NCM 121

ROLES OF NURSING IN
DISASTER AND
EMERGENCY

Kizzie Mae A. Abinal

BSN 4-A
Multiple interacting variables combine to create complexity and
uncertainty when planning for emergency health consequences during
a special event or MG. It is important to recognize that an MG may
suddenly become an MCI without any warning, resulting in a “surge” of
victims and an immediate need for disaster healthcare services.
Understanding the specific details of an event—the type and purpose of
the event, the location and duration, the characteristics of the crowd,
weather conditions, and the impacts of the presence of alcohol—can be
used to predict healthcare usage.

Advanced preparation of the nursing workforce for such events is

predicated on the belief that mastery of the unique knowledge and
skills needed to respond appropriately to such an event as an MCI can
improve patient outcomes.
Multiple interacting variables combine to create complexity and
uncertainty when planning for emergency health consequences during
a special event or MG. It is important to recognize that an MG may
suddenly become an MCI without any warning, resulting in a “surge” of
victims and an immediate need for disaster healthcare services.
Understanding the specific details of an event—the type and purpose of
the event, the location and duration, the characteristics of the crowd,
weather conditions, and the impacts of the presence of alcohol—can be
used to predict healthcare usage.

Advanced preparation of the nursing workforce for such events is

predicated on the belief that mastery of the unique knowledge and
skills needed to respond appropriately to such an event as an MCI can
improve patient outcomes.
Nurses do need to possess basic core competencies in emergency
nursing in order to respond in a timely and appropriate manner and
keep themselves safe.
Time becomes a major factor in predicting patient recovery—the
longer the delay in care for a seriously injured patient, the lesser the
chance for a full recovery.
Rapid assessment of the situation and nursing care needs, triage,
and the initiation of lifesaving measures first, and the selected use of
essential nursing interventions, along with the simultaneous
elimination of nonessential measures, are the skills needed to
successfully manage emergencies outside of the hospital.

The governing principle is always to do the greatest good for the

greatest number with the least amount of harm.
 The basic principles of disaster nursing during special (events)
circumstances and MCIs include the following:

■ Rapid assessment of the situation and of victims’ immediate nursing

care needs (see Appendix 5.1 for further discussion.)
■ Security of the scene and assessment of the potential for a secondary
disaster
■ Mass casualty triage and the initiation of lifesaving measures first
■ Knowledge of one’s role within the ICS
■ The selected use of essential nursing interventions and the
elimination of nonessential nursing activities
■ Adaptation of necessary nursing skills to a mass casualty situation
and the allocation of scarce resources (The nurse must use imagination
and resourcefulness in dealing with a lack of supplies, equipment, and
personnel.)
 The basic principles of disaster nursing during special (events)
circumstances and MCIs include the following:

■ The potential need for decontamination

■ Ongoing evaluation of the environment and the mitigation or removal
of any health hazards
■ Prevention of further injury or illness
■ Leadership in coordinating patient triage, care, and transport during
times of crisis
■ The teaching, supervision, and utilization of auxiliary medical
personnel and volunteers
■ Provision of understanding, compassion, and emotional support to all
victims and their families
■ Appreciation of and the knowledge to keep oneself safe during the
MCI response
Practice Parameters for Nursing Care
Perform a respiratory, airway assessment

Perform a cardiovascular assessment,

including vital signs, monitoring for signs of
shock

Perform an integumentary assessment,

including a burn assessment

Perform a pain assessment

Perform a trauma assessment from head
to toe
Practice Parameters for Nursing Care

Perform a mental status assessment,

including a Glasgow Coma Scale

Know the indications for intubation

Know the indications for intubation

Know emergency medications

Know the principles of fluid therapy

 Nursing Therapeutics and Core
Competencies
■ Concepts of basic first aid and hemodynamic stabilization
■ Disaster triage and transport
■ Pain management
■ Management of hypovolemia and fluid replacement
■ Suturing (if appropriate based on practice parameters) and initial
wound care
■ Blast injuries/dealing with tissue loss
■ Eye lavage techniques
■ Decontamination of chemical and radiation exposures
■ Fractures/immobilization of fractures
■ Management of hemorrhage
■ Stabilization of crush injuries
■ Movement of patients with spinal cord injury.
Nurses are expected to exercise great leadership and
discerning judgment in the following:

1. Assessment and triage of patient’s condition for priority

care
2. Provision of care, treatment, and health protection
3. Appropriate utilization of nursing service personnel
4. Detection of changes in the event environment to
organize activities to modify or eliminate health hazards.
5. Dealing with mass casualties if necessary