Chapter 15 Security and Disaster Plans

Question 0

Describe the difference between intern emergency readiness and external emergency readiness.

Answer 0

Internal. Includes safety hazardous materials protocols as infection control policies and practices.

External. Includes participation in community-wide emergencies and disasters.

Question 1

Disasters that health care facilities face include internal and external emergencies. Explain the difference.

Answer 1

Internal include loss of electric power or portable water, severe damage or causalities within the facility related to fire/weather, etc.

External include any outside mass causality experience. Hurricanes, floods, pandemic flu, major accidents.

Question 2

The Joint Commission and Emergency Preparedness standards mandate that an emergency plan is developed by all health care institutions. And there specific standards are:

Answer 2

Notifying and assuaging personnel
Notifying external authorities of emergencies
Managing space and supplies
Providing security
Isolating and decontaminating agents
Evacuating and setting up alternative care site when institution is compromised.

Question 3

TJC requires how many emergency preparedness drills a year?

Answer 3

Two. They should include. An influx of clients and either an internal or external disaster.

Also participating in one community-wide drill per year.

Question 4

What is the process when an alternative care site is necessary?

Answer 4

Client information/care packaging (medications,supplies, admissions)
Inter facility communication
Transportation of clients
Cross-privileging of medial staff

Question 5

In disaster planning and emergency response plans triage provisions are changed from a normal day to day setting, explain how ?

Answer 5

Causalities are separated in relation to their potential for survival.

Question 6

What are the categories of triage during mass casualty events?

Answer 6

Emergent (Class I) - highest priority
Urgent (Class II) - second highest priority
Nonurgent (Class III)
Expectant (IV)

Question 7

Explain Emergent Category (Class I).

Answer 7

Highest priority, given to clients who have life threatening injuries and a high possibility of survival.

Question 8

Explain Urgent category (Class II).

Answer 8

Second highest priority, given to clients with major injuries which are NOT yet life-threatening and can wait 45 to 60 min for treatment.

Question 9

Explain Nonurgent category (Class III):

Answer 9

Priority given to clients who have minor injuries that are NOT life threatening and do not need immediate attention.

Question 10

Explain Expectant category (Class IV):

Answer 10

Lowest priority given to clients who are not expected to live and are allowed to die naturally. Comfort measures may be provided but restorative care is not.

Question 11

During an emergency like fire or mass casualty what is the criteria to follow regarding discharge and relocation of clients safely?

Answer 11

• Ambulatory clients that require minimal care are discharged or relocated first.
• Clients requiring assistance are next and arrangements are made for continuation if their care.
• Clients who are unstable are not discharged or relocated unless they are imminent danger.

Question 12

During a fire, if evacuation is necessary in what direction should the evacuation occur in?

Answer 12

Horizontal evacuation is done first. Lateral evacuation is done if client safety cannot be maintained.

Question 13

During a sever thunderstorm/tornado what are some precautions?

Answer 13

Draw shades and close drapes to prevent glass shattering
Lower beds at lowest position
Place blankets over clients confined to bed.
Monitor for severe weather.

Question 14

Name some biological pathogens:

Answer 14

Inhalation of Anthrax
Cutaneous anthrax 
Botulism 
Vital Hemorragic fevers (Ebola/yellow fever)
Plague
Smallpox
Tularemia

Question 15

What are the security issues faced by health care facilities?

Answer 15

Admission of potentially dangerous individuals
Vandalism
Infant abduction
Information theft

Question 16

What organization provides recommendations for the development of security plans?

Answer 16

The internal association for Heath care security & safety (IAHSS)

Question 17

In a security plan nurses should be aware that security measures include:

Answer 17

Identification system (identifies employees, volunteers, physicians, students, etc)

Electronic security systems in high risk areas (maternal newborn)

Question 18

What are some examples of electronic security systems in high risk areas?

Answer 18

Key code access into and out of areas
Wristbands that electronically link
Alarms integrated with closed circuit tv cameras

Question 19

In the case of a client coming into contact with a chemical agent what should be the steps to assist client?

Answer 19

Undress client
Remove all identifiable chemical
Provide immediate and prolonged irrigations of contaminated area with running water.

Question 20

What procedure should be used in the case of a client coming into a dry chemical, such as a lye or white phosphorous?

Answer 20

Brush agent off clients clothing and skin.

Question 21

In the event of contamination of a biological hazard, how would a nurse decontaminate the client?

Answer 21

Wash skin with large amounts of water and antibacterial soap.

Question 22

If a bomb threat phone call is received, what should the receiver of the call do?

Answer 22

Extend conversation as long as possible
Listen for distinguishing background noises
Note voice characteristics of caller
Ask where and when bomb is set to explode.
Note whether caller is familiar with arrangement of hospital

Question 23

What are some clinical manifestations of anthrax?

Answer 23

Sore throat 
Fever
Shortness of breather
Severe dyspnea 
Meningitis

Question 24

What are nursing interventions for anthrax?

Answer 24

Oral ciprofloxian (cipro)
IV ciprofloxian
Vancomycin or penicillin

Question 25

What are the clinical manifestations of botulism?

Answer 25

Difficulty swallowing
Double vision
Slurred speech
Descending progressive weakness

Question 26

What are the nursing interventions for botulism?

Answer 26

Airway management
Antitoxin
Elimination of toxin

Question 27

What are the clinical manifestations of Pneumonic plague?

Answer 27

Fever 
Headache
Rapidly developing pneumonia 
Chest pain
Bloody or watery sputum 
Progress for 2 to 4 days.

Question 28

What are the nursing interventions for pneumonic plague?

Answer 28

Early treatment is essential
Administer antibiotics within 24 hr of first symptom (streptomycin, gentamicin, tetracyclines and chloramphenicol are all effective)

Question 29

What are the clinical manifestations of tularemia?

Answer 29

Sudden fever 
Chills
Diarrhea
Joint pain
Dry couch
If airborne, life threatening pneumonia and systemic infection.

Question 30

What are the nursing interventions for tularemia?

Answer 30

Streptomycin IV or gentamicin IV or IM are drugs of choice

In mass casualty use doxycycline or ciprofloxacin.