Chapter 66ems.jbpub.com/aehlert/paramedic/docs/PPT_Lectures/Chapter_066.pdf · Introduction...

9/10/2012

1

1

Chapter 66

Disaster Response andDomestic Preparedness

2

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

3

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

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

9/10/2012

2

4


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

5


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

6


Describe blast injuries and human responses


9/10/2012

3

7

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

8

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

9

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


9/10/2012

4

10


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

11


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

12


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


9/10/2012

5

13


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

14


15

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


9/10/2012

6

16

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

17


18


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


9/10/2012

7

19


Incident command system (ICS) Concepts

• Common terminology• Command post operations• Unified command• Consolidated response plan• Span of control• Integrated communications• Staging area

20


21

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


9/10/2012

8

22

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

23

Natural Disasters (Cont’d)

Floods Drowning primary cause of death Trauma from floating debris Secondary illness from contaminated water

24

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


9/10/2012

9

25

Weapons of Mass Destruction

Chemical agents Blood agents

• Chemicals enter body, inhibit cellular use of O2

• Hydrogen cyanide (AC)• Cyanogen chloride (CK)

26

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

27


Chemical agents Pulmonary agents

• Responders should fear most• Easy to obtain• Choking agents• Attack lungs and lung tissue


9/10/2012

10

28



• 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

29



• Chlorine Greenish-yellow gas or amber liquid with pungent odor Two times heavier than air Highly volatile, nonpersistent Strong oxidizer and highly corrosive

30



• Anhydrous ammonia Used as fertilizer Refrigerant for cooling and freezing Colorless gas in lower concentrations Higher concentrations can form white cloud Volatile, persistent


9/10/2012

11

31


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

32


Chemical agents Vesicants

• Liquid or vapor• Presentation hours after exposure• No antidote• Care is supportive• Decontamination is critical

33



9/10/2012

12

34


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

35


Chemical agents Riot control agents

• CS and CN tear gas• CS more potent• Pepper spray

36


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


9/10/2012

13

37


Biological agents Anthrax

• Bacillus anthracis• Inhalation anthrax

most lethal form• Prodromal stage• Fulminant stage• Cutaneous anthrax

38


Biological agents Smallpox

• Variole major• Lesions begin in

mouth• Uniform lesions

across body• Use N-95

respiratory protection

• Adequate vaccine available

39


Biological agents Plague

• Yersinia pestis• Early symptoms

Fever, chills, myalgia• Pneumonic plague• Bubonic plague• Septicemic plague• Treated with antibiotics• N-95 respiratory protection required


9/10/2012

14

40


41


Biological agents Tularemia

• Rabbit fever, deer fly fever• Rapid onset fever, chills, myalgia• Treated with antibiotics

42


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


9/10/2012

15

43


Biological agents Viral hemorrhagic fevers

• Ebola, Marburg, Lassa• Inordinate risk to healthcare workers• Strict infection control precautions required

44


Radiological agents Simple radiological device

• Radioactive source placed in heavily populated area• Spontaneously emit ionizing radiation

45


Radiological agents Radiological dispersal devices or weapons Dirty bomb Spreads radioactive material May be traumatic injuries from blast effect May cause acute radiation syndrome


9/10/2012

16

46


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

47


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

48


Radiological agents Acute radiation syndrome phases

• Manifest illness Severity of exposure Organs damaged

• Recovery or death


9/10/2012

17

49


Radiological agents Treatment

• Remove clothing if dirty bombs• Reverse isolation• Ambulance ventilation• Notify ED en route

50


Nuclear devices Physical effects

• Blast• Thermal radiation• Nuclear radiation

Air burst• Detonates below 30 km• Fireball does not touch ground• Significant initial radiation hazard

51


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


9/10/2012

18

52


Explosive agents Terrorists weapons of choice Readily available instructions and material Primary blast injury Secondary blast injury Quaternary blast injuries Quinary blast injuries

53


54

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


9/10/2012

19

55

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

56

Chapter Summary (Cont’d)

Responders should have a working knowledge of different types of WMD expected to be used

57

Questions?


Chapter 66ems.jbpub.com/aehlert/paramedic/docs/PPT_Lectures/Chapter_066.pdf · Introduction...

Documents

Transcript of Chapter 66ems.jbpub.com/aehlert/paramedic/docs/PPT_Lectures/Chapter_066.pdf · Introduction...