THE NOTES CONTAIN THE FOLLOWING IN DETAILS
• Chapter Outline
• Principles of Triage
• Chemical, Biological, Radiologic, Nuclear, Explosives, and Environmental Incidents
• Chemical Disasters
• Biological Disasters
•
...
THE NOTES CONTAIN THE FOLLOWING IN DETAILS
• Chapter Outline
• Principles of Triage
• Chemical, Biological, Radiologic, Nuclear, Explosives, and Environmental Incidents
• Chemical Disasters
• Biological Disasters
• Nuclear and Radiologic Disasters
• Improvised Nuclear Devices
• Radiologic Dispersal Devices (Dirty Bombs)
• Occupational Accidents and Radiologic Exposure Devices
• Natural Disasters
• Hurricanes
• Tornadoes
• Earthquakes
• Tsunamis
• Terrorism
• Preparing Before Disaster Strikes
• After a Crisis
• Posttraumatic Stress Disorder
• Special Populations
• Summary
• Clinical Applications
• Key Points
• Personal Stories
• Boston Marathon Bombings: The White Jacket
• Dixie Patterson, PA-C
• Haitian Earthquake, 2010: International Disaster Relief
• Henry Curran, PA-C
The National Disaster Medical System (NDMS) is a federally coordinated system that augments the Nation’s medical response capability. The overall purpose of the NDMS is to supplement an integrated National medical response capability for assisting State and local authorities in dealing with the medical impacts of major peacetime disasters and to provide support to the military and the Department of Veterans Affairs medical systems in caring for casualties evacuated back to the U.S. from overseas armed conventional conflicts
The Medical Reserve Corps (MRC) is a national network of volunteers, organized locally to improve the health and safety of their communities. The MRC network comprises 998 community-based units and over 200,000 volunteers located throughout the United States and its territories.
Environmental Scenario
On May 22, 2011, an EF5 tornado struck Joplin, Missouri, which created total devastation 1 mile wide and 14 miles long, killing 158 people, injuring 1150, and causing $2.8 billion of damage. The local hospital, St. John’s Regional Medical Center, was so severely damaged that it was deemed structurally compromised and had to be torn down. Six people died at St. John’s; one was a visitor, but the other five were on ventilators that failed when the backup generator failed to start. Because of the extreme damage to the hospital, it was unable to service the multiple casualties created by the tornado during the initial response.
Terrorism
On April 15, 2013, the Boston Marathon was well under way when two bombs built in pressure cookers and packed with shrapnel exploded about 200 yards and 12 seconds apart, killing three people and injuring 264. Two self-radicalized brothers were implicated. One was killed in a shoot-out with police, and the second was captured. The explosion quickly produced a mass casualty situation that challenged the robust Boston emergency medical system.
Impact and Response
Fortunately, medical help was immediately available because health care professionals were in attendance to support the runners. The availability of prompt first aid and the quick response of Boston Fire and EMS were critical in saving lives. Twenty-seven hospitals were used to treat 264 patients. Lower extremity injuries were common because of the bombs’ being placed on the ground. Seventeen amputations were performed, and many patients required multiple surgical debridements because of the vast amounts of nails and ball bearings loaded in the improvised explosive devices.
Chemical Emergencies
On June 11, 2014, a 58-year-old woman presented via ambulance to a rural Jefferson County, Georgia, ED complaining of shortness of breath, nausea, vomiting, weakness, and an inability to move, which had begun earlier that day. In addition, her young grandson and two grandchildren had similar, but milder, symptoms. It was discovered that the patient’s relative had used an agricultural insecticide inside her home called Fumitoxin, which when exposed to moisture emitted a phosphine gas. Phosphine, a colorless, odorless gas, is a lung-damaging agent that produces pulmonary edema and is fatal unless treated. The adult patient died; however, the children were treated and survived.
References
1. The PA in disaster response: core guidelines. American Academy of Physician Assistants. www.aapa.org/WorkArea/DownloadAsset.aspx?id=3087. Accessed March 20, 2016.
2. Definitions. World Health Organization. www.who.int.easyaccess1.lib.cuhk.edu.hk/hac/about/definitions/en/. Accessed March 20, 2016.
3. Mass Casualty Management System. World Health Organization. www.who.int.easyaccess1.lib.cuhk.edu.hk/hac/techguidance/MCM_guidelines_inside_final.pdf. Accessed March 20, 2016.
4. Wenck M., Van Sickle D., et al: Rapid assessment of exposure to chlorine released from a train derailment and resulting health impact. Public Health Rep 2007; 122: pp. 784-792
5. Ramesh A., and Kumar S.: Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents. J Pharm Bioallied Science 2010; 2: pp. 239-247
6. Hrdina C.M., Coleman C.N., et al: The “RTR” medical response system for nuclear and radiological mass-casualty incidents: a functional TRiage-TReatment-TRansport medical response model. Prehospital Disaster Med 2009; 24: pp. 167-178
7. Bhopal trial: eight convicted over India gas disaster. BBC News. June 7, 2010. news.bbc.co.uk/2/hi/south_asia/8725140.stm. Accessed March 20, 2016.
8. National Disaster Management Authority Government of India. www.ndma.gov.in/en/. Updated December 11, 2015. Accessed March 20, 2016.
9. Medical management of chemical and biological casualties. U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD.
10. Noah D.L., Sovel A.L., Ostroff S.M., and Kildew J.A.: Biological warfare training: infectious disease outbreak differentiation criteria. Mil Med 1998; 163: pp. 198-201
11. Improvised nuclear device. Centers for Disease Control and Prevention. emergency.cdc.gov/radiation/pdf/infographic_improvised_nuclear_device.pdf. Accessed on March 20, 2016.
12. Public Health Emergency. U.S. Department of Health and Human Services. www.phe.gov. Updated December 10, 2015. Accessed March 20, 2016.
13. Medical Reserve Corps. U.S. Department of Health and Human Services. www.medicalreservecorps.gov/pageviewfldr/About. Updated November 20, 2015. Accessed March 20, 2016.
14. Emergency Response and Disaster Preparedness. Centers for Disease Control and Prevention. emergency.cdc.gov/preparedness/kit/disasters/. Accessed March 20, 2016.
15. Post-traumatic stress disorder. National Institute of Mental Health. www.nimh.nih.gov.easyaccess1.lib.cuhk.edu.hk/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml. Accessed March 20, 2016.
16. Post-traumatic stress disorder. American Psychiatric Association. www.dsm5.org/Documents/PTSD%20Fact%20Sheet.pdf. Accessed March 20, 2016.
17. National Weather Service central region service assessment, Joplin, Missouri, May 22, 2011. Department of Commerce. www.nws.noaa.gov/os/assessments/pdfs/Joplin_tornado.pdf. Accessed March 20, 2016.
18. Murphy K. Five patients who died in Joplin hospital suffocated. Reuters. May 24, 2011. www.reuters.com/article/us-usa-weather-tornadoes-hospital-idUSTRE74N7FB20110524#GdClWE5crClcjsYB.97. Accessed March 20, 2016.
19. Campbell C. Everything was wiped out as far as you can see. Suburban Journals. June 6, 2011. www.stltoday.com/suburban-journals/metro/news/everything-was-wiped-out-as-far-as-you-can-see/article_9366c593-0a0a-5f0f-aebc-314fa55412f7.html. Accessed March 20, 2016.
20. Lengel A. Little progress in FBI probe of anthrax attacks. The Washington Post. April 8, 2008. www.washingtonpost.com/wp-dyn/content/article/2005/09/15/AR2005091502456.html. Accessed March 20, 2016.
21. Vargus E., Ross B., and Osunsami S.: Anthrax investigation/bentonite/cases [ABC Evening News video]. Nashville, TN: Vanderbilt Television News Archive, October 28, 2001.
22. Bioterrorism: Public health response to anthrax incidents of 2001. U.S. Government Accountability Office. www.gao.gov/products/GAO-04-152. October 15, 2013. Accessed March 20, 2016.
23. Straw J, Ford B, McShane L. Police narrow in on two suspects in Boston Marathon bombings. New York Daily News. April 17, 2013. www.nydailynews.com/news/national/injury-toll-rises-marathon-massacre-article-1.1319080. Accessed March 20, 2016.
24. Kotz D. Injury toll from Marathon bombs reduced to 264. Boston Globe. April 29, 2013. www.bostonglobe.com/lifestyle/health-wellness/2013/04/23/number-injured-marathon-bombing-revised-downward/NRpaz5mmvGquP7KMA6XsIK/story.html. Accessed March 20, 2016.
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