4060-3 Disaster Recovery Plan

Disaster Preparedness and Management

Introduction

Introduction

Context

You are a nurse manager working the 7:00–3:30 a.m. shift in the emergency room at your local hospital. You have 10 years experience in the hospital’s emergency department (ED).

A train has just derailed in the community, causing a range of casualties. First responders are on site and are relaying information to you via remote communication systems from across town. You are responsible for determining how your team should prioritize incoming casualties. You activate the disaster response system at your hospital, only to realize that you are short-staffed due to a recent flu outbreak. Nurses without ED experience have been reassigned to the ED from other units.

Nurses Staffing the ED

· Nurse Manager – You have 10 years ED experience and are certified in disaster management

· Novice nurse with less than 6 months experience

· Registered nurse with 20 years of rehabilitation experience, but no recent ED experience.

· ED patient care technician

Casualties

Keep in mind that these patients must have equitable access to care.

· Mayor: Minor lacerations, alert and oriented, demanding attention and priority care.

· Homeless person: Traumatic amputation of a limb, hemorrhaging profusely, alert and oriented.

· Mother-in-law/family member: You have had personal issues with this person recently; open fracture of right femur, bleeding under control, leg tourniquet, no femoral pulse.

· Immigrant: Recently found to be undocumented; language barrier; yelling for his family; daughter trapped under a collapsed bridge; small laceration on right arm; no bleeding.

· Older person: 90-years old, confused and combative; no visible injuries

· Mother: 6-months pregnant, no fetal heart tones, mother has no pulse and is unresponsive.

Activity

Activity

As the nurse manager you are responsible for assigning your staff to help with traffic control, casualty assessment and triage. You need to determine how your team should prioritize the incoming casualties.

As a nurse overseeing the triage, assign a triage level for each casualty. Use the triage labeling system:

· Red (immediate): Life-threatening injuries

· Yellow (delayed): Non-life-threatening injuries

· Green (minimal): Minor injuries; walking wounded/stable

· Black (expectant): Near death/diseased

Mayor: Minor lacerations, alert and oriented, demanding attention and priority care

a. Red (immediate):Life-threatening injuries

b. Yellow (delayed): Non-life-threatening injuries

c. Green (minimal): Minor injuries; walking wounded/stable

d. Black (expectant): Near death/diseased

Your answer is c.

The correct answer is b.

Though the influential mayor might have been tempting to help first, there were clearly others with greater immediate needs. No preferential treatment. May ask to help to provide support to the walking wounded.

Homeless person: Traumatic amputation of a limb, hemorrhaging profusely, alert and oriented

a. Red (immediate): Life-threatening injuries

b. Yellow (delayed): Non-life-threatening injuries

c. Green (minimal): Minor injuries; walking wounded/stable

d. Black (expectant): Near death/diseased

Your answer is a.

The correct answer is a.

Need immediate treatment because of his life-threatening injuries. Staff needs to remain non-judgmental of life style. The novice nurse may not know how to handle the traumatic injury, so you need to assign to the experienced nurse.

Mother-in-law/family member: You have had personal issues with this person recently; open fracture of right femur, bleeding under control, leg tourniquet, no femoral pulse.

a. Red (immediate): Life-threatening injuries

b. Yellow (delayed): Non-life-threatening injuries

c. Green (minimal): Minor injuries; walking wounded/stable

d. Black (expectant): Near death/diseased

Your answer is b.

The correct answer is a.

Need immediate treatment because of his life-threatening injuries. Nurse needs to remain non-judgmental. Assign to experienced nurse.

Immigrant: Recently found to be undocumented; language barrier; yelling for his family; daughter trapped under a collapsed bridge; small laceration on right arm; no bleeding.

a. Red (immediate): Life-threatening injuries

b. Yellow (delayed): Non-life-threatening injuries

c. Green (minimal): Minor injuries; walking wounded/stable

d. Black (expectant): Near death/diseased

Your answer is c.

The correct answer is c.

Novice nurse can care for the wound. The experienced nurse would be assigned to more traumatic cases. Staff needs to remain non-judgmental of legal status. Cannot help by providing emotional support to with walking wounded because of the language barrier. Nurse manager needs to ask the technician to call for an interpreter and contact security to attempt to locate family.

Older person: 90 years old, confused and combative; no visible injuries

a. Red (immediate): Life-threatening injuries

b. Yellow (delayed): Non-life-threatening injuries

c. Green (minimal): Minor injuries; walking wounded/stable

d. Black (expectant): Near death/diseased

Your answer is a.

The correct answer is a.

May be a head or internal injury. Income does not matter. Nurse needs to remain non-judgmental. Need immediate care. Assign to experienced nurse.

Mother: 6-months pregnant, no fetal heart tones, mother has no pulse and is unresponsive.

a. Red (immediate): Life-threatening injuries

b. Yellow (delayed): Non-life-threatening injuries

c. Green (minimal): Minor injuries; walking wounded/stable

d. Black (expectant): Near death/diseased

Your answer is d.

The correct answer is d.

She is deceased. Other casualties need emergency care.

Based on the triage system, who would you prioritize for care?

a. Immigrant: Recently found to be undocumented; language barrier; yelling for his family daughter trapped under a collapsed bridge; small laceration on right arm; no bleeding.

Feedback: Novice nurse can care for the wound. The experienced nurse would be assigned to more traumatic cases. Staff needs to remain non-judgmental of legal status. Cannot help by providing emotional support to with walking wounded because of the language barrier. Nurse manager needs to ask the technician to call for an interpreter and contact security to attempt to locate family.

b. Mayor: Minor lacerations, alert and oriented, demanding attention and priority care

Feedback: Though the influential mayor might have been tempting to help first, there were clearly others with greater immediate needs. No preferential treatment. May ask to help to provide support to the walking wounded.

c. Mother-in-law/family member: You have had personal issues with them recently; open fracture of right femur, bleeding under control, leg tourniquet, no femoral pulse.

Feedback: Need immediate treatment because of his life-threatening injuries. Nurse needs to remain non-judgmental. Assign to experienced nurse.

d. Older person: 90-years old, confused and combative; no visible injuries

Feedback: May be a head or internal injury. Income does not matter. Nurse needs to remain non-judgmental. Need immediate care. Assign to experienced nurse.

e. Mother: 6-months pregnant, no fetal heart tones, mother has no pulse and is unresponsive.

Feedback: She is deceased. Other casualties need emergency care.

f. Homeless person: Traumatic amputation of a limb, hemorrhaging profusely, alert and oriented

Feedback: Need immediate treatment because of his life-threatening injuries. Staff needs to remain non-judgmental of life style. The novice nurse may not know how to handle the traumatic injury, so you need to assign to the experienced nurse.

Your answers are c, d and f.

The correct answers are c, d and f.

How might the issues presented here impact future planning for disasters?

Your answer: This issues will impact by being prepared in case of a disaster. Disaster prevention and preparedness are key to minimizing looses and recovery time. .

Here are some potential takeaways:

· Make sure that the disaster plan is up to date and in a central location for easy access.

· Disaster preparedness and management training should be mandatory, at least annually, for all interprofessional staff hospital-wide.

· The interprofessional staff must know where to locate the disaster manual for policies.

· Mandatory disaster drills should be conducted annually.