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©2012 Chamberlain College of Nursing LLC. All rights reserved.

Disaster Preparedness for

the Bedside Nurse

Tuesday, July 10, 2012

Presented by:

Charlene Romer, PhD, MSN, RN

Toni Hebda, PhD, MSIS, RN

Professors in the Master of Science in Nursing

degree program at Chamberlain College of Nursing


Program Competencies

1. Describe the nurses’ role in disaster response in a range of

emergencies that might arise.

2. Recognize unusual events that might indicate a disaster and

describe appropriate action.

3. Describe the chain of command in emergency response.

4. Describe the nurse’s functional role(s) in emergency response.

5. Evaluate options to access and record information

normally housed in electronic records and systems

when they are not available.

6. Describe critical stress management for nurses working in

a disaster.


Definition of a Disaster

The American Red Cross (ARC, 1975)

The American Nurses Association (ANA, 2002)


Examples of Disasters

• Hurricanes

• Tornadoes

• Earthquakes

• Airplane Crash

• Power Outage

• Terrorist Attack

• Epidemics



Types of Disasters

Natural Disasters are cataclysmic events that can have

a direct or indirect impact on the public's health and well-being

(United States Department of Health and Human Services).

Man-Made Disasters are events caused directly and

principally by one or more identifiable deliberate or

negligent human actions.


Multiple Casualty Incident versus

Mass Casualty Incident

• Multiple Casualty Incident

• Mass Casualty Incident


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Role of a Nurse During a Disaster

The Joint Commission for the

Accreditation of Healthcare

Organizations (JCAHO) –

Emergency management standards

Chain of command

Alteration of regular departmental

structure & team assignments

©2012 Chamberlain College of Nursing LLC. All rights reserved. ©2012 Chamberlain College of Nursing LLC. All rights reserved.

Chain of Command

• Ability to handle the casualties

• Severity of injured - 1/3 of acute

casualties are critical and 2/3 of

acute casualties are treated

and released



Triage

The process of:

Assessing patient needs

Assigning patients a priority for receiving treatment

Balancing needs with the reality of situation


Bedside Nurse

• Patient safety is the

number 1 priority

• Know your hospital

disaster response plan

• Triage for supplies



Emergency Room Nurse

• Triage is based on casualty level

• Mass casualty - Upside down triage

• The greatest good for the greatest number

• Interventions are restricted to:

• Controlling severe hemorrhage

• Elevating patients’ lower extremities


Emergency Room Nurse

• Multiple Casualty Event – Life-saving

• Severely injured or ill patients are treated first

• Less serious injuries or illnesses treated secondarily

• Personal Protective Equipment (PPE)

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Patient Assessment

Mass casualty event rapid assessment:

Observe

Palpate

Listen

Smell


Emergency Medical Treatment and Labor Act (EMTALA)

EMTALA is a statute which governs when and how a

patient may be:

1. Refused treatment

2. Transferred from one hospital to another when he/she

is in an unstable medical condition (nasmhpd.org).

During times of a mass casualty event this statue can

be modified.


Hospital Incident Command System (HICS)

HICS is a management structure established at hospitals to

coordinate day-to-day operations with those required to

successfully manage and resolve an emergency or disaster.


Record Keeping

• If operations are not interrupted, how do you handle the

John and Jane Does in the system?

• Mobile device use?

• Information system downtime procedures?

• Patient summaries with critical information

• How are disaster records reconciled with pre- and

post-disaster records?


• Preparation & Planning Phase - While disasters are

unexpected, they can be anticipated to varying degrees.

• Threat & Warning Phase - Recognizing that a disaster could

occur and recognizing the threat or the warning. Responses

among those at risk for disaster may range from active

planning and protective measures, to denial of the threat.

Stress Management


Stress Management

• Impact and Rescue Phase – Occurs right after the disaster.

It is the time of greatest damage/disorganization. Many

behaviors are automatic, indulging such as offering help and

sharing experiences. Then the impact of the situation is

realized and the reality of the outcome.

• Staff needs to be observed for increase fatigue and signs

of stress.

• Recovery Phase – Begins 2-3 months post disaster with

the hope to return to pre-disaster level of functioning.

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Stress Management

Mental Health Triage –

Some signs to be aware of include:

• Palpitations

• Difficulty breathing

• Agitation

• Erratic behavior

• Insomnia

• Absentees

©2012 Chamberlain College of Nursing LLC. All rights reserved. ©2012 Chamberlain College of Nursing LLC. All rights reserved.

Stress Management

Psychological First-Aid:

1. Create stable environment

2. Comforting & consoling

3. Provide verbal reassurance

4. Facilitating release of feelings

5. Linking to support systems

6. Identifying & referring to additional counseling


Stress Management

• Majority of disaster-affected people spontaneously recover

• Majority of recovery takes place in first three months

• Most experience full psychological recovery in 12 to 24

months

• Small number will have long-term issues and may lead to

mental illness or physical health


Stress Management

Gender Specific Reactions:

Women tend to report more anxiety, depression and

post-traumatic stress disorder

Men are more likely to abuse alcohol, have

physical/somatic complaints & have hostility


Q/A

Questions


References

A Nurse’s Duty to Respond in a Disaster. nursingworld.org

MainMenuCategories/WorkplaceSafety/DPR/Disaster-Preparedness.pdf

Bryce, C. P., Stress Management in Disasters.

paho.org/english/ped/stressmgn.pdf

Disaster Preparedness for Health Professionals.

uctv.tv/disaster/nasmhpd.org/glossary.cfm?style=text?&lang=en_us&out

put=json#E

Introduction to emergency preparedness for all nurses.

heartlandcenters.com/Public/

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References

A Nurse’s Duty to Respond in a Disaster. nursingworld.org

MainMenuCategories/WorkplaceSafety/DPR/Disaster-Preparedness.pdf

Bryce, C. P., Stress Management in Disasters.

paho.org/english/ped/stressmgn.pdf

Disaster Preparedness for Health Professionals.

uctv.tv/disaster/nasmhpd.org/glossary.cfm?style=text?&lang=en_us&out

put=json#E

Introduction to emergency preparedness for all nurses.

heartlandcenters.com/Public/

National Nurse Emergency Preparedness Initiative.

http://www.nnepi.org/index.htm

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