Disaster Nursing

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Disaster Nursing

• VN 265
• Nursing of the Chronically ILL

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Disasters

• Any event that overwhelms existing manpower,
  facilities, equipment and capabilities of a
  responding agency or institution.

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Types of Disasters

• Internal - Hospital blackouts, power outage,
  water outage, fires, explosions
• External - natural calamities earthquake,
  hurricane, flood, fire, explosion created
  events- motor vehicles accidents, plane crashes
  9/11/01, acts of terrorism, bioterrorism

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Roles of Health Team

• MD manpower
• Administration
• Nursing staff - report to supervisor or nursing
  office.

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Disaster Nursing

• Hospitals serve as major treatment area for
  victims, also referred to as casualties.
• Hospitals activates its disaster plan outlines
  specific duties for each nursing unit and staff.
• Each nursing unit prepares for the influx of
  casualties by calling off-duty staff to report to
  work by discharging non- critical clients.

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Disaster Nursing

• Each unit is designed to receive specific types
  of trauma like major trauma, burns, medical,
  pediatrics, or psychiatric.
• Decision making prioritization of client care
  are guided by resources personnel available.
• Each hospital follows a disaster response plan
  procedures to follow when interacting with media,
  families, agencies casualties.

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Triage

• Sorting casualties for the purpose of assigning
  priorities.
• ER serves as a triage stabilization area for
  casualties.
• Additional ER staff may be called to work .
• Hospital department plan may require assigning
  one or more staff from each nursing unit and
  non-nursing department to a specific area or task
  within the ER such as triage, first aid, critical
  care, burn treatment or transportation

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Lesson Objectives

• Describe what to do when first arriving at a
  Multi-Casualty Incident
• Triage an injured patient in less than one minute
• Describe how to use patients with minor injuries
  to assist with basic first-aid
• Demonstrate how to use a triage tag

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Golden Hour

• A seriously injured patient has one hour in which
  they need to receive Advanced Trauma Life
  Support. This is referred to as the golden hour

• Triage helps to support this golden hour concept
  by identifying the most seriously injured
  patients so that they may be treated/transported
  first

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Triage

• Immediate patients are at risk for early death
• They usually fall into one of two categories.
  They are in shock from severe blood loss or they
  have severe head injury
• These patients should be transported as soon as
  possible
• If the patient passes the RPM assessment, they
  are placed in the delayed category.

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Triage

• Because patients are categorized, Delayed does
  not mean that they may not have serious injuries
  It just means that they are not at high risk for
  death
• Delayed patients may have injuries that span a
  wide range
• They may not be able to join the walking wounded
  because of a broken ankle
• They may have severe internal injuries,but are
  still compensating

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Triage

• It is important that the delayed patients are
  frequently reassessed and further prioritized for
  transport. This will usually be done in a
  central treatment area

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Triage

• Delayed patients have
• Respirations under 30/minutes
• Capillary refill under 2 seconds
• Can do-follow simple commands

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Triage

• Patients with minor lacerations, contusions,
  sprains, superficial burns are identified as
  minor/minimal
• These patients will not suffer significant
  morbidity if no medical intervention is performed

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Triage

• Patients with whom there are signs of impending
  death or massive injuries with poor likelihood of
  survival are labeled as expectant
• These are patients with penetrating head wounds,
  high spinal cord injuries, second or third degree
  burns with greater than 60 percent of total body
  surface area, profound shock with agonal
  respirations

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START

• The Race Against Time

SIMPLE TRIAGE RAPID TREATMENT
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Triage Assessment Exercise

• Victim 1
• Compound fracture, left femur
• Respirations over 30/Min
• Radial pulse absent
• Awake
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 2
• Sudden onset of chest pain with shortness of
  breath
• Respirations under 30/minute
• Capillary refill under 2 seconds
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 3
• 90 second degree burns
• Respirations none
• Radial Pulse present
• Unconscious
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 4
• Facial Injury
• Respirations over 30/ minute
• Capillary refill under 2 seconds
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 5
• Unable to move legs
• Respirations under 30/minute
• Radial Pulse Present
• Awake
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 6
• No apparent injuries
• Respirations normal
• Capillary refill under 2 seconds
• Awake
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 7
• Sucking chest wound
• Respirations over 30/minute
• Radial pulse present
• Unconscious
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 8
• Dislocated right shoulder
• Respirations under 30/minute
• Radial pulse present
• Awake
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 9
• No visible wounds
• Respirations none
• Radial pulse absent
• Unconscious
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 10
• Scalp wound
• Estimated blood loss 500 cc
• Respirations over 30/minute
• Capillary refill under 2 seconds
• Awake
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 11
• Massive head injury
• Respirations under 30/minute
• Radial pulse absent
• Unconscious
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 12
• Bruising over abdomen, complaining of abdominal
  pain
• Respirations over 30/minute
• Capillary refill under 2 seconds
• Awake
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 13
• Impaled, 1 foot piece of shrapnel in right eye
• Respirations under 30/min
• Radial Pulse present
• Awake
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 14
• Female six-months pregnant fractured left lower
  leg
• Respirations under 30/minutes
• Capillary refill under 2 seconds
• Awake
• Deceased
• Immediate
• Delayed
• Minor

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• Victim 15
• Severe difficulty breathing, chest sinks in on
  inspiration
• Respirations over 30/minute
• Radial pulse present
• Awake
• Deceased
• Immediate
• Delayed
• Minor

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Community and National Agencies

• American Red Cross - mandated by US congress to
  give relief in a disaster.
• National Guard
• Other relief agencies

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Debriefing Session

• Single 2 hour meeting with a support group.
• Share thoughts, feelings related to the trauma.
• Conducted by psychiatric nurse, social worker or
  other mental health professional
• Scheduled 48-72 hours after crisis.

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The End