National Center for Disaster Medical Response Webinar March 29, 2011

1. National Center for Disaster Medical Response WebinarMarch 29, 2011 The University of South Alabama National Center for Disaster Medical Response © University of South Alabama National Center for Disaster Medical Response. All Rights Reserved. These slides are a part of the NCDMR program and cannot be reproduced for commercial purposes.

2. Presenters Surge Capability in Complex Disasters Carl Taylor, JD Assistant Dean, USA College of Medicine Director, USA Center for Strategic Health Innovation Mobile, Alabama Introduction to Radiological Agents Craig Llewellyn, MD, MPH Colonel, U.S. Army (Retired) Center for Disaster and Humanitarian Assistance Medicine Bethesda, Maryland Meeting Mental Health Needs During and After Disasters Carolyn Ross, RN, MSN, COHN-S Assistant Director, Preparedness Training USA Center for Strategic Health Innovation Mobile, Alabama

3. Building Resiliency:Meeting Mental Health Needs During and After Disaster Events The University of South Alabama National Center for Disaster Medical Response © University of South Alabama National Center for Disaster Medical Response. All Rights Reserved. These slides are a part of the NCDMR program and cannot be reproduced for commercial purposes.

4. Introduction Every affected individual will react and cope with disaster and traumatic events with varying skills and strengths based on their life experiences, values, beliefs, cultural viewpoints, socio-economic status and intellectual capability.

5. Positive Stress Negative Stress Normal and Abnormal Stress Reactions ‘Fight or Flight’ response is a physiological response which ensures safety and survival during extreme events: When stress reaction is prevalent for a long period of time or if it is unresolved damage the physical and mental health of individuals.

6. Significant Traumatic Events • Natural Disasters • Terrorism Events • Violent Events (such as war or civil unrest) • Small or large scale personal trauma, loss or emergency • Any type of disaster or traumatic event which can cause fear, trauma or loss

7. Disaster Phases and Response • Warning and threat • Impact • Rescue or heroic • Remedy or honeymoon • Inventory • Disillusionment • Reconstruction and Recovery

8. Building Psychological Resiliency During and After Disasters Mental health education and interventions will be necessary for the following targeted groups: • Population of Affected Community • Responders • In-situ (hospital personnel, emergency responders) • Deployed disaster and emergency responders

9. Key Concepts of Disaster Mental Health • Everyone who experiences a disaster will be touched by it! • People generally will pull together during and after a disaster • There are 2 types of disasters: individual and community • Stress and grief in disasters are normal reactions to abnormal situations • Most people feel they do not need mental health services • Survivors respond to active genuine interest and concern • Use an active outreach approach instead of traditional methods Social Support systems are crucial to recovery!

10. Signs and Symptoms of Short and Long Term Reactions to Stress/Trauma Symptoms of Short Term Negative Stress • Inability to concentrate • Changes in eating and sleeping habits • Tension headaches, lower backaches, stomach aches, and other physical ailments • Common Symptoms Short & Chronic Term • Feeling depressed, helpless, sad and lethargic • Memory problems • Fatigue • Feeling angry, irritable, lashing out at others Disaster Trauma Event • Symptoms of PTSD/Chronic Stress • Feeling emotionally numb, withdrawn, disconnected or different from others • Spontaneously crying, feeling a sense of despair and hopelessness • Feeling extremely protective or fearful for the safety of loved ones • Not being able to face certain aspects of the trauma and avoiding activities, places or even people that remind you of the events • Symptoms of PTSD/Chronic Stress • Nightmares related to event • Sleep disturbances • Changes in appetite • Situational anxiety and fear • Being on ‘edge’ or easily startled or being ‘over alert’ • Inability to focus on work or daily activities • Difficulty in making decisions

11. Interventions • Individuals/Responders • CISD (Critical Incident Stress Debriefing) • Adequate rest, nutrition and exercise • Return to normal routines • Focus on pleasant memories and use relaxation techniques • Participate in a support group or seek counseling • Keep a journal • Community • Recognize importance of culture and respect diversity • Recruit disaster workers, community leaders and organizations who are representative of community • Ensure that services are accessible, appropriate and equitable • Recognize cultural patterns that may influence help seeking behaviors • Ensure that services and information are cultural and linguistically competent

12. Conclusion • Immediate Interventions and Preventive Planning are key to successful interventions! • Develop Stress Management programs to implement in order to effectively manage stress!

13. Questions?

14. Introduction to Radiological Agent Awareness The University of South Alabama National Center for Disaster Medical Response © University of South Alabama National Center for Disaster Medical Response. All Rights Reserved. These slides are a part of the NCDMR program and cannot be reproduced for commercial purposes.

15. Toxicity Basics:Chemical or Radiological Substances • Specific health effect characteristics of agent/chemical (localized versus systemic) • Mode of entry (skin, lungs, eyes, GI tract) • Dose (how much, what concentration) • Duration of Exposure (how long) • Stress (anything that increases the heart rate can increase systemic absorption) • Personal physical condition (sick, anemic, impaired skin integrity, drug/alcohol consumption)

16. Radiological Event: The higher the probability for an incident, the lower the expected #’s of casualties. Accident Terrorists Single Detonation Most Probable Incident Types: Radiological: - Industry, medicine, research, teaching or agriculture - Radioactive material or devices generating ionizing radiation Nuclear accidents: - nuclear facilities Isolated Nuclear Conflict Worldwide Nuclear Conflict

17. Comparison of Radiation Categories

18. Radiological EventPPE, Contamination Patterns and Decontamination

19. Patterns of Radiological Contamination • Important: Geiger Counter should be used to measure for radioactivity: • Scan body – front and back in systematic way • Before decontamination • After decontamination

20. Acute Radiation Syndrome 2.5 - 5 Gy (250- 500 RAD) Survival Possible Treatment for Infections, Fluids, Blood System is Necessary 1-2.5 Gy (100-250 RAD) Survival Probable Treatment for Infections, Fluids, Blood System PRN > 5 Gy (500 RAD) Survival Unlikely Supportive Care with Fluids and Electrolytes < 1 Gy (100 RAD) Survival Fairly Certain No Treatment Necessary 0 RAD > 500 RAD Increasing Dose

21. Radiation Symptoms Hematopoietic Disorders • Anemia • Bleeding • Infections • Delayed healing • Gastrointestinal Symptoms • Nausea/Vomiting ** • Diarrhea • Mouth / Throat Sores • ↓ Appetite & Weight Loss Neurovascular Symptoms • Burning sensations • Poor balance • Confusion • Cutaneous Tissue Symptoms • Burns, blistering • Skin sloughing • Hair Loss

22. Health Effects from High Radiation Exposure Sources: Environmental Protection Agency, Nuclear Regulatory Commission,: U.N. Scientific Committee on the Effects of Atomic Radiation: Canadian Nuclear Association. New York Times , March 27, 2011

23. Questions?

24. Surge Capability In Complex Disasters The University of South Alabama National Center for Disaster Medical Response © University of South Alabama National Center for Disaster Medical Response. All Rights Reserved. These slides are a part of the NCDMR program and cannot be reproduced for commercial purposes.

25. What is Surge Capacity? The ability of a healthcare system to rapidly expand beyond normal services to meet sudden or sustained increased demand for medical care.

26. Surge Capacity vs. Capability Surge Capacity: The ability to evaluate and care for a markedly increased volume of patients - one that challenges or exceeds normal operating capacity. Surge Capability: The ability to manage patients requiring unusual or very specialized medical evaluation and care, e.g., infectious disease or burn patients.

27. Key Principle We will work to maximize lives saved, which must include our staff and our patients

28. Planning For A Surge Surge conditions may last for months not just days Your other patients have needs also The usual scope of practice may not apply External events will impact internal response

29. Planning Continued The time of day or month may matter Communication both internal and external may be challenged Staff challenges will create the need for flexibility both during and after the event

30. Planning Continued Some staff may not be yours Supplies and supply chain disruption may occur Transportation and Fuel issues are problematic Alternate facilities and COOP planning a new challenge

31. Planning Final Leadership at every level will matter Security of staff, patients and facility is paramount Cash and Financial Management may be more damaging to the facility than wind and water There is no one size fits all response- the nature of the event matters

32. Important Issues Do we know our communities health? Can we communicate with public health and disaster leadership? Who is making the decisions during a disaster (and can we count on them)? When we need help where does it come from and do we know how to access it?

33. Resource and Contact Information • National Center for Disaster Medical Response Website: www.ncdmr.org/ • Contact Information: • Carl Taylor email: cwtaylor1@gmail.com • Carolyn Ross email: carolynross@usouthal.edu

34. Questions?