Class 16 B - Disaster and Emergency Management

1. benefits for pts, caregivers and staff 2. provide comfort, advocate, remind staff of person behind the trauma 3. serve as staff helpers 4. remember to explain care and answer questions

actions for facilitation of adjuncts and family (4)

L - lab studies M - monitor ECG N - NG tube // orogastric tube O - oxygenation and ventilation assessment P - pain management - combination of pharmacologic e.g., NSAIDs, IV opioids and nonpharmacologic e.g., distraction, positioning, music

actions for resuscitation adjuncts (LMNOP)

1. training for disaster response 2. establish relief centers 3. provide emergency funding

actions of FEMA (federal emergency management agency) (3)

violence

= is the acting out of the emotions of fear and/or anger = to cause harm to someone or something = can take place in a variety of settings, including home, community, workplace = the pt in the ED may be the victim or the perpetrator = EDs are high-risk areas for this

emergency response plan

= knowledge of this plan is essential for a HCP

Mass Casualty Incident (MCI)

= manmade or natural event or disaster = overwhelms community's ability to respond with existing resources = ALWAYS requires assistance from people and resources OUTSIDE affected community

shelter in place

= to stay put, in order to stay safe e.g., in home, car, school = is a collection of items to sustain a person/family for 3-7 days = stays in residence = items form go-bag plus survival gear e.g., duct tape, fishing gear, distraction supplies

critical incident stress management teams/unit

= many hospitals and DMAT (disaster management assistance teams) have it = help people cope with the disaster = arrange group discussions/debriefings to allow participants to share and validate their feelings and emotions about the experience = this is IMP ORTANT for emotional recovery

heat stroke

= most serious form of heat stress = failure of hypothalamic thermoregulatory response = medical emergency = vasodilation, increased sweating and RR deplete fluids and electrolytes (esp. sodium)

radiologic/nuclear agents of terrorism

= other category of agents of terrorism = different types

...doubling the number of victims who arrive in FIRST hour

= total number of casualties a hospital can expect is estimated by...

NDMS (national disaster medical system)

= part of department of health and human services, office of preparedness and response = expands national medical response capability = critical incident stress managment

FEMA (federal emergency management agency)

= plan prepare and mitigate disaster = help victims to stay safe until insurances kick in = application has to be filed for funding (food, shelter have priority)

Go-Bag

= portable bag = prepared for an individual = contains emergency items for 1-2 days

65-70%

%age that usually will be green and yellow

American Red Cross

= prevents and alleviates human suffering in the face of emergencies by mobilizing the power of volunteers and the generosity of donors = present for disaster relief = active in teaching disaster prepardness

disability

= pt's LOC is a measure of the degree of this = use GCS to determine LOC = do NOT raise level of this e.g., pts with SCI

tularemia

= rabbit fever

sarin

= toxic nerve gas = can cause death within minutes of exposure = enter body through eyes and skin = acts by paralyzing respiratory muscles = antidotes for these nerve agents are available

less than 15 seconds

= triage of casualties differ from usual ED triage = is conducted in less than ___ seconds

mustard gas

= yellow to brown in color with garlic-like odor = irritates eyes and causes skin burns and blisters

radiologic dispersal device (RDD) "dirty bombs"

= radiologic/nuclear agent of terrorism = mix of explosives and radioactive material = when detonated, blast scatters radioactive dust, smoke and other material into environment = result: radioactive contamination = main danger: explosion - can cause serious injury = material used e.g., uranium and iodine 131 do NOT generally generate enough radiation to cause immediate serious illness UNLESS to victims that are in close proximity to explosion = inhalation of smoke and dust can cause illness

NIMS (national incident management system)

= response to MCIs often requires the aid of a federal agency such as this organization = is a section within US department of Homeland Security = coordinates federal, state, local response efforts = develops incident command center system (ICS)

black

= tag = indicates deceased or unlikely to survive e.g., massive head injury, multiple life-threatening injuries

red

= tag = indicates life-threatening = major blood loss/shock

yellow

= tag = indicates urgent non-life threatening e.g., fractures, lacerations

green

= tag = indicates minor = pt can walk e.g., sprains, abrasions

bioterrorism

= the use of biological weapons in terrorist attacks

ARS (acute radiation syndrome)

= high dose of radiation received in a matter of minutes result into this condition = develops after a substantial exposure to ionizing radiation = follows a predictable pattern = mild effects include skin reddening = may lead to cancers (with low dose and in those surviving this condition)

emergency nursing

= initiation of interventions to reverse or prevent a crisis

1. phone call to mobile phone 2. phone call to home 3. text 4. email

4 ways to receive community alerts

triage

= "to sort" process of rapidly determining pt acuity = represents a critical assessment skill = works on the premise that pts who have a threat of life must be treated BEFORE other pts

family and Intimate Partner Violence

= IPV = pattern of coercive behavior in a relationship that involves fear, humiliation, intimidation, neglect or intentional physical, emotional, financial or sexual injury = most victims are women, children and older adults = found in all professions, cultures, socioeconomic groups, age groups and genders = routine screening for this in the ED is required = development and implementation of policies, procedures and staff education programs improve screening practices

explosive devices

= agent of terrorism = e.g., TNT, dynamite = result in injuries

primary survey

= aims to identify life-threatening conditions so that appropriate interventions can be started

psychological stress component

= all disaster events have this component

drill

= allow HCPs to become familiar with the emergency response procedures = all HCPs have a role in emergency and MCI preparedness = participation is required

emergency

= any extraordinary event that requires a rapid and skilled response = can be managed by a community's existing resources e.g., multi-vehicle crash

chemicals

= are also used as agents of terrorism = are categorized according to their target organ OR effect = protocols to treat victims of this type of exposure vary and relate to the specific agent

CERT (community emergency response team)

= are recognized partners by FEMA in emergency preparedness = training helps citizens to understand their personal responsibility in preparing for natural/manmade disaster = all healthcare providers have a role/responsibility in disaster prepardeness = participants are taught what to expect AFTER a disaster and how to safely help themselves, family and neighbors = are an extension of the first responder services = can offer immediate help to victims and organize untrained volunteers to assist until professional services are available

secondary survery

= begins after addressing each step of the primary survey and starting any lifesaving interventions = is a brief, systematic process = aims to identify ALL injuries = red tag are first = black ones are last

triage system

= categorizes pts so most critical are treated first

airway obstruction

= cause of nearly all immediate trauma deaths

disaster

= causes permanent changes to the community = overwhelms community resources = ALWAYS requires help from government agencies

phosgene

= colorless gas = normally used in chemical manufacturing = if inhaled at high concentrations for long enough period can cause severe respiratory distress, pulmonary edema and death

ICS (Incident Command System)

= developed by NIMS = all communication takes place through this

ionizing radiation

= e.g., nuclear bomb or damage to a nuclear reactor = represents a serious threat to the safety of victims and environment = exposure may or may not include skin contamination with radioactive material = INITIATE decontamination procedure immediately if external radioactive contaminants are present

heat cramp

= environmental emergency = severe cramps in large muscle groups fatigued by heavy work = occur during rest AFTER exercise or heavy labor = often seen in healthy, acclimated athletes with inadequate fluid intake = s/s: nausea, tachycardia, pallor, weakness, profuse diaphoresis

25-30%

= estimated percentage of casualties that require admission

50%

= estimated percentage of casualties that require surgery in first 8 hrs

1. lifesaving skills 2. emphasis on: - decision making - rescuer safety

CERT (community emergency response team) training includes (2)

1. variety of health or medical skills 2. specialized support skills e.g., communications, logistics, security

DMAT (disaster medical assistance team) includes the following (2)

1. CPR if absent pulse 2. hypotensive or symptoms of shock: - 2 large-bore IVs - NS, LR 3. IO or central venous access f IV access canNOT be rapidly obtained 4. administer blood products as ordered

actions for circulation (4)

1. assess and periodically reassess: - LOC - mental status - pupil size and reactivity 2. ensure injury does not get worse

actions for disability (2)

1. NIMS (national incident management system) 2. ICS (incident command center system)

NIMS requires that all emergency services-related disciplines e.g., hospitals, HCP wishing to participate in emergency management of disaster must be trained in the following (2)

1. remove clothing for adequate examination - be cautious - forensic evidence might be obtained 2. stabilize any impaled objects 3. keep pts warm: - with blankets - warmed IV fluids - overhead lights to prevent heat loss 4. maintain privacy

actions for exposure and environmental control (4)

S - sort A - assess L - life-saving T - treat and transport

SALT = mass casualty triage

Sexual Assault Nurse Examiner

SANE

Simple Triage And Rapid Treatment

START = a casualty sorting system = focusing activities in the middle of a chaotic and confusing environment = used to identify and separate patients rapidly - according to the severity of their injuries and their need for treatment

1. control bleeding with direct pressure and pressure dressings 2. open airway 3. use jaw-thrust maneuver - AVOID hyperextending the neck 4. remove or suction any foreign bodies 5. insert oropharyngeal/nasopharyngeal airway - ONLY in unconscious pts 6. rapid sequence intubation 7. immobilize cervical spine - rigid cervical collar - cervical immobilization device - secure forehead to backboard

actions for alertness and airway with cervical spine stabilization and/or immobilization (7)

1. give supplemental O2 via appropriate delivery system 2. ventilate with bag-valve-mask with 100% oxygen if respirations are inadequate or absent 3. prepare to intubate if severe respiratory distress e.g., agonal breaths or arrest 4. have suction available 5. if absent breath sounds, prepare for needle thoracostomy and chest tube insertion

actions for breathing (5)

1. if possible, EXIT building to a safe area 2. CALL 9-1-1, then security ---------------------------------------- 1. if building canNOT be exited 2. go to nearest lockable room 3. close door, lock or block door, stay out of sight 4. turn off lights and silence cellphones

active shooter situation RCSJ: EXIT building (2) canNOT exit building (4)

1. atropine 2. pralidoxime chloride

antidotes for nerve agents e.g., Sarin (2) = multiple doses might be needed to reverse effects of nerve agents

1. making referrals 2. notifying appropriate agencies - as required by law 3. providing emotional support 4. informing victims about their options e.g., safe house, legal rights

appropriate interventions for family and IPV (4)

A = alert V = responsive to voice P = responsive to pain U = unresponsive

assess alertness with AVPU

1. hospital disaster drills 2. compute simulations 3. tabletop exercises

assessment of a hospital's level of emergency preparedness includes the following (3)

1. limited privacy 2. lack of time 3. lack of knowledge about how to ask about family violence and IPV

barriers to conducting effective screening for family and IPV (3)

1. anthrax 2. smallpox - can be prevented by vaccination 3. botulism - treated with antitoxin 4. plague 5. hemorrhagic fever - some vaccines do exist 6. tularemia

biological agents most commonly used in terrorist attacks (6)

1. green 2. yellow 3. red 4. black

colors of triage tag systems (4)

1. get a rescue alert sticker = let people know how many and what kind of pets are in the house 2. arrange a safe haven = contact boarding kennels, hotels/motels that accept pets or friends/relatives outside immediate area in advance 3. designated caregivers = temporary solution 4. prepare emergency supplies and traveling kits

disaster preparedness with pets (4)

1. make a plan - evaluate needs for sheltering in place or living at a shelter for 3-4 days 2. establish a support ream e.g., people in community who might be able to assist - go with them over your plan 3. identify resources around you e.g., what are the emergency plans of medical/assistive places like paratransit services 4. make a kit e.g., basic needs, supplies for service animals, extra glasses and hearing aids

emergency preparedness for persons with disabilities (4)

NBC (Nuclear, Biological, Chemical) Weapons//Agents

example of a man-made mass casualty incident

hurricane

example of a natural mass casualty incident

1. organizes and trains disaster medical assistance teams 2. teams are sent within 8 hrs and remain self sufficient for 72 hrs - bring their own food, water, electricity lasting them for at least 72 hrs 3. plan for 250 pts/day

expansion of the national medical response capability includes the following (3)

1. nature of the event 2. age of person 3. preexisting coping behavior 4. medical hx 5. psychological hx 6. person's role in the event - responder - victim

factors that influence stress response (6)

1. older people are at high risk for injury, primarily from falls. 2. the most common causes of falls in the older adults are generalized weakness, environmental hazards, cardiovascular syncope, and orthostatic hypotension 3. when assessing a patient who has experienced a fall, it is important to determine whether the physical findings may have actually caused the fall or may be due to the fall itself

gerontologic considerations (3)

1. take time to rehearse plan 2. evacuation - have all family members present to grab their bags - meet at planned location 3. shelter in place - have all family members arrive at shelter - spend quality/quantity time there e.g., sleeping, eating , toileting

have a drill with family (3)

1. people 2. space 3. resources

hospitals muster or activate a disaster plan by identifying resources (3)

1. <C>ABC = catastrophic hemorrhage and needs to be controlled FIRST 2. APPLY direct pressure with a sterile dressing 3. pressure dressing to any obvious bleeding sites

in pts with UNCONTROLLABLE external hemorrhage the primary survey will change (3)

1. should be prepared 2. located in a place by an exit from your home 3. consider having one in your car 4. do NOT move it 5. check it seasonally 6. EVERYONE should know where it is 7. ideally should be located in a windowless room in your home (protected from the elements)

instructions for emergency kit in portable Go-Bag and for shelter in place (7)

1. LIMIT contamination e.g., covering pt's nose and mouth 2. provide decontamination e.g., shower

interventions for RRDs (2)

1. rest 2. oral or parenteral replacement of sodium and water - elevation, gentle massage and analgesia minimize pain - avoid strenuous activity for at least 12 hrs - emphasize salt replacement in the future

interventions for heat cramps (2)

1. stabilize ABCs - 100% O2 for pt's hypermetabolic state 2. rapidly decrease core temperatures - remove clothing - cover with wet sheets - place pt in front of large fan - immerse in cool water bath - apply ice packs to groins and axilla - peritoneal lavaging w. iced fluids

interventions for heat stroke (2)

1. water or water tx - 1 gallon/day 2. non-perishable food/snacks (that do NOT need to be cooked) 3. flashlight - wind-up s best 4. cellphone (and charger) 5. medications 6. rain gear 7. radio (battery) - to receive updates

items included in Go-Bag (6)

1. location of the incident 2. type of incident 3. any hazards 4. approximate number of victims 5. type of assistance required

key points of communication (5)

1. large number of victims 2. physical and emotional suffering 3. permanent changes within a community

mass casualty incidents usually involve the following (3)

1. onsite security personnel 2. police officers 3. metal detectors 4. surveillance cameras 5. self-defense training 6. locked access doors

measures to protect staff from workplace violence (6)

1. SALT - Sort // Assess // Life-saving interventions // Treat and Transport 2. START - Simple Triage and Rapid Tx

systems of triage in mass casualty (2)

1. first responders (civilians) e.g., local police 2. CERT (community trained) 3. NIMS (incident command center) 4. American Red Cross 5. FEMA (professionals) 6. NDMS (skilled medical professionals and special skills support personnel)

order of responders (6)

1. victims need to be treated and stabilized 2. moved to hospitals 3. many casualties will arrive at hospitals on their own "walking wounded"

organization of victim tx (3)

1. airway: e.g., inhalation injury (fire), obstruction from foreign bodies 2. breathing: e.g., anaphylaxis, hemothorax 3. circulation: e.g., direct cardiac injury 4. disability: e.g., head injury, stroke

potential life-threatening conditions found during primary survey (4)

1. ABC (airway, breathing, circulation) 2. disability 3. exposure 4. facilitate adjuncts and family 5. get resuscitation adjuncts (aids)

primary survey focuses on (5)

1. RUN 2. HIDE 3. FIGHT

procedure for active shooter (3)

1. call 9-1-1, then security 2. stay calm 3. do NOT confront the person or block their exit 4. leave if danger is imminent

procedure for disruptive/violent behavior at RCSJ (4)

1. disaster preparedness 2. disaster response 3. disaster recovery

role of the nurse in disaster management (3 levels)

1. dyspnea 2. inability to speak 3. gasping (agonal) breaths 4. foreign body in airway 5. trauma to face or neck

s/s of compromised airway (5)

1. NV 2. diarrhea 3. bone marrow depletion 4. weight loss 5. loss of appetite 6. flu-like symptoms 7. infection 8. bleeding

s/s of following a predictable pattern (8)

1. face, head or neck trauma 2. significant upper chest injuries

suspect cervical spine trauma in any pt with the following injuries (2)

1. anthrax 2. plague 3. tularemia

these biological agents are treated effectively with antibiotics (3) - if sufficient supplies are available and organisms are NOT resistant

1. tag system for identification of seriousness of injury and likelihood of survival 2. triage of 15 seconds 3. if contamination is suspected, decontaminate at scene

triage in a disaster event/MCI (3)

1. crush - caused by blunt trauma that occurred from falling debris 2. penetrating - caused by shrapnel (materials that are projected during explosion) 3. blast injuries - caused from supersonic overpressurization shock wave that results from explosion: - damage to lungs - damage to middle ear - damage to GI tract - damage to brain

types of injuries caused by an explosive device (3)

1. RDD (radiologic dispersal device) "dirty bomb" 2. ionizing radiation e.g., nuclear bomb

types of radiologic/nuclear agents of terrorism (2)

1. organic disease e.g., temporal lobe epilepsy 2. psychosis e.g., schizophrenia 3. criminal behavior e.g., assault, murder

violence may be the result of the following (3)