1. Respiratory Care Issues in Disasters Prepared by: CPT A. Amin, RRT, RCP and CPT W. Williams, RRT, RCP HMRG - Galveston Company Texas State Guard Texas Medical Rangers HMRG - Galveston Company

2. Objectives - at the end of this review, the TMR should be able to demonstrate an understanding of Common Environmental problems found in disasters that affect the Respiratory System Common Injuries affecting Respiratory System Common Respiratory problems found in disasters Common Respiratory Equipment likely to be found in residences - clues to problems Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

3. What is a chronic illness? A chronic illness is a medical problem that lasts a year or longer, limits what a person can do, and calls for ongoing care. Examples of common chronic illnesses include: Diabetes Chronic Obstructive Pulmonary Disease (COPD) Heart disease Chronic pain syndromes Inflammatory diseases, such as rheumatoid arthritis *More than 90 million Americans live with some form of chronic illness. Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

4. Surviving a natural or man-made disaster is no small feat, especially for those who have a chronic illness. During a disaster access to health care, personal support and medication are lessened. This leaves people with chronic medical conditions at risk for serious medical complications—even to the point of death. Background: Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

5. Data collected by the Children's Health Fund and the Columbia University Mailman School of Public Health, post Hurricane Katrina revealed the usual minor injuries, skin conditions and vaccination adminstrations. However it also revealed high incidences of: Diabetes Hypertension Asthma CHF COPD Background: Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

6. The most frequent diagnoses in those individuals who had at least one diagnosis documented were: Respiratory: URI Asthma COPD Circulatory: Hypertension CHF Minor injury and Skin conditions Background: Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

7. Background: During a disaster, access to healthcare, personal support and medication may be limited. Many problems post disaster include: Lost medications Loss of electrical power Home care equipment damage/misplaced As disaster responders, these are potential medical problems/issues that may occur and should be planned for. Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

8. As disaster medical responders, life support skills are essential. For the patient with respiratory problems, these skills include: Physical and Environmental Assessment Airway management Ventilatory support. Background: Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

9. As disaster medical responders, we will more than likely contribute significantly to: Stabilization and monitoring efforts Assessment, treatment and consultation throughout the entire medical response continuum Background: Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

10. Respiratory Care Issues in Disasters Environmental Issues Common Diseases of the Lung Common Injuries affecting the Respiratory Systems Common Equipment found in the residence of the patient with Pulmonary disease Texas State Guard Texas Medical Rangers HMRG - Galveston Company

11. Environmental Issues Water - drowning or near drowning Dust and other airborne particulates Humidity (too much or too little) Mold and fungi Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

12. Common Diseases of the Lung Asthma (small airways and secretions) Emphysema - COPD (deformed air sacks (air trapping) and secretions) Bronchitis (large airways and secretions) Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

13. Asthma –a chronic inflammatory disorder involving many cell types –manifesting with episodes of chest tightness –coughing –labored breathing and wheezing –all of which are related to bronchiole inflammation Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters

14. Asthma –Need to keep the airway patent (open) –Prevent collapse of the airway when exhaling to help decrease work of breathing –Why the straws? Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters

15. Bronchitis & Emphysema –Walls between the air sacs are destroyed (no longer grape clusters) –Airways inflamed & thickened –Copious amounts of secretions Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters

16. Typical injuries that can be sustained in traumatic disasters affecting respiration: Head injuries Loss of consciousness Upper airway injuries –facial fractures –neck injuries Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

17. Facial Fractures –Nose bridge –Jaw / mouth displacement of jaw inflammation of the tongue (airway closure) Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters

18. Neck injuries –Cervical injuries paralysis –Wounds soft tissue of neck –swollen tongue Loss of upper airway –need to establish viable airway (trach or endotube) Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters

19. Typical injuries that can be sustained in traumatic disasters affecting respiration: –Chest injuries flail chest (multiple broken ribs on one / both sides of thorax) pneumothroax - chest wounds the penetrate the lung abdominal injuries affecting diaphragm movement Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

20. Chest injuries –Broken ribs (one or both sides of chest) –May or may not puncture the lung(s) Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters Broken Ribs on both sides

21. Chest injuries –Pneumothorax lung(s) penetrated collapse of lung(s) –Internal organs can begin to shift (heart, diaphragm) –Must release pressure chest tube(s) Texas State Guard Texas Medical Rangers HMRG - Galveston Company Respiratory Care Issues in Disasters Both lungs collasped

22. We should become familiar with at least the most commonly prescribed respiratory medications and treatments during an emergency. For example, some patients with lung disease require: Breathing treatments Nebulizer MDI Supplementary oxygen Mechanical ventilation These are usually performed by a respiratory therapist but some of these skills can be easily learned by a non therapist health professional. Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

23. Common Equipment found in the residence of the patient with Pulmonary disease Clues there may be an impending patient care issue Respiratory Care Issues in Disasters Texas State Guard Texas Medical Rangers HMRG - Galveston Company

24. Nasal Cannula –Low flow device (2 to 6 lpm) Oxygen % varies from breath to breath. –Approximate O2% range = 24 to ~ 40 % Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment

25. Venti Mask - Total Gas Flow to Patient is determined by variable orifice venturi at varying liter flows (draws in air to combine with Oxygen to give approximate O2 %) Setting Suggested Oxygen Flow Total Gas Flow 24% 3 LPM 79 LPM 26% 3 LPM 47 LPM 28% 6 LPM 68 LPM 30% 6 LPM 53 LPM 35% 9 LPM 50 LPM 40% 12 LPM 50 LPM 50% 15 LPM 41 LPM Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment

26. (Non)Rebreather Mask –Moderate to High O2 concentrations (60% +) –Bag holds additional Oxygen - flows with each breath –Bag movement is important Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment

27. Trach(eostomy) Collar –Requires high flows –Produces high humidity –Usually find an “H” cylinder of Oxygen –Unable to verbalize* Common Respiratory Equipment Texas State Guard Texas Medical Rangers HMRG - Galveston Company

28. Oxygen Cylinders –Oxygen Therapy cannula mask –Different sizes are used D, E or H size –Support combustion - things that burn, burn hotter and faster Common Respiratory Equipment Texas State Guard Texas Medical Rangers HMRG - Galveston Company

29. Liquid Oxygen Systems –Dewars Liquid that vaporizes to a gas –Depending on size of vessel, can be equivalent of several “H” cylinders –Extreme freeze burns loss of limb(s) Common Respiratory Equipment Texas State Guard Texas Medical Rangers HMRG - Galveston Company

30. Medication Nebulizer –Metered Dose Inhaler Bronchodilator Steroid –Some are rescue meds Fast acting –Others are maintenance meds – do not use during breathing / airway emergency Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment

31. Medication Nebulizer –Fixed, Low flow device (6 to 8 lpm) –Generally 21% Oxygen unless run from alternate Oxygen source –Electrically powered –Aerosolizes liquid medications into small particles that are inhaled into lung Texas State Guard Texas Medical Rangers HMRG - Galveston Company Common Respiratory Equipment

32. Home care ventilator –Pt unable to breathe without assistance –May / May not require O2 –Usually find an “H” cylinder of Oxygen –Unable to verbalize* Common Respiratory Equipment Texas State Guard Texas Medical Rangers HMRG - Galveston Company

33. Home care ventilator –Various models and types –Most require use of electricity check for backup power source –Some are pneumatic look for cylinders or compressor Common Respiratory Equipment Texas State Guard Texas Medical Rangers HMRG - Galveston Company

34. Home care ventilator –May / May not require O2 Look for cylinder gases Be aware of cylinder safety –fire hazards –electrical hazards Common Respiratory Equipment Texas State Guard Texas Medical Rangers HMRG - Galveston Company

35. Observe situation and surroundings –findings may lead you to seek possible problems Assess patient and ask questions –current or previous respiratory health issues Provide care –arrange care by appropriate provider Texas State Guard Texas Medical Rangers HMRG - Galveston Company Final Thoughts - Recommendations