EMERGENCY & DISASTER NURSING

LECTURERS:

Evalynn M. Rondilla, RN Eric A. Anies, RN Neil Dionisio, RN

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Is a situation which poses an immediate risk to health, life, property or environment.

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THE GOOD SAMARITAN LAW

Good Samaritan laws only protect those that have had basic first aid training and are certified. In other jurisdictions, any rescuer is protected from liability, granted the responder acted rationally. If one is neither trained in first aid nor certified, and performs first aid incorrectly, one can still be held liable.
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THE 3 KEY ELEMENTS

(1)the care rendered was performed as the result of the emergency, (2) the initial emergency or injury was not caused by the person invoking the defense, and (3)the emergency care was not given in a grossly negligent or reckless manner.
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GUIDELINES IN GIVING EMERGENCYCARE

1.AID 2.Survey the scene. 3.Survey the victim. 4.Activate Medical Assistance (AMA) or transfer facility.
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GOLDEN RULES OF EMERGENCY CARE

(1) Obtain consent, whenever possible.

(2) Think the worst

(3) Call or send for HELP.

(4) Identify yourself to the victim.

(5) Provide comfort & emotional support. (6) Respect victims modesty and physical privacy.
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GOLDEN RULES OF EMERGENCY CARE

(7) Care for the most serious injuries first.

(8) Assist the victim with his/her prescribed medication.

(9) Keep onlookers away from the injured person. (10) Handle victim to a minimum.

(11) Loosen all tight clothings.

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GOLDEN RULES ON WHAT NOT TO DO: (1) Do not harm. (2) Do not let the victim see his own injury (3) Do not leave the victim.
(4) Do not assume.
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GOLDEN RULES ON WHAT NOT TO DO:

(5) Do not deny a victims physical or

emotional coping limitations.

(6) Do not make unrealistic promises.

(7) Do not trust the judgment of a confused victim.

(8) Do not require the victim to make decision.
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Methods of Transfer depends on:

1.Nature and severity of victim. 2.Size of the victim. 3.Physical capabilities of the first aider. 4.Number of personnel and equipment available. 5.Nature of evacuation route. 6.Distance to be covered. 7.Sex of the victim.
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Is the impact of a natural or manmade hazard that negatively affects society or environment.

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1. Natural 2. Human-Caused 3. Technological

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Nurses CanBe Key Players in all Types of Disasters

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How can nurses be prepared?

1.Personal preparedness 2.Professional preparedness 3.Volunteer

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 Educates people about

disaster preparedness for hazards and trains them in basic disaster response skills, such as fire safety, light search and rescue, team organization, and disaster medical operations.
https://www.citizencorps.gov/cert/

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The World Health Assembly resolutions of May 2005 and May 2006 (WHA58.1 and WHA59.22) requested WHO to assist Member
States in building local and national capacities, including transfer of expertise, experience and technologies among Member States in the area of emergency preparedness and response. Nurses and midwives are routinely involved in emergency care..

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THE CONSULTATION WAS ORGANIZED TO:

Discuss roles and functions of nurses and midwives in emergency preparedness and response; Identify the appropriate competencies and skills needed for nurses and midwives in emergencies; Develop guidelines for incorporating health action in crises and emergencies into the academic curricula of nursing and midwifery worldwide;

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THE CONSULTATION WAS ORGANIZED TO:

Establish priorities for in-service training programmes on the role and response of nursing and midwifery during emergencies through the use of innovative strategies and technology; Discuss methods for coordinating efforts between nurses and midwives and other health professionals as well as other members of the response team during emergencies; Identify the role of partners in support of training and deployment of nurses and midwives in case of emergencies.

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The world is different today: terrorism threats new emerging infectious climate changes

diseases

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 Role of nursing in disaster and emergency

Those who nurse are centers of the health care system, and they are the person in charge of the triage. Information gathering and assessment 21 Training of primary caring

Problem
Developing country: Lack of corresponding program and number of health care staff often trained support to those who nurse Nursing person's role: Response when disaster happens and range that should be covered Making of guideline: that is making of disaster nursing curriculum Place-making of knowledge exchange
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 Role of nursing in disaster and emergency

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PTSR

PTSD

Psycho educational nursing interventions

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NURSES are encouraged to be involved in daily community activities as a health advisor.

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Summary of Nursing Interventions

PROMOTE CLIENTS SAFETY HELP CLIENT COPE WITH STRESS AND EMOTIONS HELP PROMOTE CLIENTS SELFESTEEM
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1. POVERTY 2. RACE and ETHNICITY 3. SOCIAL NETWORKS, SOCIAL SUPPORT, SOCIAL CAPITAL, PHYSICAL LIMITATIONS (DISABILITIES, CHRONIC ILLNESS, ETC.) 4. GENDER
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VULNERABLE GROUPS
1. Racial / ethnic minorities 2. Seniors and/or frail elderly 3. Low income 4. Children 5. Child-bearing women 6. Homeless 7. Chemically dependent 8. Chronically ill 9. Prisoners, ex-convicts, registered offenders 10. Disabled 11. Mentally ill 12. Transient (tourists)
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PRIMARY RISK ON HEALTH

1.Casualties, injury or threat to life 2.Crisis reactions such as: panic, high anxiety, and fear 3.Lack or shortage of drugs or treatment regimen 4.No access to medical facilities or professionals 5.Lack of clean air, water or food
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SECONDARY RISK ON HEALTH

1. Worsen the chronic illness 2. Mental health problems including alcoholism 3. Infectious disease arisen 4. Malnutrition 5. Food poisoning 6. Deterioration of ADL 7. Disability due to injuries

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MITIGATION
Reducing potential disaster damages before a disaster threatens Occurs during recovery from a past disaster and during preparedness for a potential disaster.
Assumes that society is exposed to risks whether or not an emergency occurs
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PREPAREDNESS
Developing operational capabilities and facilitating an effective response before an emergency occurs Various domains of responsibility (warning, damage assessment, etc) are identified and assigned. Knowing what may be needed, what should be done, and how it will be done....\Videos
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 Does your agency have a disaster plan? Do you know where your agency disaster plan is located? Do you know what is in the plan? Do you know your role in the plan? Do you know what your community disaster plan is for a variety of disasters?
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Goals of the Emergency Preparedness Plan

1. Provide medical care and treatment to casualties. 2. Prevent injury to persons and prevent damage or loss of Government property. 3. Undertake immediate rescue and evacuation of casualties and entrapped persons. 4. Inform and support the local community and provide mutual aid to other agencies when assistance is requested.
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DISASTER PLANNING Emergency Preparedness

The Medical Center has an Emergency Preparedness Plan. In the event of a serious emergency, the Medical Center CEO (or designee) will declare a disaster and order the of the facility plan. Internal

activation

communications will occur via Telephones located throughout the facility at both divisions. Do you Know Your Role in the Plan?

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Saves lives, minimizes property damage and enhances effectiveness of recovery

RESPONSE
Actions taken immediately before, during, or directly after an emergency occurs. Saves lives, minimizes property damage and enhances effectiveness of recovery.

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RECOVERY
Returns infrastructure systems to minimum operating standards. Most difficult disaster phase. Requires personal and community motivation and planning in advance
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Restoring Normal Routines

Depends on the: > type of event > coverage area involved > ability of public safety personnel
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1. Training of nurses who are prepared for and can respond to disaster 2. Establishment and development of disaster nursing as discipline 3. Enlargement of organizational bases and their coordination 4. Development of information bases for disaster nursing 5. International networking.

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Are you able, ready and willing to report to duty in the event of a major catastrophic disaster in your agency or community?
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 Willingness influenced by safety concerns for family and self, and confidence in own ability to provide competent care
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Healthcare providers are used to treating the sickest, e.g. cardiac arrests are given top priority Rationing of resources / care Working while you are worried about your own family

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Personal safety: 42% of hospital employees willing to report That % would increase to 86% if personal safety measures instituted Childcare issues: Females with young children less willing than hose with older children Males more likely to report than females
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 Felt personally responsible to report 96% Intended to report during an extreme disaster= 70% Felt co-workers would respond =38% Some have barriers identified:
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THEME: (20 MINUTES)

DISASTER PREPAREDNESS: THE NURSING PROCESS

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A process for sorting injured people into groups based on their need when resources are insufficient for all to be treated.
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Goal: save the most lives

Gives highest priority to those who have a serious injury/illness, but also have a good probability of survival, and do not require extraordinary resources May have to delay treatment of selected victims
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You may act impulsively and put yourself in harms way because the scene is not safe. > Use extreme caution and check for any hazards before moving in to check on the victim.
>
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 Sort the victims

No treatment beyond simple lifesaving measures Work under the Incident Command System.
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The START and SAVE triage techniques are used in situations in which triage is dynamic, occurs over many hours to days, and only limited, austere, field, advanced life support equipment is readily available.
(Benson, Koenig, & Schultz, 1993) Disaster Triage: START, then SAVE-A New Method of Dynamic Triage for Victims of a Catastrophic Earthquake

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 START = simple triage and rapid treatment SAVE = secondary assessment of victim endpoint
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PRIORITY 3

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PRIORITY 3 START: PRIMARY TRIAGE

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PRIORITY 3

PRIMARY TRIAGE

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PRIORITY 3

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SECONDARY TRIAGE

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SAVE: SECONDARY TRIAGE

TOTAL GCS SCORE
13-15 9-12 6-8 4-5 3 = 4 3 2 1 0

+ =

RESP. RATE (RR)

10-29 30 or more 6-9 1-5 0 =

4 3 2 1 0

12 = PRIORITY 3 11 = PRIORITY 2 10 OR LESS = PRIORITY 1

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+ SYSTOLIC
BP

90 or more 76-89 50-75 1-49 0 =

4 3 2 1 0

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Disaster Triage Tags Used throughout the US Color system: Red, Yellow, Green and Black

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Red (Critical)
Serious illness/injury that has a good probability of survival it treated rapidly Transport FIRST Example Open fracture of femur with unstable V/S Severe burns Tension pneumothorax Open chest wound Upper airway obstruction
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Yellow (Delayed)
Less serious illness or injury, but may deteriorate. Still requires transport but after the RED (Critical) victims Examples: Dislocations Burns Blunt trauma with stable v/s Head injury with no change in LOC
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Green (Minimal)
Patients do not appear to have life threatening injury walking wounded Does not require treatment in an acute care facility Can delay transport or transport to a non-acute care facility via non-ambulance Examples Simple fracture Minor laceration Hysterical reaction
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