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PART I: RISKS AND THREATS. Presented to: California Indian Health Centers Presented by: Brian Tisdale April 2007. GOALS. Recognize the risk of a natural disaster, local terrorist event, or public health emergency. Understand why Indian Health Centers need to be prepared.

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PART I: RISKS AND THREATS

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Part i risks and threats

PART I: RISKS AND THREATS

Presented to:

California Indian Health Centers

Presented by:

Brian Tisdale

April 2007


Goals

GOALS

  • Recognize the risk of a natural disaster, local terrorist event, or public health emergency.

  • Understand why Indian Health Centers need to be prepared.

  • Understand the clinics role in a disaster.


Risks

RISKS

  • Agricultural

  • Earthquakes

  • Epidemics

  • Fires

  • Floods

  • Hurricanes

  • Hazardous Materials

  • Infrastructure Failure

  • Mudslides

  • Nuclear

  • Pestilence

  • Riots

  • Terrorism

  • Transportation

  • Tsunamis

  • Volcanoes


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1984

DALLES, OREGON

Bhagwan Shree Rajneesh

751 cases of Salmonella


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1995

Oklahoma City

Alfred E. Murrah building

161 DEAD


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1995

TOKYO SUBWAY

Shoko Asahara

12 Killed

5,500 Affected


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2001

NEW YORK

&

WASHINGTON DC

3000Dead


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2001

ANTHRAX

FLORIDA

WASHINGTON

NEW JERSEY

5 DEAD

22 INFECTED

30,000 placed

on prophylaxis


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2003

SOUTHERN CALIFORNIA FIRES


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2003

San Simeon

Earthquake


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2004

Levee Near Stockton


Tsunamis 2004

Tsunamis2004


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2005

LACONCHITA, CALIFORNIA


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2005

GLENDALE, CALIFORNIA

11 DEAD

180 INJURED


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2005

Red Lake High School

Red Lake Indian Reservation in Minnesota

10 Dead

7 Wounded


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Hurricane Katrina

New Orleans August 2005


Part i risks and threats

So what else can happen?

H5N1


Pandemic influenza

Pandemic Influenza


Why do clinics and medical groups need to be prepared

WHY DO CLINICS AND MEDICAL GROUPS NEED TO BE PREPARED?

  • Disasters are unpredictable and can happen at anytime.

  • First victims could present in a clinic, private practice, or other outpatient setting.

  • In a bioterrorism emergency, physicians and nurses are “first responders.”

  • Rural clinics are the sole provider in their area.

  • Small accident near a rural clinic with a relatively small number of patients could overwhelm that system.


Why do clinics and medical groups need to be prepared1

WHY DO CLINICS AND MEDICAL GROUPS NEED TO BE PREPARED?

  • Small number of patients could overwhelm a smaller facility.

  • The disaster could occur near you and may involve your clinic and staff.

  • Due to the potential numbers affected, clinics and private practices may be needed to augment the county-wide response.


If you thought you had smallpox where would you go for diagnosis or treatment

“If you thought you had smallpox, where would you go for diagnosis or treatment?”

  • 83 percent said they would go to their own doctor or medical clinic.

  • 27 percent said they would go to a public health department clinic.

Source: Harvard School of Public Health/Robert Wood Johnson Foundation Survey; 2,009 surveyed on May 10-21, 2002


How does emergency response fit into health center priorities

How does emergency response fit into health center priorities?

  • All clinics have a basic level of preparedness as required by licensing and accreditation.

  • Advanced preparedness is usually the result of a preparedness champion – physician or staff at clinic or consortia who is passionate about its importance.

  • It would be a bigger priority if benefits in other areas can be seen – e.g., Avian Flu, SARS, natural disasters, disease surveillance, data warehousing.

  • Fits in better if handled centrally with a coordinator and adequate resources that the clinics also benefit from.


What is a reasonable level of preparedness

WHAT IS A REASONABLE LEVEL OF PREPAREDNESS?

  • Develop an “All Hazards” Emergency Preparedness Plan.

  • Provide appropriate patient care.

  • Protect self, staff and other patients.

  • Communicate with local government officials.

  • Prepare for an influx of patients and “worried well.”


Location of indian health centers

LOCATION OF INDIAN HEALTH CENTERS


Rural vs urban

RURAL vs. URBAN


Firestorm 2003

FIRESTORM 2003


Indian health centers response

INDIAN HEALTH CENTERS RESPONSE

  • 3 of 4 San Diego Indian clinics are rural areas.

  • Some clinics were closed for the first week or had limited operations.

  • All rural clinics and their communities were in the path of the fire.

    • Community members evacuated and homes destroyed

    • Staff evacuated and homes destroyed.

  • Limited generator capabilities.

  • Limited or no communications.

  • ***No one reported using their Emergency Plans


Lessons learned from the fires

Lessons Learned from the Fires

  • Clinic patients WILL go to their clinic in an emergency. Be ready for them! Some will show up having lost their homes and possessions. What will you do for them?

  • Pharmaceutical supplies, prescription and over-the-counter, are quickly depleted in an emergency. “I’m out of blood pressure medicine and my pharmacy is closed.”

  • Rural clinics need to be more self-reliant. Basic emergency supplies are of the utmost importance.

  • Many phone calls and visits are related to stress and anxiety. Be ready to meet mental health needs.

  • Refugees and immigrants experience flashbacks to war in their home countries. They will call clinics for information and will not want to leave their homes.


More lessons learned

More lessons learned…

  • Leadership may be impacted by the emergency. Some will not be able to drive to their clinics. Have a backup plan!

  • Power loss will bring clinics to a standstill. Basic generators are needed by all.

  • Keep your cell phone charged (if you have power!) You will need it when the phones go down.

  • When phone lines go down, Internet connections are lost. Only computers with satellite connections will remain in service.

  • A natural relationship occurred between Red Cross and Clinics, in some cases coordinating care and services.

  • Cross-border resources WILL BE used in border region – e.g., firefighters.


Family disaster plan

Family Disaster Plan


Plan ahead

Plan Ahead

  • Preparation for a disaster is essential to maintaining the health and safety of yourself and those around you

  • Develop an emergency preparedness plan with your family

  • Learn what to prepare for


How to start

How to Start

  • Develop a family communication and

    emergency preparedness plan

  • Practice evacuation plans

  • Make a 1-week kit


Family emergency communication plan

Family Emergency Communication Plan

  • Create a support network

    • At least three contacts in an emergency

    • Give contacts all pertinent information (where important documents are, special needs of family members, etc.)

    • Make sure contact information is easily accessible to children


Communicate disaster plan

Communicate Disaster Plan

  • In the event of an emergency be sure:

    • All family members know the best route to evacuate

    • Have a designated meeting places

      • Outside the home

      • Outside the neighborhood or city

    • Be sure all family members know

      the addresses and phone numbers

      of all meeting places


Phone numbers to keep close

Phone Numbers to Keep Close

  • Home

  • Work

  • School

  • Two additional phone numbers out of state (phone lines may be jammed)


72 hour disaster kit following hurricane katrina a 7 day kit is recommended

72 Hour Disaster Kit*Following Hurricane Katrina a 7 day Kit is Recommended

  • Enough basic supplies to last three days

    • Water

    • Food

    • First aid

    • Clothing and bedding

    • Tools and emergency

      supplies

    • Special needs items


Additional supply considerations

Additional Supply Considerations

  • Have extra prescription medications in stock- minimum 2 week supply of all essential medications

  • Extra supplies for assistance devices (hearing aids, wheel chairs, oxygen)

  • First aid supplies


Water

Water

  • Three to seven days supply

    • One gallon of water per person per day

    • Store in plastic containers

    • Hot regions may need more

  • Replace water every 6 months


Part i risks and threats

Three to seven days supply of nonperishable food items

Sealed food products

Canned ready to eat:

No refrigeration

No cooking

Little or no water

Examples: Canned tuna, pork and beans, dried fruit, canned juice, peanut butter

Rotate food out every 6 months

Food


First aid kit home and car

First Aid Kit (Home and Car)


Children s needs

Additional needs

Cash $$$

Prescription medication

Entertainment items: books, games

Special foods/drinks/snacks

DVD players

Etc……………

Children’s Needs


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Pets

  • Extra food and water

  • Pet carriers ready

  • Vaccinations up to date

  • Veterinary contact info

  • medications


Preparing before an event occurs

Preparing Before an Event Occurs

The Key to Success is-


Contact information

CONTACT INFORMATION…

Brian Tisdale, MS

951-440-7495

[email protected]


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