Disaster Planning T2 Flashcards
An occurrence, natural or man-made that causes human suffering and creates human needs that can not be alleviated without assistance
An event of such magnitude that essential services are disrupted and exceeds resource capabilities
Internal vs. external
Disaster
Internal disasters
Occurs inside a healthcare facility Endangers patient Possible need for evacuation Extra personnel Fire, flood, computer system
External disasters
Event outside of the facility
In the community
May deplete resources
Internal and external disaster example?
Tornado that hits building and surroundings
Types of disasters
Natural
Technological
Bioterrorism
Accidents
Natural Earthquake, tsunami, hurricane, flooding, tornado, blizzard, wildfire Technological Explosive devices, nuclear power malfunction Bioterrorism Anthrax, Accidents Multi vs. Mass casualty
Multi-casualty vs mass casualty:
difference is the scope and scale of the incident, considering the number of victims or casualties
Can be managed by a hospital using local resources
Can contain what is going on with the resources provided
Initiates response plans
Multi casualty
Overwhelms local medical capabilities
May require collaboration of other facilities
May pull from other hospitals for needed resources
Mass-casualty *
Stages of disaster
? stage - preparing and learning disaster strategies. Know how to respond in case of a disaster
? stage- know that there is a disaster close or coming and better prepare (covid-19) watching other states have issues and prepare in advance
? stage- patients need advanced care, work on continuously getting needed supplies
? stage- after impact hit- post impact stage initial start of recovery
? stage- look at what we did right or wrong and how we can change things in the future to make things better
Non disaster stage - preparing and learning disaster strategies. Know how to respond in case of a disaster
Predisaster stage- know that there is a disaster close or coming and better prepare (covid-19) watching other states have issues and prepare in advance
Impact stage- patients need advanced care, work on continuously getting needed supplies
Emergency stage- after impact hit- post impact stage initial start of recovery
Reconstruction/recovery stage- look at what we did right or wrong and how we can change things in the future to make things better
How do disasters have impact of infrastructures
Transportation Electrical Telephone Water Fuel Supplies
Lessons learned in disaster recovery phase?
Potential threats examined Early warning systems “ If you see something, say something campaign” Red, yellow, green
Do not assume the government agencies will provide immediate help
Learn to cope without water and electricity
Disaster preparedness requirements for nursing facilities :
Planning must include what?
Which organization requires this?
To ensure safety of clients and staff.
What is the goal of preparedness ?
Planning
Since 2005 JCAHO expects communication and coordination between emergency departments to occur
Planning must include disaster recovery, Practice disaster plans: fire, mass casualty accidents, chemical spills, active shooter, evacuation plan
Goal of preparedness: effectively meet the extraordinary need for resources
Staff must actively participate and take them seriously
Nursing homes practice as well
Gatekeeper”
Sorts patients into priority levels based on illness or injury severity
Highest acuity receives quickest intervention
Triage
Patient has immediate threat to life or limb, and requires immediate treatment
Patient should be treated quickly but immediate threat to life does not exist at the moment
Patient can usually wait several hours for care without risk
Emergent
Urgent
Non urgent
Goal for mass casualty triage?***
Way of sorting the victims
Emergent-Immediate-Non-emergent
Immediate-Delayed-Dead
Red-Yellow-Green-Black
Providing the greatest benefit to the greatest number of people **
Key process in any multi/mass casualty event
Rapidly sort ill or injured patients
Emergent/red: see now or die
Wait a short time: yellow
Walking wounded: green
Expected to die/are dead: black
Normal vs mass casualty triage
?
Immediate threats to life
Airway-increases rep rate
Shock-absent radial pulse /decreased perfusion
Neuro- mental status change
Which tag?
Red /emergent
Major injures
Open fractures
Large wounds
Serious but can wait about 2 hours for care
Which tag?
Yellow/urgent
walking wounded’
Can evacuate themselves
Closed fractures
Able to walk
Non urgent green tag 🤕
Death is impending
CPR is a no
Significant head trauma
Apnea
Black tag 😢 💀
52 yo man in full cardiac arrest who has been receiving CPR continuously for the past 30 min.
Firefighter who is showing combative behavior and has a respiratory stridor.
60 yo woman with full-thickness burns to the hands and forearms
Teenager with a crushed leg that is very swollen who is anxious and has tachycardia
3 yo child with respiratory distress and burns over more than 70% of the anterior body
12 yo with wheezing and very labored respirations unrelieved by an asthma inhaler
Black
Red
Yellow or red?
Yellow?
Red/black?
6 yo with a temp of 103.2- red
22 yo female with asthma in acute respiratory distress-red
An infant who has been vomiting for 2 days-yellow?
50 yo male with low back pain and spasms-green
32 yo female with is unconscious following an automobile accident-red
40 yo woman with rhinitis and cough-green
58 yo male with midsternal chest pain-red
16 yo teenage with an angulated forearm following a sports injury.
Green?
?
A. Patient with 8 inch laceration on top of left thigh; bone is exposed
B. Patient with asthma attack and wheezing
C. Child with fever of 102
D. Patient with crush injury to left hand, able to detect radial pulse
B
Mass casualty
Sort the victims how?
Everyone gets tagged first, then treat patients
Treat the victims how?
Airway, Breathing, circulation are priorities
CPR is not done**
Document- what to document ?
Information on location of victims
Number of casualties and degree of injury
Who should triage?*
Experienced nurse who has experience with triaging and determine the tags
Nurses EMS Physicians Should have experience in triage Able to critically think and make decisions
Nurses role in disaster
Know what to do in a disaster, drills
Understand what/where the response plan is kept
Participate in the drills
Be able to locate critical supplies
Who to communicate with
Contribute to the post-disaster discussions
Participate/Request Critical Stress Debriefing Episodes (talk about what could have gone better)
Decontamination protocols ?
Removal of contaminants-No jewelry or clothing
Before coming into hospital or emergency vehicle - if not may need to shut down area
Who gets decontaminated?
Those who are triaged as immediate
In need of life saving procedures
Those exposed to nerve agents
Those closest to the release, then those who have aerosol, liquids, etc.
Outside of the ER
Large enough to get as many through as possible
Describe decontamination tent**??
Recognize the major high priority agents
Smallpox (Variola major)
Anthrax
Plague
Pages 427-429 table on 429
Bioterrorism
Considered to be eliminated worldwide
This makes it bioterrorism!!!
Sudden onset high fever, Rash starts on face and spreads
Vaccination within 2-3 days of exposure is the tx
Strict isolation including
N95 mask
Onset 10-17 days after contact (airborne or droplet, physical contact with sores)
Smallpox
Cutaneous or inhalation
Skin itching-Ulcers-sloughing
Severe respiratory distress
Up to six weeks incubation
Antibiotics (Cipro or Doxycycline)
Standard precautions for wound care, ventilator support and postmortem care
Treatment ?
Anthrax (bacillus anthracis)
Treatment is oral or IV ciprofloxacin
High fever, cough, skin lesions, bubo
Droplet transmission
Almost always fatal without treatment (antibiotics)
Bubo: painful lymphadenopathy usually inguinal, axillary, or cervical
Sepsis with DIC
Plague (yersinia pestis)
Pulmonary agents (Phosgene) Cyanide agents Nerve agents (Sarin) (Ricin)
Act to turn off the body’s acetycholinesterase (body’s off switch)
How to clean ?
Meds / treatment ?
Chemical agents
Decontamination is critical: soap and water
Meds to treat: atropine
What to do if bioterrorism is suspected
Protect self through use of Universal precautions
Recognize the possibility of an event
Contact authorities
(Your no good to others if your sick as well)
Mental health triage
Psychological first aid
Comfort, console, protect from threats,
Provide for physical needs
Establish safety and protection:
Create a calm stable environment,
Provide personal space
Facilitate sense of belonging
Connect with survivors and family
Provide opportunities to grieve
-Experiencing a disaster has both immediate and long lasting effects
Coping abilities are stressed
Unable to sleep, easily startled, flashbacks, physical symptoms of stress (nausea, dizziness, headache), decreased social/verbal interaction
Prevention:*
Post trauma -reach out for help
Healthy lifestyle: diet/exercise
Adequate sleep
Limit caffeine and avoid alcohol
(Look in book at this section)
Mental health shock phase and duration
Emotional
Cognitive
Behavioral
24-48 hours
Emotional- anxiety, helplessness, overwhelmed
Cognitive- Disorganized thinking, unable to plan, confused
Behavioral-Aimless wondering, hyper active, submissive
Mental health defensive retreat phase and duration
Emotional
Cognitive
Behavioral
2 weeks
Emotional- superficial calm
Cognitive - denies injuries , nothing is wrong , usual coping, mechanisms don’t work
Behavioral - usually withdraws, resistant time change
Mental health acknowledgment of reality phase and duration
Emotional
Cognitive
Behavioral
Emotional- tension and anxiety, self hate, low self esteem
Cognitive - attempts problem solving, trial and error approach
Behavioral - mourning , tries new approaches
Mental health Resolution phase and duration
Emotional
Cognitive
Behavioral
Emotional - painful feelings ease , new sense of self worth
Cognitive - perceived meaning in situation
Behavioral - discovers new resources
