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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 $%ent
CDC classi"ication o" potential biological
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CDC classi"ication o" potential biological
agents
Category A
*hey can be easily spread or transmitted "rom
person to person
*hey result in high death rates and ha)e thepotential "or major public health impact
*hey might cause public panic and social disruption
*hey re3uire special action "or public healthpreparedness1
CDC classi"ication o" potential biological
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CDC classi"ication o" potential biological
agents
Category B
*hey are moderately easy to spread
*hey result in moderate illness rates andlo# death rates
*hey re3uire speci"ic enhancements o"
cdcUs laboratory capacity and enhanceddisease monitoring1
CDC classi"ication o" potential biological
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CDC classi"ication o" potential biological
agents
Category C
*hey are easily a)ailable
*hey are easily produced and spread
*hey ha)e potential "or high morbidity and
mortality rates and major health impact
Category A
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Bacillus anthracis$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
&re%ention 'reatment
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
&re%ention 'reatment
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
&re%ention 'reatment
Faccination #ithin < days
Faccinia prophyla6is#ithin 2?7 days
808%VVVVVV
!rancisellar tularensis
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!rancisellar tularensis
&re%ention 'reatment
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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=