ReadyRN E-Book , livre ebook

Table of Contents

Cover Image
REVIEWERS
PREFACE
CHAPTER 1. Disaster Management
CHAPTER 2. Weather-Related and Environmental Disasters
CHAPTER 3. Public Health Emergencies
CHAPTER 4. Emerging Infectious Diseases
CHAPTER 5. Chemical Emergencies
CHAPTER 6. Biological Agents
CHAPTER 7. Radiological and Nuclear Disasters
CHAPTER 8. Explosives/Mass Casualty Events
CHAPTER 9. Personal Protective Equipment
CHAPTER 10. Triage
CHAPTER 11. Decontamination
CHAPTER 12. Burn Management
CHAPTER 13. Victim Assessment and Management
CHAPTER 14. On-Scene Management
CHAPTER 15. Psychological Considerations
CHAPTER 16. Disaster Settings
CHAPTER 17. Mass Immunization Clinics
CHAPTER 18. Legal Implications
APPENDIX A. FAMILY DISASTER PLAN
APPENDIX B. CONTACTS: LOCAL AND STATE PUBLIC HEALTH INFORMATION
GLOSSARY OF TERMS AND ACRONYMS
REFERENCES
INDEX



REVIEWERS
Margaret Irwin Crew, RN, ND

Disaster Management Consultan, Franklin, Tennessee
Cheryl K. Schmidt, PhD, RN, CNE, ANEF

Associate Professor, University of Arkansas for Medical Sciences College of Nursing, Little Rock, Arkansas



PREFACE

PURPOSE OF THE HANDBOOK
ReadyRN: Handbook for Disaster Nursing and Emergency Preparedness, second edition, has been designed for you—today's nurse. The world in which we practice today has changed dramatically, and nurses are being asked to respond to health care events for which they have had little preparation.
Hurricane Katrina in August of 2005 illustrated the health implications of the growing incidence and intensity of natural disasters. The looming threat of biological, chemical, and radiological terrorism persists. Avian and pandemic influenza appear on the global health care horizon, along with other emerging infectious diseases.
This handbook is a comprehensive yet compact resource for nurses working in all types of health care settings. Small and portable, it is readily accessible in a glove compartment, workbag, or purse. Designed for easy use, this handbook allows nurses to have critical information at their fingertips. The quick facts and clinical decision-making support in the handbook help nurses to respond appropriately to any type of disaster or public health emergency, to protect and care for their patients, and to keep themselves and their families safe.

HOW TO USE THE HANDBOOK
Keep this handbook with you or easily accessible at all times! Designed as a quick reference, this handbook is the perfect resource for emergency information and guidelines at the point of care. In the field, in the hospital, in the office or clinic setting, in long-term care facilities or visiting nurse sites, this handbook will help to keep you safe and prepared to respond to any major event.
Use this handbook to answer your most important questions:

• How do I keep myself safe?

• How do I care for my patients?

• Who can I call for help?

• How do I manage this event?

• Can I go home to my family?
Use this handbook as a teaching aid to better understand disaster nursing and emergency preparedness or as an on-scene reference when disaster strikes. Each chapter is divided into sections, which are outlined on the opening page of each chapter. Use these as a guide to the types of information to be found in the chapter.
Look for Quick Q&A: Key Questions and Quick Answers to the most frequently asked questions.
At the end of the handbook is a glossary of disaster nursing terms and acronyms. In addition, there are two customizable sections for each nurse to complete—a family disaster plan and a section with space to fill in local, state, and federal public health contact information.
NOTE: URLs used in this handbook are current as of the publication date.

SYMBOLS USED IN THE HANDBOOK
Many symbols are used throughout this handbook to relay critical information quickly. The symbols and their descriptions are outlined below SYMBOL DESCRIPTION Antidote Available Family Risk—High Family Risk— Low Isolate Patients Odorless Personal Risk—High Personal Risk—Medium Personal Risk—Low Quarantine Patients Reportable Disease



CHAPTER 1. Disaster Management

Critical Info, 3

Overview, 3

Disaster Characteristics, 5

Disaster Management Continuum, 6

Role of Nurses, 9

Levels of Response, 10

Disaster Preparedness Plans, 15

National Planning Scenarios, 19

Effective Communication, 21

American Red Cross, 22

The Aviation Disaster Family Assistance Act of 1996, 24

Other Disaster Relief Organizations, 24

National Response Framework, 25

CRITICAL INFO

• Appreciate the unique demands on healthcare providers during disasters and public health emergencies.

• Be prepared to fulfill your role in your agency’s emergency operations plan (EOP).

• In the event of an emergency, know who is in charge, and who will be assigning job action sheets (JAS) and/or where to find them.

• Have a basic understanding of the different levels of response (local, state, and federal) and how they interact.

• Know the language of disaster communication.

QUICK Q&A

Key Question:
What is different about disaster nursing than normal daily nursing practice?

Quick Answer:
During a disaster event the fundamentals of good clinical nursing care remain the same. The demands of the event will alter some characteristics of nursing response, however. The focus shifts to doing the “greatest good for the greatest number with the least amount of harm.” The components of practice that may change include the following:

1. Triage

2. Decontamination

3. Management: reporting will switch to an Incident Command System (ICS)

4. Allocation of scarce resources

5. Redesign/designation of facilities to accommodate surge of patients/surge capacity

OVERVIEW
Disasters are broadly defined as any destructive event that disrupts the normal functioning of the community. They may also be defined as an “occurrence, either natural or man-made, that causes human suffering and creates human needs that victims cannot alleviate without assistance” (American Red Cross, nd). Disasters have been an integral part of the human experience since the beginning of time, causing premature death, impaired quality of life, and altered health status.
Under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, as amended and related authorities (FEMA 592, June 2007), major disaster means “any natural catastrophe (including any hurricane, tornado, storm, high water, wind-driven water, tidal wave, tsunami, earthquake, volcanic eruption, landslide, mudslide, snowstorm, or drought) or, regardless of cause, any fire, flood, or explosion, in any part of the United States, which in the determination of the President causes damage of sufficient severity and magnitude to warrant major disaster assistance under this Act to supplement the efforts and available resources of States, local governments, and disaster-relief organizations in alleviating the damage, loss, hardship, or suffering caused thereby.”
Classified on the basis of their onset, duration, scope, and impact, from the standpoint of healthcare providers, the term disasters refers to catastrophic events that result in casualties that overwhelm the healthcare resources of the community involved.
Healthcare facilities can be affected by external or internal disasters, or both. Internal disasters occur when there is an event within the facility that poses a threat to disrupt the environment of care. External disasters become a problem for a facility when the consequences of an event create a demand for services that tax or exceed the usual available resources. External disasters may further be classified into two broad categories: natural or human-caused. See Table 1-1 for examples of external and internal disasters.
TABLE 1-1 Examples of External and Internal Disasters EXTERNAL DISASTERS INTERNAL DISASTERS NATURAL HUMAN- CAUSED

Blizzard/extreme cold

Cyclone, hurricane, typhoon

Drought

Earthquake

Extreme heat/heat wave

Flooding

TornadoTsunami

Volcanic eruption

Wildfires

Terrorism

• Chemical

• Biological

• Radiological

• Nuclear

• Explosive

Transportation accident

Industrial accident

Chemical spill

Water/power/HVAC failure

Fire/explosion

Flood

Loss of medical gases

Chemical/radiation release

Violence/hostage-taking

Elevator emergencies

Building collapse

Inability of staff to reach work

DISASTER CHARACTERISTICS
Disasters are typically classified into two main groups: natural disasters and human-caused disasters . Understanding the differences between these two groups and their unique characteristics can help define planning and response efforts.

NATURAL DISASTERS
The World Health Organization defines a natural disaster as the “result of an ecological disruption or threat that exceeds the adjustment capacity of the affected community” (Lechat, 1979). Natural disasters are of many types and have diverse characteristics that will be addressed in this chapter.

HUMAN-CAUSED DISASTERS
Human-caused disasters are those events for which the principle, direct causes are identifiable human actions, deliberate or otherwise. Human-caused disasters can be divided further into three categories:

1. Complex emergencies

2. Technological disasters

3. NA-TECHS (pronounced “Nay-Teks”), or combination, disasters

Complex Emergencies
Complex emergencies involve situations where populations suffer significant casualties because of war, civil strife, or other political conflict. Some disasters are the result of a combination of forces such as drought, famine, disease, and political unrest, resulting in the displacement of millions of people from their homes.

Technological Disasters
Technological disasters are those in which large numbers of people, property, community infrastructure, and economic welfare are affected