All-Hazards Preparation

All-Hazards Preparation

• All-encompassing term – Refers to many different emergencies

• Emergencies– Those that require the emergency response of

outside assistance, which may be at the local, county, state, or federal levels

• Emergency preparedness– Action taken by individuals, governments, and

health care facilities and systems to be prepared for an emergency

Natural Disasters

• Most common occurring type of disasters that can affect large populations– Avalanches– Rock and land slides– Winter storms– Heat waves and wildfires– Earthquakes and tsunamis– Tropical storms and hurricanes– Floods and tornados

Terms Related to Heat Wave• Heat index: Number in degrees Fahrenheit

that tells how hot it feels when relative humidity is added to the air temperature. Exposure to full sunshine can increase the heat index by 15oF

• Heat cramps: Muscular pains and spasms due to activity; often first sign/reaction by the body to heat

Terms Related to Heat Wave (cont’d)

• Heat exhaustion: Due to exercising or working for a period of time in a hot, humid place and body fluids are lost at a great rate through sweating without replacement. Mild form of shock because the body increases the blood flow to the skin, reducing blood flow to the vital organs.

Terms Related to Heat Wave (cont’d)

• Heat stroke: A life-threatening condition where the patient’s internal temperature control system stops working. The body temperature can rapidly increase, causing neurological damage as well as leading to death if not immediately treated.

Richter Scale

• <3.5 = Earthquake may be felt, but not recorded by a seismograph

• 3.5-5.4 = Earthquake felt; rarely causes damage

• <6.0 = Slight damage to well-designed, earthquake-resistant buildings, major damage to poorly constructed buildings

• 6.1-6.9 = heavy damage and destruction up to 62 miles from the epicenter

Richter Scale (cont’d)

• 7.09-7.9 = Major earthquake that causes heavy damage and destruction over a very large area

• 8 or greater = Strongest of earthquakes, with serious damage and destruction for hundreds of miles

Hurricane Categories

• Category 1 = Sustained winds 74-95 mph• Category 2 = Sustained winds 96-110 mph• Category 3 = Sustained winds 111-130 mph• Category 4 = Sustained winds 131-155 mph• Category 5 = Sustained winds ˃155 mph

Man-Made Disasters

• Disasters caused by people– Transportation accidents – Acts of terrorism and bioterrorism – Industrial incidents– Combination natural disaster—man-made disaster– Chemical release accidents– Infrastructure incidents– Radiological injuries

Specific Chemical AgentType of Agent General Information Mechanism of Action Signs and

SymptomsNerve Agent Most toxic of known

chemical agents; often cause death in minutes due to respiratory obstruction and cardiac failure

Bind with acetylcholinesterase, thus not allowing it to act on the myoneural junction of muscles, causing paralysis of the muscles

Rhinorrhea, extreme difficulty breathing, apnea, seizure, paralysis, loss of consciousness

Specific Chemical AgentType of Agent General Information Mechanism of

ActionSigns and

SymptomsVesicants “Blister agents,”

commonly known as mustard gas

Necrosis of the epidermis, severe conjunctivitis, and if inhaled injury to the mucosal tissues of the larynx and tracheobronchial tree

Skin blisters and burning of the skin and eyes, airway injury causing difficulty in breathing, conjunctivitis that varies in severity

Specific Chemical AgentType of Agent General Information Mechanism of Action Signs and

SymptomsChoking agents Most common

agents are phosgene and diphosgene. Cause severe irritation of the upper and lower respiratory tracts.

Absorbed by inhalation. Reactions occur at the level of the alveolar-capillary membrane.

Pulmonary edema; eye, nose, and throat irritations; choking; coughing; tightness in the chest; development of fatal pulmonary edema during 2- to 24-hour period

Personal Disaster Planning

• Personal and family preparation steps– Research, identify, and familiarize yourself and

your family with the local and regional emergencies that could occur

– Create a family emergency plan for each type of emergency

– Prepare emergency supplies: go-bag and in-home supplies

Local/Community/Regional Response

• Response to a disaster situation – Divided into the local and federal responses

• Local response– National Incident Management System (NIMS)– Local Emergency Management Agencies (LEMA)– Emergency Operations Center (EOC)– Incident Command System (ICS)

Federal Emergency Response• Federal assistance – Must be requested through formal channels by the local

and state governments– Assistance will take up to three days or possibly longer

• Agencies and assistance forms– Federal Emergency Management Agency (FEMA)– National Response Framework (NRF)– National Disaster Medical System (NDMS)– Disaster Medical Assistance Teams (DMATs)– Disaster Mortuary Operations Response Team (DMORT)

Health Care Facility Emergency Response

• Health care facilities– Emergency action plan (EAP) follows state and

federal emergency response guidelines • EAP components– Mitigation– Preparedness– Response– Recovery

Popular System of Triage

• Simple Triage and Rapid Treatment– (START) uses four categories in which to place

patients– DIME (Delayed, Immediate, Minimal, Expectant)– A triage tag is attached to the patient and

treatment is based upon the color of and information written on the tag

DIME Categories• Minor – Green Tag– “walking wounded”– Minor injuries – sprains, minor cuts– Self-care– Physiologically stable and will remain so

• Delayed – Yellow Tag— Airway is patent— Bleeding has been treated and controlled— Patient is physiologically stable— Injuries may be serious, but transport can be delayed

DIME Categories (cont’d)• Immediate – Red Tag– Quick, short immediate treatment intervention can

stabilize the patient, such as establishing an airway and treating bleeding

– Treatment must be given during the “golden Hour” (within 1 hour) in order for victim to survive

– Once stabilized, the patient may be re-categorized to delayed depending on extent of injuries; if it involves head or spine injury, penetrating wound, or fracture(s), patient should be transported as soon as possible

DIME Categories (cont’d)

• Expectant – Black Tag– Injuries are so extensive patient is not expected to

survive; use of medical resources is not advisable in order to use for the other three categories of patients

– Victim is made as comfortable as possible and pain relief given

Triage of Chemical and Nuclear Disaster Victims

• The patients are triaged three times:– Hot zone: Central area where the disaster occurred.

Level A PPE should be worn. Patient is quickly assessed for airway patency and severe hemorrhage

– Warm zone: Triage zone 300 feet or more from the hot zone. Patients are quickly triaged into the four categories

– Cold zone: Triage zone near the warm zone where patients are evaluated for injuries secondary to severe injuries and transported to a facility

Medical Office EAP

• Should be developed based on the community EAPs – Coordinated with the local and regional health

care system• Components– Procedures for notifying employees of an

emergency– Procedures for evacuating the building– Patient evacuation procedures

Immediate Response to an All-Hazards Event

• Important considerations– Disaster scene must be safe before entering– Standard Precautions and personal protective

equipment – Patient decontamination area– Triage of victims– Point of Distribution (POD) site– Risk communication with the public

Immediate Response to an All-Hazard Event (cont’d)

– Moral, ethical, and legal issues associated with providing care during a disaster

– Emergency System for the Advanced Registration of Volunteer Health Professionals (ESAR-VHP) and Community Emergency Response Team (CERT)