Threats That Face Our Nation and Viable Solutions - Medical Perspective

8/8/2019 Threats That Face Our Nation and Viable Solutions - Medical Perspective

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The Texas A&M University System Health Science Center

Office of Homeland Security

Threats That Face Our Nationand Viable Solutions -

Medical PerspectivePaul K. Carlton, Jr., MD, FACS

Lt. Gen, USAF, Ret

Director, Homeland SecurityThe Texas A&M University System

Health Science Center

12 September 2005


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Overview

Threat

Solutions

Katrina


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Worst Nightmare

Lose whole localhealth care

network!

Katrina


4/421The Texas A&M University System Health Science Center


Disaster Preparedness:Its All About Me!

Three deadly misconceptions:

1. It will not happen here!

2. It will not happen to me!

3. Someone else will be thereto take care of the problem!Jay A Johannigman

Crit Care Med Vol 33, No1




LEARNERS

In a time of drastic change it

is the learners who inheritthe future. The learned

usually find themselvesequipped to live in a world

that no longer exists!Eric Hoffer




LEARNERS

ALL OF US

MUST BELEARNERS!




Dont be learned!




You may obtain a copy of thispresentation at:

www.tamhsc.edu/homeland/




America is inDanger!




Danger Always Present,Just Beneath the Surface




Facing Reality is Difficult

None of us

Want to FaceWhat Lies

Ahead of Us

We Must!


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Change Is Hard

Every revolutionary idea evokes

three stages of reaction

1.Youre nuts!

2.It would work, but no reason tochange!

3.You like it? It was MY idea!


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Response

Chain


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Response Chain

LINKS:

Prevention

MitigationConsequence

Management

Recovery


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Response Chain

All of these have some part of the

response chain-Police

Fire

EMS

Medical


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Weak Link

Medicine maybe theWeakest Link!


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Response Chain

It all comes to life

or death!


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Response Chain

ITS ALL ABOUT PEOPLE

Not about bricks or lumber ina pile, not about concrete

destroyedIt is the dead and injured.

Medical Must BeConsidered


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Weak Link

We could see collapse of ourhealth care system in any bio

event!

Chuck Ludlam, Chief of Staff

Senator Lieberman15 April 05


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Weak Link

We are totally unprepared medically!

We have none of the vaccines norantibiotics that we would need in a bioevent.

Defense Contract model will not work in thissituation.

Chuck Ludlam, Chief of StaffSenator Lieberman

15 April 05


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Weak Link

Medicine is our weak linkand that is where we will

break.Ed Eberhart

CINC NORTHCOMMay 3, 2004


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These people could be wrong

butI doubt it


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Medical Response

95%

Public

PoliceFireEMS

95%

Private

Medical

Capabilities

Why?

Different worlds they do not understand each other

M di l R


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Medical Response

95%Public

PoliceFire

EMS

95%

Private

Medical

Capabilities

Different worlds they do not understand each other

R


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Medical Response

NO OWNED ASSETS

ALL PRIVATE

REQUIRES BETTER COOPERATIONand UNDERSTANDING THAN WEHAVE EVER SEEN!


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Threats

95%Private

MedicalCapabilities

Medicine, aswe know it, isin danger of

failing.

The Current Hospital


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The Current HospitalEnvironment

Key component of consequence management is timely medicalcare for victims of mass casualty incidents

Incorrect assumptions made about existing medicalcapabilities to treat mass casualties

Hospital surge capacity has never been more restricted

Medical community struggling just to

maintain everyday capacity

Majority of preparedness issues arefinancially (revenue vs cost) based

Without prompt action, the nation carries the risk thatvictims of a mass-casualty disaster might end up in ambulancesto nowhere."

Source: Barbera, Macintyre, and DeAtley

Mar 2002

A b l t N h


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Ambulances to Nowhere

Funding shortfalls

Decline in government support for public and privatehospitals

Increasing number of expensive, unfunded, or under-fundedregulatory mandates

Continued expectation that hospitals will maintain high

levels of charity medical care National shortage of nurses for acute

care hospitals, resulting in need for specialcompensation packages to attract personnel

Results -- closure, downsizing, consolidation,reconfiguration, and partnering

Abolition or downsizing of specialty services crucial to

disaster preparedness! Source: Barbera, Macintyre, and DeAtley , Mar 2002

A b l N h


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Delivery of acute medical care evolved beyond ordinary businessrelationship to "trust" with patients

Trust has extended to current threat environment

Move from individual patient to community as a whole

Financial support to hospitals by community create expectationhospitals will address community's health/medical needs, includingdisaster preparedness

Reasonable cost for hospital preparedness for mass casualtieswas assumed to be necessary cost of doing business

Financing costs

Old Medicare and fee for service

New Managed care payment system (capitation)

Bottom line: Disconnect between expectations and funding!

Source: Barbera, Macintyre, and DeAtley , Mar 2002

T bl d M di l S t


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Troubled Medical System

Growing concern over projected shortage of healthcareproviders in coming years

Other factors: aging population, increased demand, andincreased costs

Troubled specialties -- orthopedics, radiology, dermatology,cardiology, ophthalmology and anesthesiology

Bleak future forecast

Shortage of 200,000 doctors,

157,000 pharmacists

20% shortfall in nursing

requirements by 2020

Kiplinger, Mar 05

Quality of life greatest deterrent

A Strained System


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A Strained System

Hospital capacity continues to be main limiting factor in disastermedical response

Critical care services and intensive care units most affected Recent examples

Only 25 ICU beds usable for 27 patients in Madrid bombing

Only 12 ICU beds available for 20 patients in Bali bombing

2001 Houston floods reduced ICU capacity by 75%

More challenges

Toxic chemical scenario: 1200 bed hospital could handle only two

patients at one time Poor staffing levels for critical care areas

Dara, Ashton Farmer, Feb 05

A St i d S t


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A Strained System

Possible surge solutions

Pre-emptive education Increased disaster response awareness,improved skill sets, comprehension of roles and responsibilities,alternate communication styles, and expertise in cooperationduring chaos

Interfacility cooperation Creation of flexibleplans for interchanging resources to supplementexisting capacity of hospitals

Dual usage of resources Critical care

units respond outside geographicallocations; merge training and education


A St i d S t


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A Strained System

Its an unsustainable situation. Withoutsome major fix this system will self-implode.

Ted Epperly, M.D., Board Member

American Academy of

Family Physicians

A Strained System


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A Strained System

These are the facts!

Everyone is entitled to his

opinions. He is notentitled to his own facts!

Senator Daniel Patrick Moynihan, NY

Modular Medical Response Capability:


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A Possible Future

AeromedicalEvacuation

Time

Local Infrastructure BaselineCapability

Emergency RoomOperating RoomsICU BedsInpatient BedsPhysical Space

Local Response

FederalQRP

Regional Center Response

(NG and AHC Medical Center led)

Units ofMedicalCapability

Day toDayPatientCapacity

Modular Medical Response Capability:


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A Possible Future

AeromedicalEvacuation

Time

Local Infrastructure BaselineCapability



Disaster

Occurs!


Local Response

FederalQRP



Tools


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Must have response units to solve problems

Requires Tools in the Toolbox

NO Tools

NO Response


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Means military-civilian cooperation!AndCivilian- civilian cooperation!

5 Ps


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5 Ps

1. Prior

2. Planning

3. Prevents4. Poor

5. Performance


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TEAM

Preparation for the Nation


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Making the Pieces Fit

FirstPreparers

FirstReceivers

FirstResponders

Trauma & Critical Care

Pararescue Course

Trauma & Disaster Course

Mental Health Aspects Course

Public Health Course

Bio-Terrorism Course


Trauma & Dusaster Course

Critical Infectious Diseases Course

Trauma & Critical Care

Pararescue Course


Trauma & Disaster Course


Eye Trauma Course

Critical Care Transport




WE


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All Hazard


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Forward Operation Base Marez

Mosul, Iraq

24 December 04

Forward Operation Base Marez,


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Mosul, Iraq

12:15 pm Explosion in dining facility

Evacuation begins

12:25 pm 12 casualties arrive at

medical facility

Medical Fights OnTo Save Lives

Forward Operation Base Marez,


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Mosul, Iraq

12:25 pm Triage begins

12:40 pm Mortar attack hits hospital

Hospital hard and no casualties

Full speed for 12 hours

11:30 pm Breath

2:00 am CCATTs arrivemedical tune up for flight4:00 am CCATTs fly away 12 patients to Germany

Statistics


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Statistics

9 OR cases

7 Open laparotomies

10 surgeries in hallway8 pts mechanical ventilation

14 chest tubes placed

39 CT scans done

200 plain radiographs

294 lab tests

40 units of blood products

217 IV meds given

91 patients

18 DOA

4 DOW

69 left

20 to other militaryhospitals

49 to treat

Statistics


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Statistics

91 patients

18 DOA

4 DOW

69 left

20 to other militaryhospitals

49 to treat

9 OR cases

7 Open laparotomies

10 surgeries in hallway8 pts mechanical ventilation

14 chest tubes placed

39 CT scans done

200 plain radiographs

294 lab tests

40 units of blood products

217 IV meds given

Good Job Army!

A Busy Day


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y y

Attack by suicide bomber on food tent in Forward Operating BaseMarez created numerous casualties

91 casualties in 11 hours

22 died in attack; 18 were American

17 dead on arrival; 5 with nonsurvivable wounds

A busy day for casualties

Highest number of casualties treated atmilitary hospital in Iraq during war

9 surgeries performed in OR; 10 performed outside OR

Mortuary established in parking lot

NY Times, Dec 04

Standard of Care/


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Sufficiency of Care

Standard ofCare

Sufficientcare

Dem

ands

Care Capability

Standard of Care/Sufficiency of Care


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Standard ofCare

Sufficiency of Care

Sufficientcare

9 operations in OR

7 Open laparotomies

10 surgeriesin hallwaySmooth transition

Dem

ands

Care Capability

The interface of standard ofcare and sufficiency of care


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care and sufficiency of care

??????

GOLD STANDARD

Graceful Degradation

of Care

Plan B OperationsCareSta

ndards

DemandMORAL IMPERATIVEMORAL IMPERATIVE

Lessons learned for U.S. from this


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Triage needs work

Training saves lives

Resource allocation is critical!

Must have graceful degradation ofcare well planned


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care well planned

??????

GOLD STANDARD


of Care

Plan B OperationsCareSta

ndards


A Change in Standards


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g

Popular belief health care organizations/public health agenciesstructured to handle surge

Wrong! Terrorist attack could compromise current system

We must identify, plan, and prepare to make adjustments in currenthealth and medical care standards!

DHS and several key agencies recently met to discuss U.S. abilityto respond to attack

Purpose of meeting:

Examine current standards

Recommend specific actions for Federal,State, regional, community, and health systems planners

Health Systems Research, Aug 05

What to Address?


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Critical questions discussed

What knowledge must planners possess to develop effective

health and medical care response plans to mass casualty event? What key principles guide planning for health/medical response

to mass casualty event?

What issues must be considered/addressedin planning for health and medical care inmass casualty event?

What information, tools, models, and other

resources are available to address plannersneeds?


The Results


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Key findings

Goal of mass casualty response -- maximize number of lives

saved Must change process to allocate scarce resources

Many health systems do not provide adequate planning andguidance to direct change in current standards

Allocating health and medical resources in a mass casualty eventshould be fair and equitable

Protocols for triage based size and nature of event and speed of

development Must have adequate number of staff, equipment, and

pharmaceuticals on hand for any event


What Next?


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Proposed actions

Develop overarching/specific guidance for distributing scarce

health and medical care resources during mass casualty event Develop and implement method to address nonmedical (i.e.,

finance, communication,etc.) issues during event

Develop strategy for risk communication for public

Develop practical tools for medical personnel

Develop strategies for leadership/coordination on-site

Continue/expand response personnel training

Develop Community-Based Planning Guide for Mass CasualtyCare for planners


Mass Casualty Events


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y

Man Made

Natural

?Not Applicable?


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pp

I will never see that number of

casualties

I dont have to worry aboutthese things!

COMMON COMMENTS TO ME!


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ComplaintswithoutSolutions =

Whining


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SOLUTIONSCurrently under way at A&M Health Science Center


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1. Education and Training2. Menu Brief3. Medical Student Education4. Leadership Program for

Disaster Response5. Master Plans6. Plan B7. Triage8. Mobile Solutions9. Surge Hospitals or

Community Health Centers10. Veterinary School SurgeHospital

11. VA Proposal

12. Incentives CarrotCredentials

13. Medical OperationsCenter Proposal

14. NORTHCOM15. Diabetic Retinopathy

Screening16. Isolations Rooms17. Scancorder18. Ventilators

19. Hospital Flow

7 April 05

Texas A&M University System


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Austin, TexasHow to Build a

Surge Hospital for a Song

Austin, TexasAugust 2005

This Plan Protects


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Staff

Patients

Victims of MCIState Capitol

Football Stadium

Requirement by Department ofState Health Services


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112 Bed Surge Facilityin place

St. Davids requirement from

the DSHS as fair share forAustin community

The Red Wedge Concept


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Standard ofCare

Sufficient

care At some point we will goto sufficient care , notstandard of care

Surge from outside sources

Peacetime Surge - within

Soft sided solutions may apply

Plan B

Demand

Care Capability



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??????

GOLD STANDARD


of Care

Plan B Operations

This plan stays within SOC

Double the numbers moves to Sufficient Care

CareStandards


De

Entry


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Decontam

ination

I

D

E

M

1. Control hospital

2. Not allowed into facility until decon isdone

3. Allow time for preparation of day surgery

for mass casualty incident (MCI)4. Allows isolation from rest of facility

5. Central to downtown

Key

Sequence:1. Notification of MCI2. Decon and Triageprepared3. Day surgery empties4. Opens beds for MCI

Photo by: Salvador Monastra-SeBasocSt. Davids Safety Officer

Decont

Flow Pattern in Triage Area


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ontamination

Imme

diate

Minim

al

Expecta

ntDelay

ed

Triage entirelydependent on

resources and loadfrom MCI

Sequence:1. Notification of

MCI2. Decon and Triageprepared3. Day surgeryempties

4. Opens beds forMCI

Day surgery patients go

Whole separate HVAC system protected by Isolate Filter


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ImmediateRX area

straight to centralhospital

ToOR

ICU

Holding

b

eds

Sequence:1. Notification of MCI2. Decon and Triageprepared3. Day surgery empties

4. Opens beds for MCI

Photo by: Salvador Monastra-SeBasocSt. Davids Safety Officer

The Red Wedge Concept


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Standard ofCare

Sufficient

care At some point we will goto sufficient care , notstandard of care

Surge from outside sources

Peacetime Surge - within

Soft sided solutions may apply

Plan B

Demand

Care Capability



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??????

GOLD STANDARD


of Care

Plan B Operations

This plan stays within SOC

Double the numbers moves to Sufficient Care

CareStandards



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The Battle of New Orleans

2005Not January 1815

But

August 2005


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The Battle of New Orleans2005

Medical Perspective


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KATRINA:

A Rain of Terror



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Funding shortfalls

Decline in government support for public and privatehospitals

Increasing number of expensive, unfunded, or under-fundedregulatory mandates

Continued expectation that hospitals will maintain highlevels of charity medical care

National shortage of nurses for acutecare hospitals, resulting in need for specialcompensation packages to attract personnel

Results -- closure, downsizing, consolidation,reconfiguration, and partnering

Abolition or downsizing of specialty services crucial todisaster preparedness!




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Delivery of acute medical care evolved beyond ordinary businessrelationship to "trust" with patients

Trust has extended to current threat environment

Move from individual patient to community as a whole

Financial support to hospitals by community create expectationhospitals will address community's health/medical needs, includingdisaster preparedness

Reasonable cost for hospital preparedness for mass casualtieswas assumed to be necessary cost of doing business

Financing costs

Old Medicare and fee for service New Managed care payment system (capitation)

Bottom line: Disconnect between expectations and funding!


A Strained System


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Possible surge solutions

Pre-emptive education Increased disaster response awareness,

improved skill sets, comprehension of roles and responsibilities,alternate communication styles, and expertise in cooperationduring chaos

Interfacility cooperation Creation of flexible

plans for interchanging resources to supplementexisting capacity of hospitals

Dual usage of resources Critical careunits respond outside geographicallocations; merge training and education


Jim Lehrer Newshour 8 September


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Blame Amid the Tragedyby Bob Williams


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Who is to blame for the inadequate response?

The primary responsibility for dealing withemergencies does not belong to the federal

government. It belongs to local and state officialswho are charged by law with the management ofthe crucial first response to a disaster.

Source: opinionjournal.com7 September 2005



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Hurricane Katrina - New Orleans September 2005

Failure of implementation of established evacuation plan by Gov.

Blanco and Mayor Nagin

Problems that were identified in hurricane simulation in October2004 were not corrected

New Orleans contingency plan that states: the safe evacuation ofthreatened populations is one of the principle reasons fordeveloping a Comprehensive Emergency Management Plan

PLAN WAS APPARENTLY IGNOREDSource: opinionjournal.com

7 September 2005



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The federal government does not

have the authority to intervene in astate emergency without the requestof a governor.

It must be made clear that thegovernor and locally elected officials

are in charge of the first response.Source: opinionjournal.com

7 September 2005

Hurricane Katrina


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Medical Victory Due to:


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Ingenuity Dedication to patient care

Volunteerism

Good planning!

Good


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1. Waiver of Louisiana license

2. Surge

3. Regional and national plan

4. Thinking about this for long term

5. Exercises 2004 and August 2005 levees failed6. Attitude

7. Strike team into Baton Rouge day #18. Member of National Disaster Life Support

(NDLS) consortium so well educated

Bad


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1. Communication

2. Transportation

3. Deaths

4. Complacency to sit through thestorm

5. Lack of execution of evacuationplan

Ugly


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1. Lawlessness

2. Chaos

3. Looting

4. Media

Katrina Timeline


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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7

Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed

The Story Does Not Start Here

Story Begins


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Begin 4 years ago with National Disaster LifeSupport Consortium (NDLSC) first formed

LSU charter member

2001 - 2005 DLS family of courses written and

given to thousands, including LSU and BatonRouge

-medical aspects of disastermanagement and care

Katrina Timeline


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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7


Katrina Timeline - 23-27 August


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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7


23 - 27 Aug tropical storm Katrina strengthens into Hurricane Katrina and hits

Florida. It then weakens and moves to the Gulf of Mexico gathering strength into aCategory 3. New Orleans declares state of emergency with evacuation.

Medical: All patients discharged who can go, Shelters set up, Baton Rouge PeteMaravich Center made into shelter

Katrina Timeline 28 August


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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7


Katrina grows into a Category 5 New Orleans issued mandatory evacuation. 10

shelters are set up



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The Texas A&M University System Health Science CenterOffice of Homeland Security

8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7


Katrina- Category 4 hits Louisiana President Bush makes emergency disasterdeclarations

Medical: No change, levees breakdown had not impacted health care



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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7

Two levees break in New Orleans people began to escape

Medical: New Orleans Hospitals begin to flood, 72 hour backup power startsLa EOC debate about what will happen to the levees and its impact on medical, StrikeTeam from UTSW arrives to augment EOC/MOC




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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7


Announcement death toll in hundreds maybe thousands

Medical: New Orleans Hospital begin to transfer to airport for evacuation, floodingworsens

La EOC options weighed if full evacuation of New Orleans needed

Geography


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Baton Rouge

is only landtransportation

option!

Katrina Timeline 1 September


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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7

Thousands of people without food and water hospitals plead for help

Medical: New Orleans Hospitals continue transfer to airport and out of town, floodingworsening, USAF EMEDS arrives, National Guard begins air evacuation of patients andevacuees.La EOCit is clear levees will not be repaired, full medical evac of New Orleans mustoccur, Surge Hospitals decided upon and orders given to begin




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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7

President Bush tours relief efforts are unacceptable

Medical: New Orleans Hospitals flooded and out of fuel for emergency power,thousands of pts at airport, NG continues evacuation to surrounding statesLa EOC Surge Hospitals building K-Mart 1000 beds, PMac 800 beds, Field House250 beds, Earl K. Long surge in place by 200 bedstotal 2250 extra bedsSufficiency of Care



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Geography


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Baton Rouge

is only landtransportation

option!



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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7

Additional soldiers, marines and National Guard arriveMedical: New Orleans airport1500 litter pts in squalid conditions, Strike Team sent

by LaEOC to clean it out, USAF AE arrives,--2,600 pts and evacuees moved out by airand groundLaEOC/Baton Rouge- Surge Hospitals receive waves of hospital pts and evacuees bybus, PMAC-filled up and 17 vent pts, Field House- special needs, K-Mart-hundreds of ptsand evacuees, Earl K. Long filled up




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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7

Superdome emptied, paramedics begin removing dead, Governor Blanco declares astate of public health emergency

Medical: New Orleans airport empty of pts, Strike Team comes back to LaEOC,AF/EMEDS up and running, USA/FST up and running on airportLaEOC/Baton Rouge Surge Hospitals running full speed, PMAC triaging into stateand surrounding states




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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7


Some are allowed to returned for a short period

Medical: New Orleans some people remain, NG and USA restore order, multipleshoot outs occurLaEOC/Baton Rouge- demand begins to subside, expecting second peak of patients



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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7

New Orleans pumping begins, investigations into Federal response

Medical: New Orleans two hospitals reopen, order restoredLaEOC/Baton Rouge begin to close sufficient care Surge Hospitals, demandabates




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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7


Medical: New Orleans- more hospitals reopen

LaEOC/Baton Rouge K-Mart transfers all pts to other facilities, PMAC and FieldHouse slowFull Federal Response arrives and begins to be effective

Geography


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Baton Rouge

is only landtransportationoption!

Tabletops

2004 l b h d d N O l


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2004 levee breached and New Orleansflooded how to handle

August 2005 New Orleans leveebreached on Mississippi side and New

Orleans flooded, all health care facilitiesare lost!

BATON ROUGE YOU ARE UP!

Facing Reality is Difficult

N f


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None of us

Want to FaceWhat Lies

Ahead of Us

We Must!

Modular Medical Response Capability:A Possible Future

AeromedicalLocal Infrastructure BaselineC


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Evacuation

Time

Capability


Local Response

FederalQRP





Modular Medical Response Capability:A Possible Future

AeromedicalLocal Infrastructure BaselineC bili


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Evacuation

Time

Capability



Disaster

Occurs!


Local Response

FederalQRP



Surge Hospital/ Facility

Definition


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Definition

A facility that can be used to providesufficient medical care when a primarymedical facility is:

-destroyed

-contaminated and thus denied

-overwhelmed

SURGETRATEGIC


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TRATEGICHARED

TILIZATION OF

ESOURSES FOR

EOGRAPHICAL

MERGENCIES

SURGE CONCEPTS


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Surge Hospital/ Facility

Definition


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Definition

A facility that can be used to providesufficient medical care when a primarymedical facility is:

-destroyed

-contaminated and thus denied

-overwhelmed

Hospital Requirements

Space


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Ingenuity

Nice to have

ACPower

Gases

Back up power

Worst Nightmare

Lose whole local


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Lose whole local

health carenetwork!

Katrina

Tabletops

2004 levee breached and New Orleans


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2004 levee breached and New Orleansflooded how to handle

August 2005 New Orleans leveebreached on Mississippi side and New

Orleans flooded, all health care facilitiesare lost!

BATON ROUGE YOU ARE UP!

Baton Rouge Area

Kmart


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Kmart

LSU

EOC

SURGE CONCEPTS


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121/421

Fall 2004 College of Architecture Project

College ofArch fall of Who would


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Arch fall of2004 class

project surge

hospitals

Who wouldbuild a

hospital in asports

facility?

WHOEVERNEEDS TO!

What isheresy one

year is

reality thenext year!




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project surge

hospitals

Who wouldbuild a

hospital in asports

facility?

WHOEVERNEEDS TO!

What isheresy one

year is





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project surge

hospitals

Who wouldbuild a

hospital in asports

facility?

WHOEVERNEEDS TO!

What isheresy one

year is





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project surge

hospitals

Who wouldbuild a

hospital in asports

facility?

WHOEVERNEEDS TO!

What isheresy one

year is



Triage


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Triagecategories

are labeled

This isexactly whathappened inthe PeteMaravich

Center

Baton Rouge Area

Kmart


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a t

LSU

EOC

LSU Campus

Field HouseMaravich Coliseum


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Maravich Coliseum


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SURGE CONCEPTS


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Move out of circleas neededSophisticated

care done in


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Standard

of Care

Move backas quickly

as possible

hospitals

Less sophisticatedcare done in

surge hospitals


Sophisticatedcare done in

h i l

Move out of circleas needed


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Standard

of Care

hospitals


surge hospitals

Move backas quickly

as possible




133/421


??????

GOLD STANDARD

of Care

Plan B OperationsCareS

tandards


Maravich Coliseum

LabPharmacy


134/421


MIC U

Wards

SIC U

DialysisSurgical

Ward

Registration

Peds Isolation

Entrance

Red toYellow level

patients

Maravich Coliseum

LabPharmacy

SIC U


135/421


MIC U

Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to

Yellow levelpatients

Maravich Coliseum

LabPharmacy

MIC USIC U


136/421


MIC U

Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


137/421


MIC U

Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


138/421


MIC U

Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


139/421


MIC U

Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


140/421


MIC U

Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


141/421


Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


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Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


143/421


Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


144/421


Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


145/421


Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


146/421


Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


147/421


Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


148/421


Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


149/421


Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


150/421


Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


151/421


Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


152/421


Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


153/421


Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U


154/421


Wards

Dialysis

SurgicalWard

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U

Di l i


155/421


Wards

DialysisSurgical

Ward

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U

Dialysis


156/421


Wards

DialysisSurgical

Ward

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U

Dialysis


157/421


Wards

DialysisSurgical

Ward

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U

Dialysis


158/421


Wards

DialysisSurgical

Ward

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U

Dialysis


159/421


Wards

DialysisSurgical

Ward

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U

Dialysis


160/421


Wards

ySurgical

Ward

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U

DialysisS i l


161/421


Wards

ySurgical

Ward

Registration

Peds Isolation

Entrance

Red to


Maravich Coliseum

LabPharmacy

MIC USIC U

DialysisSurgical


162/421


WardsSurgical

Ward

Registration

Peds Isolation

Entrance

Red to


Baton Rouge Area

Kmart


163/421


LSU

EOC

SURGE CONCEPTS


164/421


Field House (Special Needs)

Med IPeds


165/421


Entrance

Surgical

Med II

Yellow to Green Level Patients

SURGE CONCEPTS


166/421




Move back


hospitals


167/421


Standard

of Care

as quicklyas possible


surge hospitals



hospitals


Move back


168/421



Standard

of Care


surge hospitals

as quicklyas possible


Graceful Degradationof Care

s


169/421



??????

GOLD STANDARD

Plan B OperationsCareStandard



Med IPeds


170/421



Entrance

Surgical

Med II

Yellow to Green Level Patients


SurgicalMed I

M d II

Peds


171/421



Entrance

Med II

Yellow to Green

Level Patients


SurgicalMed I

M d II

Peds


172/421



Entrance

Med II

Yellow to Green

Level Patients


SurgicalMed I

Med II

Peds


173/421



Entrance

Med II

Yellow to Green

Level Patients


SurgicalMed I

Med II

Peds


174/421



Entrance

Med II

Yellow to Green

Level Patients


175/421


SurgicalMed I

Med II

Peds


176/421



Entrance

Med II

Yellow to Green

Level Patients


SurgicalMed I

Med II

Peds


177/421



Entrance

Med II

Yellow to Green

Level Patients


SurgicalMed I

Med II

Peds


178/421



Entrance

Med II

Yellow to Green

Level Patients


SurgicalMed I

Med II

Peds


179/421



Entrance

Yellow to Green

Level Patients


SurgicalMed I

Med II

Peds


180/421



Entrance

Yellow to Green

Level Patients


SurgicalMed I

Med II

Peds


181/421



Entrance

Yellow to Green

Level Patients


SurgicalMed I

Med II

Peds


182/421



Entrance

Yellow to Green

Level Patients


SurgicalMed I

Med II

Peds


183/421



Entrance

Yellow to Green

Level Patients


SurgicalMed I

Med II

Peds


184/421



Entrance

Yellow to Green

Level Patients


SurgicalMed I

Med II

Peds


185/421



Entrance

Yellow to Green

Level Patients


SurgicalMed I

Med II

Peds


186/421



Entrance

Yellow to Green

Level Patients


SurgicalMed I

Med II

Peds


187/421



Entrance

Yellow to Green

Level Patients

Baton Rouge Area

Kmart

LSU


188/421



LSU

EOC

SURGE CONCEPTS


189/421




Move out of circle

as needed

Move back

as quicklyibl


hospitals



190/421



Standard

of Care

q yas possiblesurge hospitals


191/421


GOLD STANDARD

Graceful Degradationof Care

dards


192/421



??????

GOLD STANDARD

Plan B OperationsCare

Stand


Empty Building (formerly Kmart)

No Power

No AC


193/421



No AC

Filthy

104,992 sq. ft.

Vacant Building Set Up

Storage area

Acute

CareICUMed IMed IIPediatrics

Pediatric

Play area

Bath

rooms

Truck loading

DEC

ON


194/421



PharmacyMentalHealth

Registration

Dining

Area

Nursing

supplies

Dialysis

Dis

charge

OverflowArea

Entry Control Point ToiletsPortable generators & ac

Donated

clothing

Patient/family

sleeping


Storagearea

Mental

Registration

AcuteCare

ICU

Med IMed IIPediatricsPediatricPlay area

Bath

rooms

Dining

Nursingsupplies

Dialysis

D

ischarge

OverflowArea

Truck loading

Donated

Patient/family

sleeping

DECON


195/421



PharmacyMentalHealthArea

Entry Control PointToiletsPortable generators & ac

Donatedclothing


DECON

Storagearea

PharmacyMentalH lth

Registration

AcuteCare

ICU


Bath

rooms

DiningArea

Nursingsupplies

Dialysis

Discharge

OverflowArea

Truck loading

Donated

Patient/family

sleeping


196/421



yHealthArea


clothing


Storagearea


Registration

AcuteCare

ICU


Bath

rooms

DiningArea

Nursingsupplies

Dialysis

Discharge

OverflowArea

Truck loading

Donated

Patient/family

sleeping

DECON


197/421



HealthArea


clothing


Storagearea

PharmacyMental

Registration

AcuteCare

ICU


Bath

rooms

DiningArea

Nursingsupplies

Dialysis

Discharge

OverflowArea

Truck loading

Donated

Patient/family

sleeping

DECON


198/421



PharmacyHealthArea


Donatedclothing


Storagearea

PharmacyMental

Registration

AcuteCare

ICU


Bath

rooms

DiningArea

Nursingsupplies

Dialysis

Discharge

OverflowArea

Truck loading

Donated

Patient/family

sleeping

DECON


199/421



PharmacyHealthArea


clothing


Storagearea


Registration

AcuteCare

ICU


Bath

rooms

DiningArea

Nursingsupplies

Dialysis

Discharge

OverflowArea

Truck loading

Donatedclothing

Patient/family

sleeping

DECON


200/421



Health


clothing

DECON

Storagearea


Registration

AcuteCare

ICU


Bath

rooms

DiningArea

Nursingsupplies

Dialysis

Discharge

OverflowArea

Truck loading

Donated

Patient/family

sleeping



201/421



yHealthArea


clothing


202/421

DECON

Storagearea


Registration

AcuteCare

ICU


Bath

rooms

DiningArea

Nursingsupplies

Dialysis

Discharge

OverflowArea

Truck loading

Donatedclothing

Patient/family

sleeping



203/421




g

DECON

Storagearea


Registration

AcuteCare

ICU


Bath

rooms

DiningArea

Nursingsupplies

Dialysis

Discharge

OverflowArea

Truck loading

Donatedclothing

Patient/family

sleeping



204/421

The Texas A&M U

Threats That Face Our Nation and Viable Solutions - Medical Perspective

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Transcript of Threats That Face Our Nation and Viable Solutions - Medical Perspective