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Anaesthesiology
Disaster Preparedness
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
12 sections · 199 slides
Overview
- Scope of this topic
- Common ground across all disasters
Definitions and Types of Disaster
- Multiple casualty incident versus mass casualty event
- Environment as a determinant of hospital capacity
- Hazard to disaster: the disaster nomenclature chain
- Reading the hazard-to-disaster chain
- Resilience as the buffer between damage and disaster
- Sources of mass casualty incidents
- Types of disasters according to the Joint Commission
- Disasters the Joint Commission expects hospitals to plan for
- Intentional versus unintentional man-made events
- CBRNE as a threat grouping
- Risk reduction and international frameworks
Preparation
- The family plan as a professional duty
- Contents of a personal and family preparedness plan
- Communication failure during disasters
- Personal go-bag contents
- Family emergency plan worksheet
- Government preparedness structure
- Issues for which FEMA must prepare, by mission area
- The National Disaster Medical System
- Teams within the National Disaster Medical System
- Terms of service on a Trauma and Critical Care Team
- Why few anaesthesiologists join a DMAT
- Recent events driving hospital preparedness
- Bodies that monitor hospital emergency preparedness
- Focus areas of the Joint Commission white paper
- Preparedness as a standing system
- Surge capacity
- Patient flow through a hospital during a surge
- Creating outflow to protect inflow
- Weaknesses of current hospital disaster drills
- Benefits of departmental participation in drills
- Casualty self-presentation after an attack
- Consequences of undecontaminated casualties: St Luke's Hospital, Tokyo
- Staffing shortfall during a mass casualty event
Role of the Anesthesiologist
- Skills anaesthesiologists bring to a disaster
- Places anaesthesia providers can be deployed
- Rationale for each deployment site
- Reporting to the command and control centre
- Staff casualties from secondary contamination
- Anaesthesia demand in humanitarian settings
- Documented gaps in disaster preparedness training
- The austere environment
Triage and Decontamination
- The four triage categories
- Definition of the expectant category
- Why anaesthesiologists suit the triage officer role
- Learning curve of triage officers
- Delayed care by exposure type
- Purpose of decontamination
- The decontamination procedure
- Field decontamination line at a civil support exercise
- The exception: life-threatening injury before decontamination
- Passing through a decontamination station in protective suits
- Working in a hazmat suit
Emergency Department and Operating Room
- Anaesthesia role in the emergency department
- Fluid and airway priorities in industrial accidents and fires
- First actions of the operating room medical director
- Managing ongoing and elective cases
- Supply, coordination and the emergency department liaison
- Operating room procedures for mass casualty: management step by step
- Operating room procedures for mass casualty: management step by step (continued)
- Infrastructure degradation and surgical capability
- Commonest planned procedures after acute trauma
- The backlog and the continuing baseline workload
Chemical Agents
- History of chemical warfare
- The Chemical Weapons Convention and the shift to terrorism
- Scale of the Tokyo subway sarin attack
- G series and V series nerve agents
- Novichok agents
- Mechanism of nerve agent toxicity
- Familiar pharmacology behind an unfamiliar weapon
- Muscarinic features of nerve agent poisoning
- Nicotinic and gastrointestinal features
- DUMBBELS mnemonic for cholinergic excess
- Dose, concentration and time in chemical exposure
- Atropine and pralidoxime
- Atropine doses required in severe poisoning
- Timing of oxime administration
- Military pretreatment with pyridostigmine
- Interpreting the oxime evidence
- Graded treatment of nerve agent exposure
- Seizures in nerve agent poisoning
- Field decontamination for nerve agent casualties
- Pulmonary agents
- Treatment of chemical pulmonary injury
- Blood agents
- Treatment of cyanide toxicity
Biologic Agents
- Historical use of infectious agents as weapons
- Characteristics of an ideal biologic weapon
- Biologic agents used for warfare
- Biologic agents used for warfare (continued)
- The three categories of biologic weapon
- Eradication history of smallpox
- Infectivity and mortality of smallpox
- Residual population immunity
- Clinical course of smallpox
- Distinguishing smallpox from chickenpox
- Pustular rash of smallpox on the hand
- Transmission of smallpox
- Stored virus stocks and engineered strains
- Ring vaccination and quarantine strategy
- The smallpox vaccine and its contraindications
- Adverse events and vaccine generations
- Anthrax as a weapon in history
- Weaponisation of Bacillus anthracis
- Mortality in the 2001 and Sverdlovsk anthrax releases
- Microbiology and natural transmission of anthrax
- Types of anthrax infection
- Biphasic course of inhalation anthrax
- Antibiotic treatment of anthrax
- Historical burden of plague
- Plague as a modern bioweapon
- Reservoir and transmission of Yersinia pestis
- Bubonic plague
- Pneumonic plague and treatment
- Tularemia as a biologic weapon
- Microbiology and hosts of Francisella tularensis
- Cutaneous and pneumonic tularemia
- Treatment and prophylaxis of tularemia
- Botulinum toxin as a weapon
- Potency of botulinum toxin
- Mechanism of botulinum neuroparalysis
- Botulism as the mirror image of nerve agent poisoning
- Features that separate botulism from other biologic agents
- Clinical course of botulism
- Treatment and recovery in botulism
- Viral families causing haemorrhagic fever
- Pathogenesis and clinical spectrum of haemorrhagic fevers
- Reservoirs and transmission of haemorrhagic fever viruses
- The 2014-2015 Ebola virus disease outbreak
- Drug and vaccine therapy for filoviruses
- Occupational risk to healthcare workers from Ebola
- Full personal protective equipment at a viral isolation ward
- Donning, doffing and anticipatory airway management
- Operative policy for patients with haemorrhagic fever
- Dengue, Chikungunya and Zika
- Protecting staff from arbovirus transmission
- Lessons of the COVID-19 pandemic
- Information politics and the anaesthesia response in COVID-19
Radiation and Nuclear Events
- Likelihood ranking of radiation exposure scenarios
- Cancer risk near nuclear power plants
- The Chernobyl accident
- Fallout and evacuation at Chernobyl
- Hospital outcomes after Chernobyl
- Injuries anticipated after a nuclear accident
- Three Mile Island and Goiania
- Everyday sources of radiation exposure
- Hiroshima and Nagasaki
- Radiologic dispersion devices
- Types of ionizing radiation
- Radiation exposure terms
- How radiation units relate to each other
- Civil defence radiation survey meter
- Routes of radiation exposure in a nuclear accident
- Tissue sensitivity to ionizing radiation
- Presentation and thresholds in acute radiation syndrome
- Long-term effects of radiation exposure
- Federal agencies in a radiation response
- Containment as the governing principle
- Practical decontamination after a radiation event
- Potassium iodide prophylaxis
- Supportive and decorporation therapy after radiation exposure
- Mobilizing and chelating agents
- Combined injury after a nuclear event
- Simultaneous chemical or biologic release
Explosives
- Injury patterns from improvised explosive devices
- Airway management after blast and burn injury
- Fluid strategy: burns versus polytrauma
- Rationale for damage control resuscitation
- Crush injury and myoglobinuric renal failure
Leadership and Communication
- Leadership development routes for anaesthesiologists
- CDC principles of crisis communication
Recognition, Summary and References
- Clues to a deliberate biologic release
- Where anaesthesiologists become involved
- Emotional and ethical preparation
- Sequence when called for a mass casualty event
- Building resilience before the event
- Key points
- References
- References (continued)
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- References (continued)
- References (continued)
- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition