Disaster Management



Disaster Management





Disaster Management

Mary Schucker

Christopher Sonne


Background



  • Four phases of emergency management: mitigation, preparedness, response, and recovery.


  • Emergencies can be classified as “routine” or “crisis.”



    • All emergencies begin at the local level, with local and community resources.


  • Mass casualty incidents occur when the volume of patients and/or their acuity exceeds the available resources of the health care facility, and include:



    • Natural or man-made:



      • Natural: flooding, tornadoes, earthquakes, hurricanes, wildfires.


      • Man-made: accidental or intentional.



        • Terrorist: least predictable, intent is to cause panic, public disorder, anxiety.


        • Explosive devices.


  • Pediatric vulnerabilities: Children have many anatomic and physiologic vulnerabilities, and those with special health needs become even more vulnerable.



    • There is a lack of pediatric resources during a disaster within many cities/communities.


  • Surge planning and structural support.



    • Medical surge is predicated on the quantity of patients, the acuity level, and resources needed to deliver the required level of care. Medical surge planning addresses how local/community resources will be shared and prioritized, then state and federal assistance.


    • For larger regional and national events, delivery of care should focus on the population (as a whole) rather than individual outcomes when allocating resources.


    • In the event of scarce medical resources (e.g., pharmaceuticals, ventilators, critical care beds), efforts should be prioritized to those individuals with the highest chances of a successful clinical outcome.


  • Decontamination.



    • Required due to an exposure or contamination by a hazardous material.


    • The Occupational Health and Safety Administration defines a hazardous material as any substance that is potentially toxic to the environment or to living cells, including microorganisms, plants, animals, and humans.



      • Includes biological or disease-causing agents that may reasonably be anticipated to cause death, disease, or other health problems.


    • Patients need to be decontaminated prior to therapeutic treatment.


    • Removing the clothing of a victim (mechanical decontamination) can reduce up to 80% of the contaminant, and should be the initial direction to victims.


    • Liquid contamination poses the greatest need for a thorough decontamination using copious amounts of soap and water (when indicated).


  • Purpose of decontamination.



    • Decreases the effects and symptoms of the hazardous material, reduces the risk of secondary contamination, and prevents contamination of health care facility.



      • Four routes of exposure: inhalation, ingestion, absorption, injection.


      • Four types of toxic effects: irritant, corrosive, or oxidizing; pharmacologic; allergenic; mutagenic or carcinogenic.


  • Age-based decontamination guidelines.



    • Avoid separation from families, assist caregivers, recognize developmental needs, keep warm, and protect the airways.


    • Categories of disaster.



      • Biological disasters (based on CDC [Centers for Disease Control and Prevention]): the use of viruses, bacteria, or other naturally occurring substances with intent to harm or kill people, animals, or plants.


      • Category A: highest risk to general population, are easily spread, have major health impact.


      • Category B: not as easily spread, moderate illness, and panic.


      • Category C: emerging pathogens, readily available, have potential for major health impacts (Table 23.1).









TABLE 23.1 Specific Biologicals













































Name


Etiology


Forms/Types


Pathophysiology/Symptoms


Diagnoses


Management


Anthrax


Aerobic, gram-positive rod:


Bacillus anthracis.


Spore-forming capability.




  • Cutaneous: painless ulcer.



  • Gastrointestinal: acute gastritis or ulcers.



  • Inhalation.




  • Spores enter macrophages which then travel to regional lymph nodes, break open, release bacteria, replicate, and result in bacteremia and sepsis with high rates of mortality.




  • Clinical presentation.



  • Chest radiograph: widened mediastinum or large pleural effusion.



  • Positive blood cultures.




  • Ciprofloxacin or doxycycline for 60 d.


Botulism


Spore-forming bacteria found in soil, intentionally contaminated water or food, or aerosolization; toxins are most poisonous substance known to man.


Human contact with spores contaminated with Clostridium botulinum.


Gram-negative bacilli: Clostridium botulinum.


Three types: infantile/intestinal (70% of reported cases), food borne, and wound (rare).


Toxin affects presynaptic membranes, preventing acetylcholine release into the synaptic cleft, resulting in absence of depolarization of the postsynaptic membrane, and ultimately flaccid paralysis.




  • Clinical diagnosis, initially. Confirmatory tests sent to CDC or US Public Health laboratories.




  • Supportive care (ventilation if indicated).



  • Infant and young child management found in Section 6: Neurologic.



  • Antibiotics should not be administered; bacterial lysis may result in toxin release.


Smallpox


Smallpox has been used as a biological weapon for centuries.


Mortality rate 30%.


Hemorrhagic or flat forms: mortality 95%.


Encephalopathy is main complication.


DNA virus, Poxvirus variolae, a member of the orthopoxvirus family. Spread from person to person by aerosols and direct contact; caused by one of two viruses: variola major or variola minor.


Entering nose or oropharynx.


Symptoms: viremia, fever, toxemia, and rash. May be accompanied by malaise, myalgias, and gastrointestinal complaints.


Maculopapular lesions are predominant on the face (including oropharynx) and upper extremities, then spread to trunk and lower extremities in fewer numbers.


Become vesicular and pustular over several days.


Fluid collection from unroofed lesions or eschar.


Diagnosis with electron microscopy, viral culture, and staining. Specimen collection limited to those who have received vaccination.




  • Report to local and state health departments immediately.



  • Respiratory isolation.



  • Supportive care.



  • Protection of health care workers including laboratory personnel.



  • No available antiviral agent.



  • Cidofovir may be considered for postexposure prophylaxis.


Tularemia


Gram-negative coccobacillus:


Francisella tularensis.


Presents as a systemic illness without a focal lesion. Typically results in fever, headache, chills, nausea, vomiting, diarrhea. When associated with pneumonia, cough, pharyngitis, bronchiolitis, pneumonitis, or pneumonitis may be present.


Clinical presentation depends on method of exposure.


Seven types of clinical syndromes: pneumonic, typhoidal, ulceroglandular, glandular, oculoglandular, oropharyngeal, and septicemic.


Infection occurs when skin or mucous membranes come in contact with carcass or body fluids of an infected animal, through aerosolization or through contaminated food or water; also occurs through bite from infected tick or deer fly. Bacteria enter through skin, gastrointestinal tract, mucous membranes, or lungs and spread to local lymph nodes and multiply in macrophages, disseminating through the body.


Diagnosis is made through sputum culture, nasal pharyngeal swabbing, or secretions/exudates.


Antibodies are not reliable until approximately 2 wk after the onset of infection.


Signs of atypical pneumonia with pleural effusion or enlarged hilar lymph nodes may be noted on chest radiograph.




  • Streptomycin (medication of choice), gentamicin; alternatively, amikacin for 10 d.



  • Notification of local or state health departments.



  • Postexposure prophylaxis with doxycycline or ciprofloxacin for 14 d. Only for those with possible direct exposure to F. tularensis; not required for household contacts of infected patients.


Viral Hemorrhagic Fever


A group of RNA viruses (Filoviridae, Arenaviridae, Bunyaviridae, and Flaviviridae) that results in fever and bleeding diathesis.


This diverse group of viruses is highly contagious and is associated with high mortality rates.


Largely unknown.


All affect the vasculoendothelial system, though mechanism is unclear.


Abrupt fever, malaise, facial flushing, conjunctivitis, myalgia, petechiae, mucosal bleeding, vomiting, diarrhea, hemorrhage.


Spread by aerosols, tick bite, rodent feces, and secretions of infected animals.


Human-to-human spread for select diseases; have resulted in hospital outbreaks.


Laboratory studies demonstrate thrombocytopenia and coagulation dysfunction.




  • Supportive care.



  • Respiratory isolation.



  • Intubation and mechanical ventilation may be required in some cases.



  • Fluid resuscitation, blood products, vasopressor agents, and invasive monitoring are commonly required.



  • Monitor family members/close contacts for fever. Yellow fever vaccine is the only viral hemorrhagic fever (VHF)-approved vaccine.

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Jan 30, 2021 | Posted by in NURSING | Comments Off on Disaster Management
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