Prehos-Disaster Preparedness

8/13/2019 Prehos-Disaster Preparedness

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Section 2 : Disaster Preparedness

Disaster preparedness and response

Bomb, Blast, Crush injury

Chemical agent and Mass casualty

Bioterrorism Recognizing and Response

Radiation njury


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!hich o" the "ollo#ing are phases to a

disaster response according to the $C%

P classi"ication system&

'$( $cti)ation

'B( *riage'C( Reco)ery

'D( $ and C

'%( $ll o" the abo)e


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Disaster

+-. $C%P %P disaster

!/0:

disastercanbedefinedasasuddenecologicphenomenonofsufficientmagnitudetorequireexternalassistance


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planning

Disaster

&

!"#

&$%&' %&(

)1%

&


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C$/0 re3uirement

1$+1(#$*1

21+('rehearsal(Hospitaldisasterplanningisthe

responsibilityofadministration,nursing,

andtheentiremedicalstaff


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4ey "unction o" hospital plan

Hospital disasteradministrative and

treatment areasTraining and drills

Security and crowd

control

Activation of the plan

Assessment of thehospital's capacity

Establishment of adisaster command

Communications

Supplies


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/%CS'/ospital emergency incident com

mand system( ,& Common language

De"ine and predictable

chain o" management

5le6ible response

Prioritize response

$ccountability o" position

"unction

Document guideline "or

accountability and cost rec

o)ery

&*-& .))/ $# $$%&

%. $/

$)/ /


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Disaster response

three phases

+1 $cti)ation: noti"ication and initial response, and

establishment o" an incident command post

21 mplementation: 7 components:

search and rescue,

triage #ith stabilization

transport, and de"initi)e scene management

71 reco)ery: #ithdra#al "rom the scene and return to

normal operations1


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!hich o" the "ollo#ing is 80* one o" the

se)en 9ey "unctions o" the ncidentCommand System 'CS(&

'$( n"ormation o""icer

'B( iaison o""icer

'C( Sa"ety o""icer

'D( 5inance section chie"'%( *riage o""icer


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!hat is the M0S* common presenting

complaint

by patients at a mass gathering&

'$( Dermal injury

'B( Musculos9eletal injury

'C( /eadache

'D( $bdominal pain'%( Chest pain


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Mass gathering

)oluntary and temporary collection o"

greater than +;;; people at one site or loc

ation

ncident: major roc9 consert > sport 7?+;

times

BS and $%D should be a)ailable to alle)ent participants #ithin 7 min o" collapse


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%)ent reconnaissance

+1 Physical setting: $%0' ,$/) heatstro9e( -",, 1 /triage and treatment &%,1% )'/

21 %6pected population and hazard e6posure: old or young,number o" population

71 nteraction: #ith "ire@rescue@hazardous material '/$AM$*(,

public health, and la# en"orcement, medical "acility

communications path to o""icials responsible "or initiating

e6ecution o" the plan


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= obser)e


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Crush injury

Compartment syndrome

5asciotomy in . hr

Crush syndrome Ca, 4, P0, CP4

F "luid be"ore e6traction

Bicarbonate + amp@hr Grine output 2;;?7;; cc@hr

Manital F


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= Scopolamine %D

0bser)e .? hr , sa"ely discharge

8er)e gas


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Blister $gents@Fesicants

Sul"ur mustardPhosgene 06ime CE

8itrogen mustard

e#isite


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Fesicant Symptoms

Binds rre)ersibly #ithin minutes 5i6ingN1

0nset o" symptoms


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Bioto6in

OOO Recognition

Syndrome@Dz : rare

8o health ris9 "actor

ocalize e6posure

$nimal in)ol)e

/igh motality


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Botulinum

!ea9ness, reco)ery in 2 #9

Rapid anti?to6in

Ricin 'caster oil plant(

nhaled ?> hr necrotizing pnumonitis

Parenteral ?> 5lu?li9e, +=2< hr ?> "e)er, 8, sepsis?li9e syndrome

Staphylococcal enteroto6in B 'S%B(

/istocompatibility comple6 ?> *?cell stimulation

Reco)ery in 2


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ncapacitating $gents

8ot meant to be lethal

inability to per"orm oneQs missionN


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ncapacitating $gents:

BA

BA??7?3uinuclidinyl benzilate

$nticholinergic $gent

2=?times more potent than atropine


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BA: Symptoms Mad as a /atterN

Dry as a BoneN

Blind as a BatN

/ot as a /areN

Red as a BeetN


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BA: *reatment Control patient

4%%P FC*M C00

Physostigmine +?2 mg F

atropine at bedside

seizures and cardiac arrhythmias rare


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=;


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30 m.

30 meters in front or behind a collision,

not alongside


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=1 n dealing #ith hazardous materials incidents during

patient assessment and triage

$1 Lou should "ollo# routine procedures in all

situations

B1 Lou should ta9e all patients to a decontaminationarea

C1 Lou should care "or noncontaminated patients

li9e any other emergency case

D1 Lou should #ait until you ha)e details on the

nature o" the hazard be"ore doing any?thing

ntraining

2==;


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+1 (0,& = '0 %MS /&(0,& = "lushing s9in, gasping andchoc9ing

2

=

) (02$#"6/&%almond

%'7#

$1 MustardB1 Cyanide

C1 e#isite

D1 Phosgene

%1 organophosphorus

ntraining 2==2


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= 2 y


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Prodromal

symptom

atent

Mani"est illness

/ematopoitic

CFS and C8S

Death or Reco)ery

$cute radiation syndrome


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!hole body irradiation

$ppro6imate Dose0nset o"

ProdromeDuration o"

atent PhaseMani"est llness

>2 gy '2;; rad( !ithin 2 days +H7 #ee9s/ematopoietic syndrome, sur)i)eposible

>. gy '.;; rad( !ithin hours J+ #ee9 syndrome bleeding,

"ulminant enterocolitis, may "atal

>7; gy '7;;; rad( !ithin minutes 8oneCardio)ascular@C8S syndrome "atal

#ithin 2


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Management T Prognosis

Supporti)e treatment

Prognosis

2< hrs absolutelymphocyte count

J7;; poor prognosis

>+2;; good prognosis Dose dependent


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+( Recognition

Dosimeter, Sur)ey meter, n"ormation, SS6

2( R6 "irst

Secure $BCs and physiologic monitoring

*reat major trauma, burns and respiratory injury i" e)ident1

7( Decontamination

ess contamination

Cloth o"", co)er #ound be"ore #ashing

Debridement i" indicate

%D management


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%6ternally contamination

Decontamination

Remo)e cloth

Sur)ey "or radiation

Decontaminate patient:esp1 #ound andori"ices

Resur)ey and remo)e

particles

Contaminate tissuegently clean or e6cise

Collect samples "oreiger counter

8 "or nternalcontamination

%)ery e6creta sent tolaboratory

%)ery sta"" must

assess contaminationbe"ore lea)ing R%$


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Pregnancy

;?2 !9

$ll or none

2?- !9

0rganogenesis

?+= !9

C8S "unction i" > =;; mS)

=+


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=+


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=71&$'#)&*/) +7/&8*#/2,&

)&$&& 'class $ agent(

A. Variola major

B. Coxiella burnetii

C. Burkholderia mallei

D. Rickettsia prowazekii

E. Chlamydophila psittaci

ntraining


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i i f i i


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o# probability

/igh impact incident

"ecognition of a Bioterrorist $%ent

CDC classi"ication o" potential biological


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agents

Category A

*hey can be easily spread or transmitted "rom

person to person

*hey result in high death rates and ha)e thepotential "or major public health impact

*hey might cause public panic and social disruption

*hey re3uire special action "or public healthpreparedness1



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agents

Category B

*hey are moderately easy to spread

*hey result in moderate illness rates andlo# death rates

*hey re3uire speci"ic enhancements o"

cdcUs laboratory capacity and enhanceddisease monitoring1



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agents

Category C

*hey are easily a)ailable

*hey are easily produced and spread

*hey ha)e potential "or high morbidity and

mortality rates and major health impact

Category A


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Bacillus anthracis$nthra6 :

Clostridium botulinum toxinBotulism :

ersinia pestisPlague : Variora majorSmallpo6 : !# !rancisell tularensis*ularemia : $%& Ebola

Firal hemorrhagic"e)er

Category A

F% 5$BL


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F%?5$BL

F% 5$BL


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F%?5$BL

Fariora major

%bola ')iral hemorrhagic "e)er(

5rancisell tularesis

Bacillus $nthracis

Clostidium Botulism

Lersina pestis

Cl B t


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Coxiellaburnetii

"e)er

Brucellaspp1

Brucellosis

Burkholderiamallei

landers

Burkholderiapseudomallei

Melioidosis

Alpha"iruses'F%%, %%%,

!%%(

%ncephalitis

Rickettsiaprowazekii

*yphus "e)er

*o6ins 'e1g1,Ricin,

#taphylococcus$%nteroto6in

B( *o6icsyndromes

Chlamydiapsittaci

Psittacosis

5ood sa"etythreats 'e1g1,#almonella

spp1, Eschericiacoli0+=-:/-(

!ater sa"etythreats 'e1g1,

Vibrio cholera$Cryptosporidiu

m par"um(

Class B agents

Category C


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g y

%merging in"ectious diseases

? 8ipah)irus

? /anta)irus? S$RS

Bacillus anthracis


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Cutaneousanthra6

Gsually J+ d,

up to 2 #9reported

Macule or papule enlarging into eschar

#ith surrounding )esicles and edemasepsis possible, less common

anthra6 Gsually +H- d$bdominal pain, )omiting, bleedingprogressing to sepsis mesentericadenopathy on C*

nhalationalanthra6

Gsually J+ #9,


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Bacillus anthracis

&re%ention 'reatment

Faccination . dose

;, 2, < #9 and ., +2, +mo

Cipro"lo6acin P0@F

Do6ycycline P0@F $mo6ycillin P0

Pen F

(o to)icity* &+ ith to)icity* #-

Lersinia pestis


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Bubonicplague

2H d nitially "e)er, chills, pain"ul s#ollenlymph node's( node progresses to bubo'sometimes suppurati)e(

Pneumoni

c plague 2H7 d

5e)er chills, cough, dyspnea, nausea,)omiting, abdominal pain clinical

condition consistent #ith gram?negati)esepsis

Primarysepticemicplague

2H d$"ter bubo "ormation, the clinicalcondition is consistent#ith gram?negati)e sepsis, DC

Lersinia pestis

ersinia pestis


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ersinia pestis


8o )accine

Prophyla6is: Cipro"lo6acin

Do6ycyclin

Chloramphenical

*etracyclin

5or - days

Start #ithin 2< hrs1

Same as prophyla6is

Clostridium botulinum


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Clostridium botulinum

5ood?borne botulism +H= d

symptoms "ollo#ed bysymmetric cranial neuropathies,blurred )ision, progressing todescending paralysis

nhalational botulism +2H-2 h

Symmetric cranial ner)e palsies

"ollo#ed by descending paralysis

Clostidium botulinum


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Clostidium botulinum


8o )accine

8o prophyla6is

Supporti)e

$ntito6in protectremaining neurological

"unction

nitially "e)er, se)ere myalgias,prostration "ollo#ed #ithin 2 d by


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Fariola

majorSmallpo6 +2H+< d

prostration "ollo#ed #ithin 2 d bypapular rash on the "ace spreadingto e6tremities 'a""ecting palms and

soles( and then to trun9 'lessere6tent than chic9enpo6( lesionsprogress at same rate, becoming)esicular and then pustular#ithsubse3uent scab "ormation

5rancisellatularensis

*ularemia 2H= d $brupt nonspeci"ic "ebrile illnessprogressing to pleuropneumonitismay ha)e mucocutaneous lesions

5ilo)irusesandarena)iruses

'e1g1, %bola)irus(

Firalhemorrhagi

c "e)ers

2 dH7 #9depending

on )irus

nitial nonspeci"ic "ebrile illness,sometimes #ith rash progresses to

bloody )omiting, diarrhea, shoc91

Variola major


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Variola major


Faccination #ithin < days

Faccinia prophyla6is#ithin 2?7 days

808%VVVVVV

!rancisellar tularensis


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!rancisellar tularensis


i)e attenuated )accine

Prophyla6is:cipro"lo6acin, do6ycyclin

Streptomicin

entamicin

Cipro"lo6acin

Do6ycyclin

Bioterrorist


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Bioterrorist

OOORecognition

8oti"ication and in"ormation

=+


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=


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=

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