6593334 Emergency Nursing
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Transcript of 6593334 Emergency Nursing
What every nurse needs to know about emergencies
Kristine M. Gebbie, DrPH, RN
Columbia University
September 10, 2004
SC AHEC Sept. 10, 2004
Goals Describe the role of an incident
management system at the community and institutional level
Identify resources for competency development
Describe functional roles often filled by nurses
Identify resources for ‘just in time’ learning
SC AHEC Sept. 10, 2004
Standards are increasing Possible emergency preparedness
questions on NCLEX Possible licensing requirement similar to
blood-borne pathogen or abuse-reporting requirement
JACCHO standards require knowledge and drills of all hospital personnel
Public Health Ready includes competency training and drills for local health departments
SC AHEC Sept. 10, 2004
Coordination in Disasters
OTHERPOLICE
FEMA
STATE EMERGENCY MANAGEMENT OFFICE
State
Federal
CityFIRE & EMS
HOSPITALS &OTHER
VOLUNTARY HEALTH SECTOR
MAYOR’SOFFICE
PRESIDENT HHS/CDC/VA etc.
CITY or COUNTY DOH
STATE DOHGOVERNOR’SOFFICE
CITY OR COUNTY OFFICE OF EMERGENCY MANAGEMENT
SC AHEC Sept. 10, 2004
Incident Command System
PlanningChief
OperationsChief
LogisticsChief
FinanceChief
SafetyOfficer
Public InfoOfficer
LiaisonOfficer
Incident Commander
Unit leader
Unit leader
Unit leader
Unit leader
Unit leader
Unit leader
Unit leader
Unit leader
Unit leader
Unit leader
SC AHEC Sept. 10, 2004
Uses of ICS Jurisdiction-wide interagency
coordination Agency-specific for internal
response HEICS PhICS
SC AHEC Sept. 10, 2004
Basic principles of ICS Developed during 1970-80’s in So. CA in
response to wildfires Provides a management model for
command, control and coordination of an organization’s emergency response activities
Employs a defined management structure, with: clear reporting channels common nomenclature defined responsibilities
SC AHEC Sept. 10, 2004
Incident Action Plan The mission (example)
determine if any of these cases are SARS implement procedures to prevent transmission to
others The plan
Perform contact tracing for the nurse Perform case investigation for each ED case from
the surveillance system Initiate surveillance for all ED’s in the County Initiate a fax alert to local physicians to increase
reporting of cases of symptoms consistent with SARS
SC AHEC Sept. 10, 2004
Example: Section Action Plan
specific actions needed by each Section or unit within the agency to contribute to the accomplishment of these objectives?
SC AHEC Sept. 10, 2004
SC AHEC Sept. 10, 2004
Developing your competence Almost never begins with a blank slate You may already be competent in
emergency response You may not know it We have never measured it
Real training for competence depends on knowing the level of competency knowing the system or job to be done
SC AHEC Sept. 10, 2004
Competency: an individual measure The individual possesses knowledge
and skills and is able to perform required task or objective
Competency statements include an action verb, indicating level of
performance and a subject or content area and may include a contextual reference
SC AHEC Sept. 10, 2004
Competency combinations
Organizationalcompetencies
Emergency Preparednesscompetencies
Nursing competencies
Today’s focus
SC AHEC Sept. 10, 2004
Competencies come in different forms
Workforce competencies statements of complex
performance within the workplace, akin to the KSAs of job classifications.
Can consist of a series of embedded tasks that are either sequential or parallel.
Are demonstrated over long periods of time.
Require contextual measurement.
Allow for a range of indicators to measure competence.
Instructional competencies
building blocks of learning experiences.
Structure the learning activities.
Require higher levels of performance to be built upon lower level ones.
Determine the measurement indicators.
Require measurement in the short term
SC AHEC Sept. 10, 2004
all professional nurse roles and practice settings
acute care facilities,
clinics, schools, homes, other
community venues.
SC AHEC Sept. 10, 2004
Example: critical thinking Use an ethical and nationally approved
framework to support decision-making and prioritizing needed in disaster situations.
Describe at the pre-disaster, emergency and post-disaster phases the essential nursing care for: individuals families special groups, e.g. children, elderly, pregnant
women communities.
SC AHEC Sept. 10, 2004
Example: specific assessment
Perform an age-appropriate health assessment: airway and respiratory assessment, cardiovascular assessment, including vital signs and signs of
shock, integumentary assessment, particularly a wound, burn, and rash
assessment, pain assessment, injury assessment from head to toe, gastrointestinal assessment, including specimen collection, basic neurological assessment, musculoskeletal assessment, and mental status, spiritual, and emotional assessment.
SC AHEC Sept. 10, 2004
Example: technical skills Demonstrate knowledge and skill
related to personal protection and safety, including the use of Personal Protective Equipment (PPE) for: Level B protection, Level C protection, and Respiratory protection.
SC AHEC Sept. 10, 2004
Example: core knowledge Describe
the four phases of emergency management: preparedness, response, recovery and mitigation.
the local emergency response system for disasters.
the interaction between local, state and federal emergency response systems.
the legal authority of public health agencies to take action to protect the community from threats, including isolation, quarantine, and required reporting and documentation.
SC AHEC Sept. 10, 2004
Example: professional development Recognize the importance of
maintaining one’s expertise and knowledge in this area of practice and of participating in regular emergency response drills.
Participate in regular emergency response drills in the community or place of employment.
SC AHEC Sept. 10, 2004
Bioterrorism Competencies More specifics for
Leaders Communicable disease
staff Clinical staff Environmental staff Laboratory staff Medical
examiner/coroner Public health
information staff Other professionals Technical and support
staff
SC AHEC Sept. 10, 2004
Emergency Preparedness and Response Competencies
SC AHEC Sept. 10, 2004
Every hospital worker should be able to Describe the role of the hospital during
response to emergencies Locate and use the section of the
hospital emergency response plan that applies to his/her department and position.
Describe his/her emergency response role and demonstrate it during drills or actual emergencies.
SC AHEC Sept. 10, 2004
The clinician competencies licensed healthcare providers (e.g., MD, DO,
DDS, RN, Advanced Practice Nurse, Physician Assistant, Clinical Psychologist, Clinical Social Worker, Optometrist) who see and triage patients or communicate with patients and are in a position to recognize initial cases and manage the initial care and referral of patients.
In all cases, the competencies are understood to be defined or limited by the legal scope of practice of the specific clinician.
SC AHEC Sept. 10, 2004
The clinician in an initial assessment and decision-making role is able to
describe his/her expected role in emergency response in the specific practice setting as a part of the institution or community response.
respond to an emergency event within the emergency management system of his/her practice, institution and community.
recognize an illness or injury as potentially resulting from exposure to a biologic, chemical or radiologic agent possibly associated with a terrorist event.
SC AHEC Sept. 10, 2004
Competency assessment Self assessment, by competency:
E.g., Identify and locate the agency emergency response plan or the pertinent portion of the plan
Range of answers from Not Confident to Very Confident
We are each responsible for moving toward a high level of confidence
Adapted from University of Illinois-Chicago School of Public HealthCenter for Public Health Preparedness
SC AHEC Sept. 10, 2004
Getting ready: Family Disaster Plan
Source: http://www.fema.gov/pdf/rrr/fdp-all.pdf
SC AHEC Sept. 10, 2004
Personal emergency plan Unless you already work a random
schedule and have full-time backup, such a plan can be critical
Key items include Child care Elder care Pet care Transportation
SC AHEC Sept. 10, 2004
Saving the Whole Family
www.avma.org/disaster
SC AHEC Sept. 10, 2004
Functional Roles in an Emergency or Disaster Your role may be the same or
similar to what you do every day or
Your role may be different from what you usually do.
SC AHEC Sept. 10, 2004
Job Action Sheet (JAS) Describes a specific functional role during
emergency response: primary purpose of role during emergency response what actions need to be taken
Needed as different people may need to fill each role over duration of event, or for different events.
A person may have more than one functional role Over the time of one emergency Depending on the type of emergency
SC AHEC Sept. 10, 2004
County Department of Health Emergency Response
Job Action Sheet Operations
Field Response Team
Case Investigator
Reports to: Epidemiology Investigation Site Coordinator Operations Command Center Location: _______________ Telephone: __________ Mission: To interview review charts and/or patients using designated questionnaire and protocol and document findings. Immediate:
Read entire Job Action Sheet Obtain briefing from Epidemiology Investigation Site Coordinator Obtain and review response questionnaire Obtain site interview schedule and facility contacts Identify and obtain any required personal protective equipment
Intermediate:
Conduct review charts and conduct interviews if patient available Report any concerns with questionnaire to the Site Coordinator Turn in completed questionnaires to Site Coordinator
Extended:
Plan for the possibility of extended deployment
SC AHEC Sept. 10, 2004
Example:Potential Roles for E.D. Nurses Surveillance Safety officer Patient care Triage Risk
Communication Forensics
supervisor
SC AHEC Sept. 10, 2004
Functional roles and usual roles—one hospital Functional role
Triage Charge Nurse
Emergent Care Charge Nurse
Urgent Area Charge Nurse
Minor Treatment Leader
Minor Treatment Area Charge Nurse
Hospital Position Triage Charge
Nurse CN3, CN2, Senior
ED RN Urgent Area
Charge RN Nurse Practitioner
Medical/Surgical Nurse
SC AHEC Sept. 10, 2004
Sample JAS: Triage nurse Reports to: Mass Care
Operations Coordinator Mission: Assess individuals
presenting for care and direct them to the appropriate level of care or care site.
Immediate Read entire Job Action Sheet
and obtain briefing from Operations
Check equipment and supply expiration dates if appropriate
Conduct triage - emergent, urgent and non-urgent care
Refer to the appropriate level of care, providing first aid as needed
Intermediate Maintain patient assessment
log Prepare patient for transport
to appropriate level of care Report requests to
Operations/ Maintain contact with Medical Consultant
Extended Monitor supplies Prepare end of shift report
for Coordinator and incoming Triage Nurse
Plan for the possibility of extended deployment
SC AHEC Sept. 10, 2004
Clinical refresher: Heat ExhaustionSigns and Symptoms: C/O: light-headedness,
headache, weakness, dizziness, or fatigue
Observe: Temperature: normal or moderately elevated, excessive sweating, may have irritable behavior.
Those Most at Risk: Extremes of age Exertion in the sun, or
confinement in a hot environment
Hx of: CV, psychiatric, endocrine, obesity
Alcohol consumption and psychotropic drugs
Treatment in Community or Cooling Center:
Move out of sun, into cooler environment
Decrease activity for remainder of day
Rehydrate with electrolyte laden fluid: 16-32 ounces per hour.
Transfer to E.D. for temperature over 103 F. in adult, 104 F. in child, any fever for infant < 6 months of age.
Source: Protocol for NYC-DOH Response to Heat Waves (DRAFT) 5/13/01
SC AHEC Sept. 10, 2004
Clinical refresher: Heat Stroke Signs and Symptoms:
CNS signs: range from confused/combative to unconscious
Tachycardia, hypotension
Hot or cool, dry skin: no perspiration
Temperature > than 105 F.
+/- anhydrosis
Those Most at Risk: Elderly, alcoholism,
psychiatric & cardiovascular disorders
Pharmacy: psychotropic medications, street drugs, alcoholics
Treatment in Community Setting or Cooling Center:
Life Threatening Emergency: ABC’s and triage to EDSource: Protocol for NYC-DOH Response to Heat Waves (DRAFT) 5/13/01 &
Budassi, Sheehy, S. Emergency Nursing: Principals and PracticeMosby, St. Louis, Mo. 1992.
SC AHEC Sept. 10, 2004
Triage Guidelines The following should be triaged to the
Emergency Department: Temperature:
> 103 F. for adults > 104 F. for children Any elevation in temperature for infants < 6
months Change in mental status or level of
consciousness Abnormal vital signs: severe tachycardia,
hypotension Source: Protocol for NYC-DOH Response to Heat Waves (DRAFT) 5/13/01
SC AHEC Sept. 10, 2004
What are the boundaries? Know the limits to your own
knowledge/ skill/authority and Know key system resources for
referring matters that exceed these limits.
SC AHEC Sept. 10, 2004
Practice makes better Planning for emergencies and
training staff are only part of the picture
Regular reviews, exercises and drills are essential to maintain awareness, identify areas for improvement and develop proficiency in response
SC AHEC Sept. 10, 2004
Resources Emergency Preparedness & Response. Acute Mental Health Response to Children Affected by Terrorism.
http://www.bt.cdc.gov/children/PDF/working/mental.pdf
Emergency Preparedness and Response. Bioterrorism Agents and Diseases.http://www.bt.cdc.gov/agent/agentlist.asp
Emergency Preparedness and Response. Explosions and Blast Injuries: A Primer for Clinicians. http://www.cdc.gov/masstrauma/preparedness/primer.htm#key
Emergency Preparedness and Response. National Center for Environmental Health. Emergency Room Procedures in Chemical Hazard Emergencies A Job Aid. http://www.cdc.gov/nceh/demil/articles/initialtreat.htm
Emergency Preparedness and Response. Radiation Emergencies. Acute Radiation Syndrome: A Fact Sheet for Physicians. http://www.bt.cdc.gov/radiation/index.asp
Centers for Disaster Preparedness University of South Carolina School of Public Health, http://www.sph.sc.edu/acphp/default.htmThe Mailman School of Public Health, Columbia University. http://ncdp.mailman.columbia.edu
Facing Fear Together: Mental Health and Primary Care in a Time Of Terrorism. A Toolkit for Primary Care Providers Treating a Worried Nation. www.facingfeartogether.org , www.integratedprimarycare.org