US health final - emergency preparedness Flashcards
Be familiar with the following terms:
Bioterrorism
Department of Homeland Security
Federal Emergency Management Agency (FEMA)
Incident Command System (ICS)
Strategic National Stockpile (SNS)
Definition
An emergency is a sudden, unexpected event requiring immediate action due to a potential threat to health and safety, the environment or property
Categories of disasters
Natural disasters-can be more predictable
Earthquakes, hurricanes, tornados, tsunami, blizzards, volcanoes
Man-made (technological) disasters-Less predictable
Explosions/blasts, fires, oil spills
Bioterrorism
Bioterrorism
The unlawful release of biological agents or toxins with the intent to intimidate or coerce a government or civilian population to further political or social objectives. Humans, animals, and plants are often targets.”
Disasters
Natural epidemics or pandemics
- May involve a novel, emerging infectious disease, re-emerging disease or a previously controlled disease
Intentional or accidental release of a chemical, biological, radiological or nuclear agent
Disasters
All types of disasters can cause injuries, fatalities and loss of resources.
All healthcare facilities are at risk for explosions or fires.
Explosions are often the weapon of choice for terrorists-it has a dramatic impact.
Effect of disasters on health
Health risks after a disaster DO NOT occur at the same time.
Casualties typically occur at the time and place of impact-requiring immediate medical attention
Disease transmission takes longer to develop depending upon the extent of overcrowding and the level of sanitation maintained
Public health concerns for all disasters
Response is similar for disasters:
Search and rescue
Treatment and evacuation of injured
Food, Water, Shelter for survivors
Minimizing environmental hazards
- Sanitation
- Safety
- Transportation
Control of Epidemic/endemic diseases
Sequence of events
preparedness
disaster impact
response and recovery
Preparedness
Involves:
Planning
Procedures and Protocols
Training and exercises
Personnel qualifications and certification
Equipment certification
Preparedness
Public health preparedness for all disasters is the key for a sound public health infrastructure.
Preparedness
Preparedness is critical to the success of disaster prevention and response.
Preparedness involves actions needed to achieve and sustain the level of care that are necessary for a healthcare organization to continuously provide services during and emergency or disaster
Preparedness
Disasters may be unexpected but planning can anticipate some common problems that may arise for a particular emergency.
Remember: The best plans in place may not go according to the plan.
Plans must be FLEXIBLE and easy to change.
Plans must be acceptable to all those involved.
Preparedness
The plan should be widely disseminated to all those involved and be exercised regularly.
The plan should focus on LOCAL response with state and federal agencies only as adjuncts.
Preparedness
Plans can have two approaches:
Agent-specific (only plan for threats most likely to occur in the region- i.e. earthquakes, blizzards)
All-Hazard (Plan for common problems and tasks that occur in a majority of disasters.)
World trade center attacks
9/11/2001
2801 people lost their lives
Problems encountered:
Poor communication led to confusion
Fire and police on different radio frequencies also could not communicate with Emergency Medical Services (EMS) dispatchers
Protection of rescue and cleanup workers from environmental hazards failed
Victim location services were established, shelters for displaced residents were set up
World Trade Center Attacks
“World Trade Center Cough”
- Those who worked at the site had higher levels of exposure
- Some more incapacitated than others
Mental health concerns
- Post-traumatic stress syndrome (PTSD)
- 3 priorities identified:
—-Crisis intervention for bereaved families, survivors, workers, and general public
—Project Liberty: provided support services for 68 agencies at 120 different sites
—-Augmentation of mental health services
World Trade Center Attacks
Public health response
- Worked with the American Red Cross to staff 10 emergency shelters and to transport medical supplies
Four surveillance systems were put in place:
Rapid assessment of injuries
Hospital needs assessment
Reporting system for injuries among rescue workers
Syndromic surveillance-monitoring symptoms
World trade center Attacks
Changes that occurred from these attacks:
Changes to high rise fire safety codes
Addresses: events requiring full and rapid evacuation, shelter-in-place, partial evacuations, and building relocation
Building’s chief fire safety director would be trained to serve as the incident commander until a higher ranking official took over
Hurricane Katrina
Response was problematic
- Lack of planning for populations with special needs (hospital patients, people without cars)
- Poor communication
—-Lack of clear evacuation until too late
Too little help from outside New Orleans
Racial incidents
Damaged housing, contaminated air in FEMA trailers, displaced large amount of population
Hurricane Katrina
Problems with Katrina:
Poor communication with evacuation orders
100,000 people did not have a means of transportation and were unwilling or unable to evacuate
At first water was clean ocean water but after a couple of days the water turned black and was foul smelling from raw sewage and dead bodies.
No electricity or food
Hurricane Katrina
Superdome:
Set up as a shelter
Many issues with this shelter
Hurricane Katrina
Health Belief Model
Perceived susceptibility: longtime residents felt they had survived many hurricanes in the past
Perceived severity: Residents were confused about the evacuation orders
Barriers to action: financial, logistical, and community. Many felt they did not have enough money for travel expenses and gas
Hurricane Katrina
Housing issues:
Many destroyed
Issues with mold in homes
Temporary trailers had unhealthy levels of formaldehyde
Water wells were contaminated
Hurricane Katrina
Health issues
Many reports of PTSD
Mosquito-borne illnesses
Increase in the number of rodents and snakes
Hurricane Katrina
Lessons learned:
Many did not anticipate or prepare for extensive destruction and prolonged period of recovery
Drills should be conducted and include all critical functions and areas
Anticipate disruptions in communication
Staff may not be able to reach assigned location
Plans in place for backup sites
Incident Command System (ICS)
ICS is the model for the command, control, and coordination of a response to an emergency and provides a means to coordinate the efforts of individual agencies
Incident Commander
This person is responsible for all aspects of an emergency response. Including:
- Developing incident objectives
- Managing all operations
- Managing the application of all resources
- Responsible for all personnel involved in the incident.
This position is always designated and may assign other officers to the other positions.
it is identified before the emergency
Public Information Officer
This person is the communication coordinator of the organization (local, state, federal government, hospital, corporate office)
They differ from the public relations office-they do not engage in marketing.
They are responsible to provide information to the public and the media.
Liaison Officer
This person communicates and coordinates activities between organizations to best utilize resources.
They provide subject matter expertise of their organization.
They are the primary contact person for supporting agencies during an incident.
Safety Officer
This person is responsible for monitoring and assessing hazardous or unsafe situations during an incident.
Responsible for personnel safety during an incident.
Disasters
The type of disaster will determine the lead agency involved
i.e. Columbia gas explosions in Lawrence and North Andover had the fire department as the lead agency
Starts locally with the state and federal government providing additional assistance and backup resources
American Red Cross is in charge of shelters
Disaster Plans
It is important not only to have plans in place but they should be tested with outside organizations involved.
Full exercises are expensive so it is not feasible to perform yearly but may conduct tabletop exercises more regularly.
Bioterrorism Preparedness
The preparedness strategy is very different from that for natural disasters
The response must be the same as for natural disease outbreaks
Recognizing an attack may be difficult but surveillance is key! need solid Public health infrastructure
- anthrax goes to BSL-4 lab
Response requirements include:
- Laboratory capability
- Public health laws enabling authority to take action
- Coordination between public health and law enforcement
CDC Categories
Category A
Easy to disseminate
High mortality rate and is a major public health issue.
Requires special public health preparedness
Agents
Anthrax, small pox, plague, viral hemorrhagic fever (EBOLA), botulism, tularemia
CDC Categories
Category B
Moderately easy to disseminate
Moderate amount of mortality and morbidity - really more sick than dying
Must have enhanced disease surveillance capacities.
Agents
Brucellosis, Q-fever, Ricin, T-2 Mycotoxins, Staphylococcus Enterotoxin B (SEB)
CDC Categories
Category C
These agents could be engineered for mass dissemination.
It has the potential to increase morbidity and mortality.
Agents
Hanta Virus, MDR-TB, Yellow Fever
as the letters go from A to C, the mortality decreases and the morbidity increases (less deaths, more sick)
Public Health Activities
Education to identify unusual diseases
Use surveillance to monitor Emergency rooms for disease patterns
Laboratories to identify viruses and bacteria
Better communications between all branches of DPH and hospitals
Issues with Bioterrorism
Legal issues concerning quarantine, restricted access, zone perimeters, credentialing of providers.
Needs assessment for meds, hospital beds, special equipment (ventilators).
Arrangements for bio-safety and possible mass burials
Uninsured—not seeking medical attention
Tasks for Bioterrorism
Need a plan for the storage and security of pharmaceuticals.
Procedures in place to accommodate dosing for the pediatric population and alternatives for those allergic to meds.
Record keeping-document of who got what
Plans for community involvement.
cipro and doxycycline will treat most of the infections - not on slides tho
CDC Strategic National Stockpile (SNS)
The SNS contains:
Pharmaceuticals - specific
Medical Supplies
Medical Equipment - respirators
Vaccines
Antitoxins
What does the SNS do?
Provide rapid delivery of a broad spectrum of support for a threat in the beginning of an event.
Provide large shipments of specific material when a threat is known. (i.e.-Tamiflu®)
Provide technical assistance to receive and distribute SNS material during an event.
SNS
The formulary is based upon:
Category A Biological threats (small pox, anthrax, viral hemorrhagic fever, plague, tularemia)
Chemical nerve agents
Radiation
Antiviral agents (Tamiflu) also on formulary
12-Hour Push Packages
Pre-packed and configured material in transport ready containers.
Pre-positioned in secure facilities near major transportation hubs.
Able to deliver quickly to affected area.
Color coded and numbered for rapid identification by state and local authorities.
Surge Capacity
Most healthcare facilities are already operating at full or near full capacity
A disaster will disrupt the normal flow of care
Victims will become the major focus
Even during emergency situations people will still need to access critical daily medications such as insulin
Surge Capacity
There will be a surge of patients admitted to the hospital and visiting the ED putting a strain on the community hospitals
This will require an:
Expansion of bed capacity
Increase in staffing
Additional supplies
Opportunities to Assist?
There are opportunities to help in the event of a event.
Local Level:
Worcester Regional Medical Reserves Corps (WRMRC). www.WorcesterRegionalMRC.org
Manchester Regional Medical Reserves Corps. http://gmmrc.manchesternh.gov
MRC were established in 2002 to help communities prepare medical responses for disasters.
Use local healthcare professionals who want to donate their time and expertise.
What can pharmacists do?
Federal:
Disaster Medical Assistance Teams (DMATs)
This is composed of a group of medical professionals supported by logistical and administrative support staff.
This team provides medical care in the event of a disaster.
Typically are there to serve in a local or state capacity but they may be federalized for a national resource.
DMATs
Each DMAT team has a sponsoring organization such as a medical center, public health agency, non-profit agencies or private agencies that have a Memorandum of Agreement with the Department of Health and Human Services.
Each organization will recruit and train members
DMATs
Each DMAT team has a sponsoring organization such as a medical center, public health agency, non-profit agencies or private agencies that have a Memorandum of Agreement with the Department of Health and Human Services.
Each organization will recruit and train members
DMATs
When deployed to a site-each team will have enough supplies for a 72 hour period.
They will provide care at a fixed or temporary medical care site.
Duties may include:
Triaging patients
Providing high quality care despite environment of disaster area.
Preparing patients for evacuation
DMATs
May provide primary medical care or augment overburdened hospital staff.
These teams are designed to be a rapid-response element to supplement local medical care until other federal resources can be mobilized or the situation is resolved.
DMAT team members must maintain appropriate certifications and licensures within their discipline.
Pandemics
1918 Spanish flu
2003 SARS
2009 H1N1
2020 COVID-19
Why are we at risk for pandemics
Some challenges exists worldwide that increase the risk that outbreaks will occur and spread rapidly, including:
Increased risk of infectious pathogens “spilling over” from animals to humans
Development of antimicrobial resistance
Spread of infectious disease through global travel and trade
Acts of bioterrorism
Weak public health infrastructures
COMMUNICABLE DISEASE will spread with an increase in overcrowding and decrease in sanitation
true
false
true
The officer in charge of communicating with the press
A
Incident commander
B
Liaison officer
C
Safety officer
D
Public information officer
D
Public information officer
DIFFERENT officers and their roles
Incident commander- maintains overall responsibility for disaster response, and make sure everything runs smoothly
Liaison Officer- coordinates efforts of all responding agencies
Public Information officer- communicates with the press and public
Safety officer-responsible for the safety of officers
which disease has been eradicated
small pox
where does immunization break the chain of infection?
susceptible host
where does proper treatment break the chain of infection?
infectious agent
a place where pathogen can live and multiply
reservoir
Rx strength of folic acid is
1mg
OTC is 800mcg
:) okay
and women in their pregnant years but not pregnant should get 400mcg
prions are described
infectious protein
infant mortality rate is death before
1st birthday
the person responsible for all aspects of an emergency
incident commander
overcrowded shelters may increase the risk of infectious disease
yes
all disaster plans should be examined to determine gaps
yes
a barrier for victims of hurricane Katrina except
well-planned evacuation route
communication issues were evident with both 9/11 and Katrina
yes
which of the following is a category A agent
anthrax
all of the following are on the SNS formulary except
cold remedies
