Chapter 8. Emergency Situations and All-Hazards Preparation

can enter the body through the re- spiratory tract or can be absorbed through the mucous membranes, eyes, skin, or open wounds

Biological agents

is the intentional use of infectious agents, or germs, to cause illness. Health care facilities may be the initial site for recognition and response to

Bioterrorism

are often not thought of as a natural disaster. The storms bring life-threatening cold temperatures, low visibility, and dangerous driving conditions.

Winter storms

A popular system of triage is "Simple Triage and Rapid Treatment__________". ___________ uses four categories in which to place patients

start

This is communicating information to the public as quickly and accurately as possible about the disaster. Questions from the media and public should be referred to the public information officer (PIO)

Risk communication with the public

A patient who exhibits any of the following may be in danger of cardiac arrest:

-chest pain -unstable blood pressure -tachycardia -cardiac dysrhythmias -respiratory changes -hypovolemia -laryngospasm

Indications of Emergency Situations

-difficulty breathing -chest pain -changes in skin color -changes in vital signs -open bleeding wounds -inability to move an extremity -misshapen/misaligned body part -disorientation or confusion -severe headache (cephalagia)

Chemical Decontamination procedure:

-remove clothing -skin and wounds decontaminated with 0.5% sodium hypochlorite and irrigated with normal saline

The depth of compression for infants is approximately______ and ________ in adolescents

1 1/2 in 2 in

The new concept of "push hard, push fast" is to be applied to CPR. The recommendation is at least ____________per minute

100 compressions

The depth of compression for adults has changed from a depth of 1 1⁄2 to 2 in. to a consistent depth of

2 inches

When two or more rescuers are available, it is recommended to switch chest compressors every_______, or about every_________ of compressions and ventilations. The switch should be made in less than___________

2 minutes 5 cycles 5 seconds

The ratio of chest compressions to rescue breaths for infants, adolescents, and adults is still

30:2

The ratio for chest compressions to rescue breaths for newborns is still_________ If the arrest is due to a cardiac etiology, the ratio should be_________

3:1 15:1

Clinical death begins the moment heart action and breathing stop; the patient has only_________, before the cells of the brain begin to deteriorate

4-6 minutes

When an advanced airway is in place during two-person CPR, one breath is given every__________ without attempting to synchronize between chest compressions (this works out to 8 to 10 breaths per minute).

6-8 seconds

is an exaggerated allergic reaction to a substance or protein. Among the substances most likely to cause reaction are drugs such as local anesthetics, codeine, antibiotics, animal-derived drugs such as insulin, contrast media, and in some cases the latex found in many surgical supplies.

Anaphylactic reaction

A change in the sequence of BLS from A-B-C to:

C-A-B.

Individuals who wish to be a member of ___________ complete training through an agency such as the fire or police department; they are trained in all-hazards preparation and basic response such as fire safety, basic first aid, and search and rescue.

CERT

are a life-threatening event that can cause severe damage to the environment. Chemicals can be flammable, toxic, and/or caustic. Chemicals can cause permanent respiratory tract damage, skin burns, and diseases and permanently damage the eyes

Chemical

The initial treatment of the patient contaminated with a chemical agent is removal of the clothing. The skin and wounds are decontaminated with 0.5% sodium hypochlorite (household bleach; one part bleach mixed with nine parts water) and thoroughly irrigated with normal saline. The solution is contraindicated for use on brain and spinal cord wounds, the eyes, and the peritoneal cavity.

Chemical decontamination procedure

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 15F.

Heat index

The 2010 guidelines stress immediate activation of the ERS and starting of:

Chest Compressions

A triage tag is attached to the patient and treatment is based on the color and information written on the tag

DIME (Delayed, Immediate, Minimal, Expectant)

Minor-Green Tag Delayed—Yellow Tag Immediate—Red Tag Expectant—Black Tag

DIME triage categories

Airway is patent. Bleeding has been treated and controlled. Patient is physiologically stable. Injuries may be serious, but transport can be delayed.

Delayed—Yellow Tag

Specialized teams that can be rapidly deployed to the emergency scene to supplement the local HCPs in caring for victims. Surgical technologists are members of DMATs. The surgical technologist who has completed additional training in first aid, starting IV lines, CPR/BLS, and other emergency care is used on a DMAT

Disaster Medical Assistance Teams (DMATs)

Three of the more well- known specialty teams are:

Disaster Medical Assistance Teams (DMATs) Disaster Mortuary Operations Response Team (DMORT) National Pharmacy Response Teams (NPRTs)

Team members include medical examiners, pathologists, radiographers, and dental assistants who aid in recording the identification of victims

Disaster Mortuary Operations Response Team (DMORT)

is a pathological process in the body that occurs when blood begins to coagulate within the body. The body's blood clotting mechanisms are activated throughout the body instead of being localized to a specific area of injury.

Disseminated intravascular coagulation (DIC)

Each state has an _____________ system to preregister health professional volunteers who can respond to an emergency within their state and out of state. The volunteers are deployed through the Emergency Management Assistance Compact (EMAC), an interstate agreement to coordinate the deployment of medical supplies and equipment, and health care volunteers

ESAR-VHP

is the first-line drug in the treatment of a severe anaphylactic reaction

Epinephrine

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.

Expectant—Black Tag

is the lead federal agency during a nationally declared emergency and coordinates providing treatment to victims and food and shelter at the emergency scene

Federal Emergency Management Agency (FEMA)

Personal responsibilities in responding to an emergency Departmental role in the health care facility Chain of command Knowledge of the health care facility's signals and codes to indicate there is an emergency and the type of emergency and signals/codes used during the emergency Procedure for how supervisors will communicate to HCPs that the EAP is activated Communication procedures with HICS and between health care facility departments

HCP responsibilities: The HCP should be familiar with the following

Health care facilities have an emergency action plan (EAP similar to an EOP) that follows state and federal emergency response guidelines as required by The Joint Commission.

Health Care Facility Emergency Response

Muscular pains and spasms due to activity; often first sign/reaction by the body to the heat.

Heat cramps

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, thus reducing blood flow to the vital organs

Heat exhaustion

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

Heat stroke

The Joint Commission and federal standards require health care facilities to establish an HICS that has a chain of command that specifies the roles of HCPs. HICS allows the health care facility to work efficiently with other health facilities and responding agencies

Hospital Incident Command System (HICS)

The guidelines now emphasize a "chain of survival" that includes:

Immediate recognition of cardiac arrest and activation of the emergency response system (ERS). Early CPR that emphasizes chest compressions. Rapid defibrillation. Effective advanced life support. e. Integrated post-cardiac arrest care.

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 recategorized 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.

Immediate—Red Tag

Management system set up by LEMA to coordinate the response to a disaster; ensures all responders know their roles and duties, and whom to report to. has a structure in order to prevent confusion and establish a single person who is in charge. The charge person is the Incident Commander (IC)

Incident Command System (ICS)

include the collapse of roads, bridges, and structures. The incidents can be caused by a natural disaster such as an earthquake, flood, tornado, hurricane, or avalanche or be due to poor maintenance or poor construction.

Infrastructure incidents

initially requests federal assistance through the state government. The governor forwards the request to the president that a federal disaster be declared, which is called a presidential declaration

LEMA

Enacts the NRF; responsible for sending medical equipment, supplies, and teams to the disaster scene. Also assists with the transportation needs (e.g., transport injured and sick patients to hospitals)

National Disaster Medical System (NDMS)

Community agency that has the lead responsibility for managing and coordinating local agencies (e.g., fire department, EMS, police, public health department) in response to an emergency. is responsible for activating the Emergency Operations Center (EOC); the location of the EOC is predetermined and communicated in the EOP. a local emergency operations plan (EOP) is developed.

Local Emergency Management Agency (LEMA)

The response to a disaster situation is divided into the local and federal responses. Local governments bear the burden of primary responsibility of responding to an emergency

Local/Community/Regional Response

refer to transportation accidents and acts of terrorism or industrial incidents. are chemical or radiation release, explosion, infrastructure incidents, transportation accidents, and terrorism.

Man-made disaster

"Walking wounded." Minor injuries—sprains, minor cuts. Self-care. Patient is physiologically stable and will remain so

Minor-Green Tag

Identification of hazards located in the community and plans to prevent emergencies as well as reduce the dangers.

Mitigation

The EAP must address the following components:

Mitigation Preparedness Response Recovery Hospital Incident Command System (HICS) HCP responsibilities: The HCP should be familiar with the following

During a disaster situation, HCPs must make quick decisions on how to treat a patient and carry forward with the treatment plan. However, as previously men- tioned, HCPs will be faced with difficult decisions based on limited medical resources and supplies and using those resources to benefit the largest number of people possible

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

Team members are pharmacists and pharmacy technicians who dispense drugs and provide vaccinations to the population within the disaster area.

National Pharmacy Response Teams (NPRTs)

Guide for coordinating the disaster relief activities by government agencies, private sector, and nongovernment agencies when a presidential declaration has been made.

National Response Framework (NRF)

are unfortunately the most commonly occurring type of disasters that can affect large populations.

Natural Disaster

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

Nerve agents

Research the recommended emergency procedures provided by local disaster management and public health agencies. Create a family emergency plan for each type of emergency. Confirm children know the purpose of 911 and when to use it. Adults should be familiar with health care insurance, disability insurance, life insurance, and homeowners' insurance plans. Family members who are old enough should obtain certification in BLS/CPR (infant, adolescent, and adult) and first aid.

Personal Disaster Planning

is a temporary site for providing vaccines and medicines to a large population, called mass prophylaxis

Point of distribution (POD) site

Includes development of an EAP and establishing the health care facility EOC

Preparedness

injuries in the civilian population will most likely occur due dispersal device referred to as a "dirty bomb" or because of a nuclear power plant accident.

Radiological

Clothing should be removed as soon as possible; up to 90% of the radiological contamination will be eliminated with removal of the clothing, which should be placed in a sealed waterproof and vapor-resistant bag. If the victim has any wounds, those should be first addressed by thoroughly irrigating with normal saline. Intact skin and hair should be decontaminated with warm water and soap

Radiological decontamination procedure

Activities performed to aid the community in returning to as normal as possible, such as rebuilding structures and homes, rebuilding the infrastructure, and restoring the local and regional health care system.

Recovery

Preparations before the emergency event and actions during and after the event

Response

are administered to stabilize mast cells and slow or stop the chain of events that caused the reaction.

Steroids

Centers for Disease Control and Prevention (CDC) storage of medications and vaccines that are divided into push packs; push packs are containers with the medications and vaccines that can be quickly shipped to the disaster scene.

Strategic National Stockpile (SNS)

is defined by the U.S. Department of Defense Dictionary of Military and Associated Terms as "the unlawful use of violence or threat of violence to instill fear and coerce governments or societies is often motivated by religious, political, or other ideological beliefs and committed in the pursuit of goals that are usually political" (Department of Defense, 2010)

Terrorism

are infrequent but tend to remain in the minds of people due to their large scope of injuries and fatalities

Transportation accidents

is the process of sorting victims according to their injuries and physiological status in order to maximize the medical resources that are available. A separate triage area should be established in the treatment area or close to the scene of the disaster. Once the victims arrive at a health care facility, they may be triaged a second time

Triage of victims

"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

Vesicants

is an all-encompassing term that refers to the many different emergencies. "Emergencies" are defined as those that require the emergency response of outside assistance, which may be at the local, county, state, or federal levels

all-hazards preparation

What is AED?

automated external defibrillator

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; fatal pulmonary edema develops during 2- to 24-hour period.

choking agents

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

cold zone

Among the more powerful natural disasters are _________ that produce an incredible amount of energy when two portions of the earth's crust slide by one another (one portion on top and the other below) along a fault line. The energy travels outward from the epicenter in seismic waves, causing a violent shaking of the ground are measured on the Richter scale:

earthquakes

The following is a summary of local response agencies, chains of command, and how a local __________ is developed

emergency operations plan (EOP)

There are a number of ways ___________ occur, such as bombs and other weapons of mass destruction, various types of factory explosions, gas tank explosions, and explosions inside mines. have the potential to injure all body parts, challenging HCPs in determining the injuries that require immediate treatment to preserve the life of the patient (life over limb)

explosions

is defined as an extended period of abnormally hot weather that may be accompanied by high humidity. are also dangerous because the heat taxes the human body beyond its normal abilities. Infants, adolescents, and elderly, obese, or chronically ill people have the highest percentage of being victims of a

heat wave

Central area where the disaster occurred. Pa- tient is quickly assessed for airway patency and severe hemorrhage.

hot zone

Triage of chemical and nuclear disaster victims requires a separate system of triage in order to contain the contamination. The patients are triaged three times:

hot zone warm zone cold zone

are large storms that produce heavy amounts of rain, storm surges, and high winds. HCPs will be treating fractures, lacerations, and head and eye injuries due to falling trees, flying debris, and collapse of structures; burns and electrical shock due to fallen electrical wires; and providing resuscitation efforts for drowned individuals.sustained wind speed is 74 mph

hurricane

DIC may be stimulated by the fol- lowing factors:

infection of the blood by bacteria or fungus Severe tissue trauma (e.g., head injury, shock, or burns) Leukemia or cancer Severe liver disease Recent blood transfusion reactions Obstetric complications The prognosis for patients is often poor and depends on the underlying cause of the disorder.

A patient suffering an anaphylactic attack generally first shows only mild inflammatory symptoms such as

itching, swelling, and difficulty breathing

is a life-threatening, acute pharmacogenic disorder, developing during or after anesthesia. usually triggered by an anesthestic agent, such as halothane, enflurane, or isoflurane, and may be triggered by muscle relaxants such as succinylcholine. is also characterized by a rapid increase in body temperature, unexplained tachy- cardia, unstable blood pressure, muscle rigidity, tachypnea, and cyanosis.

malIgnant hyperthermIa

The treatment for DIC involves determining the underlying cause of the disorder and providing appropriate measures. The patient with DIC may receive a transfusion of fresh-frozen___________ to replace the coagulation factors. Cryoprecipitate may be initiated if fibrinogen is extremely low

plasma

The role of the surgical technologist in this situation is to__________________ from contamination during the resuscitation efforts

protect the sterile field

is an intense thunderstorm accompanied by sustained high wind speeds, but not as high as a hurricane; to be classified as a tropical storm the winds must be between 39 and 73 miles per hour (mph).

tropical storm

A serious earthquake can cause the formation of a_________ is an immense wave of incredible force that can travel for many miles before dissipating. The coastal areas of countries are most vulnerable and in the United States, the states that border the Pacific Ocean are vulnerable can also be caused by the underwater eruption of a volcano

tsunami

Triage zone 300 ft or more from the hot zone. Patients are quickly triaged into the four categories.

warm zone