The Role of Triage and Prioritization in the Context of Disaster
The cause of a disaster can be natural or manmade, but the outcome is always catastrophic. For example, when people experience any kind of disaster, they are exposed to hazardous situations that leave them vulnerable to injuries, increased risk of infectious diseases, mental health issues, malnutrition, and death. Since most disasters are unpredictable, and when they happen, they involve immense damage and losses. People undertake different measures to address them through disaster management. Khorram et al. (2021) suggest that disaster management is the strategic process of preparing for and responding to a catastrophic event. There is a multidisciplinary team of personnel such as chaplains, fire/police/politicians and safer officers, paraprofessionals, psychiatrists, psychologists, social workers, and nurses involved in disaster management. Each of these parties is critical in preparing and responding to a disaster. Khorram et al. (2021) suggest that nurses mark up the highest percentage of these teams and personnel working on the frontlines when preparing and responding to a disaster. With this in mind, this article discusses in detail the nurse’s role as part of this multidisciplinary team The Role of Triage and Prioritization in the Context of Disaster.
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The Phases of a Disaster
There are four disaster phases: mitigation/prevention, preparedness, emergency response, and rehabilitation reconstruction. The Mitigation phase is a pre-disaster phase where people and the multidisciplinary team undertake different measures and actions to reduce the cause, impact, and consequences of a catastrophic event (Bosher et al., 2021). For example, people usually tie their homes with ground anchors to withstand wind damage in a windstorm. If there are floods, people also dig water channels to redirect water and plant vegetation to reduce mad slides in areas that experience heavy rainfall. Spialek & Houston (2019) suggest that buying insurance policies is also one of the measures people can take to mitigate a disaster. Sometimes people also construct levees barriers to control flooding.
The preparedness phase is a pre-disaster phase where people undertake different activities, such as training, planning, and education for events that cannot be prevented, such as natural disasters. During this phase, people develop plans for speculated disasters for what to do, where to go, who to call for help, and how to save a life. People also form drills and full-scale and tabletop exercises to the effectiveness of the plan. Spialek & Houston (2019) suggest that during this phase, people can also source the equipment and item that can help respond to a specific disaster in case it happens. For example, when planning for a fire disaster, an organization can look for items such as emergency fire extinguishers and first Aid kits to help people prepare and respond to a fire disaster The Role of Triage and Prioritization in the Context of Disaster.
The emergency response phase is a post-disaster phase where people undertake immediate action to address the aftermath of a catastrophic event. Based on the level of preparedness, this phase can be done within a short time or over an extended duration. Typically, an organization or individual who is well prepared for a given disaster stands a better chance to respond quickly and secure human safety and well-being in the event of one. Generally, the response activities to a disaster include implementing a response plan, conducting search and rescue missions, and taking actions to secure human safety and well-being.
The emergency response phase generally addresses short-term needs. However, the aftermath of a disaster usually extends to a prolonged duration. This is where the recovery phase comes in. It is also a post-disaster phase, including implementing restoration efforts to help people restore their lives to normal (Spialek & Houston, 2019)The Role of Triage and Prioritization in the Context of Disaster. Some of the activities that people undertake during this phase include trying to resolve financial burdens, reducing stress-related illnesses, rebuilding damaged homes and infrastructure, and reducing vulnerability to other potential disasters in the future.
Figure 1: A summary of the phases of a disaster
The impact of a disaster on health
In a disaster, some people, such as children, the physically disabled, the old, and the sick, are more vulnerable than others because it is more difficult for them to evacuate in time. Nonetheless, everybody is vulnerable to different risks, such as injuries, mental health disorders, malnutrition, and death. This is why it is critical to have a disaster management strategy in place. Keim (2018) suggests that a disaster management strategy is the most effective approach an organization, individual, or multidisciplinary team uses to effectively direct and utilize available counter-disaster resources. It can also help individuals, organizations, or multidisciplinary teams set principles and guidelines to effectively prevent and address a disaster’s aftermath. Keim (2018) suggests that disaster management is based on the principle of prevention and reducing casualties, rescuing victims, providing first aid, evacuating the injured, providing definitive medical care, and promoting the reconstruction of lives back to a normal state The Role of Triage and Prioritization in the Context of Disaster.
The role of a disaster nurse in each phase of a disaster
Disaster management focuses on addressing the four phases of a disaster, including preparedness, mitigation, response, and recovery. Disaster nurses are a mandatory part of a disaster management committee. According to Bosher et al. (2021) and Chen et al. (2017), a disaster nurse is a health care personnel with professional nursing skills in recognizing and meeting the health needs of the individuals in a community affected by disaster aftermath. The goal is to achieve the best possible level of health for disaster victims. A disaster nurse must participate in every phase of a disaster, including preparedness, mitigation response, and recovery phase, to achieve their goal effectively. Alharti et al. (2020) suggest that in each of the four phases of a disaster, several disaster nurses should be familiar with the environmental factors and specific conditions of the given catastrophic event.
Role of a disaster nurse during the preparedness phase
The objective during the preparedness phase is to ensure the appropriate resources, equipment, and system are in place to provide prompt assistance, procedure, and guideline to the disaster victim in case it happens. Al Harthi et al. (2020) suggest that the key to disaster preparedness is to develop a strategic, realistic, and simple plan with an alternative plan or a backup’s contingencies since sometimes a plan can fail to fit once a speculative disaster happens. In this phase, a disaster nurse has different roles as an individual, a professional, and in the community. According to Bosher et al., 2021 disaster nurses must consider their preparedness by ensuring that they have the skills, capacity, and willingness to work in a multidisciplinary team working together in the planning processes. For example, a disaster nurse is expected to have good communication skills and be ready to collaborate with other professionals in the multidisciplinary team. They are also responsible for ensuring that they attend training and have the required education about a particular type of disaster and its management. For example, disaster nurses should ensure they are certified first aiders and know the community, management policies, and protocols (Bosher et al., 2021)The Role of Triage and Prioritization in the Context of Disaster. As a professional, disaster nurses have a responsibility and duty to maintain emergency facilities, resources, and equipment, create a communication system and offer disaster management training to the public. They are responsible for using training and education programs to create public awareness of the disaster management procedures and measures that an individual can take in the event of a disaster.
Role of a disaster nurse during the mitigation phase
The objective during the mitigation phase is to establish a strategic and logical approach for identifying, preventing, and managing the likelihood of a disaster or minimizing the impact of the aftermath. The core focuses in this phase is to manage the risks through identifying, analyzing, evaluating, treating, and monitoring them. Disaster nurses have major responsibility for managing disaster risks in this phase. For example, they are responsible for assessing and analyzing the risk of a potential disaster based on previous similar disasters that have happened to a particular community of interest (Al Harthi et al., 2020)The Role of Triage and Prioritization in the Context of Disaster. They must know the community to help create coping strategies and a disaster prevention plan. According to Loke et al. (2017), disaster nurses are responsible for diagnosing the community of interest to identify the risk and determine the actual threat of a speculated disaster. Loke et al. (2017) further suggest that during this phase, nurses are responsible for creating and communicating disaster prevention measures and psychologically preparing the community for potential disaster threats. They are generally responsible for ensuring and promoting community participation and awareness about actual and potential disaster threats.
Role of a disaster nurse during the response phase
The objective during the response phase is to anticipate the impact of a disaster and its aftermath during/immediately after a disaster has occurred and minimize its effect on the affected community. In this phase, Disaster nurses are responsible for ensuring that the victim in the affected community has access to immediate medical support and relief services. They are responsible for assessing the situation and identifying the event’s magnitude, defining the victims’ health needs, and establishing priority (Chen et al., 2017)The Role of Triage and Prioritization in the Context of Disaster. For example, they should be able to identify those in critical condition and prioritize emergency services. When a disaster occurs, there can be a risk of infection, especially if the affected community is exposed to a contagious disease. However, this is not always the case. Chen et al. (2017) acknowledge this perspective and suggest that disaster nurses are responsible for identifying the actual and potential public health problems during the response phase of disaster management. They are also responsible for determining the resource needed to respond to the public health problem in the affected community. To do this effectively, they must collaborate with other professionals, such as psychiatrists and doctors. They further need to have a good understanding of the preparedness and mitigation plan and other events surrounding the incident to provide the needed care to the victim and the affected community (Loke et al., 2021). For example, disaster nurses should be prepared to deal with burns, respiratory health issues, and emotional distress among the affected community and sometimes among the first responders in the event of a fire disaster.
Role of a disaster nurse during the recovery phase
The recovery phase’s objective is to address a disaster’s long-term impact and its aftermath. The duration of the recovery phase is determined by multiple factors, such as short-term and long-term needs, the type of the disaster, and nature. Hugelius & Adolfssson (2019) suggest that the short-term need of the affected communication may include operational life support and patient repatriation. On the other hand, long-term needs during this phase may include providing physical and psychological support to victims and restoring damaged infrastructure and property (Chen et al., 2017)The Role of Triage and Prioritization in the Context of Disaster. Some short-term and long-term needs require healthcare interventions and support, and nurses have major responsibilities and duties here. For example, disaster nurses must respond to alerts based on the triage approach and tools such as simple triage and rapid transport tools and inform the supervisor about victims who need more complex medical support and care than emergency first aid services. They must also help in the search, rescue, and first aid activities that are carried out during the short-term recovery phase.
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The Role of Triage and Prioritization in the Context of Disaster
Due to the scarcity of resources in the event of a disaster, nurses must have a strategic way to allocate them when carrying out their duties and responsibilities during each disaster phase discussed earlier in this article. Ghanbari et al. (2021) suggest that disaster nurses can use triage approaches such as the START Tool to identify the victim who needs immediate care, those who need urgent care, those in need of minimal care, and those in need of end-of-life care and then integrates health care services based on the specific needs. World Health Organization (2011) defines triage as a strategic process of prioritizing casualties based on agency level and availability of limited resources while managing major disasters. Additionally, disaster events usually create a state of emergency in which the first responder is required to act quickly. With this in mind, triage and prioritization can help nurses rapidly assess the need of the victims and affected community and speed up decision-making processes on what they are expected to do in different situations. Ghanbari et al. (2021) suggest that triage can help nurses quickly establish evidence-based levels of patient care for the casualties and victims of a disaster, hence promoting effective management of emergencies. Bazyar et al. (2019) reveal that first responders such as nurses can use different types of triage systems such as START, MASS, Homebush, and CBRN triage to set criteria for assessing and determining the need for health care among casualties of a disaster. Generally, triage provides a strategic process and criterion for nurses to categorize patients based on their medical needs, making it easier to allocate appropriate resources during different phases of a disaster The Role of Triage and Prioritization in the Context of Disaster