Emergency Room, Nursing Level IV

1. Asst. Prof. IV - ULYSSES T. ABELLANA RN, MN
LECTURER

2. AMBULANCE
AMBULANCE

6.  At the end of the ER lecture discussion, the
students will be able
1. Define and explain emergency care nursing.
2. Identify the different functional requirements
of an ER department.
3. States the legal aspects involved in various
emergency situation.
4. Explain the principles of ER care.
5. Discuss the process of assessment in various
emergency situations.
6. Utilize the nursing process in the care of
patients in emergency situation.

7. 7. Formulate appropriate nursing diagnosis as
to priority.
8. Evaluate outcome of the nursing care goals
for each situation.
9. Define disaster.
10. Describe examples of natural and manmade
disasters attack.
11. Describe the different phases of a disaster.
12. Describe the nurse’s role in managing the
disaster victims.
13. Compare the reactions of children and the
elderly as disaster victims.

8. 14. Discuss the role of the nurse in primary,
secondary and tertiary care.
15. Define and explain triage system.
16. Apply principles of triage to select situations.
17. Define biological warfare.
18. Identify biological agents.
19. Discuss the different causes of disaster.
20. Describe the principles of disaster
management.
21. Discuss the nursing management of victims
with Post Traumatic Stress Disorder.

9. EMERGENCY NURSING is a nursing specialty in
which nurses care for patients in the emergency
or critical phase of their illness or injury.
While this is common to many nursing specialties,
the key difference is that an emergency nurse is
skilled at dealing with people in the phase
when a diagnosis has not been made and the
cause of the problem is not known.
EMERGENCY MANAGEMENT refers to care to
patients with urgent and critical needs.
EMERGENCY DEPARTMENT often the first
place where people go to seek for help.

10. An emergency is a situation that poses an immediate
risk to health, life, property or environment. Most
emergencies require urgent intervention to prevent a
worsening of the situation, although in some
situations, mitigation may not be possible and agencies
may only be able to offer palliative care for the
aftermath.
The precise definition of an emergency, the agencies
involved and the procedures used, vary by jurisdiction,
and this is usually set by the government, whose
agencies (emergency services) are responsible for
emergency planning and management.

11. In order to be defined as an emergency, the
incident should be one of the following:
Immediately threatening to life, health,
property or environment.
Have already caused loss of life, health
detriments, property damage or
environmental damage
Have a high probability of escalating to
cause immediate danger to life, health,
property or environment

12. QUALITIES of an Emergency nurse:
 has had specialized education, training, and
experience to gain expertise in assessing and
identifying patient’s health care problems in crisis
situations.
 Establishes priorities
 monitors and continuously assesses acutely ill and
injured patients
 supports and attends to families
 supervises allied health personnel
 Teaches patients and families within a time-limited
high-pressured care environment.

13. Documentation of consent
 Consent to examine and treat the patient is part of
the ER record
 Patient must consent to invasive procedure unless
he/she is unconscious or in critical condition and
unable to make decisions
 If brought unconscious without family or friends
must be documented.
Limiting exposure to health risks
 All health care providers should adhere strictly to
standard precautions for minimizing exposure.

14.  The routine use of appropriate barrier
precautions to prevent skin and mucous
membrane exposure when contact with blood
or other body fluids of any individual may
occur or is anticipated.
 Universal Precautions apply to blood and to
all other body fluids with potential for
spreading any infections.

15. Dangers to life
 Many emergencies cause an immediate danger to the
life of people involved. This can range from
emergencies affecting a single person, such as the
entire range of medical emergencies including heart
attacks, strokes, and trauma to incidents that affect
large numbers of people such as natural disasters
including tornadoes, hurricanes, floods, and
mudslides.
 Most agencies consider these to be the highest
priority of emergency, which follows the general
school of thought that nothing is more important
than human life.

16.  Cardiovascular
 Neurologic
 Respiratory
 Traumatic
 Soft Tissues Injuries

17. MYOCARDIAL INFARCTION (Heart Attack)

18. Also known as Myocardial infarction; MI; Acute
MI; ST-elevation myocardial infarction; Non-
ST-elevation myocardial infarction
A heart attack occurs when blood flow to a part
of your heart is blocked for a long enough time
that part of the heart muscle is damaged or
dies.
Most heart attacks are caused by a blood clot
that blocks one of the coronary arteries. The
coronary arteries bring blood and oxygen to the
heart. If the blood flow is blocked, the heart is
starved of oxygen and heart cells die.

19.  A hard substance called plaque can build up in the
walls of your coronary arteries. This plaque is made
up of cholesterol and other cells. A heart attack can
occur as a result of plaque build-up.
 The cause of heart attacks is not always known.
Heart attacks may occur:
 When you are resting or asleep
 After a sudden increase in physical activity
 When you are active outside in cold weather
 After sudden, severe emotional or physical stress,
including an illness

20.  A heart attack is a medical emergency. If you have
symptoms of a heart attack, call 911 or your local
emergency number right away.
 DO NOT try to drive yourself to the hospital.
 DO NOT DELAY. You are at greatest risk of sudden
death in the early hours of a heart attack.
 Chest pain is the most common symptom of a heart
attack. You may feel the pain in only one part of your
body, or it may move from your chest to your arms,
shoulder, neck, teeth, jaw, belly area, or back.

21.  The pain can be severe or mild. It can feel like:
 A tight band around the chest
 Bad indigestion
 Something heavy sitting on your chest
 Squeezing or heavy pressure
 The pain usually lasts longer than 20 minutes.
Rest and a medicine called nitroglycerin may
not completely relieve the pain of a heart
attack. Symptoms may also go away and come
back.

22. Treatment
 You will most likely first be treated in the emergency
room.
 You will be hooked up to a heart monitor, so the health
care team can look at how your heart is beating.
 The health care team will give you oxygen so that your
heart doesn't have to work as hard.
 An intravenous line (IV) will be placed into one of your
veins. Medicines and fluids pass through this IV.
 You may get nitroglycerin and morphine to help
reduce chest pain.

23.  The following drugs are given to most people after they
have a heart attack. These drugs can help prevent another
heart attack. Ask your doctor or nurse about these drugs:
 Antiplatelet drugs (blood thinners) such as aspirin,
clopidogrel (Plavix), or warfarin (Coumadin), to help keep
your blood from clotting
 Beta-blockers and ACE inhibitor medicines to help protect
your heart
 Statins or other drugs to improve your cholesterol levels
 You may need to take some of these medicines for the rest
of your life. Always talk to your health care provider
before stopping or changing how you take any medicines.
Any changes may be life threatening.

24.  After a heart attack, you may feel sad.
 You may feel anxious and worry about being careful
in everything you do. All of these feelings are normal.
They go away for most people after 2 or 3 weeks.
 You may also feel tired when you leave the hospital
to go home.
 Most people who have had a heart attack take part in
a cardiac rehab program. While under the care of a
doctor and nurses, you will:
 Slowly increase your exercise level
 Learn how to follow a healthy lifestyle

26.  Also known as Cerebrovascular disease; CVA;
Cerebral infarction; Cerebral hemorrhage;
Ischemic stroke; Stroke - ischemic;
Cerebrovascular accident; Stroke – hemorrhagic
 A stroke happens when blood flow to a part of the
brain stops. A stroke is sometimes called a "brain
attack."
 f blood flow is stopped for longer than a few
seconds, the brain cannot get blood and oxygen.
Brain cells can die, causing permanent damage.
 There are two major types of stroke: ischemic
stroke and hemorrhagic stroke.

27.  Ischemic strokes may be caused by clogged
arteries. Fat, cholesterol, and other substances
collect on the artery walls, forming a sticky
substance called plaque.
 A hemorrhagic stroke occurs when a blood
vessel in part of the brain becomes weak and
bursts open, causing blood to leak into the brain.
Some people have defects in the blood vessels of
the brain that make this more like.

28.  High blood pressure is the number one risk factor for
strokes. The other major risk factors are:
 Atrial fibrillation
 Diabetes
 Family history of stroke
 High cholesterol
 Increasing age, especially after age 55
 Race (black people are more likely to die of a stroke)
 People who have heart disease or poor blood flow in
their legs caused by narrowed arteries are also more
likely to have a stroke.

29.  The chance of stroke is higher in people who
live an unhealthy lifestyle by:
 Being overweight or obese
 Drinking heavily
 Eating too much fat or salt
 Smoking
 Taking cocaine and other illegal drugs
 Birth control pills can increase the chances of
having blood clots. The risk is highest in
woman who smoke and are older than 35.

30.  A headache may occur, especially if the stroke is caused by
bleeding in the brain. The headache:
 Starts suddenly and may be severe
 Occurs when you are lying flat
 Wakes you up from sleep
 Gets worse when you change positions or when you bend,
strain, or cough
 Other symptoms depend on how severe the stroke is and
what part of the brain is affected. Symptoms may include:
 Change in alertness (including sleepiness, unconsciousness,
and coma); Changes in hearing; Changes in taste; Changes
that affect touch and the ability to feel pain, pressure, or
different temperatures; Clumsiness

31.  Confusion or loss of memory; Difficulty swallowing;
Difficulty writing or reading; Dizziness or abnormal feeling
of movement (vertigo); act of control over the bladder or
bowels
 Loss of balance; Loss of coordination; Muscle weakness in
the face, arm, or leg (usually just on one side)
 Numbness or tingling on one side of the body
 Personality, mood, or emotional changes
 Problems with eyesight, including decreased vision, double
vision, or total loss of vision
 Trouble speaking or understanding others who are
speaking
 Trouble walking

32.  A stroke is a medical emergency. Immediate treatment can save
lives and reduce disability. Call 911 or your local emergency
number or seek urgent medical care at the first signs of a
stroke.
 It is very important for people who are having stroke
symptoms to get to a hospital as quickly as possible. If the
stroke is caused by a blood clot, a clot-busting drug may be
given to dissolve the clot.
 Most of the time, patients must reach a hospital within 3 hours
after symptoms begin. Some people may be able to receive
these drugs for up to 4 - 5 hours after symptoms begin.
 Treatment depends on how severe the stroke was and what
caused it. Most people who have a stroke need to stay in a
hospital.

33.  The goal of treatment after a stroke is to help the
patient recover as much function as possible and
prevent future strokes.
 The recovery time and need for long-term
treatment is different for each person. Problems
moving, thinking, and talking often improve in
the weeks to months after a stroke. A number of
people who have had a stroke will keep
improving in the months or years after the
stroke.

34. The outlook depends on:
 The type of stroke; How much brain tissue is damaged
 What body functions have been affected; How quickly you
get treated
Complications
 Breathing food into the airway (aspiration); Dementia; Falls
 Loss of mobility; Loss of movement or feeling in one or more
parts of the body; Muscle spasticity; Poor nutrition; Pressure
sores; Problems speaking and understanding; Problems
thinking or focusing
 Stroke is a medical emergency that needs to be treated right
away. Call your local emergency number (such as 911) if
someone has symptoms of a stroke.

35.  Angina (an-JI-nuh or AN-juh-nuh) is chest pain or
discomfort that occurs if an area of your heart muscle
doesn't get enough oxygen-rich blood.
 Angina may feel like pressure or squeezing in your chest.
The pain also can occur in your shoulders, arms, neck,
jaw, or back. Angina pain may even feel like indigestion.
 Angina isn't a disease; it's a symptom of an underlying
heart problem. Angina usually is a symptom of coronary
heart disease (CHD).
 CHD is the most common type of heart disease in adults.
It occurs if a waxy substance called plaque (plak) builds
up on the inner walls of your coronary arteries. These
arteries carry oxygen-rich blood to your heart.

36.  Angina also can be a symptom of coronary
microvascular disease (MVD). This is heart
disease that affects the heart’s smallest
coronary arteries. In coronary MVD, plaque
doesn't create blockages in the arteries like it
does in CHD.
 Types of Angina
 The major types of angina are stable, unstable,
variant (Prinzmetal's), and microvascular.
Knowing how the types differ is important.
This is because they have different symptoms
and require different treatments.

37. Stable Angina
 Stable angina is the most common type of angina. It
occurs when the heart is working harder than usual.
Stable angina has a regular pattern. (“Pattern” refers to
how often the angina occurs, how severe it is, and what
factors trigger it.)
 If you have stable angina, you can learn its pattern and
predict when the pain will occur. The pain usually goes
away a few minutes after you rest or take your angina
medicine.
 Stable angina isn't a heart attack, but it suggests that a
heart attack is more likely to happen in the future.

38. Unstable Angina
 Unstable angina doesn't follow a pattern. It
may occur more often and be more severe than
stable angina. Unstable angina also can occur
with or without physical exertion, and rest or
medicine may not relieve the pain.
 Unstable angina is very dangerous and
requires emergency treatment. This type of
angina is a sign that a heart attack may happen
soon.

39. Variant (Prinzmetal's) Angina
 Variant angina is rare. A spasm in a coronary
artery causes this type of angina. Variant angina
usually occurs while you're at rest, and the pain
can be severe. It usually happens between
midnight and early morning. Medicine can
relieve this type of angina.
Microvascular Angina
 Microvascular angina can be more severe and
last longer than other types of angina. Medicine
may not relieve this type of angina.

40.  Age (≥ 55 years for men, ≥ 65 for women)
 Cigarette smoking
 Diabetes mellitus (DM)
 Dyslipidemia
 Family History of premature Cardiovascular
Disease (men <55 years, female <65 years old)
 Hypertension (HTN)
 Kidney disease (microalbuminuria or GFR<60
mL/min)
 Obesity (BMI ≥ 30 kg/m2)
 Physical inactivity

41.  Conditions that exacerbate or provoke angina:
Medications ; vasodilators ; excessive thyroid
replacement ; Vasoconstrictors
Other medical problems
 profound anemia ; uncontrolled HTN
 Hyperthyroidism ; hypoxemia
Other cardiac problems
 Tachyarrhythmia ;bradyarrhythmia ;valvular
heart disease ;hypertrophic cardiomyopathy

42.  The most specific medicine to treat angina is nitroglycerin. It is
a potent vasodilator that makes more oxygen available to the
heart muscle. Beta-blockers and calcium channel blockers act
to decrease the heart's workload, and thus its requirement for
oxygen.
 balloon angioplasty, in which the balloon is inserted at the end
of a catheter and inflated to widen the arterial lumen. Stent to
maintain the arterial widening are often used at the same time.
Coronary bypass surgery involves bypassing constricted
arteries with venous grafts. This is much more invasive than
angioplasty.
 The main goals of treatment in angina pectoris are relief of
symptoms, slowing progression of the disease, and reduction of
future events, especially heart attacks and, of course, death

43.  Assessments: PQRST
P – Position/Location
Where is your pain located?
Can you point to it?
Provocation
What were you doing when the pain began?
Q- Quality
How would you describe the pain?
Is it like the pain you had before?
Quantity
Has the pain been constant?

44.  R – Radiation
Can you feel the pain anywhere else?
- Relief
Did anything make the pain better?
 S – Severity
use pain rating scale
- Symptoms
Did you notice any other symptoms with
the pain?
 T – Timing
How long ago did the pain start?

45.  1. Ineffective myocardial tissue perfusion
secondary to CAD as evidenced by chest pain.
 2. Anxiety related to fear of death
 3. Deficient knowledge about the underlying
disease and methods for avoiding complications.
 4. Noncompliance, ineffective management of
therapeutic regimen related to failure to accept
necessary lifestyle changes.

46.  1. Immediate and appropriate treatment when
angina occurs
 2. Prevention of angina
 3. Reduction of anxiety
 4. Awareness of the disease process
 5. Understanding of the prescribed care,
adherence to the self-care program, and
absence of complications.

47. 1. Treating angina
> Stop activities, sit or rest in a semi- fowler position.
>Assess the angina
>Measure the vital signs
>Observe for signs of respiratory distress
>Nitroglycerin-can be repeated up to 3 doses if chest pain is
unchanged or lessened but still present.
>Oxygen therapy
>For significant pain despite treatment, transfer to ICU
2. Reducing anxiety
3. Preventing pain
4. Promoting home and community-based care.
>teaching patients self-care.

48. Assessment:
 Use systematic assessment w/c includes a
careful history, particularly as it relates to
symptoms.
 Chest pain or discomfort
 Difficulty of breathing (dyspnea)
 Palpitations
 Unusual fatigue
 Faintness (syncope)
 Sweating (diaphoresis)

49.  Ineffective cardiopulmonary tissue perfusion
related to reduced coronary blood flow from
coronary thrombus and atherosclerotic plaque.
 Potential impaired gas exchange related to fluid
overload from left ventricular dysfunction
 Potential altered peripheral tissue perfusion
related to decreased cardiac output from left
ventricular dysfunction
 Anxiety related to fear of death
 Deficient knowledge about post-MI self-care


50.  Relief of pain or ischemic signs and
symptoms
 Prevention of further myocardial damage
 Absence of respiratory dysfunction
 Maintenance or attainment of adequate tissue
perfusion by decreasing the heart’s workload
 Reduced anxiety
 Adherence to the self-care program
 Absence or early recognition of
complications.

51.  Relieving pain and other signs and
symptoms of ischemia
 Improving respiratory function
 Promoting adequate tissue perfusion
 Reducing anxiety
 Monitoring and managing potential
complications
 Promoting home and community-based care.

52.  Trauma to the abdominal area may cause a serious, life-
threatening injury that may go untreated because
immediate symptoms may not be evident. The
membranous peritoneum surrounds some organs
suspended from the abdominal wall, and others such as the
kidneys, pancreas, vena cava, aorta and duodenum have
the added protection of being located in the retroperitoneal
space, partially covered by the peritoneum.
 Lack of bony protection in the abdominal area makes the
underlying organs and surrounding structures susceptible
to serious injury from blunt force trauma. Although there
may be minimal injury to the outside of the body, there may
be life-threatening internal damage.

53.  Liver injuries may lead to profuse
hemorrhaging in the capsule surrounding
the organ or from rupture of the organ
itself. Some symptoms of injury to the liver
include pain in the upper right quadrant, a
rigid abdomen with rebound tenderness
and inactive bowel sounds. If enough
blood is lost within the abdominal cavity,
circulatory collapse and death can occur
without prompt treatment.

54.  The left upper quadrant of the abdomen houses the
spleen. It's located under the diaphragm, and to the
side of the stomach. This organ receives about 5
percent of cardiac output and holds about 7 ounces
of blood. It's also susceptible to injury from blunt
force trauma and fractures of the tenth and twelfth
ribs. Some of the same symptoms of a liver injury
apply to the spleen, except that the pain is in the left
upper quadrant. Kehr's sign may also be present,
which is pain radiating to the left shoulder. You can
live without a spleen, because the liver will take over
for it, but you can't do without a liver.

55.  Your kidneys are located in the retroperitoneal
space, with the right one being lower than the left.
Fatty tissue surrounds them and fascia holds them
in position. Since they have no attachment to the
abdominal wall, they move with inspiration and
expiration. The most common injury is laceration
or bruising. Some things to look for with a kidney
injury are flank tenderness, blood in the urine,
Grey-Turner's Sign, which is a blue or purplish
discoloration over the flank area, and Cullen's
sign, which is bruising around the navel area.

56.  Other serious intra-abdominal injuries may
include rupture of the stomach, duodenum,
large and small intestines, and bladder. These
injuries result in abdominal pain, distention
and rigidness, with a decrease in or absence of
bowel sounds. The symptoms become more
intense, as the condition progressively
deteriorates.

57.  Blunt abdominal trauma usually results from
motor vehicle collisions (MVCs), assaults,
recreational accidents, or falls. The most
commonly injured organs are the spleen, liver,
retroperitoneum, small bowel, kidneys ,
bladder, colorectum, diaphragm, and
pancreas. Men tend to be affected slightly more
often than women.

58. Categories:
Presentation Injury Type Management
Priority
Pulseless Major vascular Injury Emergency laparotomy
Emergency thoracotomy
Hemodyna- Vascular and/or Identify & control
mically unstable solid organ injury hemorrhage
Hemorrhage from
other sites
Hemodyna- Hollow viscus injury Identify presence of GI,
mically normal Pancreas or renal diaphragmatic or retroperi-
toneal injury

59.  Patients with penetrating trauma who are
hemodynamically unstable require immediate
operation.
 Hemodynamically unstable includes non-responders
and transient-responders to initial small-volume fluid
bolus administration. Patients should be taken
immediately to the operating room, without further
unnecessary investigations or interventions.
 The only decision to be made in these patients is where
is the bleeding and this which cavity to expose first.
Where there is a stab or gunshot wound obviously
involving the abdomen, the decision is simple, and the
patient has a laparotomy.

60.  The diagnosis of massive hemothorax may be made
clinically, with a FAST scan, chest tube or Chest X-ray,
depending on the degree of shock present and the rapidity
with which such tests can be performed. Cardiac
tamponade may be diagnosed with FAST or in the
operating room with a pericardial window.
 It is more important to take the patient to the operating
room and commence surgery than to make a definitive
diagnosis. If a thoracic injury is suspected during a
laparotomy a hemothorax can be explored through the
diaphragm or a formal thoracotomy, and a tamponade
explored through a pericardial window and sternotomy.
 There should be no delay in trying to resuscitate the patient
prior to surgery.

61.  Compression of the heart as a result of fluid within the
pericardial sac (pericardial effusion)
 Usually caused by blunt or penetrating trauma to the
chest.
 Penetrating wound to the heart is associated with high
mortality.
 Signs and symptoms:
 Decreased cardiac output
 Faintness
 Shortness of breath
 Anxiety
 pain

62.  Pressure created in the trachea from swelling
of the pericardial sac
 cough
 Rising venous pressure
 Distended neck veins
 Paradoxical pulse
Muffled or distant heart sound

63.  Patients with clinical signs of peritonitis, or with
evisceration of bowel should be taken
immediately to the operating room.
 Currently there are several possible options for
the evaluation of penetrating abdominal trauma
in the haemodynamically normal trauma patient
without signs of peritonitis. Many of these
patients will have some superficial tenderness
around the wound site, but no signs of
peritoneal inflammation.

64. Adjuncts of the initial evaluation of the trauma
patient can provide clues to significant intra-
peritoneal injury:
 Chest X-ray - An erect chest radiograph may identify
sub-diaphragmatic air. This must be interpreted with
some caution in the absence of peritonitis, as air may
be entrained into the peritoneal cavity with a stab or
gunshot wound. However it certainly signals
peritoneal penetration and warrants further
investigation.
 Nasogastric Tube - Blood drained from the stomach
will identify gastric injury.

65.  Urinary catheter - Macroscopic hematuria
indicates a renal or bladder injury. Microscopic
injury suggests but is not pathognomonic of
ureteric injury.
 Rectal examination - Rectal blood indicates a
rectal or sigmoid penetration. Proctoscopy &
sigmoidoscopy should be performed

67. ACUTE RESPIRATORY DISTRESS
Previously called, ADULT RESPIRATORY DISTRESS
SYNDROME
 Characterized by sudden and progressive pulmonary edema,
increasing bilateral infiltrates, hypoxemia, and reduced lung
compliance.
 Acute phase: rapid onset of severe dyspnea that usually
occurs 12 to 48 hours after the initiating event.
Nursing Management
 general measures:
 Close monitoring
 Use of respiratory modalities (O2 administration, chest
physiotheraphy, endotracheal intubation, nebulizer
therapy, mechanical vent, suctioning, etc.)

68.  Positioning to improve ventilation and
perfusion in the lungs and enhance secretion
drainage.
 Explain procedure to reduce anxiety
 Rest is essential to reduce oxygen consumption,
decreasing oxygen needs.
PULMONARY EMBOLISM
 Refers to the obstruction of the pulmonary artery
or one of its branches by a thrombus that
originates somewhere in the venous system or in
the right side of the heart.

69. Nursing Management
 Minimizing the risk of pulmonary embolism
 Preventing thrombus formation
 Assessing potential for pulmonary embolism
 Monitoring thrombolytic therapy
 Managing pain
 Managing oxygen therapy
 Relieving anxiety
 Monitoring for complications
 Providing postoperative nursing care
 Promoting home and community-based care

71.  Is severe and persistent asthma that does not respond to
conventional therapy.
 Status asthmaticus is a life-threatening form of asthma in
which progressively worsening reactive airways are
unresponsive to usual appropriate therapy that leads to
pulmonary insufficiency
 Attacks can last longer than 24 hours – (3x nebulizer only)
 - not relieved = Diazepam > constant monitoring
 The basic characteristics in asthma decrease the diameter of
the bronchi and are apparent in status asthmaticus.
 Constriction of the bronchiolar smooth muscle
 Swelling of the bronchial mucosa
 Thickened secretions

72. Nursing Management
 Constant monitoring for the first 12 to 24 hours
or until status asthmaticus is under control.
 Assessment of skin turgor to identify signs of
dehydration
 Fluid intake is essential to combat
dehydration, to loosen secretions, and facilitate
expectoration.
 Conservation of patient’s energy
 Non allergenic pillow should be used.

73.  Aspiration pneumonia
 Pneumomediastinum
 Pneumothorax
 Rhabdomyolysis
 Respiratory failure and arrest
 Cardiac arrest
 Hypoxic-ischemic brain injury.
 Death.

74.  Unconsciousness is when a person is unable to respond
to people and activities. Often, this is called a coma or
being in a comatose state.
 Other changes in awareness can occur without becoming
unconscious. Medically, these are called "altered mental
status" or "changed mental status." They include sudden
confusion, disorientation, or stupor.
 Unconsciousness or any other SUDDEN change in
mental status must be treated as a medical emergency.

76. Considerations:
 Being asleep is not the same thing as being
unconscious. A sleeping person will respond
to loud noises or gentle shaking -- an
unconscious person will not.
 An unconscious person cannot cough or clear
his or her throat. This can lead to death if the
airway becomes blocked.

77. Causes:
 Unconsciousness can be caused by nearly any major
illness or injury, as well as substance abuse and
alcohol use.
 Brief unconsciousness (or fainting) is often caused by
dehydration, low blood sugar, or temporary low blood
pressure. However, it can also be caused by serious
heart or nervous system problems. Your doctor will
determine if you need tests.
 Other causes of fainting include straining during a
bowel movement, coughing very hard, or breathing
very fast (hyperventilating).

79.  Circulatory shock, commonly known simply as
shock, is a life-threatening medical condition that
occurs due to inadequate substrate for aerobic
cellular respiration. In the early stages this is
generally an inadequate tissue level of oxygen.
 The typical signs of shock are low blood pressure
,a rapid heartbeat and signs of poor end-organ
perfusion or "decompensation" (such as low
urine output, confusion or loss of consciousness).
There are times that a person's blood pressure
may remain stable, but may still be in circulatory
shock, so it is not always a symptom.

80.  Cardiogenic shock (associated with heart
problems)
 Hypovolemic shock (caused by inadequate
blood volume)
 Anaphylactic shock (caused by allergic
reaction)
 Septic shock (associated with infections)
 Neurogenic shock (caused by damage to the
nervous system)

81. Shock can be caused by any condition that reduces blood
flow, including:
 Heart problems (such as heart attack or heart failure)
 Low blood volume (as with heavy bleeding or
dehydration)
 Changes in blood vessels (as with infection or severe
allergic reactions)
 Certain medications that significantly reduce heart
function or blood pressure
 Shock is often associated with heavy external or
internal bleeding from a serious injury. Spinal injuries
can also cause shock.
 Toxic shock syndrome is an example of a type of shock
from an infection.

82.  A person in shock has extremely low blood pressure.
Depending on the specific cause and type of shock,
symptoms will include one or more of the following:
 Anxiety or agitation/restlessness ; Bluish lips and
fingernails
 Chest pain ; Confusion
 Dizziness, lightheadedness, or faintness
 Pale, cool, clammy skin
 Low or no urine output ; Profuse sweating, moist skin
 Rapid but weak pulse
 Shallow breathing
 Unconsciousness

83.  Call 911 for immediate medical help.
 Check the person's airway, breathing, and circulation. If
necessary, begin rescue breathing and CPR.
 Even if the person is able to breathe on his or her own, continue
to check rate of breathing at least every 5 minutes until help
arrives.
 If the person is conscious and does NOT have an injury to the
head, leg, neck, or spine, place the person in the shock position.
Lay the person on the back and elevate the legs about 12 inches.
Do NOT elevate the head. If raising the legs will cause pain or
potential harm, leave the person lying flat.
 Give appropriate first aid for any wounds, injuries, or illnesses.
 Keep the person warm and comfortable. Loosen tight clothing.

85. IF THE PERSON VOMITS OR DROOLS
 Turn the head to one side so he or she will not choke. Do
this as long as there is no suspicion of spinal injury.
 If a spinal injury is suspected, "log roll" him or her
instead. Keep the person's head, neck, and back in line,
and roll him or her as a unit.
DO NOT
 Do NOT give the person anything by mouth, including
anything to eat or drink.
 Do NOT move the person with a known or suspected
spinal injury.
 Do NOT wait for milder shock symptoms to worsen
before calling for emergency medical help.

86. When to Contact a Medical Professional
 Call 911 any time a person has symptoms of shock. Stay with
the person and follow the first aid steps until medical help
arrives.
Prevention
 Learn ways to prevent heart disease, falls, injuries,
dehydration, and other causes of shock. If you have a known
allergy (for example, to insect bites or stings), carry an
epinephrine pen. Your doctor will teach you how and when
to use it.
 Once someone is already in shock, the sooner shock is
treated, the less damage there may be to the person's vital
organs (such as the kidney, liver, and brain). Early first aid
and emergency medical help can save a life.

89.  A seizure is the physical findings or changes in
behavior that occur after an episode of abnormal
electrical activity in the brain.
 The term "seizure" is often used interchangeably
with "convulsion." Convulsions are when a
person's body shakes rapidly and uncontrollably.
During convulsions, the person's muscles contract
and relax repeatedly. There are many different
types of seizures. Some have mild symptoms and
no body shaking.

90. Specific symptoms depend on what part of the brain is
involved. They occur suddenly and may include:
 Brief blackout followed by period of confusion (the person
cannot remember a period of time)
 Changes in behavior such as picking at one's clothing
 Drooling or frothing at the mouth
 Eye movements; Grunting and snorting; Loss of bladder or
bowel control; Mood changes such as sudden anger,
unexplainable fear, panic, joy, or laughter; Shaking of the
entire body; Sudden falling; Tasting a bitter or metallic
flavor
 Teeth clenching; Temporary halt in breathing
 Uncontrollable muscle spasms with twitching and jerking
limbs

91.  Symptoms may stop after a few seconds
minutes, or continue for 15 minutes. They
rarely continue longer.
 The person may have warning symptoms
before the attack, such as:
 Fear or anxiety
 Nausea
 Vertigo
 Visual symptoms (such as flashing bright
lights, spots, or wavy lines before the eyes

92.  Abnormal levels of sodium or glucose in the blood
 Brain infection, including meningitis; Brain injury that
occurs to the baby during labor or childbirth; Brain
problems that occur before birth (congenital brain
defects); Brain tumor (rare)
 Choking; Drug abuse; Electric shock; Epilepsy
 Fever (particularly in young children); Head injury
 Heart disease; Heat illness (heat intolerance); High fever
 Illicit drugs, such as angel dust (PCP), cocaine,
amphetamines
 Kidney or liver failure; Low blood sugar;
Phenylketonuria (PKU), which can cause seizures in
infants
 Poisoning; Stroke; Toxemia of pregnancy;

93.  Uremia related to kidney failure;
 Very high blood pressure (malignant hypertension);
Venomous bites and stings (snake bite)
 Use of illegal street drugs, such as cocaine or
amphetamines ; Withdrawal from alcohol after drinking
a lot on most days; Withdrawal from certain drugs,
including some painkillers and sleeping pills
;Withdrawal from benzodiazepines (such as Valium)
 Sometimes no cause can be identified. This is called
idiopathic seizures. They usually are seen in children and
young adults but can occur at any age. There may be a
family history of epilepsy or seizures.
 If seizures repeatedly continue after the underlying
problem is treated, the condition is called epilepsy

94.  When a seizure occurs, the main goal is to
protect the person from injury. Try to prevent a
fall. Lay the person on the ground in a safe area.
Clear the area of furniture or other sharp objects.
 Cushion the person's head.
 Loosen tight clothing, especially around the
person's neck.
 Turn the person on his or her side. If vomiting
occurs, this helps make sure that the vomit is not
inhaled into the lungs.
 Look for a medical I.D. bracelet with seizure
instructions.

95.  Stay with the person until he or she recovers, or
until you have professional medical help.
 If a baby or child has a seizure during a high
fever, cool the child slowly with tepid water.
 Do not place the child in a cold bath. You can
give the child acetaminophen (Tylenol) once he
or she is awake, especially if the child has had
fever convulsions before.

96.  Call 911 or your local emergency number if:
 This is the first time the person has had a seizure.
 A seizure lasts more than 2 to 5 minutes.
 The person does not awaken or have normal behavior after a
seizure ; Another seizure starts soon after a seizure ends.
 The person had a seizure in water ; The person is pregnant,
injured, or has diabetes ; The person does not have a medical ID
bracelet (instructions explaining what to do).
 There is anything different about this seizure compared to the
person's usual seizures.
 Report all seizures to the person's health care provider. The
doctor may need to adjust or change the person's medications.

97.  A drug overdose occurs when a person consumes
more of a drug than their body can tolerate. An
overdose may be accidental or intentional, as
certain individuals may be unaware of their
sensitivities to certain medications. Overdose
symptoms can range from the nodding that is related
to heroin, to the shaking that has so commonly been
associated with crack cocaine and meth; ultimately,
each type of overdose can potentially result in death.
Individuals who abuse drugs are always walking a
fine line between getting high and a serious injury
from a drug overdose or even death.

99.  The most common cause of death by a drug overdose is due to
combining various drugs, such as taking prescription drugs
and alcohol; when drugs are taken together, they can interact
in ways that may intensify their effects.
 Depressants are drugs that can slow down the respiratory
system, and a person that abuses these types of drugs may be
at risk for serious breathing problems.
 Stimulant drugs can cause an increase in systems throughout
the body and an individual who misuses stimulants can be at
an increased risk for seizures and heart attacks.
 Changes in an individual's health, such as having a bout with
illness, can also put them at a higher risk for a drug overdose;

100.  physical changes such as weight loss, may
affect an individual's tolerance level and their
body's ability to adjust to the drug.
 When an individual takes drugs while they are
alone, it greatly increases the chance of a fatal
overdose, as there is no one available to take
care of them in the case of a serious drug
interaction, and to summon emergency help if
necessary.

101.  Prescription Drugs - These types of drugs are
licensed medicines that cannot be obtained
without a prescription from a doctor; a type-
written label is characteristic of a prescription
drug and will indicate that a pharmacists has
dispensed the medication. Some examples of
prescription medications can include
Benzodiazepines, Morphine, and Amphetamines.
The largest percentage of prescription drug
overdoses is reported to be associated with
narcotic painkillers, such as OxyContin or
Vicodin

102.  Non-Prescription Drugs - These types of drugs
may be purchased over-the-counter (OTC)
without a prescription. Non-prescription OTC
drugs can include headache tablets, liquid cough
medicines, sinus tablets, or diet pills; these
medications are readily available at any retail
outlet. Common examples of some of the over-
the-counter medications are Vicks Cough Syrup,
Sudafed, Robitussin DM, and Sominex Sleep
Tablets, just to name a select few.

103.  Illicit Drugs - The types of drugs are generally
imported, grown or illegally manufactured,
and the sale of these substances is prohibited
by law. The greatest percentage of drug
overdoses throughout the United States is
related to the misuse of illicit drugs; this is not
surprising, as these types of drugs are
purchased on the black market and there is no
way to determine exactly what ingredients that
they contain. Some of the most common
examples of illicit drugs are; heroin, marijuana,
cocaine, ecstasy, and meth.

104.  An overdose of narcotics can cause sleepiness, slowed
breathing, and even unconsciousness.
 Uppers (stimulants) produce excitement, increased heart
rate, and rapid breathing. Downers (depressants) do just
the opposite.
 Mind-altering drugs are called hallucinogens. They
include LSD, PCP (angel dust), and other street drugs.
Using such drugs may cause paranoia, hallucinations,
aggressive behavior, or extreme social withdrawal.
 Cannabis-containing drugs such as marijuana may cause
relaxation, impaired motor skills, and increased appetite.

105.  Drug overdose symptoms vary widely depending
on the specific drug used, but may include:
 Abnormal pupil size ; Agitation; Convulsions
 Death; Delusional or paranoid behavior
 Difficulty breathing; Hallucinations
 Nausea and vomiting
 Nonreactive pupils (pupils that do not change size
when exposed to light);Staggering or unsteady gait
(ataxia); Sweating or extremely dry, hot skin
 Tremors; Unconsciousness (coma);Violent or
aggressive behavior

106.  Abdominal cramping; Agitation
 Cold sweat; Convulsions
 Delusions; Depression; Diarrhea; Hallucinations; Nausea
and vomiting; Restlessness; Shaking; Death
First Aid
1. Check the patient's airway, breathing, and pulse. If
necessary, begin CPR. If the patient is unconscious but
breathing, carefully place him or her in the recovery
position. If the patient is conscious, loosen the clothing,
keep the person warm, and provide reassurance. Try to
keep the patient calm. If an overdose is suspected, try to
prevent the patient from taking more drugs. Call for
immediate medical assistance.

107.  2. Treat the patient for signs of shock, if necessary.
Signs include: weakness, bluish lips and fingernails,
clammy skin, paleness, and decreasing alertness.
 3. If the patient is having seizures, give convulsion
first aid.
 4. Keep monitoring the patient's vital signs (pulse,
rate of breathing, blood pressure) until emergency
medical help arrives.
 5. If possible, try to determine which drug(s) were
taken and when. Save any available pill bottles or
other drug containers. Provide this information to
emergency medical personnel.

108. DO NOT
 Do NOT jeopardize your own safety. Some
drugs can cause violent and unpredictable
behavior. Call for professional assistance.
 Do NOT try to reason with someone who is on
drugs. Do not expect them to behave
reasonably.
 Do NOT offer your opinions when giving help.
You do not need to know why drugs were
taken in order to give effective first aid.

109. When to Contact a Medical Professional
 Drug emergencies are not always easy to
identify. If you suspect someone has
overdosed, or if you suspect someone is
experiencing withdrawal, give first aid and
seek medical assistance.
 Try to find out what drug the person has
taken. If possible, collect all drug containers
and any remaining drug samples or the
person's vomit and take them to the hospital.

110. These include diseases as well as biological agents
that may be used for terrorism. (Bioterrorism)
Bioterrorism refers to the deliberate release of
viruses, bacteria, or other agents used to cause
illness or death in people, animals, or plants.
These agents can be spread through the air, water,
or in food.
 Anthrax (malignant edema, woolsorters' disease)
 Avian Influenza (Bird Flu), Botulism (food-borne
botulism and infant botulism), Plague, Smallpox,
Influenza Pandemic

111. Chemical Emergencies
It occurs when a hazardous chemical is released and the
release has the potential for harming people’s health.
Chemical releases can be unintentional such as an
industrial accident, or intentional such as in the case of a
terrorist attack. These include harmful chemical spills
and chemicals that are used in acts of terrorism.
 Ammonia, Chlorine, Cyanides, Ricin, Serin
Radiological Emergencies
Radiation emergency could be a nuclear power plant
accident or a terrorist event such as a dirty bomb or
nuclear attack, which would expose people to
significantly higher levels of radiation than are typical in
daily life, leading to health problems such as cancer or
even death.

112. Weather and Home Emergencies
 Cold and Hot weather
 Natural disaster (natural occurrences as earthquakes,
extreme heat, floods, hurricanes, landslides and
mudslides, tornadoes, tsunamis, volcanoes, wildfires,
and winter weather.
 Carbon monoxide poisoning

113. Dangers to health
 Some emergencies are not immediately threatening to life,
but might have serious implications for the continued health
and well-being of a person or persons (although a health
emergency can subsequently escalate to be threatening to
life).
 The causes of a 'health' emergency are often very similar to
the causes of an emergency threatening to life, which
includes medical emergencies and natural disasters,
although the range of incidents that can be categorised here
is far greater than those that cause a danger to life (such as
broken limbs, which do not usually cause death, but
immediate intervention is required if the person is to
recover properly)

114. Dangers to property
 Other emergencies do not threaten any people, but do
threaten peoples' property. An example of this would be a
fire in a warehouse that has been evacuated. The situation
is treated as an emergency as the fire may spread to other
buildings, or may cause sufficient damage to make the
business unable to continue (affecting livelihood of the
employees).
 Incidents such as fires, explosions, mass transit accidents
such as train crashes or bridge collapses that cause
numerous deaths and injuries

115. Dangers to the environment
Some emergencies do not immediately
endanger life, health or property, but do affect
the natural environment and creatures living
within it. Not all agencies consider this to be a
genuine emergency, but it can have far
reaching effects on animals and the long term
condition of the land. Examples would include
forest fires and marine oil spills.

116. Most developed countries operate three core emergency services:
 Police – who deal with security of person and property, which
can cover all three categories of emergency. They may also deal
with punishment of those who cause an emergency through
their actions.
 Fire service – who deal with potentially harmful fires, but also
often rescue operations such as dealing with road traffic
collisions. Their actions help to prevent loss of life, damage to
health and damage to or loss of property.
 Emergency Medical Service (ambulance / Paramedic service)
– These services attempt to reduce loss of life or damage to
health. This service is likely to be decisive in attempts to
prevent loss of life and damage to health. In some areas
"Emergency Medical Service" is abbreviated to simply EMS.

117.  Most countries have an emergency telephone number,
also known as the universal emergency number, which
can be used to summon the emergency services to any
incident. This number varies from country to country
(and in some cases by region within a country), but in
most cases, they are in a short number format, such as 911
(United States), 999 (United Kingdom), 112 (Europe) and
000 (Australia).
 The majority of mobile phones will also dial the
emergency services, even if the phone keyboard is locked,
or if the phone has an expired or missing SIM card,
although the provision of this service varies by country
and network.

118. Civil emergency services
 In addition to those services provided
specifically for emergencies, there may be a
number of agencies who provide an emergency
service as an incidental part of their normal
'day job' provision. This can include public
utility workers, such as in provision of
electricity or gas, who may be required to
respond quickly, as both utilities have a large
potential to cause danger to life, health and
property if there is an infrastructure failure.

119.  Emergency action principles are key 'rules' that
guide the actions of rescuers and potential rescuers.
Because of the inherent nature of emergencies, no
two are likely to be the same, so emergency action
principles help to guide rescuers at incidents, by
sticking to some basic tenets.
 The adherence to (and contents of) the principles by
would be rescuers varies widely based on the
training the people involved in emergency have
received, the support available from emergency
services (and the time it will take to arrive) and the
emergency itself.

120.  The key principle taught in almost all systems
is that the rescuer, be they a lay person or a
professional, should assess the situation for
danger.
 The reason that an assessment for danger is
given such high priority is that it is core to
emergency management that rescuers do not
become secondary victims of any incident, as
this creates a further emergency that must be
dealt with.

122. State of emergency
 In the event of a major incident, such as civil
unrest or a major disaster, many governments
maintain the right to declare a state of
emergency, which gives them extensive
powers over the daily lives of their citizens,
and may include temporary curtailment on
certain civil rights, including the right to trial
(for instance to discourage looting of an
evacuated area, a shoot on sight policy may be
in force)

123. Personal emergencies
 Some people believe they have an emergency in
a situation that does not pose a risk to life,
physical health, or property. In these instances,
some people feel entitled to an emergency
response—a view emergencies agencies may
not share.

125. LAW – the sum total of rules and
regulations by which society is governed.
- it is man-made and regulates social
conduct in a formal and binding way.
CONSENT – free and rational act that
presupposes knowledge of the thing to
which the consent is being given by a
person who is legally capable to give
consent.

126.  INFORMED CONSENT
- Hayt and Hayt states that “It is established
principle of law that every human being of adult
years and sound mind has the right to determine
what shall be done with his own body.
- he may choose whether to be treated or not
and to what extent, no matter how necessary the
medical care, or how imminent the danger to his
life or health if he fails to submit to treatment.

127. 1. diagnosis and explanation of the condition
2. fair explanation of the procedures to be
done and used and the consequences
3. a description of alternative treatments or
procedures
4. description of the benefits to be expected
5. material rights if any
6. prognosis, if the recommended care,
procedure, is refused

128.  a written consent should be signed to show that
the procedures the one consented to and that the
person understands the nature of the procedure,
the risks involved and the possible consequences.
 Who must consent?
- the patient
- another person gives consent if patient is
incompetent, minor, or mentally ill or physically
unable and is not in an emergency case

129.  No consent is necessary because inaction at such
time may cause greater injury.

130.  Nurses are governed by civil and criminal law in
roles as providers of services, employees of
institutions, and private citizens.
 A nurse has a personal and legal obligation to
provide a standard of client care expected of a
reasonably competent professional nurse.
 Professional nurses are held responsible for harm
resulting from their negligent acts, or their failure
to act.

131.  Nurses are advised to be familiar with the
patient’s Bill of Rights and observe its
provisions.
 The nurse may only repeat what the doctor
wishes to disclose, if the patient insist on
knowing what the diagnosis is all about.
 Confidentiality – whatever info gathered by
the nurse during the course of caring for the
patient shall always be treated with
CONFIDENTIALITY


132.  The patient permits such revelations as in
claim for hospitalization, insurance benefits.
 The case is medico-legal such as attempted
suicide, gunshot wounds w/c have to be
reported to the local police or NBI
 Patient is ill of communicable disease and
public safety may be jeopardized; and
 Given to members of the health team if
information is relevant to his care.

133.  Systematic reporting system for incidents or
unusual occurrences.
 Proper documentation
 Nurses’ Bill of Rights
 Legal defense in a negligent action is when
nurses know and attain the standard of care in
giving service and that they have documented
the care they have given in a concise and
accurate manner.

134.  HOSPITAL POLICIES –institutional
 EMERGENCY DEPARTMENT STAFF:
1. Head of the departments
2. ER Supervisors
3. Head Nurse
4. Resident Doctors
5. Staff Nurse
6. Nursing attendants, orderlies, handlers.

146.  Trier, French word meaning, “TO SORT”
 Used to sort patients into groups based on the
severity of their health problems and the
immediacy with which these problems must be
treated.
 Looks at medical needs and urgency of each
individual patient
 Sorting based on limited data acquisition
 Also must consider resource availability

147.  Ensure early recognition and assessment of
patients' condition and prioritize the treatment
according to severity of the conditions.
 Reduce unnecessary delay of treatment .
 To give brief First-Aid advice.
 Initiate immediate diagnostic tests, intervention
and nursing treatment.
 Allow effective utilization of staff and resources
by allocating patients to appropriate treatment
area according to their conditions.

148.  Relieve congestion and confusion by controlling and
improving patient flow
 Improve patient-staff relationship and departmental
image through greeting and communication during
process of triage.
 Promote public relationship by immediate interview
with patient.
 Enable direct communication with pre-hospital care
provider.
 Provide documentation patients' condition, time of
triage and preliminary treatment given in triage.
 To provide staff training and decision making.

149.  As a system tool, it provides a way to draw
organization out of chaos.
 Helps to get care to those who need it and will
benefit from it the most and speeds efficient patient
evacuation.
 Helps in resource planning and allocation.
 Provides an objective framework for stressful and
emotional decisions, helping rescue workers to be
more efficient and effective.

150. Daily Emergencies
 Do the best for each individual.
 Do the greatest good for the greatest number.
Maximize survival.

151. This is one of the few places where a
"utilitarian rule" governs medicine: the
greater good of the greater number
rather than the particular good of the
patient at hand. This rule is justified only
because of the clear necessity of general
public welfare in a crisis.


152.  Emergent – have the highest priority
 a life-threatening conditions and must be
seen immediately
 Urgent – serious health problems, but not
immediately life-threatening ones; must be
seen within an hour.
 Non-urgent – episodic illnesses that can be
addressed within 24 hours w/out increased
morbidity
 Fast-track – requires simple first aid or basic
primary care.


153. Priorities for patient with an
emergent or urgent health problem
1. stabilization
2. provision of critical treatments
3. prompt transfer to the appropriate
setting (ICU, OR, General Care Unit)

154. Primary survey – focuses on stabilizing life-threatening
conditions.
 A – Airway - establish a patent airway
 B – Breathing- Provide adequate ventilation, employing
resuscitation measures when necessary. (Trauma patients
must have the cervical spine protected and chest injuries
assessed first)
 C – Circulation - Evaluate and restore cardiac output by
controlling hemorrhage, preventing and treating shock,
and maintaining or restoring effective circulation.
 D – Disability- Determine neurologic disability by
assessing neurologic function using the Glasgow Coma
Scale.

155. Secondary survey approach
 a. A complete health history and head-to-toe
assessment.
 b. Diagnostic and laboratory testing.
 c. Insertion or application of monitoring devices
such as ECG electrodes, arterial lines, or urinary
catheter.
 d. Splinting of suspected fractures.
 e. Cleaning and dressing of wounds.
 f. Performance of other necessary interventions
based on the individual patient’s condition.

156. Simple triage and rapid treatment (START) is a method
used by first responders to effectively and efficiently
evaluate all of the victims during a mass casualty
incident (MCI). The first-arriving medical personnel will
use a triage tool called a triage tag to categorize the
victims by the severity of their injury. Once they have a
better handle of the MCI, the on-scene personnel will call
in to request for the additional appropriate resources
and assign the incoming emergency service personnel
their tasks. The victims will be easily identifiable in
terms of what the appropriate care is needed by the
triage tags they were administered. This method was
developed in 1983 by the staff members of Hoag
Hospital and Newport Beach Fire Department located in
California.

157. The whole evaluation process is generally conducted in
60 seconds or less. Once the evaluation is complete, the
victims are labeled with one of the four triage
categories.
Minor delayed care / can delay up to three hours.
Delayed urgent care / can delay up to one hour.
Immediate immediate care / life-threatening.
Deceased victim is dead or mortally wounded / no
care required
Obviously these categories are only an indication of the
desired treatment time; in a large scale emergency,
Minor patients may be seen days later, if at all.

158. When medical personnel first arrive
on the scene, they quickly assess
the situation and do a call-out; they
ask that any victim who is able to
walk to separate themselves from
non-ambulatory victims and to
relocate to a certain area, or they
may be asked to assist the medical
personnel with the other non-
ambulatory victims. These
ambulatory victims are either
uninjured or have minor injuries
that do not need immediate care, so
they are labeled with a green tag
(minor).

159. With the non-ambulatory victims, personnel
assess their respiratory, circulatory, and
neurological functions, and based on those
conditions the patient is labeled with one of the
three remaining triage categories (i.e. delayed,
immediate, dead). The three functions to check,
respiratory, circulatory, and neurological, can be
remembered using the mnemonics RPM
(respiration, perfusion or pulse, and mental
status), or ABC (airway, breathing, and
circulation/shock).

160.  Immediate (Red): Life-threatening but treatable injuries
requiring rapid medical attention- victims needing the
most support and emergency care.
 Delayed (Yellow): Potentially serious injuries, but are
stable enough to wait a short while for medical
treatment- victims less critical but still in need of
transport to emergency centers for care
 Ambulatory (Green): Minor injuries that can wait for
longer periods of time for treatment- victims who have
minor injuries and do not warrant transport to an
emergency center.
 Expectant (Black): Dead or still with life signs but
injuries are incompatible with survival in austere
conditions

161.  Reverse Triage works on the principle of the
greatest good for the greatest number
 Persons who are the most ambulatory and least
injured would be transported or instructed to
move quickly to the warm zone away from the
immediate accident site to get processed first.
 Used for mass casualties
 Minor injuries would be treated next
 Critical injuries treated after the minor injuries
 Most critical and severely injured would be
treated last.

162.  Triage is a continuous process in which
priorities are reassigned as needed.
 Must balance lives with the realities of the
situation such as supplies and personnel.
 Crowd control is the responsibility of security
and police.
 Psychiatric services takes an active role to
prevent PTSD by assessing individual needs,
offering immediate counseling and referral for
follow up.

163. Military type triage is
designed to provide the
most effective care to save
the most number of lives.
Emphasis is on doing the
most amount of good for
the largest number of
people. It avoids expending
large amounts of resources
on patients with little chance
of survival.

164. Priority 1: The injury is critical, however, it can be cared for
with a reasonable amount of time and resources.
 Priority 1+: Occasionally this category is added; but it is not
universal. These patients have significant injury, will
probably not survive, but can be treated before Priority 2
patients
Priority 2: Injuries are significant, however, the patients will
tolerate a short delay with minimal morbidity.
Priority 3: Injuries are sufficiently minor that the patients can
tolerate significant delay. Often known as "Walking
Wounded".
 Expectant: Patients in whom severe injury makes survival
highly unlikely even with the use of significant resources.
 DEAD: Patients who are unresponsive, pulseless, and apneic
are considered dead and no further resources are used.

166. Patients can usually be assigned to a triage
category quickly with assessment of four
parameters: Airway, Respiratory Rate,
Capillary Refill, and Ability to Follow
Commands.
Patients who are able to walk away from the
scene do so, and are assigned Priority 3.
Patients who are maintaining an airway,
have a Respiratory Rate less than 30, have
normal capillary refill, and are able to follow
commands are assigned to Priority 2.
Patients without spontaneous respirations
who do not respond to simple airway
maneuvers are assigned to Expectant.
All other patients are assigned to Priority

167.  PURPOSES:
 Surveying the client’s health status and risk
factors for a particular health problems
 Identifying latent or occult (undetected) disease
 Screening for a specific disease, such as diabetes
or hypertension.
 Identifying risks for particular health problem
 Determining functional impact of disease (human
response to actual or potential health problems)
 Evaluating the effectiveness of the health care
plan


168. Purposes:
 Elicits a detailed, accurate, and chronological
health record as seen in the client’s
perspective.
 Connect with the client and develop good
rapport, provides insight into the client’s
functional status, and helps focus and guide
subsequent physical examinations.

169.  Physical examination is the second component of
a complete nursing health assessment. History
findings help focus the physical examination.
 Practice and adhere to standard precautions
throughout the entire physical assessment.
ASSESSMENT TECHNIQUES
 Inspection
 an important assessment point (but commonly
forgotten)
 Inspection employs the senses of vision and
smell to observe the client.

170.  Auscultation
 Involves listening (usually through a stethoscope) to
sounds produced in the body, particularly the heart,
lungs, blood vessels, stomach, and intestines.
 A doppler ultrasonic stethoscope and an acoustic
stethoscope can be used to amplify body sound.
 Palpation
 Different parts of the hand are used to detect
characteristics of pulsation, vibrations, texture, shape,
temperature, and movement.
 Confirm and amplify findings observed during
inspection.

171. Light palpation is always done first. Using finger
pads, provide superficial and delicate palpation to
explore skin texture and moisture; overt, large or
deep masses; and fluid, muscle guarding, and
superficial tenderness.
Deep palpation, uses the hand to explore internal
structures.
 Percussion
 Sharply tapping the body surface with the fingers,
hands, or a rubber reflex hammer produces sounds
whose quality depends on the density of underlying
structures (organ borders, fluid, gas)
 Used to elicit tenderness and to assess reflexes.

172. Laboratory Studies
 3 categories
 Urinalysis
 Hematology
 Blood chemistry
Diagnostic Studies
Performed during routine physical
examinations and assist in diagnosing
disease.

173.  The nurse is responsible for the during the pretest, intra -
test, post test periods.
 Facility policies, procedures, and protocols for collecting,
handling, and transporting specimens should be followed
at all times.
 The nurse must educate the client concerning preparation
for the diagnostic test
 Obtain written consent if necessary
 Ensure client’s safety during the procedure
 Assist with the procedure if necessary
 Monitor for complications after the diagnostic test
 Standard precaution must be adhered to at all times.

174. A hospital incident command
system (HICS) is an incident
command system designed for
hospitals and intended for use
in both emergency and non-
emergency situations. It
provides hospitals of all sizes
with tools needed to advance
their emergency
preparedness and response
capability—both individually
and as members of the broader
response community.

175.  Incident Command System (ICS) is "a systematic tool
used for the command, control, and coordination of
emergency response" according to the United States
Federal Highway Administration.
 A more detailed definition of an ICS according to the
United States Center for Excellence in Disaster
Management & Humanitarian Assistance is "a set of
personnel, policies, procedures, facilities, and
equipment, integrated into a common organizational
structure designed to improve emergency response
operations of all types and complexities.

176.  ICS is a subcomponent of the National Incident
Management System (NIMS), as released by the U.S.
Department of Homeland Security in 2004."[ An ICS is
based upon a flexible, scalable response organization
providing a common framework within which people
can work together effectively.
 ICS is designed to give standard response and operation
procedures to reduce the problems and potential for
miscommunication on such incidents. ICS has been
summarized as a "first-on-scene" structure, where the
first responder of a scene has charge of the scene until the
incident has been declared resolved, a more qualified
responder arrives on scene and receives command, or the
Incident Commander appoints another individual
Incident Commander.

177.  ICS consists of a standard management hierarchy and
procedures for managing temporary incident(s) of any
size. ICS procedures should be pre-established and
sanctioned by participating authorities, and personnel
should be well-trained prior to an incident.
 ICS includes procedures to select and form temporary
management hierarchies to control funds, personnel,
facilities, equipment, and communications. Personnel are
assigned according to established standards and
procedures previously sanctioned by participating
authorities. ICS is a system designed to be used or applied
from the time an incident occurs until the requirement for
management and operations no longer exist.

178.  RED – For Fire
 BLUE – For Adult medical emergency
 WHITE – For paediatric medical emergency
 PINK – For infant abduction
 PURPLE – For child abduction
 YELLOW – For bomb threat
 BLACK – Actual bomb present
 GRAY – For combative person
Hospital Color Code System

179.  The ICS concept was originally developed in
1968 at a Phoenix AZ meeting of Fire Chief's.
 Originally the program was established to
follow the management structure of the US
Navy and it was mainly for fire fighting of
wildfires in California and Arizona

180.  ICS fell under California's Standardized
Emergency Management System or SEMS. ICS
became a national model for command structures
at a fire, crime scene or major incident. The ICS
System was used in New York at the first terrorist
attempt on the twin towers in the 1990's. In 2003,
SEMS went national with the passage of
Homeland Security Presidential Directive 5
(HSPD5) mandating all federal, state, and local
agencies use NIMS or the National Incident
Management System to manage emergencies in
order to receive federal funding.

181.  Lack of accountability, including unclear chains of command
and supervision.
 Poor communication due to both inefficient uses of available
communications systems and conflicting codes and
terminology.
 Lack of an orderly, systematic planning process.
 No predefined methods to integrate inter-agency
requirements into the management structure and planning
process effectively.
 Freelancing by individuals with specialized skills during an
incident without coordination with other first responders
 Lack of knowledge with common terminology during an
incident.

182. The Emergency Operations Plan
(EOP) outlines the hospital’s
strategy for responding to and
recovering from a realized threat or
hazard or other incident. The
document is intended to provide
overall direction and coordination
of the response structure and
processes to be used by the
hospital. An effective EOP lays the
groundwork for implementation of
the Incident Command System and
the needed communication and
coordination between operating
groups.

183. The essence of the process includes the following
steps:
- Designating an Emergency Program Manager Program
- Establishing the Emergency Management Committee
- Developing the “all hazards ” Emergency Operations
Plan
- Conducting a Hazard Vulnerability Analysis
- Developing incident-specific guidance (Incident
Planning Guides)
- Coordinating with external entities
- Training key staff
- Exercising the EOP and incident-specific guidance
through an exercise program
- Conducting program review and evaluation
- Learning from the lessons that are identified
(organizational learning)

184.  The following educational outline was developed to combine a national
perspective regarding emergency preparedness activities with specific
information for developing a hospital-based emergency management
program.
 It includes a summary of the National Incident Management System
(NIMS)
training courses provided by FEMA’s Emergency Management Institute
(EMI)
and the HICS Learning Modules featuring key information extracted
from the
HICS Guidebook.
 The intent is to improve preparedness and response capability
through community integration and assist hospitals in implementing a
compatible emergency management program within their own facility
or healthcare system.

185. Incident Command training is
an excellent way to learn more
about leading a group and
delegating authority. Incident
Command includes some great
aspects that can be used by any
leader in almost any situation.
Common terminology, task lists,
standard job descriptions and
responsibilities, support
materials, and much more are all
part of incident command and
should be used in other areas
also. Another concept is span-of-
control.

186. In today’s healthcare environment,
an institution’s commitment to
provide safe, high-quality patient
care must be matched with a
corresponding commitment to
develop, implement, measure, and
achieve best business practices.
Insufficient federal and state
reimbursement levels, aggressive
managed care contracting, increased
patient responsibility for payment,
increased capital needs and rising
staff and operating costs make it
more critical than ever that
healthcare institutions exercise
excellent stewardship of their
resources.

187. Personal protective
equipment (PPE) refers to
protective clothing, helmets, goggl
es, or other garment or equipment
designed to protect the wearer's
body from injury by blunt
impacts, electrical hazards,
heat, chemicals, and infection, for
job-related occupational safety
and health purposes, and
in sports, martial arts, combat,
etc. Personal armor is combat-
specialized protective gear.

188. The use of personal protective
equipment is to reduce
employee exposure to
hazards when engineering
and administrative controls
are not feasible or effective to
reduce these risks to
acceptable levels.

189. Biohazard suit
Protective equipment for
biological hazards
includes masks worn by
medical personnel (especially
in surgery to
avoid infecting the patient but
also to avoid exposing the
personnel to infection from the
patient.) Gloves, frequently
changed, are used to prevent
infection but also transfer
between patients.

190. Chemicals are found everywhere. They
purify drinking water, increase crop
production, and simplify household
chores. But chemicals also can be
hazardous to humans or the
environment if used or released
improperly. Hazards can occur during
production, storage, transportation,
use, or disposal. You and your
community are at risk if a chemical is
used unsafely or released in harmful
amounts into the environment where
you live, work, or play.
Gasoline and liquid petroleum gas are
most common and also chlorine,
ammonia, and explosives.

191. Hazardous materials in various
forms can cause death, serious
injury, long-lasting health effects,
and damage to buildings, homes,
and other property. Many products
containing hazardous chemicals are
used and stored in homes routinely.
These products are also shipped
daily on the nation's highways,
railroads, waterways, and pipelines.
Hazardous materials come in the
form of explosives, flammable and
combustible substances, poisons, and
radioactive materials. These
substances are most often released as
a result of transportation accidents
or because of chemical accidents in
plants.

192. The Practice Greenhealth
website provides specific
information on the
following common hazardous
materials in health care
facilities:
mercury
pharmaceuticals
radiologicals
sterilants and disinfectants
cleaning chemicals
laboratory chemicals
pesticides

193.  Removal of hazardous substances (bacteria, chemicals,
radioactive material) from employees’ / victims bodies,
clothing, equipment, tools, and/or sites to the extent necessary
to prevent the occurrence of adverse health and/or
environmental effects.
 A decontamination/triage facility is intended to protect
hospital facilities and staff so that they can safely and
securely carry out their health care responsibilities in a
contamination-free environment. Ideally, a small number of
suitably trained hospital staff with appropriate personal
protection gear will meet victims at the entrance to the
decontamination facility and assist them in completely
disrobing, provide them a warm soapy shower, and
temporary clothing.

194. Simply removing a victim's clothing
is probably the single most
important decontamination
measure. The decontamination
facility is treated as the "Warm
Zone," i.e. potentially contaminated
through the presence of victims
arriving from the scene of a terrorist
attack.
Only after thorough
decontamination will patients be
transferred to the "Cold Zone," i.e.,
the main area of the hospital facility
that will be free of contamination,
where regular medical staff can
provide appropriate care without
being overly encumbered by the
special equipment or unusual
precautions required in the "Warm
Zone."

195. Chemical warfare agents, both nerve and blister, are highly
toxic materials that were intended to cause harm. Other
agents that might be used in a terrorist attack such as
industrial chlorine gas, are also very hazardous.
Nevertheless, the individuals who are by far at the greatest
risk are those at the site of the actual attack. Medical
personnel who come into contact with these hazardous
materials only through working with victims away from the
attack site are at substantially less risk.
Be prepared to protect facility staff with at least a minimal
face respirator and gloves (even simple face-masks designed
to protect against pesticide spray and vapor exposure would
provide some protection).
Be prepared to quickly decontaminate victims by removing
all clothing (plastic trash bags can be used for temporary
disposal) and providing a warm shower with soap and
shampoo. Lacking warm showers, a thorough sponge-bath
with lots of warm soapy water will provide significant
decontamination. Staff should be assured that
decontamination itself is treatment.

196. Biological Agents Exposure: containment
is essential; accomplished by isolation of
the victims.
Radioactive Exposure: will spread to
other persons if the patient is not isolated
Chemical Exposure: person must be
decontaminated according to protocol
prior to treatment

197. Biologic warfare – is a covert
method of effecting terrorist
objectives. Biologic weapons are
easily obtained and easily
disseminated and can result in
significant mortality and
morbidity.

198. Biologic agents – are delivered in
either a liquid or dry to foods or
water, or vaporized for inhalation
or direct contact.
Vaporization may be accomplished
through spray or explosives loaded
with the agent. Because of increases
in business and pleasure travel by
people in industrialized nations, an
agent could be released in one city
and affect people in other cities
thousands of miles away. The
vector can be an insect, animal, or
person, or there may be direct
contact with the agent itself.

199. TYPES OF BIOLOGICAL AGENTS
1. ANTHRAX ( bacillus anthracis) – is a
naturally occurring gram-positive,
encapsulated rod that lives in the soil in the
spore state throughout the world. The
bacterium sporulates( ie, is liberate)when
exposed to air and is infective only in the
spore form. Contact with infected animal
products (raw meat) or inhalation of the
spores results in infection.
It is believed that approximately 8000 to
50,000 spores must be inhaled to put a person
at risk.
As an aerosol, ANTHRAX is odorless and
invisible and can travel a great distance
before disseminating; hence, the site of
release and the site of infection can be miles
apart.

200.  Anthrax is caused by replicating bacteria that
release toxin, resulting in hemorrhage, edema,
and necrosis.
 INCUBATION PERIOD: 1 to 6 days.
 Anthrax affects farm animals more often
than people. But it can cause three forms of
disease in people. They are:
 Cutaneous, which affects the skin. People with
cuts or open sores can get it if they touch the
bacteria. Symptoms include muscle aches and
headache, fever, nausea, and vomiting.

201.  Inhalation, which affects the lungs. You can get this if
you breathe in spores of the bacteria. The first symptoms
are subtle, gradual and flu-like (influenza). In a few days,
however, the illness worsens and there may be severe
respiratory distress. Shock, coma, and death follow.
Inhalation anthrax does not cause a true pneumonia. In
fact, the spores get picked in the lungs up by scavenger
cells called macrophages.
 Gastrointestinal, which affects the digestive system. You
can get it by eating infected meat. The symptoms of this
form of anthrax include nausea, loss of appetite,
bloody diarrhea and fever followed by abdominal pain.
The bacteria invade through the bowel wall. Then the
infection spreads throughout the body through the
bloodstream (septicemia) with deadly toxicity.

202. In most cases, early treatment can
cure anthrax. The cutaneous
(skin) form of anthrax can be
treated with common antibiotics
such as penicillin, tetracycline,
erythromycin,
and ciprofloxacin (Ciprobay).
The pulmonary form of anthrax
is a medical emergency. Early
and continuous intravenous
therapy with antibiotics may be
lifesaving. In a bioterrorism
attack, individuals exposed to
anthrax will be given antibiotics
before they become sick.

203. 2. SMALLPOX (variola) is
classified as a DNA virus. It has
an incubation period of
approximately 12 days. It is
extremely contagious and is
spread by direct contact, by
contact with clothing or linens , or
by droplets from person to person
only after the fever has decreased
and the rash phase has begun.
Symptoms are flu-like and
include high fever, fatigue and
headache and backache, followed
by a rash with flat red sores.

204. Types:
Variola major, or smallpox, has a death rate
of 30%. Is more common and results in a higher
fever and more extensive rash.
Hemorrhagic smallpox, a sub-type of variola
major includes all of the above signs and
symptoms plus a dusky erythema and
petechiae to frank hemorrhage of the skin and
mucous membranes, resulting in death by day
5 or 6.
Variola minor, or alastrim, is a milder form
of the virus with a death rate of 1%.

205. Treatment: Medical treatment for smallpox eases
its symptoms. This includes replacing fluid lost
from fever and skin breakdown. Antibiotics may
be needed for secondary skin infections. The
infected person is kept in isolation for 17 days or
until the scabs fall off.

206. 3. Severe acute respiratory syndrome is
a respiratory disease in humans which is
caused by the SARS corona virus (SARS-
CoV).
INCUBATION PERIOD: 2 to 10 days.
People at risk include health workers
who have had unprotected exposure to
SARS-CoV.
SARS typically begins with flu-like
symptoms, including high fever that may
be accompanied by headache and muscle
aches, cough, and shortness of breath. Up
to 20 percent of infected people may
develop diarrhea. Most people with SARS
subsequently develop pneumonia.

207. Treatment
Persons suspected of having SARS
should be evaluated immediately by
a health care provider, and
hospitalized under isolation if they
meet the definition of a suspected or
probable case.
Treatment may include:
Antibiotics to treat bacterial causes
of atypical pneumonia
Antiviral medications
High doses of steroids to reduce
lung inflammation
Oxygen, breathing support
(mechanical ventilation), or chest
physiotherapy

208. A blast injury is a complex type of physical
trauma resulting from direct or indirect exposure to
an explosion. Blast injuries occur with the
detonation of high-order explosives as well as
the deflagration of low order explosives. These injuries
are compounded when the explosion occurs in a
confined space.
CLASSIFICATION
Blast injuries are divided into four classes:
Primary
Secondary
Tertiary
Quaternary

209. PRIMARY INJURIES
Primary injuries are caused by
blast overpressure waves, or shock
waves. These are especially likely
when a person is close to an exploding
munitions, such as a land mine. The
ears are most often affected by the
overpressure, followed by the lungs
and the hollow organs of
the gastrointestinal tract.
Gastrointestinal injuries may present
after a delay of hours or even
days. Injury from blast overpressure is
a pressure and time dependent
function. By increasing the pressure or
its duration, the severity of injury will
also increase.

210. In general, primary blast injuries
are characterized by the absence of
external injuries; thus internal
injuries are frequently
unrecognized and their severity
underestimated. There is general
agreement that spalling, implosion,
inertia, and pressure differentials
are the main mechanisms involved
in the pathogenesis of primary blast
injuries. Thus, the majority of prior
research focused on the
mechanisms of blast injuries within
gas-containing organs/organ
systems such as the lungs, while
primary blast-induced traumatic
brain injury has remained
underestimated.

211. Blast lung refers to severe pulmonary
contusion, bleeding or swelling with damage
to alveoli and blood vessels, or a combination of
these. It is the most common cause of death
among people who initially survive an
explosion.

212. SECONDARY INJURIES
Secondary injuries are due people
being injured by shrapnel and other
objects propelled by the
explosion. These injuries may affect
any part of the body and sometimes
result in penetrating trauma with
visible bleeding. At times
the propelled object may become
embedded in the body, obstructing
the loss of blood to the outside.
However, there may be extensive
blood loss within the body
cavities. Shrapnel wounds may be
lethal and therefore many anti-
personnel bombs are designed to
generate shrapnel and fragments.

213. Most casualties are caused by
secondary injuries. Some explosives,
such as nail bombs, are deliberately
designed to increase the likelihood
of secondary injuries. In other
instances, the target provides the
raw material for the objects thrown
into people, e.g., shattered glass
from a blasted-out window or the
glass facade of a building.

214. TERTIARY INJURIES
Displacement of air by the
explosion creates a blast wind that
can throw victims against solid
objects. Injuries resulting from this
type of traumatic impact are
referred to as tertiary blast injuries.
Tertiary injuries may present as
some combination of blunt and
penetrating trauma,
including bone fractures and coup
conter-coup injuries. Young
children, because they weigh less
than adults, are at particular risk of
tertiary injury.

215. QUARTERNARY INJURIES
Quaternary injuries, or other miscellaneous named
injuries, are all other injuries not included in the first three
classes. These include flash burns, crush injuries and
respiratory injuries.
Traumatic amputations quickly result in death, and are
thus rare in survivors, and are often accompanied by
significant other injuries. The rate of eye injury may
depend on the type of blast. Psychiatric injury, some of
which may be caused by neurological damage incurred
during the blast, is the most common quaternary injury,
and post-traumatic stress disorder may affect people who
are otherwise completely uninjured.

216. MECHANISM:
>High-order explosives produce
a supersonic overpressure shock wave, while low
order explosives deflagrate (subsonic combustion)
and do not produce an overpressure wave.
>A blast wave generated by an explosion starts with
a single pulse of increased air pressure, lasting a
few milliseconds.
>The negative pressure ( suction) of the blast wave
follows immediately after the positive wave. >The
duration of the blast wave, i.e., the time an object in
the path of the shock wave is subjected to the
pressure effects, depends on the type of explosive
material and the distance from the point of
detonation.

217. >The blast wave progresses from the source
of explosion as a sphere of compressed and
rapidly expanding gases, which displaces an
equal volume of air at a very high velocity.
>The velocity of the blast wave in air may be
extremely high, depending on the type and
amount of the explosive used.

218. NEUROTRAUMA
Blast injuries can cause hidden brain damage and
potential neurological consequences. Its complex clinical
syndrome is caused by the combination of all blast effects,
i.e., primary, secondary, tertiary and quaternary blast
mechanisms. It is noteworthy that blast injuries usually
manifest in a form of polytrauma, i.e. injury involving
multiple organs or organ systems. Bleeding from injured
organs such as lungs or bowel causes a lack of oxygen in all
vital organs, including the brain.
Damage of the lungs reduces the surface for oxygen uptake
from the air, reducing the amount of the oxygen delivered
to the brain. Tissue destruction initiates the synthesis and
release of hormones or mediators into the blood which,
when delivered to the brain, change its function. Irritation
of the nerve endings in injured peripheral tissue and/or
organs also significantly contributes to blast-
induced neurotrauma.

219. Individuals exposed to blast
frequently manifest loss of
memory for events before
and after explosion,
confusion, headache,
impaired sense of reality,
and reduced decision-
making ability. Patients with
brain injuries acquired in
explosions often develop
sudden, unexpected brain
swelling and
cerebral vasospasm despite
continuous monitoring.

221.  WHO defines Disaster as "any occurrence, that causes
damage, ecological disruption, loss of human life,
deterioration of health and health services, on a scale
sufficient to warrant an extraordinary response from
outside the affected community or area"
 Disasters can be defined in different ways:
 A disaster is an overwhelming ecological disruption
occurring on a scale sufficient to require outside assistance
 A disaster is an event located in time and space which
produces conditions whereby the continuity of structure
and process of social units becomes problematic
 It is an event or series of events which seriously disrupts
normal activities.

222. Disasters are classified in various ways:
 Natural disasters ( caused by acts of nature or
emerging diseases) and Man made disasters (may
be accidental or intentional)
Sudden disasters and Slow onset disasters
 The dividing line between these types of disasters is
imprecise.
 Activities related to man may exacerbate natural
disasters.

223.  Disaster is a "sudden, extraordinary calamity or
catastrophe, which affects or threatens health".
 Disasters include : Tornadoes, Fires , Hurricanes,
Floods , Sea Surges , Tsunamis, Snow storms,
Earthquakes, Landslides, Severe air pollution (smog)
Heat waves, Epidemics, Building collapse,
Toxicological accidents (e.g. release of hazardous
substances), Nuclear accidents, Explosions , Civil
disturbances, Water contamination and Existing or
anticipated food shortages.

224. TYPES OF EMERGENCIES FOR DISASTER
Multiple Casualty Incidents – complex
emergencies
Mass Casualty – more than 100 casualties

225. Disasters throughout history have had
significant impact on the numbers, health
status and life style of populations.
 Deaths
 Severe injuries, requiring extensive treatments
 Increased risk of communicable diseases
 Damage to the health facilities
 Damage to the water systems
 Food shortage
 Population movements

226.  Social reactions
 Communicable diseases
 Population displacements
 Climatic exposure
 Food and nutrition
 Water supply and sanitation
 Mental health
 Damage to health infrastructure

227.  Disasters continue to strike and cause
destruction in developing and developed
countries alike, raising peoples concern about
their vulnerability to occurrences that can
gravely affect their day to day life and their
future.
 Major disasters have had a big impact on the
migration of populations and related health
problems, and many millions are struggling
for minimum vital health and sanitation needs
and suffer from malnutrition.

228. A natural disaster is the effect of a
natural
hazard (e.g., flood, tornado, hurricane,
volcanic eruption, earthquake,
or landslide). It leads to financial,
environmental or human losses. The
resulting loss depends on the
vulnerability of the affected population
to resist the hazard, also called their
resilience.
In this event, loss of communications
(even wireless technology may not be
functional), potable water, and
electricity are usually the greatest
obstacles to a well- coordinated
emergency response.

229. GEOGRAPHIC DISASTER
Earthquakes
An earthquake is a sudden motion or trembling of the
ground produced by the abrupt displacement of rock
masses. The vibrations may vary in magnitude. The
underground point of origin of the earthquake is
called the "focus". The point directly above the focus
on the surface is called the"epicenter".

230.  Earthquake Magnitude is a measure of the strength of an
earthquake as calculated from records of the event made on
a calibrated seismograph. In 1935, Charles Richter first
defined local magnitude, and the Richter scale is commonly
used today to describe an earthquake's magnitude.
 Earthquake Intensity.
 In contrast, earthquake intensity is a measure of the effects
of an earthquake at a particular place. It is determined from
observations of the earthquake's effects on people,
structures and the earth's surface.
 Among the many existing scales, the Modified Mercalli
Intensity Scale of 12 degrees, symbolized as MM, is
frequently used.

231. Earthquake hazards can be categorized as either
direct hazards or indirect hazards.
Direct Hazards
 Ground shaking;
 Differential ground settlement;
 Soil liquefaction;
 Immediate landslides or mud slides, ground
lurching and avalanches;
 Permanent ground displacement along faults;
 Floods from tidal waves, Sea Surges & Tsunamis

232. Indirect Hazards
 Dam failures; Pollution from damage to
industrial plants; Delayed landslides.
Most of the damage due to earthquakes is the
result of strong ground shaking. For large
magnitude events, trembling has been felt over
more than 5 million sq. km.
Site Risks Some common site risks are:
(1) Slope Risks - Slope instability, triggered by
strong shaking may cause landslides. Rocks or
boulders can roll considerable distances.

233.  (2) Natural Dams - Landslides in irregular
topographic areas may create natural dams
which may collapse when they are filled.
 This can lead to potentially catastrophic
avalanches after strong seismic shaking.
 (3) Volcanic Activity - Earthquakes may be
associated with potential volcanic activity and
may occasionally be considered as precursory
phenomena. Explosive eruptions are normally
followed by ash falls and/or pyroclastic flows,
volcanic lava or mud flows, and volcanic gases.

234. Earthquakes by themselves rarely kill people or
wildlife. It is usually the secondary events that they
trigger, such as building collapse,
fires, tsunamis (seismic sea waves) and volcanoes,
that are actually the human disaster.

235. Volcanic Eruptions
Volcanoes can cause widespread destruction and
consequent disaster through several ways. The
effects include the volcanic eruption itself that
may cause harm following the explosion of the
volcano or the fall of rock. Second, lava may be
produced during the eruption of a volcano. As it
leaves the volcano, the lava destroys many
buildings and plants it encounters. Third, volcanic
ash generally meaning the cooled ash - may form
a cloud, and settle thickly in nearby locations.

236. When mixed with water
this forms a concrete-like
material. In sufficient
quantity ash may cause
roofs to collapse under its
weight but even small
quantities will harm
humans if inhaled.