DISASTER NURSING

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

WHEN DISASTER STRIKES..

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

Throughout

time mankind has been dealing with the threat of disaster

Sometimes

disasters can strike without warning.

only defense is your ability to be prepared.

Your

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

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

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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

Large scale effects not solely limited to the impact area B. Small scale effects are localized, limited to impact area
A.

4. ACCORDING TO DURATION
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.
A.

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 Preparedness Mitigation

Disaster Impact

Emergency Response

Disaster Prevention Rehabilitation

PHASES OF DISASTER
1. 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

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.

B. Alert Period-

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 injury 2.Establishment of medical triage centers 3.Search and rescue operations for those trapped 4.Appropriate medical treatment of those with

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 shelter 2.Provide adequate food and clean water 3.Continue mortality/morbidity surveillance 4.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 & U- pdated physical and psychological R- esponsible for organizing, teaching &
preparedness supervision

coordinated

S- timulate community participation E- xercise competence

B. BASIC PRINCIPLES OF NURSING CARE FOR DISASTER VICTIMS

Adaptation of nursing skills to situation Continous awareness of the patients condition Teach auxiliary awareness Selection of essential nursing care

C. ROLES AND RESPONSIBILITIES OF A DISASTER NURSE

D isseminate on information on environmental health hazard I nterpret health laws and regulation S ave oneself A ccept directions and take orders S erve the best for the most T each the meaning of warning signals E xercise leadership R efer to appropriate agencies

INCIDENT COMMAND SYSTEM (ICS) AND TRIAGE

MULTIPLE- CASUALTY INCIDENTS

Ms. Jonahlyn Gonzales Corpuz, RN,MAN 27

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

1. Incident Command 2. Communications 3. Organization

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

2 METHODS OF COMMAND

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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.

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SINGULAR
Incident Commander
Triage Officer Treatment Officer Extication Officer

SINGULAR
Incident Commander Triage Officer Treatment Officer Extrication Officer

UNIFIED
Incident Commander
Public information
EMS Operations Fire Operations Police operations

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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.
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THE AIM OF TRIAGE Basic 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
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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

OBJECTIVES OF TRIAGE ABUNDANT RESOURCES RELATIVE TO DEMAND. (DO THE BEST FOR EACH INDIVIDUAL).

PP PP P

RESOURCES OVERWHELMED (DO THE GREATEST GOOD FOR THE GREATEST NUMBER)

ppppppppppppppppppppppppp pppppppppppppppppppppppp pppppppppppppppppppppppp pppppppppppppppppppppppp pppppppppppppppppppppppp pppppppppppppppppppppppp

APPLICABILITY OF TRIAGE

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

MILITARY
Priority

CIVILIAN TRIAGE
Priority

is to get as many Soldiers back into action As possible

is to maximize survival of the greatest number of victims.

THE ADAPTABILITY OF TRIAGE

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IDEAL TRIAGE SYSTEM

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

Priority 1: Priority 2: Treatable LifeSerious But not LifeThreatening Illness or Threatening Illness or injuries. Injury. Airway breathing difficulties Burns without airway Uncontrolled severe problems bleeding Major or multiple Decreased mental status bone and joint Severe medical problems injuries Shock Back injuries with or Severe burns without spinal PRIMARY TRIAGE: damage CLASSIFY PATIENT IMMEDIATELY IN ONE OF THE 5 GROUPS

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

Priority 3 : Walking wounded. Minor musculoskeletal injuries Minor soft injuries

Priority 4 (sometimes called O priority : Dead or fatally Injured.

Exposed brain matter Cardiac arrest (no pulse for over 20 mins. Except with colddrowning or severe hypothermia) ,Decapitation, severe trunk and incineration.

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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

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TRIAGE TOOL

START/ JUMPSTART S IMPLE T RIAGE A ND R APID T REATMENT

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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

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START TRIAGE

All ambulatory patients initially tagged GREEN Respiratory Yes Under 30/min
No Position airway Immediate Over 30/min PERFUSION Cap refill > 2 sec Cap refill < 2 sec

No

Yes

Control bleeding
Immediate

Mental status

Dead of Immediate expectant

Failure to follow simple commands

Immediate

Can follow simple commands

Delayed

PHYSIOLOGIC PARAMETERS MNE MONIC RPM

R--

30 P 2 M Can do

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

TRIAGE RIBBON CONCEPT

TRIAGE 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 Level II Level III Level IV Level V

Red Yellow Green Black White

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

Level I (RED) Immediate or Critical Care Life-threatening Delay of a few minutes Fatal Immediate degree of urgency Immediate (highest priority)

EXAMPLES

Patients with airway, breathing, perfusion, or neurologic problems Airway burns also fit in this category.

Respiratory Arrest Airway Obstruction Sucking Chest Wound Cardiac Arrest Severe bleeding Shock Respiratory tract burns Acute Coronary Syndromes
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 Level

II Yellow

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

EXAMPLES

Delayed (second priority) Delayed, acute or non ambulatory care Serious but stable Delay of few hours: no impact Secondary degree of Urgency Depends on patients 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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

Level III GREEN

EXamples Minor bleeding Minor soft tissue injuries Contusions, sprains Superficial burns Partial-thickness burns of <20% BSA

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Minor (third priority) Victims who do not require hospitalization

Delay: no impact Much delayed degree of urgency Disposition depends on space availability

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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 resuscitation Massive burns (>85% BSA).

Level II 2-12 hours Disaster Response Disaster Response Level I victims Deteriorating Neurovital signs Second or third degree burns involving more than 50% of total BSA.

KNOW DISASTER RESPONSE LEVEL

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

Level III 12-24 hours disaster response Disaster response level 2 victims Those requiring formal surgical care Those requiring prolonged life support in an intensive care unit

Level IV Triage Level I victims

KNOW DISASTER RESPONSE LEVEL

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

Ms. Jonahlyn Gonzales Corpuz, RN,MAN

WHEN DISASTER STRIKES..

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

BEFORE DISASTER STRIKES

Protective Actions

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

EVACUATION

Means to leave the area of actual or potential hazard

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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. 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. in a calm manner. Be patient. Dont panic others. your home and/or business when you leave.

Know

Evacuate

Lock

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

SHELTER-IN-PLACE

Means to stay in your home, school, business, or a public building

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

If emergency officials advise you to shelter-inplace, 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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

DURING A DISASTER

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

AFTER DISASTER STRIKES

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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

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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Ms. Jonahlyn Gonzales Corpuz, RN,MAN

IF YOU ARE TRAPPED IN DEBRIS

Dont 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.

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