Emergency Preparedness

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Emergency Preparedness

  1. 1. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Emergency PreparednessEmergency Preparedness
  2. 2. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. IntroductionIntroduction With its focus on command and management, the nature of Emergency Preparedness has changed dramatically over the past decade. In today’s environment, hospitals no longer function as isolated responders to local events, but as vital components within a much larger regional response to a more global crisis.
  3. 3. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Fundamental ParadoxFundamental Paradox The fundamental paradox of Emergency Preparedness is that it requires all of us to prepare for situations we hope to avoid and are doing our best to prevent. Yet if a major event does occur, there simply will not be enough time to get oriented and learn what we need to know in order to respond. Every health care provider needs to understand how he or she fit into the emergency response plan. Each hospital or healthcare facility’s Emergency Management system makes use of organizational structures, methodologies, and terminologies that differ greatly from those that are utilized on a daily basis.
  4. 4. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. TerrorismTerrorism Terrorism has been continually in our public consciousness since the events of September 11, 2001. Acts of terrorism and the means by which they might be carried out are of special concern to healthcare professionals, who are called upon to treat people following a terrorist attack. Healthcare workers need to be aware that the effects of fear will loom large after an incident of terrorism and these effects need to be anticipated and addressed even in patients who have sustained little or no physical injury.
  5. 5. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Weapons of Mass DestructionWeapons of Mass Destruction (WMD)(WMD) The possibility that terrorists might resort to the use of WMD is of grave concern to many, including healthcare professionals. The various types of WMD—chemical, biologic, radiologic, nuclear—vary in their ability to cause damage, in their ease of production and use, in the kinds of physical and human damage they can be expected to cause, and in their likelihood of use by terrorist organizations.
  6. 6. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Chemical WarfareChemical Warfare Chemical warfare (CW) agents are nonliving, manufactured chemicals that are highly toxic and can enter the body through the lungs or the skin. They cause illness or death within minutes to hours after exposure. (MIIS, 2004)
  7. 7. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Chemical AgentsChemical Agents Chemical weapons agents generally fall into one of the following groups: • Blister agents, or vesicants (sulfur mustard, lewisite) • Choking agents (chlorine, phosgene) • Blood agents (cyanogen chloride) • Nerve agents (sarin, VX) (MIIS, 2004)
  8. 8. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Delivery MethodDelivery Method Chemical weapons agents require a delivery method, generally one of the following: • Spraying (aerosolized) • Exploding a device • Contaminating food or water • Attacking or sabotaging a chemical facility (MIIS, 2004b)
  9. 9. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Overt vs. Covert EventOvert vs. Covert Event Intentional release of chemical agents may be an overt event, one whose nature reveals itself, such as release of a nerve agent in a subway or a large explosion of a chemical container. On the other hand, a chemical release might be a covert event, an unrecognized release in which the presence of ill persons could be the first sign of an exposure, such as deliberate contamination of food, water, or a consumer product.
  10. 10. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Biological WarfareBiological Warfare Biological agents are organisms or toxins that can kill or incapacitate people, livestock, and crops. The three basic groups of biological agents that would likely be used as weapons are bacteria, viruses, and toxins. Most biological agents are difficult to grow and maintain. Many break down quickly when exposed to sunlight and other environmental factors, while others, such as anthrax spores, are very long lived. Biological agents can be dispersed by spraying them into the air, by infecting animals that carry the disease to humans, and by contaminating food and water.
  11. 11. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Category A Diseases or AgentsCategory A Diseases or Agents Category A diseases or agents are high priority and include organisms that pose a risk to national security. They can be mass-produced, transported, and disseminated with relative ease. These agents: • are easily disseminated or transmitted from person to person. • cause high mortality rates. • have the potential for major public health impact. • may cause panic and social disruption. • require special action for public health preparedness (CDC, 2004a).
  12. 12. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Category ACategory A Category A diseases or agents include: • Anthrax (Bacillus anthracis) • Botulism (Clostridium botulinum toxin) • Plague (Yersinia pestis) • Smallpox (variola major) • Tularemia (Francisella tularensis) • Viral hemorrhagic fevers (Ebola, Marburg, Lassa, Machupo) (CDC, 2004a)
  13. 13. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Category BCategory B Diseases or AgentsDiseases or Agents Category B diseases or agents are the second highest priority, and: • are moderately easy to disseminate • result in moderate morbidity rates and low mortality rates • require specific enhancements of CDC's diagnostic capacity and enhanced disease surveillance (CDC, 2004a).
  14. 14. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Category BCategory B Category B diseases or agents include: • Brucellosis (Brucella species) • Epsilon toxin of Clostridium perfringens • Food safety threats such as Salmonella, • Escherichia coli, and Shigella • Glanders (Burkholderia mallei) • Melioidosis (Burkholderia pseudomallei)
  15. 15. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Category B (cont)Category B (cont) • Psittacosis (Chlamydia psittaci) • Q fever (Coxiella burnetii) • Ricin toxin from Ricinus communis (castor beans) • Staphylococcal enterotoxin B • Typhus fever (Rickettsia prowazekii) • Viral encephalitis (Venezuelan equine encephalitis, eastern and western equine encephalitis) • Water safety threats such as Vibrio cholerae, Cryptosporidium parvum (CDC, 2004a)
  16. 16. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Category CCategory C Diseases or AgentsDiseases or Agents Category C diseases or agents are the third highest priority and include emerging pathogens that could be engineered for mass dissemination in the future because of availability, ease of production and dissemination, or potential for high morbidity and mortality rates and major health impact.
  17. 17. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Category CCategory C Category C diseases or agents include: • Emerging infectious diseases such as Nipah virus and hantavirus • Yellow fever • Tick-borne encephalitis • Tick-borne hemorrhagic fever • Multidrug-resistant tuberculosis (CDC, 2004a)
  18. 18. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. ToxinsToxins Toxins are nonliving poisons produced by living plants, insects, and animals—are in a gray area between chemical warfare (CW) and biological warfare) BW agents. They generally have an incubation period of hours to days, longer than that of CW agents but shorter than that of BW agents. (MIIS, 2004)
  19. 19. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Radiologic & Nuclear WarfareRadiologic & Nuclear Warfare Radiologic and nuclear warfare agents rely on the same sources for damage—explosive power and radiation—but there is a distinction in their forms. In addition, true nuclear weapons produce tremendous heat, which can cause burns and start fires. In the last fifty years, most radiation injuries have been the result of accidents; however, the intentional deployment of a nuclear or radiologic device is a potential terrorist threat.
  20. 20. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Lethal ThreatLethal Threat Biological agents and toxins present a more lethal threat as terrorist weapons than chemical agents do, and are more toxic than chemicals by weight. Biological agents and toxins can be insidious, because exposure may remain undetected during the incubation period and numerous victims and casualties would seem suddenly to arise.
  21. 21. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Limitations of Current TechnologyLimitations of Current Technology Current technology does not allow electronic detection of biological weapons, and we cannot sense biological agents, as we might chemicals with distinctive odors, such as chlorine.The likely method that terrorists would use in a biologic attack would be dispersion via air, with particles as small as one to five microns.
  22. 22. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Training and EducationTraining and Education Training programs focus mainly on Category A agents— pathogens that can be easily disseminated or transmitted from person to person, result in high mortality rates, have the potential for significant social disruption and public panic, and require special action for public-health preparedness.
  23. 23. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Terrorist AttackTerrorist Attack Terrorists are most likely to stage their dispersal of biological agents: • in enclosed spaces; • in areas with large crowds and/or high-profile events; • at critical facilities or infrastructure; • in places where there is a high payoff or accessibility, such as in mass transit and at power plants or chemical plants; and/or • in places of particular interest to terrorist causes, such as religious sites.
  24. 24. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Health Alert NetworkHealth Alert Network The Health Alert Network (HAN) is a nationwide communications system established by the CDC and implemented by each state. The Maryland HAN is meant to establish the communications, information, distance learning, and organizational infrastructure for a new level of defense against health threats, including the possibility of bioterrorism. The HAN will link local health departments to one another and to other organizations critical for preparedness and response: community first responders, hospital and private laboratories, state health departments, CDC, and other federal agencies (NSHD, 2005a).
  25. 25. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Health Alert Network ObjectivesHealth Alert Network Objectives • Provide for rapid dissemination of public health alerts, advisories, and updates to public health partners, the news media, and the public. • Support exchange of public health information and training materials, over the Internet, by linking public health and private partners 24/7. • Ensure secure electronic data and information exchange between public health partners. • Ensure protection of public health data, information, and systems with adequate system support and backup, organization staff redundancy, and telecom surge capacity to respond to bioterrorism and other public health threats and emergencies (NSHD, 2005b).
  26. 26. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. The National Response PlanThe National Response Plan The National Response Plan establishes a comprehensive all-hazards approach to enhance the ability of the United States to manage domestic incidents. The plan incorporates best practices and procedures from incident management disciplines—homeland security, emergency management, law enforcement, firefighting, public works, public health, responder and recovery worker health and safety, emergency medical services, and the private sector—and integrates them into a unified structure. It forms the basis of how the federal government coordinates with state, local, and tribal governments and the private sector during incidents. http://www.dhs.gov/dhspublic/interweb/assetlibrary/NRP_FullText.pdf
  27. 27. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. National Incident Management SystemNational Incident Management System (NIMS)(NIMS) The National Incident Management System (NIMS) establishes standardized incident management processes, protocols, and procedures that all responders -- Federal, state, tribal, and local -- will use to coordinate and conduct conduct response actions. http://www.fema.gov/nims/
  28. 28. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Key Roles In Emergency Response:Key Roles In Emergency Response: First DetectorsFirst Detectors This term describes the function of an alert clinician who is prepared to identify and report to public health authorities information indicative of a potential emergency. It includes individuals who, in their capacity as community-based public health and medical providers, might be the first to identify the sentinel cases of infectious agents associated with biological or infectious disease emergencies.
  29. 29. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Key Roles In Emergency Response:Key Roles In Emergency Response: First RespondersFirst Responders Those individuals who, in the early stages of an incident, are responsible for protecting and preserving life, property, evidence, and the environment at the incident site. First responders include local law enforcement, fire, HazMat, and emergency medical services personnel, among others.
  30. 30. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Key Roles In Emergency Response:Key Roles In Emergency Response: First ReceiversFirst Receivers Those individuals who receive the victims of mass casualty incidents and other emergencies in a site (such as a hospital) that is remote from the location where the incident occurred. First receivers include emergency department personnel and other staff called upon to act in this capacity due to a patient surge.
  31. 31. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Key Roles In Emergency Response:Key Roles In Emergency Response: Secondary Receivers and Responders:Those individuals who provide the second tier of response to mass casualty or emergency incidents, providing care to patients after they are triaged by the first responders and/or first receivers. This includes all members of a hospital staff called upon to work throughout the hospital to support or provide backup for the emergency department in any large-scale emergency. In most mass casualty incidents, the vast majority of hospital personnel will fulfill the role of secondary responders.
  32. 32. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Key Roles In Emergency Response:Key Roles In Emergency Response: SurgeSurge RespondersResponders Those individuals who, as members of local Medical Reserve Corps and NDMS units, respond to medical surges during mass casualty incidents. Surge responders are prepared to move out of their usual institutions and practices to support surge needs in personal care or public health response elsewhere in the community.
  33. 33. Two scenarios showing the roles of health care providers as first detectors, first responders, first receivers, surge responders and secondary responders.
  34. 34. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Education of Healthcare ProvidersEducation of Healthcare Providers Healthcare providers must support and collaborate with government and non-government organizations and agencies to develop educational strategies to educate HCW’s who may be involved in the assessment and management of victims of a terrorist attack.
  35. 35. HCW’s Wearing PPEHCW’s Wearing PPE During SimulatedDuring Simulated Haz-Mat DrillHaz-Mat Drill OSHA’s PPE standard requires that employees be provided with equipment that fits appropriately. Hospitals may assign a set of protective equipment to a specific individual, or choose to store sets of PPE by size. In this case, the packages are clearly marked only with the size. Each first receiver tries on equipment to determine what size group fits best, then, during an emergency, the employee can quickly locate an appropriate PPE set (U.S. Dept. of Labor, 2005).
  36. 36. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Additional ResourcesAdditional Resources Maryland Emergency Management Agency http://www.mema.state.md.us CDC Emergency Preparedness & Response http://www.bt.cdc.gov/agent/agentlist- category.asp.
  37. 37. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. SummarySummary The Bioterrorism Continuing Education Project (BTCEP) is part of a national effort to increase and improve emergency preparedness in hospitals throughout the United States.The Health Resources and Services Administration (HRSA) has supported this effort in recognition of the critical need to provide health care professionals across disciplines with skills that strengthen their ability to respond to public health emergencies (whether natural or manmade) within the larger context of city, state, and national emergency response plans and protocols.
  38. 38. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Join the CDC Clinician RegistryJoin the CDC Clinician Registry The Centers for Disease Control and Prevention’s Clinician Registry for Terrorism and Emergency Response Updates and Training Opportunities is a free registry that provides clinicians with real-time information to help prepare for (and potentially respond to) terrorist events and other emergencies. Participants receive regular e-mail updates on emergency issues and training opportunities. http://www.bt.cdc.gov/clinregistry/
  39. 39. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Join the Medical Reserve CorpsJoin the Medical Reserve Corps The Medical Reserve Corps (MRC) is a federal program sponsored by the Office of the Surgeon General. The program serves citizens and communities throughout the U.S. by establishing local teams of volunteers to strengthen the public health infrastructure and improve emergency preparedness. Clinicians wishing to locate or initiate a Medical Reserve Corps team in their area can learn more visiting the MRC Web site. http://www.medicalreservecorps.gov/AboutVolunteering

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