This document provides information on disaster nursing and disaster response. It begins with definitions of "disaster" from various organizations and discusses the etymology and key features of disasters. It then discusses disaster classification systems including natural vs. man-made disasters and slow vs. sudden onset disasters. The document outlines the anatomy of a disaster including pre-impact, impact, and post-impact phases. It discusses mass casualty incident response and triage systems used to prioritize patient care. It provides goals and principles of disaster nursing as well as the roles and qualities of nurses during disasters. Overall, the document serves as an introductory module on disaster nursing concepts and response.

1. DISASTER NURSING
MODULE 1
DISASTER
 The word derives from French “désastre” and
that from Old Italian
 “disastro”, which in turn comes from the Greek
pejorative prefix dus = "bad" + aster = "star"
 The root of the word disaster ("bad star" in
Greek) comes from an astrological theme in
which the ancients used to refer to the destruction
or deconstruction of a star as a disaster
 The ancient people believed that the disaster is
occurred due to the unfavourable position of the
“planets” or “Act of God”
DEFINITIONS
 Disaster is a result of vast ecological breakdown
in the relation between humans and their
environment, as serious or sudden event on such
scale that the stricken community needs
extraordinary efforts to cope with outside help or
international aid.
 WHO defines Disaster as "any occurrence that
causes damage, ecological disruption, loss of
human life, deterioration of health and health
services, on a scale sufficient to warrant an
extraordinary response from outside the affected
community or area."
 Red Cross (1975) defines Disaster as “An
occurrence such as hurricane, tornado, storm,
flood, high water, wind-driven water, tidal wave,
earthquake, drought, blizzard, pestilence, famine,
fire, explosion, building collapse, transportation
wreck, or other situation that causes human
suffering or creates human that the victims
cannot alleviate without assistance.”
 UNDP (2004) defines “Disaster is a serious
disruption triggered by a hazard, causing human,
material, economic or (and) environmental
losses, which exceed the ability of those affected
to cope.”
 Disaster can be defined as “Any catastrophic
situation in which the normal patterns of life (or
ecosystems) have been disrupted and
extraordinary, emergency interventions are
required to save and preserve human lives and/or
the environment.”
 Disaster may also be termed as “a serious
disruption of the functioning of society, causing
widespread human, material or environmental
losses which exceed the ability of the affected
society to cope using its own resources.”
Thus, a disaster may have the following main
features:-
 Unpredictability
 Unfamiliarity
 Speed
 Urgency
 Uncertainty
 Threat
What is Republic Act 10121?
 A Law that requires the Country’s Government
and its citizens to be prepared for disaster.
Why is Republic Act 10121 Important?
 Because Philippines is one of the most at risk
 In terms of disaster risk, Philippines ranked third
among all
 of the countries with the highest risks worldwide
according
 to the World Risk Report 2018,
 with index value of 25.14% (World Economic
Forum,
 2018).
Why is the Philippines at Risk?
 Geography
 Climate
 Human Induced Calamities
PHILIPPINE SETTING
 Archipelago – group of island in a large body if
water
 Visited by storm every year
 Near the ring of fire
 Prone to damage from tsunami and earthquakes
 Natural resources are deplating rapidly
- Factors that make people more vulnerable to
disasters include poverty, slum housing, limited
access to medical services and clean water,
corruption and weak law enforcement
Why was RA 10121 Implemented?
 To prevent the loss of lives during disasters,
natural or man
 made
 To reduce the loss of structures
 To prepare the people for the upcoming
Typhoons,
 Earthquakes, Landslides etc

2. What Government Sector is In Charge?
MODULE 2
TYPES OF DISASTER
Disasters are classified in various ways, on the basis
of its origin/cause.
1. Natural Disaster – tornadoes, hailstorms, tsunami,
floods, Earthquakes, communicable disease etc.
2. Man-Made Disaster- fires, explosions, toxic
materials, pollution, terrorist attack, transportation
accidents etc.
And On the basis of speed of onset:
1. Sudden onset disasters
2. Slow onset disasters
DISASTER
Human Disaster Natural Disaster
Technological
 Chemistry
 Nuclear
 Oil spill
Biological
 Epidemic
 Insect infestation
 Animal stampede
Environmental
 Greenhouse effect
 Deforestation
 Uncontrolled town
planning megacities
 Drying lakes
Geophysical
 Earthquake
 Volcano
 Mass movement DRY
Hydrological
 Flood
 Mass movement WET
Meteorological
 Storm
Climatological
 Extreme temperature
 Drought
 Wildfire

3. Goals of the Disaster Nursing
 To meet the immediate basic survival needs of
populations affected by disasters.
 To identify the potential for a secondary disaster.
 To appraise both risks and resources in the
environment.
 To correct inequalities in access to health care or
appropriate resources.
 To empower survivors to participate in and
advocate for their own health and well-being.
 To respect cultural, lingual, and religious
diversity in individuals and families and to apply
this principle in all health promotion activities.
 To promote the highest achievable quality of life
for survivors.
Principles of Disaster Nursing
 Rapid assessment of the situation and of
nursing care needs.
 Triage and initiation of life-saving measures
first.
 The selected use of essential nursing
interventions and the elimination of
nonessential nursing activities.
 Evaluation of the environment and the
mitigation or removal of any health hazards.
 Prevention of further injury or illness.
 Leadership in coordinating patient triage,
care, and transport during times of crisis.
 The teaching, supervision, and utilization of
auxiliary medical personnel and volunteers.
 Provision of understanding, compassion and
emotional support to all victims and their
families.
MAJOR ROLES OF NURSE IN DISASTER
1. Define health needs of the affected groups
2. Establish priorities and objectives
3. Identify actual and potential public health
problems
4. Determine resources needed to respond to the
needs identified
5. Collaborate with other professional disciplines,
governmental and non-governmental agencies
6. Maintain a unified chain of command
QUALITIES OF A NURSE WORKING IN
DISASTERS
1. Confidence
2. Cooperation
3. Commitment
4. Coordination
5. Control
6. Value of human life
7. Gentleness and devotion
8. Strength
9. Trust
10. Interdependence and team spirit
11. Accept self-criticism
12. Toughness and sensitivity
13. Leadership
14. Responsibility and accountability
Health Effects of Disasters
 Disasters may cause premature deaths, illnesses,
and injuries.
 Disasters may destroy the local health care
infrastructure.
 Disasters may affect the psychological,
emotional, and social well-being of the
population.
 Disasters may cause shortages of food and cause
severe nutritional deficiencies.
 Disasters may create large population
movements.
 Disasters may create environmental imbalances
IMPACTS OF DISASTERS
 Physical (buildings. Structures, physical
property, industry, roads, bridges, etc.)
 Environmental (water, land/soil, land-use,
landscape, crops, like/rivers/estuaries,
aquaculture, forest, animals/livestock, wildfire,
atmosphere, energy, etc.)
 Social (life, health, employment, relation,
security, peace, etc.)
 Economic (assets, deposits, reserves, income,
commerce, production, guarantee/insurance,
etc.)
ANATOMY OF A DISASTER
Pre-impact Phase
(disaster prevention and education)
Impact Phase
(information collection and disaster mitigation)
Post-impact Phase
(long term rehabilitation following a disaster)

4. PRE-IMPACT PHASE
 It is the initial phase of disaster, prior to the actual
occurrence. A warning is given at the sign of the
first possible danger to a community with the aid
of weather networks and satellite many
meteorological disasters can be predicted.
 The role of the nurse during this warning phase
is to assist in preparing shelters and emergency
aid stations and establishing contact with other
emergency service group.
1. Mitigation
 To prevent future emergencies and take steps to
minimize their effects
 The “mitigation” phase occurs before a disaster
takes place.
 Here, an organization will take steps to protect
people and property, while also decreasing risks
and consequences from a given disaster situation.
The organization’s main goal is to reduce
vulnerability to disaster impacts (such as
property damage, injuries and loss of life).
2. Preparedness
 To take actions ahead of time to be ready for an
emergency
 The “preparedness” phase also occurs before a
disaster takes place. Here, an organization
attempts to understand how a disaster might
affect overall productivity and the bottom line.
The organization will also provide appropriate
education while putting preparedness measures
into place.
IMPACT PHASE
 The impact phase occurs when the disaster
actually happens. It is a time of enduring hardship
or injury end of trying to survive.
 This is the time when the emergency operation
center is established and put in operation. It
serves as the center for communication and other
government agencies of health tears care
healthcare providers to staff shelters. Every
shelter has a nurse as a member of disaster action
team. The nurse is responsible for psychological
support to victims in the shelter.
3. RESPONSE
 The response phase is the actual implementation
of the disaster plan. response activities need to
be continually monitored and adjusted to the
changing situation.
 A hospital, healthcare system, or public health
agency take immediately during, and after a
disaster or emergency occurs.
POST – IMPACT PHASE
4. RECOVERY
 Once the incident is over, the organization and
staff needs to recover. Invariably, services have
been disrupted and it takes time to return to
routines.
 Activities undertaken by a community and its
components after an emergency or disaster to
restore minimum services and move towards
long-term restoration.
 Debris Removal
 Care and Shelter
 Damage Assessments
 Recovery begins during the emergency phase
ends with the return of normal community order
and functioning.
The victims of disaster in go through four stages
of emotional response.
1. Denial – during the stage the victims may deny
the magnitude of the problem or have not fully
registered.
2. Strong Emotional Response – in the second
stage, the person is aware of the problem but
regards it as overwhelming and unbearable.
3. Acceptance – During the third stage, the victim
begins to accept the problems caused by the
disaster and makes a concentrated effect to solve
them.
4. Recovery – The fourth stage represent a recovery
from the crisis reaction. Victims feel that they are
back to normal.
Evaluation/ Development
 Often this phase of disaster planning and
response receives the least attention.
 After a disaster, employees and the community
are anxious to return to usual operations.
 It is essential that a formal evaluation be done to
determine what went well (what really worked)
and what problems were identified.

5.  A specific individual should be charged with the
evaluation and follow-through activities.
Organizing an effective Disaster System
The nurse must be familiar with the personnel at the
disaster scene and their roles and functions.
A disaster scene is usually broken up into three
zones-
1. Disaster zone
2. Treatment zone
3. Transport zone
1. Disaster zone
 It is the actual location of the incident from where
patient are to be removed as soon as possible.
Majority of disaster personnel are sent to this
zone initially.
2. Treatment zone
 Nurses spend most of their time in their zone
during a disaster, where equipment and
personnel to carry out patient care are
concentrated.
 Activities carried out in this zone includes.
 Assessment of each patient
 Treatment of injuries
 Preparation for transport.
3. Transportation zone:
 It should be situated directly next to the
treatment zone so that ambulances and other
vehicles can load patient and leave for hospitals.
delivering appropriate patient care:
 Hardly a day now passes without news about a
major or complex emergency happening in
some part of the world.
 Disasters continue to strike and cause
destruction in developing and developed
countries about their vulnerability to
occurrences that can gravely affect their day to
day life and their future.
 Nurses in any location will be on the frontline as
caregiver and managers in the event of
damaging disaster.
 So you need to have adequate knowledge and
framing to work in such a unique, chaotic
stressful situations and to identify and meet the
complex, multifarious health needs of victims of
disaster.
MODULE 3
Mass Casualty Incident (MCI) Response
Objectives
 Define mass casualty triage
 Determine considerations for adults and
paediatrics.
 Understand the importance of a patient
tracking system.
 Recognize and implement the patient
admission/ discharge MCI triage process.
 Determine how to appropriately handle
the deceased in a large-scale MCI
Recognize the range of incidents that may
cause.
Assisting in MCI Response
Considerations for hospital staff in an
MCI:
 Some patients may arrive to the hospital without
having been assessed/ triaged at the scene
 MCI response requires efficiency and
coordination
 Non-clinical personnel (including hospital
volunteers) can assist in moving patients to
designated areas based on level of care
 Help gather patient information in the emergency
treatment area
 Staff should review patients in clinical
assignment for any potential discharges/
transfers to make room for potential MCI
admissions, a process known as “surge
discharge”
Triage Basics
Definition of MCI Triage
 Triage means “to sort.”
 Triage in an MCI is the assignment of resources
based on the initial patient assessment and
consideration of available resources.
 Triage is the process of prioritizing which
patients are to be treated first and is the
cornerstone of good disaster management in
terms of judicious use of resources (Auf der
Heide, 2000).
 “Triage is a process which places the right
patient in the right place at the right time to
receive the right level of care” (Rice & Abel,
1992).
 Baron Dominique Jean Larrey, who was the
Chief Surgeon for Napoleon, is credited with
organizing the first triage system.

6. MCI Triage
 MCI triage differs from day-to-day triage due to
potential resource limitations.
 Evidence based triage systems have been
developed using these documented triage basics:
• Triage prioritizes identification of those in
need of immediate intervention.
• Triage must be modified for children.
• “Triage requires situational awareness,
decisiveness, and clinical expertise.”
• Ethical justifications need to be made in order
to save large numbers instead of caring for
each individual need.
 No-notice, dynamic incident scenes with
exceedingly large numbers of patients may result
in altered triage processes.
AIMS OF TRIAGE
1. To sort patients based on needs for immediate
care
2. To recognize futility
3. Medical needs will outstrip the immediately
available resources
4. Additional resources will become available
given enough time.
PRINCIPLES OF TRIAGE
The main principles of triage are as follows: -
1. Every patient should receive and triaged by
appropriate skilled health-care professionals.
2. Triage is a clinic-managerial decision and
must involve collaborative planning.
3. The triage process should not cause a delay in
the delivery of effective clinical care.
ADVANTAGES OF TRIAGE
1. Helps to bring order and organization to a chaotic
scene.
2. It identifies and provides care to those who are in
greatest need
3. Helps make the difficult decisions easier
4. Assure that resources are used in the most
effective manner
5. May take some of the emotional burden away
from those doing triage
TYPES OF TRIAGE
There are two types of triage:
1. Simple triage
2. Advanced triage
TRIAGE
1. SIMPLE
S.T.A.R.T
(Simple Triage and Rapid
Treatment
2. ADVANCED
Patients are classified
into classes
SIMPLE TRIAGE
 Simple triage is used in a scene of mass casualty,
in order to sort patients into those who need
critical attention and immediate transport to the
hospital and those with less serious injuries.
 This step can be started before transportation
becomes available.
 The categorization of patients based on the
severity of their injuries can be aided with the use
of printed triage tags or colored flagging.
S.T.A.R.T. (Simple Triage and Rapid
Treatment) is a simple triage system that can
be performed by lightly trained lay and
emergency personnel in emergencies.
Triage separates the injured into four groups:
0 - The deceased who are beyond help
1 - The injured who can be helped by immediate
transportation
2 - The injured whose transport can be delayed
3 - Those with minor injuries, who need help less
urgently
ADVANCED TRIAGE
 In advanced triage, doctors may decide that some
seriously injured people should not receive
advanced care because they are unlikely to
survive.
 Advanced care will be used on patients with less
severe injuries. Because treatment is
intentionally withheld from patients with certain
injuries, advanced triage has an ethical
implication.
 It is used to divert scarce resources away from
patients with little chance of survival in order to
increase the chances of survival of others who are
more likely to survive.
Principles of advanced triage:
 “Do the greatest good for the greatest number”
 Preservation of life takes precedence over
preservation of limbs. Immediate threats to life:
HEMORRHAGE.

7. Triage and Assessment Tools
MINIMAL
Sick or injured, but expected to survive with
or without care, sometimes referred to as
“walking wounded”.
DELAYED
Requires care that can be safely delayed
without affecting probability of survival.
IMMEDIATE
Requires immediate care for a good
probability of survival.
EXPECTANT
Alive, but with little or no chance of survival
given current available resources.
DECEASED
A fatality with no intrinsic respiratory drive
and no other signs of life.

8. Examples of Common Traumatic Injuries
per Triage Category
MINIMAL
 Superficial wounds o Auditory blast injury
DELAYED
 Stable abdominal wounds o Soft tissue
wounds
IMMEDIATE
 Mechanical airway obstruction o Sucking
chest wound
EXPECTANT
 Agonal respirations o Profound shock
SALT MCI Triage Tool
Used primarily on scene
Sort -Sort based on whether victim can walk, wave,
or is still
Assess –Complete an individual assessment to
determine need for any lifesaving interventions
Lifesaving interventions – Control hemorrhage, open
airway, etc. and follow algorithm
Treatment and/ or transport
Pediatric Triage Considerations
 Children are different!
 Considerations during pediatric triage include:
 Anatomic Differences: Size/Structure
 Physiologic Differences
 Immunologic Differences: Immature
immune systems
 Developmental Differences
 Psychological Differences
 Children should be reassessed frequently for
changes in condition.
 Pediatric MCI Triage recommendations:
 Acknowledge that children have unique needs
and may require a referral
 Increase education and training for responders
 Group children together in the appropriate
triage areas
 Know what organizations are available to care
for critically ill pediatric patients if needed
 Exposure to disasters can affect children in three
categories: direct, interpersonal, or indirect.
 Direct
- Children who are physically present
during an incident are directly affected
 Interpersonal
- Occurs when children have loved ones
that are directly affected
 Exposure to disasters can affect children in three
categories: direct, interpersonal, or indirect.
 Indirect
- Exposure happens through secondary
consequences of a large scale incident,
such as chaos/ disruption of daily living
- Children who are a distance away from
the incident may still be affected, causing
fear and distress
JumpSTART
Triage System for Children
 Expect children to be a part of an MCI.
 JumpSTART - is a modified triage tool based on
the START triage model, focusing on the
pediatric population.
Triage System for Children
 This triage tool is designed for children 1-8 years
old. “Although the JumpSTART system parallels
the START system, it takes into consideration the
developmental and physiological differences of
children by using breathing as the cornerstone for
triage decisions” (NDLSF, 2012)
Triage System for Children
 Some modifications include:
Babies <12 months old are marked
IMMEDIATE for highest priority of care
• Pediatric Mass Casualty Incident (MCI) Triage
Tool
 MINIMAL
- All victims who are considered “walking
wounded” are directed to the minimal
injuries treatment area
 DELAYED
- If the victim can follow simple commands
when undergoing a mental assessment, or has
bleeding that can be stopped, they are
directed to the delayed treatment area
 IMMEDIATE
- If the victim cannot follow simple commands
when undergoing a mental assessment, if
bleeding cannot be stopped, the respiratory
rate is under 15 or over 45, or there is no
peripheral pulse
 EXPECTANT
- All victims struggling with injuries
incompatible with life
 DECEASED
- All victims displaying no signs or symptoms
of life
**All patients tagged EXPECTANT or
DECEASED, unless clearly suffering from injuries,
should be reassessed once critical interventions for
IMMEDIATE and DELAYED victims are
completed.*

9. Patient Identification, Tracking, and
Fatality Management
Patient Identification
 Identification is essential in treating, tracking,
and maintaining continuity of care and family
reunification
 Hospitals must have a process to identify and
track patients that works within their existing
patient records system, which may or may not
include the use of triage tags
 Know the system your hospital uses
Handling the Deceased
 Proper handling considerations during a large
scale incident:
- Recommended use of personal protective
equipment (PPE)
- Local law enforcement may provide
guidelines on handling of the deceased and
their belongings to preserve evidence
- Bodies can only be released by responsible
authority according to existing laws and
policies
- Mismanagement of deceased can lead to
legal implications
- Cultural practices related to the deceased
should be respected to the degree possible
- Engage proactively and creatively with
media to maintain family privacy
DISASTER MANAGEMENT and RISK
REDUCTION PHILIPPINE LAWS
 Philippine Disaster Risk Reduction and
Management Act of 2010 (R.A. No. 10121)
 provides a comprehensive, all-hazard, multi
sectoral, inter-agency, and community-based
approach to disaster risk management through
the formulation of the National Disaster Risk
Management Framework
 An act strengthening the Philippine disaster
risk reduction and management system,
providing for the national disaster risk
reduction and management framework and
institutionalizing the national disaster risk
reduction and management plan,
appropriating funds therefore and for other
purposes.
The Program shall include activities and processes
that
will promote and uphold the rights of children by:
(1) Providing child-centered training for all
responders;
(2) Ensuring that children are provided with adequate
access to age-appropriate information on their roles
and responsibilities and those of government
agencies before, during, and after disasters and other
emergency situations;
(3) Providing an effective mechanism for training
and meaningful participation of children in
community disaster risk reduction program; and
(4) Consulting with the affected children on their
needs and priorities for post-disaster relief and
recovery.
 R.A. 10821 “Children Emergency and
Protection Act”
 To protect the fundamental rights of children
before, during, and after disasters and other
emergency situations when children are
gravely threatened or endangered by
circumstances that affect their survival and
normal development.
 - Guided by the principles on survival and
development, on child
participation, and consistent with the United
Nations Convention on the Rights of the Child,
as well as the Children’s Charter for Disaster
Risk and Reduction, and the minimum standards
for children in humanitarian action, the State
shall establish and implement a comprehensive
and strategic program of action to provide the
children and pregnant and lactating mothers
affected by disasters and other emergency
situations with utmost support and assistance
necessary for their immediate recovery and
protection against all forms of violence, cruelty,
discrimination, neglect, abuse, exploitation and
other acts prejudicial to their interest, survival,
development, and well-being.
The Department of Social Welfare and Development
(DSWD) shall formulate a Comprehensive
Emergency Program for Children, hereinafter
referred to as the Program, taking into consideration
humanitarian standards for their protection. The
Program shall be used as the basis for handling
disasters and other emergency situations to protect
children, pregnant and lactating mothers, and support
their immediate recovery. This shall be implemented
immediately after the declaration of a national or
local state of calamity or occurrence of any other
emergency situation.
The Program shall include activities and
processes that will promote and uphold the rights
of children by:
(1) Providing child-centered training for all
responders;
(2) Ensuring that children are provided with
adequate access to age-appropriate information
on their roles and responsibilities and those of
government agencies before, during, and after
disasters and other emergency situations;
(3) Providing an effective mechanism for training
and meaningful participation of children in
community disaster risk reduction program; and
(4) Consulting with the affected children on their
needs and priorities for post-disaster relief and
recovery.

10. Philippine Environmental Laws
 Philippine Clean Air Act Republic Act 8749
o It is a comprehensive air quality management
policy and program, which aims to achieve
and maintain healthy air for Filipinos. Its
guiding principles are the following:
1. Promote and protect the global
environment while recognizing the
primary responsibility of LOCAL
GOVERNMENT UNITS to deal with
environment problems.
2. Recognize that the responsibility of
cleaning the habitat and environment is
primary are based:
3. Recognize that a clean and healthy
environment is for the good of all and
should therefore be the concern of all.
 The Pollution Control Law
P.D. 1181 (supplements the provision of P.D. 984)
o Providing for the abatement, control and
prevention of vehicular pollution and
establishing of specific air pollutants from all
types of vehicle.
 Water Pollution Control
o Prohibits the discharge of oil, noxious
liquid substances, and other harmful
substances into the country’s inland
and territorial waters.
o P.D. 825 – prohibits the improper
disposal of garbage
 R.A 6969 Toxic Substances and
Hazardous and Nuclear Waste Control
o Authorizes the DENR to establish a program
to regulate, restrict or prohibits the
importation, manufacture, processing, sale,
destruction, use and disposal of chemical
substances, and mixture that present
unreasonable risk and/or injury to health or
the environment.
 Philippine Clean Water Act (2004)
Also known as R.A. 9275
o An act providing a comprehensive water
quality management and for other purposes.
 Climate Change Act of 2009
Also known as R.A. 9729
o Ann act mainstreaming climate change into
government policy formulation, establishing
the framework strategy and program on
climate change, creating for this purpose the
climate change commission, and for other
purposes.
 Food Security Act (1985)
o Deals with preserving the natural
environment on farmlands.
o Also, increase protection for wetland and
encourages soil conservation on areas subject
to high levels of erosion.
 Solid Waste Management Act (2001)
Also known as R.A. 9003
o An act providing for an ecological solid
waste management program, creating the
necessary institutional mechanisms and
incentives, declaring certain acts prohibited
and providing penalties, appropriating funs
therefor, and for other purposes.
 Republic Act No. 9211
Also known as “Tobacco Regulation Act of
2003”
o Regulates smoking in public places, tobacco
advertising, promotion and sponsorship, and
sales restrictions, among other requirements.
In addition to the advertising, promotion and
sponsorship provisions in Rep. Act No. 9211
and the Implementing Rules and Regulations,
the Consumer Act of the Philippines (Rep.
Act No. 7394) addresses false, deceptive, or
misleading advertising in general.
 REPUBLIC ACT NO. 7586
Also known as “National Integrated
Protected Areas System Act of 1992”
o NIPAS is the classification and
administration of all designated protected
areas to maintain essential ecological
processes and life support systems, to
preserve genetic diversity, to ensure
sustainable use of resources found therein,
and to maintain their natural conditions to the
greatest extent possible.
 REPUBLIC ACT NO. 9147
Also known as “Wildlife Resources Conservation
and Protection Act.”
o AN ACT PROVIDING FOR THE
CONSERVATION AND PROTECTION OF
WILDLIFE RESOURCES AND THEIR
HABITATS, APPROPRIATING FUNDS
THEREFOR AND FOR OTHER
PURPOSES
o An Act to provide for the protection of wild
animals, birds and plants and for matters
connected therewith or ancillary or incidental
thereto with a view to ensuring the ecological
and environmental security of the country.
Mass Casualty Incidents (MCI)
MANY DISASTERS CAN LEAD TO AN MCI. A
FEW OF THE MOST COMMON ONES
INCLUDE:
• Active Shooter Situations: Unfortunately,
shootings have become increasingly common in
recent years. An active shooter incident is likely to
result in a high number of casualties.

11. MANY DISASTERS CAN LEAD TO AN MCI. A
FEW OF THE MOST COMMON ONES
INCLUDE:
• Terrorist Acts: This is something of an umbrella
term, as a terrorist act can take many forms such as a
vehicle incident, an active shooter or something else
altogether. In any case, these incidents will likely
result in a higher rate of casualties.
• Explosions: Whether it is intentional, or the result
of some unintended reaction or malfunction,
explosions can lead to a large number of casualties
relatively quickly.
• Natural Disasters: Sometimes, an MCI is the
result of nature taking its course and people getting
caught in the crossfire. This might be a hurricane,
tornado, tsunami, volcano or any number of other
natural phenomena.
• Multi-Vehicle Accidents: This category refers to
things like multi-car pile ups on the highway. While
an accident between only two cars can be
devastating, it isn’t likely to be referred to as an MCI.
As more and more cars get involved in an accident,
however, the number of casualties increases and it is
more likely to be considered an MCI.
• Mass Transit Mishaps: If a plane crashes, a train
derails, a bus topples off a bridge or any incident like
this occurs, this is what’s called a mass transit
mishap. Because so many people are generally
crowded onto mass transit, this is usually classified
as an MCI.
FIVE ESSENTIAL POINTS FOR A
RESPONDER TO BE AWARE OF DURING AN
MCI.
1. Early Command Decisions and
Communication Between EMS Responders
In most situations, an MCI response consists of a
team of EMS workers. As part of a team, it’s crucial
that all members of the team work together with each
other, as well as with other medical professionals that
may be present.
2. Requesting Additional Resources Early
When first called to a scene, it might not initially be
clear how many casualties there are after an incident,
or how severe their injuries are. It may not be clear
whether 5 or 15 additional personnel are needed.
Quickly surveying the situation and requesting the
additional resources necessary can help the team
work faster and save more lives.
3. Knowing the Distance to Exit and Access Points
Entryways and access points are of critical
importance during an MCI. Whether coordinating
medical supplies, evacuating people, or directing
additional personnel, it’s of the utmost importance to
understand and communicate where the access points
are, including any potential obstructions.
4. Initial Search and Assessment
This is an essential phase of any MCI. After arriving
on site and taking stock of the situation at hand, it is
critical to determine whether the incident is ongoing
or has concluded, fan out and search the wreckage,
locate as many injured people as possible and assess
their injuries. It is also necessary to determine if
people can safely be moved or if their injuries are too
severe. If the immediate surroundings are too
5. Triage and Treatment
Triage is one of the biggest differences that sets
MCIs apart from any other medical emergency. In
addition to a shortage of supplies, MCIs are also
typically categorized by the need for triage.
While completing the search and assessment of
the disaster site, EMS personnel need to take stock of
the injuries observed, decide which should be treated
right away and which can wait while the supplies go
to the more extreme injuries.
WHAT ARE THE BIGGEST CHALLENGES
WITH MCIS?
MCIs are highly stressful situations that bring with
them a whole host of challenges. To prepare for an
MCI, consider the following problems that are
unique to these situations:
 Location of the Incident: MCIs don’t always
happen in convenient locations. Sometimes,
they’re complicated to get to and are not in a
place that’s convenient for efficiently delivering
additional supplies and personnel. Other times,
they happen far from any hospital or medical care
facility.
 Staffing Levels: Because these incidents usually
happen unexpectedly, there aren’t normally
enough medical professionals to go around.
Because of this, everyone has to work twice as
hard to try to make up the difference.
 Limited Equipment: Just as there aren’t enough
doctors or EMS workers to go around, there
usually isn’t enough equipment. Any equipment
available is generally insufficient, meaning you
may have to wait until more equipment can arrive
from the nearest hospital or supplier.
 Ambulances from Another System:
Ambulances, workers and equipment from
surrounding areas may need to be called in. It
may be difficult to work with these other
services, as they’re likely to be unfamiliar with
local policies and procedures.

12.  Ongoing Gunfire or Explosions: Sometimes, an
MCI is ongoing even as the call for help is
received. Treatment of the injured may need to
begin even as there is still gunfire, explosions or
other violent disturbances happening. This can
present an enormous challenge keeping EMS
teams safe while also helping the injured.
 Not Having Proper Training: An incident like
this may happen before proper training has been
taken. Or, you may find yourself in a position that
no amount of training could ever prepare you for.
Perhaps you’re trained, but your only team-
members are inexperienced and untrained. No
matter what the specific case, this can make the
situation much more difficult.
ESSENTIAL DISASTER
MANAGEMENT EQUIPMENT