Disaster (chapter 10)

How often must nursing homes and LTC facilities have drills to prepare for mass casualty events

Yearly

Who direct the ancillary departments to deliver supplies, instrument trays, medications, food, and personnel to meet service demands

Hospital or ED nurse leaders

Other examples of services from the NDMS

• Disaster Mortuary Operational Response Teams (DMORTs) to manage mass fatalities • National Veterinary Response Teams (NVRTs) for emergency animal care • International Medical Surgical Response Teams (IMSuRTs) to establish fully functional field surgical facilities wherever they are needed in the world

Preventing PTSD

• Use available counseling. • Encourage and support co-workers. • Monitor each other's stress level and performance. • Take breaks when needed. • Talk about feelings with staff and managers. • Drink plenty of water, and eat healthy snacks for energy. • Keep in touch with family, friends, and significant others. • Do not work for more than 12 hours per day.

How to act towards people in crisis after mass casualty event

be calm and reassuring. Establish rapport through active listening and honest communication. Survivors benefit from talking about their experiences and being helped as they work to problem-solve. Offer choices whenever possible to help survivors gain a sense of personal control. Help survivors adapt to their new surroundings and routines through simple, concrete explanations. Convey caring behaviors, and provide a sense of safety and security to the best extent possible. If available, request that crisis counselors respond and assist in providing compassionate support to victims and their families

WHen might quarantine of units be necessary?

-Pandemic influenza -Mass casualty nature -Quarantine until risk has passed

What is a DMAT?

a medical relief team made up of civilian medical, paraprofessional, and support personnel that is deployed to a disaster area with enough medical equipment and supplies to sustain operations for 72 hours DMATs are part of the National Disaster Medical System (NDMS) in the United States. They provide relief services ranging from primary health care and triage to evacuation and staffing to assist health care facilities that have become overwhelmed with casualties Because licensed health care providers such as nurses act as federal employees when they are deployed, their professional licenses are recognized and valid in all states.

High scores on IES-R subscales

A high score on any IES-R subscale indicates a need for further evaluation and counseling. Refer the patient to a social worker or qualified mental health counselor. A high score on all subscales requires referral to a psychiatrist or clinical psychologist to evaluate the possibility of current or past trauma, such as abuse or neglect.

Mass casualty triage at the scene (who may perform this?)

A key process in any multi-casualty or mass casualty response is effective triage to rapidly sort ill or injured patients into priority categories based on their acuity and survival potential. Triage functions may be performed by EMS providers in the field, such as: • Emergency medical technicians (EMTs) and paramedics • Nurse and physician field teams who are called from the hospital to a disaster scene to assist EMS providers • Nurse and physician hospital teams to assess and reassess incoming patients

Key personnel roles and functions

Hospital incident commander: Physician or administrator who assumes overall leadership for implementing the emergency plan Medical command physician: Physician who decides the number, acuity, and resource needs of patients - calls in other specialists based on pt need. Helps determine which pts can be transported out of facility to higher level of care or specialty Triage officer: Physician or nurse who rapidly evaluates each patient to determine priorities for treatment. Acuity is re-evaluated for placement within hospital Community relations or public information officer: Person who serves as a liaison between the health care facility and the media

HICS

The facility-level organizational model for disaster management is the Hospital Incident Command System (HICS), which is a part of the National Incident Management System (NIMS) implemented by the Department of Homeland Security and FEMA to standardize disaster operations. -Roles are formally structures -Incident commander at top -Clear lines of authority/accountability for specific resources -Public info, safety/security, medical command officers -Chiefs appointed to manage logistics, planning, finance, and operations as appropriate to the type and scale of the event, delegate specific duties to other departmental officers and unit leaders -goal: achieve manageable control over personell/resources to achieve efficiency -The HICS personnel also establish an emergency operations center (EOC) or command center in a designated location with accessible communication technology.

Definition of a disaster

an event in which illness or injuries exceed resource capabilities of a health care facility or community because of destruction and devastation. internal and external disasters can occur simultaneously.

NBC

The term "NBC" was coined to describe nuclear, biologic, and chemical threats. In response, emergency medical services (EMS) agencies and hospitals improved safety by upgrading their decontamination facilities, equipment, and all levels of personal protective equipment to better protect staff

Priority things to do after event is over

-Inventory ED supplies; restock -Instrument trays must be washed, packaged, and re-sterilized. -Critical supplies that have been depleted from hospital stores must be reordered and delivered to the hospital quickly.

Nurse actions during facility fires

-Remove any patient or staff from immediate danger of the fire or smoke. • Discontinue oxygen for all patients who can breathe without it. • For patients on life support, maintain their respiratory status manually until removed from the fire area. • Direct ambulatory patients to walk to a safe location. • If possible, ask ambulatory patients to help push wheelchair patients out of danger. • Move bedridden patients from the fire area in bed, by stretcher, or in a wheelchair; if needed, have one or two staff members move patients on blankets or carry them. • After everyone is out of danger, seek to contain the fire by closing doors and windows and using an ABC extinguisher (can put out any type of fire), if possible. • Do not risk injury to you or staff members while moving patients or attempting to extinguish the fire

IES-R

22-item self-administered questionnaire including several subscales, such as avoidance. Before giving the tool, determine the patient's reading level because it is written at a 10th-grade reading level. The tool should not be used for patients with short-term memory loss. For that reason, many older survivors are often not adequately assessed for post-disaster PTSD; assess all older survivors of a disaster for this complication when possible.

WHen is it okay to "stand down" or deactivate emergency response plan

When the last major casualties have been treated and no more are expected to arrive in numbers that could overwhelm the health care system ensure that the needs of the other hospital departments have been met and all are in agreement to resume normal operations. consider staff and supply availability to meet ongoing operational needs.

Factors that affect staff available to care for pts

Worker illness, absenteeism, and personal choices to remain quarantined to avoid being exposed to the illness

2 types of debriefing

(formal systematic review and analysis) The first type entails bringing in critical incident stress debriefing (CISD) teams to provide sessions for small groups of staff to promote effective coping strategies. The second type of debriefing involves an administrative review of staff and system performance during the event to determine whether opportunities for improvement in the emergency management plan exist.

Nurses role in emergency preparedness and response

Before an event, they contribute to developing internal and external emergency response plans, including defining specific nursing roles. Nurses take into account the security needs, communication methods, training, alternative treatment areas, staffing for high-demand or surge situations, and requirements for resources, equipment, and supplies. They then test the plans by actively participating in disaster drills and evaluating the outcomes. During an actual disaster, the ED charge nurse, trauma program manager, and other ED nursing leadership personnel act in collaboration with the medical command physician and triage officer to organize nursing and ancillary services to meet patient needs. Telephone trees may be activated to call in ED nurses who are not working or are not scheduled to work. ED areas are identified and prepared to stage, triage, resuscitate, and treat the disaster victims. Efforts are made to quickly discharge or admit other ED patients as appropriate to make room for the new arrivals. ED nurses apply principles of triage as disaster victims enter the system to prioritize care delivery and direct patients to the designated areas best suited to meet their needs.

CISD

CISD is only one component of a much broader critical incident stress management (CISM) program. After working through the turmoil and the emotional impact of the incident as well as the aftermath, the staff may find it difficult to "get back to normal." Without intervention during and after the emergency, they may develop post-traumatic stress disorder (PTSD). PTSD can lead to multiple characteristic psychological and physical effects, including flashbacks, avoidance, less interest in previously enjoyable events, and detachment, as well as rapid heart rate and insomnia. People suffering from PTSD can have great difficulty relating in their usual way to family and friends. Ultimately, professional "burnout" can stem from the inability to cope with the stress effectively.

HAZMAT training

ED physician and nursing staff now routinely undergo hazardous materials (HAZMAT) training and learn how to recognize patterns of illness in patients who present for treatment that potentially indicate biologic terrorism agents, such as anthrax or smallpox

How often do hospitals have to test their emergency preparedness plan?

In the US, the joint commission mandates that hospitals have an emergency preparedness plan that is tested through drills or actual participation in a real event at least twice yearly. One of the drills or events must involve community-wide resources and an influx of actual or simulated patients to assess the ability of collaborative efforts and command structures.

People at risk for PTSD

People who are unable to sleep, are easily startled, have "flashbacks" to relive the disaster, or report "feeling numb" 2 weeks or more after a disaster or traumatic event Nurses caring for survivors with these manifestations should perform further assessment. One tool that can be used to assess survivor response to a disaster is the Impact of Event Scale—Revised (IES-R).

Patients who might be discharged early to allow for mass casualty victim placement

• Were admitted for observation and are not bedridden • Are having diagnostic evaluations and are not bedridden • Are soon scheduled to be discharged or could be cared for at home with support from family or home health care services • Have had no critical change in condition for the past 3 days • Could be cared for in another health care facility, such as rehabilitation or long-term care

Multi casualty event vs mass casualty

The main difference is based on the scope and scale of the incident, considering the number and severity of victims or casualties involved. Both require specific response plans to activate necessary resources a multi-casualty event can be managed by a hospital using local resources; a mass casualty event overwhelms local medical capabilities and may require the collaboration of multiple agencies and health care facilities to handle the crisis

How to sanitize human waste when toilets don't work

To sanitize it and provide odor control, chlorine bleach can be added and the bag tied and sealed. Portable toilet chemicals or chlorinated lime may be used as alternatives. To prevent a toxic gas reaction, remind residents not to mix any chemicals. Treated human waste bags can be buried in the ground. emphasize the importance of handwashing with soap and water or using a hand sanitizer to prevent disease transmission

Personal emergency preparedness plans

a plan developed by each nurse can help in situations that detract from staff availability. It should outline the preplanned specific arrangements that are to be made for childcare, pet care, and older adult care if the need arises, especially if the event prevents returning home for an extended period. "Go bags" are needed for all members of the family, including pets, in the event the disaster requires evacuation of the community or people to take shelter in their own homes.

All-hazards approach

accredited health care organizations are required to take an "all-hazards approach" to disaster planning. this means preparedness activities must address all credible threats to the safety of the community that could result in a disaster situation. Ideally drills are based on events most likely to happen in that area

Internal disaster defintion

any event inside a health care facility or campus that could endanger the safety of patients or staff. The event creates a need for evacuation or relocation. It often requires extra personnel and the activation of the facility's emergency preparedness and response plan Ex: fire, explosion, loss of critical utilities (e.g., electricity, water, and communications capabilities), and violence.

External disaster definition

any event outside the health care facility or campus, somewhere in the community, which requires the activation of the facility's emergency management plan. The number of facility staff and resources may not be adequate for the incoming emergency department (ED) patients Ex: natural - hurricane, earthquake or tornado. Or technologic - act of terrorism with explosive devices or a malfunction of a nuclear reactor with radiation exposure

Hospital incident commander

assumes overall leadership for implementing the institutional plan. This person is usually either a physician in the ED or a hospital administrator who has the authority to activate resources. The role can also be fulfilled by a nursing supervisor functioning as the on-site hospital administrator after usual business hours. The hospital incident commander's role is to take a global view of the entire situation and facilitate patient movement through the system. The commander brings in both personnel and supply resources to meet patient needs.

What is a MRC

made up of a group of volunteer medical and public health care professionals, including physicians and nurses. They offer their services to health care facilities or to the community in a supportive or supplemental capacity during times of need such as a disaster or pandemic disease outbreak. This group may help staff hospitals or community health settings that face personnel shortages and establish first aid stations or special-needs shelters. As a means to alleviate emergency department and hospital overcrowding, the MRC may also set up an acute care center (ACC) in the community for patients who need acute care (but not intensive care) for days to weeks.

CISD team

two or three specially trained people who come together quickly when called to deal with the emotional needs of health care team members after a particularly devastating or disturbing incident. Leader: BG in mental/behavioral health The co-leader is ideally a peer of the group being debriefed The third member of the team is known as the "doorkeeper." This person is responsible for keeping inappropriate people out (e.g., media, spectators) and talking with anyone who leaves the session early in an effort to have him or her return or accept follow-up.

Concern of walking wounded entering the hospital

green-tagged patients who self-transport may unknowingly carry contaminants from a nuclear, biologic, or chemical incident into the hospital environment with potentially disastrous consequences

First action of first-responders in disaster

remove people from danger, both the injured and uninjured. nurses not usually involved in this process situational awareness is critical for appropriate priority setting and safety in a rapidly changing environment

Ground rules for stress debriefing

strict confidentiality of information shared during the session and unconditional acceptance of the thoughts and feelings expressed by people within the group. -circular configuration of seating -Food should be provided so hunger does not distract

Catastrophic event - people who may be responders

the National Guard, the American Red Cross, the public health department, various military units, a Medical Reserve Corps (MRC), or a Disaster Medical Assistance Team (DMAT) can be activated by state and federal government authorities.

Risks for nurses going out into the field with an unstable environment

the potential for structural collapse, becoming the secondary target of a terrorist attack, interpersonal violence in unsecured locales, and working in an environment in which contagious diseases and natural hazards are common (e.g., poisonous snake bites and mosquito-borne illnesses). Disaster workers must take measures such as obtaining prophylactic medications and vaccinations, having a personal evacuation plan, and ensuring access to necessary supplies and protective equipment so that they do not become victims as well.

Goal of administrative evaluation debriefing

to discern what went right and what went wrong during activation and implementation of the emergency preparedness plan so that needed changes can be made. express both positive and negative comments related to their experiences with the event. written critique forms are also solicited to gain additional information after participants have had time to consider their overall impressions of the response and impact on departments

The goal of emergency preparedness

to effectively meet the extraordinary need for resources such as hospital beds, staff, drugs, personal protective equipment (PPE), supplies, and medical devices, such as mechanical ventilators.

Pandemic definition

(an infection or disease that occurs throughout the population of a country or the world) leads a vast number of people to seek medical care, even the "worried well." Though not yet ill, the "worried well" want evaluation, preventive treatment, or reassurance from a health care provider. A pandemic influenza outbreak, such as the 2009-2010 swine flu outbreak caused by the H1N1 virus, raised significant concerns that the resource capabilities of the entire health care system could be overwhelmed and that community systems and critical supply chains could be severely damaged

Provisions for exhausted staff

If nursing staff and other personnel were called in from home during their off hours or if they worked well beyond their scheduled shifts to meet patient and departmental needs, provision for adequate rest periods should be made. Exhaustion poses a risk not only to patient safety but also to the nurse when he or she must drive home. Sleeping quarters at the hospital might be necessary in this case, especially if the disaster event contributed to treacherous travel conditions

Difference between normal triage and triage under mass casualty conditions

Military style - greatest good for greatest # of people Emergent or class I (red tag) (immediate threat to life) Ex: airway obstruction or shock, and require immediate attention. Urgent or class II (yellow tag) (major injuries that require treatment) EX: major injuries, such as open fractures with a distal pulse and large wounds that need treatment within 30 minutes to 2 hours. Nonurgent or class III (green tag) (minor injuries that do not require immediate treatment) - walking wounded - Ex: can be managed in a delayed fashion, generally more than 2 hours. Examples of green-tag injuries include closed fractures, sprains, strains, abrasions, and contusions. Expectant or class IV (black tag) (expected and allowed to die). Examples: massive head trauma, extensive full-thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation

How often must health care facilities have fire drill/response?

Once a year Pt evac not required if its a drill All staff must have fire prevention/response training each year