ASIA PACIFIC EMERGENCY DISASTER NURSING NETWORK(APEDNN ... · care and implications for nurses...

ASIA PACIFIC EMERGENCY

DISASTER NURSING

NETWORK(APEDNN) –

TRAINERS GUIDE

TRAUMA MODULE

WHO CC UTS 2009

JANU

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2010

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TRAINING GUIDE:

TRAINING OF TRAINERS

TRAUMA CARE MODULE

Training Guide: Training of Trainers

Trauma Care Module Page | 2

About this Document

This document was prepared in January 2010 by Lisa Conlon with the

assistance of Justine Benfield (UTS WHOCC) for the World Health

Organization Regional Office for the Western Pacific (WPRO). Details of a

lecture provided by Dr Sijian Li (The Hong Kong Polytechnic University) have

been used in the production of this training guide.


PURPOSE OF THIS DOCUMENT

The purpose of this document is to provide users with details and guiding

notes when conducting a two (2) day ‘training of trainers’ course for trauma

care in an emergency or disaster situation. On completion of these capacity

building sessions, participants should be able to:

Describe a brief history of trauma care and implications for nurses

Explain some basic concepts of trauma care;

Identify the principles of triage and its use in an emergency and disaster situations;

Demonstrate a knowledge of information on the provision of clinical trauma care

State the evidence-based concepts guiding wound care and infection control.

The course is made up of the following sessions:

1. Introduction to trauma care 2. The use of triage in a mass casualty situation 3. Concepts of clinical trauma care 4. Introduction to initial wound care in a disaster and emergency

situation 5. Infection control in the emergency and disaster situation 6. Clinical skills development.

These topics related to trauma care in an emergency or disaster situation are just one component of an overall emergency and disaster core program and should be used in conjunction with other relevant subjects as required. Information provided may need to be tailored to meet the specific needs of the participants. Details of proposed lectures are provided as a guide and should be enhanced as appropriate.



PROPOSED TWO (2) DAY PROGRAM

Timing Day 1 Day 2

0900 - 1030 Introduction to trauma care Demonstration of the following clinical skills:

Basic and advanced Life support principles

Spinal immobilisation

Log roll turning

Application of neck collars

Basic dressing techniques

Stump bandaging

1030 - 1100 Morning Tea Morning Tea

1100 - 1200 The use of triage in a mass casualty situation

Skill station practice

1200 - 1300 Concepts of clinical trauma care Skill station practice

1300 - 1400 Lunch Lunch

1400 - 1630 Infection control in the emergency and disaster situation

Skill station practice



Timing Day 1 Day 2

Objectives

By the end of these sessions the participants should be able to:

Describe a brief history of trauma care and implications for nurses

Explain some basic concepts of trauma care;

Identify the principles of triage and its use in an emergency and disaster situations;

Discuss key aspects of the provision of clinical trauma care

State the evidence-based concepts guiding wound care and infection control

To provide participants with an opportunity to develop/enhance clinical skills relevant to trauma care in an emergency or disaster situation



SESSION 1: INTRODUCTION TO TRAUMA CARE

Aim of session

The purpose of this session is to provide participants with the following: A brief introduction to trauma care, including concepts involving:

History of trauma care,

Principles of triage,

Clinical trauma care,

Clinical skills sessions,

Wound care, and

Infection control to be used for patient care following an emergency or disaster situation.

Learning Objectives

At the completion of this session the participants should be able to:

Provide a brief history of trauma care and its continuing development.

Identify the concepts of trauma care including the principles of triage in an emergency and disaster situation.

Demonstrate an understanding of clinical trauma care requirements for individuals who have sustained injuries following a disaster and emergency situation.

Explain the concepts of wound care and infection control to be employed by healthcare workers following an emergency or disaster situation.

Method of session delivery

1. Powerpoint presentation (50 minutes) 2. Questions from participants (10 minutes)

Activities

Question and answer, group discussions, participant experience sharing

Resources required

Handouts, PowerPoint equipment



Proposed topics to be covered

The following section provides details of proposed topics (with information) for this session. This is purely provided as a guide and can be tailored to meet the specific needs of the participants and country receiving the lectures. Information in each section of the proposed presentation is presented in dot point format. Individual lectures/presenters can use these as a guide and may expand where necessary.



Topics covered Content Method of session delivery

History of trauma care

The history of trauma care should be provided in order to set the scene of the trauma care module. The following information may be covered:

Trauma care has been linked to wars and the care provided to military personnel in conflict situations.

The first known evidence of war wounds was found in a mass grave found in Egypt and dated to approximately 2000 BC.

The Greeks recognised the need for a system of trauma care and provided the first examples of trauma care.

The Romans further developed the delivery of combat care and set up a system of trauma centres in the Roman Empire.

Treatment plans and mechanisms of dealing with trauma care continued and still continues to be developed. It is a continuing evolving process.

PowerPoint presentation

Recent developments in trauma care

Recent developments in trauma care include the following:

The 19th and 20th centuries were notable for the improvement of surgical care in combat.

Asepsis was introduced during our Civil War, and there was a gradual decline in patients who died





from their wounds.

The surgical mortality for head, chest, and abdominal wounds also decreased after the First World War (WWI).

Between WWI and WWII, the first civilian trauma system was created in Austria by Bhöler.

The most remarkable development of a statewide trauma system occurred early in the 1970s in Germany.

In 1969, the American College of Surgeons Committee started to develop trauma care courses to train medical officers (doctors) to deliver trauma care to patients.

Trauma care was until recently, delivered primarily by doctors, but is now a multidisciplinary team approach, in most countries.

In recent years, the role of the emergency and trauma nurse has begun to be recognised and appropriate training of trauma nurses commenced.

The role of the nurse in trauma situations

As nurses are usually the first responders in an emergency, information regarding the role of the nurse in an emergency or disaster situation should be provided. In addition to this details regarding the specific role of a trauma nurse and the associated specific skills may be provided.





Community nurses are often the first responders in an emergency and or disaster situation

Identified the need to develop a nurse specific trauma training program

Trauma nursing courses developed and started running in the mid 1980s

Role of the trauma nurse Provide care to patients in an emergency situation

Administer emergency procedures, for example CPR

Be fast acting and have the ability to think on their feet

Handle complex and difficult situations

Work with limited equipment and resources

Work closely with other health professionals


Class participation of ideas of the role of a trauma nurse in a disaster or emergency situation

Trauma nurse skills The following list provides details of skills required of a trauma nurse. Group discussions may highlight what participants believe may be essential or desirable skills of a trauma nurse. Some trauma nursing skills may include, but are not limited to:

Preparation is vital

You are an essential member of every trauma team

Gain as much training as possible


Class participations of thoughts on trauma nursing skills in a disaster of emergency situation




Encourage your staff to do this also

Actively participate in planning for emergency and or disaster situations

It is our role to provide care to those injured in an emergency/disaster situation, and to the affected community

Practice according to the ICN competencies and local policies

Learn to work closely with external agencies

Develop the skills to identify problems with ourselves and our colleagues during times of emergency and high stress

Prepare staff

Be involved in the planning process

Group discussion activities

Participants could be put into small groups to discuss and later present their findings/results on the following topics:

Why is the history of trauma care important?

The history of trauma care is important in that it provide us with details of lessons learned from previous emergency and disaster situations so that we cannot make the same mistake previously made.

What are the skills required of a trauma nurse?

Group discussions and presentation of findings



SESSION 2: THE USE OF TRIAGE IN A MASS CASUALTY

SITUATION

Aim of session

The purpose of this session is to provide participants with the following details:

1. Background information in the use of triage. 2. Concepts and use of triage in a mass casualty situation. 3. The chance for participants to use triaging scales to identify

priority of care for provided case studies.

Learning Objectives


Provide a brief history in the use of triage and recognise its importance in a mass casualty situation.

Demonstrate knowledge of different triage scales available.

Prioritise care to be given to patients in a mass casualty situation.


1. Presentation (30 minutes). 2. Case studies and group discussion and presentation of findings

(20 minutes). 3. Questions from participants (10 minutes).

Activities

Question and answer, case studies, group discussions, participant

experience sharing

Resources required

Case studies, handouts, PowerPoint equipment


The following section provides details of proposed topics (with information)

for this session. This is purely provided as a guide and can be tailored to

meet the specific needs of the participants and country receiving the lectures.

Information in each section of the proposed presentation is presented in dot

point format. Individual lectures/presenters can use these as a guide and

may expand where necessary.



Topic Content Method of session delivery

History of triage Term ‘triage’ means to sort

The goal of triaging:

Is to match the injuries to the health capabilities available

Attempt to limit morbidity and mortality

Triaging can and should be done continuously (Retriage)

Is done for more than one casualty so that the correct priority of treatment can be provided

First formally used in World War I


Reverse triage

Reserve triaging is done for:

Less wounded are treated first before treating the more severely wounded

Commonly used in the military in order to return troops to the battlefield as quickly as possible

Or in disaster situations where medical resources are limited. Done in order to conserve resources for those





likely to survive, but requiring advanced medical care

Undertriaging

Undertriaging is:

The process of underestimating the severity of an illness or injury.

For example: categorizing a Priority 1 (Immediate) patient as a Priority 2 (Delayed) or Priority 3 (Minimal).


Overtriaging

Overtriaging is:

The process of overestimating the level to which an individual has experienced an illness or injury.

For example: categorizing a Priority 3 (Minimal) patient as a Priority 2 (Delayed) or Priority 1 (Immediate).


Triage levels

There are different styles of triaging used. Three examples are:

Emergent, urgent and non-urgent

Levels 1 – 4

Tag system

It will depend on your facility or health service as to





which triage system you will use

Examples of triage scales

Emergent, urgent and non-urgent scale

Emergent

Patient with life or limb threatening injuries

Treatment required straight away

Injuries can include:

Wounds to chest, fractures with vascular compromise

Urgent

Patients who require treatment within two hours of injury

Injuries may include: head trauma without loss of consciousness, extremity fractures without vascular compromise

Non-urgent

Injured patients who are able to wait for longer than two hours for treatment

Injuries may include: minor wound, soft tissue injuries, single bone fractures




Levels 1 – 4 scale

Level 1

Patients in critical condition

Requires immediate treatment

Injuries and conditions include: cardiac arrest, seizures, major multiple injuries, severe head injuries

Level 2

Unstable patients

Require treatment within 5 – 15 minutes

Injuries and conditions include:

Acute asthma attacks

Major fractures

Pregnant women

Active bleeding

Level 3

Potentially unstable patients

Require treatment within 30 – 60 minutes

Injuries and conditions include:




Closed fractures

Noncardiac chest pain

Bleeding with stable vital signs

Level 4

Routine care

Can be provided up to four hours after presentation

Flag system

Consists of colour tagging to determine the following information:

Severity of injuries

Name of patient

Injuries identified

Previous treatment provided (WHO, Pocket Emergency Tool, 2nd edition.)

Red tag

Highest priority

Life and limb threatening injuries

Patient requires treatment within 1 – 3 hours

Patients may present with:




Obstructed or damaged airway

Breathing disturbances (respiratory rate >30/min or <10/min

Circulation disturbances (heart rate >100beats per minute or presence of weak pulses)

Altered level of consciousness

External bleeding

Burns affecting the respiratory tract

Yellow tag

2nd priority

Urgent treatment required within 4 – 6 hours

Patient may present with:

Major / severe burns to face, feet or hands

Burns complicated by major soft tissue injuries

Spinal injuries, long bone or pelvic fractures

Environmental injuries from heat or cold

Black tag

Patient is deceased




Case study

History

You are called to the triage area following a gas explosion at a local factory.

On arrival there are five (5) patients who have been injured.

You quickly assess the situation and identify the following conditions of the patients.

Patient A

A young male who is screaming

Patient B

A young female who you observe to have cyanosis, tachypnea and is breathing noisily

Patient C

A middle aged male who is lying in a pool of blood. His left trouser is soaked in blood

Patient D

A young male lying face down on a stretcher and is now moving

Patient E

A young male who is shouting and swearing that

Group discussions and presentation of findings




someone should help him or he’ll call someone for legal help

1. For each of these patients what are your primary concerns?

2. For these patients identify who requires care first and list from highest priority of care to lowest priority?

3. Provide a rationale for your decision.



SESSION 3: CONCEPTS OF CLINICAL TRAUMA CARE

Aim of session

The purpose of this session is to provide participants with the following details:

1. Information regarding clinical processes relating to the basic management of the trauma patient.

2. Concepts of Basic and Advanced Life Support principles. 3. Guidelines for healthcare workers working with reduced equipment in

an emergency or disaster situation. 4. Information and concepts regarding the transfer of the trauma patient

in an emergency or disaster situation.

Learning Objectives


Detail psychological first aid.

Identify the key principles of Basic and Advanced Life Support.

Demonstrate innovative or coping strategies when dealing with limited equipment in an emergency and disaster situation.

Recognise when it is necessary to transfer the trauma patient in an emergency and or disaster situation.


1. Presentation and clinical skill demonstrations (50 minutes) 2. Questions from participants (10 minutes)

Activities

Question and answer, case studies, group discussions, participant experience sharing

Resources required



The following section provides details of proposed topics (with information) for this session. This is purely provided as a guide and can be tailored to meet the specific needs of the participants and country receiving the lectures. Information in each section of the proposed presentation is presented in dot point format. Individual lectures/presenters can use these as a guide and may expand where necessary




Basic airway and fluid resuscitation management

Managing the airway of an injured person

The following section provides some details of managing the airway of an injured patient.

Airway assessment

Must be done quickly and accurately

If problems are identified or suspected you must do something to address the situation

Question for participants

What equipment can you use to maintain an airway?

Chin-lift manoeuvre – Why?

How do you do this?

Who should have an airway maintenance device inserted?

When is the Jaw thrust manoeuvre used?

How do you do a Jaw thrust manoeuvre?

Demonstration of clinical skills

Insertion of an Oropharyngeal airway

How do you measure a guedel’s airway?

How do you insert a guedel’s airway?

When should you remove a guedel’s airway?

Insertion of a Nasopharyngeal airway

How you do measure a nasopharyngeal airway ?

When should you remove a


Questions for participants – class discussions

Demonstration of clinical skills




nasopharyngeal airway?

How to assist with the insertion of a Laryngeal mask

When should you use a laryngeal mask?

When should you remove one?

How to assist with the insertion of an Endotracheal tube (ETT)

What equipment do you need to assist with the insertion of an ETT?

How do you know if the tube is in the correct place?

What are the nursing actions of looking after a patient with an ETT?

What could you do if the ETT becomes blocked or dislodged?

How to assist with the insertion of a Needle cricothyroidotomy (if appropriate)

Can nursing staff perform this?

How do you manage this device?

How to assist with the insertion of a Surgical crichothroidotomy (if appropriate)

When should this be performed?

What are the nursing actions of looking after a




patient with this?

What are the potential complications that may occur?

Airway management in children

Important things to remember with children:

1. Children under 12 months of age are nose breathers

2. Nasal airways must remain clear unless an artificial airway is in situ

3. Trachea is shorter in children and more anterior

4. Disproportion between the size of the cranium and the mid face in children

5. Intubation may be difficult

6. Vocal cords often difficult to visualise

7. Use an un cuffed endotracheal tube in small children

8. Must maintain neutral alignment of children

9. An oral airway should only be inserted in an unconscious child


How do you know what size airway to use in a child?

Why do paediatric ETT not have a cuff?



Demonstration of clinical skills if appropriate for participants. Demonstration may include:

Entification of appropriately size ETT for various aged children

Canulated insertion of airway in children model




Fluid resuscitation Adults:

Commence isotonic electrolyte fluids initially

An initial fluid bolus is often given

Insert two large bore cannula's as soon as possible

Assess the patient’s response to the fluid resuscitation

Large volumes of fluid in an attempt to achieve a normal blood pressure isn’t a substitute for definitive control of bleeding

Remember to control haemorrhaging


How much fluid should you use?

What do you do if there is no effect from the fluid being infused?

Children:

May need to commence an intraosseous infusion in children under the age of 8 years

Required if unsuccessful cannulating child

Not to be used:

If the intraosseous site has had a previous or recent fracture

Bone disorders



Demonstration of clinical skills if appropriate for participants. Demonstration may include:

Cannulation

Calculation of fluid replacement





What considerations do you need to take into account when fluid resuscitating a child?

How do you know if your fluid resuscitation is appropriate?



SESSION 4: INTRODUCTION TO INITIAL WOUND CARE IN A

DISASTER AND EMERGENCY SITUATION

Aim of session

The purpose of this session is to provide participants with the following: 1. Details regarding initial wound care in an emergency or disaster

situation. 2. Information regarding wound care with reduced equipment. 3. Methods to carry out effective wound care. 4. Time for participants to ask questions relating to the presentation.

Learning Objectives

At the completion of this session the participants should be able to: 1. Manage wound care in an emergency and or disaster situation and

understand its importance. 2. Perform wound care with limited equipment. 3. Specify methods, and importance of early intervention and initial

management of wounds in an emergency or disaster situation.


Presentation (50 minutes) Questions from participants (10 minutes)

Activities


Resources required



The following section provides details of proposed topics (with information) for this session. This is purely provided as a guide and can be tailored to meet the specific needs of the participants and country receiving the lectures. Information in each section of the proposed presentation is presented in dot point format. Individual lectures/presenters can use these as a guide and may expand where necessary. The following lesson plan and comprehensive lecture notes have been kindly provided by Dr Sijian Li (The Hong Kong Polytechnic University), 2009.



Sub theme Content Method of session delivery

Background information Recap on the skin and its function

The largest organ in the body.

Functions include:

Protects the body from the environment, bacteria, and other foreign objects.

Regulates the temperature of the body.

Serves as a receptor of water and electrolytes (sodium and chloride)

Layers of the skins

Epidermis

Dermis

Subcutaneous layer

Accessory structures include:

Hair

Nails

Sweat glands

Oil glands


Wound and types of wounds

A wound refers to an injury to the skin and underlying tissues. Either open or closed.





Closed wounds.

The result of blunt forces that do not break the integrity of the skin.

Types of closed wounds.

Contusion or bruise

Haemotomas

Crush injuries

Contusion or bruise

An injury to blood vessels contained within the dermis.

Will cause localised swelling and pain at the injury site.

Patient may have discoloration at the injury site as the blood will leak from the damaged vessels and accumulate in the surrounding tissues.

Haematomas.

Similar to a contusion.

Usually involves damage to a large blood vessel and a larger amount of tissue.

Characterised by a lump with a bluish discolouration caused by blood collecting beneath the skin.

This blood may separate tissues and pool in the pockets they form.




Crush injuries and crush syndrome

‘A crush injury is a direct injury resulting from crush. Crush syndrome is the systematic manifestation of muscle cell damage resulting from pressure or crushing’

Characteristics of crush injuries and crush syndrome

Crush syndrome

It is a predictable change that occurs as a result of sustaining a crush injury.

The syndrome begins to develop only when the compressive force is removed and the blood commences flowing through the injured tissues.

Crush injury

ischemia and anoxia due to compressive forces. The ischemia is a contributing factor of third spacing of fluid or leaking fluid into the interstitial space which leads to oedema, raised compartment pressure, and impaired tissue perfusion which further causes ischemia (Tambimuttu, 2000).

On-site assessment of closed wound

Primary survey

Repaid, systematic approach to identify life-threatening conditions

Secondary survey





Head to toe evaluation of the patient.

Primary survey

Be sure the scene is safe, and you have taken all standard precautions before approach the patient and conduct primary survey

DRABC…

Assess for any possible spinal injury, and establish in-line stabilization of the cervical spine.

Secondary Survey

Focused history taken and physical exam

Performed before moving the patient, if no life-threatening injury or hazard present.

Should ask :

past medical history, medications, allergies, and the mechanism of injury.

Careful determination of trauma other than closed wounds

PE:

Signs and symptoms of internal bleeding and shock (hypoperfusion) if underlying organ injured




Swelling, pain, discoloration

Management Principles Close Wound

1. Take standard precautions

Wear protective gloves, eyewear and other proper personal protective equipment

2. Assure an open airway and adequate breathing

3. Treat for shock (hypoperfusion)

4. Splint suspected fracture

Management Principles- Crush injuries and Crush Syndrome

Fluids: type and quantity-much debate

The type mostly depend upon

Resources and protocols for prehospital fluid replacement.

In the United Kingdom, tends to be normal saline at a consensus meeting in 2001.

Large volumes sequestrated in injured muscle,

on the order of 12 L in the first 48 hours for a 75-kg adult and an initial infusion rate of 1-1.5L saline per hour as suggested.

Alkalinization

Mannitol diuresis

Prevent renal failure




Compartment syndrome

fasciotomy

Open wounds

The continuity of the skin is broken.

More challenging:

At risk for external bleeding and contamination

with the bacteria, may lead to infection.

The first indicator of a deeper, more serious injury,

such as fracture or ruptured or lacerated organ.

Types

Range from a slight scraping of the outermost layers of the skin to complete amputation of an extremity.

Abrasions

Lacerations

Avulsions

Amputations

Penetrations/Punctures

Abrasions

It is caused by a scraping of the skin surface (epidermis) or mucous membrane.

It often extremely painful because of the exposed nerve ending.

Blood will leak from the wound, which can be





controlled easily with direct pressure.

Lacerations

A break varying in depth

Linear (regular) or stellate (irregular).

Bleeding can be severe if an artery is involved.

o Linear laceration are usually caused by a knife, razor or broken glass.

o Stellate laceration are commonly caused by a blunt object. The edges of the wound will be jagged and healing may be prolonged.

Avulsions

A tearing away of the skin’s surface

Complete avulsion

tear away a complete segment of skin.

Incomplete avulsion

the skin is torn back and a characteristic flap forms.

Bleeding may be severe due to vessel injury.

Most commonly as result of industrial or motor vehicles accidents.

Healing is prolonged and scarring may be extensive.

The severity is directly related to the effectiveness circulation and perfusion distal to




the injury.

Amputations

It is a disruption in the continuity of an extremity or other body part.

May result by sharp or crushing forces.

Bleeding can be massive or limited.

An incomplete amputation typically bleeds more than a complete amputation.

Always consider shock (hypoperfusion) in case of amputation

Penetrations/ Punctures

As a result of a sharp, pointed object being pushed or driven into the soft tissues.

The entry wound may appear very small and cause little bleeding.

The severity depends on

the location,

the size of the penetrating object,

the depth of the penetration,

the forces, and

the structures in the path of the injury




Severity and Complications

The severity of wound depends on:

Mechanism of injury

Site of injury

Extent of the injury

Introduction of foreign bodies or contamination into the wound

Common complications:

Bleeding

Infection

Damage to underlying structure

Management Principles of an Open Wound

Take standard precautions

Assess ABC…

Exposed the wound

To assess the wound

Cut away clothing, clear the area of blood and debris with sterile gauze, dressing, or the cleanest materials available

Control the bleeding with direct pressure.

Use a pressure point if bleeding is not controlled with direct pressure and elevation.

Use a tourniquet only a last resort.

Prevent further contamination.




Keep the wound as clean as possible.

If there are loose particles of foreign material around the wound, wipe away with sterile gauze or similar clean material.

Dress and bandaging of a wound

Apply dry sterile dressing, secure with bandage.

Check distal pulses both before and after applying bandage to be sure it is not too tight.

Keep the patient calm and quite.

Treat for shock.

Transport.

Special Considerations

Chest injuries

Abdominal Injuries

Impaled Object

Amputations

Chest injuries

In case of penetrating chest wounds:

Use an occlusive dressing to prevent air from entering the chest cavity through the wound.

An occlusive dressing such as vaseline gauze, household plastic wrap, or the plastic bag. It should be secured with a tape on three sides, and




leave one side untaped in order to allow air to escape as the patient exhale.

Abdominal Injuries

May result in an evisceration (internal abdominal organs protrude through the wound)

Guidelines:

Do not touch the abdominal organs or try to replace the exposed organs.

Cover the exposed organs.

Use a sterile dressing moistened with sterile water or saline. Avoid all absorbent materials as dressing, such as toilet tissue or paper towel, which may cling to the organ.

Flex the patient’s hips and knees, if they are uninjured and if spinal injury is not suspected.

It will decrease the tension of the abdominal muscles.

Or placing pillows or other materials under patient’s knees.

Impaled Object(s)

It should never be removed in the field, unless it is through the cheek or the neck where it is obstructing air flow through the trachea.




Emergency medical care:

1. Manually secure the object.

2. Expose the wound area.

3. Control bleeding.

4. Use a bulky dressing to help stabilize the object.

Amputations

Remove any gross contamination by flushing the part with sterile water or saline.

Wrap the part in a dry sterile gauze dressing.

Wrap or bag the amputated part in plastic.

Keep the amputated part cool, but do not freeze..

Transport the part with the patient, if at all possible.

General Principles of Dressing and Bandaging

Dressing materials should be as clean as possible

Do not bandage a dressing in place until bleeding has stopped

A dressing should adequately cover the entire wound

If possible, remove all jewellery from the injury body as jewellery may interfere with circulation if swelling occurs




Bandage wounds snugly, but neither too tight nor too loosely.

If you are bandaging a small wound on an extremity, cover a larger area with the bandage.

Always place the body part in a functional position

Apply a tourniquet only as a last resort.

Summary Skin is the most durable and largest organs of the body

Initial and immediate nursing care is important to:

Assure ABC adequately

Dress and bandage the wounds from bleeding and contamination

Stabilize suspected fracture and

Treat for shock (hypoperfusion)


References:

Baranoski, S. & Ayello, E. (2004). Wound care essentials practice principles. Philadelphia: Lippincott Williams & Williams.

Consensus Meeting on Crush Injury and Crush Syndrome (2001) Faculty of Pre-Hospital Care of the Royal College of

Surgeons of Edinburgh, May 2001.



Disaster Nursing Task Force (2009) Skill station wound management in “Introduction to disaster nursing” 2009 Summer

program from 20 Jul to 31 Jul, 2009 in Chendu, Sichuan.Retrived from Website

http://sn.polyu.edu.hk/sn/eng/research/disaster.aspon Aug., 2009.

Greave, I., Porter, K., & Smith, J. (2002). Consensus statement on crush injury and crush syndrome. Trauma, 4, 129 –134.

Herny, M. C., & Stapleton, E. R. (2007). EMT Prehospital Care.Philadelphia: Elsevier.

Mistovich, J. J., & Karren, K. J. (2008). Prehospital Emergency Care.New Jersey: Pearson Prentice Hall.

Oda, J., Tanaka, H., Yoshioka, T., Iwai, A., Yamamura, H., Ishikawa, K., Matsuoka, T., Kuwagata, Y., Hiraide, A., Shimazu,

T., Sugimoto, H. (1997) Analysis of 372 patients with crush syndrome caused by the Hanshin-Awaji earthquake. The

Journal of trauma. 42:470–476.

Ramirex, E.G. (2007). Wounds and wound management. In K.S. Hoyt & J. Selfridge-Thomas (Eds.), Emergency nursing

core curriculum(pp.738 –759). St. Louis: Saunders Elsevier.

Sever, M.S., Vanholder, R. & Lameire, N. (2006). Management of crush-related injuries after disaster. The New England

Journal of Medicine, 345(10), 1052 –1063.

Tambimuttu, J. (2000). Crush injury and its management. Australian Emergency Nursing Journal, 3(1), 20 –23.

Tian-wu Chen & Zhi-gang Yang & Qi-ling Wang & Zhi-hui Dong & Jian-qun Yu & Zhang-pu Zhuang & Chang-ling Hou &

Zhen-lin Li (2009) Crush extremity fractures associated with the 2008 Sichuan earthquake: anatomic sites, numbers and

statuses evaluated with digital radiography and multidetector computed tomography The Journal of Skeletal Radiology.

10.1007/s00256-009-0743-5 on-line publication.



SESSION 5: INFECTION CONTROL IN THE EMERGENCY AND

DISASTER SITUATION

Aim of session

The purpose of this session is to provide participants with the following: A definition of infection control How the chain of infection works Infection control measures

Learning Objectives

At the completion of this session the participants should be able to: 1. Define infection control 2. Explain the chain of infection, and how it works 3. Apply infection control measures 4. Demonstrate correct nursing actions to control infection spread


Presentation (50 minutes) Questions from participants (10 minutes)

Activities


Resources required



The following section provides details of proposed topics (with information) for this session. This is purely provided as a guide and can be tailored to meet the specific needs of the participants and country receiving the lectures. Information in each section of the proposed presentation is presented in dot point format. Individual lectures/presenters can use these as a guide and may expand where necessary




Infection control

Definition

A mechanism used to attempt to decrease the risk of an infection in an individual or community

For an infection to occur the following must take place:

Presence of a infectious agent

A reservoir for growth

A port of exit from the reservoir

Mode of transmission

Port of entry in the host

A susceptible host





Infection control cycle Infectious agents

Infectious microorganisms include:

Bacteria

Viruses

Fungi

Parasites

Other microorganisms capable of causing disease

PowerPoint presentation with diagrams/photos




Reservoir

A reservoir is a place where a pathogen can survive, but may not multiply.

A variety of microorganisms exist on the skin and within body cavities and body fluids, but these microorganisms may not cause an infection

Carriers – people or animals who have pathogens but do not show any signs or symptoms of the disease. These can be transferred to others.

Can also be passive sources – water supply, soil or food.

Portal of exit

This is a way out of the carrier or host

Sneezing

Coughing

Shedding of skin and hair

Passive hosts

Food :

ingestion - eating

Water :

ingestion – such as drinking




wound dressings or cleaning people

cleaning of medical objects or food utensils

Contaminated sites – human wastes or deceased

Soil :

Previously unclean areas

Mode of transmission

Contact

Direct – person to person

Indirect – contaminated object

Droplet –air transfer

Air

Particulate matter – air transfer

Vectors

Flies

Mosquitoes

Vehicles

Water

Blood

Food




Portal of entry

The method by which the pathogen enters the susceptible host

Breathing

Swallowing and ingesting contaminates

Break(s) in the skin integrity

Susceptible host

Someone who doesn’t have resistance and becomes infected:

Individuals who are Immunosupressed

Diabetic patients

Those with existing diseases

Those with open wounds

Elderly and children

Infection control measures in the field

These include:

hand washing, as is practicable;

protective clothing, if available;

isolation procedures, think of the ways you can separate groups or individuals to reduce risks;

work from clean to dirty; and

ongoing measurement of performance.





Nursing actions

Consider threats to the individual and the community – individual wound care is different from community infection

Ensure your own safety

Delegate some actions – teach others to carry out some of these duties (local community members)

Carry out a teaching role within the community to decrease the risk of infection (practical advice to reduce risk)

Carry out an environmental scan for risk and develop a plan for separating clean and dirty activities

Identify methods and places to dispose of human waste

Determine mechanisms and methods to collect clean water

Examine the local infrastructure for equipment and resources that can be safely used in an alternative way

Do the best you can with what you have

Be adaptable

Think widely for ways to maintain infection control principles.




SESSION 5: CLINICAL SKILLS SESSIONS

Aim of session

The aim of these sessions is to provide participants with hands on practical practice in clinical skills relevant to the care required in an emergency or disaster situation. Skill stations may include:

Basic and advanced Life support principles

Spinal immobilisation

Log roll turning

Application of neck collars

Basic dressing techniques

Stump bandaging All of these skills will be demonstrated and then time allowed for participants to master these clinical skills. The type of clinical skills to be demonstrated and then practiced by the participants will depend on the requirements of the group, and the types of injuries most likely to occur in their local situation. Following this, simulated scenarios will be conducted to all for further refinement of these skills and the ability for participants to work within a team during crisis situations. Participants will also be taught how to carry out many of these clinical skills with minimal equipment in order to prepare them should this happen in a real life emergency and or disaster situation.

Learning Objectives

At the completion of this session the participants should be able to: 1. Define infection control 2. Explain the chain of infection, and how it works 3. Apply infection control measures


Demonstration time: This should be undertaken throughout the lectures, if appropriate and during the clinical skills development session on day two (2) of the program.

Participant practice: Allocated timings should be based on the number of participants, level of participant’s particular clinical skills. The program allows for the majority of day two (2) of the program for clinical skills development/enhancement.

Simulated scenarios: The use of the triage case studies may be used to

develop clinical skills.



Activities

Participant practice, teamwork

Resources required

Equipment for skill stations as necessary, simulated scenarios



Basic and advanced Life support principles Log roll turning

Resources

Lecturer

Life support equipment

Substitution in case of lack of correct equipment

scenarios

Lecturer

Log roll equipment


Scenarios

Time required

Demonstration – 30 minutes Demonstration – 30 minutes

Participant practice – 1 hour (depending on available equipment)

Participant practice – 1 hour

Simulated scenarios – 1 hour Simulated scenarios – 1 hour

Spinal immobilisation Application of neck collars

Resources

Lecturer

Spine immobilisation equipment


Lecturer

Neck collars

Substitution in case of lack of correct collar

Case Studies

Time required


Participant practice – 1 hour Participant practice – 1 hour



Basic dressing techniques Stump bandaging

Resources

Lecturer

Dressings

Substitution in case of lack of correct dressings

Lecturer

Bandages


Time required




ASIA PACIFIC EMERGENCY DISASTER NURSING NETWORK(APEDNN ... · care and implications for nurses...

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