CHN-FINALS Chapter 11-14 (1) PDF

CHAPTER 11: CONTROL OF NON-COMMUNICABLE DISEASES What are non-communicable diseases? medical condition that is non-infectious and non-transmissible referred to as chronic disease or lifestyl...

CHAPTER 11: CONTROL OF NON-COMMUNICABLE DISEASES What are non-communicable diseases? medical condition that is non-infectious and non-transmissible referred to as chronic disease or lifestyle-related disease leading cause of mortality in the philippines Examples 1. Cardiovascular disease 2. Cerebrovascular disease 3. cancer 4. Chronic Obstructive Pulmonary Disease (COPD) 5. Diabetes TOP 10 Causes of Mortality in the Philippines (NSO, 2009) NON-COMMUNICABLE DISEASE CARDIOVASCULAR AND CEREBROVASCULAR 33.8 % leading cause of death (NSO,2009) DISEASE Cardiovascular also known as heart disease , diseases that involve the heart or blood vessels (arteries, capillaries, and veins) Cerebrovascular also known as stroke, a group of brain dysfunction related to disease of the blood vessels supplying the brain Atherosclerosis and hypertension are the most common cause of these two diseases (cardiovascular and cerebrovascular) Classification of blood pressure Cholesterol (mg/dL) CANCER OR MALIGNANT NEOPLASM 50,000 cases cancer cases in the Philippines a group of various diseases involving  unregulated cell growth (Newton,2009) screening for cancer involves early detection of the warning signals of cancer Carcinogen substances that cause some cells to undergo genetic mutation women- breast cancer men- lung cancer Warning Signs of Cancer Change in bowel or bladder habits A sore that does not heal Unusual bleeding Thickening or lump in the breast Indigestions or difficulty of swallowing Obvious change in a wart or more Nagging cough or hoarseness Unexplained anemia Sudden weight loss CHRONIC OBSTRUCTIVE PULMONARY DISEASE 4.7% cause of death in the Philippines (COPD) diseases of the lungs in which the airways narrow over time smoking is a strong risk factor with15% of smokers develop COPD Examples 1. Bronchitis 2. chronic asthma 3. emphysema TWO MOST COMMON COPD CONDITIONS CHRONIC BRONCHITIS is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. Its characterized by daily cough and mucus (sputum) production EMPHYSEMA is a condition in which alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter DIABETES 18.1 per 100,000 deaths in the Philippines group of metabolic diseases in which an individual has high blood sugar because the pancreas does not produce enough insulin or the cells do not respond to the insulin produced SYMPTOMS 1. increased frequency and amount of urination (polyuria) 2. increased thirst (polydipsia) 3. constant hunger (polyphagia) 4. weight loss 5. vision changes 6. fatigue RISK FACTORS FOR DIABETES Predisposing Factors Hereditary  Age (increasing age) Obesity ○ BMI ○ Adipose tissues in obese people are more resistant to insulin SYMPTOMS OF DIABETES RISK FACTORS FOR NON-COMMUNICABLE 1. Physical Activity DISEASE 2. Cigarette smoking 3. Unhealthy eating 4. Excessive alcohol drinking 5. Viruses 6. Radiation PREVENTION AND CONTROL 1. Avoid excessive mental and physical strain by modifying lifestyle 2. Low salt diet and low fat intake 3. Avoid Alcoholism 4. No smoking 5. Regular Exercise 6. Create awareness in the community 7. Self care 8. Drug therapy MENTAL HEALTH state of social well-being in which every individual -WHO,1999 realizes his or her own potential (self-image), can cope with the normal stresses of life (resiliency), can work productively and fruitfully ( productivity and creativity), and is able to make a contribution to her or his community (sense of purpose) CONDITIONS THAT LEAD TO MENTAL PROBLEMS 1. Stressful life events 2. Difficult family background 3. Brain diseases 4. Hereditary 5. Medical Problems  CHAPTER 12: COMMUNICABLE DISEASES COMMUNICABLE DISEASE Illness caused by infectious agent or toxic products that is transmitted directly or indirectly to a person, animal, or intermediary host or inanimate environment CONTAGIOUS transmitted by direct physical contact INFECTIOUS transmitted indirectly through contaminated food, body fluids, objects, airborne inhalation, or through vector organism that would require a break or inoculation in the skin or mucous membranes of individuals TOP 10 CAUSES OF MORBIDITY IN THE PHILIPPINES (DOH,2010) EPIDEMIOLOGIC TRIANGLE MODEL 1. AGENT organism involved in the development of disease 2. HOST organism that harbors and provides nutrition for the agent 3. ENVIRONMENT condition in which the agent may exist, survive, or originate CHAIN OF INFECTION 1. Causative Agent 2. Reservoir 3. Portal of Exit 4. Mode of Transmission 5. Portal of Entry 6. Susceptible Host ERADICATION permanent reduction to zero of the worldwide prevalence of a disease caused by a specific agent ELIMINATION reduction to zero of a disease in single country, continent, or other limited geographical area DISEASES TARGETED FOR ERADICATION FUNCTIONS OF THE PUBLIC HEALTH NURSE IN 1. Report immediately to the Municipal Health COMMUNICABLE DISEASE CONTROL Office any known case of notifiable disease. 2. Refer immediately to the nearest hospital. 3. Conduct a strong health education program directed toward prevention of an outbreak. 4. Assist in the diagnosis of the suspect based  on the signs and symptoms 5. Conduct epidemiologic investigations as a means of contacting families, case finding and individual as well as community health education. Tuberculosis (Phthisis, Consumption, Koch's) Causative Agent: ○ gram (+) acid fast bacilli ○ Mycobacterium tuberculosis (humans) ○ Mycobacterium africanum (humans ○ Mycobacterium bovis (cattle) ○ Mycobacterium canettii Mode of Transmission: ○ Airborne/Droplet through inhalation of coughing, singing, or sneezing. Incubation Period: 4-6 weeks Signs and Symptoms: fever, low grade fever, loss of appetite, easy fatigability, night sweats, dry cough, later productive with hemoptysis, chest pain. LABORATORY/ DIAGNOSTIC TEST 1. Direct sputum smear microscopy 2. Chest x-ray - useful in diagnosis TB patient who are asymptomatic and those who cannot submit sputum specimen but are suspected to have TB MANAGEMENT PREVENTION 1. BCG vaccination 2. Health education 3. Environmental sanitation 4. Early diagnosis and treatment 5. Respiratory isolation ROLES AND RESPONSIBILITIES OF NURSE 1. Administrator 2. Health Educator 3. Case Manager and Coordinator 4. Community Coordinator 5. treatment partner 6. Advocate DENGUE (HEMORRHAGIC FEVER, BREAK BONE Causative agent: OR DANDY FEVER, DENGUE SHOCK SYNDROME) ○ Dengue virus 1,2,3,4 Vector: ○ Aedes aegypti ○ Aedes albopictus Mode of transmission: ○ Bite of an infected mosquito Susceptible: ○ All individuals, ○ children 0-9 y/o are commonly affected.  Incubation period: ○ 3-14 days ○ common 5-7 days LABORATORY/DIAGNOSTIC TEST 1. Tourniquet test or rumpel-Leads test 2. Capillary refill of NAil Blanch Test 3. Plate count and hematocrit count 4. Hemagglutination-inhibition test PHASES OF ILLNESS 1. Febrile Phase- 2 to 7 days 2. Critical Phase- 24 to 48 hours 3. Recovery Phase- 48 to 72 hours MANAGEMENT 1. Antipyretic 2. Oral rehydration 3. Avoid dark color food (ASCF) 4. Bed rest 5. Do not give IM 6. Refer immediately 7. Manage bleeding 8. Monitor laboratory results FOUR S IN PREVENTION 1. Search and destroy breeding places of mosquitos 2. Seek immediate treatment 3. Say no to indiscriminate fogging 4. Self-protection MALARIA ( MARSH FEVER, PERIODIC FEVER, Causative agent: KING OF TROPICAL DISEASES) ○ Plasmodium falciparum, vivax, ovale, malariae, knowlesi Vector: ○ Female anopheles mosquito Symptoms: ○ Recurrent fever preceded by chills and ○ profuse sweating (triad signs), ○ malais ○ anemia LABORATORY/ DIAGNOSTIC TEST History of having been in a malaria endemic area: Palawan and Mindoro 1. Blood smear 2. Rapid Diagnostic test (RDT) TREATMENT Oral antimalarial drugs like 1. Chloroquine 2. Sulfadoxine 3. Primaquine PREVENTION AND CONTROL 1. Mosquito control 2. Chemical method 3. Biological methods 4. Zooprophylaxis 5. Environmental methods 6. Screening of houses 7. Mechanical methods 8. Universal precaution 9. Screening of blood donors FILARIASIS (ELEPHANTIASIS, FLORIOIDEA Causative agent: INFECTION) ○ Wuchereria Bancrofti ○ Burgia Malayi Vector: Mosquito ○ aedes poecilus ○ culex quinquefasciatus Symptoms: ○ Chills, fever, myalgia, lymphangitis with gradual thickening of the skin (commonly affecting limbs, scrotum) resulting in elephantiasis and hydrocele LABORATORY/DIAGNOSTIC TEST Circulating Filarial Antigen (CEA) finger prick test TREATMENT Diethylcarbamazine citrate (Hetrazan) PREVENTION Eradication of vectors GONORRHEA (CLAP, DRIP, TULO) Causative agent: ○ Neisseira gonorrhea Mode of transmission: ○ Sexual contact Symptoms: ○ Thick purulent urethral discharge, ○ frequency of urination among females, ○ burning sensation among males/females Diagnostic/Laboratory test: ○ Culture of the specimen ○ gram stain TREATMENT 1. Penicillin 2. ceftriaxone 3. doxycycline PREVENTION Crede’s prophylaxis practice monogamous sexual contact SYPHILIS ( LUES, SYMPH, THE POX) Causative agent: ○ Treponema Pallidum Mode of transmission: ○ Sexual contact Symptoms: ○ Chancre ○ condylomata ○ gumma formation Diagnostic/Laboratory test: 1. Dark Field illumination test 2. VDRL 3. Fluorescent Treponemal Antibody Test TREATMENT 1. Penicillin 2. Tetracycline 3. Erythromycin PREVENTION 1. Sex education 2. practice monogamy HIV/ AIDS is a virus that attacks cells that help the body Human Immunodeficiency Virus (HIV) fight infection there is no cure but it is treatable with medicine Acquired Immune Deficiency Syndrome (AIDS) Causative Agent: ○ Human Immunodeficiency Virus-1 and 2 (1981) Mode of Transmission: ○ Sexual Contact - direct ○ Blood Transfusion ○ Contaminated syringes, needles, nipper, blades ○ Direct contact of open wound/mucous membranes with contaminated blood, body fluids, semen and vaginal discharges, breast milk Saliva, tears, urine – present but uncommon IP: 4-12 weeks (HIV antibodies present in blood) 8-10 years (symptoms develop) PREVENTION Blood and blood products screen blood donors observe universal precaution refrain from using contaminated needles and syringe Sexual Transmission abstain from promiscuous sexual contact be faithful to your partner follow correct and consistent use of condom Mother to child transmission consult health workers ESSENTIAL STEPS IN STI CASE MANAGEMENT SCHISTOSOMIASIS (SNAIL FEVER, BILHARZIASIS) PREVENTION AND CONTROL 1. Proper disposal of feces 2. Proper irrigation of all stagnant bodies of water 3. Prevent exposure to contaminated water 4. Eradication of breeding places of snails 5. Use of molluscicides RABIES (HYDROPHOBIA, LYSSA) MANAGEMENT LEPTOSPIROSIS (CANICOLA, WEILS DISEASE) LEPROSY (HANSENOSIS, HANSEN’S, LEONTIASIS)  CHAPTER 13: ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH Environmental health is the component of the man's well-being that is determined by interactions with the physical, chemical, biological, social, and psychosocial factors external to him. In the Philippines, maintenance of environmental health records is one of the responsibilities given to the city, municipal, and provincial health nurses. Eight environmental health indicators in the Field 1. Households with access to improved or safe Health Service Information System (FHSIS) water-stratified to Levels I, II, and III 2. Households with sanitary toilets 3. Households with satisfactory disposal of solid waste 4. Households with complete basic sanitation facilities 5. Food establishments 6. Food establishments with sanitary permit 7. Food handlers 8. Food handlers with health certificates FUNCTIONS OF LAND Platform for human activities Agricultural production Habitat of the members of the food chain where the processes of "bio-accumulation" and "bio-magnification" take place Filter for surface water SOLID WASTES Municipal Wastes Healthcare Wastes ○ Infectious ○ Pathological ○ Pharmaceutical ○ Chemical ○ Sharps ○ Radioactive Industrial Wastes Hazardous Wastes SOLID WASTE MANAGEMENT "The discipline associated with the control of generation, storage, collection, transfer and transport, processing, and disposal of solid wastes in a manner that is in accord with the best principles of public health, economics, engineering, conservation, aesthetics, and other environmental considerations, and that is also responsive to public attitudes". -R.A. 9003 SOLID WASTE STREAM Waste Generation Waste Reduction: Re-Use Waste Segregation Collection and Transportation Waste Recycling Waste Treatment and Processing Residual Waste Disposal  WASTE SEGREGATION BLACK OR COLORLESS non-hazardous, non biodegradable waste GREEN non-hazardous biodegradable waste YELLOW WITH BIOHAZARD SYMBOL pathological/ anatomical waste YELLOW WITH BLACK HAND pharmaceutical, cytotoxic, or chemical waste (labeled separately) YELLOW BAG THAT CAN BE AUTOCLAVED infectious wastes ORANGE WITH RADIOACTIVE SYMBOL radioactive wastes PROHIBITED ACTS ON SOLID WASTE Open burning of solid wastes Open dumping MANAGEMENT Burying in flood-prone areas Squatting in landfills Operation of landfills on any aquifer, groundwater reservoir or watershed Construction of any establishment within 200 meters from a dump or landfill WATER SANITATION The lead agency on the determination of standards for quality of drinking water is the Department of Health (DOH). The general requirements of safe drinking water include: 1. Microbial quality 2. Chemical and physical quality 3. Radiological quality LEVELS OF ACCESS TO SAFE WATER Level I (Point Source) - DOH FHSIS, 2008 Level II (Communal Faucet System or Standpost) Level III (Waterworks System) PROHIBITION OF THE CODE OF SANITATION ON Washing and bathing within a radius of 25 WATER SUPPLY meters from any well or other source of drinking water Construction of artesians, deep, or shallow well within 25 meters from any source of pollution (including septic tanks and sewerage systems) Drilling a well within 50-meter distance from a cemetery Construction of dwellings within the catchment area of a protected spring water source EMERGENCY WATER TREATMENT Pre-Treatment Processes - Aeration - Settlement - Filtration Disinfection - Boiling - Chemical Disinfection - Solar Disinfection (SODIS) Storage and Consumption AIR PURITY Two Major sources of Air Pollution 1. Mobile Source 2. Stationary Source COMMON COMPONENT OF AIR QUALITY 24-Hour Average Total Suspended REPORTS Particulates (TSP) 24-Hour PM10 8-Hour Carbon Monoxide 24-Hour Sulfur Dioxide 8-Hour Ozone 1-Hour Nitrogen Dioxide PARTICULATE MATTER REPORT RESULTS INTERPRETATION "Unhealthy for sensitive groups": People with respiratory disease, such as asthma, should limit outdoor exertion. "Very unhealthy" Pedestrians should avoid heavy traffic areas. People with heart or respiratory disease, such as asthma, should stay indoors and rest as much as possible. Unnecessary trips should be postponed. People should voluntarily restrict the use of vehicles. "Acutely unhealthy" People should limit outdoor exertion. People with heart or respiratory disease, such as asthma, should stay indoors and rest as much as possible. Unnecessary trips should be postponed. Motor vehicle use may be restricted. Industrial activities may be curtailed. "Emergency” Everyone should remain indoors, (keeping windows and doors closed unless heat stress is possible). Motor vehicle use should be prohibited except for emergency situations. Industrial activities, except that which is vital for public safety and health, should be curtailed. TOXIC AND HAZARDOUS WASTE CONTROL Philippine Inventory of Chemicals and Chemical substances (PICCS) National Poison Management and Control Center (NPMCC) The Department of Environment and Natural Resources (DENR) accounts the ratio of hazardous waste treatment plants and hazardous waste generating facilities. LEADING CAUSES OF POISONING IN THE Jewelry cleaners (high in cyanide) PHILIPPINES Pesticides Button batteries Watusi firecracker Jathropha seeds Multi-vitamins FOOD SAFETY "The assurance that food will not cause harm to the consumer when it is prepared and eaten according to its intended use." -NEHAP, 2010 RULES ON FOOD SAFETY  The food establishment must have a sanitary permit from the city or municipality that has jurisdiction over the business. No person shall be employed in any food establishment without a health certificate properly issued by the city/municipal health officer. No person shall be allowed to work on food handling while he/she is afflicted with a communicable disease, including boils, infected wounds, respiratory infections, diarrhea, and gastrointestinal upset. After proper washing, the utensils are then subjected to one of the following bactericidal treatments: Immersion for at least half a minute in clean hot water (77°C) Immersion for at least one minute in lukewarm water containing 55-100 ppm of chlorine solution Exposure to steam for at least 15 minutes to 77°C, or for 5 minutes to at least 200°C SANITATION "The hygienic and proper management, collection, disposal or reuse of human excreta (feces and urine) and community liquid wastes to safeguard the health of individuals and communities." -Philippine Sanitation Sourcebook, 2005 6 F’ OF FECAL-ORAL MICROBIAL TRANSMISSION 1. Feces 2. Fingers 3. Fluids 4. Flies 5. Fields/ Floors 6. Food SANITATION FACILITIES SANITARY TYPES OF TOILET FACILITIES 1. Water sealed toilet connected to a sewer or septic tank, used exclusively by the household. 2. Water sealed toilets connected to other depository types, used exclusively by the household. 3. Closed pit used exclusively by the household. VERMIN ABATEMENT METHODS 1. Environmental Sanitation 2. Naturalistic Control 3. Biological and Genetic Control 4. Mechanical and Physical Control 5. Integrated Control MINIMUM AIR-SPACE IN BUILT ENVIRONMENTS School Rooms - 3.00 cu. meters with 1.00 sq. meter of floor area per person Workshop, Factories, and Offices - 12.00 cu.meters of air space per person Habitable Rooms - 14.00 cu. meters of airspace per person MINIMUM WINDOW SIZE Rooms intended for any use, not provided with an artificial ventilation system, shall be provided with a window or windows with a total free area of openings equal to at least  10% of the floor area of the room, provided that such opening shall be not less than 1.00 sq. meter. Toilet and bath rooms, laundry rooms and similar rooms shall be provided with window or windows with an area not less than 1/20 of the floor area of such rooms, provided that such opening shall not be less than 240 sq. millimeters.  CHAPTER 14: DISASTER MANAGEMENT THE PHILIPPINE SCENARIO Medical and nursing personnel, medicine, and needed supplies were unavailable, scarce or depleted during typhoon Ondoy (2009) Evacuees had to stay in the evacuation centers for weeks which led to: ○ High incidence of acute respiratory and gastro- enteritis because of overcrowding and lack of sanitary facilities First responders and rescue teams where overwhelmed in attempts to assist victims THE NURSE'S ROLE Provide information for development of plans for disaster prevention, preparedness, response and recovery Cooperate with health and social representatives, government bodies, community groups and volunteer agencies in disaster planning and preparedness programs. Utilize knowledge of nursing, public health and cultural-familial structures as well as skills and abilities to assist or participate in all aspects and stages of an emergency or disaster EMERGENCY An emergency is any event endangering the life or health of a significant number of people and demanding immediate action. An emergency situation may result from a natural, man-made, technological, or societal hazard (DOH, 2012). The agency, community, family, or individual can manage an emergency using their own resources. DISASTER A disaster is any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources. Depending on the characteristics of the disaster, may be beyond the ability of the community to respond and recover from the incident using their own resources. CASUALTIES MASS CASUALTY A mass casualty event is one in which 100 or more individuals are involved MULTIPLE CASUALTY A multiple casualty event is one in which more than two but fewer than 100 individuals are involved. DIRECT VICTIM A direct victim is an individual who is immediately affected by the event.  Displaced persons are those who have to evacuate their home, school, or business as a result of a disaster Refugees are a group of people who have fled their home or even their country as a result of famine, drought, natural disaster, war, or civil unrest. INDIRECT VICTIM The indirect victim may be a family member or friend of the victim or a first responder. TYPES OF DISASTER NATURAL HAZARD a physical force, such as a typhoon, flood, landslide, earthquake, volcanic activity and other similar events. BIOLOGICAL HAZARD is a process or phenomenon of organic origin or conveyed by biological vectors, including exposure to pathogenic microorganisms, toxins and bioactive substances. TECHNOLOGICAL HAZARD arises from technological or industrial conditions, including accidents, dangerous procedures and infrastructure failures. SOCIETAL HAZARD results from the interaction of varying political, social, or economic factors, which may have a negative impact on the community. NA-TECH (Natural-Technological) disaster is a natural disaster that creates or results in a widespread technological problem. -an earthquake that causes structural collapse of roadways or bridges that, in turn, downed electrical wires and caused subsequent fires; a chemical spill resulting from a flood. TERRORISM "criminal acts... committed with the intent to cause death or serious bodily injury... with the purpose to provoke a state of terror in the general public" (UN Security Council, 2004). Weapon of Mass Destruction (WMD) any weapon that is designed or intended to cause death or serious bodily injury through release, dissemination, or impact of - toxic or poisonous chemicals, or its precursors - a disease organism - radioactivity at a level dangerous to human life CHARACTERISTICS OF DISASTER FREQUENCY refers to how often a disaster occurs. PREDICTABILITY Predictability - relates to the ability to tell when and if a disaster event will occur. PREVENTABILITY Preventability - refers to actions taken to avoid a disaster. 1. Primary prevention - preventing the  occurrence of a disaster or limiting consequences when event itself cannot be prevented 2. Secondary prevention - implemented once the disaster occur 3. Tertiary prevention - restoration of the community and its residents to its previous/optimum/maximum level of functioning *Nurses are involved in all stages of prevention and related activities IMMINENCE the speed of onset of an impending disaster and relates to the extent of forewarning possible and the anticipated duration of the incident. SCOPE AND NUMBER OF CASUALTIES disaster indicates the range of its effect; described in terms of the geographic area involved and the number of individuals affected, injured, or killed. INTENSITY Intensity - the level of destruction and devastation of the disaster event. GOVERNMENT RESPONSIBILITIES POLICE, FIRE, PUBLIC HEALTH, PUBLIC WORKS are the first responders responsible for incident AND MEDICAL EMERGENCY SERVICES management at the local level. LOCAL OFFICIALS AND AGENCIES are responsible for preparing their citizens for all kinds of emergencies and disasters and, where and when possible, for testing disaster plans with mock drills. THE NATIONAL DISASTER RISK REDUCTION AND MANAGEMENT PLAN 2010, R.A. 10121 Signed into law in 2010, R.A. 10121, brought about a paradigm shift from disaster preparedness and response to disaster risk reduction and management (DRRM). NDRRM PLAN The law specified the policy of developing and implementing a NDRRM Plan NDRRM FRAMEWORK The National Disaster Risk Reduction and Management (NDRRM) framework envisions a country which has "safer, adaptive and disaster- resilient Filipino communities toward sustainable development." NDRRM FOCUS 1. Building individual, collective and institutional capacities to adjust to situations (increased resilience) 2. Decreasing vulnerabilities. NDRRM AIMS 1. Strengthen the capacity of the government - national and local - together with partner stakeholders; 2. Build the disaster resilience of communities; and 3. Institutionalize arrangements and measures  for reducing disaster risks (NDRRMP, 2011). FOUR PRIORITY AREAS DISASTER PREVENTION AND MITIGATION by reducing vulnerabilities and exposure and enhancing capabilities of communities DISASTER PREPAREDNESS the capacity to effectively anticipate, respond to, and recover from the impacts of hazardous events or conditions. DISASTER RESPONSE/ DISASTER RELIEF the provision of emergency services ar public assistance during or immediately after a disaster It is sometimes called "disaster relief.” REHABILITATION AND RECOVERY restore the community's normal level functioning by rebuilding livelihood and damaged infrastructure and increasing communities' organizational capacity (NDRRMP, 2011). PUBLIC HEALTH SYSTEM MISSION OF PUBLIC HEALTH SYSTEM Promotion of health, prevention of disease, and protection from threats to health. All of the governmental and non-governmental organizations and agencies that contribute to the improvement of the health of populations PUBLIC HEALTH OFFICIALS HAVE THE detecting outbreaks, RESPONSIBILITY OF: determining the cause of illness, identifying the risk factors for the population, implementing interventions to control the outbreak, informing the public of the health risks and preventive measures that need to be taken. THE PHILIPPINE RED CROSS PHILIPPINE RED CROSS founded in 1947 RED CROSS SIX (6) MAJOR SERVICES 2013 1) NATIONAL BLOOD SERVICES provision of safe blood for medical purposes. 2) SAFETY SERVICES conduct of training in First Aid, Basic Life Support, Water Safety, Accident Prevention, and rescue courses. 3) SOCIAL SERVICES relevant to disaster and post-disaster situations include: Guidance and Counseling Psychosocial Support Program or Critical Incident Stress Management Tracing and Referral Service Early Livelihood Recovery Program Hot Meals 4) VOLUNTEER SERVICES provision of training courses Community Health and  Nursing Services 5) COMMUNITY HEALTH AND NURSING SERVICES 6) DISASTER MANAGEMENT SERVICES disaster relief operations and services of identifying hazard prone areas and making vulnerability assessments. Specific disaster management services offered include: Relief Operations; Deployment of Disaster Response Teams; Organization of Barangay Disaster Action Team; and Preposition of Relief Supplies. DISASTER MANAGEMENT PREVENTION STAGE PREPAREDNESS AND PLANNING STAGE RESPONSE STAGE TRIAGE TRIAGING TRIAGE ASSESSMENT PSYCHOLOGICAL TRIAGE RECOVERY STAGE SUMMARY