disaster management - nursing

RAK College of NursingRAK Medical and Health Sciences University

Nursing care of clients experiencing disasters

Adult Health Nursing II

Prepared by: Abdlerahman Alkilani 15906012

Submitted to Dr. Maragatham Kannan, Associate Professor

27/02/2017

Objectives

By the end of this seminar, colleges will be able to:1. Define disaster 2. Identify the types of disasters3. Discus the common injuries caused by different types of

disasters 4. Explain disaster preparedness5. Discuss the PRE-DISASTER paradigm6. Explain the disaster management 7. Describe Personal Protective Equipment (PPE)

Objectives

By the end of this seminar, colleges will be able to:8. Describe the disaster control zones9. Describe the general principles of mass casualty triage10.Perform an accurate mass casualty triage using SALT

triage system11.Record the disaster victims data accurately12.Explain the role of the nurse in disaster relief

Background

■ According to WHO- Center for research on the epidemiology of disaster, the frequency of disasters worldwide has doubled since 1995.

■ In the previous century:– 3.5 million people were killed worldwide as a result of

natural disasters– 200 million were killed as a result of human caused disaster

■ According to UAE Ministry of Foreign affairs and international cooperation, – in 2015, natural disasters happened in 113 countries, 98.6

million were injured, and 22,773 were died

Background

■ The International Nursing Coalition for Mass Casualty Education (INCMCE) was found to ensure a competent nurse workforce to respond to MCIs

■ UAE- National Emergency crisis and disaster management Authority was established in 2007

Disaster

■ An event in which the needs exceed immediately available resources

■ Local incidents or events in that their impact is immediate and direct, while time course, population, and geography are generally limited

Disaster = Needs > Resources

Types of disasters

■ Natural disasters:– Are caused by acts of nature or emerging diseases.– May be predictable or unexpected

■ Man-made disasters:– Either accidental or intentional

■ War; chemical, biologic, radiologic, and nuclear terrorism ■ Transportation accidents ■ Food or water contamination

Natural disasters Type of

disaster Common injuries

Hurricane Drowning, upper respiratory infections Tsunami Tsunami Lung: a severe infection caused by swallowing muddy,

bacteria-laden waterThunderstorm Resistance of body tissue to electrical current:

Least resistance: Nerves, blood, mucus membrane, muscleIntermediate resistance: dry skinMost resistance: tendon, fat, bone

Tornado Flying debris Earthquake High incidence of mortality and morbidity Snowstorm Overexertion and exhaustion

Man-made disastersType of

disaster Common injuries

Blast injuries Auditory, Eye, respiratory, and multi systemsBlunt trauma Head and torso the most affectedPressure trauma

Lungs, ear, and bowel

Dirty bomb Radiation sickness Nuclear detonation

Thermal burns

Chemical burns

From minor to life-threatening injuries

Disaster Preparedness

■The PRE-DISASTER paradigm:– Planning and practice– Resilience– Education and training

The PRE-DISASTER paradigm

■ Planning and practice:– Design– Implementation– Ongoing evaluation of efforts to help communities,

institutions and individuals prepare for, respond to, and recover from disasters.


■ Resilience:– Is the ability of individuals and communities to

rebound to a reasonable state of normalcy after exposure to disasters

– Being prepared through planning, education, and training can reduce fear, anxiety, and losses associated with a disaster and build resilience

– It can be build by educating the population about local disaster planning and response efforts.


■ Education and training:– INCMCE published educational competencies for

registered nurses responding to MCIs■ core competencies, core knowledge areas, and

professional role development.

(Handout)

Disaster management The DISASTER paradigm is a practical learning tool to enhance communication consistency among disaster response personnel and agencies■ Detection■ Incident management■ Safety and security■ Assess hazards■ Support■ Triage and treatment■ Evacuation■ Recovery

The DISASTER paradigm

■ Detection– Is the first step of effective disaster response– Determine:

■ Whether there is a disaster or mass causality situation present

■ Do current needs exceed available capabilities and resources?

■ Is there a suspected threat or hazardous material present?


■ Incident management – Effective incident management requires:

■ Command■ Coordination■ communication

The DISASTER paradigm■ Safety and security

– Protecting self first priority in order to save lives in safe manner – Your safety is paramount– Triage, treatment, and evacuation of causalities is secondary

consideration.– Safety and security is dynamic – Personal Protective Equipment (PPE)

■ Reparatory protection: purifiers, supplied air devices (SCBA), or air-line respirator

■ Protective garments: vapor-tight suits, partially resistance suits, or hooded coverall

(Handout)


■ Safety and security– Control zones:

Hot Exclusion zoneSite of release, most contaminated, needs HAZMAT

WarmContamination zoneLocation where workers enter and leave, decontamination occurs here

ColdSupport zoneArea contamination-free: casualty collection, triage, treatment, transport


■ Assess hazards

– A challenging feature– Risk of structural collapse, fire, ruptures gas lines,

downed power lines– Potential release of toxic chemicals and radiation– Respiratory hazards (smoke, carbon monoxide,

cyanide, dust)


■ Support– Support is getting what is needed to get the job done – It needs planning by agencies, institutions, and

communities– It includes acquisition and deployment of essential

personnel, supplies, facilities, vehicles, and other resources

The DISASTER paradigm■ Triage and treatment

– Goal: to do the greatest good for the greatest number of possible survivors

– Focusing on a severely injured casualty, before promoting the safety of the larger casualty population, would not achieve the goal.

– Objective(s):– The initial objective is to prevent expansion of the causality

population by facilitating the movement of ambulatory casualties and uninjured bystanders away from the scene

– The next objective is to sort casualties and identify those with life threatening injuries to initiate emergency treatment immediately

– Once this is accomplished, casualties with less-serious injuries can be assessed further and triaged for removal from the scene on the basis of their level of injury and available resources


■ Triage and treatment – Effective triage regulates surge demands for staff,

supplies, and space by finding the most critically injured or ill people and prioritizing them for transport from the scene.

– Treatment continues until all casualties have been transported or all available resources have been exhausted


■ Evacuation:– Must be built into community and facility disaster

response plans and practice


■ Recovery:– Is the longest phase– Begins when the event occurs– The goal of recovery is to :

■ Ensure economic sustainability of the community■ Ensure Long-term physical and mental well-being■ Rebuild and repair the physical infrastructure■ Restore normalcy as soon as possible

Mass casualty triage- Definition

■ It is a systematic method for organizing casualties at the scene of a mass casualty event.

■ It involves rapid categorization of casualties with potentially severe injuries or illnesses who require immediate medical attention at the scene

Mass casualty triage- General principles■ The goal is to create a formal, reproducible process for sorting

causalities, so that:Treat first

• the most seriously ill or injured who have reasonable possibility of survival

Treat last

• the least severe illness or injuries or a very unlikely to survive

Separate

• who require minimal or no treatment can be initially separated from the other

Mass casualty triage- Systems

■ Examples of mass casualty triage systems:– Care Fight– CESIRA– Homebush– JumpSTART– Military triage– SALT– Triage SIEVE

Mass casualty triage- SALT

■ SALT triage designed based on the best scientific evidence

■ Sort■ Assess ■ Lifesaving interventions■ Treatment and transport

Mass casualty triage- SALT■ Step 1- Sort: global sorting

■ Rapidly identify most at-risk by sorting into groups ■ Limitations: hearing, language , fear, families

Step 1- Sort: Global sorting

Still / obvious life threatAssess 1st

Wave / purposeful movement Assess 2nd

WalkAssess 3rd

Mass casualty triage- SALT■ Step 2: individual assessment

Lifesaving interventions:

- Control major hemorrhage

- Open airway (if child, consider 2 rescue breaths)

- Chest decompression- Auto injector

antidotes

Breathing?

- Obeys commands or makes purposeful movement?

- Has peripheral pulse?

- Not in respiratory distress?

- Major hemorrhage in control?

Minor injuries only?

Likely to survive given current resources?

YesAllyes

No NoDead

Yes

Delayed

Minimal

Immediate Expectant No

No

Triage Categories: ID-MED

Triage Category

Description Color code

Immediate Requires immediate care for a good probability of survival

Red

Delayed Requires care that can be safely delayed without affecting probability of survival

Yellow

Minimal Sick or injured but expected to survive with or without care

Green

Expectant Alive, but with little or no survival given current available resources

Gray

Dead A fatality with no intrinsic respiratory drive black

Triage practice 19 years old man

Appears in severe pain, cannot hear youRapid symmetric breathing Near amputation above Rt knee, bleedingLife saving interventionsControl major bleeding √Open airway Decompress chest Auto inject antidote

Response Bleeding controlled, RR 20

Still

“ID-ME”Immediate Delayed Minimal

Expectant Dead

Triage practice 19 years old man

Appears in severe pain, cannot hear youRapid symmetric breathing Near amputation above Rt knee, bleedingLife saving interventionsControl major bleeding √Open airway Decompress chest Auto inject antidote

Response Bleeding controlled, RR 20

Still

“ID-ME”Immediate Delayed √Minimal

Expectant Dead

Triage practice 48 years old woman

Unresponsive Normal breathing and radial pulse presentObvious injury to her head

Life saving interventionsControl major bleeding Open airway Decompress chest Auto inject antidote

Response

Still


Expectant Dead

Triage practice 48 years old woman

Unresponsive Normal breathing and radial pulse presentObvious injury to her head

Life saving interventionsControl major bleeding Open airway Decompress chest Auto inject antidote

Response

Still

“ID-ME”Immediate √

Delayed Minimal

Expectant Dead

Triage practice 10 years old girl

Head trauma with protruding brain matterSlow, deep respirationsMother holding her on lap in damaged carLife saving interventionsControl major bleeding Open airway and give 2 rescue breaths √Decompress chest Auto inject antidote

Response Unchanged

Still


Expectant Dead

Triage practice 10 years old girl

Head trauma with protruding brain matterSlow, deep respirationsMother holding her on lap in damaged carLife saving interventionsControl major bleeding Open airway and give 2 rescue breaths √Decompress chest Auto inject antidote

Response Unchanged

Still


Expectant √Dead

Recording victim data

■ Centers for Disease Control and Prevention (CDC) created a Mass Trauma Data Instrument to record data about victims of disasters

■ The categories on the data sheet includes demographics, circumstances of the injury, injury conditions, and disposition and details of the conditions.

■ The completion of this form will be initiated by the triage nurse and completed by the nurse who implements the treatment or transfers.

(Handout)

The role of the nurse in disaster relief

1. Prepare selves, families, friends, and communities for disasters in conjunction with the local disaster preparedness plan.

2. Continue educating self on various types of disasters and appropriate response

3. Provide emergency services with consideration of victims’ abilities, deficits, culture, language, or special needs

4. Assist in the mobilization of healthcare personnel, food, water, shelter, medication, clothing, and other assistive devices.

The role of the nurse in disaster relief

5. Collaborate with the agencies in authority to deploy resources based on the greatest good for the greatest number

6. Consider needs of victims including shelter both temporary and permanent, as well as psychologic, economic, legal, and spiritual factors

7. Become involved with the national disaster planning agencies to schedule regular meetings to continually review and modify disaster plans

Evidence Based Practice■ Review: Public Health Nurses’ Roles and Competencies in

Disaster Management■ By: Ardia Putra, Wongchan Petpichetchian, and Khomapak

Maneewat - 2011■ Purpose: to review PHNs’ roles and competencies in disaster

management in facing with natural disaster■ Results:

– Twenty eight related studies were intensively reviewed– Literatures showed that PHNs play roles as one of the

valuable resources and are actively involved in disaster management. PHNs’ roles and competencies in disaster management is necessary because they are well recognized and trusted in the community and frequently work closely with the disadvantaged and vulnerable group who often affected by disasters.

Summary ■ Disaster = Needs > Resources■ There are two types of disasters; natural and man-made■ Disaster preparedness consists of planning and practice,

resilience, and education and training■ Disaster management consists of detection, incident

management, safety and security, assess hazards, support, triage and treatment, evacuation, and recovery.

■ Salt triage: Sort, Assess, Lifesaving interventions, and Treatment and transport

■ 5 triage categories; ID-MED■ Recording victims data starts by the triage nurse and

completed by the nurse who implements the treatment or transfers.

Conclusion

■ Nurses are invaluable in disaster relief efforts.■ Nurses have a responsibility to the public to maintain

competence in nursing practice.

References ■ LeMone, P., Burke, K. M., & Bauldoff, G. (2011). Medical-

surgical nursing: critical thinking in client care. Boston: Pearson.

■ Ahuja, R. (2010). Medical-surgical nursing: clinical management for positive outcomes. New Delhi: Anmol Publications.

■ Adelman, D. S., & Legg, T. J. (2009). Disaster nursing: a handbook for practice. Sudbury, MA: Jones and Bartlett .

■ Swienton, R. E., & Subbarao, I. (2012). Basic Disaster Life Support: Course Manual 3.0. Place of publication not identified: National Diaster Life Support Foundation.

■ Putra, A., & Petpichetchian, W. (2011). Review: public health nurses’ roles and competencies in disaster management. Nurse Media Journal of Nursing, 1(1), 1-14.

disaster management - nursing

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