Natural vs Man-Made Disasters: Impact, Response, and Management
Natural vs Man-Made Disasters: Impact, Response, and Management
-Natural Disaster>> Man madeNatural Example: Bubonic Plague (Yersinia Pestis)Man Made: Chernobyl
-Today there is a Weaving Of Man Made & Natural Disaster —-> Smallpox reemergence/Disease outbreak due to Rapid Travel Ability!
Disaster Med Definition:
^^Disaster Def:
| -”Bad Star ” in Greek -Serious disruption of SocietyFunction, Causing Widespread human /Material orenvironmentalLoss, Exceeding theabilityofSocietyto cope with only its own resources! —–>High # of dead and Injured so much thatHealthsystem Cannot Handle it!Overwhelmingthe infrastructure! |
^^Disaster Medicine :
-Prevention/ Reduction /Mitigationof The Effect Of disaster effect on Health -Provide Appropriate Tx For Affected-Restoration of Health Services!-Needs Diff Approach from ER medicine because of Big |
^^Mass Casualties Incident(MCI):
-When ER medical Servicesoverwhelmedby # of Casualties!
-When 2 ER crew Respondtoaccident where 3peopleare affected
Natural Disaster:
–Naturaldisaster :Medical Sta can be Trapped(hurricane /
earthquake)
-Manmade :Explosionwith lots ofinjuries!
1- Complexity ofServices: hospitalwill not only provide health care but also Hotels/ labs/ Ret/storehouse! 2-Dependence on lifeline:Need for Water/Sewer/Power/Medical Gases/Communication!3-Hazardous Materials:Toxic inhospitals 4- Dangerous Objects:Heavy medicalEquipments/Storage shelves |
Hospital Disaster Prepare:
-if Hospital services fail during disaster—>hospital WillFaill
1-Incident Commandership:
–OprganizApproach insidehospital
2-ER Operation Center:Command post for operation during ER!
3-Exercise/Drills & Trainings:
only through exercise the plane instressfulsituation!
4-EssentialSerives& Facility engineering:
every hospital is Recommended:-Power generator for 3-4 Days-Water supply 3-4 days
-medical gases insecurelocation
-Configure heating-ventilation -air-Fuel for 3-4 days!5- Physical security:-security forces for protection!
-onentrances
6-Food Services for 3-4 days!
7- Disaster supplies
8-Triage system
Role of Prehospital ER In mass Casualties Incident:
-Service thattakepart in the Rescue organization of thepeopleinvolved in the incident awelas securing the Areas where mass casualtiesoccurs!
1- Certified first responder:
assiswith Pts Care/ Triage/ x and transport from thescnee!
2-Paramedic and EMT:-have lead in pts care as assigned by the medical officer!
3-Land ambulances:Tranportptsnadpersonal from incident to ERderpatment/and Helipad!
4-Air ambulance:Helipad to Hospital
5-Firefighters:
–InitialRescue related operation as firesuppresionand prevention!
6-Polic officer:
Securehe sceneand ensureauthoriedpeople access
7-Utility service:
–utitliestoareaareturneddof asneccto prevent further injury!
8-HazMa team:
Clean & Neutralize hazardous materials! at thescnee
9-Media:information
10-NGO’S:
Effect of Disaster on hospitals:
–Naturaldisaster :Medical Sta can be Trapped(
hurricane /earthquake)
-ManMade :Explosionwith lots ofinjruies!
1- Complexity ofCervies: hospitalwill not only provide health care but also Hotels/ labs/ Ret/storehouse! 2-Dependence on lifeline:Need for Water/Sewer/Power/Medical Gases/Communication!3-Hazardous Materials:Toxic inhsptials 4- Dangerous Objects:Heavy medicalEquipments/Storage shelves |
Hospital Disaster Prepare:
-if Hospital services fail during disaster—>hospital WillFaill
1-Incident Commandership:
–OprganizApproach insidehospital
2-ER Operation Center:Command post for operation during ER!
3-Exercise/Drills & Trainings:
only through exercise the plane instressfulsituation!
4-EssentialSerives& Facility engineering:
every hospital is Recommended:-Power generator for 3-4 Days-Water supply 3-4 days
-medical gases insecurelocation
-Configure heating-ventilation -air-Fuel for 3-4 days!5- Physical security:-security forces for protection!
-onentrances
6-Food Services for 3-4 days!
7- Disaster supplies
8-Triage system
Role of Prehospital ER In mass Casualties Incident:
-Service thattakepart in the Rescue organization of thepepleinvolved in the incident awelas securing the Areas where mass casualtiesoccurs!
1- Certified first responder:
assiswith Pts Care/ Triage/ x and transport from thescnee!
2-Paramedic and EMT:-have lead in pts care as assigned by the medical officer!
3-Land ambulances:Tranportptsnadpersonal from incident to ERderpatment/and Helipad!
4-Air ambulance:Helipad to Hospital
5-Firefighters:
–InitialRescue related operation as firesuppresionand prevention!
6-Polic officer:
Securehe sceneand ensureauthoriedpeople access
7-Utility service:
–utitliestoareaareturneddof asneccto prevent further injury!
8-HazMa team:
Clean & Neutralize hazardous materials! at thescnee
9-Media:information
10-NGO’S:
Effect of Disaster on hospitals:
–Naturaldisaster :Medical Sta can be Trapped(
hurricane /earthquake)
-ManMade :Explosionwith lots ofinjruies!
Hospital Disaster Prepare:
1-Incident Commandership:
2-ER Operation Center:Command post for operation during ER!
5- Physical security:-security forces for protection!
6-Food Services for 3-4 days!
7- Disaster supplies
8-Triage system
***Role of Prehospital Medical serves in Accident Site:
^^EMS(emergent medical Services)
Basic Life supportAdvanced Life support!
***Public health in disaster:-Seek to mitigate hazards such as explosion/ chemical/Natural Disaster
Mitigation: Recognize risk + vunerabilieis And then act to Reduce them!
^^Public health:
Later(in case of Event):
***General Principle of Triage***
***Triage at Accident Site:
”Anyone who still needs assistance yell out of raise hands”
Note:
***PRinciples of Hospital Triage:-Assessment by hospital Triage Nurse!-Nurse will evaluate Pts condition!+ Determine Priority of admission!-Then the Pts might need to be referred to itnernal Triage system!
Triage physician will field request for admission from ER or transfer tha level of Care to another state
-Triage decision major factor :is available Bed Space!-the Triage teams needs to determine what beds are avialable ! and optimal utilization of resources to provide safe care for all pts
^^Surgical Team have their own Triage for trauma & General Surgery pts!same in NEurology and Neurosurgery!
***Main Cause of Hazmat Incidents:-Hazardous meterial Are solid/Liquid /Gas that cause harm to living organism! /property /enviroments-Causes are classified by ”WHERE/ WHY / HOW ”
^^Where:
^^HazMat Behavior:
***Route of Exposure to hazardous Chemicals
^^ 3 Main mechnaism of hard in chemical ER:1-Flammability- Causing Thermal Injury!2- reactivity : Rapdi release of energy3-Health effect: Affect Body function
^^How humans can be exposed:1-Inhlation2-absorption3-ingestions4-injections!
***Principles of Decontamination:
^^Def:-Reducing & Preventing the Spread of Contaminants A Hazardous Material!
^^chemical Decontamination:
^^Material to help DC:
^^Extra note:-pts should be fully DC before taken to hospitals!-Staff should be notified about Contamination
^^Radiation accident:
^^Categories:
-Radiation >4 G DM recovery is poor-Stem Cell Transplant >7-10 G
^^ARS :
^^Phases of ARS:
***Chemical DC:
***Chemical Accidents: Principles of medical Tx:
^^Detection & Management o consequences:
^^Medical Tx:
***Radiation DC:
4 Categories of DC are Generally recognized:
***Common psychological Response to Disaster!:
CISD takes 2 Hours for 1-14 days!
1- Complexity ofCervies: hospitalwill not only provide health care but also Hotels/ labs/ Ret/storehouse! 2-Dependence on lifeline:Need for Water/Sewer/Power/Medical Gases/Communication!3-Hazardous Materials:Toxic inhsptials 4- Dangerous Objects:Heavy medicalEquipments/Storage shelves |
Hospital Disaster Prepare:
-if Hospital services fail during disaster—>hospital WillFaill
1-Incident Commandership:
–OprganizApproach insidehospital
2-ER Operation Center:Command post for operation during ER!
3-Exercise/Drills & Trainings:
only through exercise the plane in stressful situation!
4-Essential Serives & Facility engineering:
every hospital is Recommended:-Power generator for 3-4 Days-Water supply 3-4 days-medical gases in secure location
-Configure heating-ventilation -air-Fuel for 3-4 days!5- Physical security:-security forces for protection!
-on entrnaces
6-Food Services for 3-4 days!
7- Disaster supplies
8-Triage system
***Role of Prehospital Medical serves in Accident Site:
^^EMS(emergent medical Services)
-for out-of-hosptial Acute medical Care
-To Transport To Def Care of Pts with injurie/illness
-provide Tx of urgent medical care/carry the pts to next Destination where he will be provided for ER / hospital
-Main unction : Preserve Life/ Prevent urther Injury/Promote Recovery!
^^6 Stages of High Quality Prehospital Care
1-Early Detection: finding the incident2-Early Reporting: First person on scene makes the call
3-Early Response: First EMS arrive
4-Good on-Scene Care: appropriate& timel intervention
5-Care in Transit:6-Trasnfer to efinitve care: To ER /Hospital!
Basic Life supportAdvanced Life support!
***Public health in disaster:-Seek to mitigate hazards such as explosion/ chemical/Natural Disaster
-Reducing Vulnerability of Infrastructure!(WEak infrastructure/resources/personal)
Mitigation: Recognize risk + vunerabilieis And then act to Reduce them!
^^Public health:
-training and development of staff , ID and classify Public health Resources!
-Development of Standard operating Procedure
-ER plans and communications plansLater(in case of Event):
public health agencies must ID what resouces may be availabe to assits in restoring the condition as well as address the physical & emotional affected population!
***General Principle of Triage***
–Process of Determination of Pts Tx perioirty! Based on Condition!
-Order & priority of ER | ^^Simple Triage: -”in Mass Casuality Incident” -Sort pts to Hospital & those who need less serious attention-Done before transportation is available! |
| ^^S.T.A.R.T Model:-Simple triage & Rapid Tx-Injured people into 4 Groups:1-Expectant Who are Beyond Help!2-Inured who can be helped by immediate transport 3-Injired who trasnport can be delayed 4-Minor Injuryies , less urgent Tx |
| ^^Advanced Triage: -used when meical Resources are not sufficient -Doctor May decide some serious injury should not recivece adavanced Care because they are unliekly to survive! -Advanced care used of less severe injuries!-Diverts scace resources toward Pts with higher chace of survival! -used with Triage Revised Trauma(TRTS)& Injury Severe Score(ISS) |
***Triage at Accident Site:
–first thign to do is Patient Assist Method(PAM)
-Establish Casuality Collection point( CCP)
-Advice by yelling / Loudspeaker ” Any one needign assitance hsould move to this area”
—-> ID the Not so severly injuty From those who need immediate help!—->clears the scnee—–>provides possible assitant!”Anyone who still needs assistance yell out of raise hands”
—-> ID the responsive Pt but unable to move!
—–> now the responded can asses the one who are left which are either except or need immediate medical aid!
Note:
Deaf or peopel who became Partially deaf may not hear the instructions!
***PRinciples of Hospital Triage:-Assessment by hospital Triage Nurse!-Nurse will evaluate Pts condition!+ Determine Priority of admission!-Then the Pts might need to be referred to itnernal Triage system!
Triage physician will field request for admission from ER or transfer tha level of Care to another state
-Triage decision major factor :is available Bed Space!-the Triage teams needs to determine what beds are avialable ! and optimal utilization of resources to provide safe care for all pts
^^Surgical Team have their own Triage for trauma & General Surgery pts!same in NEurology and Neurosurgery!
***Main Cause of Hazmat Incidents:-Hazardous meterial Are solid/Liquid /Gas that cause harm to living organism! /property /enviroments-Causes are classified by ”WHERE/ WHY / HOW ”
^^Where:
where those material are stored & manipulated with :
1- Research and development2- site of manufacture 3-Storage Sites(manufacture)4-Trasnportation
5-Storage(site of Use)6-Site of Use7-Disporal of waste products!
^^HazMat Behavior:
inciden occur because of one or mroe of the following events:
1-Human error2-enviroment Condition3- Contaier Failure4-Equipement Fialure***Route of Exposure to hazardous Chemicals
^^ 3 Main mechnaism of hard in chemical ER:1-Flammability- Causing Thermal Injury!2- reactivity : Rapdi release of energy3-Health effect: Affect Body function
––> Injuries are complicated by toxic properties of chemicals!
^^How humans can be exposed:1-Inhlation2-absorption3-ingestions4-injections!
***Principles of Decontamination:
^^Def:-Reducing & Preventing the Spread of Contaminants A Hazardous Material!
| ^^Physical Decontamination:-Physically removing the contaminant from person/pbject!-includes: Dulution/ Brushing Scalping/Absroption! |
^^chemical Decontamination:
| -Reducing threat from Contmainant by making it less harmdu via chemical Change!-Techniques include:1-Chemical degradation :degradation afent to alter the chemical structure of hazardous material 2-Neuralziation :-of Acid or casticto corrosive Liquid still PH Related-Seeking to make it more neutral3- Solidiciation:Binding the contaminant to another Object & Encapsulating it!4-Disinfection:Inctivate / Kill the pathogenic Microganism!(never assume 100% efectivity)5-Sterlization :Destory all Microrganism or an object( steam/ Concetrated chemical Agent/ UV light)—>Decontamination needs to be exceduted at ” Decontamination coridor” between the”Hot Zone”( most hazerfous”) And ”Cold Zone” ( Non Hazardous) passing through ”Warm Zone” of fominished hazard!”clean End” ”Dirty End”—>”DC corridor ” Needs to be controlled ot Prevent the Spread! |
^^Material to help DC:
| 1-+ve & -ve Pressure rooms:+ve Pressure outside & -ve pressure inside To prevent Contamination! 2-Fixed Ventilation Sustem: 3-Safety Showed (30-50 Gallon/min4-Eyewash Fountain ! |
^^Extra note:-pts should be fully DC before taken to hospitals!-Staff should be notified about Contamination
-Pts wrapped in disposable fabric bas to prevent the spread
-fatalities should not be handled with same DC procedure!***Radiation Accidents, Principle of medical engagements:
^^Radiation accident:
-Due to the problem with nuclear reactor / industrial /medial sources
^^Categories:
| 1-External Exposure accident : -Source idstant ot proximal to the body -Once you distance yourself the Radiation stops2- Contamination accident:-a person is contaminated with radioactive material –threat continues till the mateiral is removed from them –contamination can spread from 1 part of the body to others! |
^^ Medical Managments:
-Conventional injuries Must be Treated First-Radiation is Not a Life threatenign medical ER
-Pts from traunatic blast /radation injury need to be Resusicitated& Stabilized!
-Airway/Breathing/ ciculation alaways priority!
–These Pts needs psecialized Tx
-Doc : Hematology/oncoloty/radiation / Infectious disease!
-Knowledge of istopes & Forms
-Approaches:1-Reduction of absotpion(Preussia blie)
2-Dilution (Forcefluids)
3-blockage(K Iodid)4-Displacement nonradioactive maeiral
5-Mobilization for elimination rom tissue(Ammonium chloride)
6-Chelation(Ca-DTPA & Zn-DTPA)-pts with full body low Radation may develop GI Sx and need aniemetics !
-Alpha-emmiting radioactive isotopes are excised!
^^specific managment:
-Sx Tx are needed for shock & Hypoxia!
-sedatives for seizures!(Lorazepam 2 mg IV)-Antiemetic (Metroclopramide 10-20 mg IV 4-6 H)
–antidiahreal agnets
( Koalin/pectin 30-60 ml)
-No Tx for cerebrovascular Syndrome (Fatal)-GI syndrome with aggressive Fluid resuscitation & electrolyte replacment
–Hematopotic syndrome:
—>Blood products & Transfusion to tx Anemia & T penia
—-> Hemapoteic GF!(GCSF & GMCSF)—-> borad Ax for Neutropenia!
-Radiation >4 G DM recovery is poor-Stem Cell Transplant >7-10 G
–Radation can cause sores& ulcers tha need skin grafting!
***Acute radiation Syndrome:
-occur if enough cell are affected by radation becoem damaged & Die!
Or if killed cell are essential for Human Survivial!
-BM and Intestinal mucosa are most (S) to Radiation !
–Non lethal Radiation doses can cause some cell to undergo maliganat transformation
^^ARS :
–major threat of Lige after Exposure to major Radiation Dose -Occurs when the entire body is exposed to large penetration dose for small period -3 Classic syndrome:I-BM / Hematopotetic Syndrome: -Dose >2 Sv-BM destruction produces Pancytopenia!—> icnrease infection chnance+ Clotting problems II-GISyndtome: -Dose >6 Sc-Cell Death and lsoughing of intestinal mucosa —-> N+V And diahrea! III-cardioascular+ CNS Syndrome:-Dosease >20 sc-NV+ ataxia + Convulsion!-Cause is Microvascular leak of CNS—-> Edema—> intracranial pressure |
^^Phases of ARS:
| 1-Prodromal phase:-Within hours up to 2 Days! -Sx:Anorexia/ N+V/ Dihrea/Fever/ atigue! 2-Latent Phase:-Pts is Asx-up to 3 W3- Illness phase:-over manigestation infection due to Leukopenia from T penia -Diahrea!-Altered mental status-Shock!4- Death /Revoery Phase : Weeks—> Months! -Remembered the Rapid dividing Cell are affected the First & Most! |
***Chemical DC:
| -Reducing threat from Contmainant by making it less harmdu via chemical Change!-Techniques include:1-Chemical degradation :degradation afent to alter the chemical structure of hazardous material 2-Neuralziation :-of Acid or casticto corrosive Liquid still PH Related-Seeking to make it more neutral3- Solidiciation:Binding the contaminant to another Object & Encapsulating it!4-Disinfection:Inctivate / Kill the pathogenic Microganism!(never assume 100% efectivity)5-Sterlization :Destory all Microrganism or an object( steam/ Concetrated chemical Agent/ UV light)—>Decontamination needs to be exceduted at ” Decontamination coridor” between the”Hot Zone”( most hazerfous”) And ”Cold Zone” ( Non Hazardous) passing through ”Warm Zone” of fominished hazard!”clean End” ”Dirty End”—>”DC corridor ” Needs to be controlled ot Prevent the Spread! |
***Chemical Accidents: Principles of medical Tx:
-Can be caused by environmental/industria/terrosit sources!
-Priority is ” Scene Safety” &”Staff protection” For ER and first responders@@^^industrial chemical Disaser:
–Spill of toxic Chamical that casue serious disruption to Society fnciton & Safety & Causing widespread Human & Material Losses!
^^Detection & Management o consequences:
1- Rapid assesment
2- Scene control & parameter Establishment3- product ID4-Preentry examination
5-Entry planning and equipment6-Victim rescue from release area
7-contain the spill8-Neutralize the spill9-DC the victims10-Medical care& antidotes11-Transport12- Clean up Delegation^^Medical Tx:
-Toxins can be categorized into 14 basics categoies
-Some have natidotes but most involve supportive therapy!
| Burns and trauma:(Corrosives, vesicants, explosives, oxidants,) (incendiaries, radiologics) | Intravenous fluid and suppliesPain medicationsPulmonary productsSplints and bandages |
| Respiratory FailureCorrosives, military agents, explosives,oxidants, incendiaries, asphyxiants, irritants,pharmaceuticals, metals | Pulmonary productsVentilators and suppliesAntidotes (when available)Tranquilizing medications |
| Cardiovascular Shock Pesticides, asphyxiants,pharmaceuticals | Intravenous fluids and suppliesCardiovascular productsAntidotes (when available) |
| Neurologic Toxicity Pesticides, pharmaceuticals, radiologics | Antidotes (when available) |
***Radiation DC:
4 Categories of DC are Generally recognized:
1- Personal DC(onself)
2- Casualty DC(pts casualities)
3- Personnel DC(of workers not pts)
4- Mechanical DC(removal of Radioacitve material)
-Rad DC is not ER
-goal to Remove all gross Radioactive debree from Body surface!| ^^Hospital DC:-Prevent /minimize Radiological contmaination-DC area outside the Hospital-Control of pts & staff is imp-People/equip leaving the Contaminated Area must be radiology monitered!to make ure its clean |
| ^^Pts DC :-from cloth/Exposed Skin/Hair-Doen under supervision of med personal!-Moist cottonsab of nasal Mucosa!-0.5% NaHypochloride can be used to remove cotnamiantion from Skin-Ringers Solution—->inwounds ,abdomen , Chest! -Water /Normal Saline—–>Eye Wash! -Change Contiamined tourniques with clean ones! -Wounds shoudl be covered to prevent skin contmaination |
| ^^Wound DC: -During initial DC badages shoudl be emoval and wound Flushed! –contmainated Mateiral should be Removal -After DC of wound if shoudl be irrigated with Saline/physiological solution! -If Radioactive Contaminants requires specialzied surgical Tc |
| ^^MEchanical DC: -Washing/rising with water –Vaccum -Wash with Detergent solution! -Applying protective Coating of paint over the contaminated area –Remove top layer of contamined Soid -Complexing agent Solution |
***Explosives: Principle of Medical Management:
| ^^Def: -Exothermic Rxn generated by triggering a Rapid Chemical conversation of solid /liq to gas –Blast causes overpressure due to gas expansion Creating”Underpessure ”Vaccum |
| ^^clinical Spectrum of Blast: 1-Primary blast injury : –Direct result of Overpressure -Damal intrnal organs by direct condution of forces 2-Secondary blast injuries:–accelated object due to explosion(peices of debree) -which cause blunt /penetrating injury3- teriary Blast Injury : -From decelatation forces after victim body is set in motion (sricking variosu surroudnign objects) 4- Musclleanous Blast Injury :-Thermal/chemical/Inhalation exposure/Crush Trauma |
^^Principle of medical Management: I-ABCDE Pririty II-Auditory injury:-Otologicassament and audiometry ! -Complication of perilymph Fisula should be auditory PBI rquiring Prompt surgical Tx -Cholesteatoma may be late complication (12-48 M) of TM perforation III-thoracic injury:-blast Lung Injury(BLI)-Pul hemmorhage/edema/ Alveolar disruption–Prognosi can be improved with aggressive Tx -BLI involves destruction of alveolar Tree -Chest Xray is a Must!-Managed same way as pulmonary contusion! -needs more observation-needs+ve pressure/ventilation /positive Exp pressure!-Avoid pul Complication strategies:1-Permssive hypercapnia+reduction of tidal volume 2-Intemmitent Mechnical vnetilation & contnous +ve airway pressure! 3-Prophylaxis insetion of chest Tube! IV-CVS injury!:-Fluid amdinistration (including Blood products) for Cardiorespiratory Resuscitation-invasive monitering to guide therpa often Necc -Colloid Solution often best for ResuscitationV-Abd Injury:–May be Hard due to Avute injury! -Need Abd CT/ US / Peritneal Lavage!—> evelaute intestinal PBI -Colonoscopy has been sggest to moniter LI Contusion! (Risk of Perforation so Not always used)VI-musculoskeltal/Extremity Injuty: -due to 2nd=3rd Blast injury!-Traumatic amputations in blast -Treat penetrating wound in aggressive fashion with early expoloration, Debridgment, & Delayed primary closure! –Conservate Approach may be used with Appropriate Ax Coverage! -Tetanus Immunization addressed-Primary closure increase Risk o Infection!this is why we prefered Delayedclosure! VII-CNS injury:-Sx:headache/Vertigo/ataia/alt mental Status —> Immediate O2 Administration is reuired! -Expeditious Adm of Hyperbaric Oxygen may be helpful-Left Lateral Decubitus position to avoid complication-PTSF may have Organic basis |
***Common psychological Response to Disaster!:
Phase One ” Prempact” -Before Event Takes Place–Stressor is”Worry” –Response is Normal—>anxiety |
| Phase two”Impact phase” -Disaster is occuring -Some peopel remain calm & organzied -Some Disoganized/Confused! -Many serious coping difficulty! |
Phae 3 ” Post impact phase”: -Emotional Rxns Vary-feeling of self-Conciousness -emotional lability & numbnes |
| ^^Victim of Disaster: 1-Primarycasualties:Physcialinjury / Acute psychological Consequence! 2-Secodnary:affectedrelactives& Friends of Primary casualties! 3-Teriary:RescuaWorkers & Healthcare providers! |
^^Psychological Sx:-apathy-Anx-Denial-helplessness-Jk-Insomnia-Mild Confusion-Mood swing-Terror |
^^Psychopathological features related to Trauma:-PTSD!-Substance abuse! –AnxeityDisorder -Depression |
****Dx criteria of postraumatic Stress disorder:
-PTSD is a response to catastophy!
-When Pts reexperiences the Trauma Avoid reminder of the Events!^^Dx and DMS IV:1-Having witness a truamtic Even
2-Persisitent Reexperiening og the event( dreams, Falshbacks)
3-Avoidnce of stimuli associated with event!
4-Numbing of responsivness( limited range of affect)
5-Persitant Sx of increased arousal6-Sx Must be present for at least 1M and cause significant impairment or stress!***Principle of Critical Incident Stress Management!-CISD is used as an intervention after a traumatic event!
-a group session facilitated by mental health proessional!
-During Session participant recount exp and express Fear and concenrs While facilitators aknowledge them!
-CISD goal to to normalize the Crises experience and develop a Coping mechanism!
-last 1.5-3 hours period 2-14 Days!
^^Components of CISM system:1-Pre-crises intervetion -ID those at risk of psychological Trauma nadot inform them! –Strssmanagment -Education-stress (R)-Crisis Mitgiation 2-Crises intervention-Demobilization-staff consultation–Goal:allow Psychological decompression and provide opportunity for stres management! 3-Defusing:allow Sx mitigationand give opportunity for closure! -small group discussion held withing 12 hours of critical inident! 4-Adoementioned CISD:a severe phase small group discussion( P1 :introduciton of Teams) (P2 : Fact phase , members describe their role ) (P3 : thought phase,Explore their htoughts that occured during event) (P4:Reactionphase,allow people to express their emotional rxn) (P5 :symptomnPhase : Explore physical & emotional Sx) (P6 : Teaching phase :Debreifing the teams) (P7 : Re-entry phase: meeting is summarized) |
^^CISD components:
-Individual Crises intervention (5 components)
-Pastoral crises Intervention ( 6th component)-Family/Organzied CISM( 7th component)
-Follow up(8th component)