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Chapter 66
Disaster Response andDomestic Preparedness
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Learning Objectives
Explain the importance of disaster response preplanning and preparedness
Describe the purpose of the National Response Plan
Describe the federal medical resources available from the National Disaster Medical System
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Learning Objectives (Cont’d)
Discuss the need for and use of the incident command system
Describe the role of EMS in the incident command system
Identify different types of natural disasters and the emergency medical needs associated with each
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Learning Objectives (Cont’d)
Identify chemical weapons of mass destruction agents about which first responders should be concerned
Identify five classes of chemical warfare agents and give examples from each class
Identify epidemiological clues that may indicate an act of bioterrorism is occurring
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Learning Objectives (Cont’d)
List the biological agents considered the most critical threats
Identify particular concerns with large-scale radiological events
Explain why explosive and incendiary devices are used most often by terrorists
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Learning Objectives (Cont’d)
Describe blast injuries and human responses
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Introduction
Disaster response Challenges
• Responder safety• Multiple patients• Equipment in short supply• Inexperience with mass casualty incidents
Natural or man-made disasters• Earthquakes, hurricanes, floods, tornados• Structural collapse, hazmats release, terrorist attacks
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Local and state response Preplanning is vital
• Team effort• Many agencies involved• Operating procedures developed• Response procedures to guide safe scene
operations• Patient decontamination• Treatment• Medication• Destination protocols
Disaster Response Preparedness
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Disaster Response Preparedness (Cont’d)
Local and state response Medical equipment
• Caches of supplies• PPE• Mass decontamination supplies• Antidotes
Surge capacity hospitals• Equipment stored to open temporary hospitals• Convention centers, arenas• Portable tent hospitals
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Disaster Response Preparedness (Cont’d)
Federal response National response plan (NRP) [Obj. 2]
• National approach to domestic incident management• Joins with local and state efforts• Goals
Prevent terrorist attacks within the United States Reduce the vulnerability of the United States to
terrorism, major disasters, and other emergencies Minimize damage from attacks, major disasters, and
other emergencies Facilitate recovery from domestic incidents
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Disaster Response Preparedness (Cont’d)
Federal response Federal agencies and the American Red Cross
grouped into emergency service functions (ESFs)
• ESF 1: transportation• ESF 2: communications• ESF 3: public works and engineering• ESF 4: firefighting• ESF 5: emergency management• ESF 6: mass care, housing, human services
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Disaster Response Preparedness (Cont’d)
Federal response ESFs
• ESF 7: rescue support• ESF 8: public health and medical services• ESF 9: urban search and rescue• ESF 10: oil and hazardous materials response• ESF 11: agriculture and natural resources• ESF 12: energy• ESF 13: public safety and security• ESF 14: long-term community recovery and
mitigation• ESF 15: external affairs
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Disaster Response Preparedness (Cont’d)
Federal response National disaster medical system
• Coordinated by the Department of Health and Human Services
• Staffed by the National Disaster Medical System• Disaster medical assistance teams (DMATs)• National medical response teams for WMD• International medical surgical teams• Disaster mortuary operations teams• National Veterinary Response Teams• FEMA urban search and rescue teams
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Disaster Response Preparedness (Cont’d)
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Incident Management System
National incident management system Consistent nationwide approach Provides protocols, concepts, terminology,
organization Core concepts
• Incident command system• Multiple-agency coordination• Training• Resource identification and management• Collection, tracking, reporting incident information
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Incident Management System (Cont’d)
Incident command system (ICS) Use mandated by PSHA regulation and
HASWOPER standard Structure
• Command Incident commander (IC)
• Operations section Manages all tactical operations
• Planning and intelligence Collects and evaluates information about the event Suggests action plan to IC
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Incident Management System (Cont’d)
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Incident Management System (Cont’d)
Incident command system (ICS) Structure
• Logistics Locating and organizing
• Finance or administration Tracking incident costs
• Role of EMS EMS falls into many function areas Medical sector or group under operations Medical sector or group leader Logistics Planning to identify patient needs
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Incident Management System (Cont’d)
Incident command system (ICS) Concepts
• Common terminology• Command post operations• Unified command• Consolidated response plan• Span of control• Integrated communications• Staging area
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Incident Management System (Cont’d)
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Natural Disasters
Earthquakes Most injuries are from structural collapse Many survive in collapsed structures Fade away time
• Delayed death• Dehydration• Hypothermia• Hyperthermia• Crush syndrome• Postoperative sepsis
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Natural Disasters (Cont’d)
Hurricanes and tornadoes Hurricanes cause massive disruption of the
infrastructure Tornadoes cause similar destruction on a
smaller scale Both often damage hospital resources
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Natural Disasters (Cont’d)
Floods Drowning primary cause of death Trauma from floating debris Secondary illness from contaminated water
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Response: HAZMAT versus WMDs
Similar responses in many ways Specific training
required Safe response tactics
required Specialized PPE
required Decontamination
procedures required Patient treatment
needs similar
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Weapons of Mass Destruction
Chemical agents Blood agents
• Chemicals enter body, inhibit cellular use of O2
• Hydrogen cyanide (AC)• Cyanogen chloride (CK)
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Weapons of Mass Destruction (Cont’d)
Chemical agents Treatment
• Remove to fresh air• If liquid agent,
decontamination vital
• Airway andcirculatory management
• Antidote: Taylor Cyanide Antidote Package
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Weapons of Mass Destruction (Cont’d)
Chemical agents Pulmonary agents
• Responders should fear most• Easy to obtain• Choking agents• Attack lungs and lung tissue
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Weapons of Mass Destruction (Cont’d)
Chemical agents Pulmonary agents
• Phosgene Colorless gas with newly mown hay odor Highly volatile, nonpersistent agent Heavier than air, remains in low-lying places for a long
period Gas at temperatures >47°F Easy to produce, unstable in storage, must be kept
refrigerated
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Weapons of Mass Destruction (Cont’d)
Chemical agents Pulmonary agents
• Chlorine Greenish-yellow gas or amber liquid with pungent odor Two times heavier than air Highly volatile, nonpersistent Strong oxidizer and highly corrosive
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Weapons of Mass Destruction (Cont’d)
Chemical agents Pulmonary agents
• Anhydrous ammonia Used as fertilizer Refrigerant for cooling and freezing Colorless gas in lower concentrations Higher concentrations can form white cloud Volatile, persistent
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Weapons of Mass Destruction (Cont’d)
Chemical agents Vesicants
• Blister agents• Burn and blister skin/surface they contact• Severely damage skin, eyes, lungs, GI tract• Contaminate almost everything in contact• Signs/symptoms
Erythema and blisters on skin Irritation Conjunctivitis Corneal opacity Mild upper respiratory signs to marked airway damage GI effects
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Weapons of Mass Destruction (Cont’d)
Chemical agents Vesicants
• Liquid or vapor• Presentation hours after exposure• No antidote• Care is supportive• Decontamination is critical
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Weapons of Mass Destruction (Cont’d)
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Weapons of Mass Destruction (Cont’d)
Chemical agents Nerve agents
• Most well know type of chemical
• Most toxic• Hardest to acquire• G agents• Signs and
symptoms similar, onset varies
• SLUDGE-BBM• Attach and
deactivate acetylcholinesterae
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Weapons of Mass Destruction (Cont’d)
Chemical agents Riot control agents
• CS and CN tear gas• CS more potent• Pepper spray
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Weapons of Mass Destruction (Cont’d)
Biological agents Different response than chemical weapons Biological agents have incubation period of
days, weeks No ground zero for response Hospital workers may be first responders Bioterrorism agent threat list
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Weapons of Mass Destruction (Cont’d)
Biological agents Anthrax
• Bacillus anthracis• Inhalation anthrax
most lethal form• Prodromal stage• Fulminant stage• Cutaneous anthrax
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Weapons of Mass Destruction (Cont’d)
Biological agents Smallpox
• Variole major• Lesions begin in
mouth• Uniform lesions
across body• Use N-95
respiratory protection
• Adequate vaccine available
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Weapons of Mass Destruction (Cont’d)
Biological agents Plague
• Yersinia pestis• Early symptoms
Fever, chills, myalgia• Pneumonic plague• Bubonic plague• Septicemic plague• Treated with antibiotics• N-95 respiratory protection required
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Weapons of Mass Destruction (Cont’d)
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Weapons of Mass Destruction (Cont’d)
Biological agents Tularemia
• Rabbit fever, deer fly fever• Rapid onset fever, chills, myalgia• Treated with antibiotics
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Weapons of Mass Destruction (Cont’d)
Biological agents Botulism
• Only toxin listed as class A biological agent by CDC• Foodborne most common type• Severe disease may lead to respiratory muscle
failure
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Weapons of Mass Destruction (Cont’d)
Biological agents Viral hemorrhagic fevers
• Ebola, Marburg, Lassa• Inordinate risk to healthcare workers• Strict infection control precautions required
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Weapons of Mass Destruction (Cont’d)
Radiological agents Simple radiological device
• Radioactive source placed in heavily populated area• Spontaneously emit ionizing radiation
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Weapons of Mass Destruction (Cont’d)
Radiological agents Radiological dispersal devices or weapons Dirty bomb Spreads radioactive material May be traumatic injuries from blast effect May cause acute radiation syndrome
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Weapons of Mass Destruction (Cont’d)
Radiological agents Signs
• 100 rads: GI symptoms, onset within hours• 600 rads: severe GI symptoms, dehydration and
death• Several 1000s of rads: neurological and
cardiovascular symptoms Bone marrow depression Leukopenia Infections
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Weapons of Mass Destruction (Cont’d)
Radiological agents Acute radiation syndrome phases
• Prodromal Acute illness Generalized flu symptoms Skin sensation changes Skin burns
• Latent Dormant period No symptoms Hours to week
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Weapons of Mass Destruction (Cont’d)
Radiological agents Acute radiation syndrome phases
• Manifest illness Severity of exposure Organs damaged
• Recovery or death
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Weapons of Mass Destruction (Cont’d)
Radiological agents Treatment
• Remove clothing if dirty bombs• Reverse isolation• Ambulance ventilation• Notify ED en route
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Weapons of Mass Destruction (Cont’d)
Nuclear devices Physical effects
• Blast• Thermal radiation• Nuclear radiation
Air burst• Detonates below 30 km• Fireball does not touch ground• Significant initial radiation hazard
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Weapons of Mass Destruction (Cont’d)
Nuclear devices Surface burst
• Detonates on or slightly above ground• Fireball touches surface• Radioactive fallout hazard downwind
Subsurface burst• Detonates below ground surface• Heavy local fallout
High-altitude burst• Detonates above 30 km• Creates intense electromagnetic pulse
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Weapons of Mass Destruction (Cont’d)
Explosive agents Terrorists weapons of choice Readily available instructions and material Primary blast injury Secondary blast injury Quaternary blast injuries Quinary blast injuries
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Weapons of Mass Destruction (Cont’d)
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Chapter Summary
Response to a disaster tests every part of the EMS system; mandate that paramedics use skills usually practiced only in drills and exercises
Response to a natural disaster may force medical personnel to operate for extended periods in an austere environment
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Chapter Summary (Cont’d)
Response to technological disasters may place the paramedic in an unsafe situation
Threat of WMD is always present Responders must be able to recognize
events and respond appropriately
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Chapter Summary (Cont’d)
Responders should have a working knowledge of different types of WMD expected to be used
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Questions?
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