EM E1: Disaster Preparedness

What is a hospital disaster?

ANY event that overwhelms the resources of the receiving hospital -ED cannot offer even minimal care w/o assistance

What is an external disaster?

events that occur physically outside the hospital, but impact them d/t influx of pts

hospital & its staff, patients, and visitors are in no immediate physical danger

(bombings, mass shootings, mass accident)

What is an internal disaster?

events that occur within the physical plant of the hospital itself that severely compromise the ability of the hospital, affecting operations and capacity to provide care

(fire, bomb scare, lab accident, power failure)

Biological agents are classified into what 2 groups?

Infectious agents & Biologically produced toxins

What classification of biological agents:

Contagious- propagating person to person

(smallpox, anthrax, plague)

Infectious agents

What classification of biological agents:

Chemical agents

(sarin gas, mustard gas)

Biologically produced toxins

What class of agent:

Highest risk to national security, most severe potential

Class A

What biologic agents are Class A?

Variola major (Smallpox), Bacillus anthracis (Anthrax), Yersinia pestis (Plague), Clostridium botulinum (Botulism)

What class of agent:

Moderately easy to disseminate, less potential for causing widespread illness and death

Class B

What biologic agents are Class B?

West nile virus, Hepatitis A, Ricin toxin, Salmonella, E. coli

What class of agent:

as technology improves, could emerge as future threats

Class C

What biologic agents are Class C?

Influenza, SARS, Rabies, MDR-TB, Yellow fever (arbovirus), Tickborne hemorrhagic fever

What is the causative agent of smallpox?

Variola virus

Which form of smallpox produces a more serious illness w/ a higher mortality rate?

variola major

How does smallpox present?

sudden high fever, severe HA, backache, malaise → lesions on the mucous membranes (enanthem) → rash involving the extremities, trunk, and face (exanthem)

What is the risk of mortality in smallpox closely linked to?

severity of the rash

What are complications of smallpox?

secondary bacterial infections of skin, keratitis corneal ulcerations, encephalitis

What tests are available for smallpox?

PCR or electron microscopy (virions have brick shape)

What is the mainstay tx of Smallpox?

Supportive, Tecovirimat

In the event of smallpox exposure, what may reduce the severity of disease?

immediate vaccination

What are the 3 major anthrax syndromes?

Cutaneous, inhalation, and GI tract

What tests can be done for Anthrax?

CT chest: infiltrations, LAD, effusions, mediastinal widening

Lumbar puncture: if meningitis suspected → grossly hemorrhagic w/ neutrophils and bacilli

Where do over 90% of cutaneous anthrax lesions occur?

exposed areas -face, neck, arms, hands

How does Anthrax present?

small, painless, pruritic papule → quickly enlarges, develops central vesicle/bulla, → erosion, leaving a painless necrotic ulcer with a black, depressed eschar

systemic: fever, malaise, HA

What is the tx for Anthrax?

FQs -Cipro preferred for all strains

What are the 3 major clinical syndromes associated w/ plague?

bubonic plague, septicemic plague, pneumonic plague

What is the MC form of plague?

Bubonic plague

How long is the incubation period for Bubonic plague?

2-8 days

How does Bubonic plague present?

sudden fever, chills, weakness, and HA → intense pain and swelling in a lymph node bearing area (bubo); (may be preceded by LAD)

± eschars, pustules, necrotic lesions resembling ecthyma gangrenosum

What is the most frequently involved site of the Bubonic plague?

Inguinal region

What is needed for the dx of Bubonic plague?

blood culture/smear or sputum or fluid from lymph node

What is the tx for Bubonic plague?

(high mortality rate if not tx)

Aminoglycosides (-mycin)

*Tetracyclines & Chloramphenicol may also work

How is the Anthrax vaccine given?

series of 5 shots: 0, 4, 6, 12, 18 months + yearly update shots

What are casualties?

not only poisoned, may be contaminated, may have collateral injuries

Which decontamination zone:

area of spill or chemical release, or the hospital area where arriving patients without decontamination are held

Hot zone

Which decontamination zone:

area where thorough decontamination and medical stabilization occur

Warm zone

Which decontamination zone:

area to which fully decontaminated patients are transferring

Cold zone

Where should patient decontamination ideally occur?

Outside the hospital

What level of personal protection:

fully encapsulating chemical-resistant suit and self-contained breathing apparatus

Level A

What level of personal protection:

splash protection with chemical-resistant clothing and an SCBA (self contained breathing apparatus)

Level B

What level of personal protection:

splash protection with chemical-resistant clothing and a full-faced, air-purifying canister-equipped respirator

Level C

What level of personal protection:

standard work uniform and includes firefighter bunker gear

Level D

What should be removed quickly after chemical exposure during the decontamination process?

clothing -double bag and tx as toxic waste

What is the order of decontamination?

Ocular, Wounds, Whole-body (from head to toe)

What is decontamination process for certain metals such as lithium & potassium?

pt should be wrapped in clean blankets to transfer to the cold zone

*react violently w/ water

What do you need to monitor crush injuries for?

compartment syndrome

What constitutes most injuries of explosion survivors?

penetrating trauma

What type of radiation exposure:

radioactive materials deposited on the skin (requires decontamination)

External contamination

What type of radiation exposure:

all or part of the body is exposed to a penetrating radiation source

External irradiation

What type of radiation exposure:

accidental or intentional ingestion of a radioactive source, or absorption via wounds, the lungs

*results in incorporation (uptake of radioactive material into cells, tissues, organs)

Internal contamination

Which radiation consists of heavy particles and has low penetration?

Alpha

*dangerous if inhaled

Which radiation consists of electrons or positrons and has moderate penetration?

Beta

*skin burns, harmful if ingested/inhaled

Which radiation consists of high-energy EM waves and has high penetration?

Gamma

*can penetrate body and damage internal organs/tissues

What are the biggest concerns w/ radiation exposure?

spreading contamination and risk of it getting inside the body

What is the MC radiation accident in US?

Local radiation injury

What are skin manifestations of radiation exposure?

similar to thermal burns, immediate excruciating pain, surgical resection and grafting may be required

What is acute radiation syndrome (ARS)?

predictable signs and symptoms develop when a significant portion of the body is exposed to a high level of penetrating radiation over a short period of time, typically less than 24 hours

What is the primary cause of acute radiation syndrome (ARS)?

whole body gamma dose in excess of 2 Gy (200 rad)

How long can the latent phase of ARS last before sx set in?

1-3 weeks

What are the 3 parts of the "manifest illness phase" of acute radiation syndrome (ARS)?

Hematopoietic syndrome (bone marrow sickness), GI syndrome, CV & CNS syndrome

What can alleviate sx of the prodromal phase of ARS?

zofran, anxiolytics, pain management

What is decorporation tx?

*used for ARS

reversal of cellular incorporation including blocking agents, isotopic dilution, displacement, mobilizing agents, chelation