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1. ICN CORE COMPETENCIES
IN DISASTER NURSING
Level of Nurses in Disaster Nursing
GENERAL PROFESSIONAL NURSE
Level I: any nurse who has
 completed a program of basic,
generalized nursing education; and
 Authorized to practice by the regulatory
agency of his/her country.
Examples of Level I include staff nurses in
hospitals, clinics, public health centers; all
nurse educators.
ADVANCED OR SPECIALIZED NURSE
Level II: any nurse who has achieved the Level
I competencies and is or aspires to be a
designated disaster responder within an
institution, organization or system.
Examples of Level II include supervising or
head nurses; nurses designated for leadership
within an organization’s emergency plan;
nurses representing the profession on an
institution or agency emergency planning
committee, preparedness/response nurse
educators.
Level III: Any nurse who has achieved Level I
and II competencies and is prepared to respond
to a wide range of disasters and emergencies
and to serve on a deployable team.
Examples:
 Frequent responders to either national
or
international disasters,
 military nurses,
 Nurses conducting comprehensive
disaster nursing research.
CORE COMPETENCIES IN DISASTER
NURSING
Domain 1: Preparation and Planning
GENERAL PROFESSIONAL NURSE:
 General preparedness
 Drill participation
 Updated knowledge on emergency
resources, plans, policies and procedure
 Knowledge on approaches to protect the
vulnerable
Discussion:
Competency
 Needed for us to serve as a defining
capability that distinguishes a particular
practice to other.
 A way of regulation
Discussion:
Level 1 Nurses: General Practitioners
 Who have finished the general nursing
education
 Allowed to practice nursing profession by
the regulatory agency
Discussion:
Level II Nurses: Disaster Nurse Responder
 Has all the necessary qualifications of the
Level 1 Nurse
 Aspires to be a designated Disaster Nurse
Responder
Discussion:
Level III Nurses: Disaster Nurse Educator/
Disaster Nursing Researcher
 Has all the necessary qualifications of the
Level 1 and Level II Nurse
 Deployable as a team whenever a disaster
may strike anytime
 Responds to a large or wide range of
disaster (national/international disasters)
 Travels a lot for humanitarian reasons (e.g.
military nurses)
Military Nurses:
 Have all the logistics
 Very mobile because of their assets
 They are in actual service of the country

2. Thus, refers to the nurses basic functional
knowledge and skills in area of:
 Preparation
 Drill execution
 Policies and procedure, and resources
 Care of the vulnerable/patients during
emergency or disaster response.
ADVANCED OR SPECIALIZED NURSE
 All the knowledge General Professional
Nurse
 Disciplines in planning emergency
drills/exercises at the institution or
community level
 Plans nursing improvement actions based
on evaluation
 Communicates roles and responsibilities
of nurses to others
 Actions relevant to needs of vulnerable
populations in emergency plans
Thus, carry the responsibility on planning to
improve disaster or emergency response.
Preparation and Planning, Execution, And
Post-Execution Of A Disaster Drill Or
Exercise
Domain 1: Preparation and Planning
Important aspect of Domain 1 is the preparation
and planning of disaster drill.
 General Professional Nurse is in the
ground executing and observing the
disaster drill. The Advance or specialized
nurse formulates the disaster
drill/exercise plan.
How Are Emergency Exercises are Plan and
Done?
Divided into 4 Phases:
a. pre-planning phase
b. Planning Phase
c. Exercising Phase; and
d. Post-exercise Phase
Discussion:
Core Competencies for General Nurses:
 General and basic knowledge of disaster
preparedness
 Drill participation
 Updated knowledge on emergency
resources, plans, policies and procedure
 Knowledge on approaches to protect
the vulnerable clients
Discussion:
Core Competencies for Advanced or Specialized
Nurses:
 All the knowledge General Professional
Nurse
 Planning
a) For emergency drills
b) Improvement and evaluation of
emergency drills
c) Announced/Unannounced in
anticipation of actual disaster
 Communication
a) Coordination of nurses to other
allied health team members and
external agencies/organizations.
 Makes a specialized action plan for the
most vulnerable population/clients
 Formulates the plan on how to execute
the drill

3. A. Pre-Planning Goals
1. Review the emergency response plan;
2. Conduct needs assessment
3. Assess capability
4. Define scope of and select the type of the
drill
5. Gain support from management and staff
6. Coordinate with external emergencies
B. Planning Goals
1. Determine expected action
2. List major detailed events
3. Write narrative
4. Determine exercise objectives
5. Establish exercise planning team and
subordinate units
6. Write messages
7. Develop the master scenario event list
8. Finalize exercise enhancement
9. Develop evaluation format
C. Exercising Goals
1. Preparation
2. Conduction
3. Recovery
D. Post-Exercise Goals
1. Conduct post-exercise meeting
2. Write the after-action report
3. Conduct follow-up activities
PHASE I: PRE-PLANNING
 STEP 1: Review The Emergency
Response Plan
a) Review what you have
 STEP 2: Conduct Needs Assessment
a) Determine what needs to be
done
 STEP 3: Assess Capability To
Conduct An Exercise
a) Consider what can be done
Discussion:
While reviewing the plan, you have to answer the
following questions:
a) What hazards/emergency are
addressed by the plan?
b) What emergency responses are listed in
the plan?
c) What resources or materials are used?
d) Which staff members are involved in the
plan?
e) What training is necessary for them to
carry it out?
f) What is necessary to apply the plan to
reality?
Discussion:
Conduct Needs Assessment
 Appraisal of the Hospital Actual Current
State Hospital Emergency Preparedness
 Evaluation of the Hospital’s Current
State Emergency Preparedness
 Helps determine if:
a) exercises are needed
b) In what areas should be applied
c) Who should be involved
d) What emergency function should be
tested
e) What type of exercise should be
done, if any

4.  STEP 4: Define Exercise Scope And
Type
a) Decide what will be done.
 STEP 5: Gain Support From
Management And Staff
a) Involve and inform the staff
Discussion:
Capability Assessment
 Is necessary to determine or consider
what can be done
 Resources available are inventoried for
the drill or exercise conduction
 This includes an honest assessment of
availability of the following:
a) Funding
b) Personnel
c) Skills
d) Facilities
e) Time
f) Support
Any deficiencies must be considered in the
planning of the exercise
 They may lead to leveling expectations
on what can be accomplished
 Adjustment in the scope of and the type
of exercise/drill to be used
Discussion:
Decision-Making on what will be done
 E.g. Type of emergency/exercise drill
 Based on the needs assessment and
capability assessment, the
emergency/exercise drill scope and type
can be determined.
Emergency/Exercise Drill Scope
 Pertains to the limit of and the
emergency/exercise drill
5 Exercise/Emergency Drill Scope Elements
 Each elements isolate a particular
consideration in planning and exercise:
1) Type of Emergency (what hazard
or emergency will be prepared for)
2) Location (where will the exercise
be done)
3) Functions (What emergency
respond function/operation tested)
4) Participants (Who will be
involved)
5) Exercise Type (Which particular
type will be used)
Discussion:
Involvement of the staff and management
 It is important to gain support from the
management by:
1) Prepare an Exercise Directive
Memo (containing details of the
exercise)
Exercise Directive Memorandum
 Includes the information of the following:
1) What exercise is to be done (Exercise
Type)
2) What is expected from the exercise
for the emergency drill (Objectives
of the Exercise/Emergency Drill)
3) Why is it being done (Purpose)
4) Who will be involved (Participants
in the exercise/emergency drill)
5) Where it will be done (Location)
6) When it will be scheduled (Date and
Time)
7) Who is in charge (Exercise Director
and the Planning Team)
8) How the Directive read and
approved by the Hospital Director
along with the statement of the
support for the activity
9) Send it to the hospital staff
 serves to inform and to gain
support from the administration
 announce plan to conduct an
exercise
 gains support from the rest
facility staff.

5.  STEP 6: Coordinate With External
Agencies
a) Work with others
PHASE II: PLANNING
 STEP 1. Establish Exercise Planning
Team And Subordinate Units
a) FORM THE TEAM.
b) Exercise design team.
c) Exercise control team
d) Physical arrangement team
e) Simulators team
f) Victim actor’s team.
g) Exercise evaluation team.
h) Documentation team.
i) Emergency medical service
team.
j) Food and refreshments team.
Discussion:
Coordination of the Hospital and the External
Agencies
 It is beneficial to work with the external
agencies
 Takes part to the disaster response
1) Emergency exercises
2) Provide opportunity to share
expertise, resources and
manpower
 Leads to the development of a system for
a more coordinated response in case of a
true emergency
 Example of such agency includes the
following but not limited to:
a) Other Hospital /Health Facilities
b) Provincial/City Health Officer
c) Local Government Units
d) Fire Department
e) Law Enforcement Agencies
f) Media

6. Discussion:
Exercise Planning Team
 In charge of the exercise for the
emergency drill, from the design to the
execution of the drill.
 Members may do the required tasks
themselves or oversee various specialized
subordinate teams
Specialized Subordinate Teams
a) Exercise Design Team
 Plans the exercise
1. How it will be done
2. What scenario will be used
(including assumptions,
artificialities, simulations, time
table)
3. Who are the expected
participants and volunteers
4. And all other matters pertaining
to how the exercise is conducted
b) Exercise Control Team
 Operates during all or part of the
actual exercise performance phase
 Ensures exercise purpose and
objectives are achieved in a realistic
manner
c) Logistic Team
 Gathers all supplies, materials,
equipment, services and facilities
required in the implementation of
the exercise/emergency drill.
d) Physical Arrangement Team
 In charge of the venue and other
facility arrangement
Continuation of Discussion:
e) Simulators Team
 Responsible for acting as a various
agencies that may interact
 Sends messages to the hospital for
health facility during an exercise
f) Victim Actor’s Team
 Identifies the victim’s play
 Orients them in to their assigned
rooms
 Deploys them to the assigned areas
g) Exercise Evaluation Team
 Review all exercising evaluation
tools
 Develop new tools based on the
objectives
 Identify and orient evaluators on the
tools to be used
 Reproduces and distribute the tools
 Deploys evaluators to assigned
areas
 Collate all evaluation findings
 Develop the final evaluation report
with recommendation
h) Documentation Team
 Ensures adequate documentation of
the exercise (e.g. pictures videos,
notes) from pre-planning, planning,
execution and post execution/post
incident.
i) Emergency Medical Service Team
 Provides emergency medical service
during the conduct of the exercise
 Ensures all participants, victims,
simulators, evaluators, observers
and bystanders are safe during the
conduct of exercise
j) Food and Refreshment Team
 In charge providing nourishment
during the entire process.

7.  STEP 2. Determine Exercise
Objectives
a) Set the Goals
Simple Objective
1. Standards 2. Conditions
(Within 5 minutes) (after the hospital
fire notice is given),
3. Who
(Participants)
4. Specific
Action
the (members of the
emergency operations
team)
Will (complete
notification
procedures to local
fire authorities.)
SMART Objectives:
Simple A good objective
should be simply and
clearly phrased. It
should be brief and
easy to understand.
Measurable The objective should
set the level of
performance, so that
the results are
observable, and it can
be that when
the objective is
achieved, that is
reportable.
Achievable The objective should
not be too difficult to
achieve. Achieving it
should be within the
resources that the
organization is able to
commit to an exercise
Realistic The objective should
present a realistic
expectation for the
situation. Even though
an objective might be
achievable, it might
not be realistic for the
exercise.
Task- Oriented The objective should
focus on a behavior or
procedure. With
respect to exercise
design, each objective
should focus on an
individual emergency
function.
 STEP 3. Write Exercise Narrative
a) Set the Scene
 STEP 4. List major and Detailed
Events
a) Develop the Story
Discussion:
Narrative
 Brief description of simulative events that
led up to when the exercise begins
 Sets the mood of the exercise
 Provides information that the
participants will need during the exercise
 Work the capture the participants’
attention
 Motivate them to actively involve.
Discussion:
Major Events
 Potential large problems resulting an
from an emergency
Detailed Events
 Most specific problems that requires
participants to respond with expected
actions to fulfill exercise objectives
 Provide unity to an exercise
 Link simulated events to actions that
participants perform to meet exercise
objectives

8.  STEP 5. Determine Expected
Actions
a) What Participants SHOULD DO
Sample Related Scenario, Major Event,
Detailed Event And Expected Action.
Narrative
Scenario
Major
Event
Detailed
Event
Expected
Action
Earthquak
e
Hospital
structura
l damage
Operatin
g room
gas pipe
leak
Activation
of
operating
room
evacuatio
n
procedure
within 5
minutes
 STEP 6. Write Messages
a) What Participants ARE TOLD
Who sends what to whom, via how, and with
what effect?
Message
source (who)
Who sends the message?
(must be a credible source)
Transmission
method
(how)
How the message is
transmitted? (must be a
credible means of
transmission)
Message
content (what)
What information is
conveyed? (Does this
message contain the
information needed by the
recipient to make a
decision?)
Recipient (to
whom)
Who should receive the
message? (Who would
credibly receive it, and who
would ultimately need to
receive it to take action?)
All of these variables will influence the
action taken (to what effect).
Discussion:
Expected Actions
 Actions/Decisions that should be
demonstrated by the participants to
display competence in the exercise to
fulfill exercise objectives
 Use to evaluate whether there was an
appropriate response to an emergency
situation
To determine whether an action is appropriate
for a given event:
a) One must simply GO BACK to the
emergency response plan.
b) Examples are given on the above
mentioned tables.

9.  STEP 7. Develop Master Scenario
Events List
a) Make an Overall Guide
 STEP 8. Finalize Exercise
Enhancements
a) Make the Exercise Believable
 STEP 9. Develop Evaluation Format
a) Assess the Exercise
Discussion:
Messages
 Communicate detailed events to
participants
 Meant to evoke expected actions from the
participants to meet exercise objectives
 5 Main Variables of Messages:
1) Who
2) How
3) What
4) Whom
5) Effect
 It is best to use the method of
transmission that would likely to be
used in the actual emergency:
1) Landlines
2) Cellphones
3) Videos
4) Persons
5) Facts
 Keep messages REALISTIC
 Message is successful, if it is able to
motivate the expected action.
Examples are given on the above mentioned
tables.
Discussion:
The output of the design process, are put
together in a master scenario events list:
 Chart of controllers and simulators
reference in order the exercise remains in
track.
 Overall Guide of the exercise
 It leads the following:
a) Events or messages
b) Time they are to be released
c) Expected actions of the
participants
Organizers should still remain FLEXIBLE and
appropriately adjust to participants’ responses
and exercises situations as it develops.
GOAL:
 Accomplish the objectives
 NOT being overly strict on following the
time schedule
Discussion:
Exercise Enhancements
 Tools, materials and strategies that are
used to add the realism of the exercise
 Examples given:
1) Use of real equipment and actual
locations
2) Use of simulated victims with
convincing mock injuries
3) Use of actual equipment
available in the emergency
operation center during the real
emergency
 NEED NOT require a lot of money and
energy
 It NEEDS: Creativity and
Resourcefulness

10. PHASE III: EXERCISE (The Drill)
a) Preparation (Set the stage)
b) Conduction (Monitor the action)
c) Recovery (Return to normal state)
1. STEP 1: Preparation
a) Set the stage
Discussion:
Evaluation Format
 Refers the assessment form of the
exercise drill
In order for evaluation goals to be met:
 Systematic and methodological
approach must be given to evaluation
planning and conduction:
a) Determining structure of evaluation
team
b) Objective to be measured
c) Observation methods and recording
forms to be used
d) Criteria to determine if an exercise
has been successful must be based
on the:
1. Listed objectives
2. Expected actions
Expected Actions
 Pertinent evaluation measures can be
developed.
Samples of Evaluation Tools:
1) Data collector’s observation logs
2) Observation checklist
3) Problem logs
4) Evaluator checklist
5) Narrative summary
Addition to these tools, more information can
be obtained through the conduction of post-
exercise debriefing and evaluation team
meetings.
FINAL OUTPUT of the entire evaluation
process:
 The After Action Report
 Used for the implementing
improvements to the emergency
response plan and emergency
management program.
Discussion:
Several tasks should be accomplished:
1) Last minute briefing should occur with
the staff members and participants
prior to exercise
2) Safety precautions should be
implemented:
a) Notification alerts should be
raised to those affected by the
exercise
b) PPEs should be used when
necessary
c) Briefing on the potential actions
on the event of circumstances
should occur
d) Call-off procedures should be
reiterated in the event of a real
emergency
3) Final system check should be ensured on
the importance systems and materials:
a) Computers
b) Projectors
c) Radios
d) Communication devices
e) Equipment prone to breakdowns
4) Those involved must be properly
positioned such as:
a) Simulated casualties
b) Props and equipment
c) Exercise staff members
d) Participants
e) Evaluators/observers
 Once all are CLEAR, exercise directors
can signal the exercise to begin.

11. 2. STEP 2: Conduction
a) Monitor the action
3. STEP 3: Recovery
a) Return to normal state
PHASE IV: POST-EXERCISE
a) Conduct Post Exercise Meeting
b) Write the After-Action Report
c) Conduct Follow-up Activities
1. STEP 1: Conduct Post-Exercise
Meetings
a) Debrief the participants
2. STEP 2: Write After-Action Report
a) Make a written evaluation
Discussion:
During the Actual Exercise/Emergency Drill:
 Facilitator/Controller assumes
responsibility for ensuring the exercise
follows the plan that is directed towards
the objectives, this includes:
a) Presenting the players read the
exercise narrative
b) Announcing the first event of the
scenario
c) Stimulating player responses
without assuming control of play
d) Managing how the flow and pace
of the exercise through the use of
messages
Special Consideration in Conducting the
Exercise:
a) Fostering realism
b) Maintaining valid timelines
c) Sustaining actions
d) Keeping safety, a common concern
e) Being open to capitalize problem
situations
Discussion:
At the End of the Exercise/Emergency Drill:
 There must be provisions for system
recovery and return to normal operation:
a) Mobilization and cleaning of
exercise sites
b) Return of emergency equipment
c) Proper discharge of participants
from the exercise
d) Return to regular posting
Discussion:
2 Types of Post Exercise Meetings:
1) Hot Debriefing
 Conducted immediately after the
exercise
 Also called as “Player’s
Debriefing”
2) Cold Debriefing
 Can be conducted some days
after the exercise
 Usually for evaluation team
meetings
 In either case, they involve giving
feedbacks, critiques, and suggestions
regarding the activity
Discussion:
After Action Report:
 Final output of the evaluation team
 Documents the effectiveness of the
exercise
 Improves the emergency response plan
 Improves how the emergency response
plan is implemented
 Serve as basis for future exercises
 Must be distributed to the Chief
Executive of the institution and its
participant’s department for other
affected units

12. 3. STEP 3: Conduct Follow-up
Activities
a) Apply the Learning
Discussion:
Recommendation of the After- Action Report:
 Reviewed by:
a) the Chief Executive
b) Emergency Management Program
Committee
c) Other Key Decision Making Units
 This may translate to:
a) Changing of policies
b) Resource acquisitions or
allocations
c) Personnel training
d) Decision to conduct further
exercise
Exercise Follow-Up Strategies:
a) Clearly assigning tasks and
schedules
b) Designating responsibly to each
recommended improvements
c) Establish a monitoring plan to
track the progress of the
recommendations and
implementations
d) Completing the cycle by
incorporating the testing of noted
improvement indicators into
succeeding exercises
 In the end, the recommendation, the
exercise itself, are useless if no efforts
are placed in the implementation.