EMERGENCY AND

DISASTER
NURSING
VICTOR CHRISTOPHER A. SENO
INCIDENT COMMAND SYSTEM

• The Incident Command System (ICS) is a standardized approach to the

command, control, and coordination of emergency response providing a
common hierarchy within which responders from multiple agencies can
be effective.
• ICS was initially developed to address problems of inter-agency
responses to wildfires in California and Arizona but is now a component
of the National Incident Management System (NIMS) in the US,
where it has evolved into use in All-Hazards situations, ranging from
active shootings to HazMat (hazardous materials) scenes. In addition,
ICS has acted as a pattern for similar approaches internationally.
 INCIDENT COMMAND SYSTEM

• ICS consists of a standard management hierarchy and procedures for

managing temporary incident(s) of any size. ICS procedures should be
pre-established and sanctioned by participating authorities, and
personnel should be well-trained prior to an incident.
• ICS includes procedures to select and form temporary management
hierarchies to control funds, personnel, facilities, equipment, and
communications. Personnel are assigned according to established
standards and procedures previously sanctioned by participating
authorities. ICS is a system designed to be used or applied from the time
an incident occurs until the requirement for management and operations
no longer exist.
 INCIDENT COMMAND SYSTEM
• ICS is interdisciplinary and organizationally flexible to meet the following
management challenges:
• Meets the needs of a jurisdiction to cope with incidents of any kind or
complexity (i.e. it expands or contracts as needed).
• Allows personnel from a wide variety of agencies to meld rapidly into
a common management structure with common terminology.
• Provide logistical and administrative support to operational staff.
• Be cost effective by avoiding duplication of efforts, and continuing
overhead.
• Provide a unified, centrally authorized emergency organization.
 WHEN IS ICS ACTIVATED?
• Incidents are defined within ICS as unplanned situations necessitating a response.
Examples of incidents may include:
• Emergency medical situations (ambulance service)
• Hazardous material spills, releases to the air (toxic chemicals), releases to a drinking water supply
• Hostage crises
• Man-made disasters such as vehicle crashes, industrial accidents, train derailments, or structure
fires
• Natural disasters such as wildfires, flooding, earthquake or tornado
• Public Health incidents, such as disease outbreaks
• Search and Rescue operations
• Technological crisis
• Terrorist attacks
• Traffic incidents
WHEN IS ICS ACTIVATED?

• Events are defined within ICS as planned situations.

Incident command is increasingly applied to events both
in emergency management and non-emergency
management settings. Examples of events may include:
• Concerts
• Parades and other ceremonies
• Fairs and other gatherings
• Training exercises
KEY CONCEPTS IN ICS
 UNITY OF COMMAND
• Each individual participating in the operation reports to
only one supervisor. This eliminates the potential for
individuals to receive conflicting orders from a variety of
supervisors, thus increasing accountability, preventing
freelancing, improving the flow of information, helping
with the coordination of operational efforts, and
enhancing operational safety. This concept is fundamental
to the ICS chain of command structure
 COMMON TERMINOLOGY
• Individual response agencies previously developed their protocols separately,
and subsequently developed their terminology separately. This can lead to
confusion as a word may have a different meaning for each organization.
• When different organizations are required to work together, the use of common
terminology is an essential element in team cohesion and communications,
both internally and with other organizations responding to the incident.
• An incident command system promotes the use of a common terminology and
has an associated glossary of terms that help bring consistency to position
titles, the description of resources and how they can be organized, the type and
names of incident facilities, and a host of other subjects. The use of common
terminology is most evident in the titles of command roles, such as Incident
Commander, Safety Officer or Operations Section Chief
MANAGEMENT BY OBJECTIVE

• Incidents are managed by aiming towards specific

objectives. Objectives are ranked by priority; should be
as specific as possible; must be attainable; and if
possible given a working time-frame. Objectives are
accomplished by first outlining strategies (general plans
of action), then determining appropriate tactics (how the
strategy will be executed) for the chosen strategy
FLEXIBLE AND MODULAR
ORGANIZATION

• Incident Command structure is organized in such a way

as to expand and contract as needed by the incident
scope, resources and hazards. Command is established in
a top-down fashion, with the most important and
authoritative positions established first. For example,
Incident Command is established by the first arriving
unit.
FLEXIBLE AND MODULAR
ORGANIZATION
• Only positions that are required at the time should be established. In most
cases, very few positions within the command structure will need to be
activated. For example, a single fire truck at a dumpster fire will have the
officer filling the role of IC, with no other roles required. As more trucks
get added to a larger incident, more roles will be delegated to other officers
and the Incident Commander (IC) role will probably be handed to a more-
senior officer.
• Only in the largest and most complex operations would the full ICS
organization be staffed. Conversely, as an incident scales down, roles will
be merged back up the tree until there is just the IC role remaining.
SPAN OF CONTROL

• To limit the number of responsibilities and resources being managed by

any individual, the ICS requires that any single person's span of control
should be between three and seven individuals, with five being ideal. In
other words, one manager should have no more than seven people working
under them at any given time. If more than seven resources are being
managed by an individual, then they are being overloaded and the
command structure needs to be expanded by delegating responsibilities
(e.g. by defining new sections, divisions, or task forces). If fewer than
three, then the position's authority can probably be absorbed by the next
highest rung in the chain of command
WHAT ARE THE DIFFERENT
POSITIONS AND ROLES IN AN ICS?
TIME FOR A QUIZ!!!
QUIZ:

1-9. What are the unplanned instances when ICS is

activated?
10-13. What planned instances would ICS be activated?
14-16. The Incident Command System (ICS) is a
standardized approach to the ____, ______ and _______of
emergency response providing a common hierarchy within
which responders from multiple agencies can be effective.
QUIZ

• 17-20. What are 4 characteristics of an objective in ICS?

HOSPITAL
OPERATIONS PLAN
 HOSPITAL OPERATIONS PLAN
• Hospitals are required to have an Emergency Operations Plan
(EOP) which describes how a facility will respond to and
recover from all hazards. It is inclusive of the six critical
elements within the Joint Commission’s Emergency
Management Standards:
• Communications
• Resources and assets
• Safety and security
• Staff responsibilities
• Utilities and clinical
• Support activities
HOSPITAL OPERATIONS PLAN

• The “all hazards” approach allows ability to respond to a

range of emergencies varying in scale, duration, and
cause. The EOP addresses response procedures,
capabilities and procedures when the hospital can not be
supported by the community, recovery strategies, initiating
and terminating response and recovery phases, activating
authority and identifies alternate sites for care, treatment
and services.
 HOSPITAL OPERATIONS PLAN
• The Emergency Operations Plan (EOP) provides the structure
and processes that the organization utilizes to respond to and
initially recover from an event. The EOP is therefore the
response and recovery component of the EMP. 
• The Joint Commission Emergency Management Standards are
very specific to the requirements of the hospital EOP, however
it should be noted that some of these requirements cross over
to mitigation and preparedness activities. For a suggested
outline of the Emergency Management Program and for
further guidance, see the following
 HOSPITAL DISASTER
PREPAREDNESS SELF ASSESSMENT
TOOL
• This assessment tool was developed to assist hospitals in revising
and updating existing disaster plans or in the development of new
plans. The tool was originally used by a subject matter expert
survey team to collect data for a Department of Homeland Security
(DHS) grant so it is constructed in a survey format. The data was
then used to develop a specialized instruction program for that
facility that addressed any areas needing improvements. We feel
this assessment tool can also be utilized in a self-assessment
format by the institution in the review of their disaster plans.
 KEY COMPONENTS OF A HOSPITAL
EMERGENCY MANAGEMENT
PROGRAM (EMP)
Mitigation/Preparedness and Program Support Emergency Operations Plan (EOP) –
Response/Recovery
   
 Program Description signed by:  Activation and Termination of EOP, HCC, HICS
 Hospital CEO responders (criteria and protocols)
 Medical Chief of Staff  Integration with community ICS and response
 Hazard Vulnerability Analysis -Mitigation partners
 Minutes from:  HCC specific HICS Job Action Sheets (only those
positions that may be filled by your hospital)
 Emergency Management Committee.  Relevant annexes and policy/procedures (e.g.
 HPP Committee. Pandemic Influenza, surge capacity, security and
 Other Community Planning groups lockdown, evacuation, mass fatality management,
 MOUs and other agreements event specific HICS checklists and response guides
 Training Records (e.g. IS course, HICS, for high ranking HVA events, etc.)
decontamination training, etc.)  Hospital Resource Directory (HICS form 258) or
other personalized HICS forms
 Exercise Plans and Records
 All 6 critical areas (communication, resources,
  safety, staff, utilities, clinical) must be addressed in
the EOP
 Policies addressing use of Licensed Independent
Practitioners and other volunteer practitioners
 
 QUIZ
• 1-6. What are the six critical elements within the Joint
Commission’s Emergency Management Standards?
• 7. _________ is the approach which allows ability to
respond to a range of emergencies varying in scale,
duration, and cause.
• 8. __________ is an assessment tool which was
developed to assist hospitals in revising and updating
existing disaster plans or in the development of new
plans.
PERSONAL PROTECTIVE
EQUIPMENT (PPE) FOR
INFECTION CONTROL
 WHY USE PPE?
• Working as a nurse can sometimes be hazardous. From
common infections, such as influenza to frightening diseases,
such as Ebola, nurses treat patients with all types of infectious
conditions. It is important to wear the right personal protective
equipment to keep yourself from becoming infected and to
prevent spreading illness from patient to patient inadvertently.
Knowing what type of personal protective equipment to wear in
different situations is essential for nurses.
PERSONAL PROTECTIVE
EQUIPMENT
• Personal Protective Equipment (PPE) is specialized
clothing or equipment worn by an employee for
protection against infectious materials.
• PPE prevents contact with an infectious agent or body
fluid that may contain an infectious agent, by creating a
barrier between the potential infectious material and the
healthcare worker.
PERSONAL PROTECTIVE
EQUIPMENT
• You will not need to wear all equipment in every situation.
Depending on the type of germ or infection, you may need
different equipment. For example, in order to prevent certain
types of infections, you may need to wear a mask. In other
situations, you may only need a gown and gloves.
• The type of exposure you expect to have is also an important
consideration when selecting equipment. For instance, you
may need different equipment if you are drawing blood than
you would if you are taking a medical history.
 PERSONAL PROTECTIVE
EQUIPMENT
• Keep in mind, standard
precautions apply to working
with all patients regardless of
their condition. If you will be
handling blood or other body
fluids, or will be close to open
wounds or mucous
membranes, wear gloves, a
mask and gown.
 COMPONENTS OF PERSONAL
PROTECTIVE EQUIPMENT (PPE)
• Information on specific components of PPE. Including gloves, gowns, shoe covers,
head covers, masks, respirators, eye protection, face shields, and goggles.
• Gloves
Gloves help protect you when directly handling potentially infectious materials or
contaminated surfaces.
• Gowns
Gowns help protect you from the contamination of clothing with potentially
infectious material.
• Shoe and Head Covers
Shoe and head covers provide a barrier against possible exposure within a
contaminated environment.
COMPONENTS OF PERSONAL
PROTECTIVE EQUIPMENT (PPE)
• Masks and Respirators
Surgical masks help protect your nose and mouth from
splattered of body fluids, respirators filter the air before
you inhale it.
• Other Face and Eye Protection
Goggles help protect only your eyes from splatters. A
face shield provides splatter protection to facial skin,
eyes, nose, and mouth.
INFECTION CONTROL
PRECAUTIONS
• Infection control precautions are a set of
standard recommendations for designed to
reduce the risk of transmission of infectious
agents from body fluids or environmental
surfaces that contain infectious agents.
• These precautions include the use of
personal protective equipment that serve as
barriers to protect against contact with infectious
materials.
 INFECTION CONTROL
PRECAUTIONS
• Standard Precautions
Standard precautions are the basic level of infection control that should be
used in the care of all patients in all settings to reduce the risk of
transmission of organisms that are both recognized and unrecognized.
• Contact Precautions
Contact precautions should be utilized when direct or indirect contact with
contaminated body fluids, equipment or the environment is anticipated.
• Droplet Precautions
Droplet precautions should be utilized when working within 3 feet of a
patient who is coughing or sneezing or during procedures that result in
dispelling droplets into the air.
 INFECTION CONTROL
PRECAUTIONS
• Airborne Precautions
Airborne precautions should be utilized when exposure to
microorganisms transmitted via the airborne route is
anticipated – including procedures such as nebulizing,
suctioning, intubation.
• Full Barrier Precautions
Full barrier precautions should be utilized for diseases such as
Severe Acute Respiratory Syndrome (SARS), hemorrhagic
disease, and all known and suspect avian and pandemic
influenza patients.
QUIZ

1-5. What are the 5 types of infection control precautions?

HAZARDOUS
MATERIALS
WHAT ARE HAZARDOUS
MATERIALS?
• A hazardous material is any item or agent (biological,
chemical, radiological, and/or physical), which has the
potential to cause harm to humans, animals, or the
environment, either by itself or through interaction with
other factors. Hazardous materials professionals are
responsible for and properly qualified to manage such
materials. This includes managing and/or advising other
managers on hazardous materials at any point in their life-
cycle, from process planning and development of new
products; through manufacture, distribution and use; and to
disposal, cleanup and remediation
 WHAT ARE HAZARDOUS
MATERIALS?
• OSHA's definition includes any substance or chemical which is a
"health hazard" or "physical hazard," including: chemicals which are
carcinogens, toxic agents, irritants, corrosives, sensitizers; agents
which act on the hematopoietic system; agents which damage the
lungs, skin, eyes, or mucous membranes; chemicals which are
combustible, explosive, flammable, oxidizers, pyrophorics, unstable-
reactive or water-reactive; and chemicals which in the course of
normal handling, use, or storage may produce or release dusts,
gases, fumes, vapors, mists or smoke which may have any of the
previously mentioned characteristics. (Full definitions can be found
at 29 Code of Federal Regulations (CFR) 1910.1200.)
CLASSIFICATIONS OF
HAZARDOUS MATERIALS
• Explosives
• Gases
• Flammable Liquids
• Flammable Solids
• Oxidizing Substances
• Toxic & Infectious Substances
• Radioactive Material
• Corrosives
• Miscellaneous Dangerous Goods
CLASS 1 – EXPLOSIVES

• Explosives are materials or items which

have the ability to rapidly conflagrate or
detonate as a consequence of chemical
reaction.
 • Ammunition/cartridges
• Fireworks/pyrotechnics
• Flares
• Blasting caps / detonators
• Fuse
EXAMPLES OF
• Primers
EXPLOSIVES
• Explosive charges (blasting, demolition etc)
• Detonating cord
• Air bag inflators
• Igniters
• Rockets
• TNT / TNT compositions
• RDX / RDX compositions
• PETN / PETN compositions
CLASS 2 – GASES
• Gases are defined by dangerous goods regulations as
substances which have a vapour pressure of 300 kPa or
greater at 50°c or which are completely gaseous at 20°c
at standard atmospheric pressure, and items containing
these substances. The class encompasses compressed
gases, liquefied gases, dissolved gases, refrigerated
liquefied gases, mixtures of one or more gases with one
or more vapours of substances of other classes, articles
charged with a gas and aerosols.
 • Aerosols • Hydrogen / hydrogen
compounds
• Compressed air
• Hydrocarbon gas- • Oxygen / oxygen
powered devices compounds

• Fire extinguishers • Nitrogen / nitrogen

compounds
EXAMPLES • Gas cartridges
• Natural gas
OF • Fertilizer ammoniating
• Oil gas
GASES solution
• Insecticide gases • Petroleum gases

• Refrigerant gases • ButanePropane

• Lighters • Ethane

• Acetylene / • Methane
Oxyacetylene • Dimethyl ether
• Carbon dioxide • Propene / propylene
• Helium / helium • Ethylene
CLASS 3 – FLAMMABLE
LIQUIDS
• Flammable liquids are defined by dangerous goods
regulations as liquids, mixtures of liquids or liquids
containing solids in solution or suspension which give
off a flammable vapour (have a flash point) at
temperatures of not more than 60-65°C, liquids offered
for transport at temperatures at or above their flash point
or substances transported at elevated temperatures in a
liquid state and which give off a flammable vapour at a
temperature at or below the maximum transport
temperature.
 • Acetone / acetone oils • Tars
• Adhesives • Turpentine
• Paints / lacquers / varnishes • Carbamate insecticides
• Alcohols • Organochlorine pesticides
• Perfumery products • Organophosphorus
pesticides
• Gasoline / Petrol
EXAMPLES OF • Diesel fuel • Copper based pesticides
FLAMMABLE • Aviation fuel • Esters
LIQUIDS • Liquid bio-fuels • Ethers

• Coal tar / coal tar distillates • Ethanol

• Petroleum crude oil • Benzene

• Petroleum distillates • Butanols

• Gas oil • Dichloropropenes

• Shale oil • Diethyl ether

• Heating oil • Isobutanols

• Kerosene • Isopropyls
CLASS 4 – FLAMMABLE SOLIDS; SUBSTANCES LIABLE TO
SPONTANEOUS COMBUSTION; SUBSTANCES WHICH EMIT
FLAMMABLE GASES WHEN IN CONTACT WITH WATER

• Flammable solids are materials which, under conditions

encountered in transport, are readily combustible or may
cause or contribute to fire through friction, self-reactive
substances which are liable to undergo a strongly exothermic
reaction or solid desensitized explosives. Also included are
substances which are liable to spontaneous heating under
normal transport conditions, or to heating up in contact with
air, and are consequently liable to catch fire and substances
which emit flammable gases or become spontaneously
flammable when in contact with water.
 • Alkali metals • Seed cake
• Metal powders • Oily cotton waste
• Aluminium phosphide • Desensitized explosives
• Sodium batteries • Oily fabrics
• Sodium cells • Oily fibres
• Firelighters • Ferrocerium

EXAMPLES OF
• Matches • Iron oxide (spent
FLAMMABLE SOLIDS;
SUBSTANCES LIABLE TO
SPONTANEOUS COMBUSTION;
• Calcium carbide • Iron sponge/direct-
SUBSTANCES WHICH EMIT reduced iron (spent) 
FLAMMABLE GASES WHEN IN
CONTACT WITH WATER
• Camphor
• Carbon • Metaldehyde

• Activated carbon • Naphthalene

• Celluloid • Nitrocellulose

• Cerium • Phosphorus

• Copra • Sulphur
CLASS 5 – OXIDIZING SUBSTANCES;
ORGANIC PEROXIDES
• Oxidizers are defined by dangerous goods regulations as
substances which may cause or contribute to
combustion, generally by yielding oxygen as a result of a
redox chemical reaction. Organic peroxides are
substances which may be considered derivatives of
hydrogen peroxide where one or both hydrogen atoms of
the chemical structure have been replaced by organic
radicals.
 • Chemical oxygen • Calcium nitrate
generators
• Calcium peroxide
• Ammonium nitrate
• Hydrogen peroxide
fertilizers
• Magnesium peroxide
• Chlorates
• Lead nitrate
• Nitrates
• Lithium hypochlorite
EXAMPLES OF • Nitrites
FLAMMABLE SOLIDS; • Potassium chlorate
SUBSTANCES LIABLE TO
SPONTANEOUS COMBUSTION;
• Perchlorates
SUBSTANCES WHICH EMIT • Potassium nitrate
FLAMMABLE GASES WHEN IN
CONTACT WITH WATER
• Permanganates
• Potassium chlorate
• Persulphates
• Potassium perchlorate
• Aluminium nitrate
• Potassium
• Ammonium dichromate permanganate
• Ammonium nitrate
• Sodium nitrate
• Ammonium
• Sodium persulphate
persulphate
CLASS 6 – TOXIC SUBSTANCES;
INFECTIOUS SUBSTANCES
• Toxic substances are those which are liable either to
cause death or serious injury or to harm human health if
swallowed, inhaled or by skin contact. Infectious
substances are those which are known or can be
reasonably expected to contain pathogens. Dangerous
goods regulations define pathogens as microorganisms,
such as bacteria, viruses, rickettsiae, parasites and fungi,
or other agents which can cause disease in humans or
animals.
 • Medical/Biomedical waste • Barium compounds
• Clinical waste • Arsenics / arsenic
compounds
• Biological cultures / samples
/ specimens • Beryllium/ beryllium
compounds
• Medical cultures / samples /
specimens • Lead compounds
• Tear gas substances • Mercury compounds
• Motor fuel anti-knock • Nicotine / nicotine
EXAMPLES OF mixture compounds
TOXIC SUBSTANCES;
INFECTIOUS • Dyes • Selenium compounds
SUBSTANCES
• Carbamate pesticides • Antimony
• Alkaloids • Ammonium metavanadate
• Allyls • Adiponitrile
• Acids • Chloroform
• Arsenates • Dichloromethane
• Arsenites • Hexachlorophene
• Cyanides • Phenol