RETURNS THU JAN 19 8|7c

Disaster Medicine and Preparedness

By Meg Marinis, Director of Medical Research | Nov 4th, 2010

Were you wondering when Owen would use Richard's million dollars?? I'd say he put it to pretty good use, don't you? I mean, come on—THIRTY dummies with catastrophic injuries! Talk about a tough competition for the residents. Not to mention the rain beating down in their faces... Well, what do the Boy Scouts say?

"Always be prepared!"

In Episode 707, "That's Me Trying," Owen runs a trauma certification lab for the residents in order to ensure they have the adequate skills and training to face a potential mass casualty event. A couple of episodes ago, when Owen originally gave his pitch to Richard, he described how their lack of substantial preparedness for disasters might have cost them unnecessary tragedy during the shooting. Without a clear and proper plan set in place, the risk for additional injuries and fatalities only increases.

What kinds of situations represent and require skills in 'disaster medicine'?

According to the CDC, these scenarios can be divided into several groups.

- Natural Disasters & Severe Weather Incidents (Earthquakes, tornadoes, hurricanes, wildfires, volcanoes, tsunamis, floods, extreme heat, landslides and mudslides, winter weather).

- Mass Casualties (Explosions, building collapses, mass transportation accidents, blasts, domestic bombings, terrorist attacks).

- Bioterrorism (Deliberate release of viruses, bacteria, or other germs used to cause illness or death in people, animals, or plants. Examples: Anthrax, plague, smallpox).

- Chemical Emergencies (Ricin, chlorine, nerve agents such as sarin and VX).

- Radiation Emergencies (Dirty bombs, nuclear blasts, acute radiation syndrome).

What are some of the specific skills needed to practice disaster medicine?

Depending on the type of disaster, emergency responders will see a vast range of injuries. Victims can suffer from things such as minor burns or a type of injury that many physicians have never even seen in their career. However, regardless of what they encounter, the responders will always begin with the extremely important first step of triage.

Triage is the process of determining the priority of patients' treatments based on the severity of their condition. It may result in determining the order and priority of emergency treatment, emergency transport, and transport destination of the patient. Attention should be given first to the most salvageable injuries with the most urgent conditions. To help designate patients' conditions, responders often use colored flags or printed triage tags. For example, the color red signifies "Immediate" indicating critical injury requiring immediate intervention. The color black denotes "expectant" indicating deceased or not expected to survive based on available resources given. Yellow means "delayed" indicating less severely injured than immediate. And green goes with "minimal" indicating ambulatory and not severely injured (the "walking wounded").

Once triage has been established, response teams begin their primary assessment (the ABC's) to try and stabilize the patients as best as they can. Especially with unconscious patients, the first priority (the "A") is to manage their airway to ensure the patient can receive oxygen. Common issues with the airway include blockage of the pharynx by the tongue, a foreign body, or vomit. Responders can open the airway by manual movement of the head using various techniques or depending on the availability of medical supplies, medical workers may use oropharyngeal airway procedures or intubation.

Next, the patient's breathing (the "B") must be assessed. Normal breathing rates range between twelve and twenty breaths per minute; if a patient seems to be breathing below the minimum rate, CPR or artificial respiration should be considered. In a conscious patient, important things to detect are any presence of severe asthma, pulmonary edema, or hemothorax. Steps include checking for general respiratory distress, checking the respiratory rate, examining for chest deformity and movement, listening to external breath sounds, looking for surgical emphysema, and listening for auscultation and percussion of the chest (if a stethoscope is available).

After ensuring the patient can receive oxygen in the lungs by a clear airway and efficient breathing, responders should check the victims' circulation (the "C"). The first step is to determine a pulse—if no pulse is present, CPR should be started. If the patients are breathing, responders should observe the color and temperature of the hands and fingers. Poor circulation may be indicated by cold, blue, or pale extremities. Blood pressure measurements can be taken to assess for signs of shock. Pulse checks should be performed regularly—a normal rate for a resting adult would be about 60-80 beats per minute. Secondary signs of circulatory failure can be observed if edema or frothing from the mouth can be seen.

How can you learn preparedness skills?

Even if you are not employed in a healthcare profession, you can still get involved in disaster planning. With recent hurricanes, tsunamis, acts of terrorism, and the threat of pandemic influenza, many people are concerned about the possibility of more future public health emergencies arising. Here are a few things that you and your family can do:

- Get a kit gathered of emergency supplies such as clean water, food (such as canned items and dry mixes on your pantry shelves), and disaster supplies. Good things to consider would be a first aid kit, sanitation and hygiene items, several flashlights with extra batteries, a portable battery-powered radio or television, blankets, cash, matches in a waterproof container, copies of important documents, a map, and any other essential items.

- Make a plan. Families can better cope by preparing in advance a communication plan and evacuation plan. The CDC recommends picking two places to meet such as right outside your home (in case of a sudden emergency like a fire) and outside your neighborhood in case you cannot return home.

- Stay informed. As well as having a plan in place at home, make sure to be aware of any disaster plans set up at places of work or schools. The CDC advises everyone to be familiar with CPR, first aid, and the use of an automated external defibrillator (AED). For more information on those suggestions, people can contact their local American Red Cross chapter.

For more information on Mass Casualty Event Preparedness and Response, please visit:

http://emergency.cdc.gov/masscasualties/

For more information on Field Triage Decision Schemes, please visit:

http://www.cdc.gov/fieldtriage/

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