• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/66

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

66 Cards in this Set

  • Front
  • Back
Disasters
Disasters occur every year. Can occur in any location, to anyone. (regardless of income, age, etnicity or religion) Some are slow to develope and can be forecasted. Those people make preperations prior to impact. Ready with prepardness plan and what you are going to do once it occurs.
Takes on many forms; floods, wind, fire, explosions, epidemics, multiple car crashes, environmental contamination, bioterrorism.
American red cross definition of disaster.
Occurance - natural or man made. Causes human suffering, creates human need, victims cannot alleviate without assistance. Is the EMERGENCY phase. Not three weeks after the event etc. Should not be taking care of people 10 years later. More the immediate needs right after event occ.
Disaster Relief Act
Federal, state and local gments getting involved and having money after the emergency time that the event has occurred. "In the determination of the President causes damage of sufficient severity and magnitude to warrant major assistance above and beyond services by Federal Government to supplement the efforts and available resources of the state and local governments, and private relief organizations in alleviated the damages, loss, hardship and suffering caused by the disaster.
Multiple Casualty incident
One in which there are more than 2 but fewer than 100 persons injured.
Mass casualty incident
Situation with a large number of casualties, usually 100 or more, that significantly overwhelms available emergency medical services, facilities and resources.
Two types of disasters
Natural
Man-made
Dimensions of disaster
Predictability - i.e. tornados. Can actually be predicted. Out west harder to "predict" vs. here in Ga. where we can see it coming.
Frequency - How often does it happen?
controllability - How much control we have. Some counties have sirens vs. those that do not. Controllability a bit better due to such devices.
Time - rush hour vs. late at night. Night events, people aren't forewarned and do not plan for an emergency situation in middle of night. i.e. higher causality rate.
Scope or intensity - i.e. floods lasting longer than anyone planned or expected. Also, we weren't really forewarned. Can't do much about Natural, we can do something about most of the "man made" disasters.
Predictable (means they have warning times attached to them)
Hurricanes
Floods
Tropical storms
Winter storms
High winds (i.e. around lakes, up north)
Disasters with little or no warning
Earthquakes
flash floods
fire
landslides
volcanos
Car accidents
Impact of disasters
Affected by;
Vulnerability of a population of individuals.
Environmental factors and types of impact.
Warning time and proximity to disaster.
Individual perception and response.
Altered individual health - stress related symptoms
Altered individual health (How things affect one, stressors attached etc)
Altered vital signs
GI upset
headache
malaise
irritability
depression
exhaustion
mental health disturbances
early onset of labor
Impact: Exacerbation of comorbid conditions
Hypertension
cardiac complications
respiratory problems
ulcers
seizures
Asthma
Impact: common injuries and illnesses
Only a few, there are several more that can occur while getting people to safety.
Bone, muscle, joint injury
Rashes
Burns : chemical, thermal, electrical
Hypothermia etc. Think about people falling out of the boat according to slide presentation. This is the slide they fell out on.
Risk factors for increased impact issues
These have to do with some lack of support measures etc.
Living alone - no one else to turn to vent frustrations, receive praise from etc. Live alone increase chances of disaster being more problematic for them.
Just moved - Do not have connections yet, no one to turn to.
Reduced coping skills
Emotional problems or recent emotional stress
limited financial resources - No one has money set aside for things like this
Disability - whatever disability
language barrier -
substance abuse
Controllability
If you have prewarning systems controllability is increased. No forewarning = no control over event about to happen our what the outcome is going to be.
Mitigation
Term used in disaster planning that describes actions and/or processes that can be used to prevent or reduce the damage caused by a specific disaster event. I.e. Victims mitigating slow rising flood waters by placing sandbags, trying to redirect water etc.
Scope vs. Intensity
In a building explosion, the scope is small because it only affects a limited area of the community. However, the intensity is large.
Phases of disaster
Pre-impact
Impact
post-impact
Pre-Impact phase
Initial phase
prior to actual occurrence - aka warning phase.
This is where the emergency preparedness plan is put into effect. (Sister with kids in bathroom during warning signal activation was example here). The role of the nurse during this warning phase is to assist in preparing shelters, and emergency aid stations and establishing contact with other emergency service groups.
Impact phase
Where the actual disaster occurs. What is happening to victim? They are waiting for some feeling or a more calm to occur. I.e. a tornado comes through, things are being torn apart and they are waiting for it to be over, "holding on" until help arrives. Can last for a few minutes, hours, (flooding issue ex.) may last --> days, several weeks to months. The number of persons requiring shelter, the types and number of needed disaster health services anticipated, and the general health status and needs of the community must be evaluated.
More Impact phase
The impact phase continues until threat of further destruction has passed, the emergency plan is in effect and the EOC is established. **Relief/help workers from outside do not come in during impact phase because they could potentially become victims as well. When impact is OVER disaster workers arrive.** The local help is there during Impact.
So... Impact phase ends when 1. The threat of further destruction has passed. 2. The emergency plan is in effect. 3. The EOC is established.
Shelters are opened and every shelter has a nurse as a member of their DAT (Disaster action team). The nurse is responsible for 1. assessing health needs 2. providing physical and psychological support to victims in the shelters.
EOC (Emergency Operations Center)
The EOC is the operating center for the local chapter of the ARC (American Red Cross)
It serves as the center for communication with other gment agencies, the center for recruitment of health care providers to staff shelters, and the liason center for working with other volunteer agencies.
During the END of the impact phase:
May need to set up morgue facilities, triage injured people, search and reunion activities are organized.
POST IMPACT
The recovery begins during the post-impact phase and ends with return of community order/functioning. THIS IS WHERE THE DISASTER ENDS! This can be difficult because this "thing" has happened to people. Relief workers need to be careful not to move people too quickly through the post impact aka recovery phase.
Response Phase
Going through set of emotional responses. The same as grief with amputation etc. Go through Kubler-ross type phases of grief.

Denial
Strong emotional response
acceptance
recovery
Personal Variables (factors)
that can influence individuals reation to disaster.
Psychological proximity - How close to the event were you?
coping ability - Someone who has been through a tornado and lost everything before vs. someone who is experiencing it for the first time.
personal loss
role overload - If family hasn't been able to have father return to work, stay at home mom has to work all of a sudden. Roles have reversed causing dad a lot of anxiety aka overload.
Previous disaster experience - kinda same thing as coping
An individual's risk for developing severe psycholgical consequences is greater if:
-That person is emotionally close to the individuals affected
-Has compromisd coping abilities
-feels overloaded in her or his role
-Has never before experienced a disaster.
Social factors to consider
Loss of family members
Changes in roles
Questioning of religous beliefs
Community Impact
**Disaster doesn't only affect people personally, obviously**
When the local/public facilities (i.e. breech in water, services that are not able to run etc). Those things really complicate everyones life. Communications down, cell and landline. How do you communicate w/others outside? STRESSORS
-Overstressed personnel
-Damage to public buildings
-Insufficient public food and / or medical supplies
-Rumors and panic
-basic needs unmet
-loss of human lives

**Sidebar, in a disaster if a nurse leaves patients w/out being relieved is considered "abandoning" the patients" and is likely to cost the nurse their license.
Every institution is supposed to have a disaster preparedness plan.
Community Reaction phase
**no real time frame placed on the phases**
Heroic phase - The tail end of impact phase and post impact. During this time, instead of shutting down and running for their lives, people turn into heroes and try to save others.
Honeymoon phase - "oh the event is over, now I need to do whatever I need to do to get my life under control and we will have it done by 1800 tonight" Thinking everything will return to exactly how it was before the event took place.
Disillusionment phase - Things aren't moving along as quickly as you thought they would. (It is Wednesday, I have to be at work on Friday so everything has to be fixed) Everything upsets you about everything. "Well, I haven't gotten my check yet, How am I supposed to get X,Y,Z?" or "I went to Walmart and couldn't get name brand" "Johns family got 100 more than my family did, why?"
Reconstruction phase - People take a step back, wondering how they will get back to some kind of normalcy but realize it won't be the same as it was before the disaster. Start talking about sheet rock, how much has to be ripped out, how much it will cost etc. Talk in real time and money. Understand it won't be taken care of within the week.
Heroic phase
The tail end of impact phase and post impact. During this time, instead of shutting down and running for their lives, people turn into heroes and try to save others.
Three areas of Disaster work
1. Preparing for disasters
2. Immediate response
3. Recovery Phase

**All three of the phases are extremely important. Especially preplanning phase. Because you do a lot of work based on your understanding of a disaster at the time. Then when the disaster occurs, one may reevaluate a lot of the steps that happened during that event.
Preparation: Disaster management Responsibilities
1. Planning for a disaster (involve five major areas)
2. Planning and conducting well-designed "mock disasters"
3. Nurse can volunteer or may be required by their job to take part in disaster preparation.
4. The local chapter of the ARC offers disaster nursing training sessions for nurses who are required to participate or are interested in disaster care.
5 major areas in planning for disaster.
-Use of technology - weather forecast.
-Engineer to reduce risks - how far can the river overrun its banks?
-Public education - getting information out to people over any means possible. (i.e. hurricanes, flu, storms)
Coordinated emergency response - Weather sirens
If systematic - assessment of the effects of a disaster.
Immediate Response
(State and local governments response FIRST)
Local governments: The local government MUST INVITE THE OUTSIDE AGENCIES IN! i.e. Katrina - The local gment did not invite others in until after the flooding started. This is what delayed the help response so much.
Local governments are responsible for the safety and welfare of their citizens. They act to protect the lives and property of the citizens, protect public health, carry out evacuating rescues and maintain public works. All communities SHOULD have an emergency operational plan for potential disasters.
state governments
provide financial support to local governments. For disaster planning purposes, if the disaster involves more than a local jurisdiction, th state may also coordinate services. The state governor may have some state agencines that work directly on disaster relief (i.e. state police, national guard, GEMA)
Federal government
Generally enacts laws and provides funds to support state and local governments. FEMA
FEMA
Established in 1979 as the coordinating agency for all available federal disaster assistance.
FEMA is the focal point in federal gment for emergency planning, preparedness, mitigation, response, and recovery.
GEMA
Ga version of FEMA
NSDS (National Disaster Medial System)
Designed to deal with medical care needs in disasters of great intensity and scope. It has three main objectives:
1. provide medical assistance to disaster area in the form of medical assistance teams, medical supplies and equipment.
2. Evacuate patients that cannot be cared for in the affected area to other predetermined locations.
3. To provide a national network of hospitals that are designated to accept patients in this event of a national emergency.
AMR (American Red Cross)
1881
Clara Barton

Six programs:
Damage assessment - going in and seeing how bad.
Mass care - Getting supplies, needed items to victims.
health services - taking care of minor injuries or prepping for transport.
family services - getting family back into environment where they can get the rest of their life going again,
Mental health
Disaster welfare inquiry service - searching for people and reuniting families.
Disaster Nursing Defined
Immediate emergency personnel.
Goal - Achieve the best possible level of health for the people and the community involved in the disaster.
Disaster nursing is not a clinical speciality, but it does encompass all clinical specialties within the field of nursing - medical, surgicak, ob, peds, geria, psych and public health nursing.
DHS protocols (Disaster Health Services)
We work off of a set of preplanned protocols set up by local public health departments and ARC prior to disaster. These are set up in PREPLANNING phase. A physician (someone they obviously trust, but we may have and may never meet)must review these protocols EVERY THREE YEARS, to ensure that they are still accurate and valid.

ARC protocols must be reviewed EVERY YEAR by the chapter volunteer medical consultant or local public health officer, and may be adapted to preferred local standards of medical practice.
DHS
Direct service function of ARC
Volunteer nurses and health professionals (EMTs, LPNs, LVNs and student nurses. The DECISIONS ARE MADE BY RN!
DHS protocols
These protocols/procedures:
-limit individual liablility while enhancing care delivery
-assessment
-problem-solving
-case management
-patient advocacy
- Individuals CANNOT WORK OUTSIDE these protocols!
Triage
Way of sorting/categorizing victims who are there.

Goal - maximize the number of survivors by sorting the treatable from the untreatable.
Red - most urgent. First priority. Dif breathing,
Yellow - urgent and second priority.
Green - walking wounded. Broken arm, can sling and go on.
Black - dying or dead. 30 seconds and no improvement, have multiple patients around they are black tagged and move on!
Red tags
First priorty - life threatening events. Hypoxia or close to it. Ex. Shock, chest wounds, head injuries, burns over 20-60% of body surface and chest pain. Patients with catastrophic head or chest injuries DO NOT FALL into this catagory because they have a poor chance of survival.
Yellow
Patient appears stable enough to withstand 30-60 min wait without immediate risk.

ex: open fractures, spinal injuries, large lacerations, burns 10-20% of body surface, DKA and epileptic shock.
Green
3rd priority - can wait several hours for treatment without danger. Minimal injuries unaccompanied by systemic complications.

ex. closed fractures, minor burns, minor lacerations, sprains, contusions and abrasions.
Black
Hopelessly injured or dead victims. **THESE PEOPLE WOULD NOT SURVIVE UNDER THE BEST OF CONDITIONS** Remember that personnel and equiptment must be reserved for the greatest number of VIABLE patients.
Settings for disaster support
(All the places we can work)
triage
first aid stations (not hours and hours of massive work)
mass food service
shelters
financial counseling and resource identification
resource warehouses
home visitation
hospital services
outreach
morgues
PPP Equipment
Emergency phone numbers
battery operated radio
working flashlight
First aid kig
Med information (allergies, blood types, script meds)
Dr names
Peeps to notify in an emergency
Key purposes of health interventions by DHS
Teamwork in this area is very important. Sole responsibility is to take care of the victims and their families! Confidentiality is important but you have to be able to move them from place to place.
Issues DHS can help with
Glasses, dentures, medications (but client has to have been seen by a Dr. in the last year before we can replace their meds),
**prosthetic devices, medical equipment - VA system is worst to work through. Private insurance better to work with**
Funeral assistance - we have certain amounts of fed money to spend to get the funeral taken care of.
Co-op agreements with schools, churches and public buildings to use as shelters.
Commercial and school kitchens for food service.
Food delivery to outlying areas
Temporary housing

We can also help ref making community referrals - search and reunion, mental health, funeral services etc.
Licensure and liability issues
We have no way to know what other states NPA says, so we work under "Ga law" as a good samaritan. However, good Samaritan law is one we can use in our defense. Just because we go work in Illinois, and someone thinks something done isn't ok, they can file suit. What we can do is claim Good Samaritan Law (I don't know these people, nothing against them, don't even know them, worked as a prudent nurse etc)
Injuries and Illness reported by Disaster workers
Debriefing - Where the team members evaluate how the performance has been of the members during the time they were there. What worked, didn't, needs to be modified etc. Hope team leader takes recommendations to others, and makes changes as necessary. Mostly likely for disasters after the current one they are dealing with.

As a health services person, I must set aside 14 straight days to go work.( Everyone else has to set aside 21. )
How to get involved?
AS a student:
DAT (Disaster management team)
Red Cross

Development of specialized skills:
Search and rescue
damage assessment
heavy equipment operations
biological/chemial agents
Pandemic flu
New influenza A virus appears, causes serious illness, then spreads easily from person to person worldwide.

To be considered Pandemic:
Global outbreak with:
Newlyh emerging virus (all or most people will be susceptible)
Easily transmissible from person to person
(wide geographic spread)
Highly pathogenic virus
(Will cause widespread devastating mortality worldwide)
Can have 2nd or 3rd waves
(May last 6 months or considerably longer)

BEST CASE SCENERIO - IT MAY NEVER HAPPEN.
Worst case scenerios with H1N1
Global disease w/possibility of millions of deaths worldwide in short period of time
-much of the workforce out of work
-major impact on economy
(lack of utilities, widespread quarantine and chaos)
Symptoms of pandemic flu
Symptoms will be similar but progression of symptoms to severe illness may be faster; may include diarrhea.

Pneumonia, severe resp distress and death may occur rapidly.
Interpandemic period

Phase 1
Six phases.

1. no new virus in humans
virus subtype, present iun animals, causes infection in humans. Rick of human infection low
Phase 2 (Interpandemic period)
No new virus subtypes detected in humans. Animal subtype ciruclates, poses rick of human disease.
Phase 3 (Pandemic alert period)
Human infection with new subtype
No person to person transmission or are rare instances of spread through close contact
Phase 4 - Pandemic Alert period
Small clusters with limited person to person transmission
spread is highly localized
virus is not yet well adapted to human
Pandemic alert period
Phase 5
Larger clusters but person to person transmission is localized
Pandemic period
Phase 6
Pandemic: Increased and sustained transmission to general population
High mortality
Pandemic waves: disease may occur and peak, then recur several times before it disappears
Global Preparedness will be necessary BEFORE this phase.
Expected at Anytime
Current conditions meet criteria for Phase 6 Pandemic alert period.