disaster nursing caring for vulnerable populations in the community during a disaster shirley p....
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DISASTER NURSING
Caring for Vulnerable Populations in the Community During a Disaster
Shirley P. Smith, PhD, RN, CRNP,
Duquesne University, School of Nursing,
Pittsburgh, PA
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DEFINITION
• Natural or man-made event that significantly disrupts and harms the people and environment
• ...causes human suffering and creates human needs that victims cannot alleviate without assistance (ARC, 1975)
• Multiple casualty incident• Mass casualty incident (MCI)• Chemical, Biological, Radiation, Nuclear,
Explosive (CBRNE)
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HISTORICAL FACTORS
• The Plague– 1346—Tatar army hurled corpse infected with
plague at enemy; Russian used same against Sweden—1710;
• Assyrians poison well water• Smallpox infected blankets: English to Native
Americans during French/American War—1754-1767
• 1984-- Oregon Salmonella
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Biological Weapons Convention, 1972
– Agreement to prohibit development, production, stockpiling of Bacteria, Viruses, Biological toxins
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BE ALERT! BE VIGILANT!
• Smallpox– Lesions in mouth and throat– Differs from Varicella (chicken pox) which usually
begins on the trunk
• Anthrax– Inhalation: Flu like symptoms—followed by
improvement– Malaise, fever, rigors, vomiting, headache, backache,
delirium
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PHASES OF A DISASTER
1. PreImpact a. Mitigation 1) Reduce the effect/prevent damages b. Planning 1) disaster training 2) supplies/equipment storage 3) emergency management
c. Warning system 1) line of authority 2) communication
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PHASES OF A DISASTER
2. Impacta. Response 1) Assessment
of damage 2) Triage & first
aid 3) minimize
panic & chaos
4) provide shelter/food
5) morgue facilities
established
6) Search & Rescue activities
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PHASES OF A DISASTER
3. PostImpact a. Emergency
1) rescue 2) first aidb. Recovery 1) Prevent debilitating effects 2) Restore personal, economic environmental health 3) Post-traumatic stress management 4) Evaluative feedback
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SCOPE & SEVERITY
• Vulnerability of population/individual– Age, physical/mental
status/mobility
• Environmental Factors/Type of Impact– Length time loss of utilities– Chemical leaks– Bacterial contamination
• Warning Time/Proximity to Disaster– Increased response if no
warning and close proximity
• Individual Perceptions– Coping skills– Personal losses– Previous disaster
experiences– Role overload
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CORE COMPETENCIES
• Critical Thinking
• Communication Skills
• Assessment Skills
• Technical Skills
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CRITICAL THINKING
• Ethical framework to support decision-making
• Assessing potential for appropriate and timely response
• Modify approaches to triage
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COMMUNICATION SKILLS
• Understand chain of command
• Locate emergency response plan
• Responsible party within the agency
• Accurately document
• Key referral sources
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ASSESSMENT
• Safety issues for self and team
• Sign/symptoms of common diseases
• Conduct health assessment—physical status
• Mass Casualty Event (MCE) scene
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HEALTH ASSESSMENT
• Respiratory, airway
• Cardiovascular, signs of shock
• Integumentary
• Pain
• Head to toe trauma assessment
• Basic neurological exam
• Mental status assessment
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TECHNICAL SKILLS
• Med administration
• Tube insertions
• Eye lavage
• Isolation procedure
• Fluid/nutrition support
• Prepare injured for transport
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CORE KNOWLEDGE
• Health promotion, risk reduction, disease prevention– Identify potential threats/impact on public– Protect self– Consider community health issues– Describe epidemiological and surveillance principles
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CORE KNOWLEDGE
• Health care systems and policy– Emergency response system– Describe the phases of a disaster– Aware of impact of MCIs on access to
resources– Maintain the site as crime scene (forensics)– Legal authority of public health agencies to
take action to protect the public
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CORE KNOWLEDGE
• Illness and disease management
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CORE KNOWLEDGE
• Information and health care technologies
• Ethics
• Human Diversity
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PROFESSIONAL ROLE DEVELOPMENT
• Describe nursing roles
• Choose your role
• Know limits of one’s knowledge/skills
• Continuing education in this area
• Participate in regular drills
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MENTAL HEALTH ASPECTS OF TERRORISM
• Fears, anxiety
• Insomnia, nightmares
• Sensitivity to loud noises
• Irritability, confusion
• Disobedience
• Depression
• Alcohol/drug use
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NURSES RESPONSIBILITIESNurses’ Characteristics
• Learn early signs and symptoms– First to notice increase in symptoms– Rapid recognition and diagnosis
• Learn modes of transmission
• Protect Self– Nurse on front lines at risk
• Know emergency plans
• Participate in preparedness programs
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DISCUSSION QUESTION
• Mrs. Fraker was angry and resentful. She was told that everyone would be getting 1% loans to rebuild their houses and businesses. Many of her neighbors had been seen and were starting to rebuild. Prices were going up and no one from the government had even come to look at damages to her house. Discuss her reaction to the disaster.
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DISCUSSION QUESTION
• Consider your response in an emergency situation. If you witnessed a car or bus wreck what would you do? Would you stop? If no, why not? If you were home and heard about the wreck would you report to work? If you did not work would you call the ARC and volunteer?
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WebLinks/References
www.astho.org/programs/preparedness (pandemic planning & response) Association of State and Territorial Health Officials
Ahrq.gov (how to set up mass immunization screening) Health Care Services
http://www.panurses.org/ PSNA RN Emergency Preparedness Taskforce
Beachley, M. L. (2005). Nursing in a disaster, in Maurer, F. A., & Smith, C. M., Eds.). Community/public health nursing practice: Health for families and populations, pp. 496-516.
http://www.aacn.nche.edu/Education/pdf/INCMCECompetensies International Nursing Coalition for Mass Casualty Education