Disaster Nursing 2014 p

TERRORISM, MASS CASUALTY, AND DISASTER NURSING

DISASTERSAny catastrophic situation in which the normal patterns of life (or ecosystems) have been disrupted and extraordinary, emergency interventions are required to save and preserve human lives and/or the environment

TYPES OF DISASTERSAccording to CAUSE/OCCURRENCE

Natural-caused by forces of naturee.g. earthquake, typhoons, volcanic eruptions

TYPES OF DISASTERSAccording to CAUSE/OCCURRENCE

Man-made- caused by errors of mane.g. war, civil strife or other conflicts

Technologicale.g. air crashes, pollution, nuclear accidents, explosions

According to PREDICTABILITY

Sudden Onset- no warning issuedSlow Onset-disasters that come with warningse.g. typhoons, volcanic eruptions

According to EXTENT OF DAMAGE

Large scale-effects not solely limited to the impact area

Small scale-effects are localized; limited only to the impact area

Phenomenon that poses threat (s) to people structure or economic asset that may cause a disaster either-human introduces or-naturally occurring in the environment

DISASTER NURSINGThe adaptation of Professional Nursing KNOWLEDGE , Skills and ATTITUDE in recognizing and MEETING the nursing and MEDICAL NEEDS of DISASTER VICTIMS

BASIC PRINCIPLES IN PLANNING FOR DISASTER NURSINGN- ursing Plans should be integrated and coordinatedU- pdate physical and Psychological preaparednessR- esponsible for Organizing, Teaching and SupervisionS- timulate Community ParticipationE- xercise Competence

BASIC PRINCIPLES OF NURSING CARE for DISASTER VICTIMSA- daptation of Skills to SituationC- are for Disaster VictimsC- ontinuous Awareness of the patients conditionT- each AUXILLARY personnelS-election of Essential Care

ROLES and RESPONSIBILITIES of a DISASTER NURSED- isseminate information on the prevention and control of environmental HazardsI- nterpret health laws and regulationsS- erve yourself of self-survivalA- ccepts directions and take orders from an organized authority

ROLES and RESPONSIBILITIES of a DISASTER NURSES- erve the best of the MOSTT- each the meaning of warning signalsE- xercise leadershipR- efer to appropriate agencies

HAZARDRare or extreme event in the natural or man-made environment that adversely affect human life, property or activity to the extent of causing disaster

VULNERABILITYExtent to which the community, structure, service or geographic area is likely to be damaged or disrupted by the impact of a particular hazard

HAZARD+VULNERABILITY/CAPACITY=DISASTER RISK

PHYSICAL VULNERABILITYExtent of likely damage/disruption on account of nature/construction and proximity to man-made environment (buildings and natural environment, forest, aquaculture)

CAPABILITIESResources and skills people posses, can develop, mobilize and have access to which allow them to have more control over shaping their future

Emergency Operations Plan (EOP)Health care facilities are required by the Joint Commission on Accreditation of Healthcare Organizations to create a plan for emergency preparedness and to practice this plan twice a year

describes how a facility will respond to and recover from all hazards.

Emergency Operations Plan (EOP)Essential components of the plan:An activation responseAn internal/external communication planA plan for coordinated patient careSecurity plansIdentification of external resources

Emergency Operations Plan (EOP)Essential components of the plan:A plan for people management and traffic flowEssential components of the plan:A data management strategyDeactivation responsePost-incident responseA plan for practice drillsAnticipated resourcesMass casualty incident planningAn education for all of the above

TriageThe sorting of patients to determine priority health care needs and the proper site of treatmentIn nondisaster situations, health care workers assign the highest priority and allocate the most resources to the most critically illIn disaster situations with large numbers of casualties, decisions are based on the likelihood of survival and the consumption of resources

START TriageSTART - Simple Triage And Rapid Treatment"The Race Against Time"You're first at the scene of an accident involving a car and a bus. There are two people in the car and thirty on the bus.There are various levels of injuries, but everyone seems to be hurt. Where do you START? The crying child, the pregnant woman, the hysterical bus driver? You feel overwhelmed and your mind is overloaded.

START TriageAre you prepared to handle so many patients? By triaging patients, you will be able to concentrate first responder resources on the most seriously injured.What is STARTA Simple Triage and Rapid Treatment plan designed for first responders.The START system was designed in 1983 and updated in 1994.

START TriageIt is meant for rescuers with basic first aid skills. It can be applied by fire-rescue squads, industrial or school safety personnel, and other medical professionals.

Classification

First responders using START evaluate victims and assign them to one of the following four categories:Immediate (red)Delayed (yellow)Walking wounded/minor (green)Deceased/expectant (black)[

*Free Template from www.brainybetty.com*

Free Template from www.brainybetty.com

The colors correspond to triage tags, to indicate each victim's statusResponders arriving to the scene of a mass casualty incident may first ask that any victim who is able to walk relocate to a certain area, thereby identifying the ambulatory, or walking wounded, patients. Non-ambulatory patients are then assessed. *Free Template from www.brainybetty.com*


The only medical intervention used prior to declaring a patient deceased is an attempt to open the airway. Any patient who is not breathing after this attempt is classified as deceased and given a black tag. No further interventions or therapies are attempted on deceased patients until all other patients have been treated. *Free Template from www.brainybetty.com*


Patients who are breathing and have any of the following conditions are classified as immediate:respiratory rate greater than 30 per minute.unresponsive (unable to follow commands)All other patients are classified as delayed



Treatment and EvacuationAfter all patients have been evaluated, responders use the START classifications to determine priorities for treatment or evacuation to a hospital. The most basic way to use the START classifications is to transport victims in a fixed priority manner: immediate victims, followed by delayed victims, followed by the walking wounded*Free Template from www.brainybetty.com*


Military Triage

Military TriageClassic military triage is based on a series of guidelines known as the conventional North American Treaty Organization triage classification. The "immediate" category includes patients who are to be treated first and include those with the following injuries: airway obstructioncardiorespiratory failuresignificant external hemorrhageshock**

Military TriageClassic military triage is based on a series of guidelines known as the conventional North American Treaty Organization triage classification. sucking chest woundpartial-or full-thickness burns of the face and neck. These patients have life-threatening injuries that can be treated with minimal use of resources**

Military Triage2) The "delayed" category includes patients with the following types of injuries: open thoracic wound, penetrating abdominal wound, severe eye injury, avascular limb, fractures, and partial-or full-thickness burns not involving the face, neck, or perineum. A delay in treatment of up to 6 to 8 hours will not substantially alter outcome. *Free Template from www.brainybetty.com*


Military Triage3) The "minimal" category includes patients with the following injuries: minor lacerationsContusionsSprainssuperficial burns, and partial-thickness burns of less than 20% of body surface area. These patients will not suffer significant morbidity even if no further medical intervention is performed. *Free Template from www.brainybetty.com*


Military Triage4) The "expectant" category includes patients in whom there are signs of impending death or those with treatable injuries requiring a vast expenditure of resources. This includes patients with head injury and a GCS score lower than 8, partial-or full-thickness burns affecting greater than 85% of body surface areamultisystem trauma. *Free Template from www.brainybetty.com*


Military TriageUnfortunately, this category must exist when there are inadequate resources to treat all patients, such as during wartime and in situations involving mass casualties.*Free Template from www.brainybetty.com*


Hospital Emergency Incident Command System

created in the late 1980s as an important foundation for the 5,815 registered hospitals in the United States in their efforts to prepare for and respond to various types of disasters.designed for hospitals and intended for use in both emergency and non-emergency situations. It provides hospitals of all sizes with tools needed to advance their emergency preparedness and response capabilityboth individually and as members of the broader response community.*Free Template from www.brainybetty.com*


Incident Command Education*Free Template from www.brainybetty.com*


Personal Protective Equipment (PPE)Purpose: to shield the health care provider from chemical, physical, biological, and radiologic hazards that may exist when caring for contaminated patients

Personal Protective Equipment (PPE)Categories of protective equipment:Level A: self-contained breathing apparatus (SCBA) and vapor-tight chemical-resistant suit, gloves, and bootsLevel B: high level of respiratory protection (SCBA) but lesser skin and eye protection; chemical-resistant suitLevel C: air-purified respirator, coverall with splash hood, and chemical-resistant gloves and bootsLevel D: typical work uniform

Hazardous MaterialA hazardous material is defined as any substance or material could adversely affect the safety of the public, handlers or carriers during transportation.*Free Template from www.brainybetty.com*


Hazard Class 1: Explosives1.1 mass explosion hazard 1.2 projectile hazard 1.3 minor blast/projectile/fire 1.4 minor blast 1.5 insensitive explosives 1.6 very insensitive explosives*Free Template from www.brainybetty.com*


Hazard Class 2: Compressed Gases2.1 flammable gases 2.2 non flammable compressed 2.3 poisonous

Flammable (flash point below 141) Combustible (flash point 141-200



Hazard Class 4: Flammable Solids4.1 flammable solids 4.2 spontaneously combustible 4.3 dangerous when wet

5.1 Oxidizer 5.2 Organic Peroxide



Hazard Class 6: Toxic Materials6.1 Material that is poisonous 6.2 Infectious Agents

Radioactive I Radioactive II Radioactive III



Class 8: Corrosive Material

Destruction of the human skin Corrode steel at a rate of 0.25 inches per year*Free Template from www.brainybetty.com*


Hazard Class 9: Miscellaneous

A material that presents a hazard during shipment but does not meet the definition of the other classes*Free Template from www.brainybetty.com*


Decontaminationthe process of removing accumulated contaminants, is critical to the health and safety of health care providers by preventing secondary contamination. The decontamination plan should establish procedures and educate employees about decontamination procedures, identify the equipment needed and methods to be used, and establish methods for disposal of contaminated materials*Free Template from www.brainybetty.com*


DecontaminationThe first step is removal of the patients clothing and jewelry and then rinsing the patient with water- this step alone can remove a large amount of the contamination and decrease secondary contamination The second step consists of a thorough soap-and-water wash and rinse. *Free Template from www.brainybetty.com*


DecontaminationWhen patients arrive at the facility from a prehospital provider, it should not be assumed that they have been thoroughlydecontaminated.*Free Template from www.brainybetty.com*


WEAPONS OF TERRORBiological Weapons

Biological weaponsweapons that spread disease among the general population or the military. Use of biological weapons dates far back into history, but improved production techniques and genetic engineering have expanded the potential for widespread casualties as a result of biological weaponry.*Free Template from www.brainybetty.com*


Biological Warfareis a covert method of severely affecting the target. biological weapons are easily obtained and easily disseminated, and they result in significant mortality and morbidity.Biological agents are delivered in either a liquid or dry state, applied to foods or water, or vaporized for inhalation or direct contactFree Template from www.brainybetty.com*


Biological WarfareVaporization may be accomplished through spray or explosives loaded with the agent. With increased travel, an agent could be released in one city and affect people in other cities thousands of miles away. The vector can be an insect, animal, or person, or there may be direct contact with the agent itself.Free Template from www.brainybetty.com*


Biological WeaponsANTHRAXSMALLPOXTularemiaFrancisella tularensis: gram-negative coccobacillus, one of the most infectious bacteria knownBotulismClostridium botulinum: Botulinum resulting in a flaccid paralysis.PlagueYersinia pestis The bacterium causes destruction and necrosis of the lymph nodes.Free Template from www.brainybetty.com*


Isolation Precautions for Biological Terrorism AgentsBiological agents may be delivered or spread in a number of waysDue to modern travel, spread of infection may occur in areas thousands of miles apartAlways use Standard PrecautionsSome agents require Transmission-Based PrecautionsTerminal disinfection and disposal of wastes depends on the infecting agent

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Disaster Nursing 2014 p