Mass Casualty

System Notification/Activation of Emergency PreparednessClassified disaster earthquake, tornado, accident, Terrorist attackNotify by radio/pagerUtilize telephone tree to call staff in

INCIDENT COMMAND CENTER initiated

Hospital Role

Commander Triage officerMedical command physician

DebriefingCritical Incident Stress Debriefing

2 types

Critical Incident Stress Management

Post Traumatic Stress Disorder

Administrative Review

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

Incident Command

Liaison Officer

Safety and Security Officer

Public Information Officer

Medical or Technical Officer

• (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

ID ME

Triage Description Color

Immediate Respirations are present, very serious injury that can be fixed quick with out a lot of resources

RED

Delayed Can wait to be treated for hours to days, dislocations, minor fractures

YELLOW

Minor “walking Wounded”, cuts, minor wounds

GREEN

Expectant/Deceased

Not breathing, Massive Head trauma, would take massive resources away from many others to save one

BLACK

Bioterrorism

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

Terrorism Disrupt Daily Life & Cause Terror and PanicFBI – “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”

Terrorism

International -al Qaeda, Irish Republic Army

Domestic -Klux Klux Klan, Greenpeace, and Individuals like Timothy McVeigh

Targets Anything & Anywhere that causes

large scale disruption

Large crowds/gatherings of people

Nuclear/Chemical Plants

Federal Systems

Controversial businesses (Abortion Clinics)

Purpose

• Attract Media Attention

• Increase support for Cause

• Undermine the Government or Agency attacked

• Influence Policy

• Solely For Revenge

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

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

Agent Route of Entry

• Vectors – means of spreading the agent

• Entry to body: • Ingestion• Inhalation• Injection• Dermal Exposure

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

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

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

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

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)

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

Biological

• Possible Treatment– Isolation– Vaccines– Antibiotics

Chemical

• Hazardous chemical released

• Many are industrial

• Some created by military

• Some found in nature

Chemical Weapons • Chemical substances 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

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

Chemical

• Signs/Symptoms– Variable depending on agent– Examples include: cardiac arrest, seizures,

death

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

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

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

Radiation

• Types– Dirty bombs– Contaminating food water sources– Explosion or meltdown at nuclear plant

– Exposure to radiation is affected by time, distance, and shielding

Radiation

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

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

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

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

LEVEL A LEVEL B

LEVEL C LEVEL D

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

• Clothing and personal items sent to FBI for evidence

Blast Injuries

• Most severe injuries are to lungs

• Other things include ear drum perforation, bowel perforation, lacerations

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

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

MASS CASUALTY

The point is to save as many as you can