Page 612 - ACCCN's Critical Care Nursing

Emergency Presentations 589

notification of a disaster response a number of key posi- Treatment
tions should be allocated (medical coordinator, nursing Treatment provided during a disaster will not reflect
coordinator, triage nurse, medical triage officer). These routine practices; priorities focus on resuscitation, iden-
personnel are senior staff with specific disaster training tification of serious injuries, identification of patients
and knowledge of the hospital’s disaster plan. 48,51 Nursing requiring urgent surgery and stabilisation of patients for
and medical coordinators are responsible for allocating transfer out of the ED. The best overall outcome during
staff to specific duties; all designated roles are outlined a disaster are achieved when the routine principles of
on action cards available for staff to read prior to com- resuscitation and management are adapted to reflect the
mencing their roles. 52 51,52
resources available.
The capacity of the ED to accommodate a large influx of
patients needs to be maximised. Patients currently in the
department are reviewed for a decision to admit. Patients Transfer from the ED
requiring admission are transferred out of the Depart- Patients are triaged, stabilised and transferred out to the
ment to a suitable location in the hospital. Patients suit- operating theatre or other clinical areas as soon as pos-
able for discharge or referral to their local medical officer, sible using designated transfer staff and a coordinated
including patients with minor complaints currently process outlined in the hospital plan. This will maintain
waiting, should be discharged or referred to community the effectiveness and efficiency of the department as
resources. A small number of patients may need to remain victims continue to arrive.
in the ED, and their care will need to be prioritised in
conjunction with arriving disaster victims. 50-52
Areas of the department are designated to accommodate RESPIRATORY PRESENTATIONS
the expected severity of the victims (e.g. resuscitation Patients with respiratory dysfunctions are a common
room for priority 1 patients, observation areas for priority presentation to the ED and are seen across all age
2). Walking wounded casualties with relatively minor groups. Respiratory symptoms can be associated with
injuries and who are unlikely to require admission to a broad range of underlying pathologies. This section
hospital are best accommodated in a treatment area will discuss the initial assessment and treatment of
outside the ED, as this cuts congestion and increases several common respiratory diseases seen in the ED.
the capacity for more significantly-injured victims to be Chapter 14 provides more detailed information regard-
managed. 51 ing respiratory diseases.
Additional staff members are notified from the current
staff lists to participate in the disaster management. Staff
members are allocated to teams to manage designated PRESENTING SYMPTOMS AND INCIDENCE
bed spaces within designated treatment areas. Additional Patients presenting with respiratory complaints can
staff from outside the ED may be deployed to assist; these display a range of symptoms (see Box 22.1), and these
staff should be teamed with routine ED staff, because of may vary based on the patient’s age, the underlying cause
the latter’s familiarity with the layout and location of of the symptoms and severity.
equipment and other resources. It is important to recog- Shortness of breath (SOB) or dyspnoea is a frequent
nise the need to replace staff to avoid fatigue, especially complaint for patients presenting to the ED. Respira-
in incidents of a protracted nature. Therefore, not all staff tory presentations are not isolated to any one specific
should be called in initially. Where possible, staff that
work together on a daily basis should work in teams
during the disaster period. 51,52
Triage and Reception BOX 22.1 Signs and symptoms commonly
Routine, day-to-day triage and reception processes will be associated with respiratory presentations
ineffective when receiving large numbers of disaster
victims. A registration process for disaster victims gener- l Shortness of breath
ally involves collecting minimal personal information l Dyspnoea (painful or difficulty breathing)
from the patients, where possible, and the allocation of l Decreased SaO 2
a prepared disaster hospital number used for identifica- l Cyanosis
8
tion and ordering investigations. Triage assessments will l Alteration in respiratory rate: tachypnoea/bradypnoea
often be undertaken by both a medical officer and a l Alterations in respiratory depth or pattern
nurse, and the process will be brief and focused. Most l Use of accessory muscles
victims will have been allocated a triage tag in the field, l Intercostal and/or subcostal recession
but are reevaluated for any changes, as their condition l Inability to speak in full sentences
may have deteriorated. Triage assessment is based on l Wheeze
observations of the nature and extent of the victims’ inju- l Stridor (upper airway respiratory disorders)
ries. Patients present in the ED prior to disaster notifica- l Alterations in level of consciousness
tion are considered part of the disaster event and triaged l Anxiety / feeling of impending doom
in the same manner. 4,7,8,52