Concepts of Preparedness: Disaster & Mass Casualty Flashcards
Disaster Overview
☆ Disaster events defined by 3 characteristics
- Event of destructive magnitude
- Kills, injures, or causes human suffering to a significant # of ppl or the environment
- Requires the need for external assistance
Mass Casualty Incidents
- All mass casualty events are disasters, but not all disasters are MCIs
☆ Mass casualty
- Local medical capabilities overwhelmed
- May require collaboration of multiple agencies & healthcare facilities to handle crisis
☆ GOAL is to do the greatest good for the greatest # of ppl; accomplished through DISASTER TRIAGE
Preparedness
- TJC
- CMS
- CDC
- WHO
Terrorism
- Involves overt actions for the expressed purpose of causing harm
- Terrorists use threats
- Create fear among the public
- Try to convince citizens that their government is powerless to prevent terrorism
- Get immediate publicity for their causes
> Often motivated by religious, political, or other ideological beliefs
Weapons of mass destruction/effect
> A toxin or poisonous chemical or their precursors
> A disease organism
> Radiation or radioactivity
> An explosive device
Disaster: Bioterrorism
☆ Anthrax, plague, & tularemia: treated w/abx assuming sufficient supplies & nonresistant organisms
☆ Smallpox can be prevented or ameliorated by vaccination even when 1st given >exposure
Anthrax
- Oldest recorded disease of grazing animals thought to be the “sixth plague”
> Aerosol, cutaneous, ingested (rare); bacterial w/spores
- Incubation period 1-6 days; inhalation up to 42 days
> Preferred treatment - Cipro, Levofloxacin, Doxycycline, & PCN
Small Pox
- Viral: Variola major & Variola minor
- Highly contagious (direct or indirect contact); usually droplets
- Smallpox localizes in small blood vessels of the skin & in the mouth & throat, forming fluid-filled, raised blisters (skin)
- Incubation period about 12 days
Treatment is supportive, w/use of antivirals
Disaster: Chemical
Characterized by target organ or effect
> Inactivates enzyme acetylcholinesterase, preventing the breakdown of the neurotransmitter acetylcholine in the victim’s synapses
?
- Toxic nerve gas that can cause death within min of exposure
- Enters body through eyes & skin
- Acts by paralyzing resp muscles
- Antidotes for nerve agents: atropine, pralidoxime chloride (aka Protopam) [2PAM]
Sarin
?
Colorless gas normally used in chemical manufacturing
- If inhaled @ high conc for long enough period, causes severe resp distress, pulm edema, & death
Phosgene
Mustard gas
- Yellow to brown in color w/garlic-like odor
- Irritates eyes & causes skin burns/blisters
Blood - causes intravascular hemolysis that may lead to RF
Cyanide - cherry red skin - immediate onset
Pulmonary - similar mechanism to blister agents in that the compounds are acids or acid-forming, but action is more pronounced in resp system flooding it & resulting in suffocation; survivors often suffer chronic breathing problems
Biological: Plague
A spec disease c/b Yersinia pestis; are 3 major manifestations (Gram negative)
- Bubonic plague
- Septicemic plague
- Pneumonic plague (! most lethal)
> Can cause a pandemic
> Treatment w/abx: gentamycin, Cipro
Biological: Others
Tularemia
- C/b the bacterium Francisella tularensis found in animals (esp rodents, rabbits)
- s/s flu-like w/cough
- sx’s within 3 days
- Treatment - abx
Disasters: Radiation
- Nuclear/radiological events
- Exposures to radiation may be accidents or deliberate in origin
Radiation
- Ionizing radiation
- Alpha radiation
- Beta radiation
- Gamma radiation
Means of exposure
- Irradiation
- Contamination
- Radiation effects
- Adverse health effects of exposure may not be apparent for many yrs
- 2 types of radiation injury
> Local radiation inj & acute radiation synd
Ionizing radiation
Can damage our DNA & cause health effects when humans are exposed to sufficiently high doses
Alpha radiation
Is a stream of positively charged particles that travel only about an inch in air
Beta radiation
Is a stream of electrons that can be stopped by a few millimeters of aluminum but can penetrate up to a centimeter into human tissue
Gamma radiation
Is similar to x-rays as it can penetrate the whole body but unlike x-rays they are more radioactive & can kill cells
A person is externally contaminated when material that contains radioactive atoms is deposited on the skin, clothing, or anywhere it is not desired
A person is internally contaminated if radioactive material is breathed in, swallowed, or absorbed through wounds
Most radiation injuries are “local” injuries frequently involving only the hands
Acute radiation syndrome (ARS) is an acute illness c/b irradiation of the whole body (or a significant portion of it)
Radiologic/Nuclear Agents of Terrorism
- Radiologic dispersal devices (RRDs) (“dirty bombs): mix of explosives & radioactive material
> When detonated, blast scatters radioactive dust, smoke, & other material into environment, resulting in radioactive contamination
> Main damage from RRDs: explosion
- ARS dependent on dose; 100 rads or more
Stages
- Prodromal: 48-72 hrs >exposure
- Latent: lasts about 3 wks
- Illness
- Recovery or death
Explosive Devices as Agents of Terrorism
- Result in 1 or more of following types of injuries: blast, crush, or penetrating
> Blast inj from supersonic overpressurization shock wave that results from explosion - Damage to the lungs, middle ear, GI tract
Disasters: Natural
- Earthquakes
- Tsunami
- Tornadoes
- Hurricanes, cyclones, & typhoons
- Winter storms & blizzards
- Heat waves
Disasters: Infection - Emerging infection
- SARS
- Novel Influenza A
- Novel Corona Virus (Covid-19) [SARS-CoV-2]
FYI: Covid-19 Global Pandemic Steps you can take (from the CDC, how to protect yourself & others)
✧ Get vaccinated & maintain boosters
✧ Wear a mask
✧ Keep 6 ft away
✧ Avoid poorly ventilated spaces & crowds
✧ Test to prevent spread to others
✧ Wash your hands often
✧ Cover coughs & sneezes
✧ Clean & disinfect
✧ Monitor your health daily
✧ Follow recommendations for quarantine, isolation
✧ Take precautions when you travel
Disaster Preparedness & Response
- 1st response to a disaster is the responsibility of the local government’s emergency services
- Supplemented by neighboring communities & volunteer agencies
- Governor of affected state may request federal assistance
- Federal resources mobilized through FEMA
MCI Preparedness
★ Casualties need to be treated & stabilized
> If known or suspected contamination, decontamination @ scene, then transport to hosp
- Many casualties will arrive @ hosp on their own (i.e., “walking wounded”)
- Total # of casualties a hosp can expect is est by doubling # of casualties that arrive in 1st hr
> Generally 30% will req admission to hosp, & 1/2 of these will need surgery within 8 hrs
- Communities have initiated programs to develop community emergency response teams (CERTs)
- CERTs are partners in emergency preparedness, & training helps citizens to understand their personal responsibility for natural/manmade disaster
- All heath care providers have a role in MCI preparedness
- Knowledge of the hospital’s emergency response plan
- Participation in MCI preparedness drills is req’d
Disaster Triage
★ Goal: Do the most good for the greatest amt of ppl
Gives highest priority to those who have a serious inj/illness, BUT also have a good probability of survival, & do not req extraordinary resources
✓ Triage must be rapid & conducted in 60 sec or less
✓ START method based on respirations, perfusion (or pulse), & mental status [RPM]
✓ Allows for only 2 interventions during the triage process:
1. direct pressure to control bleeding
2. basic airway-opening maneuvers
✓ Pts not moved to an area for definitive care are re-triaged on a constant basis b/c the pt’s cond may change or there may be a change in avail resource(s)
Notification & Activation of Emergency Preparedness Plans
- Radio/cellular communication between ED & EMS providers @ scene
- Media broadcast message via radio, TV, electronic media
- DMAT team - Disaster Medical Assistance Team
→ are deployed within 8 hrs of notification & remain self-sufficient for 72 hrs w/enough food, water, shelter, & medical supplies to treat about 250 pts/day - National Disaster Medical System: organizes & trains volunteer disaster medical assistance teams (DMATs)
- DMATs: categorized according to ability to respond to an MCI
Disaster Preparedness & Response
National Response Framework
- The disaster plan for the nation
Assessing risk & vulnerability
- Hazard vulnerability analysis (HVA)
Disaster phases
- Mitigation, preparedness, response, & recovery
Incident command system (ICS)
- Initial challenges met by those responding to a disaster “how to rapidly gain control of chaos @ the scene”
- 2nd challenge is how to rapidly organize the personnel resources into a hierarchy of command
Hospital Preparedness
- PPEs
- Decontamination
- Surge capacity
- Hospital evacuations
- Advanced warning events
- No advanced warning events
- Evacuation
Level A
* Is the highest lvl of resp, eye, mucous membrane, & skin protection
Level B
* Provides the greatest lvl of resp protection but a lower lvl of skin protection than Level A
Level C
* Provides the same skin protection as Level B but a lesser lvl of resp protection than lvls A & B
Level D
* PPE consists of a surgical gown, mask, & gloves
Mental health considerations
- For every person physically injured in a disaster, there are 4-20 psychological victims
Debriefing
- Should incl all participants in the disaster response
Maintaining readiness
- Disaster drills are an integral element of preparedness & should be conducted 2x yearly
Nurse’s Role During a Disaster
☆ Major role of nursing
- Disaster preparedness, response, & recovery
- Mass casualty triage, helping to ensure pts get the most appropriate lvl of care
- Putting disaster response plans into action
- Evacuation
- Decontamination
