Emergency Preparedness
Smallpox treatment/prevention
- In a pandemic situation, the immediate response is to distribute the vaccine to clients. - Clients are instructed to avoid contact with sick or dead animals. Infected clients should be isolated to reduce the transmission. Clients should be advised to reduce the supply of food and water to rodents.
Black tag
An older adult with massive head trauma; extensive full-thickness body burns
Tularemia Transmission
Being bitten by infected ticks, deerflies, other insects; Handling infected animal carcasses and skins; Eating or drinking contaminated food or water; Inhaling F. tularensis.
Preparedness Phase
Occurs before the emergency Risks are assessed and plans are developed. Emergency plans are created at the local, regional, state and federal level (FEMA, CDC, and DHS). identify ways to assist emergency response teams such as search and rescue Stake holders help plan response and should be involved in the response efforts
S/S of Anthrax
Resp exposure S/S: mild fever, sore throat, muscle aches that can advance to respiratory syndrome; cough, chest discomfort, SOB, tiredness, and aching muscles.
Yellow tag (delayed)
Respiration under 30/min Radial pulse present; cap refill less than 2 secs Responds to simple commands Patient needs treatment within 30 min - 2 hour Ex: broken leg (can't walk/risk for clots) - patient will go to med-surg and wait for surgery
Francisella tularenis
Tularemia
Critical care nurses role when preparing to participate in emergency preparedness and respond to mass casualties
can work with ED nurses in a resuscitation setting in the health care facility emergency preparedness and response; they can identify clients who can be transferred out of the critical care unit to expand critical care capacity
Anthrax treatment
ciprofloxacin 400 mg q 12 hours
Earthquake Disasters
crush injuries
Role of the Public Health Nurse: Preparedness Phase
essential for identifying populations at greater risk during a disaster. They also conduct training, evaluate plans, and work with local stakeholders.
How is Botulism spread
food-borne Develops 12-36 hours after exposure
Bruises and lacerations on skin
green tag
S/S of Viral Hemorrhagic Fevers
marked fever, dizziness, myalgia, weakness, exhaustion, rash on trunk; severe cases with bleeding under skin, internal organs, or body orifices. Severe shock, nervous system breakdown, coma, delirium and seizures. Renal failure may occur in some cases.
large wounds and open fractures
yellow tag
Nurses Role: Emergency Response Phase
Do the greatest good for the greatest number Scope of practice
Arenaviruses
Lassa and Machupo
Which phase of disaster management involves attempts to limit the disaster's impact on the population?
Mitigation ***limit a disaster's impact on human health and community functions
Yellow tag
A young adult with closed fractures of the right leg
Red tag
A middle-aged adult with third-degree burns over 20% of his body
Green tag
A young adult with bruises and superficial lacerations
Green tag (minor)
ALL walking wounded; in and out!! Treatment can be delayed for more than 3 hours Ex: strain, sprains, abrasions
Plague transmission
Aerosol (weaponized), person to person, flea bite
How is the Plague spread
Aerosol as a weapon and then spreads person-to-person, flea bites develops 1-6 days post exposure.
The Role of the ED nurse
Apply principles of triage to prioritize care delivery - Do the greatest good for the greatest number - Scope of practice
Clostridium botulinum toxin
Botulism
The Role of the ED nurse leader
Directing the ancillary departments to deliver supplies
Tularemia
If made for exposure, would experience severe respiratory illness, including life threatening pneumonia and systemic infections *life threatening pneumonia
S/S of smallpox
Infected person has no symptoms and is NOT contagious. 2-4 days of 101-104F fevers, head and body aches, possible vomiting (This phase may be contagious) Early rash is most contagious. 1st day tongue and in mouth. 2nd day spreads to entire body. 3rd day-raised rash. 4th day fluid filled. 5th day crust over and scab. iii. Individual is contagious until all scabs fall off
Botulism transmission
Ingestion of contaminated food
Nurses role: emergency management
Nurses have a critical role in emergency management. During the preparedness phase, individual nurses must gain an understanding of their expected roles in an emergency and prepare for them. They must understand ethics as nurses may face scarce supplies and resources or be forced to make difficult patient care decisions. American Nurse Association (ANA) is a good source of information about the role of nurses and possible consequences. Nurses must also know their employer's response plans and have an idea of how their state and local community will operate during an emergency. (Florida hospitals have hurricane plans that assign all nurses to two teams to respond during and after a hurricane.) Nurses can register to become disaster volunteers. The American Red Cross is one agency that enrolls nurse volunteers and coordinates training. Nurses must also have their own emergency plan for themselves and their families, including pets. Have an emergency kit prepared with essential documents and medications that can be taken with you. Understand escape routes (like hurricanes in Florida). Family members can prepare by becoming trained in CPR and first aid.
Airway obstruction
Red tag
Filovirus
Viral hemorrhagic fevers
S/S of Botulism
Visual effects (double vision), neuro changes (slurred speech, dysphagia), muscle weakness that descends the body, paralysis of breathing muscles. If left untreated may result in death.
Yersinia pestis
plague
Variola major
smallpox
Emergency Management
"Managerial function charged with creating the framework within which communities reduce vulnerability to hazards and cope with disasters"(FEMA,) §Four phases: §Mitigation §Preparedness §Response §Recovery According to the Federal Emergency Management Agency (FEMA), emergency management is the "managerial function charged with creating the framework within which communities reduce vulnerability to hazards and cope with disasters." The goals of emergency management are to reduce loss of life, minimize property loss and damage to the environment, and protect from all threats and hazards. There are four phases of emergency management: mitigation, preparedness, response, and recovery.
-The role of the nurse will vary based on the type of disaster, its location, the number and condition of victims, and the personnel and supplies available at the time it occurs.
-Nurses may be called to perform triage, first aid, or to stabilize patients in preparation for transfer to more advanced care. Initially, nurses must decide whether to assist during the disaster or not. Decisions will be based on individual safety, family safety and needs, and the greater needs of the community at large. Nurses are never expected to jeopardize their own safety or the safety of their families or other rescuers by responding to a disaster. Nurses must also consider whether they have the appropriate skills to respond- whether the skills of the nurse are adequate or better left to individuals with advanced training in disaster response. If the decision is made to participate, the nurse will follow the emergency preparedness plans created by the employing agency or within the community. The nurse must operate within the defined nursing scope of practice despite the temptation to step outside those bounds when faced with critical care needs outside the nurse's scope of practice.
Reverse traige
-The objective of triage is early assessment of patients and to prioritize care based on the severity of symptoms. Triage occurs everyday in emergency rooms, but with a mass casualty event (more than 100 victims), the demand on nurses will be even greater. Mass Casualties call for the use of reverse triage. The most severely injured or ill victims, who require the greatest resources, are treated last to allow the greatest number of victims to receive medical attention.
Bacillus anthracis
Anthrax
Public health nurse
During preparedness, public health nurses are essential for identifying populations at greater risk during a disaster. They also conduct training, evaluate plans, and work with local stakeholders. During recovery, public health nurses conduct rapid ongoing needs assessments to determine health and critical resource capacity after a disaster and work with community stakeholders to plan for long-term health concerns. They also participate in reconstruction of critical services and evaluate the long-term impact of the disaster consequences on the community.
Viral Hemorrhagic Fevers
Ebola and Marburg 5 - 10 day incubation period Affects many organs, they damage the blood vessels, and they affect the body's ability to regulate itself.
Role of the nurse: Preparedness Phase
Ethics Responsibilities and consequences (ANA) Facility policy and procedure (participating in drills; evaluating the outcomes) Register as a disaster volunteer (ex. American Red Cross) Have an emergency plan for self and family (including pets) and emergency kit
Mitigation Phase
Identify hazards and taking actions to minimize effects is the attempt limit a disasters impact on human health and community function
Emergency Response Phase
Initiation of emergency preparedness plans Triage, search and rescue, repairing utility infrastructures
Administration of Smallpox vaccine
Intradermal scratch Vaccination is scratched into the skin using a bifurcated needle
Which phase of disaster management is the nurse executing when teaching hygiene practices and symptoms of various infections to victims of a hurricane?
Mitigation ***limit a disaster's impact on human health and community functions
Nurses role: Recovery
Nurses are well qualified to participate in risk assessments and planning at all levels of disaster management. Nurses can educate patients and communities about disaster preparedness. Public health nurses conduct rapid ongoing needs assessments to determine health and critical resource capacity after a disaster and work with community stakeholders to plan for long-term health concerns. Also participate in reconstruction of critical services and evaluate the long-term impact of the disaster consequences on the community.
Nurses role: Response
Nurses need to know ANA's position on emergency and disaster responsibilities. Remember that during an emergency, the goal is to do the greatest good for the greatest number of casualties. Be prepared to provide the fundamentals of nursing care but under very stressful environments in extraordinary circumstances, including intense time constraints and quick turn around between patients. Utilize triage techniques to identify needs and move on. Assess both the physical and mental health of patients and provide treatment. Nurses must remember their defined scope of practice and not to exceed it even when circumstances would say otherwise.
nurse moved with family members into an area of the county that has a "tornado alley." Shortly after the nurse's arrival, the town was hit by a tornado. Which activities constituted the community's emergency response phase? (Select all that apply.)
Repairing utilities, Opening shelters, Establishing critical care services, Opening shelters, repairing utilities, and establishing critical care services are part of the community's emergency response phase. The mitigation phase, including implementing warning systems and establishing emergency operations centers, could happen before the emergency response phase or after the recovery phase.
How is Anthrax spread
Resp inhalation of aerolized spores (weaponized), cutaneous, Gastrointestinal
Recovery Phase
Restoration and Mitigation Rebuilding and return to employment and government operations Identify successes and failures of the response effort to prepare for the future
Role of the nurse: Recovery Phase
Risk assessment and planning Educate about disaster preparedness
S/S of Plague
S/S: fever, weakness, rapid developing pneumonia with dyspnea, chest pain, cough, blood or watery sputum *rapid developing pneumonia
Viral Hemorrhagic Fevers Transmission
VHFs are most commonly spread by exposure to an animal reservoir host or arthropod vector. Humans are not natural reservoirs for VHFs; however, some VHFs can be transmitted from individual to individual after an initial human has been infected.
Strategic National Stockpile
a program designed to ensure the immediate availability of essential medical materials to a community in the event of a large-scale chemical or biological attack. Managed by CDC and DHS, large quantities of antibiotics, vaccines, medical, surgical, and patient support supplies such as bandages, IV equipment, and airway supplies. The first component of the stockpile is a preassembled "push package" designed to meet the community's needs in the case of an undetermined biological or chemical threat. The push packages are stored in locations that will permit delivery within 12 hours after an attack. The second component is vendor-managed inventory packages that will be shipped once the threat has been clearly identified. These packages are designed to arrive within 24-36 hours.
What interventions performed bu the ED charge nurse who is following the health care facility emergency preparedness and response plan during a disaster response are most appropriate
act in collaboration with the medical command physician and triage officer to organize nursing and ancillary services to meet client needs. Assigns a communications nurse and a critical care unit nurse to transfer the clients out of the unit to expand the capacity for mass casualty victims and informs about the need for providers with specialty training General staff nurses are recruited to provide care for stable ED clients. ED nurses are assigned to care for mass casualty victims.
Anthrax transmission
aerosol (weapon), ingestion, or direct contact with spores
Smallpox transmission
airborne (aerosol as weapon) or direct transmission
Role of the Public Health Nurse: Emergency Response Phase
assess communicable disease and infection disease probability and response, assist individuals with mental health problems based on a population-based triage. Check quizlet rationale regarding this!!!
Massive head trauma
black tag
Role of the Public Health Nurse: Recovery Phase
conduct rapid ongoing needs assessment to determine health and critical resource capacity after a disaster and work with stakeholders to plan for long-term health concerns. Also participate in reconstruction of critical services and evaluate the long-term impact of the disaster consequences on the community
Mitigation
implementing warning systems and establishing emergency operations centers, could happen before the emergency response phase or after the recovery phase.
Med surgical nurses role when preparing to participate in emergency preparedness and respond to mass casualties
in collaboration with the HCP, can recommend clients who are stable for discharge to free up the beds for disaster victims
Triage
is the process of prioritizing patients for treatment based on the severity of their illness or injury and in consideration of the supplies and resources available.
Black tag (deceased)
no respiration's, positive airway = no respiration's death is expected
Red tag (immediate)
no respiration, positive airway = respiration's Respiration's over 30/min (having difficulty breathing); cap refill more than 2 secs Does NOT respond to simple commands IMMEDIATE treatment is needed Ex: Clients with shock; airway obstruction
In a facility's emergency preparedness plan, which drills would be conducted yearly to meet Joint Commission standards?
two disaster drills per year with one being a community-based drill.
What does the Joint Commission requires hospitals to have an emergency preparedness plan?
two disaster drills with one being a community-based drill
reverse triage
used only when we are doing disaster management - tornadoes - bombs - plane crashes *** a bunch of people coming at one time; we are trying to save as many lives as we can
How is smallpox spread
weaponized as aerosol incubation 7-17 days
Emergency preparedness
§Emergency preparedness: act of making plans to prevent, respond to, and recover from emergencies §CDC "all-hazards" approach §Surge capacity: community's ability to rapidly meet the increased demand for qualified personnel and resources, including healthcare resources, in the event of a disaster Emergency preparedness is the act of making plans to prevent, respond to, and recover from emergencies. The Centers for Disease Control recommends an "all-hazards" approach to emergency preparedness. This includes general preparations and training to prepare for a wide variety of emergencies. Part of this preparedness is understanding surge capacity. Surge capacity is the community's ability to rapidly meet the increased demand for qualified personnel and resources, including healthcare resources, in the event of a disaster.
Emergency management phases
§Mitigation §Before and after an emergency §Identifying hazards and taking action to minimize effects §Preparedness §Before an emergency §Emergency planning §Emergency Response §Initiation of emergency preparedness plans §Triage, search and rescue, repairing utility infrastructures §Recovery §After the emergency §Restoration and Mitigation §Rebuilding, return to employment and government operations