Unit 3: Disasters Flashcards
1
Q
Disaster
A
- causes immeasurable amount of pain and suffering
- a serious disruption of the functioning of a community or or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources
- a disaster occurs when needs exceed resources following an event
- can be natural or man-made
2
Q
Federal Emergency Management Agency (FEMA) Definition of a Disaster
A
an occurrence of a natural catastrophe, technological accident, or human event that has resulted in severe property damage, death, and/or multiple injuries
3
Q
Disaster Events are defined by 3 characteristics
A
- An event of destructive magnitude;
- That kills, injures, or causes human suffering to a significant number of people or the environment
- That requires the need for external assistance
4
Q
Mass Casualty Incident (MCI)
A
- any large-scale event in which emergency medical resources such as supplies, medical/rescue personnel, or equipment are overwhelmed by the number and severity of casualties, thus requiring prioritization of medical care by triage
- when the healthcare needs exceed the healthcare resources
- All MCIs are disasters, but not all disasters are MCIs
5
Q
Casualty
A
includes all persons who are ill, injured, missing, or dead as the result of the incident
6
Q
Incident
A
an event that requires scene or casualty management
7
Q
The goal of the response to any mass casualty incident (MCI)
A
“do the greatest good for the greatest number of people”
-this can mean delaying care to selected people who have little hope of survival or would consume too many resources
8
Q
Triage
A
process of placing the right patient in the right place at the right time to receive the right level of care
-tagged with a corresponding triage tag
9
Q
Goal of Daily Triage
A
identify and treat the most seriously ill or injured first
10
Q
Triage Models
A
- Simple Triage and Rapid Treatment (START)
- Sort, Assess, Life-saving Interventions, Treatment, and/or Transport (SALT)
11
Q
Simple Triage and Rapid Treatment (START)
A
- completed in 60 seconds or less
- based on respirations, perfusion (or pulse), and mental status “RPM”
- begins by directing all patients who are ambulatory to move to a safe area; tagged “green”, or “minor”
12
Q
How START Model Works
A
- begins by directing all patients who are ambulatory to move to a safe area; tagged “green”, or “minor”; capable of ambulating and understanding directions and have adequate perfusion to follow commands and stay upright
- triage then continues for the remainder of the patients
- patients with no spontaneous respirations receive airway repositioning
- if remain apneic, tagged “deceased” by using a black label and receive no further care or interventions
- if repositioning the airway initiates respirations; tagged “red” or “immediate”
- patients w/ respirations greater than 30 breaths/min or a capillary refill longer than 2 seconds or who are unable to to follow simple directions are tagged “immediate” or “red”
- the remaining patients are tagged “delayed” and given a yellow tag
13
Q
The START model allows for what 2 Interventions during the Triage Process
A
- direct pressure to control bleeding
2. basic airway-opening maneuvers
14
Q
Sort, Assess, Life-saving Interventions, Treatment, and/or Transport (SALT)
A
- can triage both adults and children
- first step is to address the “walking wounded”
- second step, make lifesaving interventions before assigning to a triage category
- lastly, triage category assigned (delayed, immediate, or expectant)
15
Q
How SALT method Works
A
- Address the “walking wounded”
- able to walk are prioritized last
- cannot follow a command or have an obvious life-threat are prioritized first
- can follow a command but are unable to walk, prioritized second - Make lifesaving interventions
- control of major hemorrhage, opening the airway and providing two breaths for child casualties, decompression of tension pneumothorax, and use of auto injector antidotes - Triage (delayed, immediate, expectant)
- based on breathing, peripheral pulses, respiratory distress, and hemorrhage control
16
Q
SALT Method: Expectant category
A
- the patient may have a life-threatening injury, but current resources are not available to meet the need
- as resources become available, this “expectant” category of patients should be re-evaluated frequently
17
Q
Connection Check: Which of the following statements best explains the relationship between an MCI and a disaster?
A. All disasters are mass casualty events
B. All mass casualty events are disasters
C. Mass casualty events are natural disasters
D. Mass casualty events are man-made disasters
A
B. All mass casualty events are disasters
18
Q
Disaster Preparedness and Response: The first response to a disaster is the responsibility of?
A
- the local governments emergency services, supplemented by neighboring communities and volunteer agencies
- if overwhelmed, the local government can turn to the state for assistance
- the state’s governor, not the U.S. president, is responsible for the health and welfare of the respective citizens; governor possesses broad police powers that include the legal authority to order evacuations, commandeer private property, require quarantine, and take other actions to protect public safety
- if needed, a state can request outside assistance fro other states through the Emergency Management Assistant Compact (EMAC)
- if the disaster event is more than the state and local governments can handle alone, the governor of the affected state may request federal assistance; mobilized through FEMA; agency can assist with search and rescue, electrical power, food, water, shelter, and other basic human needs
19
Q
National Response Framework
A
- disaster plan for the nation
- establishes a comprehensive, national, all-hazards approach to domestic incident response, from the smallest incident to the largest catastrophe
- identifies key response principles as well as the roles and structures that support the plan
- describes special circumstances in which the federal government exercises a larger role in a disaster response, including incidents in which federal interests are involved and catastrophic incidents in which a state requires significant support
- response plan lays the groundwork for first responders, decision makers, and supporting entities to provide a unified national response
20
Q
Hazard Vulnerability Analysis (HVA)
A
- assessment of the risks and consequences of a disaster or critical event occurring in the community
- a list of all potential hazards and threats in the region is complied
- each hazard is given a ranking of low, medium, or high probability of its occurrence
- then, the potential consequences of the event are evaluated and rated as high, medium, or low consequence
- data can then be put into a matrix that defines the probable events and consequences as high, medium, or low
21
Q
Disaster Phases
A
- Mitigation
- Preparedness
- Response
- Recovery
22
Q
Disaster phases: Mitigation
A
- activities that eliminate or reduce the chance of occurrence or the effects of an event if it occurs
- if communities cannot prevent disasters, they can reduce the damaging impact
- ex: requiring roof reinforcements to reduce damage from hurricane winds or passing legislation that prevents new construction in floodplains
23
Q
Disaster Phases: Preparedness
A
- planning how to respond when an emergency or disaster occurs
- preparing people to respond appropriately
- ex: disaster drills, evacuation plans, and fire drills
24
Q
Disaster Phases: Response
A
- covers the period during and immediately following a disaster
- emergency responders and public officials provide emergency assistance to victims of the event and try to reduce the likelihood of future damage
25
Disaster phase: Recovery
-begins almost concurrently w/ response activities and is directed at restoring essential services and resuming normal operations
26
Incident Command System
- organizational tool that is used to provide the management infrastructure to support any disaster response
- built around 5 major management activities/functions: command, operations, planning, logistics, and finance/administration
- each function is headed by a section chief, and the overall response is led by an incident commander
27
Effectively planning an emergency response requires hospitals to address many details such as:
- Staff safety
- Availability of PPE
- Decontamination equipment and processes
- Surge capacity
- Evacuation plans
- Addressing mental health and psychosocial issues
- Debriefing plans
- Maintaining readiness
28
Hospital Response to a Disaster
- need to be prepared to respond to any type of event
- for disasters such as hurricanes and floods, hospitals are likely to receive advanced warning and are able to activate their disaster plan before the event
- for disasters such as earthquakes, tsunamis, chemical plant explosions, industrial accidents, building collapses, and acts of terrorism, there is no advanced warning system
29
Personal Protective Equipment (PPE)
a means of protecting staff from hazardous materials
- election of appropriate PPE is based on a hazard assessment:
1. identifies the hazards or suspected hazards
2. identifies routes of entry of the potential hazard (inhalation, skin absorption, ingestion, eye or skin contact)
3. defines the performance of the PPE materials in providing a barrier to these hazards
30
Decontamination
- the reduction or removal of contaminating material from a person or equipment by water and mechanical processes
- eliminating contaminants from a patient's skin and clothing is important b/c it reduces the risk for further absorption or inhalation and helps to prevent others from becoming secondarily exposed or contaminated
- during the decontamination procedure, the patient must be monitored for signs of decomposition
- antidotes or other medications may need to be given
31
Goals for Patient Decontamination
1. Hospitals must not allow contaminated patients to enter the facility
2. Hospitals should decontaminate patients as rapidly as possible
3. Hospitals must plan to protect the decontamination team rom secondary exposure and injury
32
Patient Decontamination Includes the Following Procedures
-remove patients clothing
-wet the patient's skin and wash with soap and water for 5 to 10 minutes
-pay special attention to hair, face, hands, and other areas that were exposed but were not covered by clothing
-follow washing by a copious rinsing of the patient with tepid water
>Additional:
-determining level of PPE required for staff to wear
-controlling access to the decontamination site as well as the hospital
-having a container ready to receive contaminated clothing, valuables, and contaminated supplies
-ensuring screens are available for patient privacy
-ensuring a collection system for water runoff is available if needed
33
Surge Capacity
-the ability of a healthcare system to expand rapidly and to obtain adequate staff, bed, supplies, and equipment to provide sufficient care to meet the immediate needs of an influx of patients following a large-scale incident or disaster
34
Hospital Evacuations
- important to remember that hospitals are vulnerable to disasters and may need to close or evacuate depending on the circumstances
- may be necessary d/t fire or damage from a natural disaster such as a hurricane, earthquake or flood
- should have in place plans for either a full or partial evacuation and should be consistent with regulatory requirements
- full evacuation should be a last resort
- successful hospital evacuation requires the symphonic coordination of personnel, transportation, communication, and the tracking of patients and materials
35
Advanced Warning Events
- the hospital incident commander has time prior to the event to make a decision but must remember there is limited opportunity to evacuate
- once notified of an impending disaster, the hospital incident commander may decided to (1) preemptively evacuate the hospital while the hospital structure and surrounding environment are not yet compromised or (2) shelter in place (SIP)
- important to have plans that are flexible and scalable
- plans should also define what happens to those persons "locked out" when the hospital is "locked down"
- hurricanes most common examples of advanced warning events
36
Shelter in Place (SIP)
- the need to take immediate shelter in a current location
- a rapid and effective way to protect the hospital occupants from an external or internal threat
- if SIP, the building's integrity, including the availability of critical utilities (water, sewer, electricity, and heating systems) require assessment
- utilities must be assessed to determine whether the hospital can continue to provide safe, appropriate medical care or if a post event evacuation may still be necessary
37
No Advanced Warning Events
- earthquakes, building fires, tornadoes, and explosions
| - decisions must often be made very quickly in the midst of the disaster or immediately afterward
38
Debriefing
- a post event disaster briefing should be held within 24 hours of the disaster response
- should include all participants in the disaster response
- to critically analyze all aspects of the response and to identify strengths and areas that need to be improved
- allows hospital leadership to begin to identify staff who may need assistance recovering from the disaster response
39
Disaster drills/Disaster exercises
- conducted twice yearly
- controlled, scenario-driven experience designed to demonstrate and evaluate an organization's capability to execute its Emergency Operations Plan (EOP)
- goal is to assess disaster processes and staff performance when systems are stressed during a simulated emergency
- performance should be critiqued to identify deficiencies and opportunities for improvement facilitating modifications/improvements of the EOP
40
Disaster Drills/Exercises should test every aspect of the EOP including:
- setting up the incident command center
- receiving casualties
- triage
- testing communication systems, both internal and external, with responses to agencies, including other healthcare organizations
- evacuating and transporting patients
- requesting and receiving emergency supplies
- staff roles and responsibilities
- utility management
- safety and security
- resources and assets, including decontamination, PPE, transportation, communication, and emergency supplies
41
How to Maximize Effectiveness of the drill
- inject as much "reality" into the exercise as possible such as volunteer moulaged patients (using makeup to simulate injuries), donning PPE, and testing communication devices and messaging
- ensure safety for all participants during the drill
- all communications during the drill should start and end with "this is a drill"
- a safety officer with the sole responsibility to monitor and respond to any unsafe situations should be identified
42
Connection Check: Which of the following contributes to a successful hospital disaster response?
A. Aggressive resuscitation efforts for patients w/o a pulse
B. Immediate response for patients as soon as they arrive at the ED
C. Appropriate PPE to protect staff from contamination
D. Decontamination area located within the ED
C. Appropriate PPE to protect staff from contamination
43
Nurses Role During a Disaster
- in all aspects of disaster preparedness, response, and recovery
- in mass casualty triage; helping to ensure patients get the most appropriate level of care
- putting disaster response plans into action, evacuation, and decontamination when necessary
- treatment: patient stabilization, medication administration including antidotes or prophylaxis where necessary, and routine or emergency care as part of the healthcare team
- provides supportive care and mental health support to victims of the disaster
