2. All-Hazards Preparation
• All-encompassing term
– Refers to many different emergencies
• Emergencies
– Those that require the emergency response of
outside assistance, which may be at the local,
county, state, or federal levels
• Emergency preparedness
– Action taken by individuals, governments, and
health care facilities and systems to be prepared
for an emergency
3. Natural Disasters
• Most common occurring type of disasters that
can affect large populations
– Avalanches
– Rock and land slides
– Winter storms
– Heat waves and wildfires
– Earthquakes and tsunamis
– Tropical storms and hurricanes
– Floods and tornados
4. Terms Related to Heat Wave
• Heat index: Number in degrees Fahrenheit
that tells how hot it feels when relative
humidity is added to the air temperature.
Exposure to full sunshine can increase the
heat index by 15oF
• Heat cramps: Muscular pains and spasms due
to activity; often first sign/reaction by the
body to heat
5. Terms Related to Heat Wave (cont’d)
• Heat exhaustion: Due to exercising or working
for a period of time in a hot, humid place and
body fluids are lost at a great rate through
sweating without replacement. Mild form of
shock because the body increases the blood
flow to the skin, reducing blood flow to the
vital organs.
6. Terms Related to Heat Wave (cont’d)
• Heat stroke: A life-threatening condition
where the patient’s internal temperature
control system stops working. The body
temperature can rapidly increase, causing
neurological damage as well as leading to
death if not immediately treated.
7. Richter Scale
• <3.5 = Earthquake may be felt, but not
recorded by a seismograph
• 3.5-5.4 = Earthquake felt; rarely causes
damage
• <6.0 = Slight damage to well-designed,
earthquake-resistant buildings, major damage
to poorly constructed buildings
• 6.1-6.9 = heavy damage and destruction up to
62 miles from the epicenter
8. Richter Scale (cont’d)
• 7.09-7.9 = Major earthquake that causes
heavy damage and destruction over a very
large area
• 8 or greater = Strongest of earthquakes, with
serious damage and destruction for hundreds
of miles
10. Man-Made Disasters
• Disasters caused by people
– Transportation accidents
– Acts of terrorism and bioterrorism
– Industrial incidents
– Combination natural disaster—man-made disaster
– Chemical release accidents
– Infrastructure incidents
– Radiological injuries
11. Specific Chemical Agent
Type of Agent General Information Mechanism of Action Signs and
Symptoms
Nerve Agent Most toxic of known
chemical agents;
often cause death in
minutes due to
respiratory
obstruction and
cardiac failure
Bind with
acetylcholinesterase,
thus not allowing it
to act on the
myoneural junction
of muscles, causing
paralysis of the
muscles
Rhinorrhea,
extreme difficulty
breathing, apnea,
seizure, paralysis,
loss of
consciousness
12. Specific Chemical Agent
Type of Agent General Information Mechanism of
Action
Signs and
Symptoms
Vesicants “Blister agents,”
commonly known as
mustard gas
Necrosis of the
epidermis, severe
conjunctivitis, and if
inhaled injury to
the mucosal tissues
of the larynx and
tracheobronchial
tree
Skin blisters and
burning of the skin
and eyes, airway
injury causing
difficulty in
breathing,
conjunctivitis that
varies in severity
13. Specific Chemical Agent
Type of Agent General Information Mechanism of Action Signs and
Symptoms
Choking agents Most common
agents are phosgene
and diphosgene.
Cause severe
irritation of the
upper and lower
respiratory tracts.
Absorbed by
inhalation. Reactions
occur at the level of
the alveolar-capillary
membrane.
Pulmonary edema;
eye, nose, and
throat irritations;
choking; coughing;
tightness in the
chest; development
of fatal pulmonary
edema during 2- to
24-hour period
14. Personal Disaster Planning
• Personal and family preparation steps
– Research, identify, and familiarize yourself and
your family with the local and regional
emergencies that could occur
– Create a family emergency plan for each type of
emergency
– Prepare emergency supplies: go-bag and in-home
supplies
15. Local/Community/Regional Response
• Response to a disaster situation
– Divided into the local and federal responses
• Local response
– National Incident Management System (NIMS)
– Local Emergency Management Agencies (LEMA)
– Emergency Operations Center (EOC)
– Incident Command System (ICS)
16. Federal Emergency Response
• Federal assistance
– Must be requested through formal channels by the
local and state governments
– Assistance will take up to three days or possibly longer
• Agencies and assistance forms
– Federal Emergency Management Agency (FEMA)
– National Response Framework (NRF)
– National Disaster Medical System (NDMS)
– Disaster Medical Assistance Teams (DMATs)
– Disaster Mortuary Operations Response Team
(DMORT)
17. Health Care Facility Emergency
Response
• Health care facilities
– Emergency action plan (EAP) follows state and
federal emergency response guidelines
• EAP components
– Mitigation
– Preparedness
– Response
– Recovery
18. Popular System of Triage
• Simple Triage and Rapid Treatment
– (START) uses four categories in which to place
patients
– DIME (Delayed, Immediate, Minimal, Expectant)
– A triage tag is attached to the patient and
treatment is based upon the color of and
information written on the tag
19. DIME Categories
• Minor – Green Tag
– “walking wounded”
– Minor injuries – sprains, minor cuts
– Self-care
– Physiologically stable and will remain so
• Delayed – Yellow Tag
— Airway is patent
— Bleeding has been treated and controlled
— Patient is physiologically stable
— Injuries may be serious, but transport can be delayed
20. DIME Categories (cont’d)
• Immediate – Red Tag
– Quick, short immediate treatment intervention
can stabilize the patient, such as establishing an
airway and treating bleeding
– Treatment must be given during the “golden
Hour” (within 1 hour) in order for victim to survive
– Once stabilized, the patient may be re-categorized
to delayed depending on extent of injuries; if it
involves head or spine injury, penetrating wound,
or fracture(s), patient should be transported as
soon as possible
21. DIME Categories (cont’d)
• Expectant – Black Tag
– Injuries are so extensive patient is not expected to
survive; use of medical resources is not advisable
in order to use for the other three categories of
patients
– Victim is made as comfortable as possible and
pain relief given
22. Triage of Chemical and Nuclear
Disaster Victims
• The patients are triaged three times:
– Hot zone: Central area where the disaster occurred.
Level A PPE should be worn. Patient is quickly
assessed for airway patency and severe hemorrhage
– Warm zone: Triage zone 300 feet or more from the
hot zone. Patients are quickly triaged into the four
categories
– Cold zone: Triage zone near the warm zone where
patients are evaluated for injuries secondary to severe
injuries and transported to a facility
23. Medical Office EAP
• Should be developed based on the community
EAPs
– Coordinated with the local and regional health
care system
• Components
– Procedures for notifying employees of an
emergency
– Procedures for evacuating the building
– Patient evacuation procedures
24. Immediate Response to an All-Hazards
Event
• Important considerations
– Disaster scene must be safe before entering
– Standard Precautions and personal protective
equipment
– Patient decontamination area
– Triage of victims
– Point of Distribution (POD) site
– Risk communication with the public
25. Immediate Response to an All-Hazard
Event (cont’d)
– Moral, ethical, and legal issues associated with
providing care during a disaster
– Emergency System for the Advanced Registration
of Volunteer Health Professionals (ESAR-VHP) and
Community Emergency Response Team (CERT)
