Emergency preparedness is vital for the safety and security of the general public. Disasters, according to Powers (2010), are events that cause damage to lives and property during which community resources cannot keep up with the demand. In the unfortunate event of a disaster, having a plan in place as to how a it will be managed allows for the smoothest possible outcome with the fewest amount of casualties. The three levels of emergency preparedness prevention are each an important part of being ready for a disaster.
The planning involves the time before the disaster, the acute disaster scene, and the long term management of the disaster survivors (Rittenmeyer, 2007). At the disaster scene, a triage color code system is used to organize and prioritize patients and the level of care they require. There are many types of disasters that can affect the public.
Three technological disasters will be addressed, all involving exposure: biologic, chemical and radiation. Nurses and other health care workers may encounter a disaster where their skills are needed, whether it be on the job or as a citizen. It is important that health care workers understand the components of disaster management, triage at the scene, and different types of agents to which patients may have been exposed. Levels of Disaster Management–Emergency Preparedness Prevention
There are three levels of a disaster management plan: primary, secondary and tertiary. Each of them is important to allow for the best possible outcome in the event of a disaster. Primary Prevention
Primary prevention involves everything that can be done before the actual disaster occurs. This includes training personnel, educating the public, and creating evacuation plans. Rittenmeyer (2007) describes disaster planning as assessing the risk of a disaster occurring as well as the capacities that will be available during a disaster. First, a risk assessment to determine what hazards a particular community is vulnerable to is done (Powers, 2010).
Based on the findings, a disaster response plan is created for the greatest risks to the community. Training and practice for the disaster(s) are the core components of primary prevention.
For instance, in a hospital setting, nurses can attend a seminar on evacuation as well as participate in an evacuation drill to simulate a real disaster. The simulation provides the opportunity to become familiar with the disaster plan and how it will be carried out. Secondary Prevention
Secondary prevention, or relief response, is the interventions that take place during the acute disaster stage (Rittenmeyer, 2007). Patients are triaged based on level of acuity for further treatment. If exposure to a toxin or microorganism has occurred, the nurse may be assisting with decontamination and/or applying chemical suits and respirators.
As Powers (2010) mentions, nurses in the field may be assessing the needs of the community that has been affected to determine who needs shelter, food, water or vaccinations and helping them to obtain what they need. Disaster relief also includes performing rescues, relocating people who are displaced, and preventing disease and/or disability (Rittenmeyer, 2007). For instance, during Hurricane Katrina in 2005, nurses and other health care workers were deployed to assess, stabilize and evacuate patients to safer ground (Klein & Nagel, 2007). Tertiary Prevention
Tertiary prevention, or disaster recovery, begins when the initial crisis is over and involves long term support for the needs of the population affected by the disaster. Activities that take place during the recovery phase include rebuilding affected infrastructure, hospitalization for the injured, rehabilitation and therapy to cope with the disaster.
These will vary according to the type of disaster that has occurred. Rittenmeyer (2007) states that during the recovery phase the effectiveness of the disaster plan should be evaluated and the plan then altered based on the findings. Triage Color Code System
In the event of a disaster, the triage color code system is beneficial for three major reasons (Klein & Nagel, 2007). First, triage determines who needs rapid medical care. Next, triage reduces the amount of patients sent to hospitals by separating minor versus major injuries. Thirdly, triage distributes casualties among available medical facilities to keep any one facility from being deluged with patients.
The system most widely used during a disaster triage is the IDME color code system. The mneumonic IDME stands for the levels of acuity of the patients. Each level is assigned a color. They are as follows according to Husted (2012): I–Immediate (Red); D–Delayed (Yellow); M–Minimal (Green); and E–Expectant (Black).
The categories have criteria that the responder should be familiar with in order to triage the patients into the appropriate color. Based on the patient’s level of injury, each is given a triage tag, commonly placed on the wrist. Using this system, patients are treated in order of the urgency of their injury.
The red category is reserved for critical patients. These patients are seriously injured but do have a chance of surviving. The yellow category is for patients that need first aid but should not deteriorate rapidly if care is not immediate. The green category is for patients that are considered the “walking wounded”. These patients may have minor injuries such as abrasions or contusions and can either self treat or be taken care of by a someone without medical training.
The final category is the black which is for patient who is unresponsive and without a pulse or has a catastrophic chest or head injury (Husted, 2012). Types of Disasters
Three types of disasters that could occur are exposure to biologic, chemical and radioactive agents. It is important that medical personnel are familiar with the types of possible toxins and agents to appropriately treat those affected while protecting themselves as well. Exposure to Biologic Agents
This type of exposure is a deliberate release of a virus, bacteria or other germ (Briggs, 2006). These agents are used to cause illness or even death. They are naturally occurring agents and can be spread via inhalation, orally in food or water, or through the skin (Briggs, 2006). Examples of biologic
agents, also know as bioterrorism agents, are smallpox, the plague, and anthrax. Exposure to Chemical Agents
The release of a hazardous chemical that is released and may harm people’s health is termed a chemical emergency (Centers for Disease Control and Prevention, 2012). Chemicals can be natural or created. Examples of possible chemical health threats are nerve agents and vesicants. Nerve agents such as Sarin and VX affect nerve function. Vesicants cause erythema and vesicles on the skin and can also injure the eyes, the airway and internal organs.
The nerve agent Sarin was used in 1995 in a Tokyo subway, affecting over 5,500 people (Briggs, 2006). Chemical agents are now deemed terrorist weapons. Exposure to Radiation
Briggs(2006) describes ionizing radiation’s effect on the body. Radiation alters the cells in the body, damaging or killing them. External irradiation occurs when the whole body has been exposed to radiation from an external source such as an x-ray. Contamination occurs when radioactive material comes into contact with the body, either externally or internally. Contamination by radioactive agents can occur through contact with the skin, being inhaled or ingested. Conclusion
Emergency preparedness is extremely important for the safety of the public. By having a disaster management plan in place, the acute disaster scene will not be just chaos but will have a sense of order amidst the mayhem. The injured will be organized by the triage color code system to ensure the treatment of those in greatest need first and delaying treatment for those that can wait. It’s important to understand the differences in biologic, chemical and radioactive exposure in order to best treat patients should an unthinkable disaster occur.
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