Chapter 12: Concepts of Disaster Preparedness

A hospital responds to a local mass casualty event. What action would the nurse supervisor take to prevent staff posttraumatic

stress disorder during and after the event?

• Provide water and healthy snacks for energy throughout the event.

• Schedule 16-hour shifts to allow for greater rest between shifts.

• Encourage counseling upon deactivation of the emergency response plan.

• Assign staff to different roles and units within the medical facility.

Answer explanation

To prevent staff posttraumatic stress disorder during a mass casualty event, the nurses would use available counseling, encourage

and support co-workers, monitor each other’s stress level and performance, take breaks when needed, talk about feelings with staff

and managers, and drink plenty of water and eat healthy snacks for energy. Nurses would also keep in touch with family, friends,

and significant others, and not work for more than 12 hours/day. Encouraging counseling upon deactivation of the plan, or after the

emergency response is over, does not prevent stress during the casualty event. Assigning staff to unfamiliar roles or units may

increase situational stress and is not an approach to prevent posttraumatic stress disorder. These actions also help mitigate PTSD

after the event.

A client who is hospitalized with burns after losing the family home in a fire becomes angry and screams at a nurse when dinner is

served late. How would the nurse respond?

• “Do you need something for pain right now?”

• “Please stop yelling. I brought dinner as soon as I could.”

• “I suggest that you get control of yourself.”

• “You seem upset. I have time to talk if you’d like.”

Answer explanation

Clients would be allowed to ventilate their feelings of anger and despair after a catastrophic event. The nurse establishes rapport

through active listening and honest communication and by recognizing cues that the client wishes to talk. Asking whether the client

is in pain as the first response closes the door to open communication and limits the client’s options. Simply telling the client to

stop yelling and to gain control does nothing to promote therapeutic communication.

A nurse is field-triaging clients after an industrial accident. Which client condition would the nurse triage with a red tag?

• Dislocated right hip and an open fracture of the right lower leg

• Large contusion to the forehead and a bloody nose

• Closed fracture of the right clavicle and arm numbness

• Multiple fractured ribs and shortness of breath

Answer explanation

Clients who have an immediate threat to life are given the highest priority, are placed in the emergent or class I category, and are

given a red triage tag. The client with multiple rib fractures and shortness of breath has a threat to oxygenation and is the most

critical. The client with the hip and leg problem and the client with the clavicle fracture would be classified as class II (urgent,

yellow tag); these major but stable injuries can wait for 30 minutes to 2 hours for definitive care. The client with facial wounds

would be considered the “walking wounded” and classified as nonurgent (class III, green tag).

An emergency department (ED) charge nurse prepares to receive clients from a mass casualty within the community. What is the

role of this nurse during the event?

• Ask nursing staff to discharge clients from the medical-surgical units in order to

  make room for critically injured victims.

• Call additional medical-surgical and critical care nursing staff to come to the

  hospital to assist when victims are brought in.

• Inform the incident commander at the mass casualty scene about how many

  victims may be handled by the ED.

• Direct medical-surgical and critical care nurses to assist with clients currently in

  the ED while emergency staff prepare to receive the mass casualty victims.

Answer explanation

The ED charge nurse would direct additional nursing staff to help care for current ED clients while the ED staff prepares to receive

mass casualty victims; however, they would not be assigned to the most critically ill or injured clients. The hospital incident

commander’s role is to take a global view of the entire situation and facilitate patient movement through the system, while bringing

in personnel and supply resources to meet patient needs. The medical command physician would kept the incident commander

informed about victims and capacity of the ED.

An emergency department manager wants to mitigate the possible acute and chronic stress after mass casualty events in the staff.

What action would the manager take?

• Encourage all staff to join a Disaster Medical Assistance Team.

• Instruct all staff members to prepare go bags for all family members.

• Use available resources for broad education and training in disaster management.

• Provide incentives and bonuses for responding to mass casualty events.

Answer explanation

Research indicates that education and training in disaster management before an incident occurs is associated with improved

confidence and better coping after the incident. Go bags are important to maintain for all family members but would not be

effective in mitigating stress. A DMAT is a medical relief team made up of civilian medical, paraprofessional, and support

personnel that is deployed to a disaster area with enough medical equipment and supplies to sustain operations for 72 hours.

Incentives and bonuses will not help mitigate stress.

A nurse is caring for a client whose spouse died in a recent mass casualty accident. The client says, “I can’t believe that my spouse

is gone and I am left to raise my children all by myself.” How would the nurse respond?

• “Please accept my sympathies for your loss.”

• “I can call the hospital chaplain if you wish.”

• “You sound anxious about being a single parent.”

• “At least your children still have you in their lives.”

Answer explanation

Therapeutic communication includes active listening and honesty. This statement demonstrates that the nurse recognizes the

client’s distress and has provided an opening for discussion. Extending sympathy and offering to call the chaplain do not give the

client the opportunity to discuss feelings. Stating that the children still have one parent discounts the client’s feelings and situation.

A nurse cares for victims during a community-wide disaster drill. One of the victims asks, “Why are the individuals with black tags

not receiving any care?” How does the nurse respond?

• “To do the greatest good for the greatest number of people, it is necessary to

  sacrifice some.”

• “Not everyone will survive a disaster, so it is best to identify those people early

  and move on.”

• “In a disaster, extensive resources are not used for one person at the expense of

  many others.”

• “With black tags, volunteers can identify those who are dying and can give them

  comfort care.”

Answer explanation

In a disaster, military-style triage is used; this approach identifies the dead or expectant dead with black tags. This practice helps to

maintain the goal of triage, which is doing the most good for the most people. Precious resources are not used for those with

overwhelming critical injury or illness, so that they can be allocated to others who have a reasonable expectation of survival.

Victims are not “sacrificed.” Telling victims that is important to move on after identifying the expectant dead does not provide an

adequate explanation and is callous. Victims are not black-tagged to allow volunteers to give comfort care.

A nurse wants to become involved in community disaster preparedness and is interested in helping setup and staff first-aid stations

or community acute care centers in the event of a disaster. Which organization is the best fit for this nurse’s interests?

• The Medical Reserve Corps

• The National Guard

• The health department

• A Disaster Medical Assistance Team

Answer explanation

The Medical Reserve Corps (MRC) consists of volunteer medical and public health care professionals who support the community

during times of need. They may help staff hospitals, establish first-aid stations or special needs shelters, or set up acute care centers

in the community. The National Guard often performs search-and-rescue operations and law enforcement. The health department

focuses on communicable disease tracking, treatment, and prevention. A Disaster Medical Assistance Team is deployed to a

disaster area for up to 72 hours, providing many types of relief services.

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A nurse wants to become part of a Disaster Medical Assistance Team (DMAT) but is concerned about maintaining licensure in

several different states. Which statement best addresses these concerns?

• “Deployed DMAT providers are federal employees, so their licenses are good in

  all 50 states.”

• “The government has a program for quick licensure activation wherever you are

  deployed.”

• “During a time of crisis, licensure issues would not be the government’s priority

  concern.”

• “If you are deployed, you will be issued a temporary license in the state in which

  you are working.”

Answer explanation

When deployed, DMAT health care providers act as agents of the federal government, and so are considered federal employees.

Thus their licenses are valid in all 50 states. Licensure is an issue that the government would be concerned with, but no programs

for temporary licensure or rapid activation are available.

After a hospital’s emergency department (ED) has efficiently triaged, treated, and transferred clients from a community disaster to

appropriate units, the hospital incident command officer wants to “stand down” from the emergency plan. Which question would

the nursing supervisor ask at this time?

• “Are you sure no more victims are coming into the ED?”

• “Do all areas of the hospital have the supplies and personnel they need?”

• “Have all ED staff had the chance to eat and rest recently?”

• “Does the Chief Medical Officer agree this disaster is under control?”

Answer explanation

Before “standing down,” the incident command officer ensures that the needs of the other hospital departments have been taken

care of because they may still be stressed and may need continued support to keep functioning. Many more “walking wounded”

victims may present to the ED; that number may not be predictable. Giving staff the chance to eat and rest is important, but all

areas of the facility need that too. Although the Chief Medical Officer (CMO) may be involved in the incident, the CMO does not

determine when the hospital can “stand down.”