Concepts of emergency and disaster preparedness
multi casualty event
-usually managed by a hospital using local resources
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NURSE IS TRIAGING CLIENTS ARRIVING AT HOSPITAL AFTER A LARGE SCALE DISASTER. WHICH IS CORRECTLY CLASSIFIED?
-young adult with bruises and superficial laceration that is a green tag -closed fracture = green tag not yellow -abdominal pain and dazed is not a black tag -someone with 90% burns is a black tag not red
notification and activation of emergency preparedness plans
-disaster situation exists when the number of casualties exceeds the usual resource capabilities. -what may be a normal day to a large scale hospital may be a disaster situation for a small local community hospital.
mass casualty triage
-effective triage to rapidly sort ill or injured patients into priority categories based on their acuity and survival potential. -triage concepts in a mass casualty differ from civilian triage from chap 8. -disaster triage tag system.
preparing for an event
-hospital personnel participate in emergency in drills regularly. -joint commission mandates that hospitals have an emergency preparedness plan that is tested with drills 1 to 2 times a year. -nursing homes also must have a plan in case of an emergency and they need a plan to evacuate all their patients. -fire drill once a year
red tagged patients
-immediate threat to life -airway or shock -require immediate attention
pandemic
-infection or disease occurs throughout the population of a country or the world. -example is the swine flu virus in 2009 -bird flu H5N1 is scary because it could pose a global pandemic if a gene mutation occurs to allow human to human spread
yellow tagged patients
-major injury is present -open fractures -large wounds -need treatment in 30 min to 2 hours
green tagged patients
-minor injuries -generally wait over 2 hours and will be fine -sprains and strains -abrasions and contusions -"walking wounded" -usually highest scale of people are this -can self transfer lowering numbers from the disaster -carry contaminants from transporting yourself? this is a concern.
mass casualty event
-overwhelms local medical capabilities and may require collaboration of agencies and facilities to handle the crisis.
nurse's role in responding to health care facility fires
-remove patient or staff from danger or fire -discontinue o2 for all patients who can breath without it. -if on life support, maintain manual respiration's until removed from the fire area -ask ambulatory people to help push wheelchair patients
emergency preparedness
-the common goal is to effectively meet the needs for resources like beds, staff, drugs, PPE, supplies, and medical devices. -government stockpiles equipment and supplies in case of a pandemic emergency -each state has its own emergency preparedness plan for pandemic flu
During a mass casualty, which injury receives care first?
Abdominal evisceration Open fracture of the left forearm Sprained ankle Sucking chest wound The sucking chest wound is a red tag, or emergent, because it can be quickly resolved until further help can be given. The abdominal evisceration is a black tag, or is emergent for too much time, and resources are needed elsewhere in a disaster. The open fracture of the left forearm casualty is a yellow tag, or immediate, needing treatment in 30 minutes to 2 hours. The sprained ankle is a green tag, or "walking wounded," and does not require care for over 2 hours. Study Tip: Do not change your pattern of study. It obviously has contributed to your being here, so it worked. If you have studied alone, continue to study alone. If you have studied in a group, form a study group.
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The triage nurse is a member of the medical relief team who has been delegated to a hurricane-hit area. What supplies does the nurse take along in the "go bag?"
Personal ID with emergency contacts in a waterproof bag Ready-to-cook food packets and utensils for cooking Flashlight and radio with rechargeable batteries Extra blankets and pillows The nurse should take along personal ID with emergency contacts in a waterproof bag in case of a crisis. The nurse should also take along non-perishable food items that do not need cooking. A flashlight and radio with extra batteries or chemical light should also be available; if power supply in the area is disrupted, rechargeable batteries will not be of help. There is no room to carry extra blankets and pillows in a personal "go bag" but an emergency blanket or a sleeping bag and a pillow should be included.
A nurse is performing a mental health assessment for survivors of a terrorist attack. What finding in the group indicates the risk of post-traumatic stress disorder (PTSD)?
Reporting feeling numb 2 to 4 days after the incident. Assisting others to overcome their grief. Experiencing "flashbacks." Managing to sleep for 4 to 5 hours each night. People who experience "flashbacks" to relive the disaster are at a high risk for PTSD. People who report feeling numb for 2 weeks or more after the incident are also at risk for PTSD. People assisting others to overcome their grief can find an outlet for their own unexpressed emotions. People who are unable to sleep are likely to have PTSD. Study Tip: Enhance your organizational skills by developing a checklist and creating ways to improve your ability to retain information, such as using index cards with essential data, which are easy to carry and review whenever you have a spare moment.
The nurse is assisting a triage team at the site of a multiple motor vehicle crash. Which client does the nurse identify with a green tag?
Unconscious woman with a weak pulse Young man with burns over 70% of his body Older man with a cut on the forearm Young woman with a spinal injury The older man with a cut on the forearm would be identified with a green tag; green-tagged clients have minor injuries that can be managed in a delayed fashion. The unconscious woman with a weak pulse, the young man with burns over 70% of his body, and the young woman with a spinal injury are identified as emergent, and these clients are red-tagged; red-tagged clients have immediate threats to life. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten.
mass casualty triage tag system
emergent (class 1); -red tag class 2; -can wait a short time -yellow tag class 3; -non urgent or can walk wounded -green tag class 4; -expected to die or dead -black tag
What information does the nurse use on the identification band of a client brought to the triage area of the hospital?
Date of birth Name of the client Social Security number Disaster number In disaster situations, the client receives a special bracelet with a disaster number. Preprinted labels with this number can be applied to the clients' chart forms and personal belongings. Digital photos are also used as identifiers in some systems. The standard hospital registration process and identification band with date of birth, name, and Social Security number can be applied after the client's identity is established.
The trauma nurse is participating in a Critical Incident Stress Debriefing (CISD) session to prevent post-traumatic stress disorder (PTSD). What is a typical "ground rule" for stress debriefing?
Each session does not last for more than 30 minutes. Family members provide support during the session. There is strict confidentiality of information shared in the session. There is no compulsion to accept the thoughts expressed by the team. Strict confidentiality should be maintained with respect to the information shared in CISD session. Staff are given protected time of 1 to 3 hours to undergo stress debriefing. The CISD team has a "door keeper" who keeps inappropriate people out of the session. The session generally involves only the nurse and team members of the CISD; the family is not involved. The nurse is expected to accept unconditionally the thoughts and feelings expressed by the team during the session.
What is the role of the International Medical Surgical Response Teams (IMSuRTs)?
Establish first aid stations or special-needs shelters. Establish fully functional field surgical facilities. Set up acute care centers for the disaster-affected. Provide surgical staff for health care facilities and hospitals. The International Medical Surgical Response Teams (IMSuRTs) establish fully functional field surgical facilities wherever they are needed in the world. The Medical Reserve Corps (MRC) establishes first aid stations or special-needs shelters in disaster areas. They also set up acute care centers in the community for days to weeks to alleviate emergency department and hospital overcrowding. Disaster Medical Assistance Teams (DMATs) provide staff to assist health care facilities that have become overwhelmed with casualties.
Which team member is responsible for "standing down" or deactivating the emergency response plan?
Hospital incident commander Emergency department (ED) nurse Community relations officer Triage officer The incident commander deactivates the emergency response plan. This is done when the number of casualties arriving at the ED has reduced to normal levels. The ED nurses focus their efforts on aiding mass casualty victims. The community relations officer releases only accurate and appropriate information to the media. The triage officer evaluates each client to determine priorities for treatment.
The nurse is assisting the triage team at an earthquake site. Which client does the nurse refer to as the "walking wounded?"
Client with several bruises and a closed fracture of the elbow Client with third degree burns on 80% of the body Client with bleeding wounds from shrapnel and an open fracture Conscious client with a bleeding head injury The client with several bruises and a closed fracture of the elbow is "green-tagged" or referred to as the "walking wounded." This client can help evacuate himself or herself and go to the hospital in a private vehicle. The client with third degree burns on 80% of the body has a lesser chance of survival; this client is "black-tagged" or given treatment last. The client with bleeding wounds from shrapnel and an open fracture, and the client with a bleeding head injury are "yellow-tagged." These clients need treatment within at least 2 hours. Study Tip: A helpful method for decreasing test stress is to practice self-affirmation. After you have adequately studied and really know the material, start looking in the mirror each time you pass one and say to yourself—preferably out loud—"I know this material, and I will do well on the test." After several times of watching and hearing yourself reaffirm your knowledge, you will gain inner confidence and be able to perform much better during the test period. This technique really works for students who are adventurous enough to use it. It may feel silly at first, but if it works, who cares? It will work for performing skills in clinical as well, as long as you have practiced the skill sufficiently.
-types of disasters
internal disaster; -inside a health care facility or campus -can endanger the safety of patients or staff -causes a need for evacuation -requires an emergency management plan -fire, explosion, loss of utilities, violence -safety is the priority throughout this event external disaster; -somewhere in the community -activates facility emergency management plan -natural, hurricane, terrorism, accidents
