unit 4 disaster-nursing

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DISASTER NURSING

,

Ms. Jonahlyn Gonzales Corpuz, RN,MAN


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WHEN DISASTER STRIKES…..


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Throughout time mankind has been dealing with the threat of disaster

Sometimes disasters can strike without warning.

Your only defense is your ability to be prepared.

DISASTER Is any catastrophic situations in

which the normal patterns of life (or ecosystem) have been disrupted and extraordinary or emergency measures are required to save and preserve live and/ or environment.


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TYPES OF DISASTER

TYPES 1. According to causes/

occurences A. natural- caused by force of

nature extreme heat or cold, fires, floods, earthquake, storms/hurricanes, tornadoes, epidemics


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B. MAN-MADE- CAUSED BY ERRORS OF MAN Riots Bio terrorism Acts of war Accidents Fire

C. Technological- caused by faults / break down in technology Building collapse Hazardous material incidents Fires & explosions Transportation accidents Major industrial accidents

D. CIVIL & POLITICAL DISORDER Demonstration Strikes Riots Mass shootings Hostage taking terrorism

2. ACCORDING TO PREDICTABILITY A. Sudden onset – no warning

issued or can be issued

B. Slow-onset – disasters that come with warnings

3. ACCORDING TO EXTENT OF DAMAGE

A. Large scale – effects not solely limited to the impact area

B. Small scale – effects are localized, limited to impact area

4. ACCORDING TO DURATION A. Long span – when the

emergency phase last for more than 6 months to year.

B. Short span – emergency phase last from 2 weeks to 6 months.

DISASTER MANAGEMENT AND ITS PHASE

Disaster Management is a collaborative term used to

encompass all activities undertaken in anticipation of the occurrence of potentially disastrous event, including preparedness and long-term risk reduction measure.

Warning Disaster Impact

Preparedness

Mitigation Emergency Response

Disaster Prevention Rehabilitation

Development Reconstruction

PHASES OF DISASTER1. Pre-disaster Phase

A. Preparedness- includes assessments of risks, training and program planning to prevent a disaster if possible.

AIM: To make people both aware of particular local risk and ready to respond promptly to specific disaster in their area.

B. Alert Period- refers to the time when disaster is developing and when it has not yet hit the community. Threats are detected, warnings are issued and evacuation is facilitated.

AIM: To ensure that food is available and people are able to secure/buy/get what they need.

2. Disaster Phase A. Response – the period immediately

following the sudden disaster when exceptional measures have been taken to search and find survivors, as well as to meet their basic needs for shelter, water food and medical care.

Activities:1.Rapid assessment of extent of damage

and injury2.Establishment of medical triage centers3.Search and rescue operations for those

trapped4.Appropriate medical treatment of those

with injuries

Aim: 1.To assess the magnitude of the

disaster

2. its immediate impact and consequences on health – related service,

3.assess the adequacy of local resources and mount an adequate relief operation.

3. Post – Disaster Phase A. Rehabilitation- operation and decision

taken after the disaster with a view to restoring stricken community to its former living conditions while encouraging and facilitating the necessary adjustments caused by disaster.

Activities:1.Evacuate survivors and provide shelter2.Provide adequate food and clean water 3.Continue mortality/morbidity surveillance4.Re-establish PHC services and establish

nutritional survey

B. Mitigation – the collective term used to encompass all

actions taken to disaster and long-term reduction of risks and hazards.

Usually follows after a disaster has affected a community.

Geography of Disaster

Impact Area- is the actual place of disaster event. Filter Area- is the periphery surrounding the

impact area. Community Aid Area- nearby areas w/c are

usually used as evacuation or resettlement area.

BASIC PRINCIPLES FOR HEALTH SERVICE DURING DISASTER

1. Recognize that events are unpredictable

2. Learn from the experience from the past

3. Build on the strengths of the community

DISASTER NURSING

-is the adaptation of professional nursing skills in recognition and meeting the medical and nursing needs evolving from a disaster situation.

A. BASIC PRINCIPLES IN PLANNING FOR DISASTER NURSING

N- ursing plans must be integrated & coordinated

U- pdated physical and psychological preparedness

R- esponsible for organizing, teaching & supervision

S- timulate community participationE- xercise competence

B. BASIC PRINCIPLES OF NURSING CARE FOR DISASTER VICTIMS

Adaptation of nursing skills to situation Continous awareness of the patient’s

conditionTeach auxiliary awareness

Selection of essential nursing care

C. ROLES AND RESPONSIBILITIES OF A DISASTER NURSE

D isseminate on information on environmental health hazardI nterpret health laws and regulationS ave oneselfA ccept directions and take ordersS erve the best for the mostT each the meaning of warning signalsE xercise leadershipR efer to appropriate agencies

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INCIDENT COMMAND SYSTEM (ICS) AND TRIAGE

MULTIPLE- CASUALTY INCIDENTS



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MULTIPLE-CASUALTY INCIDENT (MCI) sometimes called Mass

casualty Incident or multiple-casualty situation- is any event that places excessive demands on personnel and equipment.

The ability of the EMS system to respond to the situation is challenged or hampered by the situation.

The number of patient before MCI can be declared varies in practice.


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INCIDENT COMMAND SYSTEM (ICS) also known as- Incident Management System (IMS)

A system used for the management of a MCI .It provides a clear management framework for all types of large-scale incidents.


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COMPONENTS OF ICS

1. Incident Command

2. Communications

3. Organization


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1.Incident Command- The person/persons who assume overall

direction of a large scale incident. Assume by the most senior member of

the first service on the scene When reinforcement arrive there are 2

options of the person who initially assumed command:

a)Continue to be in command b) Transfer command to someone of higher rank


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2.Communications Report should be made to the communications center after the initial

assessment.

Keep the report short and to the point; but give enough information.

The incident commander must give their name and incident location by using the radio system.

EX:

CCC(central command center),this is Medic120.We are on the scene of a 2 –car MB an 6th wheeler truck with severe entrapment of 4 priority 1 patients. Dispatch a rescue company and four paramedic ambulances. We are in between the location of Blue Bay and Manila Tytana Colleges on Macapagal Blvd, Pasay City.I will now be called Franklin Avenue Command.

Police are needed at the scene to assist with traffic and crowd control as soon as possible.

(You can also tell what equipment to bring, best access, and where to park when rescue arrive at the scene)


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3.Organization IS VERY IMPORTANT! Think big!Order big!

Must have plan to deploy resources when they arrive

Decide what sector officer will be needed Where resources will be placed. New patients not found during the scene

size up have a way of appearing. Prevent “freelancing” activity in the

scene. A INCIDENT Tactical Worksheet can be used.


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FUNCTIONS OF INCIDENT COMMANDER

1.Scene size up Arrive at the scene and establish command. Put on proper identification Do quick walk through the scene (HAZMAT observe

from a safe distance) Assess number of patient. Identify hazards and degree of entrapment. Identify numbers of patients; *apparent priority care * needs for extrication Number of ambulances needed and other resources Areas where resources can be staged.


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2 METHODS OF COMMAND

1.Singular- A single agency controls all the

resources and operations often used at fire and rescue operations

2.Unified- Several agencies work independently

but cooperatively rather than one agency exercising control over the others.

SINGULAR

Incident Commander

Triage Officer Treatment OfficerExtication Officer

SINGULARIncident Commander

Triage Officer Treatment OfficerExtrication Officer

UNIFIED Incident Commander

Public information

EMS Operations Fire Operations Police operations


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EMS SECTOR FUNCTIONS Mobile command center Staging sector Supply sector Extrication sector (in cases of

entrapment) Triage sector Treatment sector Transportation sector Rehabilitation sector (if HAZMAT)

involve.


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3.TRIAGE The process of quickly assessing MCI

patients and assigning each a priority for receiving treatment

Is a French word meaning to “SORT”

Triage officer- the person responsible for overseeing triage at an MCI..


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DISASTER TRIAGE PRINCIPLES

1.Never move a casualty backward (against the flow) 2.Never hold a critical patient for further care. 3.Salvage life over limb 4.Triage providers do not stop treating patients. 5.Never move patients before triage, except in cases

of *risks due to bad weather, *impending darkness, or darkness has fallen *continued risks of injury *medical facilities is immediately available and

with enough resources. *Tactical situation that dictates movement.


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THE AIM OF TRIAGEBasic Principle of Triage A).Principle of Rights Right patient Right place Right time Right resources Right care B)The Spock Principle Heroic act is not applicable to MCI

OBJECTIVES OF TRIAGE

ABUNDANT RESOURCES RELATIVE TO DEMAND.(DO THE BEST FOR EACH INDIVIDUAL).

R P P P P P

RESOURCES OVERWHELMED (DO THE GREATEST GOOD FOR THE GREATEST NUMBER)ppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppp

ppppppppppppppppppR


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APPLICABILITY OF TRIAGE


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THE ADAPTABILITY OF TRIAGE

MILITARY CIVILIAN TRIAGE Priority is to get as many Soldiers back into action As possible

Priority is to maximize survival of the greatest

number of victims.


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IDEAL TRIAGE SYSTEM

Should be simple Does not require advanced assessment

skills Does not rely on specific diagnosis Should be easy to perform Should provide for rapid & simple life –

saving intervention. Should be easy to teach & learn


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PRIMARY TRIAGE:CLASSIFY PATIENT IMMEDIATELY IN ONE OF THE 5 GROUPS

Priority 1: Treatable Life- Threatening Illness or

injuries. Airway breathing

difficulties Uncontrolled severe

bleeding Decreased mental status Severe medical problems Shock Severe burns

Priority 2: Serious But not Life-

Threatening Illness or Injury.

Burns without airway problems

Major or multiple bone and joint injuries

Back injuries with or without spinal damage


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Priority 3 :“Walking

wounded”. Minor

musculoskeletal injuries

Minor soft injuries

Priority 4 (sometimes called O

priority : Dead or fatally Injured. Exposed brain matterCardiac arrest (no pulse

for over 20 mins. Except with cold-drowning or severe hypothermia)

,Decapitation, severe trunk and

incineration.


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NOTE:

Extensive treatment does not occur at the incident site since it is a hazard zone and since it could impede rescue and initial treatment of other patient

TRIAGE TOOLSTART/ JUMPSTART

S IMPLET RIAGEA NDR APIDT REATMENT


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S-T-A-R-T TRIAGE The most commonly used method of

prioritizing patients. Its foundation is speed, simplicity, and

consistency of its application. Is intended to be completed in about

30 secs. Per patient It relies on some simple commands and

the PHYSIOLOGIC PARAMETERS

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Begin where you stand Ask all those who can walk to

move to a designated area. By using a bullhorn, PA system (loud voice to direct patients) away from immediate danger

START TRIAGE All ambulatory patients initially tagged GREEN

Yes

Over 30/min

Immediate

No

Position airway

Dead of expectant

No Yes

Respiratory

Immediate

Under 30/minPERFUSION

Control bleeding

Cap refill > 2 sec

Cap refill < 2 sec

Immediate

Mental status

Failure to follow simple commands

Can follow simple commands

Immediate Delayed

PHYSIOLOGIC PARAMETERSMNE MONIC RPM

R-- 30P– 2M– Can do


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TRIAGE RIBBON CONCEPTTRIAGE TAG-Color coded tag indicating the priority group to

which a patient has been assigned. Universal colors are used (Color Coding) Triage Category (Triage Tag) Color Code Level I Red Level II Yellow Level III Green Level IV Black Level V White


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Level I (RED) Immediate or Critical

Care Life-threatening Delay of a few minutes

Fatal Immediate degree of

urgencyImmediate (highest

priority) Patients with airway,

breathing, perfusion, or neurologic problems Airway burns also fit in this category.

EXAMPLES Respiratory Arrest Airway Obstruction Sucking Chest

Wound Cardiac Arrest Severe bleeding Shock Respiratory tract

burns Acute Coronary

Syndromes


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Level II YellowEXAMPLES

Delayed (second priority) Delayed, acute or non ambulatory care

Serious but stable Delay of few hours: no

impact Secondary degree of

Urgency Depends on patient’s

condition vs. resources Burn patients without

airway problems Major or multiple bone or

joint injuries Back & spine injuries

Open thoracic wound Penetrating

abdominal wound Severe eye injury Avascular limb Significant burns

other than face, neck, or perineum

Moderate bleeding Multiple fractures Conscious with head

injury Anxiety states


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Level III GREEN EXamples

Minor (third priority) Victims who do not

require hospitalization

Delay: no impact Much delayed

degree of urgency Disposition depends

on space availability

Minor bleeding Minor soft tissue

injuries Contusions,

sprains Superficial burns Partial-thickness

burns of <20% BSA


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LEVEL IV-BLACK

Expectant or Pending Care

Dead and Dying Delay, no impact Much delayed

degree of urgency When to classify a

victim dead and dying

Know disaster response level

L1. < 2 hours

L2. 2-12 hours

L3. 12-24 hours

L4. >24 hours


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KNOW DISASTER RESPONSE LEVEL

Level I< 2 hours Disaster Response Advanced neurological deficits (GCS <8)Injuries to the torso and a BP of < 50 mmHg systolic and below despite initial resuscitationMassive burns (>85% BSA).

Level II2-12 hours Disaster ResponseDisaster Response Level I victimsDeteriorating Neurovital signsSecond or third degree burns involving more than 50% of total BSA.


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KNOW DISASTER RESPONSE LEVEL

Level III12-24 hours disaster responseDisaster response level 2 victimsThose requiring formal surgical careThose requiring prolonged life support in an intensive care unit

Level IVTriage Level I victims


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Level V - WHITE No care Unaffected person Delay; no impact No degree of urgency Disposition: Safe

evacuation EXAMPLES: Evacuees Relatives of victims Onlookers Press


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TRANSPORTATION AND STAGING LOGISTICS

Treatment sector The area in which patient patients are

treated, headed by Treatment officer who is responsible for overseeing who have been triaged at an MCI.

Staging sector The area where ambulances are parked

and other resources are held until needed headed by a Staging officer.


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WHEN DISASTER STRIKES…..


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We must remember that there are common or similar preparation steps that must be taken before, during and after the disaster regardless if it is natural or manmade


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To prepare to disaster you must devise a strategy that encompasses the necessary steps that must be taken BEFORE, DURING and AFTER a disaster.


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BEFORE DISASTER STRIKES

Protective Actions


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Protective actions are the things we can do to safeguard our family members, coworkers and ourselves from harm.

As an example, using seatbelts in cars, following all workplace safety rules, wearing appropriate protective clothing at work such as safety glasses, helmets, and steel –toed boots.

Protective actions may also be necessary in the event of a natural disaster.


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Man-made disasters can threaten your workplace and community requiring you to take protective action.

The most common protective actions in an emergency are evacuation and shelter-in-place.


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EVACUATION

Means to leave the area of actual or potential hazard


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Have an emergency evacuation procedure at work and at home and review it regularly.

As often as possible, run disaster drills to keep everyone prepared.

For the office, appoint a safety person to oversee these activities.

If firefighters, police, civil defense workers or other local emergency officials ask you to evacuate, they are doing so for good reason – listen to them.

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Some key points: Know where emergency exists and staircases are

located in buildings you work in and visit.

Know which routes are designated evacuation routes before an emergency happens, and use them when directed. You may find your normal shortcuts are impassable or otherwise dangerous.

Evacuate in a calm manner. Be patient. Don’t panic others.

Lock your home and/or business when you leave.


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Stay away from downed power lines. It is often impossible to tell the difference between charged and unchanged lines.

Have a predetermined meeting place outside the affected area to save time and minimize confusion during evacuation. If you plan to go to a hotel and you have

pets, make sure the hotel is “pet-friendly”. Pets will not be permitted in a public shelter.


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Keep the following disaster supplies in an easy-to-carry container such as wheeled plastic trash can in both home and office.

Listen to your radio for news and instructions.


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SHELTER-IN-PLACE

Means to stay in your home, school, business, or a public building


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If emergency officials advise you to “shelter-in-place”, remain inside your home or office.

Close and lock all windows and exterior doors.

Turn off fans, heating and air conditioning systems.

Get your disaster kit and go to an interior room without windows.

Use duct tape to seal cracks around the door and any vents into room.


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Shelter-in-place must be ended properly in order to provide the best protection.

Listen to your radio or television for emergency authorities to announce when it is safe to evacuate.


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DURING A DISASTER


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If terms are falling from the wall, off of bookshelves, or from the ceiling, get under a sturdy table or desk to protect yourself. If there is a fire…

The importance of staying calm cannot be overemphasized. Do not allow yourself to lose self-control.

Before opening a closed door, use the palm of your hand to feel the door. If it is not hot, open it very slowly. If it is hot to the touch, do not open the door.


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If you are able to safely enter the hallway, stay close to the floor. Superheated air, poisonous gases, and heavy smoke collect first along the ceiling. Crawl to an exit and work your way out of the building as quickly and calmly as possible.


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AFTER DISASTER STRIKES


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Quickly assess yourself and those around you for injuries. Give basic first aid.

Control active, serious bleeding by pressing firmly against the wound. Cover the wound with a clean dressings and bandages and maintain pressure over the wound.

To take care burns, cool the burn with large amounts of water and then cover the burn with dry, clean dressings.

If broken bones are not suspected, place person on their back and elevate the legs about 12 inches. If the person is unconscious, put them on their side to allow fluids to drain and make breathing easier.


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Prevent all seriously injured persons from getting chilled or overheated and unless their life is in danger, do not move them.

Check for fires, fire hazards and building damage using a flashlight.

Do not light matches or candles or turn on electrical switches. If you smell gas or suspect a leak in your home or business, if possible –turn off the main gas valve, open windows, and get everyone outside and away from the building.


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IF YOU ARE TRAPPED IN DEBRIS… Don’t stir up dust. If possible, cover

your mouth with clothing to prevent inhaling dust.

Tap on pipe or wall so that rescuers can locate you. Use the whistle from your disaster kit if it is available. Resist the urge to shout as this makes it likely you will inhale dangerous amounts of dust. Note: Untrained persons should not

attempt to rescue those are trapped inside a collapsed building.

unit 4 disaster-nursing

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