DISASTER LEC- FINAL

DISASTER CAUSED BY - Acute Abdominal pain

- Ascites
BIOLOGICAL AGENTS o High level of resistance to high
temperatures and disinfectants
Category A: most deadly microbes known to man; o Anthrax Toxins
high mortality rate; induce public panic and social
o CONFIRMATORY: clinically compatible
disruption;
cause of either cutaneous, gastrointestinal,
- Anthrax (Bacillus Anthracis)
inhalation diseases, confirmed by isolation
o Zoonotic disease- herbivores
of B. anthracis from an affected tissue or
o Spore-forming bacterium
site
o Contact with infected animals or animal ISOLATION, VACCINATION, AND
products POSTEXPOSURE
o Wool Sorter’s Disease - Universal precaution: Contact with
o Extremely resilient and can remain viable suspected patients
for decades - Contact Isolation: patients with inhalation or
o Inhalation Anthrax cutaneous anthrax
- Inhalation of spores - Vaccine: AVA (Anthrax Vaccine Absorbed)
- Incubation period: 1-6 days, then POST-EXPOSURE PROPHYLAXIS:
producing bacteremia - For those exposed to airspace contaminates
- SIGNS AND SYMPTOMS: Non specific with aerosolized B. anthracis
 Viral URTI - Ciprofloxacin or doxycycline for 60 days
 Severe edema and hemorrhagic - 100 days prophylaxis for inhalation
mediastinitis exposure that is significant
 Respiratory Failure TREATMENT:
 Septic Shock - CUTANEOUS ANTHRAX: ciprofloxacin
 Hemorrhagic meningitis or doxycycline, 60 days oral course
 DEATH - INHILATION ANTHAX: ciprofloxacin or
o CATANEOUS ANTHRAX doxycycline, 60 days oral course, plus once
 Spores enter skin through cuts and or two microbials
abrasions - Aminoglycoside
- Clindamycin
 Macule or papule which ulcerates (1-
- Multidrug antibiotic regiments
7 days)
- CHEST TUBE GRAINAGE: hemorrhagic
 Black, painless eschar
pleural effusion
 Severe Local edema
 Painful regional lymphadenopathy - Botulinum toxin (Clostridium Botulinum)
o GASTROINTESTINAL ANTHARX o Clostridium botulinum (Anaerobic
- Ingested spores in the upper or lower GI, bacterium), produces BOTULINUM
that leads to sepsis TOXIN: Soil Contaminant
 UPPER GI FORM o Neuroparalytic
- Oral or esophageal ulcers o Foodborne illness that can kill rapidly
- EDEMA: Lymphadenopathy
o 4 MAJOR TYPES:
- Vomiting
1. Foodborne Botulism: Home processed
 LOWER GI FORM
foods
- Vomiting
2. Infantile Botulism: Food contamination
- Bloody Diarrhea
through ingestion
 DISASTER LEC- FINAL

3. Wound Botulism - Plague (Yersinia Pestis)

4. Intestinal Botulism o MOST feared Infectious disease in the
PATHOGENESIS history of humankind; 200M died during
- C. Botulinum is wide spread in soil, surfaces the BLACK DEATH OF THE MIDDLE
of foods, and dust AGES
- KILLED by boiling at 100 ºC o Yersinia Pestis (gram-negative bacteria)
- Blocks acetylcholine release from peripheral o Plague-infected fleas moved from their
cholinergic nerve terminals natural hosts (rodents) to human
- The neurotransmitter blockade is o TRANSMISSION
irreversible, requiring the growth of new - Bite of an infected flea
nerve endings for nerve conduction to - Droplet spread from patients with
resume pneumonic plague
CLINICAL MANIFESTATION o TYPES of PLAGUE
- Cranial nerve palsies: OPTHALMOPLEGIA 1. BUBONIC PLAGUE
- Progressive, Descending, Symmetric, - Bite of an infected flea
Weakness, or Paralysis - Bacteria migrated to local lymph nodes
- Respiratory Failure= DEATH and multiply
- Foodborne Botulism - SIGN AND SYMPTOMS:
- Nausea and Vomiting  Large swollen, extremely tender
- Diarrhea leading to constipation in lymph nodes: BUBO
advanced stage
 Bacteremia
o INFANTILE BOTULISM
 Fever, chills, myalgia
- Constipation
 Sepsis to shock
- Flaccidity (floppy baby)
 DIC
- Poor suck reflex and feeding
- Poor head control  Coma and DEATH
ISOLATION, VACCINATION, AND 2. SEPTICEMIC PLAGUE
POSTEXPOSURE PROPHYLAXIS - Bite of an infected flea
- Universal Precautions - SIGNS AND SYMPTOMS
- Droplet Precaution: isolation is not  Sepsis
necessary  DIC
- C. Botulinum antitoxin for laboratory  Gangrene
personnel  Necrosis
- Postexposure prophylaxis is not 3. PNEUMONIC PLAGUE
recommended for asymptomatic patients - Most deadly form; spread droplet.
TREATMENT Dispersal from infected patients, or by
- Ventilation support: average of 6-8 weeks, hematogenous spread
but can last to 7 months - Infected the lungs; CARDINAL SIGN:
- Administration of botulinum antitoxin Severe pulmonary involvements
- Acts only in unbound toxin and therefore, its - SIGNS AND SYMPTOMS:
efficacy is greatest early in the patient’s  Severe hemorrhagic. Necrotizing
clinical course. bronchopneumonia
- Cathartics and enemas  Dyspnea and chest pain
- INFANTILE BOTULISM: human derived  Cough and hemoptysis
Botulism Immune Giobulin (BIG) ISOLATION, VACCINATION,
POSTEXPOSURE PROPHYLAXIS
 DISASTER LEC- FINAL

-Strict isolation  Chocking/ lung/ pulmonary agents

-Gloves, gown, mask, and eye protection  Incapacitating agents
should be worn for at least 48 hours of  Long- acting anticoagulants
treatment  Metals
- Antibiotic prophylaxis: Recommended for  Nerve agents
contacts of patients with plague:  Organic solvents
 Doxycycline  Riot control agents/ tear gas
 Ciprofloxacin  Toxic alcohols
 Tetracycline  Vomiting agents
 Sulfonamides
 Chloramphenicol CHEM-AGENT EFFECTS AND TREATMENT
TREATMENT - Health Effects:
- Treatment of choice  Disoriented
 Streptomycin  Dizziness
 Gentamicin  Nausea
 Doxycycline  Blindness
 Ciprofloxacin  Serious injury
 Chloramphenicol  Immobilization
 Death
- Smallpox (Variola Major) - Mitigation
1. Minimize Exposure:
- Tularemia (Francisella Tularensis)
 Avoid chemical cloud
 Cover face to filter breathing
- Hemorrhagic Fever Viruses
2. Get medical attention:
 Skin decontamination
Category B: moderate morbidity and lower
mortality; lower infectivity  Antidote
Category C: emerging agents, potential future
infective threats TYPES OF CHEMICAL AGENTS
- Chemicals may be either persistent or non-
PREPARING FOR TRRORISM: persistent. Persistent chemicals do not
CHEMICAL WEAPONS evaporate or breakdown quickly, and may be
take days to weeks to become harmless. The
CHEMICAL AGENTS OF CONCERN rate of their evaporation or breakdown
- Chemical agents vary widely and are depends on environmental conditions
categorized by their structure and/or including temperature, wind, humidity, and
physical effect on victims. Scientist often surface type. Release of persistent chemicals
categorized hazardous chemicals by the type may require isolation of the contaminated
of chemical or by the effects a chemical area until decontamination is complete, and
would have on people exposed to it. may thereby cause a longer-term disruption.
THE CATEGORIES/ TYPES USED BY THE In contrast, nonpersistent chemicals
CDC are as follows: dissipate quickly, and thus represent only a
 Biotoxins short-term hazard after they completely
 Blister agents/ vesicants released. Nonpersistent chemicals are
 Blood agents typically gases and liquids that evaporate
 Caustic (acids) quickly. Most of the common industrial
 DISASTER LEC- FINAL

chemicals carried in bulk in the urination, sweating, copious upper and lower
transportation system are nonpersistent. respiratory secretion)
o MILD DERMAL EXPOSURE
 PRESISTENT CHEMICALS - Sweating and muscle fasciculation localized
- Remain on surface without evaporating or to the area of exposure, nausea, vomiting,
breaking down for more than 24 hours diarrhea, and possible miosis
- Can remain for days to weeks o SEVERE DERMAL EXPOSURE
 NON-PERSISTENT CHEMICALS - Sudden coma, seizure, flaccid paralysis with
- Quickly evaporate and break don apnea, miosis, diarrhea, a victim who is
- Carried in bulk on commercial carriers “wet”
1. Nerve Agents – disrupt nervous TREATMENT
system, cause paralysis, fatal quickly - Decontamination
o CLINICAL PRESENTATION: - Endotracheal intubation
 Gasping - Suctioning
 Miosis - Prophylactic anticonvulsants
 Copious Secretion - Anticholinergics (antagonize muscarinic
 Sweating effects)
 Generalized Twitching - Oximes (reactive the inhibited
acetylcholinesterase and reverse paralysis)
 Cholinergic Toxidrome
- Atropine and pralidoxime
 DUMBBELS
2. Blister Agents – destroy skin and
- Diarrhea
tissue, cause blindness, may be fatal
- Urination
3. Chocking Agents – lung fills with
- Miosis
fluid, cause chocking, quick and
- Bradycardia
delayed fatality
- Bronchorrhea
4. Blood Agents – interferes with
- Emesis
oxygen at the cellular level, fatal
- Lacrimation
quickly
- Salivation
– PRIMARY ROUTE: Inhalation
- Sweating
– Causes RBC lysis
o Nicotinic: SIGN AND SYMPTOMS:
– SYMPTOMS: weakness, SOB,
- Muscle Fasciculations
possible loss of consciousness,
- Tremors
Respiratory Failure, paralysis,
- Weakness
DEATH
o Duration/ Mortality
– LONGTERM EFFECTS: Kidney
- Recovery may take several months Damage and neuropathy
- Permanent damage to CNS is possible
o MILD INHALATION EXPOSURE:
- Rapid onset of miosis, blurry vision, runny
nose, chest tightness, dyspnea, and possible
wheezing
o SEVERE INHALATION EXPOSURE
- Sudden coma, seizure, flaccid, paralysis
with apnea, miosis, diarrhea, and a victim
who is “wet” (lacrimation, salivation,
 DISASTER LEC- FINAL

- SIGNS AND SYMPTOMS: low - Skin contact is the most common pathways
concentration of cyanide, victims will have for harm from blister agents, but nerve,
10-15 secs of: chocking, and riot-control agents can also
 Gasping cause skin and eye irritation. These exposure
 Tachypnea pathways point out that emergency workers
 Tachycardia need not only respiratory protection, but full
 Flushing body cover suit for protection from the
 Sweating effects of many of these chemical agents.
 Headache
 Agitation confusion
: high concentration of
cyanide:
 Bradycardia
 Apnea
 Seizure
 Coma
 DEATH
- ARSINE
 Burning sensation in the chest
followed by chest pain
 Nausea and vomiting
 Headache
 Malaise
 Weakness
 Dizziness
 Abdominal pain
 Dyspnea
 Bloody urine
 Jaundice
TREATMENT:
- CYANIDE ANTIDOTE KIT: CHEM-AGENT DETECTION
- Amyl nitrate - Chemical threats agents can often be seen,
- Sodium nitrate smelled, tasted, or felt. In addition,
- Sodium thiosulfate (binds with cyanide numerous instruments and even simple
and is excreted inti the urine) paper test can be used to detect and identify
- Circulation and respiratory support chemical treats. In a chemical attack, against
- Monitor serum electrolytes, BUN, are typically dispersed as a vapor, liquid
Creatinine drops, or a solid aerosol of small particles,
5. Riot- Control Agents – skin and all of which may be inhaled and also come
breathing irritation, rarely fatal. into contact with the skin and eyes.
EXPOSURE PATHWAYS Although many chemical agents have
- Al types of chemical agents can cause readily available antidotes, some do not have
significant symptoms by inhalation, whereas antidote, and treatment options are limited.
only nerve agents are likely to be effective CHEM-AGENT RESPONSE
through ingestion  Call in hazmat team

 Identify chem-agent
 Isolate and contain affected area
 Evacuate and shelter-in-place public
 Provide needed medical treatment
 Cleanup contaminated are
 The basic emergency response to a
chemical threat attack involves immediate
response by a trained HAZMAT Team,
equipped with appropriate protective gear
and measurement instrumentation.
 It is a paramount importance to identify the
chemical agents involved while isolating
and containing the affected area
 Public protection is affordable by either
evacuation or sheltering depending on the
specific circumstances of chemical type,
amount, topography, public location, and
weather conditions.
 With the chemical agents identified,
appropriate medical treatment can be
provided and the right type of clen up can
commence
 Cleanup may include the application of
neutralizing chemicals.
PREPARING TERRORISM:
NUCLEAR RADIATION
EXPOSURE
RADIATION
- Refers to ionizing radiation – radiation with
enough energy to create ion pairs in matter.
Ultraviolet light can di this, as can x-rays,
gamma rays, and other kinds of radiation.
Visible light is also radiation, but it is not
energetic enough to cause ionizations, so it
cannot normally cause problems. By
comparison, ionizing radiation can damage
our DNA, causing health effects in
sufficiently high doses.
TYPE OF RADIATION
1. ALPHA RADIATION – cause great deal
of damage to living cells it encounters, but
has such a short range in tissue that external
DISASTER LEC- FINAL
alpha radiation cannot penetrate the dead
cells of the epidermis to irradiate the living
cell beneath.
2. BETA RADIATION – electrons or
positrons and are both lighter than alpha
particles and process a lower electrical
charge. This means that they are not nearly
as damaging, although they will penetrate up
to a centimeter into tissue
3. GAMMA RADIATION – energetic
photons, similar to x-rays. Gamma radiation
is much less damaging than alpha radiation
and is about as damaging as beta radiation.
Unlike alpha and beta radiation, gamma
radiation will penetrate the whole body, so it
will deliver radiation doses to internal
organs as well as to the skin.
ARTIFICIAL SOURCES OF RADIATION
 Medical Equipment
 Radiopharmaceuticals
 Industrial Instruments
 Food irradiation facilities
 Nuclear Research reactors
 University research reactors
 Nuclear weapons
 Nuclear power plants
MESURING RADITION
1. Curie: Amount of material
2. Rem: Absorbed dose
3. Half- Life: time of decay to ½ the original
amount
CLINICAL SIGNS OF RADIATION
EXPOSURE
1. Nausea and vomiting
2. Erythema
3. Blister. Ulceration tissue, possible necrosis
4. Depression in red and white blood cell count
5. Elevated levels in chromosomal aberrations
HEALTH EFFECTS OF RADIATION
EXPOSURE
1. Prodromal Syndrome
- Patients with prodromal syndrome have
likely been exposed to at least 1 Sv (100
rem)
- Patient exhibiting symptoms like vomiting
or bloody diarrhea within 30 mins of

exposure have likely received a lethal dose
of radiation
2. Hematopoietic Syndrome
- Hematopoietic syndromes begin to appear at
doses of 3 to 8 Sv (300 to 800 rem)
- This leads to a reduction on blood cell
counts as older cells die and are not
replaced, it leaves the patient open to
infection and other related problems.
3. Gastrointestinal Syndrome
- Exposure to 10 Sv (1000 rem) or more
- Radiation exposure is this range sterilizes
dividing crypt cells, leading to loss of cells
from villi.
4. Cerebrovascular Syndrome
- Exposure to exceptionally high doses of
radiation (in excess of 100 Sv or 10, 000
rem) will result in damage to the CNS,
normally among the most radiation- resistant
parts of the body.
- Usually results in death within several hours
to a few days to exposure.
RADIOLOGICAL INCIDENTS AND
EMERGENCIES
 Traffic accidents involving a truck carrying
research or medical radioactive isotopes
 Terrorist attack with an RDD (or “dirty
bomb”)
 Fire in a hospital or university radioactive
waste storage facility
 Unplanned radioactive release from a
commercial nuclear power station
 Detonation of nuclear weapon
 Loss of a radioactive soil-density gauge pr
well-logging gauge
 Accidental exposure of maintenance
technician to radiation from an industrial
linear accelerator
RADIATION DETECTION
 Cannot be seen
 Cannot be smelled
 Cannot be tasted
 Cannot be feel
DISASTER LEC- FINAL
 CAN ONLY BE DETECTED BY
UNSTRUMENTS
PROTECTION FROM RADIATION
 Minimize time you are exposed
 Stay as far away as possible from the
source of radiation
 Use the thickest possible shielding between
you and the radiation source
INDICATIONS OF A RADIOLOGICAL
EVENT
 Radiological Event – “dirty bomb” may be
indicated by an exposed to high doses of
radiation of a fine powder or solid material.
– Early symptoms seen in people exposed
to high doses of radiation: Skin Reddening,
Hair Loss, Wide Spread incidents of
Nausea, Vomiting, headaches, and
weakened of Immune System.
RESPONSE TO A RADIOLOGICAL EVENT
1. Identify the presence of radiation beyond
normal background
2. Isolate and contain affected area –
mitigate spread of contamination
3. Shelter-in-place or evacuate depending on
dose rate
4. Provide needed immediate medical
treatment
 Radiological emergency response should be
initiated when excessive radiation is
measured. The affected area should be
mapped to identify the extent of
radiological contamination and to
determine the boundaries of the area to
isolate and contained. Isolation includes
stopping all traffic that may spread
contamination, and preventing spread by
gravity into sewer drains.
 Estimated dose rates and doses should be
used in making decisions regarding public
evacuation or sheltering. Short term
medical treatment can include wound
treatment to preclude infections since
radiation exposure can compromise the
immune system. Certain drugs can be used
if the exact radioactive material has been
identified.
 DISASTER LEC- FINAL

- These events mandate that all healthcare

ROLE OF THE PUBLIC HEALTH providers have the appropriate education and
training to deal with unusual challenges and
NURSE IN DISASTER RESPONSE use resources effectively
PHNs are prepared to do the following in an
SPECIFIC AREAS OF PUBLIC HEALTH emergency response effort:
RESPONSIBILITIES  Assess the needs of the whole community,
1. Community Preparedness including potentially at-risk populations, as
2. Community Recovery the event unfolds based on the information
3. Emergency Operations coordination available.
4. Emergency Public Information and warning
 Conduct surveillance activities within the
5. Fatality Management
health department as well as in cooperation
6. Information Sharing
with in-hospital infection control
7. Mass Care
practitioners to control the spread of
8. Medical Countermeasure Dispensing
communicable disease
9. Medical Material Management and
 Assure the health and safety of themselves
Distribution
as ell as their fellow responders.
10. Medical Surge
 Maintain communication with local, state,
11. Non-Pharmaceutical Interventions
or federal agencies, assuring the accurate
12. Public Health Laboratory Testing
dissemination of information to colleagues
13. Public Health Surveillance and
and the public-at-large
Epidemiological Investigation
14. Responder Safety and Health  Operation points of Distribution (POD)
15. Volunteer Management mass countermeasures centers as needed
ICN FRAMEFORK FOR DISASTER  Provide on0site triage of victims as needed
NURSING COMPETENCIES: ROLE OF THE PHN IN PREVENTION AND
1. Risk Reduction, Disease Prevention, and HEALTH EDUCATION
Health Promotion - PHNs will proclaim that prevention and
2. Policy Development and Planning health education make up the greatest
3. Ethical Practice, Legal Practice, and proportion of their work on a daily basis.
Accountability Thus, prevention and education on
4. Communication and Information Sharing preparation for disaster in the community
5. Education and Preparedness should be a primary focus.
6. Care of Communities - The PHN may play a leadership role in the
7. Care of Individuals and Families development of community disaster plans
8. Psychological Care and in educating the public about disaster
9. Care of Vulnerable Population (Special preparedness activities
Needs Populations) - The PHN must be sensitive to the variety of
10. Long- Term Care Needs groups within the community and design the
appropriate level of education and training
ROLE OF PUBLIC HEALTH NURSE IN A for each of these target groups:
DISASTER  Families
- Healthcare providers are often first  Community Groups
responders are often first responders and  Primary and Secondary Schools
frequently first receivers of victims in times  Faith- Based Groups
if disaster and public health emergencies.  Correctional Institutions
 Vulnerable Populations

ROLE OF THE PHN IN BIOLOGICAL
EVENTS
- The scope of the practices of PHNs can
extend from community pre-event planning,
surveillance and detection, delivering care
during an event, to post disaster evaluation
and recovery. This expanded scope of
practices is what makes the PHN such a
valued and integral member of an effective
disaster response team.
- PHNs are accustomed to infectious disease
management strategies, have pre-existing
collaborative arrangements with other
community agencies, are used to working
with other healthcare professionals in
primary and acute care systems, and may be
familiar with local law enforcement
personnel.
- Specific role of each PHN during a
biological event is a function of national
competencies for public health preparedness,
state and local regulations, and his or her
home agency’s preparedness plan specific to
bioterrorism and emergency preparedness
competencies
ROLE OF THE PHN IN AN INFECTIOUS
DISEASE EMERGENCIES
- PHNs are educators who consistently
provide information to their communities to
prevent or stop the transmission of
infectious agents. Outbreak risk from
vaccine-preventable diseases such as
measles may be reduced through PHN
community education and support.
DETERMINANTS THAT INFLUENCE THE
RESURGENCE OF BOTH OLD AND NEW
INFECTIONS INCLUDE:
 Ability of the microbe to mutate and adapt
to the prevailing treatment protocol; immune
suppression of patients due to treatments or
other immune compromise
 Climate and ecosystem changes
 International travel, allowing for rapid
transmission of existing illness or the
introduction of specific microbes into a new
environment
DISASTER LEC- FINAL
 Increasing numbers of citizen living at or
below the poverty level.
 General lack of funding or breakdown of the
public health system.
ROLE OF THE PHN IN A CHEMICAL
DISASTER
- A chemical emergency occurs when a
hazardous chemical has been accidentally or
intentionally released and has the potential
to harm the health of people
PHN MAY BE CALLED ON TO DO THE
FOLLOWING:
- Following agency protocol and report to
duty site
- Don appropriate PPE before approaching
disaster site
- Establish the role of the PHN within the
response team
- Act quickly and assess the status of the
victim’s airway
- Loosen any constrictive clothing and advise
patient to sit upright if possible
ROLE OF THE PHN IN RADIOLOGICAL
EVENT
- When large doses of radiation are released
accidentally (nuclear power plant) or
deliberately (terrorist act), there is
significant increased risk that adverse health
conditions may develop
THE PHN SHOULD BE AWARE OF THE
FOLLOWING:
 Being available to help others will not
occur f you do not take steps to protect
yourself first.
 If by chance you are near to the release site,
move away from ground zero immediately
 In the event that you are in the area when
the event unfolds, minimize your exposure
by increasing your distance from the source
of radiation and put a shield between you
and the source, such as nearby building.
 PHNs working in a receiving station should
assume that all victims have been exposed
to our contaminated by radiation and should
notify the HAZMAT team and don the

appropriate level of PPE in advance of
people arriving
 Once home, remove and bag your clothing
before entering your home and shower
thoroughly using soap and water.
Eyeglasses may be decontaminated by
vigorously washing them with soap and
water, but contact lenses should be thrown
away.
COMMUNITY HEALTH NURSING:
INTERVENTIONS DURING
DISASTER
EARTHQUAKES
- Impact is greatest close to the epicenter, but
varies depending n the type of soil (it’s
susceptibility to liquefaction)
- Injuries arise primarily from falling objects
and collapsing buildings
- Secondary hazards add to damage and
casualties
- They include:
 Aftershock: Many people, including
many whose homes have not been
destroyed, will be living in the open for
several days/weeks for fear of aftershock:
fire, landslides, and (in coastal areas)
tsunamis
TYPICAL IMPACTS OF EARTHQUAKES ON
HEALTH:
- Direst Impacts
 Highly mortality (instantaneous or
rapid death) from: sever crush
injuries, external or internal
hemorrhage, and asphyxia due to
dust inhalation or chest compression
 Many people with minor cuts and
bruises, some with fractures
 A minority with serious multiple
fractures or internal injuries and
crush syndrome requiring surgery
and other intensive treatment; some
burns and electroshocks
DISASTER LEC- FINAL
 Respiratory disease due to exposure
to dust (and possibly asbestos fibers
from rubble)
- Indirect Impact
 Disruption of water supplies and
sewerage system in urban areas
 Exposure to the environment –
hypothermia in a cold climate
 Disruption of transport (blocking of
roads, destruction of bridges, etc) –
people rendered destitute, leading to
reduce ability to pay for health care
and other services
 Delayed deaths (within a few days)
may occur due to dehydration,
hypothermia, hyperthermia, crush
syndrome, wound infections or
postoperative sepsis
SPECIFIC HEALTH INTERVENTION
 Search and rescue: Recovery of
bodies
 Casualty treatment
 Emergency shelter, water, and
sanitation
 Food (ready-to-eat) for a few days
 Psycho-social support
 Rehabilitation of people seriously
injured
 Repair/ construction of damage
health facilities
 Replacement of damage equipment
and stocks
LANDSLIDE
- Usually result from heavy storms, long-
duration rainfall, earthquakes or volcanic
eruptions
- Areas prone to landslides are generally
known from experience (historic data)
- Likelihood of landslide is increased by:
intense deforestation, soil erosion and the
construction of roads, settlements, pipelines,
and other structures in hilly/mountain areas
- Impact is generally confined to a narrow belt
where the slide passes.
TYPICAL IMPACT OF LANDSLIDE ON
HEALTH
 DISASTER LEC- FINAL

- Direct Impact - Direct Impact

 Highly mortality from suffocation EVENTS RISKS
and severe trauma in a localized area Volcanic mass, falling Mediated traumas, crush
 Generally, few injuries requiring rocks, flying glass type injuries and
treatment lacerations
 Mental health problems including Hot ash, gases, rock, Skin and lung burn,
and magma asphyxiation and
depression
conjunctivitis or corneal
- Indirect Impact abrasion
 Destruction of water springs and Ash-fall, particularly in Aggravates bronchial
distribution systems fine particles asthma and other chronic
 Exposure to the environment if a respiratory conditions (in
whole settlement is affected – children as well as in
hypothermia in a cold climate adults)
 Short-and long- term mental health Gases and fumes Can cause acute
problems, including depression, are respiratory distress
possible Ash and acid rain Provoke eye and skin
SPECIFIC HEATH INTERVENTION irritation
Hot mudflows or Bury people with little
 Search and rescue: recovery of
“lahars” chance of being rescued
bodies
alive.
 Limited casualty treatment
 Emergency shelter - Indirect Impact
 Rehabilitation of damaged water  Injuries to and asphyxiation of
sources and distribution system people in buildings that collapse
 Treatment for mental health under the weight of ash – especially
problems including depression widespan buildings and particularly
VOLCANIC ERUPTIONS if the ash is wet
- A volcanic eruption may involve some of  Possible gastrointestinal problems
all: due to ingestion of food or water
 Explosion contaminated by ash
 Pyroclastic flows (travelling at high  Accidents resulting from poor
speed) visibility and slippery roads due to
 Hot ash releases ash
 Lava flows  Possible increase in malaria/ water-
 Gas emissions borne disease if lave flows and rock
o (From a crater, or through fissures falls create unusual flooding and
or by ground soil diffusion on the pooling of water
slopes of a volcano) may occur  Impoverishment of people who loose
independently of an eruption homes and livelihoods (property,
- Secondary hazards associated with eruptions livestock and/or agricultural land)
may include leading to reduce ability to pay for
 Hot mudflows (lahars) health care (and other) services
 Fires started by lava or hot ash SPECIFIC HEALTH INTERVENTION
 Floods caused by melting ice or by  Evacuation of people from the
snow or rain during or shortly after ashfall are until the ash has settle and
an eruption no more eruptions are expected

Provision of masks (or better,
respirators) that retain small particles
of ash for those who needs to work
in an ash-contaminated environment
and for vulnerable groups
 Search and rescue: recovery of
bodies
 Restricting vehicle movements to
essential traffic only
 Maintain food security conditions
over the long term (lave, ash and
acid rain damage crops, soils and
livestock)
CYCLONES/ TYPHOONS
- Also called hurricanes or severe tropical
storms; move inland from the sea
- A wide area in struck by high winds and
heavy rains
- Greatest damage to life and property is from
associated secondary events such as storm
surge (tidal waves), flooding and landslides
- Settlements located in low-lying coastal
areas are worst affected, but flooding and
landslide further inland can also be
devastating
- Direct Impact
 Drowning
 Injuries and trauma due to flying
debris and building collapse
 Asphyxiation due to entrapment in
collapsed buildings
 Electrocution due to downed
powerlines
- Indirect Impacts
 Destruction of water storage and
distribution installations
 Contamination of water supplies if
chemical factories or storage
facilities are impacted
 Impoverization and increased food
insecurity due to destruction of
crops, trees, livestock, house and
household assets
 Outbreaks of communicable diseases
are rarely observed. Nonetheless, the
risk of water- and vector borne
DISASTER LEC- FINAL
disease can be exacerbated if
changes in the physical environment
increase human exposure to existing
disease vectors
 Short- and long-term mental health
effects are likely
SPECIFIC HEALTH INTERVENTIONS
 Information to people concerning
dangers of contaminated water and
how to assure safe drinking water
 Distribution of water treatment
tablets to people, with clear
instruction for their use
 Provision of water treatment
chemicals to health facilities and
disinfectants to any facilities flooded
 Vector Control Measure (against
vectors likely to proliferate)
 Heightened disease surveillance
 Raising awareness of the risk
associated with clean -up activities
 Search and rescue
 Evacuating people, when necessary,
establishing and managing temporary
shelter sites (e.g. in schools) until
flood waters recede
 Short-term food assistance (when
needed) and assistance to restore
food security
 Restoration of electric power and
water supplies
 Rehabilitation of sewerage
infrastructure
 Repair/ restoration of transport
routes and communication
FLASH FLOODS, TIDAL WAVES, TSUNAMIS
- Narrow valleys may be hit by flash floods as
a result of exceptionally heavy rains
upstream in the catchment are, or dam burst,
including the breaking of natural dams’
forms when debris from landslide blocks a
valley river bed
- Costal Areas may be hit by tidal waves/
storm surges (associated with cyclones/
typhoons) or tsunamis (due to undersea
earthquakes

- Direct Impact
 Drowning and some injuries,
especially during hasty evacuation
and clen-up activities (particularly
small lacerations and punctures due
to nails and broken glass in debris)
 Electrical shocks from drowned
power lines
- Indirect Impact
 Contamination of water supplies by
flood water and by overflowing
latrines and septic tanks, leading to
increased levels of diarrhea
 Wells near rivers can be
contaminated and filled with sand
 Potential for increased transmission
of endemic water- and vector-borne
diseases after a flood; due to the
emergence of new breeding sites;
dues t disruption of vector control
activities, and due to overcrowding
in shelters
 Contamination of the environment
by toxic chemicals is possible, if
industries or waste disposal sites are
flooded
 Search and rescue
 Evacuating people, when necessary,
establishing and managing temporary
shelter sites (e.g., in schools) until
flood waters recede
 Short-term food assistance (when
needed) and assistance to restore
food security
 Information to people concerning
dangers of contaminated water and
how to assure safe drinking water
 Distribution of water treatment
tablets to the people, with clear
instructions and supervision of their
use
 Provision of water treatment
chemicals to health facilities and
disinfectants to any facilities flooded
 Vector control measure
DISASTER LEC- FINAL
 Heightened disease surveillance
 Raising awareness of the risk
associated with clen-up activities
INDUSTRIAL/ CHEMICAL DISASTER
- May include industrial and transportation
accidents involving toxic chemicals and
population incidents associated with mining
activities
- Sudden, acute incidents as a result of fire,
explosion or other accident in the handling
of chemicals at an industrial or storage site,
impact of a natural disaster or terrorist attack
on such sites, transportation or hazardous
chemicals
- Silent release from industrial or storage sites
due to undetected leaks, or from waste sites.
Outbreaks or illness may be the first sign of
such releases
- Exposure may be limited to people within
the site, or extend to the public outside via
air or water pollution or, more slowly,
through the contamination of soil and food
- Direct Impact
 Deaths and serious injuries from
explosions, building collapses and
transport accidents
 Burns
 Deaths and illness
 Internal damage from exposure to
toxic chemicals:
o During the release – from direct
dermal exposure and inhalation
o Later – from dermal exposure
through contact with contaminated
objects and ingestion of
contaminated food or water, eye, or
skin irritation, bronchoconstriction
or CNS Depression, can occur
within a few minutes or hours of
exposure, Chronic lung damage,
respiratory difficulties and cancers.
 Accidents involving volatile
hydrocarbon compounds, herbicides,
ammonia or chlorine have

particularly serious public health
effects
 Low socio- economic status
population living near hazardous
sites (including storage sites) are
particularly at risk. People with
diabetes or asthma, and smokers may
be particularly susceptible
- Indirect Impact
 Psychological and psychosocial
effects: Fear and anxiety, increase in
disease and non-specific medical
symptoms
 Social Disruption if people are
displaced
 Economic cost
SPECIFIC INTERVENTION
 Registration, dx testing, treatment
and monitoring of exposed
individuals, with advance from the
nearest poisons center (in case
chemical poisoning)
 Information to the public on risks
and precautions: e.g., sheltering from
air pollution (staying indoors and
closing all windows), restrictions if
water, soil or food supplies are
contaminated
 Evacuation, if necessary, and
provision of essential services at the
evacuation sites (if health risks are
acute)
 Prevention or containment of fire-
fighting water run-off (using
drainage ditches of holding tanks)
 Monitoring the source of
contamination and likely
contaminated media well beyond the
moment at which the release is
thought to have been controlled
 Remediation measures to make the
environment safe and clean
RADIATION EMERGENCIES
- May arise from:
DISASTER LEC- FINAL
 A nuclear accident in the nuclear
reactor
 A radiological accident in a hospital,
a research institution or industrial
plant using radioactive materials
 The loss or improper disposal of
radioactive sources, or during the
transportation of radioactive
materials. Terrorist activity using
highly radioactive materials packed
around traditional explosives (dirty
bomb)
 In he short-term, people may be
exposed to external irradiation and/or
the internal radiation through
inhalation.
 Later exposure may be through the
ingestion of contaminated food
- Direct Impact
 Acute (deterministic) effects in case
of exposure to very high doses of
radiation: skin burns, radiation,
sickness (nausea, vomiting, and
diarrhea), lung impairment or death
 Visual Impairment may appear
several months after the exposure to
ionizing, and eye cataracts some
years later
 Late (stochastic) effects: cancers and
genetic (inheritable) defects
- Indirect Impact
 Psychological and psychosocial
effects: fear and anxiety, increase in
disease and non- specific medical
symptoms
 Social disruption if people are
displaced
SPECIFIC HEALTH UNTERVENTION
 First medical care for radiation
victims based on principles or
emergency medicine (physical and
biological investigations by the
emergency medical team): Life-
saving and urgent medical care of
combined injuries

 Iodine prophylaxis using single large
age- appropriate doses of stable
iodine for the whole population at
risk if the inhalation of radioactive
iodine could result in high thyroid
radiation doses (e.g., in an accident
at a nuclear reactor or radioiodine
production/ distribution facility)
 12.5 mg for infants
 100mg for adults
APPROACHES TO EMERGENCY AND
DISASTER MANAGEMENT IN THE
COMMUNITY
- Public Health Approach
 Population perspective
 Community and individual
interventions
 Long term perspective
 Focus on meeting basic needs
 Access for all but identify vulnerable
population
- Cluster Approach
 Ensure more coherent and effective
response
 Mobilize groups of agencies.
Organization and NGOs to respond
in strategic manner across all key
sectors or areas of activity each
sector having clearly a designated
lead
 In support of existing government
coordination structure and
emergency response mechanisms
DISASTER LEC- FINAL
KEY STRATEGIES
 Meet physical needs (water, food,
shelter)
 Safety:
o Protect from ongoing risk
o Avoid or minimize additional
trauma
o Reduce exposure to violence
o Physical and psychological
 Thoughtful management of deceased
bodies
 Family reunification
 Community rituals
 Meaningful activity
 Consult communities on location of
significant places
 Information
 Reduce any negative impact of
media
STEPS IN ENSURING COMMUNICABLE
DISEASE CONTROL IN EMERGENCIES
1. Conduct Rapid Health Assessment
2. Provide general prevention measures in
coordination with other sectors, including
 Food security, nutrition and food aid
 Water and sanitation
 Shelter
3. Provide community health education
message including information on how to

prevent common communicable diseases
and how to access relevant services
 Encourage people to seek early care
for fever, cough, diarrhea especially
children, pregnant women and older
people
 Promote good hygienic practice
 Ensure safe food preparation
techniques
 Ensure boiling or chlorination of
water
4. Implement as indicated, specific prevention
measures, such as mass measles vaccination
campaign. Expanded Program on
Immunization, and vector control
5. Provide essential clinical facilities
6. Set-up surveillance: early warning systems,
detect outbreaks early, report diseases of
epidemic potential immediately, monitor
disease trends
7. Control outbreak: Preparation, Detection,
Confirmation, Investigation, Control
Measure, Evaluation
PSYCHOLOGICAL FIRST AID
How do crisis events affect people?
- Different kinds of distressing events happen
in the world such as war, natural disasters,
accidents, fires and interpersonal violence
(sexual violence).
- Individuals, families, or entire families may
be affected.
- People may lose their homes or loved ones,
be separated from family and community, or
may witness violence, destruction or death.
- Although everyone is affected in some way
by these events, there are wide range of
reactions and feelings each person can have.
- Many people may feel overwhelmed,
confused or very uncertain about what is
happening.
- They can feel very fearful, or anxious, or
numb or detached. Some people may have
mild reactions, whereas others may have
DISASTER LEC- FINAL
more severe reactions.
How someone reacts depends on the following:
1. The nature and severity of the events they
experience
2. Their experience with previous distressing
events
3. The support they have in their life from
other
4. Their physical health
5. Their personal and family history of mental
health problems
6. Their cultural background and traditions
7. Their age (children of different age groups
react differently)
PSYCHOLOGICAL FIRST AID: WHO (2010)
AND SPHERE (2011)
- Describe psychological debriefing as
promoting ventilation by asking a person to
briefly but systematically recount their
perceptions, thoughts and emotional reactions
during a recent stressful event.
- This is not recommended
- This is distinct from routine operational
debriefing of aid workers used by some
organizations at the end of a mission or work
task.
- Every person has strengths and abilities to
help them cope with life challenges.
- However, some people are particularly
vulnerable in a crisis situation and may need
extra help. This includes people who may be
at risk or need additional support because of
their age (Children, elderly), because they
have a mental or physical disability, or
because they belong to a groups who may be
marginalized or targeted for violence.
WHAT PFA IS?
 Humane, supportive and practical assistance
to fellow human beings who recently

suffered exposure to serious stressors, and
involves:
 Non-intrusive, practical care and
support
 Assessing needs and concern
 Helping people to address basic need
(food, water)
 Listening, but not pressuring people
to talk
 Comforting people and helping them
to feel calm
 Helping people connect to
information, services and social
supports
 Protecting people from further harm
WHAT PFA IS NOT?
 It is NOT something only professional can
do
 It is NOT professional counseling
 It is NOT “psychological debriefing” – no
detailed discussion of distressing event
 It is NOT asking people to analyze what
happened or put time and events in order
 Although PFA involves being available to
listen people’s stories, it is NOT pressuring
people to tell you their feelings or reactions
to an event
PFA is an alternative to “psychological
debriefing” which has been found to be ineffective.
In contrast, PFA involves factors that seem to be
most helpful to people’s long-term recovery
(according to various studies and consensus of
many crisis helpers). These includes:
- Feeling safe, connected to others
calm and hopeful.
- Having access to social, physical and
emotional support; and
- Feeling able to help themselves as
individuals and communities.
WHO IS PFA FOR?
 PFA is for distressed people who have been
recently exposed to a serious crisis event.
 You can provide help for both children and
adults.
DISASTER LEC- FINAL
 Not everyone who experiences a crisis event
will need or want PFA.
 Do not force help on people who do not
want it, but make yourself easily available to
those who may want support.
People who need more immediate advanced
support:
- People with serious, life-threatening injuries
who need emergency medical care
- People who are so upset that they cannot
care for themselves or their children
- People who may hurt themselves
- People who may hurt others
Who need more advanced support that PFA
alone?
- People with serious threatening injuries
- People so upset they cannot care for
themselves or their children
- People who may hurt themselves
- People who may hurt or endanger their lives
of others.
WHEN IS PFA PROVIDED?
 PFA is aimed at helping people who have
been very recently affected by a crisis event.
 Provide PFA when you first have contact
with very distressed people.
 This is usually during or immediately after
an event.
 However, it may sometimes be days or
weeks after depending on how long the vent
lasted and how severe it was.
WHERE IS PFA PROVIDED?
 Offer PFA whenever it is safe enough for
you to do so.
 This is often in community settings such as
at the scene of an accident, or places were
distressed people are served, such as:
o Health centers
o Shelters
o Camps
o Schools
 DISASTER LEC- FINAL

o Distribution sites for food or other b. When?

types of help. c. How many and who are affected?
 Ideally, provide PFA where you can have II. AVAILABLE SERVICES
privacy to talk with the person when a. Who is providing for basic need
appropriate. For people who have been (emergency medical care, food,
exposed to certain types of crisis events such shelter)?
as sexual violence, privacy is essential for b. When and where can people
confidentiality and to respect the person’s access services?
dignity. c. Who is helping, including
community members?
WHY PFA? III. SAFETY AND SECURITY
Key resilience factors: a. Is the crisis over or on going (after
 PEOPLE DO BETTER OVER THE LONG- shocks, fighting)?
TERM IF THEY: b. What dangers may be in the
- Feel safe, connected to others, calm and environment?
hopeful c. Are there places to avoid due to
- Have access to social, physical and insecurity or because it is not
emotional support permitted to be there?
- Regain a sense of control by being able
to help themselves 3 basic Action Principles of PFA:
1. Look
Frequent Needs of People After Crisis Event: 2. Listen
 Basic needs: shelter, food, water, sanitation 3. Link
 Health services for injuries or help with ACTION PRINCIPLES of PFA will help guide
chronic medical conditions how you view and safely enter a crisis situation,
approach and affected people and understand their
 Understandable and correct information
needs, and link them with practical support and
about event, loved ones and available
information.
services
 Being able to contact loved ones
PFA ACTION PRINCIPLES:
 Access to specific support related to one’s
1. PREPARE:
culture or religion
- Learn about the crisis event
 Being consulted and involved in important
- Learn about reliable service and support
decisions
- Learn about safety and security concerns
II. LOOK:
CRISIS SITUATIONS CAN BE
- Observe for safety
CHAOTIC
- Observe for people with obvious urgent
IT OFTEN REQUIRE URGENT ACTION
basic needs
- Observe for people with serious distress
BEFORE ENTERING A CRISIS SITE:
reactions
 Wherever possible, BEFORE you enter a crisis
III. LISTEN:
site try to obtain accurate information so you
- Make contact with people who may need
can be safe and effective.
support
 Wherever possible, BEFORE you enter a crisis
- Ask about people’s needs and concerns
site try to learn the following:
- Listen to people and help them feel calm.
1. THE CRISIS EVENT:
IV. LINK
a. Where?
 DISASTER LEC- FINAL

- DI - Look for people who may need special

- KO assistance; separated children
- ALAM. PACHECK SA RECORDED LEC immobile/elderly.
-
SCENARIO: NATURAL DISASTER  Crisis situations can change rapidly
The setting: A large earthquake suddenly hit the  What you encounter may be different from you
center of the city in the middle of the work day. learned before entering
Many people are affected, the extent of the damage  Take time - even a quick scan – to LOOK around
is unclear. before offering help
Key PREPARE questions:  Be calm, be safe
- Am I ready to help?  Think before you act
- What information do I have about the crisis
situation? SAFETY - What If you’re not
- Will I travel alone or together with dangers certain about
colleagues? can you safety… DO
- What support can I expect from my agency observe? NOT GO! Seek
and others? - Can you be help from
Key LOOK questions: there other.
without Communicate
- What services and supports are available?
harm to from safe
- Where will I provide PFA?
yourself or distance.
Prepare: other?
- Learn about the crisis event -
- Learn about reliable service and support PEOPLE - Is anyone Know your
- Learn about safety and security concerns WITH critically role. Try to
Readiness: consider your health and personal OBVIOUS injured obtain help for
situation URGENT - Does people who
- Gather as much accurate as you can about: BASIC anyone need special
who is affected, how severely affected, NEEDS need assistance.
where they are rescue? Refer critically
- Work in pairs/teams for support/safety - Obvious injured people
- Your agency may be able to provide you need (torn for care
clothing)?
with: equipment, update information,
- Who may
support with coordination
need help
Look: to access
- Observe for safety services or
- Observe for people with obvious urgent to be
basic needs protected?
- Observe for people with serious distress - Who else is
reactions available to
- SAFETY ISSUES: fallen or unstable help?
buildings
- Services (i.e., emergency medical) may be PEOPLE - How many Consider who
disrupted WITH and where may benefit
- Look for seriously injured trapped people SERIOUS are they? from PFA and
DISTRESS - Is anyone how best to
- Look for people who are upset, anxious or in
extremely help.
shock
upset,

immobile,
not
responding
to others or
in shock?
PEOPLE WHO LIKELY NEED SPECIAL
ATTENTION (to be safe…to access services):
1. Children and adolescents – especially
those separated from caregivers
2. People with health conditions and
disabilities – chronic illness, elderly,
pregnant or nursing women, non-mobile,
hearing/visual impairments(deaf/blind)
3. People who are at risk of discrimination
or violence - women, certain ethnic or
religious groups, mental disabilities.
Helping people in distress
 Most people recover well over time,
especially if they can restore basic needs and
receive support (PFA).
 Those with severe or long-lasting distress
may require more support:
- Try to make sure they are not left
alone
- Try to keep them safe until the
reaction passes or you can find
help from others
Listen:
- Make contact with people who may need
support
- Ask about people’s needs and concerns
- Listen to people and help them feel calm.
GUIDELINES
 Be polite, don’t intrude and ask respectful
questions about how you can help
 Often useful to make contact through
practical helping (eg, wound care, giving
medications)
 Speak slowly, calmly, and respectful
 If people want to talk to you, listen
carefully, focus on what they are trying to
tell you and how you can help. Do not
DISASTER LEC- FINAL
actively elicit details of the traumatic
experience or their losses.
TRY TO AVOID:
 Assuming you know peoples’ experiences
or what they have been through
 Assuming that everyone is traumatized
 Do not apologize
 Do not increase people’s helplessness by
taking – your task is to help themselves
 Assuming that everyone wants or needs to
talk
1. ESTABLISH CONTACT
GOAL: TO INITIATE NON-INTRUSIVE
ENGAGEMENT
 Introduce yourself and ask about
their immediate need
 Try to find somehow private
 Ensure confidentiality is maintained
 Make contact with a parent or
guardian before speaking with
children
 It is ok if people don’t want to speak
with you
II. SAFETY ANG COMFORT
GOAL: ENHANCE IMMEDIATE AND
ONGOING SAFETY AND PROMOTE
EMOTIONAL SUPPORT
 Give current, accurate information, but
avoid too much information
 Ensure immediate physical safety
 Promote social contact with others
 Ensure children who are separated from
caregivers are protected
III.STABILIZATION
GOAL: TO CALM AND ORIENT
EMOTIONALLY OVERWHELMED AND
DISORIENTED SURVIVORS
 Observe for physical symptoms (shaking,
headaches, feeling very tired, loss of
appetite)
 Crying, sadness, depressed mood, grief
 Anxiety, fear, confused, appearing
withdrawn, disoriented

 Being “on guard” or jumpy
 Insomnia, nightmare
 Not responding to others, not speaking at
all, not being able to care for themselves
IV. INFORMATION GATHERING
GOAL: IDENTIFY IMMEDIATE NEEDS
AND CONCERNS
 Are they separated from or concerned
about a loved one?
 Do they have any illnesses?
 What support do they have?
 What coping strategies are they using?
V. PRACTICAL ASSISTANCE
GOAL: OFFER PRACTICAL
ASSISTANCE AND MEET SURVIVOR NEEDS
 Enhance problem solving by:
- Identify most immediate needs
- Help the person clarify the needs
- Develop an action plan
- Help the person act
VI. CONNECT TO SOCIAL GROUPS
GOAL: TO ESTBLISH CONATCT WITH
SUPPORT PERSONS
 Key elements of support include:
- Emotional support
- Social connection
- Reassurance of self worth
- Physical assistance
 Increasing support: enhance access to
primary support, encourage use
immediately available persons
 Discuss support seeking and giving,
model supportive responses.
VII. INFORMATION ON COPING
GOAL: TO PROVIDE INFORMATION ON
STRESS REACTIONS AND COPING
 Provide basic information on stress
reactions
 Review common psychological reactions
to trauma
DISASTER LEC- FINAL
DECONTAMINATION AND
PERSONAL PROTECTIVE
EQUIPMENT
TRIAGE OF CONTAMINATED PATIENTS IN
THE FIELD:
1. Triage in the Zones of Operation:
 HOT ZONE:
 Hot zone is the innermost zone and
the area immediately adjacent to the
location of the incident.
 Minimal triage and medical care
activities take place
 Limited to airway and hemorrhage
control, admin of antidotes and
identification of expectant cases
 All staff are in protective gear
 WARM ZONE:
 At least 300ft, from outer perimeter
of hot zone
 Uphill and upwind from the
contaminated area
 Rapid triage takes place to sort
victims
 Priority is to commence
decontamination
 Victims with most severe signs and
symptoms of contamination are
given priority for decontamination
 All staff must wear PPE
 COLD ZONE:
 Area adjacent from warm zone, into
which decontaminated victims enter
 More thorough triage is performed
 PPE is maintained in this area in case
the wind changes or victims arrive
who have been improperly
decontaminated
 The purpose of this zone is to
provide medical care and to transport
victims to higher care facilities
 DISASTER LEC- FINAL

II. Triage in Hospital Setting (blood) cytochrome (perles),

 WARM ZONE: agents oxidase at the sodium
 Adjacent to the hospital (usually the (cyanide) cellular level, nitrite,
ED) that has a source of water for inhibiting sodium
decontamination aerobic thiosulfate
 Barriers to control entrance and exit metabolism. (Pasadena
Results in Cyanide Kits
from the area
hypoxia. contains both
 Triage station is at the entrance to the sodium
warm zone decontamination area nitrite and
 Cases that are clearly not sodium
contaminated enter the ED thiosulfate).
 Those that require decontamination Vesicants Tissue damage Decontamina
go through from tion with
 Those that require decontamination alkylation of soap and
go through the warm zone are before DNA or water 5%
exiting into the clean zone in the ED modification solution of
 CLEAN ZONE: of other bleach and
 Treatment are inside ED or hospital cellular water.
macromolecul British and
after being triaged and
es. Results in Lewisite
decontaminated vesicles and (BAL) for
 Considered clean or non- blisters. Lewisite.
contaminated Pulmonary Cellular No known
 Any staff or patients who have Agent Damage to the antidote.
entered the warm zone must be capillaries and Must provide
decontaminated before entering alveoli causing oxygen and
TYPES OF PHYSIOLOGI ANTIDOTE leakage of absolute rest.
AGENT CAL EFFECT fluids into the
Nerve Inhibit the Atropine, alveolus and
Agents activation of Protopam (2- resulting in
acetylcholinae PAMCI), pulmonary
sterase Diazepam for edema.
(AChE), which prolonged Riot Local irritants Decontamina
results in convulsions, control te with soap
accumulation MARK 1 agents and water
of KIT contains (which mat
neurotransmitt 2 spring- initially
ers, and results loaded auto- increase
in injectors that burning
overstimulatio contain sensation) or
n of exocrine atropine and a solution of
glands, protopam (2- 6% sodium
skeletal and PAMCI) bicarbonate,
smooth 3% sodium
muscles, and carbonate
the central and 1%
nervous benzalkoniu
system. m chloride.
Tissue Binds with Amyl nitrite

PERSONAL PROTECTIVE EQUIPMENT
- To ensure the greatest possible protection for
nurses in the workplace, hospital and other
healthcare facility. Employers are responsible
for:
 Performing a “hazard assessment” of the
workplace to identify and control
physical and health hazard
 Identifying and providing appropriate
PPEs for employees
 Training employees in the use and care
of PPE
 Maintaining PPE, including replacing
worn or damages PPE
 Periodically reviewing, updating and
evaluating the effectiveness of the PPE
program
 In general, nurses should:
 Properly wear PPE
 Attend training sessions for
PPE
 Care for, clean and maintain
PPE
 Inform a supervisor of the
need to repair or replace PPE
FOUR CLASSES OF PROTETIVE CLOTHING:
1. LEVEL A:
a. Provides the highest level of skin,
respiratory, eye and mucus
membrane protection
b. Equipment includes a fully
encapsulated water – and vapor-
proof suit, gloves, boots, and
hardhat, which contains a self-
contained breathing apparatus)
c. The suits contain a cooling and
communication system
d. Level A PPE is required by
HAZMAT teams for use in the field
2. LEVEL B
a. Used when the highest level of
respiratory protection is required, but
skin and eye protection will suffice
with splash-resistant gear.
DISASTER LEC- FINAL
b. The equipment includes SCBA and
splash-resistant clothing, hood,
gloves, hardhat, booties, and two-
way communication and cooling
system.
3. LEVEL C
a. Provides the same skin and eye
protection as level B, but uses an air-
purifying respirator (APR, rather
than a SCBA)
b. The APR filters the air rather than
providing oxygen from an outside
source
c. The APR uses a hood rather than a
mask, which reduces the risk of
contamination around the edges of
the mask and avoids the need for t
testing to ensure a proper t.
d. Level C gear is to be used only when
the chemical contaminant is known
and the criteria for use of an APR are
met.
4. LEVEL D
a. Standard work protection form
splashes; no respiratory and minimal
skin protection are required
b. The gear includes cover or standard
work clothing, safety glasses, gloves,
and face shield.
Nurses should be prepared to expect the ff.
conditions while wearing PPE:
- Extreme heat
- Poor ventilation
- Lack of peripheral vision because of the
goggles or head gear
- Inhibited sense of touch because of the gloves
- Claustrophobia
- Heavy weight
- Fatigue
- Difficulty in communications
PATIENT DECONTAMINATION
 Decontamination is the process or
removing or neutralizing a hazard from the
environment, property or life form
 DISASTER LEC- FINAL

 The goals of decontamination are: b. Appropriately decontaminate and treat the

 To reduce or remove the hazardous patients while protecting hospital staff, other
agent while maintaining staff safety patients and visitors.
 To prevent further contamination of c. Reestablish normal service as quickly as
the environment possible
 For victims, the goal is to prevent further
harm and to enhance the potential of a full HOSPITAL DECONTAMINATION WORK
clinical recovery from the exposure. ZONE

FOUR BASIC METHODS FOR

DECONTAMINATION:
1. PHYSICAL REMOVAL
- Flushing with water or aqueous
solutions.
- This method is highly effective and
significantly dilutes or reduces the
amount of chemical agent on the skin
or mucus membrane. DECONTAMINATION PROCEDURES
- For absorbent materials: Rub with  Get information. Identify the agent if
our followed by wet tissues. This is possible
suggested for emergency situations  Determine the level of PPE required
where water flushing is not available.  Mobilize security personnel and trained
2. CHEMICAL METHODS triage and decontamination staff
- Water/soap wash: this is most likely  Control access to the decontamination site as
method to be sued in the hospital well as to the hospital
setting.  Prepare decontamination area (warm zone
- The chemical agent is removed via should be outside the facility)
mechanical force as well as  Gather decontamination supplies sand
hydrolysis equipment
3. OXIDATION
- Hypochlorite solutions are VICTIM DECONTAMINATION
considered to be universally effective  Having the patient perform as much of the
for removing organophosphates and decontamination as possible is preferable to
mustard agents decrease the amount of cross-contamination
4. HYDROLYSIS  Remove all clothing (this will remove 80%-
- Hydrolyzing agents: alkaline 90% of the contaminants)
hypochlorite is effective for
 Place all clothing and valuables in a bag.
hydrolyzing VX and G agents
Pace these individual bags in a larger
collection container, taking care to not touch
PATIENT DECONTAMINATION IN THE ED
the outside of the container
The primary goals in treating patient who has been
 Wet skin and wash down with soap and
exposed to a HAZMAT and may be contaminated
water. Attention needs to be given to hair,
or who has not undergone adequate
face, hands and other areas that were
decontamination before arrival at the hospital:
exposed and not covered by clothing. Avoid
a. Isolate the chemical contamination
vigorous scrubbing to prevent skin
breakdown. Wash for 5-10 minutes and rinse
 DISASTER LEC- FINAL

 Decontaminate open wounds by irrigation

with saline or water for an additional 5-qo
minutes
 Try t avoid contaminating unexposed skin
on the patient. Use surgical drapes if
necessary
 Flushed exposed areas with saline for 10-15
minutes, except in alkali exposures, which
require 30-60 minutes of irrigation
 Clean under fingernails with a scrub brush
 Check for presence of agent using CAM or
M-8 paper, and
 If positive, decontaminate again
 Relocate to clean are, don’t dry clothing
 Ideally, collect runoff water in steel drums if
possible
 IV setups and solutions can be left in during
decontamination but should be replaced as
soon as possible with new clean setups.
 Endotracheal tubes can remain in place
during decontamination, but should be
replaced as soon at possible with new clean
tubes

EVACUATED OF THE ED
Nurses should contact the chief nurse executive or
hospital administrator-on-call and consider
evacuation of the ED in the following situations:
 Toxic materials are spilled in the ED
 Nearby HAZMATs are threatening the
hospital
 A patient is contaminated with a volatile
toxic or flammable chemical and is
decontaminated insufficiently prior to
entering the ED