Emergency Planning and Response

Internal and external disasters are increasingly prevalent worldwide. Employers in healthcare facilities must ensure that their clients and the communities they serve receive appropriate treatment. To achieve this, they train their employees in how to respond effectively, ensuring that each individual understands their roles and responsibilities.

In this learning experience, learners receive instruction on planning for and responding to both internal and external disasters, as well as preparing for emergencies.

5.1 Internal Disasters

Internal disasters such as fires, utility failures, radiation contamination, workplace violence, bomb threats, terrorism and bioterrorism, are events that can occur within healthcare facilities and pose potential harm to occupants, including clients, employees, and visitors (Burke, 2023). These internal disasters encompass:

Fires (Burke, 2023)

During a fire, nurses should follow the RACE protocol:

1. Rescue: Prioritize the rescue of everyone in the healthcare facility as per the facility's plan. Evacuation may occur horizontally (moving clients from one floor to another) or vertically (relocating individuals within the same floor). It's essential not to use elevators, as they are needed by emergency personnel.
2. Alert: Pull the fire alarm to notify others.
3. Contain: Prevent the fire from spreading by closing doors and windows.
4. Extinguish: If the fire is small and can be safely put out, proceed to extinguish it.

The choice of fire extinguisher type depends on the materials involved in the fire (Burke, 2023):

• Type A: For solid materials like cloth, paper, and mattresses.
• Type B: Suitable for fires caused by grease, oils, and gasoline.
• Type C: Designed for electrical fires.
• Type AB: Effective for fires covered by Types A and B.
• Type ABC: Versatile and can extinguish all types of fires, making it the preferred choice.

To use a fire extinguisher, nurses should remember the acronym PASS (Burke, 2023):

• Pull: Pull the pin located on the fire extinguisher.
• Aim: Aim at the base of the fire.
• Squeeze: Squeeze the trigger to release the spray.
• Sweep: Sweep the spray back and forth across the fire's base until it is extinguished

This acronym, PASS, serves as a helpful tool for nurses when using a fire extinguisher.

Failure of Utilities

Healthcare facilities must have a contingency plan for unexpected power outages as they can impact crucial equipment that is used for client care, including mechanical ventilator, oxygen supply systems and suction devices. Additionally, communication devices such as client call bells, intercoms, telephones, computers, and fax machines may also be affected. To address these challenges, nurses can physically check on clients with mechanical bells for communication (Burke, 2023).

Radiation Contamination

Radiation contamination can occur due to deliberates acts of terrorists or by accidental incidents in specialized areas such as nuclear medicine departments. It is important to adhere to both the healthcare facility’s policy and that of the Centers for Disease Control and Prevention (CDC). The CDC recommends that exposed individuals leave the contaminated area, isolated any radiation-contaminated clothing by removing the outer layer and placing it in a plastic bag, shower or thoroughly wash any exposed areas, and utilize designated decontamination areas, often found in departments like the emergency or nuclear medicine department, for this purpose (Burke, 2023).

Violence in the Workplace

Incidents of workplace violence can involve employees, clients, and/or visitors. Nurses should strictly adhere to their facility’s policies when they observe behaviors that could potentially lead violence. Some effective interventions include de-escalation techniques and promptly calling security. Having security guards and surveillance cameras in place can act as deterrents to workplace violence.

Bomb Threat

If anyone receives a bomb threat by telephone, they promptly alert the relevant authorities while keeping the caller on the line and attentively listening for any sounds that might indicate the caller’s location. Remaining on the line also facilitates gender identification and helps determine the potential location of bomb detonation.

Terrorism and Bioterrorism

Terrorists deliberately and violently employ various weapons, methods, or biological agents to target both property and individuals. They may use weapons such as nuclear, radiologic, or chemicals, as well as means such as bombs or hijacked airlines. Biologic agents include diseases like smallpox, plague, botulism, anthrax, tularemia, and viral hemorrhagic fevers such as yellow fever and Ebola. The management of affected individuals generally depends on the type of microbe involved in the bioterrorism attack and includes sterilization, disinfection, isolation, and adherence to standard precautions. Examples of acts of terrorism include the Boston Marathon bombing and the World Trade Center attack (Burke, 2023).

5.2 External Disasters

External disasters are significant events, such as jumbo jet crash, that occur in the surrounding community and result in injuries to many individuals requiring medical treatment. Some examples of external (and internal) disasters include hurricanes, cyclones, tornadoes, and severe floods and storms. Hurricane Katrina serves as an illustration of both types of disasters (Burke, 2023).

Nurses play an active role in responding to external (and internal) disasters, necessitating their knowledge of adherence to their healthcare facilities' emergency preparedness response plans (Burke, 2023).

Nurses are responsible for triaging “mass casualties” based on the severity their injuries and their prognosis (Burke, 2023). During triage, color-coded tags are affixed to injured individuals, providing information to inform others regarding their level of illness and likelihood of survival (Burke, 2023; Kaplan Nursing, 2023). For example:

• Black tag: These individuals are likely to die from their severe traumatic injuries and receive supportive care and pain relief to ensure their comfort.
• Red tag: Persons with red tags, also referred to as the “immediate care group,” are unstable persons and could die without immediate medical treatment. They typically receive care first.
• Yellow tag: Individuals in this group can wait for treatment, usually up to 30 – 60 minutes. They are treated after the red-tagged group. Examples include individuals with eye injuries and moderate burns.
• Green tag: This group, also known as the “minimal care group,” has the least severe injuries and is treated after the other groups.

5.3 Prepare for Emergencies

Emergencies such as internal and external disasters are inevitable challenges for healthcare facilities. Consequently, they establish, review, implement, and revise emergency response plans to address these potential disasters, ensuring they can provide care for and protect their clients, visitors, and employees (Burke, 2023).

Some of the information contained in these plans is derived from mandates issued by the Joint Commission on the Accreditation of Health Care Organizations, the states in which the facilities are located, and the United States Government (Burke, 2023).

Nurses should actively participate in the work groups and committees responsible for creating these plans. They must also be prepared to educate other employees and clients, as well as to plan, implement, evaluate, and engage in drills (Burke, 2023). This includes the information discussed in the sections above.

Upon concluding this learning experience, learners will acquire a deeper understanding of how to plan and respond to both internal and external disasters and emergencies.

The resources provided will enable learners to gain proficiency in disaster and emergency planning and response. The main goals are to achieve success in both the NCLEX examination and in the workplace.

After reviewing the resources, identify areas for improvements and concentrate on addressing them.

• Burke, A. (2023, August 11). Emergency Response Plans: NCLEX-RN. https://www.registerednursing.org/nclex/emergency-response-plans/
• Kaplan Nursing. (2023). NCLEX-RN Content Review Guide: Preparation for the NCLEX-RN Examination (9th ed.). Kaplan Test Prep.

Readings

• U.S. Department of Labor. (n.d.). Emergency Preparedness and Response: Getting Started. https://www.osha.gov/emergency-preparedness/getting-started

Videos

• Healthier Workforce Center. (2020, September 22). An Introduction to Emergency Preparedness [Video]. YouTube. https://youtu.be/pXkOscAY8zk