GETTING DOCS into the DISASTER PREPAREDNESS LOOP

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GETTING DOCS into theDISASTER
PREPAREDNESS LOOP Joanne Selkurt MD, FAAP
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Introduction

• The Reality
• September 11, 2001
• 9 - 11

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All-Hazards

• Man-made
• Fires
• Explosive devices
• Firearms
• Structural collapse
• Transportation event
• Air, Rail, Roadway, Water
• Industrial HAZMAT
• WMD NBC events
• Etc

• Natural
• Earthquake
• Landslides
• Avalanche
• Volcano
• Tornado
• Hurricanes, floods
• Fires
• Meteors
• Etc

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Are We Prepared?

• Is the US healthcare system prepared?
• We appear to be each Hospital, EMS agency, Law
  enforcement agency, Fire department, and
  Community has
• a disaster plan
• properly documented drills
• annual training documented
• But...

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Are We Prepared?

• KATRINA

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Are We Prepared?

• Interagency communication failures!
• Why do we all treat a cardiac arrest the same?
• because there is an agreed-upon approach.

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Are We Prepared?

• Critical to healthcare preparedness
• uniform
• coordinated approach
• mass casualty management from any cause
• NEED A nationally standardized training program

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Course Description

• BDLS
• Didactic - 8 hours
• Distance learning option
• For healthcare providers
• Physicians, Nurses, Paramedics, EMTs
• Mid-level providers, Allied health, Public health
• Provider status course credit awarded
• Course completion
• Written examination passage
• BDLS providers are eligible to take ADLS

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BDLS Course Outline

• Examination
• Course evaluations

• Overview Concept
• DISASTER Paradigm
• Natural Disasters
• Explosive Traumatic
• Nuclear Radiological
• Biological Agents
• Chemical Agents
• Psychosocial Aspects
• Public Health System

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Course Description

• ADLS
• 16 hour class (8-didactic, 8-practical)
• Advanced practicum hands on course
• Meets Hazmat Operations-level trainingrequirement
  (CFR 1910.120)
• Must have completed
• BDLS course
• Provider status course credit awarded

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ADLS Course Outline

• Day-Two
• Skills Lab hands on
• MASS Triage
• Clinical Scenarios
• Human simulator use
• Disaster Skills
• Personal Protective Equip
• Decontamination

• Day-One
• Classroom Interactive
• DISASTER Paradigm
• Casualty Decontamination
• Legal Issues
• Media Communications
• Community and Hospital Disaster Planning
• Community, State and Federal Resources
• Mass Fatality Management

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What is a Disaster?

• Disaster- disaster n.
• An occurrence causing widespread destruction and
  distress a catastrophe.
• A grave misfortune.
• Informal- A total failure

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Disaster Definition

• A disaster is present when need exceeds resources!

• A response need that is greater than the response
  available!

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Mass Casualty Incident (MCI)

• Is this an MCI ?
• The first step in identifying an MCI is knowing
  your own capabilities.
• Any incident that exceeds the responders or
  receiving hospitals capability to treat or
  transport is a Mass Casualty Incident

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• D-I-S-A-S-T-E-R Paradigm

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• D Detection
• I Incident Command
• S Safety Security
• A Assess Hazards
• S Support
• T Triage Treatment
• E Evacuation
• R Recovery

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D-I-S-A-S-T-E-R Paradigm Incident Command

• Incident Command System (ICS)
• Born in Fire Service
• Managing wildfires in early 1970s
• Interagency task force collaborative effort
• Uniform structure
• Clearly delineated roles/responsibilities
• Clear chain of command/ communication

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Incident Command System

• The Basics

Commander
Unified Command
Planning
Operations
Finance
Logistics
Thinkers
Getters
Doers
Payers
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Incident Command System Operations
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D-I-S-A-S-T-E-R ParadigmAssess Hazards

• Be Aware of Secondary Devices!
• Bombs, Shrapnel devices, Incapacitating Devices,
  Multiple Snipers/Terrorists, Delay Devices

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D-I-S-A-S-T-E-R ParadigmAssess Hazards

• Be Aware of Secondary Devices!
• Bombs, Shrapnel devices, Incapacitating Devices,
  Multiple Snipers/Terrorists, Delay Devices

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D-I-S-A-S-T-E-R ParadigmSupport

• Unexpected Volunteers and Donations
• Positive intentions, often negative impact
• Does your preparedness plan include them?
• ICS, Identify needed skills and needed supplies
• Negatives
• Time to sort large, poorly labeled goods
• Storage space used
• Unplanned personnel are a liability
• At risk of injuries, require food, water and
  shelter

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Volunteers

• Need to Address
• Licensure in state
• Credentialing for specific responder
  organization
• Just-in-Time Training
• Management logistics, supervision,
  transportation, medical other care needs
• Well-Meaning Volunteers Can Overwhelm,
  Interfere, Confuse, Burden Even Endanger
  themselves and others

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• Best if a member of a recognized, organized
  response team that has been invited in
• DONT JUST SHOW UP !!

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M.A.S.S. Triage

• M Move
• A Assess
• S Sort
• S Send
• M.A.S.S. Triage is a disaster triage system that
  utilizes US military triage categories with a
  proven means of handling large numbers of
  casualties in a mass casualty incident (MCI).

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ID-me!

• I Immediate
• D Delayed
• M - Minimal
• E Expectant
• D - DEAD 
• ID-me! - a mnemonic for sorting patients
  during MCI triage. It is utilized effectively in
  the M.A.S.S. Triage model.

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ID-me! - a mnemonic for sorting patients
during MCI triage. It is utilized effectively in
the M.A.S.S. Triage model.

• M Minimal
• D Delayed
• I Immediate
• E Expectant
• D - Dead

• I Immediate
• D Delayed
• M - Minimal
• E Expectant
• D - DEAD 

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Tips for talking to children after a disaster

• Provide opportunities to talk about what they are
  seeing on television and to ask ?
• Dont be afraid to admit you dont know all the
  answers
• Answer ? At a level the child can understand
• Establish a family emergency plan (Sense of doing
  something is helpful)
• Monitor childrens TV watching..dont need to see
  event over over) Watch with children
• Help kids to understand there are no bad emotions
• Try to not focus on blame
• In addition to tragic things seen, also help kids
  focus on good things such as heroic actions,
  reuniting of families, assistance offered by
  people throughout the world

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For children closer to disaster

• Disasters often reawaken a childs fear of loss
  of own parents when parents are preoccupied with
  own fears consider family counseling
• Families may permit some regressive behavior
  weaning off by leaving bedroom door open, night
  lights, extra time with parents
• Parents may have trouble leaving child after a
  disaster,,,may be able to use childs problem as
  a way of asking for help themselves
• Get the children into some sense of routine of
  school and play even if displaced
• Teachers can help kids with art, and play
  activities, encouraging group discussions and
  presentations about the disaster

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For more information on children disasters

• Child Health Alliance of Wisconsin (CHAW)
• www.chawisconsin.org
• Click Programs
• Click Trauma preparedness

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A
A stuffed animal can help a lot