cman 380 exam 2

principles of disaster management

1. Prevent disaster

2. Minimize casualties

3. Prevent further casualties

4. Rescue victims

5. Provide first aid

6. Evacuate injured

7. Provide medical care

8. Promote reconstruction of lives

how do critical rescue workers use the principles of disaster management?

critical rescue workers apply these principles in proper sequence, or they will be ineffective and possibly detrimental to disaster victims

disaster risk reduction (drr)

aims to reduce the damage caused by natural hazards like earthquakes, hurricanes, floods, droughts, cyclones, and disease through an ethic of prevention

what does disaster severity depend on?

how much a hazard impacts the vulnerable society and environment

direct victim definition

individual immediately affected by event

indirect victim definition

family member, friend of the victim, or first responder.

displaced person definition

are those who evacuate their homes, schools, or businesses due to disaster

refugees definition

are those who fled their country due to famine, drought, natural disaster, war, or civil unrest

categories of disasters

- mass casualty event

- multiple casualty event

define disaster

-occurrence: natural or man-made

-must causes human suffering

-must creates human needs that victims CANNOT alleviate without assistance

define mass casualty event

- Usually >3-100 casualties

A mass casualty incident (MCI) is an incident where the number of patients exceeds the amount of healthcare resources available. This number varies widely across the country...but is typically greater than 10 patients.

define multiple casualty event

<2 persons injured

what are dimensions of a disaster?

-Predictability (natural/man-made)

-Frequency (impacted more often)

-Controllability (prevent/reduce damage)

- Time (period of warning)

- Scope (geographical area)

- Intensity (ability to inflict damage $$$ and injury)

factors that impact the scope & severity of disasters

- vulnerability of population

- environmental conditions: chemical, physical, biological, social

- warning duration & proximity to disaster

- individual perception & response

effects of a disaster on a community

•Public service personnel overworked

•Lifelines are disrupted (phone/TV/water/sewer)

•Resources depleted (food/medicine)

•Public/private buildings are damaged

•($)

•Impacting the role of a disaster response nurse

what are the three phases of a disaster?

1. pre-impact: mitigation & preparedness

- efforts to reduce risk, checking supplies/resources, warning the public at first possible sign of danger

2. impact:

- initial assessment of disaster, estimating needed resources, rescue efforts, injured people undergoing triage, morgue facilities.

3. post-impact: emergency phase (begins end of impact phase until there is no longer any immediate threat from the destruction)

- rescue & first aid, recovery (from emergency to full recovery), evaluate and debrief

what is the nurse's role during the impact phase of a disaster?

nurse's role: assess health needs and provide physical/mental support to victims.

federal agencies responsible for disaster management

- federal emergency management agency (FEMA): supports state and local governments. involved in mitigation, preparedness, response, and recovery activities.

how are different levels of government involved in disaster management?

- local government responds first

- followed by state

- federal government provides support

FEMA emergency cycle

purpose of prevention & mitigation efforts

• to reduce loss of life and property by decreasing impact of disaster by assuming that disaster is inevitable.

mitigation phase? and types

mitigation: reducing severity of human and material damage caused by the disaster. takes place before and after emergencies.

1. structural mitigation: actions to change characteristics of buildings or environment (i.e. raising building elevation, flood control projects, etc.)

2. non-structural mitigation: most of the time adopting or changing building codes (minimum standards & requirements for building structures)

preparedness phase of the emergency cycle

takes place before a disaster

• a continuous cycle of planning, organizing, evaluating, training, etc. to focus on readiness to respond to disasters.

response phase of the emergency cycle

• occurs immediately after a disaster. during this phase operations do not function normally. duration of the response phase depends on the level of preparedness.

recovery phase of the emergency cycle

• restoration efforts occurring with regular operations and activities'

• recovery period can take a while 

who has the power to declare a disaster?

FEMA

what level of government is FEMA?

federal

responsibility of state agencies for disaster management

state governor (after making a request to president to declare disaster) coordinates state’s Emergency Operations Plan (EOP) & opens Emergency Operations Center (EOC)

Emergency Operations Center (EOC)?

state agencies work together to direct agency’s functions for disaster relief

Emergency Operations Plan (EOP)?

aka all-hazards plan

• plans and assigns resources to other organizations

• sets up lines organizational relationships and how each organization operates in emergencies

responsibility of local agencies for disaster management

• also has EOP

• involves fire dept, police, nurses, volunteers, hospitals

• performs mock disaster drills & exercises

• focused on providing direct care

community reactions to disasters

follows a pattern

1. heroic phase: help people survive

2. honeymoon phase: drawing people together

3. disillusionment phase: disappointment with delays to aid

4. reconstruction phase: belief in community & restoration

emotional responses to disaster

victims go through:

1. denial

2. strong emotional response

3. acceptance

4. recovery

nursing implications for patients of long-term disaster experiences

• Lead to interpersonal or social problems

• Some turn to alcohol or drugs to relieve stress

• Others might have difficulty resuming their usual routines and relationship patterns

• Long-term respiratory syndromes such as asthma and bronchitis and mental health problems such as post traumatic stress disorder (PTSD) and depression

• Children: mental or behavioral problems years after the event

what symptoms are indicative of PTSD?

two or more symptoms indicative of  PTSD:

• hyper-alertness

• exaggerated startle response

• sleep disturbance

• survivor guilt

• decreased concentration

• impaired memory

• avoidance behavior.

nursing responsibilities in disaster management 

• adapting nursing skills to meet needs of community from a disaster

• CHN & PHN from state and local levels

• American Red Cross Nurses (>20,000)

what is triage?

• prioritizing victims of disaster for treatment

• color coded tags to assign care: black → red → yellow → green

• “START” is the most common Mass Casualty Triage algorithm.

what is START?

• the most common Mass Casualty Triage algorithm

• BLACK: (Deceased/expectant) injuries incompatible with life or without spontaneous respiration; should not be moved forward to the collection point

• RED: (Immediate) severe injuries but high potential for survival with treatment; taken to collection point first

• YELLOW: (Delayed) serious injuries but not immediately life-threatening

• GREEN: (Walking wounded) minor injuries

triage in a mass casualty incident (MCI)

• disaster triage: greatest good for the greatest number in the shortest time

• sorting system of patients

• fast sorting: 30sec-60sec → Tag → next person

  • 1st triage station: first contact, quick assessment, assign tag (left upper arm or leg)

  • 2nd station: victims move to color coded area (treatment/holding) or move patients to casualty collection point (CCP)

  • 3rd station: receive ongoing care (until transported)

what does a red tag mean?

• 1st priority

• life-threatening injuries that need immediate care

• experiencing or near hypoxic

• CAN BE HELPED BUT NEED MEDICAL ATTENTION WITHIN MINUTES OR UP TO 60 MINUTES

what does a yellow tag mean?

• 2nd priority

• care can be delayed until all reds are transported

• not yet hypoxic or in shock

• can wait 2 hours without immediate risk

what does a green tag mean?

• “walking wounded”

• can survive >2+ hours without treatment

• assign to casualty collection point (CCP) to get them out of the way

what does a black tag mean?

• hopelessly injured patients/dead

• would not survive under the best of circumstances

• present the greatest difficulty to nurses because conflicts with nursing ethics to not treat these patients

hazmat tag?

• might be color coded or triangle tag

• contaminated with hazardous bacterial/viral OR chemical substances

• need to be decontaminated

  • eliminate hazards before additional treatment provided

clinical parameters in START

• focusing on respiration, profusion, and mental status assessments (RPMs)

• involves:

  • ability to walk

  • presence or absence of breathing

  • respiratory rate greater OR less than 30 per min

  • perfusion assessment (cap refill, radial pulse)

  • mental status assessment (ability to obey commands)

how to assess respirations during RPM

• not breathing = reposition airway

  • no breathing = black tag

• breathing = assess quality of breaths

  • >30 = red (indicates respiratory distress

how to assess pulse (RPM)

• cap refill >2 seconds or no radial pulse = RED (signs of shunting)

• cap refill <2 seconds or radial pulse present = check mental status

how to assess mental status (RPM)

• unable to answer/follow commands = red

• able to follow commands = yellow

mnemonic for RPM

30-2-can do

what to do for pediatric patients who are apneic in RPM

if they have a pulse, give 5 rescue breaths

what organization developed the World Health Organization?

United Nations

what does WHO do?

• promotes health on a global basis

• direct and coordinate authority for international health work & collaboration with UN and other organizations

• mobilizes resources of governments and financial institutes

what is WHO the best source for?

• global morbidity and mortality data

what is the World Bank?

• global financial & health-related org that collaborates with WHO to:

  • lend money to low-income countries with lower interest rates

  • provide resources

  • reinsurance

what is PEPFAR?

• President’s Emergency Plan for AIDS Relief

• national org launched in 2003 by Bush to combat HIV/AIDS

• at the time was “the largest commitment by any nation to combat a single disease in history”

• GOAL: increase % of HIV+ individuals receiving antiretroviral therapy

what is an NGO and what is an example of it?

• Non-governmental organization: private health company driven by a health goal

• Global Grand Challenge is an NGO

• other examples: Global Health Council, Feed My Starving Children, International Council of Nurses

What is Global Challenges?

• launched by Bill & Melinda Gates in 2003

• focuses attention and efforts to unsolved global problems that are hard to address

• offers grants for research projects in 33+ countries

what do all agencies have in common? (global health related)

• strive to fulfill countries’ health-promoting priorities

• protect rest of the world from the spread of diseases

• develop a reliable global incidence report to make sound policy decisions

what environmental hazards are killing children worldwide?

• inadequate drinking water

• indoor air pollution & accidents

• injuries & poisoning

what are the top 10 leading causes of death globally?

1)Ischemic Heart Disease

2)Stroke

3)Chronic Obstructive

4)Pulmonary Disease (COPD)

5)Neonatal Conditions

6)Trachea, Bronchus, and Lung Cancers:

7)Diabetes Mellitus

8)Alzheimer’s Disease and Other Dementias

9)Diarrheal Diseases:

10)Tuberculosis (TB)

trends in causes of death in developed vs developing nations

• developing: more causes related to communicable, maternal, neonatel, or nutritional conditions

• developed: more noncommunicable diseases (stroke, ischemic heart disease)

• throughout all nations: lower respiratory infections & road injuries are remain some of the most common reasons of death

#1 global cause of death

cardiovascular disease

• caused often by smoking, making smoking “hidden” cause of death

how have health organizations impacted health outcomes?

• over the past 25 years, children who died before their 5th birthday has fallen dramatically

why do we need to know the reasons people die?

• to understand how diseases and injuries affect people

• assess the country’s health system

what groups can receive social security?

retirees, disabled, survivors (of deceased workers)

what is social security?

a program that uses public funds to provide some economic security for the public.

what role does SSA have in medicare/medicaid?

• determines eligibility for medicare/medicaid

• independent from HHS

how much does medicare cover?

• 80% of medical expenses. patients pay 20% of bill after meeting annual deductible

• does NOT cover most long-term care

what role does HHS have in medicare/medicaid?

• oversees and administers Medicare & Medicaid as CMS (Centers for medicare/medic

what is medicare and who does it cover?

• public health insurance from federal government for people 65 and older. Includes disabled and end-stage renal disease

• must also be a US citizen or permanent US resident, having lived in the US for 5 continuous years

• DO NOT have to be retired to receive medicare benefits

parts of medicare

2 parts: part A (hospital) + part b (medical)

***part c (medicare advantage) and d (prescription drug) are choices you can buy

medicare costs for original

parts a +b

• monthly premium with yearly deductible

• some people may not have to pay monthly premium based on income

• after meeting your annual deductible, you pay 20% of the bill for the medicare-approved amount

medicare part A deadline

• must apply 3 months before age 65 or receive penalty

medicare part A coverage

• all services free for a limited time (w monthly premium)

  • covers first 20 days of each benefit period (time spent in the hospital). coverage restarts if you stay out of the hospital for 60 days

  • provider must “certify the need” for care

• Inpatient care in a hospital (including nursing services)

• Skilled nursing facilities (rehabilitation/cardiac rehab)

• Short-term nursing home care (inpatient care in a skilled nursing facility/not custodial or long-term care)

• Hospice care (6 months-can recertify if live >6mos.)

• Some home health care and PT (short-term and discharged from the hospital)

• ***pays nurses***

how can retirees get SS benefits

• age >65-67

• work hx needed (10 years/40 credits)

• amount of money received is affected by age of retirement and earned income

SS benefits for spouse/family of retirees

• eligible spouse

• children can get up to half of the parent’s full retirement benefits if:

  • unmarried

  • under 18 OR 19 in high school or two months after HS graduation

SSA definition of disability

• inabiltiy to engage in ADL’s due to medically diagnosable physical or mental impairment that can be lead to death

• OR lasted or can be expected to last for >12 months

types of disability programs

• social security disability insurance (SSDI

• supplemental security income (SSI)

eligibility for SSDI

• worker with disability under retirement age

  • cant work do to medical condition that lasts >12 months

• must meet earnings tests (aka insured status)

  • “recent work” test: based on age at start of disability

  • “duration of work” test: show that a person worked long enough to earn benefits under SS

• at retirement age- pulled from retirement funds at same rate

SSDI for children and young adults

• SSDI can also pay benefit throughout adulthood (whole life) if disability started <22

• paid through parents’ social security record

• to be eligible at least ONE parent must:

  • be receiving SS benefits OR

  • have died + worked long enough to meet earnings test

eligibility for SSI

• little or no income

• disability OR >65

• benefits NOT based on prior work experience

• if eligible for SSI, also eligible for Medicaid

SSI for disabled children

• age <18 with disability

• based on family income

• conditions that qualify for immediate SSI payments to child (or else takes 3-5 months to come to decision)

  • HIV

  • total blindness

  • total deafness

  • cerebral palsy

  • down syndrome

  • muscular dystrophy

  • severe intellectual disorder

  • birth weight <2lbs 10oz

SS benefits for survivors

• available for family members of deceased eligible persons (like parents)

  • children under 18 (or 19 if still in highschool)

  • any age if disabled before 22 (can receive up to 75% throughout life)

• widows + full retirement age (receive 100% of deceased spouse’s benefits)

  • widows under retirement age receive reduced amount

• widow, any age, caring for child <18 OR disability (75%)

can you collect your deceased spouse’s SS and your own at the same time?

no, SS will pay the higher of the two

what does medicare part b cover?

covers 80% expenses on:

• provider services inpatient

• out patient provider services (primary care visits)

  • will cover visits focusing on treating specific problem

  • will NOT cover yearly physical or exams focusing on preventative care

• ER visits (for emergencies only)

• some home health services (“contract goals'“)

• durable medical equipment

• preventative vaccines

what is not covered by part A&B

• annual physical exams

• dental care

• eye exams

• acupuncture

• dentures

• hearing aids

• long term care

what is part c of medicare?

• medicare advantage plans

• offered by private insurances that cover services that a+b does not

• includes part d (medications)

• out of pocket add on

types of medicare advantage plans

HMO

PPO: more flexible

medicare part d

• covers prescription drugs

• different tiers of copy (tiers 1-4, 4 being most expensive)

• two ways to get part d:

  • buying part d

  • buying part c (which includes part d)

  • ***buying part d will not include part c, however

what is medigap?

• a medicare “supplement insurance” that helps fill the gaps of original medicare (a+b)

• sold by private companies but plan approved by The Office of Medicare

• cannot have part c if you buy medigap

hospital acquired “never events”

• policy medicare made that says Medicare will no longer reimburse hospitals for preventable errors in healthcare (i.e. performing surgery on the wrong patient)

readmissions reduction program

• established by ACA that penalizes hospitals for patients that are readmitted to a hospital within 30 days of discharge

who is medicare overseen by

• center for medicare & medicaid services (CMS) that is under HHS

• eligibility for medicare through SSA

what is medicAID?

• established as extension of the Social Security Act to provide health insurance for the poor

• eligibility follows federal poverty guidelines

• funded by both state & federal government through tax revenues

who administers and regulates medicaid?

• by individual states

• therefore benefits vary by state

medicaid benefits

• federal government requires minimum coverage similar to medicare a+b

• states can “expand” and add more coverage

  • MAY cover prescription drugs, dental, eye care, long term nursing care

can you have both medicare & medicaid?

• yes!

• can be dual eligible for medicare-medicaid

  • for low income medicare recipients (both retirees and disabled), medicAID pays for medicare part B “premium” + part D

  • acts like medigap

illinois medicaid requirements

• must be resident of illinois

• in need of health insurance assistance and has low income or very low income (poverty line)

• adults must be US national or have satisfactory immigration status

components to medicaid in illinois

1. All Kids

2. Moms and Babies

3. Family Care

4. Aid to Aged, Blind, and Disabled

5. ACA Adults “The Marketplace”

All Kids

• covers children 0-18, not matter who they live with

  • does NOT have to be a citizen or be legal immigrant