Was ist das eigentlich? Cyberrisiken verständlich erklärt

Es wird viel über Cyberrisiken gesprochen. Oftmals fehlt aber das grundsätzliche Verständnis, was Cyberrisiken überhaupt sind. Ohne diese zu verstehen, lässt sich aber auch kein Versicherungsschutz gestalten.

Beinahe alle Aktivitäten des täglichen Lebens können heute über das Internet abgewickelt werden. Online-Shopping und Online-Banking sind im Alltag angekommen. Diese Entwicklung trifft längst nicht nur auf Privatleute, sondern auch auf Firmen zu. Das Schlagwort Industrie 4.0 verheißt bereits eine zunehmende Vernetzung diverser geschäftlicher Vorgänge über das Internet.

Anbieter von Cyberversicherungen für kleinere und mittelständische Unternehmen (KMU) haben Versicherungen die Erfahrung gemacht, dass trotz dieser eindeutigen Entwicklung Cyberrisiken immer noch unterschätzt werden, da sie als etwas Abstraktes wahrgenommen werden. Für KMU kann dies ein gefährlicher Trugschluss sein, da gerade hier Cyberattacken existenzbedrohende Ausmaße annehmen können. So wird noch häufig gefragt, was Cyberrisiken eigentlich sind. Diese Frage ist mehr als verständlich, denn ohne (Cyber-)Risiken bestünde auch kein Bedarf für eine (Cyber-)Versicherung.

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Medical CFRN : Certified Flight Registered Nurse ACTUAL EXAM QUESTIONS

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Exam Number : CFRN
Exam Name : Certified Flight Registered Nurse
Vendor Name : Medical
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CFRN test Format | CFRN Course Contents | CFRN Course Outline | CFRN test Syllabus | CFRN test Objectives


1. General principles of transport nursing practice

A. Transport physiology

1. Physiologic stressors of transport

2. Effects of altitude on patients

B. Scene operations

1. Secure landing zone

2. Incident Command System

C. Communications

1. Radio operations

2. Patient handoff (e.g., history from referring provider, updates for receiving provider, SBAR)

3. Crew resource management

D. Safety and survival

1. ELT

2. Navigation (e.g., maps, GPS, night-vision goggles)

3. Transponder codes

4. Survival principles (post-crash)

5. Transport vehicle emergencies

6. Pre-mission preparation (e.g., shift preparedness, risk exam, crew briefings, weather limitations,AMRM)

E. Management of man-made disasters (e.g., terrorism, industrial accident, transportation accident, mass casualties)

F. Professional issues

1. Evidence-based practice and research

2. Legal issues

a. HIPAA

b. EMTALA

c. Consent

d. Mandatory reporting (e.g., abuse, neglect, diversion, non-accidental trauma)

e. Legal concepts in patient care (e.g., negligence, assault, battery, abandonment)

3. Ethical issues

4. Psychosocial issues in transport, including families

G. Management

1. Quality management and fair work environment

2. Outreach and community education

3. Stress management (e.g., self-care, post-traumatic critical incident)

2. Resuscitation principles 27 31

A. Principles of test and patient preparation

1. Physical test

2. Pain and comfort test

3. Preparing the patient for transport (i.e., packaging)

B. Airway management

1. Airway test

2. Airway management

3. Difficulties encountered with airway

4. Rapid Sequence Induction for Intubation (RSI), including pharmacology

C. Mechanical ventilation

1. Invasive ventilation

2. Non-invasive ventilation

D. Perfusion

1. Components of oxygen delivery

2. Shock pathophysiology

3. Trauma triad (hypothermia, acidosis, coagulopathies)

4. Acid base imbalances

3. Trauma 26 31

A. Principles of management

1. Mechanism of injury

2. Shock

a. Hypovolemic

b. Obstructive

c. Distributive (including neurogenic)

d. Cardiogenic

3. Immobilization

B. Neurologic

1. Traumatic brain injuries

2. Spinal cord injuries

3. Post-traumatic seizures

C. Thoracic

1. Chest wall injuries

2. Pulmonary injuries

3. Cardiac injuries

4. Great vessel injuries

D. Abdominal

1. Hollow organ injuries

2. Solid organ injuries

3. Diaphragmatic injuries

4. Retroperitoneal injuries

5. Abdominal compartment syndrome

E. Orthopedic

1. Vertebral injuries

2. Pelvic injuries

3. Compartment syndrome

4. Amputations

5. Extremity fractures

6. Soft-tissue injuries

F. Burn

1. Chemical burns

2. Electrical burns

3. Thermal burns

4. Radiological burns

5. Inhalation injuries

G. Maxillofacial and neck

1. Facial injuries, including fractures

2. Ocular injuries

3. Blunt and penetrating neck injuries

4. Medical emergencies 44 44

A. Neurologic

1. Seizure disorders

2. Stroke

3. Neuromuscular disorders

4. Space occupying lesions

a. Blood

b. Tumors

c. Abscesses

d. Hydrocephalus

e. Encephalopathies

B. Cardiovascular

1. Acute coronary syndrome

2. Congestive heart failure

3. Pulmonary edema

4. Dysrhythmias

5. Aortic abnormalities

6. Hypertension

7. Mechanical/circulatory support (e.g., IABP, VAD, pacing)

C. Pulmonary

1. COPD

2. Acute lung injury/ARDS

3. Pulmonary infections

4. Asthma

5. Pulmonary embolism

D. Abdominal

1. Abdominal compartment syndrome

2. GI bleed

3. Conditions of the hollow organs (e.g., obstruction,rupture)

4. Conditions of the solid organs (e.g., pancreatitis, hepatitis)

E. Electrolyte disturbances

F. Metabolic and endocrine

1. Diabetic emergencies

2. Neuroendocrine disorders (e.g., diabetes insipidus, SIADH, HHNK)

3. Thyroid conditions

4. Adrenal disorders

G. Hematology

1. Coagulopathies (including platelet disorders)

2. Anemias

H. Renal

1. Acute kidney injury (i.e., acute renal failure)

2. Chronic renal failure

I. Infectious and communicable diseases

1. SIRS and sepsis

2. Isolation precautions (e.g., MRSA, influenza-like illness, highly-infectious diseases)

J. Shock

1. Hypovolemic

2. Obstructive

3. Distributive (including neurogenic and anaphylaxis)

4. Cardiogenic

K. Environmental and toxicological emergencies

1. Environment

a. Allergic reactions

b. Cold related (e.g., hypothermia, frostbite)

c. Heat related (e.g., heatstroke, heat exhaustion)

d. Submersion injuries (i.e., diving injuries, drowning, near drowning)

e. Bites and envenomation

2. Toxicology

A. Obstetrical patients

1. Complications of pregnancy

2. Delivery and post-partum care of mother and infant

3. Trauma

B. Pediatric

1. Trauma

2. Medical (e.g., respiratory, cardiac, and neurological emergencies, metabolic disturbances)

C. Geriatric

1. Trauma (e.g., falls, immobilization)

2. Medical (e.g., drug interactions and comorbidities, dementia)

D. Bariatric (e.g., logistical issues, drug dosage, skin issues,airway management)



Procedures

PA catheter

Point-of-care testing

Video laryngoscopy

Chest radiographs

Transvenous pacing

Capnography for non-intubated patients

Surgical cricothyrotomy

Therapeutic hypothermia

Central venous pressure measurement

Arterial line

Needle cricothyrotomy

Needle thoracostomy

Tourniquet application

Central line

Chest tube

Pelvic stabilization

Non-invasive mechanical ventilation

Traction splint

12-lead ECG

Invasive mechanical ventilation

Transcutaneous pacing

Blood product administration

Capnography for intubated patients

Endotrachael intubation

Initiate/titrate medications

Intraosseous catheter

IABP operation

Escharotomy

CT scans

Medical circulatory devices (VAD, Impella®)

Fracture/dislocation reduction

ICP monitoring

Pericardiocentesis

Neck radiographs

Ventriculostomy monitoring



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Garfield Medical Center nurses launch 10-day strike

Rachel Matteson is used to being short on supplies.

As a nurse in Garfield Medical Center’s intensive care unit, she sometimes has to improvise on the fly. That happened recently as she was preparing a patient for a procedure.

“I had a critical patient who needed multiple blood transfusions, but it required a special kind of tubing that they didn’t have on hand,” the 36-year-old North Hollywood resident said. “So I had to invent something. I tried a number of different solutions, and that took about half an hour.”

Her fix worked and the patient pulled through. But it left her sweating.

The nurses, represented by SEIU Local 121RN, say they’ve repeatedly raised their concerns throughout contract negotiations, which began in January. The hospital said the two sides have reached agreement on most of the outstanding contract issues. (Photo courtesy of SEIU Local 121RN)

That kind of scenario, coupled with complaints of chronic understaffing and inadequate security, prompted the Monterey Park hospital’s 350 nurses to launch a 10-day strike Friday, Aug. 18.

The nurses, represented by SEIU Local 121RN, say they’ve repeatedly raised their concerns throughout contract negotiations, which began in January. The medical center is owned by AHMC Healthcare, which owns nine California healthcare facilities, including five in the Los Angeles area.

Nurses have also complained in the past of being shifted to other areas of the hospital where they may not have the familiarity and training needed to provide adequate patient care. On Friday, union said that issue appears to have been addressed in negotiations.

In a statement issued Friday, Garfield management said it hired qualified replacement nurses to pick up the slack during the walkout.

“We have been bargaining with the union since January and have reached agreement on most of the outstanding contract issues,” the hospital said, adding that “no nurse at their hospital is ever assigned to care for a patient whom they are not qualified to treat.”

Nurses, including Christina Smith, also are calling for increased security at Garfield.

“I was hit in the face with a patient’s cell phone,” said Smith, who has been a registered nurse at the facility for 35 years. “She hit me as hard as she could and knocked me to the ground. It was very traumatic, both physically and mentally.”

Garfield said it has stepped up security measures at the hospital.

“This includes providing metal detectors in their ED entrances and lobby to be used when admitting patients suffering a mental health crisis and training staff in workplace violence prevention,” management said.

Garfield acknowledged that the nationwide nursing shortage has impacted virtually every hospital, including Garfield, but said it has made “great strides” in hiring nurses by offering generous sign-on bonuses and holding multiple job fairs.

Still, nurses say it hasn’t been enough.

Jennifer Huynh, a former ER nurse at Garfield, said she was sometimes forced to provide longer-term care for patients because of chronic understaffing.

“My specialty is to treat people coming into the ER,” the 32-year-old Alhambra resident said recently. “But they would sometimes end up staying for several days because there weren’t enough nurses and nursing assistants. My job was not specialized in taking care of patients for that long.”

Garfield said the union has rejected its proposed salary increase totaling nearly 21% over three years, which it says is competitive with salaries at similar hospitals in the area.

That proposed raise, the hospital said, would increase the average annual salary of a full-time nurse from around $102,700 to approximately $125,500 over the three-year period.

Complaints of understaffing have also cropped up at Prime Centinela Hospital Medical Center in Inglewood, Cedars-Sinai Marina del Rey Hospital, Kaiser facilities throughout Southern California, West Anaheim Medical Center, and several LA County nursing homes, among other medical centers.

Kevin Smith handles business news and editing for the Southern California News Group, which includes 11 newspapers, websites and social media channels. He covers everything from employment, technology and housing to retail, corporate mergers and business-based apps. Kevin often writes stories that highlight the local impact of trends occurring nationwide. And the focus is always to shed light on why those issues matter to readers in Southern California.


NorthBay Health’s Nurse Camp returns

The COVID-19 pandemic changed the medical industry, often leaving even the most anticipated of events stuck on the back burner. At NorthBay Health of Solano County, such was the case with its annual Nurse Camp.

Nurse Camp has made its triumphant return this year. The program, which began back in 2004, allows local high school students and students who are entering college to gain and array of skills while taking part in a slew of activities — all courtesy of current NorthBay nurses.

The three-day camp began on Tuesday and runs through Thursday. On Tuesday at the VacaValley Health Plaza, students learned about using sterile gloves, suturing wounds, inserting IVs, intubating and the safe administration of medications.

Wednesday’s docket at the NorthBay VacaValley Hospital included trauma tasks, splinting broken bones, trauma response in the emergency room, how to stop bleeding and experiencing drunkenness with goggles.

One of the founders of the program, Maureen Allain says she is training others to take over the program for her in the future. Those two nurses taking over happen to be Nurse Camp alumni.

“We are very excited to have the program back,” said Allain. “The students are learning a lot. It’s not only good for the students, it’s also very good for the staff. I think the staff needed something like this after COVID to lift their spirits and help them realize they are getting back to normal. The staff looks forward to this just as much as the students do.”

One of those nurses taking over for Allain is Nora Fey, a current labor and delivery nurse.

“I am absolutely thrilled Nurse Camp is back,” said Fey. “I just found a photo of myself doing casting from seven years ago during Nurse Camp. I was so excited that the leadership program asked me to take over. It’s the reason I’m a nurse.”

The 31 campers arrived on the second floor of an empty Intensive Care Unit and split into five groups. Each group spent around 20 minutes at each station.

At the trauma tasks station, nurses Michaella Caponio and Pam Baumann taught the students about how to use backboards, cervical collars and the straps which hold patients on the board.

They also explained how triage tags work. Triage tags are used during natural disasters or mass casualty incidents to indicate a patient’s state as either minor, delayed, immediate, or deceased.

Rodriguez High School student Sophia Marquez volunteered to lay on the board as fellow camper Benicia High student Giana Mauros strapped her into the cervical collar.

Registered Nurse Michaella Caponio helps Giana Mauros, from Benicia High School, stabilize the neck of Sofia Marquez, from Rodriguez, as students learn about trauma tasks during Nursing Camp at NorthBay Medical in Vacaville on Wednesday. (Chris Riley/The Reporter) Registered Nurse Michaella Caponio helps Giana Mauros, from Benicia High School, stabilize the neck of Sofia Marquez, from Rodriguez, as students learn about trauma tasks during Nursing Camp at NorthBay Medical in Vacaville on Wednesday. (Chris Riley/The Reporter)

Caponio and Baumann then showed the students how to “log roll” the patient, thus helping avoid damage to their neck, but check for back injuries.

After the completion of each station, the campers received a button as a keepsake.

Next door, nurse Jesse Perla taught the students about splinting a wrist. He showed them how to wet the plaster and place it without touching the skin. It was Perla’s first time teaching as a part of Nurse Camp.

The campers then paired up and gave each other splints, which they were allowed to keep on for the rest of the day.

Mason Maurice and Lola Bernhardt practice casting during Nurse Camp at NorthBay Health Center in Vacaville on Wednesday. (Chris Riley/The Reporter) Mason Maurice and Lola Bernhardt practice casting during Nurse Camp at NorthBay Health Center in Vacaville on Wednesday. (Chris Riley/The Reporter)

Perla explained that typically eight layers of plaster will be applied and can be removed with a special saw that won’t cut skin.

Over in the trauma response room, the energy was a bit more chaotic. A dummy audibly groaned, “bloody” towels were strewn about the floor and a rogue plastic foot was on the floor as students worked to tourniquet the wound of the “patient.”

That “patient,” a dummy man, theoretically had his foot blown off in an explosion at work. The campers got firsthand experience in what to do in a trauma situation that required immediate action.

As the dummy was rolled in on a gurney, the students transferred him to the operating table and were told to cut all of his clothes off.

As the dummy repeated, “Ouch my leg!” students worked to check for internal bleeding and made sure his airways were clear.

“Where is his foot?” asked one of the students as it lay on the ground. Once it was found, the students were informed that in a real-life situation, the foot would need to be put on ice.

Emergency room nurse and 2012 Nurse Camp alumna Mariah Hartmann and ICU nurse Danielle Manno led the “Stop the Bleed” demonstration. This was Hartmann’s first time teaching in Nurse Camp. Manno has been a part of Nurse Camp since 2015.

Hartmann and Manno taught the campers the three ways to stop bleeding: Pressure, packing and tourniquet.

Students were able to practice using a tourniquet and used jello blocks with “wounds” to practice packing and applying pressure.

The nurses also taught the students about Narcan and its importance, especially during the current fentanyl crisis. They passed around the bottle and taught the students how to use the life-saving measure if they encounter an overdose. Each student received a box of Narcan to have with them in case of an emergency.

Narcan is administered as a nasal spray to reverse the effects of a drug overdose. Hartmann says anyone can stop by the ER and ask for a box and that soon it will be available in pharmacies.

The last station of the morning took the students back to their days of riding a Razor scooter as a child. This time, however, they were driving a scooter while “drunk.” Each camper put on “drunk goggles” and rode a Razor scooter down the hallway and back.

“Can you imagine driving a car like this?” asked one of the nurses.

This station allowed the campers to understand just how dangerous drunk driving can be and why it can lead to such traumatic situations.

After lunch, the students were set to view a helicopter landing on the hospital’s helipad. Activities on Thursday at NorthBay Health Medical Center in Fairfield will include a hospital tour, operating room activities, labor and delivery, the Neonatal Intensive Care Unit and the Mother-Baby unit.


 




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Warum sind Cyberrisiken so schwer greifbar?

Als mehr oder weniger neuartiges Phänomen stellen Cyberrisiken Unternehmen und Versicherer vor besondere Herausforderungen. Nicht nur die neuen Schadenszenarien sind abstrakter oder noch nicht bekannt. Häufig sind immaterielle Werte durch Cyberrisiken in Gefahr. Diese wertvollen Vermögensgegenstände sind schwer bewertbar.

Obwohl die Gefahr durchaus wahrgenommen wird, unterschätzen viele Firmen ihr eigenes Risiko. Dies liegt unter anderem auch an den Veröffentlichungen zu Cyberrisiken. In der Presse finden sich unzählige Berichte von Cyberattacken auf namhafte und große Unternehmen. Den Weg in die Presse finden eben nur die spektakulären Fälle. Die dort genannten Schadenszenarien werden dann für das eigene Unternehmen als unrealistisch eingestuft. Die für die KMU nicht minder gefährlichen Cyber­attacken werden nur selten publiziert.

Aufgrund der fehlenden öffentlichen Meldungen von Sicherheitsvorfällen an Sicherheitsbehörden und wegen der fehlenden Presseberichte fällt es schwer, Fakten und Zahlen zur Risikolage zu erheben. Aber ohne diese Grundlage fällt es schwer, in entsprechende Sicherheitsmaßnahmen zu investieren.

Erklärungsleitfaden anhand eines Ursache-Wirkungs-Modells

Häufig nähert man sich dem Thema Cyberrisiko anlass- oder eventbezogen, also wenn sich neue Schaden­szenarien wie die weltweite WannaCry-Attacke entwickeln. Häufig wird auch akteursgebunden beleuchtet, wer Angreifer oder Opfer sein kann. Dadurch begrenzt man sich bei dem Thema häufig zu sehr nur auf die Cyberkriminalität. Um dem Thema Cyberrisiko jedoch gerecht zu werden, müssen auch weitere Ursachen hinzugezogen werden.

Mit einer Kategorisierung kann das Thema ganzheitlich und nachvollziehbar strukturiert werden. Ebenso hilft eine solche Kategorisierung dabei, eine Abgrenzung vorzunehmen, für welche Gefahren Versicherungsschutz über eine etwaige Cyberversicherung besteht und für welche nicht.

Die Ursachen sind dabei die Risiken, während finanzielle bzw. nicht finanzielle Verluste die Wirkungen sind. Cyberrisiken werden demnach in zwei Hauptursachen eingeteilt. Auf der einen Seite sind die nicht kriminellen Ursachen und auf der anderen Seite die kriminellen Ursachen zu nennen. Beide Ursachen können dabei in drei Untergruppen unterteilt werden.

Nicht kriminelle Ursachen

Höhere Gewalt

Häufig hat man bei dem Thema Cyberrisiko nur die kriminellen Ursachen vor Augen. Aber auch höhere Gewalt kann zu einem empfindlichen Datenverlust führen oder zumindest die Verfügbarkeit von Daten einschränken, indem Rechenzentren durch Naturkatastrophen wie beispielsweise Überschwemmungen oder Erdbeben zerstört werden. Ebenso sind Stromausfälle denkbar.

Menschliches Versagen/Fehlverhalten

Als Cyberrisiken sind auch unbeabsichtigtes und menschliches Fehlverhalten denkbar. Hierunter könnte das versehentliche Veröffentlichen von sensiblen Informationen fallen. Möglich sind eine falsche Adressierung, Wahl einer falschen Faxnummer oder das Hochladen sensibler Daten auf einen öffentlichen Bereich der Homepage.

Technisches Versagen

Auch Hardwaredefekte können zu einem herben Datenverlust führen. Neben einem Überhitzen von Rechnern sind Kurzschlüsse in Systemtechnik oder sogenannte Headcrashes von Festplatten denkbare Szenarien.

Kriminelle Ursachen

Hackerangriffe

Hackerangriffe oder Cyberattacken sind in der Regel die Szenarien, die die Presse dominieren. Häufig wird von spektakulären Datendiebstählen auf große Firmen oder von weltweiten Angriffen mit sogenannten Kryptotrojanern berichtet. Opfer kann am Ende aber jeder werden. Ziele, Methoden und auch das Interesse sind vielfältig. Neben dem finanziellen Interesse können Hackerangriffe auch zur Spionage oder Sabotage eingesetzt werden. Mögliche Hackermethoden sind unter anderem: Social Engineering, Trojaner, DoS-Attacken oder Viren.

Physischer Angriff

Die Zielsetzung eines physischen Angriffs ist ähnlich dem eines Hacker­angriffs. Dabei wird nicht auf die Tools eines Hackerangriffs zurückgegriffen, sondern durch das physische Eindringen in Unternehmensgebäude das Ziel erreicht. Häufig sind es Mitarbeiter, die vertrauliche Informationen stehlen, da sie bereits den notwendigen Zugang zu den Daten besitzen.

Erpressung

Obwohl die Erpressung aufgrund der eingesetzten Methoden auch als Hacker­angriff gewertet werden könnte, ergibt eine Differenzierung Sinn. Erpressungsfälle durch Kryptotrojaner sind eines der häufigsten Schadenszenarien für kleinere und mittelständische Unternehmen. Außerdem sind auch Erpressungsfälle denkbar, bei denen sensible Daten gestohlen wurden und ein Lösegeld gefordert wird, damit sie nicht veröffentlicht oder weiterverkauft werden.

Ihre Cyberversicherung sollte zumindet folgende Schäden abdecken:

Cyber-Kosten:

  • Soforthilfe und Forensik-Kosten (Kosten der Ursachenermittlung, Benachrichtigungskosten und Callcenter-Leistung)
  • Krisenkommunikation / PR-Maßnahmen
  • Systemverbesserungen nach einer Cyber-Attacke
  • Aufwendungen vor Eintritt des Versicherungsfalls

Cyber-Drittschäden (Haftpflicht):

  • Befriedigung oder Abwehr von Ansprüchen Dritter
  • Rechtswidrige elektronische Kommunikation
  • Ansprüche der E-Payment-Serviceprovider
  • Vertragsstrafe wegen der Verletzung von Geheimhaltungspflichten und Datenschutzvereinbarungen
  • Vertragliche Schadenersatzansprüche
  • Vertragliche Haftpflicht bei Datenverarbeitung durch Dritte
  • Rechtsverteidigungskosten

Cyber-Eigenschäden:

  • Betriebsunterbrechung
  • Betriebsunterbrechung durch Ausfall von Dienstleister (optional)
  • Mehrkosten
  • Wiederherstellung von Daten (auch Entfernen der Schadsoftware)
  • Cyber-Diebstahl: elektronischer Zahlungsverkehr, fehlerhafter Versand von Waren, Telefon-Mehrkosten/erhöhte Nutzungsentgelte
  • Cyber-Erpressung
  • Entschädigung mit Strafcharakter/Bußgeld
  • Ersatz-IT-Hardware
  • Cyber-Betrug