MC- NURSES ROLE IN EXTERNAL DISASTER EMERGENCY

PREPAREDNESS
NURSING EDUCATION DEPARTMENT (NEU)
CONTENTS
• Introduction
• Disaster Preparedness Plan
• Triage Area
• Triage Zones
• Triage System
• Conclusion
• Post Test

ADHUM GENERAL HOSPITAL JEDDAH

MINISTRY OF HEALTH
KINGDOM OF SAUDI ARABIA
DISASTER ???
Definition Of Disaster

Any events in which the need

exceed capacity.

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Type Of Disaster

Rapid
onset
Chemical Terrorist Plane Cras
Volcano Flood Cyclone h
Earth qu Spill Attack
ake ‫براكين‬ ‫فياضانات‬ ‫زوبعة‬
‫تسرب كيميائي‬ ‫هجمات إرهابية‬ ‫تحطم طائرة‬
‫زالزل‬
onset
Slow

Famine Epidemic Civil unrest

Drought War
‫مجاعة‬ ‫وباء‬ ‫اضطرابات‬
‫جفاف‬ ‫حروب‬
‫مدنية‬

Natural Manmade

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CODE

Emergency Code Nomenclature

‫الكود المستخدم في حاالت الطوارئ‬

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CONTENTS
• Introduction
• Disaster Preparedness Plan
• Triage Area
• Triage Zones
• Triage System
• Conclusion
• Post Test

ADHUM GENERAL HOSPITAL JEDDAH

MINISTRY OF HEALTH
KINGDOM OF SAUDI ARABIA
 ADHUM GENERAL HOSPITAL JEDDAH
MINISTRY OF HEALTH
KINGDOM OF SAUDI ARABIA

NURSES ROLE IN EXTERNAL

DISASTER PREPAREDNESS
( CODE YELLOW )

PRESENTED BY :
MS. KATHERINE DAVID BALTAZAR
NURSING EDUCATION DEPARTMENT
 EXTERNAL EMERGENCY DISASTER

• -Is any event (disaster) occurring

outside the hospital parameter that
produces victims in numbers, and types
of injuries, that threaten to overwhelm the
hospital’s normal response capacity.
 EXTERNAL EMERGENCY PREPAREDNESS PLAN

• Is a plan that has been developed to facilitate a

smooth coordinated response to foreseeable
disaster situations. It incorporates emergency
responses and procedures.
Disaster Management
• All staff shall have
• Quick & Effective action periodic training
• Having plans in place • Life safety procedures
• Delayed of response and devices
• Fire Alarm
Planning
Training

Element to Success in
Disaster Management

Monitor and Simulated

• Monitor and control Evaluation Drill • For all staff
progress • To familiarize facility
• Ensuring adherence to • Test the efficiency,
project knowledge and
• Adjustments response

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EXTERNAL DISASTER
PREPAREDNESS PLAN

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External Disaster CODE

WHAT IS THE CODE USING FOR EXTERNAL DISASTER

??????

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External Disaster CODE

WHAT IS THE CODE USING FOR EXTERNAL DISASTER

??????

Code Yellow (External disaster)

)‫ألصفر (كوارث خارجية‬V‫ا‬
Code Yellow alert

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Plan Activation

• Activation By Hospital Director or his designee.

• EIC will take over if hospital director/deputy not
around
• Three times announcement of

CODE YELLOW ALERT

CODE YELLOW

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 DISASTER STATUS
ALERT
-The threat is either potential, not near, or not large.
LIMITED DISASTER
-The threat is confirmed to be an estimate of

10-15 critical cases ( RED AND YELLOW TRIAGED).

DISASTER STATUS........
FULL DISASTER
-The threat is confirmed to be an estimate of
15-20 critical cases ( red and yellow
triaged ), which have a major disruption of
most AGH operations.
 ACTIVATION OF EXTERNAL DISASTER
• When central operator receive a call from
police or civil defense there is a disaster in a
certain place, so we are expecting large number
of patients to come in our hospital brought from
disaster scene.
 ACTIVATION OF EXTERNAL DISASTER
ACTION CARD COLOR CODING
External action cards are kept in Incident commander room,
distribution of action cards will be done by chiefs to their
members.
HCC- Hospital Command Center
The main control room in the event of disasters and crises
meet heads of departments approved by the organizational
structure of the HICS organization for communication and
decision-making and conduct internal and external activities

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TRIAGE AREA
EXTERNAL DISASTER AREAS (LOCATION , TEAM /STAFFING & RESPONSIBILITIES)
 TRIAGE AREA (WHITE AREA)
LOCATION: In front of STAFF ENTRANCE.
TRIAGE:
• - comes from the French word “TRIER”
meaning “TO SORT” is used to determine
those patients in need of immediate
treatment and those who can safely wait.
 Disaster Triage

Aim of Triage
Greatest Good for the Greatest Number
Medical Councils often force us to deal with an overwhelming situation where there are
perhaps limited resources, supplies, and personnel. So, we have to be able to provide
the best care to the most appropriate patients that have a chance of surviving.

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 Disaster Triage

Aim of Triage
To do the best for the most using the
least

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Disaster Triage

Golden Hour…

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 Disaster Triage

Daily
Emergencies Do the best for each individual

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 TEAM/STAFFING
• The Disaster Response Coordinator as appointed by
the Command Center, will serve as the TEAM LEADER
(ER DIRECTOR).
• E.R Staff Nurses.
• ER Consultant, 2 Surgical Registrars.
• Admission Clerks(2).
 OBJECTIVE
• 1. To classify different illness and injuries.
• 2. To ensure proper management of the emergency.
• 3. To prioritizing those in need of immediate treatment

( tag )
• 4. To stabilize and provide critical treatment and prompt
transfer to appropriate sitting
• ( ICU, OR, General Unit).
TRIAGE TEAM RESPONSIBILITIES:
• 1. The triage team will assess all external disaster
casualties and will direct them to appropriate
treatment zone.
• 2. Minimal First Aid will be administered in the
triage area.
• 3. The triage team will have absolute authority for
assessing sorting and assignment of cases.
 NURSES RESPONSIBILITY IN TRIAGE AREA:
• Assisting patients upon arrival of ambulance in front of triage
area. The Triage Team will assess all external disaster
casualties and will direct them to the appropriate treatment
zone.
• A level of priority of care.
• Ensuring that the more seriously ill are treated first.
(assessing, sorting and proper assignment of casualties).
• Monitor evacuation of casualties efficiently, rapidly, and
safely.
 NURSES RESPONSIBILITY IN TRIAGE AREA:

• Ensure proper tagging of casualties.

 NURSES RESPONSIBILITY IN TRIAGE AREA:

• No procedures will be administered in the Triage

area unless (ABC) is threatened.
CONTENTS
• Introduction
• Disaster Preparedness Plan
• Triage Area
• Triage Zones
• Triage System
• Conclusion
• Post Test

ADHUM GENERAL HOSPITAL JEDDAH

MINISTRY OF HEALTH
KINGDOM OF SAUDI ARABIA
ZONES

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 External Disaster Triage Area

Red Zone

Yellow Zone

Green Zone

Black Zone

Holding Area

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 Casualties will be assigned to the following zones

• Immediate life threating condition

Red Zone • Urgent and aggressive resuscitation 2+1
• Injuries with no immediate threat to life or limb
Yellow Zone • Stable with replacement therapy and close care 2
• Cases with minor or superficial wounds
Green Zone • Behavioral disorders 2
Black Zone • Pronounced dead
1
• Receive evacuated pt. safely and maintain continues care
Holding Area • Establish proper transportation 2
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 RED
ZONE
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RED ZONE (PRIORITY ONE)
• LOCATION EMERGENCY (PRIORITY I AREA)

CPR ROOM.
RED TRIAGE- IMMEDIATE CARE CASUALTIES WHOSE CONDITIONS IS
CRITICAL AND WHOSE CARE CANNOT WAIT.
• HEAD INJURIES
• SEVERE BURNS
• SEVERE BLEEDING
• HEART ATTACK
• BREATHING IMPAIRED
• INTERNAL INJURIES
 RED ZONE
( LIFE THREATENING CONDITION).
• Immediate Care - casualties whose condition
is critical and whose care cannot wait. They
are the first priority for transportation from the
scene and first to receive care on arrival.
TEAM/STAFFING
• General Surgeon (Team Leader).
• Anesthetist
• Internal Medicine Consultant
• Orthopedic Consultant or Specialist
• Pharmacist (1) (outside with cart).
• Nurses (3) (Including nursing supervisor).
• X-Ray Technician (1)
• Clerk/Translator (1)
• Housekeeping (2)
 NURSES RESPONSIBILITIES IN RED ZONE AREA:
• Use the ATLS & ACLS approach in the assessment and management of
critically ill/injured patients and to maximize the number of survivors.
• To provide immediate attention to the ABCDE’s of resuscitation.
• To identify and prioritize the treatment of life threatening conditions.
• To ensure rapid and efficient definitive care.
• To ensure safe and rapid transfer of patients to the ICU or operating room.
• To ensure transfer of mis-triaged patients to the Yellow and Green
Treatment Zones.
• To coordinate actions with Team Leader.
 NOTE:
• Casualties pronounced dead after
resuscitation should quickly be move into the
black Zone to make room for newer casualties.
Delays in removing dead bodies causes delay
in action and saving lives.
YELLOW
ZONE
 YELLOW TRIAGED-(PRIORITY II)
DELAYED CARE-CASUALTIES WHO REQUIRE HOSPITAL CARE BUT CAN
WAIT UNTIL ALL THE RED TRIAGED VICTIMS ARE DEALT WITH.

• There is no threaten to the life

• Need medical intervention within few hours

LOCATION:YELLOW TRIAGE- MINOR ROOM
 TEAM/STAFFING
• Consultant General Surgeon (Team Leader).
• E.R Residents (2)
• Internal Medicine Consultant
• Pediatric Resident
• Nurses (2)
• Internal Medical Resident (2)
• E.R Residents (3)
 NURSES RESPONSIBILITIES IN YELLOW ZONE .
• The team’s responsibility is to save lives and minimize disability through the
ACLS systematic approach ABCDE’s of Emergency assessment and
management of casualties.
• Identify & prioritize the treatment of life threatening injuries.
• Ensure rapid and efficient definitive care.
• To ensure safe and rapid transfer of patients to the operating room, ICU, or
ward.
• To ensure transfer of mis-triaged patients to the Red and Green Treatment
Zones.
• Complete rapidly and efficiently all clerical work, including the Disaster
admission File.
• To coordinate actions through Team Leader.
GREEN
ZONE
 GREEN ZONE (PRIORITY III)
MALE & FEMALE OBSERVATION ROOM
.

-CASUALTIES WHO HAVE MINOR INJURIES

WHOSE CARE CAN WAIT WITH A PROLONGED
TIME.
 TEAM/STAFFING
• The E.R residents.
• Staff Nurses (2).
• Admission Clerks (2)
• 2 Porters.
 NURSES RESPONSIBILITIES IN GREEN ZONE AREA:

• Provide First Aid for patients and arrange for Discharge process.
• Perform secondary triage on all external disaster casualties who
have been triaged & directed to the green Zone.
• Administer First aid measures.
• Monitor evacuation of casualties efficiently, rapidly, and safely.
• Ensure that the “Disaster Admission File” of the casualties has
been rapidly & efficiently completed.
BLACK
ZONE
8.15 BLACK ZONE- ISOLATION ROOM ER
(0 PRIORITY).
• Victims who are dead at the scene
or on arrival but make sure of
death before assign them as dead.
 TEAM/STAFFING
• Medical Resident (1)
• Staff Nurses (1)
• Porters (2)
• Security Officers (2)
• Admission Clerk (1)
NURSES RESPONSIBILITIES IN
BLACK ZONE AREA.

• To receive casualties who die on route to AGH or

disaster area.
• Final ECG prior to the declaration of death.
• To retain all casualties until all administrative
steps have been completed.
HOLDING AREA:- INFRONT OF OPD
 Code Green
• Once a disaster has been declared, all staff will
remain on duty until released by their immediate
supervisor.
• Disaster preparedness is the responsibility of all
hospital staff.
So be ready to save life.
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REFERENCES
• Adhum General Hospital Policy and Procedure in External
Emergency Preparedness Plan.
Code Number: IPP-FMS-038 , Page:1-11
• EMERGENCY COURSE FOR NURSES , Emergency and Crisis
Administration ,Supervisor of Emergency Plans Deputy , Jeddah

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