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5/3/02
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Authors
Paul Rega, M.D., FACEP
Kelly Burkholder-Allen
Module 4
The ABC’s of Bioterrorism
Preparation, Considerations
and Precautions for Bioterrorism Patient Care
DMATs & Bioterrorism
Covert Assault Clues
Flip Side of De-contamination
Standard Precautions
Airborne I.C. Precautions
Droplet I.C. Precautions
Contact I.C. Precautions
Therapeutic Precautions
Specific Pediatric Considerations
Agencies of Assistance
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DMATs & Bioterrorism
Responders
Targets
DMAT personnel do not have the luxury of believing a biological attack is impossible or improbable.
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Covert Assault Clues
Severe disease manifestations in previously healthy people
Higher than normal number of patients with fever & respiratory/GI complaints
Multiple people with similar complaints from a common location
An endemic disease appearing during an unusual time of year
Unusual number of rapidly fatal cases
Greater number of ill/dead animals
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Currently, 17 nations have active bioweapons R & D, including 5 sponsors of international terrorism.
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Flip Side of De-contamination
Removal of clothing in the decon procedure has the additional advantage of detecting weapons or a secondary device on a victim or “pseudo-victim.”
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Standard Precautions
Wash hands
Wear gloves
Wear face shield
Wear cap/gown
Process contaminated equipment and linen
Clean and disinfect environmental surfaces
Adhere to occupational health & blood-borne pathogen requirements to lessen risk of infection with performing risky patient procedures
Place patients at risk for environmental contamination in private or cohort location
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Airborne I.C. Precautions
Place patient in negative pressure room, when possible
Apply high-intensity air filter respiratory protection
Limit patient transport
Place tight sealing mask on patient when transporting
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Droplet I.C. Precautions
Place patient in private or cohort room
Wear masks, eye protection, and face shields within three feet of patient
Limit patient transport
Apply suitable masking of patient when transport is required
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Contact I.C. Precautions
Place patient in private/cohort room
Limit patient transport
Apply suitable mask on patient during transport
Dedicate patient care equipment to one patient. Otherwise, clean & disinfect between patients
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Therapeutic Precautions
Certain medications that may be contraindicated in specific circumstances (i.g., pediatrics, pregnancy) may be advisable to administer after a bioterrorist attack when the risk of contracting a lethal disease is weighed against the drug effect.
When treatment may deviate from normal standard of care, consultation with regional and Federal authorities is necessary.
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Specific Pediatric Considerations
Greater exposures to aerosolized agents due to increased respirations/minutes
Increased exposure to transdermal toxins due to greater surface/mass ratio.
Greater permeability of intact skin resulting in easier absorption
Increased risk of heat loss with showering due to an increased total body surface area
Greater risk of dehydration/shock due to vomiting and diarrhea
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Agencies of Assistance
CDC Emergency Preparedness & Response
Branch:
1-770-488-7100
DOJ Domestic Preparedness National Response
Hotline (agencies only):
1-800-424-8802
USAMRIID: 1-888-872-7443 (1-888-USA-RIID)
Domestic Preparedness Helpline (M-F),
0900-1800):
1-800-368-6498