NURS 340: UNIT 17 - DISASTER

A community is overwhelmed after a sudden event and needs outside help. How is a disaster defined?

Any SUDDEN, unexpected disruption, destruction, or devastation that overwhelms local resources & REQUIRES EXTERNAL ASSISTANCE.

How does a disaster differ from an emergency?

A disaster disrupts community function & causes hardship; an emergency does not always cause serious disruption.

Can natural disasters be prevented?

No, they are unpreventable, but preparedness can lessen the effects.

Can human-made disasters be prevented?

Many are preventable & can worsen natural disasters (for example, effects of war, cyberattacks).

Which weather events are natural disasters?

Hurricanes, tornadoes, cyclones, tsunamis, blizzards, hailstorms, floods, mudslides, droughts, & lightning-induced forest fires.

Which geologic and health events are natural disasters?

Earthquakes, volcanic eruptions, avalanches, & communicable disease epidemics.

Which accidents and failures are human-made disasters?

Transportation accidents, structural collapse, critical infrastructure failure, water supply contamination, explosions/bombings, fires, & pollution.

Which hazardous and violent events are human-made disasters?

Nuclear power plant incidents, radiation, hazardous materials incidents, terrorism (CBRNE: chemical, biological, radiological, nuclear, explosives), war, civil unrest (riots), & cyberattacks.

A forest fire or pandemic develops slowly over time. Which onset is this, and what does the nurse monitor?

Gradual onset: monitor mortality rates, immunization rates, & environmental conditions.

A sudden disaster strikes a community. What decisions does the nurse’s team make first?

Decide evacuate vs. shelter-in-place vs. lockdown, then begin mass-casualty triage.

How are disasters characterized in terms of scale and needs?

Rapid needs assessment & ongoing surveillance.

What health effects do disasters have on populations?

Physical injury & illness; disease from disrupted environmental/health services; psychological effects; loss of shelter, food, water, & services.

How does the nurse know the difference between natural and human-made disasters when classifying?

Natural disasters can only be prepared for; many HUMAN-MADE disasters are preventable (for example, inspecting bridges, bioterrorism surveillance).

Why must a community’s disaster plan be rehearsed and coordinated?

Plans are necessary to reduce effects; they must be realistic, well planned, REHEARSED, & coordinated across several agencies.

What is the goal of a community disaster plan?

Provide the community with support to promote RESILIENCE; clear communication is key.

What does the Red Cross do in disasters?

A global organization for community preparedness, response, and recovery.

What does public health do in disaster planning?

Studies effects on the population to develop new prevention.

A nurse surveys bridges and checks the code cart for supplies. Which disaster stage is this?

Prevention (mitigation and protection): reduce risks to people & property BEFORE a hazard occurs (also active surveillance for bioterrorism weapons).

A nurse educates families and runs a drill. Which disaster stage is this?

Preparedness: education, planning, drills, & personal & family plans.

Triage and incident command are in use. Which disaster stage is this?

Response: immediate actions during/after the event, starting at the local level.

A community is rebuilding and providing mental health services. Which disaster stage is this?

Recovery: a return to a “new normal”; the hardest part.

Which elements make up community disaster resilience?

Self-organization, effective communication, understanding risks & uncertainty, local knowledge & resources, social connectedness, empowerment, preparation engagement, stakeholder collaboration, & flexibility.

What should a disaster plan include for simplicity and flexibility?

Simple plans with alternatives, easy to adapt with core functions.

Which communication and evacuation issues does disaster plan development address?

A warning system & how it functions, & an evacuation plan & refusals (where can people go?).

How does plan development address untrained volunteers?

Decide how to involve them safely.

How are disaster drills used to update plans?

After-action reports update the plans.

A group sits in a room and talks through a disaster scenario to find gaps. Which drill is this?

Tabletop exercise: discussion-based simulation that identifies gaps/duplications & talks through the response.

What does an operations-based disaster drill do?

Activates the response network.

What is the National Exercise Program (NEP)?

Organizations evaluate their ability to respond.

What is the Homeland Security Exercise and Evaluation Program (HSEEP)?

The standard methodology/terminology for exercises.

What are a nurse’s responsibilities in disaster planning?

Know the facility plan & your role; advocate (identify hazards/vulnerabilities where you work); educate on disaster preparedness; participate in planning; make a personal plan.

Which training can a nurse take for disaster nursing?

Red Cross nurse disaster training & the SIGMA disaster course.

What happens in a community without a disaster plan?

Duplication of efforts, communication failures, preventable harm, & delayed recovery.

Which stakeholders take part in community disaster preparedness?

The general public, all levels of government, public health agencies, hospitals, first responders, emergency management, community health care providers, schools/universities, & businesses & organizations.

What do mutual aid agreements do in disaster response?

They reduce barriers (regulatory authority, jurisdictional boundaries, organizational control) & allow sharing of people, equipment, services, & supplies.

How does the nurse tell the disaster stages apart?

• Surveying bridges & checking the code cart = PREVENTION

• Educating families & running a tabletop = PREPAREDNESS

• Triage & incident command = RESPONSE

• Rebuilding & mental health services = RECOVERY

Which structural measures help prevent disaster damage in a community?

Protect buildings/infrastructure from wind & water.

Which nonstructural measure helps prevent disaster damage?

Land development restrictions.

How is prevention approached for human-made hazards and terrorism?

Deter, detect, strike, & eliminate the threat.

Which measures prevent terrorism and human-made hazards?

Inspections, improved surveillance & security operations, public health & agricultural surveillance/testing, immunizations, isolation or quarantine, & halting CBRNE threats.

How does the nurse help a family involve children in disaster planning?

Make plans ahead of time & involve KIDS (control helps resilience).

A family must evacuate and leave a pet behind. What should they do?

Lock the pet in a safe closed room with a sign on the door for first responders.

Whom should a family choose as their disaster contact person?

A designated family contact person, preferably someone who lives OUTSIDE the disaster area.

What communication and route planning should a family do for evacuation?

Alternative meeting places; evacuation options & alternate routes (“don’t wait”).

Which health items should a family bring when evacuating?

List of medications/dosages; allergies & physician names.

Which supplies and documents should a family bring when evacuating?

Sanitation supplies (toilet paper, soap, feminine hygiene items, garbage bags); items for infants, older adults, & disabled family members; pet supplies; documents (passport, birth certificate, insurance).

How should a family store documents left behind during evacuation?

In a waterproof/fireproof bag or box.

A train derails outside a family’s home with toxic chemicals and unsafe air outside. What should they do?

SHELTER IN PLACE: stay in the home when the threat is outside.

When should a family evacuate rather than shelter in place?

If the environment is unsafe at home (for example, fire or flood), evacuate; if the environment is safe, evacuate per the plan.

What are the three Red Cross “Ready” steps?

Get a Kit, Make a Plan, Be Informed.

How much food and water belongs in a family disaster kit?

At least 3 days of nonperishable food & WATER (1 gallon per person per day).

Which other items belong in a family disaster kit?

Battery or hand-crank radio (NOAA if possible), flashlight & batteries, first aid kit, medications & medical items, & copies of important documents.

How many meeting places should a family disaster plan include, and where?

TWO: right outside the home for sudden emergencies such as fire, & one outside the neighborhood.

How should a family contact each other if local phone lines are overloaded?

An out-of-area contact person (call long distance or text).

Which other steps does the Red Cross disaster plan include?

Tell everyone where supplies are kept; practice evacuating TWICE a year; plot alternative routes; plan for pets.

What does the Red Cross “Be Informed” step include?

Know the risks where you live, work, learn, & play; learn how you would receive official information; learn first aid & CPR/AED.

At which level does disaster response begin?

At the LOCAL level: fire, police, emergency services, & public health.

What does incident command do in a disaster?

Directs response efforts at the disaster site; it is the place to meet to learn how you are needed & your role.

Will first responders respond to a disaster immediately in every situation?

No, they will not respond immediately if the environment is unsafe.

What does the National Response Framework (NRF) focus on?

7 community lifelines (FEMA).

Which community lifelines involve safety and basic needs?

• 1) Safety and security (curfew)

• 2) Food, water, shelter

• 3) Health & medical (office of public health steps in).

Which community lifelines involve infrastructure?

• 4) Energy (power and fuel)

• 5) Communications (cell towers, radios)

• 6) Transportation (evacuation after the disaster)

• 7) Hazardous materials

How does FEMA direct national disaster responses?

Through the 15 EMERGENCY SUPPORT FUNCTIONS (ESFs).

Which four areas make up public health and medical preparedness in a disaster?

• 1) Biosurveillance

• 2) Countermeasure stockpiling and distribution (vaccines, antidotes, equipment)

• 3) Mass casualty care

• 4) Community resilience

What does NIMS provide in a disaster response?

A common language & structure so responders communicate efficiently (National Incident Management System).

What is a DMAT?

A Disaster Medical Assistance Team, activated by the US Public Health Service: trained doctors & nurses who assist with triage & medical care until evacuation.

What is the Medical Reserve Corps (MRC)?

Government reserves on call.

What is a CERT?

A Community Emergency Response Team: designated community individuals who respond.

What does the Office of Public Health and Medical Services do in a disaster?

Guides medical & mental health personnel & equipment/supplies, assesses public health infrastructure, & monitors for outbreaks.

How does public health respond to an outbreak in a disaster?

• 1) Detect the outbreak

• 2) Determine the cause

• 3) Identify risk factors

• 4) Implement control measures

• 5) Inform the medical & public communities about treatments, health consequences, & preventive measures

What is the nurse’s role in disaster response?

Know your role in the facility & incident command plans; follow orders; use the 8 disaster nursing core competencies.

How does disaster response escalate when local resources are overwhelmed?

Local → city → county/parish → regional → state; then the Governor requests national assistance & FEMA responds.

When may federal assistance begin for a hurricane?

BEFORE the disaster.

How do nurses and the public know who to call and where to report in a disaster?

Mutual aid agreements & NIMS reduce confusion; know the chain of command.

What is the first step for anyone in a mass-casualty disaster area?

Triage, the immediate FIRST step.

What is the goal of mass casualty triage?

Get medical resources to the people who can best benefit as quickly as possible to preserve life.

On what basis does the nurse categorize patients in mass casualty triage?

SURVIVAL POTENTIAL.

Which ethical principle guides mass casualty triage?

Utilitarianism: the greatest good for the greatest number.

A casualty is deceased or unlikely to survive given current resources. Which triage tag is this?

BLACK: casualty/dying (expectant).

A casualty has a life-threatening injury with the best chance of survival if stabilized. Which triage tag is this?

RED: HIGHEST priority (immediate).

A casualty has systemic issues that are not life-threatening. Which triage tag is this, and how long can she wait?

YELLOW (delayed): can wait about 1 hour for help.

A casualty has a localized problem and is walking. Which triage tag is this?

GREEN (minor): the “walking wounded;” can wait hours (for example, controlled minor injuries, or a GSW that is just tissue damage).

In START triage, where does the nurse send a walking adult casualty?

GREEN, directed to a designated area (out of the way).

In START triage, what does the nurse check in an adult who is not walking?

Spontaneous breathing; if there is no breathing after airway repositioning = BLACK; breathing = continue.

Which START findings make an adult RED?

RR > 30; absent radial pulse or capillary refill > 2 seconds; cannot obey commands.

When is an adult YELLOW in START triage?

When none of the RED criteria apply (otherwise YELLOW).

A walking, calm adult has a minor bleed but is loud and crying. Which START tag is correct?

GREEN.

In JumpSTART pediatric triage, how does the nurse start?

Walking → GREEN; no spontaneous breathing → reposition the airway.

What does the nurse do for a child with no spontaneous breathing after repositioning the airway?

If apneic with a pulse present, give 5 RESCUE BREATHS; breathing = RED; still apneic = BLACK.

Which JumpSTART findings make a child RED or BLACK?

RR < 15 or > 45 = RED; no palpable pulse = BLACK.

How does JumpSTART assess a child’s neurologic status?

AVPU: alert/verbal/appropriate pain = YELLOW; inappropriate or unresponsive = RED.

What does SALT triage stand for?

Sort (walk, purposeful movement, still/life threat), Assess, Lifesaving interventions, Treatment/Transport.

Which lifesaving interventions does SALT include?

Control major hemorrhage, open airway, chest decompression, & auto-injector antidotes.

Does SALT use respiratory rate?

No. SALT does not count respiratory rate.

When is SALT used rather than START?

SALT is used if EMS is farther away; START is used if EMS is closer.

In which order does the nurse assess a casualty in SALT?

ABCs; circulation (cap refill, peripheral pulses, decreased BP); neuro last.

A casualty has agonal breathing. How does the nurse interpret it?

Agonal breathing = not breathing (no true exchange of air); call a code.

What are the nursing priorities in mass casualty triage?

Triage first, treat second; direct walking wounded to a designated area; reassess as the situation changes.

What does the “Where/Who” question of a rapid needs assessment determine?

The magnitude of the disaster.

What does the “What” question of a rapid needs assessment determine?

The health needs.