1. Care of the person with functional needs in disaster situations: The respiratory system Rachel K. Vanek, RN, BS, BSN, MSN Acute Care Nurse Practitioner Medical Intensive Care Unit University/Case Medical Center

2. Great Dismal Swamp Fire

3. Apartment Fire Large apartment complex caught fire Large apartment complex caught fire >100 elderly and poor evacuated >100 elderly and poor evacuated Many had respiratory and other illnesses making them vulnerable in emergency situations Many had respiratory and other illnesses making them vulnerable in emergency situations Evacuated to hospitals and nursing homes for care/access to medical supplies Evacuated to hospitals and nursing homes for care/access to medical supplies

4. Heat Waves

5. Cold Snaps

6. Floods

7. Weather

8. Illness outbreaks Flu Flu Cold season Cold season Water-borne illness Water-borne illness Crowded living situations Crowded living situations

9. Dust/Environmental Disasters Dust storms Dust storms Toxic chemical leaks Toxic chemical leaks Santa Anna winds Santa Anna winds Other exposures that may require evacuation or special treatment Other exposures that may require evacuation or special treatment

10. Purpose Learn a bit about normal respiratory functions Learn a bit about normal respiratory functions Determine strategies to plan for the management vulnerable persons in the event of an emergency Determine strategies to plan for the management vulnerable persons in the event of an emergency Answer YOUR questions Answer YOUR questions

11. Respiratory Anatomy and Physiology Respiratory system comprised of conducting system and gas exchange system Respiratory system comprised of conducting system and gas exchange system Upper airway filters and warms air Upper airway filters and warms air Gas exchange occurs at the level of the alveoli Gas exchange occurs at the level of the alveoli

13. Functions of Respiratory System Warm and humidify air Warm and humidify air Provide oxygen Provide oxygen Remove carbon dioxide Remove carbon dioxide Cough and sneeze reflex to clear foreign material Cough and sneeze reflex to clear foreign material Filters blood of small material in the circulation Filters blood of small material in the circulation Release and convert special hormones Release and convert special hormones

14. Respiratory Disorders COPD COPD Asthma Asthma Heart Failure Heart Failure Pulmonary Hypertension Pulmonary Hypertension Pneumonia Pneumonia Pulmonary embolism Pulmonary embolism Pneumonia Pneumonia Sleep apnea Sleep apnea Lung Cancer Lung Cancer Fibrosis Fibrosis Cystic fibrosis Cystic fibrosis

15. Medical Technologies Enabling many people with severe disease to live longer, better lives Enabling many people with severe disease to live longer, better lives Patient is dependent on technology to survive Patient is dependent on technology to survive May be simple to complex May be simple to complex Most are fairly compact and portable now Most are fairly compact and portable now

16. Medications Always have a supply on hand Always have a supply on hand Always carry a list of medications and allergies Always carry a list of medications and allergies Have name and number of pharmacy Have name and number of pharmacy

17. Intravenous Medications Some medications are infused into veins Some medications are infused into veins Insulin pumps infuse subcutaneously Insulin pumps infuse subcutaneously Flolan pumps require cassettes and special handling and infuse into central line Flolan pumps require cassettes and special handling and infuse into central line

19. IV medication safety Running out of insulin or medication for pulmonary hypertension is an emergency Running out of insulin or medication for pulmonary hypertension is an emergency Patients have premixed supply Patients have premixed supply Needs refrigeration Needs refrigeration Needs special handling to prevent overdose or infection Needs special handling to prevent overdose or infection Friends, family or aides to assist Friends, family or aides to assist

20. Medication Safety Child proof caps Child proof caps Never mix different medicines in one container Never mix different medicines in one container Never share or take someone else’s medications Never share or take someone else’s medications Expiration dates should be on the bottle Expiration dates should be on the bottle Never alter medication unless instructed to do so Never alter medication unless instructed to do so

21. Oxygen Used in a variety of health situations Used in a variety of health situations May be used constantly or as needed, for example with exercise May be used constantly or as needed, for example with exercise Delivered via nasal cannula Delivered via nasal cannula Can be used with CPAP or BiPap at home Can be used with CPAP or BiPap at home Can be used with mechanical ventilator Can be used with mechanical ventilator

22. Oxygen Delivery Nasal Cannula Nasal Cannula Simple Mask – used for O2 and nebulizer Simple Mask – used for O2 and nebulizer Venturi Mask Venturi Mask Increased O2 needs requires specialty care Increased O2 needs requires specialty care May have concentrator or storage tank May have concentrator or storage tank

24. Oxygen Safety Keep tanks 5-10 feet from heat source or open flames Keep tanks 5-10 feet from heat source or open flames Secure an oxygen cylinder to a solidly fixed object Secure an oxygen cylinder to a solidly fixed object No smoking in car or home when O2 in use No smoking in car or home when O2 in use Do not use petroleum based products near O2 use Do not use petroleum based products near O2 use

25. Oxygen Safety Be careful when long lengths of tubing in use to avoid tripping Be careful when long lengths of tubing in use to avoid tripping If O2 is pressurized avoid touching iced areas If O2 is pressurized avoid touching iced areas

26. Oxygen concentrators

27. Inhalers/Nebulizers Medications delivered directly into the lung Medications delivered directly into the lung Used in a variety of respiratory illnesses Used in a variety of respiratory illnesses Inhalers deliver medications in aerosol form to effect the airways Inhalers deliver medications in aerosol form to effect the airways Nebulizer delivers the medication in a mist Nebulizer delivers the medication in a mist Drugs and method of delivery are prescribed Drugs and method of delivery are prescribed

30. Ventilators Provides gas movement in and out of lungs Provides gas movement in and out of lungs Replaces work of breathing for person who can’t breathe or can’t breathe effectively Replaces work of breathing for person who can’t breathe or can’t breathe effectively It is a life critical machine It is a life critical machine

33. Ventilators Person will have a tracheostomy Person will have a tracheostomy Require specialized training Require specialized training People on ventilators have family, friends, or aides trained in the care and management People on ventilators have family, friends, or aides trained in the care and management Battery packs can last up to 8 hours Battery packs can last up to 8 hours

34. Mechanical Ventilator Safety Airway must be secured Airway must be secured Machines have alarms Machines have alarms Airway requires suctioning at times Airway requires suctioning at times If disconnected easy to reconnect If disconnected easy to reconnect Bag valve mask can replace the ventilators work in an emergency Bag valve mask can replace the ventilators work in an emergency Back up power source Back up power source

35. Ventilator Safety Avoid loops of tubing – can be hazardous Avoid loops of tubing – can be hazardous Homes that have patients on ventilators have special emergency plans Homes that have patients on ventilators have special emergency plans Same safety precautions for oxygen if they have it as well Same safety precautions for oxygen if they have it as well

37. CPAP and BPAP CPAP is now a common modality for the treatment of obstructive sleep apnea CPAP is now a common modality for the treatment of obstructive sleep apnea BPAP is used as an adjunctive modality to assist in ventilatory support BPAP is used as an adjunctive modality to assist in ventilatory support Machines have settings preset Machines have settings preset Can be attached to oxygen Can be attached to oxygen

39. CPAP and BPAP BPAP is used to assist ventilatory support when sleeping BPAP is used to assist ventilatory support when sleeping CPAP is used to stent open airways for obstructive sleep disorders CPAP is used to stent open airways for obstructive sleep disorders May have different uses in the hospital May have different uses in the hospital

40. CPAP and BPAP saftey Never use someone else’s machine Never use someone else’s machine Avoid long loops of tubing Avoid long loops of tubing Most have built in humidity that need to be maintained and refilled Most have built in humidity that need to be maintained and refilled Masks and tubing can be cleaned with soap and water Masks and tubing can be cleaned with soap and water

41. Key Points O2 safety O2 safety People with medical needs will generally have the equipment they need People with medical needs will generally have the equipment they need Providing safe haven Providing safe haven Enlist the assistance of family and friends Enlist the assistance of family and friends

42. Thank you for your kind attention Questions????