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Difficulty: MediumEmergency Response Plan

A mass casualty incident involving the partial collapse of a local sports stadium has prompted the facility to activate its emergency response plan. The hospital incident commander requests that the charge nurse on a medical-surgical unit identify clients who can be safely discharged to free up beds for incoming trauma victims. Which of the following clients should the charge nurse recommend for immediate discharge?

  1. A
    A client admitted 24 hours ago with exacerbation of chronic obstructive pulmonary disease who is receiving continuous bi-level positive airway pressure therapy.
  2. B
    A client admitted for a severe diabetic foot ulcer who received an initial dose of intravenous vancomycin two hours ago and is awaiting surgical evaluation.
  3. A client admitted three days ago with community-acquired pneumonia who has been afebrile for 24 hours and is maintaining an oxygen saturation of 96% on room air.Answer
  4. D
    A client who is 12 hours post-operative following an open bowel resection and requires intravenous hydromorphone for severe incisional pain.

Answer

The client admitted three days ago with community-acquired pneumonia who has been afebrile for 24 hours and is maintaining an oxygen saturation of 96% on room air.
During a mass casualty incident, hospitals must implement surge capacity protocols, which involves discharging the most clinically stable clients. The client with pneumonia has met key stability criteria (afebrile for 24 hours, stable oxygenation on room air) and can safely complete their recovery at home with oral medications. This action safely frees up an inpatient bed for an incoming trauma victim.

Step-by-Step Solution

1
Evaluate the clinical stability and physiological needs of each client.
Identify which clients require acute care interventions (IV medications, ventilatory support, post-operative monitoring) versus those who can continue recovery at home.
During an external disaster, surge capacity requires discharging the most stable clients to make room for critical incoming casualties.
2
Apply the principles of safe discharge prioritization.
The client with pneumonia is afebrile and oxygenating well on room air, indicating they can safely transition to oral antibiotics at home.
Clients who do not require continuous specialized nursing care, IV therapies, or acute monitoring should be prioritized for discharge during an emergency response.

Key Concept

Discharge Prioritization during Emergency Response Surge Capacity
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Topics

Emergency Response Plan

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