Disaster Planning

Security Plans

all facilities should have plans in place that include preventive, protective, and response measures designed for identified security needs *possible security issues faced by health care team members include admission of potentially dangerous individual, vandalism, infant abduction, and information theft *international association for healthcare security and safety provides recommendations for the development *nursing role is to be prepared to make immediate action when breaches of security occur; time is of the essence *secutiry measures - an ID system that identifies employees, volunteers, students etc -electronic security in high risk areas -key code access -wrist bands that link parents and infants -alarms w/ closed circuit tv/cameras

Radiological Incidents

amount of exposure is related to duration of exposure, distance from source, and amount of shielding facility where victims are treated should activate interventions to prevent contamination of treatment areas wear water resistant gowns, double glove, and fully cover bodies w/ caps, booties, masks, and goggles wear radiation or dosimeters badges to monitor amount of radiation exposure survey clients initially w/ a radiation meter to determine amount of contamination decontamination w/ soap/water and disposable towels should occur prior to the patient entering the facility; water run off should be contained after decontamination, resurvey clients for residual contamination and continue irrigation skin until they are free of all contamination

Disaster

an event that can cause serious damage, injuries, death or destruction

Biological Incidents

be alert to signs of bioterrorism attack because early detection and management is key watch for appearance of a disease that does not occur at a specific time or place, atypical manifestations, or occurs in a specific community/people group most of the time, infections are not spread from one client to another; management includes recognizing the occurrence, directing personnel in proper use of PPE, and decontamination/isolation transport or move client only if needed for treatment and care take measures to protect self and others recognize s/s of infection/poisoning and identify appropriate treatment/interventions

Bomb Threat

do not touch a bomb if it has been located; clear the areas and isolate device by closing doors notify appropriate authorities and personnel cooperate; assist to conduct search, provide copies of floor plans, have master keys available, and watch for and isolate suspicious objects keep elevators available for authorities remain calm/alert and try not to alarm patients if a phone call is received *extend the conversation as long as possible *listen for distinguishing background noises *note distinguishing voice characteristics of the caller *ask where and when the bomb is set to explode *note whether the caller is familiar w the physical plan of the facility

Severe Thunderstorm/Tornado

draw the shades/close drapes to protect against shattering glass lower all beds to the lowest position/move them away from windows place blankets over patients who are confined to beds close all doors relocate ambulatory patients into hallways or other secure location away from windows do not use elevators turn on severe weather channel to monitor warnings

Categories for Triage

emergent - class I; the highest priority is given to people who have life-threatening injuries BUT have a high priority of survival once they are stable urgent - class II; second highest priority is given to people who have major injuries that are not yet life threatening and usually can wait 45-60 minuses to receive treatment non urgent - class III; next highest priority is given to people who have minor injuries that are not life threatening AND do not need immediate attention expectant - class IV; lowest priority is given to people who are expected not to live AND will be allowed to die naturally; comfort measure can be provided but restorative care will not be provided

Emergency Designations

health care facilities have designed color codes for emergencies code red = fire code blue = cardiac/resp arrest code pink = newborn/infant abduction code orange = chemical spill code gray = tornado code black = bomb threat nurses need to be familiar w policies and procedures and know when their role is in each emergency

Hospitals

must have an emergency operating plan in place the most important part is that all employees are trained regarding the plan nurses must understand their role *the Joint Commission mandates that hospitals test this plan at least 2 times a year *the plan should interface with local, state, and federal resources

Fire

nurse should use RACE

Discharge/Relocation of Clients

nurses will help to make decisions about the patients who can be d/c or relocated in order to use their beds for patients who have higher priority needs *d/c or relocate ambulatory clients in whom require minimal care *make arrangements for continuation of care for patients who require some assistance, which may be done at home or a tertiary care facility *do not d/c or relocate patients who are unstable or require continuing nursing care and assessment unless they are in imminent danger

Internal Emergencies

occurs within a facility, includes the loss of power or water, AND severe damage or casualties related to fire, weather, explosion, or a terrorist act being ready includes policies and procedures, safety, hazardous material protocol etc.

Hazardous Material Incident

take measures to protect self and avoid contact approach scene w/ caution identify hazardous material w/ available resources know location of SDS manual try to contain material in one place prior to arrival of hazardous material team decontaminate affected individual as much as possible at or close to the scene *don gloves, gown, mask, and shoe covers *carefully and slowly remove contaminated clothing so that the material does not become airborne *water is usually universal antidote; wash skin w/ copious amounts of water and antibacterial soap *place contaminated materials into large plastic bags and seal them

Disaster Response agencies

there are many agencies involved examples of such agencies include the federal emergency management agency, CDC, homeland security, office of emergency management, and the public health department

Mass Casualty Triage

these principles are different than the day-to-day services in an emergency/urgent care setting casualties are separated based upon their survival, and treatment is allocated accordingly; this is based upon doing the greater good for the greatest number of people nurses can find MCIs stressful, because clients who are not expected to survive are cared for last

External Emergencies

a facility will be impacted indirectly includes weather, earthquakes, pandemic flu, chemical plant explosions, industrial accidents, building collapses, major transportation accidents, and terrorist acts being ready includes having a plan for how the facility will participate in community wide emergencies/disasters

Emergency Response Plans

a planning committee is used to develop the plans for emergency preparedness committee reviews information for various types of natural/man made emergencies based on the characteristics of the community the committee will determine what resources are necessary in order to handle the potential emergencies and includes this in the plan hospital incident command system offers clear structure for disaster management at the facility nurses and other healthcare workers need to be involved in the development of the plan for these emergencies criteria for when the plan should be activated must be clear roles need to be outlined and administrative control should be determined a designated area for a command center as well as person who will serve this role is to be determined nurse should create an action plan for personal family needs

Chemical Incidents

can occur from an accident or purposeful action such as terrorism take measures to protect self and avoid contact assess/intervene to maintain ABCs; administer first as needed remove offending chemical by undressing the client and removing all identifiable particulate matter; provide immediate and prolonged irrigations of contaminated areas; irrigate skin w/ running water, except dry chemical (brush off) gather a specific hx of injury if possible know which facilities are open to exposed clients and which are only open to unexposed clients follow facilities emergency response plan

Mass Casualty Incident

catastrophic event that overwhelms all resources usually local, federal, and maybe even state resources are used to handle the event