage Cannot be managed by routine procedures Requires Extraordinary Efforts beyond what is needed to respond to everyday
Categories of Disaster Natural Disasters o Result of an ecological disruption or threat that exceeds the adjustment capacity of the affected community (WHO, 1979) o Examples of Natural Disasters are: Earthquakes Floods Tornadoes Hurricanes Volcanic Eruptions Tsunami Geological Meteorological Phenomena Man-Made Disasters (Human Generated) o Principal direct causes are identifiable deliberate human actions or otherwise (Noji, 1996) o Examples of Man-made Disasters are: Biological and Biochemical Terrorism Chemical Spills Radiologic (Nuclear Spills) Fires Explosions Transportation Accidents Armed Conflicts Acts of War o Three Broad Categories 1. Complex Emergencies Suffering and devastation caused by war, civil strife and other political conflicts 2. Technologic Disasters Direct and adverse effect of major industrial accidents, unplanned release of nuclear energy, fires or explosions from hazardous materials 3. Disasters that Occur in Human Settlements Results of combination of forces like famine, drought, epidemics and political unrest Combination or Synergistic Disasters o Also known as NA-TECH o A Natural disaster or phenomena that may trigger a secondary disaster
OTHER CATEGORIES Onset, Impact, Duration Rapid-Onset Events Short durations but with a sudden impact (e.g. Earthquakes and Tornadoes) Sudden Impact (e.g. Hurricanes and Volcanic Eruptions) Rapid-Onset with Unanticipated and Prolonged Impact (e.g. Bioterrorism Attack) Creeping Disasters (e.g. Droughts and Famines) Internal Disasters ^ Caused by disruption of normal hospital function due to injuries or deaths of hospital personnel or damage to health care facility External Disasters ^ Exhaustion of health care / hospital resources due to large volumes of patients with varying types of injuries being admitted o Internal and External Frequently used in hospitals and health care facilities
Key Components of Disaster Preparedness Definition and classification system for disasters (Onset, Duration, Effect and Reactive Period) Disaster epidemiology and measures of health consequences Essentials of Disaster Management Planning Nursing Care During Disasters
jcmendiola_Achievers2013 Disaster Epidemiology Characteristics Epidemiology Disaster Epidemiology Measures Health-related determinants Distribution of states or events Adverse health effects of disasters Contributory factors to the effects of disaster Need of disaster affected populations Application Disease surveillance and control Match available resources to the needs of disaster affected populations Prevent further adverse effects Evaluate program effectiveness
Health-Related Effects of Disaster Premature Deaths, Illness and Injuries Exceeds capacity of local health care system Destruction of local health care infrastructure Disables the health care unit to respond to emergencies Environmental Imbalances Increased risk of communicable diseases Environmental Hazards Affects psychological, emotional and social well-being of the population Disrupts the adaptation and normal coping Shortage of food and Water Severe nutritional deficiencies Large Population Movement (Refugee) Health consequences of crowded living conditions
Disaster Management Planning
Considerations Related to Levels of Disaster Level I Response team should be competent in basic emergency preparedness Adequate surge capacity to respond to routine emergencies (Power outages, weather events, etc.) Level II Assure adequate linkages with other organizations and agencies in the surrounding community Local support and assets should readily be procured Level III Assure adequate linkages between local and national level organizations Knows the communication chain of command for the national level linkages
Disaster Continuum Also known as Emergency Management Cycle (EMC) Provides guide on the time line of a disaster Consists of three phases o Pre-impact o Impact o Post-Impact
Level I Local emergency response personnel and organizations can contain and effectively manage the disaster and its aftermath Level II Regional efforts and aid from surrounding communities are sufficient to manage effects of the disaster Level III Local and regional assets are overwhelmed; statewide assistance is required
Notes: The time-line provides guide on what specific actions to take during the occurrence of a specific phase of a disaster These phases were accompanied with specific actions and disaster management programs. The first 24 hours after impact is critical because it is the time when disaster casualties come to hospitals (first hour) and few that were rescued from the site of impact jcmendiola_Achievers2013 Disaster Planning Cyclical process Composed of phases, often taking place concurrently, indicative of specific actions, along with the nature and scope of the plan Aims to reduce the negative impact or consequences of adverse events
Disaster Management Cycle Mitigation o Measures put in place to minimize the results from a disaster o Risk Assessment, Prevention Measures Preparedness o Planning how to respond o Forecasting, Preparedness Plans, Communications Management Response o Initial actions taken as the event takes place. It involves efforts to minimize the hazards created by a disaster o Evacuations, Search and Rescue, Emergency Relief Recovery o Returning the community to normal (pre-disaster state) o Rehabilitation and Reconstruction
PHASE I: Mitigation and Prevention O All actions taken before a disaster to reduce its impacts, including preparedness and long-term risk reduction measures O Two Main Categories o Structural Mitigation - Activities or Projects which aims to reduce economic and societal impacts o Non-Structural Mitigation - Policies and Practices which raise awareness of hazards or encourage developments to reduce the impact of disasters O Mitigation Strategies 1. Risk Assessment Hazard Identification Vulnerability Analysis 2. Various mitigation strategies or measures (Capacities)
RISK ASSESSMENT: HAZARD IDENTIFICATION
O Industrial chemicals O Transportation elements O Collections of people in areas with limited access O Environmental and meteorological hazards O Explosions and Terrorism
Notes The ideal is for communities to be prepared at all times for all types of hazards. In practical terms however, this is not possible Preparedness for one hazard or disaster may increase your risk to another. For example, structures designed to withstand hurricane force winds may incur or cause greater damage if there is an earthquake. The more logical solution would be to adapt best practices as much as possible for the most likely scenario A crucial first step in mitigation is deciding which hazards have the greatest potential to affect the community, which is called: Hazard Identification First you have to identify the nature of the threat and its variation in between locations. Also determine which threat is frequently occurring on a specific location, as well as presence of risk factors, to be able to have effective identification of the hazard jcmendiola_Achievers2013 RISK ASSESSMENT: VULNERABILITY ANALYSIS Vulnerability Is the extent to which a communitys structure, services or environment is likely to be damaged or disrupted by the impact of a hazard Type of Vulnerability Characteristics Tangible / Material (Easy to see; value easily determined) O People Lives, health, security, living conditions O Property Services, physical property loss, loss of use O Economy Loss of products and production income O Environment Water, soil, air, vegetation, wildlife Intangible / Abstract (Difficult to see; value difficult to determine) O Social Structures Family and Community relationships O Cultural Practices Religious and agricultural O Cohesion Disruption of normal life O Motivation Will to recover; government response Vulnerability Analysis Methods used to determine: o WHO Is most likely to be affected o WHAT Property is most likely to be damaged or destroyed o WHAT Is the capability of the community to deal with the effects of the disaster Data that were collected will be used to develop prevention strategies
Mitigation Strategies and Measures Adjusting normal development programs to reduce losses Plant crops that are resistant to locations prone to calamities Economic diversification Introduce other economic activities that are less vulnerable when the primary source of income is threatened Developing disaster resistant economic activities Match the type of economic enterprise to the placement location considering the presence of hazards
Mitigation Strategies and Measures (Capacities) Positive resources and abilities which are helpful to individuals, families, and community in mitigating, preparing for, responding to, and recovering from the hazard impact Risk Assessment: - Utilizes the results of the hazard identification and vulnerability analysis - Determines the probability of a specified outcome from a given hazard that affects a community with known vulnerabilities - Risk is a function of the hazards to which a community is exposed and the vulnerabilities of that community. However, that risk is modified by the level of the local preparedness of the community at risk. It is expressed by the following notation Risk Assessment Benefits: - Prevention or removal of hazards - Removal of at-risk populations from hazards - Provision of public information and education - Establishment of early warning systems - Reduction of risk posed by some hazards - Enhanced of a local communitys capacity to respond during disasters
PHASE II: Preparedness Preparedness Preparedness is a continuous cycle of planning, organizing, training, equipping, exercising, evaluation and improvement activities to ensure effective coordination and the enhancement of capabilities to prevent, protect against, respond to, recover from, and mitigate the effects of natural disasters, acts of terrorism and other man-made disasters DISASTER PREPAREDNESS A continuous and integrated process Involves a wide range of activities and resources taken before the onset of a disaster from multi-sectoral sources
jcmendiola_Achievers2013 Enables successful discharge of emergency management programs, by which disaster relief is coordinated and mobilized from governmental and nongovernmental organizations to helpless victims of a disaster GOALS: o To achieve a satisfactory level of readiness to respond to any emergency situation o Develop programs that will strengthen the technical and managerial capacity of governments, organizations, and communities o Build response mechanisms and procedures, rehearsals, developing long-term and short-term strategies, public education and building early warning systems
KEY POINTS: E Disaster Mitigation and Preparedness go hand-in-hand o Disaster preparedness for example includes implementation of mitigation measures to ensure that existing that infrastructure can withstand the forces of disasters or that people can respond in their communities and at the same time protect themselves E Mitigation is important, but preparedness is DOUBLE important o In local circumstances and because of historical proneness to disasters, mitigation is important, but preparedness is doubly important E Involves the preparation of people and essential service providers o Consideration must be given to the manner in which the formal responders (Police and Fire Services, Emergency Medical Services personnel and the Military) prepare to respond to disasters. For example, the personnel in these response agencies may have to learn the use of new equipment methods for diseases E Requires global, national, community and individual inputs o According to the International Federation of Red Cross and Red Crescent Societies (IFRCRCS, 2005), Disaster Preparedness incorporates all activities that will enhance the efficiency, effectiveness and impact of disaster emergency response mechanisms in the local community and throughout the country
DISASTER PREPAREDNESS MEASURES: + Preparedness plans + Emergency exercises/training + Warning systems + Emergency communications systems + Evacuation plans and training + Resource inventories + Emergency personnel/contact lists + Mutual aid agreements + Public Information/education
Disaster Risk Reduction (DRR) Physical measures to reduce the vulnerability and exposure of infrastructure to natural hazards as well and to provide coping and adaptive infrastructure in case of a disaster event (IFRCRCS, 2005) Forms the pillars of disaster preparedness Recommendations: o Policy planning and capacity building in disaster management o Physical prevention; example, building sea-walls against storm surge or flood shelters during flood events o Capacity building at institutional and systemic level in disaster preparedness
PHASE III: Response Act of putting preparedness plans into action Measures taken to save lives and prevent further damage in a disaster or emergency situation
AIMS OF DISASTER RESPONSE: 1. Support Morale o In situations of civil or international conflict, ensure protection and assistance of the civilian population 2. Provide Immediate Assistance jcmendiola_Achievers2013 o Re-establish self-sufficiency and essential services as quickly as possible, with special attention to those whose needs are greatest: the most vulnerable and underprivileged 3. Maintain Life o Ensure the survival of the maximum possible number of victims, keeping them in the best possible health in the circumstances 4. Improve Health o Provide adequate supply of basic needs. Ensure reduction of health-related threats in relocation sites
Disaster Response Activities 1. Warning - Refers to information concerning the nature of the danger and imminent disaster threats - Action: Rapidly disseminate warnings to government officials, institutions and the population at large in the areas at immediate risk - Dissemination Methods: Radio, Television, Written Press, Telephone/Cell-phones 2. Evacuation and Migration - Involves the relocation of a population from zones at risk of imminent disaster to a safer location - Primary Concern: Protection of life, immediate treatment of injuries - Measures for effective evacuation: Timely and accurate warning system Clear identification of escape routes Established policy for evacuation procedures Public education program (Evacuation plan awareness) 3. Search and Rescue (SAR) - The process of identifying the location of disaster victims that may be trapped or isolated and bringing them to safety and medical attention - During Floods: - Located stranded victims and transfer them to a safer place or; - Provide them with foods and first aid until evacuated or returned to their homes - During Earthquakes - Locate trapped and or injured victims 4. Post-disaster Assessment - The primary objectives: Provide a clear, concise picture of the post-disaster situation To identify relief needs To develop strategies for recovery - It determines options for humanitarian assistance, how best to utilize existing resources, or to develop requests for further assistance 5. Response and Relief - Should take place immediately - There should be no delays - Contingency plans should be constructed - Relief Is the provision on a humanitarian basis of material aid and emergency medical care necessary to save and preserve human life Enables families to meet their basic needs for medical and health care, shelter, clothing, water and food (including the means to prepare food). Relief supplies or services are typically provided, free of charge, in the days and weeks immediately following a sudden disaster 6. Logistics and Supply
jcmendiola_Achievers2013 7. Communication and Information Management - Two Aspects to Communications in Disasters: 1. Communication Equipments: Radios, Telephones, Wireless devices Supporting Systems: Satellites, Transmission Lines 2. Information Management System: Protocol of communication Information Dissemination and interpretation - All of the above activities are dependent on communication. There are two aspects to communications in disasters. One is the equipment that is essential for information flow, such as radios, telephones and their supporting systems of repeaters, satellites and transmission lines. - The other is information management: the protocol of knowing who communicates what information to whom, what priority is given to it, and how it is disseminated and interpreted 8. Survivor Response and Coping - Assess victims for existing social coping mechanism - Provide social services to victims with special needs to hep hem adjust with the trauma and disruption caused by the disaster - ACTIVE PARTICIPATION OF VICTIMS == HEALTH RECOVERY! 9. Security - Not always a priority issue after a sudden onset of disasters - Civil defense or police departments should ensure the protection of the human rights and safety of displaced populations or refugees 10. Emergency Operations Plan - Emergency Operations Plan (EOP) - Policies and procedures that sets out the scope of activities required for community preparedness and response - Allows the community to respond to threats and engages responders in the short-term recovery - Must be flexible (adjustable in real and potential emergencies) 11. Rehabilitation - Actions taken in the aftermath of disaster to: > Resumption of basic services > Assist victims in repair of dwellings and community facilities > Facilitate revival of economic activities - Rehabilitation focuses on enabling the affected populations (Families and local Communities) to resume more-or-less normal (pre-disaster) patterns of life - It may be considered as transitional phase between: i. Immediate relief and ii. More major, long-term reconstruction and the pursuit of ongoing development 12. Reconstruction - Is the permanent construction or replacement of severely damaged physical structures - The full restoration of all services and local infrastructure - Revitalization of the economy (Including agriculture) - Reconstruction must be fully integrated into ongoing long-term development plans, taking account of future disaster risks. It must also consider the possibilities of reducing those risks by the incorporation of appropriate mitigation measures
Traditional Responses to Disaster * Provisions in-kind * Provisions in cash * Local Partnerships * Civil Service
Modern Responses to Disaster: * Cell Phones * Spatial Devices * Social Networking * Social Media PHASE IV: Recovery Actions taken to return the community to normal following a disaster There is no distinct point at which immediate relief changes into recovery Continues until all systems return to normal or better Short Term Recovery Long Term Recovery Restore interrupted utility services Clear roads Fix of demolish severely damaged buildings Complete redevelopment of damaged areas Improve the status of community better than its pre-disaster state jcmendiola_Achievers2013 Provide foods and shelter to displaced victims Develop new mitigation strategies
Recovery Plan Designed to spell out major steps for managing successful recovery Involves designation of key partners for each steps including their roles and instruction for mobilization - Gathering Basic Information - Organizing Recovery - Mobilizing Resources for Recovery - Administering Recovery - Regulating Recovery - Coordinating Recovery Activities - Evaluating Recovery
Disaster Plan Evaluation (Plan, Personal Property and Equipment) Purposes: Evaluate the disaster response plan for effectiveness and completeness Assess the comprehension of key personnel expected to execute the plan and their ability to perform the assigned duties Ensure availability and functionality of equipment to be called in during disaster events
Disaster Drills Best method to evaluate disaster plans for effectiveness Staging of full-scale or small segment of disaster response Assessment techniques: o Table top academic exercises o Mock patients o Computer simulations o Seminar sessions focused on key personnel or aspects of disaster Essentials of Effective Disaster Drill Implementation: o Goals and Objectives should be clearly communicated o The more realistic the exercise, the more likely it is to be useful in assessing the strengths and weakness of both the disaster plan and the responders o Include all individuals and agencies likely to be involved in a disaster response, and a critique during debriefing of the participants Key Points to Disaster Plan Evaluation: o Any modifications made to a disaster plan or response procedures must be communicated to all groups involved o Evaluate personnel to ensure their familiarity with their roles in disaster situation o Accommodate changes in population demographics, regional emergency response operations, hospital renovations and other variables o At a minimum, disaster drills should take place once every 12 months in the community, and more frequently in hospitals