Concepts of Emergency and Disaster Preparedness

Internal disasters:

fire, explosion, loss of utilities

Notification & Activation of Emergency Preparedness Plans

-Radio/cellular communication between ED and EMS providers at scene -Media broadcast message via radio, TV, electronic media -DMAT team - Disaster Medical Assistance Team

Mass triage

Red: Emergent (class I) Yellow: Can wait short time for care (class II) Green: Non-urgent or "walking wounded" (class III) Black: Expected to die/are dead (class IV)

What constitutes a disaster?

-A catastrophic event that leads to great destruction and loss -Excessive morbidity and mortality -Extensive damage to crucial infrastructure

Hospital Incident Command System

-Facility-level organizational model for disaster management -Roles formally structured under hospital or long-term care facility incident commander with clear lines of authority and accountability for specific resources -Emergency operations center or command center -Hospital incident commander -Medical command physician -Triage officer

Mass casualty

-Local medical capabilities overwhelmed -May require collaboration of multiple agencies and health care facilities to handle crisis

Emergency Operations Plan: A good EOP should address each phase of disaster management:

-Mitigation -Preparedness -Response -Recovery

External disaster

-Natural (hurricanes, flooding, tornadoes, earthquakes) -Technologic: terrorism (Boston Marathon bombing, 9/11, bioterrorism, nuclear meltdown. Etc.)

Role of Nursing in Hospital Incident Command System:

-Policy development prior to disaster situation -Meet patient needs in collaboration with medical command -Personal emergency preparedness plan -Personal readiness supplies or "go bag" -Creativity and flexibility are essential

Principles of Triage

-Ration limited medical resources -Number of injured needing care exceeds resources -Treat the greatest number of victims possible -Triage is an ongoing dynamic process that continues until all viable victims receive definitive medical care -Ethical justification: greatest number vs. particular good

Emergency Operations Plan: should include plans for communication:

-Resources and assets -Safety and security -Staff responsibilities -Utilities -Clinical activities

Event Resolution:

-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

What patients can be discharged from Hospital/ED?

-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 rehab or long-term care.

Multi-casualty

Can be managed by a hospital using local resources

EVENT RESOLUTION AND DEBRIEFING

Critical incident stress - debriefing -Administrative evaluation Psychosocial response of survivors to mass casualty events

Disaster

Event in which illness or injuries exceed resource capabilities of a health care facility or community due to destruction and devastation

Hospital Incident Command System: Community relations or public information officer

Person who serves as a liaison between the health care facility and the media

Hospital Incident Command System: Hospital incident commander

Physician or administrator who assumes overall leadership for implementing the emergency plan

Hospital Incident Command System: Medical command physician:

Physician who decides the number, acuity, and resource needs of patients

Role of Nursing in Hospital Incident Command System: 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.

Role of Nursing in Hospital Incident Command System: Make room-

discharge patients from ED

Role of Nursing in Hospital Incident Command System: Telephone trees to

call in ED nurses

Hospital Incident Command System:Triage officer Physician or nurse who

rapidly evaluates each patient to determine priorities for treatment

Role of Nursing in Hospital Incident Command System: Identify areas to

treat /triage survivors

Yellow tag (triage)

• patients have major injuries, such as open fractures with a distal pulse and large wounds that need treatment within 30 minutes to 2 hours

The weather center issued a tornado warning. As the charge nurse in the ED, what type of disaster do you anticipate will be activated? A.Pandemic B.Internal disaster C.External disaster Mass casualty event

•Answer: C •Rationale: An internal disaster is any event inside a health care facility or campus such as a fire, explosion, or violence that could endanger patients or staff. An external disaster is any event outside the health care facility or campus, somewhere in the community, which requires the activation of a facility's emergency management plan. External disasters can be either natural, such as a tornado or hurricane, or technological, such as a biological terror attack. Multi-casualty and mass casualty (disaster) events are based on the scope and scale of the incident, considering the number and severity of victims or casualties involved.

After the crash of a 747 airplane at the local airport, the nurse is performing disaster triage. Which patient would be given a black tag? A.38-year-old male, left hand injury, moaning B.26-year-old male with an open femur fracture C.52-year-old female, crying, with facial lacerations D.42-year-old male, screaming, full-thickness burns to torso, upper and lower extremities

•Answer: D •Rationale: Emergent (class I) patients are identified with a red tag; patients who can wait a short time for care (class II) are marked with a yellow tag; nonurgent or "walking wounded" (class III) patients are given a green tag; and patients who are expected to die or are dead are issued a black tag (class IV). Typical examples of black-tagged patients are those with massive head trauma, extensive full-thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation. The rationale for this seemingly heartless decision is that limited resources must be dedicated to saving the most lives rather than expending valuable resources to save one life at the possible expense of many others.

Red tag (triage)

•have immediate threats to life, such as airway obstruction or shock, and require immediate attention

Green tag (triage)

•minor injuries that can be managed in a delayed fashion, generally more than 2 hours. Fractures, sprains, strains, abrasions, and contusions.

Black tag (triage)

•those with massive head trauma, extensive full-thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation.