General Preparedness

1. Fire
Key elements for fire preparedness are:
-regular assessments & records
-early warning, i.e. fire warning or voice communication systems such as megaphones
-adequate means of escape, i.e. minimum 2 clearly signposted safe escape routes, evacuation kits familiarity
with the emergency plan through knowledge and practice

• PREPARE for a Fire Incident

• ASSESS - know and recognize the hazards
• STAY SAFE during a Fire Incident
• RECOVER after a Fire Incident

2.Earthquake
Step 1:
Secure your space by identifying hazards and securing moveable items.
Step 2:
Plan to be safe by creating a disaster plan and deciding how you will communicate in an emergency.
Step 3:
Organize disaster supplies in convenient locations.
Step 4:
Minimize financial hardship by organizing important documents, strengthening your property, and
considering insurance.

3. Volcanic Eruptions
• Photo of emergency supplies.
• Flashlight and extra batteries
• First aid kit and manual
• Emergency food and water
• Manual (nonelectric) can opener
• Essential medicines
• Sturdy shoes
• Respiratory (breathing) protection
• Eye protection (goggles)
• Battery-powered radio

4. Floods, Tornadoes, Typhoons, Cyclones, and Tsunami

Floods are among the earth’s most common and dangerous natural hazards, formed due to a
flow of water on areas of land that are usually dry. Excessive rain, damage to nearby dams, and
tsunamis are some of its causes. When faced with flooding, these tips are to be followed:
• Do not attempt to walk, swim, or drive through the floods. Floodwater contains
debris and contamination and can also be deadly due to fallen electrical lines in
the water.
• Stay clear of bridges over fast-moving water.
• Keep an eye out for evacuation alerts.
• Move to higher ground.
• If your vehicle is trapped in flood and water starts filling inside the car, seek
refuge on the roof.
Tornadoes continue to impact locations across the country every year, bringing massive winds
and destruction in their paths.
To stay safe during a tornado, prepare a plan and an emergency kit, stay aware of weather
conditions during thunderstorms, know the best places to shelter both indoors and outdoors,
and always protect your head.

To prepare for a Typhoon, you should take the following measures:

• To begin preparing, you should build an emergency kit and make a family
communications plan.
• Know your surroundings.
• Learn the elevation level of your property and whether the land is flood-prone.
This will help you know how your property will be affected when storm surge or
tidal flooding are forecast.
• Identify levees and dams in your area and determine whether they pose a
hazard to you.
• Learn community Typhoon evacuation routes and how to find higher ground.
Determine where you would go and how you would get there if you needed to
evacuate.
• Make plans to secure your property

Cyclones are tropical storms, caused by atmospheric disturbances around a low-pressure area.
Cyclones are accompanied by strong winds, moving at a speed of sixty-two kmph or more. When
faced with a hurricane, keep these tips in mind:
• Be alert to changing weather conditions.
• Listen to radio/TV for the latest information.
• Look for approaching storms.
• Look for the following warning signs: – Dark, often greenish sky – Large
hailstones, a large, dark, low-lying cloud (particularly if rotating), roars, similar to
a freight train.
• If you see approaching storms or any of the danger signs, be prepared to take
shelter immediately.
• If you are under a tornado warning, seek shelter immediately. NOTE: In places
where you have designated cyclone shelters, take refuge there.

Tsunamis are a series of enormous ocean waves caused by earthquakes, underwater landslides,
or volcanic eruptions. Tsunami waves range from tens to hundreds of feet tall and can travel
twenty to thirty miles per hour. When faced with this phenomenon, these tips are to be
followed:
• Turn on your radio/TV to learn and follow the precautionary instructions during
a tsunami warning, primarily when you reside near a coastal area.
• Move inland to higher ground immediately and stay there.
• Check for a noticeable recession in water away from the shoreline as this is
nature’s tsunami warning and should be heeded. It would help if you moved
away immediately.
• Please stay away from flooded and damaged areas until officials say it is safe to
return.
• Please keep yourself away from debris in the water; it may pose a safety hazard
to boats and people.
EMERGENCY CODES ARE COLOR-CODED INDICATORS used in health care facilities to alert all
staff members of potential issues arising in a facility. These codes include unique prescribing
criteria for how staff members should respond to a particular situation, ranging from an active
shooter incident to cardiac arrest.

Preparing Family Communication Plan

Preparedness Planning
a. Assembling Emergency Kit
b. Learning Preparedness Skills
1) early warning,
2) disaster triage,
3) first aid,
4) search and rescue,
5) logistic and communication, and
6) team organizations.

Patterns of Survival (Staying Alive)

a.Finding Fast Solutions Naturally
b.Food and Water Procurement
c.Signals
d.Navigation
e.Special Needs

Health Needs arising at Natural Disasters

1. Immediately after the disaster, health needs emerge with medical needs.
2. Health needs are diverse
3. Health needs may persist for a mid to long period of time, depending on the prolonged
evacuation and the time required until the reconstruction of livelihood.

PACE Planning

-Primary: The main form of communication. For most business travelers, this in the form of
digital cellular communications. Depending on Wi-Fi is not advised.
-Alternate: If the primary fails, this is your secondary form of communication. Most common is
voice calls when the data network is down.
-Contingency: Tertiary method of communication. A satellite phone is a great example as it is
not reliant on any cellular network.
-Emergency: If all else fails, this is the worst-case option. It is usually ugly but will get a message
across. Examples go from sending shortcodes or texts from GPS tracking devices to using
landlines if available. High Frequency (HF) radios have also been used but extremely rarely.

b. Shelter in Place or Bugging Out

Bug In – Shelter-in-Place – Hunker Down – Stay Home
Bugging in is a term commonly used by preppers to refer to a time when you choose to face
impending dangers from your well-stocked, secured home. The benefits of facing danger from
your prepper home far outweigh the benefits of bugging out unless the situation demands it.
Bug Out – Evacuate – Escape – Vacate – Leave Home
Bug out is a military term that is commonly used by preppers to refer to a time when you may
need to leave your home quickly due to a dangerous situation.

B. Impact Response
1. Disaster Triage Categories
-Simple Triage and Rapid Treatment (START)
-Immediate/Emergent (Class I) Tagged as RED
-Delayed/Urgent (Class II) Tagged as YELLOW
-Minimal/Non-Urgent (Class III) Tagged as GREEN
-Expectant (Class IV) Tagged as BLACK
-JumpSTART (Children)

The START triage tool is a commonly used adult MCI primary triage tool developed by the
Newport Beach Fire and Marine Department and Hoag Hospital in California, first published in
1983 and revised in 1994

It was devised for use only for adults, with an arbitrary lower application limit of a patient
weight of 100 pounds.

The five basic parameters assessed with START are:

(a) the ability to walk,
(b) the presence or absence of spontaneous respirations,
(c) the respiratory rate,
(d) an assessment of perfusion, and
(e) the ability to obey commands. These parameters are often referred to as respirations,
perfusion, and mental status (RPM).

TAGGING OF PATIENT:

INTERVENTION: RED AREA

Ÿ Assist medical consultation: Stabilization of ABC
Ÿ Mental Care
Ÿ Support for families
Ÿ Sharing of information
Ÿ Consideration of safety
Ÿ Privacy protection
Ÿ Consideration to hygiene
Ÿ Securing of manpower
Ÿ Preparation for wide-area transportation
Ÿ Responses for crash syndrome

Triage Category : YELLOW

-Continue to perform re-triage till treatment starts
-Assumed patients: those with injuries such as spinal cord damage and fracture
Ÿ Stable respiration/circulation dynamics
Ÿ Clear consciousness
First-aid & Follow-up
Ÿ Physical assessment
- see, listen & touch
Ÿ Keeping of a peripheral intravenous access
Ÿ Arrest of bleeding/fixation (stabilization)
Ÿ Oxygen administration (priority to red area)
Ÿ Monitoring by ME device (minimum)
Triage Category : RED
-Places to be given the highest priority in all responses
-Prevent "preventable death" through appropriate initial response in order to improve the
quantity and quality of responses in the Red Zone.

Emergency medical care for traumatized patients

Ÿ Multiple trauma
Ÿ Head trauma
Ÿ Chest/abdominal trauma
Ÿ Pelvic fracture/Open fracture
Ÿ Crash syndrome
Ÿ Extensive burn

INTERVENTION: YELLOW AREA

Ÿ Increased number of patients: To secure the area and manpower
Ÿ Sharing of information
Ÿ Responses to the complaints by patients and their families
Ÿ Re-triage: To secure ABC and find crash and spinal cord damage
Ÿ Selection and distribution of equipment & material: Monitoring
Ÿ Consideration of privacy protection
Ÿ Management of infusion, confirmation of treatment
Ÿ Heating
Ÿ Giving of words; response to anxiety
Ÿ Securing of means of transport to the Red Area and of communication
Ÿ Division of the area into sub-areas

Triage Category : GREEN

-Therapy-waiting group
-Re-triage should not be missed
Ÿ Re-triage
Ÿ To perform medical examination, treatment and care after completing all and majority of
responses to the emergency treatment group
Ÿ Cases without indication for hospitalization
Ÿ Checking of the conditions of their house
Ÿ Taking to an evacuation shelter

Nursing intervention in Green Area

Ÿ To control a crowd of people. Posting of instructions on a whiteboard
Ÿ To develop a collaborative network with a local community
Ÿ Re-triage
Ÿ First-aid treatment
Ÿ To let patients go home if they can do
Ÿ Responses to complaints: Patients & their families
Ÿ Preparation and distribution of the area according to season and weather
Ÿ Selection of equipment & material
Ÿ To understand medical records and injured persons
Ÿ Guiding to and introduction of an evacuation shelter
Ÿ Lifestyle guidance at home, requiring medical examination if any change is felt or seen.

Triage Category : BLACK

-Response to patient's families by regarding the patients as "Treatment-waiting group" until
death is confirmed.
-Instruction on basic life support
Ÿ Risk intervention
Ÿ Preparation of the place for the patient families to stay at the patient's deathbed
Ÿ Death certification, examination and morgue procedures after the completion of all and
majority of responses to emergency treatment group
Nursing intervention in Black Area
Ÿ To secure a place in an invisible area, and cover the place with blanket and curtain.
Ÿ To respond and explain to the patient's families, followed by subsequent response and the
description of the conditions on a tag.
Ÿ To confirm and manage patient's identity and describe a clue on the tag.
Ÿ Management of belongings
Ÿ Management of the corpse (to prevent family to take it away)
Ÿ To share and manage patient's information (with headquarters)
Ÿ To divide those with vital sign from those without it into different areas
Ÿ To clean the patients as much as possible

JumpSTART
Pediatric MCI Triage Tool was the first objective tool developed specifically for the primary
triage of children in the multi-casualty/disaster setting.
JumpSTART was developed in 1995 and modified in 2001 by Dr. Lou Romig, a pediatric
emergency medicine physician with a background in both EMS and pediatric disaster
preparedness and response.
2. mass casualty incident (MCI)
is defined as “an event that overwhelms the local healthcare system, where the number of
casualties vastly exceeds the local resources and capabilities in a short period of time.”
Ÿ Patient Assessment and Identification
Ÿ Scene Size-up
Ÿ Obtaining Patient History
Ÿ Physical Examination
Ÿ Medical History
Ÿ Rapid Trauma Assessment
Ÿ On-going Assessment

3.Patient Handling / Rapid Extrication Technique

Ÿ Rescuer staging
Ÿ Body Substance Isolation (BSI) Universal Precaution including Personal Protective Equipment
(PPE)
Ÿ Safe patient Lifting and Moving
Ÿ Extrication
Ÿ Use of Kendric Extrication Device (KED)
Ÿ Dressing and Bandaging
Ÿ Stabilization
Ÿ Restraints

1. Critical incident Stress Debriefing

• Supportive
• Communication Skills
• Assisted Coping Techniques
• Common Emergency Stress Reactions
2. Psychological First Aid (PFA
• Role of Psychological First Aider in a Class
• Fear Management Strategies
3. Patient Handling / Rapid Extrication Technique
Ÿ Rescuer staging
Ÿ Body Substance Isolation (BSI) Universal Precaution including Personal Protective Equipment
(PPE)

C. Post-Impact Recovery, Reconstruction, Rehabilitation

1. Critical incident Stress Debriefing
• Supportive
• Communication Skills
• Assisted Coping Techniques
• Common Emergency Stress Reactions
2. Psychological First Aid (PFA)
• Role of Psychological First Aider in a Class
• Fear Management Strategies
3. Public Health Interventions

Disaster Mental Health and Psychological Support for Survivors

Goals of the Lecture:
• To understand the psychological distress of survivors in the wake of disasters
and major incidents.
• To understand the need for mental health support for disaster survivors.
• To learn the basic concept of Psychological First Aid.
• To understand disaster workers distress and how to cope it.
REACTIONS AFTER DISASTERS AND MAJOR INCIDENTS
traumatic Events
• Emotional shock entails different reactions and symptoms
• People read differently; some reactions are more prominent than others.
• Many reactions are expected ("Normal reaction to an abnormal situation").
• Recovery is expected overtime

NORMAL RESPONSE AFTER TRAUMA

• The intensity of response varies with the severity of trauma
• Re-experiencing symptoms (thoughts, dreams, images)
• Intense emotional reactions: fear, bewilderment, anger, helplessness and
despair
• Reminders and cues (smells, sounds, situations, etc.) from the experience might
cause anxiety.
• Increased vigilance and autonomic arousal
• Persistent memory often with vivid imagery
• Basic assumption of the world (safe) and the self (competent) may change
(cognitive aspects)
• General adjustment over weeks to months.

PSYCHOLOGICAL CARE FOLLOWING DISASTERS AND MAJOR INCIDENTS

• Promote a sense of safety, self, and community efficacy/empowerment,
connections, calm, and hope.
• Provide general support, access to social support, physical support, and
psychological support.
• Provide support to the family as well as individual.
• Provide practical help and pragmatic support in an empathic manner.
• Psychological reactions should be normalized.
• Provide written leaflets containing education about responses to traumatic
events, helpful coping, and where to seek help if necessary.
• Survivors should be neither encouraged nor discouraged from giving detailed
accounts.
Psychological Debriefing (PD)
• a single session intervention
• typically within 72 hrs post trauma
• delivered in a group or individual setting
• encourage a full narrative account of the trauma (facts, cognitions, feelings)
• Normalize emotional reactions
• Prepare for later emotional reactions

Psychological First Aid (PFA)

• is an evidence-informed modular approach to help children, adolescents, adults, and
families in the immediate aftermath of disaster and terrorism. Individuals affected by a
disaster or traumatic
• Designed to reduce the initial distress caused by traumatic events and to foster short-
and-long-term adaptive functioning and coping
• Does not assume that all survivors will develop severe mental health problems or long-
term difficulties in recovery.
• Disaster survivors will experience a broad range of early reactions
• Some reactions will cause enough distress to interfere with adaptive coping, and
recovery may be helped by support from compassionate and caring disaster responders.

The Eight PFA Core Actions include:

1. Contact and Engagement
2. Safety and Comfort
3. Stabilization (if needed)
4. Information 5. Practical Assistance
5. Gathering on Current Needs and Concerns:
6. Connection with Social Supports
7. Information on Coping
8. Linkage with Collaborative Services
Acute Grief Reactions
• Sadness
• Anger
• Guilt or Regret
• Disbelief
• Yearning, Wish for reunion

WORKING ON ACUTE GRIEF REACTIONS

• Treat acutely bereaved children and adults with dignity, respect, and
compassion.
• There is no single "correct" course of grieving.
• Grief reactions vary from person to person.
• Grief puts people at risk for abuse medications, increased smoking, and
consumption. of alcohol.
• Make survivors aware of these risks, the importance of self-care, and the
availability of professional help.
Guidelines in Disaster and Emergency Situations

Psychological Consequences of Disaster

• Extreme anxiety
• Mental paralysis
• Psychological recovery process

1. Heroic phase: Immediately after disasters

Disaster-affected people behave courageously without regard for their own safety, in
order to protect lives and properties of themselves, their families and neighbors.
2. Honeymoon phase: 1 week - 6 months
The affected people, who share the catastrophic experience and have survived the
disaster together are tied with a strong sense of unity. Encouraged by the support they
receive, they help each other and clean up rubbles and wreckage. The community of
affected area is filled with warm and hopeful atmosphere.
3. Disillusionment phase: 2 months - 1 to 2 years
The affected people reached the end of their patience, and their dissatisfaction with
delayed disaster relief and the government's misconduct grows. They tend to feel
unfocused anger and cause troubles such as fighting. Alcohol problems may occur. As
the affected people are busy struggling to reconstruct their own livelihood and to solve
personal problems, community bonding and mutual sympathy are lost.
4. Reconstruction phase: Several months
Usual life is returning to the affected area, where the affected people gain the courage
to recobstruct their livelihood. The people gradually recover self-confidence by
participating in the reconstruction efforts of their community. However, those who are
behind the reconstruction or have lost their spiritual support, continue to suffer
stressful life.

RECOVERY AS A COMMUNITY
• Not only the people affected by the disaster but also the whole community are
damaged and paralyzed by the shock of the disaster. (Usual life is lost in the community
where the familiar scenery is destroyed and the industry is damaged. And the
community is divided geographically by the disrupted transportation system.)

• Consequently, people and the community have to recover jointly from the damage of
disasters.

• The disaster assistance system should focus not only on "assisting the affected people"
but also on helping the community and the residents regain the power to rise by
themselves.

THE PRACTICE OF DISASTER NURSING

Goals
• To understand how the patients in tbe acute stage should be treated at the hospitals in
the disaster area
• To understand the nursing activities of Disaster Medical Assistance Team (DMAT) in
Japan
• To understand what should be prepared during non-disaster times

Preconditions of Disaster Nursing

• Best possible care for the greatest number of people
• Limited nursing resources
- The number of nurses
- Knowledge, technique and skills of nurses
- Limited medical resources and equipment
• Limited length of time
 - Nursing care to the greatest number of people
- Urgent medical relief activities in a limited period of time

Roles of Disaster Nursing

1. To assist life-saving and quicker cure from diseases of disaster victims who suffer from
various health problems such as trauma and exacerbated chronic diseases under the
abnormal conditions at disaster.
2. To improve disaster-caused problems in the living environment (meal, toilet facilities,
sleeping, privacy, protection, etc.) and help victims maintain good health coniditions.
3. To support the restoration from disaster to enable the victims to return to a normal life
4. To support people and communities to improve prepared for disaster during non-
disaster time.

1. To understand how to treat victims in the acute stage at the hospitals in the disaster area.
Risk management system
Group management
Nursing intervention in individual areas