This document discusses emergency preparedness for biological agents, chemical weapons, radiological/radioactive agents, and disaster nursing. It covers: 1) The four main biological agents of concern: anthrax, botulism, plague, and smallpox. It describes their transmission methods and key signs/symptoms. 2) Chemical weapons like nerve agents and choking agents. Nerve agents cause effects like rhinorrhea, salivation, and convulsions. Choking agents can cause ocular and respiratory irritation. 3) Radiological/radioactive agents from dirty bombs which can contaminate victims. Acute radiation syndrome causes illness from high dose radiation exposure. 4) Disaster nursing roles

1. EMERGENCY PREPAREDNESS

2. CLINICAL PREPAREDNESSBiological AgentsChemical WeaponsRadiological/Radioactive AgentsDisaster NursingLevels of DisasterTriage

3. Biological AgentsFour top agents for potential bioterrorism:Anthrax- durable spore that lives in the soilTransmitted by inhalation, contact with spore, or ingestion of contaminated foodS/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, emesisVaccine availableStandard isolation precautions until client is sick, then no person to person transmissionBotulism- transmitted by ingestion of toxin, manmade aerosolsS/S include: drooping eyelids, weakened jaw clench, difficulty speaking or swallowing, blurred vision, double vision, arm paralysis followed by respiratory and leg paralysis, respiratory depressionVaccine available, type specificNo isolation precautions

4. Biological AgentsPlague- most likely to be aerosolized in terrorist eventS/S include: fever, cough, chest pain, bloody sputum, bronchopneumoniaNo proven vaccineDroplet isolation precautionsSmallpox- Transmission person to personS/S include: prodrome of fever, myalgia, vesicles on distal limbsVaccine created in 1700s. Eradicated in 1979 Droplet precautions

5. Chemical WeaponsNerve 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 headacheSevere poisoning: bronchospasm, vomiting, incontinence, muscle fasciculation, convulsions, respiratory failure, death.Antidote: Atropine at high doses and pralidoximeChoking Chemical AgentsChlorine gas and PhosgeneS/S: ocular, nasal, and respiratory irritation, cough, suffocation

6. Radiological and Radioactive AgentsDirty 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

7. Disaster NursingImplementation of the public health levels of preventionPrimary 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.

8. Levels of DisasterLevel 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)

9. TriageThe 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.

10. Public Health Preparedness and Administrative EffortsHealth 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 systemsBed tracking systemEmergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)Facility management plansHospital evacuation plans

11. Community Health Nurse IssuesEpidemiological AspectsEpidemiologists 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 SurveillanceApplies 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 codesChief complaintFrequency of antibiotic and prophylactic therapyKey Concepts of Successful Syndromatic Surveillance:Timelines of reporting dataValidity and quality of dataSystem ExperienceExample of System: Outbreak Management System

12. Strategic National StockpileCDC 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 ResourcesThe Emergency System for Advance Registration of Volunteer Health ProfessionalsMedical Reserve CorpsDisaster Medical Assistance Teams

13. Community Preparedness Issues The National Response Framework See Figure 26-2Three critical components of preparedness for the community health nurse are:Mental health preparednessFamily/individual preparednessBusiness preparedness

14. Disaster Mental HealthTraumatic 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.)

15. Individual and Family Preparedness IssuesThe development of family communications and evacuation plans should include:Recognizing potential disasters in the family’s communityPrimary and secondary meeting places in the event of evacuationA designated emergency contact person that is out of the area in case the disaster overwhelms local communication resourcesDisaster Preparedness KitA list of recommended items to include in a basic emergency supply kit are listed in box 26-3