6593334 Emergency Nursing

What every nurse needs to know about emergencies

Kristine M. Gebbie, DrPH, RN

Columbia University

September 10, 2004

SC AHEC Sept. 10, 2004

Goals Describe the role of an incident

management system at the community and institutional level

Identify resources for competency development

Describe functional roles often filled by nurses

Identify resources for ‘just in time’ learning


Standards are increasing Possible emergency preparedness

questions on NCLEX Possible licensing requirement similar to

blood-borne pathogen or abuse-reporting requirement

JACCHO standards require knowledge and drills of all hospital personnel

Public Health Ready includes competency training and drills for local health departments


Coordination in Disasters

OTHERPOLICE

FEMA

STATE EMERGENCY MANAGEMENT OFFICE

State

Federal

CityFIRE & EMS

HOSPITALS &OTHER

VOLUNTARY HEALTH SECTOR

MAYOR’SOFFICE

PRESIDENT HHS/CDC/VA etc.

CITY or COUNTY DOH

STATE DOHGOVERNOR’SOFFICE

CITY OR COUNTY OFFICE OF EMERGENCY MANAGEMENT


Incident Command System

PlanningChief

OperationsChief

LogisticsChief

FinanceChief

SafetyOfficer

Public InfoOfficer

LiaisonOfficer

Incident Commander

Unit leader

Unit leader

Unit leader

Unit leader

Unit leader

Unit leader

Unit leader

Unit leader

Unit leader

Unit leader


Uses of ICS Jurisdiction-wide interagency

coordination Agency-specific for internal

response HEICS PhICS


Basic principles of ICS Developed during 1970-80’s in So. CA in

response to wildfires Provides a management model for

command, control and coordination of an organization’s emergency response activities

Employs a defined management structure, with: clear reporting channels common nomenclature defined responsibilities


Incident Action Plan The mission (example)

determine if any of these cases are SARS implement procedures to prevent transmission to

others The plan

Perform contact tracing for the nurse Perform case investigation for each ED case from

the surveillance system Initiate surveillance for all ED’s in the County Initiate a fax alert to local physicians to increase

reporting of cases of symptoms consistent with SARS


Example: Section Action Plan

specific actions needed by each Section or unit within the agency to contribute to the accomplishment of these objectives?



Developing your competence Almost never begins with a blank slate You may already be competent in

emergency response You may not know it We have never measured it

Real training for competence depends on knowing the level of competency knowing the system or job to be done


Competency: an individual measure The individual possesses knowledge

and skills and is able to perform required task or objective

Competency statements include an action verb, indicating level of

performance and a subject or content area and may include a contextual reference


Competency combinations

Organizationalcompetencies

Emergency Preparednesscompetencies

Nursing competencies

Today’s focus


Competencies come in different forms

Workforce competencies statements of complex

performance within the workplace, akin to the KSAs of job classifications.

Can consist of a series of embedded tasks that are either sequential or parallel.

Are demonstrated over long periods of time.

Require contextual measurement.

Allow for a range of indicators to measure competence.

Instructional competencies

building blocks of learning experiences.

Structure the learning activities.

Require higher levels of performance to be built upon lower level ones.

Determine the measurement indicators.

Require measurement in the short term


all professional nurse roles and practice settings

acute care facilities,

clinics, schools, homes, other

community venues.


Example: critical thinking Use an ethical and nationally approved

framework to support decision-making and prioritizing needed in disaster situations.

Describe at the pre-disaster, emergency and post-disaster phases the essential nursing care for: individuals families special groups, e.g. children, elderly, pregnant

women communities.


Example: specific assessment

Perform an age-appropriate health assessment: airway and respiratory assessment, cardiovascular assessment, including vital signs and signs of

shock, integumentary assessment, particularly a wound, burn, and rash

assessment, pain assessment, injury assessment from head to toe, gastrointestinal assessment, including specimen collection, basic neurological assessment, musculoskeletal assessment, and mental status, spiritual, and emotional assessment.


Example: technical skills Demonstrate knowledge and skill

related to personal protection and safety, including the use of Personal Protective Equipment (PPE) for: Level B protection, Level C protection, and Respiratory protection.


Example: core knowledge Describe

the four phases of emergency management: preparedness, response, recovery and mitigation.

the local emergency response system for disasters.

the interaction between local, state and federal emergency response systems.

the legal authority of public health agencies to take action to protect the community from threats, including isolation, quarantine, and required reporting and documentation.


Example: professional development Recognize the importance of

maintaining one’s expertise and knowledge in this area of practice and of participating in regular emergency response drills.

Participate in regular emergency response drills in the community or place of employment.


Bioterrorism Competencies More specifics for

Leaders Communicable disease

staff Clinical staff Environmental staff Laboratory staff Medical

examiner/coroner Public health

information staff Other professionals Technical and support

staff


Emergency Preparedness and Response Competencies


Every hospital worker should be able to Describe the role of the hospital during

response to emergencies Locate and use the section of the

hospital emergency response plan that applies to his/her department and position.

Describe his/her emergency response role and demonstrate it during drills or actual emergencies.


The clinician competencies licensed healthcare providers (e.g., MD, DO,

DDS, RN, Advanced Practice Nurse, Physician Assistant, Clinical Psychologist, Clinical Social Worker, Optometrist) who see and triage patients or communicate with patients and are in a position to recognize initial cases and manage the initial care and referral of patients.

In all cases, the competencies are understood to be defined or limited by the legal scope of practice of the specific clinician.


The clinician in an initial assessment and decision-making role is able to

describe his/her expected role in emergency response in the specific practice setting as a part of the institution or community response.

respond to an emergency event within the emergency management system of his/her practice, institution and community.

recognize an illness or injury as potentially resulting from exposure to a biologic, chemical or radiologic agent possibly associated with a terrorist event.


Competency assessment Self assessment, by competency:

E.g., Identify and locate the agency emergency response plan or the pertinent portion of the plan

Range of answers from Not Confident to Very Confident

We are each responsible for moving toward a high level of confidence

Adapted from University of Illinois-Chicago School of Public HealthCenter for Public Health Preparedness


Getting ready: Family Disaster Plan

Source: http://www.fema.gov/pdf/rrr/fdp-all.pdf


Personal emergency plan Unless you already work a random

schedule and have full-time backup, such a plan can be critical

Key items include Child care Elder care Pet care Transportation


Saving the Whole Family

www.avma.org/disaster


Functional Roles in an Emergency or Disaster Your role may be the same or

similar to what you do every day or

Your role may be different from what you usually do.


Job Action Sheet (JAS) Describes a specific functional role during

emergency response: primary purpose of role during emergency response what actions need to be taken

Needed as different people may need to fill each role over duration of event, or for different events.

A person may have more than one functional role Over the time of one emergency Depending on the type of emergency


County Department of Health Emergency Response

Job Action Sheet Operations

Field Response Team

Case Investigator

Reports to: Epidemiology Investigation Site Coordinator Operations Command Center Location: _______________ Telephone: __________ Mission: To interview review charts and/or patients using designated questionnaire and protocol and document findings. Immediate:

Read entire Job Action Sheet Obtain briefing from Epidemiology Investigation Site Coordinator Obtain and review response questionnaire Obtain site interview schedule and facility contacts Identify and obtain any required personal protective equipment

Intermediate:

Conduct review charts and conduct interviews if patient available Report any concerns with questionnaire to the Site Coordinator Turn in completed questionnaires to Site Coordinator

Extended:

Plan for the possibility of extended deployment


Example:Potential Roles for E.D. Nurses Surveillance Safety officer Patient care Triage Risk

Communication Forensics

supervisor


Functional roles and usual roles—one hospital Functional role

Triage Charge Nurse

Emergent Care Charge Nurse

Urgent Area Charge Nurse

Minor Treatment Leader

Minor Treatment Area Charge Nurse

Hospital Position Triage Charge

Nurse CN3, CN2, Senior

ED RN Urgent Area

Charge RN Nurse Practitioner

Medical/Surgical Nurse


Sample JAS: Triage nurse Reports to: Mass Care

Operations Coordinator Mission: Assess individuals

presenting for care and direct them to the appropriate level of care or care site.

Immediate Read entire Job Action Sheet

and obtain briefing from Operations

Check equipment and supply expiration dates if appropriate

Conduct triage - emergent, urgent and non-urgent care

Refer to the appropriate level of care, providing first aid as needed

Intermediate Maintain patient assessment

log Prepare patient for transport

to appropriate level of care Report requests to

Operations/ Maintain contact with Medical Consultant

Extended Monitor supplies Prepare end of shift report

for Coordinator and incoming Triage Nurse

Plan for the possibility of extended deployment


Clinical refresher: Heat ExhaustionSigns and Symptoms: C/O: light-headedness,

headache, weakness, dizziness, or fatigue

Observe: Temperature: normal or moderately elevated, excessive sweating, may have irritable behavior.

Those Most at Risk: Extremes of age Exertion in the sun, or

confinement in a hot environment

Hx of: CV, psychiatric, endocrine, obesity

Alcohol consumption and psychotropic drugs

Treatment in Community or Cooling Center:

Move out of sun, into cooler environment

Decrease activity for remainder of day

Rehydrate with electrolyte laden fluid: 16-32 ounces per hour.

Transfer to E.D. for temperature over 103 F. in adult, 104 F. in child, any fever for infant < 6 months of age.

Source: Protocol for NYC-DOH Response to Heat Waves (DRAFT) 5/13/01


Clinical refresher: Heat Stroke Signs and Symptoms:

CNS signs: range from confused/combative to unconscious

Tachycardia, hypotension

Hot or cool, dry skin: no perspiration

Temperature > than 105 F.

+/- anhydrosis

Those Most at Risk: Elderly, alcoholism,

psychiatric & cardiovascular disorders

Pharmacy: psychotropic medications, street drugs, alcoholics

Treatment in Community Setting or Cooling Center:

Life Threatening Emergency: ABC’s and triage to EDSource: Protocol for NYC-DOH Response to Heat Waves (DRAFT) 5/13/01 &

Budassi, Sheehy, S. Emergency Nursing: Principals and PracticeMosby, St. Louis, Mo. 1992.


Triage Guidelines The following should be triaged to the

Emergency Department: Temperature:

> 103 F. for adults > 104 F. for children Any elevation in temperature for infants < 6

months Change in mental status or level of

consciousness Abnormal vital signs: severe tachycardia,

hypotension Source: Protocol for NYC-DOH Response to Heat Waves (DRAFT) 5/13/01


What are the boundaries? Know the limits to your own

knowledge/ skill/authority and Know key system resources for

referring matters that exceed these limits.


Practice makes better Planning for emergencies and

training staff are only part of the picture

Regular reviews, exercises and drills are essential to maintain awareness, identify areas for improvement and develop proficiency in response


Resources Emergency Preparedness & Response. Acute Mental Health Response to Children Affected by Terrorism.

http://www.bt.cdc.gov/children/PDF/working/mental.pdf

Emergency Preparedness and Response. Bioterrorism Agents and Diseases.http://www.bt.cdc.gov/agent/agentlist.asp

Emergency Preparedness and Response. Explosions and Blast Injuries: A Primer for Clinicians. http://www.cdc.gov/masstrauma/preparedness/primer.htm#key

Emergency Preparedness and Response. National Center for Environmental Health. Emergency Room Procedures in Chemical Hazard Emergencies A Job Aid. http://www.cdc.gov/nceh/demil/articles/initialtreat.htm

Emergency Preparedness and Response. Radiation Emergencies. Acute Radiation Syndrome: A Fact Sheet for Physicians. http://www.bt.cdc.gov/radiation/index.asp

Centers for Disaster Preparedness University of South Carolina School of Public Health, http://www.sph.sc.edu/acphp/default.htmThe Mailman School of Public Health, Columbia University. http://ncdp.mailman.columbia.edu

Facing Fear Together: Mental Health and Primary Care in a Time Of Terrorism. A Toolkit for Primary Care Providers Treating a Worried Nation. www.facingfeartogether.org , www.integratedprimarycare.org


http://www.nursing.hs.columbia.edu

or

[email protected]

Date post:	09-Apr-2015
Category:	Documents
Upload:	evangelineroldan9576
View:	318 times
Download:	3 times

6593334 Emergency Nursing

Documents