Nursing care of clients experiencing disasters

1. RAK College of Nursing
RAK Medical and Health Sciences University
Nursing care of clients experiencing disasters
Adult Health Nursing II
Prepared by: Abdlerahman Alkilani 15906012
Submitted to Dr. Maragatham Kannan,Associate Professor
27/02/2017

2. Objectives
By the end of this seminar, colleges will be able to:
1. Define disaster
2. Identify the types of disasters
3. Discus the common injuries caused by different types of disasters
4. Explain disaster preparedness
5. Discuss the PRE-DISASTER paradigm
6. Explain the disaster management
7. Describe Personal Protective Equipment (PPE)

3. Objectives
By the end of this seminar, colleges will be able to:
8. Describe the disaster control zones
9. Describe the general principles of mass casualty triage
10. Perform an accurate mass casualty triage using SALT triage system
11. Record the disaster victims data accurately
12. Explain the role of the nurse in disaster relief

4. Background
■ According toWHO- Center for research on the epidemiology of disaster, the
frequency of disasters worldwide has doubled since 1995.
■ In the previous century:
– 3.5 million people were killed worldwide as a result of natural disasters
– 200 million were killed as a result of human caused disaster
■ According to UAE Ministry of Foreign affairs and international cooperation,
– in 2015, natural disasters happened in 113 countries, 98.6 million were
injured, and 22,773 were died

5. Background
■ The International Nursing Coalition for Mass Casualty Education
(INCMCE) was found to ensure a competent nurse workforce to respond
to MCIs
■ UAE- National Emergency crisis and disaster management Authority
was established in 2007

6. Disaster
■ An event in which the needs exceed immediately available resources
■ Local incidents or events in that their impact is immediate and direct,
while time course, population, and geography are generally limited
Disaster = Needs > Resources

7. Types of disasters
■ Natural disasters:
– Are caused by acts of nature or emerging diseases.
– May be predictable or unexpected
■ Man-made disasters:
– Either accidental or intentional
■ War; chemical, biologic, radiologic, and nuclear terrorism
■ Transportation accidents
■ Food or water contamination

8. Natural disasters
Type of disaster Common injuries
Hurricane Drowning, upper respiratory infections
Tsunami Tsunami Lung: a severe infection caused by swallowing muddy, bacteria-
laden water
Thunderstorm Resistance of body tissue to electrical current:
Least resistance: Nerves, blood, mucus membrane, muscle
Intermediate resistance: dry skin
Most resistance: tendon, fat, bone
Tornado Flying debris
Earthquake High incidence of mortality and morbidity
Snowstorm Overexertion and exhaustion

9. Man-made disasters
Type of disaster Common injuries
Blast injuries Auditory, Eye, respiratory, and multi systems
Blunt trauma Head and torso the most affected
Pressure trauma Lungs, ear, and bowel
Dirty bomb Radiation sickness
Nuclear
detonation
Thermal burns
Chemical burns From minor to life-threatening injuries

10. Disaster Preparedness
■ The PRE-DISASTER paradigm:
– Planning and practice
– Resilience
– Education and training

11. The PRE-DISASTER paradigm
■ Planning and practice:
– Design
– Implementation
– Ongoing evaluation of efforts to help communities, institutions and
individuals prepare for, respond to, and recover from disasters.

12. The PRE-DISASTER paradigm
■ Resilience:
– Is the ability of individuals and communities to rebound to a
reasonable state of normalcy after exposure to disasters
– Being prepared through planning, education, and training can
reduce fear, anxiety, and losses associated with a disaster and build
resilience
– It can be build by educating the population about local disaster
planning and response efforts.

13. The PRE-DISASTER paradigm
■ Education and training:
– INCMCE published educational competencies for registered nurses
responding to MCIs
■ core competencies, core knowledge areas, and professional role
development.
(Handout)

14. Disaster management
The DISASTER paradigm is a practical learning tool to enhance
communication consistency among disaster response personnel and
agencies
■ Detection
■ Incident management
■ Safety and security
■ Assess hazards
■ Support
■ Triage and treatment
■ Evacuation
■ Recovery

15. The DISASTER paradigm
■ Detection
– Is the first step of effective disaster response
– Determine:
■ Whether there is a disaster or mass causality situation present
■ Do current needs exceed available capabilities and resources?
■ Is there a suspected threat or hazardous material present?

16. The DISASTER paradigm
■ Incident management
– Effective incident management requires:
■ Command
■ Coordination
■ communication

17. The DISASTER paradigm
■ Safety and security
– Protecting self first priority in order to save lives in safe manner
– Your safety is paramount
– Triage, treatment, and evacuation of causalities is secondary consideration.
– Safety and security is dynamic
– Personal Protective Equipment (PPE)
■ Reparatory protection: purifiers, supplied air devices (SCBA), or air-line respirator
■ Protective garments: vapor-tight suits, partially resistance suits, or hooded coverall
(Handout)

18. The DISASTER paradigm
■ Safety and security
– Control zones:
Hot
Exclusion zone
Site of release, most contaminated, needs HAZMAT
Warm
Contamination zone
Location where workers enter and leave, decontamination
occurs here
Cold
Support zone
Area contamination-free: casualty collection, triage,
treatment, transport

19. The DISASTER paradigm
■ Assess hazards
– A challenging feature
– Risk of structural collapse, fire, ruptures gas lines, downed power
lines
– Potential release of toxic chemicals and radiation
– Respiratory hazards (smoke, carbon monoxide, cyanide, dust)

20. The DISASTER paradigm
■ Support
– Support is getting what is needed to get the job done
– It needs planning by agencies, institutions, and communities
– It includes acquisition and deployment of essential personnel,
supplies, facilities, vehicles, and other resources

21. The DISASTER paradigm
■ Triage and treatment
– Goal: to do the greatest good for the greatest number of possible survivors
– Focusing on a severely injured casualty, before promoting the safety of the
larger casualty population, would not achieve the goal.
– Objective(s):
– The initial objective is to prevent expansion of the causality population by
facilitating the movement of ambulatory casualties and uninjured bystanders
away from the scene
– The next objective is to sort casualties and identify those with life threatening
injuries to initiate emergency treatment immediately
– Once this is accomplished, casualties with less-serious injuries can be
assessed further and triaged for removal from the scene on the basis of their
level of injury and available resources

22. The DISASTER paradigm
■ Triage and treatment
– Effective triage regulates surge demands for staff, supplies, and
space by finding the most critically injured or ill people and
prioritizing them for transport from the scene.
– Treatment continues until all casualties have been transported or all
available resources have been exhausted

23. The DISASTER paradigm
■ Evacuation:
– Must be built into community and facility disaster response plans
and practice

24. The DISASTER paradigm
■ Recovery:
– Is the longest phase
– Begins when the event occurs
– The goal of recovery is to :
■ Ensure economic sustainability of the community
■ Ensure Long-term physical and mental well-being
■ Rebuild and repair the physical infrastructure
■ Restore normalcy as soon as possible

25. Mass casualty triage- Definition
■ It is a systematic method for organizing casualties at the scene of a
mass casualty event.
■ It involves rapid categorization of casualties with potentially severe
injuries or illnesses who require immediate medical attention at the
scene

26. Mass casualty triage- General principles
■ The goal is to create a formal, reproducible process for sorting causalities, so that:
Treat first
• the most seriously ill or injured who have reasonable possibility of
survival
Treat last
• the least severe illness or injuries or a very unlikely to survive
Separate
• who require minimal or no treatment can be initially separated from
the other

27. Mass casualty triage- Systems
■ Examples of mass casualty triage systems:
– Care Fight
– CESIRA
– Homebush
– JumpSTART
– Military triage
– SALT
– Triage SIEVE

28. Mass casualty triage- SALT
■ SALT triage designed based on the best scientific evidence
■ Sort
■ Assess
■ Lifesaving interventions
■ Treatment and transport

29. Mass casualty triage- SALT
■ Step 1- Sort: global sorting
■ Rapidly identify most at-risk by sorting into groups
■ Limitations: hearing, language , fear, families
Step 1- Sort: Global sorting
Still / obvious life threat
Assess 1st
Wave / purposeful movement
Assess 2nd
Walk
Assess 3rd

30. Mass casualty triage- SALT
■ Step 2: individual assessment
Lifesaving interventions:
- Control major
hemorrhage
- Open airway (if child,
consider 2 rescue breaths)
- Chest decompression
- Auto injector antidotes
Breathing
?
- Obeys commands or
makes purposeful
movement?
- Has peripheral pulse?
- Not in respiratory
distress?
- Major hemorrhage in
control?
Minor
injuries
only?
Likely to survive given
current resources?
Yes
All
yes
No No
Dead
Yes
Delayed
Minimal
ImmediateExpectant
No
No

31. Triage Categories: ID-MED
Triage Category Description Color code
Immediate Requires immediate care for a good probability of survival Red
Delayed Requires care that can be safely delayed without
affecting probability of survival
Yellow
Minimal Sick or injured but expected to survive with or without
care
Green
Expectant Alive, but with little or no survival given current available
resources
Gray
Dead A fatality with no intrinsic respiratory drive black

32. Triage practice
19 years old man
Appears in severe pain, cannot hear you
Rapid symmetric breathing
Near amputation above Rt knee, bleeding
Life saving interventions
Control major bleeding √
Open airway
Decompress chest
Auto inject antidote
Response
Bleeding controlled, RR 20
Still
“ID-ME”
Immediate
Delayed
Minimal
Expectant
Dead

33. Triage practice
19 years old man
Appears in severe pain, cannot hear you
Rapid symmetric breathing
Near amputation above Rt knee, bleeding
Life saving interventions
Control major bleeding √
Open airway
Decompress chest
Auto inject antidote
Response
Bleeding controlled, RR 20
Still
“ID-ME”
Immediate
Delayed √
Minimal
Expectant
Dead

34. Triage practice
48 years old woman
Unresponsive
Normal breathing and radial pulse present
Obvious injury to her head
Life saving interventions
Control major bleeding
Open airway
Decompress chest
Auto inject antidote
Response
Still
“ID-ME”
Immediate
Delayed
Minimal
Expectant
Dead

35. Triage practice
48 years old woman
Unresponsive
Normal breathing and radial pulse present
Obvious injury to her head
Life saving interventions
Control major bleeding
Open airway
Decompress chest
Auto inject antidote
Response
Still
“ID-ME”
Immediate √
Delayed
Minimal
Expectant
Dead

36. Triage practice
10 years old girl
Head trauma with protruding brain matter
Slow, deep respirations
Mother holding her on lap in damaged car
Life saving interventions
Control major bleeding
Open airway and give 2 rescue breaths √
Decompress chest
Auto inject antidote
Response
Unchanged
Still
“ID-ME”
Immediate
Delayed
Minimal
Expectant
Dead

37. Triage practice
10 years old girl
Head trauma with protruding brain matter
Slow, deep respirations
Mother holding her on lap in damaged car
Life saving interventions
Control major bleeding
Open airway and give 2 rescue breaths √
Decompress chest
Auto inject antidote
Response
Unchanged
Still
“ID-ME”
Immediate
Delayed
Minimal
Expectant √
Dead

38. Recording victim data
■ Centers for Disease Control and Prevention (CDC) created a Mass
Trauma Data Instrument to record data about victims of disasters
■ The categories on the data sheet includes demographics, circumstances
of the injury, injury conditions, and disposition and details of the
conditions.
■ The completion of this form will be initiated by the triage nurse and
completed by the nurse who implements the treatment or transfers.
(Handout)

39. The role of the nurse in disaster relief
1. Prepare selves, families, friends, and communities for disasters in
conjunction with the local disaster preparedness plan.
2. Continue educating self on various types of disasters and
appropriate response
3. Provide emergency services with consideration of victims’ abilities,
deficits, culture, language, or special needs
4. Assist in the mobilization of healthcare personnel, food, water,
shelter, medication, clothing, and other assistive devices.

40. The role of the nurse in disaster relief
5. Collaborate with the agencies in authority to deploy resources
based on the greatest good for the greatest number
6. Consider needs of victims including shelter both temporary and
permanent, as well as psychologic, economic, legal, and spiritual
factors
7. Become involved with the national disaster planning agencies to
schedule regular meetings to continually review and modify
disaster plans

41. Evidence Based Practice
■ Review: Public Health Nurses’ Roles and Competencies in Disaster
Management
■ By:Ardia Putra,Wongchan Petpichetchian, and Khomapak Maneewat - 2011
■ Purpose: to review PHNs’ roles and competencies in disaster management in
facing with natural disaster
■ Results:
– Twenty eight related studies were intensively reviewed
– Literatures showed that PHNs play roles as one of the valuable resources
and are actively involved in disaster management. PHNs’ roles and
competencies in disaster management is necessary because they are well
recognized and trusted in the community and frequently work closely
with the disadvantaged and vulnerable group who often affected by
disasters.

42. Summary
■ Disaster = Needs > Resources
■ There are two types of disasters; natural and man-made
■ Disaster preparedness consists of planning and practice, resilience, and
education and training
■ Disaster management consists of detection, incident management,
safety and security, assess hazards, support, triage and treatment,
evacuation, and recovery.
■ Salt triage: Sort, Assess, Lifesaving interventions, andTreatment and
transport
■ 5 triage categories; ID-MED
■ Recording victims data starts by the triage nurse and completed by the
nurse who implements the treatment or transfers.

43. Conclusion
■ Nurses are invaluable in disaster relief efforts.
■ Nurses have a responsibility to the public to maintain competence in
nursing practice.

44. References
■ LeMone, P., Burke, K. M., & Bauldoff, G. (2011). Medical-surgical
nursing: critical thinking in client care. Boston: Pearson.
■ Ahuja, R. (2010). Medical-surgical nursing: clinical management for
positive outcomes. New Delhi: Anmol Publications.
■ Adelman, D. S., & Legg,T. J. (2009). Disaster nursing: a handbook for
practice. Sudbury, MA: Jones and Bartlett .
■ Swienton, R. E., & Subbarao, I. (2012). Basic Disaster Life Support:
Course Manual 3.0. Place of publication not identified: National Diaster
Life Support Foundation.
■ Putra, A., & Petpichetchian, W. (2011). Review: public health nurses’
roles and competencies in disaster management. Nurse MediaJournal of
Nursing, 1(1), 1-14.