Exemplar 46.A Emergency Preparedness

An emergency is defined as . . .

A sudden, often unforeseen event that threatens health or safety.

A disaster is defined as . . .

A public emergency necessitating assistance from outside the affected community.

Three things in common with disasters

Little or no warning before the event.
Available personnel and emergency services that are overwhelmed initially.
A serious threat to life, public health, and the environment.

A pandemic is defined as . . .

An infection that spreads rapidly around the world.

Emergency preparedness is defined as . . .

The act of making plans to prevent, respond to, and recover from emergencies.

The CDC recommends an all-hazards approach to emergency preparedness. This provides for . . .

General preparation and training that can be applied in a wide variety of emergency situations.

Surge capacity refers to a community's . . .

Ability to rapidly meet the increased demand for qualified personnel and resources (including healthcare resources) in the event of a disaster.

The four phases of emergency management


The Mitigation phase is defined as . .

Identifying potential hazards.
Taking action to to reduce their likelihood.
And minimizing the effects of those that cannot be prevented.
Takes place before and after an emergency occurs.

Examples of mitigation

A person that lives in a flood zone who purchases flood insurance.
Local/state/regional agency implements warning systems for tornadoes and tsunamis (also an excellent example of disaster planning).

The Preparedness phase is defined as . . .

Risks are assessed and plans are developed to address them.
Takes place before an emergency occurs.

Emergency plans are developed at which levels?

Federal, regional, state, and local.
Designed to save lives and to assist first response and rescue teams that are often overwhelmed.

Who creates plans that identify national threats?

The Federal Emergency Management Agency (FEMA),
The Department of Homeland Security,
And the CDC
They coordinate planning efforts among people, agencies, and all levels of government.

For communities, the most critical task performed during the preparedness phase is the development of an . . .

Emergency operations plan.
Includes ID'ing, organizing, and training emergency personnel.
Stockpiling equipment and supplies.
Implementing comm. and warning systems.
Emergency operation centers.
Response and evacuation plans.

Because nurses will be required to allocate scarce resources/supplies and make difficult care decisions, they must understand . . .

The ethics behind such choices.
The ANA is a good source for understanding their roles and consequences.

Public health nurses and their role in the preparedness phase.

They plan ahead of time by assessing at risk pop. and their functional needs during a disaster.
Then develop care plans to address those needs.
Conduct training drills
Evaluate operational plans
Work with local stakeholders

One way for a nurse to become recognized as part of an organized disaster system is to . . .

Register with an agency such as the American Red Cross
Doing so, ensures they are properly trained disaster volunteers.

To give assurance to a nurse that participates in disaster relief, the nurse should develop . . .

An emergency preparedness plan for themselves and their immediate family.
Everyone should do this.
FEMA and the Red Cross are good resources for this.

Not only should the adults be aware of the emergency preparedness plan, but also . . .

Children should be aware of it too
(knowing what to do in an emergency).

Things to include in an emergency preparedness plan include . . .

A disaster kit to be used/taken
Escape routes from the home/environment
Meeting places
Contact info/An outside contact (away from disaster zone)
Shutting off utilities (per authorities)
Insurance, Medical, Financial, Other vital records (stored offsite an

Someday, one's life may depend on how . . .

Current their emergency plan is.
Should be reviewed and updated on a regular basis.

The Emergency Response phase is defined as . . .

The implementation of emergency preparedness plans.
Takes place during and immediately after the emergency.
Provides a means for responders to:
Save lives,
Prevent additional property damage,
And meet basic human needs.

Included in the emergency response effort are . . .

Local law enforcement, paramedics, emergency dept. personnel, local govt. staff, public health nurses.
Public health nurses, ensure that:
Logistics and in place to support community care during the crisis,
And they provide ongoing response planning during

Public health nurses use population-based triage to assess . . .

Communicable disease outbreak impact and needed response,
The probability of infectious diseases and addressing them,
And identifying and providing support to individuals with mental health problems.

The responsibility of nurses during an emergency (like other first responders) is to do . . .

The greatest good for the greatest number of casualties.
They should not use their time to provide care that will be of minimal or questionable benefit.
Should also observe both physical and mental status.

The Recovery phase is defined as . . .

Designed to restore the community to normal balance (restoration),
Or, create a new, safer normal by updating the community's preparedness plan to address lessons learned during the emergency (Mitigation)
Takes place after the emergency.

The recovery phase includes the reconstitution (reconstruction) of government operations and services, if necessary, and includes provision of . . .

Public assistance by the private and public sectors.
Other elements include:
And Repair of essential Infrastructure.

During the recovery phase, each community must reassess . . .

Risks and update plans.
Nurses are qualified to participate in risk assessment and planning at all levels.
Are also perfect candidates to educate pt.s and communities.

Local emergency management agency (LEMA) is defined as . . .

A governmental agency with expertise in public safety, emergency medical services, and management.
e.g. State divisions of emergency management.

The National Incident Management System (NIMS)

Federal guidelines that local governments must follow during an emergency or disaster.
e.g. While local resources may become overwhelmed, citizen volunteers often act as extensions of the first responders. A corps of trained citizens.
Created by the U.S.

The Community Emergency Response Team (CERT) pogram

Prepares interested community members to assist in disasters.
Assisting themselves, family, and neighbors.
Provides facts on what to expect of immediate services, Alerts citizens of responsibility for mitigation and preparedness,
Trains lifesaving skills

Clinician Outreach Communication Activity (COCA)

Ensures clinicians have up-to-date info.
Provides two-way comm. between clinicians and CDC on emerging threats such as pandemics, natural disasters, and terrorism.
Has a list of emergency preparedness and training resources.
Created by CDC.

Mass Casualty Events (MCEs) and nurses

Nurses are the largest pool of healthcare pros.
As such, they are call in to assist with MCEs.
Training for MCEs can include:
Pro Journal articles
Mock disaster drills
Volunteering in community services
Obtaining CERT certification
Nursing during an MCE

Box 46-3 Categories of Educational Competencies for RN Responding to Mass Casualty Incidents.

See Box 46-3 on pg 2789
Doesn't seem important, seems like general nursing practice.

The National Nurse Emergency Preparedness Initiative

A highly interactive, web-based course for all nurses.
Focuses on providing opportunities for dynamic and interactive application of both theory and practice through scenario-based learning.

Many agencies are mandated by law to . . .

Develop plans that dictate the roles and responsibilities of all individuals who respond during emergencies, disasters, and MCEs.

Triage is defined as . . .

A process involving prioritizing patients for treatment based on severity of illness or injury and in light of the supplies and resources available.
Goal is early assessment of patients and the prioritization of care based on severity of symptoms.
EMTs ar

A Mass casualty event is defined as . . .

More than 100 victims

Mass casualty events call for the implementation of . . .

Reverse triage
Where the most severely injured or ill victims who require the greatest resources are treated last to allow the greatest number of victims to receive medical attention.


A color classification system used to prioritize adult patients.

Adult Triage Questions (Figure 46-5)

Spontaneous breathing?
Respiratory rate?
Mental Status?


A color classification system used to prioritize pediatric victims.

Pediatric (Figure 46-6)

Respiratory Rate?
Palpable pulse?
-"P" (Inappropriate) posturing = IMMEDIATE
-"A" , "V" , or "P" (appropriate) posturing = DELAYED

Triage Categories (Colors)

-Unlikely to survive; palliative and pain relief
-Req. medical attention within minutes (up to 60) to survive; Compromised ABCs
DELAYED (yellow)
-Serious injury, but not likely to deteriorate significantly over several ho

When a site-specific disaster occurs, access to the site of contamination is . . .

Limited, and safety zones are established.
e.g. Weapons (bombs), chemical leaks (tanker care derailment).
The initial site of the incident is a "hot zone."
Only personnel with appropriate protective equipment are allowed in the hot zone.

Designated safety zones should be located . . .

Uphill, upwind, and upstream from the site of the disaster.
Topography, weather, and physical layout (buildings, roads, etc.) will affect this.

Bioterrorism is defined as the deliberate release of . . .

Viruses, bacteria, or other microbes as weapons.
The CDC rates highest priority to:
Easily disseminated/transmitted agents from person to person.
High mortality rate.
Impact on public health.
Cause public panic.
Disrupt society and government.

Primary agents identified by the CDC as potential bioterrorist threats are . . .

Anthrax (Bacillus anthracis)
Botulism (C. Botulinum toxin)
Plague (Yersinia pestis)
Smallpox (variola major)
Tularemia (Francisella tulnarensis)
Viral hemorrhagic fevers (Filoviruses [Ebola and Marburg])
Arenaviruses (Lassa and Machupo)

Inhalation of Anthrax has been effectively treated with . . .

Ciprofloxacin 400mg administered IV over 12 hours

Primary treatment of biological agents used in terrorism is . . .

Limited. No effective therapies to most viruses.
Some can be protected against via vaccine. So, only prior protection helps.

Hot Zone (Red)

Most dangerous, adjacent to the site of the disaster, PPE required, Antidotes admin., dead ID.
Only the most basic services are performed:
Victims are located, BLS (airways and bleed controlled).
Decontamination is NOT done here.
Survivors are moved to wa

Warm Zone (Yellow, contamination, or contamination reduction zone)

At least 300 feet from outer edge of hot zone.
Primarily decontamination.
PPE required
Rapid triage and emergency treatment to stabilize is also done here.
Individuals with highest levels of contamination are the highest priority
Victims are then moved to

Cold Zone (Green, support zone)

Outside warm zone
Decontaminated victims are triaged and treated.
Comparatively safe
PPE still required r/t changes (wind direction shifts)
Primary purpose is to provide medical services and transport victims who require more than first aid to locations w

Strategic National Stockpile program

Ensures the immediate availability of essential medical materials to a community.
Jointly maintained by CDC and DHS.

Two components of the Strategic National Stockpile program

push package" designed to meet the community's needs in case of biological/chemical threat.
Located in locations that will permit delivery within 12 hours after an attack.
Vendor-managed inventory packages.
Shipped once the threat has been clearly identi

Emergency Considerations for Children

Do not play in floodwaters/drainage ditches/storm drains
Watch for livewires, etc.
Use portable generators outdoors, keep children away.
Limit the amount of media and new coverage children are exposed to (frightening to them).

Emergency Considerations for Older Adults

Often have chronic disease which can worsen quickly due to lack of food, water, and extreme heat/cold.
A reliance on meds, O2, etc. which require electricity.
Limited mobility, low sensory awareness, low thermoregulation, social & economic limits.

Nurses are never expected to jeopardize . . .

Their own safety or the safety of their families or other rescuers by responding to a disaster.
They must consider if they have the skills needed to respond, or whether the job would be better left to individuals with advanced training in disaster respons

If a nurse decides to participate during a disaster, the nurse must follow the . . .

Emergency preparedness plans created by the agency or within the community.
They must act within their defined scope of practice.
Follow ethics guidelines in disasters, such as ANA.
And can proactively prepare communities by becoming community leaders; re

Box 46-5 The Emergency Medical Services System: EMRs & EMTs

EMRs provide initial care.
Assessment, opening airways, ventilating, bleed control, CPR, stabilizing spine/limbs, childbirth, aid other EMS.
EMTs do everything that EMRs do.
Additional training and cert allows them to:
Assist with Rx meds, give aspirin, N

Box 46-5 The Emergency Medical Services System: AEMTs & Paramedics

Advanced emergency medical technicians.
May start and admin IV fluids, give meds, and assess need for/provide advanced airway procedures
Receive the most training and are qualified to do more in-depth assessments of patients: Abnormal heart rh