Terrorism, Mass Casualty and Disaster Nursing PDF

Terrorism, Mass Casualty and Disaster Nursing Prepared by Suzanne Badawi Terrorism, Mass Casualty and Disaster Nursing The World Health Organization defines mass casualty incidents as disasters and major incidents characterized by quantity, severity, and diversity of patients t...

Terrorism, Mass Casualty and Disaster Nursing Prepared by Suzanne Badawi Terrorism, Mass Casualty and Disaster Nursing The World Health Organization defines mass casualty incidents as disasters and major incidents characterized by quantity, severity, and diversity of patients that can rapidly overwhelm the ability of local medical resources to deliver comprehensive and definitive medical care. Terrorist incidents involving biological, nuclear, incendiary, chemical, or explosive materials are considered technological hazardous incidents by nature (earthquake, tornado…) Preparedness and planning are vital, as these events can happen in any community at any given time. Defined pre-hospital triage systems are essential in saving lives and optimizing the initiation of resource allocation when these disasters strike. Mass casualty incidents triage systems are implemented to offer the greatest good to the greatest amount of people as healthcare resources are limited or strained due to the number of injured individuals. Treatment during triage is minimal. The goal is to move patients away from the incident and toward resources that offer more comprehensive care. Terrorism, Mass Casualty and Disaster Nursing The Emergency Plan: emergency disaster plan is a pre set protocol for a brutal event, causing many victims. Disaster planning is a systematic process that has four main components: 1- Identifying hazards 2- Mitigating risks: In certain cases, some of the devastating effects of disasters can be reduced before the actual event. ( Early warning allows residents to seek shelter from tornadoes and approaching hurricanes) 3- Preparing and responding to emergencies: In addition to having a specific written plan, disaster planning involves exercising, practicing and revising the plan including community and emergency resources. Response: - Activation: Organization of command and scene assessment - Implementation: Search and rescue - Definitive scene management 4- Recovery and development: Debriefing All components of the planning process have to be documented and recorded for evaluation and future Terrorism, Mass Casualty and Disaster Nursing Level of disasters: _ Level 1: disaster is one in which local emergency response personnel and organizations are able to contain and effectively deal with the disaster and its aftermath _ Level 2: disaster requires regional efforts and mutual aids from surrounding communities _ Level 3: disaster is of such a magnitude that local and regional assets are overwhelmed, requiring statewide or federal assistance Terrorism, Mass Casualty and Disaster Nursing Most mass casualty incident triaging systems use tags or colored designations for categorizing injured persons. It is important to designate areas where to tagged and/or labeled individuals can relocate. However, emphasis should be placed on rapid assessment and quick movement of patients. Multiple triage systems are currently being implemented around the world. Some of the more well-known algorithms include : START (simple triage and rapid treatment) SALT (sort, assess, life-saving interventions, treatment/triage) STM (Sacco triage method) Care Flight Triage SAVE (Secondary assessment of victim endpoint). JumpSTART However, it is important to choose one and adhere to its algorithm to maintain an ordered approach. Terrorism, Mass Casualty and Disaster Nursing Simple triage and rapid treatment (START) is currently the most widely used triage system in the United States for mass casualty incidents. First responders delegate the movement of injured victims to a designated collection point as directed by using four main categories based on injury severity: The triage colors may be assigned by giving triage tags to patients or simply by physically sorting patients into different designated areas BLACK: (Deceased/expectant) injuries incompatible with life or without spontaneous respiration; should not be moved forward to the collection point RED: (Immediate) severe injuries but high potential for survival with treatment; taken to collection point first YELLOW: (Delayed) serious injuries but not immediately life- threatening GREEN: (Walking wounded) minor injuries Terrorism, Mass Casualty and Disaster Nursing START Triage Green patients are assigned by asking all victims who can walk to a designated area. All non- ambulatory patients are then assessed. Black tags are assigned to victims who are not breathing even after attempts to open the airway. Red tags are assigned to any victim with the following: _ Respiratory rate greater than 30 _ Absent radial pulse or capillary refill greater than 2 sec _ Unable to follow simple commands Yellow tags are then assigned to all others. Terrorism, Mass Casualty and Disaster Nursing SALT Triage: The sort, assess, life-saving interventions, and triage/treatment approach is similar to the START system; however, it is more comprehensive and adds simple life-saving techniques during the triage phase. SORT: sort the walking, waving, and still. This can be achieved by asking everyone at the scene to walk to a designated casualty collection point similar to the START method; however, this is followed by asking to wave an arm or leg if they need help. Those who cannot move or follow commands should be assessed first. ASSESSMENT: assessment and life-saving interventions go hand in hand. When you assess a victim and find life-threatening injuries, you should intervene. LIFE-SAVING INTERVENTIONS: simple techniques such as controlling major hemorrhage, opening airways, needle decompression, and auto-injector antidotes should be performed as long as it is not time intensive. Once performed, the provider should assign a color-coded tag similar to the START system and move onto the next patient to ensure the forward flow of patients. TREATMENT AND TRANSPORT: Once tagged, patients will be moved to the designated casualty collection point for transport by emergency management services to receiving facilities. Terrorism, Mass Casualty and Disaster Nursing JumpSTART JumpSTART is a modification to the START system and takes into account the difference in “normal” respiratory rates for children. This tool acts to assess pediatric patients better. The age cutoff for use is eight years old. The differences in this algorithm include: Five rescue breaths are to be given to apneic children with a pulse; then, they are given a black tag. Normal RR are more than 15 or less than 45 Neurological assessment is done using the mnemonic AVPU (alert, responds to verbal stimuli, responds to painful stimuli, and unresponsive). Any patient who has abnormal posturing to painful stimuli or is unresponsive gets a red tag designation. Terrorism, Mass Casualty and Disaster Nursing Terrorism, Mass Casualty and Disaster Nursing Catastrophic Plan at the Hospital: Once we have a catastrophic plan, the director will call the stuff through a messenger system to come to the hospital, and all the stuff on duty have to take there place based on catastrophic plan Triage outdoor the ED by a physician and a nurse, victims will be divided into colors groups based on their injuries gravity , an administrative agent has to follow the victim’s number and collaborate with the minister and Red cross. Every victim has: _ To wear a disaster triage card and numbered same number as the bracelet _ Take his number (victims are evaluated and identifying based on numbers and not on their names) _ Put a bracelet based on his number Thank you