Diaster & Triage
Triage colors
- minor= green - delayed= yellow - immediate= red - dead/no saving=black
Only medical tx during triage?
- open airway - insert oral airway prn - stop bleeding - elevate extremities for shock: bring blood return back to heart
Yellow examples
- open chest wound - penetrating abdominal wound - open wound - non-life threatening fracture - 2/3 degree burns NOT on face
Disaster Level 2
- regional efforts and aid from surrounding communities can contain and manage
How to triage?
- separate walking wounded from others - use life functions to tag remaining: breathing, blood flow, mental status RPM Respiration, Perfusion, Mental Status -RATE PENIS MORE-
START
- simple assessment for triage and rapid treatment - 30 seconds or less - RPM R: respiratory, P:erfusion, M:ental status START RATING PENIS MORE
Volcanic eruption risks?
- smoke inhalation - burns
Start triage kit
- tape to create triage areas - pt triage tags - clipboards - ID vests
Red Tag examples
- airway obstruction - sucking chest wound - massive bleeding - shock - incomplete amputation - 2/3 degree burns face and neck - white phosphorus burn
Role of nursing in disasters
- determine magnitude of event - define health needs of affected groups - establish priorities and objectives - identify problems - collaborate - maintain chain of command - communication
Flood risks?
- drowning - infection from contaminated water
Hurricane risks?
- drowning - injury from flying debris
Trauma Center: Level IV
- eval, stabilize, transfer - trauma trained RN
In order to be a green tag you have to what?
- get up and walk - treatment can be delayed for several hours - vitals not abnormal
Tornado risks?
- head and chest trauma from flying debris
Developing countries are at an increased risk of deaths from disasters due to what?
- lack of preparedness and infrastructure
Triage principles
- life over limb - bodily function over cosmetic appearance - greatest good for greatest number of people
When dealing with children following a disaster?
- listen attentively - do not deny their feelings - answer the questions clearly and make it easy for them to understand - provide a safe secure area
Disaster Level 3
- local and regional not enough - state/federal assistance needed
Disaster Level 1
- local emergency response can contain and manage
The nurse is the first responder at the scene of a 6-car crash on a highway. Which victim should the nurse attend to first? 1.A victim experiencing dyspnea 2.A victim experiencing confusion 3.A victim experiencing tachycardia 4.A victim experiencing intense pain
1.A victim experiencing dyspnea The client experiencing dyspnea is the priority. Needs related to maintaining a patent airway are always the priority. The victims experiencing confusion, tachycardia, and intense pain would be assessed following stabilization of the client with an airway problem.
The nurse in the hospital emergency department is notified by emergency medical services that several victims who survived a plane crash will be transported to the hospital. Victims are suffering from cold exposure because the plane plummeted and was submerged in a local river. What is the initial action of the nurse? 1.Call the nursing supervisor to activate the agency disaster plan. 2.Supply the triage rooms with bottles of sterile water and normal saline. 3.Call the intensive care unit to request that nurses be sent to the emergency department. 4.Call the laundry department, and ask the department to send as many warm blankets as possible to the emergency department.
1.Call the nursing supervisor to activate the agency disaster plan.In an external disaster, many people may be brought to the emergency department for treatment. The initial nursing action must be to activate the disaster plan. Although options 2, 3, and 4 may be additional measures that the nurse would take, the initial action would be to activate the disaster plan.
The community health nurse is working with disaster relief after a tornado. The nurse assists in finding safe housing for survivors, providing support to families, organizing counseling, and securing physical care when needed. Which level of prevention does the nurse exercise? 1.Primary level of prevention 2.Secondary level of prevention 3.Tertiary level of prevention 4.Quaternary level of prevention
3.Tertiary level of prevention Tertiary prevention involves reduction of the amount and degree of disability, injury, and damage after a crisis. Primary prevention means keeping the crisis from occurring, and secondary prevention focuses on reducing the intensity and duration of a crisis. There is no known quaternary prevention level.
The nurse from a medical unit is called to assist with care for clients coming into the hospital emergency department during an external disaster. Using principles of triage during a disaster, the nurse should attend to the client with which problem first?1.Fractured tibia 2.Penetrating abdominal injury 3.Bright red bleeding from a neck wound 4.Open massive head injury in deep coma
3. Bright red bleeding from a neck wound The client with arterial bleeding from a neck wound is in immediate need of treatment to save the client's life. This client is classified as such and would wear a color tag of red from the triage process. The client with a penetrating abdominal injury would be tagged yellow and classified as "delayed," requiring intervention within 30 to 60 minutes. A green or "minimal" designation would be given to the client with a fractured tibia, who requires intervention but who can provide self-care if needed. A designation of expectant is applied to the client with massive head or other injuries and minimal chance of survival; the corresponding color code is black in the triage process. Such clients receive supportive care and pain management but are given definitive treatment last.
Emergency Assessment ABCDEFG
A: airway B: breathing and ventilation C: circulation and hemorrhage control D: disability (neuro status) E: exposure and environmental control (prevent hypothermia) F: facilitate, adjuncts and family (VS, focused assessments, family presence) G: get resuscitation adjuncts (determine need for additional measures to monitor pt's condition) aka get back up
Disasters that have the most injuries vs deaths are?
Involving Wind
Signs that lead to immediate red tag care?
RR > over 30 bpm cap refill > 2 seconds unable to follow simple commands
Preparedness
ER plans, training and exercises, sirens ie evacuation plans/routes/ designated shelters
Recovery
Economic recovery, debris management, housing, health and social services ie. damage assessments, funding assistance
Tags explained
Green: moving walking around Black: no respirations after head tilt Red: Breathing but unconscious, RR >30, Cap refill >3 seconds or no pulse, unable to follow commands Yellow: RR= 30 or less, Perfusion= 2 or less, Able to obey commands
Trauma center: Level 3
No 24hr/day surgery
Best response to a global pandemic?
PREVENTION
Emergency Assessment SAMPLE
S: symptoms A: allergies M: med hx P: past med hx L: last meal E: events leading up to injury
Trauma center: Level 2
Same as 1, no educational research programs
In order to be a yellow tag you have to what?
VS must be within normal limits and cannot walk - if VS are not within normal range: red tag
Disasters that involve the most fatalities are what?
Water Disasters
If nurses are the most trained personnel at the site, do they take charge?
YES
Trauma centers: Level 1
high level medical care, surgical care, equipment, and specialists available 24 hrs a day - general surgeons 24/hrs a day - educational and research programs with prevention and outreach programs
Response
life safety, incident stabilization, property preservation, evacuation, shelters, mass care ie. search and rescue, clearing debris, feeding/sheltering victims
In mass casualty injuries rank how?
minor: WAIT severe: IMMEDIATE mortal: NO CARE
Disaster Management Cycle
mitigation, preparedness, response, recovery
Mitigation
public education, hazard & vulnerability assessment, improved infrastructure ie stockpile supplies and equipment, immunization programs