Sunday, September 04, 2005

TAKING CARE OF YOURSELF IF IN NOLA:DANGERS OF FLOOD WATER CONTAMINATION

THIS POST IS ABOUT WATER CONTAMINATION ISSUES FACED BY THOSE IN THE FLOODWATERS OF NOLA, AND THE GULF.
THE FLOOD WATERS OF NEW ORLEANS ARE TOXIC AT THIS TIME, PRECAUTIONS NEED TO BE TAKEN BY THOSE GOING TO RENDER CARE, SUPPORT RESCUE AND RECOVERY, AS WELL AS THOSE REPORTING FROM THE SCENE.THIS TOXIC CESSPOOL IS DANGEROUS, FULL OF CHEMICALS, OILS, DEBRIS, ROTTING GARBAGE, SEWAGE AND ROTTING CORPSES. IT WILL BE MANY WEEKS FOR THE CITY TO BE DRAINED, AND MANY OGANISMS WILL BE BREEDING BY THE HOUR IN THE HEAT. THIS WATER IS NOT JUST DANGEROUS ON THE SKIN CONTACT, IT ALSO CAN MAKE PEOPLE SICK FROM THE FUMES BEING INHALED. AT THIS POINT THE ODORS MIGHT INDICATE HOW TOXIC IT IS. BUT WITH PROTECTION AND PRECAUTIONS ALL CAN PROCEED WITH THEIR WORK AND BE SAFER.
RISKS INCLUDE: HEPATITIS, DYSENTARY, SHIGELLA, KLEBSIELLA, E.COLI, AND TETANUS TO NAME A FEW.
**** After watching CNN live reports today I realized that the many of the workers and reporters could be exposed to a wide array of contaminants, and need better protection. This also includes many of the citizen rescuers that have showed up to help with their watercraft. Other people have said that they want to go to the area to help- but they should be aware of risks. After examining online sites at DHHS, I realized I could compile a fairly complete helplist.It also is good for people to be aware that people that were in these flood zones were exposed to a horrendous amount of contamination, they need to be monitored for symptoms. And they need shelters that now provide the best hygiene possible, and why mass shelter may indeed lead to massive disease out breaks.

PROTECTION:
[1]SHOT UPDATE: Workers and reporters from scene will need to make sure their shots are up to date. This includes Tetanus.
This is critical as there will be a risk of open wounds being exposed to the flood waters. Also it would be advisable to get a full hepatitis series if possible. Meningitis vaccine should aslo be persued. All of these should be advised with consultation of physician.
[2]ESPECIALLY REPORTERS IN AREA NEED BETTER PROTECTION :
PROTECTION KIT:
1) In fanny packs: gloves, face masks, and gloves. While they are reporting, they can remove masks, but while wading through sludge, or even riding around in boats. Some Sewage born illnesses can be airborne. Masks don't have to be Medical supply. Ones can be picked up from Home Depot- heavy duty construction masks are fairly protective, but they need to be changed daily or they get too wet or moist. They do hold germs when wet. They also can help with the odors, and relieve nausea. There is a way to make them also effective against odor control. On inside of mask a drop or two of peppermint oil or lavender oil.
2) Hygiene when in Zone: foam soap. Wipes, the best would be antibacterial Kitchen wipes.
3) Hip waders or dry suit
4) Sturdy Steel Toed Boots ( Walmart or Hardware Store)
5)Bugs/Mosquito control : One of the things that African Relief workers have been using is Oil with Eucalyptus, it repels.
CDC /NIH still examining and encourage DEET, but oil would work better in Wet environment.
6) Good Mobile First Aid Kit. Extra Towels and buy a couple sets of cotton sheets to keep for first aid.
7) Carry extra water, gatorade powder and jello powder in case of heat /vapors related nausea.
8) Extra bottle of Bleach. Bottle of Peroxide- good for water, and wounds.
9) Water purifying tablets- Hiking stores usually have. ( REI in Seattle) Could use in emergency for water to use topically- not drinking water.
10) Salt Tablets to prevent dehydration
11) Carry small bottle of peroxide with you to rinse wounds, and also a tube of antibiotic ointment.

PART II: DYSENTERY:
Unfortunately since we have discussed Risks of Contaminated waters, we may as well talk of Dysentery.
Tonight the first Round appeared from a group that was staying in a Mississippi shelter, and it sounds as if there was no toilet and there was contaminated water coming from a pipe that people had started to use. As of tonight 20 from that shelter are hospitalized.

Dysentery is actually a Disorder first noticed on mass, the troops of WWI had it from living in the trenches- they had no facilities for hygiene and then they also were using the trenches as their latrines. ( Vietnam vets know it as well)

Dysentery starts with cramps of the gut, the intestines because they become imflamed and irritated. If there is an organism involves especially if there is sewage involved it is usually shigella. ( In this situation there could indeed be a mixed bag, including aomeba,and other parasites). After cramping comes the diahreea and the nausea. it will come in waves.

And if not treated it will lead to dehydration. A common mistake is that people will try to Stop the diahrrea- and take OTC med, an opiate product to do that, but this usually makes the cramping worse because then the organism really causes more inflammation of the intestine. If one has cramping and diahreea, chances are this is what it will be this, and not stop with the diarrhea. And the diarrhea will lead to dehydration. Person sick with this will need metronidiazole, sometimes if someone is going in a Critical zone they can be issued this script- and take with them so they have in case they have limited access to medical care.( 400mg 2-3x/d).

In 24-48 hours people can get severely dehydrated and need IV fluids and medication IV, because they can't keep meds donw by mouth. So once it starts it is important to treat right away. Seek medical attention and monitor closely.

If you are working in a zone without a toilet, you can choose to use a container, or bag so that you do not have to squat down on ground. And then dispose of waste elsewhere. It is the proximity to the ground , esp.contaminated ground that contributes to getting this disorder. And again Definently carry the Antibiotic wipes with you.

Even when gut is being treated it still needs rest- a BRAT diet would help , applesauce, bananas, and rice and tea.
While the gut is healing, avoid nuts, acids, and milk products,raw frutis and vegis or anything that would agitate the gut.
Gatorade or even warm jello water will feel good on the gut.


MENINGHITIS
If a person working in the Zone should have symptoms, or fever, they MUST be checked out. Especially if they develope any symptoms such as Headaches, vomiting,dizziness, or stiff neck, light sensitivity. (for these can be indicative of meninghitis- very serious- get care immediately). Sometimes people will think they are just dehydrated, but if they have a sore neck or if they can not touch their chin to their chest they may have a meningeal infection. Now I mention this after the Intestinal Infections because even with treatment Intestinal Infections can spread to other sytems. So if someone is being treated for Intestinal infection and then they complain of any of the neuro symptoms I mentioned they need Hospital Care STAT- because they will need stronger meds and IV meds and IV fluids.

But with these precautions above illness rates can be decreased....hopefully.

****Remember this is a blog by just a grumpy old nurse- I am not a doctor****

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