Emergency Response Plan (Nursing)

00:01 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.

00:12 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.

00:48 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.

01:06 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.

02:41 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.

03:09 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.

03:47 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.

04:28 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.

04:48 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.

07:07 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.

07:23 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.

08:13 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.

09:03 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.

10:25 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.

10:42 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.

11:42 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.