63713468 Disaster Nursing (2)

8/2/2019 63713468 Disaster Nursing (2)

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LECTURE NOTES IN EMERGENCY AND DISASTER NURSINGMary C. Balintona, RN, MAN

DEFINITION OF TERMS

Disaster

Any destructive events that disrupts thenormal functioning of a community.

Ecologic disruptions or emergencies of aseverity and magnitude that result indeaths, injuries, illness and propertydamage that cannot be effectivelymanaged using routine procedures orresources that require outsideassistance.

Types of Disaster

1. Natural- cause by natural or

environmental forces. It includesearthquakes, floods, tornadoes,hurricanes, volcanic eruptions, etc.

2. Man Made/Human Generated

- The principal direct causes areidentifiable human actions,deliberate or otherwise.

- It has three broad categories:

complex emergencies,technologic emergencies,disasters that are cause bynatural hazards but occur innatural settlements.

- Complex emergencies: involvesituations where populationssuffer significant casualties asa result of war, civil strife, orother political conflict.

- Technologic emergencies:large number of people,property, communityinfrastructure, and economicwelfare are directly andadversely affected by majorindustrial accident, unplannedrelease of nuclear energy andfires or explosions fromhazardous substances such as

fuel, chemicals, or nuclematerials.

Medical Disaster

- Is a catastrophic event that results casualties that overwhelm the healcare resources in that community.

Disaster Planning

- Addresses the problems posed bvarious potential vents, ranging in scalfrom mass casualty incidents.

Types of Disaster Planning

1. Agent specific approach

Its a planning type that focuseon the preparedness on molikely threats to occur based otheir geographic location.

2. All hazards approach

Is a conceptual model for disastpreparedness that incorporatedisaster managemecomponents that are consisteacross all major types of disasteevents to maximize resourceexpenditures and planning effort

Crisis/crisis management

Administrative measures thidentify, acquire, and plan the usof resources need to acquire anplan the use of resources need tanticipate, prevent, and or resolva threat to public health ansafety.

Triage


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Is a process which places the rightpatient in the right place at theright time to receive the rightlevel of care.

The word triage is derived fromthe French word trier, whichmeans to sort out or choose.

DISASTER MANAGEMENT AND PLANNING

Disaster Planning

Requires the cooperative efforts of the

hospital, community agencies and localgovernment.

Cunny describes three types ofadvanced planning activities

i. Strategic Planning

These are planning activitiesthat focus on preparing theorganization for any type ofthreat. This is commonlyreferred to as the all hazards

approach.

ii. Contingency Planning

These are planning activitiesrelated to a site-specific threatthat may occur at any time. Anexample of this is in thehospital setting would beplanning activities from afacility that is in closeproximity to a nuclear power

plant or an airport.

iii. Forward Planning

These are planning activitiespt a known imminent disaster;for example, a pendingsnowstorm, hurricane or majorrock concert.

Internal vs External Disaster

Internal Disaster

o Occurs when there is an event within thfacility that poses a threat to disrupt thenvironment of care. (e.g., related tphysical plants, loss of utilities or fire).

External Disaster

o Becomes a problem for a facility whe

the consequences of the event thcreates a demand for services that taor exceed the usual available resource(e.g., arrival of large number of traumpatients of a chemical spill).

Combined Internal and External Disaster

o Classified as

i. Level 1- if the organization, agencor community is able to contain thevent and respond immediately.

ii. Level 2- if the disaster requireassistance from external sources, bthese can be obtained from nearbagencies.

iii. Level 3- if the disaster is of magnitude that exceeds the capacitof the local community or region an

requires assistance form nationlevel.

Disaster Management Programs

o is composed of five phases

i. Preparedness/Risk Assessment


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o Evaluates the facilitys

vulnerability or propensity fordisasters. Issues to considerinclude weather patterns,geographic locations,expectations related to publicevents and gatherings, age,condition, and location of thefacility.

ii. Mitigation

o Steps that are taken to lessen the

impact of as disaster should oneoccur and can be considered asprevention measures.

o Examples are installing and

maintaining backup generators tomitigate the effects of powerfailure or cross training staff toperform tasks to maintainservices during staffing crisis thatis due to weather emergency.

iii. Recovery

o Once the incident is over, the

organization and staffs need torecover. Invariably, services

have been disrupted and ittakes time to return to routine.

iv. Evaluation

Often this phase of disasterplanning and responsereceives the least attention.After a disaster, employees ofthe community are anxious toreturn to usual operations. It isessential that a formalevaluation be done todetermine what went well andwhat problems were identified.

Phases of Disaster Management

1. Risk Assessment

The disaster manager needs consider what type of disasteis most likely to bencountered by thorganization.

All types of events need to bconsidered includindeliberate human-causetechnological and naturevents.

The disaster manager needs perform also a risk assessmein the area of staffinDepending on the nature anextent of the disaster and thdemographics of th

workforce, there may bvariation in the employeeability and or willingness treport to work.

2. Mitigation

Lessens the severity animpact of the disaster througappropriate planning anpractice. The best ways tmitigate the results of

disaster are to perform thorough hazard vulnerabilirisk assessment and be suthat your plan includeprovisions for each of the likeevents.

Essential Elements for Hospital DisasteManagement

1. An appropriate infrastructure to suppothe disaster response which includemaintaining services for preexistinpatients as well as the new arrivals.

2. An appropriately trained staff who acompetent to perform their disastresponse functional roles and able an


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willing to report to work during any sortof disaster.

3. A clearly defined, executable, practicedemergency response plan.

4. A strong foundation of preexistingrelationships with partneringorganizations and agencies that can becalled on to provide mutual aid andsupport when needed.

Hospital Incident Command System (HICS)

- Is an emergency management systemthat is comprised of specific disasterresponse functional role positions withina hierarchical organization chart.

Key Features of Incident Command andHICS

i. Predictable, responsibility orientedchain of command.

o There is one incident commander.

This individual has overall

responsibility for the managementof the incident and the employeesknow who report to them and towhom they report.

ii. Use of common nomenclature

o All agencies utilizing ICS use the

same titles and functional rolesfor the command staff positions.

iii. Modular, flexible organization

o Only those portions of the systemthat are needed for the responseare activated.

iv. Unified command structure

o This allows all agencies involved

in the response to coordinateefforts by establishing a unified

set of incident objectives anstrategies.

v. Incident Action Plan (IAP)

o This is a plan that is develope

when multiple agencies ainvolved in the disaster response

vi. Facility Action Plan (FAP)

o A FAP describes the purpos

goals and objectives for thhospitals response.

vii. Unity of Command

o Each person reports to only on

individual.

viii. Manageable span of control

o Each manager controls a define

amount of resources, which limited to what can realistically bmanaged.

ix. Use of JAS (Job Action Sheets)

o JAS define for the staff what the

defined functional role is durin

emergency and sister response.

TRIAGE

1. Daily Triage

Triage perform by nurse in themergency room. It is a routintriage.

The goal is to identify the sickepatients in order to assess anprovide treatment to them firsbefore providing treatment tothers who are less ill.

2. Incident Triage


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Occurs when the emergencydepartment is stressed by a largenumber of patients but is still ableto provide care to all victimsutilizing existing agencyresources.

3. Disaster Triage

Is employed when localemergency services areoverwhelmed to the point thatimmediate care cannot beprovided everyone who needs it.

During disaster triage, patientsare usually sorted into

i. Critical- are those that arelife threatening but likely tobe amenable to rapidintervention that does notrequire an inordinateamount of resources (e.g.,upper airway obstruction).

ii. Urgent- those conditionsthat are serious and if nottreated in a timely mannerare likely to deteriorate to

become critical (e.g.,compound fracture of along bone).

iii. Minor- the care requiredcan be provided in a lowtech tribute setting and adelay in treatment wouldunlikely constitute to asignificant deterioration inthe victims condition.

iv. Catastrophic- conditions

that have either a verygrave prognosis or wouldrequire an amount ofresources that are so largethey would divert care fromothers with a much betterprognosis (e.g., cardiacarrest).

4. Tactical Triage

Is similar to disaster triage, onmilitary mission objectives rathethan traditional civilian guidelinedrive the triage and transpodecisions.

5. Special Conditions Triage

Is used when patients presefrom incidents such as radiatiobiological or chemiccontamination.

6. Triage during an epidemic

Usually use during mass casualttrauma situations (e.gbioterrorism).

I. In-Hospital Triage Systems

Utilize a triage system that habetween three and fivcategories.

The three main categories are

i. Emergent- signifies condition that requiretreatment immediatewithin 15mins.-30min(e.g., cardiac arrest, airwaobstruction).

ii. Urgent- utilized for seriouillness or injury that mube attended to but a waof up to 2 hours would noadd to the morbidity an

mortality of the patient.iii. Non-urgent- is an

condition that can wait fomore than 2 hours to bseen without the likelihooof deterioration.

II. Disaster Triage System


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Simple Triage and RapidTreatment System (START) foradults

JumpSTART system (for triagingpediatric patients)

Start/Save (when the triageprocess must be over anextended period of time)

1. Simple Triage and Rapid TreatmentSystem (START) for adults

A common algorithm that is usedwith adult pre-hospital triage.

Developed by Newport BeachCalifornia, Fire and MarineDepartment and Hoag Hospital.

It is based on the persons abilityto respond verbally and ambulateand their respirations, perfusion,and mental status (RPM). Thesystem works as follows

i. All patients who can walk(walking wounded) are

categorized as Delayed(Green) and are asked tomove away from theincident area to a specificlocation.

ii. The next group of patientsis assessed quickly (30-60seconds per patient) byevaluating RPM:respiration, perfusion andmental status.

2. JumpSTART

Created to meet the unique needsof assessing children less than 8years of age.

Should be used if t5he victilooks like a child and STARshould be sued whenever thvictim looks like a young adult oolder.

The JumpSTART Pediatric MTriage Tool is the first objectivtool developed specifically for thtriage of children in thmulticasualty/disaster setting.

The objective of JumpSTART are

i. To optimize the primatriage of injured children the MCI setting

ii. To enhance theffectiveness of resourceallocation for all Mvictims

iii. To reduce the emotionburden on triage personnwho may have to makrapid life or death decisioabout injured children chaotic circumstances.

3. START/SAVE Triage for CatastrophDisasters

The SAVE Triage was developeto direct limited resources to thsubgroup of patients expected tbenefit most from their use.

The SAVE assesses survivability patients with various injuries anon the basis of relationsh

between expected benefits anresources consumed.

Two types of area location START Triage


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i. Expectant area- wouldrequire the use of significant medicalresources.

ii. Treatment area- would use

few resources and wouldhave a reasonable chanceof survival.

III. Disaster Triage for Chemical andHazardous Material Disasters

Triage for chemical incidents willoccur in several places

i. In the field

o Hot Zone- this is the

area immediatelyadjacent to thelocation of theincident.

o Warm Zone- this is

the distance of atleast 300 feet fromthe outer perimeterof the hot zone and

is upwind and uphillfrom thecontaminated area.

o Cold Zone- this area

is adjacent (anduphill and upwind)to the warm zoneand is wheredecontaminatedvictims enter.

ii. In the hospital setting

o Warm Zone- this is

an area that isadjacent to thehospital (usually theemergencydepartment), whichhas a source ofwater.

o Clean Zone- this

the treatment areinside of themergencydepartment hospital whenewly arrivinpatients and victimare sent afthaving been triageanddecontaminated.

NATURAL DISASTERS

Cyclones

Are large scale storcharacterized by low pressure in thcenter surrounded by circular winmotion.

Drought

Is often seen as a result of tolittle rain and is often synonymouwith famine. Drought often triggers

crisis in arid and semi arid areabecause rain is sparse and irregular.

Earthquake

Considered to be the modestructive and frightening of aforces of nature, is a sudden, rapshaking of the earth caused by thbreaking and shifting of rock beneat

the Earths surface.

The Ritcher scale, used as aindication of the force of aearthquake, measures the magnitudand intensity of energy released bthe quake.


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Tsunamis

Series of waves usually generated bylarge earthquakes under or near theocean occur when a body of water israpidly displaced on a massive scale.

Submarine landslides and volcaniceruptions beneath the sea or on smallislands can also be responsible fortsunami but their effects are usuallylimited to smaller areas.

The following events may signal a tsunami

1. A recent submarine earthquake

2. The sea appears to be boiling, as largequantities of gas rises to the surface ofthe water.

3. The water is hot, smells of rotten eggs,or stings the skin.

4. There is an audible thunder or boomingsound followed by a roaring or whistlingsound.

5. The water may recede a great distancefrom the coast.

6. Red light might be visible near thehorizon and, as the wave approaches,the top of the wave may glow red.

ENVIRONMENTAL EMERGENCIES andDISASTERS

Environmental emergencies

Is a sudden threat to the public health orto the well being of the environmentarising from the release or potentialrelease of oil, radioactive materials orhazardous chemicals into the land, air orwater.

These emergencies may occur fromtransportation accidents, events atchemical facilities or other facilities

using or manufacturing chemicals or aa result of natural or manmade disasteevents.

Environmental disasters

Is defined as an environmentemergency or ecologic disruption of severity and magnitude resulting deaths, injuries, illness and/or propertdamage that cannot be effectivemanaged by the application of routinprocedures or resources and that resuin a need for additional assistance.

Measures that are implemented durin

environmental disasters:

1. The immediate removal of the hazafrom the environment.

2. Decontamination of exposeindividuals.

3. The restoration of services to methe immediate physiological needs the affected people.

4. The prevention of further illness o

injury as a result of exposure to thhazard.

Environmental Hazards

1. Chemical Spills

o Intentional or accidental leakag

or spill of certain chemicsubstances into the environmethat can have devastatin

consequences on human health.

2. Oil spills

o The leakage of oil in the bodies

water surrounding a land area.

BIO-CHEMICAL WARFARE AND TERRORISM


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Biochemical terrorism

o According to Bruce Hoffman, it is the

deliberate creation and exploitation offear through violence or the threat ofviolence in the pursuit of political

change.

o The use of chemical or biological agents

as the main element of a terrorist attackor threat.

Chemical Agents

o Are those chemical compounds

synthesized artificially and include themany toxic chemicals that may beavailable to terrorists.

o Chemical weapons utilize the toxic

nature of selected substances to causedeath or injury. These chemical warfareagents may cause injury via therespiratory route, through the skin byingestion.

Biological Agents

o Are those pathogens used deliberately

to infect persons as well as toxinsnormally derived from plants or animals.In biological warfare, infectious agentscan infect through respiratory andingestion routes.

Chemical Terrorism

Delivery of Chemical Agents

o Is optimized by producing contaminated

areas with high concentrations of a toxiccompound. Chemical compounds thatare gaseous at room temperature or areextremely volatile do not need muchengineering to deliver.

o For a terrorist who is intent on causin

chemical casualties, acquiring highend agents such as military nervcompounds might be too difficult unnecessary.

o Some of the chemical agents used are

a) Nerve agents (e.g., sarin)

b) Tissue (blood) agents (e.gcyanide)

c) Lung irritants (e.g., chlorine gas)

d) Vesicants (i.e., blister agents sucas mustard or lewsite)

e) Psychoincapacitants (e.g., B

LSD)

f) Pesticides

Nerve Agents

o Include the chemical tabun, sari

soman, and VX. These toxorganophosphate compounds all operaon the same basic principle-they inhibacetylcholinesterase.

Tissue (Blood) Agents

o Includes cyanide in its various form

Ultimately cyanide blocks the enzymcytochrome oxidase, shutting down thenergy transport (ATP) system.

Lung Irritants

o Attack the respiratory system causin

tightness in the airways, hypoxia, and

more severe cases, pulmonary edema.

o Vesicants

- the so-called vesicants or blister agensuch as mustard gas and lewisite, havless utility for terrorist.

o Psychoincapacitants


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- The psychotropic compounds such asthe belladonna drug BZ (3-quinuclidinylbenzilate) or the hallucinogen LSD havebeen considered by militaries for use incombat and for sabotage. Theirperformance on the battlefield, however,has largely been consideredunpredictable and impractical.

o Pesticides

- Refers to a group of agents used to kill anumber of different pests, such asweeds, insects, ticks, rats, and so forth.

Bioterrorism

o The act of biological terrorism

(bioterrorism) involves the deliberateuse of microbial pathogens or toxins.Unlike a chemical incident, the effectsfrom bioterrorism may not be fullyknown until many hours or days afterthe event.

o The following are the agents used in

bioterrorism

- Bacterial agents

- Viral agents

- Toxins (derived from plant or animals)

- Parasites

PHILIPPINE DISASTER COORDINATING

COUNCIL AND THE PHILIPPINE NATIONAL

RED CROSS

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63713468 Disaster Nursing (2)