Disaster Management Flashcards
disaster that occurs inside a healthcare facility that could endanger workers and patients
Internal Disaster
disaster that occurs anywhere outside the healthcare facility requiring activation of a facility’s emergency response system
External Disaster
The Joint Commission requires how many disaster drills per year?
Two
the ability of a facility to rapidly expand during an emergency
surge capacity
What are the 4 phases of Emergency Management?
Mitigation, Preparedness, Response & Recovery
physician or administrator who assumes overall leadership for implementing the emergency plan
Hospital Incident Commander
physician who decided the number, acuity and resource needs of patients
Medical Command Physician
physician or nurse who rapidly evaluates each patient to determine priorities for treatment
Triage Officer
person who serves as a liaison between the health care facility and the media`
Community Relations/ Public Information Officer
triage category in which injuries are life-threatening but survivable with intervention ( EX: sucking chest wound, hemothorax, unstable chest/abdominal wounds, 2nd & 3rd degree burns over less than 50% TBSA)
Category Red/ Immediate/ Priority 1
triage category in which injuries are significant and require medical care but can wait 30 minutes- 2 hours without threat to life or limb (EX: stable abdominal wounds w/o significant hemorrhage, soft tissue injuries, maxillofacial wounds w/o airway compromise, fractures requiring ORIF)
Category Yellow/ Delayed/ Priority 2
triage category in which injuries are minor and treatment can be delayed hours or days… “walking wounded” (EX: extremity fractures, minor burns, sprains, behavioral disorders or psychological disturbances)
Category Green/ Minimal/ Priority 3
triage category in which injuries are extensive and chances of survival are unlikely even with definitive care (EX: unresponsive patients w/ penetrating head wounds, high spinal cord injuries, 2nd & 3rd degree burns in excess of 50% TBSA, patients exposed to large amounts of radiation)
Category Black/ Expectant/ Priority 4
level of PPE worn when the highest level of protection is needed with a self-contained breathing aparatus (SCBA), fully encapsulated, vapor-tight, chemical-resistant suit, and chemical-resistant boots & gloves
PPE Level A
level of PPE worn when the highest level of respiratory protection but a lesser level of skin/eye protectant is needed with SCBA and chemical resistant but not vapor-tight suits
PPE Level B
level of PPE containing air-purified respirator, chemical resistant coveralls w/ splash hood, chemical resistant gloves & boots
PPE Level C
level of PPE used most often in hospitals as a typical work uniform that is not adequate when caring for chemically, biologically or radiologically contaminated patients
PPE Level D
First Step of Decontamination Process
removal of clothing & jewelry and rinsing w/ water
Second Step of Decontamination Process
washing thoroughly with soap & water
injuries caused by pipe bombs, Molotov cocktails, fertilizer bombs and “dirty” bombs w/ nuclear material
Blast Injury
injury from over-pressurization force (blast wave)…pulmonary damage, tympanic membrance rupture, abdominal hollow organ preforation
primary blast injury
injury resulting from projectiles during a blast…penetrating traumas, fragmentation injuries, blunt trauma
secondary blast injury
injury resulting from the blast wind that causes a victim to be thrown resulting in traumatic injury…head injury, fractures, traumatic amputations
tertiary blast injury
all explosion-related injuries not due to primary, secondary or tertiary mechanisms including exacerbations of or complications r/t existing conditions…burns, crush injuries, head injuries, exacerbations of COPD, asthma, diabetes, cardiac conditions, hypertension
Quaternary blast injury
injury resulting from hyper-inflammatory state commonly seen in bystanders near a blast and due to toxic substances or uncommon explosives…hyperpyrexia (fever >106)
Quinary blast injury
bioterrorism category that is easily spread, results in high death rates, and requires special action for public health awareness
Bioterroism Category A
bioterrorism category that is moderately to easily spread resulting in moderate illness rates and low death rates
bioterrorism category B
bioterrorism category that is easily available, easy to produce & spread with a potential to cause high morbidity and major health impact
bioterrorism category C
the most potentially threatening biochemical weapon occurring seasonally in nature in two forms: variola major & variola minor
Smallpox
transmission route for smallpox
aerosol– oropharyngeal route
incubation period for smallpox
7-20 days
How soon after incubation period can symptoms of smallpox begin?
10-14 days
How long is smallpox stable in aerosol form?
48 hours
How far away can smallpox transmit in aerosol form?
30 feet
When is smallpox most contagious?
first 7-10 days of rash
What are the symptoms of the prodomal phase of smallpox?
flu-like symptoms: HA, fever, fatigue
What are the stages of smallpox rash?
macule—> vesicle –> papule –> pustule
What serious complications can the smallpox rash lead to?
corneal ulcers & blindness
What is the only treatment for smallpox?
supportive care and antibiotics for additional infections in skin lesions
What must laundry and biological waste from smallpox patient be washed in?
hot water and bleach
What kind of room must a smallpox patient be placed in?
Negative-Pressure Isolation Room
Who receives the smallpox vaccination?
military & outbreak first responders
If exposed to smallpox, when should the vaccine be administered?
within 3 days
What is the smallpox vaccine made from?
“Cow Pox”
mild case of cow pox in immunosuppressed patients caused by exposure to person who has received the smallpox vaccine
Vaccinia
most widely weaponized biological agent available…gram positive rods that release toxins causing hemorrhage, edema and necrosis
Anthrax
Why are cows vaccinated against anthrax?
because the spores can live in the ground for decades
What are the 4 routes that anthrax can be transmitted?
cutaneous, ingestion, inhalation, injection
transmission of anthrax that is the most common and causes edema, pruritis and necrosis
cutaneous
transmission of anthrax that causes fever, nausea, vomiting, abdominal pain, bloody diarrhea, and ascites
ingestion
transmission of anthrax that is odorless and invisible and causes flu-like symptoms of cough, headache, fever, chills, & vomiting
inhalation
What is the only difference between anthrax inhalation symptoms and flu symptoms?
no rhinorrhea or nasal congestion in anthrax
stage of anthrax infection disease w/ symptoms of fever, sever respiratory distress, stridor, hypoxia, cyanosis, diaphoresis, hypotension, shock, and hemorrhagic medistinitis
second stage of anthrax infection
bleeding within the chest wall
hemorrhagic medistinitis
What is the treatment for anthrax inhalation?
100% oxygenation- ventilation, correction of electrolyte imbalances and hemodynamic support, Cipro & Doxycycline
How soon after exposure to anthrax does antibiotic therapy need to start to ensure survival?
60 hours
Who receives the anthrax vaccine?
veterinarians and military
Why is cremation recommended for anthrax victims?
because the spores can live for decades
What precautions does the nurse use when caring for anthrax patient?
standard precautions (patient is not contagious–anthrax cannot be spread from person to person)
biological agent caused by bacterium found in animals
Tularemia
What are the symptoms of tularemia?
flu-like symptoms, life-threatening pneumonia, chest pain, bloody sputum, respiratory failure
How is tularemia spread?
airborne
What is the treatment for tularemia?
streptomycin IM BID x 10 days and gentamycin IV QD x 10 days
Is tularemia contagious?
No
muscle-paralyzing disease caused by a toxin clostridium botulinum
botulism
type of botulism that occurs when a person ingests pre-formed toxin that leads to illness w/in a few hours to days…public health emergency
foodborne botulism
type of botulism that occurs in a small number of infants per year due to ingestion of honey
infantile botulism
type of botulism that occurs when wounds a infected by the toxin
wound botulism
How soon after eating toxin-containing food do botulism symptoms occur?
12-36 hours
symptoms of double-vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, descending muscle weakness
foodborne botulism symptoms
Is foodborne botulism contagious?
No
What is the treatment for botulism?
botulism antitoxin must be administered early
What bacterium causes plague?
Yersinia pestis
most common type of plague that results from infected flea type and causes swollen, tender lymph nodes, fever, HA, chills
bubonic plague
Is bubonic plague contagious?
No
type of plague that is a complication of bubonic or pneumonic plague and leads to septic shock
septicemic shock
What animals carry plague?
rodents and fleas that live on rodents
most deadly type of plague that is contagious and can be aerosolized and used as biological weapon causing fever, HA, rapidly developing pneumonia, dyspnea, chest pain, cough, and hemoptysis
pneumonic plague
How long does pneumonic plague progress leading to respiratory failure and death?
2-4 days
How soon after symptoms of pneumonic plague are antibiotics administered?
24 hours
What antibiotics are given for pneumonic plague?
streptomycin, gentamycin, and tetracyclines
Ebola is a type of _____________?
viral hemorrhagic fever
Where do viral hemorrhagic fevers naturally reside?
in rodents
Are viral hemorrhagic fevers contagious?
Yes HIGHLY
Is there treatment for viral hemorrhagic fevers?
No effective treatment
What are the main symptoms of viral hemorrhagic fevers?
fevers and bleeding (leading to shock and death)
How long after exposure to ebola do symptoms appear?
2-21 days
How high is the fever in ebola?
greater than 101.5
These are symptoms of what?…high fever, severe HA, muscle pain, constant diarrhea, constant vomiting, abdominal pain, bleeding/ bruising
Ebola
How is ebola transmitted?
through contact w/ infected animal (primate), person-to-person spread through direct contact w/ blood or body fluids, or contaminated objects (needles)
How is ebola diagnosed?
symptoms and bloodwork
What are the lab tests for ebola?
ELISA, IgM ELISA, and virus isolation
What are the palliative treatments for ebola?
IV fluids (electrolyte replacement), maintaining oxygenation and BP, treating super-infections, experimental treatments
the tendency of chemical weapons to become a vapor
volatility
the tendency of chemical weapons to be less likely to vaporize and disperse
persistence
the potential of chemical weapons to cause injury
toxicity
the time from absorption to the appearance of signs and symptoms in chemical weapons
latency
the evacuation and decontamination of chemical weapons
limiting exposure
type of chemical weapon that causes blistering and results in large number of injuries
vesicants (EX: lewisite, phosgene, nitrogen mustard, sulfur mustard)
What type of chemical weapon would cause large burns in moist areas of the body, like the axilla or perineum?
vesicants
What type of chemical weapon would cause purulent fibrinous psuedomembrane discharge that may cause obstruction of the airway?
vesicants
What is the treatment for vesicant chemical weapon exposure?
decontamination w/ soap and water, copious irrigation of the eyes, intubation, and bronchoscopy
type of chemical weapon that is the most toxic in existence (widespread death), inexpensive, effective and easily dispersed
nerve agents
What does nerve agent exposure cause?
cholinergic crisis
What are the symptoms of a cholinergic crisis?
bilateral miosis, visual disturbances, increased GI motility, bradycardia, AV block
What will a lethal dose of a nerve agent cause?
loss of consciousness, seizures, fasisculations (twitching), seizures, and apnea
What is the treatment for nerve agent chemical weapon exposure?
decontamination w/ soap and water or saline for 20 minutes, maintain the airway (NO PLASTIC AIRWAYS), Atropine IV, Protopam
The military carry auto-injectors of what medication for chemical weapon exposure?
Protopam
the type of chemical weapon that directly effects cellular metabolism resulting in asphyxiation through alterations in hemoglobin
blood agents
What is the most common blood agent used?
Hydrogen cyanide
What does cyanide smell like?
bitter almonds
What should you do if you are exposed to a chemical agent?
Evacuate, Stay upright, carry children, stay upwind, remove clothing, and wash with soap and water
What should you do with clothing after chemical exposure?
seal in 2 bags and turn it over to the local health workers
How can cyanide be put into the body?
ingested, inhaled or absorbed
What does cyanide exposure cause?
respiratory muscle failure, respiratory arrest, cardiac arrest and death
What is the first-line treatment for cyanide exposure?
intubation w/ mechanical ventilation
What is the second-line treatment for cyanide exposure?
rapid administration of amyl nitrate pearls, sodium nitrate, and sodium thiosulfate
What is the third-line treatment for cyanide exposure?
give IV Vit. B12
What do amyl nitrate pearls do in a patient exposed to cyanide?
it causes methemoglobinemia which binds to cyanide
What does sodium nitrate and sodium thiosulfate do in a patient exposed to cyanide?
it excretes methemaglobin via the kidneys
How can radiation be put into the body?
inhaled, ingested, injected or absorbed
How can most radiation patients be treated with to recover?
decontamination with soap and water
condition that arises with a large amount of radiation exposure
Acute Radiation Syndrome
phase of acute radiation syndrome that occurs 48 to 72 hours after exposure
prodomal phase
phase of acute radiation syndrome that occurs after resolution of prodomal phase and last up to 3 weeks
latent phase
phase of acute radiation syndrome that occurs after the latent phase
manifest illness phase
last phase of acute radiation syndrome that can take weeks to months
recovery phase
What is the first sign of impending death due to acute radiation syndrome?
increased intracranial pressure (change in LOC)
What is triage based on for of acute radiation syndrome?
whether or not the patient will survive
Who is at risk for severe and longer lasting reactions to trauma?
people proximal to the event, people w/ multiple stressors, people w/ history of prior traumas, people w/ chronic medical illness or psychological disorders
What are the immediate effects of trauma?
severe panic and anxiety
What is a long-lasting effect of trauma?
PTSD
the impact of event scale used to determine psychosocial response to trauma
Likert Scale
With disabled adults, what are the concerns during a disaster?
mobility, medications, access to healthcare/ evacuations/ shelters,
With older adults, what are the concerns during a disaster?
aging changes, co-morbidities, lack of physiological reserves to recover, drug metabolism/ excretion
With pediatric patients, what are the concerns in a disaster?
short stature, BSA for antidote dosage, psychological trauma, respiratory problems
