Job Action Sheets – Vest Cards

DISASTER LEAD RN / FIRST 15 MINUTES / AS PATIENTS ARRIVE / NOTES
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 radio 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 Cones 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 Decon 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 Triage-upgrade/downgrade as indicated
Apply Colored Wrist Ribbon
  • Direct EMS to offload Patients into Immediate/Delayed 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 / 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 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 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 Areas to ensure adequate Patient Care
  • Ensure Runners Return for appointed tasks
  • Maintain TEAM based care until re-assigned by Disaster Lead
  • Triage Tag = Chart until formal chart is created
PPEs
  • Standard for ALL Response
  • Nitrile Gloves
  • N95 Mask
  • Isolation Gown

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 Trays 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 Areas to ensure adequate Patient Care
  • Ensure Runners Return for appointed tasks
  • Maintain TEAM based care until re-assigned 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)andReddiNet traffic
/
  • Coordinate Patient Flow from Immediate and Delayed areas into ED
  • Patient Tracking via ReddiNet/CAMIS/Treatment 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)andReddiNet 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 them-assign to rooms upon arrival
PPEs
  • Nitrile Gloves
  • N95 Mask
  • Isolation Gown

ED STAFF / FIRST 15 MINUTES / AS PATIENTS ARRIVE / NOTES
RNs
EMTs
MDs
RNs from Units
RNs from Labor Pool /
  • Close Lobby Triage
  • Move Fast Track Patients to Lobby
  • All admissions sent to floors-report out during transfer process to ANY RN
  • Rapid restock of rooms
  • Cluster Non-Disaster patients in one section of ED
  • Empty Gurneys/Wheelchairs to External Treatment Area
  • Expand assignment area(s) to cover External RNs positions
/
  • Triage Tag=Chart until proper documentation 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
  • Boots
  • 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
  • OrderXRay/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