Trauma, Emergencies, Disasters Flashcards
Natural vs. Man Made Disasters
Natural Disasters: events that occur from forces in nature that are not the direct result of human activity.
- Earthquakes
- Floods
- Tornadoes
- Wildfires
- Hurricanes
- Tsunamis
- Communicable diseases
- Epidemics and pandemics
Man-Made Disasters: events with a human element; may be unintentional exposures/incidents or intentional events
- Mass transportation accidents
- Terrorist attacks (bombing, riots, bioterrorism)
- Structural collapse, fire, or explosions
- Dam failures resulting in flooding.
- Radioactive material exposures
- Hazardous substance accidents (chemical spills, toxic gas leaks)
Internal vs. External Disasters
Internal
- Occur within a healthcare agency and disrupt the everyday services and ability to care for patients
- Example: Hospital Fire, Power Outage, Active Shooter
External
- Occur outside the healthcare agency.
- Typical resources are overwhelmed by the rapid surge of needs
- Example: Mass transit casualty that could send hundreds of victims to emergency departments, terrorist attack
Note: Some Disasters may be internal AND external
Phases of Disaster Planning
Preparedness
Occurs before impact and is a proactive process for putting the structure needed for disaster response in place
*Begins with defining the precise role of public health providers during various disaster events
*Focuses on improving community and individual reaction and responses so that the effects of a disaster are minimized
- Plans for rescue, evacuation, and caring for disaster victims.
- Plans for training disaster personnel and gathering resources, equipment, and other materials needed
- Identification of specific responsibilities for various emergency response personnel
- Establishment of a community emergency response plan and an effective public communication system
- Development of an emergency medical system & how to activate.
- Verification of proper functioning of emergency equipment
- Collection of anticipatory provisions and creation of a location for providing food, water, clothing, shelter, supplies, & medicine.
- Inventory of supplies on a regular basis and replenishment of outdated supplies
Practice of community emergency response plans (disaster drills)
Phases of Disaster Planning
Mitigation
A means to limit adverse effects of the disaster.
- Actions or measures that can prevent the occurrence of a disaster or reduce the damaging effects of a disaster.
- Determination of the community hazards and community risks (actual and potential threats) before a disaster occurs.
- Awareness of available community resources and community health personnel to facilitate mobilization of activities and minimize chaos and confusion if a disaster occurs.
- Determination of the resources available for care to infants, older adults, disabled individuals, & those with chronic health problems
Phases of Disaster Planning
Response:
Requires activation of the procedures planned prior to the event.
- May begin before the actual impact of the event with predicted weather events such as hurricanes and blizzards.
- Time frame is specific to the event.
- Purpose is to save lives, address health threats, and maintain basic human needs such as food, shelter, and water.
Phases of Disaster Planning
Recovery:
Begins as the event ends with a focus on stabilizing the community through reconstruction and rehabilitation.
- Purpose is to minimize the long-term effects of the disaster and address the immediate and long-term needs of the community.
- Length of recovery varies depending on the type and intensity of the disaster.
Phases of Disaster Planning
Evaluation
Quality assurance process to inform the response on areas that are going well and areas that need improvement.
- Ongoing process that may begin during the event.
- Thorough evaluation that identifies areas of response that need improvement.
- Process should involve all responding agencies and participants.
- Future disaster planning should always be based on empirical evidence derived from previous disasters.
Primary Prevention:
Examples
Aims to prevent disease or injury before it even occurs.
- Legislation to ban use of hazardous products or mandate safe practices.
- Education about healthy and safe habits
- Immunization against infectious disease
Examples: COVID 19 Vaccine, Equitable Quarantine
Secondary Prevention:
Example:
Aims to reduce the impact of a disease or injury that has already occurred.
- Regular exams and screening tests to detect disease in its earliest stages.
Examples: COVID 19 Testing, Isolation
Tertiary Prevention:
Example:
Aims to soften the impact of an ongoing illness or injury that has lasting effects.
Examples: Hospitalization, Rehabilitation, Support groups
Disaster Epidemiological Surveillance:
Emergency Information Systems
Key focus is to prevent or decrease morbidity and mortality associated with acute or noncommunicable illness associated with a disaster event.
Emergency Information Systems
- Designed to collect population data during the impact, mitigation, and recovery phases.
- Rapid data collection and analysis during a disaster ensure a timely flow of information to the appropriate responders.
- Concentrates on the incidence, prevalence and severity of illnesses and injury related to the event.
Disaster Epidemiological Surveillance:
Postimpact Epidemiological Surveillance
Used to determine the association between the exposure, the disaster event, and the outcome.
- Ex: Respiratory illness and long-term burn treatment will be anticipated following a wildfire
- Surveillance would monitor the increase in respiratory disease and track burn cases caused by environmental exposure.
START Adult Triage - What is it?
Back Triage Tag Color
*A quick and rapid method to identify and sort patients in a situation in which the number of patients overwhelms current resources available.
*Patients are sorted in a manner that allows the trauma nurse to provide the most good for the greatest number of patients.
Expectant
- Victim unlikely to survive given severity of injuries, level of available care, or both.
- Palliative care and pain relief should be provided.
START Adult Triage
Red Triage Tag Color
Immediate
- Victim can be helped by immediate intervention and transport.
- Requires medical attention within minutes for survival (up to 60).
- Included compromises to patient’s airway, breathing, and/or circulation.
START Adult Triage
Yellow Triage Tag Color
Delayed
- Victim transportation can be delayed.
- Includes serious and potentially life-threatening injuries, but status not expected to deteriorate significantly over several hours.
START Adult Triage
Green Triage Tag Color
Minor
- Victim with relatively minor injuries
- Status unlikely to deteriorate over days.
- May be able to assist in own care: “Walking Wounded”
Emergency Nursing
Staff Safety
Personal Protective Equipment (PPE)
Hostile Patients and Families
- De-escalation techniques
- ALWAYS have an escape route
- Know emergency codes and how to reach security.
Ensure safety when caring for individuals in custody.
Never deliver bad news alone
Emergency Nursing
Patient Safety
High risk for injury and errors due to fast-pace and inherent chaos
- Ensure 2 patient identifiers at all times.
- Fall Prevention
- Reduce medication errors.
Be objective – make no assumptions!
EMTALA (Emergency Medical Treatment and Active Labor Act)
Three Primary Requirements
- Performance of a medical screening examination. All Patients MUST receive a medical screening exam
- Provide necessary stabilizing treatment of emergency medical conditions and labor.
- Restricting transfers unless emergency medical condition is stabilized. Transfer criteria must be met PRIOR to transfer
Emergency Nursing
HIPAA (Health Insurance Portability and Accountability Act)
Be aware of potential HIPAA violations when working in public spaces such as the hallway or waiting room.
Triage in the Emergency Department
Emergency Severity Index Scale
Emergency triage is the complex complaint-based process of sorting patients to ensure the right patient sees the right provider at the right time in the right place for the right reason.
Emergency Severity Index Scale
- Most commonly used triage system in EDs in the United States
- A five-level triage scale categorizing patients initially by acuity for emergent and high-risk patients then by expected resource consumption required for providers to make a disposition.
- Does patient need immediate life saving intervention?
- Is it safe for the pt to wait in the waiting room?
- How many resources?
- Are vital signs stable?
Emergency Severity Index Scale
Level 1
Immediate
Patient requires immediate lifesaving intervention.
- Airway Management
- Emergency Medications
- Hemodynamic Interventions
Example: Cardiac Arrest, Apneic, Pulseless, Severe Respiratory Distress, Unresponsiveness
Emergency Severity Index Scale
Level 2
Emergent
Patient is high-risk and should not wait (it would be unsafe for pt to wait)
Example: Chest pain with high suspicion of ACS, Stroke Symptoms, Suicidal or Homicidal patients, Ectopic pregnancy
Emergency Severity Index Scale
Level 3
Urgent
Patient requires two or more resources.
- Labs
- EKG, X-ray, CT Scan, US, IV Fluids
- IV, IM, or Nebulized Medications
- Specialty Consultation
- Simple Procedure (=1)
- Complex Procedure (=2)
Unstable vital signs
Example: Abdominal pain with stable vital signs, Low Risk Chest Pain, Extremity Swelling (Atraumatic)
Emergency Severity Index Scale
Level 4
Non-urgent
Patient requires one resource.
- Labs
- EKG, X-ray, CT Scan, US, IV Fluids
- IV, IM, or Nebulized Medications
- Specialty Consultation
- Simple Procedure (=1)
- Complex Procedure (=2)
Stable Vital Signs
Example: Healthy patient with a sore throat and fever, simple lacerations, simple fractures/sprains
Emergency Severity Index Scale
Level 5
Non-urgent
Patient requires no resources.
Example: Healthy patient with poison ivy rash, medication refills, wound checks
Levels of Trauma Care
Level I
- Example: UAB, Huntsville Hospital, USA Health, Children’s of Alabama
- Provides comprehensive trauma care.
- Serves as a regional resource center to provide leadership in education, outreach and systems planning.
- Admits at least 1200 trauma patients annually
- Attending surgeon with 24-hour in-house availability who can respond within 15 minutes
- Conducts trauma research
Levels of Trauma Care
Level II
- Example: Baptist South, Southeast Health, Piedmont Midtown
- Provides comprehensive trauma care as a supplement to a Level I center.
- Attending surgeon with 24-hour in-house availability.
Levels of Trauma Care
Level III
Example: East Alabama, DCH, Flowers Hospital
- Provides immediate emergency care and stabilization of a patient before transfer to a higher level of care.
- Attending surgeon with a maximum response time of 30 minutes.
- Serves a community that does not have immediate access to a Level I or II center
Levels of Trauma Care
Level IV
Example: Wellstar West Georgia
- Provides advanced trauma life support before transfer to a higher-level trauma center.
- Has primary goal of resuscitation/
stabilization of the patient and arrangement of immediate transfer to a higher level of care
3 Levels of Injury Prevention
Primary Prevention:
Involves interventions to prevent the event.
- Driving safety classes, speed limits, campaigns against drunk driving, fall prevention intervention, drug awareness programs
3 Levels of Injury Prevention
Secondary Prevention:
Strategies to minimize the impact of the traumatic event.
- Seat belt use, helmets, anti-bullying hotlines
3 Levels of Injury Prevention
Tertiary Prevention:
Interventions to maximize patient outcomes after a traumatic event.
- Emergency response systems, medical care, rehabilitation
Mechanisms of Injury
Blunt Trauma
Most common mechanism of injury
- MVCs, assaults with blunt objects, falls, sport-related injuries, pedestrian injuries
Injury may be caused by several energy forces.
- MVC injury often results from acceleration-deceleration forces.
Severity of injury depends on the duration of the energy exposure, the body organ involved, and the underlying structures.
- Heart, spleen, and liver are less resilient because of their high-density tissue and decreased ability to release energy without resultant tissue damage.
Mechanisms of Injury
Penetrating Trauma
Results from impalement of the body by foreign objects
More easily diagnosed and treated than blunt injuries because of the obvious signs.
Damage caused by penetrating mechanisms depends on several variables.
- Point of impact
- Velocity and speed of impact
- Proximity
Mechanisms of Injury
Blast Injuries, classification
A combination of blunt and penetrating trauma
Blast Injury Classification
- Primary: Direct blast effects – direct tissue damage from the high pressure of the blast.
- Secondary: Debris and projectiles propelled by explosion – tissue damage caused by objects impaling the body.
- Tertiary: Individual thrown by the blast wind – tissue damage results from blunt trauma.
- Quaternary: injuries occur as a result of chemical, thermal and biological exposure – tissue damage from burns, inhalation, etc.
Trauma Labs
Complete Blood Count (CBC)
- H/H for bleeding
Complete Metabolic Panel (CMP)
- Electrolytes
- LFTs for liver injury
- BUN for CT/contrast
PT/PTT/INR
- Coagulation
Arterial blood Gas (ABG)
- Respiratory status
Serum Lactate
- If elevated, there is a perfusion issue
Urinalysis
- Blood
- Drugs
Toxicology and Ethanol Level
- Alcohol levels
Type and Screen/Cross
- Screen: blood type
- Cross: preparing blood for pt
Creatinine Kinase (CK)
- Looks at muscle and tissue breakdown
- Elevated CK = rhabdomyolysis
Pregnancy
Troponin
Trauma Diagnostics
Plain Film X-Rays
Chest, Pelvis, Extremities
Chest
- Confirm support device placement
- Identify immediate life-threatening injuries
Pelvis
- Quick diagnosis of severe fractures which may be a cause of hemorrhage
Extremities with suspected injury
- Identify fractures and/or foreign bodies in extremities with suspected injury
