w6 Flashcards
Communicable vs Infectious
________ disease – when living organism enters the body and causes disease (ex: Lyme disease)
_________ disease – when the disease can be transmitted from one person/non-human to another (covid, flu)
All communicable diseases are infectious?
All infectious diseases are communicable?
Infectious disease – when living organism enters the body and causes disease (ex: Lyme disease)
Communicable disease – when the disease can be transmitted from one person/non-human to another (covid, flu)
All communicable diseases are infectious
Not all infectious diseases are communicable
Communicable diseases and pandemics throughout history
1918 – influenza
1980’s – HIV, antibiotic resistance, casual connections between infectious organisms/chronic disease
1990’s – food supply concerns, hantavirus pulmonary syndrome, bovine spongiform encephalopathy (mad cow disease), variant crutzfeldt Jakob disease, VRSA, avian influenza, west nile virus
2000’s – viral hemorrhagic fevers (ebola and Marburg), SARS (select agent = has potential to cause great harm), E-coli, salmonella, listeria, new influenza strain, MERS-COV, zika, COVID-19
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Factors influencing new infectious diseases
- Societal events
- Health care
- Food production
- Human behavior
- Environmental
- Public health
- Microbial adaption
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Epidemiological triangle
Agent – cause of disease
- _____– bacteria, virus, fungus, parasite
- Ability to cause injury or illness to the host
- _____ – agents ability to enter the host and multiply
- ______ – agents ability to spread through the host
- _______ – agents ability to cause disease in host
- _______ – measure of the serverity of disease caused by agent
- ______ – – ability to produce damaging poison/toxin
- ______ – ability to stimulate an immune response in the host
pathogenicity
Toxigenicity
type
virulence
invasiveness
Antigenicity
infectivity
- Type – bacteria, virus, fungus, parasite
- Ability to cause injury or illness to the host
- Infectivity – agents ability to enter the host and multiply
- Invasiveness – agents ability to spread through the host
- Pathogenicity – agents ability to cause disease in host
- Virulence – measure of the serverity of disease caused by agent
- Toxigenicity – ability to produce damaging poison/toxin
- Antigenicity – ability to stimulate an immune response in the host
Epidemiological triangle
_____ – person/animal that harbors disease causing agent
- Exposure
- susceptibility
- response
Host – person/animal that harbors disease causing agent
- Exposure
- Host susceptibility
- Host response
Epidemiological triangle
_________– external conditions that influence the interaction between the agent and hots
- Physical
- Biological
- Psychosocial
Environment – external conditions that influence the interaction between the agent and hots
- Physical
- Biological
- Psychosocial
Epidemiological triangle
________ – where an agent survives/multiplies
- External or internal
- Inanimate – water, soil, food
- Animate (human) – symptomatic or non-symptomatic carrier
- Animate (animal) – zoonosis – agents harbored by non-human vertebrate animal reservoirs
Reservoir – where an agent survives/multiplies
- External or internal
- Inanimate – water, soil, food
- Animate (human) – symptomatic or non-symptomatic carrier
- Animate (animal) – zoonosis – agents harbored by non-human vertebrate animal reservoirs
Modes of transmission
Direct – immediate transfer of agent from one human to another, distance is 3 feet or ______
- contact or droplet transmission? – direct transfer with very close contact (STIs, athletes foot)
- contact or droplet transmission? – expelled large droplets from one person and picked up by another (flu, RSV, diptheria)
Modes of transmission
Direct – immediate transfer of agent from one human to another, distance is 3 feet or less
- Contact transmission – direct transfer with very close contact (STIs, athletes foot)
- Droplet transmission – expelled large droplets from one person and picked up by another (flu, RSV, diptheria)
Modes of transmission
Indirect – transfer of agent from one human to another, distance is 3 feet or _______
air, vehicle, or vector?
- _______ borne
o Animate objects – poor hand washing
o Inanimate objects – shared equipment/toys
o Food/liquid – food borne illness - _______ borne
o Usually arthropods/invertebrates
o Mosquitos with west nile virus - _____ borne
o Expelled through small droplets – cough, sneeze, singing
o TB, COVID, chicken pox, cold
Indirect – transfer of agent from one human to another, distance is more than 3 feet
- Vehicle borne
o Animate objects – poor hand washing
o Inanimate objects – shared equipment/toys
o Food/liquid – food borne illness
- Vector borne
o Usually arthropods/invertebrates
o Mosquitos with west nile virus
- Airborne
o Expelled through small droplets – cough, sneeze, singing
o TB, COVID, chicken pox, cold
Patterns of transmission
____directional – nonhuman to human
____directional – nonhuman to human, human to nonhuman
______ – parent to child during fetal development, birth, breast feeding (HIV)
_____ – person to person
____genous – internal source (present and asymptomatic in the body, ex: E coli. Can exist in gut with no symptoms but if it gets into urinary tract it causes problems)
_____genous – external source (eating contaminated food and getting botulism)
Patterns of transmission
Unidirectional – nonhuman to human
Bidirectional – nonhuman to human, human to nonhuman
Vertical – parent to child during fetal development, birth, breast feeding (HIV)
Horizontal – person to person
Endogenous – internal source (present and asymptomatic in the body, ex: E coli. Can exist in gut with no symptoms but if it gets into urinary tract it causes problems)
Exogenous – external source (eating contaminated food and getting botulism)
Stages of infection
Latent
Transmissibility
Incubation
Communicability
________ period – period between an infectious agent entering a host and finding conditions favorable, replicating, shedding
_________ period – period of time the person is contagious/can infect others
________ period – period between invasion of agent and symptoms appearing
________ period – estimations of the basic reproductive number
Stages of infection
Latent period – period between an infectious agent entering a host and finding conditions favorable, replicating, shedding
Communicability period – period of time the person is contagious/can infect others
Incubation period – period between invasion of agent and symptoms appearing
Transmissibility – estimations of the basic reproductive number
Common ports of ______
- Mucous membranes – syphilis
- Respiratory tract – flu, cold
- Skin – hook worm
- Blood vessels – HIV, Hep B
- Placenta – HIV, Hep B
Common ports of ______
- Intestinal tract (feces) – cholera
- Respiratory tract (cough, sing, sneeze) – COVID, TB
- Skin (lesions) – scabies
- Blood – Hep B
- Semen and vaginal fluids – STIs
- Wound exudate – MRSA
Common ports of entry
- Mucous membranes – syphilis
- Respiratory tract – flu, cold
- Skin – hook worm
- Blood vessels – HIV, Hep B
- Placenta – HIV, Hep B
Common ports of exit
- Intestinal tract (feces) – cholera
- Respiratory tract (cough, sing, sneeze) – COVID, TB
- Skin (lesions) – scabies
- Blood – Hep B
- Semen and vaginal fluids – STIs
- Wound exudate – MRSA
Controlling communicable diseases
- Control the ______ (bacteria, virus, fungus, parasite) - cause of the disease
- Control the ______ - where an agent survives/multiplies
- Eradicate nonhuman reservoir
- Control human reservoir
- Control portals of entry/exit
- Improve host resistance and immunity
- Control the agent (bacteria, virus, fungus, parasite) - cause of the disease
- Control the reservoir - where an agent survives/multiplies
- Eradicate nonhuman reservoir
- Control human reservoir
- Control portals of entry/exit
- Improve host resistance and immunity
Controlling communicable diseases
Contact tracing
Quarantine
Isolation
_________– individual level, for communicable diseases
________ – population level, for communicable diseases to natural/chemical disasters
3 levels
- Shelter in place
- Targeted restrictions on movement/activities
- Compulsory widespread restriction of movements/activities
________ – finds new cases quickly so they can be isolated to stop further spread
Isolation – individual level, for communicable diseases
Quarantine – population level, for communicable diseases to natural/chemical disasters
3 levels
- Shelter in place
- Targeted restrictions on movement/activities
- Compulsory widespread restriction of movements/activities
Contact tracing – finds new cases quickly so they can be isolated to stop further spread
Disease ________ process
- Outbreak control team
- Determine coverage in affected surrounding areas
- Enhance surveillance
- Notify appropriate people
- Educate patients and their contacts
- Case management
- Lab confirmation
- Control activities to limit transmission
- Collect data on cases and outbreak response
Disease Outbreak process
- Outbreak control team
- Determine coverage in affected surrounding areas
- Enhance surveillance
- Notify appropriate people
- Educate patients and their contacts
- Case management
- Lab confirmation
- Control activities to limit transmission
- Collect data on cases and outbreak response
Disease rates
_______ – number of NEW cases of disease (at a given time period)
________ – number of ALL/CURRENT cases of disease (at a given time period)
Disease rates
Incidence – number of NEW cases of disease (at a given time period)
Prevalence – number of ALL/CURRENT cases of disease (at a given time period)
Focus of public health
Control
Elimination
Prevention
Eradication
__________– reduce/eliminate exposure or susceptibility to a disease
__________ – reduce incidence/prevalence of a disease
__________ – control of a disease within a specific geographical area
_______ – reduce incidence worldwide to 0
Focus of public health
Prevention – reduce/eliminate exposure or susceptibility to a disease
Control – reduce incidence/prevalence of a disease
Elimination – control of a disease within a specific geographical area
Eradication – reduce incidence worldwide to 0
__________ - Ongoing systemic collection, analysis, and interpretation of health data
- Purpose – detect, monitor, and control spread of communicable disease
Organizations
- Health care provider
- Local health depts
- State health depts – state laws prevail over federal laws
- CDC
- WHO
Surveillance
Pandemics
Endemic
Epidemic
__________ - When a disease growth is exponential
- Focus is on how far it reaches (not severity)
- Spreads to international boundaries
- Unpredictable
- Ex: black death, small pox, spanish flu, bird flu, AIDS
________– occurrence of disease in a community/region in excess of normal expectancy
________ – constant presence of a disease with a geographic area/population
- Provides baseline for establishing a public health problem
Pandemics - When a disease growth is exponential
- Focus is on how far it reaches (not severity)
- Spreads to international boundaries
- Unpredictable
- Ex: black death, small pox, spanish flu, bird flu, AIDS
Epidemic – occurrence of disease in a community/region in excess of normal expectancy
Endemic – constant presence of a disease with a geographic area/population
- Provides baseline for establishing a public health problem
Medical mistrust
J Marion Sims
- Research on enslaved black women without anesthesia
- Believed black people didn’t feel pain
Henrietta Lacks
- Her cells (Hela cells) taken without consent
- Used in a petri dish to advance science
Tuskegee syphilis study
- Not notified of syphilis treatment
- Did not give informed consent
- Used to study syphilis in black men
Current racism in healthcare
- Pain ignored, denied, believed to be less than white pts
- Higher rates of misdiagnosis
- Poorer health outcomes
- Cheaper/less desirable procedures
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_________ – 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
- Multiple casualty (3-99 individuals)
- Mass casualty (100+)
- _________ = injured or dead, direct victims, indirect victims, displaced person, or refugee
- Effects populations, environment, food/water supply, infrastructure, psychological/social/economic stability
Disaster
Casualties
human vs natural
________ disaster
- Sudden impact or acute onset
- Slow or chronic impact
_________ disaster
- Unintentional or intentional
- Biologic
- Nuclear
- Incendiary
- Chemical
- Explosive
- Technologic
Natural
Human generated
Disaster management
4 phases
1. ______ – plan for risk
2. ________ – build for risk, mitigate risk
3. ________ – respond to events
4. _______ – recover and improve
Disaster management
4 phases
1. Prepare – plan for risk
2. Prevent – build for risk, mitigate risk
3. Respond – respond to events
4. Recover – recover and improve
Disaster management
4 phases: Prevent, prepare, respond, recover
__________
- Identify potential hazards
- Vulnerabilities
- Strengthen capacity – resources, organization, resilence
Prevent
- Identify potential hazards
- Vulnerabilities
- Strengthen capacity – resources, organization, resilence
Disaster management
4 phases: Prevent, prepare, respond, recover
__________
- Timely warnings
- Protective factors
- Emergency management activities
- Evacuating populations pre-disaster
Prepare
- Timely warnings
- Protective factors
- Emergency management activities
- Evacuating populations pre-disaster
Disaster management
4 phases: Prevent, prepare, respond, recover
___________
- Disaster management team leader
- Clear roles of team
- Triage system
- Life saving actions – START, decontamination
- Surveillance – quarantine, isolation
- Evacuating populations post disaster
Respond
- Disaster management team leader
- Clear roles of team
- Triage system
- Life saving actions – START, decontamination
- Surveillance – quarantine, isolation
- Evacuating populations post disaster
Disaster management
4 phases: Prevent, prepare, respond, recover
___________
- Illness and injury d/t post disaster environment
- Re-establish health services
- Debrief
- Evaluate disaster management response
- Improve
Recovery
- Illness and injury d/t post disaster environment
- Re-establish health services
- Debrief
- Evaluate disaster management response
- Improve
Disaster management: respond
______________ – chemical exposure
- Prevents further absorption and spreading of chemical by victim
- Prevents spreading to others
- Avoid skin to skin contact
- Wear PPE – latex gloves not adequate, chemical protective gloves required
- Do not attempt mouth to mouth resuscitation without proper shields for protection
Process
- Remove articles, seal in double bag
- Neutralize agent
- Wash, flush eyes 5-10 mins
- Dispose of contaminated articles and wash water
- For ingestion – don’t induce emesis
Decontamination
Disaster Hazards in KY
- Sherwin wiliams paint plant
- Carpet factories
- Farms
- Railroads
- Toyota
- Breweries
- Tobacco warehouse
- Coal processing plants
- Structure fires
- Blue grass army depot
____________
Chemical weapon stores
Nerve agents (organophosphate) – readily absorbed by inhalation, ingestion and dermal contact, rapidly fatal systemic effects
- Lowered acetylcholinesterase levels are indicators of nerve agent intoxication in victims
blue grass army depot
s/s organophosphate poisoning
- salivation
- urine incontinence
- diarrhea
- GI cramps
- Emesis
- Miosis
- lacrimation
immediate response
- protect self, scene safety – don’t enter scene with unknown chemicals
- remove victims from exposure as fast as possible
- decontaminate
- drug therapy
o atropine sulfate for anticholinergic properties
o 2 pam chloride pralidozime salts to restore acetylcholinesterase activity
o Mechanical vent for respiratory failure
o Diazepam for convulsions
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_________ poisoning
Originates from release of hydrogen cyanide gas and cyanide salts, certain meds
Causes histotoxic hypoxia
- h/a
- dizzy
- seizure
- SOA
- Low BP
- Death
Antidote
- Amyl nitrate
- Cyanokit hydroxocobalamin
Cyanide
_________ poisoning
Common in winter – poorly vented furnaces
s/s
- h/a
- dizzy
- seizure
- SOA
- Vomit
- Chest pain
Treatment
- Pulse ox that measures CO
- Pt will read 100% O2 even when they aren’t
- High flow O2 via nonrebreather mask
- Hyperbaric chamber and oxygen washout
Carbon monoxide
Industrial exposure
- Acids
- Bases
- MSDS
- Placards – on vehicles, tanks, packaging
- Safety officer or hazmat tech
- Call poison control
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Hazmat zones
_____________
- Contamination present – everything inside contaminated
- PPE
- Limited # of personnel
_____________
- Contamination control zone
- PPE
- Decontamination corridor
- Life saving emergency care
___________
- CP location
- Treatment/transport areas
- Staging
- Medical monitoring/rehab
Hot zone/red zone
Warm zone/yellow zone
Cold zone/green zone
National incident management system (NIMS)
Standard approach to incident management and response in the US
- Established by dept of homeland security
- Result of 9/11
- Incidents include: natural disasters, terrorism, failing infrastructure, transportation incidents
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Benefits of NIMS
- Standardized and organized process
- National standard for training
- Personnel qualification standards
- Interoperable communication
- Information management systems with commonly accepted architecture
- Supporting technologies and infrastructure
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(1) Level 1 role
Incident commander
- Responsible for creating a unified command between responding agencies
- Evaluates incident
- Creates/oversees plan of action
- Determines needs
Benefits
- Common language and clear communication
- Point of command limits duplication
- Final operational control
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(3) Level 2 roles
Safety officer
- Responsible for monitoring hazards for daily operations
- Enforcing safety plans for scene operations
- Helps develop emergency response plans if further incidents ensue
Public information officer
- Responsible for communicating info to public
- Facts and viewpoints of responding agency
- Speaks to response efforts/operations
- Death disclosure
Liaison officer
- Relays info between incident commander, general staff, and other agencies
- Group of officers that report to chief officer
- Assist in communication between departments and field response efforts
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(4) Level 3 roles
Operations section
- Manage and plan day to day response
- Oversee all field operations
- Chain of command – field operations back to command
Planning section
- Problem solving issues as they come up during response
- Predicting and planning next phase of incident response
- Develop demobilization plan and emergency action plan
Logistics section – service branch and support branch
- Facilities
- Medical response
- Food and water
- equipment
- movement of equipment – may be contracted by FEMA before disaster, trucking and utility companies, generator and heavy equipment rentals, medical evacuation
Finance/admin. Section
- Responsible for documenting all expenses that need reimbursed (federal and state dollars)
- Tracks hours worked, cost of supplies, cost of compensation
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Standardized communication
- All responding units use a standardized ________ frequency for incident response
- Naming ________ assets is standardized
Standardized communication
- All responding units use a standardized radio frequency for incident response
- Naming equipment assets is standardized
Mobilization and deployment
- Identify needed resources – sourced locally and nationally
- Expected response time given
- Each resource tracks cost to submit to finance
- Incident commander briefs individuals as they arrive to scene
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Medical incident command
- response to medical emergency is broken down to _____, _____, ____
- Over seen by medical director
- Staging supervisor – runs staging location, establishes entrance/exit, prevent traffic congestion
- Physician on scene – provides medical direction
- Rehabilitation supervisor – in charge of onsite rehab, monitors staff for stress and fatigue
triage, treatment, transportation
Medical incident command
- _________
The process of prioritizing or sorting sick/injured people for treatment according to seriousness of the condition or injury
- Triage and tag all pts
- Provide very limited treatment – manually open airway, clear airway w/ finger sweep or head position, instruct to control major bleeding
- Collab with treatment and extrication supervisor
- Quickly and efficiently assess pts (30 secs or less per patient)
- Establish morgue
- Document triage process
Triage
Primary vs Secondary
________ triage
- on scene prior to transport
- at hospital if arrived by foot/personal vehicle
_________ triage
- incident dependent, probably prior to/during transport
- at receiving facility
- triage is an ongoing process
Primary triage
- on scene prior to transport
- at hospital if arrived by foot/personal vehicle
Secondary triage
- incident dependent, probably prior to/during transport
- at receiving facility
- triage is an ongoing process
Triage type - START (Simple, Triage, And, Rapid, Treatment)
- Developed by Newport beach fire dept
- Easy to use
- Focus is on _______
- Fast
- Jump START – for kids
4 focus areas of START
- Ability to follow direction and ______
- _________ effort
- ______/perfusion
- _________ status
Triage type - START (Simple, Triage, And, Rapid, Treatment)
- Developed by Newport beach fire dept
- Easy to use
- Focus is on s/s
- Fast
- Jump START – for kids
4 focus areas of START
- Ability to follow direction and walk
- Respiratory effort
- Pulse/perfusion
- Mental status
Tags/triage categories:
Black/expectant, Red/Immediate, Delayed/yellow, Minor/green
__________
- Unlikely to survive
- Palliative care and pain relief
Black/expectant
Tags/triage categories:
Black/expectant, Red/Immediate, Delayed/yellow, Minor/green
____________
- Victim can be helped with immediate intervention and transport
- Requires medical attention within minutes
Red/Immediate
Tags/triage categories:
Black/expectant, Red/Immediate, Delayed/yellow, Minor/green
___________
- Transport can be delayed
- Includes serious or potentially life threatening injuries but status not expected to deteriorate significantly over several hours
Delayed/yellow
Tags/triage categories:
Black/expectant, Red/Immediate, Delayed/yellow, Minor/green
___________
- Relatively minor injuries
- Status unlikely to deteriorate over days
- “walking wounded”
- May be able to assist in own care
Minor/green
Medical incident command
- __________
- Separate pts into priority groups
- Assign staff to treat pts
- Ensure supplies and personnel
- Maintain security and decontamination
- Work with transport to hospital
- Provide updates to EMS director
Treatment
Medical incident command
- __________
- All pt movement from area of treatment
- Establish loading zone for pt transport
- Determine destination based on needs
- Work with local resources to find transport
- Document all pt transport
Transportation
___________
- 3-99 patients
- Requires mutual aid and strains resources
- Declare if more resources are needed
Multiple casualty incidents (MCI)
Multiple vs mass
________ casualty = 3-99 patients
_______ casualty = 100+ patients
Multiple casualty incidents (MCI) = 3-99 patients
Mass casualty = 100+ patients
Closed vs Open incident
___________ incident
- Unknown causalities
- Search and rescue required
- Long and ongoing
__________ incident
- Number of patients known, not expected to change
- Patients triaged, treated, and removed from scene
open
Closed
Critical incident stress management (CISM)
- Emergency workers may suffer from psychological impact of MCI
- Disaster plans must include resources for debriefing responders
- CISM team available all times during response efforts
- Participation not required, highly encouraged
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After action review
- Detailed review of response and actions, for learning purposes
- Observations documented for future review
- Never accuse someone of wrong doing during response
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Emergency responses: nurses role
Plan
- Develop community response plan
- Education on prevention and response plans
Scene response
- Provide triage and primary care
- Help with home searches and provide medical assessment
Hospital response
- Assist in influx
- Executing emergency plan
Community response
- Respond to shelters to assist in medical care
After care
- Help return community to normal
- Reestablish resources in community
- Medical care and mental care to responders
Disaster response plan
- Be familiar with facility plan for different types of disasters
- Know local resources for disaster management – emergency services, hospital capabilities
- Be familiar with threats
- Practice
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