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DISASTER NURSING Caring for Vulnerable Populations in the Community During a Disaster Shirley P Smith PhD RN CRNP Duquesne University School of Nursing Pittsburgh PA DEFINITION Natural or man made event that significantly disrupts and harms the people and environment causes human suffering and creates human needs that victims cannot alleviate without assistance ARC 1975 Multiple casualty incident Mass casualty incident MCI Chemical Biological Radiation Nuclear Explosive CBRNE HISTORICAL FACTORS The Plague 1346 Tatar army hurled corpse infected with plague at enemy Russian used same against Sweden 1710 Assyrians poison well water Smallpox infected blankets English to Native Americans during French American War 17541767 1984 Oregon Salmonella Biological Weapons Convention 1972 Agreement to prohibit development production stockpiling of Bacteria Viruses Biological toxins BE ALERT BE VIGILANT Smallpox Lesions in mouth and throat Differs from Varicella chicken pox which usually begins on the trunk Anthrax Inhalation Flu like symptoms followed by improvement Malaise fever rigors vomiting headache backache delirium PHASES OF A DISASTER 1 PreImpact a Mitigation 1 Reduce the effect prevent damages b Planning 1 disaster training 2 supplies equipment storage 3 emergency management c Warning system 1 line of authority 2 communication PHASES OF A DISASTER 2 Impact a Response 1 Assessment of damage 2 Triage first aid 3 minimize panic chaos 4 provide shelter food 5 morgue facilities established 6 Search Rescue activities PHASES OF A DISASTER 3 PostImpact a Emergency 1 rescue 2 first aid b Recovery 1 Prevent debilitating effects 2 Restore personal economic environmental health 3 Post traumatic stress management 4 Evaluative feedback SCOPE SEVERITY Vulnerability of population individual Warning Time Proximity to Disaster Age physical mental status mobility Increased response if no warning and close proximity Environmental Factors Type of Impact Length time loss of utilities Chemical leaks Bacterial contamination Individual Perceptions Coping skills Personal losses Previous disaster experiences Role overload CORE COMPETENCIES Critical Thinking Communication Skills Assessment Skills Technical Skills CRITICAL THINKING Ethical framework to support decisionmaking Assessing potential for appropriate and timely response Modify approaches to triage COMMUNICATION SKILLS Understand chain of command Locate emergency response plan Responsible party within the agency Accurately document Key referral sources ASSESSMENT Safety issues for self and team Sign symptoms of common diseases Conduct health assessment physical status Mass Casualty Event MCE scene HEALTH ASSESSMENT Respiratory airway Cardiovascular signs of shock Integumentary Pain Head to toe trauma assessment Basic neurological exam Mental status assessment TECHNICAL SKILLS Med administration Tube insertions Eye lavage Isolation procedure Fluid nutrition support Prepare injured for transport CORE KNOWLEDGE Health promotion risk reduction disease prevention Identify potential threats impact on public Protect self Consider community health issues Describe epidemiological and surveillance principles CORE KNOWLEDGE Health care systems and policy Emergency response system Describe the phases of a disaster Aware of impact of MCIs on access to resources Maintain the site as crime scene forensics Legal authority of public health agencies to take action to protect the public CORE KNOWLEDGE Illness and disease management CORE KNOWLEDGE Information and health care technologies Ethics Human Diversity PROFESSIONAL ROLE DEVELOPMENT Describe nursing roles Choose your role Know limits of one s knowledge skills Continuing education in this area Participate in regular drills MENTAL HEALTH ASPECTS OF TERRORISM Fears anxiety Insomnia nightmares Sensitivity to loud noises Irritability confusion Disobedience Depression Alcohol drug use NURSES RESPONSIBILITIES Nurses Characteristics Learn early signs and symptoms First to notice increase in symptoms Rapid recognition and diagnosis Learn modes of transmission Protect Self Nurse on front lines at risk Know emergency plans Participate in preparedness programs DISCUSSION QUESTION Mrs Fraker was angry and resentful She was told that everyone would be getting 1 loans to rebuild their houses and businesses Many of her neighbors had been seen and were starting to rebuild Prices were going up and no one from the government had even come to look at damages to her house Discuss her reaction to the disaster DISCUSSION QUESTION Consider your response in an emergency situation If you witnessed a car or bus wreck what would you do Would you stop If no why not If you were home and heard about the wreck would you report to work If you did not work would you call the ARC and volunteer WebLinks References www astho org programs preparedness pandemic planning response Association of State and Territorial Health Officials Ahrq gov how to set up mass immunization screening Health Care Services http www panurses org PSNA RN Emergency Preparedness Taskforce Beachley M L 2005 Nursing in a disaster in Maurer F A Smith C M Eds Community public health nursing practice Health for families and populations pp 496 516 http www aacn nche edu Education pdf INCMCECompete nsies International Nursing Coalition for Mass Casualty Education

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