Concepts of Emergency and Disaster Preparedness Key Points Ch. 10 Iggy Book
Debriefing:
- provides a formal systematic review and analysis after an event. Two types of debriefings occur following a mass casualty event or period. • Critical incident stress management programming addresses pre-crisis through post-crisis interventions for small to large groups, including communities. • Critical incident stress debriefing (CISD) teams provide small group sessions for staff to promote effective coping strategies. • A team is composed of two to three specially trained individuals who come together quickly when called to deal with the emotional needs of health team members after a particularly devastating or disturbing incident. • The team leader typically has background in a mental health/behavioral health field. • The second type of debriefing is an administrative function directed at analyzing the hospital or agency response to an event soon afterward. An administrative review of staff and system performance is done to determine opportunities for improvement in the emergency management plan. • The goal of this type of debriefing is to evaluate the implementation of the emergency preparedness plan so that changes can be made. • Representatives from all groups that were involved in the incident come together for discussion.
Emergency Preparedness and Response:
• The National Disaster Life Support Foundation offers Basic and Advanced Disaster Life Support training courses that include all essential aspects of disaster response and management. They include the core competencies of disaster management to all levels of health care professionals. • The Federal Emergency Management Agency (FEMA) provides Community Emergency Response Team (CERT) training to citizens. • All medical centers must have an emergency preparedness and response team in case of mass casualty (disaster). • Notification of a disaster incident initiates the hospital preparedness plan. • Notification that a multi-casualty or mass casualty situation exists usually occurs by radio or cellular communication between the ED and EMS providers at the scene or by notification from a state or regional emergency management agency to the ED. • Each hospital specifies who has the authority to activate and how to activate the disaster or emergency preparedness plan using technologies such as group paging systems, telephone trees, and instant computer-based alert messages. • A key process in any multi-casualty or mass casualty response is effective triage to rapidly sort ill or injured patients into priority categories based on their acuity and survival potential.
Impact of Recent External Disasters:
• The term "NBC" was coined to describe nuclear, biologic, and chemical threats. • Emergency medical services (EMS) agencies and hospitals improved safety by upgrading their decontamination facilities, equipment, and all levels of personal protective gear to better protect staff. • Emergency department (ED) physician and nursing staff underwent hazardous materials (HAZMAT) training and learned how to recognize patterns of illness in patients who present for treatment that potentially indicate biologic terrorism agents, such as anthrax or smallpox.
Role of Nursing in Community Emergency Preparedness and Response:
• Nurses have important roles in preparing for, managing, and debriefing after an internal health care facility disaster. • Nurses play a major role in triage, first aid and emergency care, and shelter assistance in external community disasters. • The ED charge nurse, trauma program manager, and other ED nursing leadership personnel act in collaboration with the medical command physician and triage officer to organize nursing and ancillary services to meet patient needs. The safety of all patients is vital. • Each nurse should have a personal emergency preparedness plan that outlines their preplanned arrangements for child care, pet care, and older adult care if the need arises, especially if the event prevents returning home for an extended period of time.
Even Resolution and Debriefing:
• Once the incident commander determines that the last major casualties have been treated and no more are expected to arrive in numbers that could overwhelm the system, he or she can consider "standing down" or deactivating the emergency response plan. • Before "standing down," assess all areas of the hospital that may still be under stress and need additional support with the supplemental resources provided by the emergency plan activation. Ensure that departments in all areas are in agreement to resume normal operations. • A vital consideration for event resolution is having available staff and supplies to meet ongoing operational needs. Severe shortages of supplies and the need to clean and restock the ED may also pose a threat to normal operations at the conclusion of an incident. collaboration between the ED and central supply is crucial for resolving stock availability problems.
Most mass casualty response teams, both in the field (at the disaster site) and in the hospital setting, use a disaster triage tag system that categorizes triage priority by color and number:
- Emergent (class I) patients are identified with a red tag, indicating immediate threats to life. - Patients who can wait a short time for care (class II) are marked with a yellow tag, indicating major injuries that need treatment within a 30-minute to 2-hour time frame. - Nonurgent or "walking wounded" (class III) patients are given a green tag, indicating minor injuries that can be managed in a delayed fashion, generally more than 2 hours. - Patients who are expected to die or are dead are issued a black tag (class IV). • The facility-level organizational model for disaster management is the Hospital Incident Command System (HICS), which is a part of the National Incident Management System (NIMS) implemented by the Department of Homeland Security and FEMA to standardize disaster operations. • Hospital Emergency Preparedness and Response Plans include different roles and responsibilities for the personnel. - An incident commander is usually identified, along with a medical command physician, triage officer, and others responsible for public information, safety, and security, in order to achieve a manageable span of control over the available personnel or resources. - The hospital establishes an emergency operations center (EOC) or command center in a designated location with accessible communication technology.
Type of Disasters:
• A disaster is commonly defined as an event in which illness or injuries exceed the resource capabilities of a community or medical facility. Each facility defines its own parameters to identify when a disaster situation is present. • An internal disaster is any event inside a health care facility or campus that could endanger patients or staff and 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). - Examples of potential internal disasters include fire, explosion, and violence. • An external disaster is any event outside the health care facility or campus, somewhere in the community, that requires the activation of the facility's emergency management plan. - The number of facility staff is not adequate for the incoming patients. - External disasters can be either natural, such as a hurricane, tornado, or earthquake, or technological, such as an act of terrorism with explosive devices or nuclear reactor malfunction. • The main difference between multi-casualty event and mass casualty (disaster) event is based upon the scope and scale of the incident and the number and severity of victims or casualties. • To maintain disaster preparedness skills, hospital personnel and disaster teams participate in emergency training and drills or an actual event at least twice yearly. • One of the drills or events must involve community-wide resources and an influx of actual or simulated patients to assess the ability and effectiveness of collaborative efforts and command structures, and must use an "all-hazards approach." • This approach must address all credible threats to the safety of the community that could result in a disaster situation. • For all mass casualty events, the goal of emergency preparedness is to define ways to meet the extraordinary need for hospital beds, staff, drugs, personal protective equipment, supplies, and medical devices, such as mechanical ventilators.
PTSD:
• A disaster may cause some survivors to develop post-traumatic stress disorder (PTSD), which can potentially last for a lifetime. • People who are unable to sleep, are easily startled, have "flashbacks" to relive the disaster, or report "feeling numb" 2 weeks or more after a disaster or traumatic event are at risk for PTSD. • Nurses caring for survivors with these manifestations should perform further assessment. One tool that can be used to assess survivor response to a disaster is the Impact of Event Scale-Revised (IES-R). • Provide emotional support through encouraging relaxation, listening to survivor feelings, and referring for appropriate counseling. • Be honest with victims and their families, and help them adapt to their changed or new surroundings. Take precautions to prevent staff from developing PTSD.
