Welcome! This lecture is going to be on emergency
response plans, and it falls under the safe
and effective care of environment safety and
infection control under the NCLEX headings.
My name is Diana Shenefield. When we talk about
emergency response plans, all healthcare
facilities are required to have a plan for
emergency response. So, we’re going to just
review some of those today. What are our learning
outcomes? We’re going to understand your
role as the nurse in emergency response plans.
We’re going to understand the color-coded
disaster triage. So, if you’ve forgotten what
those colors are, we’re going to review
those. And we’re going to understand the
steps involved in fire safety. We know as
nurses, fire safety is a big role that we
play in the emergency response plan.
It’s something that you’ll memorize. We don’t
memorize a lot. But you need to make sure
you’ve memorized the fire safety facility-wide
policies. But again, what do I need to do
as a nurse by keeping my patients safe? So,
let’s start off with a question.
Following a major earthquake, patients begin to arrive
in the emergency room. Using the disaster
triage system, which patient should be treated
first? So, we’re talking about the patients
are coming into the emergency room and you’re
the emergency room nurse, and you have these
four patients that are coming in. So using the
triage system, which patient are you going
to see first? We have A, a patient with an open
pneumothorax and severe dyspnea. B, patient
with a major head trauma, pupils are fixed and
dilated. C, patient with a closed fracture
of the femur. D, patient with multiple abrasions
and contusions. So if you picture an earthquake
and what all kinds of things happen to our
patients, and think about the kind of patients
that would be showing up at your ER, how are
you going to triage these patients? The answer
to this question is A, patient with an open
pneumothorax and severe dyspnea. So as we
go through and we review the triage colors,
we’ll review disaster triage and we’ll
review hospital triage. If this is something
that you’re not familiar with or something
that you have forgotten, make sure that you
go back and you review this. This will also
help as you’re prioritizing your patient care.
So general, what do we need to remember?
Hospitals are required to have disaster plans.
This is a requirement, hospitals have to have
plans. As nurses, we have to be familiar with
the plans. We need to know what each of the
codes mean and what our role is. Hospitals
are required to periodically practice.
That’s why you have fire drills. They’ll have tornado
drills. All kinds of drills to make sure that
not only do we have the plans but whosoever
working, whichever nurses, whichever healthcare
providers know exactly what to do at the time
of a disaster. Nurses are required to know
all the steps in fire safety. And if you’ve
been anywhere in a hospital setting, you know
that that’s been drilled into you, and it’s
something that you need to remember.
Nurses must educate patients about safety at home.
A lot of times, we know what to do in the
hospital, but are we educating our patients
on how to be safe at home in case of emergency?
So, disaster emergency response plans. The
whole goal is to reduce morbidity and mortality
of the public. We need to make sure that we
are taking care of and preventing the injuries
of, the most people that we can, and that we
are doing everything that we can as a healthcare
facility, whether it’s a manmade disaster or
whether it’s a naturally occurring disaster.
So, what is the role of healthcare agencies?
To provide early warning signals with realistic
expectations. Again, if there is a man-made
disaster, that’s something that we can’t
plan for, we can’t know in advance, so what
could we plan for. Well we can have systems
in place as early warning systems, as ways to
communicate across facilities, maybe across
cities with our fire, with our ambulance services
and our police services, and making sure that
we have a plan in place, so in case something
happens, we have an early warning signal.
We also need to provide brief and concise
assessments. So as nurses, how can we assess
patients quickly and move patients through
our facilities quickly so that we can reduce
the morbidity and mortality rates? We need
to provide simple, flexible rescue algorithms.
So as you remember PALS and ACLS and all of
our algorithms, disaster planning has the
same algorithm, so that they’re easy to memorize
in a crisis situation and we can follow through
to make sure that we’re all doing the same
thing the way that we should be. So, what
is our responsibility as nurses in a disaster
response plan, not only for NCLEX review but
as we keep our patients safe? And one of the things
is, is at the scene, nurses are responsible
to rescue our patients, to remove patients
from danger. We’re also there to help evacuate
patients, whether it’d be to a permanent station
or temporary station, and then provide
first aid. And one of the things that bring
up a lot of ethical decisions is what patients
need to be treated? How do we treat patients?
Because in a disaster, what a nurse does is
a lot different than with that patient, just
a regular patient coming into the ER. We also
need to know what hospital triage is, and understand
what that means, and we are responsible
in the hospital to triage those patients and
provide acute care. And understanding the
difference between at-site triage and hospital
triage. In the community and in community
shelters, if we are out and about in the community,
we need to make sure that we’re providing
ongoing healthcare needs. We know that after
a disaster, it’s not about that day, it’s
about things that happened days, weeks, months
later, and as nurses in the community, being
able to provide healthcare on an ongoing basis.
When we talk about triage, let’s talk a
little bit about what triage is and make sure
that you remember what triage is. And then what it
is, is we use triage in an emergency. And what
it does, is it looks at providing the rule
of the greatest risk receives priority. Now,
that’s triage in emergencies. During a major
disaster, triage is the benefit of the largest
number of victims. So, a little bit different,
and we’re just talking about the quantity
of victims, whether I have two or three victims
or whether I have 2,000. We’re trying to
provide the best care for the most people.
So when you look at triage, make sure you
review the colors. When they talk about black
in triage, remember that that equals death.
Red equals emergency. Yellow is caution.
And green is go. So we’re going to talk about
each of those to make sure you remember what
each one of those means. So remember black.
Black are patients that are deceased or not
expected to recover. These are patients that
we give comfort measures to, but that we don’t
spend a lot of time treating their wounds.
Red are victims that are the most severe injuries
or illnesses. They’re going to benefit the
most from our limited resources. And if you
think about mass disasters, we only have a
certain amount of resources. And so, which patients
are going to benefit from those resources?
Red patients are the ones that are most severe
that are going to benefit. They are expected
to recover, but they need the most acute care.
Yellow are victims with potentially serious
injuries or illnesses, but are able to wait
until we’ve treated all of the people that
are tagged red. They can wait a little bit
longer before they’re transported and treated, but
they are still physically or could potentially
have serious injuries. Green are what we call
the walking wounded. These are people that
can wait the most. These are people that can
wait until we treated the reds and we’ve
treated the yellows. So again, as you’re
thinking about patients and you’re thinking
about your ABCs and you’re thinking about
who is the most at risk, that will help you
move through the different color designations.
So then we move to the hospital. And if you’ve
ever worked in the ER, you know that how we
triage in the hospital is different to the map.
We have our deceased. We have patients
that are already deceased or emergent patients
who have DNR orders; do not resuscitate orders.
Again, if a patient comes in and they have
do not resuscitate orders, then they are moved to
the bottom of the list because of our resources
and time. Emergent patients are patients with
potentially life-threatening illnesses or
trauma. Urgent, are patients with potentially
serious illnesses but are stable and can wait
until after the emergent patients are treated.
Then non-urgent are patients with minor illnesses
or injuries. Again, so if you think about
using your ABCs, if you have somebody that
comes in with chest pain and are having potential
myocardial infarction, they move up to the
emergent over maybe somebody who has a broken
femur, as we look at our ABCs. So, as you’re
trying to figure out your questions in NCLEX,
look at stable versus unstable, chronic versus
acute, potential versus actual, and that will
help you decide what level of triage you should
place that patient. Now, we’re moving on to
fire safety. This should all be reviewed.
Again, if you forget any of this, I would
make sure that you memorize this. This is
pretty much the same across the board, and
you will see questions on NCLEX because this
is how we keep patients safe in a crisis situation.
So remember your R for RACE is remove.
Remove the patient from the fire. That seems pretty
self-explanatory, but as you’re reading
through questions, make sure that you’re
moving the patient away, make sure that you
are moving on the same level before you move
up and down. Activate and alert is A, activate
the alarm. C, contain. After you’ve removed
the patient, you’ve activated the alarm,
you’d try to contain the fire, whether that’s
just shutting doors or whether that’s throwing
a blanket over the trashcan, whatever situation
it is. You remove the patient first, you activate
the alarm to get the fireman there, and then
you contain by closing doors. And then the
last thing, the E is extinguish. Get rid of
the fire, whether you grab a fire extinguisher
or whatever you need to get rid of that fire.
But again, it’s really important that you
follow these steps that you remove the patient
first, activate, contain, and extinguish.
So now that we’ve gone to extinguish, how
do I remember how to use my extinguisher?
We have the PASS acronym. P, pull the pin-
A, aim the nozzle at the base of the fire,
remember, you’ll always go at the base.
S, the first S is squeeze, squeeze the handle-
and the last S is sweep, sweep at the base
of the fire. Again, that may seem very self-explanatory
but in a crisis situation, it helps to have
acronyms. That’s why this have been developed
so that we don’t have to think through but
that we can automatically take care of our
patients and keep everybody safe. Patient
education is a huge part, not only out in
the community or in the schools, but also
in the hospital. We need to make sure that
we’re teaching patients and families. And
on pediatrics where I work, we do that a lot
with teaching the children to make sure that
they’re safe but also making sure that parents
have a plan in case of a disaster. What are
the emergency numbers? You’d be amazed that
how many small children know 911. But how
many adults have forgotten what to do?
So again, with different phones and being in
different areas, again, making sure that people
know how to get help when it’s needed. Smoke
alarms, making sure that the families have
smoke alarms. And if they can’t afford smoke
alarms, where they can get them? Most fire
stations will provide them, but again, making
sure that families understand the importance
of smoke alarms, and along with that, carbon
dioxide alarms as well. Fire extinguishers,
does the family have a fire extinguisher?
Do they know where it is? Does each family
member know how to use the fire extinguisher?
And then, what are their evacuation routes?
Does each family have a plan? Do they know
where to meet once they get out of the house?
Do they know where their water supply is?
Do they know where their medication supply
is? So again, a lot of times, people don’t
think about these things until it’s too
late. And as nurses, that’s part of our
community teaching is making sure that people
are prepared. So in closing, again, each hospital,
each facility is required to have emergency
response plans. Nurses are required to understand
triage and understand what their role is in
triage. And also, fire safety. So make sure
that you’re going back and you’re reviewing
those things. And again, as you’re thinking
about triage that will help you as you’re
prioritizing your patients in any questions
for NCLEX or as a nurse. So again, look at
your patients, read the question carefully,
and make sure you know exactly what it’s
asking you, and then follow your ABCs.
Good luck on NCLEX.