Terrrorism, Mass Casuality Flashcards
How many times per yr is req by Joint Commission to create plan for emergency preparedness?
Twice
Essential components of emergency plan
- Activation response
- Internal/external communication plan
- Plan for coordinated pt care
- Security plans
- ID of external resources
- Plan for people management & traffic flow
- Data management strategy
- Demobilization response
- After-action reporter corrective plan
- Plan for practice drills
- Anticipated resources
- Mass causality incident (MCI) planning
- Education for above
Triage in disaster
Immediate
Priority: 1
Color: Red
Conditions: sucking chest wound, airway obstruction due to mechanical cause, shock, hemothorax, tension pneumo, asphyxia, unstable chest/abd wound, incomplete amputation, open FX, 2nd/3rd degree burns of 15-40% BSA
Triage in disaster
Delayed
Priority: 2
Color: yellow
Conditions: stable abd wounds w/o evidence of hemorrhage, soft tissue injury, maxillofacial wounds w/o airway compromise, vascular injuries w/adequate collateral circulation, GU disruption, FX needing SX repair, eye/CNS injuries
Triage in disaster
Minimal
Priority: 3
Color: green
Conditions: UE FX, minor burns, sprains, small lacerations w/o significant bleeding, behavioral D/O or psychological disturbance
Triage in disaster
Expectant
Priority: 4
Color: black
Conditions: unresponsive patients w/penetrating head wounds, high spinal cord injuries, wounds involving multiple sites/organs, 2nd-3rd degree burns over 60% BSA, SZ/vomiting w/in 24 hrs radiation exposure, profound shock, agonal respirations, no pulse/BP, fixed & dilated pupils
Level A PPE
Self-contained breathing apparatus (SCBA), vapor-tight chemical resistant suit, gloves, boots
Level B PPE
High level of respiratory protection (SCBA) but lesser skin & eye protection, chemical resistant suit
Level C PPE
Air-purified respirator, coverall w/splash hood, chemical resistant gloves & boots
Level D PPE
Typical work uniform
Primary blast injury
Mechanism
Results from pressure wave
Primary blast injury
Injuries
- Pulmonary barotrauma, contusion
- Head injuries
- Tympanic membrane rupture, middle ear injury
- Abdominal hollow organ perforation, hemorrhage
Secondary blast injury
Mechanism
Results from debris from the scene or shrapnel from the bomb
Secondary blast injury
Injuries
- Penetrating trunk, skin, soft tissue injuries
- FX, traumatic amputation
Tertiary blast injury
Mechanism
Results from pressure wave that causes the victim to be thrown
Tertiary blast injury
Injuries
- Head injuries
- FX (including skull)
Quaternary blast injury
Mechanism
Results from pre-existing conditions exacerbated by the force of the bast of by post blast injury complications
Quaternary blast injury
Injuries
- Severe injuries w/complex injury patterns - burns, crush, head
- Common pre-existing conditions = COPD, asthma, cardiac conditions, diabetes, HTN
Anthrax
Incubation
1-6 days
Anthrax
Spread
Skin contact, GI ingestion, inhalation
Anthrax
S/S
Skin lesions, fever, N/V, abdominal pain, diarrhea
Respiratory S/S mimic flu
Anthrax
Treatment
Penicillin V, erythromycin
Smallpox
Incubation
Virus, 12 days
Smallpox
Spread
- Extremely contagious
- Spread by direct contact, contact w/clothing or linens, droplet person-person
Smallpox
S/S
High fever, malaise, HA, backache, prostration
After 1-2 days, maculopapular rash forms on face, mouth, pharynx, forearms
Smallpox
Treatment
Supportive care w/ABX for additional infection
Vesicants
Type
Lewisite, sulfur mustard, nitrogen mustard, phosgene
Vesicants
S/S
Blistering, burning
Respiratory effects can be serious —> death
Vesicants
Decontamination
Soap & water, do not scrub or use hypochlorite solutions
Eye exposure requires copious irrigation
Vesicants
Treatment
Lewisite: dimercaprol IV or topically
Nerve agents
Types
Sarin, soman, tabun, organophosphates, VX
Nerve agents
MOA
Inhibit cholinesterase, causing cholinergic crisis
Nerve agents
S/S
Cholinergic S/S progressing to loss of consciousness, SZ, copious secretions, apnea, death
Nerve agents
Decontamination
Copious amts of soap and water or saline for at least 20 min
Blot, do not wipe off
**Plastic equipment will absorb sarin gas
Nerve agents
Treatment
Supportive care, atropine, Benzos, pralisoxime
Blood agents
Types
Hydrogen chained, cyanogen chloride
Blood agents
MOA
Direct effect on cellular metabolism, resulting in asphyxiation through alterations in hgb
Blood agents
Spread
Inhalation, ingestion, absorbed in the skin & mucus membranes
Blood agents
S/S
Leads to respiratory muscle failure, respiratory arrest, cardiac arrest, death
Blood agents
Treatment
Rapid admin of amyl nitration, sodium nitrite, and sodium thiosulfate after patient is incubated and placed on vent
Pulmonary agents
Types
Phosgene and chlorine
Pulmonary agents
MOA
Destroy the pulmonary membrane that separates the alveolus from the capillary bed, disrupting alveolar-capillary oxygen transport mechanisms. Capillary leakage results in fluid-filled alveoli
Pulmonary agents
S/S
Pulmonary edema w/SOB, especially on exertion
Initial hacking cough followed by frothy sputum production
Radiation exposure
External
All or part of the body is exposed to radiation
Decontamination not necessary
Not emergency
Radiation exposure
Contamination
Exposure to radioactive gases, liquids, or solids
Immediate medical management to prevent incorporation
Radiation exposure
Incorporation
Uptake of radioactive material into body
Radiation decontamination
- Triage OUTSIDE of hospital
- Cover floor & use strict isolation precautions to prevent the tracking of contaminants
- Air ducts and vent sealed
- Waste double bagged and labeled “radiation waste”
- Decontaminate each patient outside ED w/shower
- Internal contamination: catharsis, gastric lavage w/chelating agents
Radiation decontamination
Staff protection
- Water-resistant gowns, two pairs of gloves, caps, goggles, masks, booties
- Dosimetry devices
Acute radiation syndrome
Probable survivors
No initial symptoms or only minimal s/s
ARS
Possible survivors
Present w/ N/V that persist for 24-48 hrs
ARS
Improbable survivors
Acutely ill w/ N/V/D, shock
Neuro S/S suggest a lethal dose
