Charge Nurse Becomes Disaster Lead Assigns Internal ED Charge Role Stationed at External Treatment Area Determine level of Decon Needed (with MICN/MD) Get Disaster Response Boxes from Radio Room Initiate ED Team meeting to assign roles and distribute radios and Treatment Area Boxes Ensure Treatment Area Team(s) are present Ensure Treatment Area supplies are set up Walkie-Talkie check with: -MD -ED Charge RN -Immediate RN -Delayed RN -Decon -Triage RN -Command Center Report To Command Center when set up complete and ready to receive Patients Assign Staff to Treatment areas-ensure role card, ID, vest and Map attached to vest Coordinate Patient flow with Triage RN Coordinate Patient flow into ED with ED Charge RN -Immediates first -Delayed next Request Labor Pool Staff as needed from Command Center Primary Concerns: -Patient Flow -Staff & Equipment PPEs Standard for ALL Response Nitrile Gloves N95 Mask Isolation Gown Decon PPEs (as directed by EMS/MD) Tyvek Suit Boots PAPR Hood Outer Gloves
TRIAGE RN FIRST 15 MINUTES AS PATIENTS ARRIVE NOTES Assigned by Charge RN Stationed at External Triage/ Treatment Area Establish Triage Zone as per Map/Treatment Area Set Up Training Ensure Safety and Signage outside treatment area are set up Ensure 10 Wheelchairs and 5 Gurneys are at Triage Walkie Talkie radio check with Disaster Lead RN If Needed; Ensure patient decon supply cart is available Ensure Dosimeter scan completed if radiological contamination suspected START Triage protocols -Respirations -Perfusion -Mental Status -Walking= Minor Treatment Area Confirm Field as indicated Apply Colored Wrist Ribbon Direct EMS to offload Patients into or Minor Treatment Areas Keep Field Tag on Patient PPEs Standard for ALL Response Nitrile Gloves N95 Mask Isolation Gown Decon PPEs (as directed by EMS/MD) Tyvek Suit Boots PAPR Hood Outer Gloves
IMMEDIATE TEAM 15 MINUTES AS PATIENTS ARRIVE NOTES 1 RN from ED 1 MD from ED 1 RT 2 Runners 2 Registrars ED RN is LEAD in Treatment Area RNs Get Supply Carts and Set Up per layout map Set Up Cots on RED Tarp Get IV Supplies Ready Ensure Pharmacy Cart has arrived Radio Check with Disaster Lead RT 4 Intubation Trays Ready O2 Tanks Available Vortran Vents Ready Registrars Registration Packets Ready Tracking Logs (Color Coded) Ready ED RN Secondary Triage Prioritize Patients to ED, OR and ICU Assign Staff to Patients Update Disaster Lead 10 Minutes with: # of Patients # of monitored beds needed # of OR Patients # of needed Supplies needed Registrars Attach Wrist Band Basic Data Only Treatment Area Log to Command Center every 10 minutes Move Patients to Main ED ASAP Assign Additional RNs to Treatment to ensure adequate Patient Care Ensure Runners Return for appointed tasks Maintain TEAM based care until by Disaster Lead Triage Tag = Chart until formal chart is created PPEs Standard for ALL Response Nitrile Gloves
DELAYED TEAM FIRST 15 MINUTES AS PATIENTS ARRIVE NOTES 1 RN from ED 1 MD from ED 1 RT 2 Runners 2 Registrars ED RN is LEAD in Treatment Area RNs Get Supply Carts and Set Up per layout map Set Up Cots on RED Tarp Get IV Supplies Ready Ensure Pharmacy Cart has arrived Radio Check with Disaster Lead RT 4 Intubation Ready O2 Tanks Available Vortran Vents Ready ED RN Secondary Triage Prioritize Patients to ED, OR and ICU Assign Staff to Patients Update Disaster Lead every 10 Minutes with: # of Patients # of monitored beds needed # of OR Patients # of staff needed Supplies needed Registrars Attach Wrist Band Basic Data Only Treatment Area Log to Command Center every 10 minutes Move Patients to Main ED ASAP Assign Additional RNs to Treatment to ensure adequate Patient Care Ensure Runners Return for appointed tasks Maintain TEAM based care until by Disaster Lead Triage Tag = Chart until formal chart is created PPEs Nitrile Gloves N95 Mask Isolation Gown
LEAD RN IN ED FIRST 15 MINUTES AS PATIENTS ARRIVE NOTES Stationed at Main Nurse’s Station or Radio Room Close Lobby Triage Move Fast Track Patients to Lobby Assign staff to all rooms Facilitate Immediate admission of ED patients to floor(s) Identify additional ED staff needed to Lead Disaster RN Monitor Radio (MAC)and ReddiNet traffic Coordinate Patient Flow from Immediate and Delayed areas into ED Patient Tracking via Area Logs Coordinate Floor Staff/Labor Pool RN assignments in ED Identify who needs: -Monitor Bed admit -OR/Surgery -ICU Bed admit With Command Center every 15-30 minutes Monitor Radio (MAC)and ReddiNet traffic and update -Triage -MDs -Disaster Lead RN Keep most critical patients in Main A Patient Tracking up to date ASAP Can fit 2 patients per room if necessary Call for additional RNs from Labor Pool BEFORE you think you need to rooms upon arrival PPEs Nitrile Gloves N95 Mask Isolation Gown
ED STAFF 15 MINUTES AS PATIENTS ARRIVE NOTES RNs EMTs MDs RNs from Units RNs from Pool Close Lobby Triage Move Fast Patients to Lobby All admissions sent to out during transfer process to ANY RN Rapid restock of rooms Cluster patients in one section of ED Empty to External Treatment Area Expand assignment area(s) to cover External RNs positions Triage Tag=Chart until proper completed Update Lead RN of open beds ASAP Update Lead RN of patient transfers ASAP NO Families with Patients unless: -Pediatrics -Translator -AMS/Combative 2 Patients per room PRN Rapid Admits to “clean out” ED in first 10 minutes can go to units with minimal chart copies, beds pending, and stay on gurney/cot in halls PRN. Floor RNs to call PMD for orders PPEs Nitrile Gloves N95 Mask Isolation Gown
SET UP FIRST 15 MINUTES AS PATIENTS ARRIVE COMMENTS 2 (or more) EMTs Any Responding Staff Earl St. Dock cleared and closed off Position cones to block Earl St as per map Get Supply Carts from Shed Directional Signs and Barrier Tape as needed If Decon Needed; Move Decon Trailer to proper location Plug in Electrical and Water Turn on System Patient Decon Supply bin to Triage Area(s) 1 Dosimeter (Geiger Counter) to Triage 1 Dosimeter to Shower Exits 1 EMT to Immediate Treatment Area 1 EMT to Delayed Treatment Area Assist with Patient Care as needed If Decon needed: Suit Up and assist with Decon Team response PPEs Standard for ALL Response Nitrile Gloves N95 Mask Isolation Gown Decon PPEs (as directed by EMS/MD) Tyvek Suit PAPR Hood Outer Gloves
MINOR TREATMENT AREA FIRST 15 MINUTES AS PATIENTS ARRIVE COMMENTS 1 RN from ED 1 MD from ED 1 EMT from ED Radiology Registrar Pharmacy Establish Treatment Area in CHE Minor Treatment Supplies in Dialysis Room (code 5600) Set Up Chairs Set Up Tables Set Cots (PRN) Re-Assess Patients Upgrade PRN Order XRay/CT (PRN) Coordinate Patient Care Coordinate Patient Flow Administer Meds PRN Use White Board for PT Tracking Dispo Patients Follow Treatment Plan PPEs Nitrile Gloves N95 Mask Isolation Gown