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CH 28


any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources

mass casualty

disaster involving 100+ individuals

multiple casualty

disaster involving 2-99 individuals

direct victim, indirect victim, displaced person, or refugee

how are casualties classified?


events that require a swift, intense response on the part of existing community resources; personal

natural disasters

tornadoes, hurricanes, earthquakes, etc.

man-made disasters

terrorism, riots, war

NA-TECH (natural/technological) disaster

natural disaster that creates or results in a widespread technological problem

cause premature death, illnesses

destroy local health care infrastructure & prevent effective response to emergency

create environmental imbalances (increasing risk for communicable diseases & environmental hazards)

affect people's psychological, emotional, & social well-being

cause food & water shortages

displace populations of people

disasters may do the following...

scope & number of casualties

characteristics of disasters


how often disasters occur


ability to tell when and if a disaster event will occur


actions taken to avoid disaster


speed of onset of impending disaster

scope & number of casualties

range of effect, geographic area involved, # of people affected


level of destruction & devastation

by the amount of resources needed

how are levels of a disaster determined?


three ways to classify a disaster

requires activation of the local emergency medical system

costs <$10,000

level I

costs >$10,000 but <$50,000

level II

costs >$50,000 but <$250,000

level III

costs >$250,000 but <$2.5 mil

level IV

costs >$2.5 mil

level V

disaster medical assistance teams (DMAT)

in a federal disaster, ________________ supplement local & state medical care needs & can be activated

before the disaster event occurs

when does disaster management begin?


stages of disaster

preventing occurrence of disaster or limit consequences

occurs in nondisaster & predisaster stages

primary prevention

search, rescue, & triage of victims
assessment of destruction & devastation
implemented once disaster occurs

secondary prevention

recovery & restoration of community to previous level of functioning

aimed at preventing a recurrence or minimizing effects of future disasters

tertiary prevention


initiates proactive mitigation activities, trains 1st responders, manages National Flood Insurance Program & US Fire Administration

US Public Health Service

responsible for clean drinking water, food, shelter, & medical care

American Red Cross

provides disaster relief, not a gov't agency, has great emphasis on preparedness

dept of health & human services

monitors for disease outbreaks, their cause, risk factors, & implements interventions for control

national incident management system

oversees actions of protecting against, responding to, recovering from, & preventing effects of disaster

identification of hazards
analysis of vulnerability
assessment of risk

pre-disaster planning should include...

identification of hazards

first step in planning for an effect response

analysis of vulnerability

predicts who will be affected the most & identifies community resources that are available for a response


place on Earth most vulnerable to natural disasters

tend to be physically isolated, disabled, unable to access disaster services

have fewer resources or less ability to withstand/survive a disaster without physical harm

assessment of risk

solid disaster plan
participate in yearly mock drills
adequate warning system
backup evacuation plan to remove individuals who hesitate to leave their home from areas of danger

community's need for disaster preparedness

1. promote confidence
2. develop skills
3. coordinate activities
4. coordinate participants

mock disasters: objectives


effort to prevent identified risks from causing a disaster

initiate measures to limit damage, disease, disability, & loss of life among members of a community

how does mitigation work?

level of disaster

response is determined by..

office of emergency management (OEM)

develops & coordinates emergencies within their defined area
directs nurses' response to a countrywide disaster

manages blood service & bone marrow registry
assists military with leaves
provides disaster training for health care professionals
takes part in disaster preparedness, response & recovery
provides individual/family assistance to meet emergency needs (food, shelter)
coordinates distribution of emergency relief supplies
works with FEMA in federal disasters
teaches first aid, water safety, CPR
administers Project Share

American Red Cross duties

operates shelters
provides feeding services
provides individual & family assistance
provides disaster health services
handles inquiries from concerned family
coordinates relief activities with other agencies, business, labor, & gov't
seeks contributions

American Red Cross responsibilities in disaster (7)

project share

provides emergency energy assistance to elderly & disabled in peak winter & summer months for Alabamians

safety & welfare of the community

the local government is responsible for the...

how many people are affected, injured, or dead?
how much fresh water & food is available?
what are the areas of risk or sanitation problems?

initial response assessment

triage victims
prioritize care
transfer those requiring immediate attention to medical facilities
give tetanus shots, first aid, & medical attention to victims
shelter nursing

what is the nurse's role in response?


process of separating casualties & allocating treatment based on the victim's potential for survival

"Simple Triage And Rapid Treatment"
used in multicasualty or mass casualty incident
to occur in <1 min
uses people with minor injuries to assist
person is tagged with colored triage tag
victims moved to the treatment area

START triage system

1st check for respirations
2nd check for perfusion by capillary refill
3rd check mental status by asking simple ?s beginning with "who are you?"

1 minute assessment guideline

victims who have life-threatening injuries but have a high probability of survival once stabilized

who is given highest priority?

victims who have injuries with systemic complications that are not yet life-threatening but can wait up to 45-60 mins for tx

who is given second priority?

victims with local injuries without immediate complications & can wait several hours for medical attention

who is given last priority?

dead or no hope of living
--multiple severe injuries


top/highest priority
--amputations, impalement


second priority
--simple fractures


local injuries
--walking around wounded with minor injuries (cuts & abrasions)



stabilization of community and return of disaster area to its previous status

the government; business community

who take the lead in rebuilding efforts? provide economic support?

continuing death, chronic illness, and/or disability
population shift if recovery prolonged
contamination of food/water supplies (infectious diseases)
decreased access to care
PTSD & delayed stress reaction (DSR)

adverse health effects after disaster

heroic phase

occurs at time of disaster
intense excitement and concern for survival

honeymoon phase

post-disaster period (2 wk-2 mo)
individuals feel support from government

disillusionment phase

several months to a year or more
contains unexpected delays in receiving aid

reconstruction phase

several years
attempt to rebuild

extreme and widespread property damage
serious and ongoing financial problems
high prevalence of trauma
when human intent cause the disaster

4 factors that increase the risk of long-term mental health problems


use of force or violence against people or property in violation of the criminal laws of the US for purposes of intimidation, coercion, or ransom

can be easily disseminated or transmitted from person-to-person

results in high mortality rates

have the potential for major public health impact

might cause public panic & social disruption & require special attention for public health preparedness

categories of bioterrorism agents

highest priority; easily transmitted & have high mortality rates

anthrax, plague, botulism, smallpox, tularemia, viral hemorrhagic fevers

category A

moderately easy to disseminate, moderate morbidity rate, low mortality rates

typhus, cholera, salmonella, shigella, e.coli

category B

emerging pathogens that can be engineered for mass dissemination bc they are easily produced

hantavirus, tickborne viruses, yellow fever, multi-drug resistant TB

category C

small sore that develops to blister, then skin ulcer with a black area in center; does NOT hurt

if left untreated. 80% of infected individuals do not die

cutaneous anthrax

nausea, loss of appetite, bloody diarrhea, fever followed by bad stomach pain

more serious, 1/4 - more than 1/2 of cases lead to death

GI anthrax

first s/s cold/flu-like
later s/s cough, chest discomfort, SOB, tiredness & muscle aches

half cases end in death; more severe

*anthrax incubation period 1 wk-42 days; Cipro with antianthrax vaccine to prevent anthrax infection

inhalation anthrax

incubation period 7-17 days

s/s: high fever, fatigue, severe HA, *rash that turns to pus-filled lesions*, vomiting, delirium, excessive bleeding

no cure; *international health emergency!!*
dept of homeland security becomes involved


detect outbreak (most crucial aspect)
determine cause
ID factors that place people at risk
implement measures to control outbreak
inform medical & public communities about tx, health consequences, & preventive measures

response to bioterrorism

Push Package
1. oral abx & supplies
2. IV drugs & supplies
3. chemical antidotes & related supplies
4. airway supplies
5. pediatric supplies

Vendor Managed Inventory
--resupply push package
--supplement push package stock
--majority of SNS assets are in VMI Roles

coordinated by dept of homeland security, must have federal order

sufficient to vaccinate 6-7 mil in US

strategic national stockpike (SNS)

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