JUST-IN-CASE Training for a Public Health Emergency School of Nursing University of Texas at Austin 2011

Speakers Trish O’Day, MSN, RN –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 –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?

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 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 Responsible Agency 1.Dept of Transportation 2.National Communication Center 3.USA Corps of Engineers 4.Dept of Agriculture 5.FEMA 6.American Red Cross 7.Government Services Agency 8.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 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 & UT Deans for Schools will be contacted Disaster Mobilization Plan of the Schools may be deployed

School of Nursing Template 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 surveillance- prevent spread of communicable disease

Mass Shelters How is the shelter organized? What are the needs of the sheltered residents?  Safety  Food/Water  Hygiene  Assistance to transition to another setting Preventing the spread of disease  Hand-washing  Disinfection  Separation of residents  Surveillance and Monitoring

Mass Shelters What kinds of health care are provided?  First Aid  Primary Care  Medication Issues  Transport to another setting  Referral

Medical Special Needs Shelter Special or Vulnerable Populations  Cognitively Impaired  Morbidly Obese  Mentally Ill  Persons with Addictions  Pregnant  Mobility Impaired  Frail Elderly  Children

Hurricane Ike: Shelter in Austin Texas

THE WORLD HAS CHANGED

Man-Made Disasters: CBRNE Chemical Terrorism Biological Terrorism Radiological Terrorism Nuclear Terrorism Explosives (high yield)

Radiological Nuclear Terrorism

Chemical Terrorism Tokyo Sarin Gas Attack 1995 Tokyo underground Ricin Las Vegas 2008 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 Anthrax Botulism (toxin) Plague Smallpox Tularemia Viral Hemorrhagic Fevers

Category A Agent Anthrax CDC: gram stain of B. anthracis History of Anthrax

Cutaneous Anthrax Vesicle Development Day 2 Day 4 Day 6 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 USAMRICD: Inguinal/femoral buboes Bubonic Image: Armstrong & Cohen Pneumonic

Category A Agent Smallpox

Smallpox Day 2 Day 4 Day 8

SmallpoxChickenpox Photo courtesy of CDC 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 Training 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

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

–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

Thank You! UT Disaster Plan Disaster Basics –know who is in charge –know what you don’t know Get organized Sign up for more training Volunteer in your community Questions?