Disaster Nursing Concepts

Wk 12

Disaster Definition

A situation in which a healthcare facility or community resources are overwhelmed due to devastation or destruction

Types of Disasters

• Facility/Technical Disasters: Fires, utility failures (power, water, IT systems), active shooter situations, or chemical plant explosions.

• Natural Disasters: Hurricanes, earthquakes, tornadoes, or pandemics (e.g., COVID-19).

Multi-Casualty Event Description

Can be managed by the hospital without requiring external assistance.

• Example: A bus crash resulting in 10 to 15 injuries.

Mass Casualty Event Description

Overwhelms local capabilities, requiring multiple agencies, multiple healthcare facilities, and potentially a federal emergency response.

• Examples: A terrorist attack or an earthquake affecting hundreds of people.

All-Hazard Approach (Disaster Preparedness Drills)

Hospitals must prepare for all possible threats ranking hazards by likelihood, ranging from natural disasters to manmade crises (active shooters, bioterrorism).

Training and drills are not just regulatory requirements; they save lives by improving response times, coordination, and decision-making.

Joint Commission Mandate for Disaster Preparedness

Hospitals must conduct at least two drills per year.

One drill must involve real or simulated patients as well as external community partners.

CMS Mandates for Long-Term Care

Facilities (nursing homes, group homes) are mandated to conduct annual fire drills and must include evacuation plans to protect residents.

Phase 1 Mitigation (Phases of Emergency Management)

• Definition: Identifying and evaluating risks and reducing their impact before a disaster happens.

• Actions: Developing strategies and plans to avert risks and build safer systems; breaking the cycle of damage and reconstruction.

• Example: A hospital upgrading its emergency generators.

Phase 2: Preparedness (Phases of Emergency Management)

• Definition: Enhancing the system's capabilities of responding to disasters.

• Actions: Continuous planning, training, conducting drills, and preparing equipment and procedures for use in an event.

• Example: The Joint Commission's mandate for two hospital drills per year.

Phase 3: Response (Phases of Emergency Management)

• Definition: Immediate actions to save lives and minimize damage immediately before, during, and after the disaster.

• Actions: Conducting an immediate rapid assessment; mobilizing emergency staff and efficiently coordinating resources.

• Example: Implementing mass casualty triage and emergency treatment.

Phase 4 Recovery (Phases of Emergency Management)

• Definition: Activities to restore normal or near-normal conditions and operations post-disaster.

• Actions: Addressing immediate needs, making decisions, and coordinating with response efforts.

• Example: The National Disaster Medical System (NDMS) helping coordinate large-scale recovery efforts, or hospitals relocating patients due to ICU flooding after Hurricane Sandy.

Mass Casualty Triage Description

Different from normal emergency triage

• Resources are prioritized for patients with the highest chance of survival ("do the greatest good for the greatest number").

Patients Graded Based on Color System

• Red (Immediate)

• Yellow (Delayed)

• Green (Minor)

• Black (Expectant)

Red/Immediate (Mass Casualty Triage Description)

Life-threatening conditions but have survivable injuries

• Can be helped by immediate intervention/transport

• Involves Airway, breathing, circulation compromise

• Examples: Shock, airway obstructions, hemorrhage

Yellow/Delayed (Mass Casualty Triage Description)

Serious life-threatening injures, but stable condition

• Not expected to deteriorate for several hours

• Examples; Open fractures, large wounds

Green/Minor (Mass Casualty Triage Description)

Walking wounded

Relatively minor injuries unlikely to deteriorate over days

• Person able to assist in own care

• Sprains, abrasions

Black Tag\Expectant (Mass Casualty Triage Description)

Unsurvivable Injuries - Victim is unlikely to survive given the severity of injuries/level of available care.

• Provide palliative care and pain relief

• Examples: Severe head trauma, full thickness bunrs over 80% of body

START Adult Triage Algorithm Description

A rapid assessment system categorizing patients into the four color-coded groups based on ability to walk, respiratory effort, perfusion, and mental status

START Adult Triage Steps

• Step 1 (Walking): Is the patient able to walk?

  • Yes: Tag MINOR (Green) and move to secondary triage.

  • No: Proceed to Step 2.

• Step 2 (Breathing/Airway): Are they breathing spontaneously?

  • No: Position the airway. If they start breathing spontaneously, tag IMMEDIATE (Red). If they remain APNEIC, tag EXPECTANT (Black).

  • Yes: Proceed to Step 3.

• Step 3 (Respiratory Rate): Check respiratory rate.

  • > 30 breaths/min: Tag IMMEDIATE (Red).

  • < 30 breaths/min: Proceed to Step 4.

• Step 4 (Perfusion): Check circulation.

  • Absent radial pulse OR Capillary refill > 2 seconds: Tag IMMEDIATE (Red).

  • Present radial pulse OR Capillary refill < 2 seconds: Proceed to Step 5.

• Step 5 (Mental Status): Can they follow commands?

  • Doesn't obey commands: Tag IMMEDIATE (Red).

  • Obeys commands: Tag DELAYED (Yellow).

Activation of Emergency Plan Criteria

• Declaration: A disaster is declared when casualties exceed available resources. Activation thresholds vary by hospital size (small/rural hospitals may declare a disaster for fewer patients than a large urban trauma center) and staffing/timing (nights vs. weekends).

• Notification: Hospitals receive notifications from EMS, state, or regional agencies via radio, cellular, or electronic alerts.

Hospital Incident Command System (HICS) Description

• Definition: A structured organizational model/system that organizes hospital disaster response at the facility level.

• Purpose: Assigns clear roles to avoid confusion, improves coordination, and establishes clear lines of authority and accountability for resources.

Hospital Incident Command System (HICS) Key Roles

• Hospital Incident Commander: Leads response efforts

• Medical Command Physician: Determines the number of patients, resources needed, and the allocation of resources.

• Triage Officer: Rapidly evaluates and categorizes patients.

• Public Information Officer (PIO): Communicates with the media and the public.

Emergency Operations Center (EOC) Description

HICS personnel establish a command center in a designated location with accessible communication technology.

Federal & Specialized Disaster Response Teams

• Training: FEMA and the National Disaster Life Support Foundation provide essential disaster response training. Responders must assess risks (structural collapse, violence, infectious disease).

• NDMS (National Disaster Medical System): Coordinates large-scale recovery efforts.

• MRC (Medical Reserve Corps): Volunteer health professionals supporting hospitals and shelters during a crisis (e.g., during the pandemic).

• DMAT (Disaster Medical Assistance Teams): Provides critical medical relief for up to 72 hours when local facilities are overwhelmed.

• DMORT (Disaster Mortuary Operational Response Team): Manages mass fatalities.

• NVRT (National Veterinary Response Team): Provides veterinary emergency care.

• IMSuRT (International Medical Surgical Response Team): Deploys field surgical facilities when needed.

Nurses Role in Disasters

Nurses don't just provide care; they save lives through preparedness.

• Before the Disaster: Participate in emergency training drills and develop a personal emergency preparedness plan (arranging childcare, pet care, evacuations).

• During the Disaster: Implement triage, provide life-saving care, and collaborate with interprofessional teams.

• After the Disaster: Participate in debriefing sessions to improve future responses.

Event Resolution & Deactivating the Plan

• Deactivation: The emergency response plan is deactivated once the patient influx subsides and the hospital can manage normal operations. Transition back to normal must be gradual because hospital units may still be overwhelmed.

• Staff Exhaustion: A major concern; nurses working extra shifts must be given time to rest to prevent medical errors.

• Supply Shortages: Restocking essential items (medications, PPE, sterile instruments) must be prioritized; communication with vendors for emergency resupply is essential.

Post-Disaster Debriefing

• Purpose: A critical step in the post-disaster recovery plan to process trauma, ensure continuous improvement, and build team resilience.

• Crisis Support (Psychosocial Debriefing): Helps staff process trauma and stress. Team workers are specially trained in psychological first aid and behavioral health.

• Administrative Debriefing ("Hot Wash"): Allows hospitals to analyze their operational response and refine future emergency plans.

Psychological and Emotional Impacts of Disasters

• Common Reactions: PTSD, anxiety, grief, and survivor's guilt. Disasters cause long-term mental health issues for both survivors and responders (e.g., several 9/11 first responders still experience PTSD).

• Support Strategies: Active listening, crisis counseling, providing a sense of safety and reassurance, and making referrals for mental health support.

• Nursing Role: Debriefing sessions are vital to help nurses process the trauma they endure during mass casualty events.

Nurse's Role in Community Emergency Preparedness

• Division of Labor: First responders (firefighters, search & rescue) handle initial evacuations, while nurses focus on medical care, triage, and health education.

• Shelters: Nurses assist with healthcare, hygiene, and education at American Red Cross shelters.

• Water Safety: Access to clean water is a major concern. Nurses educate communities on boiling water, using purification filters, or using chlorine bleach to ensure safety.

• Sanitation: When toilets are inoperable, sanitation challenges arise. Nurses must stress the importance of hand hygiene to prevent disease transmission.

Rapid Response & Personal Staffing Preparedness

• Personal Planning: Know your role, know where to report for duty, and arrange child or pet care in advance so you can focus on patient care.

• Extended Shifts: Hospitals may require staff to stay for extended periods during disasters (e.g., during COVID-19, nurses quarantined at work to protect families).

• Go-Bag / Emergency Kit: Nurses should pack essentials for extended shifts, including ID, medications, food, water, and first aid supplies.