Nursing Disaster Management

and Disaster Triage

Ns. Furaida khasanah, M.Kep
 Mahasiswa mampu menjelaskan :

Dasar keperawatan bencana

Dampak bencana terhadap kesehatan

Capaian Sistem penanggulangan bencana terpadu

pembelajaran
Sistem pelayanan kesehatan

Konsep dan model-model Triase bencana

Berfikir kritis dan sistematis

 • Disasters have been integral parts of the human
experience since the beginning of time, causing
premature death, impaired quality of life, and altered
health status.
• The risk of a disaster is ubiquitous. On average, one
disaster per week that requires international assistance
occurs somewhere in the world.
Introduction • The recent dramatic increase in natural disasters, their
intensity, the number of people affected by them, and
the human and economic losses associated with these
events have placed an imperative on disaster planning
for emergency preparedness.
• Global warming, shifts in climates, sea-level rise, and
societal factors may coalesce to create future calamities.
 As part of the country’s overall plan for disaster
preparedness, all nurses must have a basic
understanding of disaster science and the key
components of disaster preparedness, including
the following:
• The definition and classification system for disasters and
DISASTER major incidents based on common and unique features of
disasters (onset, duration, effect, and reactive period).
MANAGEMENT • Disaster epidemiology and measurement of the health
consequences of a disaster.
• The five areas of focus in emergency and disaster
preparedness: preparedness, mitigation, response, recovery,
and evaluation.
• Methods such as risk assessment, hazard identification and
mapping, and vulnerability analysis.
• Awareness of the role of the nurse in a much larger response
system.
 “Triage is a process which places the right patient
in the right place at the right time to receive the
right level of care” (Rice & Abel, 1992).

The word triage is derived from the French word

Disaster triage trier, which means, “to sort out or choose.”

Triage is the process of prioritizing which patients

are to be treated first and is the cornerstone of
good disaster management in terms of judicious
use of resources (Auf der Heide, 2000).
 The triage nurse must
accurately decide which
patients need care, the
location of the care, in
Disaster triage will always
what order they should
be a difficult and daunting
receive care, and in
task.
situations of severely
constrained resources, who
should not receive care at
all.

Con’t…
In a large-scale disaster,
mass casualty incident, or
Previous triage experience
epidemic in all likelihood
in an emergency
many health care providers
department is excellent
will be called on to perform
preparation for disaster
triage at the scene of the
triage.
event, in a community
setting or in the hospital.
 ■ Clinically experienced
■ Good judgment and leadership
■ Calm and cool under stress
Burkle (1984)
■ Decisive
identified a variety of
■ Knowledgeable of available resources
personal abilities that
■ Sense of humor
are essential to be an
effective triage officer ■ Creative problem solver
during a disaster: ■ Available
■ Experienced and knowledgeable regarding anticipated
casualties
 Con’t…
Triage methodologies are
focused on the proper sorting
and distribution of patients,
either in the prehospital (field or
community) or hospital
(emergency department)
settings.
One model for understanding
triage divides the process into
five conceptual categories: daily
triage, incident triage, disaster
triage, tactical-military triage,
and special condition triage
(Hogan & Lairet, 2002).
 Examples of three well-known disaster triage
systems are the following: ■ Simple Triage and
DISASTER Rapid Treatment (START) system (for triaging
adults)
TRIAGE ■ JumpSTART system (for triaging pediatric
SYSTEMS patients)
■ Start/Save (when the triage process must be
over an extended period of time)
 Emergency Medical Service (EMS)
providers are very experienced in the
Simple Triage use of the START system.
and Rapid
Treatment
(START) The START system is easy to learn and
simple to use. It is based on the
System person’s ability to respond verbally
and ambulate and their respirations,
perfusion, and mental status (RPM).
 The system START works as follows

(2) The next group of patients is assessed

quickly (30– 60 seconds per patient) by
(1) All patients who can walk (walking
evaluating RPM: Respiration (position upper
wounded) are categorized as Delayed (GREEN)
airway or determine respiratory rate);
and are asked to move away from the incident
Perfusion/blood circulation (check capillary
area to a specific location.
refill time); Mental status (determine
patient’s ability to obey commands)
 Because the physiological indicators used
in START are not appropriate when
assessing young pediatric patients, the
JumpSTART system was originally created
to meet the unique needs of assessing
children less than 8 years of age (Romig,
2002b).
JumpSTART Because it may be difficult to determine
actual age during a disaster event,
JumpSTART should be used if the victim
“looks like a child” and START should be
used whenever the victim “looks like a
young adult or older” (Romig, 2006,
personal communication).
 To optimize the
primary triage
of injured
children in the
MCI setting.

JumpSTART’s
objectives
are the
following:
 JumpSTART was designed for
use in disaster/ multicasualty
settings, not for daily EMS or
hospital triage.

Con’t…
JumpSTART is also intended for
the triage of children with
The triage philosophies in the
acute injuries and may not be
two settings are different and
appropriate for the primary
require different guidelines.
triage of children with medical
illnesses in a disaster setting.
 children with medical illnesses in
a disaster setting. In this triage
system a child’s respiratory rate is
assessed as “good” if it is
between 15 and 45 (∼one breath
every 2–4 seconds).
Con’t… A child with a weak or
nonexistent distal pulse gets
classified as Critical (RED).
In addition, unlike the START
system, in the JumpSTART
system, a young child who is not
breathing on initial assessment
should still be checked for a pulse.
A child with a rate 45 would be A child’s perfusion is checked by
classified as Critical (RED). palpating the distal pulses.
Assess for mental status using the A child who is unresponsive or has
AVPU system (Alert, responds to
Vocal stimuli, responds to Painful
stimuli, Unresponsive).
an inappropriate response to pain
would be classified as Critical
(RED).
If a pulse is found, the child
If breathing is restored, the
receives a brief (5 breaths)
patient is classified as Critical
ventilatory trial, which, if not
(RED) (Romig, 2002b; see
successful results in assigning the
chapture 9.1).
patient as Expectant (BLACK).
 • The SAVE triage was developed to direct
limited resources to the subgroup of
patients expected to benefit most from
their use.
START/SAVE • The SAVE assesses survivability of patients
with various injuries and, on the basis of
Triage for trauma statistics, uses this information to
describe the relationship between
Catastrophic expected benefits and resources
consumed.
Disasters • Because early transport to an intact
medical system is unavailable, this
information guides treatment priorities in
the field to a level beyond the scope of the
START methodology (Benson et al., 1996).
DISASTER TRIAGE
FOR CHEMICAL
AND HAZARDOUS
MATERIAL
DISASTERS
 Never move a casualty backward (against the flow).

Never hold a critical patient for further care.

SUCCESSFUL
DISASTER Salvage life over limb.
TRIAGE
PRINCIPLES Triage providers do not stop to treat patients.

Never move patients before triage except in cases of: Risks due to bad
weather. Impending darkness or darkness has fallen. A continued risk of
injury. Medical facilities are immediately available. A tactical situation that
dictates movement.
THANK YOU