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Chapters Seven and Eight

-Crisis and disaster management in hospitals

What is the difference between crisis and disaster?

The Crisis :

Threat means an expected or unexpected danger to the goals, values, beliefs, and property of individuals, organizations, and nations that limits the process of

Make decision.

It is a situation resulting from environmental changes that generate crises and includes a degree of danger, threat, lack of time, and surprise, and requires

Use innovative and rapid management methods.

Disaster:

Disasters caused by human action, negligence, error, or involving system failure are called man-made disasters.

Man-made disasters are in turn classified as technological or social. Technological disasters are the results of technology failure

Such as engineering failure, transportation disasters, or environmental disasters. Social disasters have a strong human motive, like criminal acts

Stampedes, riots and war. It is an environmental disruption in the relationship between humans and their environment, largely represented by a sudden or dangerous event.

Society needs to make exceptional efforts to organize foreign aid and international aid.

Meaning of crisis management:

Crisis management means the art of controlling an emergency situation through predicting crises and sensing and monitoring internal or external variables

The external factors that generate it, mobilize available resources, raise the efficiency and capacity of the decision-making system to confront it, and reduce losses

minimum.

Symptoms of the crisis:

1. Surprise: It is an unexpected event, a quick and mysterious event, or a sudden situation in which the necessary creative events occur to surprise the decision maker.

2. The seriousness of the threat: which may lead to massive material or human losses that threaten stability and sometimes lead to the elimination of organization entity.

3. Confusing: It threatens the main assumptions on which the system is based, and creates a state of anxiety, tension, and mistrust in the available alternatives, especially in light of the lack of information, which doubles the difficulty of decision-making, and makes any a decision that involves some degree of risk.

4. The lack of time available to confront the crisis: events occur and escalate in a conflicting and perhaps severe manner, which leaves parties lost crisis, sometimes the ability to control the situation and understand it well, where efforts must be focused to make decisive decisions and quickly in a time of distress and pressure.

5. The multiplicity of parties and forces influencing the occurrence and development of the crisis, and the conflict of their interests, which creates great difficulties in controlling and managing the situation. Some of these difficulties are administrative, material, human, political, environmental, etc.

Steps to deal with the crisis:

• Forming a work team for times of crises and providing it with the best personnel, equipment, and tools.

• Planning time during crises and making use of every minute to mitigate the impact of crises.

• Raising the morale of workers in times of crises, making them feel enthusiastic, energetic, and committed to work.

• Creativity and innovation in difficult situations and igniting the spirit of creativity among employees to provide unprecedented solutions and opinions.

• Solve problems in times of crisis by identifying the problem, conducting counseling, and then choosing the most appropriate solution from the available solutions.

Disaster division:

According to location, it is divided into:

Internal disasters.

External disasters.

According to the number of victims, they are divided into:

Small disasters (the number of victims does not exceed 25)

Moderate disasters (the number of victims does not exceed 100)

Major disasters (the number of victims exceeds 100).

According to the reasons, they are divided into:

Natural disasers .

Man-made disasters.

Types of disasters:

  •  Natural disasters.
  •  Epidemics.
  •  Disasters resulting from transportation.
  •  Technological disasters.
  •  Terrorism disasters.

Tornadoes :

  •  The main health risks from tornadoes and hurricanes lie in the risk of drowning from storms over land.

Most hurricane-related deaths are caused by drowning.

  •  Secondary health risks include injuries resulting from flying fragments caused by strong winds.
  •  The nurse can provide direct care in cases of previous head injuries and drowning emergencies.

Floods:

  •  Floods may develop very quickly after a rapid rainstorm, or during a short period of prolonged rain

Or rapid snow melting.

  •  The main danger from floods is drowning.
  •  In the long term, health concerns from floods lie in the development of diseases from water pollution and lack of hygiene.

Earthquakes:

  •  A problem of great global concern
  •  Main health problems related to earthquakes:
  •  Injuries resulting from the collapse of facilities.
  •  Most injuries among trapped people occur at the time of the earthquake.
  •  One of the most well-known preventive strategies is to prevent structures from collapsing.
  •  There is recognition of the need to develop better strategies to rescue people from collapsing buildings.

Volcanoes:

  •  Although rare, it can be catastrophic when it occurs.
  •  Health outcomes associated with volcanic eruptions:

1. Respiratory diseases resulting from inhalation of ash Dr.

2. The danger for individuals near the volcano is from the presence of lava flows, or more likely from

Mudflows.

Patterns of deaths and injuries:

  •  Disasters involving water are the largest cause of the increase in the number of deaths.
  •  Floods and storm surges all cause the number of deaths to increase by a greater proportion than the number of injuries.
  •  As for earthquakes and disasters associated with strong winds, they cause an increase in the number of injuries by a greater percentage than the number of deaths.

Expected risks:

  •  Road accidents.
  •  Fires.
  •  Fires and collapses inside the hospital building.
  •  Radioactive contamination in the nuclear medicine building.
  •  Mass poisoning.
  • Chemical leakage.

A plan must be designed to confront disasters and crises for each hospital, according to its expectation of disasters, its capabilities, and the number of employees in it.

And the number of sick and injured people visiting it. Therefore, it is necessary to make a solid plan, run committees in it, and determine the role of each member

Members of committees restricted to the plan.

Disaster management resources:

  •  Forming an emergency and disaster response committee.
  •  A list of emergency workers’ telephone numbers: (doctors - nurses - employees - workers).
  •  The structure of emergency and hospital personnel within 24 hours.
  •  Schematic drawing of the hospital buildings.
  •  Training program for the disaster management unit.

Formation of the Crises and Disasters Committee from:

  •  Chairman of Board of Directors . - Director of therapeutic affairs.
  •  Deputy Director of Crisis Management. - Head of the toxicology department.
  •  All hospital and hospital managers (such as the director of emergency care and surgery).
  •  (Director of Pharmacy, Engineering, Communications and Warehouses).

  •  Managing Director.
  •  From nursing, it includes the director of nursing, the head of the trauma nurse, the head of the reception nurse, and the head of nursing
  • Surgery and Operations Departments and Head of Crisis Nurse)

The special role of nurses when disasters occur:

  •  Determine the size of the disaster
  •  Identifying the health needs of affected groups
  •  Setting priorities and goals
  •  Identify actual and potential public health problems
  •  Identify resources needed to respond to identified needs
  •  Cooperation with professional specialists and governmental and non-governmental agencies
  •  Unifying the chain of command communications

Communication...the key to success:

  •  Nursing organizations must have accurate and comprehensive records for all members of the organization
  •  In addition to an organized plan that includes:
  •  Cooperation and coordination with local authorities
  •  Hot line
  •  Inform nursing staff about where and how to report (with documentation)
  •  Ensure there is a coordinator to prevent any potential chaos
  •  Ensure that there are means of communication between patients and their families.

The need for training in disaster nursing:

  •  More than 11 million nurses around the world:
  •  It forms the backbone of the health care system
  •  Represents the front line of health care workers with direct contact with the public and contributes to the health of individuals

families, communities, and the world

  •  Nursing schools provide little or no information about disaster nursing. (World Health Organization, 2008)
  •  There is a shortage of trained educational personnel and colleges.

Topics to be covered in disaster nursing training:

  •  Organizing and planning the nurse’s work environment.
  •  Communication (what should the report be written about and to whom should it be sent)
  •  Working in destroyed facilities and damaged equipment
  •  Patient and worker safety
  •  Working with the team (being aware of each member’s responsibility and role)
  •  Control of disease infections
  •  Psychological and mental support.

When an earthquake occurs, nurses in the departments must follow some instructions:

  •  Complete calm, reassurance and presence with patients.
  •  Do not get down quickly, run away, leave the department, or create a state of terror for the patients.
  •  Follow up heart patients carefully.
  •  Quick call the emergency number via Soweto.
  •  If everyone feels a strong wind and there is a possibility of the building collapsing, everyone must go down under a cover such as a bed or being next to a concrete column.
  •  The head nurse or her representative goes over all the roles and checks on the patients.

Job duties and job cards for nursing staff members:

A- A work card for the head of the nursing staff or her representative: during disaster response:

  •  The presence of the head of the nursing staff immediately when the disaster is announced.
  •  Follow up on the attendance of nursing staff members registered in the six-call period.
  •  Coordinating work between the emergency department and other departments to receive victims.
  • Ensure the presence of cleaners in all departments.
  •  Ensure the presence of employees responsible for warehouses, maintenance and entry who are registered with the Disaster Committee.
  •  Ensure the availability of all medical supplies, tools and devices necessary to prepare to receive victims in the reception department intensive care, operations and all internal departments.
  •  Continuous supervision of the performance of the nursing staff in all departments.
  •  Ensure that victims’ data is recorded in disaster records and that supplies used are recorded in victim forms.
  •  Writing reports for the hospital director to monitor performance and improve performance.

B- A work card for the reception department supervisor during disaster response:

  •  Attending the hospital immediately when called when a disaster occurs.
  •  Participate in sorting and classifying victims in the reception department.
  •  Preparing the necessary medical supplies, tools and devices in all reception rooms.
  •  Participate in helping victims and providing them with the necessary care.
  • General supervision of the performance of the reception nursing staff in providing assistance to victims.
  •  Giving orders not to use phones for personal calls.
  •  Supervising the implementation of doctors’ orders (including treatment, x-rays, and tests).
  •  Supervising the immediate bringing of test results and rumors.
  •  Inform the Emergency and Operations Department of preparations to receive victims who need operations.
  •  Supervising the recording of victims’ data in disaster records.
  • Supervising the cleanliness of the reception rooms immediately after treating the victims and transporting them to the internal departments, while placing the waste in bags red and sent to the incinerator.
  •  Delegating reception nurses to work rules according to the color of the card that distinguishes their performance:

▪ A- Red color // Cardiopulmonary recovery nurse.

▪ B- Yellow color// General surgery case nurse.

▪ C- Green color // Nurse for mild cases.

▪ D- Blue color // Medicines and supplies nurse.

▪ D- Blue color // Victim triage and classification nurse.

▪ T- Yellow color // Coordination Nurse) handles the nurses’ needs during their work.

  •  Writing a report to the Chairman of the Disaster Committee on the nurses’ performance while treating victims.

C- Work card for the operations department supervisor during disaster response:

  •  The presence of the surgical and emergency nursing supervisor when called when a disaster occurs.
  •  Ensure the presence of all nurses in the operating rooms.
  •  Ensure the presence of all anesthesia nurses in the operating and recovery rooms.
  •  Ensure the presence of all nurses responsible for machines and sterilization of operations.
  •  Ensure the presence of a nurse responsible for supplies in the operating department.
  •  Ensure the presence of a pharmaceutical nurse in the operations department.
  •  Ensure the presence of cleaning workers in the operations department
  •  Ensure that all medical devices in the operations department are working, exclude broken devices and send them to the maintenance department immediately.
  •  Ensure that a large number of brushes, clothing, and sterile instruments are available in the operating rooms.
  •  Supervising the dispensing of supplies and medications in operating rooms
  •  Supervising the performance of nurses while performing operations on victims.
  •  Supervising the cleanliness of operating rooms after each operation.
  •  Increasing the number of operating trolleys to transport injured people using the trolleys of some departments.
  •  Supervising the disposal of waste by placing it in red bags. The section, date, and time are written and placed in the bag

Garbage to be burned in the engine.

  •  Supervising the placement of the laundry used during operations with the used laundry holder and placing it in the special room with used laundry.
  •  Supervising the transfer of victims from the operating room to the recovery room and then to other departments.
  •  Ensure that victims’ data is recorded in notebooks for disaster cases and ensure that the supplies used in the disaster are recorded victims' form.
  •  Writing a report to the Chairman of the Disaster Committee regarding the incapacity that occurred, if any, and the nurses’ performance while performing operations on the victims.

Note: In the event of disasters, surgical operations are canceled and the operating rooms become hospital rooms for performing operations on victims’ cases.

D- Work card for the supervisor of the intensive care department during disaster response:

  •  Attending the hospital immediately when called when a disaster occurs.
  •  Ensure the presence of a cardiopulmonary recovery nurse.
  •  Ensure the presence of a general surgery nurse.
  •  Ensure the availability of a nurse for medications and supplies.
  •  Ensure the presence of a coordination nurse (who handles the nurses’ needs during their work).
  •  Distributing nurses to intensive care beds, 2 nurses per bed, to give them the necessary care.
  •  Assisting department nurses to assist if there is a shortage, and these nurses are distributed for handling, coordination, and coordination he relies on her to take care of a sick person.
  •  Preparing the medical supplies, tools and devices necessary to receive victims in the intensive care department.
  •  Participate in providing first aid to victims and providing them with the necessary care.
  •  General supervision of the performance of nurses in the intensive care department while receiving victims.
  •  Giving orders not to use phones for personal calls.
  •  Supervising the implementation of doctors’ orders (such as treatment, scans, and tests), and supervising the bringing of the results of the tests and scans immediately.
  •  Inform the Emergency and Sixth Operations Department of preparations to receive victims who require operations.
  •  Supervising the recording of victims’ data in disaster records.
  •  Supervising the cleanliness of intensive care rooms immediately after treating victims, while placing waste in red bags and sending it away to the Holocaust.
  •  Writing a report to the Chairman of the Disaster Committee on the nurses’ performance while treating victims.

It is a business card for supervisors during disaster response:

  •  Attend the hospital immediately when called and announce when a disaster occurs.
  •  Evacuate beds occupied by stable cases by informing the doctors and the head of the department.
  •  Preparing new mattresses for all beds to prepare for the entry of infected people.
  •  Ensure the presence of all department nurses.
  •  Ensure the availability of a nurse for medications and medical supplies.
  •  Ensure the presence of cleaners in the department.
  •  Supervising the dispensing of medications for each case of the victims.
  •  Supervising the taking of laboratories and x-rays for all infected people, and bringing the results of the tests and reports to each the injured.
  •  Supervise the implementation of treatment, take vital notes for all victims and ensure that nurses do nursing care for every injured person.
  •  Supervising the cleanliness of all department rooms immediately after treating victims, and placing waste in red bags and send it to the incinerator.
  •  Writing a report to the Chairman of the Disaster Committee on the nurses’ performance during aiding, receiving, and providing nursing care for the victims.

Action in the event of a fire:

  •  Press the alarm button located next to the counter on the floor.
  •  Pull the patient’s bed out of the room and evacuate the patients from the department under the supervision of the head nurse or her representative during shifts and staying up late.
  •  Evacuating patients from the hospital by transporting them to the bed via elevator, in the event that the electricity supply to the hospital is cut off unable patients are carried.
  •  Take down the room's curtains.
  •  Evacuate the floor of visitors.
  •  Close doors and bathrooms to prevent the spread of fire.
  •  Trying to put out the fire using firefighting equipment in the building.
  •  The maintenance department disconnects the electrical current according to the situation.
  •  The civil defense team acts quickly to extinguish the fire.
  •  If a fire occurs in the care or operations department, the maintenance department separates the gases from the critical departments and monitors ventilator patients are given care or operations using cylinders or manually until they are transferred according to the situation.
  •  Containing the fire and trying not to spread it anywhere else.

Extinguishing means or tools:

Providing these tools in all hospital areas:

- Fire extinguishers in front of elevators filled with carbon dioxide gas.

- Dry powder device on each floor. - Fire hydrants and hoses on the roads.

- A container containing sand to be used in some fires that cannot be extinguished with water.

- Blankets next to exits for use during a fire.