CHAPTER 10: PREVENTING AND

MANAGING COMMUNITY
EMERGENCIES: DISASTERS AND
INFECTIOUS DISEASES
INTRODUCTION

Community Emergencies: events large enough to have a major impact on

community functioning when events exceed the communitys capacity to manage
them disaster
o May occur naturally (hurricanes), or have human etiology (explosion)
o May occur spontaneously (bird flu outbreak)

PREVENTING AND MANAGING DISASTERS

Disasters particularly affect vulnerable groups (children and elderly)

HEALTHY PEOPLE 2020 AND DISASTER PREPAREDNESS

National Preparedness Goal: improve the nations ability to prevent, prepare for,
respond to, and recover from a major health incident
o Develop and maintain the workforce needed for national health security
o Ensure timely and effective communications
o Ensure prevention of environmental and emerging threats to health
National plans for emergency and disaster preparedness:
o Collaboration between government and nongovernmental agencies or
organizations, private sector groups, communities, and individuals aimed at
enhancing preparation for, prevention of, response to, and recovery from
health threats

COMPONENTS OF COMMUNITY DISASTER MANAGEMENT

DEFINITION OF TERMS

Disasters: sudden or serious events of such a scale that there is considerable

human, property, or environmental damage or loss; results from hazards,
conditions of vulnerability, and insufficient capacity to reduce negative
consequences
Hazards: phenomena with the potential to cause disruption or damage to people
and their environment
Risks: the odds or possibilities that human lives or property will be lost or
damaged
Vulnerabilities: social, economic, physical, or environmental factors that increase
individual or community susceptibility to the effects of hazards
Risk reduction: actions intended to prevent or lessen the effects of hazards
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Mass trauma/mass casualty incidents: events resulting in the deaths, injuries,

disabilities, or emotional distress of many people
Weapons of mass destruction: circumstances that produce many casualties
and influence health care or critical service access
o CBRNE:
Chemical agents
Biologic agents
Radiological agents
Nuclear agents
Explosive agents
Surge capacity: the ability of health care systems to quickly expand in order to
meet emergency needs

COMMUNITY PLANNING FOR DISASTER PREPAREDNESS

Multiple organizations may be involved in disaster planning: health care,

law enforcement, emergency services and first aid, financial institutions,
emergency shelters, faith-based groups, utility companies, and the postal service
American Red Cross- nongovernmental
FEMA: support citizens and first responders to ensure the nation can work
together to build, sustain, and improve capability to prepare for, protect against,
respond to, recover from, and mitigate hazards
Department of Homeland Security: ensures a homeland that is safe, secure,
and resilient against terrorism and other hazards

STAGES/PHASES OF DISASTER PLANNING

Four stages: preparedness, response, recovery, and mitigation

Agent-specific approach: addresses the most likely threats or hazards
o Planning for flooding, for example
o Warning systems
o Protection through sheltering in place
o Care for the injured
o Control of the scene
o Investigation of the event
All-hazards approach: recognizes that people may encounter multiple types of
hazards
o Planning involves identification of potential hazards, assessment of
vulnerabilities, and determination of potential effects
o Five hazard categories:
Natural or accidental man-made disasters (storm, fire)
Traumatic or explosive disasters (bomb, plane crash)
Nuclear or radiation disasters (dirty bomb)
Biologic disasters (anthrax, SARS, bird flu)
Chemic disasters (cyanide)
Personal Emergency Preparedness
o Assemble as emergency supply kit (BP cuff, stethoscope, watch)
o Prepare and practice personal/family emergency plan
o Get trained or ensure at least one household member is trained in CPR/AED
and first aid
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Get involved in community; know most likely disasters and assist

community to prepare

RESPONDING TO A DISASTER
DETECT

Some
o
o
o

may be obvious, but others may be difficult to detect because of:

Delayed reactions to an agent
Prolonged incubation period
Nonspecific symptoms

INCIDENT COMMAND

Approach to handling emergencies with the integration of resources

Five functions:
o Command
o Operations
o Planning
o Logistics
o Finance/administration

SCENE SECRUITY AND SAFETY

A scene is considered unsafe until proven otherwise

ASSESS HAZARDS

May be obvious or less-apparent

SUPPORT

Considerations include personnel, organizations/agencies, facilities to be used,

vehicles ,and supplies

TRIAGE AND TREATMENT

Meeting the needs of the largest number of victims to maximize the number of lives
saved
START: simple triage and rapid treatment
o Observe respirations, perfusion, and mental status
o Classifies victims into 4 categories:
Minor: green tag; care may be delayed up to 3 hours
Delayed: yellow tag; urgent care, but can be delayed up to 1 hour
Immediate: red tag; life threatening, need immediate care
Dead: black tag

EVACUATION AND TRANSPORT OF VICTIMS AND CASUALTIES

Evacuation: removal of both injured and noninjured persons to a safe environment

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Have one ambulance for every five patients

RECOVERY

The period during which the community strives to return to a normal function level

PREVENTING AND MANAGING INFECTIOUS DISEASES

Rapid proliferation of drug-resistant organisms

Emergence of new pathogens and new infectious diseases

HEALTY PEOPLE 2020 AND INFECTIOUS DISEASES

Topic areas: immunization, infectious diseases, STDs, HIV/AIDS

PRINCIPLES OF INFECTION
SPECTRUM OF INFECTION

Subclinical/asymptomatic: when the agent invades and multiplies without

producing overt symptomatic disease
Infection: the entry and multiplication of an infectious agent

STAGES OF INFECTION

Latent period: the period of replication before shedding

Communicable period: begins with shedding of the agent; usually begins before
symptoms are present
Incubation period: the time of invasion to the time when symptoms first appear

SPECTRUM OF DISEASE OCCURRENCE

Endemic: occur at a consistent, expected level in a geographic area

Outbreak: the unexpected occurrence of an infectious disease in a limited
geographic area
Pandemic: the steady occurrence of a disease over a large geographic area or
worldwide
Epidemic: an unexpected increase of an infectious disease in a geographic area

CHAIN OF TRANSMISSION
INFECTIOUS AGENTS

Organisms capable of producing infection in a host

Properties: morphology, chemical composition, growth requirements, viability
Classified as viruses, bacteria, fungi, protozoa, rickettsia, helminths, and prions
Interaction with the host:
o Mode of action
o Infectivity: power to invade and infect large numbers of people
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o
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Pathogenicity: ability to produce disease in those affected

Virulence: ability to produce serious disease in their hosts
Toxigenicity: produces a toxin
Antigenicity: stimulates an immune response in the host
Ability to adapt to the host

RESERVOIRS

The environment in which a pathogen lives and multiplies

Can be humans, animals, arthropods, plants, soil, or any organic substance

PORTALS OF ENTRY AND EXIT

Portals of exit: respiratory secretions, vaginal secretions, semen, saliva, lesion

exudate, blood, feces
Portals of entry: respiratory passages, mucous membranes, open wounds,
ingestion, through the placenta, and through the skin

MODES OF TRANSMISSION

Direct: person-to-person
Indirect: implies a vehicle of transmission
o Fomite: an inanimate object, material, or substances that transports an agent
o Vector: animals, insects, or arthropods
Biologic route: when the parasite grows or multiples inside the animal
Mechanical route: no multiplication, but the animal/insect carries the
agent to a new location
Airborne: through aerosols and droplets

HOST SUSCEPTIBILITY

The presence or lack of sufficient resistance to an infectious agent to prevent

contracting an infection
Influenced by gender, age, genetics, general health status, personal behaviors, lines
of defense, and immunity

BREAKING THE CHAIN OF TRANSMISSION

CONTROLLING THE AGENT

Use disinfection, sterilization, and radiation

Anti-infective drugs

ERADICATING THE NONHUMAN RESERVOIR

Common nonhuman reservoirs: water, food, milk, animals, insects, sewage

Spray for mosquitoes

CONTROLLING THE HUMAN RESERVOIR

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Treat infected people

Quarantine: restricting the activities of those who have been exposed during the
incubation period

CONTROLLING THE PORTALS OF EXIT AND ENTRY

Properly dispose of secretions, excretions, and exudates

Isolate sick people
Barrier precautions
Avoid unnecessary invasive procedures
Protect against vectors

IMPROVE HOST RESISTANCE AND IMMUNITY

Factors that contribute to host resistance: age, general health status, nutrition, health
behaviors
Natural immunity: innate resistance to a specific antigen or toxin
Acquired immunity: derived from actual exposure to the specific infectious agent,
toxin, or vaccine
Active immunity: when the body produces its own antibodies
Passive immunity: temporary resistance that has been donated to the host through
transfusions of plasma proteins, immunoglobulins, and antitoxins, or through the
placenta
o Lasts only as long as they stay in the bloodstream
Primary vaccine failure: the failure of the vaccine to stimulate any immune
response
Secondary vaccine failure: waning of immunity following an initial immune
response
Herd immunity: a state in which those not immune to an infectious agent will be
safe if a certain proportion (80%) of the population has been vaccinated or immune

PUBLIC HEALTH CONTROL OF INFECTIOUS DISEASES

DEFINING AND REPORTING INFECTIOUS DISEASES

Diseases are defined and classified according to confirmed case, probable cases, labconfirmed cases, etc.
Health care providers who encounter these diseases must report them to the local or
regional health department

PREVENTING BY VACCINATION

Go to the CDC to determine which immunizations to give, to whom they should be

given, how they should be given, and how they are to be transported, stored, and
administered
Legal documentation: patient name, date immunized, vaccine type, vaccine
manufacturer, vaccine lot number, date of the VIS, name, title, address of person
administering vaccine
Must report specific post-vaccination adverse events
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RESPONDING TO AN OUTBREAK

Investigation and containment are the responsibility of the local health department
Verify diagnosis and establish case definition
Confirm existence of an outbreak
Identify characteristics of affected people
Define and investigate the population at risk
Investigate the outbreak and formulate a hypothesis as to its chain of transmission
Determine most effective control measures

RISK COMMUNICATION

Local public health agencies have the official responsibility for communicating with
the public during infectious disease outbreaks in their jurisdiction

Trust
Early announcement
Transparency

Listening
Planning