Iggy Chapter 10

disaster

an event in which illness or injuries exceed resource capabilities of a health care facility or community because of destruction and devastation. Can be internal or external or both at the same time. Ex. Superstorm Sandy incapacitated several hospitals on the Atlantic coast in late October 2012.

Internal disaster

an event occurring inside a health care facility or campus that could danger the SAFETY of patients or staff. The event creates a need for evacuation or relocation. It often requires extra personnel and the activation of the facility's emergency preparedness and response plan (emergency management plan). Ex. fire, explosion, loss of critical utilities (e.g., electricity, water, computer systems, and communication capabilities), and violence. Most important outcome for any internal disaster is to maintain patient, staff, and visitor safety.

External disaster

an event outside the health care facility or campus, somewhere in the community, which requires the activation of the facility's emergency management plan. 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. Ex. 2015 Ebola virus crisis in a Dallas Hospital, 2013 Boston Marathon bombing, and the West Texas fertilizer plant explosion. St. John's Region Medical Center in Joplin, Missouri had an internal and external disaster in 2011 when it was directly hit by an EF-5 tornado that destroyed a large part of the town.

Pandemic

an infection or disease that occurs throughout the population of a country or the world leads to a vast number of people to seek medical care, even the "worried well".

Hospital Incident Commander

assumes overall leadership for implementing the institutional plan. This person is usually either a physician in the ED or a hospital administrator who has the authority to activate these resources. He or she might direct patients that are due to be discharged move down to a lounge area to make room for mass casualty event. Order that all elective surgeries be stopped.

Notification and activation occurs how?

by radio, cellular, or electronic communication between ED AND EMS providers at the scene. A state or regional emergency management agency may also notify the ED of the event. Group paging systems, telephone trees, and instant computer bases automated alert messages are the most common means of notifying essential personnel of a mass casualty incident or disaster.

Red tagged patients have

immediate threats to life such as airway obstruction or shock, they require immediate attention

Yellow tagged patients have

major injuries, such as open fractures with a distal pulse and large wounds that *need treatment within 30 min to 2 hours*

Black tagged patients have

massive head trauma, extensive full thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation

Green tagged patients have

minor injuries that can be managed in a delayed fashion - generally more than 2 hours Ex. closed fractures, sprains, strains, abrasions, contusions

Mass casualty event

overwhelms local medical capabilities and may require the collaboration of multiple agencies and health care facilities to handle the crisis

MRC

Medical Reserve Corps Group of volunteer medical and public health care professionals, including physicians and nurses.

Hospital Incident Command System (HICS)

The hospital facility level organization model for disaster management. Roles are formally structured under the hospital or long-term care facility incident commander with clear lines of authority and accountability for specific resources.

emergency preparedness plan

The joint commission 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. Accredited health care organizations are required to take an "all-hazards approach" to disaster planning. Disaster drills are ideally planned based on a risk assessment or vulnerability analysis that identifies the events most like to occur in a particular community. Nursing homes and other long term care facilities are required to have annual drills to prepare for mass casualty events.

Triage officer

This person is generally a physician in a large hospital who is assisted by triage nurses. When physician resources are limited, an experienced nurse may assume this role. The triage officer rapidly evaluates each person who presents to the hospital, even those who come with triage tags in place.

Stand down

When the last major casualties have been treated and nom ore are expected to arrive in numbers that cold overwhelm the health care system, the incident commander considers "stand down" or deactivating the emergency response plan.

two types of debriefing

1. Critical incident stress debriefing - provide sessions for small groups of staff to promote effective coping strategies. 2. Administrative Review - administrative review of staff and system performance during the event to determine whether opportunities for improvement in the emergency management plan exist.

What is the nurses role in responding to health care facility fires?

1. Remove any patient or staff from immediate danger of the fire or smoke. 2. Discontinue oxygen for all patients who can breathe without it. 3. For patients on life support, maintain their respiratory status manually until removed from the fire area. 4. Direct ambulatory patients to walk to a safe location. 5. If possible ask ambulatory patients to push wheelchair patients out of danger. 6. Move bedridden patients from he first area in bed, by stretcher, or in a wheelchair, iff needed have one or two staff members move patients on blankets or carry them. 7. After everyone is out of danger, seek, to contain the fire by closing doors and windows and using ABC extinguisher (can put out any type of fire) if possible. 8. Do not risk injury to yourself or staff members while moving patients or attempting to extinguish the fire.

The Life Safety Code

Published by the National Fire Protection Association provides guidelines for building construction, design, maintenance, and evacuation. Centers for Medicare and Medicaid Services requires every health care facility to practice atlas one fire drill or actual fire response once a year. Patient evacuation is not required if the event is a drill.

Mass Casualty triage

Red: Emergent needing immediate attention (class I) Yellow: Can wait short time for care (class II) Green: Non-urgent or "walking wounded" (class III) Black: Expected to die or are dead (class IV)

Medical Command Physician

Focuses on determining the number, acuity, and medical resource needs of victims arriving from the incident scene to the hospital and organizing the emergency health care team response to the injured or ill patients. Responsibilities include identifying the need for and calling in specialty-trained providers such as: Surgeons, pulmonologists, infectious disease physicians, industrial hygienists and radiation safety personnel.

disaster triage tag system

Categorizes triage priority by color and number.

DMAT

Disaster Medical Assistance Team A medical relief team made up of civilian medical, paraprofessional, and support personnel that is deployed to a disasters area with enough medical equipment and supplies to sustain operations for 72 hours. They are apart of the National Disaster Medical System in the US. They provide services ranging from primary health care and triage to evacuation and staffing to assist health care facilities that have become overwhelmed with casualties.

What is the role of nurses in health care facility emergency preparedness and response?

Nurses play a key role before, during, and after a disaster. Before a disasters nurses contribute to developing internal and external emergency response plans. During an actual disaster nurses collaborate with medical command physician to meet patient needs. Nurses can develop a personal emergency preparedness plan to help provide the coverage needed if a large scale disasters would occur. Personal readiness supplies or a "go bag" allows for rapid response in the event a disasters requires evacuation of the community or people.

Emergency Operations Center (EOC)

Physical location identified for coordination of information and resources to support incident management activities.

Multi-casualty event

can be managed by a hospital using local resources