disaster and emergency nursingnew

8/11/2019 Disaster and Emergency NursingNEW

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DISASTER

Disaster Nursing can be defined as the

adaptation of professional nursing skills inrecognizing and meeting the nursingphysical and emotional needs resulting from

a disaster.The overall goal of disaster nursing is to

achieve the best possible level ofhealth for the people and thecommunity involved in the disaster.


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TYPES OF DISASTER

Disasters may be:

Natural

Technological

Those in between or hybrid

Another way to classify disasters isbased on speed of onset:

Rapid onset

Slow Onset


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NATURAL DISASTER

1. Geophysical (earthquakes, landslides, tsunamis andvolcanic activity)

2. Hydrological(avalanches and floods)

3. Climatological (extreme temperatures, drought andwildfires)

4. Meteorological(cyclones and storms/wave surges)5. Biological (disease epidemics and insect/animal

plagues).


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TECHNOLOGICAL DISASTERS:

Conflict and Wars leading to refugees and internaldisplacement.

Structure failure and building collapse

Transportation crashes and accidents

Military accidents

Fire disasters Terrorism

Industrial Incidents


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PHASES OF DISASTER MANAGEMENT

1. Mitigation

andPrevention

2. Preparedness3. Response

4. Recovery


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1.PreventionPhase

Mitigation activitiesactually eliminate or

reduce the probability ofdisaster occurrence, orreduce the effects ofunavoidable disasters.


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2.PreparednessPhase

Personal preparedness

Professional

preparedness Community preparedness


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4.Recovery Phase During this phase actions

are taken to repair,rebuilt, or reallocatedamaged homes and

businesses and restorehealth and economicvitality to the community.

Psychological recoverymust be addressed. Bothvictims and relief workersshould be offered mentalhealth activities andservices.


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TRIAGE SYSTEM

Triage system: The process by which a

clinician assesses a patients clinicalurgency.

Triage: A triage system is the basicstructure in which all incomingpatients are categorized into groups

using a standard urgency rating scaleor structure. Triage is a dynamicprocess and is usually done more thanonce.


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TRIAGE

- Primary Triage: is the initial triage done inthe field, allowing responders to quickly andaccurately categorize the patientscondition and transport needs.

- Based on physiologyHow well the patient is able to utilize

their own resources to deal with theirinjuries

Patients unable to physiologicallycompensate for their injuries areassigned higher priority.


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TRIAGE

- Secondary Triage: is done as patients arebrought to the treatment area.

Goal: to best match patients current andanticipated needs with available resources.

Incorporates:

A reassessment of physiology

An assessment of physical injuries

Initial treatment and assessment of

patient responseFurther knowledge of resource

availability


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Secondary Triage cont

Goals is to distinguish between:

Victims needing life-savingtreatment that can only beprovided in a hospital setting.

Victims needing life-savingtreatment initially available onscene.

Victims with moderate non-life-threatening injuries, at risk fordelayed complications.

Victims with minor injuries.


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TRIAGE CATEGORY

RED TAGFIRST

PRIORITY

TYPICAL INJURIESAirway and breathing difficulties

Uncontrolled or severe bleeding

Severe medical problems

Signs of shock

Severe Burns

Open chest or abdominalinjuries


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TRIAGE CATEGORY

YELLLOWTAG

SECONDPRIORITY

TYPICAL INJURIESBurns without airway problems

Major or multiple bone or joint

problems.Back injuries with or withoutspinal cord injury.


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TRIAGE CATEGORY

GREENTAG

THIRDPRIORITY

TYPICAL INJURIESMinor fractures

Minor soft-tissue injuries


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TRIAGE CATEGORY

BLACKTAG

FOURTHPRIORITY

TYPICAL INJURIESObvious death

Obviously non-survivable injury,

such as major open braintrauma

Respiratory arrest (if limited

resources)Cardiac arrest


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TRIAGE

The assignment of degreesof urgency to wounds orillnesses to decide the order

of treatment of a largenumber of patients or

casualties.


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START TRIAGE (Steps)

1. Calling out patients at the disaster

site.

START TRIAGE (S )


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2. Move to the non-ambulatory patient

and check your RPM Assist respiratory status

Hemodynamic status (Pulse)

Neurologic Status

START TRIAGE (S )


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3. Check the

RESPIRATORY None Open the

Airway

Still None? BLACK Restored? RED

Present?

Above 30 RED Below 30 Check

Perfusion

START TRIAGE (S )


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4. Check the

CIRCULATION No pulse or

Greater than 2 RED

Present or Lesserthan 2 CheckMental Status

START TRIAGE (St )


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5. Check MENTAL

STATUS Can not follow

simple

commands RED

Can follow

simplecommands -

YELLOW

START TRIAGE SUMMARY


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MILITARY VS CIVILIAN TRAIGE


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MILITARY VS CIVILIAN TRAIGE

MILITARY CIVILIANPriority is to get as manysoldiers back into action

as possible.

Priority is to maximizesurvival of the greatest

number

Those with least seriouswound may be the first

treatment priority

Those with most seriousbut realistically

salvageable injuries are

treated firstIn both models, victims with clearly lethal injuries orthose who are unlikely to survive even with extensiveresource application are treated as the lowest priority.


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EMERGENCY


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EMERGENCY

A situation that arises

suddenly and threatens thelife or welfare of a person or agroup of people, as a naturaldisaster, medical crisis, ortrauma situation.

EMERGENCY NURSING


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EMERGENCY NURSING

Nursing care provided to prevent

imminent severe damage ordeath or to avert serious injury.

Require urgent intervention to

prevent a worsening of thesituation, although in somesituations, mitigation may not be

possible and agencies may onlybe able to offer palliative care forthe aftermath.

The Father of Modern Medicine


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The Father of Modern Medicine

In fifth century BC,Hippocrates was one of

the first people in theworld to studyhealthcare, earning himthe title of "the father of

modern medicine".Western European concepts

of nursing were firstpracticed by male

Catholic monks whoprovided for the sick andill during the Dark Agesof Europe.

NURSING


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NURSING

In 17th Century Europe, Nursing care wasprovided by persons serving punishment. Itwas associated with prostitutes, and womenserving time for other crimes.

These persons had a reputation of being drunkand obnoxious, a view amplified by thephysicians of the time to make themselvesseem more important and able.

FRANCE


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FRANCE

By the 1600s the French Sisters of mercy wasone of the first organized nursing orders thatresponded to care for epidemic victims.

FRANCE


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FRANCE

During the French Revolution (1789), after seeingthe speed with which the carriages of theFrench flying artillery maneuvered across thebattlefields, French military surgeon DominiqueJean Larrey applied the idea of ambulances, or

"flying carriages", for rapid transport ofwounded soldiers to a central place wheremedical care was more accessible and effective.Larrey manned ambulances with trained crews

of drivers, corpsmen and litter-bearers and hadthem bring the wounded to centralized fieldhospitals, effectively creating a forerunner.

USA


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USA

Nurses in the United States Army actually startedduring the Revolutionary War when a generalsuggested to George Washington that the heneeded female nurses "to attend the sick andobey the matron's orders. In July 1775, a plan

was submitted to the Second ContinentalCongress that provided one nurse for every tenpatients and provided that a matron be allottedto every hundred sick or wounded"


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WWII


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WWII

There were no male nurses in the American military untilyears later

Army and Navy nursing was highly attractive and a largerproportion of nurses volunteered for service higherthan any other occupation in American society

POST WAR CARE


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POST WAR CARE

The military nurses returnedhome as the nations

experts in blood transfusionand the application of newdrugs like penicillin. Whenthe nurses returned home

they used the previouslypowerless American NursesAssociation to take controlof the nursing profession


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PARAMEDICS


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PARAMEDICS

At the same time ERs were becoming more recognized,transport of patients to hospitals for care was also

gaining attention

PARAMEDICS


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PARAMEDICS

Community leaders recognized that lessons learned fromWWII and the Korean Conflict about triage, field care

and rapid transport could be translated to civilianpractice

Korea Air ambulance transport was initiated.

ED TRIAGE


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ED TRIAGE

1. Identify patients requiring immediate care.

2. Determine the appropriate area for treatment3. Facilitate flow through the ED and avoid

unnecessary congestion.

4. Provide continued assessment and

reassessment of arriving and waitingpatients.

5. Provide information and referrals to patients

and families.6. Ease patient and family anxiety and enhance

public relations.

EMERGENCY SITUATION?


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EMERGENCY SITUATION?

Emergent situations are potentially

life-threateningUrgent situations are serious but not

life-threatening if treatment is delayed

briefly;

Nonemergency situations are notacute and are considered minor tomoderately severe

HOSPITAL INCIDENT COMMAND SYSTEM (HICS)


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HOSPITAL INCIDENT COMMAND SYSTEM (HICS)

System for managing emergent and

non-emergent situations Provides hospitals with required tools

to address the event

HICS initiated by an internal/externalevent

Flexible in scale

Only those positions needed areactivated

Administrative position assumes role

as Incident Commander


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