JUST-IN-CASE Training
for a Public Health Emergency
School of Nursing
University of Texas at Austin
2011
Speakers
• Trish O’Day, MSN, RN
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Public Health Nursing Faculty
Katrina and Ike vet
Community and Rural Health, Texas Department of Health
Medicaid Managed Care, Texas Department of Health
• Linda Chambers, MPH, RN
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Public Health Nursing faculty
Lt. Col. (ret.) USAF, BSC
Public Health Officer, US Air Force
TX Smallpox Vaccination Program Coordinator, Texas Department of Health
Firsthand from Haiti
Topics
• UT and the UTSON have a disaster plan.
• We have to understand it.
– Disaster Basics 101
• We have formed partnerships:
– City of Austin and the University of Texas
– Nursing, Pharmacy, Social Work
• All RNs should have disaster preparedness
skills.
• We hope you will volunteer in your
community.
What is a Disaster?
What is a Disaster?
• Destructive
event that
overwhelms all
available
resources.
Types of Disasters
• Natural
– With warning
– Without warning
• Man-made
– Unintentional
– Intentional
• Criminal
• Terrorism
• Weapons of Mass
Destruction
Phases of Emergency
Management
Emergency Management
System
• National Incident Management System
(NIMS) - A federal response plan,
Presidential declaration in response to state
and local requests.
• Incident Command System (ICS)
Federal Response Plan
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Function
1. Transportation
2. Communication
3. Public Works
4. Fire Suppression
5. Information Planning
6. Mass Care
7. Resource Support
8. Health/Medical
9. Urban search/rescue
10. HAZMAT
11. Food services
12. Energy
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Responsible Agency
1.
2.
3.
4.
5.
6.
7.
8.
Dept of Transportation
National Communication Center
USA Corps of Engineers
Dept of Agriculture
FEMA
American Red Cross
Government Services Agency
Dept of Health and Human
Services
9. FEMA
10. Environmental Protection Agency
11. Dept of Agriculture
12. Dept of Energy
Key Questions for RNs, need to
consider BEFORE a disaster
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What will I need?
What do I have?
What can I get and who knows?
What if I can’t get what I need?
How do I stretch what I have?
How do I decide who gets what I have?
Do I stay or do I go?
Am I part of the solution or part of the problem?
Key Questions for RNs, need to
consider BEFORE a disaster
Important Resources:
1. Altered Standards of Care in Mass Casualty Events
(AHRQ)
1. Providing Mass Medical Care with Scarce Resources
(AHRQ)
The University has a disaster
response plan.
• Emergency
Management Plan
• Hurricane Plan
Considerations for
Mass Sheltering
• Infectious Disease
Plan (previously
known as Pandemic
Flu Plan)
Memorandum of Cooperation:
UT & City of Austin Health Dept
• Collaborative Agreement
• In public health emergency, Austin will take the
lead
• Campus Safety & Security @ UT
• Deans for Schools will be contacted
• Disaster Mobilization Plan of the Schools may
be deployed
School of Nursing Template
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Committee Structure
Disaster Mobilization Plan
Call-up Process
Your role at SON
Your expected role: Prevention of
Disease
• Assist in disease
surveillance
• Distribute public stocks
of drugs and vaccines
• Prevent local disease
transmission using
containment strategies
• Prepare educational
campaigns to reduce
disease spread
Your expected role: Mass Sheltering
• Psychological first aid
• Assistance with ADLs;
minor first aid
• Basic screening triage
(vitals, medical history,
chief complaints, some
specialized care)
• Disease surveillanceprevent spread of
communicable disease
Mass Shelters
• How is the shelter organized?
• What are the needs of the
sheltered residents?
oSafety
oFood/Water
oHygiene
oAssistance to transition to
another setting
• Preventing the spread of disease
oHand-washing
oDisinfection
oSeparation of residents
oSurveillance and Monitoring
Mass Shelters
• What kinds of health
care are provided?
oFirst Aid
oPrimary Care
oMedication Issues
oTransport to another
setting
oReferral
Medical Special Needs
Shelter
• Special or Vulnerable
Populations
oCognitively Impaired
oMorbidly Obese
oMentally Ill
oPersons with Addictions
oPregnant
oMobility Impaired
oFrail Elderly
oChildren
Hurricane Ike: Shelter in
Austin Texas
THE WORLD HAS CHANGED
Man-Made Disasters: CBRNE
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Chemical Terrorism
Biological Terrorism
Radiological Terrorism
Nuclear Terrorism
Explosives (high yield)
Radiological
Nuclear Terrorism
Chemical Terrorism
Ricin Las Vegas 2008
Tokyo Sarin Gas Attack
1995 Tokyo underground
Mustard Gas
Explosives (high yield)
Bioterrorism
Epidemiological Clues
Key: Look for change or trend in
your population baseline
When you hear hoof beats, think
of a horse, but don’t rule out a
zebra
The Point
• Many biological agents have been
weaponized
• Biological agents have been used
multiple times in the past as weapons
• Bioterrorism has occurred several times
already in the United States
• Biological agents will be used again
• Healthcare workers must be prepared!
Category A Critical Agents
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Anthrax
Botulism (toxin)
Plague
Smallpox
Tularemia
Viral Hemorrhagic Fevers
Category A Agent
Anthrax
History of Anthrax
CDC: gram stain of
B. anthracis
Cutaneous Anthrax
Day 6
Vesicle
Development
Day 4
Day 2
Eschar
formation
Day 10
Mediastinal Widening
JAMA 1999;281:1735–1745
Category A Agent
Plague
CDC: Wayson’s Stain of Y. pestis
showing bipolar staining
History of Plague
Plague
Bubonic
USAMRICD: Inguinal/femoral
buboes
Pneumonic
Image: Armstrong & Cohen
Category A Agent
Smallpox
Smallpox
Day 2
Day 4
Day 8
Smallpox
Photo courtesy of CDC
Chickenpox
Photo courtesy of CDC PHIL
Tularemia (“Rabbit Fever”)
Francisella tularensis
Route of infection: Tick and fly bites,
infected animals, inhalation
Presentation
• Incubation period: 1 to 21 days
• Acute febrile illness with severe
generalized weakness
• Pneumonia in 80%
• May have conjunctivitis or skin
ulcers with swollen lymph nodes
No person-to-person transmission
USAMRICD: Pneumonic
infiltrates of
pneumonic tularemia
Seventeen-Year Old Patient with
Mild Botulism
History of Botulism
Category A Agent
Viral Hemorrhagic Fever
CDC: Electron
micrograph of
Ebola virus
Bolivian Hemorrhagic Fever
Marburg Disease
How can I remember all these diseases?
(S-A-F-E-T-Y)
• S: skin rash with fever
Smallpox
• A: acute pulmonary syndrome with fever
Anthrax and plague
• F: flu like syndrome with fever
Tularemia and SARS
• E: excessive bleeding
Viral hemorrhagic fevers
• T: toxin effect without fever
Botulism
• Y: Your personal safety and the safety of your community
depend on recognition and awareness
Public Health & Hospital
Responsibilities
How can healthcare professionals
contribute to public health
preparedness?
Roles and Responsibilities:
PRE-EVENT
Public Health Emergency
Public Health
• Disease surveillance
• Respond to outbreaks
• Investigation
• Control and prevention
• Laboratory support
• Participate in planning
activities
Hospitals/HCW
• Disease reporting
• Immediately notify public
health of unusual group
expressions of illness or
outbreaks
• State laboratory utilization
• Participate in planning
activities
• Exercise plans
• Training
• Training
Roles and Responsibilities:
DURING a Public Health Emergency
Public Health
• Implement notification
• Activate/deploy staff
• Implement response
plans/guidelines
• Provide treatment & control
recommendations
• Conduct investigations
• Implement control measures
• Mass
vaccination/prophylaxis
• Provide/coordinate health
related information
– Healthcare workers
– Public
– Media
Hospitals/HCWs
• Implement notification
• Activate staff
• Implement response
plans/guidelines
• Coordinate efforts with public
health
• Provide care
• Coordinate health related
information
– Public health
– Public
– Media
Roles and Responsibilities:
POST-EVENT
Public Health Emergency
Public Health
• Evaluate response
• Review after-action
reports
• Coordinate &
implement changes to
plans & procedures
• Implement recovery
plans
Hospitals/HCWs
• Evaluate response
• Review after-action
reports
• Coordinate &
implement changes to
plans & procedures
• Implement recovery
plans
http://www.citizencorps.gov/cert/about.shtm
http://www.austinhsem.com/go/site/2333/
– Disaster Preparedness
– Fire safety
– Rescue safety - Light search and rescue
– Disaster psychology, team organization
– Disaster medical operations - simple
triage, rapid treatment, head to toe
assessment
https://tx.train.org/DesktopShell.aspx?tabid=1
http://www.bt.cdc.gov/training/index.asp
Thank You!
• UT Disaster Plan
• Disaster Basics
– know who is in charge
– know what you don’t know
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Get organized
Sign up for more training
Volunteer in your community
Questions?