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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

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just in case training for a public health emergency

JUST-IN-CASE Training for a Public Health Emergency

School of Nursing

University of Texas at Austin


  • 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
  • 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 disaster1
What is a Disaster?
  • Destructive event that overwhelms all available resources.
types of disasters
Types of Disasters
  • Natural
    • With warning
    • Without warning
  • Man-made
    • Unintentional
    • Intentional
      • Criminal
      • Terrorism
      • Weapons of Mass Destruction
emergency management system
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



Public Works

Fire Suppression

Information Planning

Mass Care

Resource Support


Urban search/rescue


Food services


Responsible Agency

Dept of Transportation

National Communication Center

USA Corps of Engineers

Dept of Agriculture


American Red Cross

Government Services Agency

Dept of Health and Human Services


Environmental Protection Agency

Dept of Agriculture

Dept of Energy

Federal Response Plan
key questions for rns need to consider before a disaster
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 disaster1
Key Questions for RNs, need to consider BEFORE a disaster

Important Resources:

  • Altered Standards of Care in Mass Casualty Events (AHRQ)
  • 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)

The University has a disaster response plan.
memorandum of cooperation ut city of austin health dept
Memorandum of Cooperation: UT & City of Austin Health Dept
  • Collaborative Agreement
  • In public health emergency, Austin will take the lead
  • Campus Safety & Security @ UT
  • Deans for Schools will be contacted
  • Disaster Mobilization Plan of the Schools may be deployed
school of nursing template
School of Nursing Template
  • Committee Structure
  • Disaster Mobilization Plan
  • Call-up Process
  • Your role at SON
your expected role prevention of disease
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
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?




oAssistance to transition to another setting

Preventing the spread of disease



oSeparation of residents

oSurveillance and Monitoring

Mass Shelters
mass shelters1
What kinds of health care are provided?

oFirst Aid

oPrimary Care

oMedication Issues

oTransport to another setting


Mass Shelters
medical special needs shelter
Special or Vulnerable Populations

oCognitively Impaired

oMorbidly Obese

oMentally Ill

oPersons with Addictions


oMobility Impaired

oFrail Elderly


Medical Special Needs Shelter
man made disasters cbrne
Man-Made Disasters: CBRNE
  • Chemical Terrorism
  • Biological Terrorism
  • Radiological Terrorism
  • Nuclear Terrorism
  • Explosives (high yield)
chemical terrorism
Chemical Terrorism

Ricin Las Vegas 2008

Tokyo Sarin Gas Attack

1995 Tokyo underground

Mustard Gas

epidemiological clues
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
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
Category A Critical Agents
  • Anthrax
  • Botulism (toxin)
  • Plague
  • Smallpox
  • Tularemia
  • Viral Hemorrhagic Fevers
category a agent anthrax
Category A AgentAnthrax

CDC: gram stain of B. anthracis

History of Anthrax

cutaneous anthrax
Cutaneous Anthrax

Day 6

Day 4

Vesicle Development

Day 2

Eschar formation

Day 10


Mediastinal Widening

JAMA 1999;281:1735–1745

category a agent plague

Category A AgentPlague

CDC: Wayson’s Stain of Y. pestis showing bipolar staining

History of Plague




Image: Armstrong & Cohen

USAMRICD: Inguinal/femoral



Day 8

Day 4

Day 2

smallpox chickenpox

Photo courtesy of CDC

Photo courtesy of CDC PHIL

tularemia rabbit fever
Tularemia (“Rabbit Fever”)

Francisella tularensis

Route of infection: Tick and fly bites, infected animals, inhalation


  • 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

category a agent viral hemorrhagic fever

Category A AgentViral Hemorrhagic Fever

CDC: Electron micrograph of

Ebola virus

how can i remember all these diseases s a f e t y
How can I remember all these diseases?(S-A-F-E-T-Y)
  • S: skin rash with fever


  • 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


  • Y: Your personal safety and the safety of your community depend on recognition and awareness
public health hospital responsibilities

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


Control and prevention

Laboratory support

Participate in planning activities



Disease reporting

Immediately notify public health of unusual group expressions of illness or outbreaks

State laboratory utilization

Participate in planning activities

Exercise plans


Roles and Responsibilities:PRE-EVENTPublic Health Emergency
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




Implement notification

Activate staff

Implement response plans/guidelines

Coordinate efforts with public health

Provide care

Coordinate health related information

Public health



Roles and Responsibilities:DURING a Public Health Emergency
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


Evaluate response

Review after-action reports

Coordinate & implement changes to plans & procedures

Implement recovery plans

Roles and Responsibilities:POST-EVENTPublic Health Emergency


  • 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
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?