The Philippines is among the most hazard-exposed countries in the world: about 20 tropical cyclones enter the Philippine Area of Responsibility each year, and floods, landslides, earthquakes, volcanic eruptions, storm surges, and droughts are frequent. PAGASA issues tropical cyclone wind signals numbered 1 to 5, and PHIVOLCS monitors earthquakes and volcanoes.

Key terms

Disaster risk reduction and management (DRRM) shifts the focus from reacting to disasters toward reducing risk before they happen while still preparing for effective response and recovery.

Vulnerable groups in disasters: infants and children, pregnant and lactating women, older persons, persons with disabilities, people with chronic illness or on dialysis or oxygen, people with mental illness, indigenous peoples, and the very poor. Assessment of a family's disaster vulnerability considers members' health and mobility, housing location and structure, income and savings, access to information, and social support — not unrelated factors such as personal hobbies.

Philippine Disaster Risk Reduction and Management Act of 2010 (RA 10121)

• Reconstituted the former National Disaster Coordinating Council as the National Disaster Risk Reduction and Management Council (NDRRMC).
• Chair: Secretary of National Defense. Vice-chairs by thematic area:

• Office of Civil Defense (OCD) — secretariat and executive arm of the NDRRMC; the OCD Administrator is the Council's Executive Director.
• Local DRRM councils at the provincial, city, and municipal levels, with Local DRRM Offices; at the barangay level, the Barangay Development Council performs the functions of the Barangay DRRM Committee.
• State of calamity: declared by the President upon the NDRRMC's recommendation, or by the local sanggunian upon the local council's recommendation, based on damage assessment.
• Local DRRM Fund: at least 5% of estimated regular revenue, of which 30% is a Quick Response Fund for relief and recovery.
• Prohibited acts include preventing the distribution of relief goods, buying relief goods from relief agencies, selling or diverting relief goods, and misrepresenting their source.
• The national framework and plan are organized around the four thematic areas above.

Disaster management cycle

1. Prevention and mitigation — reduce the chance of a disaster or lessen its impact: hazard mapping, building codes, relocation from danger zones, flood control, vaccination, and risk education. Most risk reduction activity belongs here.
2. Preparedness — plans, drills, early warning systems, stockpiles, training, pre-positioned medicines, family emergency kits.
3. Response — rescue, triage, emergency care, evacuation, shelter, water and sanitation, disease surveillance, psychological first aid.
4. Rehabilitation and recovery — restore services and livelihoods, rebuild and strengthen the health system, long-term mental health support, and "build back better."

Humanitarian standards used in the field

• Sphere — the Humanitarian Charter and minimum standards for water, sanitation and hygiene, food and nutrition, shelter, and health; its purpose is to ensure people affected by disaster live with dignity and receive assistance of acceptable minimum quality (for example, at least 15 liters of water per person per day for drinking, cooking, and hygiene as a key indicator).
• Cluster approach — organizes responders by sector (health, WASH, nutrition, shelter, protection, logistics) so that each has a lead agency, gaps and duplication are avoided, and coordination with government is clear; in the Philippines, government agencies lead the national clusters, with the DOH leading the health cluster (which includes WASH, nutrition, and mental health and psychosocial support sub-clusters).
• Humanitarian principles — humanity, neutrality, impartiality, and independence; aid is distributed according to need, without discrimination.

START triage (adults) — consistent with the triage topic:

• Can walk → Green (minor).
• Not breathing → reposition the airway; still not breathing → Black (expectant/deceased); breathes after repositioning → Red.
• Respiratory rate > 30/min → Red.
• No radial pulse or capillary refill > 2 seconds → Red (control bleeding).
• Cannot follow simple commands → Red; otherwise → Yellow (delayed).

Preparedness (before)

• Participate in hazard, vulnerability, and capacity mapping with the barangay; keep an updated list of vulnerable persons and their needs (mobility aids, oxygen, dialysis, medicines).
• Prepare the health facility's emergency plan, communication tree, and backup communication (radios, messengers); train staff; conduct drills.
• Pre-position medicines (including doxycycline for leptospirosis prophylaxis as directed by the DOH), vaccines, ORS, water purification supplies, and PPE.
• Teach families to prepare go-bags (water, food, medicines, documents, flashlight, radio) and an evacuation plan.

Response (during and immediately after)

1. Scene safety first — for chemical spills, approach from upwind and uphill, stay out of the contaminated zone, and wait for decontamination teams; an injured responder becomes another casualty.
2. Triage with START; treat Red first; reassess repeatedly.
3. If communication systems fail, follow the pre-arranged emergency plan and chain of command, use backup channels, and report through the incident command structure rather than acting alone.
4. Evacuation centers: the top infection-prevention priority is safe water, sanitation, and hygiene (toilets, handwashing, waste disposal), plus adequate ventilation, space, and isolation areas for people with fever, cough, diarrhea, or rash.
5. Disease surveillance in evacuation centers: watch for diarrhea, acute respiratory infection, measles, skin infections, dengue, and — after floods — leptospirosis. A cluster of fevers after an earthquake or flood may also signal waterborne illness from contaminated supplies.
6. Food safety: serve food promptly, keep it covered, discard leftovers that were not kept cold, and use safe water; do not keep cooked food at room temperature for hours.
7. Psychological first aid (PFA): ensure safety, comfort, and basic needs; listen without pressure; never force people to describe the traumatic event; connect them with family and services; refer severe reactions.
8. Special populations: ensure continuity of medicines, maternal and newborn care, infant feeding support (breastfeeding protection), and accessible shelter for persons with disabilities.

Rehabilitation and recovery (after)

• Restore primary care services, cold chain, and records; repair water and sanitation systems.
• Follow up chronic disease and mental health needs; watch for delayed stress reactions.
• Community health education on environmental hazards after floods — boil water, clean safely with boots and gloves, remove standing water (dengue), and avoid wading (leptospirosis).
• Build back better — relocate or strengthen facilities, update plans from lessons learned.

Responder well-being

• Rotate shifts, ensure rest, food, and water; use peer support and supervision; monitor for secondary traumatic stress and burnout; refer for professional help as needed. Routine single-session psychological debriefing is not recommended.

International and external relief teams

• First step on arrival: coordinate with local authorities and the cluster system, and assess needs before acting.
• Distribute supplies by need and impartiality, respecting culture and dignity.
• In conflict areas, follow humanitarian principles and security rules.
• On exit, hand over to local health services and build local capacity so services continue.

1. Planner — contribute to barangay and facility DRRM-health plans; map vulnerable persons.
2. Educator — preparedness training, go-bag and evacuation drills, first aid, post-disaster health teaching.
3. Responder — triage, emergency care, evacuation center health services, surveillance, PFA.
4. Coordinator — work within the incident command system with the LDRRMO, DSWD, DOH, and volunteers.
5. Advocate — protect the needs of vulnerable groups and fair distribution of relief.
6. Expanded role — in disasters nurses often take on extended functions (field triage, leadership of shelter health teams, community organizing) within their competence and legal scope.
7. Recovery worker — restore services and follow up long-term physical and mental health needs.

• RA 10121 defines the DRRM structure; nurses act through their local DRRM system and incident command, not independently.
• Relief goods must not be diverted, sold, or withheld — these are prohibited acts under the law.
• Justice and impartiality — triage and aid follow need, not status or relationships.
• Duty to care vs. personal safety — responders must not enter unsafe scenes without protection.
• Documentation of triage categories, treatments, and referrals continues in disasters; protect personal data (RA 10173).
• Crisis standards of care are declared through proper authority, not decided alone at the bedside.

Case 1. After a typhoon, an evacuation center reports several children with diarrhea.

Action: Check water sources and toilets, ensure safe drinking water and handwashing, isolate ill children, report the cluster, and give ORS. Why: water, sanitation, and hygiene are the top priorities for preventing outbreaks in shelters.

Case 2. At a bus crash, a man walks to the nurse holding his bleeding arm.

Action: Tag him Green, direct him to the minor-injury area, and continue assessing others. Why: in START, anyone who can walk is initially Green.

Case 3. A casualty has a respiratory rate of 34/min and a radial pulse.

Action: Tag Red. Why: respiratory rate above 30/min is a Red criterion.

Case 4. A barangay asks how to prepare before the rainy season.

Action: Update hazard maps and the vulnerable-persons list, conduct evacuation drills, and pre-position supplies. Why: preparedness and mitigation reduce deaths far more than response alone.

• Treating disaster management as response only — RA 10121 emphasizes prevention, mitigation, and preparedness.
• Mixing up NDRRMC vice-chairs: DOST mitigation, DILG preparedness, DSWD response, economic planning agency for recovery.
• Tagging a non-breathing casualty Red — only one who breathes after airway repositioning is Red.
• Forcing survivors to retell the traumatic event.
• Giving routine antibiotics to everyone in shelters instead of focusing on water and sanitation (the DOH-advised doxycycline for flood exposure is a specific exception).
• Relief teams acting before coordinating with local authorities.

• RA 10121 (2010): NDRRMC chaired by the Secretary of National Defense; OCD is secretariat and executive arm.
• Vice-chairs: DOST (prevention/mitigation), DILG (preparedness), DSWD (response), economic planning agency (rehabilitation/recovery).
• Local DRRM councils and offices; Barangay Development Council acts as the BDRRM Committee.
• LDRRMF ≥ 5% of estimated regular revenue; 30% of it is the Quick Response Fund.
• State of calamity: President (on NDRRMC recommendation) or local sanggunian (on local council recommendation).
• Cycle: prevention/mitigation → preparedness → response → rehabilitation/recovery.
• START: walk → Green; RR > 30, no radial pulse or CRT > 2 s, cannot follow commands → Red; not breathing after repositioning → Black.
• Shelters: water, sanitation, hygiene first; watch diarrhea, respiratory infection, measles, dengue, leptospirosis.
• PFA: safety, comfort, needs, connection — never force retelling.
• Sphere = minimum standards for dignity; cluster approach = sector coordination; humanitarian principles = humanity, neutrality, impartiality, independence.