Week 13: Triage, Emergency Management, Disaster Management Flashcards
What 3 things can be done to increase situational awareness?
- Perceive critical elements in the environment
- Understand the significance of available information
- Project what could happen next
What color codes are used in disaster triage?
Red - immediate treatment
Yellow - delayed treatment
Green - minor treatment
Black - deceased
Gray - expectant
What criteria are used to sort patients quickly during a disaster?
RPM
Respirations, pulse & perfusion, mental status
What treatment interventions should be performed as you are triaging?
- Manually open the airway
- Clear the airway with a finger sweep
- Insert nasal airway
- Control major bleeding
- Elevate the legs to prevent worsening shock
How would you open the airway of a patient who is not traumatically injured? If they are traumatically injured?
Not traumatically injured —> head tilt chin lift
Traumatically injured —> jaw thrust
Which patients would be sorted as red?
Those with:
- Severe altered mental status
- Airway compromise
- Severe difficulty breathing
- Cardiovascular problems
- Hemorrhage
- Major trauma
- Major wounds
- All injured rescuers, responders, and emergency personnel
Which patients would be sorted yellow?
Patients with injuries requiring evaluation that are not immediately life-threatening such as:
- Extremity burns (without airway or reps compromise)
- Isolated extremity injuries
- Spinal injuries
- Awake and alert head injury patients
Requires basic life support, stretcher or significant assistance w/ movement
Which patients would be sorted as green?
Patients with non life-threatening injuries or medical conditions such as:
- Small wounds
- Small burns
- Small abrasions
- Psychiatric conditions exacerbated by the disaster (ex: anxiety)
Requires basic life support, but patients are ambulatory
Which patients would be classified as gray?
Patients who are mortally wounded and have non-survivable injuries (ex: 100% third degree burns)
What are the different triage systems that are available?
- START triage
- JUMP START (add parameters for pediatric population)
- SALT triage (similar to START except you sort individuals based on their ability to respond to you & their ability to walk)
How are patients transported to different triage zones based on their color?
Green - walk to green zone
Yellow - requires assistance of 1-2 individuals
Red - requires assistance of 2 individuals
Black - require a temporary morgue and are the last to be transported
How many times will triage be performed?
- On scene, in wreckage, on site
- At treatment area, collection area (ex: colored tarps)
- In an ambulance
- In the ED
What is another way that patients can be triaged?
1, Primary - immediate
- Secondary - delayed
- Tertiary - minor
- Quaternary - deceased
What is a critical incident stress debriefing (CISD)?
A formalized, structured method whereby a group of rescue and response workers reviews the stressful experience of a disaster
Designed to be delivered in a group format and meant to be incorporated into a larger, multicomponent crisis intervention system
What is a multi-casualty incident (MCI)?
Situation in which medical resources are strained but not overwhelmed
Which patients are treated first in MCIs?
Those with life-threatening problems and those sustaining multiple system injuries
What is a mass-casualty event (MCE)?
Situation in which casualty numbers are large enough to disrupt the healthcare services in the affected community or region
Which patients are treated first in an MCE?
Patients having the greatest chance of survival and requiring least expenditure or time, equipment, supplies, and personnel
What is the 1st and most effective intervention to reduce the impact of disasters?
Personal disaster preparedness
What are local governments responsible for in emergency management?
Emergency planning response and continued assessment of its ability to protect citizens and property within the community
What are State governments responsible for in emergency management?
- Assisting communities within the State by reviewing plans and providing guidance
- Makes plans and assesses its capability to provide protection from large-scale, statewide disasters
- Assist communities within the State that do not have adequate resources to protect themselves or to recover from disaster
What is the Federal government responsible for in emergency management?
- Assisting the States by reviewing plans, providing guidance, making plans and assessing their capability to provide protection from large-scale, nationwide disasters
- Supplements State assistance when State and local resources are insufficient to complete recovery
How is financial assistance enacted?
Local governor applies to the Governor who then studies the damage estimates to declare the area a State disaster
If local and State resources are not sufficient, the Governor applies to the President for Federal disaster assistance who then declares a major disaster declaration
What are the steps in the Emergency Management cycle?
- Prevention & mitigation
- Preparedness
- Response
- Rehabilitation & recovery
What occurs during the mitigation step?
Activities that prevent an emergency, reduce the chance of an emergency happening, or reduce the damaging effects of unavoidable emergencies
What occurs during the preparedness step?
Preparing to handle an emergency
Plans or preparations made to save lives and to help response and rescue operations –
What occurs during the response step?
Responding safely to an emergency
Includes actions taken to save lives and prevent further property damage in an emergency situation
What are steps of emergency management in the context of nursing?
- Preparedness/risk assessment
- Mitigation
- Response
- Recovery
- Evaluation and follow-through
What is preparedness/risk assessment in the context of nursing?
The evaluation of the likelihood of emergencies or disasters for the specific institution
Evaluation of staffing under various conditions
Develop an all-hazards approach & have specific appendices for the events that are most likely to occur in the area
What occurs during an evaluation and follow through?
Every time an organization engages in a disaster response, whether as an exercise or in response to a real situation, an evaluation needs to be done
This formal evaluation is critical to determine what went well and what problems arose
Each organization, agency, and unit should examine its own performance & include what went well and what was problematic
All organizations involved should convene to evaluate interagency performance
A detailed list of recommendations for changes to the emergency response plan should be compiled
A final report that includes the critique and the improvement plan should be made available to all staff,
What is a disaster?
An occurrence of a natural catastrophe, technological accident, or human-caused event that results in a serious disruption of the functioning of community
What is a health disaster?
A catastrophic event that results in casualties that overwhelm the healthcare resources in that community
What is disaster preparedness?
The readiness for and the anticipation of contingencies that follow in the aftermath of disasters
Responsibility of every healthcare facility and professional
What is the best guideline for developing disaster plans?
Adherence to the highest standards of medical practice consistent with the available medical resources
What are the 2 disaster categories?
Natural - those caused by environmental factors
Anthropogenic - man made
What is the purpose of the Stafford Act & Homeland Security Act?
Provide federal government assistance to state and local governments to help them manage major disasters and emergencies
What is the Department of Homeland Security?
An agency that commits to prevent future attacks against the United States and our allies, and responds decisively to natural and man-made disasters, and advancing American prosperity and economic security long into the future
Created as a way to integrate all law enforcement and healthcare agencies under one unit
What is FEMA?
Federal Emergency Disaster Agency that handles large scale and long term disasters
What is SEMO?
Office of Emergency Management (also referred to as OEM)
Responsible for coordinating the activities of all State agencies to protect New York’s communities, the State’s economic well-being, and the environment from natural and human-caused disasters and emergencies
What is the federal response plan?
Supports implementation of the Stafford Act
Designed to deliver assistance and resources when state and local government is overwhelmed by a disaster or an emergency situation.
The FRP is designed for all risks and is applicable to both natural and manmade disasters.
What is the National Disaster Medical System?
Supports the management and coordination of medical responses to major emergencies and federally declared disasters by working in collaboration with the states and other public health and private entities to provide health and human services during public health emergencies for limited periods of time
What is DMAT?
A group of professional and paraprofessional medical personnel designed to provide medical care during a disaster or other event
Each team responds rapidly to supplement local resources until other resources can be mobilized or the emergency ends
What is DMORT?
Disaster Mortuary Operational Response Team
Provide victim identification and processing and family assistance
What is NVRT?
National Veterinary Response Team
Provides disaster veterinary services (animals, live stock, etc)
What is the National Response Framework?
Supersedes the National Response Plan
Serves as a guide to how the nation conducts comprehensive incident response using an all-hazards approach to respond to natural and man-made disasters
Includes guiding principles that detail how federal, state, local, tribal, and private sector partners, including the healthcare sector prepare for and provide a unified domestic response through improved coordination and integration
What is the National Incident Management System?
Provides a template for incident management regardless of size, scope, or cause
The template includes a core set of concepts, doctrines, principles, organizational processes, and terminology
It standardized emergency management, personnel, and resource management procedures, promoting coordination among departments and agencies at all levels of government, nongovernmental organizations, and the private sector during planning and response
What is the Incident Command System?
The model for command, control, and coordination of a response to an emergency
Provides the means to coordinate the efforts of individual agencies
What is the Hospital Incident Command System?
An incident management system based on principles of the Incident Command System (ICS)
Assists hospitals and healthcare organizations in improving their emergency management planning, response, and recovery capabilities for unplanned and planned events
Provide an organizational structure for incident management but it also guides the process for planning, building, and adapting that structure
It can be used by any hospital to manage threats, planned events, or emergency incidents
What is surge capacity?
The ability to evaluate and care for a markedly increased volume of patients—one that challenges or exceeds normal operating capacity
What are complex human emergencies?
Situations where populations suffer significant casualties as a result of war, civil strife, or other political conflict
What is a hazard?
The possibility of the occurrence of a disaster caused by natural phenomena (e.g. hurricane, earthquake), failure of man-made sources of energy (e.g. nuclear power plant), or human activity (e.g. war)
What is risk?
The actual exposure of something of human value and is often measured as the product of probability and loss
What are the disaster stages?
- Pre-Impact Stage
- Impact Stage
- Honeymoon Stage
- Disillusionment Stage
- Reconstruction Stage
What occurs during the pre-impact stage?
- Information sharing to raise awareness
- Threat identification → people know what they are dealing with
- Planning
- Preparedness
- Readiness activities (ex: getting a full tank of gas, a working vehicle, showing up early to work, setting up extra supplies, etc.)
- Evacuation
What occurs during the impact stage?
- Lifesaving missions
- Critical infrastructure support protections
- Emergency Medical Services
- Firefighting, search and rescue
- Law Enforcement
- Survivors assisting others (heroic phase)
What occurs during the honeymoon stage?
Feelings of joy, relief and elation by the survivors.
Those affected feel special from receiving aid from public and private organizations
What occurs during the dillusionment stage?
Increased frustration and resentment among those affected by the incident
People become frustrated with the agencies and organizations that are trying to help them
What occurs during the reconstruction stage?
- The development, coordination, and execution of service- and site-restoration plans for impacted communities and the reconstitution of government operations and services through individual, private-sector, nongovernmental, and public assistance programs
- Recover & Rebuild
- Implement the disaster recovery plan!
What is hazard identification & mapping?
Hazard identification is used to determine which events are most likely to affect a community and to make decisions about whom or what to protect as the basis of establishing measures for prevention, mitigation, and response
Historical data and data from other sources are collected to identify previous and potential hazards
Data are then mapped using aerial photography, satellite imagery, remote sensing, and geographic information systems
What is a hazard vulnerability assessment?
Used to determine who is most likely to be affected, the property most likely to be damaged or destroyed, and the capacity of the community to deal with the effects of the disaster
Data are collected regarding the susceptibility of individuals, property, and the environment to potential hazards in order to develop prevention strategies
What are resilient communities?
The ability to resist, absorb, recover from, or adapt to an adverse occurrence
T/F: A nurse is not held liable for the care performed during an emergency situation
False
A nurse may be held liable for providing professional care that is below the standard followed by the profession
Absent special legislation, liability for medical professionals continues, even when they are performing medical care in an emergency situation
What are “Good Samaritan” laws?
Laws which may provide immunity from civil liability for persons when they render care in emergency situations
What is New York’s Public Health Law?
The first New York “Good Samaritan” law
Provides protection in a civil lawsuit for someone providing aid to another “at the scene of an accident or other emergency outside of a hospital, doctor’s office, or any other place having necessary medical equipment” if they are doing so “voluntarily and without expectation of payment”
What is New York’s Penal Law?
Law to encourage people to call 911 for assistance by removing fear that the caller may be arrested and charged with a drug or alcohol possession offense
What is emergency management?
A discipline that deals with risk and risk avoidance
What are the 3 components of emergency management?
- Many common features of technological and natural disasters and attack = many of the same management strategies can apply to all emergencies
- Finding resources for disaster management requires a partnership among all levels of government (local, State, and Federal) and the private sector (business and industry, voluntary organizations, and the public)
- There is an emergency life cycle for disasters (mitigation, preparation, response, recovery)
