Medical Care - Hospital Care

Staff Preparation

The fourth objective of facility preparation involves preparing the staff for triage and treatment of casualties (ambulatory and non-ambulatory). The hospital incident command system addresses this with the assignment of a person in charge of the emergency department and oftentimes this is a charge nurse due to their day-to-day experience with making the ED function and operate with varying patient throughput and needs.

Establish a triage sector with nursing, technician, registration, security and physician personnel. The physician may likely function in a consulting capacity for patient priority or medical decisions. Security will help to control this access and entry point and to assist in crowd control so the medical and nursing personnel can focus on patient care. Equipment at triage can be simplified to disposable blood pressure cuffs and stethoscopes, basic vital signs of pulse and respirations initially are the most important.

Utilizing the S.T.A.R.T. and pediatric Jump S.T.A.R.T. paradigms basic vital signs can assist in initial triage of patients. Preparing for an inevitable influx of concerned but noninjured/asymptomatic patients (often labeled "worried well” ) will be necessary to continue care of injured or symptomatic patients. Psychological/psychiatric staff and/or clergy can assist in the ongoing needs of these patients, after appropriate triage and evaluation for exposure or injury has occurred.

Personnel require an awareness of their limitations and stressors (physical and psychological) of these types of incidents. Incorporating a designated safety officer and developing a rest/rehabilitation program with rehydration breaks allow for a continued safer and better incident response. A radiation safety officer or infectious disease specialist may be necessary for consultation depending on the type of agent or exposure. Critical Incident Stress Debriefing (CISD) as soon as possible after the termination of the event will allow for the care and support of responding personnel as well as lessons learned to address areas for improvement.

Security staffing is a critical component of staff safety and facility management. Additional supplementary security staff may include: environmental, maintenance and other designated facility employees.

Communications via a Public Address system (if capability intact) will assist in providing instructions and directions to the patients. The hospital public information officer (PIO) should be integrated with the NIMS unified command Public Affairs Officer (PAO) so that one designated person is providing information to the media and community for a clear, concise, and consistent message. Public information, through scheduled and coordinated press releases/conferences, assists in rumor control and the provision of accurate public information. Support services including: patient advocates or representatives, pastoral care and social workers, can assist in addressing patients personal support needs.

Addressing the challenge identifying and contacting supplemental/additional healthcare staff including Nurses, Technicians, Allied healthcare personnel and physicians should be addressed in the hospital response plans with frequent updating and sometimes testing of contact information. Some personnel may not live locally, and recent increases in per diem staffing and additional job/duty circumstances may hamper staffing capabilities. Recent research has shown that staff place family safety and personal safety important priorities in their willingness to respond to disaster situations and some expressed reticence to report to work with CBRNE (Chemical Biological Radiation Nuclear and Explosive) type of events.

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