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DISASTER NURSING
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Ms. Jonahlyn Gonzales Corpuz, RN,MAN
Ms. Jonahlyn Gonzales Corpuz, RN,MAN
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WHEN DISASTER STRIKES…..
Ms. Jonahlyn Gonzales Corpuz, RN,MAN
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Throughout time mankind has been dealing with the threat of disaster
Sometimes disasters can strike without warning.
Your only defense is your ability to be prepared.
DISASTER Is any catastrophic situations in
which the normal patterns of life (or ecosystem) have been disrupted and extraordinary or emergency measures are required to save and preserve live and/ or environment.
Ms. Jonahlyn Gonzales Corpuz, RN,MAN
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TYPES OF DISASTER
TYPES 1. According to causes/
occurences A. natural- caused by force of
nature extreme heat or cold, fires, floods, earthquake, storms/hurricanes, tornadoes, epidemics
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B. MAN-MADE- CAUSED BY ERRORS OF MAN Riots Bio terrorism Acts of war Accidents Fire
C. Technological- caused by faults / break down in technology Building collapse Hazardous material incidents Fires & explosions Transportation accidents Major industrial accidents
D. CIVIL & POLITICAL DISORDER Demonstration Strikes Riots Mass shootings Hostage taking terrorism
2. ACCORDING TO PREDICTABILITY A. Sudden onset – no warning
issued or can be issued
B. Slow-onset – disasters that come with warnings
3. ACCORDING TO EXTENT OF DAMAGE
A. Large scale – effects not solely limited to the impact area
B. Small scale – effects are localized, limited to impact area
4. ACCORDING TO DURATION A. Long span – when the
emergency phase last for more than 6 months to year.
B. Short span – emergency phase last from 2 weeks to 6 months.
DISASTER MANAGEMENT AND ITS PHASE
Disaster Management is a collaborative term used to
encompass all activities undertaken in anticipation of the occurrence of potentially disastrous event, including preparedness and long-term risk reduction measure.
Warning Disaster Impact
Preparedness
Mitigation Emergency Response
Disaster Prevention Rehabilitation
Development Reconstruction
PHASES OF DISASTER1. Pre-disaster Phase
A. Preparedness- includes assessments of risks, training and program planning to prevent a disaster if possible.
AIM: To make people both aware of particular local risk and ready to respond promptly to specific disaster in their area.
B. Alert Period- refers to the time when disaster is developing and when it has not yet hit the community. Threats are detected, warnings are issued and evacuation is facilitated.
AIM: To ensure that food is available and people are able to secure/buy/get what they need.
2. Disaster Phase A. Response – the period immediately
following the sudden disaster when exceptional measures have been taken to search and find survivors, as well as to meet their basic needs for shelter, water food and medical care.
Activities:1.Rapid assessment of extent of damage
and injury2.Establishment of medical triage centers3.Search and rescue operations for those
trapped4.Appropriate medical treatment of those
with injuries
Aim: 1.To assess the magnitude of the
disaster
2. its immediate impact and consequences on health – related service,
3.assess the adequacy of local resources and mount an adequate relief operation.
3. Post – Disaster Phase A. Rehabilitation- operation and decision
taken after the disaster with a view to restoring stricken community to its former living conditions while encouraging and facilitating the necessary adjustments caused by disaster.
Activities:1.Evacuate survivors and provide shelter2.Provide adequate food and clean water 3.Continue mortality/morbidity surveillance4.Re-establish PHC services and establish
nutritional survey
B. Mitigation – the collective term used to encompass all
actions taken to disaster and long-term reduction of risks and hazards.
Usually follows after a disaster has affected a community.
Geography of Disaster
Impact Area- is the actual place of disaster event. Filter Area- is the periphery surrounding the
impact area. Community Aid Area- nearby areas w/c are
usually used as evacuation or resettlement area.
BASIC PRINCIPLES FOR HEALTH SERVICE DURING DISASTER
1. Recognize that events are unpredictable
2. Learn from the experience from the past
3. Build on the strengths of the community
DISASTER NURSING
-is the adaptation of professional nursing skills in recognition and meeting the medical and nursing needs evolving from a disaster situation.
A. BASIC PRINCIPLES IN PLANNING FOR DISASTER NURSING
N- ursing plans must be integrated & coordinated
U- pdated physical and psychological preparedness
R- esponsible for organizing, teaching & supervision
S- timulate community participationE- xercise competence
B. BASIC PRINCIPLES OF NURSING CARE FOR DISASTER VICTIMS
Adaptation of nursing skills to situation Continous awareness of the patient’s
conditionTeach auxiliary awareness
Selection of essential nursing care
C. ROLES AND RESPONSIBILITIES OF A DISASTER NURSE
D isseminate on information on environmental health hazardI nterpret health laws and regulationS ave oneselfA ccept directions and take ordersS erve the best for the mostT each the meaning of warning signalsE xercise leadershipR efer to appropriate agencies
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INCIDENT COMMAND SYSTEM (ICS) AND TRIAGE
MULTIPLE- CASUALTY INCIDENTS
Ms. Jonahlyn Gonzales Corpuz, RN,MAN
Ms. Jonahlyn Gonzales Corpuz, RN,MAN
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MULTIPLE-CASUALTY INCIDENT (MCI) sometimes called Mass
casualty Incident or multiple-casualty situation- is any event that places excessive demands on personnel and equipment.
The ability of the EMS system to respond to the situation is challenged or hampered by the situation.
The number of patient before MCI can be declared varies in practice.
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INCIDENT COMMAND SYSTEM (ICS) also known as- Incident Management System (IMS)
A system used for the management of a MCI .It provides a clear management framework for all types of large-scale incidents.
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COMPONENTS OF ICS
1. Incident Command
2. Communications
3. Organization
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1.Incident Command- The person/persons who assume overall
direction of a large scale incident. Assume by the most senior member of
the first service on the scene When reinforcement arrive there are 2
options of the person who initially assumed command:
a)Continue to be in command b) Transfer command to someone of higher rank
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2.Communications Report should be made to the communications center after the initial
assessment.
Keep the report short and to the point; but give enough information.
The incident commander must give their name and incident location by using the radio system.
EX:
CCC(central command center),this is Medic120.We are on the scene of a 2 –car MB an 6th wheeler truck with severe entrapment of 4 priority 1 patients. Dispatch a rescue company and four paramedic ambulances. We are in between the location of Blue Bay and Manila Tytana Colleges on Macapagal Blvd, Pasay City.I will now be called Franklin Avenue Command.
Police are needed at the scene to assist with traffic and crowd control as soon as possible.
(You can also tell what equipment to bring, best access, and where to park when rescue arrive at the scene)
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3.Organization IS VERY IMPORTANT! Think big!Order big!
Must have plan to deploy resources when they arrive
Decide what sector officer will be needed Where resources will be placed. New patients not found during the scene
size up have a way of appearing. Prevent “freelancing” activity in the
scene. A INCIDENT Tactical Worksheet can be used.
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FUNCTIONS OF INCIDENT COMMANDER
1.Scene size up Arrive at the scene and establish command. Put on proper identification Do quick walk through the scene (HAZMAT observe
from a safe distance) Assess number of patient. Identify hazards and degree of entrapment. Identify numbers of patients; *apparent priority care * needs for extrication Number of ambulances needed and other resources Areas where resources can be staged.
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2 METHODS OF COMMAND
1.Singular- A single agency controls all the
resources and operations often used at fire and rescue operations
2.Unified- Several agencies work independently
but cooperatively rather than one agency exercising control over the others.
SINGULAR
Incident Commander
Triage Officer Treatment OfficerExtication Officer
SINGULARIncident Commander
Triage Officer Treatment OfficerExtrication Officer
UNIFIED Incident Commander
Public information
EMS Operations Fire Operations Police operations
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EMS SECTOR FUNCTIONS Mobile command center Staging sector Supply sector Extrication sector (in cases of
entrapment) Triage sector Treatment sector Transportation sector Rehabilitation sector (if HAZMAT)
involve.
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3.TRIAGE The process of quickly assessing MCI
patients and assigning each a priority for receiving treatment
Is a French word meaning to “SORT”
Triage officer- the person responsible for overseeing triage at an MCI..
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DISASTER TRIAGE PRINCIPLES
1.Never move a casualty backward (against the flow) 2.Never hold a critical patient for further care. 3.Salvage life over limb 4.Triage providers do not stop treating patients. 5.Never move patients before triage, except in cases
of *risks due to bad weather, *impending darkness, or darkness has fallen *continued risks of injury *medical facilities is immediately available and
with enough resources. *Tactical situation that dictates movement.
Ms. Jonahlyn Gonzales Corpuz, RN,MAN
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THE AIM OF TRIAGEBasic Principle of Triage A).Principle of Rights Right patient Right place Right time Right resources Right care B)The Spock Principle Heroic act is not applicable to MCI
OBJECTIVES OF TRIAGE
ABUNDANT RESOURCES RELATIVE TO DEMAND.(DO THE BEST FOR EACH INDIVIDUAL).
R P P P P P
RESOURCES OVERWHELMED (DO THE GREATEST GOOD FOR THE GREATEST NUMBER)ppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppp
ppppppppppppppppppR
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APPLICABILITY OF TRIAGE
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THE ADAPTABILITY OF TRIAGE
MILITARY CIVILIAN TRIAGE Priority is to get as many Soldiers back into action As possible
Priority is to maximize survival of the greatest
number of victims.
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IDEAL TRIAGE SYSTEM
Should be simple Does not require advanced assessment
skills Does not rely on specific diagnosis Should be easy to perform Should provide for rapid & simple life –
saving intervention. Should be easy to teach & learn
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PRIMARY TRIAGE:CLASSIFY PATIENT IMMEDIATELY IN ONE OF THE 5 GROUPS
Priority 1: Treatable Life- Threatening Illness or
injuries. Airway breathing
difficulties Uncontrolled severe
bleeding Decreased mental status Severe medical problems Shock Severe burns
Priority 2: Serious But not Life-
Threatening Illness or Injury.
Burns without airway problems
Major or multiple bone and joint injuries
Back injuries with or without spinal damage
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Priority 3 :“Walking
wounded”. Minor
musculoskeletal injuries
Minor soft injuries
Priority 4 (sometimes called O
priority : Dead or fatally Injured. Exposed brain matterCardiac arrest (no pulse
for over 20 mins. Except with cold-drowning or severe hypothermia)
,Decapitation, severe trunk and
incineration.
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NOTE:
Extensive treatment does not occur at the incident site since it is a hazard zone and since it could impede rescue and initial treatment of other patient
TRIAGE TOOLSTART/ JUMPSTART
S IMPLET RIAGEA NDR APIDT REATMENT
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S-T-A-R-T TRIAGE The most commonly used method of
prioritizing patients. Its foundation is speed, simplicity, and
consistency of its application. Is intended to be completed in about
30 secs. Per patient It relies on some simple commands and
the PHYSIOLOGIC PARAMETERS
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Begin where you stand Ask all those who can walk to
move to a designated area. By using a bullhorn, PA system (loud voice to direct patients) away from immediate danger
START TRIAGE All ambulatory patients initially tagged GREEN
Yes
Over 30/min
Immediate
No
Position airway
Dead of expectant
No Yes
Respiratory
Immediate
Under 30/minPERFUSION
Control bleeding
Cap refill > 2 sec
Cap refill < 2 sec
Immediate
Mental status
Failure to follow simple commands
Can follow simple commands
Immediate Delayed
PHYSIOLOGIC PARAMETERSMNE MONIC RPM
R-- 30P– 2M– Can do
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TRIAGE RIBBON CONCEPTTRIAGE TAG-Color coded tag indicating the priority group to
which a patient has been assigned. Universal colors are used (Color Coding) Triage Category (Triage Tag) Color Code Level I Red Level II Yellow Level III Green Level IV Black Level V White
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Level I (RED) Immediate or Critical
Care Life-threatening Delay of a few minutes
Fatal Immediate degree of
urgencyImmediate (highest
priority) Patients with airway,
breathing, perfusion, or neurologic problems Airway burns also fit in this category.
EXAMPLES Respiratory Arrest Airway Obstruction Sucking Chest
Wound Cardiac Arrest Severe bleeding Shock Respiratory tract
burns Acute Coronary
Syndromes
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Level II YellowEXAMPLES
Delayed (second priority) Delayed, acute or non ambulatory care
Serious but stable Delay of few hours: no
impact Secondary degree of
Urgency Depends on patient’s
condition vs. resources Burn patients without
airway problems Major or multiple bone or
joint injuries Back & spine injuries
Open thoracic wound Penetrating
abdominal wound Severe eye injury Avascular limb Significant burns
other than face, neck, or perineum
Moderate bleeding Multiple fractures Conscious with head
injury Anxiety states
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Level III GREEN EXamples
Minor (third priority) Victims who do not
require hospitalization
Delay: no impact Much delayed
degree of urgency Disposition depends
on space availability
Minor bleeding Minor soft tissue
injuries Contusions,
sprains Superficial burns Partial-thickness
burns of <20% BSA
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LEVEL IV-BLACK
Expectant or Pending Care
Dead and Dying Delay, no impact Much delayed
degree of urgency When to classify a
victim dead and dying
Know disaster response level
L1. < 2 hours
L2. 2-12 hours
L3. 12-24 hours
L4. >24 hours
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KNOW DISASTER RESPONSE LEVEL
Level I< 2 hours Disaster Response Advanced neurological deficits (GCS <8)Injuries to the torso and a BP of < 50 mmHg systolic and below despite initial resuscitationMassive burns (>85% BSA).
Level II2-12 hours Disaster ResponseDisaster Response Level I victimsDeteriorating Neurovital signsSecond or third degree burns involving more than 50% of total BSA.
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KNOW DISASTER RESPONSE LEVEL
Level III12-24 hours disaster responseDisaster response level 2 victimsThose requiring formal surgical careThose requiring prolonged life support in an intensive care unit
Level IVTriage Level I victims
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Level V - WHITE No care Unaffected person Delay; no impact No degree of urgency Disposition: Safe
evacuation EXAMPLES: Evacuees Relatives of victims Onlookers Press
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TRANSPORTATION AND STAGING LOGISTICS
Treatment sector The area in which patient patients are
treated, headed by Treatment officer who is responsible for overseeing who have been triaged at an MCI.
Staging sector The area where ambulances are parked
and other resources are held until needed headed by a Staging officer.
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WHEN DISASTER STRIKES…..
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We must remember that there are common or similar preparation steps that must be taken before, during and after the disaster regardless if it is natural or manmade
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To prepare to disaster you must devise a strategy that encompasses the necessary steps that must be taken BEFORE, DURING and AFTER a disaster.
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BEFORE DISASTER STRIKES
Protective Actions
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Protective actions are the things we can do to safeguard our family members, coworkers and ourselves from harm.
As an example, using seatbelts in cars, following all workplace safety rules, wearing appropriate protective clothing at work such as safety glasses, helmets, and steel –toed boots.
Protective actions may also be necessary in the event of a natural disaster.
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Man-made disasters can threaten your workplace and community requiring you to take protective action.
The most common protective actions in an emergency are evacuation and shelter-in-place.
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EVACUATION
Means to leave the area of actual or potential hazard
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Have an emergency evacuation procedure at work and at home and review it regularly.
As often as possible, run disaster drills to keep everyone prepared.
For the office, appoint a safety person to oversee these activities.
If firefighters, police, civil defense workers or other local emergency officials ask you to evacuate, they are doing so for good reason – listen to them.
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Ms. Jonahlyn Gonzales Corpuz, RN,MAN
Some key points: Know where emergency exists and staircases are
located in buildings you work in and visit.
Know which routes are designated evacuation routes before an emergency happens, and use them when directed. You may find your normal shortcuts are impassable or otherwise dangerous.
Evacuate in a calm manner. Be patient. Don’t panic others.
Lock your home and/or business when you leave.
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Stay away from downed power lines. It is often impossible to tell the difference between charged and unchanged lines.
Have a predetermined meeting place outside the affected area to save time and minimize confusion during evacuation. If you plan to go to a hotel and you have
pets, make sure the hotel is “pet-friendly”. Pets will not be permitted in a public shelter.
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Keep the following disaster supplies in an easy-to-carry container such as wheeled plastic trash can in both home and office.
Listen to your radio for news and instructions.
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SHELTER-IN-PLACE
Means to stay in your home, school, business, or a public building
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If emergency officials advise you to “shelter-in-place”, remain inside your home or office.
Close and lock all windows and exterior doors.
Turn off fans, heating and air conditioning systems.
Get your disaster kit and go to an interior room without windows.
Use duct tape to seal cracks around the door and any vents into room.
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Shelter-in-place must be ended properly in order to provide the best protection.
Listen to your radio or television for emergency authorities to announce when it is safe to evacuate.
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DURING A DISASTER
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If terms are falling from the wall, off of bookshelves, or from the ceiling, get under a sturdy table or desk to protect yourself. If there is a fire…
The importance of staying calm cannot be overemphasized. Do not allow yourself to lose self-control.
Before opening a closed door, use the palm of your hand to feel the door. If it is not hot, open it very slowly. If it is hot to the touch, do not open the door.
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If you are able to safely enter the hallway, stay close to the floor. Superheated air, poisonous gases, and heavy smoke collect first along the ceiling. Crawl to an exit and work your way out of the building as quickly and calmly as possible.
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AFTER DISASTER STRIKES
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Quickly assess yourself and those around you for injuries. Give basic first aid.
Control active, serious bleeding by pressing firmly against the wound. Cover the wound with a clean dressings and bandages and maintain pressure over the wound.
To take care burns, cool the burn with large amounts of water and then cover the burn with dry, clean dressings.
If broken bones are not suspected, place person on their back and elevate the legs about 12 inches. If the person is unconscious, put them on their side to allow fluids to drain and make breathing easier.
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Prevent all seriously injured persons from getting chilled or overheated and unless their life is in danger, do not move them.
Check for fires, fire hazards and building damage using a flashlight.
Do not light matches or candles or turn on electrical switches. If you smell gas or suspect a leak in your home or business, if possible –turn off the main gas valve, open windows, and get everyone outside and away from the building.
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IF YOU ARE TRAPPED IN DEBRIS… Don’t stir up dust. If possible, cover
your mouth with clothing to prevent inhaling dust.
Tap on pipe or wall so that rescuers can locate you. Use the whistle from your disaster kit if it is available. Resist the urge to shout as this makes it likely you will inhale dangerous amounts of dust. Note: Untrained persons should not
attempt to rescue those are trapped inside a collapsed building.