Disaster Preparedness and Emergency Response: A Guide for Healthcare Professionals, Exams of Biology

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Lesson 29:

Emergency

response Plan,

Disasters, and

Triage

Emergency response plan - answer a health care agency's preparedness and response plan in the event of a disaster Disaster - answer is any event, human-made or natural, that results in destruction or large-scale injury that cannot be addressed without assistance (i.e., medical, local, or federal government assistance). Examples of disasters - answer Human- made: Dam failure resulting in flooding, Hazardous materials exposure (e.g., pollution, chemical spill, or toxic gas leak), Release of radioactive material, Resource shortage (e.g.,

food, water, electricity), Structural collapse, Fire or explosion, Terrorist attack (e.g., bombing, bioterrorism), Rioting, Mass-transportation accident. Natural: Blizzard, Epidemic, Cyclone, Drought, Earthquake, Flood, Forest fire, Hailstorm, Hurricane, Landslide, Mudslide, Tornado, Tsunami, Volcanic eruption. Internal disaster - answer those that occur within a health care agency, include such events as fires, structural collapses, explosions, and radiation spills. External disasters - answer those that occur outside the health care agency, may result in multi-casualty or mass casualty that could send a rush of clients to emergency departments (EDs) in the area. Phases of disaster management: Mitigation - answer This phase consists of actions or measures to prevent the occurrence of a disaster or reduce the damaging effects of one.

• It involves a determination of community hazards and risks for the occurrence of a disaster.
• Community resources and health personnel are identified, as are resources for the care of infants, older clients, clients with disabilities, and those with chronic health problems.

Phases of disaster management: Preparedness - answer - This phase involves the formulation of plans for rescue, evacuation, and care of disaster victims.

• Disaster personnel are trained and resources, equipment, and other materials that will be needed to deal with a disaster are gathered.
• A community disaster plan and an effective public communication system are established, as are an emergency medical system and a plan for its activation.
• Provisions are stockpiled and a location for distribution of food, water, clothing, shelter, medicine, and other supplies is established.
• Supplies are regularly assessed; those that are outdated are replenished. Phases of disaster management: Response - answer - Response involves putting disaster planning services into action and enumerating the actions needed to save lives and prevent further damage.
• The primary concerns are the safety and physical and mental health of both the victims and the members of the disaster response team. Phases of disaster management: Recovery - answer - In this phase, action is taken to facilitate a return to normal after the disaster: prevention of debilitating effects and

restoration of personal, economic, and environmental health and stability to the community.

• Acute stress disorder or posttraumatic stress disorder is a concern for disaster survivors. Personal Emergency plan - answer - Agree on a meeting place for family members.
• Determine where to go if an evacuation is necessary.
• Learn when and how to turn off water, gas, and electricity to the residence.
• Locate safe places in the home for each type of disaster.
• Replace the stored water supply every 3 months and stored food every 6 months. Personal and Professional Preparedness - answer - Be aware of disaster plans in the workplace and the community.
• Maintain certification in disaster training and in cardiopulmonary resuscitation.
• Prepare professional emergency response items (e.g., copy of nursing license, personal health care equipment such as a stethoscope, cash, warm clothing, record- keeping materials, and other nursing care supplies such as gauze pads, bandages, and slings).

Role of the Nurse in Disaster Preparedness: Health care - answer - The nurse may need to decide which clients in the facility may be safely discharged home to make beds available for disaster victims.

• Clients with high-priority needs (e.g., oxygenation problems, otherwise unstable conditions) require continued hospitalization; discharge home, with assistance and support from community resources, may be possible for those with intermediate- or low-priority needs (i.e., those in stable conditions). Role of the Nurse in Disaster Preparedness: Community setting - answer - A nurse who is the first responder to a disaster cares for victims by attending to those with life- threatening problems who can be saved first.
• Once rescue workers have arrived on the scene, immediate plans for triage would be made. Hazardous Materials Response Team - answer - known as the "HAZMAT team," responds to emergency situations in which a leak or spill of a hazardous substance has occurred, is suspected to have occurred, or is likely to occur.
• the team is an organized group of employees, designated by the employer, who are expected to handle and control hazardous substances.
• The nurse must be familiar with the agency's procedures for when a leak or spill of a hazardous material occurs and must be prepared to follow the

directions of the HAZMAT team to ensure the safety of clients, staff, and visitors. Triage - answer the classification of victims based on the severity of injury, urgency of need for treatment, and place and resources for treatment. Client Assessment in the Emergency Department: Primary

• answer - or initial assessment is used to identify client problems that pose an actual or potential threat to life.
• Assessment is based primarily on objective data; if any abnormalities are found, interventions are immediately initiated.
• The nurse also assesses the client who has sustained traumatic injury for signs/symptoms of head or cervical spine injury. Note that CAB (Chest compressions, Airway, Breathing) guidelines are used if cardiopulmonary resuscitation is necessary. Client Assessment in the Emergency Department: Secondary - answer - conducted after treatment of any problems identified during the primary assessment. It is used to identify any other life-threatening problems the client might be experiencing.
• Both subjective and objective data are obtained; this assessment comprises a history, general overview, vital signs measurement, neurologic assessment, pain

assessment, and a complete or focused physical assessment. SECURITY PLANS AND EVACUATION PROCEDURES: Nursing responsibilities - answer - The nurse must be aware of the agency's security plan and evacuation procedures in the event that security is threatened (e.g., bomb threat, explosion, and fire).

• The nurse would follow agency protocols and procedures if the security plan is activated.
• Evacuation procedures would be implemented if the nurse is directed to carry them out. SECURITY PLANS AND EVACUATION PROCEDURES: Guidelines for Evacuation - answer - All personnel are mobilized to evacuate clients.
• Clients who are close to the area of risk (e.g., fire or explosion) are at risk for injury and must be moved to another area.
• If a client is receiving oxygen but not life support, the oxygen is shut off in the event of a fire, because oxygen is an accelerant and will worsen an existing fire.
• If the client is on life support, respiratory status is maintained manually with the use of a bag-valve-mask device until the client has been removed from the area of risk. Ambulatory clients are directed to walk to a safe area.

• In some cases, ambulatory clients may be able to help move clients in wheelchairs.
• bedridden clients are moved on stretchers or in their beds or wheelchairs; if these methods are not feasible, clients must be carried from the area. Care must be taken not to exceed the nurse's capacity for lifting because injury to the nurse will result in further injury to the client. Examples of Warfare Agents - answer Biological: Anthrax, Botulism, Hemorrhagic fever, Plague, Smallpox, Tularemia Chemical: Ionizing radiation, Mustard gas, Phosgene, Sarin Warfare agents - answer A biological or chemical substance that can cause mass destruction or fatalities Agents of biological and chemical warfare: Nurse's Role - answer - The must be aware that a bioterrorism attack may initially resemble a naturally occurring outbreak of infectious disease.
• Nurses and other health care workers must be prepared to assess clients and the circumstances and determine what type of event occurred, the number of clients who may be affected, and how and when clients may arrive.

• It is essential to find any changes in the microorganism that might increase its virulence or make it resistant to conventional antibiotics or vaccines. PRIORITY POINTS TO REMEMBER! - answer A disaster is any event, human-made or natural, that results in destruction or large-scale injury that cannot be addressed without assistance (i.e., medical, local, or federal government assistance). PRIORITY POINTS TO REMEMBER! - answer A disaster preparedness plan is a formal plan of action for coordinating the response of a health care agency's staff in the event of a disaster, either within the agency or in the surrounding community. PRIORITY POINTS TO REMEMBER! - answer The nurse must be aware of disaster preparedness plans, security plans, and evacuation procedures at their place of employment and in the community. PRIORITY POINTS TO REMEMBER! - answer If a disaster occurs within a health care agency, the agency's disaster preparedness plan is immediately activated and the nurse responds by following the directions identified in the plan.

PRIORITY POINTS TO REMEMBER! - answer A nurse who is the first responder to a disaster in the community attends first to individuals with life-threatening problems; once rescue workers have arrived on the scene, immediate plans for triage would be made. PRIORITY POINTS TO REMEMBER! - answer Various rating systems are used in different clinical settings; the nurse must be familiar with the rating system of the health care agency in which they are employed. PRIORITY POINTS TO REMEMBER! - answer One rating system commonly used in the emergency department consists of three tiers: "emergent," "urgent," and "non- urgent"; such categories may also be identified with the use of color-coding or numbers. PRIORITY POINTS TO REMEMBER! - answer The purpose of primary assessment is to identify any problem that poses an immediate or potential threat to the life of the client in question. PRIORITY POINTS TO REMEMBER! - answer Secondary assessment, performed after treatment of problems detected during the primary assessment, is used to identify any other life-threatening problems the client might be experiencing.