Which action would the nurse think should be excluded to prevent staff from having posttraumatic stress disorder (PTSD) during a mass casualty assessment? Show
To work continuously without any breaks Working continuously without any breaks will result in increased stress. Working less than 12 hours may reduce stress. By motivating team members, posttraumatic stress disorder can be prevented. By discussing feelings with team members or nurse managers, stress can be reduced. Clients in which class are given a yellow tag according to the disaster triage tag system? Class II Class II clients may have major injuries. Though they have major injuries, they can wait a short time for treatment. They are issued a yellow tag according to the disaster triage tag system. Class III clients are nonurgent clients with minor injuries that do not require immediate treatment. Thus they are given green tags. Class I clients are emergent clients. They require immediate treatment and are identified with red tags. Class IV clients are expected to die and they are issued black tags. Which color tag should be given to "walking wounded" clients according to the disaster triage tag system? Green Green tagged clients are referred to as "walking wounded" because they may evacuate themselves from the mass casualty scene and go to the hospital in a private vehicle. Clients with life-threatening conditions that need immediate treatment are given red tags. Black-tagged clients are expected to die or may be dead. Clients with major injuries are tagged with yellow. They may require urgent treatment but can wait a short time for care as injuries are not life threatening. A hospital is implementing a Hospital Incident Command System (HICS) for a disaster preparedness plan for the entire health system. Which resource can the staff educators use to assist with the education of health care providers who
work within the system? Federal Emergency Management Administration (FEMA) FEMA offers free courses on the NIMS model and HICS structure through their website (www.training.fema.gov/IS/). CMS requires a certain number of drills per year to be in compliance with their disaster preparedness mandates. OSHA does not provide education for the implementation of a disaster preparedness plan on the hospital level. Clients with which tag are referred to as "walking wounded" clients while managing a disaster? Green Clients who sustained minor injuries during a disaster and can evacuate themselves are referred to as walking wounded clients and they are green-tagged. Red tags are given to clients who have immediate threats to the life and should be treated immediately. Black tags are given the clients who are not expected to live or are dead. Yellow tags are given to clients who sustained major injuries and need treatment within 30 minutes to 2 hours. Which colors are often included in an organizational disaster plan for use
during triage? Select all that apply. Red Colors that are often used for triage purposes in an organizational disaster plan include red, black, green, yellow, and blue. White is not a color that is used during the triage process. Which statement by the nurse is true regarding mass casualty events related to
disasters? "They may require the association of multiple agencies and healthcare facilities to handle the crisis." A mass casualty event overwhelms local medical capabilities and may require the collaboration of multiple agencies and healthcare facilities to handle the disaster. Multi-casualty events can be managed by the hospital using local resources. An internal disaster is an event that occurs inside a healthcare facility or campus that could endanger the safety of clients or staff. An external disaster is an event outside the healthcare facility or campus, somewhere in the community, that may require the activation of the facility's emergency management plan. Which intervention is a part of the response phase of disaster planning? Implementing the disaster plan The response phase of disaster management deals with the implementation of the disaster plan. The recovery phase of disaster management involves stabilizing the community. Mitigation focuses on limiting the impact of a disaster. The last phase of disaster management focuses on evaluation of the plan. How often should a healthcare facility that is Joint Commission accredited plan to test the emergency preparedness
plan? Twice a year The Joint Commission mandates that hospitals have an emergency preparedness plan that is tested through drills or actual participation in a real event at least twice yearly. Annually or every 2 years is not frequent enough to test the emergency preparedness plan. It is not necessary to test the plan as frequently as every three months. Which clients belong to class I according to the disaster triage tag system? Clients who need emergency treatment Emergent clients are identified with red tags and belong to class I according to the disaster triage tag system. Clients who can wait a short time for treatment are identified by yellow tags and belong to class II according to the disaster triage tag system. Clients who are expected to die or are dead are given a black tag and belong to class IV in the disaster triage tag system. Clients who have no urgency for treatment are issued green tags and belong to class III. Which injuries would likely be given a green tag after a disaster? Select all
that apply. Strains According to the disaster triage tag system, green tags are applied to clients with strains, sprains, and abrasions. Clients with shock and airway obstruction are marked with red tags according to the disaster triage tag system. Which disaster event involves an internal
disaster compounded with an external disaster? St. John's Regional Medical Center in Joplin, MO An internal disaster is an event inside a healthcare facility that could endanger the safety of clients or staff. St. John's Regional Medical Center in Joplin experienced an internal disaster compounding an external disaster when it was directly hit by an EF-5 tornado. A large part of the town was destroyed (external disaster) and 6 people inside the hospital died (internal disaster). The fertilizer plant explosion in Texas, the 9/11 World Trade Center terrorist attack, and the Cocoanut Grove nightclub fire in Boston are external disasters. An external disaster is an event outside a healthcare facility Which
is the function of the medical command physician according to the Emergency Preparedness and Response Plan? Deciding the number, acuity, and resource needs of clients The function of the medical command physician, according to the Emergency Preparedness and Preparedness Plan, is deciding the number, acuity, and resource needs of clients. The function of the community relations or public information officer is serving as a liaison between the healthcare facility and the media. The function of the hospital incident commander is assuming overall leadership for implementing the emergency plan. The function of the triage officer is evaluating each client rapidly to determine priorities for treatment. Which emergency medical service (EMS) healthcare professional provides advanced life support to the clients who survived a large-scale disaster? Paramedics Paramedics provide advanced life support such as cardiac monitoring and establishing intravenous access to the clients who survived a large-scale disaster. A triage officer rapidly evaluates each client to determine priorities for treatment. Prehospital care providers are the first caregivers that clients see before transport to the ED by an ambulance or helicopter. Emergency medical technicians provide basic life support interventions such as oxygen and basic wound care to the clients who survived large-scale disaster. What does the nurse
understand to be the role of emergency medical technicians (EMTs) in emergency nursing after a disaster? To monitor vital signs EMTs offer basic life support interventions that include monitoring vital signs. Paramedics are advanced life support care providers that perform advanced techniques such as providing intubation, establishing IV access, and performing advanced airway management. Which would the nurse state is an example of a natural disaster? Floods External disasters can be natural, such as floods, earthquakes, or tornadoes. Acts of terrorism are external disasters that use technology such as explosive devices or a malfunction of a nuclear reactor. A fire explosion is an internal disaster. A building collapse is a consequence of internal or external disaster. The victims of a terrorist attack involving sarin are brought to the emergency department. Which statement does the nurse know to be true regarding the characteristics of sarin? Sarin can cause death within minutes of exposure. Sarin is a highly toxic nerve gas that can cause death within minutes of exposure. Mustard gas causes skin burns and blisters. A garlic-like odor and brown color are characteristics of mustard gas. While pralidoxime chloride (2-PAM chloride) is used as an antidote for nerve agent poisoning, multiple doses may be needed to reverse the effects of nerve agents; also, sarin acts by paralyzing the respiratory muscles. A triage nurse assigns a green tag to a client during triage after a mass casualty event. Which statement is true about the client's injuries? The client has minor injuries that do not require immediate treatment. The green tag is assigned to the client who has minor injuries that do not require immediate treatment. The client who is expected and allowed to die will be given a black tag. The client who has an immediate threat to life will be given a red tag. The client who has major injuries that require treatment is given a yellow tag. A group of bomb blast victims needs to be transported to the hospital immediately. Which staff members of an emergency unit are most appropriate to handle this situation? Prehospital care providers Prehospital care providers are the first caregivers who provide transport to the emergency department by ambulance or helicopter for clients in an emergency situation. Triage officers are responsible for evaluating each client to determine priorities for treatment. The medical command physician decides the number, acuity, and resource needs of clients. Emergency medicine physicians have specialized education and training in emergency client management. The
nurse is assessing four clients who were injured in a mass casualty event. Which client does the nurse plan to treat first according to the disaster triage tag system? Client belonging to class I Class I clients are emergent clients who are marked with red tag. These clients have an immediate threat to life and need attention first. Class II clients have major injuries and need treatment within 30 minutes to 2 hours. Class III clients have minor injuries and can be treated in a delayed manner. Class IV clients are those who are expected to die or are dead. Which health care team member is a first responder when an emergency or mass casualty incident (MCI) occurs? Critical care nurse Critical care nurses are often considered emergency medical personnel that respond to emergency or MCIs. Firemen and police officers are first responders but are not members of the health care team. Unlicensed assistive personnel are not first responders. The nurse is reassessing level of consciousness and mental status in a client who
survived a fire. Which type of emergency assessment of the trauma client is the nurse performing? Disability Reassessing the level of consciousness and mental status in a client would provide baseline assessment of neurologic status, which is an aspect of emergency assessment of disability performed in a primary survey as a life-saving intervention. Emergency assessment of the airway is performed to assess respiratory distress, bleeding, and edema. Emergency assessment of breathing is performed to assess normal airway passage, tension pneumothorax, or the need for mechanical ventilation. Assessing the full set of vital signs involves monitoring temperature, heart rate and, respiratory rate. What services can be provided by level II trauma care centers during mass causality events? Provide care to most injured clients. Level II trauma centers are community-based trauma centers that can provide most trauma care to clients. Level III trauma centers can provide care up to the stabilization of clients. A full continuum of trauma services for all clients is provided in Level I trauma centers. Basic trauma client stabilization and advanced life support are provided in Level IV trauma centers. Which disaster can be categorized as an internal disaster? Explosion in a hospital An internal disaster is any event inside a health care facility or campus that could endanger the safety of clients or staff. An explosion inside a hospital is an example of internal disaster. A hurricane, earthquake, or flooding in a town, all occurring out of the hospital setting but requiring an emergency management plan from the hospital, can be categorized as external disasters. In a mass casualty situation, which is the facility-level organizational model for disaster management
used by the hospital or long-term care facility? Hospital Incident Command System (HICS) The facility-level organizational model for disaster management is the Hospital Incident Command System (HICS). It attempts to standardize disaster operations by formally structuring roles under the hospital or long-term care facility incident commander with clear lines of authority and accountability for specific resources. The EOC, NIMS, and FEMA are not facility-level organizational models for disaster management. The EOC is established by the HICS personnel in a designated location with accessible communication technology to manage the overall incident. The NIMS is the overall system for incident management of which the HICS is a part; it is implemented by the Department of Homeland Security and FEMA. The FEMA provides numerous online resources so that people are better prepared for disasters and are able to respond more self-sufficiently to incidents and hazard situations in their own communities. Which phase in the disaster management continuum does the nurse understand as including the attempt to limit a disaster's impact on human health and community
function? Mitigation There are five phases in the disaster management continuum, which include preparedness, mitigation, response, recovery, and evaluation. In mitigation, there will be plans for attempting to limit a disaster's impact on human health and community function. Recovery includes focusing on stabilizing the community and returning it to the previous status. Response includes implementation of the disaster plan. Preparedness is the preparation of a protective plan that is designed before the event has occurred. A client who survived an explosion was found with moist blebs and blisters on the skin with cherry red color. The client is having severe pain. After assessing, the nurse finds the skin is hypersensitive to touch or air. Which condition can be suspected in the client? Second-degree burn Characteristic findings of a second-degree burn are moist blebs and blisters in the skin. The skin appears as a mottled white, pink to cherry-red colour. The skin is also hypersensitive to touch or air and there may be moderate to severe pain. The assessments of first-degree burn are redness, pain, moderate to severe tenderness, and minimal edema. In third and fourth-degree burns there is a dry, leathery eschar on the skin. The skin appears as waxy white, dark brown, or charred. The skin becomes insensitive to touch. Several nurses from Pennsylvania who are members of a disaster medical assistance team (DMAT) are being sent to South Carolina to provide healthcare to hurricane victims. What action is required prior to these nurses providing care? None since the nurses are acting as federal employees Because licensed healthcare providers such as nurses act as federal employees when they are deployed, their professional licenses are recognized and valid in all states. There is no need for the nurses to apply for licensure in South Carolina, show Pennsylvania license, or call the National Council for the State Board of Nursing to request licensure. The first responders rescue and bring submersion victims of a natural disaster to the emergency department. Which is an appropriate intervention for treating clients with submersion injuries? Stabilize or immobilize cervical spine in all near-drowning victims The nurse should assume cervical spine injury in all near-drowning victims and stabilize or immobilize the victim's cervical spine. The nurse should insert a gastric tube and urinary catheter as an initial intervention for a submersion victim. The nurse should anticipate the need for intubation and mechanical ventilation if the airway is compromised, such as if the gag reflex is absent; intubation and mechanical ventilation need not be provided immediately to all clients if not required. While the client should be warmed if needed, the nurse needs to monitor the client's temperature and maintain normothermia. The nurse is helping a triage officer
evaluate the victims of a large scale disaster. Which client does the nurse anticipate will be given a black tag? A client with extensive full-thickness body burns The nurse is caring for the victims of a terrorist attack involving explosive devices. Which type of damage is most likely caused by a crush injury? Blunt trauma to the head Crush injuries often result from explosions in confined spaces causing structural collapse, such as falling debris. Blunt trauma to the head is an example of a crush injury. Middle ear injury is a common type of blast injury that results from the supersonic over pressurization shock wave caused by the explosion. Some explosive devices contain materials that are projected during the explosion, leading to penetrating injuries. Shrapnel injury in the abdomen is a type of penetrating injury. Lung damage due to a shock wave is a type of blast injury. A client rescued from a fire was found unconscious and having difficulty breathing. Which team should the nurse consider to be responsible for the treatment of this client? Paramedics An unconscious client who is unable to breathe may require intubation. Paramedics are the advanced life support (ALS) providers who can perform advanced techniques that include cardiac monitoring, advanced airway management, and intubation. Prehospital care providers are the first caregivers who provide preliminary care in an ambulance or a helicopter before the client is admitted to the emergency department. Emergency medicine physicians have special education and training in emergency client management. EMTs are responsible for providing the basic life support interventions such as oxygen, basic wound care, monitoring of vital signs, etc. In a health care system, the nurse is planning management of a disaster that involves second order change. Which type of change would characterize this disaster? Select all that
apply. Revolutionary and episodic change A second order change is an unanticipated or unexpected change that may occur as a result of disaster in a health care system. Second order change is revolutionary and episodic and requires radical adjustments in a person or in the structure of the system. First order change involves harmony with people or systems. This type of change is evolutionary with continuous improvement and includes small ongoing steps to make things better to sustain the change. Which internal
disaster may create a need for evacuation or relocation of clients? Gas explosion A gas explosion is an internal disaster that creates a need for evacuation or relocation. A hurricane or earthquake are natural disasters and are external. The use of explosive devices for a terrorist attack is also an external disaster.
Which statement by the registered nurse is true regarding the mitigation phase of disaster management? It is a process of minimizing of the disaster's influence on human health and community. The process of minimizing the disaster's influence on human health and community is the mitigation phase. Identifying potential risks due to the disaster is the preparedness phase of disaster management. The process of assisting clients to regain a normal level of functioning is the response phase. The process of combating a disaster event and providing assistance to victims is the recovery phase. Triage officers are tagging clients with disaster triage tags at the site of an earthquake. Which client's tag requires replacement? C closed tibial fracture black tag Clients with closed fractures may be given green disaster triage tags. Therefore the black tag on client with a closed tibial fracture should be replaced with a green tag. The client with a closed femur fracture has correctly been given a green tag. Clients with life-threatening conditions such as airway obstruction or shock are applied with red disaster triage tags. Therefore the client B is correctly given a red tag. Clients with open fractures with a distal pulse are given yellow tags. Therefore, the client D is correctly tagged. Community
members have received mailed notices asking them to come to different healthcare agencies within the community at the same time on the upcoming Saturday afternoon. What is the purpose of asking community members to perform this task? Test the emergency preparedness plan The Joint Commission mandates that hospitals have an emergency preparedness plan that is tested through drills. One of the drills or events must involve communitywide resources and an influx of actual or simulated clients to assess the ability of collaborative efforts and command structures. Asking community members to come to healthcare agencies in the community at the same time is testing the emergency preparedness plan through simulating a disastrous event. The mailed notice was not sent to determine if community members can read, measure the effectiveness of mailed communication, or to identify community members who do not work weekends. What areas should the nurse keep in mind when participating in the planning of an organization's emergency preparedness plan? Select all that apply. Needs for security Before an event, nurses contribute to the development of emergency response plans to include security needs, staffing for surge situations, methods of communication, and defining specific nursing roles. Activation of telephone trees would occur during an actual disaster. The nurse is a member of the critical incident stress management unit that looks to meet the psychosocial needs of first responders after a mass casualty incident. Which action by the nurse is appropriate when conducting a session? Arranging group discussion Many hospitals and DMATs have a critical incident stress management unit, which arranges group discussions to allow participants to share and validate their feelings and emotions about the experience. This is important for emotional recovery. The nurse does not administer antianxiety medications to the participants, schedule individual therapy appointments, or document individual responses to the group session. The terrorist
attack event on the World Trade Center on September 11, 2001, resulted in mass casualties that led to changes in hospital and community disaster planning efforts. What would the nurse say was the impact of this technological external disaster on the emergency medical services (EMS) for improving the safety of the public? Select all that apply. Providing routine training to facility staff about hazardous materials The technological external disaster event of September 11, 2001 and the resulting focus on terror threats had a great impact on the disaster planning efforts for improving the safety of the public. Emergency medical services (EMS) agencies and hospitals improved safety by providing routine training to staff about hazardous materials handling. Upgrades were made to decontamination facilities and equipment to protect staff. Approaches were designed to make the staff prepared for nuclear, biologic, and chemical (NBC) threats. Preparedness of healthcare facilities for pandemic infections resulted more from natural external disasters, such as Hurricane Katrina. Unfortunately, there still have not been sufficient structural changes that would offer protection from utility failures. A nurse on the disaster management team is caring for survivors of an earthquake. The nurse understands that some
survivors may have chest trauma and may need a needle decompression to relieve the air or fluid trapped in the chest. Following the initial assessment, which client would the nurse treat first? Client C with cyanosis, air hunger, violent agitation, tracheal deviation away from affected side The assessment findings of cyanosis, air hunger, violent agitation, and tracheal deviation away from affected side indicates tension pneumothorax. This is a medical emergency and intervening by needle decompression is appropriate. Muffled, distant heart sounds and neck vein distention indicates cardiac tamponade; pericardiocentesis with surgical repair may be appropriate. Paradoxic movement of chest wall and respiratory distress indicates flail chest. Stabilizing flail segment with positive pressure ventilation is appropriate. Hyperresonance to percussion and diminished or absent breath sounds on the affected side indicates pneumothorax. The treatment for this includes chest tube insertion with a flutter valve or chest drainage system. After a hurricane, the nurse is assessing the response of a client to stimuli on the Glasgow Coma Scale (GCS) as a part of the primary survey. The nurse observes that the client opens his eyes when his name is stated, uses disorganized words, and is unable to follow commands, but attempts to remove the offending stimulus. What is the Glasgow coma score for this client? Record your answer using a whole number.____________ 11 Glasgow scale (GCS) is used by the nurse to conduct neurologic assessment as a part of primary survey. It is performed to determine the client's response to verbal and/or painful stimuli in order to assess the level of consciousness and degree of disability. A score of 3 is given when the client opens the eyes when the name is stated. If disorganized use of words is present, a score of 3 is given. A score of 5 is given when there is a lack of obedience but attempts to remove the offending stimulus. Therefore the client's GCS score would be 3+3+5= 11. After an earthquake, there were a large number of deaths and casualties who required acute care for several days in the field. Which teams activated by state and federal government authorities would the nurse consider to be the most suitable in managing the event? Select all that apply. Medical Reserve Corps (MRC) State and federal government authorities can activate teams such as MRC and the National Disaster Management System (NDMS) that include DMAT, NVRT, DMORT, and IMSRT. MRC may set up an acute care center (ACC) in the community for clients who need acute care for days to weeks. DMORTs are effective in managing mass fatalities. DMAT is deployed with enough medical equipment and supplies to sustain operations only for 72 hours, so it may not provide acute care to clients for several days. NVRT mainly focuses on providing emergency animal care. IMSuRT establishes fully functional field surgical facilities during disaster events that may not be suitable in this scenario. Which order would clients receive care based on triage tag color?RED: (Immediate) severe injuries but high potential for survival with treatment; taken to collection point first. YELLOW: (Delayed) serious injuries but not immediately life-threatening. GREEN: (Walking wounded) minor injuries.
Which client would be triaged first based on condition?Triage categories
Highest priority is given to clients who have life-threatening injuries but also have a high possibility of survival once they are stabilized. Second-highest priority is given to clients who have major injuries that are not yet life-threatening and can usually wait 30 minutes to 2 hours for treatment.
In which order from the most to the least urgent would the emergency department nurse triage clients based on the clients conditions?The triage registered nurse might assign you a priority level based on your medical history and current condition according to the following scale: Level 1 – Resuscitation (immediate life-saving intervention); Level 2 – Emergency; Level 3 – Urgent; Level 4 – Semi-urgent; Level 5 – Non-urgent.
Which client should be treated first according to the disaster triage tagging system quizlet?Which client does the nurse plan to treat first according to the disaster triage tag system? Class I clients are emergent clients who are marked with red tag. These clients have an immediate threat to life and need attention first.
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In which order would Clients receive care based on triage tag color quizlet?
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