Public Health Nursing: Role in Disasters Flashcards

Question

manmade disasters**

Answer 1

Accidental Deliberate Chemical Biological Radiological Nuclear Explosives

Answer 2

Earthquake Tornado Floods Hurricanes Blizzards Wildfires Tsunamis Nuclear Temperature Extremes

Answer 3

bioterrorism

Answer 4

Anthrax * Botulism Pneumonic Plague Smallpox * Tularemia Viral Hemorrhagic Fevers Ebola Marburg

Answer 5

* Easily disseminated or transmitted person to person * High mortality or major public health impact * May cause panic or social disruption * Requires special public health action

Answer 6

* Brucellosis * C. perfringens toxin * Glanders * Q Fever * Ricin Toxin * Staph Enterotoxin B * Water or Food Agents

Answer 7

Moderately easy to disseminate Moderate morbidity and low mortality Requires specific enhancement of diagnostic capacity and enhanced

Answer 8

Yellow fever virus * Influenza virus * Tuberculosis, including drug resistant TB * Rabies virus * SARS * Chikungunya virus * Tickborne --* Hemorrhagic fever viruses --* Encephalitis complex flaviviruses

Answer 9

Anthrax Smallpox Plague Tularemia

Answer 10

Caused by Bacillus anthracis bacteria found in soil Incubation period 1-6 days (up to 60 days) Inhalation anthrax is not spread person to person Skin (Cutaneous) Digestive (Gastrointestinal) Lungs (Inhalation)* Death can occur within 24 hours Quarantine not necessary No treatment in early stages: death approaches 100%

Answer 11

Incubation 1-7 days Initially mimics cold or flu Brief period of improvement (hours) Rapid progression to severe respiratory distress

Answer 12

Cipro 500mg BID 60 days Doxyclycline 100 mg BID 60 days Vaccine available for military

Answer 13

◦ Variola major ◦ Variola minor

Answer 14

Presence of virus, antigen, nucleic material, or immunoglobulin in clinical specimens (blood and/or vesicles)

Answer 15

One of the first symptoms is usually a high fever Next a rash…first on the tongue & in the mouth: highly contagious stage Rash develops into sores and spreads to all parts of the body within 24 hours (starts on face) **Sores become fluid-filled raised bumps, with an indentation, may resemble a belly button: the most distinguishing feature Contagious until scabs have disappeared-usually 3 weeks

Answer 16

Smallpox -fever - 2-4 days before rash -rash appearance - pocks at same stage -rash development - slow -rash distribution - more pocks on arms and legs -rash palms and soles - usually present -death - usually 1/10 die Chickenpox -fever - at the same time as rash -rash appearance - pocks in several stages -rash development - rapid -rash distribution - more pocks on body -rash palms and soles - usually absent -death - very uncommon

Answer 17

No proven treatment Supportive therapy ◦ Intravenous fluids ◦ Analgesics/Antipyretic ◦ Antibiotics for secondary infections ◦ Cidofovir (being studied for antiviral effects)

Answer 18

Vaccination Isolation/decontamination ◦ Droplet and Airborne precautions for 17 days after a person’s exposure. ◦ Isolation/quarantine while individual is infected. ◦ Considered infectious until scabs fall off. – Scabs contain live virus.

Answer 19

>90,000 cases worldwide Mortality 0.04% US Deaths 54

Answer 20

Febrile Prodrome 2-5 days before rash (not always recognized or not always occurring) Fever Headache Respiratory symptoms Lymphadenopathy Lower GI general issues Rectal bleeding Conjunctivitis

Answer 21

Texas resident shared on Instagram (Silver Steele name) photos since little was known about monkey pox. He sent them to the CDC so they could share. -Similar to smallpox with centrifugal distribution -Progresses from Macule-> Papule ->vesicle-> pustule-> crust -> desquamation -Deep-seated firm well circumscribed with ventral umbilication -Single state of development to a given site of the body -Rash is often present on palms and soles -Genital and perianal areas -Lesions do not always disseminate to most sites of the body -Number of lesions is lower -21 days clears up

Answer 22

Bronchopneumonia Dehydration GI disruption Secondary infections Sepsis Encephalitis Ocular infection & corneal scarring Skin scarring Death (11% in unvaccinated)

Answer 23

Highly infectious Diagnosis by specimen of lesions 80,000 test per week

Answer 24

Many cases are mild and self-limiting (nonfatal) Prognosis depends on ◦ Prior immunization status ◦ Health status ◦ Concurrent illness ◦ Comorbidities Early 2000 panic smallpox vaccination, there may be some residual immunity No current approved treatment for MPX However antiviral and vaccines developed for smallpox can be use ◦ Antivirals Tecoviramax

Answer 25

Vaccinating high risk individuals and those in contact via contact tracing. Indications High risk: immunocompromised, pediatrics, hx of atropic dermatitis or exfoliative skin disorders pregnant or breast feeding, one of more complications (cellulitis, gastroenteritis, pneumonia)

Answer 26

2 shot series PEP and PrEP Longer onset to protection, 2-4 weeks Provided to jurisdictions and federal entities

Answer 27

Prevention EUA Two intradermal injections four weeks apart Max protection two weeks after dose 0.1 intradermal as effective as 0.2 IM Prioritized for high-risk individuals and safe in HIV and persons with atopic dermatitis (different from previous smallpox vaccine)

Answer 28

cardiac, eye disease on topical steroids, immunosuppressed, atopic dermatitis or other exfoliative diseases, pregnancy, HIV (regardless of immune status)

Answer 29

FDA licensed for treatment of vaccinia vaccination complications No data - unknown effectiveness in MPX May consider in severe cases of PEP

Answer 30

FDA approved for smallpox for adults and pediatrics No studies in MPX Minor side effects OraL or injectable CDC holds EA protocols

Answer 31

FDA approved for CMV retinitis in AIDS patients Data not available but effective against OPV in vitro and animal trials CDC holds EA for use in OPV (including MPX) May be considered for severe disease Renal toxicity RISK

Answer 32

FDA Treatment approved for adults, children and neonates Data not available Not as much renal toxicity

Answer 33

Consider contact and droplet (not airborne) highly infectious ◦ N-95 ◦ Face shield ◦ Gown ◦ Gloves Limit aerosol generating procedures Thorough cleaning between patient use

Answer 34

Strict isolation beyond COVID, do not share anything Own sink and shower, minimize any cross contact Bleach towels and sheets Other people take care of pets Use protective contact face mask to cover lesions Quarantine 4 weeks until all lesions are healed

Answer 35

◦Addresses problems posed by various events ◦Broad in scope ◦Addresses collaboration ◦Mutual aid agreements --◦Agencies --◦Organizations

Answer 36

All-hazards mitigation (prevention) ◦ Reducing risks to people and property from natural hazards before they occur Prevention against natural disasters ◦ Structural measures ◦ Protecting buildings and infrastructure ◦ Threats include forces of wind and water ◦ Nonstructural measures ◦ Land development restrictions Prevention against human-made disasters  Heightened inspections  Improved surveillance and security operations  Public health and agricultural surveillance and testing  Immunizations  Isolation  Quarantine  Halting of chemical, biological, radiological, nuclear, and explosive (CBRNE) threats

Answer 37

 Measures taken to reduce harmful effects Prevention Occurs before incident Adjust the plan as needed

Answer 38

◦ Disaster kits for home, workplace, and car ◦ Disaster plan

Answer 39

◦ National Disaster Medical System (NDMS) ◦ Disaster Medical Assistance Team (DMAT) ◦ Medical Reserve Corps (MRC) ◦ Community Emergency Response Team (CERT)

Answer 40

Proactive planning efforts Evaluating potential vulnerabilities Warning/looking for indicators  Location  Timing  Magnitude

Answer 41

National Health Security Strategy (NHSS) Disaster and mass casualty exercises  The National Exercise Program (NEP)  Homeland Security Exercise and Evaluation Program  Federal Emergency Management Agency (FEMA)

Answer 42

First level: first responders ◦ Mobilization of local responders ◦ Fire department, law enforcement, public health, and emergency services National Response Framework (NRF) ◦ Emergency support functions (ESFs) National Incident Management System (NIMS) Response to biological incidents ◦ Biodefense programs ◦ BioWatch, BioSense, Project BioShield, Cities Readiness Initiative, Strategic National Stockpile (SNS)

Answer 43

 Saving lives  First aid  Minimizing and restoring damaged systems  Care and basic life requirements to victims -- Food -- Water -- Shelter

Answer 44

First responder Epidemiology and ongoing surveillance Rapid needs assessment Disaster communication Disaster response ethics Sheltering

Answer 45

Workers at risk for stress reactions May not recognize the need for self-care Symptoms may signal need for stress management assistance ANA Well-Being initiative:

Answer 46

Remember why you chose the nursing profession? ◦ To Care for others in their times of need Our role as registered nurses is to understand your scope of practice We will be called upon to care for the wounded, but also care for the mentally unstable patients as well.

Answer 47

Health care organization have to be prepared to respond to acts of terrorism and public health emergencies Most plans assume care according to established standard of care A mass casualty event could compromise these plans Adjustments in standards will ensure care will save as many lives as possible

Answer 48

Efforts need to focus on maximizing number of lives save ◦ Identify cause, protect staff and limit exposure ◦ Identify and treat those with a critical need and most likely to survive ◦ ED may be reserved for immediate-need patients ◦ Ambulatory patients delivered to alternate care sites ◦ Needs of current patients will become part of resource allocation.

Answer 49

Nurses may function as physicians Physicians may function outside their specialty Credentialing may be on an emergency or temporary basis EMS could treat patients and not transport

Answer 50

may be rationed if something breaks may not have ability to repair disposable supplies may be refused supplies could be contaminated

Answer 51

1 Staff may be scarce 2 Some equipment may not be used without trained staff to operate them. 3 Staff may not have access to facility if they do not preplan 4 Concern for family needs versus work requirements 5 Staff could be directly affected (ill)

Answer 52

Patients may be backlogged Surgeries may be delayed Radiology and laboratory services may be rationed Non-emergent care may not be given  Patients turned away  EMS reprioritizing responses and transportation (zone car triage) Primary care space for clinic may become alternate care site or staff reassigned and appointments cancelled.

Answer 53

May be based on clinical judgment with the lack of advanced technology May not be made by specialist Best use of available medications, supplies, resources Chronic care resources may be diverted

Answer 54

Acute event impact Identification of staff not coping Include mental health providers in team Creative breaks Staff communication with family Surveillance of high-risk staff Impact of inability to help given constraints on care Forceful removal from duties CISM essential

Answer 55

May be impossible to maintain Regression to paper system from electronic May not be able to obtain informed consent May not be able to document care provided Verbal handoffs important Tracking of patients can be a challenge

Answer 56

Backlog May not be able to accommodate cultural expectations toward death and handling of bodies Temporary morgue Difficulty identifying dead or confirm death May have difficulty finding and notifying next of kin Burial and cremation services may be overwhelmed Standards for completeness and timeliness of death certificates may need to be lifted temporarily

Answer 57

1. In planning for mass casualty event, the aim should be to keep health care system functioning and to deliver acceptable quality of care to preserve as many lives as possible 2. Planning a health and medical response to a mass casualty event must be comprehensive, community-based and coordinated at the regional or national level 3. There must be an adequate legal framework for providing health and medical care in a mass casualty event 4. The rights of individuals must be protected to the extent possible and reasonable under the circumstances 5. Clear communication with the public is essential before during and after a mass casualty event ◦ Public acceptance of event or situation that deviates from standard practice 6. Post event clean up poses high risk for additional injuries/illness - often lacks oversight and organization

Answer 58

Circumstances should be defined Clarification to who can make the call and at what level (site, community, region, state or federal) Under what legal, statutory authority Identify who assumes responsibility for directing emergency actions Clarify relationship of autonomous institutions to the incident management system.

Answer 59

Emergency Medical Treatment and Active labor Act (EMTALA)  Health Insurance Portability and Accountability Act (HIPAA)  Federal Volunteer Protection Act  Good Samaritan Act

Answer 60

 80 hr work week for medical residents  OSHA and workplace regulations  Building codes  Publicly funded health insurance  Human subject research laws  Use and licensure of drugs and devices

Answer 61

Liability of providers functioning with inadequate resources Certification and licensing Scope of practice Institutional autonomy Facility standards Patient privacy and confidentiality Documentation of care Property seizures Quarantine and mass immunization

Answer 62

COST TO PROVIDE CARE IN TRADITIONAL, ALTERNATE SETTINGS, AND PRE-HOSPITAL CARE SETTINGS CREATING ALTERNATE CARE SITE IN SCHOOLS, NEIGHBORHOOD CENTER AND HOTELS TRAINING PROVIDERS (ADVANCE AND JUST IN TIME) STAGING DRILLS REPAIRING PHYSICAL PLANT TRACKING COST SUPPLY PROCUREMENT

Answer 63

Participate in mass immunization programs Surveillance and early detection Education and public health initiatives What can be done to help the infrastructure to survive / respond to any hazard?

Answer 64

◦ Focuses on stabilization ◦ Returning community to pre-impact status – make it better ◦ Rehabilitation ◦ Reconstruction ◦ Epidemiological surveillance is needed

Answer 65

Ready.gov Homeland Security Federal Emergency Management Agency (FEMA) NC Department of Public Safety – Emergency Management NC Division of Public Health DHHS Department of Health and Human Services

Answer 66

To save the largest number of survivors from a multiple casualty incident

Answer 67

As nurses we want to help everyone we can. We have a sense of helping, fixing and see positive results. This is not always the case during a disaster. The “walking wounded”, and by-standers are more likely to request or require more of your attention than the severely injured victims

Answer 68

those requiring immediate intervention and stabilization in order to preserve life or limb and still have a reasonable survivability index once stabilization has occurred

Answer 69

Victims will require treatment, which is minimal, and can be delayed without detriment. Will possibly need to be re-triaged for deterioration.

Answer 70

"walking wounded" patients will need medical treatment at some point

Answer 71

Patients are deceased or injuries are so extensive that they would not be able to survive with the care available.

Answer 72

Sticks for splints Plastic bags with ice Clothing for splints Sheets for transport Tables for backboards

Answer 73

Medical Surge Capacity – the evaluation and care of a significantly increased number of patients beyond the typical capability of the establishment. Disaster Drills (evidence – based) Hazmat team training Yearly competencies geared towards disaster preparedness PRACTICE, PRACTICE, PRACTICE! Just Remember: No matter how much we feel prepared for a disaster, there will always be chaos and uncertainty.

Answer 74

Be familiar with the nurse practice act of your state Clarify the expectations for licensure and liability protection with the organization they plan to volunteer in. Be familiar with your employer’s plans for staff who wish to respond and what their duty expectations are to their organization, both legally and ethically.

Answer 75

Good Samaritan laws generally provide liability protection to individuals for situations where emergency care is rendered using reasonable and prudent judgment for the circumstances. Do not protect a provider working as an employee or as an organizational volunteer. Do not protect against negligence or gross misconduct.

Answer 76

No comprehensive national legal protection for healthcare providers working in the disaster cycle. Patchwork --Federal Volunteer Protection Act --Federal Public Readiness and Emergency --Preparedness Act --State Volunteer Protection Acts, --Model State Emergency Health Powers Acts --State Public Health and Emergency Management Provisions