National Center for Disaster Medical Response Webinar March 29, 2011 The University of South Alabama National Center for Disaster Medical Response © University of South Alabama National Center for Disaster Medical Response. All Rights Reserved. These slides are a part of the NCDMR program and cannot be reproduced for commercial purposes. Presenters Surge Capability in Complex Disasters Carl Taylor, JD Assistant Dean, USA College of Medicine Director, USA Center for Strategic Health Innovation Mobile, Alabama Introduction to Radiological Agents Craig Llewellyn, MD, MPH Colonel, U.S. Army (Retired) Center for Disaster and Humanitarian Assistance Medicine Bethesda, Maryland Meeting Mental Health Needs During and After Disasters Carolyn Ross, RN, MSN, COHN-S Assistant Director, Preparedness Training USA Center for Strategic Health Innovation Mobile, Alabama Building Resiliency: Meeting Mental Health Needs During and After Disaster Events The University of South Alabama National Center for Disaster Medical Response © University of South Alabama National Center for Disaster Medical Response. All Rights Reserved. These slides are a part of the NCDMR program and cannot be reproduced for commercial purposes. Introduction Every affected individual will react and cope with disaster and traumatic events with varying skills and strengths based on their life experiences, values, beliefs, cultural viewpoints, socio-economic status and intellectual capability. Normal and Abnormal Stress Reactions Positive Stress ‘Fight or Flight’ response is a physiological response which ensures safety and survival during extreme events: Negative Stress When stress reaction is prevalent for a long period of time or if it is unresolved damage the physical and mental health of individuals. Significant Traumatic Events Natural Disasters Terrorism Events Violent Events (such as war or civil unrest) Small or large scale personal trauma, loss or emergency Any type of disaster or traumatic event which can cause fear, trauma or loss Disaster Phases and Response Warning and threat Impact Rescue or heroic Remedy or honeymoon Inventory Disillusionment Reconstruction and Recovery Building Psychological Resiliency During and After Disasters Mental health education and interventions will be necessary for the following targeted groups: Population of Affected Community Responders In-situ (hospital personnel, emergency responders) Deployed disaster and emergency responders Key Concepts of Disaster Mental Health Everyone who experiences a disaster will be touched by it! People generally will pull together during and after a disaster There are 2 types of disasters: individual and community Stress and grief in disasters are normal reactions to abnormal situations Most people feel they do not need mental health services Use an active outreach approach instead of traditional methods Social Support systems are crucial to recovery! Survivors respond to active genuine interest and concern Signs and Symptoms of Short and Long Term Reactions to Stress/Trauma Symptoms of Short Term Negative Stress Common Symptoms Short & Chronic Term • • • • Feeling depressed, helpless, sad and Inability to concentrate Changes in eating and sleeping habits Tension headaches, lower backaches, stomach aches, and other physical ailments Disaster Trauma Event lethargic •Memory problems •Fatigue •Feeling angry, irritable, lashing out at others •Symptoms of PTSD/Chronic Stress Symptoms of PTSD/Chronic Stress •Nightmares related to event •Sleep disturbances •Changes in appetite •Situational anxiety and fear •Being on ‘edge’ or easily startled or being ‘over alert’ •Inability to focus on work or daily activities •Difficulty in making decisions •Feeling emotionally numb, withdrawn, disconnected or different from others •Spontaneously crying, feeling a sense of despair and hopelessness •Feeling extremely protective or fearful for the safety of loved ones •Not being able to face certain aspects of the trauma and avoiding activities, places or even people that remind you of the events Interventions Individuals/Responders Community CISD (Critical Incident Stress Debriefing) Recognize importance of culture and respect diversity Adequate rest, nutrition and exercise Recruit disaster workers, community leaders and organizations who are representative of community Return to normal routines Ensure that services are accessible, appropriate and equitable Focus on pleasant memories and use relaxation techniques Participate in a support group or seek counseling Keep a journal Recognize cultural patterns that may influence help seeking behaviors Ensure that services and information are cultural and linguistically competent Conclusion Immediate Interventions and Preventive Planning are key to successful interventions! Develop Stress Management programs to implement in order to effectively manage stress! Questions? Introduction to Radiological Agent Awareness The University of South Alabama National Center for Disaster Medical Response © University of South Alabama National Center for Disaster Medical Response. All Rights Reserved. These slides are a part of the NCDMR program and cannot be reproduced for commercial purposes. Toxicity Basics: Chemical or Radiological Substances Specific health effect characteristics of agent/chemical (localized versus systemic) Mode of entry (skin, lungs, eyes, GI tract) Dose (how much, what concentration) Duration of Exposure (how long) Stress (anything that increases the heart rate can increase systemic absorption) Personal physical condition (sick, anemic, impaired skin integrity, drug/alcohol consumption) Radiological Event: The higher the probability for an incident, the lower the expected #’s of casualties. Most Probable Incident Types: Radiological: - Industry, medicine, research, teaching or agriculture - Radioactive material or devices generating ionizing radiation Nuclear accidents: - nuclear facilities Accident Terrorists Single Detonation Isolated Nuclear Conflict Worldwide Nuclear Conflict Comparison of Radiation Categories Alpha Beta (β-) or Gamma •Two protons and two neutrons bound together • Very high energy levels, highly ionizing • Protection with STANDARD PPE - low penetration (paper & cloth adequate barriers) - short travel distance centimeters (heavy) • Hazards: ingestion or inhalation - deposits in organs - immediate damage and ongoing chronic exposure risk • Single electrons or positrons •Electromagnetic radiation (pass through) • Varying energy levels and speed • Standard/Special PPE provides NO protection - high penetration, travels long distances - Time/Distance/ Shielding until gamma rays pass- concrete, steel dense barriers, lead • Hazard: ionizing penetrating rays - Immediate damage, ends when rays pass • High energy, high speed • SPECIAL PPE required - Travel distance – 10-15 feet lighter weight - Penetrates skin- metal, plastic, glass are adequate barriers • Hazards: Contact, inhalation, ingestion - Skin and eyes- burning w/ high levels - Deposits in organskidneys, liver, lungs, bone - Immediate and chronic exposure risk Radiological Event PPE, Contamination Patterns and Decontamination Personal Protective Equipment Radiological Contamination – Internal/External Decontamination Particulate Radiation Exposure •Contact, Inhalation, Ingestion Risk •A high efficiency particulate air (HEPA) filter •Standard universal precautions clothing or chemical suits (gown/suit, gloves, goggles) To determine radiation exposures check individuals with a Geiger Counter or other reputable radiation measurement devices: • Note: Decontamination is 95% effective in contaminant removal Electromagnetic Radiation Exposure •No PPE needed after gamma rays pass - Before disrobement and decontamination - After decontamination • Wet patient down to reduce airborne particles • Remove clothing… even underwear!! • Do not remove clothing over head! • Flush with large amounts of water (Soap and water to remove from skin and hair.) •Measure residual radiation with a Geiger Counter •Re-dress Patterns of Radiological Contamination Important: Geiger Counter should be used to measure for radioactivity: •Scan body – front and back in systematic way •Before decontamination •After decontamination Internal External Suspect Internal Radiation: - If Geiger Counter readings are the same on the front and back of person after decontamination - If swab from nasal turbinates is positive for radioactivity Suspect External Radiation Only: - If Geiger counter shows no activity after person has disrobed and been decontaminated *** Observe closely for systemic effects of radiation syndrome - If Geiger Counter registers positive only on front OR back of body (One side of the body) Acute Radiation Syndrome 2.5 - 5 Gy (250- 500 RAD) Survival Possible Treatment for Infections, Fluids, Blood System is Necessary 1-2.5 Gy (100-250 RAD) Survival Probable Treatment for Infections, Fluids, Blood System PRN > 5 Gy (500 RAD) Survival Unlikely Supportive Care with Fluids and Electrolytes < 1 Gy (100 RAD) Survival Fairly Certain No Treatment Necessary 0 RAD > 500 RAD Increasing Dose Radiation Symptoms Hematopoietic Disorders •Anemia •Bleeding •Infections •Delayed healing Neurovascular Symptoms •Burning sensations •Poor balance •Confusion Gastrointestinal Symptoms •Nausea/Vomiting ** •Diarrhea •Mouth / Throat Sores •↓ Appetite & Weight Loss Cutaneous Tissue Symptoms •Burns, blistering •Skin sloughing •Hair Loss Health Effects from High Radiation Exposure Sources: Environmental Protection Agency, Nuclear Regulatory Commission,: U.N. Scientific Committee on the Effects of Atomic Radiation: Canadian Nuclear Association. New York Times , March 27, 2011 Questions? Surge Capability In Complex Disasters The University of South Alabama National Center for Disaster Medical Response © University of South Alabama National Center for Disaster Medical Response. All Rights Reserved. These slides are a part of the NCDMR program and cannot be reproduced for commercial purposes. What is Surge Capacity? The ability of a healthcare system to rapidly expand beyond normal services to meet sudden or sustained increased demand for medical care. Surge Capacity vs. Capability Surge Capacity: The ability to evaluate and care for a markedly increased volume of patients - one that challenges or exceeds normal operating capacity. Surge Capability: The ability to manage patients requiring unusual or very specialized medical evaluation and care, e.g., infectious disease or burn patients. Key Principle We will work to maximize lives saved, which must include our staff and our patients Planning For A Surge Surge conditions may last for months not just days Your other patients have needs also The usual scope of practice may not apply External events will impact internal response Planning Continued The time of day or month may matter Communication both internal and external may be challenged Staff challenges will create the need for flexibility both during and after the event Planning Continued Some staff may not be yours Supplies and supply chain disruption may occur Transportation and Fuel issues are problematic Alternate facilities and COOP planning a new challenge Planning Final Leadership at every level will matter Security of staff, patients and facility is paramount Cash and Financial Management may be more damaging to the facility than wind and water There is no one size fits all response- the nature of the event matters Important Issues Do we know our communities health? Can we communicate with public health and disaster leadership? Who is making the decisions during a disaster (and can we count on them)? When we need help where does it come from and do we know how to access it? Resource and Contact Information National Center for Disaster Medical Response Website: www.ncdmr.org/ Contact Information: Carl Taylor Carolyn Ross email: [email protected] email: [email protected] Questions?