Disaster in nursing and emergency preparedness jobs,preparedness tips for drought,earthquake preparedness courses vancouver 2014 - PDF 2016

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What they found is that while all Medicare- and Medicaid-certified nursing homes have written emergency plans and provide emergency preparedness training, the Centers for Medicare and Medicaid Services (CMS) had issued guidance checklists for emergency planning for long-term care facilities.
What HHS found is that the CMS checklists were missing some important information that would help these nursing homes and long-term care facilities to not only be more in compliance with expectations of HHS, but to make their jobs and lives more easy with some additional disaster preparedness work. The CMS’ checklist is missing a task and information on searching for missing patients. While the CMS checklist includes reviewing emergency plans every year, it does not mention that facilities should update recommended practices from groups like FEMA, which means they may not have the most up-to-date information or recommendations. Basically, this report illustrates the importance of working with experts in issues like disaster preparedness. This article is about the concept of triage as it occurs in medical emergencies and disasters.
Triage may also be used for patients arriving at the emergency department, or to telephone medical advice systems,[3] among others. Triage originated in World War I by French doctors treating the battlefield wounded at the aid stations behind the front. For many emergency medical services (EMS) systems, a similar model can sometimes still be applied. Simple triage is usually used in a scene of an accident or "mass-casualty incident" (MCI), in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries. In advanced triage, doctors may decide that some seriously injured people should not receive advanced care because they are unlikely to survive. In Western Europe, the criterion used for this category of patient is a trauma score of consistently at or below 3.
The use of advanced triage may become necessary when medical professionals decide that the medical resources available are not sufficient to treat all the people who need help. In these extreme situations, any medical care given to people who will die anyway can be considered to be care withdrawn from others who might have survived (or perhaps suffered less severe disability from their injuries) had they been treated instead. If immediate treatment is successful, the patient may improve (although this may be temporary) and this improvement may allow the patient to be categorized to a lower priority in the short term.
Continuous Integrated Triage is an approach to triage in mass casualty situations which is both efficient and sensitive to psychosocial and disaster behavioral health issues that affect the number of patients seeking care (surge), the manner in which a hospital or healthcare facility deals with that surge (surge capacity)[10] and the overarching medical needs of the event. Continuous Integrated Triage combines three forms of triage with progressive specificity to most rapidly identify those patients in greatest need of care while balancing the needs of the individual patients against the available resources and the needs of other patients. During the early stages of an incident, first responders may be overwhelmed by the scope of patients and injuries. In addition to the standard practices of triage as mentioned above, there are conditions where sometimes the less wounded are treated in preference to the more severely wounded. Upon completion of the initial assessment by medical or paramedical personnel, each patient will be labelled with a device called a triage tag. Immediate: The casualty requires immediate medical attention and will not survive if not seen soon. Minimal: "Walking wounded," the casualty requires medical attention when all higher priority patients have been evacuated, and may not require stabilization or monitoring. Expectant: The casualty is expected not to reach higher medical support alive without compromising the treatment of higher priority patients.
Priority: evacuation is necessary within four hours or the casualty will deteriorate to "Urgent". In a "naval combat situation", the triage officer must weigh the tactical situation with supplies on hand and the realistic capacity of the medical personnel. Class I Patients who require minor treatment and can return to duty in a short period of time.
Class III Patients for whom definitive treatment can be delayed without loss of life or limb.
Class IV Patients requiring such extensive care beyond medical personnel capability and time. In the mid-1980s, The Victoria General Hospital, in Halifax, Nova Scotia, Canada, introduced paramedic triage in its Emergency Department.
For routine emergencies, many locales in Canada now employ the Canadian Triage and Acuity Scale (CTAS) for all incoming patients.[23] The system categorizes patients by both injury and physiological findings, and ranks them by severity from 1-5. In the UK, the commonly used triage system is the Smart Incident Command System,[25] taught on the MIMMS (Major Incident Medical Management (and) Support) training program.[26] The UK Armed Forces are also using this system on operations worldwide. Triage at an accident scene is performed by a paramedic or an emergency physician, using the four-level scale of Cannot wait, Has to wait, Can wait and Lost. In the emergency room of a hospital, the triage is performed by a physician called MAO–medecin d'accueil et d'orientation (reception and orientation physician), and a nurse called IOA– infirmiere d'organisation et d'accueil (organisation and reception nurse). France has also a Phone Triage system for Medical Emergencies Phone Demands in its Samu Medical Regulation Centers through the 15 medical free national hot line. Preliminary assessment of injuries is usually done by the first ambulance crew on scene, with this role being assumed by the first Notarzt arriving at the scene.
The German triage system also uses four, sometimes five colour codes to denote the urgency of treatment.[31] Typically, every ambulance is equipped with a folder or bag with coloured ribbons or triage tags. Category II: Used for victims with non-life threatening injuries, but who urgently require treatment. Category III: Used for victims with minor injuries that do not require ambulance transport. Immediate or Priority 1 (red) evacuation by MEDEVAC if available or ambulance as they need advanced medical care at once or within 1 hour.
Delayed or Priority 2 (yellow) can have their medical evacuation delayed until all immediate persons have been transported. Minor or Priority 3 (green) are not evacuated until all immediate and delayed persons have been evacuated. Alternative care facilities are places that are set up for the care of large numbers of patients, or are places that could be so set up. Some crippling injuries, even if not life-threatening, may be elevated in priority based on the available capabilities. Within the hospital system, the first stage on arrival at the emergency room is assessment by the hospital triage nurse. For a typical inpatient hospital triage system, a triage physician will either field requests for admission from the ER physician on patients needing admission or from physicians taking care of patients from other floors who can be transferred because they no longer need that level of care (i.e.
Bioethical concerns have historically played an important role in triage decisions, such as the allocation of iron lungs during the polio epidemics of the 1940s and of dialysis machines during the 1960s.[37] As many health care systems in the developed world continue to plan for an expected influenza pandemic, bioethical issues regarding the triage of patients and the rationing of care continue to evolve.
In a potential influenza pandemic, it is anticipated that, as hospitals and treatment centers become overwhelmed, shortages of critical equipment such as ventilators will occur.
Mental health triage - brief overview of the Australian concept for dealing with psychiatric emergencies, similar to physical triage. Putni Gurung, 26, holds her nine-month-old baby boy Jitu in a destroyed village in the Tsum valley of Gorkha District, on 7 May 2015. Our medical teams have been helping people across Nepal since two major earthquakes hit the region.


On Tuesday 2 June, a helicopter delivering humanitarian aid crashed in Sindhupalchowk district, Nepal. The team were delivering much-needed medical and humanitarian assistance in Sindhupalchowk district when the accident occurred. We trust that the privacy of the families will be respected at this difficult time, and we continue to offer our support to all affected staff and their families. Ann Taylor, our head of mission, speaks about responding to the huge needs in the aftermath of the massive natural disaster.
A second major earthquake struck Nepal yesterday, just over two weeks after the previous earthquake hit.
Shortly after the second earthquake hit Nepal we quickly started assessing needs in the affected areas, most of which are again in the remote mountain districts. An MSF team that headed for Dolakha district witnessed first-hand villages being destroyed by the earthquake and landslides. Image taken by our assessment team in Charikot, near the epicentre of the 2nd #Nepal #Earthquake. MSF is assessing the needs in the affected areas while providing medical and relief assistance to the populations in need including those affected by the April 25 earthquake. While the most critically injured people were evacuated in the days immediately after the earthquake, those remaining have been trapped in their villages as roads and walking tracks have been cut off by avalanches and landslides. MSF medical teams are flying by helicopter to assess the needs and provide assistance in these remote villages.
On 3 May, an MSF team also set up a temporary clinic in the area of Chhapchet, in Dhading district, and began providing basic healthcare and minor surgical interventions.
The team will work to spread the word in the surrounding villages that people can now come to the clinic to receive care. Tremors were also strongly felt in northern India, in the states of Bihar and Uttar Pradesh. This page will be updated regularly with new information on our emergency response as the situation develops.
MSFThe first baby delivered by an MSF surgical team in the MSF-supported Ministry of Health hospital in Bhaktapur.
Despite Nepal’s struggles with political stability after the peace process, MSF left the country as government agencies and developmental organisations started to take a longer-term approach to covering the people’s health needs. Teams worked to increase knowledge about reproductive health and called for better access to good-quality public health services. In December 2009, MSF handed over its last remaining programme in the Terai region of Nepal, which provided free medical services, emergency consultations, maternal healthcare, and treatment of acutely malnourished children.
In the areas affected by internal unrest MSF used mobile clinics in the most neglected areas and transferred patients needing more care to its facility at Gaur District Hospital. In the areas where it worked, MSF left behind an improved level of care for mothers and newborns, and better trained staff. The course aims to provide the essential foundations of disaster nursing to healthcare providers in order to fill the need in responding to emergencies and disasters.
And half of the nursing homes in the survey did not include procedures to find missing residents in their emergency plans.
The nursing homes HHS checked had varying amounts of water, and methods with how it would be stored. Of the 24 nursing homes, seven of them had inaccurate and potentially dangerous processes that conflicted with FEMA’s safety recommendations during tornados and hurricanes. Whether it’s a nursing home, long-term facility, a hospital, or even a corporation, we specialize in disaster preparedness and continuity of operations (COOP). As a Consultant, Mike provides training in Emergency Medical Services and Public Health Preparedness for hospitals and healthcare organizations throughout Indiana. In this role, he trains and tests hospital plans in Hospital Incident Command System (HICS), assists in the creation of customized plans for specific needs and is the lead consultant for evacuation training and exercises.
As a Consultant, Gary provides training in hazardous materials and incident command, including hospital decontamination in the form of classroom facilitation, on-site and hands-on training, post-scenario evaluation, and recommendation. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately.
This article deals with the concept of triage as it occurs in medical emergencies, including the prehospital setting, disasters, and during emergency room treatment. However once a full response has occurred and many hands are available, paramedics will usually use the model included in their service policy and standing orders. The outcome and grading of the victim is frequently the result of physiological and assessment findings. The treatment being prioritized can include the time spent on medical care, or drugs or other limited resources.
It becomes the task of the disaster medical authorities to set aside some victims as hopeless, to avoid trying to save one life at the expense of several others. Triage should be a continuous process and categories should be checked regularly to ensure that the priority remains correct. This may arise in a situation such as war where the military setting may require soldiers be returned to combat as quickly as possible, or disaster situations where medical resources are limited in order to conserve resources for those likely to survive but requiring advanced medical care.[12] Other possible scenarios where this could arise include situations where significant numbers of medical personnel are among the affected patients where it may be advantageous to ensure that they survive to continue providing care in the coming days especially if medical resources are already stretched. This will identify the patient and any assessment findings and will identify the priority of the patient's need for medical treatment and transport from the emergency scene.
An example of this would be categorizing a Priority 1 (Immediate) patient as a Priority 2 (Delayed) or Priority 3 (Minimal). A battlefield situation, however, requires medics and corpsmen to rank casualties for precedence in MEDEVAC or CASEVAC.
Any compromise to the casualty's respiration, hemorrhage control, or shock control could be fatal. Injuries are potentially life-threatening, but can wait until the Immediate casualties are stabilized and evacuated. Unlike all other centres in North America that employ physician and primarily nurse triage models, this hospital began the practice of employing Primary Care level paramedics to perform triage upon entry to the Emergency Department. As a rule, there will be no cardiopulmonary resuscitation, so patients who do not breathe on their own or develop circulation after their airways are cleared, will be tagged "deceased". Examples include schools, sports stadiums, and large camps that can be prepared and used for the care, feeding, and holding of large numbers of victims of a mass casualty or other type of event.[34] Such improvised facilities are generally developed in cooperation with the local hospital, which sees them as a strategy for creating surge capacity.
During peacetime, most amputations may be triaged "Red" because surgical reattachment must take place within minutes, even though in all probability the person will not die without a thumb or hand.
This nurse will evaluate the patient's condition, as well as any changes, and will determine their priority for admission to the Emergency Room and also for treatment.[36] Once emergency assessment and treatment are complete, the patient may need to be referred to the hospital's internal triage system. Similar issues may occur for paramedics in the field in the earliest stages of mass casualty incidents when large numbers of potentially serious or critical patients may be combined with extremely limited staffing and treatment resources.
MSF extends its deepest condolences to the families and friends of our staff, and to those of the pilot of the helicopter, who was also sadly killed. The districts of Dhading, Gorkha, Rasuwa and Sindhupalchowk were hit hard on 25 April and little or no assistance has reached many villages. On 4 May, another team landed in Lapubesi in Gorkha district, and will stay for three days to provide medical assistance in the area. Although the extent of the damages is still unknown, initial reports say houses and buildings collapsed in Kathmandu and surrounding areas.


Teams provided healthcare to people affected by the conflict between government forces and the Communist Party of Nepal which lasted from 1996 until 2006, and by the resurgence of violence that accompanied a chaotic peace process. Through a number of national radio announcements and education at local level, MSF also addressed the issue of oxytocin misuse. Up until then MSF had offered basic and secondary healthcare, tuberculosis treatment and emergency services with a special focus on healthcare for pregnant women and children under five. If you have a nursing home, assisted living, long-term care facility, or other healthcare facility, we can help you with your emergency preparedness plan and training. Troy is an OSHA 10- and 30-hour General Industry Training Program instructor and is well seasoned at performing safety audits and inspections. Sta[ read more ]Frank KrizFrank has been with Lighthouse Readiness Group (LRG) in Plainfield, IN since 2010, and currently serves as a Consultant, Level II Instructor.
In the earliest stages of an incident, however, when one or two paramedics exist to twenty or more patients, practicality demands that the above, more "primitive" model will be used.
Some models, such as the START model, are committed to memory, and may even be algorithm-based. Because treatment is intentionally withheld from patients with certain injuries, advanced triage has ethical implications. Each category is scored from 0 to 5 using the Abbreviated Injury Scale, from uninjured to critically injured, which is then squared and summed to create the ISS. This has happened in disasters such as volcanic eruptions, thunderstorms, and rail accidents. A trauma score is invariably taken when the victim first comes into hospital and subsequent trauma scores taken to see any changes in the victim's physiological parameters. This does several things at once, it identifies patients that are not so severely injured, that they need immediate help, it physically clears the scene, and provides possible assistants to the responders. In 1997, following the amalgamation of two of the city's largest hospitals, the Emergency Department at the Victoria General closed.
The model provides a common frame of reference for both nurses and paramedics, although the two groups do not always agree on scoring.
The absolute urgencies are usually treated onsite (the PMA has an operating room) or evacuated to a hospital. While hospitals remain the preferred destination for all patients, during a mass casualty event such improvised facilities may be required in order to divert low-acuity patients away from hospitals in order to prevent the hospitals becoming overwhelmed.
The triage hospitalist must determine, in conjunction with a hospital's "bed control" and admitting team, what beds are available for optimal utilization of resources in order to provide safe care to all patients.
MSF worked where help was most needed, including in basic healthcare, reproductive healthcare and water and sanitation provision. The drug can be used safely in small doses if the baby is overdue, but in Nepal it is common to take high doses to try to induce a birth prematurely, especially to make the birth take place on a religiously significant date. He has over 20 years of emergency management experience at the state and local level and has participated in 11 Presidential declared disasters. It was developed at Hoag Hospital in Newport Beach, California for use by emergency services. It is used to divert scarce resources away from patients with little chance of survival in order to increase the chances of survival of others who are more likely to survive. A score of 6, for "unsurvivable", can also be used for any of the three categories, and automatically sets the score to 75 regardless of other scores. In these cases some percentage of patients will die regardless of medical care because of the severity of their injuries. If a record is maintained, the receiving hospital doctor can see a trauma score time series from the start of the incident, which may allow definitive treatment earlier. As those who can move, do so, the responders then ask, "anyone who still needs assistance, yell out or raise your hands"; this further identifies patients who are responsive, yet maybe unable to move. Overtriage is the process of overestimating the level to which an individual has experienced an illness or injury. The paramedic triage system was moved to the city's only remaining adult emergency department, located at the New Halifax Infirmary. It also provides a method, in some communities, for benchmarking the accuracy of pre-triage of calls using AMPDS (What percentage of emergency calls have return priorities of CTAS 1,2,3, etc.) and these findings are reported as part of a municipal performance benchmarking initiative in Ontario.
A patient with a traumatic amputation of the forearm might just be tagged yellow, have the bleeding stopped, and then be sent to a hospital when possible.
A typical surgical team will have their own system of triage for trauma and general surgery patients.
Methods will be required for determining who will receive access to life saving technologies, and who will not.
Joe is versed in the education of Incident Command and Tactical instruction and is a Paramedic and a HAZMAT Technician. It has been field-proven in mass casualty incidents such as train wrecks and bus accidents, though it was developed for use by community emergency response teams (CERTs) and firefighters after earthquakes.
Depending on the triage situation, this may indicate either that the patient is a first priority for care, or that he or she will not receive care owing to the need to conserve care for more likely survivors.
Now the responders can rapidly assess the remaining patients who are either expectant, or are in need of immediate aid.
Some of these tracking systems are beginning to incorporate the use of handheld computers, and in some cases, bar code scanners.
An example of this would be categorizing a Priority 3 (Minimal) patient as a Priority 2 (Delayed) or Priority 1 (Immediate).
In 2006, a triage protocol on whom to exclude from treatment during a flu pandemic was written by a team of critical-care doctors at the behest of the Ontario government. The involved are addressed to another structure called the CUMP–Cellule d'urgence medico-psychologique (medical-psychological urgency cell); this is a resting zone, with food and possibly temporary lodging, and a psychologist to take care of the brief reactive psychosis and avoid post-traumatic stress disorder.
After the preliminary assessment, a more specific and definite triage will follow, as soon as patients are brought to a field treatment facility. For example, if a hypothetical emergency department has all three of its ventilators currently in use for elderly patients with influenza, who will not survive without them, how should it act when paramedics arrive with a forty year old, otherwise healthy patient who is being ventilated due to influenza, but for whom no hospital ventilator is available.
From that point the first responder is quickly able to identify those in need of immediate attention, while not being distracted or overwhelmed by the magnitude of the situation. At its most primitive, however, patients may be simply marked with coloured tape, or with marker pens, when triage tags are either unavailable or insufficient. Acceptable overtriage rates have been typically up to 50% in an effort to avoid undertriage.
The overall goal of triage, in this system, is to both determine if a patient is appropriate for a given level of care and to ensure that hospital resources are utilized effectively. As a Consultant, Jason designs, develops, delivers, and evaluates training exercises for clients in order to test and adjust their current policies, plans and procedures to enhance practices. Deaf, partially deaf or victims of a large blast injury may not be able to hear these instructions.



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