Hospital Disaster Preparedness Training Mid Level Training Based on the Recommended Hospital Staff Core Competencies for Disaster Preparedness 2006
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
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
ICS Requirements 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)
Incident Command 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
ICS Coordination 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
Multiple Emergency Operations Centers (EOC) 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.
Incident Commander and EOC Staff Job Descriptions Provides information to the news media. Functions as contact with other agencies. Organizes and enforces scene/facility protection and traffic security. Recommended: Scribe
Incident Commander (IC) • 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)
Logistics Chief 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
Planning Chief 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
Finance Chief 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
Operations Chief 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
How are duties assigned?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
ICS Review Questions 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
Communication Devices • Phones: cell, satellite, land based • 800 mgHz / MED Radios • Pagers • Overhead paging systems • Dispatcher • Email • HAM Radio
Hospital Issues In Disasters • 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
Casualties may be transported by EMS or personal vehicle to multiple hospitals
Catastrophic / Mass CasualtyTriage & Treatment Procedures • Save the MOST lives possible • Efficient use of human resources, equipment, & supplies • START / JumpSTART Triage (< 30 seconds) What is your role?
Special Populations 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.
The size of thepsychological “footprint”maygreatly exceed the size of themedical “footprint” Psychological vs. Medical “Footprint” psychological “footprint” medical “footprint”
EVIDENCE & Chain of Custody
Evidence Collection & Handling Evidence may be clothing, lab specimens, or embedded objects • Place in most appropriate container • Know Your Hospital Policy & Protocols
Personal Protective Equipment (PPE) 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!
Protective Gear: Respiratory & Skin • 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.
Chemical 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.
Industrial Chemicals Choking Agents Blood Agents Warfare Agents Blister Agents Nerve Agents Chemical Agents
Exposure To Chemicals 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
Reaction to Nerve Agent Nerve Agent Pupils in dim light Pupils in normal light
Biological Agents: Undetectable by human senses + Prolonged incubation period + Limited surveillance capability = Unrecognized exposure
Biothreat Agents Biological agents may be: • Bacteria • Viruses • Toxins They are naturally occurring and / or can be bioengineered as Weapons of Mass Destruction.
Routes of Transmission • Absorption: • Skin and mucus membranes • Inhalation • Respiratory through air droplets • Ingestion • Gastrointestinal through consumption of food or drink • Injection • From needle or other object
Vectors • Letters / packages • Insects / animals • Contaminated food / water • Contaminated clothing • Air via aerosol dissemination device
CDC Category 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])
Bacteria: Anthrax Cutaneous Contact Precautions Gastrointestinal Standard Precautions Inhalational Standard Precautions
Small pox rash is: Face and limbs Chickenpox rash is: Face and trunk Do not be confused:
Smallpox: Infection Control • Highly contagious • Infectious until all scabs are healed over • Contact and airborne isolation precautions • Patient isolation • Lesions in same stage of development