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Questions and Answers
What is the purpose of The Joint Commission established emergency preparedness management standards for health care facilities?
What is the purpose of The Joint Commission established emergency preparedness management standards for health care facilities?
In internal emergencies, clients requiring assistance are the first to be discharged or relocated.
In internal emergencies, clients requiring assistance are the first to be discharged or relocated.
False
During an emergency, decisions are made regarding discharging clients or relocating them so their beds can be given to clients who have higher-priority needs. Criteria for identifying when clients can be safely discharged takes into consideration all of the above factors.
During an emergency, decisions are made regarding discharging clients or relocating them so their beds can be given to clients who have higher-priority needs. Criteria for identifying when clients can be safely discharged takes into consideration all of the above factors.
ambulatory clients requiring minimal care
Match the following categories of triage during mass casualty events with their descriptions:
Match the following categories of triage during mass casualty events with their descriptions:
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When are attempts at extinguishing the fire made?
When are attempts at extinguishing the fire made?
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What is Bioterrorism?
What is Bioterrorism?
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In most instances, infection from biological agents spreads easily from one client to another.
In most instances, infection from biological agents spreads easily from one client to another.
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Management of a biological incident includes recognition of the occurrence, directing personnel in the proper use of personal protective equipment, and, in some situations, __________ and isolation.
Management of a biological incident includes recognition of the occurrence, directing personnel in the proper use of personal protective equipment, and, in some situations, __________ and isolation.
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Match the following biological pathogens with their manifestations:
Match the following biological pathogens with their manifestations:
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During a bomb threat received by phone, what action should be taken by the nurse to show understanding?
During a bomb threat received by phone, what action should be taken by the nurse to show understanding?
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Which client should a nurse recommend for discharge in the event of a mass casualty event to make beds available for injury victims?
Which client should a nurse recommend for discharge in the event of a mass casualty event to make beds available for injury victims?
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What should a nurse do when a client is exposed to a dry chemical resulting in a chemical burn?
What should a nurse do when a client is exposed to a dry chemical resulting in a chemical burn?
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Which of the following clients should be a nurse's priority during a mass casualty event?
Which of the following clients should be a nurse's priority during a mass casualty event?
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What information should a nurse educator include when teaching staff members about facility protocol in the event of a tornado?
What information should a nurse educator include when teaching staff members about facility protocol in the event of a tornado?
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What is the primary consideration for evacuating clients in a horizontal (lateral) manner during an emergency?
What is the primary consideration for evacuating clients in a horizontal (lateral) manner during an emergency?
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What is the role of the incident control manager in a disaster plan?
What is the role of the incident control manager in a disaster plan?
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What action should a nurse take when discovering a fire that threatens the safety of a client?
What action should a nurse take when discovering a fire that threatens the safety of a client?
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Why is it important to turn off supplemental oxygen for clients who can safely tolerate room air during an emergency?
Why is it important to turn off supplemental oxygen for clients who can safely tolerate room air during an emergency?
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What is the principle of triage that guides healthcare providers during a mass casualty event?
What is the principle of triage that guides healthcare providers during a mass casualty event?
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What is the primary goal of emergency preparedness planning in healthcare facilities?
What is the primary goal of emergency preparedness planning in healthcare facilities?
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What is the role of nurses in the development of a disaster plan?
What is the role of nurses in the development of a disaster plan?
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What is the primary consideration when categorizing clients during a mass casualty event?
What is the primary consideration when categorizing clients during a mass casualty event?
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What is the purpose of identifying a designated area for the command center during an emergency?
What is the purpose of identifying a designated area for the command center during an emergency?
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Which of the following actions is NOT recommended during a severe thunderstorm/tornado event?
Which of the following actions is NOT recommended during a severe thunderstorm/tornado event?
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What is the purpose of the 'Rescue' step in the RACE mnemonic during a fire emergency?
What is the purpose of the 'Rescue' step in the RACE mnemonic during a fire emergency?
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Which category of triage has the second-highest priority during a mass casualty event?
Which category of triage has the second-highest priority during a mass casualty event?
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What is the recommended action for clients who are confined to beds during a severe thunderstorm/tornado event?
What is the recommended action for clients who are confined to beds during a severe thunderstorm/tornado event?
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What is the primary goal of categorizing clients during a mass casualty event?
What is the primary goal of categorizing clients during a mass casualty event?
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What is the recommended action for ambulatory clients during a severe thunderstorm/tornado event?
What is the recommended action for ambulatory clients during a severe thunderstorm/tornado event?
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Which of the following is NOT a recommended action during a severe thunderstorm/tornado event?
Which of the following is NOT a recommended action during a severe thunderstorm/tornado event?
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What type of clients are prioritized for evacuation in an emergency situation?
What type of clients are prioritized for evacuation in an emergency situation?
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What action should be taken after clearing the room or area during a fire emergency?
What action should be taken after clearing the room or area during a fire emergency?
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When should a nurse attempt to extinguish a small fire?
When should a nurse attempt to extinguish a small fire?
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What is the primary goal of containment during a fire emergency?
What is the primary goal of containment during a fire emergency?
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What should be used to smother a small fire?
What should be used to smother a small fire?
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What is the primary goal of isolation measures during a biological incident?
What is the primary goal of isolation measures during a biological incident?
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What should be done to a client who has been exposed to a dry chemical resulting in a chemical burn?
What should be done to a client who has been exposed to a dry chemical resulting in a chemical burn?
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What should be the primary focus during a mass casualty event?
What should be the primary focus during a mass casualty event?
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What should be done to the client's skin after exposure to a dry chemical?
What should be done to the client's skin after exposure to a dry chemical?
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During a bomb threat, what should the nurse do to gather information?
During a bomb threat, what should the nurse do to gather information?
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What is the primary goal of decontamination procedures?
What is the primary goal of decontamination procedures?
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During an emergency, what should be the nurse's primary focus?
During an emergency, what should be the nurse's primary focus?
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What should be done in the event of a chemical attack?
What should be done in the event of a chemical attack?
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Study Notes
Safe, Effective Care Environment
- The Joint Commission established emergency preparedness management standards for healthcare facilities, which mandate the development of an institutional emergency preparedness plan.
- The plan must include institution-specific procedures for:
- Notifying and assigning personnel
- Notifying external authorities of emergencies
- Managing space and supplies, and providing security
- Isolating and decontaminating radioactive or chemical agents
- Evacuating and setting up an alternative care site when the environment cannot support adequate client care and treatment
- Disasters can be internal (e.g. loss of electric power, communication ability, or severe damage within the facility) or external (e.g. hurricanes, floods, disease epidemics)
Security and Disaster Plans
- A healthcare facility's emergency preparedness plan must include:
- Evacuation and relocation plans
- Procedures to notify extra personnel
- Safety and hazardous materials protocols
- Infection control policies and practices
- The plan must also include a process for conducting two emergency preparedness drills per year, which should include an influx of clients beyond those being treated by the facility
- Participating in one community-wide practice drill per year is also required
Nursing Role in Disaster Planning and Emergency Response Plans
- Nurses are involved in the development of a disaster plan for healthcare facilities
- The plan must take into consideration the potential for various types of natural and man-made emergencies, and resources necessary to meet the potential emergency
- Nurses are expected to set up an emergency action plan for personal family needs
- Communication, using common terminology, is important within any emergency management plan
Triage
- Triage principles are followed in healthcare facilities involved in a mass casualty event
- Casualties are separated based on their potential for survival, and treatment is allocated accordingly
- The categories of triage are:
- Emergent or Immediate Category (Class I): highest priority, life-threatening injuries with high possibility of survival
- Urgent or Delayed Category (Class II): second-highest priority, major injuries that are not yet life-threatening
- Nonurgent or Minimal Category (Class III): next highest priority, minor injuries that are not life-threatening
- Expectant Category (Class IV): lowest priority, clients who are not expected to live and are allowed to die naturally
Fire
- If evacuation of the unit is necessary, horizontal (lateral) evacuation is done first, followed by vertical evacuation to other floors if client safety cannot be maintained
- The RACE (Rescue, Alarm, Contain, and Extinguish) mnemonic is used to guide the order of actions in case of a fire
Severe Thunderstorm/Tornado
- In the event of a severe thunderstorm or tornado, shades and drapes are drawn to protect against shattering glass
- Beds are lowered to the lowest position and moved away from windows
- Ambulatory clients are relocated to hallways or other secure locations
Biological Pathogens
- Bioterrorism is the intentional release of pathogens that can harm people, livestock, or crops
- Early detection and management is key, as manifestations are often similar to other illnesses
- Recognition of a possible bioterrorism attack includes:
- Unusual disease occurrence at a specific time or place
- Atypical manifestations
- Disease occurrence in a specific community or people group
- Management of a biological incident includes recognition of the occurrence, directing personnel in the proper use of personal protective equipment, and decontamination and isolation in some situations### Biological Pathogen Manifestations, Prevention, and Treatment
Inhalational Anthrax
- Manifestations: fever, cough, shortness of breath, muscle aches
- Prevention: anthrax vaccine for high-risk individuals, antibiotics (ciprofloxacin and doxycycline)
- Treatment: antibiotics (ciprofloxacin, doxycycline, vancomycin, penicillin, and anthrax antitoxin), plus supportive care
Viral Hemorrhagic Fevers (Ebola, Yellow Fever)
- Manifestations: high fever, chills, fatigue, internal and external bleeding, shock, jaundice
- Prevention: vaccination available for yellow fever, barrier protection from infected person, insect repellent use
- Treatment: supportive care (prevent dehydration, provide skin care, medications for pain and fever), antibiotics for secondary infections
Smallpox
- Manifestations: high fever, chills, vomiting, delirium, rash
- Prevention: vaccine, contact and airborne precautions
- Treatment: supportive care (prevent dehydration, provide skin care, medications for pain and fever)
Cutaneous Anthrax
- Manifestations: starts as a lesion that becomes vesicular and necrotic with black eschar, fever, chills
- Prevention: anthrax vaccine for high-risk individuals
- Treatment: antibiotics (ciprofloxacin, doxycycline)
Plague
- Manifestations: sudden fever, headache, weakness, pneumonia with shortness of breath, chest pain, cough, and bloody or watery sputum
- Prevention: vaccine under review by the Food and Drug Administration, insect repellent use
- Treatment: streptomycin or gentamicin, doxycycline or ciprofloxacin in mass casualty situations
Botulism
- Manifestations: double vision, slurred speech, descending progressive weakness, nausea, vomiting, abdominal cramps, difficulty breathing
- Prevention: airway management, antitoxin
- Treatment: supportive care, elimination of toxin
Fundamentals for Nursing: Security and Disaster Plans
Hazardous Material Incidents
- Identify the hazardous material with available resources
- Contain the material in one place prior to the arrival of the hazardous materials team
- Decontaminate individuals as much as possible at the scene or as close as possible to the scene
- Follow the facility's emergency response plans
Nuclear Incidents
- Decontamination is necessary
- Irrigate skin with running water, except in the case of dry chemicals (lye or white phosphorus)
Explosive Incidents
- Gather a specific history of the injury, if possible
- Follow the facility's emergency response plans
Bomb Threat
- Listen for distinguishing background noises and voice characteristics
- Ask where and when the bomb is set to explode
- Clear the area and isolate the device as much as possible
- Cooperate with police and others
Active Shooter Situation
- Run and evacuate if there is a clear path of exit
- Hide and silence phone if unable to evacuate
- Fight and throw items to stop the shooter if unable to run or hide
Security Plan
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Nurses should be aware of security measures, including identification systems, electronic security systems, and key code access
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Prepare to take immediate action when security breaches occur
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Time is of the essence in preventing or stopping a breach in security### Mass Casualty Event and Client Discharge
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In a mass casualty event, stable clients need to be discharged to make beds available for injury victims.
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A client who is dehydrated and receiving IV fluid and electrolytes should not be recommended for discharge.
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A client with a nasogastric tube to treat a small bowel obstruction should not be recommended for discharge.
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A client scheduled for elective surgery can be recommended for discharge.
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A client with chronic hypertension and a blood pressure of 135/85 mm Hg can be recommended for discharge.
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A client with acute appendicitis and scheduled for an appendectomy should not be recommended for discharge.
Clients in Emergency Situations
- Unstable clients or those requiring nursing care are not discharged or relocated unless they are in imminent danger.
Disaster Plan
- The disaster plan is developed by nurses and other healthcare team members.
- Criteria for activating the disaster plan must be clear.
- Each employee has a role outlined in the plan, and administrative control is determined.
- A designated area for the command center is identified, along with an incident control manager.
Emergency Communication
- Communication is key in emergency management, using common terminology.
Fire Safety
- If a nurse discovers a fire, they use the RACE (Rescue, Alarm, Contain, and Extinguish) mnemonic to guide actions.
- Nurses turn off supplemental oxygen for clients who can safely tolerate room air.
- Ambulatory clients are asked to assist in removing clients from wheelchairs.
Triage
- Triage principles are followed in health care facilities during mass casualty events.
- The principles differ from those used in day-to-day services or urgent care settings.
- Casualties are separated into categories according to their potential for survival and treatment is allocated accordingly.
Triage Categories
- Emergent or Immediate Category (Class I): Highest priority for clients with life-threatening injuries and high possibility of survival.
- Urgent or Delayed Category (Class II): Second-highest priority for clients with major injuries that are not yet life-threatening.
- Nonurgent or Minimal Category (Class III): Next highest priority for clients with minor injuries that are not life-threatening.
- Expectant Category (Class IV): Lowest priority for clients who are not expected to live and are allowed to die naturally.
Severe Thunderstorm/Tornado
- Draw shades and close drapes to protect against shattering glass.
- Lower beds to the lowest position and move away from windows.
- Place blankets over clients who are confined to beds.
- Close all doors.
- Relocate ambulatory clients to hallways or other secure locations.
- Monitor for severe weather warnings using television, radio, or Internet.
- Do not use elevators.
Biological Pathogens
- Use recommended isolation measures as indicated.
Emergency Response Guidebook
- If a bomb-like device is located, do not touch it and try to contain it in one place while closing doors to isolate the area.
- Know the location of the safety data sheets manual and notify the appropriate authorities and personnel (police, administrator, director of nursing).
- If individuals are contaminated, decontaminate them as much as possible at the scene or as close as possible to the scene.
Safety Precautions
- Wear gloves, gown, mask, and shoe covers to protect yourself from contamination.
- Keep elevators available for authorities and watch for suspicious objects (packages and boxes).
- Remain calm and alert, and try not to alarm clients.
Active Shooter Situation
- Evacuate if there is a clear path of exit, leaving belongings behind.
- Transport or move clients only if needed for treatment and care.
- Take measures to protect yourself and others, and recognize indications of infection/poisoning and recommended treatment.
Radiologic Incidents
- Bioterrorism is the intentional release of pathogens that can harm people, livestock, or crops.
- Be alert to indications of a possible bioterrorism attack, and recognize early signs of infection/poisoning.
- Management of the incident includes recognition of the occurrence, directing personnel in the proper use of personal protective equipment, and decontamination and isolation.
Chemical Incidents
- Take measures to protect yourself and avoid contact with the chemical.
- Assess and intervene to maintain the client’s airway, breathing, and circulation, and administer first aid as needed.
- Decontamination is necessary, except in cases of dry chemicals (lye or white phosphorus).
Explosive Incidents
- Can result in burn injuries, wounds from airborne fragments, force due to altered air pressure, and temperature changes.
- Gather a specific history of the injury, if possible (name and concentration of the chemical, duration of exposure).
Bomb Threat
- When a phone call is received, extend the conversation as long as possible and listen for distinguishing background noises.
- Note distinguishing voice characteristics of the caller and ask where and when the bomb is set to explode.
- Approach the scene with caution and note whether the caller is familiar with the physical arrangement of the facility.
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Description
This quiz covers the Joint Commission's standards for emergency preparedness in healthcare facilities, including institutional plans and procedures for responding to emergencies.
