EMERGENCY NURSING

EMERGENCY MEDICAL SERVICES:

Public law 93-154- goal is to improve EMcare and EMS Elements: 1. Personnel 2. Training 3. Communication 4. Transportation 5. Facilities 6. Critical care units 7. Public safety agencies 8. Consumer participation 9. Access to care 10. Transfer of care 11. Standardization of patients records 12. Public information and education 13. Independent review and evaluation 14. Disaster linkage 15. Mutual aid agreements

DISASTER:
Noji (1997) suggests that health care providers should define disaster based on how it impacts health and health services. From a health care standpoint, the type and timing of a disaster event are predictors of the types of injuries and illnesses that occur.

DISASTER MANAGEMENT KIT:

First aid kit and essential medications. Canned food and can opener. At least three gallons of water per person. Protective clothing, bedding, or sleeping bags. Battery-powered radio, flashlight, and extra batteries. Special items for infant, elderly, or disabled family members. Written instructions on how to turn off electricity, gas, and water if authorities advise you to do so. (Remember, you'll need a professional to turn natural gas service back on.)

TORNADO
PREPARE A HOME TORNADO PLAN:
Pick a place where family members could gather if a tornado is headed your way. It could be your basement or, if there is no basement, a center hallway, bathroom, or closet on the lowest floor. Keep this place uncluttered. If you are in a high-rise building, you may not have enough time to go to the lowest floor. Pick a place in a hallway in the center of the building. Stay Tuned for Storm Warnings: Tornado watch Tornado warning

WHEN A TORNADO WATCH IS ISSUED:

 Listen to local radio and TV stations for further updates. Be alert to changing weather conditions. Blowing debris or the sound of an approaching tornado may alert you. Many people say it sounds like a freight train.

WHEN TORNADO WARNING IS ISSUED:

If you are inside, go to the safe place you picked to protect yourself from glass and other flying objects. The tornado may be approaching your area. If you are outside, hurry to the basement of a nearby sturdy building or lie flat in a ditch or low-lying area. If you are in a car or mobile home, get out immediately and head for safety (as above).

AFTER A TORNADO PASSES:

Watch out for fallen power lines and stay out of the damaged area. Listen to the radio for information and instructions. Use a flashlight to inspect your home for damage. Do not use candles at any time.

SEVERE THUNDERSTORM
BEFORE LIGHTNING STRIKES:
Keep an eye on the sky. Look for darkening skies, flashes of light, or increasing wind. Listen for the sound of thunder. If you can hear thunder, you are close enough to the storm to be struck by lightning. Go to safe shelter immediately. Listen to Weather Radio, commercial radio, or television for the latest weather forecasts.

WHEN A STORM APPROACHES:

Find shelter in a building or car. Keep car windows closed and avoid convertibles. Telephone lines and metal pipes can conduct electricity. Unplug appliances. Avoid using the telephone or any electrical appliances. ( Leaving electric lights on, however, does not increase the chances of your home being struck by lightning.) Avoid taking a bath or shower, or running water for any other purpose. Turn off the air conditioner. Power surges from lightning can overload the compressor, resulting in a costly repair job! Draw blinds and shades over windows. If windows break due to objects blown by the wind, the shades will prevent glass from shattering into your home

IF CAUGHT OUTSIDE:
If you are in the woods, take shelter under the shorter trees. If you are boating or swimming, get to land and find shelter immediately!

PROTECTING YOUR SELF OUTSIDE:

Go to a low- lying, open place away from trees, poles, or metal objects. Make sure the place you pick is not subject to flooding. Be a very small target! Squat low to the ground. Place your hands on your knees with your head between them. Make yourself the smallest target possible. Do not lie flat on the ground-- this will make you a larger target!

AFTER A STORM PASSES:

Stay away from storm- damaged areas. Listen to the radio for information and instructions

IF SOMEONE IS STUCK BY LIGHTNING:

People struck by lightning carry no electrical charge and can be handled safely. Call for help. Get someone to dial 9-1-1 or your local Emergency Medical Services ( EMS) number. The injured person has received an electrical shock and may be burned, both where they were struck and where the electricity left their body. Check for burns in both places. Being struck by lightning can also cause nervous system damage, broken bones, and loss of hearing or eyesight. Give first aid. If breathing has stopped, begin rescue breathing. If the heart has stopped beating, a trained person should give CPR. If the person has a pulse and is breathing, look and care for other possible injuries.

FLASH FLOODS
KNOW WHAT TO EXPECT:
Know your area' s flood risk-- if unsure, call your local red cross, emergency management office, or planning and zoning department. If it has been raining hard for several hours, or steadily raining for several days, be alert to the possibility of a flood. Listen to local radio or TV stations for flood information.

REDUCE POTENTIAL DAMAGE BY:

Raising your furnace, water heater, and electric panel if they are in areas of your home that may be flooded. Consult with a professional for further information if this and other damage reduction measures can be taken. Prepare a family disaster plan Check to see if you have insurance that covers flooding. If not, find out how to get flood insurance. Keep insurance policies, documents, and other valuables in a safedeposit box. Assemble a disaster supply kit

WHEN A FLOOD WATCH IS ISSUED:

Move your furniture and valuables to higher floors of your home. Fill your car' s gas tank, in case an evacuation notice is issued.

WHEN A FLOOD WARNING IS ISSUED:

Listen to local radio and TV stations for information and advice. If told to evacuate, do so as soon as possible.

TOP SAFETY TIPS FOR BLACK- OUT:

Only use a flashlight for emergency lighting. Never use candles! Turn off electrical equipment you were using when the power went out. Avoid opening the refrigerator and freezer. Do not run a generator inside a home or garage. If you use a generator, connect the equipment you want to power directly to the outlets on the generator. Do not connect a generator to a home' s electrical system. Listen to local radio and television for updated information.

HOW TO PREPARE BEFORE A BLACK- OUT:

Flashlight Batteries Portable radio at least one gallon of water a small supply of food. Due to the extreme risk of fire, do not use candles during a power outage.

WHAT TO DO DURING A BLACK- OUT:

Turn off all elctrical appliances and switches Leave 1 bulb on Avoid opening the refrigerator Use the phone if necessary Limit travel esp by car Keep cool if it is hot and warm yourself if it is cold

CHEMICAL BURNS
HOW YOU MAY BE EXPOSED TO A CHEMICAL:
You may be exposed to a chemical in three ways: Breathing the chemical Swallowing contaminated food, water, or medication Touching the chemical, or coming into contact with clothing or things that have touched the chemical.

PREVENTION:
Store chemicals in proper places, out of reach by children

Avoid mixing 2 or more household chemicals Never smoke near a chemical If spilled, clean area immediately Air dry outdoors, avoid contact Make a family disaster plan Make a disaster kit: A first aid kit A battery- operated radio, flashlight, and extra batteries Bath size towels Plastic garbage bags Wide tape A county map Bottled water ( at least 3 gallons of water per person) Non- perishable snack food List of family medications, eyeglasses, hearing aids Shelter in place Gather your family indoors Protect your breathing by covering your mouth and nose with a damp cloth. Close all windows in your home. Turn off all fans, heating and air conditioning systems Close the fireplace damper Go to an above- ground room ( not the basement) with the fewest windows and doors. Take your Family disaster kit with you. Wet some towels and jam them in the crack under the doors. Tape around doors, windows, exhaust fans or vents. Use the plastic garbage bags to cover windows, outlets, and heat registers. If you are told there is danger of explosion, close the window shades, blinds, or curtains. To avoid injury, stay away from the windows. Stay in the room and listen to your radio until you are told all is safe or you are told to evacuate.

CHEMICAL POISONING
MANIFESTATIONS:
Difficulty breathing Changes in skin color Headache or blurred vision Dizziness Irritated eyes, skin, throat Unusual behavior Clumsiness or lack of coordination Stomach cramps or diarrhea

FIRST AID TREATMENT FOR CHEMICAL BURNS:

Remove any affected clothing or jewelry from the injury. Flush w/ cool running water. If no large amount of clean water is available, gently brush the chemical off the skin and away from the victim and you. If the chemical is on the face, neck, or shoulders, ask the victim to close his or her eyes before brushing off the chemical. Cover the wound very loosely with a dry, sterile or clean cloth so that the cloth will not stick to the wound. Do not put any medication on the wound. Seek medical attention immediately.

IMPORTANT POINTS TO REMEMBER:

Chemicals are everywhere. The most common chemical accidents occur in our own homes and can be prevented. The best ways to avoid chemical accidents are to read and follow the directions for use, storage, and disposal of the product. Don' t mix products, especially household cleaning products. Develop a disaster plan In the event of an emergency, ff the instructions of the authorities carefully. Listen to your emergency broadcast stations on radio and TV. Use your phone only in life- threatening emergencies, and then call the Poison Control Center, EMS, 9-1-1, or the operator immediately. If you are told to " shelter in place", go inside, close all windows and vents and turn off all fans, heating or cooling systems. Take family members and pets to a safe room, seal windows and doors, and listen to emergency broadcast stations for instructions. If you are told to evacuate immediately, take your disaster supply Kit. Pack only the bare essentials, such as medications, and leave your home quickly. Follow the traffic route authorities recommend. Don' t take short cuts on the way to the shelter. If you find someone who appears to have been injured from chemical exposure, make sure you are not in danger before administering first aid. And lastly, remember, the best way to protect yourself and your family is to be prepared.

VOLCANO
BEFORE:
Learn about your community warning systems and emergency plans. Be prepared for the hazards that can accompany volcanoes: Mudflows and flash floods Landslides and rockfalls Earthquakes Ashfall and acid rain

 Tsunamis Make evacuation plans Develop an emergency communication plan Have disaster supplies on hand: Flashlight and extra batteries First aid kit and manual Emergency food and water Non- electric can opener Essential medicines Dust mask Sturdy shoes

DURING

Follow the evacuation order issued by authorities. Avoid areas downwind and river valleys downstream of the volcano.

IF CAUGHT INDOORS:
Close all windows, doors, and dampers. Put all machinery inside a garage or barn. Bring animals and livestock into closed shelters.

IF CAUGHT INDOORS:
Seek shelter indoors. If caught in a rockfall, roll into a ball to protect your head. If caught near a stream, be aware of mudflows. Move up slope, especially if you hear the roar of a mudflow.

PROTECT YOURSELF DURING ASH- FALL:

Wear long- sleeved shirts and long pants. Use goggles to protect your eyes. Use a dust mask or hold a damp cloth over your face to help breathing. Keep car or truck engines off. After: If possible, stay away from volcanic ashfall areas. When outside: Cover your mouth and nose. Volcanic ash can irritate your respiratory system. Wear goggles to protect your eyes. Keep skin covered to avoid irritation from contact with ash. Clear roofs of ashfall Avoid driving in heavy ashfall If you have a respiratory ailment, avoid contact with any amount of ash

FIRE / CARBON MONOXIDE DISASTER

Make your home fire safe Plan the escape route Escape Safely Once you are out, stay out! Call the fire department from a neighbor' s home. If you see smoke or fire in your first escape route, use your second way out. If you must exit through smoke, crawl low under the smoke to your exit. If you are escaping through a closed door, feel the door before opening it. If it is warm, use your second way out. If smoke, heat, or flames block your exit routes, stay in the room with the door closed. Signal for help using a bright- colored cloth at the window. If there is a telephone in the room, call the fire department and tell them where you are.

DROUGHT
Water conservation Risk for water borne diseases Risk for heatstroke and dehydration

TERRORISM
Create an emergency communications plan. Choose an out- of- town contact your family or household will call or e- mail to check on each other should a disaster occur. Your selected contact should live far enough away that they would be unlikely to be directly affected by the same event, and they should know they are the chosen contact. Make sure every household member has that contact' s, and each other' s, e- mail addresses and telephone numbers ( home, work, pager and cell). Leave these contact numbers at your children' s schools, if you have children, and at your workplace. Establish a meeting place. Having a predetermined meeting place away from your home will save time and minimize confusion should your home be affected or the area evacuated. You may even want to make arrangements to stay with a family member or friend in case of an emergency. Be sure to include any pets in these plans, since pets are not permitted in shelters and some hotels will not accept them. Assemble a disaster supplies kit. Prepare a disaster supplies kit in an easy- to- carry container such as a duffel bag or small plastic trash can.

 Include " special needs" items for any member of your household ( infant formula or items for people with disabilities or older people), first aid supplies ( including prescription medications), a change of clothing for each household member, a sleeping bag or bedroll for each, a battery powered radio or television and extra batteries, food, bottled water and tools. It is also a good idea to include some cash and copies of important family documents ( birth certificates, passports and licenses) in your kit. Check on the school emergency plan of any school- age children you may have. You need to know if they will they keep children at school until a parent or designated adult can pick them up or send them home on their own. Be sure that the school has updated information about how to reach parents and responsible caregivers to arrange for pickup. And, ask what type of authorization the school may require to release a child to someone you designate, if you are not able to pick up your child.

IF DISASTER STRIKES:
Remain calm and be patient. Follow the advice of local emergency officials. Listen to your radio or television for news and instructions. If the disaster occurs near you, check for injuries. Give first aid and get help for seriously injured people. Call your family contact do not use the telephone again unless it is a life- threatening emergency.

If the disaster occurs near your home while you are there:
Check for damage using a flashlight. Do not light matches or candles or turn on electrical switches. Check for fires, fire hazards and other household hazards. Sniff for gas leaks, starting at the water heater. If you smell gas or suspect a leak, turn off the main gas valve, open windows, and get everyone outside quickly. Shut off any other damaged utilities. Confine or secure your pets. Check on your neighbors, especially those who are elderly or disabled.

EVACUATION:
If local authorities ask you to leave your home, they have a good reason to make this request, and you should heed the advice immediately. Listen to your radio or television and follow the instructions of local emergency officials and keep these simple tips in mind Wear long- sleeved shirts, long pants and sturdy shoes so you can be protected as much as possible.

 Take your disaster supplies kit. Take your pets with you; do not leave them behind. Because pets are not permitted in public shelters, follow your plan to go to a relative' s or friend' s home, or find a " pet- friendly" hotel. Lock your home. Use travel routes specified by local authorities don' t use shortcuts because certain areas may be impassable or dangerous. Stay away from downed power lines.

First Aid Primer:

If you encounter someone who is injured, apply the emergency action steps: Check- Call- Care. Check the scene to make sure it is safe for you to approach. Then check the victim for unconsciousness and life- threatening conditions.. Call out for help. Care for non life threatening injuries.

CONTROL BLEEDING:
Cover the wound with a dressing, and press firmly against the wound ( direct pressure). Elevate the injured area above the level of the heart if you do not suspect that the victim has a broken bone. Cover the dressing with a roller bandage. If the bleeding does not stop: Apply additional dressings and bandages. Use a pressure point to squeeze the artery against the bone. Provide care for shock.

CARE FOR THE SHOCK:

Keep the victim from getting chilled or overheated. Elevate the legs about 12 inches ( if broken bones are not suspected). Do not give food or drink to the victim.

TEND BURNS:
Stop the burning by cooling the burn with large amounts of water. Cover the burn with dry, clean dressings or cloth.

CARE FOR INUJURIES TO MUSCLES, BONES AND JOINTS:

Rest the injured part. Apply ice or a cold pack to control swelling and reduce pain. Avoid any movement or activity that causes pain. If you must move the victim because the scene is becoming unsafe, try to immobilize the injured part to keep it from moving.

BE AWARE OF BIOLOGICAL / RADIOLOGICAL EXPOSURE:

 Listen to local radio and television reports for the most accurate information from responsible governmental and medical authorities on what' s happening and what actions you will need to take.

REDUCE ANY CARE RISKS:

The risk of getting a disease while giving first aid is extremely rare. However, to reduce the risk even further: Avoid direct contact with blood and other body fluids. Use protective equipment, such as disposable gloves and breathing barriers. Thoroughly wash your hands with soap and water immediately after giving care.

LANDSLIDE / MUDSLIDE:
Factors that allow the force of gravity to overcome the resistance of earth material to landslide movement include: saturation by water, steepening of slopes by erosion or construction, alternate freezing or thawing, earthquake shaking, and volcanic eruptions. Landslides are typically associated with periods of heavy rainfall or rapid snow melt and tend to worsen the effects of flooding that often accompanies these events. In areas burned by forest and brush fires, a lower threshold of precipitation may initiate landslides. Debris flows, sometimes referred to as mudslides, mudflows, lahars, or debris avalanches, are common types of fast- moving landslides. These flows generally occur during periods of intense rainfall or rapid snow melt. They usually start on steep hillsides as shallow landslides that liquefy and accelerate to speeds that are typically about 10 miles per hour, but can exceed 35 miles per hour. The consistency of debris flows ranges from watery mud to thick, rocky mud that can carry large items such as boulders, trees, and cars.

AWARENESS INFORMATION:
Areas that are generally prone to landslide hazards include existing old landslides; the bases of steep slopes; the bases of drainage channels; and developed hillsides where leach- field septic systems are used. Areas that are typically considered safe from landslides include areas that have not moved in the past; relatively flat- lying areas away from sudden changes in slope; and areas at the top or along ridges, set back from the tops of slopes. Learn what to watch for prior to major landsliding. Look for patterns of storm- water drainage on slopes near your home, noting especially the places where runoff water converges, increasing flow over soilcovered slopes. Check hillsides around your home for any signs of land movement, such as small landslides or debris flows or progressively tilting trees Make a disaster plan If you are at risk from landslides: Talk to your insurance agent. Develop an evacuation plan.. Discuss landslides and debris flow with your family.

 Prepare a diasaster kit Disaster Suplies Kit basics Evacuation Supplies Kit

WHAT TO DO BEFORE INTENSE STORMS:

Become familiar with the land around you. Learn whether landslides and debris flows have occurred in your area by contacting local officials, state geological surveys or departments of natural resources, and university departments of geology. Knowing the land can help you assess your risk for danger. Watch the patterns of storm- water drainage on slopes near your home, and especially the places where runoff water converges, increasing flow over soil- covered slopes. Watch the hillsides around your home for any signs of land movement, such as small landslides or debris flows, or progressively tilting trees. Watching small changes could alert you to the potential of a greater landslide threat. Stay alert and awake. Many debris- flow fatalities occur when people are sleeping. Listen to a NOAA Weather Radio or portable, batterypowered radio or television for warnings of intense rainfall. Be aware that intense, short bursts of rain may be particularly dangerous, especially after longer periods of heavy rainfall and damp weather. If you are in areas susceptible to landslides and debris flows, consider leaving if it is safe to do so. Remember that driving during an intense storm can be hazardous. If you remain at home, move to a second story if possible. Staying out of the path of a landslide or debris flow saves lives. Listen for any unusual sounds that might indicate moving debris, such as trees cracking or boulders knocking together. A trickle of flowing or falling mud or debris may precede larger landslides. Moving debris can flow quickly and sometimes without warning. If you are near a stream or channel, be alert for any sudden increase or decrease in water flow and for a change from clear to muddy water. Such changes may indicate landslide activity upstream, so be prepared to move quickly. Don' t delay! Save yourself, not your belongings. Be especially alert when driving. Embankments along roadsides are particularly susceptible to landslides. Watch the road for collapsed pavement, mud, fallen rocks, and other indications of possible debris flows.

WHAT TO DO IF YOU SUSPECT IMMENENT LANDSLIDE DANGER:

Contact your local fire, police, or public works department. Local officials are the best persons able to assess potential danger. Inform affected neighbors. Your neighbors may not be aware of potential hazards. Advising them of a potential threat may help save lives. Help neighbors who may need assistance to evacuate. Evacuate. Getting out of the path of a landslide or debris flow is your best protection.

WHAT TO DO DURING LANDSLIDE:

 Quickly move out of the path of the landslide or debris flow. Moving away from the path of the flow to a stable area will reduce your risk. If escape is not possible, curl into a tight ball and protect your head. A tight ball will provide the best protection for your body.

WHAT TO DO AFTER LANDSLIDE:

Stay away from the slide area. There may be danger of additional slides. Check for injured and trapped persons near the slide, without entering the direct slide area. Direct rescuers to their locations. Help a neighbor who may require special assistance-- infants, elderly people, and people with disabilities. Elderly people and people with disabilities may require additional assistance. People who care for them or who have large families may need additional assistance in emergency situations. Listen to local radio or television stations for the latest emergency information. Watch for flooding, which may occur after a landslide or debris flow. Floods sometimes follow landslides and debris flows because they may both be started by the same event. Look for and report broken utility lines to appropriate authorities. Reporting potential hazards will get the utilities turned off as quickly as possible, preventing further hazard and injury. Check the building foundation, chimney, and surrounding land for damage. Damage to foundations, chimneys, or surrounding land may help you assess the safety of the area. Replant damaged ground as soon as possible since erosion caused by loss of ground cover can lead to flash flooding. Seek the advice of a geotechnical expert for evaluating landslide hazards or designing corrective techniques to reduce landslide risk. A professional will be able to advise you of the best ways to prevent or reduce landslide risk, without creating further hazard.

TRIAGE
START- SIMPLE TRIAGE AND RAPID TREATMENT - quick assessment of respiration, perfusion, mental status SAVE- SECONDARY ASSESSMENT OF VICTIM ENDPOINT - used to identify who may benefit fr care available Red Most urgent Yellow 2 nd urgent Green

TRIAGE CATEGORIES
Black

Non- urgent

death

LifeInjuries w/ threatening systemic shock, hypoxia effects but not yet life threatening

Localized injuries w/ o immediate systemic implications

No distinction bet. Clinical and biological death

TOXICOLOGY:
Poisoning- an event where a living organism is exposed to a chemical that adversely affects the functioning of that organism. Toxidrome- collection of signs and symptoms that are observed after a exposure to a substance

MODE OF ACQUISITION:
1. 2. 3. 4. Inhalation Ingestion cutaneous exposure injection

OUTCOME OF POISONING:
Inhibit or alter normal cell function Change normal organ function Change normal uptake or transport of substances

GENERAL MANAGEMENT:
ABC Medical history Toxicologic physical examination Decontamination: 1. Gross decontamination- undress and wash wt H2 O 2. Eyes- flush after topical anesthesia 3. GI decontamination- removal of toxin, binding it inside the gut lumen, mechanical flushing Gastric emptying 1. Emesis- syrup of ipecac, 15 ml in children, 30 ml in adults ffed by sips of H2 O. CI: Altered mental status Active or prior vomiting Caustic ingestion A toxin wt more pulmonary than GI toxicity. E. g. hydrocarbons Potential for seizure 2. Orogastric lavage

 F36-40 adults, F22-24 pedia Px lying in LLD, lavage wt room- temp water until effluent is clear Activated charcoal is instilled before removing the catheter (1 g/ kg) Contraindications: Pills that won t fit the holes Non- toxic ingestions Non- life threatening ingestions unassured airway Caustic ingestions Toxic ingestions more damaging to lungs 3. Adsorption of toxin fr GUT lumen Activated charcoal- produced by pyrolysis of carbonaceous materials and activated by steam cleaning to increase surface area. It adsorbs the toxin fr GUT lumen. First Dose- given wt a cathartic to reduce GI transit time ( sorbitol, Mg citrate) 4. Enhanced Elimination Alkalinization- non ionized are free to move across memb. Weak acids are uncharged- so alkalinize urine by giving NaHCO3. Hemodialysis Initial Interventions: Administer empiric antidotes ( O2, 1-2 mg naloxone, D5050 water,100 mg thiamine)

END