NCM 222A Disaster Preparedness & Risk Management Nursing Past Paper

‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) CHAPTER 1:...

‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) CHAPTER 1: In December 1, 1970, the Emergency Lecturer: Ian Van V. Sumagaysay, MAN, RN Department Nurses Association was established by ANITA M. DORR (Emergency Room Nurses llf UNIT OUTLINE Association – East Coast) and Judith C. Kelleher (Emergency Room Nurses Association – West Page Coast). In 1985, the emergency department nurses association (EDNA) was formally renamed to ENA. EMERGENCY AND DISASTER NURSING INTRODUCTION EMERGENCY NURSING (AS A PROFESSION) Textbook: Disaster Nursing and Emergency According to ENA it involves: Preparedness for clinical, biological, and radiologic Assessment, diagnosis, and treatment of Author: Venema perceived, actual or potential, sudden or More on caring for the patient up to the urgent, physical or psychosocial problems point where the patient can be wheeled-in to that are primarily episodic or acute. the ER A specialty, because it is care given in a Learn phase when a diagnosis has not been made Apply expertise and the cause of the problem is not yet Improve treatment of client known. EMERGENCY NURSING QUALIFICATIONS OF AN ER NURSE The care of individuals of all ages with perceived or actual physical or emotional alterations of A BSN graduate and holder of a current health that are undiagnosed or require further license to practice nursing in the interventions. Philippines. Perceived – feeling or own perspective of Has had specialized education, training how they are sick; mental, physical and experience to gain expertise in well-being assessing and identifying patient’s health As the first person who attends to your care problems in crisis situations. patient, what will you do? Injuries and illnesses are often undiagnosed BASIC NURSING RESPONSIBILITIES No assistance from physicians 1. Establish priorities Pre-hospital setting 2. Provide holistic care Actual Not only patient-centered May be episodic, primary, usually acute and occurs acknowledge the family as well. in a variety of settings (Emergency Nurses 3. Monitors and continuously assesses acutely Association of America (ENA)). ill and injured patients Monitor for any instability (especially Note: Most cases are undiagnosed -> provide if it is already in the hospital setting) provisionary diagnosis as a basis for treatment 4. Document all procedures made Procedures to do and Procedures to HISTORY OF EMERGENCY NURSING delegate (VS taking can be delegated) 1. Supervise other allied health personnel WEST VISAYAS STATE UNIVERSITY NCM 222A 1 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) As the person with the most ○ Intraosseous IV insertion - long experience, you must supervise bones (humerus, femur, tibia [tibia is other allied health personnels most common]) 2. Support and attend to families Wound management 3. Give health teachings to patients and their Pain management families in a time-limited and high-pressured Family presence care environment Organ and tissue donation Expect patient to come back if not Palliative and end of life care in the ER health teaching is given Forensic Nursing in the ER 4. Request for and refill supplies ○ How to keep and discard evidence Know the rate of consumption of (not sure if evidence man gid huhu, materials so that there are ample basta ang mga knife and bala) requested materials for the next gunshot wounds - bullets month stab wounds - knives rape Note: Most common way to make a patient with rape kit (???) - USA distended bladder pee is to apply hot and cold medications to compress. prevent pregnancy swab testing done to 5. Protect self and others get evidence to turn Use universal precaution on body over to the police fluids Emergency preparedness Use masks and gowns Nuclear, biologic and chemical agents of mass destruction COMPONENTS OF EMERGENCY NURSING CBRNE – Chemical, Biologic, Radiologic, Establish priorities (triage and nursing Nuclear, Explosives (most risky) assessment) Management of the patient in the Field or Health history and complete head to toe department assessment Intraosseous IV is inserted in long bone, Formulate nursing diagnoses (base on most commonly the tibia NANDA) Planning/implementation DISASTER & EMERGENCY NURSING BASED ON CMO 14 S. 2009 Nursing documentation/evaluation Patient transport A. Definition of emergency B. Types of emergency CLINICAL FOUNDATIONS OF EMERGENCY C. Triage NURSING - Objectives Triage - Start triage ○ Most important - Military triage ○ START - Simple Triage Assessment D. Hospital emergency incident command Rapid Treatment (Simple Triage And system Rapid Treatment online) E. Incident command education Patient assessment F. Hospital operations plan Air and surface patient transport G. Personal protective equipment Vascular access and fluid replacement H. Hazardous materials I. Decontamination J. Biological warfare and biological agents WEST VISAYAS STATE UNIVERSITY NCM 222A 2 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) K. Blast injuries An unforeseen combination of L. Natural disasters circumstances or the resulting state that M. Stress reactions calls for immediate action. - Post traumatic Is a situation that poses an immediate risk - Stress disorder critical incident or threat to health, life, property, or stress management environment. N. Debriefing Requires urgent attention to prevent O. Nurses role in disaster and emergency worsening or to do more damage and complications. EMERGENCY NURSING ENVIRONMENT Note: Hierarchy/Prioritization of Interventions Unplanned situations that require immediate Life over limb, limb over property intervention Allocation of limited resources DANGERS TO LIFE Need for immediate care perceived by the Emergencies affecting a single person, such patient and others as the entire range of medical Geographic variables emergencies including heart attacks, Unpredictable number of patients strokes, and trauma, to incidents that ○ Be proactive - lowers the number of affect large numbers of people such as patients natural disasters. Unknown patient severity, urgency and Most agencies consider these to be the diagnosis highest priority of emergency, which follows Cultural diversity the general school of thought that nothing is Emergency departments (ED) more important than human life Free-standing EDs (ER that is completely Life is the utmost priority. separate from the hospital, if cases are In a military sense, treat the one with the severe, patients are referred to the hospital) most chance to survive. Prehospital DANGERS TO HEALTH ○ Rescue units - like medical first responders Not immediately threatening to life, but ○ Medical City Iloilo - equipped with might have serious implications for the prehospital care continued health and well-being of a person Air and ground transport or persons. Military The causes of a health emergency are often Urgent care center very similar to the causes of an emergency Health clinic threatening to life, which includes medical Health maintenance organizations emergencies and natural disasters, Ambulatory services although the range of incidents that can be Schools and universities categorized here is far greater than those Business/industry that cause a danger to life (such as broken Correctional facilities limbs, which do not usually cause death, but Occupational health clinics immediate intervention is required if the person is to recover properly) NOTE : Safety officer – green hat/equipment with i.e. Person with loss of consciousness > white cross Person with fracture EMERGENCY DANGERS TO PROPERTY Do not threaten any people,but do threaten peoples’ property categorized as the lowest WEST VISAYAS STATE UNIVERSITY NCM 222A 3 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) priority, and may not take as many risks in vulnerability dealing with it. An example of this would be a fire in a PATIENT ASSESSMENT warehouse that has been evacuated. The situation is treated as an emergency as the fire may spread to other buildings, or may ESTABLISH PRIORITIES cause sufficient damage to make the I. Primary Survey business unable to continue (affecting The rapid initial assessment of the client’s livelihood of the employees). presenting symptoms DANGERS TO ENVIRONMENT A - Airway 1. Open the airway Do not immediately endanger life, health, or Jaw thrust maneuver – property, but do affect the natural if patient has suspected environment and creatures living within it. spinal injury Not all agencies consider this to be a Head tilt/chin lift genuine emergency, but it can have far maneuver - if without reaching effects on animals and the long head injury term condition of the land. Examples would 2. Visualize if foreign object include forest fires and marine oil spills. occludes airway DISASTERS If patient loses consciousness - check pulse and breathing Overwhelms a community If no breathing and with pulse - Compromise services rescue breathing Requires external assistance If no breathing and no pulse - A result of vast ecological breakdown in the CPR relation between humans and their environment as a serious or sudden event 3. If there is an occlusion on such a scale that the stricken community Finger sweep maneuver needs extraordinary efforts to cope with - only do it ONCE with the outside help or international aid. pinky finger. Doing it Natural disasters trend for all and more than once may individual continents for the period make the airway more 1960–2015 (EM-DAT 2016) occluded. Signs of choking Infant - cry without sound School age and adult (pa double check huhu) - holding the throat with 2 hands B - Breathing Breathing check (LLF) Look for rise and fall Listen for breathing Feel for patient’s breath All poor people are vulnerable but not all vulnerable people are poor. Poverty is a core dimension of WEST VISAYAS STATE UNIVERSITY NCM 222A 4 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) Purpose - to immediately identify any Note: In prehospital setting, do problem that poses a threat, immediate or not LLF for not more than 10 potential to life, limb or vision. seconds Procedure - information is gathered C - Circulation Check for pulses primarily through objective data 1. Adults If abnormalities are found, immediate a. Jugular vein; always interventions such as CPR and ACLS must check one at a time be instituted to aid in preserving the client’s Location: from middle of life, limb or vision. the neck slide two fingers b. If no pulse in jugular; NOTE: check apical and radial History of Illness - describes disease pulse process on how it is caused 2. Child - Brachial Mechanism of Injury - discusses how 3. Infant - Apical trauma cases happened (dog bite, knife Check for capillary refill stab) PR does not matter, presence of Airway: maintain patent airway pulse is most important a. Head tilt/chin lift, jaw thrust, suctioning, oropharyngeal or nasotracheal intubation or Check/confirm capillary refill if no tracheostomy pulse b. Cervical spine immobilization should be maintained D - Disability Check for the following: C collar use is not recommended anymore (DCAP-BTLS) Manual stabilization is preferred compared - Deformities to C collar use - Contusions c. Advanced airways - OPA (oropharyngeal - Abrasions airway) and NPA (nasopharyngeal airway) - Puncture wounds Breathing - Burn a. Provide adequate ventilation, employing - Tenderness resuscitation measures when necessary - Laceration b. Application of oxygen via mask or bag-valve - Swelling mask device c. Assisting in chest tube insertion or No blood no DOTS endotracheal intubation DOTS - Deformities, Open d. Covering of open chest wound with wounds, Tenderness, Swelling occlusive dressing. - Gloves are white or blue Circulation for EMS; so that you can a. CPR check for blood after b. Evaluate and restore cardiac output by: palpation i. Controlling hemorrhage ii. Preventing and treating shock E - Exposure What happened before the iii. Maintaining and restoring effective or event injury? circulation It determines the presence of life c. Control hemorrhage and blood/fluid loss by: threatening conditions while simultaneously applying direct pressure (external bleeding), intervening WEST VISAYAS STATE UNIVERSITY NCM 222A 5 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) insertion of IVF, fluid volume replacement REACTION LEVEL SCALE (RLS) with NSS, blood transfusion, etc. 1. Alert, Fully Conscious d. Use of tourniquet to control bleeding in 2. Drowsy Slightly confused amputees 3. Very drowsy, very confused, arousable to pain (only sternal rub can make them feel or Disability react) a. Deformity - Open wound Tenderness - 4. unconscious, localizes Swelling Dots/DCAP-BTLS 5. unconscious, withdraws, can feel if right or b. Determine neurologic disability by left but do not know the exact position completing a brief neurological assessment 6. unconscious, decorticate (towards the core) c. Determine baseline functioning, potential life 7. unconscious decerebrate (hands away from threatening complications body) d. Check LOC using GCS or RLS 8. no response PERTINENT HISTORICAL DATA: SAMPLE GLASGOW COMA SCALE - Signs and symptoms - Allergies - Medications - Past health history - Last meal taken - Events leading to injury or illness PQRST MNEMONIC - Provocation - Quality - Radiation - Severity - Time II. Secondary Survey F - Full set of vital signs, focused adjuncts, family presence G - give comfort measures BRIEF NEUROLOGICAL ASSESSMENT: AVPU H - history and head-to-toe assessment Alert - awake, alert and needs no stimulus I - inspect posterior surfaces to respond to the environment Verbal - requires verbal stimulus to elicit a Identify any other non-life threatening problems response - Both subjective information and objective Pain - requires a painful stimulus to evoke data are obtained response - Cervical immobilization is maintained at all Unresponsive - unresponsive to any times during secondary assessment. applies stimulus Neurologic Assessment CAUSES OF ALTERED CONSCIOUSNESS 1. Level of Consciousness (AEIOU-TIPPS) 2. Orientation to person, place, time, and Alcohol event Epilepsy/electrolyte imbalance Insulin WEST VISAYAS STATE UNIVERSITY NCM 222A 6 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) Opiates Uremia Triage is done by: Trauma Trained individuals Infection Paramedical personnel (medics, EMR’s, Poisoning EMT’s) Psychosis Medical personnel (doctors, nurses, medical Syncope technologists, institutional workers as long ORDER OF ASSESSMENT as they have training) Initial Triage: At the scene 1. AVPU Secondary Triage: During treatment 2. Primary survey 3. SAMPLE HOW TO BE AN EFFECTIVE TRIAGE NURSE 4. Secondary Survey 1. Be clinically experienced 🆒🤙 2. Good judgment and leadership skills 3. Calm and cool TRIAGE 4. Decisive Comes from French word “trier” (to sort or 5. Knowledgeable of available resources choose) 6. Anticipate casualties - A method of quickly identifying victims of a mass casualty incident (MCI) who may have immediately life threatening injuries and S.T.A.R.T. SYSTEM (Simple Triage and Rapid Treatment) those who have the best chance of surviving - A simple triage system that can be - Sort patients based on the (1) severity of performed by lightly trained lay and their injuries or (2) immediacy with which emergency personnel in emergencies. It is these problems must be treated not intended to supersede or instruct medical personnel or techniques. It has been (2003) taught to California emergency workers for use in earthquakes. - It was developed at Hoag Hospital in Newport Beach, California for use by emergency services. It has been field-proven in mass casualty (incidents such as train wrecks and bus accidents though it was developed for use by - Looks at medical needs and urgency of community emergency response teams each individual patient ADD - Sorting based on limited data acquisition All patients who can walk are categorized as - Also must consider resource availability delayed (green) and are asked to move away - classification of clients presenting to the ER from the incident area to a specific location. for the purpose of prioritizing treatment - The goal is to identify the sickest patients in The next group is assessed quickly by evaluating order to assess and provide treatment to RPM: respiration, perfusion, and mental status them first before providing treatment to and then tagged accordingly others who are less ill - Placing the right patient in the right place at R - > 30 BrPM the right time for the right reason P - Capillary Refill > 2 Seconds Always start with patient nearest you M - Does not obey commands WEST VISAYAS STATE UNIVERSITY NCM 222A 7 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) IF NOT BREATHING do not instantly tag as Urgent R - Patient Assessment parents -> Exposure History Work History Duty Environmental History Confidentiality, Resuscitation, Assisted Admision History Suicide Personal Protective Equipment Critical Stress Management Purpose: To shield health care workers from - It is important to brief the team before chemical, physical, biologic, and radiologic hazards deployment to the scene so they will know what to expect. Level A Highest Level of respiratory, skin, eye - An approach to preventing and treating the and mucous membrane protection emotional trauma that can affect emergency (self-contained breathing apparatus or responders as a consequence of their jobs SCBA, suit, gloves, boots) and that can also occur to anyone involved E.g. Hazmat suit, with oxygen inside in a disaster or MCI. Education before the incident Level B Highest level of respiratory protection Field support during the incident but less of skin and eye protection - Apply shifting (SCBA and suit) - While operations are ongoing find ways to boost their morale. You can provide snacks and drinks to your constituents. WEST VISAYAS STATE UNIVERSITY NCM 222A 17 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) 1. Geological Level C Air purifying respirator and chemical ○ Earthquakes, avalanches, volcanic resistant coverall with splash hood, eruptions gloves, and boots 2. Hydrological Level D common working uniform ○ Tsunamis, storm surge, flooding, limnic eruptions 3. Meteorological Decontamination ○ Tornadoes, cyclones, typhoons, Process of removing accumulated hurricanes, hailstorms, La niña, El contaminants, is critical to the health and niño, blizzards, heat waves, safety of health care providers by droughts preventing secondary contamination 4. Fire Two steps of decontamination: ○ Forest fires ○ Stripping and Rinsing i. Ground fire ○ Soap and Water Wash 5. Health ○ Epidemics, famines Once identified as contaminated, you will be 6. Space isolated. When you are being washed, a nurse will ○ Asteroid strike, probably UFO, be outside wearing Level A equipment. There will anything that may come out of space only be an armhole where they can insert their and the sky, solar flare arms and rinse you. After rinsing and washing, you will be patted dry and given an extra set of clothes. Natural Disasters can be categorized as: Before you totally leave the area, you will be Acute onset - avalanche, blizzard, swabbed. earthquake, fire, flood, heat wave, hurricane, typhoon, tsunami, volcanic NATURAL DISASTERS eruptions, wildfire Slow or Gradual Onset - deforestation, - Occur anytime and anywhere results to a desertification, drought, pest infestation mass casualty incident - Tornadoes, hurricanes, floods, avalanches, Heat Wave tidal waves, earthquakes and volcanic Heat stroke - body temperature reaches eruptions 40.4 degrees Celsius - Loss of communication, electricity and Rapid progression of lethargy, confusion potable water and unconsciousness - Electrocution is the major cause of injury Heat exhaustion - Food and water; shelter Heat syncope - PPEs Heat cramps Prevention: Cool environment, cool beverages, loose and light cotton clothing Cyclones, hurricanes and typhoons Cyclones are large scale storms with low pressure in the center; over tropical or subtropical waters Hurricanes - storms formed in the Atlantic ocean Types of Natural Disasters WEST VISAYAS STATE UNIVERSITY NCM 222A 18 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) Typhoons - storms formed in the Pacific Morbidity is caused by crowded living conditions, ocean and the West Philippine Sea low personal hygiene, contamination of water Normal wind speeds reach up to 74 mph or sources more Waterborne diseases, vector borne diseases, food Storm surge - a distinctive characteristic of shortages hurricanes Tornado Risk of Morbidity and Mortality: Wind velocity of 200 mph and travels as far Failure to evacuate as 20 kms Food and water safety Severity of damage is measure by a Fujita Shelter scale F0 (no damage) - F5 (total Drowning, electrocution, lacerations destruction) Morbidity: STI ( Soft Tissue Injuries), head Risk reduction: early detection injuries - Advanced warning systems are needed Prevention: early warning and protective shelters Drought Result of too little rain, desertification, deforestation and unskilled irrigation Causes disease because of stress, crowding and unsanitary conditions Drought - Due to reckless slash and burn practice (kaingin) Earthquake Measured using a Richter scale Injury and death occurs from being trapped in the rubble Injuries include cuts, broken bones, crush injuries, Thunderstorms dehydration Lightning strikes are the major cause of Prevention: seismic safety into construction of deaths structures A bolt of lightning could reach 50,000 Richter scale - magnitude size degrees Fahrenheit (27 760 Celsius) PEIS (PHIVOLCS Earthquake Intensity Scale) - Prevention: avoid open spaces and high spots; Intensity natural lightning rods Risk reduction: counterweights like pendulums, Tsunami rollers under buildings, deep foundations Signs of an approaching tsunami: 1. Recent submarine earthquake Flood 2. Sea appears to be boiling Rain of one inch per hour 3. Water is hot, smells of rotten egg or stings Causes 30% of the world's disasters per year the skin Caused by deforestation, urbanization and El Niño 4. Audible thunder or booming sound followed Deaths are commonly caused by flash floods by a roaring or whistling sound 5. Water recede a great distance from the coast 6. Red light might be visible near the horizon WEST VISAYAS STATE UNIVERSITY NCM 222A 19 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) Risk reduction: Biologic Agents Early warning devices and animals moving ANTHRAX to higher grounds Flood gates and barriers Anthrax- Bacillus Anthracis; replicates if Morbidity and mortality: same as flooding exposed to air and infective in their spore state only Winter/Ice storm Incubation: 60 days Wind chill is a combination of extremely low Infects through direct contact or temperature and wind speed inhalation Winter storm watch Odorless and invincible; can travel Winter storm warning great distances before disseminating Blizzard warning - wind speeds of 35mph 8000 to 50,000 spores must be inhaled Risk for injuries: winter driving, frostbite, to be infected hypothermia, carbon monoxide poisoning, 1500 BC (Egypt); 1979 (Russia) 1995 STI (Soft-Tissue Injuries) (Japan); 2001 (US) Wildfires S/SX Causes hemorrhage, edema and necrosis Types: Incubation time: 1-6 days 1. Surface fire - forest floor Skin, inhalation and gastrointestinal 2. Ground fire - caused by lightning; forest Skin lesions are the primary infection; floor to the mineral soil develops to an ulcer with 1-3 mm vesicles - Create ditch to prevent spread and lastly a painless eschar falls off after - A gap between a set of trees or 1-2 weeks grass GI: fever, nausea, vomiting, abdominal 3. Crown fire - tree tops; affected by the wind pain, bloody diarrhea and ascites; attacks speed the terminal ileum and cecum URT: flulike symptoms and not treated by antibiotics Cause of injuries: Cough, headache, fever, vomiting, chills, Burn weakness, mild chest discomfort, dyspnea, inhalation injuries syncope respiratory complications Brief recovery followed by a second stage MI within 1-3 days Fever, severe respiratory distress, stridor, Prevention: hypoxia, cyanosis, diaphoresis, Build fires away from trees and bushes hypotension, shock Be prepared to extinguish fire quickly and Mediastinitis on CXR (Hallmark SIgn) Mortality rate is 100% 24 to 36 hours after completely onset of the second stage r Never leave a fire unattended ​ Develop a wildfire evacuation plan Fire stick TREATMENT BIOLOGIC WEAPONS Biologic weapons- weapons used to spread - Penicillin sensitive - Penicillin, if allergic to penicillin: disease Erythromycin Gentamicin Doxycycline Biological warfare WEST VISAYAS STATE UNIVERSITY NCM 222A 20 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) - In MCI: Doxycycline; Ciorofloxacin for 60 - Predecessor of COVID-19 and days MERS-CoV - Death: cremation is recommended - No vaccine available to the public except S/SX the military * It is controlled to avoid resistance in masse - SOB, dry cough, pneumonia or ARDS because another strand may develop which will be in CXR; evident of 7-10 days resistant to penicillin TREATMENT SMALLPOX (Variola) - Droplet precaution - Support - A DNA virus - Antiviral drugs - Approximately 12 days incubation period Chemical Weapons - Extremely contagious, spread by direct - Used in chemical warfare; overt agents contact, contact with vectors or by - Results in major mortality or morbidity, droplets panic, social disturbance - Rashes will appear after the fever state; 30% case fatality rate These chemicals are: - Smallpox survives in a cool and low Nerve agents humidity environment up to 24H Blood agents S/SX Vesicants Heavy metals - initial : High fever, malaise, headache, Volatile toxins backache Pulmonary agents - After 1-2 days: appearance of Corrosive acids (the most accessible) maculopapular rash appears from the face to the trunk Characteristics of Chemicals: - Contagious after the appearance of the Volatility rash - Tendency of a chemical to be a vapor, most chemicals are heavier than air, most volatile are phosgene TREATMENT and cyanide - Isolation antibiotics, decontamination Persistence - Cremation; virus survives in scabs for - Less likely to vaporize and disperse; 13 years most industrial chemicals are not persistent Toxicity - Potential of a chemical to cause Severe Acute Respiratory Syndrome injury to the body (SARS) Latency - Time from absorption to the - SARS-CoV appearance of s/sx; sulfur mustards - Incubation period: 2-10 days and pulmonary agents - Started in China as an atypical pneumonia (Feb. 2003) Lethal dose: (LD50) WEST VISAYAS STATE UNIVERSITY NCM 222A 21 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) Effective Dose: (ED50) how much do you need ot intubation and bronchoscopy, take to feel its “positive” effects in your body Concentration time (CT) Dimercaprol IV for Lewisite exposure Concentration Time: Concentration x time of exposure: = mg/min NERVE AGENTS Material Data Safety Sheet: COMPONENTS OF CHEMICALS Most toxic agents First aid measures in case of ingestion, Sarin, Soman, Tabun, VX, and direct skin contact, and inhalation Organophosphates (pesticides) Hence, farmers are prone to paralysis inexpensive , effective in small VESICANTS quantities and easily dispersed Cause blisters and results in burning, Usually evaporates to a colorless and conjunctivitis bronchitis, pneumonia, odorless vapor hematopoietic suppression and death Effects begin at 30 minute to 18 hours Lewisite, phosgene, nitrogen mustard after exposure and sulfur mustard Liquid sulfur is the most commonly S/SX used vesicant Highly incapacitating Cholinergic crisis (hypersalivation, increased secretions in orifices) S/SX Visual disturbances superficial to partial thickness burns in Increased GI motility warm and moist areas, Nausea and vomiting stinging and erythema, Diarrhea pruritus Substernal spasm vesicle formation at 2-18 hours Indigestion EYE Bradycardia photophobia Insomnia lacrimation Forgetfulness decreased vision Impaired judgment Respiratory Depression airway obstruction LOC GI Seizures nausea Copious secretions vomiting Flaccid muscles upper GI bleeding apnea Tx Tx decontamination with soap and water Decontamination or saline solution for 8-20 min, avoid scrubbing blotted dry (do not rub to avoid eye irrigation absorption in the skin), WEST VISAYAS STATE UNIVERSITY NCM 222A 22 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) maintain airway patency, NUCLEAR RADIATION EXPOSURE suctioning, Atropine 2-4mg IV; Radiologic weapon or dirty bomb Pralidoxine IV and Diazepam Weapon grade plutonium or uranium Nuclear fuel or medical nuclear supplies BLOOD AGENTS TYPES OF RADIATION Hydrogen cyanide, cyanogen chloride Alpha particles - cannot penetrate the skin, Directly affects cellular metabolism ingestion, inhalation, and injection, local which results to asphyxiation damage Also emitted during house fires during Beta particles - moderately penetrate the combustion of plastic, rugs, furniture, skin skin damage and other construction materials Gamma radiation - short wavelength Ingested, inhaled or absorbed electromagnetic energy; penetrating X RAY S/sx Measurement: Rad - 0.01 joule of energy/kg of tissue, basic unit of respiratory muscle failure measurement respiratory arrest Em (roentgen equivalent man) cardiac arrest -reflects the type of radiation and the potential of flushing damage ; normal exposure per year is at 360 mrem tachypnea (1 rem = 1000 mrem) bradycardia half-life - amount of time for a radioactive stupor and coma product to lose half of is radioactivity Detected by: a Geiger counter or Geiger-Mueller survey master PULMONARY AGENTS Exposure: Chlorine, phosgene Causes: pulmonary edema, SOB External irradiation - physical exposure Mask is used for protection Contamination - exposure to gasses, liquids, solids Incorporation- uptake of cells tissues, and organs Tx Decontamination ad menstruation of amyl nitrate - Must done outside the ER to prevent sodium nitrate secondary contamination sodium thiosulfate Survival Intubation - Probable - no s/sx Hydroxocobalamin Vit b12A, binds with - Possible - nausea and vomiting for 1-2 days cyanide to form cyanocobalamin - Improbable - rad at 800, shock WEST VISAYAS STATE UNIVERSITY NCM 222A 23 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) Chairperson: Secretary of the Department of National Defense (DND) RELATED LAWS AND POLICIES Vice Chairperson for Disaster Preparedness: Secretary of the Department of the Interior and R.A. 10121 (Philippine Disaster Risk and Local Government (DILG) Management Act of 2010) Vice Chairperson for Disaster Response: Secretary of the Department of Social Welfare TITLE: Philippine Disaster Risk Reduction and and Development (DSWD) as Vice Chairperson Management Act of 2010 for Disaster Response Vice Chairperson for Disaster Prevention and PREAMBLE Mitigation: An act strengthening the Philippine Disaster Secretary of the Department of Science and Risk Reduction and Management System, Technology (DOST) providing for the National Disaster Risk Reduction Vice Chairperson for Disaster Rehabilitation and and Management framework and institutionalizing Recovery: the National Risk Reduction and Management Director-General of the National Economic and Plan, appropriating funds therefore and for other Development Authority (NEDA) purposes. 2. Creation of Local DRRM Councils (LDRRMCs) -The law mandates the establishment of Local PROVISIONS Disaster Risk Reduction and Management Councils 1. Establishment of the National Disaster Risk (LDRRMCs) at the regional, provincial, city, Reduction and Management Council (NDRRMC) municipal, and barangay levels. - The law replaces the National Disaster -These councils are tasked with coordinating, Coordinating Council (NDCC) with the NDRRMC, integrating, supervising, and monitoring DRR which serves as the central authority for disaster programs at their respective levels, ensuring that management in the Philippines. disaster management efforts are decentralized and -The NDRRMC is responsible for ensuring the responsive to local needs. protection and welfare of the people during disasters 3. Allocation of the Local Disaster Risk Reduction and Management Fund (LDRRMF) -RA 10121 requires that no less than 5% of the estimated revenue from regular sources of local government units (LGUs) be allocated to the LDRRMF. -This fund is intended for disaster risk reduction and preparedness activities, and any unspent funds can be carried over to the next year. 4. Thematic Areas of DRRM - The law identifies four thematic areas that form the basis of the DRRM framework: “Disaster Prevention and Mitigation” Strategies to avoid or minimize the adverse impacts of hazards. WEST VISAYAS STATE UNIVERSITY NCM 222A 24 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) “Disaster Preparedness” Ensuring that -The law mandates the inclusion of disaster risk individuals, communities, and institutions are ready reduction and management in the formal education to respond effectively to disaster risks. system. “Disaster Response” Providing immediate -It also promotes the conduct of regular training and assistance and meeting the basic needs of those drills to prepare communities and institutions for affected by disasters. disaster response. “Disaster Rehabilitation and Recovery” Restoring and improving communities, livelihoods, 8. Early Warning Systems and services after a disaster. -RA 10121 requires the establishment of community-based and nationally coordinated early warning systems. -These systems are designed to ensure timely and effective warnings for impending hazards, allowing communities to take appropriate action to mitigate the impact. 9. Roles and Responsibilities of Government Agencies -The law clearly defines the roles and responsibilities of various government agencies in disaster risk reduction and management. -It assigns specific tasks to agencies such as the Department of National Defense (DND), the Department of Social Welfare and Development (DSWD), the Department of Health (DOH), and the Department of Education (DepEd), among others. 10. Monitoring and Evaluation 5. Integration of DRR into Development Plans -RA 10121 establishes mechanisms for the - RA 10121 mandates the integration of DRR into continuous monitoring and evaluation of DRRM local and national development plans and policies. programs and activities. -This ensures that disaster risk reduction is -This includes regular assessment of DRRM plans, considered in the planning and implementation of the performance of DRR councils, and the development projects, thereby reducing effectiveness of disaster management efforts. vulnerability and enhancing resilience. 11. Accountability and Transparency 6. Community-Based Disaster Risk Reduction -The law holds government officials and entities and Management accountable for the implementation of DRRM -The law emphasizes the importance of community policies. involvement in disaster risk reduction. -It requires transparency in the use of funds and -It encourages the participation of local resources allocated for disaster management, with communities in planning, decision-making, and mechanisms in place for auditing and public implementing DRR activities, recognizing that local reporting. knowledge and participation are crucial for effective disaster management. 12. International Cooperation 7. Education and Training WEST VISAYAS STATE UNIVERSITY NCM 222A 25 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) - RA 10121 recognizes the importance of presence in public life, expressing the international cooperation in disaster risk reduction interests and values of their members or and management. others, and are based on ethical, cultural, -The law provides for the acceptance of scientific, religious or philanthropic international humanitarian assistance and considerations. CSOs include encourages collaboration with international nongovernment organizations (NGOs), organizations and foreign governments in disaster professional associations, foundations, response and recovery efforts. independent research institutes, community-based organizations (CBOs), 13. Public Awareness and Advocacy faith-based organizations, people’s -The law mandates the government to promote organizations, social movements, and labor public awareness on disaster risks and the unions. importance of DRR. Climate Change- a change in climate that -It encourages information campaigns and can’ be identified by changes in the mean advocacy efforts to educate the public on disaster and/or variability of its properties and that preparedness and risk reduction. persists for an extended period typically decades or longer, whether due to natural 14. Risk Financing variability or as a result of human activity. -The law supports the development of risk financing Community-Based Disaster Risk mechanisms, such as insurance and contingency Reduction and Management (CBDRRM)- funds, to help manage the financial impacts of a process of disaster risk reduction and disasters. management in which at risk communities -It promotes the use of financial instruments to are actively engaged in the identification, enhance the country’s capacity to respond to and analysis, treatment, monitoring and recover from disasters. evaluation of disaster risks in order to reduce their vulnerabilities and enhance DEFINITIONS their capacities, and where the people are at the heart of decision-making and Adaptation - the adjustment in natural or implementation of disaster risk reduction human systems in response to actual or and management activities. expected climatic stimuli or their effects, Complex Emergency- a form of which moderates harm or exploits beneficial human-induced emergency in which the opportunities. cause of the emergency as well as the Capacity- a combination of all strengths assistance to the afflicted IS complicated by and resources available within a community, intense level of political considerations. society or organization that can reduce the Contingency Planning- a management level of risk, or effects of a disaster. May process that analyzes specific potential include infrastructure and physical means, events or emerging situations that might institutions, societal coping abilities, as well threaten society or the environment and as human knowledge, skills and collective establishes arrangements in advance to attributes such as social relationships, enable timely, effective and appropriate leadership and management. Capacity may responses to such events and situations. also be described as capability. Disaster- a serious disruption of the Civil Society Organizations (CSOs)- functioning of a community or a society non-state actors whose aims are neither to involving widespread human, material, generate profits nor to seek governing economic or environmental losses and power. CSOs unite people to advance impacts, which exceeds the ability of the shared goals and interests. They have a WEST VISAYAS STATE UNIVERSITY NCM 222A 26 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) affected community or society to cope using Disaster Response- the provision of its own resources. Disasters are often emergency services and public assistance described as a result of the combination of: during or immediately after a disaster in the exposure to a hazard; the conditions of order to save lives, reduce health impacts, vulnerability that are present; and ensure public safety and meet the basic insufficient capacity or measures to reduce subsistence needs of the people affected. or cope with the potential negative Disaster response is predominantly focused consequences, Disaster impacts may on immediate and short-term needs and is include loss of life, injury, disease and other sometimes called “disaster relief”. negative effects on human, physical, mental Disaster Risk- the potential disaster losses and social well-being, together with damage in lives, health status, livelihood, assets and to property, destruction of assets, loss of services, which could occur to a particular services, Social and economic disruption community or a Society over some specified and environmental degradation. future time period. Disaster Mitigation- the lessening or Disaster Risk Reduction- the concept and limitation of the adverse impacts of hazards practice of reducing disaster risks through and related disasters. Mitigation measures systematic efforts to analyze and manage encompass engineering techniques and the causal factors of disasters, including hazard-resistant construction as well as through reduced exposures to hazards, improved environmental policies and public lessened vulnerability of people and awareness. property, wise management of land and the Disaster Preparedness- the knowledge environment, and improved preparedness and capacities developed by governments, for adverse events. professional response and recovery Disaster Risk Reduction and organizations, communities and individuals Management- the systematic process of to effectively anticipate, respond to, and using administrative directives, recover from, the Impacts of likely, imminent organizations, and operational skills and or current hazard events or conditions. capacities to implement strategies, policies Preparedness action is carried out within and improved coping capacities in order to the context of disaster risk reduction and lessen the adverse impacts of hazards and management and aims to build the the possibility of disaster. Prospective capacities needed to efficiently manage all disaster risk reduction and management types of emergencies and achieve orderly refers to risk reduction and management transitions from response to sustained activities that address and seek to avoid the recovery. development of new or increased disaster Disaster Prevention- the outright risks, especially if risk reduction policies are avoidance of adverse impacts of hazards not put in place. and related disasters. It expresses the Disaster Risk Reduction and concept and intention to completely avoid Management Information System- a potential adverse impacts through action specialized database which contains, taken in advance such as construction of among others, information on disasters and dams or embankments that eliminate flood their human material, economic and risks, land-use regulations that do not environmental impact, risk assessment and permit any settlement in high-risk zones, mapping and vulnerable groups. and seismic engineering designs that Early Warning System- the set of ensure the survival and function of a critical capacities needed to generate and building in any likely earthquake. disseminate timely and meaningful warning WEST VISAYAS STATE UNIVERSITY NCM 222A 27 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) information to enable individuals, formulation and promulgation of plans that communities and organizations threatened describe the permitted or acceptable uses. by a hazard to prepare and to act Mitigation- structural and non-structural appropriately and in sufficient time to reduce measures undertaken to limit the adverse the possibility of harm or loss. A impact of natural hazards, environmental people-centered early warning system degradation, and technological hazards and necessarily comprises four (4) key to ensure the ability of at-risk communities elements: knowledge of the risks; to address vulnerabilities aimed at monitoring, analysis and forecasting of the minimizing the impact of disasters. hazards; communication or dissemination of National Disaster Risk Reduction and alerts and warnings; and local capabilities to Management Framework (NDRRMF)- respond to the warnings received. The provides for comprehensive, multi-sectoral, expression “end-to-end warning system” is inter-agency and community-based also used to emphasize that warning approach to disaster risk reduction and systems need to span all steps from hazard management. detection to community response. National Disaster Risk Reduction and Emergency- unforeseen or sudden Management Plan (NDRRMP)- the occurrence, especially danger, demanding document to be formulated and immediate action. implemented by the Office of Civil Defense Emergency Management- the organization (OCD) that sets out goals and specific and management of resources and objectives for reducing disaster risks responsibilities for addressing all aspects of together with related actions to accomplish emergencies, in particular preparedness, these objectives. response and initial recovery steps. Post-Disaster Recovery- the restoration Exposure- the degree to which the and improvement where appropriate, of elements at risk are likely to experience facilities, livelihood and living conditions. of hazard events of different magnitudes. disaster-affected communities, including Geographic Information System- a efforts to reduce disaster risk factors, in database which contains, among others, accordance with the principles of “build back geo-hazard assessments, information on better”. climate change, and climate risk reduction Preparedness- pre-disaster actions and and management. measures being undertaken within the Hazard- a dangerous phenomenon, context of disaster risk reduction and substance, human activity or condition that management and are based on sound risk may cause loss of life, injury or other health analysis as well as pre-disaster activities to impacts, property damage, loss of livelihood avert or minimize loss of life and property and services, social and economic such as, but not limited to, community disruption, or environmental damage. organizing, training, planning, equipping, Land-Use Planning- the process stockpiling, hazard mapping, insuring of undertaken by public authorities to identify, assets, and public information and evaluate and decide on different options for education initiatives. the use of land, including consideration of Private Sector- the key actor in the realm long-term economic, social and of the economy where the central social environmental objectives and the concern and process are the mutually implications for different communities and beneficial production and distribution of interest groups, and the subsequent goods and services to meet the physical needs of human beings. The private sector WEST VISAYAS STATE UNIVERSITY NCM 222A 28 ‘ NCM 222A: Disaster Preparedness and Risk Management Nursing A.Y. 2024 - 2025 UNIT 1 Level 4- Class 2025 (Batch Avani) comprises private corporations, households obtain resources from the other party after a and nonprofit insncs serving households.all disaster occurs, in exchange for ongoing or persons in the civil service. compensatory social or financial benefits Public Sector Employees- all persons in provided to that other party. the civil service. State of Calamity- a condition involving Rehabilitation- measures that ensure the mass casualty and/or major damages to ability of affected communities/areas to property, disruption of means of livelihoods, restore their normal level of functioning by roads and normal way of life of people in the rebuilding livelihood and damaged affected areas as a result of the occurrence infrastructures and increasing the of natural or human-induced hazard. communities’ organizational capacity. Sustainable Development- development Resilience- the ability of a system, that meets the needs of the present without community or society exposed to hazards to compromising the ability of future resist, absorb, accommodate and recover generations to meet their own needs. It from the effects of a hazard in a timely and contains within it two (2) key concepts: (1) efficient manner, including through the the concept of “needs”, in particular, the preservation and restoration of its essential essential needs of the world’s poor, to which basic structures and functions. overriding priority should be given; and (2) Response- any concerted effort by two (2) the idea of limitations imposed by the state or more agencies, public or private, to of technology and social organizations on provide assistance or intervention during or the environment’s ability to meet present immediately after a disaster to meet the life and future needs. preservation and basic subsistence needs Vulnerability- the characteristics and of those people affected and in the circumstances of a community, system or restoration of essential public activities and asset that make it susceptible to the facilities. damaging effects of a hazard. Risk- the combination of the probability of Vulnerable and Marginalized Groups- an event and its negative consequences. those that face higher exposure to disaster Risk Assessment- a methodology to risk and poverty including, but not limited to, determine the nature and extent of risk by women, children, elderly, differently-abled analyzing potential hazards and evaluating people, and ethnic minorities. existing conditions of vulnerability that together could potentially harm exposed