All-Hazards PreparationANES 1501

INTRODUCTION TO ANESTHESIA TECHNOLOGY

COLLEGE OF DUPAGE

All-Hazards Preparation

All-encompassing term

Refers to many different emergencies

Emergencies

Those that require the emergency response of outside assistance, which may be at the local, county, state, or federal levels

Emergency preparedness

Action taken by individuals, governments, and health care facilities and systems to be prepared for an emergency

Natural Disasters

Most common occurring type of disasters that can affect large populations

Avalanches

Rock and land slides

Winter storms

Heat waves and wildfires

Earthquakes and tsunamis

Tropical storms and hurricanes

Floods and tornados

Terms Related to Heat Wave

Heat index: Number in degrees Fahrenheit that tells how hot it feels when relative humidity is added to the air temperature. Exposure to full sunshine can increase the heat index by 15oF

Heat cramps: Muscular pains and spasms due to activity; often first sign/reaction by the body to heat

Terms Related to Heat Wave (cont’d)

Heat exhaustion: Due to exercising or working for a period of time in a hot, humid place and body fluids are lost at a great rate through sweating without replacement. Mild form of shock because the body increases the blood flow to the skin, reducing blood flow to the vital organs.

Terms Related to Heat Wave (cont’d)

Heat stroke: A life-threatening condition where the patient’s internal temperature control system stops working. The body temperature can rapidly increase, causing neurological damage as well as leading to death if not immediately treated.

Richter Scale

<3.5 = Earthquake may be felt, but not recorded by a seismograph

3.5-5.4 = Earthquake felt; rarely causes damage

<6.0 = Slight damage to well-designed, earthquake-resistant buildings, major damage to poorly constructed buildings

6.1-6.9 = heavy damage and destruction up to 62 miles from the epicenter

Richter Scale (cont’d)

7.09-7.9 = Major earthquake that causes heavy damage and destruction over a very large area

8 or greater = Strongest of earthquakes, with serious damage and destruction for hundreds of miles

Hurricane Categories

Category 1 = Sustained winds 74-95 mph

Category 2 = Sustained winds 96-110 mph

Category 3 = Sustained winds 111-130 mph

Category 4 = Sustained winds 131-155 mph

Category 5 = Sustained winds ˃155 mph

Man-Made Disasters

Disasters caused by people

Transportation accidents

Acts of terrorism and bioterrorism

Industrial incidents

Combination natural disaster—man-made disaster

Chemical release accidents

Infrastructure incidents

Radiological injuries

Specific Chemical Agent

Type of Agent

General Information

Mechanism of Action

Signs and Symptoms

Nerve Agent Most toxic of known chemical agents; often cause death in minutes due to respiratory obstruction and cardiac failure

Bind with acetylcholinesterase, thus not allowing it to act on the myoneural junction of muscles, causing paralysis of the muscles

Rhinorrhea, extreme difficulty breathing, apnea, seizure, paralysis, loss of consciousness

Specific Chemical Agent

Type of Agent

General Information

Mechanism of Action

Signs and Symptoms

Vesicants “Blister agents,” commonly known as mustard gas

Necrosis of the epidermis, severe conjunctivitis, and if inhaled injury to the mucosal tissues of the larynx and tracheobronchial tree

Skin blisters and burning of the skin and eyes, airway injury causing difficulty in breathing, conjunctivitis that varies in severity

Specific Chemical Agent

Type of Agent

General Information

Mechanism of Action

Signs and Symptoms

Choking agents

Most common agents are phosgene and diphosgene. Cause severe irritation of the upper and lower respiratory tracts.

Absorbed by inhalation. Reactions occur at the level of the alveolar-capillary membrane.

Pulmonary edema; eye, nose, and throat irritations; choking; coughing; tightness in the chest; development of fatal pulmonary edema during 2- to 24-hour period

Personal Disaster Planning

Personal and family preparation steps

Research, identify, and familiarize yourself and your family with the local and regional emergencies that could occur

Create a family emergency plan for each type of emergency

Prepare emergency supplies: go-bag and in-home supplies

Local/Community/Regional Response

Response to a disaster situation

Divided into the local and federal responses

Local response

National Incident Management System (NIMS)

Local Emergency Management Agencies (LEMA)

Emergency Operations Center (EOC)

Incident Command System (ICS)

Federal Emergency Response

Federal assistance Must be requested through formal channels by the local and state governments

Assistance will take up to three days or possibly longer

Agencies and assistance forms

Federal Emergency Management Agency (FEMA)

National Response Framework (NRF)

National Disaster Medical System (NDMS)

Disaster Medical Assistance Teams (DMATs)

Disaster Mortuary Operations Response Team (DMORT)

Health Care Facility Emergency Response

Health care facilities

Emergency action plan (EAP) follows state and federal emergency response guidelines

EAP components

Mitigation

Preparedness

Response

Recovery

Popular System of Triage

Simple Triage and Rapid Treatment

(START) uses four categories in which to place patients

DIME (Delayed, Immediate, Minimal, Expectant)

A triage tag is attached to the patient and treatment is based upon the color of and information written on the tag

DIME Categories

► Minor – Green Tag

► “walking wounded”

► Minor injuries – sprains, minor cuts

► Self-care

► Physiologically stable and will remain so

► Delayed – Yellow Tag

► Airway is patent

► Bleeding has been treated and controlled

► Patient is physiologically stable

► Injuries may be serious, but transport can be delayed

DIME Categories (cont’d)

Immediate – Red Tag

Quick, short immediate treatment intervention can stabilize the patient, such as establishing an airway and treating bleeding

Treatment must be given during the “golden Hour” (within 1 hour) in order for victim to survive

Once stabilized, the patient may be re-categorized to delayed depending on extent of injuries; if it involves head or spine injury, penetrating wound, or fracture(s), patient should be transported as soon as possible

DIME Categories (cont’d)

Expectant – Black Tag

Injuries are so extensive patient is not expected to survive; use of medical resources is not advisable in order to use for the other three categories of patients

Victim is made as comfortable as possible and pain relief given

Triage of Chemical and Nuclear Disaster Victims

The patients are triaged three times:

Hot zone: Central area where the disaster occurred. Level A PPE should be worn. Patient is quickly assessed for airway patency and severe hemorrhage

Warm zone: Triage zone 300 feet or more from the hot zone. Patients are quickly triaged into the four categories

Cold zone: Triage zone near the warm zone where patients are evaluated for injuries secondary to severe injuries and transported to a facility

Medical Office EAP

Should be developed based on the community EAPs

Coordinated with the local and regional health care system

Components

Procedures for notifying employees of an emergency

Procedures for evacuating the building

Patient evacuation procedures

Immediate Response to an All-Hazards Event

Important considerations

Disaster scene must be safe before entering

Standard Precautions and personal protective equipment

Patient decontamination area

Triage of victims

Point of Distribution (POD) site

Risk communication with the public

Immediate Response to an All-Hazard Event (cont’d)

Moral, ethical, and legal issues associated with providing care during a disaster

Emergency System for the Advanced Registration of Volunteer Health Professionals (ESAR-VHP) and Community Emergency Response Team (CERT)