Disasters are unpredictable and can occur anywhere, at any time. Nursing during a disaster requires a coordinated effort among professionals throughout the health care, public, and private service sectors.
Today’s nurses are faced with the challenges of responding to natural, anthropogenic, and technological disasters. Strong leadership is required to address the unique set of challenges and necessary preparation for such events. “When a disaster strikes a community—whether a bus accident, a tornado, a hurricane, or terrorist attack—nurses will be on the front lines helping those who are in need” (Knebel, as cited inGoodwin Veenema, 2013, p. xxvi). As the frequency, magnitude, and variety of disasters, both anthropogenic and natural, continue to escalate, nursing leaders will need to respond with “awareness, preparedness, political prowess…and most of all, teamwork on all levels” (Ford, as cited by Goodwin Veenema, 2013, p. xxix).
After completing this chapter, you should now be able to:
- Discuss the four areas of focus in emergency and disaster planning—mitigation, preparedness, response, and recovery.
- Describe the core preparedness actions.
- Recognize situations that may call for additional comprehensive planning.
1. Watch this video titled “START Simple Triage and Rapid Treatment” (18:19) on START triage basics, then read the following simulated scenario:
You are on a ride-along with EMS and are first on the scene to a multi-vehicle collision on Highway 1 involving five passenger vehicles and one semi carrying non-hazardous materials. There are ten victims in various stages of crisis.
Triage the following victims using the START adult triage categories: green, yellow, red, and black.
(a) Female, 77 years, scalp avulsion, no spontaneous breathing
(b) Male, 45 years, ambulatory, RR 20, bleeding noted from scalp, asking if he can help
(c) Male, 30 years, no spontaneous breathing, impaled pipe through chest
(d) Male, 55 years, gasping respirations RR 32, bleeding from both arms
(e) Female, 27 years, non-ambulatory, RR 18, obeys commands
(f) Male, 23 years, RR 28/minute, large laceration to head, decreased LOC, not obeying commands
(g) Female, 44 years, limping, complaining of left knee pain, painful left arm. Obvious deformity of left arm, cap refill < 2 seconds, RR 24/minute
(h) Male, 79 years, walking between vehicles, calling for his wife, no obvious injuries
(i) Female, 19 years, ambulatory, c/o feeling dizzy, RR 16, no obvious injuries
(j) Female, 18 years, ambulatory, crying, RR 22, bleeding from nose
2. Several city hospitals create a network of policies and agreements governing the redirection of patients should one emergency department become overwhelmed beyond ability to respond. Which phase of the emergency management plan does this action exemplify?
3. Choose the statement which best describes the mitigation phase of a disaster event.
(a) Establishing a protocol for the safe transport of patients back to their designated facility as soon as possible occurs during the mitigation phase.
(b) The mitigation phase of disaster encompasses assessing physical and structural damages.
(c) Mitigation begins with identifying the risks.
(d) The mitigation phase of a disaster is the final phase of a disaster experience.
1. (a) Female, 77 years, scalp avulsion, no spontaneous breathing (black)
(b) Male, 45 years, ambulatory, RR 20, bleeding noted from scalp, asking if he can help (green)
(c) Male, 30 years, no spontaneous breathing, impaled pipe through chest (black)
(d) Male, 55 years, gasping respirations RR 32, bleeding from both arms (red)
(e) Female, 27 years, non-ambulatory, RR 18, obeys commands (yellow)
(f) Male, 23 years, RR 28/minute, large laceration to head, decreased LOC, not obeying commands (red)
(g) Female, 44 years, limping, complaining of left knee pain, painful left arm. Obvious deformity of left arm, cap refill < 2 seconds, RR 24/minute (yellow)
(h) Male, 79 years, walking between vehicles, calling for his wife, no obvious injuries (green)
(i) Female, 19 years, ambulatory, c/o feeling dizzy, RR 16, no obvious injuries (green)
(j) Female, 18 years, ambulatory, crying, RR 22, bleeding from nose (green)
2. (b) Preparedness. Rationale: Establishing inter-hospital agreements and coordination arrangements prior to a disaster, constitutes a preparedness phase action.
3. (c) Mitigation begins with identifying the risks. Rationale: Disaster mitigation measures are those that eliminate or reduce the impacts and risks of hazards through proactive measures taken before an emergency or disaster occurs. It begins with identifying the risks.
Assid, P. A. (2014). Disaster management. In D. Gurney (Ed.), Trauma nursing core course (7th ed.), pp. 311–324. Des Plaines, IL: Emergency Nurses.
Canadian Nurses Association. (2010). Evidence-informed decision-making and nursing practice. Retrieved from http://cna-aiic.ca/~/media/cna/page-...med_2010_e.pdf on 9-December-2016
Emergency Management Act, S.C. 2007, c. 15 Retrieved from http://laws-lois.justice.gc.ca/PDF/E-4.56.pdf. Généreux, M., Petit, G., Maltais, D., Roy, M., Simard, R., Boivin, S., Shultz, J. M., & Pinsonneault, L. (2014) The public health response during and after the Lac-Mégantic train derailment tragedy: A case study. Disaster Health, 2, (3–4), 113–120. doi:10.1080/21665044.2014.11031
Goodwin Veenema, T., Andrews Losinski, S., Newton, S. M., & Seal, S. (2017). Exploration and development of standardized nursing leadership competencies during disasters. Health Emergency and Disaster Nursing, 4(1), 26-38. https://doi.org/https://doi.org/10.2...hedn.2015-0016
Goodwin Veenema, T. (2013). Disaster nursing and emergency preparedness for chemical, biological, and radiological terrorism and other hazards (3rd ed.). New York, NY: Springer.
Guha-Sapir, D., Hoyois, P., & Below, R. (2015). Annual disaster statistical review 2015: The numbers and trends. Brussels: Centre for Research on the Epidemiology of Disasters. Retrieved from http://reliefweb.int/sites/reliefweb.../ADSR_2015.pdf
Hammond, K. S., Arbon, P., Gebbie, K., & Hutton, A. (2012). Nursing in the emergency department (ED) during a disaster: A review of the current literature. Australasian Emergency Nursing Journal, 15, 235–244. doi:10.1016/j.aenj.2012.10.005
Hendrickson, R. G., & Horowitz, B. Z. (2016). Disaster preparedness. In J. E. Tintinalli, J. S. Stapczynski, O. J. Ma, D. M. Yealy, G. D. Meckler, & D. M. Cline (Eds.), Tintinalli’s emergency medicine: A comprehensive study guide (8th ed.). Retrieved from http://accessmedicine.mhmedical.com/...ionid=40381465
Morgan, G. (2016, December 29). Rebuilding in the wake of “the beast”; Massive effort ahead in Fort Mac. National Post. Retrieved from http://search.proquest.com/docview/1...ccountid=39725
Nash, T. J. (2016). A guide to emergency preparedness and disaster nursing education resources. Health Emergency and Disaster Nursing, 4, 12–25.
Proehl, J. A. (2009). Emergency nursing procedures (4th ed.). St. Louis, MO: Saunders Elsevier.
Public Safety Canada. (2016). Emergency management planning. Retrieved from https://www.publicsafety.gc.ca/cnt/m...lnnng-eng.aspx
Public Safety Canada. (2015). About disaster mitigation. Retrieved from https://www.publicsafety.gc.ca/cnt/m...-mtgtn-en.aspx
Saunderson Cohen, S. (2013). Mass casualty incidents. In B. B. Hammond & P. Gerber Zimmerman (Eds.), Sheehy’s manual of emergency care (7th ed.), pp. 19–35. St. Louis, MO: Elsevier Mosby.
Stopford, B. M. (2007). Disaster preparedness and response. In K. S. Hoyt & J. Selfridge-Thomas (Eds.), Emergency nursing core curriculum (6th ed.), pp. 955–969. St. Louis MO: Saunders Elsevier.
Upton, L. A. (2013). Disaster. In Emergency nursing pediatric course: Provider manual(4th ed.), pp. 365–382. Des Plaines, IL: Emergency Nurses Association.
US Department of Homeland Security. (2008). National incident management system. Retrieved from https://www.fema.gov/pdf/emergency/nims/NIMS_core.pdf
World Health Organization definitions: emergencies. (n.d.). Retrieved from http://www.who.int/hac/about/definitions/en/