Slide 1: Chapter 7 Nursing Care of
Disasters Dr. Marylynn Aguirre Disasters and Emergencies : Disasters and Emergencies Types of Disasters
Natural: caused by acts of nature or emerging diseases
Man-made: may be accidental or intentional
Types of Emergencies
Multiple casualty incidents-complex emergencies
Mass casualty: more than 100 casualties Natural Disaster Injuries : Natural Disaster Injuries Hurricane – drowning, bone, joint & muscle injuries, disease
Tsunami – Tsunami lung
Earthquake – GI & resp problems, burns
Snowstorm – MI
Thunderstorm – Electrical burns
Tornado – Debris related injuries Cholera : Cholera Acute bacterial infection (vibrio cholerae) of the small intestine
Severe diarrhea, vomiting, muscular cramps, dehydration
Oral/fecal route in water or food
50% mortality untreated
Antibiotics, IV fluids, clean water, cholera vaccine Typhoid Fever : Typhoid Fever Bacterial infection (salmonella typhi) transmitted by contaminated milk, water or food
Headache, delirium, cough, watery diarrhea, intestinal hemorrhage or perforation
Antibiotics, annual typhoid vaccine, proper disposal of human waste Terrorism : Terrorism Conventional weapons – bombs, guns
Nonconventional weapons – contact infection control, lab, CDC
Chemical: toxin into food, water, air, medications
Biologic: use of disease (bioterrorism) detected by surveillance system in public health
Nuclear: radiologic dispersion bomb Anthrax : Anthrax Bacillus anthracis – gram pos bacteria
Inhalation: flu-like symptoms to hemodynamic collapse in 3-5 days
Cutaneous: itching papule to vesicle with black, necrotic center
GI: n/v, bloody diarrhea
Treat with ciprofoxacin or doxycycline for 60 days Ricin : Ricin Potent toxin from castor beans (Ricinus communis)
Produces agglutination of RBCs, inflammation, and hemorrhage of the resp and GI mucosa Smallpox : Smallpox Highly contagious viral disease
Fever, prostration, vesicular, pustular rash
Humans are the only reservoir
Smallpox vaccine made from dried smallpox virus only for lab workers exposed to pox virus Ebola Virus : Ebola Virus Lethal disease (90% in one week) characterized by hemorrhage and fever
Initial symptoms fever, HA, chills, malaise
Later severe abd pain, vomiting,diarrhea
Incubation period 2 -21 days: natural reservoir unknown, blood/body secreations, airborne particles Radiation Exposure : Radiation Exposure A measure of the ionization produced in air by x-rays or gamma rays
Unit of exposure is the roentgen
Exposure of whole body to 10,000 rad is fatal in 24 hours
Dose between 500 to 1200 rad is fatal in 2-3 days
Death may occur weeks after exposure of 200 to 500 rad, but 600 rad considered fatal Radiation Sickness : Radiation Sickness Radiation breaks DNA chains, cells die or mutate
Severity determined by volume of radiation, length of time, and area of body
Moderate exposure: HA, n/v, anorexia, diarrhea
Long term: leukemia, other cancers, survivable with bone marrow tranplant Thermal Nuclear Blast : Thermal Nuclear Blast Thermal burns are caused as thermal energy travels through the air until absorbed on contact
Burns may involve only epidermis and upper layers of dermis and treated as any burn
Flash blindness is temporary
Radiation suppresses the immune system Situations Requiring Isolation or Decontamination : Situations Requiring Isolation or Decontamination Biological Agents Exposure: containment is essential; accomplished by isolation of the victim
Radioactive Exposure: will spread to other persons if the patient is not isolated
Chemical Exposure: person must be decontaminated according to protocol prior to treatment Terrorism Associated Symptoms or Injuries : Terrorism Associated Symptoms or Injuries Healthcare providers must be alert to the recognition, reporting, and treatment of high-priority biologic agents.
A disaster preparedness plan should be established in every healthcare facility
During a disaster, nurses may be expected to perform triage. Simple Triage : Simple Triage A very basic triage system is to categorize or label victims.
Immediate (Red) = victims needing the most support and emergency care
Delayed (Yellow) = victims less critical but still in need of transport to emergency centers for care
Ambulatory (Green) = victims who have minor injuries and do not warrant transport to an emergency center
Expectant (Black) = victims who are least likely to survive or are already deceased Reverse Triage : Reverse Triage When there is a mass casualty event with greater than 100 victims, reverse triage may be instituted.
Reverse triage works on the principle of the greatest good for the greatest number.
Persons who are the most ambulatory and least injured would be transported or instructed to move quickly to the warm zone, away from the immediate accident site to get processed first. Terrorism Associated Symptoms or Injuries : Terrorism Associated Symptoms or Injuries Reverse Triage
Used for mass casualties
Least injured would be transported away from a scene first
Minor injuries would be treated next
Critical injuries treated after the minor injuries
Most critical and severely injured would be treated last Casualty Management : Casualty Management Triage is a continuous process in which priorities are reassigned as needed.
Must balance lives with the realities of the situation, such as supplies and personnel.
Crowd control is the responsibility of security and police.
Psychiatric services takes an active role to prevent PTSD by assessing individual needs, offering immediate counseling and referral for follow-up. The Role of the Nurse : The Role of the Nurse It is imperative that nurses first know how to take care of themselves in order to assist others.
By educating oneself and being proactive in regular drills and practice of skills, nurses take an active role in helping others to save lives and fulfill an important obligation to society.
Applying basic first aid skills can be very helpful in immediate disaster relief efforts until emergency help can be obtained. The Role of the Nurse : The Role of the Nurse - Prepare selves, families, friends, and communities for disasters in conjunction with the local disaster preparedness plan.
Continue educating self on various types of disasters and appropriate response.
Provide emergency services with consideration of victims’ abilities, deficits, culture, language, or special needs.
Assist in the mobilization of healthcare personnel, food, water, shelter, medication, clothing, and other assistive devices. The Role of the Nurse : The Role of the Nurse Collaborate with agencies in authority including local, state, and federal representatives to deploy resources based on the greatest good for the greatest number.
Consider needs of victims including shelter both temporary and permanent, as well as psychologic, economic, legal, and spiritual factors.
Become involved with local, state, and national disaster planning agencies to schedule regular meetings to continually review and modify disaster plans. Nursing Diagnoses : Nursing Diagnoses Anxiety
Impaired verbal communication
Risk for Post-Trauma Syndrome
Risk for Injury
Risk for Trauma Predisaster Preparation : Predisaster Preparation Mitigation - disaster prevention programs
Preparedness – comprehensive disaster plan in place
Response – happens in the emergency stage including surge capacity
Recovery – reconstruction, the final stage is mitigation to prevent or reduce the harmful effects of a disaster Special Considerations : Special Considerations Older Adults
Do not generalize their needs
Need to determine the “appropriateness” of staying in their own home during a disaster
List of medications, names of family members, attorney, and who to notify in case of emergency
Need list of allergies, special dietary information, name of healthcare provider, and any special equipment needed for ADL Special Considerations : Special Considerations Immunocompromised
Assess client’s knowledge level concerning drinking and dietary restrictions
Sensory Deficit, Speech, or Language Impaired
Assess the most effective means of communication
Mobility Deficit (13% US pop)
Asses the support services needed Special Considerations : Special Considerations Non-English Speaking
Assess the literacy of the client in their own language through the use of an interpreter or use visual aids
Religion is a source of comfort
Be sensitive to religious beliefs when concerning the human body and tissues