Mass Casualty

1. Mass Casualty

2. System Notification/Activation of Emergency Preparedness • Classified disaster earthquake, tornado, accident, Terrorist attack • Notify by radio/pager • Utilize telephone tree to call staff in • INCIDENT COMMAND CENTER initiated

3. Hospital Role • Commander • Triage officer • Medical command physician

4. Debriefing • Critical Incident Stress Debriefing • 2 types • Critical Incident Stress Management • Post Traumatic Stress Disorder • Administrative Review

5. Psychological Effects After a Disaster • Provide active listening and emotional support • Provide information as appropriate • Refer to therapist or other resources • Discourage repeated exposure to media regarding the event • Encourage return to normal activities and social roles

6. Incident Command Public Information Officer Liaison Officer Safety and Security Officer Medical or Technical Officer

7. (ID the walking wounded) • Green :minor injuries • Yellow: injuries can be controlled or treated for limited time in field • Red: respirations present but minimal, multiple injuries, decreased LOC, • Black: dead or near dead…no respirations detected

8. ID ME

10. Bioterrorism

11. What is it? • Deliberate release of viruses, bacteria, or other germ agents to cause illness and/or death in people, animals, plants • The purpose is to disrupt daily life and cause terror and panic • http://www.youtube.com/watch?v=2t_MsSO9qRk

12. Terrorism • Disrupt Daily Life & Cause Terror and Panic • FBI – “the unlawful use of force or violence against person’s or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives”

13. Terrorism • International - • al Qaeda, Irish Republic Army • Domestic - • Klux Klux Klan, Greenpeace, and Individuals like Timothy McVeigh

14. Targets • Anything & Anywhere that causes large scale disruption • Large crowds/gatherings of people • Nuclear/Chemical Plants • Federal Systems • Controversial businesses (Abortion Clinics)

15. Purpose • Attract Media Attention • Increase support for Cause • Undermine the Government or Agency attacked • Influence Policy • Solely For Revenge

16. National Standards of Nursing Education • Pre-September 11, 2001 – considered unnecessary • Now Emergency and Disaster Preparedness Core Competencies for Nurses are standard and have been added to Education Curriculums • Core Competencies pg. 2386 Chart 72-2

17. Identification of Events • Weapons of Mass Destruction (WMD) • Because they cause massive destruction and injury • Incident identification can be difficult especially if delayed onset from exposure (Especially with biological agents) • Recognizing clusters-found usually by public health epidemiological methodology

18. Agent Route of Entry • Vectors – means of spreading the agent • Entry to body: • Ingestion • Inhalation • Injection • Dermal Exposure

19. Chart 72-5 pg 2389 • Hot Zone – (red zone) – the area of highest contamination, waiting to be contaminated, triage area • Warm Zone – (yellow zone) – contamination reduction corridor, where decontamination process takes place • Cold Zone – (green zone) – support zone – decontaminated

20. Isolation Precautions for Biological Terrorism Agents • Due to modern travel, spread of infection may occur in areas thousands of miles apart • Health care providers need to be aware of potential signs of biological weapon s • signs and symptoms are similar to those of common disease process • Isolation practices depend upon the infecting agent • Always use Standard Precautions • Some agents require Transmission-Based Precautions • Terminal disinfection and disposal of wastes depends on the infecting agent

21. Types • 3 major types • Biological • Chemical • Radiation • 3 minor types • Eco terrorism • Narcotic trafficking to fund terror • Cyber-attacks civilians to draw notoriety to cause

22. Biological • Documented use in the 6th century • Ex: Asyrians poisoned enemy water wells with rye ergot (a fungus that grows on rye) causing hallucinations and cardiac problems • WW2: shigella and others • French and Indian War: Smallpox • Russia 1979: Anthrax

23. Biological • 3 categories • A: high priority • easy to spread person to person • High death rate • Require special action (anthrax, botulism, plague, smallpox, hemorragic fever, tularemia) • B: second highest priority • Moderately easy to spread • Moderate illness • Low death (Salmonella, e coli, Q fever, Ricin toxin, etc) • C: third highest priority • Easy available • Easy produced • Potential for high death and major health impact (hantavirus)

24. Biological • Signs/Symptoms • Vary upon agent (example: hantavirus causes a resistent TB) • Death is result of respiratory failure, paralysis, hypovolemic shock, multi organ failure, etc http://www.bt.cdc.gov/bioterrorism/factsheets.asp

25. Biological • Possible Treatment • Isolation • Vaccines • Antibiotics

26. Chemical • Hazardous chemical released • Many are industrial • Some created by military • Some found in nature

27. Chemical Weapons • Chemicalsubstances that quickly cause injury and/or death and cause panic and social disruption • Agents: • Nerve agents • Blood agents • Vesicants • Pulmonary agents • Agents vary in toxicity • Limitation of exposure is essential with evacuation and decontamination as soon possible and as close to the scene of the incident as possible

28. Chemical • Types • Biotoxins ( poison from plant or animal) • Blister agents (lewisite, sulfar mustard, nitrogen mustard, etc) • Blood agents (hydrogen cyanide, cyanide chloride) • Caustics (acid) • Choking agents (chlorine, phosgene, etc) • Incapacitating agents • Long acting anticoagulants • Metals • Nerve agents (VG, VM, sarin, soman, etc) • Organic solvents • Riot control agents (tear gas) • Toxic alcohols • Vomitting agents

29. Chemical • Signs/Symptoms • Variable depending on agent • Examples include: cardiac arrest, seizures, death

30. Nerve Agents • Inhibit cholinesterase-causing cholinergic symptoms • loss of consciousness, seizures, copious secretions, apnea, and death • Treatment: supportive care, atropine, benzodiazepine, and pralidoxime • Decontaminate with copious amounts of soap and water or saline for at least 20 minutes • Blot; do not wipe off • Plastic equipment will absorb sarin gas

31. Vesicants • Lewisite, sulfur mustard, nitrogen mustard, and phosgene • Cause blistering and burning • Respiratory effects can be serious and cause death • Decontaminate with soap and water • DO NOT scrub • Eye exposure requires copious irrigation

32. Chemical • Possible treatment • Give antidote if available and if known agent • Administer O2 • CPR • Flush eyes • DO NOT induce vomitting • Take off clothes and wash skin immediately http://usmilitary.about.com/library/milinfo/blchemical.htm

33. Radiation • Types • Dirty bombs • Contaminating food water sources • Explosion or meltdown at nuclear plant • Exposure to radiation is affected by time, distance, and shielding

34. Radiation • Signs/Symptoms • Cancer • Death to those near site • Itching and erythema • Edema • Feel heat • Ulcers/necrosis

35. Radiation • Possible treatments • Burn unit • Possible anticoagulants • Antibiotics to prevent infection • Pain management • Corticosteroids • surgery • Pyschological support http://www.bt.cdc.gov/radiation/criphysicianfactsheet.asp

36. Radiation Decontamination • Triage outside the hospital • Cover floor and use strict isolation precautions to prevent the tracking of contaminants • Seal air ducts and vents • Waste is double bagged and put in a container labeled radiation waste • Staff protection • Water-resistant gowns, 2 pairs of gloves, caps, goggles, masks, and booties

37. Levels of PPE • A: highest level for skin, eyes, mucous membranes, and respiratory system • B: Chemical protective clothing used instead of the fully encapsulated suit • C: Full face piece with air purifier and chemical resistant clothing • D: regular clothes

38. LEVEL A LEVEL B

39. LEVEL C LEVEL D

40. Decontamination • Removal of contaminating material • Areas: • Hot Zone: highest contamination • Warm Zone: contamination reduction corridor • Cold Zone: support zone • Steps: disrobe completely, step in shower, lather completely including creases, dry off, then dress in hospital gown and go to cold zone

41. Clothing and personal items sent to FBI for evidence

42. Blast Injuries • Most severe injuries are to lungs • Other things include ear drum perforation, bowel perforation, lacerations

43. Psychological Effects After a Disaster • Provide active listening and emotional support • Provide information as appropriate • Refer to therapist or other resources • Discourage repeated exposure to media regarding the event • Encourage return to normal activities and social roles

44. National Resources(was national pharmaceutical stock pile) • Strategic National Stock Pile • Push Packs-shipped within 12 hours of the decision to deploy 4% of the stockpile • Antibiotic agents • IV/IM medications • Bulk Supplies-First Aid • Analgesics • Other Emergency Medications

45. MASS CASUALTY The point is to save as many as you can