In response to the healthcare issues resulting from Hurricane Katrina, The Nurse Practitioner has compiled information from the Centers for Disease Control and Prevention (CDC) to educate nurse practitioners (NPs) about previously uncommon illnesses presenting in the wake of the disaster, CDC recommendations on immunizations and infection prevention, and guidelines for providing proper wound care. Visit http://www.cdc.gov for full text of these articles.


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Guidelines for Advising Travelers to Affected Areas

The response to the hurricane will probably be long-term, so NPs who assess travelers (relief workers) going to areas affected by Hurricane Katrina should be aware of current health risks in those areas and recommended vaccines and other measures to minimize infection or injury.

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Persons traveling to affected areas should ideally be assessed at least 4 to 6 weeks before travel so recommended vaccines can be completed and provide maximum benefit. All travelers with a history of incomplete or lapsed routine "childhood" immunization schedules should be brought up-to-date. A full medical history should be taken to determine fitness for travel. Travelers who are acutely ill, medically or psychologically unstable, or pregnant should postpone travel if possible. In addition, because of the loss of possibly thousands of lives and widespread damage, travelers should be aware that there is a risk for increased emotional stress.


Psychological/Emotional Risks

The traveler should recognize that the situation may be extremely stressful. Keeping an item of comfort nearby, such as a family photograph, favorite music, or religious material, can be helpful.


Risks from Food and Water

Natural disasters contribute to the spread of serious food and water-borne diseases, especially since water supplies and sewage systems have been disrupted. Diarrheal diseases due to bacteria, parasites, or hepatitis A can occur.


An antibiotic for self-treatment of acute diarrhea, such as fluoro-quinolone (Ciprofloxacin) is appropriate. Azithromycin (Zithromax) can be used as an alternative. Travelers should seek medical attention for diarrhea accompanied by a high fever or blood. Additionally, replacement of lost fluids by drinking clean water (bottled or boiled) is the most important means of maintaining wellness.


Other Risks

Leptospirosis may occur in individuals who wade, swim, or bathe in waters contaminated by animal urine. In addition, exposure to animal bites pose a potential risk for rabies and other infections. Individuals who sustain a bite should seek immediate medical attention for both appropriate management of the bite wound and assessment regarding postexposure prophylaxis.


Natural disasters may also lead to air pollution and lung infections may occur after inhalation of sea water. Disasters resulting in massive structural collapse can cause the release of chemical or biologic contaminants (e.g. asbestos or arthrospores leading to fungal infections). Travelers with chronic pulmonary disease may be more susceptible to adverse effects from these exposures.


Emergency Wound Management

The risk for injury during and after a natural disaster is high. Tetanus is a potential health threat for persons who sustain wound injuries. Any wound or rash has the potential to become infected and should be assessed by a healthcare provider as soon as possible.


These principles can assist with wound management and aid in the prevention of amputations. In the wake of a flood disaster, resources are limited. Following these basic wound management steps can help prevent further medical problems.




* Ensure that the scene is safe for you to approach the patient, and that if necessary, it is secured by the proper authorities prior to patient evaluation.


* Observe universal precautions when possible while participating in all aspects of wound care.


* Obtain a focused history from the patient, and perform an appropriate examination to exclude additional injuries.




* Apply direct pressure to any bleeding wound to control hemorrhage. Tourniquets are rarely indicated since they may reduce tissue viability.


* Examine wounds for gross contamination, devitalized tissue, and foreign bodies.


* Remove constricting rings or other jewelry from the injured body part.


* Cleanse the wound periphery with soap and sterile water or available solutions, and provide anesthetics and analgesia whenever possible.


* Irrigate wounds with saline solution using a large bore needle and syringe. If unavailable, bottled water is acceptable.


* Leave contaminated wounds, bites, and punctures open. Wounds that are sutured in an unsterile environment, or are not cleansed, irrigated, and debrided appropriately are at high risk for infection due to contamination. Wounds that are not closed primarily because of high risk of infection should be considered for delayed primary closure by experienced medical staff using sterile techniques.


* Remove devitalized tissue and foreign bodies prior to repair as they may increase the incidence of infection.


* Clip hair close to the wound, if necessary. Shaving hair is not necessary, and may increase the chance of wound infection.


* Cover wounds with dry dressing; deeper wounds may require packing with saline-soaked gauze and subsequent coverage with a dry bulky dressing.


What is Vibrio vulnificus?

Vibrio vulnificus is a bacterium that is a rare cause of illness in the United States. The illness is very different from cholera, which is caused by different bacteria, called Vibrio cholerae. V. vulnificus infections do not spread directly from one person to another and are a serious health threat predominantly to persons with underlying illness, such as liver disease or a compromised immune system. The organism is a natural inhabitant of warm coastal waters. Infection can occur after a wound is exposed to warm coastal waters where the V. vulnifi-cus organism is growing.


Symptoms of Infection with V. vulnificus


* Acute illness, with a rapid decline in health following exposure


* If exposed by contamination of an open wound, increasing swelling, redness, and pain at the site of the wound


* Illness typically begins within 1 to 3 days of exposure, but begins as late as 7 days after exposure for a small percentage of cases


* Fever


* Swelling and redness of skin on arms or legs, with blood-tinged blisters


* Low blood pressure and shock By contrast, the symptoms of cholera are: profuse watery diarrhea, vomiting, cramps, and low-grade fever.