Disaster & the Nursing Response (Carter-Snell) MSK Alterations (Trauma) Shock (types + phases + priorities)

Disaster & the Nursing Response (Carter-Snell) MSK Alterations (Trauma) Shock (types + phases + priorities)

What are the operational phases of a disaster (4)?

Mitigation/Prevention; Preparedness; Response; Recovery.

What model is referenced for psychological phases of disaster?

Zunin & Myers, 2000 (as cited in Adams et al., 2022; Tompkins, 2025).

What do nurses “must respect strategies” that… (4 items)?

Respect human rights, social justice; ensure equity of access to health and social services; address safety and security of ALL affected and displaced (especially women and children); if emergency interferes with individual rights, advocate for the least restrictive measures (may need to shift from patient-centred to population-centred).

What is the CNA (2018) position statement topic?

Emergency preparedness and response.

Pre-emergency: what should nurses do (CNA)?

participate in education and planning (e.g. ICS-100).

During emergency response: what roles are listed (CNA)?

Providing care; contributing to capacity for health surveillance; educating health professionals/volunteers/public; assessing needs and allocating resources; evaluating response measures; making decisions about limited resource allocation (e.g. vaccines).

Post-disaster: what roles are listed (CNA)?

Assistance in promoting resiliency to trauma and to future disaster; evaluation of nursing responses.

What terms are listed under “Terms and Definitions – What term to use?”

Mass Casualty Incident (MCI); Surge; Disaster; Emergency; Incident; Event.

ICS stands for what?

Incident Command System (ICS).

What are the 3 main purposes of ICS?

( slide has blanks — typically command, control, coordination; if your instructor gave exact wording, use that.)

Types of ICS facilities listed?

incident Command; Base; Staging Area; Camp; Helibase; Helispot.

What does EOP stand for?

Emergency Operations Plans (EOPs).

Resiliency planning: what 2 items are listed?

Disaster Risk Reduction (DRR); Resilient Community Assessment.

“Levels of disaster” listed?

3 (slide shows “3” but not the names).

What does CBRNE stand for?

Chemical; Biologic; Radiologic; Nuclear; Explosives.

AHS code: Black

Bomb

AHS code: Grey

Shelter in place, air exclusion.

AHS code: Red

Fire

AHS code: Green

Evacuation.

AHS code: Brown

Chemical spill.

AHS code: Orange

Mass casualty incident.

AHS code: White

Violence or aggression.

AHS code: Purple

Hostage

Normally, what triage tool is used?

CTAS (Canadian Triage and Acuity System).

Disaster triage category: Red

Immediate (Emergent): Patients with lives in immediate danger—need immediate treatment.

Disaster triage category: Yellow

Delayed or Observation (Urgent): Not in immediate danger but require urgent medical care.

Disaster triage category: Green

Minimal (Less Urgent): Minor injuries who eventually need treatment (walking wounded).

Disaster triage category: White

Dismiss: Do not need a physician or NP care—can manage on own at home.

Disaster triage category: Black

No Priority/Expectant (Resuscitative): Dead or extensive injuries not expected to live and cannot spare resources.

PPE level A

Breathing/skin protection (highest), SCBA, chemical/vapor resistant suit/gloves/boots.

PPE level B

Breathing, some skin protection (SCBA, suit chemical resistant).

PPE level C

Air purified filter respirator, chemical suit, boots, splash hood.

PPE level D

Most common protection.

Key rule about decontamination (as written)?

Decontamination a key — REPEAT even if done on site.

What should assessment & documentation include (2 main items)?

Injuries; mechanisms of injury.

Mechanisms of injury listed.

Blunt force; penetrating force; chemical/electrical/thermal; blast; acceleration/deceleration

Blunt force examples listed.

Bruises, abrasions, bites, deformities.

Penetrating force examples listed.

Incised, penetrating, gunshot.

Injury terminology guide to use?

BALD STEP guide.

Bruises: what instruction is written?

Do not attempt to date bruises — describe colour. NOT the same as ecchymosis.

Lacerations: definition as written.

Blunt injuries — edges irregular, possible cross-bridges.

Petechiae: definition as written.

Red “dots” above areas of compression/strangulation.

Penetrating: incised vs stab (wording)?

Incised: wider than deep. Stab: deeper than wide. Can be hard to see without skin traction.

Gunshot: what to describe?

Describe burns around hole or tattooing of gunpowder.

Burn injuries: accidental description (wording)?

Irregular edges; arrow supports direction.

Burn injuries: non-accidental clues listed.

Patterned: flames, grids, cigarettes, lighters, electrical burns, contact burns (patterned); symmetrical glove/stocking burn; splash burns in wrong direction.

Blast injury: description written.

Mixed blunt/penetrating.

Blast injury types listed (headings)?

Primary; secondary; tertiary; miscellaneous.

What affects radiation symptoms/effects?

Time, distance, shielding.

Radiation phases listed.

Prodromal; latent; recovery or death.

Prodromal phase timing + key detail (as written)?

48–72 h; symptoms dose dependent.

Latent phase timing (as written)?

Up to 3 weeks.

Acute radiation sickness—probable survivors presentation (as written)?

Minimal symptoms (N&V for 24–48 hrs).

Improbable survivors presentation (as written)?

Acute nausea/vomiting, diarrhea, shock, neurologic symptoms.

Community plan: key domains listed.

Food; shelter; safety/vulnerability; services; supplies; documentation/storage.

Gender-based violence safety/services—items listed.

Separate area for women/girls; dignity packs; reproductive/sexual assault/IPV services; consider restraining/protection orders.

CISM (Mitchell model): when is it effective (as written)?

Effective IF used as intended.

CISM requirement (as written).

Ready to talk about trauma.

CISM phases listed.

Defusing; debriefing.

Debriefing controversy (as written).

Can be harmful if single session and no followup.

Stepped-care approach: levels of care (headings).

psychological First Aid (PFA); Skills for psychological recovery (SPR); clinical treatment.

PFA: who should perform?

All should perform.

PFA: developed to be used by who?

Anyone, including lay people after disaster.

PFA aim (list).

Meet basic needs; restore safety; calm; connectedness; resiliency.

3 steps of PFA (word-for-word).

Look; listen; link.

Recovery takes TIME: what key phrases are listed?

Not always linear; not everyone recovers at same time (can take years); may never return to “normal” but to new normal; need to facilitate resilience.

Supporting resilience: what actions are listed?

Recognize fluctuations/individuality; support positive coping (hope, reframing, safety, support, control); minimize secondary victimization (minimizing, shutting down, delays); positive reactions to disclosure (PFA: belief, look/listen/link).

Caring for caregiver: what stress disorders are listed?

Burnout; compassion fatigue; secondary traumatic stress.

ABCs for stress self-care factors listed.

Awareness; balance; connections.

MSK & trauma: “Know your patient” includes what categories?

Risk factors; recent history; getting more information; assessments; diagnostics.

What are the msk “complications” categories listed?

→ Early: fat embolism, compartment syndrome, rhabdomyolysis.
→ Delayed: osteomyelitis.
→ Discharge teaching.

FRAX risk factors listed.

Increasing age; women experiencing menopause; previous fractures; family history/genetics; smoking; prolonged glucocorticoid administration; history of arthritis/osteoporosis; alcohol intake; diet; lifestyle; cancer.

Recent history: events leading up + following includes what?

Loss of consciousness; immobilization of affected areas; time from incident to first response; initial vital signs/trend; declining function; past medical history; current medications.

If patient can’t communicate history, what should you do?

Ask family/friend/person who accompanied the patient.

Diagnostics listed for MSK trauma.

Bone mineral density test (BMD); xray; ultrasound; MRI; CBC, PTT/INR, lytes, Ca, CK

Assessments listed.

Comprehensive neuro assessment; CMST (circulation, motion, sensation, temperature); the 6 P’s.

Define contusion (wording).

Soft tissue injury with hematoma.

Define strain (wording).

Stretch/tearing injury to muscle or tendon.

Define sprain (wording).

Twisting/tearing to muscle or ligament.

Management listed for contusions/strains/sprains.

POLICE or PEACE and LOVE; early weight bearing with functional bracing; pain management; physical therapy/rehabilitation.

Fractures can be what (wording)?

Complete or incomplete; open versus closed; combined with soft tissue injury.

Clinical manifestations of fracture list.

Pain; loss of function; edema; ecchymosis; deformity; shortening; crepitus.

Emergency management priorities list.

ABCs; airway protection; perfusion/hemodynamics; immobilize affected areas; splint; control bleeding; pain; history/patient info; prompt imaging; neurovascular assessments; CBC, PT/INR.

Procedural/surgical interventions listed.

Reductions; external/internal fixature.

Non-emergent management list.

Immobilization; NPO for surgical interventions; patient information (type and screen, allergies, consent, past medication history); education (expectations pre/post); begin discharge teaching; complications; medications (pain, anxiety, daily meds—hold or give).

Immediate post-op: ABC issues listed.

Hypoventilation from medications; hyperventilation from pain; oxygenation.

Hemodynamic concerns listed.

Blood loss and/or medications.

What are immediate post-op problem areas listed?

Bleeding; pain; nausea/vomiting; medications; other considerations.

External fixators: description.

Fixed on the outside; rods/screws; often hemodynamically unstable patients.

External fixator nursing care list.

Never adjust the pins; pin & wound care; pain management; positioning and exercise as tolerated.

Internal fixators: description.

Fixed on the inside; rods, plates, pins, screws.

Internal fixator nursing care list.

Wound care; pain management; positioning and exercise as tolerated.

Early complications list.

Shock; fat embolism; thromboembolism; compartment syndrome; rhabdomyolysis; infection.

Fat embolism risk factors listed.

Young age; long bone fracture.

Fat embolism patho phrase (wording).

Fat globules enter vasculature.

Fat embolism clinical manifestations list.

Respiratory distress/ARDS; white sputum; petechial rash to chest; tachycardia; fever; altered neurological status; ground glass findings on CT.

Fat embolism treatment list.

Supportive care; PEEP/mechanical ventilation; hemodynamic stabilization.

Compartment syndrome risk factors list.

Young age; male; high energy trauma; proximal tibial fractures.

Compartment syndrome patho phrase (wording).

Sudden decrease in perfusion due to increased compartmental pressure.Earliest sign (wording)?

Earliest sign (wording)?

++Pain is the earliest sign.