Triage System Identification
The Emergency Severity Index (ESI) is a triage system that allows for sorting patients according to the severity of their states and evaluating the necessary resources. Level 1 implies that a nurse should assess whether a patient needs life-saving interventions or not. If yes, the nurse refers the patient to the corresponding unit and procedure, including hemodynamics, electrical therapy, breathing, et cetera (Hong et al., 2015). If level 1 is marked by “no”, the nurse proceeds with patient evaluation, focusing on the risks, resources needed, and the overall, urgency of the situation. Considering the threat of terrorist attacks and explosions, the hospital should be prepared for severe burns, suffocation from smoke, and other related issues. Children are at a high risk of dehydration, skin contamination, anxiety, and post-traumatic stress (Council & Committee on Pediatric Emergency Medicine, 2015). Accordingly, to set level 1 triage, the nurse should observe the patient’s body and pay attention to clinical signs of breathing and consciousness.
Level 2 refers to the case when a patient does not have life-sustaining procedures at the time of sorting. However, if he or she is in a high-risk situation, disoriented, or experiences panic, his state is to be identified as level 2. If the danger zone vitals, such as saturation, pulse, and respiratory rate, are normal, the patient is assigned level 3 triage (Hong et al., 2015). Depending on the resources needed, the patient is given levels 4 and 5, respectively. Thus, the main benefit of this system is a structured and quick assessment based on meaningful clinical vitals, which allows for sorting out the flow of patients in an emergency.
Additional Precautions
Since the flow of patients is expected to be high, it is critical to prepare resources that can be used to rapidly help them. In particular, first aid for wound care and initial treatment resources are to be prepared in advance, which can involve cleansing agents, intubation, dressing, grafting, and medications. Among the relevant resources for non-life-saving processes, there should be diagnostic tests, oxygen administration, medications, and so on (Council & Committee on Pediatric Emergency Medicine, 2015). The hospital’s staff should be reminded of burn trauma management and protocols of action. With sufficient resources in the hospital, it would be more effective to address patients’ health needs and achieve greater coordination between care providers.
Another area of additional precautions is related to the workforce that would be directly involved in the emergency care process. First, one or two triage clinicians should be chosen to be responsible for sorting the patients, and it is preferable to assign this role to experienced staff members. Second, professionals who would provide first aid care are given certain areas of responsibility, including but not limited to wound management, resuscitation, and so on. Third, the hospital needs more nurses to ensure that all the patients receive the necessary procedures on time. Since the case implies mass casualties, it is critical to have qualified and educated staff.
Agencies Involved
The agencies to be involved are law enforcement agencies, both local and state ones, which is important for having minimal losses. The counter-terrorism measures of these agencies may include border patrol and airport security to timely detect terrorists (Petkova et al., 2017). Among other preventative efforts, there can be community engagement and education to recognize the signs of terrorism. For example, intelligence-led policing can be realized through the Neighborhood Watch programs. However, as terrorists are relatively rare, it is significant to educate the population and provide them with information brochures.
In addition, police agencies should be contacted to notify them of the threat, so that they can be ready for organizing people and ensuring social order while transporting affected children to the hospital. The contribution of the military law enforcement agency can be necessary in case of an armed force encounter or the need to protect the community members (Petkova et al., 2017). Another potential development of this situation is a siege of the school. If the local and state agencies would be unable to resolve the case, it is essential to contact federal agencies that have more resources and workforce. It is also important to ensure that all the agencies coordinate with each other and make sure that their actions are not contradictory.
Community Emergency and Disaster Management Team
The Community Emergency and Disaster Management Team should be a liaison with the involved agencies, the hospital, the school, and the parents of students. Considering that the members of this team are volunteering citizens, they would be able to provide qualified assistance and guide other people. For example, their help can be useful until the arrival of medical services and the police. At the same time, they can act as care assistants in transporting and instructing patients and their families (Goralnick et al., 2017). In case of an identified emergency disaster, this team can offer basic care to minimize the damage and reduce further deterioration of patients’ health outcomes. In addition, the team can be involved in disaster preparedness by educating teachers, medical staff, and citizens in general.
The cooperation with media is an integral part of any emergency as the local press would highlight the event and keep the viewers aware of the recent decisions and results. In the given case, a leader of the Community Emergency and Disaster Management Team can be assigned the role of a person who would speak with the media representatives. It is better, however, to engage the hospital leadership in this important issue as well, which would provide more comprehensive information (Magruder et al., 2016). The paramount goal of journalists is to offer verifiable information to avoid misunderstanding. Nevertheless, this information should be balanced and accurate, without exaggeration to cause fear in citizens. Every citizen has a right to access information, and the role of the response team is to serve as the link that aggregates information and translates it to the local press.
Communication with the parents of the students who can be affected by the explosion or otherwise in the given emergency is probably one of the most complicated tasks. It should be put on nurses who were trained to speak about problematic health issues and who are ready to provide the first psychological aid. In this case, some part of communication can be taken by the emergency management team since their community members can be impacted (Goralnick et al., 2017). For both nurses and the team, it is of great importance to providing reliable information regarding their children’s conditions and risks. In addition, the families of the involved children should be offered psychological assistance and medical services, if necessary.
References
Council, D. P. A., & Committee on Pediatric Emergency Medicine. (2015). Ensuring the health of children in disasters. Pediatrics, 136(5), 1407-1417.
Goralnick, E., Van Trimpont, F., & Carli, P. (2017). Preparing for the next terrorism attack: Lessons from Paris, Brussels, and Boston. JAMA Surgery, 152(5), 419-420.
Hong, R., Sexton, R., Sweet, B., Carroll, G., Tambussi, C., & Baumann, B. M. (2015). Comparison of START triage categories to emergency department triage levels to determine need for urgent care and to predict hospitalization. American Journal of Disaster Medicine, 10(1), 13-21.
Magruder, K. M., Kassam-Adams, N., Thoresen, S., & Olff, M. (2016). Prevention and public health approaches to trauma and traumatic stress: A rationale and a call to action. European Journal of Psychotraumatology, 7(1), 1-9.
Petkova, E. P., Martinez, S., Schlegelmilch, J., & Redlener, I. (2017). Schools and terrorism: Global trends, impacts, and lessons for resilience. Studies in Conflict & Terrorism, 40(8), 701-711.