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Disaster Nursing

Disaster Nursing


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Balintona, RN, MAN DEFINITION OF TERMS Disaster • • Any destructive events that disrupts the normal functioning of a community. Ecologic disruptions or emergencies of a severity and magnitude that result in deaths, injuries, illness and property damage that cannot be effectively managed using routine procedures or resources that require outside assistance.

Types of Disaster 1. Natural- cause by natural or environmental forces. It includes earthquakes, floods, tornadoes, hurricanes, volcanic eruptions, etc.

2. Man Made/Human Generated The principal direct causes deliberate or otherwise. are identifiable human actions,

It has three broad categories: complex emergencies, technologic emergencies, disasters that are cause by natural hazards but occur in natural settlements. Complex emergencies: involve situations where populations suffer significant casualties as a result of war, civil strife, or other political conflict. Technologic emergencies: large number of people, property, community infrastructure, and economic welfare are directly and adversely affected by major industrial accident, unplanned release of nuclear energy and fires or explosions from hazardous substances such as fuel, chemicals, or nuclear materials.



Medical Disaster Is a catastrophic event that results in casualties that overwhelm the health care resources in that community.

Disaster Planning Addresses the problems posed by various potential vents, ranging in scale, from mass casualty incidents.

Types of Disaster Planning 1. Agent specific approach

ii. MAN • It’s a planning type that focuses on the preparedness on most likely threats to occur based on their geographic location. Contingency Planning • These are planning activities related to a site-specific threat that may occur at any time. which means “to sort out or choose. acquire. and or resolve a threat to public health and safety. The word triage is derived from the French word trier. prevent. community agencies and local government. Cunny describes three types of advanced planning activities Strategic Planning • These are planning activities that focus on preparing the organization for any type of threat. Crisis/crisis management • Administrative measures that identify. 2.LECTURE NOTES IN EMERGENCY AND DISASTER NURSING Mary C. Triage • • Is a process which places the right patient in the right place at the right time to receive the right level of care. Balintona. All hazards approach • Is a conceptual model for disaster preparedness that incorporates disaster management components that are consistent across all major types of disaster events to maximize resources. An example of this is in the hospital setting . RN. expenditures and planning efforts.” DISASTER MANAGEMENT AND PLANNING Disaster Planning • • i. Requires the cooperative efforts of the hospital. This is commonly referred to as the all hazards approach. and plan the use of resources need to acquire and plan the use of resources need to anticipate.

Level 2. (e. arrival of large number of trauma patients of a chemical spill).g.if the organization. Forward Planning • These are planning activities pt a known imminent disaster. loss of utilities or fire). Disaster Management Programs o i..if the disaster is of a magnitude that exceeds the capacity of the local community or region and requires assistance form national level. MAN would be planning activities from a facility that is in close proximity to a nuclear power plant or an airport. RN. iii. Balintona. Classified as Level 1. iii.g.if the disaster requires assistance from external sources. Combined Internal and External Disaster o i. is composed of five phases Preparedness/Risk Assessment . a pending snowstorm. hurricane or major rock concert. ii. Internal vs External Disaster Internal Disaster o Occurs when there is an event within the facility that poses a threat to disrupt the environment of care. for example. External Disaster o Becomes a problem for a facility when the consequences of the event that creates a demand for services that tax or exceed the usual available resources (e. but these can be obtained from nearby agencies. Level 3.LECTURE NOTES IN EMERGENCY AND DISASTER NURSING Mary C.. related to physical plants. agency or community is able to contain the event and respond immediately.

age. expectations related to public events and gatherings. The disaster manager needs to perform also a risk assessment in the area of staffing.LECTURE NOTES IN EMERGENCY AND DISASTER NURSING Mary C. Issues to consider include weather patterns. Balintona. Mitigation • Lessens the severity and impact of the disaster through appropriate planning and practice. ii. Mitigation o o Steps that are taken to lessen the impact of as disaster should one occur and can be considered as prevention measures. RN. Invariably. and location of the facility. Examples are installing and maintaining backup generators to mitigate the effects of power failure or cross training staff to perform tasks to maintain services during staffing crisis that is due to weather emergency. Recovery o Once the incident is over. Depending on the nature and extent of the disaster and the demographics of the workforce. condition. employees of the community are anxious to return to usual operations. Phases of Disaster Management 1. After a disaster. The best ways to mitigate the results of a disaster are to perform a thorough hazard vulnerability risk . Evaluation • Often this phase of disaster planning and response receives the least attention. It is essential that a formal evaluation be done to determine what went well and what problems were identified. there may be variation in the employees’ ability and or willingness to report to work. iv. geographic locations. iii. MAN o Evaluates the facility’s vulnerability or propensity for disasters. technological and natural events. Risk Assessment • • • The disaster manager needs to consider what type of disasters is most likely to be encountered by the organization. the organization and staffs need to recover. 2. All types of events need to be considered including deliberate human-caused. services have been disrupted and it takes time to return to routine.

practiced emergency response plan. A clearly defined. responsibility oriented chain of command. . RN. Unified command structure o This allows all agencies involved in the response to coordinate efforts by establishing a unified set of incident objectives and strategies. Modular. o There is one incident commander. iv. A strong foundation of preexisting relationships with partnering organizations and agencies that can be called on to provide mutual aid and support when needed. An appropriately trained staff who are competent to perform their disaster response functional roles and able and willing to report to work during any sort of disaster. iii. Essential Elements for Hospital Disaster Management 1.LECTURE NOTES IN EMERGENCY AND DISASTER NURSING Mary C. executable. MAN assessment and be sure that your plan includes provisions for each of the likely events. Use of common nomenclature o All agencies utilizing ICS use the same titles and functional roles for the command staff positions. flexible organization o Only those portions of the system that are needed for the response are activated. Key Features of Incident Command and HICS i. This individual has overall responsibility for the management of the incident and the employees know who report to them and to whom they report. Predictable. 3. Hospital Incident Command System (HICS) Is an emergency management system that is comprised of specific disaster response functional role positions within a hierarchical organization chart. 2. 4. An appropriate infrastructure to support the disaster response which includes maintaining services for preexisting patients as well as the new arrivals. Balintona. ii.

Daily Triage • • Triage perform by nurse in the emergency room. Critical. Use of JAS (Job Action Sheets) o JAS define for the staff what their defined functional role is during emergency and sister response. 3. This is a plan that is developed when multiple agencies are involved in the disaster response. Balintona. Manageable span of control o Each manager controls a defined amount of resources. patients are usually sorted into i. During disaster triage. viii. which is limited to what can realistically be managed.. The goal is to identify the sickest patients in order to assess and provide treatment to them first. Disaster Triage • • Is employed when local emergency services are overwhelmed to the point that immediate care cannot be provided everyone who needs it.are those that are life threatening but likely to be amenable to rapid intervention that does not require an inordinate amount of resources (e. . goals and objectives for the hospital’s response. TRIAGE 1. Incident Triage • Occurs when the emergency department is stressed by a large number of patients but is still able to provide care to all victims utilizing existing agency resources. vii. MAN v. Facility Action Plan (FAP) o A FAP describes the purpose. ix.LECTURE NOTES IN EMERGENCY AND DISASTER NURSING Mary C. Incident Action Plan (IAP) o vi. 2. before providing treatment to others who are less ill. Unity of Command o Each person reports to only one individual. RN. upper airway obstruction).g. It is a routine triage.

Tactical Triage • Is similar to disaster triage.-30mins. Disaster Triage System • Simple Triage and Rapid Treatment System (START) for adults . cardiac arrest. Balintona. Special Conditions Triage • Is used when patients present from incidents such as radiation. Urgent.g. Urgent. biological or chemical contamination. I. 6. 4..those conditions that are serious and if not treated in a timely manner are likely to deteriorate to become critical (e.signifies a condition that requires treatment immediately within 15mins. Emergent.. 5. MAN ii. bioterrorism). iv.. Triage during an epidemic • Usually use during mass casualty trauma situations (e.LECTURE NOTES IN EMERGENCY AND DISASTER NURSING Mary C. RN.the care required can be provided in a low tech tribute setting and a delay in treatment would unlikely constitute to a significant deterioration in the victims condition.g.is any condition that can wait for more than 2 hours to be seen without the likelihood of deterioration. iii..utilized for serious illness or injury that must be attended to but a wait of up to 2 hours would not add to the morbidity and mortality of the patient. compound fracture of a long bone).g. In-Hospital Triage Systems • • Utilize a triage system that has between three and five categories. Catastrophic. (e. Non-urgent. only military mission objectives rather than traditional civilian guidelines drive the triage and transport decisions. ii.conditions that have either a very grave prognosis or would require an amount of resources that are so large they would divert care from others with a much better prognosis (e. The three main categories are i. cardiac arrest). Minor.g. airway obstruction). iii. II.

The JumpSTART Pediatric MCI Triage Tool is the first objective tool developed specifically for the triage of children in the multicasualty/disaster setting. and mental status (RPM). To optimize the primary triage of injured children in the MCI setting To enhance the effectiveness of resources allocation for all MCI victims To reduce the emotional burden on triage personnel who may have to make rapid life or death decision about injured children in chaotic circumstances. Balintona. 2. It is based on the person’s ability to respond verbally and ambulate and their respirations. MAN • • JumpSTART system (for triaging pediatric patients) Start/Save (when the triage process must be over an extended period of time) 1. Simple Triage and Rapid Treatment System (START) for adults • • • A common algorithm that is used with adult pre-hospital triage. The system works as follows i. Should be used if t5he victim looks like a child and START should be sued whenever the victim looks like a young adult or older. All patients who can walk (walking wounded) are categorized as Delayed (Green) and are asked to move away from the incident area to a specific location.LECTURE NOTES IN EMERGENCY AND DISASTER NURSING Mary C. The objective of JumpSTART are i. ii. Fire and Marine Department and Hoag Hospital. iii. JumpSTART • • • Created to meet the unique needs of assessing children less than 8 years of age. perfusion. RN. • . perfusion and mental status. The next group of patients is assessed quickly (30-60 seconds per patient) by evaluating RPM: respiration. ii. Developed by Newport Beach California.

this is the treatment area inside of the emergency department or hospital where newly arriving patients and victims are sent after having been triaged and decontaminated.this is the area immediately adjacent to the location of the incident. Balintona. Warm Zone. The SAVE assesses survivability of patients with various injuries and on the basis of relationship between expected benefits and resources consumed.would use few resources and would have a reasonable chance of survival. START/SAVE Triage for Catastrophic Disasters • • The SAVE Triage was developed to direct limited resources to the subgroup of patients expected to benefit most from their use. which has a source of water. o . RN. ii. In the field o o Hot Zone.would require the use of significant medical resources. • Two types of area location in START Triage i.this is an area that is adjacent to the hospital (usually the emergency department).LECTURE NOTES IN EMERGENCY AND DISASTER NURSING Mary C. Cold Zone. Expectant area. Clean Zone. o ii. In the hospital setting o Warm Zone.this is the distance of at least 300 feet from the outer perimeter of the hot zone and is upwind and uphill from the contaminated area. Disaster Triage for Chemical and Hazardous Material Disasters • Triage for chemical incidents will occur in several places i. Treatment area. MAN 3. III.this area is adjacent (and uphill and upwind) to the warm zone and is where decontaminated victims enter.

or stings the skin.LECTURE NOTES IN EMERGENCY AND DISASTER NURSING Mary C. is a sudden. • The Ritcher scale. MAN NATURAL DISASTERS Cyclones • Are large scale storm characterized by low pressure in the center surrounded by circular wind motion. rapid shaking of the earth caused by the breaking and shifting of rock beneath the Earth’s surface. Submarine landslides and volcanic eruptions beneath the sea or on small islands can also be responsible for tsunami but their effects are usually limited to smaller areas. Red light might be visible near the horizon and. smells of rotten eggs. RN. The water is hot. used as an indication of the force of an earthquake. The following events may signal a tsunami 1. Tsunamis • • Series of waves usually generated by large earthquakes under or near the ocean occur when a body of water is rapidly displaced on a massive scale. measures the magnitude and intensity of energy released by the quake. as large quantities of gas rises to the surface of the water. 3. as the wave approaches. . Drought often triggers a crisis in arid and semi arid areas. There is an audible thunder or booming sound followed by a roaring or whistling sound. The water may recede a great distance from the coast. Balintona. 6. the top of the wave may glow red. because rain is sparse and irregular. Drought • Is often seen as a result of too little rain and is often synonymous with famine. 4. 5. A recent submarine earthquake 2. The sea appears to be boiling. Earthquake • Considered to be the most destructive and frightening of all forces of nature.

4. Decontamination of exposed individuals. events at chemical facilities or other facilities using or manufacturing chemicals or as a result of natural or manmade disaster events. air or water. The restoration of services to meet the immediate physiological needs of the affected people. Oil spills o The leakage of oil in the bodies of water surrounding a land area. Measures that are implemented during environmental disasters: 1. Balintona. 2. 3. The immediate removal of the hazard from the environment. illness and/or property damage that cannot be effectively managed by the application of routine procedures or resources and that result in a need for additional assistance. radioactive materials or hazardous chemicals into the land.LECTURE NOTES IN EMERGENCY AND DISASTER NURSING Mary C. • Environmental disasters • Is defined as an environmental emergency or ecologic disruption of a severity and magnitude resulting in deaths. RN. BIO-CHEMICAL WARFARE AND TERRORISM . injuries. The prevention of further illness or injury as a result of exposure to the hazard. • Environmental Hazards 1. MAN ENVIRONMENTAL EMERGENCIES and DISASTERS Environmental emergencies • Is a sudden threat to the public health or to the well being of the environment arising from the release or potential release of oil. 2. These emergencies may occur from transportation accidents. Chemical Spills o Intentional or accidental leakage or spill of certain chemical substances into the environment that can have devastating consequences on human health.

LECTURE NOTES IN EMERGENCY AND DISASTER NURSING Mary C. Some of the chemical agents used are a) Nerve agents (e. Chemical compounds that are gaseous at room temperature or are extremely volatile do not need much engineering to deliver.. Chemical Terrorism Delivery of Chemical Agents o Is optimized by producing contaminated areas with high concentrations of a toxic compound. The use of chemical or biological agents as the main element of a terrorist attack or threat. o Chemical Agents o o Are those chemical compounds synthesized artificially and include the many toxic chemicals that may be available to terrorists. sarin) b) Tissue (blood) agents (e. infectious agents can infect through respiratory and ingestion routes.. blister agents such as mustard or lewsite) o o .. Balintona.g. In biological warfare. chlorine gas) d) Vesicants (i. These chemical warfare agents may cause injury via the respiratory route. RN. MAN Biochemical terrorism o According to Bruce Hoffman.. For a terrorist who is intent on causing chemical casualties.g. through the skin by ingestion.g. it is the deliberate creation and exploitation of fear through violence or the threat of violence in the pursuit of political change. cyanide) c) Lung irritants (e. Biological Agents o Are those pathogens used deliberately to infect persons as well as toxins normally derived from plants or animals. Chemical weapons utilize the toxic nature of selected substances to cause death or injury.e. acquiring “higher end” agents such as military nerve compounds might be too difficult r unnecessary.

insects. BZ. and so forth.g.” such as weeds. MAN e) Psychoincapacitants (e. Psychoincapacitants The psychotropic compounds such as the belladonna drug BZ (3-quinuclidinyl benzilate) or the hallucinogen LSD have been considered by militaries for use in combat and for sabotage. soman. Tissue (Blood) Agents o Includes cyanide in its various forms. the effects from bioterrorism may not be fully known until many hours or days after the event. Their performance on the battlefield. RN. however. Pesticides Refers to a group of agents used to kill a number of different “pests. sarin. shutting down the energy transport (ATP) system. pulmonary edema. Balintona. and VX. Vesicants the so-called vesicants or blister agents such as mustard gas and lewisite. rats.LECTURE NOTES IN EMERGENCY AND DISASTER NURSING Mary C. Lung Irritants o o o Attack the respiratory system causing tightness in the airways. ticks. Unlike a chemical incident. hypoxia. and in more severe cases. o - Bioterrorism o The act of biological terrorism (bioterrorism) involves the deliberate use of microbial pathogens or toxins. LSD) f) Pesticides Nerve Agents o Include the chemical tabun. These toxic organophosphate compounds all operate on the same basic principle-they inhibit acetylcholinesterase. has largely been considered unpredictable and impractical.. The following are the agents used in bioterrorism Bacterial agents Viral agents Toxins (derived from plant or animals) o - . have less utility for terrorist. Ultimately cyanide blocks the enzyme cytochrome oxidase.


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