Koenig and Schultz's Disaster Medicine by Koenig, Kristi L. -- Read -- Imperial Library of Trantor

Index

Half title Epigraph Title page Imprints page Contents Contributors Foreword

Disclaimer for ACEP

Perspective Preface Part I Conceptual Framework and Strategic Overview

1 Disaster Research and Epidemiology

Overview

Defining Disaster Historical Overview of Disaster Research

Early Disaster Research Epidemiology, Public Health, and Emergency Medicine

Epidemiology Publications, January 2007–April 2013

Prehospital and Disaster Medicine, January 2007–April 2013

Social Science Publications, January 2007–April 2013 Summary

Current State of the Art

Disaster Research Methods Disaster Research Objectives Disaster Research Settings Disaster Research Variables Disaster Research Study Designs Disaster Research Data Collection Information Technology Applications in Disaster Research Ethics in Disaster Research

Disaster Vulnerability

Disaster Morbidity and Mortality

Patterns of Morbidity and Mortality by Disaster Type Consistency of Estimation Methods

Recommendations for Further Research References

2 Disaster Health Education and Training:

Overview

What Is Disaster Health? Who Is Involved? What is Individual Learning and How Is It Linked to Organizational Learning? Foundations for Disaster Health Education and Training The Problem

Is the Workforce Prepared?

Effectiveness of disaster health education and training Linkage between disaster health and disaster management systems Linkage to actual requirements generated by disasters

State of the Art

Establishing an Evidence Base Use of Quality Management System Approaches

Planning Frameworks and Core Capabilities

National Incident Management System

Incident Management Systems for Public Health and Medical Services

Homeland Security Exercise and Evaluation Program

Conceptual Basis for Linking Disaster Requirements, Organizational Capabilities, and Individual Competencies Establishing Core Content

Competency Development Existing Courses Education and Training Methods Target Groups and Sources of Education and Training

Evaluation

Exercises

Using the EMS Education Agenda for the Future as a Template Plan of Action

Recommendations for Further Research References

3 Surge Capacity and Scarce Resource Allocation

Overview

Defining the Gap in Medical Surge

State of the Art

Definitions and Perspectives Healthcare Facility Surge Capacity Staff Support Options Medical Supply Surge Considerations in Development of Surge Capacity Evolution and Historical Context of Surge Capacity Recent Developments Clinical Development and Tools to Support Medical Surge Plans

Recommendations for Further Research References

4 Climate Change

Overview Current State of the Art Recommendations for Further Research References

5 International Perspectives on Disaster Management

Overview State of the Art

40 Years of Steady Improvement in the Approach to Preparedness From Preparing the Response to Mitigating the Impact From Mitigation to Resilience Shift in the Institutional Approach Institutionalization of Knowledge Broadening the Approach to Include Multiple Institutions

Recommendations for Further Research

Striking the Appropriate Balance between International Response and National Preparedness Strengthening Emergency Medicine Improving Donations and Countering Disaster Myths Improving Knowledge Discovery Strengthening the All-Hazard Approach Toward Stronger Inter-Agency Cooperation Addressing Climate Change and Security A Stronger Scientific and Professional Approach Reconstruction Resilience Conclusions Acknowledgment

References

6 Community Resilience

Overview Definition of Resilience Resilience as an Emergent Process Differences between Personal Resilience and Community Resilience The Role of Human Agency Properties of Community Resilience Attributes of Resilient Communities Adaptive Capacities Characteristics of Safe and Resilient Communities State of the Art Principles Processes Community-Based Activities International Organizational Support for Community Resilience Recommendations for Further Research Assessment and Measurement Context Attributes and Capacities Sustaining Resilience Development, Implementation, and Evaluation of Interventions Community-Based Research Conclusion Acknowledgments References

7 Ethical Issues in Disaster Medicine

Overview State of the Art

Theories of Medical Ethics War and Humanitarian Law Human Rights Law Case-Based Examples of Applying Ethical and Human Rights Principles

The Boston Marathon Bombing

Medical Ethics and Response to Haiti Earthquake The Standard of Care Resource Allocation Hurricane Katrina Plagues Ethics and Ethical Codes Summary

Recommendations for Further Research References

8 Emerging Infectious Diseases:

Overview Overview

The Threat of Emerging Infectious Diseases Infectious Diseases and Disaster Medicine

The Infectious Agent The Disease Transmission of the Infectious Agent Response Personnel Resources The Public Ethics and Law Terrorism

State of the Art

Disaster Response Plans

International Plans – the International Health Regulations (2005) U.S. Local, State, and National Systems Hospital Emergency Management Systems Mechanisms to Prevent Disease Transmission in the Community

Science and Technology

Identification and Characterization of the Agent Diagnostic Assays Therapeutics Vaccines Government Incentives Dual-Use Risk

Surveillance

International Surveillance Efforts National Surveillance Efforts – U.S. Model

Workforce Preparedness

Public Health Workforce Public Safety Workforce Healthcare Facility Workforce International Workforce

Response Communications

International Communication National Response Communication Communication with the Public

Resource Management

National Resources Hospital Resources Allocation of Resources A Specific Case: 2009 H1N1 Pandemic Influenza and Resource Availability

Preparedness Training Exercises Modeling Evaluation

Recommendations for Further Research

Preparedness

Preparedness Strategies EID Surveillance

Research

Basic Research Drug and Vaccine Development EID Surveillance Research

References

9 Disaster Behavioral Health

Overview

Range and Timeline of Typical Reactions

Distress Reactions Changes in Behavior/Health Risk Behaviors Psychiatric Disorders

State of the Art

Adherence to Public Health Measures Management of Demand Surge Understanding Community and Social Support Factors Approaches for Screening, Triage, and Referral

Longitudinal Incident Management: Toward a Disaster Mental Health Concept of Operations

Preventing and Managing Psychological Injuries

Estimates of Disaster-Related Behavioral Health Casualties Basic Disaster Mental and Behavioral Health Intervention Early Intervention Psychological First Aid World Health Organization Guidelines

Behavioral Preparedness for Disaster Responders

Responder Resilience Promoting Resiliency in Emergency Responders

Recommendations for Further Research

Conclusion

References

10 Populations with Functional or Access Needs

Overview State of the Art

A Social Vulnerability Perspective

Age The Elderly Children

Income Race and Ethnicity Gender Disability Language and Literacy Congregate Facilities Immigrants and International Visitors People in Rural Areas Intersected Vulnerabilities A Resilience Perspective The Life Cycle of Emergency Management

Legal Issues Preparedness

Know the Community Training and Education Registries Evacuation

Response Warnings

Shelters

Recovery

Recovery Planning Debris Psychological Reestablishing Medical Facilities Continuity of Care

Mitigation

Emerging Policies and Practices

Recommendations for Further Research

Conclusion Resources

References

Part II Operational Issues

11 Public Health and Emergency Management Systems

Overview

Introduction What Are Emergency Management and Public Health Systems? Has There Been an Increase in Risk and Vulnerability of Society to Disasters? Are There Successful Disaster Health Outcomes as a Result of Public Health and Emergency Management System Interventions? Who Is Responsible for Emergency Management and Public Health Systems? What Are the Problems, Gaps, or Challenges?

State of the Art

Status and Best Practices

Risk Identification, Assessment, Monitoring, and Early Warning

Technology/Social Media's Impact on Warning and Monitoring Surveillance

Risk Reduction

Technical Assistance Readily Available Health Information Community-Based Risk Reduction Programs

Governance: Organizational, Legal, and Policy Frameworks

Advocacy – Sustainability/Resilience and Health Security U.S. Emergency Management Policies

U.S. Public Health and Medical Policies Knowledge Management and Education

Citizen Involvement Whole Community Citizen Corps: Government /Citizen Partnership Education within the United StatesNational Center for Disaster Medicine and Public Health Competencies FEMA Center for Domestic Preparedness

Education within Afghanistan Preparedness for Effective Response and Recovery Healthcare Coalitions Partnerships Disaster Stress

Recommendations for Further Research References

12 Legislative Authorities and Regulatory Issues

Overview Current State of the Art

Medical Malpractice and Disaster Medicine Legal Framework for Disaster Medicine and Public Health Emergencies: Public Health Powers Provider Obligation to Protect Patient Rights

Privacy Federal Health Insurance Portability and Accountability Act Requirements and Protected Health Information in the United States Location/Health Status Public Health Officials Immediate Danger Reporting and Recordkeeping Requirements Media Data Storage and Security

Individual Liberty

Legal Basis of Mandatory Public Health Measures Consent

Authorization to Provide Medical Care

Licensing and Credentialing

Licensing Hospital Credentialing

Financial and Reimbursement Issues

Healthcare Facilities Medical Screening Exams in Disasters Emergency Management and Public Health Systems U.S. Federal Disaster Assistance Programs U.S. Government Emergency Powers over Healthcare Facilities Emergency Waiver of U.S. State Laws

Recommendations for Further Research

Comparative Research on Public Health Emergency Laws

Public Health Emergency Legal Drills and Exercises

Acknowledgments

References

13 Syndromic Surveillance

Overview Current State of the Art

Surveillance Systems – A World View Data Integration Data Analysis Technology and Social Media Forecasting/Predictive Analysis Privacy/Ethics

Recommendations for Further Research

Acknowledgments

References

14 Triage

Overview

Introduction History of Mass Casualty Triage

Current State of the Art

Vignette Triage Systems

Start Homebush Triage Standard CareFlight Triage Triage Sieve Sacco Triage Method CESIRA Protocol Military/NATO Triage SALT Triage

Standardizing the Structure for Disaster Triage Secondary Triage Systems

SAVE Triage Triage Sort

Pediatric Triage Systems

JumpSTART Pediatric Triage Tape

Comparison of Pediatric Triage Systems Use of Common Scales for Triage Outcome Measures for Triage Research Other Triage Considerations

Differentiation of Disaster Triage from Other Triage Modalities Context-Specific Triage

Recommendations for Further Research References

15 Personal Protective Equipment

Overview Current State of the Art

Background Routes of Exposure Types of PPE Chemical Protective Clothing Respiratory Protection Levels of PPE PPE in Radiation Emergencies11 PPE in Biological Emergencies Special PPE Considerations

How can the level of PPE be reduced in the hospital setting? What are the hazards associated with using PPE? What are medical surveillance requirements for wearing PPE? What are the logistical constraints of wearing PPE in biohazard event? How should PPE be maintained, inspected, and stored?

Recommendations for Further Research

Acknowledgments

References

16 Decontamination

Overview Current State of the Art

Introduction Background Initial Approach to Contaminated Patients Recognition of a Hazardous Material Exposure Identification of the Contaminant Prevention of Further Contamination Stabilization of Acute Medical Conditions Removal of Contaminant from Victims Preservation of Evidence Removal and Disposal of Contaminant and Runoff

Decontamination in Healthcare Facilities Special Considerations

How Clean is Clean? Who Should Perform Decontamination? In What Order Should Patients Be Decontaminated? How Should Pediatric Patients Be Decontaminated? What Are Important Considerations in Decontamination of At-Risk Populations?

Recommendations for Further Research

Conclusion

References

17 Quarantine

Overview Current State of the Art

Defining Quarantine Quarantine in Theory and Practice Legal Issues Underlying the Use and Implementation of Quarantine Ethical Issues

Recommendations for Further Research References

18 Mass Dispensing of Medical Countermeasures

Overview

Historical Perspectives

Current State of the Art

Examples of International Efforts Examples of Federal Assistance from the U.S. Model: Strategic National Stockpile and Cities Readiness Initiative Programs Planning for Points of Dispensing Points of Dispensing Site Selection Equipment for Points of Dispensing Points of Dispensing Operations Points of Dispensing Functional Areas Staffing and Training for Points of Dispensing Public Information Delivery Related to Points of Dispensing Points of Dispensing Deactivation Special Considerations

Drug Formulations for Patients at Extremes of Age Dispensing Laws – The U.S. System Investigational New Drugs Adverse Events Cold Chain Management Ancillary Supplies

Recommendations for Further Research References

19 Management of Mass Gatherings

Overview

Introduction Definitions Classification of Mass Gatherings History of Mass Gathering Medicine Types and Sites of Mass Gathering Events

Current State of the Art

Mass Gathering Event Planning Event Planning Timeline

Local Planning Authority

Define Event Walk Event Site Event Planning Meetings/Get Site Plans Designate and Agree on Responsibilities Designate Medical and Administrative Controllers Develop Event Medical Plan Develop Site Emergency Plan Liaise with Local Emergency Departments/Emergency Medical Services/Trauma Units Ride-Alongs to Local Emergency Departments/Venues Confirm Indemnity/Malpractice/Insurance Confirm Financial Arrangements/Attendance/Camping/VIP Arrangements Recruit Staff and Check Experience/Train and Credential Staff Develop Medical Protocols and Standard Operating Procedures Procure Clothing Procure Equipment Generate Rosters/Assign Roles/Procure Passes and Credentials Establish Event/Begin Construction/Check Adequacy of Medical Facilities Pre-Event Briefing Debriefing Dismantle Event

Medical Reconnaissance Negotiations Level of Care Medical Oversight Medical Staff Selection Medical Staff Training Triage Required Resources Estimating Medical Resources Equipment Pharmaceuticals Transport (On- and Off-Site) Medical Indemnity – Medical Malpractice Medical Records

Patient Medical Record (PMR) Injured Staff Medical Record (ISMR) Patient Transfer Record (PTR)

Treatment Facilities Communications Audit

Recommendations for Further Research References

20 Transportation Disasters

Overview Current State of the Art

Air Disasters

Incidence Data Injury Events: Historical Perspective Injury Events: Current Perspective Errors: Human-Machine Interface

2009 Crash in the Atlantic Ocean Amsterdam 2009

Errors: Human Factors and Communication during Fog Conditions

Tenerife, Spain Milan, Italy

Errors: Aircraft/Equipment Failure

The British Comet Chicago, Illinois United States: Jammed Valve

Errors: Physical Environment, Debris on Runway, and Hostile Weather

Paris, France Toronto, Ontario, Canada

Errors: Socioeconomic Environment and Failure in the Organization

Stockholm, Sweden

Crashes Caused by Shootings and Terrorist Attacks

Sakhalin, Russia Irish Sea Iran Lockerbie, Scotland Moscow, Russia

Intentional Crashes: Suicide The Disappearance of Malaysian Airlines Flight MH 370 What the Human Body Can Survive

Preparation Planning Equipment Training

Scene Response

Command Safety Communication Assessment Triage Treatment and Transport

Sea Disasters

Incidence Data Injury Events: Historical Perspective Injury Events: Current Perspective Errors: Human and Design Shortcomings

Estonia – Baltic Sea

Errors: Human Factor – Command Failure Errors: Shipwreck and Delayed Rescue

Al Salam Boccaccio

Errors: High-Speed Vessel and Bad Weather Navigation

Sleipner

Errors: Intentional Incident – Fire on Board

Scandinavian Star

Preparation

Planning Equipment Training

Scene Response

Command Safety Communication Assessment Triage and Hypothermia Treatment Transport

Rail Disasters

Incidence Data Preparation

Pre-Event Planning Equipment Training

Pre-Incident Incident Post-Incident Scene Response

Command Safety Communication Assessment Triage Treatment Transport

Road Motor Vehicle Disasters

Injury Incidents: Historical Perspective Typical Injury Incidents: Current Perspective Buses Using Compressed Natural Gas (CNG) Errors: Human, Vehicle, and Regulation Factors Errors: Human and Rescue Factors Errors: Vehicle and Environmental Factors Errors: Environmental Road Factor Preparation

Planning Equipment Training

Scene Response

Command Safety Communication Assessment Triage Treatment and Transportation

Recommendations for Further Research

Air Disasters Sea Disasters

Rail Disasters

Motor Vehicle Disasters Common Challenges: All Modes of Transportation Acknowledgment

References

21 Emergency Medical Services Scene Management

Overview Current State of the Art

Dispatch, Communications, and Initial Intelligence Gathering Initial Response Extended Response and Incident Organization Command and General Staff

Planning Section Logistics Section Finance/Administration Section Operations Section Area Command

Victim Triage and Transport Medical Management Decontamination and Special Hazards Victim Tracking Multi-Jurisdictional Coordination

Recommendations for Further Research References

22 Healthcare Facility Disaster Management

Overview

History of Healthcare Disaster Planning and Preparedness

The United States Prepares The Cold War Period The Modern Era

Current State of the Art

Healthcare Facility Preparedness

The Emergency Management Committee Familiarization with Standards for Healthcare Emergency Management Performing a Hazard Vulnerability Analysis Common Factors in Disasters Health Facility Management of Disaster The Incident Command System

Multiagency Coordination Systems The Hospital Incident Command System

The National Incident Management System Hospital Physical Plant Preparedness

Electrical Heating, Ventilating, and Air Conditioning Water Damage Control Supplies Communications

Surge Capacity for Healthcare Facilities

Background

Creation of a Surge Program Types of Surge Capacity Supplies Staff Evacuation

Superstorm Sandy Hospital Evacuation Case Study The Disaster Recovery Phase

Recommendations for Further Research

Protecting the Hospital from Chemical and Biological Threats Improved Reserve Supply Inventory Hospital Preparedness Funding Radiological Training for Hospital Employees Hospital Evacuation Methodology

References Additional Resources

23 Mass Fatality Management

Overview Current State of the Art

Legal and Social Concerns in Mass Fatality Management Public Health and Responder Safety Concerns The Role of the Event in Response Management Mass Fatality Response and Government Agencies Disaster Victim Identification Considerations in Mass Fatality Management DNA and Mass Fatality Management Mass Fatality Operations

Search and Recovery Disaster Morgue Selection

Incident Morgue Operations

Collection and Use of Antemortem Data

Policy and Ethical Questions in Mass Fatality Management Caring for Mass Fatality Workers Assistance to Victims and Their Families of Victims

Recommendations for Further Research References

24 Rehabilitation of Disaster Casualties

Overview Current State of the Art

Disaster Rehabilitation Continuum Operationalizing the Disaster Rehabilitation Continuum Role of Rehabilitation Providers Rehabilitation of Traumatic Disabling Injuries

Recommendations for Further Research

Conclusion Acknowledgements

References

25 Crisis and Emergency Risk Communication

Overview

A Case for Emergency, Crisis, and Health-Risk Communication Emergency Communication Purposes What the Public Expects

Current State of the Art

Defining Crisis and Emergency Risk Communication

Crisis Communication Issues Management Communication Health-Risk Communication Crisis and Emergency Risk Communication

Organizational Credibility and Trust Reputational Risk Management

Empathy Competence and Expertise Honesty Accountability and Commitment

Crisis Communication Life Cycle

Pre-Crisis Phase Initial Phase Crisis Maintenance Phase Resolution Phase Evaluation

Communication in a Crisis Is Different

Simplify Maintain Current Beliefs

During a Disaster, What Are People Feeling?

Fear, Anxiety, Confusion, and Dread Hopelessness and Helplessness The Myth of Panic Uncertainty

Acknowledge People's Fears

Stigmatization

Perception of Risk Role of the Spokesperson Five Communication Failures that Inhibit Operational Success

Mixed Messages Information Released Late Paternalistic Attitudes Not Countering Rumors in Real Time Public Power Struggles or Confusion

The Message – Content Is Critical in an Emergency

Identify Your Audiences and Their Concerns How Audiences Judge Messages in a Crisis

Speed of communication Factual content of the message

Crafting the Best Messages

Know the Needs of Stakeholders The Town Hall Meeting

Questions to Assist the Lay Public with Taking Ownership of Protective Public Health Measures

Recommendations for Further Research

Vicarious Rehearsal and Risk Communication Emergency Messages in Multicultural Settings Summary

References Additional Resources

26 Telemedicine and Telehealth:

Overview

Telemedicine and Telehealth Role of Telemedicine and Telehealth in Public Health Emergencies Practical Technologies to Provide Telehealth-Based Services Telehealth and Systems Reengineering Health Needs as Drivers of Telehealth Implementation for Emergency and Disaster Management Telehealth Emergency Response Scenario The Electronic Health Record and Telehealth Telecommunications Technology Support of Telehealth Telehealth and the Standardization of Support Services for the Emergency Response to Public Health Emergencies Clinical Care Networks to Support a Telehealth Response to Public Health Emergencies Business Processes That Support Telehealth Networks

Current State of the Art

Introduction State of the Art for Real-Time Videoconferencing Applications Satellite Communications for Synchronous Telehealth in Emergency and Disaster Management Land-Based Communications for Synchronous Telehealth in Emergency and Disaster Management Real-Time Simulations Using Synchronous Telehealth State of the Art of Home Telehealth Applications State of the Art for Store-and-Forward Applications State of the Art for Public Telephone Systems The Current Role of Amateur Radio Networks in Providing Telehealth The Current Role of Web-Based Information

Recommendations for Further Research

Policy Considerations Organizational Strategic Considerations Networks of Networks Research on the Clinical Effectiveness of Telehealth Robustness, Standardization, and Interoperability of Technology Telehealth Requires a Complex Adaptive System Conclusion

References

27 Complex Public Health Emergencies

Overview

Public Health Emergencies Complex Humanitarian Emergencies

Current State of the Art

Measuring the Human Cost of CHEs

Direct Indices Indirect Indicators Achievement Indicators

Epidemiology of CHEs

Developing Country Model Smoldering or Chronic Country Model Developed Country Model

Communicable Diseases in CHEs Malnutrition and Micronutrient Diseases in CHEs Psychosocial and Mental Health Problems

Risk Factors Interventions

Those Suffering from Severe Psychological Reactions to Trauma Those Presenting with Significant Psychosocial and/or Behavioral Problems Who May Be Able to Adapt and Cope Once Stability Is Restored Those Suffering from Disabling Psychiatric Illnesses

Measuring and Monitoring Effectiveness

The International Response to CHEs and the Changing Face of Humanitarian Assistance

Recommendations for Further Research References

28 Patient Identification and Tracking

Overview

Importance of Patient Tracking

Proper Allocation of Resources by a Common Operational Picture Psychological Impact of Uncertainty Workload for Healthcare Facilities Family Reunification Restoration of Healthcare Services Hazard Management

Defining Patient Identification and Tracking

Current State of the Art

Paper-Based Patient Tracking Systems Governmental Guidance Solutions for Patient Tagging

Unique Identifiers Barcodes Radio-Frequency Identification (RFID) Intelligent Tags Wearable Sensors

ePTS Functions and Limiting Conditions

Data Entry Multiple Locations for Data Entry Amount of Data vs. Essential Data Set Inclusion Criteria Flags for Special Conditions Data Viewing and Presentation Data Security System Reliability and Redundancy System Usability in Hazardous Environments

Technical Components of ePTS Localization Technologies Organizational Issues for ePTS

Recommendations for Further Research References

Part III Clinical Management

Subpart IIIA: CBRNE and HAZMAT

29 Explosive Events

Overview

Individual Impact Epidemiology Societal Impact

Current State of the Art

Blast Physics

Blast Waves Internal Force Propagation Pathophysiology Injury Classification

Injury Patterns and Initial Management

Brain Eyes, Ears, Sinuses, and Throat Chest Abdomen Other Primary Blast Injuries

Local Medical Responders Access Out-of-Hospital Triage Out-of-Hospital Care Evacuation

Specialized Responses

Urban Search and Rescue Dirty Bombs Nuclear Detonations

Local Medical Receivers

Primary Triage Emergency Care Anesthesia and Surgery Intensive Care Additional Triage Disposition Follow-up

Healthcare Systems

Permanent Facilities Surge Capacity Temporary Facilities

Rapid Needs Assessments External Response Public Information

Recommendations for Further Research

Response System Preparedness Hazard Determination Personal Protective Equipment Clinical Care Longitudinal Studies

References

30 Burn Disaster Management:

Overview Current State of the Art

Burn Surge

Other Considerations

Staff Outpatients Transfer

After the Surge: Triage and Burn Management Basic Burn Pathophysiology Other Burn Care Supply Needs Burn Care Resource Needs: People Other Considerations

Recommendations for Further Research

Acknowledgment

References

31 Clinical Aspects of Large-Scale Chemical Events

Overview Current State of the Art

Chemical History Chemical Warfare and Terrorism Agents: Clinical Considerations and Treatment Recommendations Pulmonary Intoxicants Cyanides Vesicants Nerve Agents Incapacitating Agents Chemical versus Biological Emergencies Examples of Chemical Events: Implications for Disaster Preparedness

Intentional (Non-State-Sponsored) Chemical Events

Cyanide Poisoning of Water Supply in 1985 – The Covenant, the Sword, and the Arm of the Lord

General Commentary Mitigation Preparedness Response

Nerve Agent Use in 1995 – Aum Shinrikyo

General Commentary Mitigation Preparedness Response Recovery

Improvised Explosive Devices as Chemical Weapons in Iraq from 2004–2007

Examples of Unintentional Chemical Events

Ammonia Release in 2002 in Minot, North Dakota

General Commentary

Mitigation

Preparedness Response Recovery Methyl Isocyanate Release in 1984 in Bhopal, India

General Commentary Mitigation Preparedness Response Recovery

Medical Response to Large-Scale Chemical Events

Recommendations for Further Research

General Comments Research Priorities in Specific Categories of Chemical Agents

Pulmonary Agents Cyanides Mustard and Other Vesicants Nerve Agents Incapacitating Agents Research Priorities in Response to Chemical Attacks

Useful Websites Acknowledgments

References

32 Biological Events

Overview

A Brief History of Biological Warfare Developing a Threat List Biological Warfare versus Bioterrorism

Current State of the Art

The Terrorist Threat Category A Agents

Anthrax Smallpox Plague Botulism Viral Hemorrhagic Fevers Tularemia

Recommendations for Further Research

Conclusion

References

33 Radiation Accidents and the Medical Management of Acute Radiation Injury

Overview

Large-scale Radiation Events: An Evolving Risk Scenarios of Concern

Criticality Accidents Nuclear Power Plant Accidents Radionuclide Exposures Radiotherapy and Industrial Radiography Accidents Terrorist Threat Scenarios

Radiological Terrorism Nuclear Terrorism

Nuclear Detonation Effects

General Considerations Prompt Effects Radiation Effects Blast Effects Thermal Effects Fallout

Fallout Composition

Dynamic Dose Rates Due to Fission Product Decay Benefits of Shielding

Current State of the Art

Basics of Radiation Biology

Determinants of Biological Effects

Dose Rate Radiation Quality Physiological Variables

Biodosimetry and Radiological Triage

Cytogenetic Biodosimetry Historical Experience with Early Phase Acute Biodosimetry Electron Paramagnetic Resonance Physical Dosimetry

Acute Radiation Syndrome

General Considerations Clinical Progression

Prodromal Phase Latent Phase Manifest (Illness) Phase Recovery or Death

Acute Hematopoietic Syndrome Acute Gastrointestinal Syndrome Acute Neurovascular Syndrome Acute Cutaneous Radiation Injury (≤ 90 days) Radiation Combined Injury Delayed Effects of Acute Radiation Exposure Radiation-Induced Malignancy

Treatment of Acute Radiation Syndrome

Medical Management of Acute External Radiation Syndrome

Acute Management

Medical Countermeasures and Treatments Internally Deposited Radionuclides Treatment for Internal Radionuclide Contamination

The Psychological and Behavioral Consequences of Radiation Events Case Studies in Radiation Medicine

Goiânia (Large 137Cs Source in the Public Domain) The Radiation Accident in Estonia (Large 137Cs Source in a Private Home) Criticality Accidents in the United States

Los Alamos Plutonium Sphere Cases Los Alamos Liquid Criticality Event Wood River Junction Criticality Event

Clinical Course of the Criticality Cases

Recommendations for Future Research

Conclusions

References

34 Hazardous Material, Toxic, and Industrial Events

Overview

Epidemiology of Acute Hazardous Material Events Bhopal Methyl Isocyanate Event: Example of a Fixed Facility Industrial Disaster Graniteville Chlorine Event: Example of a Transportation Incident Hazardous Wastes and the Environment Chemical Incidents and Environmental Justice

Current State of the Art

Hazardous Materials Identification and Classification Public Health Response Cycle in an Industrial Hazardous Material Incident Risk Management, Prevention, and Mitigation Preparedness

Planning and Systems Staff Stuff and Structure

Response

Prehospital Response Triage Decontamination and PPE Transportation and Evacuation

Hospital-Based Response

Decontamination Again? Medical Treatment Recovery

Recommendations for Further Research

Research in Hazardous Material, Toxic, and Industrial Events Strengthen Both Regional and Global Public Health Responses

References

Section IIIB: Environmental Events

35 Floods

Overview

Definition and Classification Causes of Floods Nature of Floods

Fluvial Floods Coastal Floods Scope of the Problem

Public Health Impacts of Flood Disasters

Loss of Safe Water and Adequate Sanitation Food Insecurity: Crop Losses and Disruption of Food Distribution Loss of Shelter and Population Displacement Toxic Chemical Exposures Toxic Mold Exposures Disruption of Healthcare Services Disruption of Public Services

Flood Myths

Flood-Related Morbidity and Mortality

Flood-Related Mortality Flood-Related Morbidity

Poverty and Flood-Related Morbidity Communicable Diseases and Flood-Related Morbidity Diarrheal Illness

Flood-Related Diarrheal Illness in High-Income Nations Flood-Related Diarrheal Illness in Low-Income Nations

Respiratory Infections Vector-Borne Diseases Arthropod-Borne Diseases

Flood-Related Arthropod-Borne Disease in High-Income Nations Flood-Related Arthropod-Borne Disease in Low-Income Nations

Rodent-Borne Diseases Dermatological Conditions Wound Infections Injuries Mental Health Effects

Anxiety and Depression Post-Traumatic Stress Disorder Suicides

Noncommunicable Diseases

Short-Term Effects: Acute Exacerbations of Chronic Diseases Long-Term Effects: Chronic Exacerbations and New-onset of Chronic Disease Floods and Cancer

Carbon Monoxide Poisoning

Current State of the Art

Sustainable Development and Disaster Risk Management Toward Sustainable Flood Risk Management Lessening Public Health Vulnerability to Flood Disasters Vulnerability Reduction Strengthening Public Health Resilience to Flood Disasters Preventing the Public Health Impact of Flood Disasters Mitigating the Public Health Impact of Flood Disasters Preparing for the Public Health Impact of Floods Responding to the Public Health Impact of Floods

Community Needs Assessment Disease Risk Assessment Clinical Diagnosis and Management of Flood-related Morbidity Disaster Relief Services after a Flood Mass Care and Shelter of Flood-Displaced Populations Environmental Health Services for Flood-Affected Populations Flood-Related Morbidity and Mortality Surveillance Chemical Emergency Response The Role of Social Support in Improving Behavioral and Physical Health Outcomes

Recovering from the Public Health Impact of Floods

Recommendations for Further Research

Disclaimer

References

36 Cyclones, Hurricanes, and Typhoons

Overview

Introduction Tropical Cyclones

Current State of the Art

Health Consequences and Public Health Evacuations Mortality Morbidity Infectious and Environmental Disease Populations with Functional or Access Needs Hospital Mitigation, Preparedness, Response, and Recovery

Pre-Impact Phase Impact Phase and Immediate Aftermath Post-Impact Phase Pharmaceutical Needs

Recommendations for Further Research References

37 Tornadoes

Overview Current State of the Art

Tornado Science

Tornado Rating Scales Forecasting Thunderstorms Forecasting Tornadoes Tornado Warning

Risk of Injury and Death

Bangladesh Canada United States Summary

Recommendations for Further Research

Acknowledgments

References

38 Earthquakes

Overview Current State of the Art

Earthquake Characteristics Management Issues

Incident Command Prehospital Response Hospital and Community Response

Medical Issues

Crush and Reperfusion Injuries Pain Management Fluid Resuscitation Transition from Immediate to Subacute/Ambulatory Care

Non-trauma-related Medical Conditions

Myocardial Infarction Acute and Chronic Pulmonary Disease End-Stage Renal Disease Management of Psychological Distress Infection and Epidemics Disposal of Bodies

Prevention

Recommendations for Further Research

Summary

References

39 Tsunamis

Overview Current State of the Art

On-Shore Tsunami Effects Immediate Tsunami Risks for Humans and Animals Public Health Aspects of Tsunami Events Tsunami Warning Systems Mitigating the Effects of Tsunamis

Recommendations For Further Research

Summary

References

40 Winter Storms and Hazards

Overview

Scope of Winter Storms Scope of Other Winter Hazards

Current State of the Art

Winter Hazards

Weather Conditions Avalanche Terrain Cold Environments

Local Medical Responders

Access Out-of-Hospital Care Evacuation

Local Medical Receivers

Primary Triage Emergency Care Secondary Triage

Healthcare Facilities Rapid Needs Assessments External Response Public Information

Cold Exposure Carbon Monoxide Poisoning Vehicle Incapacitation Other Injuries Avalanche Mitigation

Recommendations for Further Research

Risk Mitigation System Preparedness Emergency Services Rapid Needs Assessments Preventive Medicine Infrastructure Recovery

References

41 Extreme Heat Events

Overview Current State of the Art

Health Risk Factors from Extreme Heat Events

Physics, Physiological, and Meteorological Effects of Heat Exposure Diagnosis and Treatment of Heat Stress Illnesses Emergency Medical Services, the ED, and Extreme Heat Events Hospital/ED Surge Capacity and Extreme Heat Events Mortality and Morbidity from Heat Exposure Demographic and Individual Factors in Heat Exposure Geographical Factors in Heat Exposure

Urban Heat Islands as Risk Factors

Urban Heat Island and Bioclimates Heat in the Indoor Environment Air Conditioning

Planning for Extreme Heat Events

The Extreme Heat Event Planning Process Community Prevention and Mitigation Plans for EHEs Community Participation Early Information Dissemination High-Risk Populations Heat Monitoring Methods and Plan Activation Interventions Evaluation

Elements of Effective Extreme Heat Event Plans

Extreme Heat Event Prediction: Ensure Prediction of Extreme Heat Event Conditions 1–5 Days in Advance Extreme Heat Event Risk Assessment of Potential Health Impacts from Rising Temperatures Extreme Heat Event Notification and Effective Response Actions Extreme Heat Event Mitigation

The Philadelphia Extreme Heat Event Response Plan The Chicago Heat Wave of 1995 Extreme Heat Events in the Developing World

Recommendations for Further Research

Hospitals/EDs/EMS in the United States

EDs Can and Should Be Used to Predict the Healthcare Burden and Epidemiological Consequences of Environmental Disasters Individual Hospitals and Medical Systems Should Arrange for Extra Medical Staffing in Support of ED Services Local Emergency Medical Systems Need Fiscal and Institutional Support at the Regional, State, and Federal Levels

Local and Regional Governments

Urban Areas at Substantial Risk for EHEs Should Develop Listings of Vulnerable Individuals, Especially Those Older than 75 Years of Age Research Exploring the Effectiveness of EHE Preparedness and Response Strategies as well as the Association between EHEs and Morbidity Is Necessary to Aid in the Development of Evidenced-Based Plans

International Initiatives

An International Institute Is Needed to Coordinate the Various Aspects of EHE Preparedness and Response, Focusing on Emergency Management and Planning Efforts Related to Weather, Public Health, Medical, Structural, Environmental, and Urban and Regional Planning Issues Proposed Solutions to the Challenges of EHEs in Cities of the Developing World Weather Prediction Based on Air Mass Modeling from Entities Such as NOAA and the European Union Should be Used as the Basis for Alert/Watch/Warning Systems Education and Communication with Residents of Urban Areas Is Necessary. These Efforts Must Anticipate Cultural and Religious Diversity and Be Externally Funded Targeted Funding for Specific Public Health Measures Is a Necessity Effective Urban and Regional Planning Is Needed in Cities That Feature Extensive Areas of Slum Housing Distribution of Bottled Water and Potable Water Systems Can Be Effective Short-Term Solutions to EHEs

Future Research Directions Acknowledgment

References

42 Landslides

Overview Current State of the Art

Definition Types of Landslides and Their Characteristics Landslide Epidemiology Health Impacts

Post-Disaster Infectious Diseases Psychosocial Effects and Impacts on Mental Health

Risk Perception Risk Mitigation/Reduction Measures

Disaster Response and Recovery

Recommendations for Further Research

Acknowledgments

References

43 Volcanoes

Overview

Introduction Recent Historical Record of Volcanic Eruptions Vulnerability to Volcanic Disasters

Current State of the Art

Types of Volcanoes and Their Eruptions Locations of Volcanoes Scale of Eruptions Evaluating Hazards and Risks in Volcanic Eruptions

Pyroclastic Density Currents Explosion Hazards to Scientists and Tourists Lava Flows Lahars Ash Fall Volcanic Gases

Emergency Planning for Cities and Islands The Need for Medical Planning Triage and Treatment of Burns in Surge Eruptions

Recommendations for Further Research

Conclusion

References

Index

← Prev
Back
Next →

← Prev
Back
Next →