Seequip Disaster 2013 · YOUR SOCIAL LIFE (if you are in Emergency Services) 2/9/13 6 DISASTER ......

2/9/13

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Things I Wish They Told Me About Disasters

Wake Forest Baptist Health

Forsyth County Emergency Services

• 160 Paramedics and EMTs • 800 Firefighters • 16 Ambulances • 22 Fire Departments • 50000 EMS Calls • 5000 Fire / Rescue • 135 Square Miles • 378000 persons


x x

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Wake Forest University

• 7000 Students • 450 Medical Students • School of Medicine



"Things I Wish They Told Me About Disasters"

•  ObjecAves of the talk: At the conclusion of the presentaAon the aGendee will be able to:

•  1) Describe the importance of an "All Hazards" approach to disaster medical response

•  2) Discuss the difference in triage prioriAes between day to day versus disaster events

•  3) Understand that disaster communicaAons is not focused solely on the technology

•  4)List the phases of disaster medical response

Background

•  NDMS •  EMS •  ADMR •  State of NC

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DMAT NC-1 NMRT -E

Disaster Medicine: Frank Caruso

Very Few Experts •  Different types of disasters •  Different Causes

–  Natural •  Flood •  Earthquake •  Tsunami •  Storms •  Ice and Winter •  Pandemic

–  Man Made •  Hazmat •  Terrorism •  Humanitarian Events

–  Can seem overwhelming

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Disaster Response is the Ultimate TEAM SPORT!

All Egos and Attitudes should be checked at the Door!

Lesson #6

A Whole New World!

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DEFINE “DISASTER”

DefiniAon: FEMA

“An emergency that disrupts the normal community function and causes concern for the safety and property and lives of its citizens… but cannot be managed with routine resources and procedures.”

DefiniAon: RealisAc

•  Many people trying to do quickly, what they do not ordinarily do… in an environment with which they are not familiar!

DefiniAon: Truth

YOUR SOCIAL LIFE (if you are in Emergency Services)

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DISASTER

•  A Situation Where Demands Upon the System Are Greater Than the Resources Available.

•  Thus a Disaster Is a Relative Event and Dependent Upon Resources.

•  The Available Resources Directly Impact Upon TRIAGE

•  Disasters Are Dynamic Events.

Disasters Are Different

•  You cannot Handle them by “DOING MORE OF WHAT YOU DO EVERY DAY!”

Guiding Principle

•  GREATEST GOOD for the GREATEST NUMBER….

•  With the least depletion of resources

•  We Must Allocate Resources to where they will do the most good

•  Emphasis on the Community not the Individual

Change in Emphasis

•  Emphasis on the Community not the Individual

•  Sounds a lot like Public Health

Phases of Disaster

•  Planning and Preparation – Mitigation – HVA – Training

•  Event •  Emergency •  Response •  Recovery

Key components in All Disasters

•  Basic Principles •  Command and Control •  Planning •  LogisAcs •  OperaAons •  Records and Finance

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Planning

•  All Hazards – Based on HVA for

Community – Available resources

•  Scalable •  Flexible •  Sustainable •  Realistic •  Tested

Planning

•  Process may be more important than the plan

•  Good Plans – Scalable – Flexible – Adaptable – Sustainable

US Disaster Planning

•  Reactive •  Who determined

policy from the mid 90’s to 2001?

•  Aum Shinrykyo

Disaster Planning •  Based on RealisAc events •  Hazard Vulnerability Analysis

–  Industry – Weather – TransportaAon – Public Events

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What Do You Do NOW!

THIS IS YOUR HOSPITAL

Disasters are LOCAL EVENT

•  It is your town •  Your friends •  Your family •  Your home •  Help will come…. But it may take a while

What Do You Have Available?

•  What Supplies? •  What Personnel? •  How do you get them?

AllocaAon of Resources

•  Challenging •  All have their needs and want it fixed now •  In Medicine we Triage •  Your community may be compeAng with others for the same assets

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Disaster Exercise •  Based on HVA •  RealisAc GOALS

–  SMART ObjecAves •  Afer AcAon Report

– Must have follow through on items found – No Blame – OpportuniAes to Improve

•  Train the Way You Play and Play the Way You Train

•  Not Simply to Meet RegulaAons

The system should be stressed!!

CommunicaAons

•  Always an Issue in Disasters •  Most afer acAon reports point to problems •  We tend to focus on the technology

–  It does fail – But even when it works there can be problems

What is the Purpose of CommunicaAon?

•  Exchange of informaAon •  Do we exchange the right informaAon? •  Is my communicaAon focuses solely on my job?

•  Do I have REDUNDNAT COMMUNICATIONS? •  How do I know messages understood?

Disaster Response is a Team Sport

•  All players have a role •  All must contribute •  One Captain or team leader

–  all must follow the lead – Leaders must encourage discussion

•  Only one person is in charge •  Freelancing is dangerous

Disaster Preparedness is a TEAM SPORT!

•  All players have a role •  All must contribute •  One Captain or team leader

–  all must follow the lead – Leaders must encourage discussion

•  Only one person is in charge •  Freelancing is dangerous

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Building Silos

•  Common pracAce •  Each agency has own plan and objecAves •  DuplicaAon of effort •  Poor coordinaAon •  Wasted resources

Community Planning

•  This is the Typical Model

•  Each Area with its own plan

F I R E

E M S

L A W E N F O R C E

MEDI CAL

Who Is At The Table?

•  EMS •  Fire •  Police •  EM •  Public Health •  Private Practice •  Mental Health

§  HOSPITALS §  Long Term Care §  Home Care §  Special Needs §  Pharmacy §  Private Ambulance

Disaster Plans

•  RealisAc based on Community HVA •  Involve all key stakeholders •  Plan is ALL HAZARD •  Annexes for specific types of events •  CommunicaAons Channels and Lines of Authority Established in Advance

Cooperation is Key

•  No one agency has the assets to manage such events

•  The entire community is impacted •  Opposite of Day to Day Operations •  Must be developed BEFORE the Event

Stages of a Disaster

•  Pre Disaster – Planning and PreparaAon – Most Important – Our Current Phase

•  Impact •  Emergency •  Response •  Recovery

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Disasters are PoliAcal Events

•  PoliAcs can interfere with Planning and Response – Affect Funding and PrioriAes

•  Disasters can make or break a career – Guliani versus Brown

Just Like Politics…

•  All Disasters are: – LOCAL EVENTS – Political Events – Career Ending Events

Disasters and PoliAcs

•  Career Making Events •  Leadership is Needed

•  Decisions May be Unpopular

•  Politics is a Danger to Disaster Response and Planning

Medical Disaster Response

•  Medical types thing this is most important •  Disasters are public health events •  Greatest Good for Greatest Number

– Least depleAon of resources •  Tend to send what we think is necessary

The Belief

Reality !!

Disaster Medical

•  Which has bigger impact on communiAes health? – Disaster Field Hospitals? –  Food, Water and Shelter?

•  Response has to match the needs – Medical Intelligence

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Disaster Medical

•  Not just acute care!!! •  Loss of Medical Infrastructure

– Must be replaced – Babies sAll are born and people sAll have MI

•  Management of Untreated Chronic Diseases in an Austere Environment

Lesson

•  Major Portion of Disaster Medical Response is the Replacement of Community Medical Care disrupted by the Disaster – The same things we do day to day –  In a poorly equipped and unfamiliar

environment

Chronic Diseases

•  Dialysis –  Water Dependent –  May be easier to

move patients than water

•  Home Vent Patients

The Media

•  Friend or Foe? •  Both •  Can get messages out to populaAon – Be accurate – Update Regularly

•  Some media have agenda – They want you to fail… sells more newspapers!

Media

•  One Message from One Source •  ContradicAng messages = CONFUSION

– Distrust •  Work with the Media…. Not against them!

Responders

•  Take care of yourself •  You are not superman •  Rest when off

–  Deal with stressors –  All Families see on TV is destrucAon… where you are

•  It does have an effect on you –  At event –  Afer you return home

•  Have resources to help them

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Spontaneous Volunteers

•  They will show up •  They have no supplies •  They only want to do what they want •  DO NOT IGNORE THEM •  Be prepared to deal with them




$

Special Medical Needs •  Persons with Special Medical Needs include

individuals who require special assistance with medical or personal care during evacuations and sheltering because of physical or mental impairment

–  The level of care goes beyond the “basic first aid” available

in the general shelters, and does not include those who are self-sufficient in their daily personal care needs




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What types of Patients have Special Medical Needs?

•  Elderly –  In Facilities –  In Homes

•  Children with Disabilities •  Other adults with Medical Disabilities

Who will be the Special Medical Needs Shelter Population?

•  Referrals: – Nursing / Rest Homes – Home Care System – Hospital Emergency Rooms

•  DMATS •  EMS •  Police

Anything that has a major affect on the ability of a Special Medical Needs patient

to gain access to services creates a personal DISASTER!

TRIAGE SEQUENCE

•  Begins upon arrival •  Scene assessment •  Type of response •  Personnel and Resources needed •  Notification of Hospitals:

IMPORTANT!

TRIAGE CLASSIFICATION

• Based Upon Severity of Injury and Survivability Given Available Resources.

• Multiple Systems Exist and in Use • Can Become Confusing

Triage Classification - WHO

CLASS CONDITION COLOR STATUS

I Immediate RED Likely to survivew/ immediate

careII Delayed YELLOW Likely to survive

w/simple carewithin hours

III Minimal GREEN Likely to survivew/minor carewithin a day

IV Expectant BLACK Dead or nonsurvivable injuryor require care

exceedingresourcs

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Modifications

• Some Advocate Fifth Class – Between RED and GREEN

• BLUE –  Catastrophic or Expectant –  Treat After Yellow and Before

Green

"IDEAL" Triage System

•  Simple •  Quick •  Similar to Day-to-Day Operations •  Adaptable

Dynamic

•  Just as Disasters are dynamic events •  Triage is a DYNAMIC Process •  Multiple Times •  Criteria can Change!

– Demands – Resources

Primary or Field Triage • Physiologic Status •  Identify Unstable who need

immediate care •  Tendency to Over Triage • Based upon our baseline bias

START /JumpSTART

•  Most Commonly Used •  Not based on Outcomes •  SACCO triage

– Claims evidence based All based upon Primary Survey

Primary Triage

• Physiologic Status • Identify Unstable

• need immediate care •  Tendency to Over Triage

• Based upon our baseline bias

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R

P

M

Secondary Triage •  At casualty collection point

(CCP) •  More detailed evaluation of

injuries •  Treatment area based upon

classification •  Geographically separate •  Transport determined by

injuries and definitive treatment resources

S. A. V. E. Secondary Assessment of Victim End-Point

•  Reassess patient based on S. T. A. R. T. Triage •  Assign patients to areas based on two critical decsions

–  Victim’s prognosis if minimal treatment is provided –  Victim’s prognosis with treatment using resources available at the

[treatment area]?” •  Observation

–  Those that will die •  Periodic reassessment for improvement

–  Those not needing care •  Provide basic care •  Periodic reassessment

•  Treatment area –  Treated in order of severity and resources

NDMS Response Team Training Program

Tertiary Triage

•  Done at receiving hospital •  Treatment areas

– OR – ICU – Ventilators in a Pandemic

•  Limited Formal Guidelines compared to Prehospital

Surge

•  Surge Capacity – Space

•  Surge Capability – Personnel and equipment

•  Most Hospitals today have little of either – Early Discharge?? – Staff availability

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TRIAGE PROBLEMS

•  Less Injured Self Triage to closest facility – Facility MUST have Lockdown

•  All Patients presenting must be in the Triage Scheme

•  Most Disaster Medical Care is PRIMARY CARE!

TRIAGE PROBLEMS

•  Tag Systems –  Hard to Fill In –  Don’t Allow Patient to Change

•  Can Only Get Worse, Not Better –  Personnel Not Used to Using Tags –  Different Systems Use Different Tags

Patient Tracking

•  Very Important component •  Relatives will be looking for family

members •  WHO WENT WHERE? •  You do not want to loose Grandma!!

Your Role and Responsibilities

•  To yourself and your family •  Your practice •  Your patients •  Your facility •  Your Community

Your Family

•  Have a plan •  Stay or Go? •  If you have to evacuate:

–  Supplies: Water and Blankets –  Meds –  Records and Heirlooms (?) –  Care of Pets

•  Assembly Point •  Rally Point

Your Organization

•  Can it stay open? •  Continuity of Operations

(CCOP) Plan – Staff and Supplies – Finances – Facility

•  How to communicate with your Patients?

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Your Patients •  They will look to you for advice •  Special needs children •  Ventilator Dependent •  Evacuation plans and arrangements

–  Longer than you think –  EMS will not be available to do this

•  Supply list to take •  Additional medications and Rx

Your Facility

•  Become active in disaster response and planning

•  Take part in exercises •  Be an advocate for children in the planning •  The hospital’s function in a disaster is not to

care for people. –  It is to stay functioning so that YOU can care for

people

Your Community

•  Take a role in planning and educating •  Consider joining Medical Reserve Corps •  NC Baptist is Sponsor of SMAT 2 Team •  NGO’s and Faith Based Response •  Take the training before you go!

– Not Trained and Not Equipped = PROBLEM

Summary

•  Disasters are complex situations that are dynamic

•  Require planning and teamwork to manage

•  Flexibility and communications are key •  Practice, Practice, Plan and Practice

Thank you

Seequip Disaster 2013 · YOUR SOCIAL LIFE (if you are in Emergency Services) 2/9/13 6 DISASTER ......

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