disaster nursing.ppt 3
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Terrorism, Mass Casualty and Disaster Nursing
● Terrorism: “ the unlawful use of force or threats of violence against people in order to intimidate or coerce
● Mass Casualty Incident (MCI): “a situation in which the number of casualties exceeds the number of resources”
● Disaster Nursing: “the adaptation of professional nursing knowledge, skills and attitude in recognizing and meeting the nursing, health and emotional needs of disaster victims.”
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DISASTER NURSING“Doing the best for the most, with the least, by the fewest”● Definition: “The adaptation of professional nursing
knowledge, skills and attitude in recognizing and meeting the nursing, health and emotional needs of disaster victims.”
● Goal: “To achieve the best possible level of health for the people and the community involved in the disaster.”
PRINCIPLES OF DISASTER NURSING● Rapid assessment of the situation and of
nursing care needs.● Triage and initiation of life-saving measures
first.● The selected use of essential nursing
interventions● Adaptation of necessary nursing skills and
resourcefulness in dealing with a lack of supplies, equipment, and personnel.
● Evaluation of the environment and the lessening or removal of any health hazards.
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● Prevention of further injury or illness.● Leadership in coordinating patient triage,
care, and transport● The teaching, supervision, and utilization
of auxiliary medical personnel and volunteers.
● Provision of understanding, compassion, and emotional support to all victims and their families.
Classification Levels for Disasters Classied by the anticipated necessary response
● Level I: Local emergency response; personnel and organizations
● Level II: Regional assistance is needed from surrounding communities
● Level III: Statewide or federal assistance
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Federal Agencies ▪ Federal agencies that may provide resources in response
to mass casualty or disaster include:▪ Department of Health and Human Services (DHHS)
▪ DMORTs▪ NVRTs
▪ IMSuRTs ▪ Disaster Medical Assistance Teams (DMATs) organize
voluntary medical personnel (Health care providers, nurses, EMT’s, Technical Staff, and other health care professionals)
▪ Department of Justice (DOJ) ▪ Department of Homeland Security
Emergency Operations Plan (EOP)� Health care facilities are required by the Joint
Commission (TJC) to create a plan for emergency preparedness and to practice this plan twice a year
� Essential components of the plan:◦ An activation response◦ An internal/external communication plan◦ A plan for coordinated patient care◦ Security plans◦ Identification of external resources◦ A plan for people management and traffic flow
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Emergency Operations Plan (EOP)� Essential components of the plan cont.
● A data management strategy● Deactivation response● Post-incident response● A plan for practice drills● Anticipated resources● Mass casualty incident planning● Education for all of the above
The Nurse’s Role in Disaster Response Plans
● Nursing care in a disaster focuses on essential care from a perspective of what is best for all patients.
● Depends on the specific needs of the facility for patient care (Atypical roles)
● Serve as a triage officer● Take roles normally held by physicians based on
their area of expertise. i.e. CCN may intubate patients
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DISASTER MANAGEMENT CYCLE
The Disaster Event: Real-time event of a hazard occurring The response phase is the actual implementation of the disaster plan
Recovery the organization and staff needs to recover
Evaluation & Development: determine what went well
Mitigation: ways to lessen the impact of a disaster
Preparedness: Evaluate the facility’s vulnerabilities for disasters
Triage● Determines priority health care needs and the proper
site of treatment.● In non-disaster situations, the highest priority and
allocation of resources are for the most critically ill.● In disaster situations with large numbers of
casualties, decisions are based on survival and the consumption of resources
● Triage categories separate patients according to severity of injury.
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Triage Categories:Triage Description Color
Emergent Immediate threats to life. Require immediate attention.
RED
Urgent Major injuries. Requires treatment 30 mins-2 hours
YELLOW
Nonurgent Minor injuries. Can be treated in a delayed fashion >2 hours
GREEN
Expectant/Deceased
Expected to die or is deceased BLACK
TYPES OF TRIAGE● Two types of triage:
● Simple triage● S.T.A.R.T. (Simple Triage and Rapid Treatment) performed by first
responders and emergency personnel in emergencies. ● 0 – The deceased who are beyond help● 1 – The injured who can be helped by immediate
transportation● 2 – The injured whose transport can be delayed● 3 – Those with minor injuries, who need help less
urgently● Advanced triage
● Diverts scarce resources away from patients with little chance of survival in order to increase the chances of survival of others who are more likely to survive.
● “Do the greatest good for the greatest number” ● Ethical decisions are made
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Critical Incident Stress Management (CISM)
● Critical Incident Stress Management (CISM) is implemented to prevent /treat emotional trauma affecting emergency responders
● Incident stress can affect anyone who is involved in a disaster or mass casualty.
● Agencies, resources and education are made available ● Defusing is a process by which the person receives
education about recognition of stress reactions and management strategies for handling stress.
Personal Protective Equipment (PPE)
● The purpose of PPE: shield health care workers from the chemical, physical, biologic, and radiologic hazards that may exist when caring for contaminated patients.
● Chemical or biologic agents and radiation are silent killers (color-less and odorless)
● U.S. Environmental Protection Agency (EPA)has● Four categories Levels A – D
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Personal Protective Equipment (PPE)● PPE donned before patient contact● Use specific PPE based on agent involved● Training is required
Personal Protective Equipment● Level A – highest level of
respiratory, skin and eye, fully encapsulated chemical resistant suit, full face piece and supplied air (self-contained breathing apparatus or SCBA)
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● Level B - protection requires the highest level of respiratory protection but a lesser level of skin and eye protection than with level A situations.
● Level C – Full face piece with air purifying canister-equipped respirator, chemical-resistant clothing (including gloves & boots)
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● Level D – Regular work clothing, safety shoes, goggles/splash shield
Decontamination● Reduction or removal of
contamination agents.● Radioactive agents – the
runoff also needs to be contained
● Victims need to be decontaminated before they can be admitted to the emergency facility or hospital
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Terrorism
▪ Disrupt Daily Life & Cause Terror and Panic▪ FBI definition– “the unlawful use of force or violence
against person’s or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives”
Blast Injuries● Physical Injuries After Blast Events
● Blast Lung● Tympanic Membrane Rupture ● Abdominal and Head Injuries
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Biologic Weapons● Biologic weapons are weapons that spread disease● Bacteria - Viruses - Toxins● Delivered in either a liquid or dry state, applied to foods or
water, or vaporized for inhalation or direct contact. ● Anthrax the most likely biologic agent available; a highly
debilitating agent for centuries. ● Bacteria releases toxins causing hemorrhage, edema,
and necrosis. Penicillin sensitive; initiate treatment within 24 hours
● Smallpox (variola) is a DNA virus. Incubates 12 days. Highly contagious and is spread by direct contact, by contact with clothing or linens, or by droplets. Patient isolation and antibiotic therapy.
Chemical Weapons ● Chemical substances that quickly cause injury
and/or death● Agents
● Nerve agents ● Blood agents● Vesicants● Pulmonary agents
● Agents vary in volatility, persistence, toxicity, and period of latency
● Limitation of exposure is essential with evacuation and decontamination
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Radiation Exposure● Radiation exposure may occur due to nuclear weapon or
exposure to radioactive samples ● Signs and symptoms determine predicted survival; most
common nausea and vomiting persists for 24-48 hours● Improbable survivors are acutely ill with nausea, vomiting,
diarrhea, and shock. Neurologic symptoms suggest lethal dose. Survival time is variable
● Radiation Decontamination● Triage outside the hospital● Cover floor and use strict isolation precautions to
prevent the tracking of contaminants● Air ducts and vents are sealed● Waste is double bagged and labeled radiation waste
Psychological Effects After a Disaster � Provide active listening and emotional support
� Provide information as appropriate
� Refer to therapist or other resources
� Discourage repeated exposure to media regarding the event
� Encourage return to normal activities and social roles
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The point is to save as many people as possible!