AH Chapter 10 Test 4
examples of external disasters
external disasters can be either natural such as a hurricane, earthquake, or tornado, or technologic such as an act of terrorism with explosive devices or a malfunction of a nuclear reactor with radiation exposure. Recent external disasters include the 2015 Ebola virus crisis in a Dallas hospital, the 2013 Boston Marathon bombing, and the West Texas fertilizer plant explosion.
Debriefing
formal systematic review and analysis, occur after a mass casualty incident or disaster
emergency operations center (EOC)
A designated location in the Hospital Incident Command System (HICS) with accessible communication technology. Also called the command center
multi-casualty event
A disaster event in which a limited number of victims or casualties are involved and can be managed by a hospital using local resources.
mass casualty event
A situation affecting the public health that is defined based on the resource availability of a particular community or hospital facility. When the number of casualties exceeds the resource capabilities, a disaster situation is recognized to exist.
The experienced nurse is teaching a new nurse about hospital emergency plans and personal emergency preparedness. Which specific arrangements should the experienced nurse discuss? Select all that apply. A. Assembly of a "go bag" B. Plans for child and/or elder care C. Neighbor who is willing to care for dog D. Who will be called when the plan is activated E. How long an emergency is expected to last F. Where a nurse is expected to report if the emergency plan is activated G. Names, addresses, and telephone numbers to be used if a crisis occurs
A,B,C,D,F,G NOT E
A number of nurses are floated to the ED to care for clients affected by an earthquake. Which appropriate float nurse assignments will the ED charge nurse make? Select all that apply. A. GI laboratory nurse assigned to clients undergoing sedation B. Orthopedic nurse assigned to accompany clients to radiology C. Nursing administrator assigned to monitor loved ones in the waiting room D. Community health nurse assigned to care for clients with fractures E. Medical-surgical nurse assigned to health care worker who is feeling overwhelmed
A,C A. GI laboratory nurse assigned to clients undergoing sedation C. Nursing administrator assigned to monitor loved ones in the waiting room
action alert
Action Alert A high score on any IES-R subscale indicates a need for further evaluation and counseling. Refer the patient to a social worker, psychiatric mental health nurse specialist, or qualified mental health counselor. A high score on all subscales requires referral to a psychiatrist, clinical psychologist, or psychiatric mental health nurse practitioner or clinical specialist to evaluate the possibility of current or past trauma, such as abuse or neglect.
Hospital Incident Command System (HICS)
An organizational model for disaster management in which roles are formally structured under the hospital or long-term care facility incident commander, with clear lines of authority and accountability for specific resources.
CISD
Critical Incident Stress Debriefing
After a mass casualty event, the nurse is triaging clients in the field. Which client is correctly classified? A. 38-year-old with an open femur fracture: black tag B. 42-year-old with multiple abrasions and contusions: yellow tag C. 54-year-old with third-degree burns over 90% of the body: green tag D. 61-year-old who is having difficulty breathing and wheezing: red tag
D. 61-year-old who is having difficulty breathing and wheezing: red tag
disaster
Defined as an event in which illness or injuries exceed resource capabilities of a health care facility or community because of destruction and devastation
Pandemic
Disease that occurs over a wide geographic area and affects a very high proportion of the population. other definition from our book: (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."
examples of internal disasters
Examples of potential internal disasters include fire, explosion, loss of critical utilities (e.g., electricity, water, computer systems, and COMMUNICATION capabilities), and violence.
green tags
Green-tagged patients have minor injuries that can be managed in a delayed fashion, generally more than 2 hours. Examples of green-tagged injuries include closed fractures, sprains, strains, abrasions, and contusions.
roles
Hospital Incident Commander: Physician who assumes overall leadership for implementing the emergency plan Medical Command Physician: Physician who decides the number, acuity, and resource needs Triage Officer:Physician or nurse who rapidly evaluates each patient to determine priorities Community or Public Information Officer: Person who serves as a liasion between health care facility and media
generally, red tags mean
In general, red-tagged patients have immediate threats to life such as airway obstruction or shock, and they require immediate attention.
key points
Key Points Review these Key Points for each NCLEX Examination Client Needs Category. Safe and Effective Care Environment • Describe the hospital emergency preparedness and response team that all hospitals are required to have in case of mass casualty (disaster). QSEN: Teamwork and Collaboration • Apply principles of triage by using the typical triage system for a mass casualty situation, which includes an additional category for patients allowed to die (black-tagged) (see Table 10-1). Ethics • Describe the special roles that are assigned in a mass casualty incident as identified in Table 10-2. • Understand how to assist in determining the need for initiating the emergency preparedness plan based on available resources and staffing. QSEN: Teamwork and Collaboration • Develop a personal emergency preparedness plan (see Table 10-3). • Compare key nursing and interprofessional team roles in emergency preparedness and in response plan and debriefing. QSEN: Teamwork and Collaboration • Recall that nurses play a major role in triage, first aid and emergency care, and shelter assistance in external community disasters. Psychosocial Integrity • Assess survivors and families for their ability to adapt to the effects of disaster changes or traumatic events, including acute stress disorder (ASD) or post-traumatic stress disorder (PTSD). QSEN: Patient-Centered Care • Provide emotional support to the person and/or family coping with life changes resulting from a disaster through active listening and appropriate referrals. QSEN: Patient-Centered Care • Be honest with victims and their families. Avoid giving false reassurance. Offer orienting information and help them adapt to their changed or new surroundings. Ethics • Provide support by taking precautions to prevent staff from developing ASD or PTSD as outlined in Chart 10-2. • Recognize that older adults may not be properly assessed for ASD or PTSD. Health Care Disparities Physiological Integrity • Take precautions for meeting basic needs in a mass casualty situation; know your own limitations and develop situational awareness when responding. QSEN: Safety
Medical Reserve Corps (MRC)
Medical volunteer agency that is committed to supporting public health and emergency response in the community
Community relations or public information officer
Person who serves as a liaison between the health care facility and the media
hospital incident commander
Physician or administrator who assumes overall leadership for implementing the emergency plan
Triage officer
Physician or nurse who rapidly evaluates each patient to determine priorities for treatment
Medical command physician
Physician who decides the number, acuity, and resource needs of patients
IES-R
The IES-R is a 22-item self-administered questionnaire that includes 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 this reason, many older survivors often are not adequately assessed for post-disaster PTSD. Assess all older survivors of a disaster for this complication when possible.
2 types of debriefing
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. (talk about what went right and wrong)
typically the black tag means....
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 very difficult 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.
yellow tags
Yellow-tagged patients have major injuries such as open fractures with a distal pulse and large wounds that need treatment within 30 minutes to 2 hours.
disaster triage tag system
a system that categorizes triage priority by colored and numbered tags
2 types of disasters
internal to a health care facility or external from situations that create casualties in the community they can happen at the same time....such as a storm devastating the community and also filling up the hospitals.
DMAT (Disaster Medical Assistance Team)
is 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
The Joint Commission (2017) mandates that hospitals have an emergency preparedness plan that is tested through drills or actual participation in a real event at least _____________________
twice a year.
Basic Supplies for Personal Preparedness (3-Day Supply)
• Backpack • Clean, durable weather-appropriate clothing; sturdy footwear • Potable water—at least 1 gallon per person per day for at least 3 days • Food-nonperishable, no cooking required • Headlamp or flashlight—battery powered; extra batteries and/or chemical light sticks (NOTE: a headlamp is superior because it allows hands-free operation) • Pocket knife or multi-tool • Personal identification (ID) with emergency contacts and phone numbers, allergies, and medical information; lists of credit card numbers and bank accounts (keep in watertight container) • Towel and washcloth; towelettes, soap, hand sanitizer • Paper, pens, and pencils; regional maps • Cell phone and charger • Sunglasses/protective and/or corrective eyewear • Emergency blanket and/or sleeping bag and pillow • Work gloves • Personal first aid kit with over-the-counter (OTC) and prescription medications • Rain gear • Roll of duct tape and plastic sheeting • Radio—battery powered or hand-crank generator • Toiletries (toothbrush and toothpaste, comb, brush, razor, shaving cream, mirror, feminine supplies, deodorant, shampoo, lip balm, sunscreen, insect repellent, toilet paper) • Plastic garbage bags and ties, resealable plastic bags • Matches in a waterproof container • Whistle • Household liquid bleach for disinfection
other needed teams
• 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
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
color of tags
• 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. • Patients who are expected (and allowed) to die or are dead are issued a black tag (class IV).
nurse's role in responding to healthcare 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 yourself or staff members while moving patients or attempting to extinguish the fire.
Preventing Staff Acute Stress Disorder and Post-Traumatic Stress Disorder Following a Mass Casualty Event
• 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 more than 12 hours per day.
people who might be discharged early to free up beds
• 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