Exploring The Apocalypse: Disaster Types

heck1

(I couldn’t find any good apocalypse photos, so I used this one I found in my scrapbook that captures my experience from high school. )

For those of you who have been following my blog, I have already shared some initial thoughts about Doomsday Preppers (who are waiting for when the SHTF).  Rather than wallow in depressive hopelessness, I want to explore the issues in an academic manner.  I think there are some things that aren’t being taken into consideration, like what we may actually face versus what we can prepare for.

The types of disasters, according to the U.S. Federal Government, include: biological, chemical, drought, earthquake, fire, flood, heat, hurricane, nuclear, tornado, tsunami, volcano, wildfires, and winter storm. Most of these appear to be natural disasters, so the scale isn’t necessarily global. Many of these are globally-specific threats, as well. Volcanos are dependent on proximity to tectonic plate borders. Hurricanes and tornadoes are heavily mitigated by mountainous areas, and more likely to roam in flatter topographical areas. Tsunamis are limited to coastal areas; just like flooding will be limited to those near rivers and streams. Flooding, just as wildfires and droughts are fairly cyclical – and occur naturally. Winter storms, as well as heat, are seasonal (and conditional) threats. This leaves us with chemical, biological, and nuclear.

Chemical threats would include mismanagement of the resources we already use. It isn’t necessarily something triggered by terrorists.  Taking illegally dumped chemicals out of the equation for the moment, we have countless chemical plants used in a variety of uses all around us.  We also have industrial chemicals in our environment already. For example, the natural gas industry pumps a liquid, deep into the ground to shatter rock which allows them to collect the gas.  This process called ‘fracking’ already poses a threat to our global environment. The BBC wrote an article to identify what fracking is and the controversies around it, including pumping carcinogenic compounds into our water tables. A USA Today article points out that a Duke University study shows increases radioactive materials in the water table, as a result of fracking. Let’s not forget to mention that there are many other nasty chemicals, according to this New York Times magazine article. My point is that the chemical threats are already here. It won’t necessarily be some external threat.  We have our own home-grown people who may have some ideations to initiate “end times” by sabotaging such places. There are also businesses that have used oils and hydraulic fluids, concentration of heavy metals, acids, and other caustic chemicals on premises. Those chemicals are also just an accident away from exposing us, too.

Nuclear threats are real, too. Again, it is already integrated into our society.  Bad guys don’t have to run to the store to pick-up radioactive material or have it shipped into the country. It is here already.  Yucca Mountain is one such place, but used radioactive material is stored in nearly every state in the United States – as seen here on this Federal Government website.  These are highly secured areas, but are just as subject to accidents – as well as any potential home-grown threats.  The Federal Government has many resources, including this page on potential nuclear fallout from our current nuclear reactors. While the dropping of nuclear bombs on Nagasaki and Hiroshima in the 1940s provided a great deal of data about radiation fallout, sickness, and radii of contamination; there is still a hypothetical element to any potential future radioactive events – which include weather systems, topography, water table, as well as the amount and time that exposure occurs.  All of these factors will shape the intensity of radiation sickness one might experience, which is a public group. Radiation sickness is also documented on Federal Government websites, too. I have a feeling that if a wide-scale nuclear disaster were to occur; a Pinterest-inspired bug out bag and stockpile may not really change the  drastically horrible outcomes that would follow.

Biological threats would not be limited to man-made ones.  We are in the middle of many battles within a wide-range war with microorganisms, as we speak.  MRSA (Methicillin-resistant Staphylococcus aureus) is one such potential threat. VRE (Vancomycin-resistant enterococci) is another. Yet another, newly emerging threat is CRE (Carbapenem-resistant Enterobacteriaceae) explained on a governmental website.  These “superbugs” have developed a resistance to powerful medications, which means that they pose a threat – especially once they become pathogenic. In other words, once these “germs” cause illness – we are in serious trouble.  The same Darwinistic ability to adapt to their environment that humans have is shared with other organisms. Our environment poses a threat to a living organism. Some die. Some survive. Those that do, pass on their ability to survive that threat – or, at least provide some level of protection from that environmental condition. We have created a pattern of make a drug/see resistance appear to it as an on-going cycle. That has brought us to this point. However, I have seen a TED TALK from a molecular biologist named Bonnie Bassler that discusses “quorum sensing” which is how microorganisms chemically “talk” amongst themselves to function. I am not sure where this stands on the experimental process, as the talk was in 2009. It does sound promising.  The bottom line is that this threat is, again, a natural one.  Once again, natural recurrence of microorganistic threats are cyclical – as documented at this Federal Governmental website.  Even with the knowledge of standard precautions to prevent the spread of infection, things could get ugly very quickly – depending on the germ, exposure, and how it is managed.

I would also add that a power grid failure, or collapse of our network that provides power to everyone would be another cause for potentially apocalyptic conditions.  A few years ago, we all experienced large regional outages that cause quite a disruption of our lives.  There was a cascading effect where one site failed, which then led to other sections failing.  The talk was that our power grid is outdated and piecemealed together, and needed serious upgrades. Unfortunately, the “out of sight, out of mind” mentality has kept that issue out of the spotlight.  Have we taken our access to electricity for granted (not granite, people) that we are assuming that it won’t fail? Or that we can pick up the pieces fast enough when it crashes again?  If it were to fail, our whole infrastructure would follow in the collapse.  Our commerce, our businesses, our economy, our ability to communicate, our livelihood, our wealth……everything lost without access, once the power goes out.  Our data on our harddrives, documents, etc. Gone. I would think that our ability to travel would be lost, as well.  Power is needed to pump fuel from the ground, yes? People can’t get around. Goods can’t be moved. And, once again, a few days supply of water/food/stuff may not ultimately help. Somehow, the acronym “SHTF” will likely fall short of what we can expect from such an event. It could be a chain reaction that makes the apocalypse a long, drawn out event. We will be ultimately left to survive off the land, shaped by the catastrophic events that lay before us.

This is shaping my views of doomsday prepping to more of a “embrace the chaos” plan.  I can hope my family will be around each other when such an event occurs. For there, we would have to figure out what our assets and liabilities are.  Not a pleasant thing to consider, but seemingly more real.

Peace out.

 

The Atlantic: We’re Running Out Of Nurses!

nurses1

America’s 3 million nurses make up the largest segment of the health-care workforce in the U.S., and nursing is currently one of the fastest-growing occupations in the country. Despite that growth, demand is outpacing supply. By 2022, The Bureau of Labor Statistics projects, there will be more than a million job openings for nurses, a considerable shortfall. “The magnitude of the 2025 deficit would still be more than twice as large as any nurse shortage experienced since the introduction of Medicare and Medicaid in the mid-1960s,” a team of Vanderbilt University nursing researchers wrote in a 2009 paper on the issue.

The Atlantic: We’re Running Out Of Nurses

The Patriot Nurse: Why Nurses Eat Their Young -(her story)

patriotnurse1

Why Nurses Eat Their Young: My Story

This YouTube video is one woman’s perspective on the culture that allows nurse bullying. She boldly shares the darker side that most nurses, statistically, face in the workplace. There is a lot of truth here. She does describe the ‘trial by fire’ (my words, not hers) that nurses face through our training, orientation at a new job, and after being in the field for awhile. Personally, I agree with a good portion of what she offers to counter this negative dynamic.

Embrace The Chaos

Shift report can be a funny thing. Your patient assignment, even if you have had the group before; can go in many directions. You may have a patient whose vital signs are “circling the drain,” or lab results have just come back all wonky.  Altered mental status, sometimes in the form of ‘sundowners’ can make a quiet evening a noisy/busy one.  There have been shift reports where I felt like that last click on the first hill of a rollercoaster. Butterflies in the stomach. You know it’s going to be a wild ride, but you don’t know where it will go. This is where I came up with the phrase, ’embrace the chaos.’  You fight that new nurse urge to go in the opposite direction of the crisis, and step towards it.  You tap into your spiritual center to remain calm, build upon your desire to help people, then tap into your skill sets and knowledge to work towards saving the patient.

However, those evenings that feel like all the little things spin out of control.  You begin to feel like everything is closing in. Perhaps the feeling of being trapped in a strange medical game show.  I think these are the moments that separate new nurses from experienced ones. As the saying goes, “new nurses run/old nurses don’t.’  Experience nurses work smarter, not faster.  I was able clear my mind, take a deep breath, then attempted to use my best critical thinking skills to determine what I needed to focus on first.  I also found out that all of the rituals I had developed to improve my time management skills, including those during med pass paid off.  Reading this, I feel that I am making smaller events seem larger – which is probably the case. However, I think I had a glimpse into even more intense rapid response/codes in the future.

Not that I have had many of these moments, but I have had a couple. A few cases had to do with hypoglycemia. Another case, a patient I had just collected blood labs on, came back with a 7.2 Potassium level. The free charge was very supportive. There is a set protocol, listing everything to do – include contacting the doctor.  The supplies were organized. The checklist was followed. Luckily, everything turned out well. It was scary, but a manageable, learning moment scary.  I was able to ask questions while things unfolded. Since then, I have also seen other nurses go through crises with their patients.  The sense of teamwork and commitment that my peers and I share reinforce the decision that I made to join this team. Nursing rocks.

Nurseeyeroll: When Your Patient Starts Crying

If they really trust you to do a good job with their loved one, that will put them at ease and support them by taking one big stressor off their plate. I don’t mean all of the technical stuff like getting all of your charting perfect, interpreting lab values, giving all of your meds precisely on time, or consulting with the interdisciplinary team. I mean the more basic stuff. Things like taking extra time to comb their hair, getting their favorite flavor of Jello, or trying to connect with them and make a joke to get them to laugh…that can really mean the world to someone. If they trust that they or their loved ones are safe and cared for in your hands, that itself provides emotional support.

Nurseeyeroll: When Your Patient Starts Crying

Nurses get front row seats to every aspect of patient care, including facing and dealing with the sometimes-tangled arena of emotions.  The post I am sharing offers some good insight into managing those situations.

Troubleshooting IV Pumps: How To Stop (Some) Of The Beeping

pump1

These machine used to frighten me in nursing school.  They have evolved into being an occasional annoyance when they make their beeping sound (or otherwise choose not to work they way they are supposed to). Here are some tips for newer nurses:

1) Don’t overthink things. Make sure the pump is plugged in, and not running on battery power. The pump pictured above will beep when the battery is running low. This can be really easy to check, especially when you set foot in the room at the beginning of the shift.  Before you leave the room, add checking the plug as part of your routine – along with making sure the bed is in the lowest position, bed/clip alarms on and functioning, three rails up, etc.

2) “HIGH PRESSURE” alarms can be somewhat tricky to identify. It can be as simple as making sure that the IV line is not kinked, or tucked under the patient from an earlier bed strip. It can also occur when the IV site is located at a joint, antecubital or wrist.  You can try stopping the pump, adjust the IV tubing, then start it up again. If that doesn’t work, sometimes swapping out the IV pump and/or switching out the IV tubing will work. However, if you are only dealing with small IV infusions; switching out tubing is probably out of the question as you’d waste over 20 mls of medicine with the switch out.

3) “AIR BUBBLE” alarms, which used to terrify nursing students, can be dealt with in several ways. My favorite would be the “guitar strumming” method, where you hold the IV tubing near the pump – then “strum” the line – to work air bubbles away from the pump. You can also consider re-priming the pump, but that could keep you busy for awhile. Remember that “time management” thing?  The bad news is that even microscopic bubbles will set off the alarms.  The good news is that a few tiny air bubbles aren’t likely to harm the patient.  The bad news is that there isn’t a general consensus on what that amount it.Here is a National Institute of Health article on embolisms.  Use your own critical thinking skills to assess your own pumps, please.

4) If all else fails, read the error message on the pump.  I am not familiar with ALL pumps; just the electronic nightmare generating machine pictured above. If you believe there is something wrong with your pump, take it down immediately! Follow your facility’s guidelines for labeling out-of-commission/broken items.  Pumps that aren’t working correctly could mean no medicine is given (bad) or that too much medicine is given too quickly (very, very bad).  Again, use those critical thinking skills for your own situations, please.

5) Ask peers for help. Try to do some troubleshooting on your own, but don’t be afraid to ask others for help.  You are just looking for ideas, not necessarily have them do it for you. Remember what they show you. Thank them for their time. In time, you will develop your own troubleshooting bag of tricks.

Vesicants and Extravasation | Infusion Nurse Blog

Vesicant – an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue.

Extravasation – the inadvertent infiltration of vesicant solution or medication into surrounding tissue

While I have not worked with many IV meds that cause complications when they leak outside of veins, I have worked with a few – like Vanco – that can make infusion complicated.   I found this link interesting enough to share it.

Source: Vesicants and Extravasation | Infusion Nurse Blog