Disaster management in hospital

settings

Prepared by
Ms.Jenisha Adhikari
BSN
 Content
• Trauma team
• Triage nurse and their
responsibilities
• Hospital response
• Emergency preparedness
• Use of triage in hospital
• Disaster management
• Post disaster action
 Multi-disciplinary trauma team
• Emergency Attending Physician/
Specialist
• Trauma surgeon
• Triage nurse
• Resident
• Registered Nurse (RN)
 Contd..
• Emergency Department Coordinator
(EDC)
• Pharmacist
• Therapist
• Security
 Triage
nurse
Registered nurse positioned in an emergency
room (ER); responsible for assessing patients,
initiating emergency treatment and
determining their level of need medical
assistance.
 Responsibilities of a Triage
Nurse
• Responsibilities of a Triage Nurse
include :
• Perform patient assessment
• Reassess patients who are waiting
• Initiate emergency treatment if necessary
• Manage and communicate with patients in
waiting room
 Contd..
• Provide education to patients and families
when necessary
• Sort patients into priority groups
according to guidelines
• Transport patients to appropriate treatment
areas
 Contd.
• Communicate status of patients to doctors
and nurses
 Hospital response
o Notification
o Preparation
o Receiving
Casualties
o Stand down
 Notification
• The hospital is informed about
the disastrous event, type of
disaster, number of casualties
and severity
• All the department are notified
 Contd..
• Selected Physicians are nurses are sent
at the site to assess and prioritized
critical cases
 Preparation
• Empty and expand the emergency room
– Immediate disposition decisions and movement
– Triage order - red and yellow for emergency
room and green to outpatient
 Contd..
• Empty and expand hospital
– Early discharge
– Transferring patient
– Postponing elective surgery
• Additional staff
– Staff as per duty and manage volunteers
• Stock all necessary medical supplies
• Inform the blood bank
 Receival of casualties
• Quick and through assessment of
victims
• Triage
• Rapid turnover of of patient
• Life and limb threat take priority
• Disaster paperwork
• None is expected to perform roles they are
not trained for
 Stand down
• Workload returns to
normal
• Restock
• Staff debriefing
 Emergency
preparedness
• Formulate hospital policy and action plan
for Emergency preparedness for disaster
management (EPDM)
• Strength the capabilities of health worker in
the disaster management team
• Establish triage protocol
 Contd.
• Specify protocol for response to
disaster who would all report to and
has what responsibilities
• Have a back up plan for persistent flow
of electricity, water and fuel supplies
 Contd.
• Keep stock of medical supplies for use
of emergency
• Carry out regular drills (Mock drill) to
be well prepared for genuine response to
disaster
 Use of triage in hospital
• Usually four category system in
used to sort out the case on
the basis of need for immediate,
therapeutic intervention
• Usual color are
– Red
– Green
– Yellow
– Black
• Nevertheless individual hospital can have
their own protocol
 Contd ..
• Red
All life threatening patient who needs
immediate intervention
Eg –
Acute cardio pulmonary insufficiency
Severe hemorrhage
Chest injuries Spleen/ liver injuries
State of shock
Skull injury with coma Burn over 20 %,
etc
 Contd..
• Yellow
All patient for whom treatment can wait for 5-
60 minute fall in this category
 Contd..
Eg –
Close fracture and dislocation Closed
abdominal trauma Skull injury without coma
Less severe burn, etc
These patient require close monitoring
and immediate intravenous infusion
 Contd ..
• Green
In this category those patient whose
treatment can be delayed for 4 – 6 hours
who needs minor treatment and who need
no treatment are included
Eg –
Simple fracture
Minor wound and laceration
Minor burn, etc
• Black
No need for medical care
Eg –
dead on scene
Absence of brain activity
 Disaster management
 Respond to disaster
Before the arrival of victims
o Collect information from the authorized
person
in the disaster site about type of disaster,
number of casualties and severity
o Apoint commander and vice commander for
disaster management
 Contd.
o Activate the disaster protocol
o Specify the receiving area or casualty
collection point the triage area based number of
injury
o Alert all department to remain stand by;
operation theater, all indoor unit, laboratory,
radiology, etc
 Contd.
o Assign definite task to people in disaster
plan
o Suspend all other regular hospital activities
except for the critical one
o Prepare standardized tag in advance
o Evacuation of minor cases
 Contd.
 After the arrival of the victim
o Triage nurse or volunteer receive in the reception
area
o Triage nurse keep the crowd away with the help of
volunteer of team
o The nurse in charge mobilizes nurses and mobilizes
to their duties
 Contd.
o Triage nurse screen the case before moving
the victim to triage area
and carryout rapid concise and focused
subjective and objectives assessment of case
and categories patient as the
severity of illness
 Contd.
o Patient are tagged before moving from
reception area and tag must include such
information on patient as their
name, age, sex, triage category, diagnosis
and initial treatment
 Contd..
o Triage nurse coordinates with different
diagnostic facilities X- ray, laboratory, etc for
investigation required
o Triage nurse constantly assess the progress of
patient and report to physician if patient need
change in his/her triage category
 Contd.
oThe triage physician decide appropriate place
for the treatment of each treatment of
each patient which could be operation theater,
ICU,CCU, other ward or the emergency room
or triage area
 Contd.
oOne among the triage nurse, who is identified
as the spokesperson communicate with
family in waiting room through phone or
intercom
oCompletes all legal procedure before sending
the dead bodies to morgue or handing them
over to families
 Contd…
 Crowd controlling
– Managed in collaboration with security and other
volunteer
– The main hospital gate should be closed and
only vehicle and individual carrying casualty
should be permitted
 Contd..
• People from media should be allowed entrance only
as far as the information center or reception area
 Contd..
• Record and reporting
– Document all cases with full detail and as medico
legal cases
– Inform the police if case are discharged, referred
or expired
 Contd..
– Never handover the dead body to relative
without post – mortem
 Post disaster action
• Routine tasks that were suspended in the
emergency management of disaster
are resumed.
• After the disaster management the reports are
analyzed to assess the effectiveness of the disaster
preparedness and response activities is carried
out
 Referenc
e
• Singh Indira, leading and managing in Health,
5th edition, Hisi offset printer Pvt. Ltd page no
410-416
• Metha R S, Pokharel Tara, leadership and
mangement (nursing management ) 1st
edition, Heidal press Pvt Ltd, page no 382-394
• https://www.slideshare.net/NcDas/disaster-
management-11960149