DISASTER NURSING PREFINALS CATEGORIES

WHAT IS TRIAGE? RED (immediate) - the casualty requires immediate

 Trier (French) to sort out or choose. medical attention and will not survive if not seen
 A method of quickly identifying victims of a mass soon.
casualty incident (MCI) who may have immediate life-
threatening injuries and those who have the best YELLOW (delayed) - the casualty requires medical
chance of surviving. attention within 6 hours. Injuries are life threatening
 Is a process which places the right patient in the right but can wait until the immediate casualties are
place at the right time to receive the right level of care. stabilized and evacuated.
(Rice and Abel 1992)
GREEN (minimal) - "walking wounded" the casualty
WHY TRIAGE?
requires medical attention when all higher priority
Goal: to identify the sickest patient in order to assess and
provide treatment to them first, before providing patients have been evacuated and may not require
treatment to other who are less I’ll. stabilization or monitoring.
Triage is done by:
BLACK (expectant) - the casualty is expected not to
 Trained individuals
 Paramedical Personnel (Medics, EMRs, EMTs) reach higher medical support alive without
 Medical Personnel (doctors, nurses) compromising treatment of higher priority patients.
Care should not be abandoned, spare any remaining
HOW TO BE AN EFFECTIVE TRIAGE NURSE? time and resources after immediate and delayed patients
 Clinically experienced have been treated.
 Good judgement and leadership skills
 Calm and cool
 Decisive
 Knowledgeable of available resources
 Anticipate casualties

START
SIMPLE TRIAGE AND RAPID TREATMENT
START System:
1. All patients who can walk are categorized as "Delayed"
and are asked to move away from the incident area to a
specific location.
2. The next group is assessed quickly by evaluating RPM
(respiration, perfusion, and mental status) and then tagged
accordingly.
CATEGORY (Color) RPM Indicators
Critical - RED R - > 30 bpm
P – capillary refill > 2sec
M – does not obey commands
Urgent - YELLOW R - < 30 bpm
P – < 2 sec
M – obeys command
Expectant, Dead or Dying - R – not breathing
BLACK
Disaster - any destructive event that disrupts the  Response - implementation of a disaster plan
normal functioning of a community  Recovery - stabilization and returning to pre
 Natural Disaster impact phase. The following composes the NDRRMC:
 Man-Made Disaster  Evaluation - conducted to determine what  Chairperson - Sec. Of Department of National
 Medical Disaster worked, what did not work. Defense
 Complex Emergencies  Vice Chairperson for Disaster Preparedness - Sec.
 Technological Disasters CHALLENGES OF DISASTER PLANNING Of Interior and Local Government
 Synergistic Emergencies  Communication  Vice Chairperson for Response - Sec. Of DSWD
Key characteristics:  Distribution of all types of resources  Vice Chairperson for Prevention and Mitigation -
Onset - Sudden, without warning  Advance warning systems Sec. Of Department of Science and Technology
Duration- time it starts to time immediate crisis has  Evacuation  Vice Chairperson for Disaster Rehabilitation and
passed  Mass media Recovery - Director General of the National
Impact - extent to which the population or  Comprehensive disaster plan Economic Development Authority.
community has been affected  Information system
EMERGENCY MANAGEMENT DURING A DISASTER
EFFECTS OF DISASTER DEFINITIONS
COMMON REACTIONS OF DISASTER SURVIVOR
 Premature death, illnesses and injuries
 Emotional - depression, sadness, irritability,  Emergency Management: creating the
 Destroy local health care infrastructure
anger, resentment, anxiety, fear, despair, framework within agencies, facilities, and
 Environmental imbalances, increases risk of
hopelessness, guilt, self-doubt. communities to reduce vulnerability to hazards
communicable diseases and environmental
 Behavioral - sleep problems, cry easily excessive and risks and to cope with disasters
hazards.
 Affect the psychological, emotional and social activity level, hypervigilance  Disaster: A serious disruption of the functioning
well-being of a population  Cognitive - confusion, disorientation, of a society, causing widespread human,
 Cause shortages of food and water. nightmares material, or environmental losses that exceed
 Large population movement.  Physical - fatigue exhaustion. Gl distress the ability of the affected society to cope using
appetite changes. only its own resources.
DISASTER CONTINUUM/EMERGENCY  Risk: the probability, based on history, that
MANAGEMENT CYCLE NATIONAL DISASTER RISK REDUCTION AND identified hazards natural or caused by human
 Pre-impact MANAGEMENT COUNCIL activity will occur and need to be planned for.
 Impact NDRRMC formerly called NDCC (National Disaster  Emergency Operations Plan (EOP): Describes
 Post impact Coordinating Council) how the hospital will respond to and recover
 Is an agency of the Philippine government under from a threat, hazard, or other incident.
BASIC PHASES OF DISASTER MANAGEMENT the Department of National Defense,  The Hospital Incident Command System (HICS):
PROGRAM An emergency management system that
responsible for ensuring the protection and
 Preparedness - proactive planning efforts
welfare of the people during disaster or employs a logical, flexible structure; defined
designed to structure the disaster response
emergencies. responsibilities; clear reporting channels and a
prior to its occurrence.
 In February 2010 NDCC was renamed, common nomenclature.
 Mitigation - measures taken to reduce the
reorganized, and subsequently expanded.  Multiple Patient Incident: These incidents have
harmful effects of a disaster
fewer than 10 victims/casualties.
  Multiple Casualty Incident: These incidents
have more than 10 but less than 100
victims/casualties
 Mass Casualty Incident (MCI): These incidents
involve the greatest amount of
victims/casualties, deaths, and property
damage. Examples may include major
earthquakes, tsunamis, and large-scale
terrorist/active shooter incidents
 Surge Capacity: The maximum potential delivery
of required resources either through
augmentation or modification of resource
management and allocation. Resources include:
system, space, staff, and supplies.
THE HOSPITAL INCIDENT COMMAND SYSTEM (HICS)
The Command Section
Key Leadership Program
 The Incident Commander (IC): The only position
always activated in HICS. The IC is responsible for
the management of the incident within the
hospital.
 The Public Information Officer (PIO): Personnel in
this position are responsible for coordinating
information sharing inside and outside the
hospital
 The Liaison Officer Personnel: in this position are
the hospital's primary contact for external
agencies assigned to support the hospital during
incident response.
 The Safety Officer: Personnel in this position
monitor the hospital response operations to
identify and correct unsafe practices.
 Medical-Technical Specialists: Personnel in this
position are persons with specialized expertise in
areas such as infectious disease, legal affairs, risk
management, medical ethics
 Operations Section: Manages all incident tactical
activities and implements the Incident Action Plan
(IAP).
 Planning Section: Collects, eval
 uates, and disseminates situational information and
intelligence regarding incident operations and
assigned resources.
 Logistics Section: Provides for all the support needs
of the incident (acquires resources from
internal/external sources, uses standard and
emergency procedures, etc.).
 Finance/Administration Section: Coordinates
personnel time; orders items and initiates
contracts; arranges personnel-related payments
and Workers’ Compensation; and tracks response
and recovery costs and payment of invoices.
Disaster Incidents and Response
Natural Disasters: Natural disasters occur suddenly
or there may be some warning.
Anticipate
 Patients may surge to hospitals and EDs, even if
they do not have injuries.
 Planning for the surge should include staffing
additional food, water, and augmented standards
of care such as MCI Triage, to successfully handle
these incidents.
 Plan for pediatric victims and anticipate the need
to manage unaccompanied minors
 Plan for patients with access and functional needs
MCI-Trauma Incidents: Motor vehicle or
transportation incidents, active shooters, terrorism
Anticipate:
 There may be a sudden surge in the inflow of
injured patients.
 The first priority is to rapidly process a large
number of casualties through the system.
 Need to implement the Emergency
Operation/Disaster Plan and the HCS early.
 Involve key personnel from identified
departments or units outside the ED ahead of
time: administration, surgery, ICU, and other
clinical areas
 Plan for pediatric victims and anticipate the need
to manage unaccompanied minors
 Plan for patients with access and functional
needs.
Mass Casualty Incident (MCI) - Medical Incidents:
involve multiple victims, usually related to a single
geographic region or area and may gradually occur
over time.
Anticipate:
 A drastic influx of patients presenting for care.
 A potential issue with resource management,
such as the management of protective N-95
masks and ventilators.
 If the level of the Medical MCI is large enough
(e.g., Pandemic flu or Ebola), ventilators and PPE
will be critical pieces of equipment
 Plan for pediatric victims and anticipate the need
to manage unaccompanied minors.
 Plans for patients with access and functional
needs
MC-Hazmat Incidents:
Anticipate:
 An influx of patients with a risk of contamination
and need to perform mass decontamination.
 Plan for an area to place the incoming patients,
contaminated patients may pose a significant
threat to the staff, other patients, and the facility.
 Prepare for the influx of patients and the
potential for contamination. If contaminated
individuals gain entrance to the facility. Think
 built-in decon systems/showers, decon tents, or
hose and a pop-up pool.
 Set up perimeters to prevent the spread of
contamination.
 Plan for pediatric victims and anticipate the need
to manage unaccompanied minors.
 Plan for patients with access and functional
needs.
Recommended Control Zones for Decontamination
 Exclusion/Hot/Red Zone: Highest level/risk of
contamination in the field. Victims stage to await
triage and decontamination. Access is restricted
to responders and receivers with proper levels of
training and PPE
 Contamination Reduction/Warm/Yellow Zone:
Decontamination activities are conducted. The
zone should have different lanes for ambulatory
and nonambulatory victims. Consider and plan for
the vulnerable populations and populations with
special needs.
 Support/Cold/Green Zone: For command and
support personnel working to manage the
incident, decon team staging, and where other
“post decon” activities such as on-going triage,
medical treatment, and transfer occur. Utilize
gloves, gowns, masks and other forms of PPE as
appropriate.
Personal Protective Equipment
Many different types of PPE are available to be
utilized.
 Level A Protective Ensemble: Highest level of
protection against vapors, gases, mists and
particles. Fully encapsulated, chemical protective
suit with either Self Contained Breathing
Apparatus (SCBA) tank or a supplied air
respirator (SAR) with an escape cylinder
 Level B Protective Ensemble: Chemical protective
suit that provides protection against splashes
from a hazardous chemical. It has either a SCBA
tank or a SAR with an escape cylinder
 Level C Protective Ensemble: Most common type
found in healthcare receiving facilities. Protective
ensemble is a level B chemical protection suit, but
different respiratory protection
 Level D Protective Ensemble: No respiratory
protection and minimal dermal protection (eg.
EMS jumpsuit, firefighter gear, healthcare
provider's scrub wear).
  MASS (Move, Assess, Sort, Send) MCI Triage  No spontaneous respirations after opening
Algorithm airway in adults or no spontaneous respirations
 SALT (Sort, Assess, Lifesaving Interventions, after opening airway and providing five rescue
Treatment/Transport) MCI Triage Algorithm breaths in pediatrics.
 START (Simple Triage and Rapid  No palpable pulse. Remember, do not perform
Treatment/Transport) MCI Triage Algorithm CPR in MCI Triage unless the resources are
available to do so.
Color-Coded Triage System  Unsalvageable due to massive injury or obvious
Minor Care Patients: Green Tag. Ambulatory signs of death.
“walking wounded” adults and pediatrics with minor  Expectant victims still receive palliative care
or no injury. These patients have:
 Normal respirations
 Normal capillary refill/radial pulse
 Normal mentation

Delayed Care Patients: Yellow Tag. Patients with the

potential for serious injury need treatment but have
non-life-threatening injuries. These patients have:
 Normal respirations
 Normal capillary refill/radial pulse
 Normal mentation

Immediate Care Patients: Red Tag. Patients with the

Multi-Casualty/MCI Triage
MCI Goals and Challenges
 To do the greatest good for the greatest number
of people rather than identifying the priority of
care.
 Disaster triage is unique in that there are large
numbers of patients to be prioritized, usually
with fewer available care providers than there
are patients.
 Providers are faced with potential danger to
themselves and others.
Types of Disaster Triage Methods
potential for fatal injury who need emergency
treatment and lifesaving measures. These patients
have:
 Abnormal respirations
 Adults: Rate over 30 breaths/min
 Pediatrics: Rate less than 15 breaths/min or
greater than 45 breaths/min
 No radial pulse or cap refill more than 2
seconds. Altered mentation in adults and/or
posturing in pediatrics.
Expectant/Deceased Care Patients: Black Tag:
Patients that are deceased or unsalvageable and
cannot be saved. These patients have:
DISASTER RESPONSE AND VULNERABLE
POPULATIONS: FOR PEDIATRIC, PREGNANT, AND
OLDER ADULT PATIENTS
Pediatric Considerations
 Infants have larger heads, at higher risk for
traumatic brain injury (TBI).
 Chest injuries by blunt force impact are a
common cause of death in children.
 Children are more prone to abdominal injuries
because of smaller, more pliable ribs.
 Children have narrower airways and as a result
are more prone to bronchospasm and
obstruction.
Pregnancy Considerations
 You are treating a minimum of two patients.
 Incident involving high explosives can travel
through the amniotic fluid, causing injury to the
placenta (e.g., detachment).
 Second or Third Trimester of Pregnancy: After
life threatening conditions have been stabilized,
should be admitted to labor and delivery for
fetal monitoring and further testing.
Older Adult Considerations
 Increased risk of fractures (loss of bone calcium
and muscle density).
 Thinner skin and decreased subcutaneous fat
contribute to maintaining body temperature.
 Natural changes in brain size with aging; older
patients can sustain a significant amount of
intracranial bleeding from a closed head injury
before symptoms occur.
 Chronic medical conditions exacerbated by the
incident and potential medication history.

GOD BLESS FOR PREFINALS

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