Disaster Management

Disaster Management Overview involves a comprehensive approach to understanding and mitigating various emergencies and disasters. This framework is critical for healthcare professionals and responders in preparing for, responding to, and recovering from disasters. It relies on clear guidelines and protocols to ensure effective management of resources and coordination during crises.

Source Materials:
Lewis: Chapter 21, Page 385
ATI: Med-Surg Chapter 3, Page 15

Learning Outcomes

Emergency Management Skills:

  • Understand the steps in triage, primary and secondary surveys for emergencies.

  • Link pathophysiology with clinical practices in environmental and toxicological emergencies, fostering a deeper understanding of how these conditions affect patient outcomes.

  • Prioritize collaborative nursing management for clients in violence, emphasizing the importance of interprofessional collaboration in addressing complex patient needs.

  • Identify healthcare provider responsibilities and community roles in mass casualty preparedness, highlighting the need for community engagement in disaster readiness.

Triage Prioritization

Importance:
The ability to set patient acuity is vital for prioritizing care based on the severity of injuries. Rapid triage decisions can significantly impact patient survival and recovery outcomes, especially in mass casualty situations.

Critical Assessment Skills Needed:

  • Identify life-threatening injuries using the ABCs (Airway, Breathing, Circulation) to ensure immediate attention to critical areas.

Triage Tag System:
Categorization:

  • Red: Critical - Patients who need immediate care to survive.

    • Shock, pneumothorax

  • Yellow: Serious - Patients who are stable but may deteriorate without care.

    • See second, needs delayed attention

    • Open fractures

  • Green: Minor - Patients with non-life-threatening injuries who can wait for treatment.

    • See last- non urgent “walking wounded”

    • Minimal lacerations, anxiety

  • Black: Deceased or not expected to survive - Patients who have no chance of survival given their injuries and available resources.

    • Agonal breathing, grey matter exposed.

Primary Survey (ABCDEFG) (systemic approach)

A: Airway

  • Ensure alertness and assess the airway by checking level of consciousness (LOC) to prevent suffocation.

  • Use AVPU:

    • A: Alert

    • V: Verbal response

    • P: Pain response

    • U: Unresponsive

B: Breathing

  • Assess ventilation; look for signs of dyspnea, asymmetry in chest wall movement, and other indicators of respiratory distress.

  • Breathing changes may occur with;

    • fractured ribs

    • pneumothorax

    • penetrating injury

    • allergic reactions

    • Pulmonary embolism

    • asthma attacks

  • Assess for:

    • Dyspnea

    • Paradoxical or asymmetric chest wall movement

    • decreased or absent breath sounds

    • visible wound to chest wall

    • cyanosis

    • tachycardia

    • hypotension

C: Circulation

  • Monitor for hemorrhagic shock; assess pulse quality and skin condition for clues about perfusion status.

    • Bleeding internally/shock= tachycardia, mental status.

      • Peripheral pulses may be absent because of injury or vasocontraction.

  • Check for delayed capillary refill and specific signs of shock, such as tachycardia and hypotension.

  • Assess skin: color, temperature, moisture.

D: Disability

  • Assess neurologic status: LOC, measure degree of disability.

  • Evaluate neurologic status using the Glasgow Coma Scale (GCS) to determine changes in consciousness and potential brain injury.

    • not accurate with intubated or aphasic patients.

  • Check pupil size, shape, equality, and reactivity to gauge neurological health.

E: Exposure & Environmental Control

  • Remove clothing for assessment while being careful not to compromise forensic evidence.

    • DO NOT CUT THROUGH FORENSIC EVIDENCE

    • DO NOT REMOVE IMPALED OBJECTS

  • Maintain privacy when possible

  • obtain vs and pulse ox, BP in both arms.

  • Prevent hypothermia.

    • Warm blankets, warm IV fluids, overhead warmers, increase temp in room.

F: Facilitate interventions and comfort

  • Involve family during procedures for emotional support and better patient outcomes.

  • Family presence during resuscitation and invasive procedures.

  • Assign someone to explain care and answer questions.

G: Get Resuscitation Adjuncts (LMNOP)

  • L: Laboratory tests

    • H&H, CBC, ABG, CMP, RAINBOW

  • M: Monitor ECG for cardiac abnormalities.

  • N: Nasogastric tube or orogastric tube placement as needed for decompression or feeding.

    • Ingestion /poisons

  • O: Oxygenation and ventilation assessment to ensure adequate respiratory support.

  • P: Pain management to address distress and improve patient comfort during treatment.

    • crucial! Protocols for early treatment.

    • Pharmacologic:

    • Nonpharmacologic: distraction, positions, heat/ice

Secondary Survey

H: Head-to-Toe Examination

  • Examine all body parts thoroughly and obtain vital signs to establish a comprehensive understanding of the patient's condition.

    • TURN THE PATIENTS

    • VITALS

  • Use SAMPLE:

    • S: symptoms

    • A: allergies and tetanus status

    • M: medication history

    • P: past health history

    • L: last meal/oral intake

    • E: events or environmental factors proceeding illness or injury.

I: Inspect Posterior Surfaces

  • Assess the patient's back and posterior areas for injuries that may have been missed in the initial assessment.

J: Just Keep Reevaluating

  • Continuous reassessment of vitals and injuries is crucial to monitor progression and detect changes in patient status.

    • Vitals

    • Injuries sustained

    • primary survey (A-G)

    • control pain

Environmental Emergencies

Heat-Related Emergencies:

  • Types: Heat cramps, Heat exhaustion, Heat stroke requiring immediate attention due to potentially life-threatening outcomes.

    • heat cramps

    • heat exhaustion- dizziness, thirst, heavy sweating, nausea

      • Move to cool area, loosen clothing, sip cool water, seek medical attention if s/s don’t improve.

    • heat stroke- confusion, dizziness, dry skin, becomes unconscious.

      • call 911, move to cooler area, loosen clothing &remove layers, cool with water and ice.

  • Risk Factors:

    • elderly individuals, children, chronic illness

    • Outdoor workers, athletes, no cooling systems

    • Alcohol or drug use- this impairs ability to regulate temp.

  • Prevention: Encourage lightweight clothing, avoiding sun exposure, and utilizing air conditioning to mitigate risks.

    • Avoid excessive sun exposure

    • stay inside when elevated outdoor temps

    • sunscreen= SPF 30 or greater.

    • cool shower if overheating

  • Nursing Interventions for Heat Stroke: Provide supplemental oxygen, initiate IV fluids rapidly, and implement cooling measures such as ice packs or cooling blankets to lower body temperature effectively.

    • ABCDE

    • give 02 as needed

    • large gauge IV

      • rapid IVF infusion (NS-0.95%)

    • Foley if needed

    • cool the person (wet towels, ice packs, cooling blankets)

Cold-Related Emergencies:

  • Hypothermia: Causes include prolonged cold exposure; monitor vital signs closely for indications of decreased physiological function.

    • R/F: exposure to cold, environment, 02, IVF, homeless, diabetes, hypothyroidism, alcohol/drug use.

    • S/S: shivering, impaired judgement, dysarthria, drowsiness, decreased body temperature (below 94/35), LOC changes,

    • Nursing: assess ABCDE, core temp&VS, remove any wet clothing, warm them, monitor for complications: hypoxia, acidosis, coma.

  • Frostbite: Degrees of frostbite (1st degree to 4th degree) depend on severity, and massage of affected areas should be strictly avoided to prevent further injury.

    • extent of injury to exposed skin may not be evident for at least 24 hrs after the injury.

    • 1st degree: superficial - cold, sore, painful, skin red/purple.

    • 2nd degree: partial thickness- pins and needles, patches of peeling skin.

    • 3rd degree/4th degree: full thickness- numbness, hard/black skin forms.

    • Nursing care: reward- bathing the area (104-108), give pain meds, give tetanus shot.

    • DO NOT RUB OR MASSAGE THE AFFECTED AREA.

  • Nursing Care: Rewarm appropriately using controlled methods like warm baths; monitor for complications, including rewarming shock.

Toxicological Emergencies

Poisoning:

  • Causes; intention vs unintentional. Children under 5=more at risk.

    • medications

    • illicit drugs

    • toxic agent

    • Enviromental

      • pollutants, spider, and snake bites.

  • Assessment: Perform a thorough health history to identify the specific poison and provide necessary respiratory support until stabilization can be achieved.

    • Health history: ID agent

    • Respiratory support

    • Call poison control

    • Labs: tox screen, electrolytes, ABG’s, blood glucose, coag, kidney and liver function.

    • Extract poison- pump stomach, give antidote.

    • Monitor circulation: BP, cardiac monitoring, EKG.

      • Vomiting, diarrhea, excessive perspiration, give IVF

  • Actions: Consult poison control, consider methods to extract poison, and monitor vital signs and circulation closely for signs of deterioration.

Opioid Poisoning:

  • Assess for typical symptoms like pinpoint pupils and respiratory depression indicative of overdose, necessitating rapid intervention.

  • Expected findings: pinpoint pupils, decreased BP, resp depression, seizures, decreased LOC, hypoxia.

  • Nursing action: check responsiveness & breathing,

    • not breathing/no pulse= CPR

    • breathing and have a pulse= maintain airway, give rescue breaths.

  • Administer Naloxone (Narcan) promptly to reverse the effects of opioid toxicity and utilize supportive care as needed.

  • Substance use treatment referral.

Bites

Snake Bites:

  • High risk in children aged 1-9 years; assess local swelling, systemic symptoms, and manage pain but avoid ice or tourniquets as these may worsen the situation.

  • S/S: pain, N/V, numbness, paresthesia.

  • Nursing:

    • assess swelling q15-30 mins

    • opioids for pain.

    • avoid ice, tourniquets, heparin, and steroids for 1st 6-8 hours.

    • Antivenom: most effective 4-12 hrs after bite.

Animal Bites:

  • Clean the bite area thoroughly (5-10 mins) and apply antibiotic ointment; administer tetanus and rabies vaccines as appropriate according to the type of exposure and local protocols.

    • rabies- given day 3, 7, & 14.

  • Give antibiotics for deep puncture wounds.

Violence Assessment

  • Expected findings: bruising, hematomas, burns, lacerations, fractures, black eyes, blunt trauma, frightened appearance, agitation, human trafficking (headache, dizziness, rash, sores, abdominal pain)

  • It's essential to be supportive, establish trust, refer to appropriate services, and take measures to preserve evidence for potential legal follow-up.

Emergency & Mass Casualty Incident Preparedness

Definition: Mass casualty incidents involve multiple victims requiring external assistance and coordinated efforts from various agencies to manage effectively.

  • Triage during such events must be more rapid than standard Emergency Department processes and ideally take less than 15 seconds per patient to maximize survival chances.

  • Support Agencies: Engage with existing organizations such as NIMS, Red Cross, FEMA, NDMS, and local emergency services for coordinated efforts in emergencies, ensuring a unified response to disasters.

Notes for test