Disaster Preparedness and Response
CLINICAL GUIDELINES
The response to disaster varies based on the type of disaster (i.e., natural disaster vs. bioterrorist act); it is important to be knowledgeable regarding your own facility/community plan and the procedures to follow based upon whether the disaster is internal such as a tornado and the need to shelter in place or require moving patients to other facilities, or external as outlined below.
Key components of disaster preparedness are as follows:
Describe the role of the facility during response to an emergency/disaster.
Locate and use the section of the facility/hospital emergency response plan that applies to your department and position.
Describe your emergency response role and demonstrate it during drills or actual emergencies.
Demonstrate the use of emergency equipment (such as personal protective equipment) required by your emergency response role.
Describe your communication responsibilities and demonstrate them during drills or actual emergencies. Know the chain of command in a disaster, which may not be the same as the facility/hospital organization structure.
Identify and describe the limits to your skills, knowledge, and authority.
Demonstrate flexible thinking and use of resources to solve problems that arise during emergency situations or drills. Routine resources may not be available (e.g., telephones, electrical power).
Decontamination areas should have the following:
A water source
The ability to collect and contain large quantities of water
Soap available to remove the contaminant (water alone is not as effective)
Adequate lighting
Electricity (understand which electrical plugs are attached to the backup generators)
A conveyor system for nonambulatory patients (such as “sleds”)
Provisions for patient privacy
Room for two to three personnel and family
Appropriate heating capability for pediatrics
Special management plans should be in place to address the unique physical and psychological vulnerabilities of children (Chart 35-1). Ensure adequate supplies of antibiotics, antidotes, and vaccines in pediatric doses. Have ready access to a dosing guide, preferably in hard copy in the event of power loss.
Keep family units together during a disaster whenever possible. Ensure only facility/hospital staff or known family members are left to care for the child.
EQUIPMENT
Personal protective equipment (gowns, gloves, masks including N95 masks, goggles/eyewear)
Patient identification bands
Decontamination kits for adults and children (gown, storage bag for contaminated clothing, soap for cleaning off the chemical contaminate, and tags for personal belongings)
Emergency equipment as listed in Chapter 24
Equipment as needed to start an intravenous line, as listed in Chapter 53
CHILD AND FAMILY ASSESSMENT AND PREPARATION
Assess type of disaster. Assessment of the child varies based on type of disaster, usually one of the following:
Violence, explosions, or force from natural disaster: assess and prepare as any other trauma patient based on the nature of their injuries. Symptoms vary, based on the area that is injured and the extent of the injury.
Nuclear/radiologic attacks: assess exposure and/or contamination. Symptoms vary from no obvious injury to deep burns. Some symptoms will develop over time because of a burn to the deep tissue.
External exposure: assess if radiation was from a source distant or in close proximity to the body and if external radiation was to whole body or a local exposure
Contamination: an unwanted radioactive material in or on the body
Chemical attacks: assess for symptoms of hazardous chemical exposure:
Nerve agents (Sarin, VX): sudden loss of consciousness, seizures, apnea, and death
Vesicants (mustard agents): blistering and injury to the eyes, skin, airways, and some internal organs
Cyanide: hyperventilation, convulsions, asystole, and death
Pulmonary intoxicants (Phosgene, chlorine): cause life-threatening lung injury after inhalation, effects are usually delayed; irritation to the eyes and respiratory tract and severe pulmonary edema
Riot control agents (Mace, tear gas, pepper spray): tearing; eye, nose, mouth, and throat irritation
Biologic attacks: assess for signs of common diseases associated with bioterrorism:
Cutaneous anthrax (incubation period of 12 hours to 12 days): initial lesion resembling a pimple or
insect bite with surrounding erythema and often satellite vesicular or bullous lesions; by the fifth to seventh day the lesion becomes a painless black eschar
Inhalation or pulmonary anthrax (incubation period 1 to 7 days, may be as long as 60 days): nonspecific respiratory symptoms (cough with low-grade fever), fatigue, malaise, and muscle aches; respiratory distress becomes rapidly progressive and is often accompanied by a high fever and signs of systemic toxicity (sepsis or meningitis)
Smallpox (incubation period 7 to 17 days): initial symptoms include high fever, fatigue, and head and backaches; synchronous vesiculopustular eruption, predominately on face and extremities, follows in 2 to 3 days
Plague (incubation period 2 to 8 days if due to flea-borne transmission, 1 to 3 days for pulmonary exposure): febrile prodrome with rapid progression to fulminant pneumonia with bloody sputum, sepsis, and disseminated intravascular coagulopathy (DIC)
Tularemia (incubation period 1 to 14 days, average 3 to 5 days): signs depend on how bacteria enters the body, the pneumonic form (inhaled) is most serious—cough, chest pain, difficulty breathing
Typhoidal fever, malaise, abdominal pain
Botulism (incubation 1 to 5 days): afebrile; descending flaccid paralysis; cranial nerve palsies, sensation and mentation intact
Viral hemorrhagic fevers (incubation 2 to 21 days): febrile prodrome with rapid progression to shock, purpura, and bleeding diathesis
Prepare the child and family for assessments and interventions using developmentally appropriate language and methods.
CHART 35-1 Special Pediatric Considerations in Terrorism and Disaster PreparednessChildren Are More Vulnerable Than Adults
Children are particularly vulnerable to aerosolized biologic or chemical agents because they may breathe more times per minute than adults and they would get relatively larger doses of the substance in the same period of time. Also, because some such agents (e.g., sarin and chlorine) are heavier than air, they accumulate close to the ground (i.e., right in the breathing zone of children).
Children are more vulnerable to agents that act on or through the skin because their skin is thinner and they have a larger surface-to-mass ratio than adults.
Children are more vulnerable to the effects of agents that produce vomiting or diarrhea because they have less fluid reserve than adults, increasing the risk of rapid dehydration.
Children have smaller circulating blood volumes than do adults; without rapid intervention, relatively small amounts of blood loss can quickly tip the physiologic scale from reversible shock to profound, irreversible shock or death.
Children have significant developmental vulnerabilities not shared by adults. Infants, toddlers, and young children do not have the motor skills to escape from the site of a chemical, biologic, or other terrorist incident. Even if they are able to walk, young children may not have the cognitive ability to figure out how to flee from danger or to follow directions from others.
Children are more susceptible to the effects of radiation exposure because they have a relatively greater minute ventilation compared with adults. They are likely to have greater exposure to radioactive gases, and because nuclear fallout quickly settles to the ground, children are exposed to a higher concentration of radioactive material because they are closer to the ground.
Children Have Unique Treatment Needs
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