Unit 3: Disasters

Question 1

Disaster

Answer 1

• causes immeasurable amount of pain and suffering
• a serious disruption of the functioning of a community or or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources
• a disaster occurs when needs exceed resources following an event
• can be natural or man-made

Question 2

Federal Emergency Management Agency (FEMA) Definition of a Disaster

Answer 2

an occurrence of a natural catastrophe, technological accident, or human event that has resulted in severe property damage, death, and/or multiple injuries

Question 3

Disaster Events are defined by 3 characteristics

Answer 3

1. An event of destructive magnitude;
2. That kills, injures, or causes human suffering to a significant number of people or the environment
3. That requires the need for external assistance

Question 4

Mass Casualty Incident (MCI)

Answer 4

• any large-scale event in which emergency medical resources such as supplies, medical/rescue personnel, or equipment are overwhelmed by the number and severity of casualties, thus requiring prioritization of medical care by triage
• when the healthcare needs exceed the healthcare resources
• All MCIs are disasters, but not all disasters are MCIs

Question 5

Casualty

Answer 5

includes all persons who are ill, injured, missing, or dead as the result of the incident

Question 6

Incident

Answer 6

an event that requires scene or casualty management

Question 7

The goal of the response to any mass casualty incident (MCI)

Answer 7

“do the greatest good for the greatest number of people”

-this can mean delaying care to selected people who have little hope of survival or would consume too many resources

Question 8

Triage

Answer 8

process of placing the right patient in the right place at the right time to receive the right level of care
-tagged with a corresponding triage tag

Question 9

Goal of Daily Triage

Answer 9

identify and treat the most seriously ill or injured first

Question 10

Triage Models

Answer 10

• Simple Triage and Rapid Treatment (START)

- Sort, Assess, Life-saving Interventions, Treatment, and/or Transport (SALT)

Question 11

Simple Triage and Rapid Treatment (START)

Answer 11

• completed in 60 seconds or less
• based on respirations, perfusion (or pulse), and mental status “RPM”
• begins by directing all patients who are ambulatory to move to a safe area; tagged “green”, or “minor”

Question 12

How START Model Works

Answer 12

• begins by directing all patients who are ambulatory to move to a safe area; tagged “green”, or “minor”; capable of ambulating and understanding directions and have adequate perfusion to follow commands and stay upright
• triage then continues for the remainder of the patients
• patients with no spontaneous respirations receive airway repositioning
• if remain apneic, tagged “deceased” by using a black label and receive no further care or interventions
• if repositioning the airway initiates respirations; tagged “red” or “immediate”
• patients w/ respirations greater than 30 breaths/min or a capillary refill longer than 2 seconds or who are unable to to follow simple directions are tagged “immediate” or “red”
• the remaining patients are tagged “delayed” and given a yellow tag

Question 13

The START model allows for what 2 Interventions during the Triage Process

Answer 13

1. direct pressure to control bleeding

2. basic airway-opening maneuvers

Question 14

Sort, Assess, Life-saving Interventions, Treatment, and/or Transport (SALT)

Answer 14

• can triage both adults and children
• first step is to address the “walking wounded”
• second step, make lifesaving interventions before assigning to a triage category
• lastly, triage category assigned (delayed, immediate, or expectant)

Question 15

How SALT method Works

Answer 15

1. Address the “walking wounded”
   - able to walk are prioritized last
   - cannot follow a command or have an obvious life-threat are prioritized first
   - can follow a command but are unable to walk, prioritized second
2. Make lifesaving interventions
   - control of major hemorrhage, opening the airway and providing two breaths for child casualties, decompression of tension pneumothorax, and use of auto injector antidotes
3. Triage (delayed, immediate, expectant)
   - based on breathing, peripheral pulses, respiratory distress, and hemorrhage control

Question 16

SALT Method: Expectant category

Answer 16

• the patient may have a life-threatening injury, but current resources are not available to meet the need
• as resources become available, this “expectant” category of patients should be re-evaluated frequently

Question 17

Connection Check: Which of the following statements best explains the relationship between an MCI and a disaster?
A. All disasters are mass casualty events
B. All mass casualty events are disasters
C. Mass casualty events are natural disasters
D. Mass casualty events are man-made disasters

Answer 17

B. All mass casualty events are disasters

Question 18

Disaster Preparedness and Response: The first response to a disaster is the responsibility of?

Answer 18

• the local governments emergency services, supplemented by neighboring communities and volunteer agencies
• if overwhelmed, the local government can turn to the state for assistance
• the state’s governor, not the U.S. president, is responsible for the health and welfare of the respective citizens; governor possesses broad police powers that include the legal authority to order evacuations, commandeer private property, require quarantine, and take other actions to protect public safety
• if needed, a state can request outside assistance fro other states through the Emergency Management Assistant Compact (EMAC)
• if the disaster event is more than the state and local governments can handle alone, the governor of the affected state may request federal assistance; mobilized through FEMA; agency can assist with search and rescue, electrical power, food, water, shelter, and other basic human needs

Question 19

National Response Framework

Answer 19

• disaster plan for the nation
• establishes a comprehensive, national, all-hazards approach to domestic incident response, from the smallest incident to the largest catastrophe
• identifies key response principles as well as the roles and structures that support the plan
• describes special circumstances in which the federal government exercises a larger role in a disaster response, including incidents in which federal interests are involved and catastrophic incidents in which a state requires significant support
• response plan lays the groundwork for first responders, decision makers, and supporting entities to provide a unified national response

Question 20

Hazard Vulnerability Analysis (HVA)

Answer 20

• assessment of the risks and consequences of a disaster or critical event occurring in the community
• a list of all potential hazards and threats in the region is complied
• each hazard is given a ranking of low, medium, or high probability of its occurrence
• then, the potential consequences of the event are evaluated and rated as high, medium, or low consequence
• data can then be put into a matrix that defines the probable events and consequences as high, medium, or low

Question 21

Disaster Phases

Answer 21

1. Mitigation
2. Preparedness
3. Response
4. Recovery

Question 22

Disaster phases: Mitigation

Answer 22

• activities that eliminate or reduce the chance of occurrence or the effects of an event if it occurs
• if communities cannot prevent disasters, they can reduce the damaging impact
• ex: requiring roof reinforcements to reduce damage from hurricane winds or passing legislation that prevents new construction in floodplains

Question 23

Disaster Phases: Preparedness

Answer 23

• planning how to respond when an emergency or disaster occurs
• preparing people to respond appropriately
• ex: disaster drills, evacuation plans, and fire drills

Question 24

Disaster Phases: Response

Answer 24

• covers the period during and immediately following a disaster
• emergency responders and public officials provide emergency assistance to victims of the event and try to reduce the likelihood of future damage

Question 25

Disaster phase: Recovery

Answer 25

-begins almost concurrently w/ response activities and is directed at restoring essential services and resuming normal operations

Question 26

Incident Command System

Answer 26

- organizational tool that is used to provide the management infrastructure to support any disaster response - built around 5 major management activities/functions: command, operations, planning, logistics, and finance/administration - each function is headed by a section chief, and the overall response is led by an incident commander

Question 27

Effectively planning an emergency response requires hospitals to address many details such as:

Answer 27

- Staff safety - Availability of PPE - Decontamination equipment and processes - Surge capacity - Evacuation plans - Addressing mental health and psychosocial issues - Debriefing plans - Maintaining readiness

Question 28

Hospital Response to a Disaster

Answer 28

- need to be prepared to respond to any type of event - for disasters such as hurricanes and floods, hospitals are likely to receive advanced warning and are able to activate their disaster plan before the event - for disasters such as earthquakes, tsunamis, chemical plant explosions, industrial accidents, building collapses, and acts of terrorism, there is no advanced warning system

Question 29

Personal Protective Equipment (PPE)

Answer 29

a means of protecting staff from hazardous materials - election of appropriate PPE is based on a hazard assessment: 1. identifies the hazards or suspected hazards 2. identifies routes of entry of the potential hazard (inhalation, skin absorption, ingestion, eye or skin contact) 3. defines the performance of the PPE materials in providing a barrier to these hazards

Question 30

Decontamination

Answer 30

- the reduction or removal of contaminating material from a person or equipment by water and mechanical processes - eliminating contaminants from a patient's skin and clothing is important b/c it reduces the risk for further absorption or inhalation and helps to prevent others from becoming secondarily exposed or contaminated - during the decontamination procedure, the patient must be monitored for signs of decomposition - antidotes or other medications may need to be given

Question 31

Goals for Patient Decontamination

Answer 31

1. Hospitals must not allow contaminated patients to enter the facility 2. Hospitals should decontaminate patients as rapidly as possible 3. Hospitals must plan to protect the decontamination team rom secondary exposure and injury

Question 32

Patient Decontamination Includes the Following Procedures

Answer 32

-remove patients clothing -wet the patient's skin and wash with soap and water for 5 to 10 minutes -pay special attention to hair, face, hands, and other areas that were exposed but were not covered by clothing -follow washing by a copious rinsing of the patient with tepid water >Additional: -determining level of PPE required for staff to wear -controlling access to the decontamination site as well as the hospital -having a container ready to receive contaminated clothing, valuables, and contaminated supplies -ensuring screens are available for patient privacy -ensuring a collection system for water runoff is available if needed

Question 33

Surge Capacity

Answer 33

-the ability of a healthcare system to expand rapidly and to obtain adequate staff, bed, supplies, and equipment to provide sufficient care to meet the immediate needs of an influx of patients following a large-scale incident or disaster

Question 34

Hospital Evacuations

Answer 34

- important to remember that hospitals are vulnerable to disasters and may need to close or evacuate depending on the circumstances - may be necessary d/t fire or damage from a natural disaster such as a hurricane, earthquake or flood - should have in place plans for either a full or partial evacuation and should be consistent with regulatory requirements - full evacuation should be a last resort - successful hospital evacuation requires the symphonic coordination of personnel, transportation, communication, and the tracking of patients and materials

Question 35

Advanced Warning Events

Answer 35

- the hospital incident commander has time prior to the event to make a decision but must remember there is limited opportunity to evacuate - once notified of an impending disaster, the hospital incident commander may decided to (1) preemptively evacuate the hospital while the hospital structure and surrounding environment are not yet compromised or (2) shelter in place (SIP) - important to have plans that are flexible and scalable - plans should also define what happens to those persons "locked out" when the hospital is "locked down" - hurricanes most common examples of advanced warning events

Question 36

Shelter in Place (SIP)

Answer 36

- the need to take immediate shelter in a current location - a rapid and effective way to protect the hospital occupants from an external or internal threat - if SIP, the building's integrity, including the availability of critical utilities (water, sewer, electricity, and heating systems) require assessment - utilities must be assessed to determine whether the hospital can continue to provide safe, appropriate medical care or if a post event evacuation may still be necessary

Question 37

No Advanced Warning Events

Answer 37

- earthquakes, building fires, tornadoes, and explosions | - decisions must often be made very quickly in the midst of the disaster or immediately afterward

Question 38

Debriefing

Answer 38

- a post event disaster briefing should be held within 24 hours of the disaster response - should include all participants in the disaster response - to critically analyze all aspects of the response and to identify strengths and areas that need to be improved - allows hospital leadership to begin to identify staff who may need assistance recovering from the disaster response

Question 39

Disaster drills/Disaster exercises

Answer 39

- conducted twice yearly - controlled, scenario-driven experience designed to demonstrate and evaluate an organization's capability to execute its Emergency Operations Plan (EOP) - goal is to assess disaster processes and staff performance when systems are stressed during a simulated emergency - performance should be critiqued to identify deficiencies and opportunities for improvement facilitating modifications/improvements of the EOP

Question 40

Disaster Drills/Exercises should test every aspect of the EOP including:

Answer 40

- setting up the incident command center - receiving casualties - triage - testing communication systems, both internal and external, with responses to agencies, including other healthcare organizations - evacuating and transporting patients - requesting and receiving emergency supplies - staff roles and responsibilities - utility management - safety and security - resources and assets, including decontamination, PPE, transportation, communication, and emergency supplies

Question 41

How to Maximize Effectiveness of the drill

Answer 41

- inject as much "reality" into the exercise as possible such as volunteer moulaged patients (using makeup to simulate injuries), donning PPE, and testing communication devices and messaging - ensure safety for all participants during the drill - all communications during the drill should start and end with "this is a drill" - a safety officer with the sole responsibility to monitor and respond to any unsafe situations should be identified

Question 42

Connection Check: Which of the following contributes to a successful hospital disaster response? A. Aggressive resuscitation efforts for patients w/o a pulse B. Immediate response for patients as soon as they arrive at the ED C. Appropriate PPE to protect staff from contamination D. Decontamination area located within the ED

Answer 42

C. Appropriate PPE to protect staff from contamination

Question 43

Nurses Role During a Disaster

Answer 43

- in all aspects of disaster preparedness, response, and recovery - in mass casualty triage; helping to ensure patients get the most appropriate level of care - putting disaster response plans into action, evacuation, and decontamination when necessary - treatment: patient stabilization, medication administration including antidotes or prophylaxis where necessary, and routine or emergency care as part of the healthcare team - provides supportive care and mental health support to victims of the disaster