Initial Response

When a call is made to a hospital about a disaster or a potentially mass-casualty-producing event, the recipient of the call must have a procedure to follow for verification of the incident. A disaster notification form is used by some facilities to remind the staff of the questions they are to ask the caller.

The appropriate hospital official or administrator on duty is then given this information. When the emergency department is notified by hospital administration (now Disaster Command) that the external disaster plan is in effect, it sets in motion a series of activities. The information obtained from the call is given to the charge nurse; the clerical, registration, nursing, and medical personnel in the department are notified of the impending arrival of casualties; and the emergency department plan for calling additional staff is activated.

An initial needs assessment is conducted by the nurse and physician in charge, given the information available. They must evaluate and prioritize the patients currently in the department and admit, discharge, or transfer them. All stable and nonurgent patients should be given plans for follow-up care and discharged from the emergency department with responsible individuals.

Based on this initial assessment, the number of patients that the department can receive is determined and communicated to the prehospital disaster communications center. The nurse and the physician in charge then determine whether more physician and nursing coverage is required in the emergency department and assign staff to those areas in the department to be used during the disaster. As patients begin to arrive, the charge nurse must be alert to signs of staff stress and work overload before the problem gets out of hand. Family members and representatives of the media should be directed away from the emergency department.

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