Casualties and injuries are a part of our lives and being a nurse, I always need to deal with patients with severe injuries. Some of the experiences leave some unforgettable memories in our life. Here in this paper I am going to reflect my experiences while handling casualties due to fire in a hospital. The mass casualties’ simulation incident helped me in gaining lots of ideas as well as knowledge required while handling patients when working as a team. I am going to use Gibbs cycle of reflection method to present my reflective essay.
This reflective essay is going to present my experience of the mass casualties’ simulation which I had on 3rd of October on a given case scenario of fire at a hospital. In the scenario the casualties were my friends to act like injured but the makeup of blood, bruise and others were so real that gave a real look to the scenario. While working in a group of 6 people I was the triage nurse along with other nurses to look after and treat the casualties. In order to provide the best treatment I tried a lot and always discussed with my team leader to take suggestion while handling patients. We had to go through primary assessment and triage as well as treat accordingly as it was considered as an emergency case. I was providing primary care after an assessment to their injuries and there I followed several methods like A-G assessment, triage and sieve etc. Several kinds of casualties have been found while treating them and all their injuries were different from each other. Their condition of health also varied a lot. Therefore, I kept communicating constantly with my team leader in order to get valuable suggestion while assessing and treating them accordingly. One of the patients, Evelyn Touma, who was 57 years old woman admitted for her leg ulcer, debris from the building collapse had hit her in the head and she had a significant head injury. She was constantly moaning and unable to talk. She was localised to pain due to the head injury.
I was alarmed by the condition of the patients and I felt the leader is more experienced than me and therefore I should ask her about the exact way of treating the patients. When I faced all the patients, I became nervous at the first sight because all of them were looking seriously affected. When handling Evelyn, I realized that we need primary survey regarding the condition of her injured area. At the same time, it was also important to check if airway was needed. She was unable to talk and I felt that an A-G assessment was necessary in her case. Simultaneously, triage sieve was also required to assess her physical condition and after triaging an immediate treatment was also required. In order to perform the assessment program, I discussed with my team leader and asked for support from other members as well.
The whole incident was extremely challenging for me as I had to deal with many patients with multiple health condition on an emergency basis. However, I am happy that my nervousness could not stop me from providing treatment to the injured ones. I also observed how my team leader and other team members were working to treat patients. My leader supported me a lot and I found it positive enough to provide the best effort in treating and assessing people. However, the task was not so easy and especially, it was challenging for me while dealing with the patient whose head was injured as she was unable to talk. I have learned from the incident that active participation is highly important in this nursing profession.
When dealing with Evelyn, use of technical methods for assessing and treating was necessary according to Riahi, Thomson & Duxbury (2016). A-G assessment is one of the important methods of assessing patients (Buljac-Samardži? & van Woerkom, 2018). It basically checks the airway, breathing, circulation, disability, exposure, further information, goals about the patient (Szanton et al., 2015). Along with the A-G assessment triage sieve and sort was also necessary for them (Currie, Kourouche, Gordon, Jorm & West, 2018) (Coppens, Verhaeghe, Van Hecke & Beeckman, 2018). Triage is one of the key principles in the effective management at any major incident (Vassallo, Beavis, Smith & Wallis, 2017). In case of Evelyn, a detailed A-G assessment was necessary in order to check if airway was needed. As the patient was constantly moaning, so it could be a sign of airway obstruction. Her breathing rate and circulation to find the BP was also calculated from the A-G assessment. It also helped to assess the disability and exposure of injured area of Evelyn. In order to find the GCS of the patient, I also performed triage and sieve. During my triage sort, I found that her eye-opening was spontaneous and thus the score was 4, her verbal response was incomprehensible and the score was 2, the patient localised to pain and then the motor response score was 5. Combining all the details I found that her GCS score was 11. The combination of respiratory rate and systolic BP of the patient which was found from the A-G assessment provided the total Triage Sort Score for getting the priority level. Therefore, triage is an important process in determining the priority of the patients’ treatment. Even in many studies, it has been found that triage provides the emergency medical guidelines for the head-injured people (Nishijima et al., 2017). After triaging an immediate treatment is highly important. Efficient, accurate as well as timely communication is helpful in delivering and effective patients’ care (Gausvik, Lautar, Miller, Pallerla & Schlaudecker, 2015). Improved communication among healthcare professionals always improves the quality of interdisciplinary care. The interaction with the team members always opens an opportunity to raise questions and concerns which produces helpful results (Gausvik, Lautar, Miller, Pallerla & Schlaudecker, 2015). Support from all the team members while working in a group is extremely essential to provide an effective care. While assessing the patient, I got constant support from my team members and team leader and at the same time I realized, how assertive response from colleagues can be helpful in treating any patient (Laschinger, Borgogni, Consiglio & Read, 2015).
Conclusion
Looking back at the incident I can understand that I should not get nervous and should have acted sooner to treat the injured people. I constantly kept asking my team leader before taking any action and in this regard I realized that I need to develop my self-confidence. I also felt that nursing profession is challenging and there is no place of getting weak at any time, rather, we need to be active enough to take any prompt action while dealing with serious patients.
In future, I will be more focused to develop my assertive skill while working as a team member and I will prepare my mind to be stronger while dealing with casualties. In my next task, I will make the experience as a goal for my learning and I will discuss with my mentors to get some valuable strategies to enhance self-confidence while working in this profession.
References
Buljac-Samardži?, M., & van Woerkom, M. (2018). Improving quality and safety of care in nursing homes by team support for strengths use: A survey study. PloS one, 13(7), e0200065.
Coppens, I., Verhaeghe, S., Van Hecke, A., & Beeckman, D. (2018). The effectiveness of crisis resource management and team debriefing in resuscitation education of nursing students: A randomised controlled trial. Journal of clinical nursing, 27(1-2), 77-85.
Currie, J., Kourouche, S., Gordon, C., Jorm, C., & West, S. (2018). Mass casualty education for undergraduate nursing students in Australia. Nurse education in practice, 28, 156-162.
Gausvik, C., Lautar, A., Miller, L., Pallerla, H., & Schlaudecker, J. (2015). Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal of multidisciplinary healthcare, 8, 33.
Laschinger, H. K. S., Borgogni, L., Consiglio, C., & Read, E. (2015). The effects of authentic leadership, six areas of worklife, and occupational coping self-efficacy on new graduate nurses’ burnout and mental health: A cross-sectional study. International journal of nursing studies, 52(6), 1080-1089.
Nishijima, D. K., Gaona, S. D., Waechter, T., Maloney, R., Bair, T., Blitz, A., … & Bell, J. M. (2017). Out-of-hospital triage of older adults with head injury: a retrospective study of the effect of adding “Anticoagulation or Antiplatelet Medication Use” as a criterion. Annals of emergency medicine, 70(2), 127-138.
Riahi, S., Thomson, G., & Duxbury, J. (2016). An integrative review exploring decision?making factors influencing mental health nurses in the use of restraint. Journal of psychiatric and mental health nursing, 23(2), 116-128.
Szanton, S. L., Wolff, J. L., Leff, B., Roberts, L., Thorpe, R. J., Tanner, E. K., … & Gitlin, L. N. (2015). Preliminary Data from Community Aging in Place, Advancing Better Living for Elders, a Patient?Directed, Team?Based Intervention to Improve Physical Function and Decrease Nursing Home Utilization: The First 100 Individuals to Complete a Centers for Medicare and Medicaid Services Innovation Project. Journal of the American Geriatrics Society, 63(2), 371-374.
Vassallo, J., Beavis, J., Smith, J. E., & Wallis, L. A. (2017). Major incident triage: derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT). Injury, 48(5), 992-999.
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