Emergency Health Services in Disasters and Public Health Emergencies

Emergency Health Services System

 3 Basic medical functions: Evacuation, stabilization and redistribution

EHS Components

1. Prehospital Emergency Services

 Includes all services from receipt of emergency request for assistance to the transport of
patient to the Emergency Department.
 Medical Priority Dispatched System (MPDS)- a commonly used triage system specifically
designed to abstract caller information through a question-driven protocol and direct
appropriate resources based on that information.
 Through the protocol-driven triage, dispatchers determine the level and rapidity of
response required. EMS providers must have trainings and certification in emergency
response (BLS, ACLS).
 BLS providers and Advance Emergency Medical Technicians are allowed to administer
oxygen and provide extrication, immobilization and bleeding control and also assist
patients In taking their medication. Some areas allow them to administer additional
medications (albuterol, naloxone, epinephrine) or perform additional procedures
(Continuous positive airway pressure).
 ALS Providers can perform more advance skills including intubation, needle
thoracostomy, defibrillation and cardiac pacing, while administering wide variety of
pharmacotherapy.
2. Hospital Emergency Department
 EDs and inpatient capabilities of hospitals may range from providing basic care to
administering specialized, advanced interventions such as trauma, stroke and cardiac
care.
 Based on the services available in the hospital, the EMS system may have protocol in
place to direct patients with certain condition (e.g., burn, trauma)
3. Alternate source of Emergency Care
 Many communities have urgent care centers that provide care for minor illnesses and
injuries. Some are equipped to perform laboratory testings and radiographs, provide
intramuscular or intravenous medications, or provide advanced therapies.

Telemedicine- use of electronic information and communication technologies to provide and support
healthcare when distance separates the participants.

Mass Gathering (MG)

 A situation during which crowd gathers and where there is a potential for delayed
response to emergencies because of limited access to patients or other features of the
environment and the location.
 MGs and place a strain on the local health system. Responders must be able to secure
the safety of the scene, control crowd, delineate access and evacuation routes,
 coordinate, collaborate and communicate across services and rapidly identify the
potential for a secondary event.

Healthcare Emergency Management

 The science of managing complex systems and multidisciplinary personnel ton address
emergencies and disasters in health care systems, across all hazards, and through the phases of
mitigation, preparedness, response and recovery.

Emergency Medical Consequence Planning

3 types of planning

1. Strategic Planning- these are planning activities that focus on preparing the organization for any
type of threat or event.
2. Contingency Planning- these are planning activities related to a site-specific threat that may
occur at any time.
3. Forward Planning- These are planning activities for a known imminent event, for example, an
impending snowstorm or rock concert.

Goals of Emergency Care are Mass Gathering

1. Evaluate and stabilize injury and illness in participants, support staff and spectators.
2. Preserve the capacity of the local public health and acute medical care system to serve their
local constituents.
3. Optimally respond to extraordinary or catastrophic event through utilization of ICS.

Activities during Emergency Consequence Planning

1. Information Collection
 When will the event occur?
 Where will the event be located?
 What type of audience is expected?
 What weather conditions are likely
 What type of health facilities will be available in the vent?
2. Risk Assessment—should be a continuous process and must be documented for later review.

Information Collection

1. Event Type- Determining the type of the crowd, type of event and environmental factors may
help in predicting the nature of patients.
 Psychosocial domain
 Biomedical domain
 Environmental domain
2. Weather- type of weather, terrain and accessibility of the event are major factors in determining
type of illness and injuries to which the health care team will need to respond.
a. Heat
  Heat-related illnesses (e.g., heat stroke, blisters, and sunburn) are the most cvommonly
identified environmental health concern for MG events.
 The demographic profile of the attendees need to be considered. For instance, infants,
children, elderlies, outdoor workers and athletes have greater vulnerability to heat-
related illnesses particularly cardiovascular and pulmonary.
1. Heat Rash “Prickly Heat”
 Maculopapular rash accompanied by acute inflammation and blocked sweat gland.
 Common in body parts covered by tight clothing.
 Assessment: Red cluster of small blisters that look like pimples on the skin (usually on
the neck, groin, or in elbow creases)
 Treatment: Application of Chlorhexidine lotion to remove desquamated skin (Talcum
powder is not effective)
 Nursing Management:
1. Keep in a cool and dry place
2. Keep the rash dry
3. Use powder (baby powder) to soothe the rash
2. Heath Cramps
 Painful, often severe involuntary spasm of the large muscle groups in strenuous
exercise.
 Hyponatremia results and causes cramping in the overstressed muscle.
 Assessment: Heavy sweating during intense exercise, muscle pain or spasm.
 Treatment:
 Intravenous Rehydration
 Electrolyte drinks
***DO not give salt tablets—they cannot provide adequate fluid replacement and
can be a gastric irritant
 Nursing management
1. Move to a cool place
2. Provide water or electrolyte drinks
3. Get medical help if: Cramps last longer than 1 hour and if the patient has existing
heart problem

3. Heat Syncope

 result from intense sweating which leads to dehydration, followed by peripheral

vasodilation.
 Tx: Cooling and rehydration of the patient with oral rehydration solutions.

4. Heat Exhaustion

 Precursor to heat stroke.

 Heat stroke and heath exhaustion are similar clinically, however, with heat exhaustion, the
patient remains neurologically intact.
 Assessment:
1. Headache
 2. Nausea and vomiting
3. dizziness
4. fatigue
5. myalgias
6. tachycardia (fast, weak pulse)
7. Temperature is generally elevated
8. Excessive dehydration and electrolyte depletion
 Treatment:
1. Remove patient from source of heat and bring him to a cool and dry place)
2. Mild case—oral rehydration; moderate-severe—IV therapy
3. Loosen clothes of the patient
4. Give patient a cool bath or put wet cloths on his body

5. Heat Stroke

 May occur in hig tempeaqture and humidity

 High risk populations: infants, elderly and chronically ill patients
 Sweating is absent in many of those affected
 It is an emergency condition that requires lifesaving measures and transport to the nearest
emergency facility.
 Assessment:
1. High body temperature
2. Hot, red, dry, or damp skin
3. Fast and strong pulse
4. Headache
5. Dizziness
6. Nausea
7. Confusion
8. Loss of consciousness
 Complications
1. Rhabdomyolysis
2. Acute renal failure
3. Hepatic damage
4. Impairment of CNS
5. Disseminated intravascular coagulation
 Management:
1. Transport to the nearest hospital is a must
2. Move oatient to a cooler place
3. Help patient lower temperature with cool cloth and baths
4. Do not give the person anything to drink

Cold- Related Illness

A. Local Cold Injuries

1. Frostnip
 Precursor to frostbite
  Superficial cold injury without ice crystal formation or tissue damage.
 Assessment:
1. Area affected is pale from vasoconstriction
2. Mild burning or stinging is usually felt.
 Management:
1. Rewarming

2. Frostbite

 Most common in face, nose, ears, hands and feet

 It can be superficial or deep injury
 Assessment:
1. First degree frostbite—Erythema, Mild edema, no blisters, burning and stinging.
2. Second Degree frostbite—erythema and edema followed by formation of clear blisters in 6-
12 hours
B. Systemic State
Hypothermia
 A core temperature of less than 35 degrees Celsius
 Neurologic and cardiovascular systems are most affected
 May not only occur in extreme colod temperature, it may also occur during flooding,
thunderstorms, etc
 Assessment
1. Mild Hypothermia- core body temperature between 32c and 35c
-- Shivering and increased heart rate and blood pressure
2. Moderate- core body temp of 27c to 32c
--- all bodily functions will progressively slow
--- shivering stops at 30c
--- arrythmia may occur
---below 28c the irritability of the myocardium increases, making the patient more
susceptible to the development of ventricular fibrillation.

Event Duration

 Healthcare usage may be higher in settings where groups are allowed to move about more
freely. Such mobility heightens the risk of minor trauma and exposure- or exertion related
illnesses compared to events where spectators are sited for most of the time.
 The plan must include provisions for drinking water and sanitation facilities, adequate water
supply and rubbish disposal.
 Shelter should be a major concern during event planning, especially for outdoor events, lengthy
events or adverse weather condition.

Characteristics of the crowd

 Size- a large group of people

  Density—people collocated in a particular area with a particular density distribution
Crowd Density—higher crowd density may lead to increased interactions between
individuals.
 Time—individuals who come together in a specific location for a specific purpose over a
measurable amount of time
 Collectivity- crowd members share a social identity, including common goals and interests, and
act in coherent manner
 Novelty- individuals act in a social coherent manner, despite coming together in an ambiguous
or unfamiliar situation.

Medical Aid Stations

 Medical and treatment stations must be placed in an accessible area

 The size of the event and the site layout will determine the number of aid stations needed
 All aid station should be clearly marked with signs
 Aid stations should have tables and sufficient room for equipment, supplies, and personnel.
 There should be beds where patients can lay down

Transportation

 Ambulance areas should be within easy reach and are accessible from the medical treatment
stations.
 The receiving hospitals for patients should be determined in advance, and mechanisms for
notifying these hospitals of incoming patients must be implemented prior to an event.

Practice Parameters for Nursing Care

Nursing Assessment

 Perform a respiratory, airway assessment

 Perform cardiovascular assessment, including Vital signs, monitoring for signs of shock
 Perform an integumentary assessment including burn assessment
 Perform pain assessment
 Perform trauma assessment from head to toe
 Perform a mental status assessment, including Glasgow Coma Scale
 Know the indication of intubation
 Know IV insertion and administration of IV medication
 Know the emergency medications
 Know the Principles of fluid therapy

Nursing therapeutics and Core Competencies

 Concepts of basic first aid and hemodynamic stabilization

 Disaster triage and transport
 Pain Management
 Management of Hypovolemia and fluid replacement
 Suturing (if appropriate based on practice parameter) and initial wound care
 Blast injuries
 Eye lavage technique
 Decontamination of chemical and radiation exposures
 Fractures and immbolization of fractures
 Management of hemorrhage
 Stabilization of crush injury
 Movement of patient with spinal cord injury