Registered nurse positioned in an emergency room (ER); responsible for assessing patients, initiating emergency treatment and determining their level of need medical assistance.

1. Disaster management in hospital
settings
Prepared by
Ms.Jenisha Adhikari
BSN

2. Content
• Trauma team
• Triage nurse and their responsibilities
• Hospital response
• Emergency preparedness
• Use of triage in hospital
• Disaster management
• Post disaster action

3. Multi-disciplinary trauma team
• Emergency Attending Physician/ Specialist
• Trauma surgeon
• Triage nurse
• Resident
• Registered Nurse (RN)

4. Contd..
• Emergency Department Coordinator (EDC)
• Pharmacist
• Therapist
• Security

5. Triage nurse
Registered nurse positioned in an emergency
room (ER); responsible for assessing patients,
initiating emergency treatment and
determining their level of need
medical assistance.

6. Responsibilities of a Triage Nurse
• Responsibilities of a Triage Nurse include :
• Perform patient assessment
• Reassess patients who are waiting
• Initiate emergency treatment if necessary
• Manage and communicate with patients
in waiting room

7. Contd..
• Provide education to patients and families
when necessary
• Sort patients into priority groups according
to guidelines
• Transport patients to appropriate treatment
areas

8. Contd.
• Communicate status of patients to doctors and
nurses

9. Hospital response
o Notification
o Preparation
o Receiving Casualties
o Stand down

10. Notification
• The hospital is informed about the
disastrous event, type of disaster,
number of casualties and severity
• All the department are notified

11. Contd..
• Selected Physicians are nurses are sent
at the site to assess and prioritized
critical cases

12. Preparation
• Empty and expand the emergency room
– Immediate disposition decisions and movement
– Triage order - red and yellow for emergency room
and green to outpatient

13. Contd..
• Empty and expand hospital
– Early discharge
– Transferring patient
– Postponing elective surgery

14. • Additional staff
– Staff as per duty and manage volunteers
• Stock all necessary medical supplies
• Inform the blood bank

15. Receival of casualties
• Quick and through assessment of victims
• Triage
• Rapid turnover of of patient
• Life and limb threat take priority

16. • Disaster paperwork
• None is expected to perform roles they are not
trained for

17. Stand down
• Workload returns to normal
• Restock
• Staff debriefing

18. Emergency preparedness
• Formulate hospital policy and action plan for
Emergency preparedness for disaster
management (EPDM)
• Strength the capabilities of health worker in
the disaster management team
• Establish triage protocol

19. Contd.
• Specify protocol for response to disaster
who would all report to and
has what responsibilities
• Have a back up plan for
persistent flow of electricity,
water and fuel supplies

20. Contd.
• Keep stock of medical supplies for use of
emergency
• Carry out regular drills (Mock drill)
to be well prepared for genuine
response to disaster

21. Use of triage in hospital
• Usually four category system in used
to sort out the case on
the basis of need for immediate,
therapeutic intervention

22. • Usual color are
– Red
– Green
– Yellow
– Black
• Nevertheless individual hospital can have their
own protocol

23. Contd ..
• Red
All life threatening patient who needs
immediate intervention

24. Eg –
Acute cardio pulmonary insufficiency
Severe hemorrhage
Chest injuries
Spleen/ liver injuries
State of shock
Skull injury with coma
Burn over 20 %, etc

25. Contd..
• Yellow
All patient for whom treatment can wait for
5- 60 minute fall in this category

26. Contd..
Eg –
Close fracture and dislocation
Closed abdominal trauma
Skull injury without coma
Less severe burn, etc
These patient require close monitoring and
immediate intravenous infusion

27. Contd ..
• Green
In this category those patient whose
treatment can be delayed for 4 – 6 hours
who needs minor treatment and who
need no treatment are included

28. Eg –
Simple fracture
Minor wound and laceration
Minor burn, etc

29. • Black
No need for medical care
Eg –
dead on scene
Absence of brain activity

30. Disaster management
 Respond to disaster
Before the arrival of victims
oCollect information from the authorized
person
in the disaster site about type of disaster,
number of casualties and severity
oApoint commander and vice commander
for disaster management

31. Contd.
oActivate the disaster protocol
oSpecify the receiving area or casualty collection
point the triage area based number of injury
oAlert all department to remain stand by;
operation theater, all indoor unit,
laboratory, radiology, etc

32. Contd.
oAssign definite task to people in disaster plan
oSuspend all other regular hospital activities
except for the critical one
oPrepare standardized tag in advance
oEvacuation of minor cases

33. Contd.
 After the arrival of the victim
oTriage nurse or volunteer receive in the reception
area
oTriage nurse keep the crowd away with the
help of volunteer of team
oThe nurse in charge mobilizes nurses and mobilizes
to their duties

34. Contd.
o Triage nurse screen the case before
moving the victim to triage area
and carryout rapid concise and focused
subjective and objectives assessment of case
and categories patient as the
severity of illness

35. Contd.
oPatient are tagged before moving from
reception area and tag must include such
information on patient as their
name, age, sex, triage category, diagnosis
and initial treatment

36. Contd..
oTriage nurse coordinates with different diagnostic
facilities X- ray, laboratory, etc for investigation
required
oTriage nurse constantly assess the progress
of patient and report to physician if patient
need change in his/her triage category

37. Contd.
oThe triage physician decide appropriate place
for the treatment of each treatment of
each patient which could be operation theater,
ICU,CCU, other ward or the emergency room
or triage area

38. Contd.
oOne among the triage nurse, who is identified
as the spokesperson communicate with family
in waiting room through phone or intercom
oCompletes all legal procedure before sending
the dead bodies to morgue or handing them
over to families

39. Contd…
 Crowd controlling
– Managed in collaboration with security and other
volunteer
– The main hospital gate should be closed
and only vehicle and individual carrying
casualty should be permitted

40. Contd..
• People from media should be allowed entrance only
as far as the information center or reception area

41. Contd..
• Record and reporting
– Document all cases with full detail and as medico
legal cases
– Inform the police if case are discharged, referred
or expired

42. Contd..
– Never handover the dead body to relative without
post – mortem

43. Post disaster action
• Routine tasks that were suspended in the
emergency management of disaster
are resumed.
• After the disaster management the reports are
analyzed to assess the effectiveness of the disaster
preparedness and response activities is carried out

44. Reference
• Singh Indira, leading and managing in Health,
5th edition, Hisi offset printer Pvt. Ltd page no
410-416
• Metha R S, Pokharel Tara, leadership and
mangement (nursing management ) 1st
edition, Heidal press Pvt Ltd, page no 382-394
• https://www.slideshare.net/NcDas/disaster-
management-11960149