Emergency Emergency PreparednessPreparedness

What you need to knowWhat you need to know

Objectives: Objectives:

After completing this learning module you will After completing this learning module you will be able to:be able to:

1.1. Identify what constitutes an all hazards plan.Identify what constitutes an all hazards plan.

2.2. Discuss the nurse’s role in disaster planning.Discuss the nurse’s role in disaster planning.

3.3. Discuss the triage system, it’s patient Discuss the triage system, it’s patient organization, and assessment procedures. organization, and assessment procedures.

Driving FactorDriving Factor

The bombing of the Okalahoma City The bombing of the Okalahoma City Federal building, the September 11 Federal building, the September 11 attacks, anthrax cases, and natural attacks, anthrax cases, and natural disasters such as Hurricane Katrina have disasters such as Hurricane Katrina have prompted new federal, state, and local prompted new federal, state, and local standards for safety and public standards for safety and public preparedness. preparedness.

National Preparedness:National Preparedness:

Homeland security established the Homeland security established the National National Preparedness GoalPreparedness GoalFederal, state, and local agencies collaborate in Federal, state, and local agencies collaborate in bioterrorism preparednessbioterrorism preparednessIncludes the term "all-hazards preparedness", Includes the term "all-hazards preparedness", and refers to the preparedness for domestic and refers to the preparedness for domestic terrorist attacks, major disasters, and other terrorist attacks, major disasters, and other emergenciesemergenciesRequires hospitals to confirm successful training Requires hospitals to confirm successful training of hospital staff of hospital staff

Defining QuoteDefining Quote

“ “The goals of disaster preparedness are to The goals of disaster preparedness are to anticipate, mitigate, and rehabilitate. All health anticipate, mitigate, and rehabilitate. All health professionals can and should contribute to this professionals can and should contribute to this process. Among the most essential process. Among the most essential competencies are the ability to locate your competencies are the ability to locate your institutional or office disaster plan, to understand institutional or office disaster plan, to understand your role in an emergency; and to know how to your role in an emergency; and to know how to communicate with patients, ancillary staff, and communicate with patients, ancillary staff, and governmental agencies during an governmental agencies during an emergency”(emergency”(DiMaggio, et al 2005DiMaggio, et al 2005).).

Disaster preparedness plan:Disaster preparedness plan:

Formal plan of actionFormal plan of action

Coordinates the response of the health Coordinates the response of the health care agency staff in the event of a disaster care agency staff in the event of a disaster in the health care facility or surrounding in the health care facility or surrounding community community

Nurses role in disaster Nurses role in disaster planning:planning:

Personal and professional Personal and professional preparedness: 1-3preparedness: 1-3

The nurse makes personal and family The nurse makes personal and family preparations, e.g.: family meeting place, preparations, e.g.: family meeting place, evacuation plan, food and water supplies, evacuation plan, food and water supplies, etc. etc. Is familiar with the emergency plan at Is familiar with the emergency plan at place of employment and within the place of employment and within the communitycommunityMaintains certification in disaster training Maintains certification in disaster training and participates in mock disaster drillsand participates in mock disaster drills

Personal and professional Personal and professional preparedness: 4-6preparedness: 4-6

Is familiar with the triage system of the health Is familiar with the triage system of the health care facility in which he or she is employedcare facility in which he or she is employed

Is aware of the clinical and public health Is aware of the clinical and public health responses to emerging infectious diseases such responses to emerging infectious diseases such as H1N1, SARS, and the West Nile virus as H1N1, SARS, and the West Nile virus ((DiMaggio, et al 2005DiMaggio, et al 2005).).

Recognizes and responds to chemical, Recognizes and responds to chemical, biological, radiological, nuclear, and explosive biological, radiological, nuclear, and explosive threats a.k.a. C.B.R.N.E. threats a.k.a. C.B.R.N.E.

CBRNE:CBRNE:

Chemical Chemical

Biological Biological

Radiological/Nuclear Radiological/Nuclear

Explosive agents Explosive agents

Chemical agents Chemical agents

Nerve agents: sarin, sobin, tabun, and vx Nerve agents: sarin, sobin, tabun, and vx gassesgasses

Choking agents: chlorine gas and Choking agents: chlorine gas and phosgenephosgene

Biological agents Biological agents

AnthraxAnthrax

BotulismBotulism

PlaguePlague

Small poxSmall pox

Radiological/Nuclear Radiological/Nuclear

Dirty bombs are a true threatDirty bombs are a true threat

Decontamination process is lengthyDecontamination process is lengthy

High mortality rate appeals to terroristsHigh mortality rate appeals to terrorists

Has the potential for mass casualties and Has the potential for mass casualties and structural damage structural damage

Explosive agents Explosive agents

Materials are easily accessible Materials are easily accessible

Potential for chemical and or radiologic Potential for chemical and or radiologic contaminationcontamination

Mass casualties and heavy structural Mass casualties and heavy structural damages are likelydamages are likely

Disaster ResponseDisaster Response

In the health care facility:In the health care facility: The emergency response plan is activatedThe emergency response plan is activated The nurse responds by following the The nurse responds by following the

directions outlined in the plandirections outlined in the plan

In the community:In the community: The nurse cares for highest priority patients The nurse cares for highest priority patients

firstfirst Once rescue workers arrive, immediate Once rescue workers arrive, immediate

plans for triage should beginplans for triage should begin

Defining QuoteDefining Quote

“ “Triage is a system of sorting clients Triage is a system of sorting clients according to medical need when according to medical need when resources are unavailable for all persons resources are unavailable for all persons to be treated” (Zerwekh, 2009). to be treated” (Zerwekh, 2009).

Disaster/Emergency Triage Disaster/Emergency Triage SystemSystem

Clients are assessed and classified Clients are assessed and classified according to: according to:

Need and or priority of careNeed and or priority of care

Type of illness or injuryType of illness or injury

Severity of problemSeverity of problem

Resources available Resources available

Triage Systems DefinedTriage Systems Defined

The The three-tier triagethree-tier triage system and the system and the START triageSTART triage system utilize color coded system utilize color coded triage cards. The colors red, yellow and triage cards. The colors red, yellow and green are interchangeable between the green are interchangeable between the two triage systems. The three-tier system two triage systems. The three-tier system is most commonly used in the health care is most commonly used in the health care setting whereas the START system is setting whereas the START system is more commonly used in the community more commonly used in the community disaster setting. disaster setting.

Color CodesColor Codes

Red (Immediate) Red (Immediate)

Priority 1Priority 1Life threatening injuries; but have a high Life threatening injuries; but have a high probability for survival once stabilizedprobability for survival once stabilizedExamples include: Examples include: Trauma/limb amputationTrauma/limb amputation Chest pain/severe respiratory distress/cardiac Chest pain/severe respiratory distress/cardiac

arrestarrest Acute neurological deficitsAcute neurological deficits Chemical splashes to the eyes Chemical splashes to the eyes

Yellow (delayed) Yellow (delayed)

Medically stableMedically stableTreated after “immediate” patients, but Treated after “immediate” patients, but within one to two hourswithin one to two hoursWill require an ongoing evaluation every Will require an ongoing evaluation every 30 to 60 minutes prior to medical attention30 to 60 minutes prior to medical attentionExamples include:Examples include: Simple fractureSimple fracture FeverFever Abdominal painAbdominal pain

Green (minor) Green (minor)

Medically stableMedically stable

Treated after “immediate” patients and “delayed” Treated after “immediate” patients and “delayed” patientspatients

Can wait several hours for medical attention, but Can wait several hours for medical attention, but will require an ongoing evaluation every one to will require an ongoing evaluation every one to two hours prior to medical attentiontwo hours prior to medical attention

Examples include:Examples include: Minor lacerationMinor laceration SprainSprain

Black (deceased) Black (deceased)

Resuscitation attempts are unsuccessful Resuscitation attempts are unsuccessful

Sustained injuries are beyond the scope of Sustained injuries are beyond the scope of medical staffmedical staff

Client assessment in the triage Client assessment in the triage settingsetting

Primary assessment Primary assessment

Primarily objective dataPrimarily objective data

Using the ABC’s (airway, breathing, and Using the ABC’s (airway, breathing, and circulation) as a guide to identify circulation) as a guide to identify immediate or potentially life threatening immediate or potentially life threatening medical needsmedical needs

Assess for head or spinal injuriesAssess for head or spinal injuries

Initiate interventions immediatelyInitiate interventions immediately

Secondary assessment Secondary assessment

Follows primary treatment and initial medical Follows primary treatment and initial medical treatmenttreatmentUtilizes objective and subjective dataUtilizes objective and subjective dataIncludes:Includes: General overviewGeneral overview Health historyHealth history Vital signsVital signs Neurological assessmentNeurological assessment Pain assessmentPain assessment Physical assessmentPhysical assessment

Defining QuoteDefining Quote

“ “Triage and life saving treatment should Triage and life saving treatment should never be delayed because of the never be delayed because of the possibility of radioactive contamination of possibility of radioactive contamination of the victim. In general, the risk of exposure the victim. In general, the risk of exposure to caregivers is small. Universal to caregivers is small. Universal precautions effectively protect against precautions effectively protect against radiological secondary contamination of radiological secondary contamination of first responders and first receivers” (CDC, first responders and first receivers” (CDC, 2008).2008).