Disaster Flashcards
Definition of disaster:
Number of casualities/ their needs > usual (incl surge) resources.
Disaster Triage SIEVE
BLACK- Dead or Expectant
- Not breathing after airway opened
- Analgesia but leave / palliate.
RED- Immediate life-threat
- RR > 29/<10, no radial pulse or cap refill >2, not obeying*
- Taken to collection point 1st
- Resus area
YELLOW- Serious, but not immediate life-threat
- All others
- Taken to collection point 2nd
GREEN- Walking wounded
- Can walk
- Walk to designated area, then transport en masse (eg. busload) later on
ED Disaster Response:
NOTIFY
- Activate Code Brown and local disaster plan
- Meet with Nurse in Charge
Call:
- HoD, Hospital CEO
- ICU, Anos, Trauma, Paeds/NPICU
- Orderlies, security, pharmacy
- Blood bank, radiology, pathology
- Public Health PRN
SPACE
- Clear out dept and WR
- Command centre
- Triage (1 ambos, 1 walk-ins)
- Decontamination
- Spec areas for colours
- Utilise Non-clinical areas:
–> Offices for telcom
–> Plaster room for minors
–> Cafeteria/ lecture theatre for relatives
- Overflow: clear/open up wards/ OT/ recovery for overflow
STAFF
- Call in extra staff
- Designate to areas, senior in each
- Volunteer manager
- Single media liason
EQUIPMENT + DRUGS
- Access hospital surge supply
- PPE
- Pelvic binders, splints/plaster, tourniquets, ventilators
- Radios, whiteboard
- Antis, fluids, blood, TXA
PROCESSES
- Disaster triage including diversion
- Paper records (consider labels/ paper attached to patients for tracking)
- Radio comms
ONGOING
- Rostering/ staff relief
- Nutrition
- Psychol support
- Coordinating aid
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OSCE:
- General plan
- Specify roles/ immediate steps
- Summarise
What are the ‘zones’ to set up in a chemical/ biohazard scene:
HOT ZONE
- Including + immediately around incident site
- Restricted to personnel in full HazMat
- Single entry/exit points
- Victims are moved out via a 3rd designated point
WARM ZONE
- Around hot zone, used for decontamination
- Must be UPHILL and UPWIND from Hot Zone
- Also restricted to personnel in full Hazmat, via single entry/exit points.
- Victims enter from hot zone (via single point) to be decontaminated in warm zone
- Seperate decontam area for personnel
- 3rd site to hold contaminated articles/ evidence
COLD ZONE
- Restricted to personnel and support agencies
- PPE not required
- Triage and treatment
How does disaster triage differ for children?
- If no breathing after airway manoeuvre, not immediately Black
–> If pulse, *try rescue breaths before deciding futile. - RR decision for Red vs Yellow is age-appropriate parameters
- ‘Obeys’ becomes ‘AVPU’. U or inappropriate P –> Red.
Identifying bioterrorism/ biohazard:
Clues:
- Multiple patients with same
- Geographically co-located
- At event (eg. concert)
- Dead plants/ animals
- Intelligence/ reports
- Unusual, non-endemic organisms (or susbtance)
Principles of decontamination:
- Full PPE
- One-way conveyor
- Enter, clothes off, wash, soap/shamp, wash again, clean clothes –> out
- Single entry/exit points- all one-way
- Restricted/ secure points
- Full HazMat + trained personnel enter only
What is dry vs wet decontamination?
Dry: scraping, vacuuming etc. (pre-wash)
Wet: showering/washing
Components of PPE for chemical/biohazard:
Infection control can advise exact level of PPE
- Hooded suit/ hat
- Glasses
- N95 mask/ respirator
- Coveralls
- Gloves
- Shoe covers
6 key elements of on-scene disaster management:
Command & control
Safety- of self, scene, survivors
Communications
Triage, Assessment, Treatment, Transport
METHANE disaster communication:
Major incident declared
Exact location
Type of incident (explosion, biological etc.)
Hazards present and potential
Access
Number and Nature of casualties
Emergency services present and required
Disaster Triage: about
On-scene at site of disaster, primary disaster triage (SEIVE) occurs:
—> Black, red, yellow, green
—> Determines priority of initial treatment
Once in designated collection point, secondary disaster triage (SORT) occurs:
—> Uses GCS and vitals
—> Determines priority of transport (eg. amongst all the red patients)
Exposure in department: (eg. measles)
- Acknowledge gravity and need for urgent Mx
- About disease:
—> Nature, symptoms, danger, vulnerable groups, infectious period - Broad management:
—> Patient well-being and plan
—> Notifications: Director, Infection control, public health
—> Staff and WR exposure trace and offer PEP PRN.
—> Review processes
___________________
PATIENT
- Call and check well-being
- Plan for Tx with GP/ return to hospital etc. (neg pressure room)
- Advise isolation, avoid risk groups
- Vaccinate if unvacc
WORKPLACE
- Gather facts:
—> Locations, durations, specific interactions, nature of contact.
—> Notify all exposed (staff/ patient)
—> Offer PEP if signif exposure + not vacc.
PROCESSES
- RCA + QI
- Education re recognition etc.
