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Broker model of advocacy

Uses negotiation, compromise and persuasion (Responsible)
-responsible

1

emergency nursing

the provision of msg care for pts with acute injuries or life threatening illness

2

Adversarial mode

Legalistic
Act as an adversary to other HCP who don't share advocates concerns with all focus on Rights of the client

3

Ombudsmen

Program for nsg homes so residents and families would have an advocate

4

Grievance

A circumstance or action believed to be in violation of a contract

5

Press ganey

Company that surveys pt about care @ hospital

6

Infection control

Reporting, tracking and trending
CDC standards

7

Focus of risk manager

Pt safety
Prevent occurrences
Prevent/minimize loss
Look at cause and effect

8

NYSDOH

report
HAI
NYPORT (NY pt occurrence and tracking system)

9

Disaster Nsg

Involves response to and preparedness for natural or man made events that affect an entire community. Involves massive #s of casualties and extensive property damage

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Disaster

Destructive event that disrupts normal functioning of a community
Cannot be effectively managed with routine procedures or resources

11

Medical disaster

Catastrophic event that results in casualties that overcome the health care resources

12

US Dept of Homeland Security

Created after 9/11

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Disaster Principles

The degree of PREPAREDNESS often spells the difference between emergency and disaster

14

MCI

Mass casualty incident
Any incident that causes a large # of casualties to the extent that necessary resources become scarce

15

Mutual aid agreements

A hospital taking pts from a hospital because they don't have enough resources

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Internal disasters

disrupts routine and infrastructure
-Fire/flood
-Threat to staff/pt/visitor
-Explosions/power failure
-Worker strike
-Loss of telecommmunication

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External

Doesn't affect infrastructure but taxes it resources
-Multiaccident
-Train derailment
-Tornado with injuries
-Boston marathon
-Hurricane Katrina

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what does the JC say about disasters?

Require hospitals to have detailed plans for both types of disasters
They myst address all potential scenarios (evacuation and role of staff)
-Need training and practice at least once a year

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Incident Command System

Federally mandated to coordinate personnel, facilities, equipment and communication in emergency situations
-Center of operations (safe, quiet place)

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HEICS

Hospital Emergency Incident Command system
Used by Health care systems
-Emergency preparedness coordinator is the liaison to HEICs
-National standardized action for disaster
-The administrator is the incident commander, if not, the nsg supervisor.
Need a EOC (emergency operations center)

21

EOC

Emergency operations center, used for mass casualties, incidents, weather, power loss, pandemics.

22

HEICS equipment

vests
tool kits (name cards, who to call)
Carts
ER
Manual

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Response of hospital to disasters

-Discharge noncritical pts
-staff changes (1 RN from each unit)

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Triage

Sorting pts to determine the priority of healthcare needs
NONdisaster: most critically ill pts receive most resources
DISASTER: the greatest good for the greatest number of people.

25

NATO colors

North Atlantic Treaty Organization
Red: immediate tx, survival possible with minimal tx.
Yellow: delayed tx, can wait hours w/o threat to life or limb
Green: minimal tx, injuries are minor, can wait hours to days
Black: expectant, injuries are extensive, chance of survival unlikely, even with tx. Comfort measures needed.

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Man made unintentional distaster

Nuclear power plant accident
chemical spills

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Intentional man made disaster

chemical
nuclear
radiological
explosion
acts of terror
Bioterrorism

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Greatest threats during disasters

food
water
shelter

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Terrorism

The use of force or violence (WMD) against persons or property, in violation of the criminal law o the U.S.
Purpose is to intimidate, coerce & create fear among the public.

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Acts of terrorism

Chemical, biological and nuclear weapons
Threats of terrorism
Assasinations
Kidnapping
Hijacking
Bombscares &bombing
Cyber attacks

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Efforts to secure the Homeland

Respond to and recover from incidents that do occur

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Injuries

burns
Traumatic amputations
Tympanic membrane rupture
Shearing wounds
Lung blasts
Abdominal organs can be ruptured

33

Anthrax

Highly debilitating available agent
Bacillus anthracis-aerobic Gm + spore
Infection: skin contact, inhalation and GI (not in US)
Toxin causes: hemorrhage, edema and necrosis
Skin lesions: edema, pruritis, macule/papule formation -- ucleration, eschar formation
Inhalation : worse. Starts with flu like symptoms, reap. distress, hypoxias, hypotension, sepsis, shock. Death imminent 24-36 hrs after resp. distress

34

Anthrax tx

Cutaneous: 60 day course PO Abxs (Cipro or doxy) 99% effective if started 24 hrs after exposure
Inhalation: 60 day cpro or doxy, high mortality
via aerosolized route.
No S&S same tx

35

Clue of WMD use

Large number of people with same illness
healthy people ill
Unusual diseases (out of season)
Disease thought to be gone resurges.

36

HAZMAT

hazardous materials by industry and the US government

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Things to know with HAZMAT

-how was the agent disseminated (dispersed)? liquid or gas
what is the volatility (rate that it evaporates)
Considerations: vapor density, odor, routes of entry
S&S: onset 4 hrs---cough, lung damage, burns, nose/throat irritation, death.

38

Types of chemical weapons

Vesicants and nerve agents

39

Vesicants

cause blistering (inflammation of reps, tract and death)

40

Nerve agents

Most toxic/lethal
small amounts needed, cheap
easily dispersed
pesticides

41

Decontamination

to make and individual/equipment safe by physically removing toxic substances quickly and effectively

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Decontaminate with

water
soap
bleech

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hot zone

Specified area
isolated

44

Decontamination corridor

uphill and upwind