Disaster Preparedness

The earthquake happens at 2 PM on a Tuesday. Within one hour, 300 people arrive at the community shelter. The nurse has a first aid kit, a clipboard, and no physician. What happens next depends entirely on what was planned before today.

Disaster preparedness is a core public health nursing competency. The four phases of emergency management are mitigation (preventing or reducing impact — building codes, flood zones, community education), preparedness (planning and training before the event — stockpiling supplies, conducting drills, establishing communication plans, training volunteers), response (immediate actions during and after the event — triage, first aid, shelter operations, search and rescue coordination), and recovery (restoring the community — rebuilding infrastructure, mental health support, economic recovery, after-action review). The community health nurse's disaster roles include community education on personal preparedness (72-hour supply kits, family communication plans, medication supply planning), participation in community emergency response teams (CERT), triage at disaster sites or shelters using the START triage system (Simple Triage and Rapid Treatment): can the victim walk? (walking wounded = green/minor) → is the victim breathing? (no breathing after repositioning airway = black/deceased or expectant) → is the respiratory rate greater than 30? (yes = red/immediate) → assess perfusion: is radial pulse absent or capillary refill greater than 2 seconds (protocol-dependent), or is the victim unable to follow commands? (yes = red/immediate; no = yellow/delayed). Mass casualty incident (MCI) operations use the Incident Command System (ICS) with a single incident commander and organized sections (operations, planning, logistics, finance/administration). The nurse operates within the ICS structure, not independently. Sheltering operations include health surveillance, chronic disease management for displaced individuals (ensuring access to insulin, dialysis, oxygen), mental health first aid, infection control in congregate settings, and coordination with public health and emergency management agencies.

Key Distinctions

In a mass casualty event, the nurse's ethical framework shifts from individual-focused to population-focused — the goal is the greatest good for the greatest number. This means a patient who would normally receive aggressive resuscitation (black tag/deceased or expectant) may not receive treatment in an MCI because resources are directed to salvageable victims. Students struggle with this shift. START triage is a rapid assessment tool — it takes 30-60 seconds per victim and uses only three physiologic parameters (respirations, perfusion, mental status). It is NOT a comprehensive assessment. The Incident Command System creates a unified command structure — the nurse does not freelance. Even experienced nurses report to the section they are assigned to.

Clinical Pearl

In a disaster, the hardest decision is walking past the patient you cannot save to reach the ten you can. START triage makes that decision for you — trust the algorithm, do not freelance.

Disaster Preparedness & Emergency Response

In a mass casualty incident (MCI), the nurse shifts from individual-focused care to population-focused care. The goal becomes doing the greatest good for the greatest number, which means triage drives every decision. The START triage system assigns color-coded tags: GREEN (minor — can walk, "walking wounded"), YELLOW (delayed — serious but can wait hours for treatment), RED (immediate — life-threatening but survivable with rapid intervention), and BLACK (expectant — dead or injuries incompatible with survival given available resources). Triage flows in a specific order: first assess ability to walk, then respirations — if absent, reposition the airway once; if respirations resume, tag RED; if not, tag BLACK. If respirations are present but >30/min = RED. Next assess perfusion (capillary refill >2 seconds or absent radial pulse = RED), then mental status (unable to follow commands = RED). The nurse's role includes activating the facility's emergency operations plan, following the chain of command (incident command system, or ICS), maintaining documentation even under pressure, and knowing their assigned role before an event occurs. Decontamination happens BEFORE the patient enters the facility to prevent secondary exposure. Nurses do not freelance — they follow the institutional plan and report to their designated area.

Key Distinctions

Don't confuse MCI triage with ER triage — in the ER, the sickest patient is seen first; in an MCI, the most salvageable patient is prioritized. BLACK tag does not mean dead on arrival — it includes victims who would normally receive aggressive care but cannot given current resources. Students mix up decontamination timing: it occurs outside, before entry, not in the ED.

Clinical Pearl

RPM — Respirations, Perfusion, Mental status. That's your START triage sequence after you sort out the walkers. RPM saves time when seconds decide who lives.