Nursing in Disaster: Role of the Nurse – Flashcards
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Define emergency
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Events that require a swift, intense response on the part of existing community resources
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Define disaster
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Occurrence, either natural or man-made, that causes human suffering and creates human needs that victims cannot alleviate without assistance
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4 types of disasters?
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Natural: Flooding, Hurricanes, Earthquakes, Tornadoes, etc. Man=made Disasters: Intentional, Wars, Terrorist Attacks, Forest fires- arson Accidental: Forest Fires-lightning Environmental Contamination: Oil spills
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What are agents of harm/damage? Can be either? examples of each?
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Item that actually causes injury or destruction primary or secondary primary: hurricane with rising water (flooding and high winds) secondary: damaged building's infrastructure
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With disasters, mass causality vs multiple causality?
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Mass Casualty Incident: 100 or > significantly overwhelms ER Med services, resources Multiple Casualty Incident: >2 but < 100 injured may strain, sometimes overwhelm ER resources
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Vulnerability of individuals depends on?
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age: the elderly, the young pre-existing health conditions: physically handicapped, respiratory/cardiac, degree of mobility, emotional stability, resources
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Environmental factors that matter?
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Those without power for short time (1-2 days) cope better than those out for longer Those with support do better that those without
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In regards to warning and proximity, psychological distress increases when?
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longer exposed closer to site little or no warning
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With individual perception, severe psychological consequences are greater if?
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emotionally close to those affected has compromised coping abilities has experienced many personal losses in role overload never before experienced disaster
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Disasters vary by? (4)
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Type of onset: sudden or predictable? Duration of immediate crisis: how long? Scope/magnitude Extent
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Most damage when? (3)
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no time for warning long period of impact rapid onset
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Disaster management includes? (3)
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preimpact impact postimpact
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Describe the pre-impact period.
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preimpact: phase before a disaster. This is the time for disaster planning and mitigation before the actual occurrence. the time for assessment of probabilities and risks of occurrence of certain types of disasters. Based on risk assessment and hazard vulnerability analyses, specific action plans should be designed to reduce the effects of predicted disasters. Mitigation might involve legislating specific building codes and land-use restrictions
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Describe the impact period.
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During this phase, there should be a preliminary assessment of the nature, extent, and geographical area of the disaster. The number of persons requiring shelter, the type and number of anticipated disaster health care services, and the general health status and needs of the community must be determined. It is important to have an estimate of the needed emergency resources as soon as possible after a disaster event to activate mutual aid plans and ensure a timely response from emergency medical services and other vital community support services.
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Describe the post-impact period
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Has two components: emergency and recovery. Emergency phase begins at the end of the impact phase and ends when there is no longer any immediate threat of injury or destruction. This phase is the time of rescue and first aid. Incident command is established if it was not established in the warning phase. An assessment is made to establish the extent and types of emergency resources needed. Recovery begins during the emergency phase and ends with the return of normal community order and functioning. The disaster planning cycle should begin again during the recovery phase.
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5 components of disaster management continuum?
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Preparedness Mitigation Response Recovery Evaluation
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What is the goal of preparedness? Includes?
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Goal: reduce Impact Includes: Identifying hazards, proactive planning, & evaluating possible damage.
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Components of the preparedness stage?
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ID Hazards: Existing & potential; unique to community Analyze vulnerability: Who affected most; resources Assess risk: Use comprehensive assessment, rate ( ie, low, medium, or high risk)
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Some characteristics of an effective disaster plan?
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Realistic, concise, official, developed with local input, responds to direct needs, has central control, collects & integrates data, gets data to necessary source, avoids duplication and addresses resources available
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Role of community nurse in preparedness?
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Know community agency and social agency resources available know where equipment & supplies stored know prearranged role, rendezvous site (& alternative)
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Role of ER personnel during preparedness?
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be familiar with equipment/supplies keep them updated practice have protective gear & know how to use have previous knowledge/training on hazard assessment know chain of command
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What is the national response framework (Office of Homeland Security: FEMA & others) used? Its purpose?
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Used when disaster is more than local and state governments can manage Helps to coordinate efforts Responds to all moderate and massive disasters Provides direct aid (supplies & personnel) Provides indirect aid (funding & coordination)
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In regards to emergency preparedness, what is the job of the Red Cross?
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Primary voluntary national disaster relief agency Damage Assessment Mass Care Health Services Family Services Disaster welfare inquiry service
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Job of CDC is emergency preparedness?
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Disaster prevention/mitigation of epidemics, biochemical hazards
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Job of the states in emergency preparedness?
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Usually one agency designated as Emergency Management Agency Coordinates state plan, resources, requests for help Supplement/facilitate local efforts
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Role of local government in emergency preparedness?
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Where response begins Primary responsibility for preparedness & response Responsible for safety and welfare of the citizens Protects lives, health, property Carry out evacuation rescues Maintain public works
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Role of the individual in emergency preparedness?
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Reduce hazards Prepare emergency supply kits Prepare emergency plans Monitor emergency communications
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Items individuals/families should have in an emergency kit?
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Water (1 gallon per person per day) Food (stock up on non-perishable items that you eat regularly) Medications (this includes prescription and non-prescription meds) Tools and Supplies (utility knife, duct tape, battery powered radio, etc.) Sanitation and Hygiene (household bleach, soap, towels, etc.) Clothing and Bedding (a change of clothes for each family member and blankets) Important documents (copies of your driver's license, passport, and birth certificate to name a few) First Aid supplies (to treat basic cuts and lacerations that you might get during a tornado or hurricane)
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Things individuals/families should consider when forming an emergency plan?
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ID types of emergencies Pick a meeting place outside home for sudden emergencies outside neighborhood if unable to return home right away. ID emergency contacts. police, fire department out-of-state contact that you can call to let the rest of your family know you are ok. Plan your evacuation route.
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Within the disaster management continuum, describe what goes on during mitigation.
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Effort to prevent risks from causing disaster Taking action to limit damage, disease, etc.
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Within the disaster management continuum, describe what goes on during response.
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implement disaster plan provide emergency care restore communication & transportation
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In regards to response, what are components of the emergency response network?
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Incident Command System: Command Center for coordination of community wide response at the scene Emergency Operation Center/Medical Center Command Center for coordination of community wide response P.O.D- Point of Distribution Strategic National Stockpile Incident Command Structure
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Examples of nursing roles in regards to response?
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Remain in place until situation stabilized survey assessment (often CHN) crucial information needed asap Determining immediacy of care (triage) ER aid stations Shelters
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Issues nurses may experience when responding?
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duty vs. family need want to render immediate care when not your role
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Major health concerns in regards to response?
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Disruption: decreases in personal hygiene, sanitation and privacy; increases in overcrowding, malnutrition and personal injury; increased potential for food and water contamination, spread of communicable disease Preparedness key to mitigation Epidemics not automatic
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Purpose of the recovery phase of the nursing continuum?
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Stabilization of the community Return to previous/normal status
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Possible issues during recovery?
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Continuing death Population shift Contamination: food, water Increased need for psychological first aid
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The American Red Cross (ARC) recognizes what 4 stages of recovery?
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Heroic: help others Honeymoon: pull together Disillusionment: disappointment, self care Reconstruction: reaffirm faith in community
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Describe the heroic phase.
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This occurs immediately after a disaster strikes. The community is often shell-shocked and in dire need of basic emergency needs such as food and shelter - because the red cross is there and providing assistance they are perceived by the community as the heroes
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Describe the honeymoon phase.
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Occurs in first few days after the disaster. Usually it carries with it a great deal of public support and media coverage. This is also the time when ARC receives the most praise from public officials. Fundraising/volunteer recruitment are easiest. In addition to helping people know how to GET help, in this phase the messages expand to help people know how to GIVE help (and how NOT to help)
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Describe the disillusionment phase.
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By this time, the community and survivors are getting tired. They are being worn thin by the stress of the ongoing recovery efforts. People sometimes begin to question ARC and its service delivery, fundraising methods or community partnerships. During this phase, media, elected officials, partners or the general public are more apt to vocalize criticism.
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Describe Reconstruction phase.
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This is the long-term phase of the disaster where we must manage the expectations of the public regarding the ongoing recovery process. By now, the news media will likely have shifted their focus somewhere else. Likewise, the public's attention moves from Red Cross services to the work of our partners.
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The nurse's role during recovery?
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Goal: restore community to normal -referrals for rehab, convalescence -continued psychological status assessment -referrals for food, clothing, shelter, counseling -evaluate & revise disaster plan (all phases)
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Components of the evaluation phase of the disaster continuum?
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Review, report, improve Evidence based practice
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Define disaster nursing. Its goals?
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Adaptation of professional nursing skills to recognize and meet the nursing, physical, and emotional needs resulting from a disaster Goal: achieve best level of health for people and community
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Roles of disaster nurse management?
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PHN: ongoing community assessment, first responder, public education Field Triage Point of Distribution (POD) plans Personal protective equipment Documentation Skill building
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Examples of volunteer opportunities in disaster nursing?
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Disaster Medical Assistance Team (DMAT) volunteers: nurses, ER personnel, physicians rapid response team: can go nationwide Medical Reserve Corps Red Cross Disaster Assistance Team (DAT)
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Examples of disaster nursing roles?
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US PHS Nurse Corp & US Military Nurse Corps: -first responders Local ER & ICU Nurses: -own facility or sent as team close to site -disaster response, damage assessments, mass care, shelter care
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What are some jobs of the nurse when considering the psychological needs of victims?
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Assess for those at greatest risk Anticipate and prepare for crisis intervention Recognize that victims have legitimate reason for reaction/emotions
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Some psychological needs of victims?
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Use simple support measures at triage/disaster site: families together assign companion as needed give tasks communicate encourage sharing of feelings/support isolate those with hysterical or panic behavior
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What are some psychological needs of the first responders?
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Psychological response overwhelmed overworked, understaffed feeling unqualified burnout work/family conflict
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What are legal and ethical implications of disaster nursing?
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No laws specifically defining scope of practice in disaster guidelines Nurse practice act standards of practice state attorney opinions Good Samaritan Acts
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Give the reality Myth: Epidemics and Plagues are inevitable
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Reality: Do not occur spontaneously or lead to outbreaks of exotic disease
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Give the reality Myth: Brings out the worst in human behavior
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Reality: Majority respond spontaneously and generously
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Give the reality Myth: Medical volunteers with any kind of medical background are needed
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Reality: Only those with skills not available in affected area may be needed
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Give the reality Myth: Any kind of assistance is needed & its needed now
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Reality: Wait until genuine needs assessment has been done
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Give the reality Myth: The affected population is too shocked and helpless to take responsibility for their own survival
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Reality: Many find new strength and volunteerism is high
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Give the reality Myth: Disaster is a random killer
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Reality: The vulnerable are the hardest hit: the poor, especially women, children, & elderly
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Give the reality Myth: Locating victims in temporary settlements is best solution
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Reality: Usually should be last choice: need funds for permanent construction
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Give the reality Myth: things are back to normal within a few weeks
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Reality: may last years; may never recover
