disaster preparedness & mgt (329 E3) Flashcards
a disaster is
any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources
casualties & types of casualties
Casualties can be those injured or dead. Classified as a direct victim, indirect victim, displaced person, or refugee
Mass casualty involves 100+ individuals
Multiple casualty involves 3 to 99 individuals
major categories of disasters: natural
Sudden impact or acute onset
Slow or chronic impact
major categories of disasters: human - generated
Unintentional/Intentional
- Biologic
- Nuclear
- Incendiary
- Chemical
- Explosive
- Technologic – more recently added
natural disasters examples
Hurricanes
Tornadoes
Hailstorm
Drought
Floods
Mudslides
Earthquakes
Pandemics and epidemic
Bug infestations
Extreme heat or cold
human made disasters
Conventional Warfare
Unconventional Warfare (nuclear and chemical)
Transportation accident
Structural collapse/ infrastructure failure
Fires
Explosions
Water supply contamination
Food supply contamination
Civil unrest (riots or genocide)
major effects of disasters
1) Populations
2) The environment
3) Food and water supplies
4) Infrastructure
5) Psychological, social, and economic stability
disaster mgt phases
prepare
prevent
respond
recover
look at slide, for the box examples that go around the phases
disaster mgt: prevention
Nurses may be involved in the following activities:
-Identifying potential hazards
- Identifying vulnerabilities
- Strengthening capacity:
Identify existing strengths, attributes and
resources available within a community,
organization or society to manage and reduce
disaster risks and strengthen resilience.
disaster mgt: preparedness
Nurses may be involved in the following activities:
- Issuing timely warnings
- Implementing protective actions
- Undertaking emergency management activities
- Evacuating population pre-disaster as needed
disaster mgt: reaction/respond
Nurses may be involved in the following activities:
Establishing control of the situation by:
- Identifying the disaster management team leader
- Determining and clearly articulating roles of each member of the team, including your own role
- Setting up a viable and realistic triage system
- Implementing life-saving actions (i.e., S.T.A.R.T., decontamination)
- Implementing public health management and surveillance (i.e. quarantine)
- Evacuating populations immediate post-disaster as needed
Disaster Management – Reaction/Respond: Decontamination (chemical exposure)
Used with chemical exposures for 3 primary reasons:
1) To prevent further absorption of a chemical by the victim;
2) To prevent the chemical from spreading on the victim’s body;
3) To prevent the chemical from spreading to others
Process includes:
1) Removing potentially contaminated articles (clothing, jewelry, etc.);
2) Washing exposed areas or entire body;
3) Safely disposing of contaminated articles and wash water.
Disaster Management - Reaction: Isolation
- Individual-level
- Generally for communicable/infectious diseases
Disaster Management - Reaction: Quarantine
- Population-level
- Used across spectrum, from communicable disease to natural or chemical disasters, etc.
-3 levels:
- Shelter-in-place
- Targeted restriction on movements and activities
- Compulsory restriction of all movements and activities
Disaster Management: Recovery
Nurses may be involved in the following activities:
- Continuing to monitor communities/populations for ongoing effects (illness and injury due to post-disaster environment)
- Re-establishing health services
- Debriefing population and responders
- Evaluating disaster management response
- Applying these lessons learned for the next steps in preparation for the next one
nerve agents
GB (sarin) is an organophosphate nerve agent that is a clear, colorless liquid that is volatile at ambient temperatures
VX is an amber-colored, oily liquid with low volatility unless temperatures are high
Nerve agents are readily absorbed by inhalation, ingestion, and dermal contact
Rapidly fatal systemic effects may occur after exposure to these agents
nerve agents effects on the body
HA, restlessness, convulsions, coma, redness & tearing of the eyes, constrictions of the pupils, shortness of breath, chest tightness, wheezing, excessive fluid secretions, V/D, urinary incon, inc BP & HR, profuse, sweating, muscle fasciculations
nerve agent dx
Lowered acetylcholinesterase levels are indicators of nerve agent intoxication in victims
**onset is usually rapid, occurring within minutes of exposure
Signs and symptoms of Organophosphate poisoning: sludge
-salivation
-lacrimation
-urine incontinence
-diarrhea
-GI cramps
-emesis
Signs and symptoms of Organophosphate poisoning: dumbels
-diarrhea
-urination
-miosis
-bronchospasm, bronc horrhea
-emesis
-lacrimation
-salivation
Nerve agent: immediate response
1) Protect yourself-scene safety
2) Remove victims from exposure as rapidly as possible.
3) Decontaminate
4) Drug therapy
scene safety
If you don’t protect yourself, you will be of no help to anyone
Rule of Thumb: hold up thumb and you should be far enough away that your thumb covers the entire scene
Take in surrounds and position your self as far away as possible & up wind so you do not inhale anything
Do not enter a scene with unknown chemicals
nerve agent: immediate response - decontamination process, order of operation
Remove clothing and personal belongings and place in a sealed double bag
Remove or neutralize agent present on the skin by blotting visible droplets away using an absorbent material (e.g., towelettes moistened with a neutralizing solution, paper towels, facial tissues, etc.); adsorbent powders may also be used
Wash skin and hair with soap and water while containing run-off
Flush eyes with water for 5-10 minutes
For ingestion, do not induce emesis
immediate response drug therapy (for organophosphate poisoning?)
Atropine sulfate IM or IV for anticholinergic properties extremely high doses
Atropine eye drops reportedly gave some symptomatic relief for eye problems following the use of sarin by terrorists in the Tokyo subway system
2-pam chloride-Pralidoxime salts IV to restore acetylcholinesterase activity
Mechanical ventilation as needed for respiratory failure try not to intubate until after decontamination
Diazepam as needed for convulsions
precautions when removing and decontamination victims
Medical personnel should avoid direct (skin-to skin) contact or contact with clothing
Protective gear, including self-contained breathing equipment or gas mask with appropriate filter and barrier suit, must be used
Latex gloves are not adequate protection Chemical protective (butyl rubber) gloves must be worn
While exhaled air is not ordinarily a hazard, do not attempt mouth-to-mouth resuscitation without proper shields owing to the possible presence of residual agent on the face
hazards in central KY
-Sherwin Williams Paint Plant
-Carpet Factories
-Farms-farm supply stores, fertilizer, methane pits
-Railroads
-Toyota
-Breweries
-Tobacco warehouse
-Coal Processing Plants
-All Structure Fires
cyanide poisoning
Headache/dizziness/seizures
Shortness of air, low blood pressure, death
Originates from release of hydrogen cyanide gas and cyanide salts, certain medications
Causes histotoxic hypoxia
Antidote:
- Amyl Nitrate
- Cyanokit-Hydroxocobalamin
carbon monoxide poisoning
Greatest occurrence in wintertime due to poorly vented furnaces
Headache/dizziness/seizures
Shortness of air, vomiting, chest pain
CO has a higher affinity to hemoglobin then O2-patient will read 100% even when they are not
Place patient on pulse ox that monitors CO
Place on high flow O2 via Nonrebreather mask no matter what bc have to track CO2 out
Treat with hyperbaric chamber and oxygen washout
industrial exposure
Acids
Bases
MSDS
Look at placards on vehicles, storage tanks, and packaging
Ask the safety officer or hazmat tech about exposure
Call poison control
DECON: hazmat zones
green/cold zone: CP location, treatment/transport areas, stages, medical monitoring/rehab
- can start IVS
yellow/warm zone: contamination control zone, appropriate PPE, decon corridor, life saving emergency care
red/hot: contamination present, appropriate PPE, limited number of personnel
everything inside considered contaminated
