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Disaster management in hospital setting

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

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Disaster management in hospital setting

  1. 1. Disaster management in hospital settings Prepared by Ms.Jenisha Adhikari BSN
  2. 2. Content • Trauma team • Triage nurse and their responsibilities • Hospital response • Emergency preparedness • Use of triage in hospital • Disaster management • Post disaster action
  3. 3. Multi-disciplinary trauma team • Emergency Attending Physician/ Specialist • Trauma surgeon • Triage nurse • Resident • Registered Nurse (RN)
  4. 4. Contd.. • Emergency Department Coordinator (EDC) • Pharmacist • Therapist • Security
  5. 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. 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. 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. 8. Contd. • Communicate status of patients to doctors and nurses
  9. 9. Hospital response o Notification o Preparation o Receiving Casualties o Stand down
  10. 10. Notification • The hospital is informed about the disastrous event, type of disaster, number of casualties and severity • All the department are notified
  11. 11. Contd.. • Selected Physicians are nurses are sent at the site to assess and prioritized critical cases
  12. 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. 13. Contd.. • Empty and expand hospital – Early discharge – Transferring patient – Postponing elective surgery
  14. 14. • Additional staff – Staff as per duty and manage volunteers • Stock all necessary medical supplies • Inform the blood bank
  15. 15. Receival of casualties • Quick and through assessment of victims • Triage • Rapid turnover of of patient • Life and limb threat take priority
  16. 16. • Disaster paperwork • None is expected to perform roles they are not trained for
  17. 17. Stand down • Workload returns to normal • Restock • Staff debriefing
  18. 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. 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. 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. 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. 22. • Usual color are – Red – Green – Yellow – Black • Nevertheless individual hospital can have their own protocol
  23. 23. Contd .. • Red All life threatening patient who needs immediate intervention
  24. 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. 25. Contd.. • Yellow All patient for whom treatment can wait for 5- 60 minute fall in this category
  26. 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. 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. 28. Eg – Simple fracture Minor wound and laceration Minor burn, etc
  29. 29. • Black No need for medical care Eg – dead on scene Absence of brain activity
  30. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 40. Contd.. • People from media should be allowed entrance only as far as the information center or reception area
  41. 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. 42. Contd.. – Never handover the dead body to relative without post – mortem
  43. 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. 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 • management-11960149