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Disaster Nursing
Definition: Disaster is defined as any occurrence that causes damage , economic disruption ,loss of human life deterioration in health and health services on a scale sufficient warrant and extraordinary response from outside the affected community or area. Disaster is the occurrence of a sudden or major WHO which disrupts the basic fabric and normal functioning of a society . TYPES OF DISASTER : There are two types of disasters one is natural and other is manmade . In both these two types many categories of disasters occur which will be discussed in detail later. Every catastrophic events has its own special features. Some events are predicted but some occur without warning
Disaster Nursing
Warfare and terrorism are just two of the reasons that health care providers need to plan for mass casualties. Air plane crashes, train crashes, toxic substance spills, and infectious disease outbreaks are other disasters that can result in casualties and tax the resources of health care facilities and communities. In addition, natural phenomena such as floods, tornadoes, hurricanes, fires and earthquakes, kill and injure hundreds of thousands of people worldwide each year.
Disaster Levels
Disasters are often categorized by level to indicate the anticipated level of response. Level I: Local emergency response personnel and organizations can contain and effectively manage the disaster and its aftermath. Level II: Regional efforts and aid from surrounding communities are sufficient to manage the effects of the disaster. Level III: Local and regional assets are overwhelmed; statewide or federal assistance is required.
Federal Agencies
State authorities must request federal assistance with sources through appropriate government channels. A request for federal resources generally is made when local resources have become or are expected to become depleted. >DHHS (Dept. of Health and Human Svc.) >DOJ >DOD (Dept. of Defense) >DHS (Dept. of Homeland Security)
TRIAGE
Triage is the sorting of patients to determine the priority of their health care needs and the proper site for treatment. In NON-DISASTER situations, health care team assign a high priority and allocate the most resources to those who are the most critically ill, however in a DISASTER, when health care providers are faced with a large number of casualties, the fundamental principle guiding resource allocation is to do the greatest good for the greatest number of people. Decision are based on the percentage of survival although it really contradict our ethical principle.
TRIAGE
Staff should control all entrances to the acute care facility so that incoming patients are directed to the triage area first. Triage area may be outside the entry or just at the door of the ED. This facilitates the triage of all patients, including those arriving by medical transport and those who walk into the ED.
3. Minimal (3) (Green) -injuries are minor and treatment can be delayed hours to days. Individuals in this group should be moved away from the main triage area. -ex: Upper extremity fractures, minor burns, sprains, small lacerations without significant bleeding. 4. Expectant (4) (Black) -injuries are extensive and chances of survival are unlikely even with definitive care. Persons in this group should be separated from other casualties, but not abandoned. Comfort measures should be provided when possible. -ex: unresponsive patients with penetrating head wounds, high spinal cord injuries, wounds involving multiple anatomical sites and organs, no pulse no blood pressure, pupils fixed and dilated.
Natural Disaster
Natural Disaster may result in mass casualties. Natural disasters can occur anywhere at any time and include events such as tornadoes, hurricanes, floods , avalanches, tidal waves, earth quakes and volcanic eruptions. The majority of clients arrives just a hour after the event. Casualties arrive at hospitals in three ways:
1st wave: consists of minimally injured people who arrive at their own accord.
3rd wave: consists of injured patients who arrive after they are discovered by rescuers:
WEAPONS OF TERROR
Blast Injury Types of explosive devices: Pipe bombs, Molotov cocktails, fertilizer bombs, and dirty bombs (so called because they spread radiation) a. Physical Injuries the actual blast occurs during the initial seconds of the bombing causes a pressure wave or primary blast wave. Injuries can result from the impact of the explosion, the primary blast wave, or shrapnel within the bomb. b. Blast Lung results form the vlast wave as it passes through air filled lungs. The result is hemorrhage and tearing of the lung. Typical s/sx: dyspnea, tachypnea, or apnea (depending on the severity) c. Tympanic Membrane Rupture the most frequent injury after subjection to a pressure wave because it is the bodys most sensitive organ to pressure d. Abdominal and Head Injuries blast abdomen may be evidenced by abdominal hemorrhage and internal organ injury. The typical s/sx: pain, guarding, rebound tenderness, rectal bleeding and nausea and vomiting. e. Special Population too old, bone fracture.
WEAPONS OF TERROR
Biologic Weapons are weapons that spread disease among the general population or the military. Biologic Warfare is a cover method of effecting terrorist objectives. The potential use of biological agents calls for continous increased index of suspicion by clinicians.
Ebola, one of the most deadly viruses, is a potential bioweapon. The Japanes Aum sect, known for the poisonous gas attack on the Tokyo Metro, allegedly attempted to get hold of Ebola samples by sending cult members to Zaire during an Ebola outbreak.
Foot and mouth disease is an example for anti-animal weapons. Biological weapons are not restricted to human pathogens. Any living agent that is used for hostile purposes regardless of its origin and target is considered a biological weapon under the BTWC.
Chemical Weapons
Agents that may be used in chemical warfare or for terrorist purposes are overt agents in that the effects are more apparent and occur more quickly than those caused by biologic weapons. Types of chemicals: 1. Vesicants (Lewisite, Sulfur Mustard, Nitrogen Mustard, Phosgene) - are chemicals that cause blisstering and result in burning, conjunctivitis, bronchitis, pneumonia, hematopoietric suppresion, and death. It was used in World War I and in the Iran-Iraq conflict.
Treatment: -decontamination using soap and water. -scrubbing using hypochlorite solutions should be avoided because they increase penetration. -for respiratory exposure, intubation and bronchoscopy to remove necrotic tissue are essential.
Treatment: - Decontamination with copious amounts of soap and water or saline solution for 8-20 minutes is essential. - The water is blotted off the skin, not wiped off. - Suctioning can perform when patient is having dob. - Atropine sulfate and Pralidoxime (Protopam) administration to return anticholinergic activity (decreased secretions, tachycardia, and decreased gastrointestinal motility)
Treatment: -rapid administration of amyl nitrate, sodium nitrate and sodium thiosulfate. (first patient is intubated and placed on a ventilator, next amyl nitrate pearls are crushed and placed in the ventilator reservoir to induce methemoglobinemia.