Pharmaceutical agents may exceed the available supply
transient while awaiting resupply or long-term shortage
Requires planned monitoring
May need to alter dispensing practices, change formulary, or impose new restrictions on the usage
Chapter 16
Laboratory Preparedness
Role of the Laboratory in Emergency Preparedness
Public health laboratories, state and local, = first line of defense
provide diagnostic and surveillance testing
Laboratory Response Network (LRN)
Global network established by the Centers for Disease Control and Prevention (CDC) in 1999
in response to the Homeland Security Presidential Decision Directive 39.
To strengthen the preparedness of the U.S. to prevent and respond to threatened or actual domestic terrorist attacks, major disasters, and other public health emergencies
The other founding members of the LRN are the Federal Bureau of Investigation (FBI) and the Association of Public Health Laboratories (APHL).
Role of the Laboratory Response Network
Maintains an integrated network of state and local public health, federal, military, and international laboratories that can respond to bioterrorism and chemical terrorism as well as other public health emergencies.
Divisions of the LRN
biological terrorism (BT), chemical terrorism (CT), radiation terrorism (RT).
The main federal agency = CDC with the U.S. Army Medical Research Institute for Infectious Diseases (USAMRIID), and the Naval Medical Research Center (NMRC) as backup
Facilities located in Australia, Canada, and the United Kingdom serve as back-up laboratories abroad.
Hospital-based Units
Hospital-based units, are considered “sentinel laboratories” and play a key role in the early detection of biological infectious agents.
These sentinel laboratories provide routine diagnostic services.
Chapter 17
Principles of Disaster Triage
Triage Categories
The most common categories that are utilized are based upon those U.S. military.
Casualties are divided into five categories:
Immediate
Delayed
Minimal
Expectant
Dead
Immediate
Need immediate medical attention because of an obvious threat to life or limb.
Examples :
unresponsive, an altered mental status, respiratory distress, uncontrolled hemorrhage, sucking chest wounds, unilateral absent breath sounds, or absent peripheral pulses.
Delayed
In need of definitive medical care, but are unlikely to decompensate rapidly if care is delayed.
Examples :
deep lacerations with controlled bleeding and good distal circulation, open fractures, abdominal injuries with stable vital signs, amputated fingers, or hemodynamically stable head injuries with an intact airway.
Minimal
Minor injuries that require medical attention, but this care can be delayed for days, if necessary, without an adverse effect.
Examples :
abrasions, contusions, and minor lacerations.
Expectant
Little or no chance for survival despite maximum therapy.
Examples:
95% total body surface area burns or multiple trauma with exposed brain matter.
In systems with only four triage categories, the expectant category is not used and these patients are triaged as either immediate or dead.
Dead
The final category is dead, which is used for those patients who are not breathing.
Because of resource limitations, no CPR in a MCE
Except a child: cardiac arrest most commonly = respiratory not cardiac.
However, whether the patient is a child or an adult, the responder will need to provide only limited interventions before considering the patient to be dead;
a full attempt at resuscitation is not recommended unless there are more resources at the scene than are needed.
Lifesaving Interventions
No complex medical care
intubation, chest tube insertion, or traction splinting
Keep sight of their goal during triage, which is to prioritize patients for treatment and/or transport
Otherwise may incorrectly apply resources
However, there are some cases where simple rapid lifesaving procedures should be provided during the triage process.
Triage Tags
May include commercial triage tags, marking the patient with some type of pen or marker, or placing the patient in a geographic area that has been designated for a specific triage category.
SALT Triage
One system not better than the others
However, proposed national standard for mass casualty triage is called SALT triage
SALT stands for: Sort, Assess, Lifesaving interventions, Treatment and/or Transport
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