Foundations Chapter 15: Security and Disaster Plans PDF

CHAPTER 15 UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT THE JOINT COMMISSION AND SECTION: SAFETY AND INFECTION CONTROL EMERGENCY PREPAREDNESS Security and The Joint Commission established...

CHAPTER 15 UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT THE JOINT COMMISSION AND SECTION: SAFETY AND INFECTION CONTROL EMERGENCY PREPAREDNESS Security and The Joint Commission established emergency CHAPTER 15 preparedness management standards for various types of Disaster Plans health care facilities. These standards mandate that an institutional emergency preparedness plan is developed by all health care institutions and that these plans include institution‑specific procedures for the following. A disaster is a mass casualty or intra‑facility Notifying and assigning personnel. Notifying external authorities of emergencies. event that at least temporarily overwhelms Managing space and supplies and providing security. or interrupts the normal flow of services of a Isolating and decontaminating radioactive or chemical agents (measures to contain contamination, hospital. Disasters that health care facilities face decontamination at the scene of exposure). include internal and external emergencies. Evacuating and setting up an alternative care site when the environment cannot support adequate client care Internal emergencies include loss of electric and treatment. Critical processes when an alternative care site is necessary include the following. power or potable water, loss of communication ◯ Client information/care packaging (medications, ability, disruption of computer information supplies, admissions, medical records, and tracking) ◯ Interfacility communication systems, and severe damage or casualties within ◯ Transportation of clients, staff, and equipment the facility related to fire, weather (tornado, ◯ Cross‑privileging of medical staff Performing triage of incoming clients. hurricane), explosion, or a terrorist act. Internal Managing clients during emergencies, including emergency readiness includes evacuation and scheduling, modification or discontinuation of services, control of client information, and client discharge relocation plans, procedures to notify extra and transportation. personnel, safety and hazardous materials Interacting with family members and the media and responding to public reaction. protocols, and infection control policies Identifying backup resources (electricity, water, fire and practices. protection, fuel sources, medical gas, and vacuum) for utilities and communication. External emergencies include hurricanes, Orienting and educating personnel participating in implementation of the emergency preparedness plan. floods, volcano eruptions, earthquakes, disease Providing crisis support for health care workers (access epidemics, industrial accidents, chemical plant to vaccines, infection control recommendations, mental health counseling). explosions, major transportation accidents, Providing performance monitoring and evaluation building collapse, and terrorist acts (including related to emergency preparedness. Conducting two emergency preparedness drills biological and chemical warfare). External each year. emergency readiness includes a plan for ◯ Drills should include an influx of clients beyond those being treated by the facility. participation in community‑wide emergencies ◯ Drills should include either an internal or an external and disasters. disaster (a situation beyond the normal capacity of the facility). Participating in one community‑wide practice drill per year. FUNDAMENTALS FOR NURSING CHAPTER 15 Security and Disaster Plans 77  NURSING ROLE IN DISASTER PLANNING DISCHARGE/RELOCATION OF CLIENTS AND EMERGENCY RESPONSE PLANS During an emergency (a fire or a mass casualty event), decisions are made regarding discharging clients or Emergency response plans relocating them so their beds can be given to clients who Each health care institution must have an emergency have higher‑priority needs. preparedness plan developed by a planning committee. Criteria for identifying when clients can be This committee reviews information regarding the safely discharged potential for various types of natural and man‑made Ambulatory clients requiring minimal care are emergencies depending on the characteristics of the discharged or relocated first. community. Resources necessary to meet the potential Clients requiring assistance are next and arrangements emergency are determined and a plan is developed that are made for continuation of their care. takes into consideration all of the above factors. Clients who are unstable and/or require nursing care Nurses, as well as a cross‑section of other members of are not discharged or relocated unless they are in the health care team, are involved in the development imminent danger. of a disaster plan for such emergencies. Criteria under which the disaster plan is activated must be clear. Roles FIRE for each employee are outlined and administrative If evacuation of the unit is necessary, horizontal (lateral) control determined. A designated area for the area evacuation is done first. Vertical evacuation to other command center is identified as well as a person to floors is done if client safety cannot be maintained. serve as the incident control manager. If a nurse discovers a fire that threatens the safety of Communication, using common terminology, is a client, use the RACE (Rescue, Alarm, Contain, and important within any emergency management plan. Extinguish) mnemonic to guide the order of actions. (15.1) Nurses are expected to set up an emergency action plan Turn supplemental oxygen off for clients who can safely for personal family needs. tolerate room air. Ask ambulatory clients to assist removing clients who TRIAGE are in wheel chairs. Principles of triage are followed in health care facilities involved in a mass casualty event. These differ from the SEVERE THUNDERSTORM/TORNADO principles of triage that are typically followed during Draw shades and close drapes to protect against provision of day‑to‑day services in an emergency shattering glass. or urgent care setting. During mass casualty events, Lower beds to the lowest position and move away from casualties are separated in relation to their potential for the windows. survival, and treatment is allocated accordingly. Place blankets over all clients who are confined to beds. Close all doors. Categories of triage during mass casualty events Relocate as many ambulatory clients as possible into the hallways (away from windows) or other secure location Emergent or Immediate Category (Class I): Highest designated by the facility. priority is given to clients who have life‑threatening Do not use elevators. injuries but also have a high possibility of survival once Monitor for severe weather warnings using television, they are stabilized. radio, or Internet. Urgent or Delayed Category (Class II): Second‑highest priority is given to clients who have 15.1 Race mnemonic major injuries that are not yet life‑threatening and can usually wait 30 min to 2 hr for treatment. R Rescue the client and other individuals from the area. RESCUE Nonurgent or Minimal Category (Class III): The next highest A Sound the fire alarm, which activates the EMS response system. Systems that could increase fire spread are automatically priority is given to clients who ALARM shut down with activation of the alarm. have minor injuries that are not After clearing the room or area, close the door life‑threatening and do not need C leading to the area in which the fire is located as well as the fire doors and any open windows. immediate attention. CONTAIN Fire doors are kept closed as much as possible when moving from Expectant Category (Class IV): The area to area within the facility to avoid the spread of smoke and fire. lowest priority is given to clients Make an attempt to extinguish small fires using a single fire who are not expected to live and are extinguisher, smothering them with a blanket, or dousing allowed to die naturally. Comfort with water (except with an electrical or grease fire). E Complete evacuation of the area occurs if the nurse measures can be provided, but restorative care is not. EXTINGUISH cannot put the fire out with these methods. Attempts at extinguishing the fire are only made when the employee is properly trained in the safe use of a fire extinguisher and when only one extinguisher is needed. 78 CHAPTER 15 Security and Disaster Plans CONTENT MASTERY SERIES  BIOLOGICAL PATHOGENS Use recommended isolation measures as indicated. Transport or move clients only if needed for Bioterrorism is the intentional release of pathogens treatment and care. that can harm people, livestock, or crops. Be alert Take measures to protect self and others. to indications of a possible bioterrorism attack, as Recognize indications of infection/poisoning and early detection and management is key. Often the recommended treatment. (15.2) manifestations are similar to other illnesses. Be alert for the appearance of a disease that does not usually occur at a specific time or place, has atypical CHEMICAL INCIDENTS manifestations, or occurs in a specific community or Chemical incidents can occur as result of an accident or people group. due to a purposeful action (terrorism). In most instances, infection from biological agents is Take measures to protect self and to avoid contact. not spread from one client to another. Management Assess and intervene to maintain the client’s airway, of the incident includes recognition of the occurrence, breathing, and circulation. Administer first aid as needed. directing personnel in the proper use of personal protective equipment, and, in some situations, decontamination and isolation. 15.2 Biological pathogen manifestations, prevention, and treatment Inhalational anthrax Viral hemorrhagic fevers Smallpox MANIFESTATIONS (Ebola, yellow fever) MANIFESTATIONS Fever Mild chest pain MANIFESTATIONS High fever Chills Cough Meningitis Fatigue Internal and Fatigue Vomiting Shortness Shock Kidney failure external bleeding Severe headache Delirium of breath Sweats (often Elevated Shock Rash Muscle aches drenching) temperature Jaundice (yellow fever) PREVENTION PREVENTION Nausea, vomiting, diarrhea Vaccine; can vaccinate within Anthrax vaccine for high‑risk 4 days of exposure Ciprofloxacin & Doxycycline IV/PO PREVENTION Contact and airborne precautions Vaccination available for yellow fever, TREATMENT: includes one or two Argentine hemorrhagic fever TREATMENT additional antibiotics (vancomycin, Supportive care (prevent Barrier protection from infected person, penicillin, and anthrax antitoxin) isolation precautions specific to disease dehydration, provide skin care, medications for pain and fever) Insect repellent use Cutaneous anthrax Antibiotics for secondary infections TREATMENT MANIFESTATIONS Starts as a lesion that can be itchy No cure, supportive care only Tularemia Minimize invasive procedures Develops into a vesicular lesion MANIFESTATIONS that later becomes necrotic with Sudden fever Dry cough Plague the formation of black eschar Chills Progressive Fever, chills MANIFESTATIONS weakness Headache PREVENTION: Anthrax Yersinia pestis bacterium is Diarrhea If airborne, vaccine for high‑risk the causative agent life‑threatening Muscle aches These forms can occur separately pneumonia and TREATMENT: Ciprofloxacin, Doxycycline Joint pain systemic infection or in combination Pneumonic plague: fever, headache, PREVENTION Botulism ◯ weakness, pneumonia with shortness Vaccine under review by the Food of breath, chest pain, cough, and and Drug Administration MANIFESTATIONS bloody or watery sputum. Difficulty swallowing Insect repellent use Bubonic plague: swollen, tender ◯ Double vision lymph glands, fever, headache, TREATMENT: streptomycin or gentamicin Slurred speech chills, and weakness. are the medications of choice; in mass Descending progressive weakness Septicemic plague: fever, chills, ◯ causality, use doxycycline or ciprofloxacin Nausea, vomiting, abdominal cramps prostration, abdominal pain, shock, disseminated intravascular coagulation Difficulty breathing (DIC), gangrene of nose and digits. Sensation of a thickened tongue (difficulty controlling tongue) PREVENTION: Contact precautions until decontaminated or buboes no longer drain PREVENTION/TREATMENT (bubonic, septicemic); droplet precautions Airway management until 72 hr after antibiotics (pneumonic) Antitoxin TREATMENT: Streptomycin/gentamicin Elimination of toxin or tetracycline/doxycycline. FUNDAMENTALS FOR NURSING CHAPTER 15 Security and Disaster Plans 79  Remove the offending chemical by undressing the client, NUCLEAR INCIDENTS removing all identifiable particulate matter. Provide Can result in long-term contamination, burn injuries, immediate and prolonged irrigations of contaminated and puncture wounds. areas. Irrigate skin with running water, with the Decontamination is necessary. exception of dry chemicals (lye or white phosphorus). In the case of exposure to a dry chemical, brush the agent off of the client’s clothing and skin. EXPLOSIVE INCIDENTS Gather a specific history of the injury, if possible (name Can result in burn injuries, wounds from airborne and concentration of the chemical, duration of exposure). fragments, force due to altered air pressure, and In the event of a chemical attack, have knowledge of temperature changes. which facilities are open to exposed clients and which are only open to unexposed clients. Follow the facility’s emergency response plans (personal BOMB THREAT protection measures, the handling and disposal of wastes, When a phone call is received: use of space and equipment, reporting procedures). Extend the conversation as long as possible. Listen for distinguishing background noises (music, HAZARDOUS MATERIAL INCIDENTS voices, traffic, airplanes). Note distinguishing voice characteristics of the caller. Take measures to protect self and to avoid contact. Ask where and when the bomb is set to explode. Approach the scene with caution. Note whether the caller is familiar with the physical Identify the hazardous material with available resources arrangement of the facility. (emergency response guidebook, poison control centers). If a bomb‑like device is located, do not touch it. Clear Know the location of the safety data sheets manual. the area and isolate the device as much as possible by Try to contain the material in one place prior to the closing doors, for example. arrival of the hazardous materials team. Notify the appropriate authorities and personnel (police, If individuals are contaminated, decontaminate them as administrator, director of nursing). much as possible at the scene or as close as possible to Cooperate with police and others. Assist to conduct a the scene. search as needed, provide copies of floor plans, have ◯ Don gloves, gown, mask, and shoe covers to protect master keys available, and watch for and isolate self from contamination. suspicious objects (packages and boxes). ◯ With few exceptions, water is the universal antidote. Keep elevators available for authorities. For biological hazardous materials, wash skin with Remain calm and alert and try not to alarm clients. copious amounts of water and antibacterial soap. ◯ Carefully and slowly remove contaminated clothing so that deposited material does not become airborne. ACTIVE SHOOTER SITUATION ◯ Place all contaminated material into large plastic bags One or more persons attempting to kill people in a and seal them. confined area. Run RADIOLOGIC INCIDENTS Evacuate if there is a clear path of exit. The amount of exposure is related to the duration Leave belongings behind. of the exposure, distance from source, and amount Instruct others to follow, but do not wait for them. of shielding. Prevent others from entering the area. The facility where victims are treated activates Hide interventions to prevent contamination of treatment If unable to evacuate areas (floors and furniture are covered, air vents and ◯ Stay out of shooter's sight. ducts are covered, radiation‑contaminated waste is ◯ Find a protected area. disposed of according to procedural guidelines). ◯ Block or lock doors. Wear water‑resistant gowns, double glove, and fully cover ◯ Silence phone and remain quiet. their bodies with caps, shoe covers, masks, and goggles. Fight Wear radiation or dosimetry badges to monitor the If unable to run or hide and if danger is imminent amount of their radiation exposure. ◯ Throw items and yell at shooter to stop, or wound Survey clients initially with a radiation meter to the shooter. determine the amount of contamination. Call 911 if possible, remain calm, do not attempt to Decontamination with soap, water, and disposable move wounded people, and keep hands visible if police towels occurs prior to entering the facility. Water runoff enter the area. is contaminated and contained. After decontamination, resurvey clients for residual contamination. Continue irrigation of the skin until the client is clean of all contamination. 80 CHAPTER 15 Security and Disaster Plans CONTENT MASTERY SERIES  SECURITY PLAN Application Exercises All health care facilities have security plans in place that include preventive, protective, and response measures 1. A nurse is caring for multiple clients designed for identified security needs. during a mass casualty event. Which of the Security issues faced by health care facilities include following clients is the nurse's priority? admission of potentially dangerous individuals, A. A client who received crush injuries to the vandalism, infant abduction, and information theft. chest and abdomen and is expected to die The International Association for Healthcare Security & B. A client who has a 4‑inch laceration to the head Safety provides recommendations for the development C. A client who has partial‑thickness and of security plans. full‑thickness burns to his face, neck, and chest D. A client who has a fractured fibula and tibia NURSING ROLE IN SECURITY PLAN 2. A nurse educator is teaching staff members Nurses should be aware that security measures include: about facility protocol in the event of a An identification system that identifies employees, tornado. Which of the following should the volunteers, physicians, students, and regularly nurse include? (Select all that apply.) scheduled contract services staff as authorized A. Open doors to client rooms. personnel of the health care facility. B. Place blankets over clients who Electronic security systems in high‑risk areas (maternal are confined to beds. newborn to prevent infant abductions, the emergency C. Move beds away from the windows. department to prevent unauthorized entrance). D. Draw shades and close drapes. ◯ Key code access into and out of high‑risk areas E. Instruct ambulatory clients in the ◯ Wristbands that electronically link parents and hallways to return to their rooms. their infants ◯ Alarms integrated with closed‑circuit television cameras 3. An occupational health nurse is caring for an employee who was exposed to an unknown dry chemical, resulting Nurses should prepare to take immediate action when in a chemical burn. Which of the following interventions breaches in security occur. Time is of the essence in should the nurse include in the plan of care? preventing or stopping a breach in security. A. Irrigate the affected area with running water. B. Wash the affected area with antibacterial soap. C. Brush the chemical off the skin and clothing. Active Learning Scenario D. Leave the clothing in place until emergency personnel arrive. A nurse educator is teaching a module on biological pathogens during orientation to a group of newly hired nurses. What information should the nurse 4. A security officer is reviewing actions to take in educator include? Use the ATI Active Learning the event of a bomb threat by phone to a group Template: Basic Concept to complete this item. of nurses. Which of the following statements by a nurse indicates understanding? RELATED CONTENT: List four manifestations A. “I will get the caller off the phone as soon and the recommended treatment for anthrax, as possible so I can alert the staff.” botulism, pneumonic plague, and tularemia. B. “I will begin evacuating clients using the elevators.” C. “I will not ask any questions and just let the caller talk.” D. “I will listen for background noises.” 5. A nurse on a medical‑surgical unit is informed that a mass casualty event occurred in the community and that it is necessary to discharge stable clients to make beds available for injury victims. Which of the following clients should the nurse recommend for discharge? (Select all that apply.) A. A client who is dehydrated and receiving IV fluid and electrolytes B. A client who has a nasogastric tube to treat a small bowel obstruction C. A client who is scheduled for elective surgery D. A client who has chronic hypertension and blood pressure 135/85 mm Hg E. A client who has acute appendicitis and is scheduled for an appendectomy FUNDAMENTALS FOR NURSING CHAPTER 15 Security and Disaster Plans 81