Disaster Flashcards
factors that indicate an increasing probability of mass casualty incident
terrorist activity, increasing population density in floodplains, seismic zones and areas susceptible to hurries, production and transport of thousand of toxic and hazardous materials, risk associated with fixed-sitenuclear and chemical facilities, possibility of catastrophic fires and explosions and climate change
what are the 3 basic components of surge capacity
staff (hospital personnel)
stuff (supplies and pharmaceuticals)
structure (physical location and management infrastructure)
what is surge capacity
situation where demand exceeds available resources
define disaster
an event which overwhelms response capabilities
how to define a potential injury creating event (PICE)
A: static vs. dynamic (is there potential for more victims)
B: controlled, disruptive, paralytic (need of more resources - no, augmentation, and total reconstitution)
C: local, regional, national, international
Projected Need 0 - None I- Small II- Moderate III- Large
six critical substrates for hospital operations
physical plant personnel supplies and equipment communication transportation supervisory managerial support
how is triage different in disaster ?
attempts to do the most good for the most people, if patient does not have respirations after repositioning airway, should move on to next
which groups o people are at greater risk for injuryy, death, and property loss resulting from a disaster
children elderly racial and ethnic minorities disabled those siding in institituoins mentally ill
components and roles of incident command system
incident commander: overall mgmt responsibility for incident
operations section: mgmt of tactical activities, resources assigned to staging areas
planning section: collects, evaluations and disseminates info about incident operations and status of resources
logistics section: providing facilities, services and material in support of the incident (i.e. food, medical support, transportation)
finance section: maintaining records on personnel and equipment, paying vendors/supplies, determingin cost of alternative of strategic planning
4 phases of comprehensive emergency management
mitigation: taking action to reduce impact of identified hazards, i.e enhanced seismec structural design of hospital
preparedness: training, drills and cataloging of resources
response: assessment of situation and coordination of resources
recovery: return to normal operations and debriefing to critique response
potential agents of high concern for use as weapons of mass destruction
chemical: nerve agents: sarin, soman, tabun, VX; mustard agent
biologic: anthrax, plague, smallpox, botulism, viral hemorrhagic fever, tularemia
radiologic: simple device, dispersal device
clinical features of patient exposed to radiation (WMD)
symptoms within hours to days
dermal burns, bone marrow failure, GI dysfunction
3 types of radiation exposure
irradiation, internal contamination, and external contamination
which type of radiation exposure poses no threat to ED personnel
irradiation
same as getting a CXR
management of internally contaminated radiation patient
isolation room where all secretions and body fluids can be collected
agents to limit uptake or facilitate removal of certain radioactive substances:
Prussian blue for caesium/thallium ingestions
diethylenetraiminepentaacetic acid (DTPA) for plutonium exposure
management of external contaminated radiation patient
removal and clothing and washing with soap and water
washing by protected personal should continue until monitoring by the radiation safety officer demonstrates the absence of radioactivity
if wounds present, decontaminate these first, then cover with sterile ,waterproof dressing, then remaining skin washed
ideally decontaminate before hospital entry
features of weapons of mass destruction threat
fear of unknown or unfailiar
lack of training for hospital personnel
lack of equipment, including PPE and diagnostic aids
potential for mass casualties
psychological cassaties
crime scene requiring evidence collection and interaction with law enforcement
potential for ongoing morbidity and mortality (dynamic situation)
signs suggesting biological weapon deployment
syndromes: pulmonary symptoms, pneumonia, rashes, sepsis syndrome, influenza symptoms
epidemiology: multiple, simultaneous events, dead animals, large numbers of patients with high toxicity and death rate
three groups of biologic weapons
bacteria, viruses and toxins
recommendations for prevention of in-hospital transmission of contagious agents
isolate patient in single room with adjoining anteroom
have hand washing facilities and PPE in anteroom
use negative air pressure if possible
use strict barrier precautions: PPE, gowns, gloves, high efficiency particulate air (HEPA) filter respirators, shoe covers, protective eye wear
alert hospital departments that generate aerosols : lab (centrifuges), pathology (autopsies)
what is anthrax / how spread
Bacillus anthracis, a gram positive spore-forming bacterium – spores cause disease
inhaled spores, etc.
no human to human
clinical manifesations of anthrax infection
influenza like illness, with malaise, fever and nonproductive cough with 2-10 days of exposure to spores
within 24-48 hours of illness, abrupt deterioration occurs with overwhelming sepsis, shock, hemorrhagic mediasitnitis, dyspnea and stridor
what is clinical course of cutaneous anthrax
spores introduced through skin usually through open wounds or abrasions; mortality rate 20% without tx, 1% with treatment
papule develops in 1-5 days and progresses to form a large vesicle, then severe edema around the lesions with regional lymphadenitis
after 1 week lesion ruptures forming a black eschar
in 2-3 weeks it sloughs off and illness is over or organism disseminates and pt dies
presentation of oropharyngeal anthrax
ingestion of contaminated meat, pt develops sore throat and neck swelling from cervical and submandibular lymphadenitis
dysphagia and resp distress develop
presentation of GI anthrax
ingestion of contaminated meat, N/V and fever with mesenteric lymphadenitis
pt then experience severe abdominal pain, hematemesis, ascites, and bloody diarrhea
treatment of anthrax - cutaneous anthrax without toxicity
cipro 500mg po Bid or doxycycline 100mg po bid, or amoxicillin 500mg PO TID x 7-10 days
treatment of inhalation, cutaneous, or GI anthrax WITH toxicity
cipro 400mg IV q12h or doxycyclin 100mg IV q12h, or penicillin G 4 million units IV q4h
PLUS clindamycin or linezolid
if meningitis ADD drug that penetrates CNS - meropenem
treatment of post exposure prophylaxis for anthrax
cipro 500mg po Bid or doxycycline 100mg po bid, or amoxicillin 500mg PO TID
treat for 60 days or until patient receives three doses of vaccine
what is the plague caused by
Yersinia pestis a gram negative bacillus
disease of rodents transmitted to humans by flea or inhalation
what are the 3 forms of the plague
bubonic, septicemic, pneumonic
clinical features of pneumonic plague
incubation of 2-3 days
sudden onset of fever, chills and flu-like illness
within 24 hours fulminant pneumonia associated with hemoptysis, systemic toxicity, respiratory failure, circulatory collapse, and death
ecchymoses, DIC and aural gangrene (black death)
human to human transmission possible with pneumonic plague only
clinical features of bubonic plague
organisms inoculated into skin, usually from flea bite
2-3 day incubation, bacilli migrate to lymph nodes and cause inflammation/necrosis, causing large tender nodes or buboes
half will become disseminated
treatment of plague
pneumonic isolation x 4 days
bubonic/septicemic isolation x 48 hours
streptomycin 1g IM BID, gentamicin 5mg/kg once daily IM or IV, doxycycline 100mg IV BID, ciprofloxacin 400mg IV BID, chloramphenicol 25mg/kg IV QID for minimum 10 days
OR doxyclycline 100mg BID, copra 500mg Bid, or chloramphenicol 25mg/kg QID
prophylaxis medications for the plague
tetracycline, doxycycline, cirpro, chloramphenicol and possible septra for kids
how is smallpox spread
variola virus, spread as aerosol, can survive 24-48 hours in environment
people infectious from time rash first appears until scabs fall off (1-2 weeks)
clinical course of smallpox
virus inhaled
migrates to regional lymph nodes, replicates for 2-4 days then spreads to spleen, bone marrow and other lymphoid tissue and liver
8-12 days fever, prostration and headache, mental status changes can occur
rash appears first on face and forearms, later spreading to legs and trunk
all lesions at same stage in one area of the body
during next 8-14 days pustules crust over and separate from the skin, leaving pitted scars
major criteria for diagnosis of smallpox
3 major:
febrile prodrome
classic smallpox lesions
lesions in small stage of development
5 minor: centrifugal distribution of pustules first lesions on the oral mucosa, face or forearms toxic appearnce slow evolution of lesions pustules on palms and soles
treatment of smallpox
cidofovir in animal trial showed 100% survival
vaccinia immune globulin - no role in active disease, can give within 3 days of exposure to prevent or ameliorate illness, within 7 days may prevent death
emergency department preparedness for chemical weapons of mass destruction
community-based hospital planning
personnel trained in recognition, mass casualty triage and treatment
decontamination facility with protocols (runoff water, warm water)
PPE readily accessible and compliant with regulations
rapid access to antidotes, cyanide kits, and anticonvulsants
hospital incident management system in place
knowledge of how to access experts quickly
4 classes of chemical compounds used as WMDs
nerve agents
vesicants (blistering)
cyanides
pulmonary intoxicants
how does nerve agents work
organophosphates
inhibit AChE, block degradation of ACh at postsynaptic membrane
cholinergic toxidrome - most worrisome symptoms bronchorrhea and bronchoconstriction
mitosis and fasciculations occur
bradycardia rare with nerve agents unlike other organophosphate
symptom onset after exposure to nerve agentss
seconds after inhalation and peak at 5 mins
if patient asymptomatic after 1 hour they have not received clinically significant exposure
treatment of nerve agent exposure
VAPOR
mild: observe for 1 hour, then release
moderate: one or two Mark I kits IM or atropine 2-4mg IV, may repeat q5-10mins pen and 2-PAM 1g IV during 20 mins, may repeat q1h
severe: three Mark I kits IM and one diazepam auto injector IM; or atropine 6mg IV, may repeat 2mg boluses IV q5-10mins, and 2-PAM g IV during 30 mins,
LIQUID
mild: one Mark I kit, or atropine 2mg IV and 2PAM 1gIV
mod/sevre: same as for vapor
symptoms by mild, moderate severe after vapour exposure to nerve gas Sarin
mild: rhinorrhea and mitosis
moderate: mild sx. plus increased secretions, wheezing/dyspnea, muscle weakness or fasciculations or GI effects
severe: apnea, seizures, LOC, flaccid paralysis, or major involvement of 2 organ systemns
