Background - correct answer - guidelines were created to assist policy makers and emergency managers at all levels within a country to find and correct
... [Show More] the gaps in emergency preparedness
- topics addressed National emergency systems, Mass casualty at national level, state, community levels; and the health care facility level
Background: What Was the Concern? - correct answer - Mass Casualty includes a wide range of incidents:
- natural disasters
- man made (bioterrorism)
- transportation accidents (car, trains, planes, buses)
- breakdown of authority (riots)
- governments are responsible for public safety and emergency relief in crisis
- increasing evidence suggests there are many gaps in communities worldwide regarding preparedness
Emergency/ Mass Casualty Incidents - correct answer Emergency:
- extraordinary event that requires rapid and skilled response within a community
- existing resources can manage event
Mass Casualty:
- natural event/disaster (such as a tornado); or a manmade event/disaster (chemical agents of terrorism)
- overwhelms communities existing resources
Requires assistance from other agencies outside of community
- MCI: Involves many victims; permanent change within community; Concern of post traumatic issues; physical & emotional suffering
- response to MCIs often requires the aid of a federal agency such as the National Incident Management System (NIMS). Section within the U.S. Department of Homeland Security that is responsible for coordination of the federal medical response to MCIs
Emergency/ MCI Response in Field - correct answer - emergency response system activated
- trained emergency responders, police arrive on scene
- trained EMS personnel arrive and begin triage
- authorities in field send information to medical facilities regarding numbers, types, and severity of casualties
- most serious casualties transported to hospital first
Triage - correct answer - process of sorting or quickly determining victim acuity
- categorizes patients so that most critical are treated first.
- emergency Severity Index (ESI): Five levels of triage
- ESI-1 & ESI-2 most critical
- ESI-3, ESI-4, ESI-5 patients are stable
(table 69-2 in book)
ESI Triage Algorithm - correct answer - Initially, the nurse would assess the patient for any threats to life or the presence of a high-risk situation
- next, evaluate patients who do not meet the criteria for ESI-1 or ESI-2 for the number of anticipated resources they may need
- nml vital signs are required for patients assigned to ESI level 3
- patients with abnormal vital signs may be reassigned to ESI level 1 or 2
Triage: Different System for MCI - correct answer - systematic triage: Color coding of victims to designate critical injuries and likelihood of survival
- green: Minor Injuries
- yellow: Urgent, non life-threatening injuries (open fractures)
- red: Life-threatening injury requiring immediate intervention (shock)
- blue: Expected to die (Massive head trauma)
- black: Dead
- Triage of mass casualties differs from usual ED triage and is conducted in <15 seconds
- 2/3 will be tagged green or yellow, and the remaining will be tagged red, blue, or black
Triage of Emergency/ MCI - correct answer - total number of casualties a hospital can expect is estimated by doubling number of casualties that arrive in first hour
- 30% will require admission to hospital, 1/2 will need surgery within 8 hours
- obtain history and complete a full head to toe assessment
- inspect posterior: log roll client, inspect and palpate. Is there bleeding, bruising, deformities?
4 Stages of Disaster - correct answer - mitigation
- preparedness
- response
- recovery
Mitigation (Prevention) - correct answer - process of preventing disasters or hazards from developing, involves local, state, federal, and international govt
- can include reviewing what hazards may potentially affect people or property in the long run
- these efforts include zoning, land use planning, developing building codes
- prevention of flooding due to erosion or building collapses due to building codes and inspections are all a process of mitigation
- by having housing codes and environmental inspections and assessments, hopefully hazards can be avoided
Preparedness - correct answer - Stage of readiness; continuous process of planning, training, and disaster drills
Response - correct answer - mobilization of first responders
-save lives, reduce further damage
- includes firefighters, police, ambulance, search and rescue
- shelters created
- damage assessment
Recovery - correct answer - restoring to previous state
- includes rebuilding, repairing, replacing property that is destroyed
- re-employment for the community to return stable economically
- may require counseling services for psychological stress; develop or support coping mechanisms, support groups
Disaster Planning: Federal/ State - correct answer - federal: National Response Framework and National Incident Management System provide framework for states to follow; assists with national communication about potential disasters, threats
- state: provides information to citizens within the state, gives direction for local government to be prepared
Disaster Plans: Federal/ State - correct answer Federal:
- FEMA.gov lists how to: plan, prepare, mitigate disaster survivor assistance
- response & recovery
- provides information on how to make a disaster kit
State:
- website for NC Dept Safety
Disaster Plans: Community - correct answer - most cities have an established emergency preparedness plan for potential hazards or disasters
- provides information on local first responders, emergency services, or emergency alert systems
- plan may include information on how to make a plan and prepare for potential hazards or disasters
- plan encourages citizens to make a kit, stay informed, and be involved
- Community Emergency Response Teams (CERTs)- recognized teams by FEMA as partners in emergency preparedness
- CERT teams train local citizens how they can assist if there was a disaster (lifesaving skills, rescuer safety)
- these trained citizens could assist victims on site in a disaster until professional services arrive
Disaster Plans: Healthcare Facility - correct answer - institutions must have an emergency preparedness policy and plan per federal government guidelines
- emergency plan may include procedures for different potential hazards or threats (fire, loss of electricity, communication outage, water loss)
- all staff members must be educated regarding their role and responsibility within a disaster
- historically has received financial support via grants to implement an emergency preparedness program
- accrediting bodies review standards that might infringe on patient safety (The Joint Commission, Centers for Medicare and Medicaid Services).
- other agencies that follow up on potential safety issues: OSHA, CDC, DHHS
Healthcare Facility Specific Disaster Plan - correct answer - specific plan of action in case there is a surge of patients
- assess acuity of all patients and discharge those less acute
- cancel elective procedures
- add beds to rooms, or units/wards
- set up cots in open spaces
- have procedure to call back staff for extra shifts
- maintaining or increasing stocks of medications, supplies, equipment
- surge: greater number of clients than can usually hold. Must attempt to move clients out of ED and even hospital to make room for greater numbers of clients
Terrorism - correct answer - planned violent actions that are meant to cause harm to people or property
- used to intimidate, create fear
- used for coercion, ransom, and publicity for the terrorists cause
Acts of terrorism include:
- using weapons of mass destruction (missiles, nuclear bombs)
- dispensing biologic or chemical agents
- kidnapping
- assassination [Show Less]