Definitions

• Disaster = "A serious disruption of the functioning of society, causing wideshpread human, material, or enviornmental losses which exceed the ability of affected society to cope using only its own resources" (UN, 1992). Emphasis is the inability of a society (community, state, nation) to respond to the event.

• Disaster cycle is composed of:
  

1. Preparation
   
2. Event Response
   
3. Recovery
   
4. Mitigation
   

• Resilience = The capacity to cope with or recover from emergencies and disasters  
  

Basics of Personal Security for Travel to Developing Countries - Macpherson

• Before you travel, do some research (can consult the following sites)
  

- http://www.travel.state.gov
- https://www.cia.gov/library/publications/the-world-factbook/
- http://www.doingbusiness.org/
- http://www.lonelyplanet.com

• The most important aspect of security when you travel is your situational awareness
  

1. Pay attention to your surroundings
   
2. Be sensitive to change
   
3. Act accordingly (trust your instincts)
   

• Travel to/from and within the country
  

1. Cell phone  - most vital piece of equipment (consider getting a local cell phone)
   
2. Don't travel with more than you are willing to lose
   
3. Don't travel with more than you can carry yourself
   
4. Have an advance plan for travel from airport to hotel
   
5. Don't travel around alone
   
6. Find out what areas to avoid
   
7. Vary your route
   

• Be careful what you post on social media  
  

Pediatric Disaster Medicine and Triage - Noste

• The pediatric population is at higher risk of injury during a MCI/disaster/CBRNE event

1. Body heat loss is increased during exposure or following decon
   
2. Vital sign screening is frequently inadequate
   
3. Internal organ damage is often overlooked
   
4. Thinner skin is more vulnerable to the effects of radiation
   
5. Typically closer to the ground and more likely to ingest heavier than air gases or contaminated particulate matter
   

•  Children <4 years old have a 4.5x rate of death from cholera  
  
• JumpSTART modifications for pediatric MCI
  

1. Why? Cap refill is unreliable and strongly influenced by the environment in the pediatric patient
2. Respirations may be normally > 30/min
3. Not all children can walk or follow commands
   
4. Biggest modifications are: Normal respiration rate 15-45 bpm, if patient is apneic after repositioning the airway give 5 rescue breaths (if no response then triage code black, if response then triage code red),
   
5. There is a high rate of "over-triage" pediatric patients in MCI (300-400%)

Myth 4 - The extent of surface burn determines the extent of the injury. Unfortunately, skin findings can be misleading.

Myth 5 - The pathway the electricity takes through the body predicts the pattern of injury.  It is helpful to be able to see evidence of the path that the electricity took (ex, from toe to hand), but once again, this can be misleading.

Myth 6 - All patients with electric injuries require 24 hours of cardiac monitoring.  Most patients who arrive to the ED without having had an arrhythmia and who have a normal ECG with no symptoms do not require prolonged monitoring.

Myth 7 - Cardiac monitoring and further testing is always required for TASER injuries. There have been deaths noted with TASER injuries, but these have all been associated with patients who had "excited delirium" -- PCP and TASER is a bad combination.

Myth 8 - Victims of lightning injury should not undergo prolonged resuscitation.  Lightning victims can have meaningful recoveries after prolonged resuscitation.  They can even present with Fixed and Dilated pupils.  Do not tell EMS providers to pronounce the victim in the field. Continue to resuscitate and bring them to the ED to further assess.

Crotalid Envenomations Dr. Beuhler

• 2 classes of poisonous snake in NC - pit vipers & coral snakes.  Pit vipers make up the majority of bites we're going to see (Eastern diamondback, Timber rattler, Pygmy rattlesnake, cotton mouth & copperhead)
  

• The venom in the pit vipers is made to digest tissues - has proteolytic and hyaluronisdase activity - this leads to localized extremity dysfunction & systemic effects (emesis, tachycardia, hypotension, flushing, mytoxicity, renal toxicity, allergic reactions, angioedema, coagulopathy, and renal dysfunction)

• Pit viper venom has a degree of neurotoxin activity as well which can lead to weakness, ptosis, and fasiculations as well as localized numbness at bite site

Important steps in management of bite care:

1. First aid: NO ICE; NO TOURNIQUET; Elevation of affected site - don't bend major joints 90 degrees - need to make sure there is good lymphatic flow 
2. Grade bite - this will help determine administration of Crofab, length of observation vs admission 

• Mild - mild swelling, no systemic involvement or lab abnormalities
• Moderate - <50% limb involvement, minimal systemic involvement
• Severe - >50% of limb involvement (crosses major joint), lab abnormalities, systemic effects

3. Decision to treat with Crofab is multifactorial - should be used only in high risk populations or those with moderate to severe envenomations. 

Don't just treat lab abnormalities   

a. Crofab = 10cc/hr; 4 vials & reevaluate after 1-2 hrs. 
Remember crofab interrupts coagulopathy & helps lower compartment pressures & possibly helps with pain - it will NOT stop or reverse local tissue destruction

If you DC home have follow up in < 24 hrs for wound reevaluation