Patients evacuation

Disaster planning must include a community mutual aid plan in the event that the hospital (s), nursing home(s), or other residential health care facility needs to be evacuated. Plans for evacuation of health care facilities must be realistic and achievable, and contain sufficient specific detail as to where patients will be relocated to and who will be there to care for them. Patient evacuation was a major challenge to disaster response efforts following Hurricane Katrina, and was hampered by the destruction of all major transportation routes in and out of the city. Pre-planning for the possibility of the need to evacuate entire health care facilities must address alternative modes of transportation and include adequate security measures (see Figure 1.4). 

The foundation of ESF 8 is the multiagency National Disaster Medical System (NDMS). Directed by the Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, the NDMS has the following three primary functional elements medical response, patient evacuation, and hospitalization. 

Patient evacuation. Arrangements are coordinated for patients who cannot be cared for locally to be evacuated to designated locations tbrougbout the United States. 

Patient Evacuation. Lead HHS Agency ASPR in coordination with DHS/FEMA... 

Patient evacuation Most coalitions face the potential of a hazard impact that would require the evacuation of a healthcare facility. Clearly defined procednres for how the coalition might support this should be included within the context of a hazard or incident-specific annex. This material should be presented in a format that is useful during response... 

However effective at-scene decontamination is, a number of patients will still arrive at hospital requiring decontamination. These may be critically ill patients evacuated from the scene before treatment or after initial assessment and treatment, patients who have self-evacuated or patients who are suspected of being incompletely decontaminated. Decontamination should be carried out in teams of 2-4 and may take up to 20 minutes per patient to complete. 

Irritable bowel syndrome (DBS) is an exceedingly common condition in all societies, characterized by abdominal discomfort or pain in association with altered bowel habit or incomplete stool evacuation, bloating and constipation or diarrhoea, easily go undetected and do not show up with common tests such as blood tests or x-rays. The estimated prevalence in the community is about 10%. Irritable bowel syndrome and its variants, collectively called functional gastrointestinal disorders, constitute 40-50% of all the patients seen by gastroenterologists in Western countries. 

A laxative is most often prescribed for the short-term relief or prevention of constipation. Certain stimulant, emollient, and saline laxatives are used to evacuate the colon for rectal and bowel examinations. Fecal softeners or mineral oil are used prophylactically in patients who should not strain during defecation, such as after anorectal surgery or a myocardial infarction. Psyllium may be used in patients with irritable bowel syndrome and diverticular disease. Fblycarbophil may be prescribed for constipation or diarrhea associated with irritable bowel syndrome and diverticulosis. Mineral oil is... 

The effect of orlistat in adolescent patients has been evaluated recently. In a group of 12- to 16-year-old individuals, orlistat (120 mg three times daily) in combination with diet, exercise, and behavior modification exhibited minimal weight increase after 1 year (0.53 kg) compared with placebo-treated patients (3.14 kg). Common adverse reactions observed were fatty or oily stools, oily spotting, oily evacuation, or abdominal pain and/or flatulence with bowel movements. Soft stools, nausea, increased defecation, and fecal incontinence also were noted. Orlistat may be better suited for prevention of weight gain in tolerant adolescents, but more studies are warranted before providing a solid recommendation.36... 

Malaria cases in Sicily exceeded battle casualties. At some West African airbases, personnel averaged an infection and a relapse yearly. The disease was an important factor in the fall of Bataan in the Philippines and in other early Pacific war disasters. For each battle casualty early in the New Guinea campaign, six to eight malaria patients had to be evacuated. An entire division of U.S. Marines was withdrawn from the front after more than half contracted malaria in the summer of 1942. Unless malaria could be controlled, General Douglas MacArthur said that he would have one division of men hospitalized with malaria and another division recuperating from it for every combat-ready division. 

Incompletely fixed cysts may stain predominantly red, and organisms which have degenerated before fixation often stain pale green. Poor fixation due to an inadequate mixing of the specimen in fixative may result in both of these, appearances. In some specimens, degeneration has occurred before the specimen is placed in fixative, either in the patient before the specimen was evacuated or because of delay in fixing the specimen. 

OBD comprises a constellation of GI symptoms including OIC, incomplete evacuation, inhibition of gut peristalsis, bloating, pain, nausea/ vomiting, and increased gastric reflux and tone of intestinal sphincters [3]. Approximately 40% of patients taking chronic opioids for nonmalig-nant pain develop bowel dysfunction [25]. 

Four liters of this solution is administered over 3 hours to obtain complete evacuation of the GI tract. The solution is not recommended for the routine treatment of constipation, and its use should be avoided in patients with intestinal obstruction. 

Two years later, an explosion and fire at Bartlo Packaging (BPS, Inc.), in West Helena, Arkansas, killed three firefighters and seriously injured another. Hundreds of residents, including patients at a local hospital, were either evacuated or sheltered-in-place (USEPA-OSHA, 1999). Property damage was extensive. Major roads were closed and Mississippi River was traffic halted for nearly 12 hours. 

Pleural effusions or ascites In patients with significant third space accumulations, evacuate the fluid before treatment and monitor plasma methotrexate levels. Psoriasis lesions Lesions of psoriasis may be aggravated by concomitant exposure to ultraviolet radiation. Radiation dermatitis and sunburn may be recalled by the use of methotrexate. 

Portal-systemic encephalopathy PO Initially, 30-45 ml every hr. Then, 30-45 ml (20-30 g) 3-4 times a day. Adjust dose q 1-2 days to produce 2-3 soft stools a day. Rectal (as retention enema) 300 ml with 700 ml water or saline solution patient should retain 30-60 min. Repeat q4-6h. If evacuation occurs too promptly, repeat immediately. 

It is indicated in all forms of constipation, e.g. in bedridden patients, due to change of food or environment, illness or digestive disorders relief of evacuation in painful conditions such as haemorrhoids pre and postoperatively pre-paration for barium enema preparation of colon for proctosigmoidoscopy. Dose DULCOLAX 5-15 mg HS oral and suppository (5-10 mg). 

Laxatives are typically used whenever normal bowel movements have been impaired but no obstruction exists in the GI system. For instance, laxatives may benefit patients on prolonged bed rest, patients with infrequent or painful bowel movements, patients with spinal cord injuries, or patients who should avoid straining during defecation (e.g., postpartum patients and those recovering from surgical procedures). Laxatives are also indicated for bowel evacuation prior to surgical or diagnostic procedures. 

Disturbances in the GI system, such as nausea and cramps, may occur with laxative use. With prolonged use, serious lower GI irritation, including spastic colitis, may occur. Fluid and electrolyte abnormalities are also a potential problem. Excessive loss of water and the concomitant loss of electrolytes may transpire, resulting in dehydration and possible acid-base imbalances.44 These abnormalities are especially significant in older or debilitated patients. Finally, chronic administration may result in a laxative dependence when bowel evacuation has become so subservient to laxative use that the normal mechanisms governing evacuation and defecation are impaired. 

Includes rehabilitative and recovery therapy for those who may return to duty if convalescence from injury does not exceed the established theater evacuation policy. This level of care is becoming less prevalent in contemporary warfare and battlefield patient management. Highest level treatment capability Army field hospitals, general hospitals, and combat support hospital echelon above corps. 

Constipation is a complaint commonly seen in clinical practice. Because of the wide range of normal bowel habits, constipation is difficult to define precisely. Most persons have at least three bowel movements per week, and constipation has been commonly defined as a frequency of defecation of less than three times per week. However, stool frequency alone is not a sufficient criterion to use because many constipated patients describe a normal frequency of defecation but subjective complaints of excessive straining, hard stools, lower abdominal fullness, and a sense of incomplete evacuation. Thus, a combination of objective and subjective criteria must be used to define constipation. 

In the patient presenting with a recent onset of constipation, an obstructing lesion of the colon should be sought. In addition to a colonic neoplasm, other causes of colonic obstruction include strictures due to colonic ischemia, diverticular disease, or inflammatory bowel disease foreign bodies or anal strictures. Anal sphincter spasm due to painful hemorrhoids or fissures also may inhibit the desire to evacuate. 

This contains, besides ordinary fats, about 10% of croton-resin, the active component producing the local and systemic effects of the oil. It is destroyed by boiling with alkalis. Croton oil is the most violent of all cathartics, 1/2 to 1 drop producing burning in the mouth and stomach, often vomiting, and after 1/2 to 3 h, several extensive fluid evacuations, with much colic and tenesmus. It was formerly used in extreme cases of constipation, and in unconscious patients (uremic and... 

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