PN245 Class 5: Community Health and Disaster Flashcards

Practice vocabulary flashcards based on PN245 Class 5 lecture notes covering Community Health assessments, Disaster management levels, START triage protocols, and PPE donning/doffing procedures.

Objective of a community health assessment

To describe how to complete a community health assessment and identify community conditions that influence health.

PN245 Clinical judgment flow

Recognize cues → Analyze cues → Prioritize hypotheses → Generate solutions → Take actions → Evaluate outcomes.

Four core components of a community assessment

People, Place, Environment, and Social Systems.

People: demographics assessment

Population distribution, mobility, density, and census data.

People: biologic factors assessment

Health and disease status, genetics, race/ethnicity, age, gender, and causes of death.

People: social factors assessment

Occupation, activities, marital status, education, income, crime rates, recreation, and industry.

People: cultural factors assessment

Ethnohistory, hierarchy and roles, language, religion/spirituality, values, customs, and norms.

Place assessment

Geography/terrain, type of community, location of health services, housing, animal control, blight, employment, and grocery-store access.

Urban food desert

The nearest supermarket or grocery store is at least $1/2\,mile$ from the residence; low-cost, high-calorie outlets with poor nutritional value do not count.

Rural food desert

The nearest supermarket or grocery store is at least $10\,miles$ from the residence.

Environment assessment

Industries, pollutants, water, contamination, climate/weather patterns, flora and fauna, toxic substances, and vectors.

I PREPARE

Environmental history mnemonic: Investigate exposures; Present work; Residence; Environmental concerns; Past work; Activities; Referrals/resources; Educate.

I PREPARE: I

Investigate potential exposures, current and past.

I PREPARE: first P

Present work: job exposures and use of PPE.

I PREPARE: first R

Residence: age of home, remodeling, chemical storage, and water source.

I PREPARE: first E

Environmental concerns: nearby industries, waste sites, or landfills.

I PREPARE: second P

Past work: previous exposures, farm work, or military service.

I PREPARE: A

Activities: hobbies such as gardening and pesticide use.

I PREPARE: second R

Referrals and resources.

I PREPARE: second E

Educate about risk reduction, prevention, and follow-up.

Social systems assessment

Health, economic, education, religious, welfare, political, recreation, legal, communication, transportation, resources, and services.

Informant interview

Talking directly with community residents.

Community forum

An open public meeting used to gather community input.

Existing or secondary data

Records and databases such as vital statistics, census data, reportable diseases, schools, health departments, foundations, and universities.

Participant observation

Observing formal or informal community activities to determine what is occurring in selected settings.

Focus group

A directed discussion using open-ended questions with a representative sample of the community.

Survey

A random sample answers specific questions; the data are analyzed for trends and patterns.

Windshield assessment

The motorized equivalent of a simple head-to-toe assessment of a community.

Windshield assessment observations

Physical area, boundaries, zoning, housing, open spaces, people, schools, religion, media, stores, services, transportation, economy, safety, hazards, blight, and animal control.

Disaster

A sudden event large enough to overwhelm local or hospital resources and require outside support.

Internal vs. External disaster

Internal occurs inside the facility and threatens staff/patients; external occurs outside and creates a surge of casualties or strains resources.

Internal disaster examples

Fire or explosion in the building, power/utility failure, bomb threat, and active shooter.

External disaster examples

Transportation accident, chemical spill, community fire/explosion, natural disaster, and mass violence.

Three broad disaster categories

Natural, human-caused, and technology-related.

Four phases of the disaster management cycle

Mitigation/Prevention, Preparedness, Response, and Recovery.

Mitigation/Prevention phase

Reduce risk or impact before an event; teach prevention and identify hazards and vulnerable populations.

Preparedness phase

Plan and train before an event; know the EOP, participate in drills, prepare self/family, and understand ethical duties.

Response phase

Immediate action: follow EOP, triage, evacuate, decontaminate, use PPE, treat, and do the greatest good for the greatest number.

Recovery phase

Restore services, assess ongoing needs/resources, collaborate with stakeholders, and monitor long-term health effects.

Key ethical principle in disaster nursing

Do the greatest good for the greatest number.

START

A rapid mass-casualty triage method using RPM: Respirations, Perfusion, and Mental status.

RPM

Respirations, Perfusion, Mental status.

START: ambulatory patients

Initially tagged GREEN (minor/walking wounded).

START: non-breathing patient

Open/reposition the airway. If still apneic, tag BLACK.

START: RED (respiratory)

Respiratory rate greater than $30/\text{min}$.

START: RED (perfusion)

Poor perfusion, such as absent radial pulse or delayed capillary refill.

START: RED (mental status)

Inability to follow simple commands.

GREEN tag (START)

Minor: ambulatory/walking wounded; can wait and be directed to a separate treatment area.

YELLOW tag (START)

Delayed: serious but stable enough that treatment can safely wait after immediate threats.

RED tag (START)

Immediate: life-threatening but potentially survivable with rapid intervention.

BLACK tag (START)

Expectant/deceased: no respirations after airway repositioning or survival is unlikely with available disaster resources.

Hospital evacuation order

Ambulatory patients before stretcher patients; horizontal evacuation before vertical evacuation.

Evacuation priority after stabilization

The most critical but transportable patients, based on medical urgency and transport feasibility.

Pre-requisite for evacuation priority

Stabilize immediate threats such as bleeding and airway compromise, then reassess.

Scenario 1 Patient A: abdominal impalement, RR 18, delayed cap refill, alert

START color: RED. Delayed capillary refill indicates poor perfusion/possible shock despite normal RR and alertness.

Scenario 1 Patient B: 20-foot fall, RR 34, asymmetric chest rise

START color: RED. RR is over $30$ and the chest findings suggest a major respiratory injury.

Scenario 1 Patient C: pregnant, ambulatory, arm pain, RR 27

START color: GREEN. She is ambulatory and does not meet RED criteria; pregnancy alone does not change START color.

Scenario 1 Patient D: femur deformity, RR 24, pulses present, coherent

START color: YELLOW. Serious injury, but respirations, perfusion, and mental status do not meet RED criteria.

Scenario 1 Patient E: facial/neck trauma, gurgling, cannot follow commands

START color: RED by standard START because of threatened airway and inability to follow commands (Note: instructor may label BLACK).

Scenario 2 Patient A: under car, RR 18, pulses present, confused but follows directions

START color: YELLOW. Significant injury, but RPM does not meet RED criteria because he follows commands.

Scenario 2 Patient B: unconscious, RR 9, oral bleeding; RR improves with jaw thrust

START color: RED. Airway repositioning improves breathing; this is a lifesaving intervention and she cannot follow commands.

Scenario 2 Patient C: RR 28, weak central pulse, absent radial pulse, responds to pain

START color: RED. Poor perfusion and altered mental status; femur injury may be causing major blood loss.

Scenario 2 Patient D: RR 44 shallow, pulses present, cannot walk

START color: RED. RR greater than $30$ automatically meets RED criteria.

Scenario 2 Patient E: agonal respirations, no pulse

START color: BLACK. No effective respirations and no pulse in a mass-casualty setting.

Scenario 2 priority order

B first (airway), C second (shock/perfusion), D third (severe respiratory distress), A fourth (delayed), E fifth (black/expectant).

CBRNE

Chemical, Biological, Radiological, Nuclear, and Explosive.

WMD event clues

Unusual clusters of similar symptoms, rare/unexpected disease patterns, shared exposure locations, dead animals, powders/aerosols, suspicious packages, or chemical odors.

Chemical-agent onset and clues

Often within minutes: excessive salivation, pinpoint pupils, twitching, breathing difficulty, seizures, or sudden collapse of multiple victims.

Biological-agent clues

Lesions/blisters/rashes, descending flaccid paralysis, visual changes, slurred speech, rapidly developing pneumonia, or bleeding.

Acute Radiation Syndrome manifestations

Hematopoietic effects and gastrointestinal effects.

Hematopoietic radiation syndrome

A drop in all blood cells, increasing infection and hemorrhage risk.

GI radiation syndrome

Diarrhea or bloody diarrhea.

Explosive-event injuries

Burns and trauma from heat, fragments, pressure changes, and airborne debris.

First action for suspected WMD event

Protect yourself with appropriate PPE.

WMD reporting chain

Charge nurse → nurse supervisor → ED leadership → hospital incident commander.

WMD event activations

The disaster plan, HAZMAT response, Emergency Operations Plan, or Incident Command System.

WMD event documentation

Symptoms, exposure history, time of onset, number affected, and associated location.

PPE level determinant

The expected or known agent/hazard.

PPE Level A protection

Highest skin, eye, and respiratory protection. Memory: A = All.

PPE Level B protection

Highest respiratory protection with less skin protection than Level A. Memory: B = Breathing.

PPE Level C protection

Lower respiratory and skin protection for a known hazard when air-purifying respirators are appropriate.

PPE Level D protection

Lowest respiratory and skin protection; routine work clothing/PPE. Memory: D = Daily.

General PPE donning principles

Remove jewelry, hydrate/use restroom, inspect PPE, verify respirator fit, use a buddy/checklist, review signals, and follow protocol.

Routine Level D donning order

Gown → mask/respirator → goggles/face shield → gloves.

Routine Level D doffing order (Example 1)

Gloves → goggles/face shield → gown → mask/respirator → hand hygiene.

Routine Level D doffing order (Example 2)

Gown and gloves together → goggles/face shield → mask/respirator → hand hygiene.

Contaminated PPE surfaces

Outside of gloves and eye protection, gown front and sleeves, and front of mask/respirator.

Eye protection removal method

From the back by lifting the headband or earpieces; do not touch the front.

Mask or respirator removal method

Do not touch the front. Remove using bottom ties/elastics first, then the top.

Respirator removal timing

After leaving the patient room and closing the door.

Hand hygiene during doffing

Immediately if hands become contaminated, between steps as needed, and after all PPE is removed.

Safe work practices with PPE

Keep hands away from face, limit surfaces touched, change torn/heavily contaminated gloves, and perform hand hygiene.