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Hospital Disaster Preparedness Training Mid Level Training Based on the Recommended Hospital Staff Core Competencies for Disaster Preparedness 2006 Hospitals Face Many Types of Disasters, Natural & Man-made Review: Awareness Level RAIN R ecognize the presence of a hazard

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Hospital disaster preparedness training l.jpg

Hospital Disaster Preparedness Training

Mid Level Training Based on the Recommended Hospital Staff Core Competencies for Disaster Preparedness 2006



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Review: Awareness Level

RAIN

  • Recognize the presence of a hazard

  • Avoid contamination through use of protection

  • Isolate hazards by securing the area

  • Notify appropriate higher level persons


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Hospital Communications In Disasters: Incident Command System (ICS)

  • Provides direction in disaster management & recovery tasks

  • Common terminology for communication, command, and control to minimize confusion

    • In the hospital

    • In the community with other health & medical agencies such as public health, EMS, & Law enforcement

  • Allows for resource sharing between hospital, county, state, and federal


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ICS Requirements System (ICS)

JCAHO standard requires an ICS that coordinates with the community

  • “The hospital establishes the following with the community: An All-Hazards command structure within the hospital that links with the community’s command structure.”

  • ICS is part of the National Incident Management System (NIMS)


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Incident Command System (ICS) System (ICS)

  • Defines roles, responsibilities, and reporting channels for everyone involved

  • Each position has a job action sheet

  • Forms for proper documentation of event

  • Allows for flexibility

  • Applicable to varying types and magnitudes of emergency events, i.e. All - Hazards


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ICS Coordination System (ICS)

IS THROUGH THE EMERGENCY OPERATIONS CENTER (EOC)

  • Center for all communications including with outside agencies

  • Provides overall direction for hospital operations during a disaster

    • Authority to activate and deactivate disaster plans

    • Authority to evacuate


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Multiple Emergency Operations Centers (EOC) System (ICS)

Requesting assistance and additional resources

HOSPITAL EOC

COUNTY EOC

STATE EOC

FEDERAL

Requests for assistance from local, state, and federal partners are coordinated through the respective EOCs. Assistance may come from other hospitals, law enforcement, EMS, health department, or emergency management.


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Incident Commander and EOC Staff Job Descriptions System (ICS)

Provides information to the news media.

Functions as contact with other agencies.

Organizes and enforces scene/facility protection and traffic security.

Recommended: Scribe


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Incident Commander (IC) System (ICS)

  • Every incident will have an IC who provides overall direction for hospital operations

  • Organizes and directs EOC

  • Typically the most senior person on duty at the time of the incident (i.e. CEO or Nursing House Supervisor)



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Logistics Chief System (ICS)

Organizes and directs those operations associated with the maintenance of the physical environment, and adequate levels of food, shelter, and supplies to support the medical objectives.

Positions reporting to Logistics Chief

  • Facilities Unit Leader

  • Nutrition Supply Unit Leader

  • Materials Management Unit Leader

  • Transportation Unit Leader

  • Communications Unit Leader


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Planning Chief System (ICS)

Organizes and directs all aspects of planning section by compiling information from all section chiefs and effects long range planning through distribution of facility Action Plan.

Positions reporting to Planning Chief

  • Situation Unit Leader

  • Personnel Pool Leader

  • Medical Staff Unit Leader

  • Nursing Unit Leader

  • Patient Tracking Officer

  • Patient Information Officer


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Finance Chief System (ICS)

Monitors the utilization of financial assets necessary to carry out the hospital’s medical mission by overseeing the acquisition of supplies & services, and supervising the documentation of relevant expenditures.

Positions that report to Finance Chief

  • Time Unit Leader

  • Procurement Unit Leader

  • Claims Unit Leader

  • Cost Unit Leader


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Operations Chief System (ICS)

Organizes and directs the operations section by carrying out directives of the Incident Commander.

Positions that report to Operations Chief

  • All Medical Services

    • In-patient, Out-patient, ED

  • Ancillary Clinical

    • Lab, Radiology, Pharmacy, Cardiology, Respiratory

  • Human Services

    • Dependent care (family & child), staff support, behavioral support


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How are duties assigned? System (ICS)There is a Job Action Sheet for each position

Each of the Chiefs, assigned by the IC, will determine which positions need to be opened.

Depending upon the type of disaster/emergency, not all positions may be necessary.

One person may be able to handle more than one position.

SAMPLE


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ICS Review Questions System (ICS)

1. “All-hazards” approach means you have a different command structure for each type of problem (e.g. mass casualty, hurricane, utility failure, infant kidnapping).

TRUE or FALSE

2. Who is in charge? Name the four section chiefs.

Logistics, Finance, ______, Operations


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Communication Devices System (ICS)

  • Phones: cell, satellite, land based

  • 800 mgHz / MED Radios

  • Pagers

  • Overhead paging systems

  • Dispatcher

  • Email

  • HAM Radio


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Hospital Issues In Disasters System (ICS)

  • Surge of patients

  • High-volume demand for medical attention

  • Patient tracking

  • Competition for scarce medical resources

  • Impact on caregivers

  • Need for psychological support

  • Need for security


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Casualties may be transported System (ICS)

by EMS or personal vehicle to

multiple hospitals


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Catastrophic / Mass Casualty System (ICS)Triage & Treatment Procedures

  • Save the MOST lives possible

  • Efficient use of human resources, equipment, & supplies

  • START / JumpSTART Triage (< 30 seconds)

    What is your role?


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Special Populations System (ICS)

This is an everyday issue for hospitals on a small scale. We need to plan to support large numbers of persons who are hard to reach or have disabilities.


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The size of the System (ICS)psychological “footprint”maygreatly exceed the size of themedical “footprint”

Psychological vs. Medical “Footprint”

psychological

“footprint”

medical

“footprint”


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EVIDENCE System (ICS)

& Chain of Custody


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Evidence Collection & Handling System (ICS)

Evidence may be clothing, lab specimens, or embedded objects

  • Place in most appropriate container

  • Know Your Hospital Policy & Protocols


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Personal Protective Equipment (PPE) System (ICS)

WHAT IS PPE?

  • Protective clothing and/or equipment used in order to protect you from harmful contaminants in environment.

  • Provides a shield between you and contaminant

    • To be effective it must prevent you from being contaminated by airborne or surface agents.

    • Proper use is a must!


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Protective Gear: Respiratory & Skin System (ICS)

  • Level A: (Highest level of protection)

    • SCBA or supplied-air respirator with fully encapsulating chemical protective suit capable of maintaining a positive air pressure within the suit.

  • Level B:

    • SCBA or supplied-air respirator with chemical-resistant clothing. Does not include a positive-pressure suit.

  • Level C:

    • PAPR / APR with chemical resistant suit

  • Level D: (Least protection)

    • Choice of work uniform / coveralls / splash protection with full-face mask, simple face mask or HEPA mask & goggles.



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C System (ICS)hemical

Biological

Radiological

Nuclear

Energetics / Explosives

CBRNE

A Weapon of Mass Destruction is a device or material specifically designed to produce casualties or terror. CBRNE incidents may result from industrial accidents, acts of war, or acts of terrorism.


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Industrial System (ICS)

Chemicals

Choking Agents

Blood Agents

Warfare Agents

Blister Agents

Nerve Agents

Chemical Agents


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Exposure To Chemicals System (ICS)

Routes of exposure

  • Inhalation, skin contact, ingestion, injection

    Effect depends on dose

  • Larger dose: earlier and more severe effects

  • Effects may be immediate or delayed

    Individual susceptibility varies

  • Age, chronic illness, medications


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Industrial Chemicals System (ICS)


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Blister Agent System (ICS)


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Nerve Agent System (ICS)


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Reaction to Nerve Agent System (ICS)

Nerve Agent

Pupils in dim light

Pupils in normal light


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Biological Agents: System (ICS)

Undetectable by human senses +

Prolonged incubation period +

Limited surveillance capability =

Unrecognized exposure


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Biothreat Agents System (ICS)

Biological agents may be:

  • Bacteria

  • Viruses

  • Toxins

    They are naturally occurring and / or can be bioengineered as Weapons of Mass Destruction.


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Routes of Transmission System (ICS)

  • Absorption:

    • Skin and mucus membranes

  • Inhalation

    • Respiratory through air droplets

  • Ingestion

    • Gastrointestinal through consumption of food or drink

  • Injection

    • From needle or other object


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Vectors System (ICS)

  • Letters / packages

  • Insects / animals

  • Contaminated food / water

  • Contaminated clothing

  • Air via aerosol dissemination device


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CDC Category System (ICS)A Agents

  • Anthrax (Bacillus anthracis)

  • Botulism(Clostridium botulinum toxin)

  • Plague (Yersinia pestis)

  • Smallpox (Variola major)

  • Tularemia (Francisella tularensis)

  • Viral Hemorrhagic Fevers(Filoviruses [e.g., Ebola, Marburg] and Arenaviruses [e.g., Lassa, Machupo])


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Bacteria: Anthrax System (ICS)

Cutaneous

Contact Precautions

Gastrointestinal

Standard Precautions

Inhalational

Standard Precautions


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Anthrax System (ICS)



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Tularemia System (ICS)


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Smallpox System (ICS)


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Small pox rash is: System (ICS)

Face and limbs

Chickenpox rash is:

Face and trunk

Do not be confused:


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Smallpox: Infection Control System (ICS)

  • Highly contagious

  • Infectious until all scabs are healed over

  • Contact and airborne isolation precautions

  • Patient isolation

  • Lesions in same

    stage of development



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Ricin System (ICS)


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Botulinum System (ICS)


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Radiation Exposure System (ICS)

  • External – deposited on skin

  • Internal – inhaled, swallowed, absorbed through skin, or introduced through wounds

  • Incorporation of radioactive materials – uptake by body cells, tissues, or organs such as kidney, liver, and bone


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Symptoms of Radiation Exposure System (ICS)

  • Nausea

  • Vomiting

  • Diarrhea

  • Changes in mental status


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  • Alpha System (ICS)

  • Beta

  • Gamma

paper

lead

Self - Protection

TIME

DISTANCE

SHIELDING


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Review Questions: System (ICS)True or False

  • Medical casualties are expected to far exceed psychological casualties in a catastrophic incident.

  • Lab specimens may be considered evidence in a law enforcement investigation and require special handling.

  • When using START methodology, triage in a catastrophic incident will take a minimum of two minutes.

  • Pandemic flu outbreaks are the result of nerve agents.


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Review Questions: System (ICS)True or False

  • Biological threats are naturally occurring and cannot be bioengineered in any way.

  • If wearing protective gear from Level D, the lowest level of protection, it is ok because you can be partially protected from a contaminant.

  • Many of the biological and chemical agents have similar presentation of symptoms and it is important to maintain a high index of suspicion.


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References & Resources System (ICS)

  • Centers for Disease Control

    www.bt.cdc.gov

  • Office of Domestic Preparedness

    www.ojp.usdoj.gov/odp/training.htm

  • National Institute for Occupational Safety www.cdc.gov/niosh/homepage.html

  • Occupational Safety & Health Administration

    www.osha.gov

  • HEICS / HICS

    www.emsa.cahwnet.gov/dms2/heics_main.asp

  • NIMS

    www.fema.gov/nims

  • START & JUMP START Triage

    www.citmt.org/start/background.htm


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