Ch 10 Concepts of Emergency and Disaster Preparedness
During a mass casualty, which injury receives care first? 1 Abdominal evisceration 2 Open fracture of the left forearm 3 Sprained ankle 4 Sucking chest wound
Sucking chest wound The sucking chest wound is a red tag, or emergent, because it can be quickly resolved until further help can be given. The abdominal evisceration is a black tag, or is emergent for too much time, and resources are needed elsewhere in a disaster. The open fracture of the left forearm casualty is a yellow tag, or immediate, needing treatment in 30 minutes to 2 hours. The sprained ankle is a green tag, or "walking wounded," and does not require care for over 2 hours.
Which clients does the emergency department (ED) nurse prepare to discharge to free up beds for disaster victims? Select all that apply. 1 Client who was admitted following a myocardial infarction 2 Client with no critical change in condition for the past 3 days 3 Bedridden client who is undergoing diagnostic evaluation 4 Client being discharged soon to be cared for at home by the family 5 Client who is to be shifted to a rehabilitation or long-term center
-Client with no critical change in condition for the past 3 days -Client being discharged soon to be cared for at home by the family -Client who is to be shifted to a rehabilitation or long-term center In a disaster situation, the nurse should provide discharge teaching and prepare to discharge the client who has had no critical change for the past 3 days. The client who is scheduled to be discharged soon should be discharged a few days earlier to free beds for disaster victims. The client who is referred to a rehabilitation or long-term center should also be discharged earlier. The client who was hospitalized following a myocardial infarction and the client who is bedridden and undergoing diagnostic evaluation should not be discharged, as they are considered critical.
What factors adversely affect the resource capabilities of the health care system during the outbreak of a pandemic? Select all that apply. 1 Increase in the number of people seeking medical care 2 Widespread vaccination programs 3 Public information campaigns 4 Self-imposed quarantine by health care workers 5 Worker illness and absenteeism
-Increase in the number of people seeking medical care -Self-imposed quarantine by health care workers -Worker illness and absenteeism A pandemic leads a vast number of people to seek medical care. These include not only the sick, but also those who seek preventive care and evaluation of their current health status. Some health care workers may choose to remain quarantined to avoid infection. Some health care workers may be absent from work due to illness. All these factors adversely affect the resource capabilities of the health care system. Widespread vaccination programs and public information campaigns are factors that help to manage the pandemic.
The supervising nurse in collaboration with a resident physician has been assigned to select patients who may be discharged to make room for more critical patients during a mass casualty event. Which is the most appropriate patient for discharge? A A 64-year-old ambulatory male admitted to observation for atypical chest pain B A 75-year-old female with no caregiver who was admitted for a UTI and has 2 more days of IV antibiotics C A 24-ear-old male admitted 2 days ago following a car crash who was diagnosed with an epidural hematoma D A 44-year-old homeless female admitted this morning with abdominal pain due to suspected appendicitis
A 64-year-old ambulatory male admitted to observation for atypical chest pain During a mass casualty event, patients who are most stable may be discharged early, including those who: were admitted for observation and are not bedridden; are having diagnostic evaluations and are not bedridden; are soon scheduled to be discharged or could be cared for at home with support from family or home health care services; have had no critical change in condition for the past 3 days; or could be cared for in another, lower level of care facility.
The nurse is assisting a triage team at the site of a multiple motor vehicle crash. Which client does the nurse identify with a green tag? 1 Unconscious woman with a weak pulse 2 Young man with burns over 70% of his body 3 Older man with a cut on the forearm 4 Young woman with a spinal injury
Older man with a cut on the forearm The older man with a cut on the forearm would be identified with a green tag; green-tagged clients have minor injuries that can be managed in a delayed fashion. The unconscious woman with a weak pulse, the young man with burns over 70% of his body, and the young woman with a spinal injury are identified as emergent, and these clients are red-tagged; red-tagged clients have immediate threats to life.
The triage nurse is a member of the medical relief team who has been delegated to a hurricane-hit area. What supplies does the nurse take along in the "go bag?" 1 Personal ID with emergency contacts in a waterproof bag 2 Ready-to-cook food packets and utensils for cooking 3 Flashlight and radio with rechargeable batteries 4 Extra blankets and pillows
Personal ID with emergency contacts in a waterproof bag The nurse should take along personal ID with emergency contacts in a waterproof bag in case of a crisis. The nurse should also take along non-perishable food items that do not need cooking. A flashlight and radio with extra batteries or chemical light should also be available; if power supply in the area is disrupted, rechargeable batteries will not be of help. There is no room to carry extra blankets and pillows in a personal "go bag" but an emergency blanket or a sleeping bag and a pillow should be included.
The nurse in the emergency department is caring for mass casualty victims. Which task does the nurse delegate to the nurse from the critical care unit? 1 Provide care for stabilized clients. 2 Resuscitate the client if required. 3 Assist with client identification. 4 Monitor vital signs.
Resuscitate the client if required. The nurse in the emergency department can delegate the task of resuscitating clients, if required, to the nurse from the critical care unit. The nurse from the critical care unit could also identify clients who can be transferred out of the critical care unit to rapidly expand critical care bed capacity. A general staff nurse may be asked to care for stabilized clients. Staff from ancillary departments may help to identify clients. A general staff nurse can monitor vital signs of clients.
After successful treatment of clients involved in a mass casualty incident, the incident commander deactivates the emergency response plan. Which activity is most important for the emergency department (ED) charge nurse to initiate at this time? 1 Analyze the ED response to the mass casualty incident. 2 Take inventory and restock the ED with supplies and equipment. 3 Initiate critical incident stress debriefing (CISD) for staff members. 4 Follow up with survivors to determine the need for additional referrals.
Take inventory and restock the ED with supplies and equipment. The priority is to restock the ED to return to normal operation. Analysis of the ED response, CISD debriefing, and follow-up with survivors and referrals can occur after the ED is restored.
A client comes to the emergency department covered with coagulated blood and a white powder. The client is hysterical and fears that it is anthrax. What does the nurse do first? 1 Administers antibiotics. 2 Provides emotional support. 3 Takes the client to the decontamination room. 4 Triages the client.
Takes the client to the decontamination room. Decontamination should precede triage. Only the most basic life-sustaining interventions should be performed before or during decontamination. The coagulated blood indicates that any major active bleeding has likely subsided. Taking antibiotics unnecessarily will promote the growth of resistant bacteria and may cause serious drug-related side effects. In addition, anthrax exposure has not yet been verified. Emotional support is important but is not the priority here. Triage is important but is not the first action that should be taken.
The nurse has a suggestion for improving response in the next mass casualty event. Which channel does the nurse use to introduce this idea? 1 The Administrative Review 2 The Critical Incident Stress Briefing (CISB) 3 The supervisor 4 The hospital suggestion box
The Administrative Review The goal of the Administrative Review is to discern what went right and what went wrong during activation and implementation of the emergency preparedness plan. In this way, changes can be made. CISB programming addresses precrisis through postcrisis interventions for small to large groups, including communities. Going through the supervisor and using the suggestion box are not the best ways to introduce a change of this type.
The trauma nurse is participating in a Critical Incident Stress Debriefing (CISD) session to prevent post-traumatic stress disorder (PTSD). What is a typical "ground rule" for stress debriefing? 1 Each session does not last for more than 30 minutes. 2 Family members provide support during the session. 3 There is strict confidentiality of information shared in the session. 4 There is no compulsion to accept the thoughts expressed by the team.
There is strict confidentiality of information shared in the session. Strict confidentiality should be maintained with respect to the information shared in CISD session. Staff are given protected time of 1 to 3 hours to undergo stress debriefing. The CISD team has a "door keeper" who keeps inappropriate people out of the session. The session generally involves only the nurse and team members of the CISD; the family is not involved. The nurse is expected to accept unconditionally the thoughts and feelings expressed by the team during the session.
The triage nurse is part of an emergency team at the site of an earthquake. Which client does the nurse identify as being in the "expectant" category? 1 Young lady with multiple fractures in the leg 2 Unconscious man with agonal breathing 3 Baby with no visible wounds, crying aloud 4 Young man with abdominal injury
Unconscious man with agonal breathing In a military form of triage, the unconscious man with agonal breathing is identified as an "expectant" category; clients who are critically ill or have life-threatening injuries are identified as "expectant." These clients are treated after others have received care. During usual operations, these clients would have received resuscitation. The young lady with multiple fractures, the baby with no visible wounds, and the young man with an abdominal injury would be taken care of before the unconscious man receives care.
How do health care workers identify people of position in the chaotic work environment during an emergency situation? 1 Using specific job action sheets. 2 Using brightly colored vests with large lettering. 3 Enquiring at the emergency operations center. 4 Communicating with the command center.
Using brightly colored vests with large lettering. The Hospital Incident Command System (HICS) ensures that brightly colored vests with large lettering help health care workers identify people of position in the chaotic environment. Specific job action sheets are circulated to all personnel with leadership roles in the HICS that predefine reporting relationships and list prioritized tasks and responsibilities. The HICS personnel also establish an emergency operations center (EOC) or command center in a designated location with accessible communication technology.
The nurse is assisting with triage in the field after a large airplane crash. She is assessing a victim who has an open tibial fracture and a large laceration to his head, but is otherwise stable. What is the appropriate color tag for the victim? A Red B Black C Green D Yellow
Yellow In general, yellow-tagged patients have major injuries, such as open fractures with a distal pulse and large wounds that need treatment within 30 minutes to 2 hours. Red-tagged patients have immediate threats to life, such as airway obstruction or shock, and require immediate attention. Green-tagged patients have minor injuries that can be managed in a delayed fashion, generally more than 2 hours. Black-tags are reserved for patients who are not expected to survive.
How does the high school nurse react directly after a random shooting at a high school? 1 Actively listens to students 2 Assesses his or her own individual feelings 3 Encourages students to vent feelings 4 Facilitates community cohesion
Assesses his or her own individual feelings Assessing his or her individual feelings is the best answer; one must be able to support oneself before supporting others. Allowing students to express their feelings, active listening, and facilitating community cohesion are important, but are not what should be done first.
The triage nurse informs the incident commander that all clients in the triage area have been cared for, and some have left the hospital for their homes. What does the incident commander consider before resolving the emergency plan? 1 Ensure that the instrument trays are washed, packaged, and re-sterilized. 2 Arrange sleeping quarters for the staff at the hospital. 3 Ensure staff and supply availability to meet ongoing needs. 4 Check inventory and restock the emergency department.
Ensure staff and supply availability to meet ongoing needs. The incident commander ensures that staff and supply is available to meet ongoing needs at the hospital. All departments must be in agreement to resume normal operations before resolving the emergency plan. The emergency department (ED) and central supply will collaborate to check inventory and restock the ED and ensure that instrument trays are washed and re-sterilized. The facility will arrange for sleeping quarters to ensure all personnel have periods of rest.
What care does the hospital incident commander take before deactivating the emergency response plan? 1 Checks that all critical supplies are refilled in all departments. 2 Coordinates with the central supply department to resolve stock availability. 3 Ensures that all departments are able to return to normal operations. 4 Ensures that extra staff has left the hospital.
Ensures that all departments are able to return to normal operations. The hospital incident commander ensures that not only the triage area, but all departments have returned to normal operations before deactivating the emergency response plan. The incident commander checks that all critical supplies are available during the emergency operation. After "standing down," the incident commander coordinates with the central supply department to resolve stock availability. Thereafter, all stocks are replenished. Temporary sleeping quarters at the hospital may be needed to allow additional staff to rest before they leave for their homes.
What is the role of the International Medical Surgical Response Teams (IMSuRTs)? 1 Establish first aid stations or special-needs shelters. 2 Establish fully functional field surgical facilities. 3 Set up acute care centers for the disaster-affected. 4 Provide surgical staff for health care facilities and hospitals.
Establish fully functional field surgical facilities. The International Medical Surgical Response Teams (IMSuRTs) establish fully functional field surgical facilities wherever they are needed in the world. The Medical Reserve Corps (MRC) establishes first aid stations or special-needs shelters in disaster areas. They also set up acute care centers in the community for days to weeks to alleviate emergency department and hospital overcrowding. Disaster Medical Assistance Teams (DMATs) provide staff to assist health care facilities that have become overwhelmed with casualties.
What is a manifestation of post-traumatic stress disorder (PTSD)? 1 Feeling "numb" 2 weeks or more after a disaster. 2 Working for more than 12 hours a day. 3 Seeking interaction with family and friends. 4 Prefering the company of coworkers.
Feeling "numb" 2 weeks or more after a disaster. PTSD can lead to characteristic psychological and physical effects. The person with PTSD generally loses interest in activities that were enjoyable earlier. The person may report "feeling numb" 2 or more weeks after the disaster. The person is most likely to experience "professional burnout" and may not work for more than 12 hours a day. PTSD causes an individual to detach from others and become an introvert, often avoiding the company of family, friends, or coworkers.
Which team member is responsible for "standing down" or deactivating the emergency response plan? 1 Hospital incident commander 2 Emergency department (ED) nurse 3 Community relations officer 4 Triage officer
Hospital incident commander The incident commander deactivates the emergency response plan. This is done when the number of casualties arriving at the ED has reduced to normal levels. The ED nurses focus their efforts on aiding mass casualty victims. The community relations officer releases only accurate and appropriate information to the media. The triage officer evaluates each client to determine priorities for treatment.
The nurse is assisting the triage team at an earthquake site. Which client does the nurse refer to as the "walking wounded?" 1 Client with several bruises and a closed fracture of the elbow 2 Client with third degree burns on 80% of the body 3 Client with bleeding wounds from shrapnel and an open fracture 4 Conscious client with a bleeding head injury
Client with several bruises and a closed fracture of the elbow The client with several bruises and a closed fracture of the elbow is "green-tagged" or referred to as the "walking wounded." This client can help evacuate himself or herself and go to the hospital in a private vehicle. The client with third degree burns on 80% of the body has a lesser chance of survival; this client is "black-tagged" or given treatment last. The client with bleeding wounds from shrapnel and an open fracture, and the client with a bleeding head injury are "yellow-tagged." These clients need treatment within at least 2 hours.
A school bus overturns in a small, rural community that is served by a critical access hospital and one volunteer fire department. How is the incident of the overturned school bus categorized? 1 Not a mass casualty 2 May be a mass casualty 3 Mass casualty 4 Internal disaster
May be a mass casualty A mass casualty event overwhelms local medical capabilities. It may require the collaboration of multiple agencies and health care facilities to handle the crisis. Depending on the community, available resources, and the quantity and severity of those injured, this may be a mass casualty. The overturned school bus will likely require the hospital to activate their disaster plan; however, since it occurred outside of the facility, this would be an external disaster.
Which essential item is added to a personal-readiness supplies "go bag?" 1 Fruits and vegetables 2 Potable water 3 Television 4 Laptop computer
Potable water The go bag should contain 1 gallon of potable water per person per day. Potable water is required to prevent dehydration. Any foods included in a go bag should be nonperishable. A television would not be practical; a radio (battery-powered or hand-crank generated) would be better. A laptop computer would also not be practical.
