Emergency Management

Learning Objectives

  • Disaster
  • Mass Casualty Triage
  • Bioterrorism
  • First Response

Disasters & Mass Casualty Events

  • Categories of disasters:
    • Warfare
    • Terrorism
    • Natural Disasters
    • Airplane crashes
    • Toxic substance spills
    • Infectious disease outbreaks

Mass Casualty Event (MCI)

  • Defined as any event that results in a large number of casualties.
  • Resources available for treatment of survivors become scarce.
  • Philosophy: The greatest good for the greatest number.

Disaster Types

  • Disaster types correlate with the anticipated duration of the incident and the required resources for response:
    • Type 1 & 2: National and State Level
    • Type 3: State or Metropolitan Area Level
    • Type 4: City, County, or Fire District Level
    • Type 5: Local Village and Township Level

Federal, State, & Local Response to Emergencies

  • Federal Agencies:
    • Department of Health and Human Services
    • FEMA (Federal Emergency Management Agency)
    • CDC (Centers for Disease Control and Prevention)
  • State and Local Agencies:
    • Often branches of federal agencies.
    • Office of Emergency Services (OES) is responsible for coordination during emergencies.

Hospital Emergency Preparedness Plans

  • Hospitals must have a coordinated plan for large-scale incidents, typically organized by a disaster management committee.
  • Plans should include discussions on the vulnerabilities of the area.

Emergency Operations Plan

  • Includes components like Triage, The Nurse's Role in Disaster Response, and Critical Incident Stress Management.

Disaster Triage

  • Purpose: Sort patients by priority instead of providing immediate life-saving treatments.
  • NATO (North Atlantic Treaty Organization) Triage System:
    • A widely used system involving a tagging color system: Red, Yellow, Green, Black to signify priority levels.
Triage Levels
  • Red (Immediate):
    • Injuries are life-threatening but survivable; require immediate medical intervention.
  • Yellow (Delayed):
    • Injuries are serious but treatment can wait hours; no immediate threat to life or limb.
  • Green (Minimal):
    • Minor injuries; can wait hours to days for treatment.
  • Black (Expectant):
    • Extensive injuries, low likelihood of survival; high resource consumption.

START Triage Method

  • Assess, Treat, Move On:
    • Assess whether patients can walk; use bystanders for assistance.
    • Clear criteria for determining triage color levels:
    • Respirations over 30/min or no radial pulse: Assign immediate care
    • Perfusion ≥ 2 seconds: Immediate care required.
    • Mental status unable to follow commands: Assign immediate care.
  • Follow the triage protocol based on clinical findings:
    • All Walking Wounded: Start triaging.
    • No Respirations: Position airway or assign deceased.

Recognition & Awareness of Mass Casualty Situations

  • Indicators of MCI:
    • Unusual increase in patient visits with similar complaints.
    • Clusters of patients from similar geographical locations (events, etc.).
    • Significant fatalities in generally healthy populations.
  • Report any unusual increases to the CDC.

Natural Disasters

  • Common natural disasters include:
    • Tornadoes
    • Hurricanes
    • Floods
    • Tsunamis
  • Consequences: Loss of communication, food sources, electricity, drinking water.

Weapons of Terror

  • Chemical Warfare:
    • Initiated in WWI, chemical agents used resulted in substantial non-fatal casualties.
    • Various poisonous gases were employed causing diverse effects on human health.
  • Types of Chemical Agents Used:
    • Tear Gases:
    • Agents such as ethyl bromoacetate and chloroacetone; cause severe eye irritation leading to temporary blindness.
    • Chlorine:
    • Yellow-green gas; reacts with water in lungs; can cause rapid death in high concentration.
    • Phosgene:
    • Colorless gas; causes suffocation and delayed respiratory effects.
    • Mustard Gas:
    • Yellow-brown liquid; a blistering agent leading to severe injuries.

Explosive Devices

  • Importance of bomb type to coordinate care plan for affected individuals.
  • Common types: Pipe bombs (may include nails or bearings) and dirty bombs (radioactive substances).

Phases of Blast and Associated Injuries

  • Primary Phase: Pressure wave injuries.
  • Secondary Phase: Injuries from debris.
  • Tertiary Phase: Injuries from being thrown by the pressure wave.
  • Quaternary Phase: Exacerbation of pre-existing conditions due to blast force.

Physical Injuries from Blasts

  • Blast Lung: Injury resulting from the blast wave.
  • Tympanic Membrane Rupture: Most common injury post-blast.
  • Hollow Organ Damage: Abdominal hemorrhage and concussions are prevalent.
  • Special Populations Vulnerabilities:
    • Older adults may face fractures; pregnancy increases risk of placental abruption.

Biologic Weapons

  • Can spread diseases; dangerous and easily obtainable.
  • Effective management requires knowledge of the agent and decontamination procedures.
Anthrax (Bacillus anthracis)
  • Odorless and invisible; transmitted through contact or inhalation.
  • Infection can occur miles away from the release site.
  • Treatment involves antibiotics like Penicillin V, erythromycin, gentamicin, or doxycycline.
Smallpox
  • Highly contagious, ceased vaccinations in 1972; last cases in 1977.
  • Symptoms include fever and rash; isolation and sanitation are critical in outbreak management.

Treatment Protocols for Smallpox

  • Supportive care, isolation, vaccination of contacts, and proper disposal of biological waste recommended.
Nerve Agents
  • Include substances like Sarin and VX; considered highly toxic and dispersible.
  • Symptoms encompass cholinergic crises including GI disturbances and respiratory failure.
Treatments for Nerve Agents
  • Priority on decontamination; administer Atropine for symptoms and Diazepam for seizures.

Nuclear Radiation Exposure

  • Can occur via an explosive device; involves alpha, beta, and gamma particles.
  • Key factors: time, distance, and shielding.
Safety During Radiological Events
  • Decontamination procedures and PPE protocols are essential.
  • Patients should be triaged outside of hospital settings; effective washing is crucial.
Radiation Exposure and Survivability
  • Three categories of survivability: Probable, Possible, Improbable, based on initial symptoms and treatment response statistics.

Critical Incident Stress Management

  • Designed to prevent emotional trauma in emergency responders.
  • Involves education, field assistance, defusing, and debriefing processes to address psychological impacts.

Conclusion

  • Emphasis on teamwork, critical preparation, and effective management are key in emergencies.
  • Ongoing evaluations and updates of disaster plans essential for maintaining readiness.