Respiratory Care Issues in Disasters

1. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters Prepared by: CPT A. Amin, RRT, RCP and CPT W. Williams, RRT, RCP HMRG - Galveston Company

2. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Objectives - at the end of this review, the TMR should be able to demonstrate an understanding of • Common Environmental problems found in disasters that affect the Respiratory System • Common Injuries affecting Respiratory System • Common Respiratory problems found in disasters • Common Respiratory Equipment likely to be found in residences - clues to problems

3. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • What is a chronic illness? • A chronic illness is a medical problem that lasts a year or longer, limits what a person can do, and calls for ongoing care. Examples of common chronic illnesses include: • Diabetes • Chronic Obstructive Pulmonary Disease (COPD) • Heart disease • Chronic pain syndromes • Inflammatory diseases, such as rheumatoid arthritis • *More than 90 million Americans live with some form of chronic illness.

4. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters Background: Surviving a natural or man-made disaster is no small feat, especially for those who have a chronic illness. During a disaster access to health care, personal support and medication are lessened. This leaves people with chronic medical conditions at risk for serious medical complications—even to the point of death.

5. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters Background: • Data collected by the Children's Health Fund and the Columbia University Mailman School of Public Health, post Hurricane Katrina revealed the usual minor injuries, skin conditions and vaccination adminstrations. • However it also revealed high incidences of: • Diabetes • Hypertension • Asthma • CHF • COPD

6. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters Background: • The most frequent diagnoses in those individuals who had at least one diagnosis documented were: • Respiratory: • URI • Asthma • COPD • Circulatory: • Hypertension • CHF • Minor injury and Skin conditions

7. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Background: • During a disaster, access to healthcare, personal support and medication may be limited. Many problems post disaster include: • Lost medications • Loss of electrical power • Home care equipment damage/misplaced • As disaster responders, these are potential medical problems/issues that may occur and should be planned for.

8. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters Background: • As disaster medical responders, life support skills are essential. For the patient with respiratory problems, these skills include: • Physical and Environmental Assessment • Airway management • Ventilatory support • .

9. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters Background: • As disaster medical responders, we will more than likely contribute significantly to: • Stabilization and monitoring efforts • Assessment, treatment and consultation • throughout the entire medical response continuum

10. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters Environmental Issues Common Diseases of the Lung Common Injuries affecting the Respiratory Systems Common Equipment found in the residence of the patient with Pulmonary disease

11. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Environmental Issues • Water - drowning or near drowning • Dust and other airborne particulates • Humidity (too much or too little) • Mold and fungi

12. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Common Diseases of the Lung • Asthma (small airways and secretions) • Emphysema - COPD (deformed air sacks (air trapping) and secretions) • Bronchitis (large airways and secretions)

13. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Asthma • a chronic inflammatory disorder involving many cell types • manifesting with episodes of chest tightness • coughing • labored breathing and wheezing • all of which are related to bronchiole inflammation

14. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Asthma • Need to keep the airway patent (open) • Prevent collapse of the airway when exhaling to help decrease work of breathing • Why the straws?

15. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Bronchitis & Emphysema • Walls between the air sacs are destroyed (no longer grape clusters) • Airways inflamed & thickened • Copious amounts of secretions

16. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Typical injuries that can be sustained in traumatic disasters affecting respiration:Head injuries • Loss of consciousness • Upper airway injuries • facial fractures • neck injuries

17. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Facial Fractures • Nose • bridge • Jaw / mouth • displacement of jaw • inflammation of the tongue (airway closure)

18. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Neck injuries • Cervical injuries • paralysis • Wounds • soft tissue of neck • swollen tongue • Loss of upper airway • need to establish viable airway (trach or endotube)

19. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Typical injuries that can be sustained in traumatic disasters affecting respiration: • Chest injuries • flail chest (multiple broken ribs on one / both sides of thorax) • pneumothroax - chest wounds the penetrate the lung • abdominal injuries affecting diaphragm movement

20. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Chest injuries • Broken ribs (one or both sides of chest) • May or may not puncture the lung(s) Broken Ribs on both sides

21. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Chest injuries • Pneumothorax • lung(s) penetrated • collapse of lung(s) • Internal organs can begin to shift (heart, diaphragm) • Must release pressure • chest tube(s) Both lungs collasped

22. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • We should become familiar with at least the most commonly prescribed respiratory medications and treatments during an emergency. For example, some patients with lung disease require: • Breathing treatments • Nebulizer • MDI • Supplementary oxygen • Mechanical ventilation • These are usually performed by a respiratory therapist but some of these skills can be easily learned by a non therapist health professional.

23. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters • Common Equipment found in the residence of the patient with Pulmonary disease • Clues there may be an impending patient care issue

24. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment • Nasal Cannula • Low flow device (2 to 6 lpm) Oxygen % varies from breath to breath. • Approximate O2% range = 24 to ~ 40 %

25. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment • Venti Mask - Total Gas Flow to Patient is determined by variable orifice venturi at varying liter flows (draws in air to combine with Oxygen to give approximate O2 %) • Setting Suggested Oxygen Flow Total Gas Flow • 24% 3 LPM 79 LPM • 26% 3 LPM 47 LPM • 28% 6 LPM 68 LPM • 30% 6 LPM 53 LPM • 35% 9 LPM 50 LPM • 40% 12 LPM 50 LPM • 50% 15 LPM 41 LPM

26. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment • (Non)Rebreather Mask • Moderate to High O2 concentrations (60% +) • Bag holds additional Oxygen - flows with each breath • Bag movement is important

27. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment • Trach(eostomy) Collar • Requires high flows • Produces high humidity • Usually find an “H” cylinder of Oxygen • Unable to verbalize*

28. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment • Oxygen Cylinders • Oxygen Therapy • cannula • mask • Different sizes are used • D, E or H size • Support combustion -things that burn, burn hotter and faster

29. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment • Liquid Oxygen Systems • Dewars • Liquid that vaporizes to a gas • Depending on size of vessel, can be equivalent of several “H” cylinders • Extreme freeze burns • loss of limb(s)

30. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment • Medication Nebulizer • Metered Dose Inhaler • Bronchodilator • Steroid • Some are rescue meds • Fast acting • Others are maintenance meds – do not use during breathing / airway emergency

31. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment • Medication Nebulizer • Fixed, Low flow device (6 to 8 lpm) • Generally 21% Oxygen • unless run from alternate Oxygen source • Electrically powered • Aerosolizes liquid medications into small particles that are inhaled into lung

32. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment • Home care ventilator • Pt unable to breathe without assistance • May / May not require O2 • Usually find an “H” cylinder of Oxygen • Unable to verbalize*

33. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment • Home care ventilator • Various models and types • Most require use of electricity • check for backup power source • Some are pneumatic • look for cylinders or compressor

34. Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment • Home care ventilator • May / May not require O2 • Look for cylinder gases • Be aware of cylinder safety • fire hazards • electrical hazards

35. Texas State Guard Texas Medical Rangers HMRG - Galveston Company • Observe situation and surroundings • findings may lead you to seek possible problems • Assess patient and ask questions • current or previous respiratory health issues • Provide care • arrange care by appropriate provider Final Thoughts - Recommendations