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“Preparing Our Communities”

“Preparing Our Communities”. Welcome!. Faculty Disclosure. For Continuing Medical Education (CME) purposes as required by the American Medical Association (AMA) and other continuing education credit authorizing organizations:

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“Preparing Our Communities”

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  1. “Preparing Our Communities” Welcome!

  2. Faculty Disclosure • For Continuing Medical Education (CME) purposes as required by the American Medical Association (AMA) and other continuing education credit authorizing organizations: • In order to assure the highest quality of CME programming, the AMA requires that faculty disclose any information relating to a conflict of interest or potential conflict of interest prior to the start of an educational activity. • The teaching faculty for the BDLS course offered today have no relationships / affiliations relating to a possible conflict of interest to disclose. Nor will there be any discussion of off label usage during this course.

  3. All Hazards Course Overview and DISASTER Paradigm Chapter 1 Part A

  4. Objectives • Discuss the importance of a nationally standardized disaster education and training program • Describe the National Disaster Life Support (NDLS) courses • Define disaster, Mass CasualtyIncident (MCI) and related terms • Identify the components of the D-I-S-A-S-T-E-R paradigm

  5. Overview & Concept DISASTER Paradigm Triage Natural Disasters Explosive & Traumatic Nuclear & Radiological Biological Agents Chemical Agents Psychosocial Aspects Public Health System / Your local system Examination Course evaluations BDLS Course Outline Replace picture

  6. Disaster Preparedness The Reality of … September 11, 2001 (“9-11”)

  7. Disaster Preparedness The Reality of… September 2005 Hurricanes “Katrina” & “Rita” Photo Source: Phillip L. Coule, MD

  8. NDLS Concept • Critical to healthcare preparedness: • Uniform, coordinated approach to mass casualty management from all-hazards • Seamlessly integrated • Scaleable response • Best accomplished by standardized education and training

  9. NDLS Mission • To implement and maintain a nationwide foundation in education and training resulting in a measurable impact in disaster preparedness to a critical mass of the healthcare workforce Photo Source: Raymond Swienton, MD

  10. NDLS • A comprehensive, nationally-standardized family of all-hazards training programs developed by the NDLS consortium of academic, state, and federal centers. Local Preparedness, Global Response!

  11. DISASTER Paradigm D Detection I Incident Management S Security and Safety A Assess Hazards S Support T Triage / Treatment E Evacuation R Recovery Photo Source: Phil Jones, Medical College of Georgia

  12. NDLS Courses are Practical Photo Source: Phillip L. Coule, MD

  13. Definitions • Disaster • A disaster is present when need exceeds resources • A response need that is greater than the resources available defines a disaster. Disaster = Need > Resources

  14. Definitions • Mass Casualty Incident • A healthcare disaster where the number of casualties is greater than the ability of the healthcare system to care for them Healthcare need > Resources • May result from natural or man-made incident • Requires a clear understanding of your own capabilities and capacities

  15. Definitions • All-Hazards Preparedness • Plans and training for incidents regardless of the cause, man-made or naturally occurring • Man-made • Terrorism, Bioterrorism, Structural collapse, Fires, Explosions etc. • Natural • Hurricanes, Floods, Tornadoes, Emerging Infectious Diseases, etc.

  16. Definitions • Terrorism • An act intended to inflict harm upon a civilian population to coerce or intimidate • Bioterrorism • An act of terrorism using biological agents (e.g. anthrax). • WMD • Weapons of Mass Destruction • WME • Weapons of Mass Effect • CBRNE • Chemical, Biological, Radiological, Nuclear, Explosive

  17. DISASTER Paradigm D Detection I Incident Management S Security A Assess Hazards S Support T Triage / Treatment E Evacuation R Recovery Does your need exceed your resources in any of these areas?

  18. D-I-S-A-S-T-E-R ParadigmDetection • Not all disasters are obvious • Onset of the event may be insidious • Biological event • Important to communicate effectively with public health officials early in event • Awareness that resources are being overwhelmed • Detection of potential cause of the event (e.g. biological vs. Chemical, etc) • Must communicate “Disaster” status to others

  19. D-I-S-A-S-T-E-R Paradigm Incident Management • National Incident Management System (NIMS) • Command and control • Information management • Equipment and training standards • Mandated by Homeland Security Presidential Directive (HSPD #5) • Incident Command is major component of Command and Control • Provides orderly chain of command • Clearly delineated roles / responsibilities • Manageable “span of control”

  20. D-I-S-A-S-T-E-R Paradigm Incident Command System The Basics Unified Command Planning Logistics Operations Finance

  21. Image source: California EMS Authority, Public Domain

  22. D-I-S-A-S-T-E-R Paradigm Incident Management • Hospital Emergency Incident Command System (HICS) • Incident Command System specific for hospitals • Meets JCAHO requirements for disaster management command and control scheme • Clearly defined roles, responsibilities and lines of communication

  23. D-I-S-A-S-T-E-R Paradigm Security and Safety • Secure ingress and egress • Scene • Hospital • Prevent self transport • ~80% will self transport unless provided care on scene • Identify and mitigate obvious threats to Security • Secondary devices? (e.g. second bomb) • Ongoing action by perpetrator? • Power lines, gas leaks, building collapse • Crowd surge

  24. D-I-S-A-S-T-E-R ParadigmAssess Hazards • Priority One • Protect yourself and your team first! • Don’t become part of the problem! • Utilize personal protective equipment • Medical decontamination methods • Your next priorities • Protect the public • Protect the patients • Protect the environment • Avoid tunnel vision on the ill and injured

  25. D-I-S-A-S-T-E-R ParadigmAssess Hazards • Secondary devices / threats? • Second bomb • Sniper etc. • Hazardous Materials? • CBRNE Event? • Personal Protective Equipment • Consider potential future hazards • Shifting winds? Darkness? Crowd surge? • Continual reassessment of the scene

  26. D-I-S-A-S-T-E-R ParadigmSupport • What resources are needed? • Who has them? • Local • Regional • State • Federal • When will they arrive? • Minutes, Hours, or Days Photo Source: Raymond Swienton, MD

  27. D-I-S-A-S-T-E-R ParadigmSupport • Pharmaceuticals • Local Stockpiles (30 min – 1 hr) • Regional Stockpiles (Chempack) (1 – 2 hrs) • Strategic National Stockpile (12 – 48 hrs*) • Equipment • Local Stockpiles / mutual aid (30 min – 1 hr) • Regional Stockpiles (1 – 2 hrs) • Strategic National Stockpile (12 – 48 hrs*) • * SNS will be delivered within 12 hrs after agreement of the order to send it. Photo Source: CDC.gov

  28. D-I-S-A-S-T-E-R ParadigmSupport • Personnel • Clear chain of command defined in plan • Activation communication system • Activate back-up and call in personnel • Plan a realistic mobilization timetable • Mutual aid scene response (30 min – 1 hr) • Off-duty personnel (1 hr – 2 hrs) • Regional or State Teams (4 – 8 hrs) • Medical Reserve Corps (MRC) • Federal Disaster Teams (48 – 72 hrs) • Disaster Medical Assistance Teams (DMAT) Photo Source: DMAT GA-4

  29. D-I-S-A-S-T-E-R ParadigmSupport Unexpected Volunteers and Donations: • Does your preparedness plan include them? • Ability to identify needed skills and needed supplies • Positive intentions • Community reaching out to help others in need • Can have a negative impact • Time to sort large and label goods • Storage space used • Unplanned personnel are a liability • At risk of injuries, require food, water and shelter

  30. D-I-S-A-S-T-E-R ParadigmTriage • Sorting of patients into severity of injury AND likelihood of survival • Consider disposition and available transportation • Several different triage systems currently • Long term vision of one triage system used by all healthcare providers, facilities and agencies

  31. D-I-S-A-S-T-E-R ParadigmTriage • M.A.S.S. Triage System M – Move A – Assess S – Sort S – Send Photo Source: Raymond Swienton, MD

  32. D-I-S-A-S-T-E-R ParadigmTriage Triage Categories • “ID-me”! • A mnemonic for sorting patients during triage I – Immediate D – Delayed M – Minimal E – Expectant D -DEAD

  33. D-I-S-A-S-T-E-R ParadigmTreatment • Treatment continues until: • All patients transported to healthcare areas • Resources unavailable to provide treatment • Comfort is Care! • Treatment locations • Scene, hospitals, secondary treatment areas • Documentation • Patient Identification / Triage Tag • Medical Record

  34. D-I-S-A-S-T-E-R ParadigmEvacuation • Patient evacuation from scene to hospital or treatment area • Consider routes, vehicles, staging areas • Public evacuation of elderly, poor, nursing homes, etc. • Special needs patients • Hospital evacuation during a catastrophic event • Flooding, power outages • Facility contamination • Essential part of your plan! Photo Source: Phillip Coule, MD

  35. D-I-S-A-S-T-E-R Paradigm Recovery • Long-term goal of the event! • Minimize event’s impact • Injured victims, families, rescue personnel • Community, state, and nation • Environment • Preparedness Plan must include • Begins… when the incident occurred • Ends… often years later

  36. D-I-S-A-S-T-E-R Paradigm Recovery • Operational and Logistic considerations: • Personnel: • Fed, hydrated, rested and released ASAP • Many personnel may have been injured • Tendency to down-play importance • Pre-release medical exams • Vehicles: • Clean, disinfect, restock, refuel units • Equipment: • Repair / replace equipment (and evaluate) • Inventory & order supplies (and evaluate)

  37. D-I-S-A-S-T-E-RParadigm Recovery • Psychosocial • Identifying those at risk is challenging • Survivor Guilt • Feelings of helplessness • Haunting images • Sleep disturbance • Substance abuse • Depression / suicide • Facilitate appropriate interventions Photo Source: www.indystar.com, public domain

  38. D-I-S-A-S-T-E-R Paradigm Recovery • Community infrastructure impacted • Basic needs: Food, water, shelter, clothing • Financial: Reestablish businesses • Reestablish local healthcare access • Recognize hospital as critical infrastructure asset in planning • Sharing After Action Reviews (AAR) to improve local, regional, state and federal future planning

  39. Summary Now you can: • Discuss the importance of a nationally standardized disaster education and training program • Describe the National Disaster Life Support (NDLS) courses • Define disaster, Mass CasualtyIncident (MCI) and related terms • Identify the components of the D-I-S-A-S-T-E-R paradigm

  40. Thank You! Questions?

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