Disaster Medicine

Disaster Basics & Triage - Chaos Control Crew

• Disaster: Event overwhelming local resources; MCI (Mass Casualty Incident).
• Types: Natural (e.g., earthquake, flood), Man-made (e.g., CBRNE, industrial).
• Phases: Mitigation → Preparedness → Response → Recovery.
• Triage: "To sort". Rapidly prioritizes care. Goal: Greatest good for greatest number.
  • START: Adults. RPM (Respirations, Perfusion, Mental Status). <60 sec/pt.
  • JumpSTART: Pediatrics (1-8 yrs). Modified START.
  • SALT: Sort, Assess, Lifesaving Interventions, Treatment/Transport. Universal.
• Categories (Color Codes):
  • 🔴 Red (I - Immediate): Critical, life-threatening, salvageable with immediate care.
  • 🟡 Yellow (II - Delayed): Serious injuries, can wait hours for definitive care.
  • 🟢 Green (III - Minor): "Walking wounded," minor injuries, self-care possible.
  • ⚫ Black (0/IV - Expectant/Deceased): Unlikely to survive given resources; comfort care.

⭐ START Triage: Apneic adult after airway opening = BLACK. JumpSTART (child): Apneic after airway opening + 2 rescue breaths = BLACK.

CBRNE Agents & Effects - Toxic Trouble Tactics

CBRNE: Chemical, Biological, Radiological, Nuclear, Explosive threats. Prioritize scene safety, decontamination, PPE.

• Chemical Agents:
  • Nerve Agents (e.g., Sarin, VX): Cholinergic crisis (SLUDGEM). Rx: Atropine, Pralidoxime (2-PAM), Diazepam. 📌 SLUDGEM: Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis, Miosis.
  • Vesicants (e.g., Mustard Gas, Lewisite): Skin blistering, airway damage. Rx: Decontaminate, supportive. Lewisite: Dimercaprol.
  • Cyanides (e.g., Hydrogen Cyanide): Blocks cellular respiration, hypoxia; cherry-red skin (late). Rx: Hydroxocobalamin, Sodium thiosulfate + Sodium nitrite.
  • Pulmonary Agents (e.g., Chlorine, Phosgene): Cough, dyspnea, acute pulmonary edema. Rx: Oxygen, supportive care.
• Biological Agents:
  • Anthrax: Cutaneous (painless black eschar), Inhalational (widened mediastinum, hemorrhagic mediastinitis), GI. Rx: Ciprofloxacin/Doxycycline.
  • Plague (Yersinia pestis): Bubonic (painful buboes), Septicemic, Pneumonic (hemoptysis, rapid decompensation). Rx: Streptomycin/Gentamicin.
  • Smallpox: Febrile prodrome then centrifugal rash (all lesions in same stage of development). Rx: Tecovirimat, supportive care.
• Radiological/Nuclear Agents:
  • Acute Radiation Syndrome (ARS): Dose-dependent syndromes (hematopoietic, GI, neurovascular). Rx: Supportive, cytokines (G-CSF), Potassium Iodide (KI) for $I^{131}$ thyroid protection.
• Explosive Agents:
  • Blast Lung: Most common fatal primary blast injury.
  • Injury Types: Primary (blast wave overpressure), Secondary (projectiles), Tertiary (victim displacement), Quaternary (burns, crush, toxins).

⭐ Nerve agent poisoning requires rapid administration of atropine (to dry secretions & block muscarinic effects) and pralidoxime (to reactivate acetylcholinesterase, ideally within hours of exposure).

Response Systems & Public Health - Rescue & Recovery Rally

Error: Failed to generate content for this concept group.

High‑Yield Points - ⚡ Biggest Takeaways

• Triage (START) is paramount: Categorize victims - Red (Immediate), Yellow (Delayed), Green (Minor), Black (Expectant/Deceased).
• Incident Command System (ICS) ensures standardized, on-scene disaster management.
• Disaster Cycle phases include Mitigation, Preparedness, Response, and Recovery.
• Surge Capacity is the healthcare system's ability to handle a sudden patient influx.
• Decontamination is critical for CBRN events, utilizing Hot, Warm, Cold zones.
• Psychological First Aid (PFA) addresses immediate mental health needs of survivors.