Exam 3 - Disaster/Triage (ATI 3 & 6)

Smallpox considerations

Transmitted person to person (natural occurrence has been eradicated worldwide) Often confused with varicella

Anthrax considerations

Treated with ciprofloxacin after exposure Can vaccinate prior to exposure, but must treat exposure

The emergency __ system is required to broadcast emergency information to residents during a disaster or emergency

alert

A deliberate release of a pathogen that is either naturally occurring or man-made and can create a public health emergency

bioterrorism Agent is bacterial or viral An infection epidemic Primary care providers and community hospitals are first to experience influx of patients following use of a biological weapon; therefore, detection and diagnosis would be made at the local level

Triage level for patient is deceased

black

Result of a device explosion

blast event

Disaster preparedness should be _____

broad and scope

Triage level for immediate treatment critical

red

the actual response to a disaster or implementation of the plan

response Activities used to address the event Notify the correct agencies: - FEMA: disaster - FAA: has jurisdiction for all *airplane crashes/accidents* - Coast guard: water disasters w/ boats/passengers - CDC: disease outbreak - EPA: water/chemical spills, etc. - DHS: terrorist attack - National guard/military: activated for disasters/warfare Focus on emergency relief - Saving lives, first aid, minimizing and restoring damaged systems - Care and basic life requirements to victims: food, water, and shelter - After the disaster: The mental health effects after a traumatic event can be devastating for individuals and communities. It is important to implement interventions that can assist community members in getting help for depression, anxiety, or post-traumatic stress disorder

an active process involving individuals, groups, and institutions through the exchange of information of an associated public health risk

risk communication

_____ has made the rapid exchange of information possible and have revolutionized disaster communication

social/mass media

A fire burning along the forest floor

surface fire

Burns along the forest floor, moves slow, extremely damaging

surface fire

If a __ is imminent, take immediate shelter in a basement, away from any windows, or in the inner most room or closet

tornado

To sort victims according to the severity of their injuries/treatment needed

triage

Signs of hypothermia include _____

uncontrollable shivering slow speech memory lapses frequent stumbling drowsiness exhaustion

Fire burning out of control (spread rapily)

wildfires

. Triage level for treatment can be delayed up to 3 hours, walking wounded

yellow

Category A bioterrorism agents include _____

Smallpox Plague Tularemia Botulism Anthrax Viral hemorrhagic fevers (Ebola)

The PHN understands that updating building codes and ordinances to require that buildings are more resistant to seismic activity in an area more prone to earthquakes is an example of: A. Evaluation B. Mitigation C. Emergency Preparedness Plan D. Recovery

B

Strategic National Stockpile (SNS)

- Large amounts of pharmaceutical and medical supplies - The strategic national stockpile is a national repository of antibiotics, chemical antidotes, antitoxin's, life-support medications, IV administration, airway maintenance supplies, and medical surgical items. - The Department of Health and Human Services and the CDC are responsible for maintenance and delivery of strategic national stockpile SNS, assets

Earthquake considerations

- Most destructive and frightening - Can cause buildings and bridges to collapse - Disrupt gas, electric, phone, and water service - Can trigger landslides, avalanches, flash floods, fires, and huge destructive tsunamis - Effective policy change: Updating building codes and ordinances to require that buildings are more resistant to seismic activity (mitigation) because it reduces the impact of the earthquake

A PHN is educating local girl scouts on fire identification. The PHN understands that a ___________ burns below the forest floor, usually down in the humus layer of the soil. These fires are usually started by lightning strikes A. Wildfire B. Ground fire C. Surface fire D. Crown fire

B - ground fire

The nurse is using the epidemiological triad model to explain the factors that contribute to a disaster. Which of the following statements best correlates with the definition of environmental factors of the epidemiologic triad? A. circumstances that could potentially contribute to or mitigate a disaster B. natural or technological elements that cause the disaster C. the agencies that respond to the disaster D. the people who experience the disaster

A

Mudslide and flood considerations

- 30% of world disasters, caused by prolonged rainfall - Flash floods catch people unprepared - Flash floods are the most common disaster in the u.s. - Waterborne diseases (The health impacts of flooding include communicable disease exacerbated by crowded living conditions and compromised personal hygiene, contaminated water sources, disruption of sewer service, and solid waste collection, and increased vector populations, such as mosquitoes) - The rise in floods can be attributed to urbanization, deforestation and effects of climate change - Storms that affect large bodies of water can affect the fishing industry

Volcano considerations

- Burns or injuries from lateral blasts, or sideways-directed volcanic explosions. - *Respiratory illnesses due to inhalation of ash and other toxic gases or irritants* - People at greatest risk for inhaling ash, etc = COPD and emphysema

FEMA (Federal Emergency Management)

- Coordinates disaster response following a presidential declaration of authority - Has direct access to federal resources and funding - Can provide technical support and personnel for the purpose of disaster planning and mitigation

Disaster triage

- EMS: Emergency responders begin victim treatment with a field triage - Greatest good for the greatest number of people - Sort pts according to the *severity of their tx* - Allows first responders to appropriately manage the care of a large number of people, and help get patients to where they will receive the best care - Nurses should ensure: staffing, supplies, patients treated and who needs care

National Response Framework (NRF)

- National Incident Management System (NIMS) - Each key element of NIMS involves an intricate process and directly affects the overall effectiveness of the systems - The national response framework serves as a guide to how the nation conducts comprehensive incident response using an all-hazards approach to respond to natural and man-made disasters - Includes guiding principles that detail how federal, state, local, tribal, and private sector partners, including the healthcare sector, prepare for and provide a unified domestic response through improved coordination and integration - The plan provides national direction for all responders during a domestic disaster - The large-scale disaster response will require access to large amounts of pharmaceutical and medical supplies

Types of injuries related to blast events include ____

- Primary: ruptured eardrum - Secondary: extremity injury d/t flying debris - Tertiary: result of being thrown by the blast - Quarternary: include all explosion-related injuries, illnesses, or diseases not due to primary, secondary or tertiary mechanism, including exacerbation of existing noncommunicable diseases as well as the threat of infection at the site of the wounds inflicted by the flying debris

Nursing in disasters

- Respond quickly - Clinically competent to provide safe, appropriate, individual and population-based care - First receivers of inured victims - First responders to render emergency aid and triage - Nurses = largest in healthcare

Botulism considerations

- Richin is found in cantor beans causing illness not botulism - Botulism comes from ingested or contaminated foods - Botulism is a neurotoxin - Report to the cdc, even with one incident - Paralysis occurs within 12-72 hrs after exposure - Nausea/emesis is expected exposure - No vaccine, must treat the illness

Levels of disaster response

1.) local 2.) state 3.) federal

A PHN is setting up disaster relief in the middle school gymnasium. A tornado demolishes the adjacent neighborhood without warning. As people start to flood in for shelter and to find their loved ones, the nurse requests assistance from the local fire department and national guard to move uninjured persons to the adjacent high school gymnasium to reunite with their family. This is an example of: A. Mitigation B. Preparedness C. Triage D. Recovery

A

A community/public health nurse is working with a community that is identifying risk factors for program development in case of a disaster. This community is in which phase of disaster management? A. prevention B. preparedness C. recovery D. response

A

The community/public health nurse understands that the recovery phase of a disaster event is consistent with which timeframe? A. long term after the response phase of the disaster event B. immediately after the onset of the disaster event C. one or two days after the disaster event occurs D. approximately 12 hours after the disaster event occurs

A

The school nurse is preparing to return to school after a school shooting which claimed the life of eight students and two teachers. Since school is resuming, what is the priority for this community? A. Screen and manage PTSD, depression and anxiety in those involved. B. Develop an active shooter emergency safety plan and complete a drill. C. Host a debriefing in the gymnasium for anyone who would like to attend. D. Encourage everyone to resume normal activities to put the shooting in the past. E. None of the above.

A

Which of the following agencies would a community/public health nurse expect to coordinate a disaster response in the U.S.? A. federal emergency management agency (FEMA) B. the world health organization's (WHO) emergency relief operations C. american red cross D. pan american health organization

A

Which of the following terms correlates with the level of destruction and devastation caused by a disaster? A. intensity B. scope C. complex emergency D. casualty

A

Which of the following actions by the community/public health nurse are associated with the provision of psychological first aid? (Select all that apply) A. helping survivors help themselves B. giving clear and reliable information C. being calm and compassionate D. working without a break because victims need timely help

A, B, C

A community/public health nurse is assisting the local community in preparing a disaster plan. Which of the following would the nurse expect to be included in the disaster plan? (select all that apply) A. effective communication plan B. chain of command/authority C. triage plan D. copies of licenses and vaccinations of likely volunteers E. routes and modes of transport for victims

A, B, C, E

A community/public health nurse is engaging in primary prevention activities related to disasters. Which of the following would be examples or appropriate primary prevention activities? (select all that apply) A. planning disaster drills B. practicing an escape plan C. providing emergency assistance D. reducing the degree of disability E. conducting prompt rescue of victims F. increasing community awareness

A, B, F

The community/public health nurse knows that the recovery phase of a disaster includes which of the following activities? (Select all that apply) A. relocation of survivors who have lost their homes B. triage and rescue of living casualties C. rebuilding of the community's infrastructure D. stabilization of the community physically, economically, and psychologically E. notification of family members of deceased victims

A, C, D

Critical incident stress debriefing (CIDS) is a group process by which relief workers are able to emotionally reconcile their experiences after responding to a disaster. Which of the following statements have been associated with CISD? (select all that apply) A. CIDS accelerates the relief workers' healing process B. Research regarding the effectiveness of CISD is strong C. CISD reinforces or restores group cohesiveness D. CISD acts as a good substitute for individual counseling E. CISD reduces relief worker's anxiety

A, C, E

Which of the following measures helped flood victims avoid waterborne diseases? (select all that apply) A. wash hands frequently with soap and a safe water supply B. use the normal water supply unless specifically directed otherwise C. if bottled water is not available for hand washing, use water that has been boiled for 2 mins D. drink only bottled water E. use bottled water when brushing teeth

A, D, E

Man-made disasters include _____

Accidental Deliberate Biological Chemical Radiologic Explosive

A disaster preparedness plan should be: Select all that apply: A. Broad in scope and address multiple types of disasters. B. Should be comprehensive and contain plans for advanced preparation. C. Should contain disaster management, and post-disaster evaluation. D. It should include information about long-term management. E. Should include information about the after effects of the disaster. F. The plan should stress collaboration and cooperation with nearby organizations.

All of them are correct

A PHN evaluates the aftermath of a hurricane in her hometown located in the panhandle of Florida.  The PHN understands that there needs to be an area of safety for evacuation purposes, which was not made available to the residents until it was too late. The PHN begins that disaster planning process in the event of a future natural disaster. This is an example of: A. Mitigation B. Preparedness C. Triage D. Recovery

B

A community health nurse is determining available and needed supplies in the event of a bioterrorism attack. The nurse should be aware that community members exposed to anthrax will need access to which of the following medications? A. Metronidazole B. Ciprofloxacin C. Zanamivir D. Fluconazole

B

A newly hired public health nurse is familiarizing himself with the levels of disaster management. Which of the following actions is a component of disaster prevention? A. Outlining specific roles of community agencies B. Identifying community vulnerabilities C. Prioritizing care of individuals D. Providing stress counseling

B

Assisting individuals and families adversely affected by a natural disaster to rebuild their lives through counseling and other services and support is an example of which level of prevention? A. primary prevention B. tertiary prevention C. quaternary prevention D. secondary prevention

B

The community/public health nurse suspects that a client who was a victim of a disaster 3 months ago is experiencing PTSD. Which of the following would the nurse expect to find in this client? (select all that apply) A. diminished startle response B. reports of flashbacks C. hypervigilance D. feelings of detachment E. full range of emotions

B, C, D

A home health nurse is discussing portals of entry with a group of newly hired assistive personnel. Which of the following locations should the nurse include as a portal of entry? (Select all that apply) A. Respiratory secretions B. Skin C. Genitourinary tract D. Saliva E. Mucous membranes

B, C, E

A nurse is heading to work when she comes up on a multi-car pileup on the interstate. Paramedics are on site. The nurse asks if additional assistance is needed. The paramedics ask the nurse to assist. The nurse understands that it is important to: A. Notify the local radio/news stations to provide detour routes for safety. B. Call the local ER to give a "heads up" to obtain additional staff for patient care. C. Triage the victims in the field according to the severity of their injuries. D. Interview bystanders for a complete understanding of what occurred. E. Call 911 for additional EMS crews and state police assistance.

C

A nurse is preparing a community health program on communicable diseases. When discussing modes of transmission, the nurse should include which of the following illness as airborne? A. Cholera B. Malaria C. Influenza D. Salmonellosis

C

According to a study by Zidek, West, Holmes, and Crytzer, approximately how many people who rely on electronic medical equipment to maintain their health have no plan for a sustained power outage? A. 75% B. 50% C. 25% D. 10%

C

The role of the community/public health nurse in disaster and post-disaster situations often includes which of the following? A. working beyond the scope of the RN license and PHN practice due to necessity B. working only at the community and systems levels C. a unique awareness of vulnerable populations in the community who are at high risk D. limited awareness of disaster preparedness plans

C

A local fertilizer plant has exploded. The PHN nurse in the area assists the first responders in field triage. The first person the PHN triages has an AMS and has an open femur fracture. The PHN understands that this patient is classified as: A. Primary B. Secondary C. Tertiary D. Quaternary

C - tertiary

A community health nurse is educating the public on the agents of bioterrorism. Which of the following includes Category A biological agents? (Select all that apply) A. Hantavirus B. Typhus C. Plague D. Tularemia E. Botulism

C, D, E

Hurricane considerations

Cause an increase in sea level Rated on a scale of 1-5 (> 3 = major storm) Hurricane season: june 1 - nov 30 Peak season: august-september High tides occur: greatest damage from tidal surges and flash floods Low pressure winds: create tidal surges as high as 50 feet above sea level Impact on humans exacerbated by *deforestation*: - *Deforestation* along the coast can increase risk and severity of strong storm surges during hurricanes or coastal storms - Flash floods - Landslides - Typhoons are severe storms in the pacific and china seas

Natural disasters considerations

Caused by forces of nature, not a result of human activity Lack controllability Vary in predictability Vary in degree and type of population impact Vary in geographic region/season Nurses become active participants *Drills should occur twice a year*

A community/public health nurse is working with a community that is striving to improve its ability to respond to a disaster so that the effects can me minimized. This community is in which phase of disaster management? A. response B. prevention C. recovery D. preparedness

D

A community/public health nurse is working with people who have experienced a tornado and have been forced to leave their homes to escape the effects of a disaster. The nurse would identify these people as which of the following? A. Casualties B. Refugees C. Indirect victims D. Displaced persons

D

A student nurse is sunbathing at the local swimming pool. The friend accompanying her states that she feels dizzy and tired and states that she is going to lie down on her towel.  The SN knows that the heat index is 110 degrees. What should the SN do? A. Call 911, stay with your friend. B. Tell your friend to close her eyes and rest. C. Give her some cool water to drink. D. Get in the AC and give her a Gatorade.

D

The PHN nurse is planning a disaster training exercise. The PHN understands that there are _______ components to a disaster preparedness framework. The PHN understands that these components are:  A. pre-incident and post-incident. B. pre-incident, trans-incident, and post-incident. C. local (community), state, national, and global levels. D. preparedness, response, recovery, mitigation, and evaluation.

D

The community/public health nurse is working with a community that has experienced flooding associated with contaminated floodwater. Which of the following organisms is the least likely to be found in floodwater? A. salmonella B. shigella C. e. coli D. hepatitis b

D

When performing triage during a disaster, which color would indicate that the victim is stable, but has the potential to deteriorate? A. red B. green C. black D. yellow

D

A PHN nurse is educating local girl scouts on fire identification. The PHN understands that a ____________ burns along the top of the trees and easily jumps from tree to tree. A. Wildfire B. Ground fire C. Surface fire D. Crown fire

D - crown fire

Which of the following examples of disasters are natural disasters? (Select all that apply) A. The oil spill on the Gulf Coast in 2010 that threatened hundreds of species B. A natural gas pipeline explosion in a major metropolitn area C. The attack on the World Trade Center on September 11th D. Wildfires in California that occur annually E. The earthquake and subsequent tsunami in Japan in 2011

D, E

_____ is central to disaster planning and mitigation

Disaster communication

A PHN is educating room full of girl scouts about severe weather and tornado safety actions. The PHN understands that: A. You should watch the storm develop from a western facing window. B. You should take shelter immediately in the center of a room under a blanket. C. You should head to the nearest emergency shelter in your town. D. You should take shelter in the basement by the exterior wall and window. E. You should take shelter in the basement away from exterior windows.

E

Natural disasters include _____

Earthquake Tornado Floods Hurricanes Blizzards Wild fires Tsunamis Nuclear

What populations need assistance during disaters?

Elderly Children Disabled

The disaster preparedness officer and a PHN are preparing a disaster management plan for the local hospital. The PHN understands that: A. Training drills should be conducted on a regular basis. B. Drills should be realistic in terms of patient care and supplies. C. Should involve many different departments in the hospital. D. Everyone should have an assigned role in an emergency. E. A, C & D F. All of the Above.

F

A student nurse asks the PHN during a disaster briefing which levels manage disasters? The PHN understands that: A. Disasters are managed at the local level. B. Disasters are managed at the state level. C. Disasters are managed at the national level. D. Disasters are managed at the global level. E. A & B only. F. All of the above. G. None of the above.

F - all the above

Extreme heat can cause _____

Hyperthermia Dehydration Heat stroke Heat exhaustion: cool them quicker and replenish electrolytes Older adults, infants, people with noncommunicable diseases, obesity, people taking medications (neuroleptics or anticholinergics), people who are bedbound or cannot care for themselves are at increased risk

Nurses must report incidences of _____ to the CDC!! It is nationally reportable for tracking.

Lyme disease

Plague considerations

No vaccine Droplet precuations

What are the steps of the disaster preparedness cycle?

Preparedness Mitigation Response Recovery Response evaluation

Wildfires can cause _____

Respiratory injuries Burns Stress related cardiovascular events Respiratory illness *The nurse should remain on site to monitor for and track respiratory disease cases until the numbers of such cases return to the community baseline*

Winter weather considerations

Snow, ice, dangerous driving conditions Car accidents = leading cause of death The homeless are at risk Causes of death: *Car accidents* Power outages Avalanches Hypothermia: body temp < 90 F Frostbite

Disasters can result from a variety of specific hazards including natural disasters such as _____, as well as man-made disasters such as _____

communicable disease epidemics or severe weather terrorism and chemical spills

True Emergency preparedness and disaster management is _____

continuous, there is no beginning or end

___ nurses must plan for the safety of all people internally and externally should an escape happen as a result of disaster

corrections

A fire rapidly moving along the treetops, jumping from tree to tree

crown fire

Burns along the top of trees and easily jumps from tree to tree

crown fire

An emergency of such severity and magnitude that the resultant combination of death, injury, illness, and property damage cannot be effectively managed with routine resources or procedures

disaster

Facilities should have disaster __ training that is scheduled frequently, continuous, on site with appropriate materials

drill

_____ is a national public warning system in the US managed by the Federal Communications Commission in conjunction with FEMA and the National Weather Service used to tell people to seek shelter or evacuate

emergency alert system

loss of feeling and a light or pale appearance in fingers, toes, nose, or earlobes are symptoms of _____

frostbite

Triage level for no immediate treatment required or no injuries

green

A fire burning below the forest floor in the humus layer of soil

ground fire

Burns below the forest floor, down to humus layer of soil, start by lightning

ground fire

A person showing signs and symptoms of __ should be moved to a cool environment immediately and rehydrate with electrolytes

heat exhaustion

process of planning for the harm or impact of disaster and taking measures to reduce harmful effects

mitigation - Doing the greatest good for the greatest number of people by targeting populations that will be most impacted - Preventions - Occurs before incident - Adjust the plan as needed - Includes establishing immediate changes to the response plan and identifying a safe structure to which to relocate the population - Ex.) relief shelters should be identified in coastal regions prior to a hurricane

process of proactively planning for disaster and emergency situations

preparedness

Exposure to _____ has been linked with increased risk of leukemia, mental illness, thyroid disease and solid cancers

radiation It is especially important to track cases among the people living in the affected communities

returning the community back to its prior state

recovery Focuses on stabilization Returning community to pre-impact status Rehabilitation Reconstruction Epidemiological surveillance is needed