Emergency and Disaster Preparedness

Question 1

Disaster

Answer 1

• Event in which illness or injuries exceed resource capabilities of a health care facility or community due to destruction and devastation.
• Internal vs External

Question 2

Multi-Casualty & Mass Casualty Events

Answer 2

Multi-casualty
- Can be managed by a hospital using local resources
Mass casualty
- Local medical capabilities overwhelmed
- May require collaboration of multiple agencies and health care facilities to handle crisis

Question 3

The Life Safety Code

Answer 3

• Published by National Fire Protection Association
• Every health care facility required to practice at least ONE fire drill every year.
• All facilities must have an evacuation plan.

Question 4

Impact of Recent Disasters

Answer 4

• Events of September 11, 2001
• HAZMAT training
• Emergency preparedness

Question 5

*Disaster Triage Tag System Table 10-1
Usual vs mass casualty conditions.

Answer 5

• Red: Emergent (class I)
• Yellow: Can wait short time for care (class II)
• Green: Non-urgent or “walking wounded” (class III)
• Black: Expected to die/are dead (class IV)

Question 6

In mass casualty or disaster situations, implement a military form of triage with the overall desired outcome of doing the greatest good for the greatest number of people

Question 7

Notification & Activation of Emergency Preparedness Plans

Answer 7

• Radio/cellular communication between ED & EMS providers at scene
• Media broadcast message via radio, TV, electronic media
• DMAT team – Disaster Medical Assistance Team

Question 8

Hospital Incident Command System

Answer 8

• Facility-level organizational model for disaster management
• Roles formally structured under hospital or long-term care facility incident commander with clear lines of authority and accountability for specific resources
• Emergency operations center or command center
• Hospital incident commander
• Medical command physician
• Triage officer

Question 9

Role of Nursing in Hospital Incident Command System

Answer 9

• Policy development prior to disaster situation
• Meet patient needs in collaboration with medical command
• Personal emergency preparedness plan
• Personal readiness supplies or “go bag”
• Creativity and flexibility are essential

Question 10

Event Resolution

Answer 10

• Debriefing:
  — Critical incident stress debriefing
  — Administrative evaluation
• Psychosocial response of survivors to mass casualty events

Question 11

Regulatory Agencies and Preparedness

Answer 11

• Federal agencies
• State and local response agencies
• The Incidental Command System
• Hospital emergency preparedness plan

Question 12

Regulatory Agencies and Preparedness

Answer 12

• Federal agencies
• State and local response agencies
• The Incidental Command System
• Hospital emergency preparedness plan

Question 13

Emergency Operations Plan (EOP) #1

Answer 13

• Health care facilities are required by The Joint Commission to create a plan for emergency preparedness and to practice this plan twice a year.
• Essential components of the plan
  — An activation response
  — An internal and external communication plan
  — A plan for coordinated patient care
  — Security plans
  — Identification of external resources
  — A plan for people management and traffic flow

Question 14

Emergency Operations Plan #2

Answer 14

• Essential components of the plan
• Data management strategy
• Demobilization response
• After-action report or corrective plan
• A plan for practice drills
• Anticipated resources
• Mass causality incident (MCI) planning
• An education for all of the above

Question 15

Question #1
Is the following statement true or false?
- Health care facilities are required by The Joint Commission to create a plan for emergency preparedness and to practice this plan once a year.

Answer 15

False
- Health care facilities are required by The Joint Commission to create a plan for emergency preparedness and to practice this plan twice a year, not once a year.

Question 16

Triage

Answer 16

• The sorting of patients to determine priority health care needs and the proper site of treatment
• In nondisaster situations, health care workers assign highest priority and allocate most resources to the most critically ill patients.
• In disaster situations with large numbers of casualties, decisions are based on the likelihood of survival and the consumption of resources.
• North Atlantic Treaty Organization (NATO) triage system
• Red, yellow, green and black (Table 73-1)

Question 17

Triage Considerations

Answer 17

• Managing internal problems
• Communicating with the media and family
• Managing media requests for information
• Caring for families
• Stress management

Question 18

Triage Considerations: The Nurse’s Role

Answer 18

• Nurse’s role varies during disaster
• May be asked to perform duties outside of expertise: intubate, insert chest tube, suture
• May serve as triage officer
• Nurses must strive to maximize patient safety
• Be aware of state regulation

Question 19

Triage Considerations: Ethical Conflicts

Answer 19

• Assisted suicide
• Confidentiality
• Consent
• Duty
• Futile therapy
• Rationing care
• Resuscitation

Question 20

Triage Considerations: Managing Behavioral Issues

Answer 20

• Anxiety
• Depression
• Impaired performance
• Interpersonal conflicts
• Posttraumatic stress disorder
• Somatization (fatigue, general malaise, headaches, gastrointestinal disturbances, skin rashes)
• Substance abuse

Question 21

Question #2
What is the name for the triage category in which injuries are significant and require medical care but can wait hours without threat to life or limb?
- A. Delayed
- B. Expectant
- C. Immediate
- D. Minimal

Answer 21

A.
- Delayed Delayed injuries are significant and require medical care but can wait hours without threat to life or limb. Expectant injuries are extensive, and chances of survival are unlikely even with definitive care. Immediate injuries are life threatening but survivable with minimal intervention. Minimal injuries are minor, and treatment can be delayed hours to days.

Question 22

Personal Protective Equipment

Answer 22

• Purpose: to shield the health care provider from chemical, physical, biological, and radiological hazards that may exist when caring for contaminated patients
• Categories of protective equipment
  — Level A: self-contained breathing apparatus (SCBA) and vapor-tight chemical resistant suit, gloves, and boots
  — Level B: high level of respiratory protection (SCBA) but lesser skin and eye protection; chemical-resistant suit
  — Level C: air-purified respirator, coverall with splash hood, chemical-resistant gloves and boots
• Level D: typical work uniform

Question 23

Question #3
What is level A protective equipment?

Answer 23

• A. Self-contained breathing apparatus (SCBA) and vapor-tight chemical resistant suit, gloves, and boots
• B. High level of respiratory protection (SCBA) but lesser skin and eye protection; chemical-resistant suit
• C. Air-purified respirator, coverall with splash hood, chemical-resistant gloves and boots
• D. Typical work uniform
  A?

Question 24

Common Biological Weapons: Smallpox

Answer 24

Smallpox
- Virus, Incubation 12 days
- Extremely contagious; spread by direct contact, by contact with clothing or linens, Or by droplets person-to-person
- Manifestations: High fever, malaise, headache, backache, and prostration; after 1 to 2 days a maculopapular rash appears on the face, mouth, pharynx, and forearms
- Treatment is supportive care with antibiotics for any additional infection

Question 25

Chemical Weapons

Answer 25

- Effects are more apparent and occur more quickly than those caused by biologic weapons. (Table 73.6) - Agents vary in — Volatility — Persistence — Toxicity — Latency — Limiting exposure - Limitation of exposure is essential with evacuation and decontamination as soon possible and as close to the scene of the incident as possible

Question 26

Types of Chemical Agents

Answer 26

- Vesicants - Nerve agents - Blood agents - Pulmonary agents

Question 27

Vesicants

Answer 27

- Lewisite, sulfur mustard, nitrogen mustard, phosgene - Cause blistering and burning - Respiratory effects can be serious and cause death - Decontamination with soap and water; do not scrub or use hypochlorite solutions - Eye exposure requires copious irrigation - Treatment for lewisite exposure: dimercaprol IV or topically

Question 28

Nerve Agents

Answer 28

- Sarin, soman, tabun, organophosphates, and VX - Inhibit cholinesterase, causing cholinergic symptoms progressing to loss of consciousness, seizures, copious secretions, apnea, and death - Treatment: supportive care, atropine, benzodiazepine and pralidoxime - Decontaminate with copious amounts of soap and water or saline for at least 20 minutes - Blot; do not wipe off - Plastic equipment will absorb sarin gas

Question 29

Pulmonary Agents

Answer 29

- Phosgene and Chlorine: both vaporize rapidly causing pulmonary injury - Destroy the pulmonary membrane that separates the alveolus from the capillary bed, disrupting alveolar–capillary oxygen transport mechanisms. Capillary leakage results in fluid-filled alveoli - Manifestations include pulmonary edema with shortness of breath, especially during exertion. An initial hacking cough is followed by frothy sputum production

Question 30

Radiation Exposure

Answer 30

- Radiation exposure may occur because of nuclear weapon, nuclear reactor incidents, or exposure to radioactive samples - Exposure to radiation is affected by time distance and shielding - Types of radiation-induced injury — External irradiation: all or part of the body is exposed to radiation; decontamination is not necessary; not a medical emergency — Contamination: exposure to radioactive gases, liquids, or solids; requires immediate medical management to prevent incorporation — Incorporation: uptake of the radioactive material into the body

Question 31

Radiation Decontamination #1

Answer 31

- Triage outside the hospital - Cover floor and use strict isolation precautions to prevent the tracking of contaminants - Air ducts and vent are sealed - Waste is double bagged and labeled “radiation waste” - Staff protection — Water-resistant gowns, two pairs of gloves, caps, goggles, masks, and booties — Dosimetry devices

Question 32

Radiation Decontamination #2

Answer 32

- Patients are surveyed for radiation and directed to the decontamination area - Decontaminate each patient outside the ED with a shower - Water, tarps, towels, soap, gowns, all patient belongings, and so on must be collected and contained - Patients are resurveyed and reshowered as necessary - Showering should be performed to not contaminate clean areas with runoff from the showering - Biologic samples: nasal and throat swabs, blood - Internal contamination requires additional treatment—catharsis and gastric lavage with chelating agents

Question 33

Acute Radiation Syndrome

Answer 33

- Acute radiation syndrome (ARS): dose of radiation determines if ARS will develop - All body systems are affected by ARS - Presenting signs and symptoms determine predicted survival - Probable survivors have no initial symptoms or only minimal symptoms - Possible survivors present with nausea and vomiting that persists for 24 to 48 hours - Improbable survivors are acutely ill with nausea, vomiting, diarrhea, and shock. Neurologic symptoms suggest a lethal dose