Disaster Nursing : Disaster Nursing Unit 6
NUR 159 Levels of Disasters : Levels of Disasters Disasters are given levels by the amount of anticipated response that will be necessary to contain it.
Level one: local emergency response personnel and organizations can contain and manage it.
Level two: help from the surrounding area will be needed to contain the disaster.
Level three: Local and regional resources are overwhelmed. State and federal help is needed. Types of disasters : Types of disasters Chemical weapons attack
Biological weapons attack
Toxic substance spills
Floods, hurricanes, fires, tornadoes, earthquakes Federal Agencies that help with Disasters : Federal Agencies that help with Disasters Department of Justice
Department of Health and Human Services
Department of Homeland Security
Federal Emergency Management Agency
These agencies call in different teams for the type of emergency. State and Local Resources : State and Local Resources Office of Emergency Management( most larger cities should have them) Hospital Emergency Preparedness Plans : Hospital Emergency Preparedness Plans Health care facilities are required by the Joint Commission on Accreditation of Healthcare Organizations to create an emergency preparedness plan and to practice it 2 times a year.
A planning committee at the facility comes up with a profile of the community( military base, nuclear power plant, near the coast) in order to put a likely disaster scenario in place Components of any emergency preparedness plan : Components of any emergency preparedness plan Activation response
Internal/external communication plan
Plan for coordinated patient care
Identification of external resources
Plan for people management and traffic flow Data management strategy
Post incident response
Plan for practice drill
MCI planning: mass fatality and morgue readiness
An educational plan Steps to responding to a disaster : Steps to responding to a disaster ID the patients, patient tracking is critical: name, address, age, location, description of injuries, triage category, treatments already performed Cont. : Cont. Triage is the sorting of patients to determine the priority of their health care needs and the proper sites for treatment.
The goal is to do the most good for the most people. Decisions are made on the likelihood of surviving and how many resources will be consumed in the process.
There should be designated triage officers and the triage spot should be outside or at the door to the ER.
Most organizations use a four color triage system to prioritize patients. Triage Categories : Triage Categories Red(highest): ex. sucking chest wounds, airway obstruction, shock, hemothorax, tension pneumothorax, unstable chest and abdominal wounds, open long bone fractures, 2nd/3rd degree burns
Yellow(lower priority than red): ex. stable abdominal wounds without hemorrhage, soft tissue injuries, facial injuries without airway compromise, vascular injuries with collateral circulation, genitourinary tract disruption, fractures requiring open reduction, most eye and CNS injuries Cont. : Cont. Green(minimal): ex. upper extremity fractures, minor burns, sprains, small lacerations without major bleeding, behavioral or psychological disturbances
Black( expectant): unresponsive patients with penetrating head wounds, high spinal cord injuries, multiple system injuries, 2nd/3rd degree burns over 60% of the BSA, profound shock with multiple injuries, seizures or vomiting within 24 hours of radiation exposure, agonal respirations, no pulse and fixed, dilated pupils Communicating with the media and families : Communicating with the media and families There should be a clear spokesperson for the Health care facility to speak to the press. Security shouldn’t allow the press into the patient care areas. Updates should be given on regular intervals.
Families of victims should be taken to an appointed area staffed by therapists, counselors and clergy. What is the Nurse’s role? : What is the Nurse’s role? Our flexibility can put us in many roles during a real disaster: caring for patients, triage, bereavement. Possible ethical conflicts : Possible ethical conflicts Rationing care
Assisted suicide Behavioral issues after a disaster : Behavioral issues after a disaster The following behavioral responses are common after a disaster: depression, anxiety, somatization[fatigue, general malaise, headaches, GI disturbances, skin rashes], posttraumatic stress disorder, substance abuse, interpersonal conflicts, impaired performance
Critical Incident Stress Management can help emergency providers to help prevent and/or treat emotional trauma from dealing with a disaster. Trends that can indicate a biological or chemical attack : Trends that can indicate a biological or chemical attack An unusual increase in the number of people seeking care for fever, respiratory or GI symptoms.
Clusters of patients with the same unusual symptoms from a single location.
Large number of quickly fatal cases, especially less than 72 hours after hospital admission.
Any increase in disease incidence in a normally healthy population. Personal Protective Equipment : Personal Protective Equipment The EPA has placed protective equipment into 4 categories A-D.
A: worn when you need the most protection available. Self contained breathing apparatus(SCBA), vapor tight chemical suit with chemical resistant gloves and boots.
B: lesser protection but still includes SCBA and chemical suit.
C: Air purified respirator, coveralls with face splash guard, chemical resistant gloves and boots.
D: typical work uniform Decontamination : Decontamination Critical step in exposure, the removal of accumulated contaminants.
2 steps: removal of patient’s jewelry and clothes and rinsing them with water.
Second step is a thorough soap and water wash and rinse.