EMERGENCY PREPAREDNESS

CLINICAL PREPAREDNESS

• Biological Agents• Chemical Weapons• Radiological/Radioactive Agents• Disaster Nursing• Levels of Disaster• Triage

Biological Agents

• Four top agents for potential bioterrorism:– Anthrax- durable spore that lives in the soil

• Transmitted by inhalation, contact with spore, or ingestion of contaminated food

• S/S include: flu-like symptoms, respiratory failure, hemodynamic collapse, localized itching leading to papular lesion that develops black eschar in 2-6 days, abd pain, N&V, fever, bloody diarrhea, emesis

• Vaccine available• Standard isolation precautions until client is sick, then no person to

person transmission– Botulism- transmitted by ingestion of toxin, manmade aerosols

• S/S include: drooping eyelids, weakened jaw clench, difficulty speaking or swallowing, blurred vision, double vision, arm paralysis followed by respiratory and leg paralysis, respiratory depression

• Vaccine available, type specific• No isolation precautions

Biological Agents

– Plague- most likely to be aerosolized in terrorist event• S/S include: fever, cough, chest pain, bloody sputum,

bronchopneumonia• No proven vaccine• Droplet isolation precautions

– Smallpox- Transmission person to person• S/S include: prodrome of fever, myalgia, vesicles on distal

limbs• Vaccine created in 1700s. Eradicated in 1979 • Droplet precautions

Chemical Weapons

• Nerve agents(aka organophosphate esters) are the most likely to be implemented among all chemical agents, and they are also the most incapacitating and severe.– Muscarinic and Nicotinic effects:

• Initial: rhinorrhea, salivation, miosis and headache• Severe poisoning: bronchospasm, vomiting, incontinence, muscle

fasciculation, convulsions, respiratory failure, death.• Antidote: Atropine at high doses and pralidoxime

• Choking Chemical Agents– Chlorine gas and Phosgene

• S/S: ocular, nasal, and respiratory irritation, cough, suffocation

Radiological and Radioactive Agents

• Dirty Bombs-radioactive dispersal device that combines an explosive with a radioactive material.– Major concern in the hospital setting are clients coming

in contaminated with a radioactive material. PPE essential.

– Acute Radiation Syndrome- illness caused by irradiation of the entire body or most of the body by a high dose of penetrating radiation in a very short period of time.• See Table 26-2 for signs and symptoms

Disaster Nursing

• Implementation of the public health levels of prevention– Primary public health prevention focuses on preparedness.

Nursing responsibilities include knowledge of the disaster plans of the community and the facility and educating clients on disaster kits and family emergency response plans.

– Secondary public health prevention focuses on response. Nursing responsibilities include efficient execution of nursing practice while maintaining professionalism and metal support to the afflicted community and clients.

– Tertiary public health prevention focuses on recovery. In this stage the nurse must learn to cope with sudden losses of personnel and clients as well as managing the mental health issues in individuals related to the disaster.

Levels of Disaster

• Level I – Working with local emergency medical systems. (auto accidents, house fires)

• Level II – Working with regional agencies, state health and emergency management agencies (train derailments, building collapses, tornadoes)

• Level III – Working with local, state, and federal resources (earthquakes, hurricanes, and tsunamis)

Triage• The core concept that ED nurses face in natural disasters brought to wide

attention by the California emergency medical services in response to the earthquakes in the 1990s. – The START system: simple method of triage that divides injured persons into four

separate groups.• Deceased(Black): injured persons who are beyond the scope of medical assistance. Tagged

deceased only if not breathing and attempts to resuscitate have been unsuccessful.• Immediate(Red): injured persons who can be assisted or their health aided by advanced

medical care immediately or within one hour of care.• Delayed(Yellow):injured persons who can be assisted after immediate persons are medically

cared for first. Delayed persons are medically stable but require medical assistance.• Minor(Green): injured persons who can be assisted after immediate and delayed persons

have been medically attended to. Persons tagged minor will not need medical care for at least several hours and can usually walk with assistance.

– The triage leader must consider bed availability issues for optimal utilization of resources to provide safe care to all clients.

Public Health Preparedness and Administrative Efforts

• Health Resources and Services Administration (HRSA)• Hospital Emergency Incident Command System (HEICS)• National Incident Management System (NIMS)• National Preparedness Goal-aims to develop and maintain the

capabilities to prevent, protect against, respond and recover from major events:– Interoperable communication systems– Bed tracking system– Emergency System for Advance Registration of Volunteer Health

Professionals (ESAR-VHP)– Facility management plans– Hospital evacuation plans

Community Health Nurse Issues• Epidemiological Aspects

– Epidemiologists and infection control nurses must:• Recognize and act upon rapid determination that an unusual event has occurred.• Perform surveillance for additional case identification and tracking, prevent the disease via intervention methods.

– Two major clues of a biological terrorism has occurred are a clear differential diagnoses and the formation of an epidemiological curve.

See Box 26-2 for more clues that signal a biological event. • Syndromic Surveillance

– Applies health related data such as trends in client symptomology or disease presentation that precedes clinical diagnosis and can indicate a substantial probability of an outbreak that would warrant further investigation and public health response. Examples of data collected include:• ICD-9 codes• Chief complaint• Frequency of antibiotic and prophylactic therapy

– Key Concepts of Successful Syndromatic Surveillance:• Timelines of reporting data• Validity and quality of data• System Experience

– Example of System: Outbreak Management System

• Strategic National Stockpile– CDC stores large quantities of medicine and medical supplies in the

United States in preparation for public health emergencies. This stockpile consists of antibiotics, chemical antidotes, antitoxins, airway maintenance supplies, and other medical equipment. Will be delivered to any state or U.S. territory within 12 hours.

• CHEMPACK– A federal program designed to supplement the medical response in the

event of a chemical nerve agent release, specifically targeted to organophosphates. These CHEMPACK containers are stored in geographically strategic locales, and possess EMS and hospital caches. They contain items like chemical antidotes, atropine injectors, PAM kits, diazepam, and sterile water.

• Other Emergency Resources– The Emergency System for Advance Registration of Volunteer Health

Professionals– Medical Reserve Corps– Disaster Medical Assistance Teams

Community Preparedness Issues

• The National Response Framework See Figure 26-2

• Three critical components of preparedness for the community health nurse are:– Mental health preparedness– Family/individual preparedness– Business preparedness

Disaster Mental Health

• Traumatic events effect those who witness the event, as well as survivors, rescue workers, and friends and relatives of victims.

• Nurses should be aware of the onset of psychological reactions in persons suffering from disaster mental health symptomology. (See table 26-3)

• (Guidelines for the community health nurse responding to clients after a disaster are listed on pages 583-585.)

Individual and Family Preparedness Issues

• The development of family communications and evacuation plans should include:– Recognizing potential disasters in the family’s community– Primary and secondary meeting places in the event of

evacuation– A designated emergency contact person that is out of the

area in case the disaster overwhelms local communication resources

• Disaster Preparedness Kit– A list of recommended items to include in a basic

emergency supply kit are listed in box 26-3