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CHEMICAL DISASTERS: NURSING MANAGEMENT

CHEMICAL DISASTERS: NURSING MANAGEMENT. Nerve Agents Part I. OBJECTIVES. Identify common nerve agents Discuss signs and symptoms Discuss nursing management and treatment Discuss the nurse roles and responsibilities Discuss personal safety risk exposure.

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CHEMICAL DISASTERS: NURSING MANAGEMENT

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  1. CHEMICAL DISASTERS: NURSING MANAGEMENT Nerve Agents Part I

  2. OBJECTIVES • Identify common nerve agents • Discuss signs and symptoms • Discuss nursing management and treatment • Discuss the nurse roles and responsibilities • Discuss personal safety risk exposure

  3. Emergency Support Function (ESF) 8 OVERVIEW • DHH has the role of providing leadership for planning, directing and coordinating the overall State efforts to provide public health and medical assistance. • The Secretary of Health and Human Services through the Office of Public Health Emergency Preparedness is responsible for the federal coordination. • The command and control of operations are consistent with the National Response Framework and compliant with National Incident Management System requirements.

  4. Command Chain/ICS

  5. Unified Command • Enables all agencies with responsibility to manage an incident together by establishing a common set of incident objectives and strategies. • Allows Incident Commanders to make joint decisions by establishing a single command structure. • Maintains unity of command. Each employee only reports to one supervisor. Agency 2 Incident Commander Agency 1 Incident Commander Agency 3 Incident Commander

  6. Disaster Management Continuum

  7. Chemical Disasters • May result from industrial accidents, accidental exposure, or terrorist acts • Chemical Agents of Concern • Nerve agents • Blister agents/vesicants • Blood agents • Choking/lung/ • pulmonary agents

  8. Agencies/Partners Involved • Federal Bureau of Investigation (FBI) • Military • US Department of Health and Human Services (HHS)-Centers for Disease Control and Prevention (CDC) • Other Federal partners • Governors Office of Homeland Security and Emergency Preparedness • Fire/Hazmat

  9. Agencies/Partners Involved • Department of Environmental Quality • Department of Health and Hospitals • Law Enforcement: Louisiana State Police • Louisiana State National Guard • Department of Public Works • Department of Wildlife and Fisheries • Department of Agriculture and Forestry • Other state agencies

  10. Agencies/Partners Involved • Local Parish Office of Homeland Security and Emergency Preparedness Office • Louisiana Poison Center • Healthcare facilities • Medical Examiners/Coroners • Animal Control • Local Partners • LAVA: Volunteers agencies/volunteers

  11. Nerve Agents • Most toxic of chemical warfare agents and inhibit the body’s normal functions • Dangerous to humans and can be utilized as potential weapons by terrorist • Act as acetylcholinesterase inhibitors which produce the same signs and symptoms of organophosphate poisioning

  12. Nerve Agents • Sarin • Soman • Tabun • VX • Odorless • Slight camphor odor • Faint fruity odor • Odorless

  13. Nerve Agents Exposure • Inhalation • Can be dispersed as aerosols, vapors, or liquids • Vapors: absorbed by inhalation and vapor contact • Immediate onset of symptoms

  14. Nerve Agents Exposure • Ingestion • Readily absorbed • Skin/eye • Onset depends on concentration; can be delayed for several hours

  15. Safety Risk • First responders are trained individuals who will respond to the event • Nurses should not be first responders unless you have been trained on hazardous materials or part of a fire response team

  16. Signs and Symptoms

  17. Signs and Symptoms • Mild • Miosis • Nausea • Diarrhea • Severe • Muscle weakness • Fasciculations • Respiratory failure • Coma • Seizures • Permanent damage to the CNS after high toxic exposure

  18. Real Life Incidents • Sarin incident in Tokyo-1995 • Carbamate insecticide methomyl was added to salt at a restaurant in Fresno, California-1999

  19. Exposure to Healthcare Workers • Tokyo incident several people were exposed. Contaminated individuals may self present to a facility. • Healthcare workers must wear PPE and use it correctly • Contaminated individuals must be decontaminated

  20. Exposure to Healthcare Workers • Sudden and severe symptoms may occur hours after treatment/contamination (through skin) • You must have appropriate PPE to approach any contaminated victim

  21. Precautions • Standard • Airborne • Droplet • Contact

  22. PPE Equipment • Determined by the type and level of exposure and duration of exposure • Nerve agents are absorbed through intact skin and even through the clinical examination gloves

  23. Treatment/Exposure

  24. Treatment/Exposure

  25. Treatment • Adults • Atropine 2mg (antimuscarinic) • Pralidoxime (2 Pam) 600mg • Children • Pediatric atropine autoinjector is now available • Supportive therapy and assisted ventilation as need • Benzos for prevention of seizures

  26. STRATEGIC NATIONAL STOCKPILE

  27. Strategic National Stockpile • CHEMPACK • Managed Inventory • Antivirals • Vaccines • Federal Medical Stations

  28. Pharmacy’s Role

  29. CHEMPACK • Hospital/EMS Containers (contents are different) • Mark 1 Kits • Atropine Sulfate 0.4mg/mL • Pralidoxime 1gram vials • Atropen® 0.5mg auto-injectors • Atropen® 1mg auto-injectors • Diazepam 10mg/2mL auto-injectors • Diazepam 5mg/mL 10mL • Sterile Water for Injection 20mL single use vials

  30. CHEMPACK • Prepositioned across the state. Locations are confidential. • Louisiana Poison Control • 1-800-222-1222 • Will provide consultation on symptoms of nerve agents and organophosphate poisoning to first responders and health care professionals. • Will provide assistance regarding dosing questions.

  31. Labeled Containers with Buffers

  32. Treatment • Duodote eventually will replace Mark I Kits

  33. PREHOSPITAL MANAGEMENT

  34. Scene Safety Management • Minimize casualties • Decontamination • Triage • Antidote therapy • Crisis scene management

  35. Emergency Medical Service's (EMS) Role • EMS has 2 Mark I Kits available on the ambulance • State Police will pick up EMS container if CHEMPACK is needed • Administer Mark 1 Kit per protocol • Airway support and ventilation. Perform endotracheal intubation if needed. • Circulatory support: IV therapy and pulse oximetry monitoring • Consultation with Louisiana Poison Control

  36. Field Treatment

  37. Transport

  38. HOSPITAL MANAGEMENT

  39. Hospital’s Role • Ventilatory support: patients with respiratory failure and compromised airways will require immediate endotracheal intubation and positive pressure ventilation. • Oxygen supplement • Decontamination before entering the emergency department • Suctioning for removal of bronchial secretions • Gastric decontamination-activated charcoal

  40. Hospital’s Role • Observation • Treatment-Atropine and Pralidoxime • Monitoring for seizure activity (administering anticonvulsants for prevention) • Recovery may take several months • Risk of permanent damage to the Central Nervous System (high dose exposure) • Consult with the Louisiana Poison Center

  41. Hospital’s Role • Employee training • Hospitals are going to be reserved for your critically ill individuals • Medical Surge • Decontamination • Treatment/Supportive Measures/Assisted Ventilation

  42. PUBLIC HEALTH

  43. Public Health Preparedness • Strategic National Stockpile • Exercises, drills, trainings • State and local planning efforts • Paradigm shift to all hazards approach

  44. Public Health’s Role • Promote life safety through education, information and planning • Goal is to prevent illness by minimizing exposure and rapid, effective response • Provide medical intelligence such as knowledge of antidotes and symptoms of exposure • Procure resources available to the State with forward placement whenever possible

  45. Public Health’s Role • Provide guidance for use of assets under the direction of the State Health Officer • Participate as ESF 8 in Incident Command and/or Unified Command • Assist in the development of factual communication for multiple audiences during response • Promote behavioral health

  46. Public Health’s Role • Conduct epidemiological investigations • Coordinate laboratory services • Participate assessments and actions to minimize the health and environmental impacts

  47. Office of Public Health Nurse’s Role • Planning, preparedness, and response • Assessment • Triage • Treatment/Education • Sheltering

  48. Personal Safety • Having a family emergency plan • Decontamination of self • PPE • Emergency Communication Devices

  49. Vulnerable Populations • Communication • Establish safe shelter • Food and water • Shelter in place versus Medical Special Needs Shelters, General Population Shelters, Critical Transportation Needs Shelters • Rely on existing agencies • Will need assistance if decontamination is needed • Time of day when incident happens

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