Disaster Nursing Mine
Disaster Nursing Mine
Disaster Nursing Mine
Other goals of disaster nursing are the following: Disasters affect the health status of a community in the
following ways: -
1. To meet the immediate basic survival needs of
populations affected by disasters (water, food, · Disasters may cause premature deaths, illnesses,
shelter, and security). and injuries in the affected community, generally exceeding
2. To identify the potential for a secondary disaster. the capacity of the local health care system.
3. To appraise both risks and resources in the
· Disasters may destroy the local health care
environment.
infrastructure, which will therefore be unable to respond to
4. To correct inequalities in access to health care or
the emergency. Disruption of routine health care services
appropriate resources.
and prevention initiatives may lead to long-term
5. To empower survivors to participate in and
consequences in health outcomes in terms of increased
advocate for their own health and well-being.
morbidity and mortality.
· Disasters may create environmental imbalances, The impact phase continues until the threat of further
increasing the risk of communicable diseases and destruction has passed and emergency plan is in effect.
environmental hazards. This is the time when the emergency operation center is
established and put in operation. It serves as the center for
· Disasters may affect the psychological, emotional,
communication and other government agencies of health
and social well-being of the population in the affected
tears care healthcare providers to staff shelters. Every
community. Depending on the specific nature of the
shelter has a nurse as a member of disaster action team.
disaster, responses may range from fear, anxiety, and
The nurse is responsible for psychological support to
depression to widespread panic and terror.
victims in the shelter.
· Disasters may cause shortages of food and cause
POST – IMPACT PHASE
severe nutritional deficiencies.
Recovery begins during the emergency phase and ends
· Disasters may cause large population movements
with the return of normal community order and functioning.
(refugees) creating a burden on other health care systems
For persons in the impact area this phase may last a
and communities. Displaced populations and their host
lifetime (e.g. - victims of the atomic bomb of Hiroshima).
communities are at increased risk for communicable
The victims of disaster in go through four stages of
diseases and the health consequences of crowded living
emotional response.
conditions.
1. Denial - during the stage the victims may deny the
PHASES OF A DISASTER
magnitude of the problem or have not fully registered. The
There are three phases of disaster. victims may appear usually unconcerned.
MITIGATION The word triage is derived from the French word trier, which
means, “to sort out or choose.”
The Baron Dominique Jean Larrey, who was the Chief TYPES OF TRIAGE
Surgeon for Napoleon, is credited with organizing the first
There are two types of triage:
triage system.
1. Simple triage
“Triage is a process which places the right patient in the
right place at the right time to receive the right level of care” 2. Advanced triage
(Rice & Abel, 1992).
SIMPLE TRIAGE
Triage is the process of prioritizing which patients are to be
treated first and is the cornerstone of good disaster Simple triage is used in a scene of mass casualty, in order
management in terms of judicious use of resources (Auf der to sort patients into those who need critical attention and
Heide, 2000). immediate transport to the hospital and those with less
serious injuries.
NEED OF THE DISASTER TRIAGE
This step can be started before transportation becomes
1. Inadequate resource to meet immediate needs available.
2. Infrastructure limitations
3. Inadequate hazard preparation The categorization of patients based on the severity of their
4. Limited transport capabilities injuries can be aided with the use of printed triage tags or
5. Multiple agencies responding colored flagging.
6. Hospital Resources Overwhelmed S.T.A.R.T. (Simple Triage and Rapid Treatment) is a simple
AIMS OF TRIAGE triage system that can be performed by lightly trained lay
and emergency personnel in emergencies.
1. To sort patients based on needs for immediate
care Triage separates the injured into four groups:
2. To recognize futility 0 - The deceased who are beyond help
3. Medical needs will outstrip the immediately
1 - The injured who can be helped by immediate
available resources
transportation
4. Additional resources will become available given
2 - The injured whose transport can be delayed
enough time.
3 - Those with minor injuries, who need help less
PRINCIPLES OF TRIAGE urgently
The main principles of triage are as follows: - ADVANCED TRIAGE
1. Every patient should receive and triaged by In advanced triage, doctors may decide that some seriously
appropriate skilled health-care professionals. injured people should not receive advanced care because
2. Triage is a clinic-managerial decision and must they are unlikely to survive.
involve collaborative planning.
Advanced care will be used on patients with less severe
3. The triage process should not cause a delay in
the delivery of effective clinical care. injuries. Because treatment is intentionally withheld from
patients with certain injuries, advanced triage has an ethical
implication.
It is used to divert scarce resources away from patients with
little chance of survival in order to increase the chances of
ADVANTAGES OF TRIAGE
survival of others who are more likely to survive.
1. Helps to bring order and organization to a chaotic
Principles of advanced triage is
scene.
2. It identifies and provides care to those who are in · “Do the greatest good for the greatest number”
greatest need
3. Helps make the difficult decisions easier · Preservation of life takes precedence over
preservation of limbs.
4. Assure that resources are used in the most
effective manner · Immediate threats to life: HEMORRHAGE.
5. May take some of the emotional burden away
from those doing triage
ADVANCED TRIAGE CATEGORIES “Dead or expected to die—massive head injury,
extensive full-thickness burns”
CLASS I
(EMERGENT) RED IMMEDIATE
– Victims with serious injuries that are life threatening but USING RPM TO CLASSIFY PATIENTS
has a high probability of survival if they received
immediate care. CATEGORY (COLOR) RPM INDICATORS
– They require immediate surgery or other life-saving Critical (RED) R = Respiratory rate > 30;
intervention, and have first priority for surgical teams or
P = Capillary refill > 2
transport to advanced facilities; they "cannot wait" but
seconds;
are likely to survive with immediate treatment.
M = Doesn’t obey
“Critical; life threatening—compromised airway, shock,
commands
hemorrhage”
CLASS II
(URGENT) YELLOW D Urgent (YELLOW) R < 30
ELAYED P < 2 seconds
– Victims who are seriously injured and whose life is not M = Obeys commands
immediately threatened; and can delay transport and
treatment for 2 hours.
Expectant: dead or dying R = not breathing
– Their condition is stable for the moment but requires (BLACK)
watching by trained persons and frequent re-triage, will
need hospital care (and would receive immediate priority ROLE OF NURSING IN DISASTERS
care under "normal" circumstances).
“Disaster preparedness, including risk assessment and
“Major illness or injury;—open fracture, chest wound” multi-disciplinary management strategies at all system
levels, is critical to the delivery of effective responses to the
CLASS III (NON-URGENT) short, medium, and long-term health needs of a disaster-
GREEN MINIMAL stricken population.” (International Council of Nurses, 2006)
– "Walking wounded," the casualty requires medical MAJOR ROLES OF NURSE IN DISASTERS
attention when all higher priority patients have been
evacuated, and may not require monitoring. 1. Determine magnitude of the event
2. Define health needs of the affected groups
– Patients/victims whose care and transport may be 3. Establish priorities and objectives
delayed 2 hours or more. 4. Identify actual and potential public health
problems
“minor injuries; walking wounded—closed fracture,
5. Determine resources needed to respond to the
sprain, strain”
needs identified
CLASS IV 6. Collaborate with other professional disciplines,
(EXPECTANT) BLACK EXPECTANT governmental and non-governmental agencies
7. Maintain a unified chain of command
They are so severely injured that they will die of their 8. Communication
injuries, possibly in hours or days (large-body burns,
severe trauma, lethal radiation dose), or in life-
threatening medical crisis that they are unlikely to
DISASTER TIMELINE AND NURSING ACTION/
survive given the care available (cardiac arrest, septic
RESPONSIBILITIES
shock, severe head or chest wounds);
They should be taken to a holding area and given
painkillers as required to reduce suffering.
CONCLUSION
Disaster is an emergency situation where the need of the
victims mounts over the medical and nursing resources or
services particularly in the developing countries like India
where the resources are already short the situation
becomes worst; therefore coordination of actions and
various departments is an essential requisite for efficient
management of mass casualties. So, in such a scenario a
prudent nurse should be resourceful, making best use of
the available resources like governmental,
nongovernmental organizations, self-help groups, public,
etc. and should act ethically with best of her knowledge,
patience and judgement to minimize the effect of disaster.