Question

Pretend you are the first response team for the following disaster:

You are in a rural town. The tornado siren has gone off.   A tornado has gone through the town.  Many power lines are down, trees are uprooted and broken in half, and roads are totally blocked throughout the town by debris.  Police are working on setting up traffic diversions. You see minor and major damage to homes and business, crumbling brick, missing roofs, collapsed walls, and a fire hydrant is gushing water into the streets. The majority of the damage is on the edge of town.  The lone apartment building shows signs of severe structural damage, with partial collapse noted. There are victims scattered about, both inside and outside the building, some appear to have been thrown from the winds.  

You are the local emergency response team and your resources are limited. All of your crew has reported to the firehouse.  You have 2 ambulances and 6 people on your team of first responders including yourself.   Your team goes immediately to where the apartment building was.  

1. Identify what duties you would assign to your 6 people team.

2. What information do you need to communicate to the hospital that is 12 miles away?

3. Using the triage categories for emergency preparedness please identify triage categories for each of the victims and how you will treat each one of them. (ABC’s, also  D-Disability, E-Environment)

Victim	Category	Triage
1		Young adult male lying next to a collapsed brick wall, under heavy rubble.  His upper torso is exposed.  He is calling out  “help me”. His exposed skin is covered in dust, pale, diaphoretic.  His feet are exposed, there are no pulses palpable.  There is no visible blood.
2		32 y.o. male laying on rubble, weeping, upper body rocking. Lt. leg contorted in unnatural way, apparent tib-fib fracture, pulses.  No other injuries noted.
3		12 y.o. female sitting on rubble. Dust covering body. Crying, rubbing left side of head. Neuro’s intact.  All pulses palp.
4		Young adult female, appears to be lying on her back- a pipe is impaled into her Rt. chest. Appears in resp. distress, tachypneic, pale, diaphoretic.  Is speaking one word sentences.
5		A car is impaled into a tree. The victim is trapped inside appears to be folded, not able to identify sex. No carotid pulse palpable, agonal breathing, no other signs of life.
6		Young man rummaging through the rubble calling out for “Sammie”. Very anxious.  “Sammie, where are you?”  He is throwing debris all around.  Multiple small abrasions on face and upper ext.
7		Elderly person, trapped in the basement stairwell.  Appears to be saturated with water, uncontrollably shivering. No apparent blood. Appears alert & orientated.
8		8 yo male.  Covered in dust, audible wheeze noted.  C/O SOB, states has asthma.  Is speaking in full sentences.  Is Alert & orientated.  Tachycardic.
9		28 yo female, apparent head trauma – very lg. goose egg on left temple, multiple lacerations, not following directions.  Alert to self only.
10		20 yo female leaning against a tree, holding lt. arm across chest, shoulder appears dislocated. States “I’m ok”.  Pulses palpable.  Resp. easy. No blood noted.
11		Young male, covered in dust, alert, multiple abrasion noted on upper arms bil.,  pale, diaphoretic, screaming out, holding his upper  lt. thigh, the rest of the leg is trapped under a bathroom, bright red blood is noted .
12		Young male, covered in dust, raspy voice, tachypneic, SOB, Tachycardic, hypoxic, airway obstruction?

Category	Priority	Color	Typical Conditions
Immediate:  Injuries are life-threatening but survivable with minimal intervention.  Can progress rapidly to expectant if treatment is delayed	1	Red	Sucking chest wound, airway obstruction, shock, hemothorax, tension pneumothorax, asphyxia, unstable chest or abdominal wounds, incomplete amputations, open fractures of long bone 2nd/3rd degree burns 15-40% BSA
Delayed:  Injuries are significant and require medical care, but can wait hours without threat to life or limb.   Receive care only after immediate casualties are treated.	2	Yellow	Stable abdominal wounds without evidence of significant hemorrhage, soft tissue injuries, maxillofacial wounds without airway compromise, vascular injuries with adequate collateral circulation, GI tract disruption, fractures requiring open reduction, debridement, external fixation, most eye and injuries.
Minimal:  Injuries are minor and treatment can be delayed hours to days.  Move away from the main triage area	3	Green	Upper extremity fractures, minor burns, sprains, small lacerations without significant bleeding, behavioral disorders or psychological disturbances
Expectant:  Injuries extensive and chances of survival are unlikely even with definitive care.  Separate from other casualties but not abandoned.  Comfort measures should be provided when possible	4	Black	Unresponsive patients with penetrating head wounds, high spinal cord injuries, wounds involving multiple  anatomical sites and organs, 2nd/3rd degree burns > 60% BSA, seizures or vomiting within 24 hr after radiation exposure, profound shock with multiple injuries, agonal respirations, no pulse, no BP, pupils fixed and dilated.

4. Decide which people to transport to the local hospital, which ones to specialty hospitals and in which order they should be transported

5.

Your first job as an RN is in an emergency department.  Which of the following principles

    would alert you of a potential disaster situation (Select all that apply)  

___ An increase in disease incidence in a normally healthy population.

___ A large number of rapidly fatal cases, especially when death occurs within 72

      hours after hospital admission.
___ There is a cluster of patients presenting with the same unusual illness from a

       single location.

___ An unusual increase in the number of people seeking care for fever, respiratory,

       or GI symptoms.

Answer 1

1. Disaster is something which occurs suddenly and disaster preparedness and mitigation plays a very important role. The duties which is being assigned to the team of 6members would be like again making them into 3groups each containing 2. One group would evacuate the people. Other group would identify and categorise the people based on their severity of the injury and the other group provides first aid and communicates to the health care services.

2. The information to the hospital has to be conveyed as to receive many hands of help. The information which can be shared to the hospital which is 12miles apart is the present situation of the victims. How many are into each category. How many needs the immediate ambulatory service with treatment and what resources are available and Need of those including man power too.

3. The categorisation of people based on the trailer system are as follows :

1. Category of 1 red were he needs his immediate treatment as he is conscious and shouts for help and can be treated with proper monitoring.

2. Category red were by the patient has to be immobilised and taken care of.

3. Category 2 yellow she is fine and if she is delayed with treatment there is no issues in that.

4. Category 1 were by immediate evacuation and life saving procedures to be implemented.

5. Category 4 black were by the person is not in a stage to be assessed and if assessed too will not gain the life.

6. Category 3 Green the injuries are very minor and can be treated very late and not threatening the life.

7. Category 1 to be treated immediately as he is very old person were by he may go for hypothermia with decrease in vitals.

8. Category 1 red requires immediate support in breathing airway and to be treated immediately.

9. Category 1 as person oriented to only self and not the environment and to be treated immediately.

10. Category 2 dislocation present immobilisation to be done immediately but not threatening the life.

11. Category 1 to be rescued out of the brick to prevent bleeding g and Compression of the bones.

12. Category red 1 immediately to be treated.

4. To the local hospital victims3, 6,7,9,10,

To the speciality hospital 1,2,4, 8,11,12 they must be transferred with necessary first aid and ambulatory services.

5. When there is cluster of patients with same illness.