Today s Topics. Age-related changes that increase vulnerability. Geriatric-specific disaster planning. Geriatric decontamination

Transcription

1 1 Geriatric Preparedness, Triage, and Treatment in Disasters Deborah Smith, RN, BSN, CEN Manager, Clinical Services YNHH Center for Emergency Preparedness and Disaster Response June 3, 2010 Photo credit: FEMA Today s Topics Age-related changes that increase vulnerability Geriatric-specific disaster planning Geriatric decontamination Geriatric Response training 2 Learner Objectives Differentiate key physiological changes that occur with aging and can increase the vulnerability of older individuals during disasters Identify the need for geriatric-specific disaster planning, including the necessary personnel, equipment, and infrastructure Discuss triage, decontamination regulation, and special considerations for evacuation of the geriatric population Outline recommendations for geriatric disaster training and exercises 3

2 4 What does the term geriatric mean? Definition of Geriatrics Geriatric individuals: Are over 65 years of age Have varying levels of disease and disability Are a highly vulnerable population Are concerned with preserving their independence 5 Functional Changes that Occur with Aging Examples include: Increased incidence of chronic disease Functional impairment Sensory Impairment 6

3 7 Physiological Changes that Occur with Aging Examples include: Decreased immune function Altered lung mechanics Thinner skin Mental status changes Disease Onset in Older Individuals Predisposing Factors Precipitating Factors Geriatric Patient 8 Predisposing Factors Examples include: Chronic diseases Impaired mobility and/or disability Polypharmacy 9

4 10 Precipitating Factors Examples include: New disease process Chronic disease exacerbation Toxic exposures Changes in medication dosing or frequency Predisposing and Precipitating Factors Compounded in a Disaster Predisposing Factors Precipitating Factors Geriatric Patient Disaster ADVERSE OUTCOME 11 Challenges in Managing Geriatric Victims For events with large numbers of geriatric victims: Rapid triage and assessment is difficult There is a higher risk of misdiagnosis or inappropriate triage Photo credit: FEMA 12

5 13 Key Points to Remember The most vulnerable geriatric individuals are: Disabled or have impaired mobility Institutionalized in nursing homes or assisted-living facilities Suffering from dementia Geriatric vulnerability in disasters 14 Geriatric Vulnerability Many age-related physiological changes make older individuals more susceptible to injury and exposure. 15

6 16 Physiological Reasons for Higher Susceptibility Examples include: Decreased immune function Poor thermoregulation Decreased circulating blood volume Skin changes Faster respiratory rates Cardiac factors Geriatric Vulnerability in Biological Outbreaks Influenza Secondary bacterial infections due to lower immunity Viral Hemorrhagic Fevers Bleeding more severe due to decreased circulating blood volume or thinned blood from medications Smallpox Decreased immune function and faster respiratory rates 17 Geriatric Vulnerability in Anthrax Outbreaks Anthrax Common routes of infection: Skin Gastrointestinal tract Inhalation of spores Thinning skin, decreased immune function, and faster respiratory rates increase susceptibility Photo credit: CDC 18

7 19 Geriatric Vulnerability in Chemical Exposure Organophosphate nerve agents (e.g. tabun, sarin) Cardiopulmonary disease, causing bronchorrhea, bronchospasm, and bradycardia put patient at higher risk Respiratory chemicals (e.g. chlorine gas, phosgene, cyanide) Respiratory conditions such as chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), or tuberculosis put patient at higher risk Dermatologic chemicals Thinning skin decreases the ability to retain fluid or fight off infection Geriatric Vulnerability in Trauma A, B, Cs Physiological complications in performing assessment Injury patterns Falls are the fifth leading cause of injury in the elderly, and are exacerbated in disaster situations due to disorientation Burns Decreased blood circulating volume increases the risk of shock and death Crush injury Decreased kidney function complicates fluid resuscitation 20 Geriatric Vulnerability: Lessons Learned Prior disasters: September 11, 2001 Hurricane Katrina, August 2005 Alzheimer s Safe Return Program, Photo credit: FEMA, Hurricane Katrina 21

8 22 Geriatric Triage Atypical presentation of life-threatening disease Confounding effects of co-morbid disease Frequency of polypharmacy or adverse drug reactions Communication difficulties Unrecognized cognitive impairment Limited understanding of medical history START Triage 23 START Triage (con t) 24

9 25 General Geriatric Treatment Principles Precautions for medication administration: Take careful medication history Start low and go slow Use anticholinergics Monitor for adverse reactions Photo credit: FEMA Decontamination Decontamination at a disaster site protects patients and health care workers from chemical, biological or radiological substances. 26 Special Issues in Geriatric Decontamination Mobility issues require added assistance accessing and disrobing in the decontamination area Mobility or assistive devices require decontamination if new ones are not available 27

10 28 Lessons from Trauma Literature Lessons learned include: Geriatric patients are consistently under-triaged Advancing age alone is NOT predicative of poor outcomes Medical co-morbidities contribute adversely to predicted outcome Post-injury complications negatively impact geriatric patient survival Case Study 75 year old man presents with altered mental status. He is the victim of an explosion originating in his retirement community and is having difficulty hearing above the noise in the triage area. 29 Case Study (continued) Medical history: patient states that he has diabetes, and is undergoing treatment for cancer Medications: patient remembers taking insulin, blood pressure medication, and strong pain medication Physical exam: lethargic male, inattentive to questions, afebrile, pulse 65, other vitals stable, dry skin and mucous membranes, cardiopulmonary exam normal, no abdominal tenderness, questions of pelvic fullness or mass 30

11 31 Which predisposing factor is the most troubling in this scenario? Diabetes Cancer Unknown conditions Which medication may be exacerbating this patients condition? Opioid Blood pressure Insulin 32 Based on the case study information provided, is the patient suffering from dementia? Yes No 33

12 34 Special considerations for geriatric evacuation Geriatric Disaster Preparedness Creation of an emergency kit will assist in evacuation and allow for enhanced emergency care. 35 Geriatric Emergency Kit Contents Basic geriatric emergency kit contents should include: List of prescription medications and allergies to drugs/food Key contact information Copies of insurance information Advanced directive documents 36

13 37 Geriatric Emergency Kit Contents (con t) Additional suggested supplies include: Extra vision/hearing aids (with batteries) Bottled water Non-perishable snacks Nutrition supplements Flashlight Specialized Equipment Recommendations of additional supplies for first receivers to have on hand: Mobility aids Hearing devices Continence supplies Soft foods Wound care supplies Warming blankets Radiant warmers 38 Geriatric Evacuation Challenges during evacuation impact the initial presentation of patients at first receiving facilities. Photo credit: FEMA 39

14 40 Common Geriatric Conditions Exacerbated During Evacuation Physiological examples include: Mental status changes Pressure/bed sores Dehydration Exacerbation of chronic conditions Photo credit: FEMA Common Geriatric Conditions Exacerbated During Evacuation (con t) Psychological examples include: Depression Delirium/confused state Sundowning Psychotic symptoms and/or paranoia Alcohol abuse or withdrawal 41 Why is geriatric response training necessary? 42

15 43 Geriatric Disaster Response Training It is necessary in order to understand the special needs of older individuals. Resources for Geriatric Training Additional resources for geriatric training include: Area agencies on aging Local nursing organizations Visiting nurses associations Nursing home staff (registered nurses and aides) Alzheimer s Association American Association for Retired Persons American Geriatrics Society 44 Exercises Provide important opportunity to involve different groups in planning and execution of real-life scenarios. 45

16 46 Questions? Thank You for Your Participation 47 Contact Information For more information please contact Rebecca Cohen (203) , Presented by Deborah Smith, RN, BSN, CEN (203) , Yale New Haven Center for Emergency Preparedness and Disaster Response One Church Street, New Haven, CT