US health final - emergency preparedness

Question 1

Be familiar with the following terms:

Answer 1

Bioterrorism
Department of Homeland Security
Federal Emergency Management Agency (FEMA)
Incident Command System (ICS)
Strategic National Stockpile (SNS)

Question 2

Definition

Answer 2

An emergency is a sudden, unexpected event requiring immediate action due to a potential threat to health and safety, the environment or property

Question 3

Categories of disasters

Answer 3

Natural disasters-can be more predictable
Earthquakes, hurricanes, tornados, tsunami, blizzards, volcanoes

Man-made (technological) disasters-Less predictable
Explosions/blasts, fires, oil spills

Bioterrorism

Question 4

Bioterrorism

Answer 4

The unlawful release of biological agents or toxins with the intent to intimidate or coerce a government or civilian population to further political or social objectives. Humans, animals, and plants are often targets.”

Question 5

Disasters

Answer 5

Natural epidemics or pandemics
- May involve a novel, emerging infectious disease, re-emerging disease or a previously controlled disease

Intentional or accidental release of a chemical, biological, radiological or nuclear agent

Question 6

Disasters

Answer 6

All types of disasters can cause injuries, fatalities and loss of resources.

All healthcare facilities are at risk for explosions or fires.

Explosions are often the weapon of choice for terrorists-it has a dramatic impact.

Question 7

Effect of disasters on health

Answer 7

Health risks after a disaster DO NOT occur at the same time.

Casualties typically occur at the time and place of impact-requiring immediate medical attention

Disease transmission takes longer to develop depending upon the extent of overcrowding and the level of sanitation maintained

Question 8

Public health concerns for all disasters

Answer 8

Response is similar for disasters:

Search and rescue

Treatment and evacuation of injured

Food, Water, Shelter for survivors

Minimizing environmental hazards
- Sanitation
- Safety
- Transportation

Control of Epidemic/endemic diseases

Question 9

Sequence of events

Answer 9

preparedness

disaster impact

response and recovery

Question 10

Preparedness

Answer 10

Involves:
Planning
Procedures and Protocols
Training and exercises
Personnel qualifications and certification
Equipment certification

Question 11

Preparedness

Answer 11

Public health preparedness for all disasters is the key for a sound public health infrastructure.

Question 12

Preparedness

Answer 12

Preparedness is critical to the success of disaster prevention and response.

Preparedness involves actions needed to achieve and sustain the level of care that are necessary for a healthcare organization to continuously provide services during and emergency or disaster

Question 13

Preparedness

Answer 13

Disasters may be unexpected but planning can anticipate some common problems that may arise for a particular emergency.

Remember: The best plans in place may not go according to the plan.

Plans must be FLEXIBLE and easy to change.

Plans must be acceptable to all those involved.

Question 14

Preparedness

Answer 14

The plan should be widely disseminated to all those involved and be exercised regularly.

The plan should focus on LOCAL response with state and federal agencies only as adjuncts.

Question 15

Preparedness

Answer 15

Plans can have two approaches:

Agent-specific (only plan for threats most likely to occur in the region- i.e. earthquakes, blizzards)

All-Hazard (Plan for common problems and tasks that occur in a majority of disasters.)

Question 16

World trade center attacks

Answer 16

9/11/2001
2801 people lost their lives
Problems encountered:
Poor communication led to confusion
Fire and police on different radio frequencies also could not communicate with Emergency Medical Services (EMS) dispatchers
Protection of rescue and cleanup workers from environmental hazards failed
Victim location services were established, shelters for displaced residents were set up

Question 17

World Trade Center Attacks

Answer 17

“World Trade Center Cough”
- Those who worked at the site had higher levels of exposure
- Some more incapacitated than others

Mental health concerns
- Post-traumatic stress syndrome (PTSD)
- 3 priorities identified:
—-Crisis intervention for bereaved families, survivors, workers, and general public
—Project Liberty: provided support services for 68 agencies at 120 different sites
—-Augmentation of mental health services

Question 18

World Trade Center Attacks

Answer 18

Public health response
- Worked with the American Red Cross to staff 10 emergency shelters and to transport medical supplies

Four surveillance systems were put in place:
Rapid assessment of injuries
Hospital needs assessment
Reporting system for injuries among rescue workers
Syndromic surveillance-monitoring symptoms

Question 19

World trade center Attacks

Answer 19

Changes that occurred from these attacks:
Changes to high rise fire safety codes
Addresses: events requiring full and rapid evacuation, shelter-in-place, partial evacuations, and building relocation
Building’s chief fire safety director would be trained to serve as the incident commander until a higher ranking official took over

Question 20

Hurricane Katrina

Answer 20

Response was problematic
- Lack of planning for populations with special needs (hospital patients, people without cars)
- Poor communication
—-Lack of clear evacuation until too late

Too little help from outside New Orleans
Racial incidents
Damaged housing, contaminated air in FEMA trailers, displaced large amount of population

Question 21

Hurricane Katrina

Answer 21

Problems with Katrina:
Poor communication with evacuation orders
100,000 people did not have a means of transportation and were unwilling or unable to evacuate
At first water was clean ocean water but after a couple of days the water turned black and was foul smelling from raw sewage and dead bodies.
No electricity or food

Question 22

Hurricane Katrina

Answer 22

Superdome:
Set up as a shelter
Many issues with this shelter

Question 23

Hurricane Katrina

Answer 23

Health Belief Model
Perceived susceptibility: longtime residents felt they had survived many hurricanes in the past
Perceived severity: Residents were confused about the evacuation orders
Barriers to action: financial, logistical, and community. Many felt they did not have enough money for travel expenses and gas

Question 24

Hurricane Katrina

Answer 24

Housing issues:
Many destroyed
Issues with mold in homes
Temporary trailers had unhealthy levels of formaldehyde
Water wells were contaminated

Question 25

Hurricane Katrina

Answer 25

Health issues Many reports of PTSD Mosquito-borne illnesses Increase in the number of rodents and snakes

Question 26

Hurricane Katrina

Answer 26

Lessons learned: Many did not anticipate or prepare for extensive destruction and prolonged period of recovery Drills should be conducted and include all critical functions and areas Anticipate disruptions in communication Staff may not be able to reach assigned location Plans in place for backup sites

Question 27

Incident Command System (ICS)

Answer 27

ICS is the model for the command, control, and coordination of a response to an emergency and provides a means to coordinate the efforts of individual agencies

Question 28

Incident Commander

Answer 28

This person is responsible for all aspects of an emergency response. Including: - Developing incident objectives - Managing all operations - Managing the application of all resources - Responsible for all personnel involved in the incident. This position is always designated and may assign other officers to the other positions. it is identified before the emergency

Question 29

Public Information Officer

Answer 29

This person is the communication coordinator of the organization (local, state, federal government, hospital, corporate office) They differ from the public relations office-they do not engage in marketing. They are responsible to provide information to the public and the media.

Question 30

Liaison Officer

Answer 30

This person communicates and coordinates activities between organizations to best utilize resources. They provide subject matter expertise of their organization. They are the primary contact person for supporting agencies during an incident.

Question 31

Safety Officer

Answer 31

This person is responsible for monitoring and assessing hazardous or unsafe situations during an incident. Responsible for personnel safety during an incident.

Question 32

Disasters

Answer 32

The type of disaster will determine the lead agency involved i.e. Columbia gas explosions in Lawrence and North Andover had the fire department as the lead agency Starts locally with the state and federal government providing additional assistance and backup resources American Red Cross is in charge of shelters

Question 33

Disaster Plans

Answer 33

It is important not only to have plans in place but they should be tested with outside organizations involved. Full exercises are expensive so it is not feasible to perform yearly but may conduct tabletop exercises more regularly.

Question 34

Bioterrorism Preparedness

Answer 34

The preparedness strategy is very different from that for natural disasters The response must be the same as for natural disease outbreaks Recognizing an attack may be difficult but surveillance is key! need solid Public health infrastructure - anthrax goes to BSL-4 lab Response requirements include: - Laboratory capability - Public health laws enabling authority to take action - Coordination between public health and law enforcement

Question 35

CDC Categories

Answer 35

Category A Easy to disseminate High mortality rate and is a major public health issue. Requires special public health preparedness Agents Anthrax, small pox, plague, viral hemorrhagic fever (EBOLA), botulism, tularemia

Question 36

CDC Categories

Answer 36

Category B Moderately easy to disseminate Moderate amount of mortality and morbidity - really more sick than dying Must have enhanced disease surveillance capacities. Agents Brucellosis, Q-fever, Ricin, T-2 Mycotoxins, Staphylococcus Enterotoxin B (SEB)

Question 37

CDC Categories

Answer 37

Category C These agents could be engineered for mass dissemination. It has the potential to increase morbidity and mortality. Agents Hanta Virus, MDR-TB, Yellow Fever as the letters go from A to C, the mortality decreases and the morbidity increases (less deaths, more sick)

Question 38

Public Health Activities

Answer 38

Education to identify unusual diseases Use surveillance to monitor Emergency rooms for disease patterns Laboratories to identify viruses and bacteria Better communications between all branches of DPH and hospitals

Question 39

Issues with Bioterrorism

Answer 39

Legal issues concerning quarantine, restricted access, zone perimeters, credentialing of providers. Needs assessment for meds, hospital beds, special equipment (ventilators). Arrangements for bio-safety and possible mass burials Uninsured---not seeking medical attention

Question 40

Tasks for Bioterrorism

Answer 40

Need a plan for the storage and security of pharmaceuticals. Procedures in place to accommodate dosing for the pediatric population and alternatives for those allergic to meds. Record keeping-document of who got what Plans for community involvement. cipro and doxycycline will treat most of the infections - not on slides tho

Question 41

CDC Strategic National Stockpile (SNS)

Answer 41

The SNS contains: Pharmaceuticals - specific Medical Supplies Medical Equipment - respirators Vaccines Antitoxins

Question 42

What does the SNS do?

Answer 42

Provide rapid delivery of a broad spectrum of support for a threat in the beginning of an event. Provide large shipments of specific material when a threat is known. (i.e.-Tamiflu®) Provide technical assistance to receive and distribute SNS material during an event.

Question 43

SNS

Answer 43

The formulary is based upon: Category A Biological threats (small pox, anthrax, viral hemorrhagic fever, plague, tularemia) Chemical nerve agents Radiation Antiviral agents (Tamiflu) also on formulary

Question 44

12-Hour Push Packages

Answer 44

Pre-packed and configured material in transport ready containers. Pre-positioned in secure facilities near major transportation hubs. Able to deliver quickly to affected area. Color coded and numbered for rapid identification by state and local authorities.

Question 45

Surge Capacity

Answer 45

Most healthcare facilities are already operating at full or near full capacity A disaster will disrupt the normal flow of care Victims will become the major focus Even during emergency situations people will still need to access critical daily medications such as insulin

Question 46

Surge Capacity

Answer 46

There will be a surge of patients admitted to the hospital and visiting the ED putting a strain on the community hospitals This will require an: Expansion of bed capacity Increase in staffing Additional supplies

Question 47

Opportunities to Assist?

Answer 47

There are opportunities to help in the event of a event. Local Level: Worcester Regional Medical Reserves Corps (WRMRC). www.WorcesterRegionalMRC.org Manchester Regional Medical Reserves Corps. http://gmmrc.manchesternh.gov MRC were established in 2002 to help communities prepare medical responses for disasters. Use local healthcare professionals who want to donate their time and expertise.

Question 48

What can pharmacists do?

Answer 48

Federal: Disaster Medical Assistance Teams (DMATs) This is composed of a group of medical professionals supported by logistical and administrative support staff. This team provides medical care in the event of a disaster. Typically are there to serve in a local or state capacity but they may be federalized for a national resource.

Question 49

DMATs

Answer 49

Each DMAT team has a sponsoring organization such as a medical center, public health agency, non-profit agencies or private agencies that have a Memorandum of Agreement with the Department of Health and Human Services. Each organization will recruit and train members

Question 50

DMATs

Answer 50

Each DMAT team has a sponsoring organization such as a medical center, public health agency, non-profit agencies or private agencies that have a Memorandum of Agreement with the Department of Health and Human Services. Each organization will recruit and train members

Question 51

DMATs

Answer 51

When deployed to a site-each team will have enough supplies for a 72 hour period. They will provide care at a fixed or temporary medical care site. Duties may include: Triaging patients Providing high quality care despite environment of disaster area. Preparing patients for evacuation

Question 52

DMATs

Answer 52

May provide primary medical care or augment overburdened hospital staff. These teams are designed to be a rapid-response element to supplement local medical care until other federal resources can be mobilized or the situation is resolved. DMAT team members must maintain appropriate certifications and licensures within their discipline.

Question 53

Pandemics

Answer 53

1918 Spanish flu 2003 SARS 2009 H1N1 2020 COVID-19

Question 54

Why are we at risk for pandemics

Answer 54

Some challenges exists worldwide that increase the risk that outbreaks will occur and spread rapidly, including: Increased risk of infectious pathogens “spilling over” from animals to humans Development of antimicrobial resistance Spread of infectious disease through global travel and trade Acts of bioterrorism Weak public health infrastructures

Question 55

COMMUNICABLE DISEASE will spread with an increase in overcrowding and decrease in sanitation true false

Answer 55

true

Question 56

The officer in charge of communicating with the press A Incident commander B Liaison officer C Safety officer D Public information officer

Answer 56

D Public information officer

Question 57

DIFFERENT officers and their roles

Answer 57

Incident commander- maintains overall responsibility for disaster response, and make sure everything runs smoothly Liaison Officer- coordinates efforts of all responding agencies Public Information officer- communicates with the press and public Safety officer-responsible for the safety of officers

Question 58

which disease has been eradicated

Answer 58

small pox

Question 59

where does immunization break the chain of infection?

Answer 59

susceptible host

Question 60

where does proper treatment break the chain of infection?

Answer 60

infectious agent

Question 61

a place where pathogen can live and multiply

Answer 61

reservoir

Question 62

Rx strength of folic acid is

Answer 62

1mg OTC is 800mcg :) okay and women in their pregnant years but not pregnant should get 400mcg

Question 63

prions are described

Answer 63

infectious protein

Question 64

infant mortality rate is death before

Answer 64

1st birthday

Question 65

the person responsible for all aspects of an emergency

Answer 65

incident commander

Question 66

overcrowded shelters may increase the risk of infectious disease

Answer 66

yes

Question 67

all disaster plans should be examined to determine gaps

Answer 67

yes

Question 68

a barrier for victims of hurricane Katrina except

Answer 68

well-planned evacuation route

Question 69

communication issues were evident with both 9/11 and Katrina

Answer 69

yes

Question 70

which of the following is a category A agent

Answer 70

anthrax

Question 71

all of the following are on the SNS formulary except

Answer 71

cold remedies