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DISASTER
Is a catastrophe which may be natural in origin or manmade, whether produced
accidentally or by design
TYPES:
1. Typhoon, floods
2. Fire, vehicular accident
3.earthquakes, landslides
4. Plane crash, nuclear warfare
MANAGEMENT
TRIAGE - sorting of casualties
Prevent panic or hysteria
Priority should be given to the severely injured who have a good chance to live
Treat as many in the shortest possible time
Deal with radiations
STAGES OF DISASTER
THREAT STAGE
- when situations occurs that have potential or creating crises but do not show actual
conditions of peril
2. WARNING
- is most specific than the first stage of threat & almost assures the reality of disaster
3. IMPACT
- when the disaster is manifested full-blown
4. RECOVERY
- when the assessment of the disaster effects is made, the injured are rescued, &
rehabilitation of people & their lives is begun
TRIAGE
Advance skill
Ensures that patients most in need of care do not wait to receive it
Nurse must also collect crucial initial data: vital signs and history, neurologic
assessment findings, diagnostic data
FIELD TRIAGE
Scarce resources must be used to benefit the most people possible
FAST TRACK
Requires simple first aid or basic primary care
May be treated in the ED or safety referred to a clinic or physician’s office
Urgency Life, limb, eye Needs treatment Can wait hours or days
threatening, needs in 20 minutes to
immediate action 20 hours
B - BREATHING
* possible interventions for INEFFECTIVE BREATHING PATTERN include
application of supplemental oxygen by mask or bag-valve mask device, assisting with
chest tube insertion or intubation, covering of open chest wound with 3 sided occlusive
dressing & use of pressure dressing on a flail segment of ribs
C - CIRCULATION/CONTROLLED HEMORRHAGE
*Finding of adequate perfusion include:
-full, regular, & normal pulse rate; pink, warm, & dry skin with capillary refill
*Indications of decreased circulation include:
- bradycardia, tachycardia, hypotension, cool, pale & diaphoretic skin, external
bleeding, decreased level of consciousness
*Interventions: direct pressure to control external bleeding, insertion of IV access
device, fluid volume replacement with normal saline, blood or blood products, CPR
D - DISABILITY
* Complete a brief neurological assessment to determine baseline functioning,
potential life-threatening complications, & level of consciousness.
*Glasgow Coma Scale assess the arousal component of responsiveness; it measures
eye opening, best verbal response, & best motor response minimum score of 3 & max
score is 15
E - EXPOSE
* Remove all clothing from the client to facilitate a through complete secondary
assessment examination
B. SECONDARY ASSESSMENT
- A brief systematic head-to-toe assessment that identifies injuries; cervical
immobilization is maintained at all times during the secondary assessment as well as the
continual assessment of hemodynamic & oxygenation status
F - FAHRENHEIT
* is important to provide measures to prevent body heat loss at this time through the
use of warmed IV fluids, warmed blankets, or heating lamps
G - GET VITAL SIGNS
* obtain a full set of vital signs
MINIMAL TREATMENT
Minor treatment can be delayed hours to days
- patients who can be returned to active duty immediately
This group should be moved away from the main triage area.
Can be returned to active duty immediately
Priority -3
Color –GREEN
MINIMAL CONDITIONS
Upper extremity fractures
Minor burns
Sprains
Small laceration without significant bleeding
Behavioral disorders
Psychological disturbance
IMMEDIATE TREATMENT
LIFE THREATENING
patients whom the available expedient procedures will save life or limb
Survivable with minimal interventions
Can progress rapidly to expectant if treatment is delayed
Priority -1
Color – RED
IMMEDIATE CONDITIONS
Sucking chest wound
Airway obstruction
Shock
Hemothorax
Tension pneumothorax
Asphyxia
Unstable chest
Abdominal wounds
Incomplete amputations
IMMEDIATE CONDITIONS
Open fractures of long bones
2nd and 3rd degree burns of 15-40% TBSA
DELAYED TREATMENT
Injuries are significant and require medical care
patients who, after emergency treatment will incur little increased risk by having
surgery withheld temporarily.
Can wait hours without threat to life or limb
Treated only after immediate causalities
Priority -2
Color – YELLOW
DELAYED CONDITIONS
Stable abdominal wounds without hemorrhage
Soft tissue injuries
Maxillofacial wounds without airway compromise
Vascular injuries with adequate collateral circulation
Genitourinary tract disruption
Fractures for ORIF
DELAYED CONDITIONS
Debridement external fixation
Eye injury
CNS injury
EXPECTANT TREATMENT
Injuries are extensive and chances of survival are unlikely even with definitive
care
critically injured patients who will be given treatment if time & facilities are
available
This group should be separated from other causalities but not abandoned
Comfort measures should be provided when possible
Priority -4
Color- BLACK
EXPECTANT CONDITIONS
Unresponsive patients with penetrating head wounds
High spinal cord injuries
Wounds involving multiple anatomical sites and organs
2nd and 3rd degree burns in excess of 60% of body surface area
Seizures and vomiting within 24 hours after radiation exposure
EXPECTANT CONDITIONS
Profound shock with multiple injuries
Agonal respirations
No pulse, BP, pupils fixed and dilated.
***the following is a priority schedule which serves as a guide to establish the flow of
casualties from the disaster are through the FIRST AID STATION to FORWARD
TREATEMNT CENTER AND HOSPITAL
PRIORITIES OF TREATEMNT
FIRST PRIORITY
- individual needing immediate attention to save life
a. any wound interfering with airway or causing airway obstruction
=includes sucking chest wounds, tension pneumothorax & maxillofacial wounds 9n
which asphyxia is present
b. any wound requiring immediate pressure for bleeding
c. shock due to major hemorrhage, to wounds of any organ systems, fractures.
2.SECONDARY PRIORITY
- individual needing early surgery
a. visceral injuries, including perforations of the gastro intestinal tract; wounds of the
biliary & pancreatic system
b. vascular injuries requiring repair
c. closed cerebral injuries with increasing loss of consciousness
3. THIRD PRIORITY
- patients who requires surgery but can tolerate a delayed
a. spinal injuries in which decompression is required
b. soft tissue wounds in which debridement is necessary
c. lesser fractures & dislocations
d. injuries of the eyes
e. maxillofacial injuries without asphyxia
Chemical Weapons
Chemical substances that quickly cause injury and/or death and cause panic and
social disruption
Agents:
Nerve agents
Blood agents
Vesicants
Pulmonary agents
Agents vary in volatility, persistence, toxicity, and period of latency
Limitation of exposure is essential with evacuation and decontamination as soon
possible and as close to the scene of the incident as possible
Nerve Agents
Sarin and soman organophosphates
Inhibit cholinesterase-causing cholinergic symptoms progressing to loss of
consciousness, seizures, copious secretions, apnea, and death
Treatment: supportive care, atropine, benzodiazepine, and pralidoxime
Decontaminate with copious amounts of soap and water or saline for at least 20
minutes
Blot; do not wipe off
Plastic equipment will absorb sarin gas
Vesicants
Lewisite, sulfur mustard, nitrogen mustard, and phosgene
Cause blistering and burning
Respiratory effects can be serious and cause death
Decontaminate with soap and water; do not scrub or use hypochlorite solutions
Eye exposure requires copious irrigation
Treatment for lewisite exposure: dimercaprol IV or topically
Radiation Exposure
Radiation exposure may occur due to nuclear weapons, nuclear reactor incidents,
or exposure to radioactive samples
Exposure to radiation is affected by time, distance, and shielding
Types of radiation exposure:
External radiation: all or part of the body is exposed to radiation; as
decontamination is not necessary, it is not a medical emergency
Radiation Decontamination
Triage outside the hospital
Cover floor and use strict isolation precautions to prevent the tracking of
contaminants
Seal air ducts and vents
Waste is double bagged and put in a container labeled radiation waste
Staff protection
Water-resistant gowns, 2 pairs of gloves, caps, goggles, masks, and booties
Dosimetry devices
Patients are surveyed for radiation and directed to the decontamination area
Each patient is decontaminated with a shower outside the ED
Water, tarps, towels, soap, gowns, all the patient’s belongings, etc., must be
collected and contained
Patients are surveyed and showered again as necessary
Showering should be performed so as not to contaminate clean areas with runoff
from the showering
Biologic samples: nasal and throat swabs; blood
Internal contamination requires additional treatment: catharsis and gastric lavage
with chelating agents
Radiation Injuries
Acute radiation syndrome (ARS): dose of radiation determines if ARS will
develop
All body systems are affected by ARS
Presenting signs and symptoms determine predicted survival
Probable survivors have no initial symptoms or only minimal symptoms
Possible survivors present with nausea and vomiting that persists for 24 to 48
hours
Improbable survivors are acutely ill with nausea, vomiting, diarrhea, and shock;
neurologic symptoms suggest lethal dose; and survival time is variable