Disaster Module 5 (NV, EXAM 2)
Disaster There are many definitions of disaster
A serious disruption of the functioning of a community or society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope with its own resources
Tsunami
A tremendously powerful ocean wave that is the result of an underwater earthquake, landslide, or a volcano. It is a series of waves spaced minutes to more than one hour apart.
Red (emergent) shock compromised airway unstable wounds chest trauma
According to the color-coded priority tagging a patient with life-threatening injuries with high probability for survival if immediate treatment is received would receive what color? What are some examples of these types of patients?
Black (expectant) pulselessness apnea severe neurological trauma full thickness burns greater than 60% total body surface area
According to the color-coded priority tagging extensive injuries with poor prognosis regardless of the treatment would receive what tag? What are some examples?
Green (non-urgent) infections minor burns or lacerations closed fractures
According to the color-coded priority tagging injuries requiring treatment but can wait for two hours or longer would receive what tag? What are some examples?
Yellow (urgent) open fractures with palpable distal pulse large wounds
According to the color-coded priority tagging; serious injuries requiring treatment within 30 minutes and two hours would receive what tag? What are some examples of these types of patients?
Recovery
During this stage of disaster planning there is restoration of property; rebuilding and repairing and replacing property. Returning to school and work. Continuing without those lost in the disaster. Life of the community returns to normal. Preparation for mitigation of future disasters.
Fault line epicenter
Earthquakes are defined as a sudden rapid shaking of the ground caused by the shifting of the tectonic plates that formed the earths crust. Where the edges of the tectonic plates meet is referred to as a major _______ _______ the point of rupture is known as the _________.
Red (immediate) START Adult triage
Victim can be helped by immediate intervention and transport. Requires medical attention within minutes for survival (up to 60) includes compromises to patient's airway, breathing, and circulation. What triage tag color is this?
Black (expectant) START Adult triage
Victim unlikely to survive given the severity of injuries, level of available care, or both. Palliative care and pain relief should be provided. What triage tag color is this?
Green (Minor) START Adult triage
Victim with relatively minor injuries. Status unlikely to deteriorate over days. May be able to assist in One care: "walking wounded ". What triage tag color is this?
Yellow (delayed) START Adult triage
Victims transport can be delayed. Includes serious and potentially life-threatening injuries, but status not expected to deteriorate significantly over several hours. What triage tag color is this?
Blast front blast wind
Explosions occur when a solid or liquid material is rapidly transformed into a gas and energy is released. The gas expands outward in a high pressure blast wave that exceeds the speed of sound. Air is highly compressed on the leading edge of the wave, creating a shock or ______ ______. the body of the wave and the associated mass outward movement of ambient air is called The ______ ______ which follows the front.
Blind injuries (rapid movement of victims through the air who then strike a stationary object) penetrating ballistics (wind driven projectiles striking people) crush injuries (from collapse of structures) traumatic injuries to the head, thorax, and abdomen Eye injuries closed and open brain injuries
What types of injuries might you see from a tornado?
Drowning blunt force trauma crush injuries impalements penetrating trauma closed head injury Eye injuries pulmonary injury from aspiration of contaminated water orthopedic injuries
What types of injuries might you see from a tsunami?
Orthopedic injuries acute myocardial infarction carbon monoxide poisoning cold exposure hypothermia , frostbite Frostnip motor vehicle accidents injuries from the use of power equipment for clearing debris , falling trees and snow head, chest, and abdominal injuries from snowmobile accidents
What types of injuries might you see with a blizzard?
Heat stroke sunstroke heat cramps heat exhaustion fatigue
What types of injuries might you see with a heat wave?
Gastric lavage cathartics blocking the uptake to the thyroid by administering potassium iodide excision of the wound to minimize absorption dilution altering the chemistry of the substance chelation (binding of ions and molecules to render a harmful agent inactive or facilitate excretion ) bronchoalveolar lavage
A person is internally contaminated if radioactive material is breathed in, swallowed , or absorbed through wounds. what is the treatment for internal contamination?
Debriefing this should include all participants in the response
A post event disaster _______ should be held within 24 hours of the disaster response. The purpose is to critically analyze all aspects of the response and identify strengths and areas that need to be improved. It also allows hospital leadership to identify staff who needs assistance recovering.
Disaster drill - setting up the incident command center - receiving casualties - triage testing communication systems - evacuating and transporting patients - requesting and receiving emergency supplies -staff roles and responsibilities -utility management - safety and security - resources and assets
A _______ ______ or exercise is a controlled, scenario driven experience design to demonstrate and evaluate an organizations capability to execute it's emergency operations plan (EOP). What all is included?
Mass casualty incident (MCI) all mass casualty events are disasters, but not all disasters are MCI's
A _______ _______ ______ refers to any large scale event in which emergency medical resources such as supplies, medical or rescue personnel, or equipment are overwhelmed by the number and severity of casualties, thus requiring prioritization of medical care by triage.
Chemical incident An outdoor vapor cloud release is quickly dissipated by the wind resulting in a small number of casualties at the release site an agent released indoors does not dissipate as easily and can lead to a greater number of casualties temperature, humidity, and type of terrain can affect dispersal
A _______ _______ usually involves the release of a vapor or liquid. The type and volume of the agent released determines the type and volume of injuries
Dirty bomb > The secondary agent can be any hazardous or infectious agent Improvised explosive devices (IED)
A common explosive weapon is called The _______ _______ which is an explosive device that intentionally releases a secondary agent. ______ _____ ______ are conventional explosive devices deployed in an unconventional fashion such as a suicide bombing.
Foreshocks aftershocks
A major earthquake can be preceded by less severe preliminary tremors called ______ smaller tremors after the main earthquake are called ______
Green/minor
All walking wounded are considered what SMART tag?
Category A: > easily disseminated or transmitted > resulting in high mortality rates with the potential for a major public health impact, may cause panic and social disruption, may require special action by public health officials category B & C agents: > less easily disseminated and result in lower morbidity and mortality rates The anthrax contaminated letters in 2001 is an example of biological weapons
Bioterrorism is when organisms and toxins are used as biological weapons. What three categories are they categorized by?
Mitigation For example requiring roof reinforcements to reduce damage from hurricane winds or passing legislation that prevents new construction in flood plains
Disasters have an occurrence cycle which entails a series of management phases that include strategies to mitigate hazards and prepare for, respond to, and recover from disasters and their effects. There are four phases of the disaster cycle. This phase of the cycle includes activities that eliminate or reduce the chance of occurrence or the effects of an event if it occurs.
Casualty collection area (CCA) secondary triage
During a disaster event, prehospital personnel arriving at the scene usually establish a clear area for casualty collection this is known as the ______ ________ ________ ; patients are brought to this area and triaged and tagged with a corresponding color triage tag, provided with basic field care for stabilization, and transported to the most appropriate facility for care. Then, at the healthcare facility _______ _______ is typically performed by ED personnel immediately upon a patient's arrival ; they are then assigned a treatment area for care
Skull fractures spinal cord injuries hypothermia wound infections exacerbation of pulmonary diseases such as asthma crush injuries
What types of injuries or medical issues might you see from an earthquake ?
The adverse effects of exposure may not be a parent for many years and can be mild or serious mild : skin reddening serious : cancer and death large doses can cause death within a few hours or days
How does radiation affect the body?
Advanced warning event hurricanes
In some situations the actual hospital needs to be evacuated. With this type of event the hospital incident commander has time prior to the event to make an evacuation decision but must remember there is a limited opportunity to evacuate. What is this type of hospital evactuation? What is an example?
Impact
In this stage the disaster has occurred. Community experiences immediate effects. Rapid assessment of damage, injury, and community needs.
Non-disaster
In this stage there is a disaster in the future. It allows time for planning, preparation and mitigation or reducing the harmful effects of the potential disaster.
Predisaster
In this stage there is evidence of an impending disaster. Actions include warning, pre-impact, mobilization, and evacuation as necessary.
Emergency
In this stage there is immediate and long-term need for assistance including first aid, search and rescue, emergency medical assistance, establishment and restoration of transportation, restoration of communication, community assessments of infectious disease, and mental health. Continued evactuation as needed.
Additional considerations for evacuation include sequences of the evacuation, urgency of the evacuation, extent of the evacuation, condition of hospital infrastructure, types of patients, road conditions, and transportation resources Usually the most medically fragile and resource intensive patients are evacuated first > sometimes in cases where all patients are in immediate danger and evacuation must be conducted as quickly as possible mobile patients are evacuated first sometimes there is a drop everything and go evacuation in which patients and staff are in immediate danger and must exit the unit or hospital as quickly as possible if only one hospital in the community is being evacuated patients can more easily be disbursed to nearby hospitals
Notes:
Airway repositioning if repositioning initiates respirations the patient is tagged "immediate "- red
Patients with no spontaneous respirations receive what before being tagged deceased?
Red - immediate yellow - delayed
Patients with respirations greater than 30 breaths per minute or capillary refill less than two seconds (or lack a radial pulse) or who are unable to follow simple directions are tagged _______ those remaining patients are tagged ______
Rewatch video in module!
Rewatch video in module!
Patient capable of ambulating and understanding directions and have adequate perfusion to follow commands and stay upright
START begins by tagging which types of patients green or minor?
Direct pressure to control bleeding basic airway opening maneuvers Note: there are usually two waves of casualties that arrive at the hospital. - The first wave is between 15 to 30 minutes and they are the walking wounded who were able to self extricate from the scene - the second wave will follow in 30 to 45 minutes and this group needs assistance and were transported by EMS these are usually the more seriously injured
The START triage allows for only two interventions during the triage process. What are they?
Safety/security officer liaison officer
The _____ _______ is responsible for monitoring and assessing personnel hazards and unsafe situations The ________ _______ acts as the unseen contact point for assisting agencies
The national response framework
The ______ ______ _______ is the disaster plan for the nation. The document establishes a comprehensive, national, all hazards approach to domestic incident response, from the smallest incident to the largest catastrophe. It lays the groundwork for first responders, decision-makers, and supporting entities to provide a unified national response
Incident command system (ICS) command operations planning logistics finance/administration * the ideal span of control is three people, and the maximum is seven. For terrorist incidents a sixth role intelligence gathering may be added
The _______ _______ ______ is an organizational tool used to provide the management infrastructure to support any disaster response. What are the five management activities or functions common to all events regardless of size or type?
Hazard vulnerability analysis (HVA) events are categorized as high, medium, or low probability and consequences are also rated disaster planners then use the grid for planning purposes
The first step in disaster planning is development of a _______ ______ _____which is an assessment of the risks and consequences of a disaster or critical event occurring in the community. A list of all potential hazards and threats in the region is compiled. Each hazard is then given a ranking of low, medium, or high probability of occurrence.
Incident commander
The incident command system includes many roles and responsibilities. This role is responsible for all aspects of the response. They have overall authority and are responsible for the entire operation. Four chiefs report to them and each chief supervises a team of responders
Color code patient tagging (disaster triage color-coded priority tagging) : Black - expectant red - emergent yellow - urgent Green - non-urgent START adult iTriage method algorithm: Black - expectant red - immediate yellow - delayed green - minor
The previously mentioned Triage algorithm is the START adult triage algorithm. Another method is the color code patient tagging. What are the four parts of this method compared to the START adult triage algorithm?
Level A - totally encapsulating chemical protective suit a.k.a. moon suit - with self-contained breathing apparatus - gloves - boots When the hazards are unknown or unquantifiable or when the greatest level of protection is required generally not appropriate for hospital staff
The selection of appropriate PPE (personal protective equipment) for a disaster is complex and based on a hazard assessment that identifies the hazards or suspected hazards, the routes of entry of the potential hazard (inhalation, absorption, ingestion, Eye or skin contact) and the performance of the PPE materials and providing a barrier to these hazards. There are different levels. This level is the highest level of respiratory, Eye, mucous membrane, and skin protection. It provides protection against gas, vapor, liquid, and oxygen deficient atmospheres. What is this level? What does it include in regard to equipment? When should this level be selected?
Casualty incident
The term ________ includes all persons who are ill, injured, missing, or dead as a result of the disaster event. The term ________ is defined as an event that requires scene or casualty management
Hurricanes cyclones typhoons
These three things are storm systems that can produce extremely powerful winds, torrential rain, high waves, and Damaging storm surges as well as Spawn tornadoes.
Level D surgical gown mask gloves
This level provides no additional protection for respiratory or splash hazards, only minimal protection for nuisance contamination. What type of PPE is included?
Level B self-contained breathing apparatus non-encapsulated chemical resistant garments gloves boots should be selected when the highest level of respiratory protection is necessary but a lesser level of skin protection is needed
This level provides the greatest level of respiratory protection but a lower level of skin protection. It is not fully encapsulated and airtight but provide splash protection against liquid. What level is this? What is included equipment wise? When should it be selected?
Level C Nonencapsulated chemical resistant suit (splash protection) air purifying respirator (APR) gloves boots used when the type of airborne exposure is known to be guarded against adequately by an air purifying respirator
This level provides the same skin protection as level B, but less respiratory protection than The others. It consists of what equipment? When is it used?
Public information officer
This member of the incident command system is responsible for advising the commander on all public information matters, manages the media and warnings, and rumor monitoring; all in order to verify, coordinate, and spread accurate, accessible, and timely information related to the incident
Response
This phase of the cycle includes emergency assistance to victims of the event
Recovery
This phase of the disaster cycle includes activities directed at restoring essential services and resuming normal operations.
Preparedness Examples include disaster drills, evacuation plans, and fire drills.
This phase of the disaster cycle is planning how to respond when an emergency or disaster occurs
Beta radiation large beta particles impinging on the skin can damage the basal layer of the skin and cause radiation burns. Beta radiation as with alpha particles can also cause biological damage when ingested or inhaled
This type of ionized radiation is a stream of electrons that can be stopped by a few millimeters of aluminum but can penetrate up to a centimeter into human tissue.
Gamma radiation
This type of ionized radiation is similar to x-rays as it can penetrate the whole body, but unlike x-rays they are more radioactive and can kill cells. Because of its high penetrability, it can deliver radiation doses to the internal organs as well as the skin, resulting in damage.
Alpha radiation
This type of ionizing radiation is a stream of positively charged particles that travel only about an inch in the air. They have no penetration power past the keratinized layer of the skin and can be stopped by a thin clothing or a sheet of notebook paper. However, It can be very damaging if inhaled or introduced into an open wound because of the energy transfer to the delicate cells of the lungs or internal organs.
Earthquakes, building fires, tornadoes, and explosions. Decisions must often be made very quickly in the midst of the disaster and immediately afterward
What are examples of no advance warning events?
- Casualty triage - putting the response plans into action, evaluation, and decontamination when necessary - treatment: stabilization, med administration, antidotes or prophylaxis, routine or emergency care as dictated by the patient's condition - supportive care and mental health support to the victims a great distractor for nurses is worrying about family and significant others > nurses feel more comfortable that their family members know what to do in the event of a disaster > comprehensive family disaster planning information is available from the American red cross and FEMA
What are nursing roles in a disaster? What is one of their main concerns?
Acute local: > present with a skin lesion without a history of chemical or thermal burn, insect bite, or skin disease or allergy > they may provide a history of radiation exposure or handling an unknown metallic object > these injuries evolve very slowly > erythema, blistering, dry or wet desquamation, epilation, ulceration conventional wound management is not effective Acute radiation syndrome: > initial symptoms are non-specific and hard to distinguish from other illnesses > nausea, vomiting, anorexia, diarrhea, fever, possible mild skin erythema > > skin damage; swelling, itching, redness like a bad sunburn - complete healing can take years > hair loss > these symptoms may start minutes to days after exposure, last up to several days, and may come and go > later they may have vomiting, seizures or coma - this seriously ill stage can last up to months followed by recovery or death > early onset of anorexia, N/V, and malaise is an indication of high-dose exposure
What are the clinical manifestations of patients with acute local injury from radiation? What about acute radiation syndrome (ARS)?
Ensure contamination has been addressed identify victims belongings that have been exposed identify potential evidence
What are the functions of the contaminated strip in the disaster triage method?
Non-disaster pre-disaster impact emergency recovery
What are the stages of disaster planning?
1) An event of distructive magnitude 2) that kills, injures, or causes human suffering to a significant number of people or the environment 3) and that requires the need for external assistance
What are the three main characteristics that define most disaster events?
Remove the patients clothing wet the patients skin and wash with soap and water for 5 to 10 minutes pay special attention to hair, face, hands, and other areas that were exposed but not covered by clothing follow washing by a copious rinsing of the patient with tepid water
What is included in patient decontamination?
Local government emergency services with neighboring communities and volunteer agencies are first then if overwhelmed they turn to the state for assistance who can respond with the National Guard or other state agencies > the state governor is responsible if needed they can request assistance through the emergency management assistance compact (EMAC) then, the governor of the affected state may request federal assistance if needed > FEMA (Federal emergency management agency) can assist with search and rescue, electrical power, food, water, shelter, and other basic needs > FEMA evaluates the request and recommends action to the White House for approval > this may take a few hours or several weeks if a presidential major disaster declaration is declared funding comes from the presidents disaster relief fund managed by FEMA
What is the chain of command in responding to a disaster; who comes first etc.?
Tornado watch is issued when although a tornado has not been seen, conditions are very favorable for one to occur at any moment tornado warning is issued when a tornado has actually been cited or picked up on radar
What is the difference between a tornado watch and a tornado warning?
Focused on support and recovery of the hematological system Prevent neutropenia and sepsis The higher dose of radiation, the more likely they are to die usually within several months of exposure the cause of death is the destruction of bone marrow resulting in infections and internal bleeding for survivors, the recovery can last up to two years
What is the treatment for ARS (acute radiation syndrome)?
Rapid onset of symptoms large numbers of patients presenting with common symptoms low-lying clouds or vapors dying animals or insects unexplained odors concentrations of dead, dying, or sick people at the scene
What kind of clues can help in the detection of a chemical event?
Green (Minor) they can go to secondary triage START Adult triage
What triage tag color would there be for a patient able to walk?
Death by interfering with the nervous system inhibit breathing and lead to asphyxiation Caustic effects on contact depends on the route by skin or inhalation treatment is difficult because there are many different kinds of chemicals encountered medical personnel may need to wear PPE from a simple mask to a chemical protection suit and breathing apparatus exposure can also complicate or trigger existing illnesses such as asthma
What types of effects can chemical agents cause?
Drowning electrocution lacerations punctures from flying debris blunt trauma or bone fractures from falling trees or other debris heart attacks and other stress related disorders injuries from improper use of chainsaws or other power equipment disrupted wildlife (bites from animals, insects, and snakes)
What types of injuries might you see from a cyclone, hurricane, or Typhoon?
Authorities will monitor the levels of radiation > officials may advise people to shelter in place or move to another more safe location Local radiation injury - usually involving only the hands and may coexist with acute radiation syndrome acute radiation syndrome - an acute illness caused by irradiation of the whole body (or a significant portion of it)
What were to happen if there was a radiation emergency in the United States... What steps are taken in these instances? What are the two types of radiation injury?
14 days
When it comes to a disaster supply kit; how long of a medication supply is recommended?
Operations chief * responsible for tactical operations; decontamination, rescue/extraction, triage, treatment, transportation, communication, and medical control planning chief * continuously evaluates the response by maintaining resource status, evaluate future resource needs and personnel, maintain incident records logistics section chief * obtains and provides services and resources, equipment needed, and staff support finance/administration chief * documents all financial costs including recovery for services and supplies
Who are the four chiefs who report to the incident commander and what are their responsibilities?
Yellow (delayed) START Adult triage
You have a patient that is unable to walk, respiratory rate less than 30, radial pulse is present and capillary refill less than two seconds. You check their mental status: they are able to obey commands. What is their triage tag?
First, position in the airway if the result is apnea: black tag (expectant) if the result is spontaneous breathing: red tag (immediate) START Adult triage
You have a patient who is unable to walk and no spontaneous breathing. What do you do? If the result is apnea (no breathing) what is the triage tag? If the result is spontaneous breathing what is the triage tag?
Red (immediate) START Adult triage
You have a patient who is unable to walk but is breathing. Their respiratory rate is greater than 30; what is the triage tag?
Red (immediate) START Adult triage
You have a patient who is unable to walk, and breathing at a respiratory rate of less than 30. You check perfusion: their radial pulse is absent and/or their capillary refill is greater than two seconds. What is the triage tag?
Red (immediate) START Adult triage
Your patient is unable to walk, has a respiratory rate of less than 30, radial pulse is present and capillary refill is less than two seconds. You check their mental status: they do not obey commands. What is the triage tag?
Tornadoes
______ Are spawned by severe thunderstorms. There are approximately 1000 each year in the United States
Ionizing Alpha Beta Gamma
______ Radiation can damage our DNA and cause health effects when humans are exposed in high doses. What are the three different types?
Severe acute respiratory syndrome (SARS) spread by droplets through the air can last on surfaces for up to six hours and up to three hours after droplets have dried
______ ______ ______ _______ is a contagious respiratory infection. It is a serious form of pneumonia caused by a virus.
Surge capacity
______ ______ has been defined as the ability to obtain adequate staff, supplies and equipment, structures and systems to provide sufficient care to meet the immediate needs of an influx of patients following a large scale incident or disaster.
Simple triage and rapid treatment (START) RPM: respirations perfusion (or pulse) mental status
______ _______ ________ _______ ________ Is the most commonly used triage system in the United States. It uses physiological parameters and is designed to be completed in 60 seconds or less. What are the three observations that it is based on?
Emerging infections
______ _______ can be considered an MCI (mass casualty incident) if large numbers of people are affected for example severe acute respiratory syndrome (SARS) and novel influenza A (H1 N1)
Radiation * people are exposed to radiation every day in the form of TV, microwave, and diagnostic testing etc. These sources pose no health risk.
_______ is a form of energy that is present all around us.
Influenza A (H1N1, Swine Flu)
_______ is a highly contagious viral disease that typically occurs as an epidemic (a widespread disease that spreads rapidly and affects many in the population) during the cold months. A pandemic occurs when a new influenza virus emerges and starts spreading all around the world. This particular pandemic was a global outbreak of a new strain of influenza A virus.
Terrorism There are many definitions Acts of terrorism can include threats, assassinations, kidnappings, hijackings, bomb scare's, bombings, cyber attacks, the use of chemical, biological, radiological, nuclear, and explosive weapons >>> or weapons of mass destruction - any weapon or device that is intended, or has the capability, to cause death or serious bodily injury to a significant number of people through the release, dissemination, or impact of a toxin or poisonous chemical or other precursors, a disease organism, radiation or radioactivity, or an explosive device
_______ is a particular type of disaster that may or may not produce an MCI (mass casualty incident). It is premeditated, politically motivated violence perpetrated against noncombatant target by subnational groups or clandestine agents, usually intended to influence an audience.
Triage the goal of daily triage is to identify and treat the most seriously ill or injured first In a disaster situation there Has to be a shift of doing the most good for the greatest number of people rather than doing everything possible to save every life. This may mean delaying care to selected patients who have little hope of survival or would consume too many resources > disaster triage is only in the most catastrophic situations
_______ is the process of placing the right patient in the right place at the right time to receive the right level of care.
Irradiation a person is irradiated when he or she is "exposed" to ionizing radiation from sources outside of the body. There is no transfer of the material from the environment to the body, and the person poses no radiological hazard to anyone else. Being exposed to external radiation does not make a person radioactive
________ is the act of "exposing" something or someone to radiation.
decontamination Hospitals first lock down the entrances in order to protect patients and staff if possible patients should be decontaminated at the incident site Or sometimes decontamination sites are set up immediately outside of the ED hospitals must plan for the decontamination team to be protected with enough suits, respirators, boots, and gloves
________ is the reduction or removal of contaminating material from a person or equipment by water and mechanical processes.
Contamination a person externally contaminated with radioactive materials will be irradiated until the source of radiation is removed from the body, clothing, or wound. Decontamination is typically performed to remove external contamination.
________ occurs when people have radioactive material on or in them. A person is externally contaminated when the material that contains radioactive Atoms is deposited in the skin, clothing, or anywhere it is not desired.
Primary secondary tertiary
_________ blast injury is a result of barotrauma, unique to explosions, which causes damage to air filled organs - the lungs (hemothorax, pneumothorax), gastrointestinal tract (bowel perforation), and auditory system (Tympanic membrane rupture). _______ Blast injuries refer to a trauma caused by projectiles carried by the blast pressure wave penetrating any body part _______ blast injuries are caused by the individual being propelled by the blast wave and thrown into an object or when a structure collapses and causes injury.
