Hospital Disaster Preparedness Training

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Hospital Disaster Preparedness Training

• Mid Level Training Based on the Recommended
  Hospital Staff Core Competencies for Disaster
  Preparedness 2006

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Hospitals Face Many Types of Disasters, Natural
Man-made
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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

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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

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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
  communitys command structure.
• ICS is part of the National Incident Management
  System (NIMS)

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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

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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

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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.
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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
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(No Transcript)
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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)

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Incident Command Structure
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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

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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

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Finance Chief

• Monitors the utilization of financial assets
  necessary to carry out the hospitals 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

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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

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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
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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

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Communication Devices

• Phones cell, satellite, land based
• 800 mgHz / MED Radios
• Pagers
• Overhead paging systems
• Dispatcher
• Email
• HAM Radio

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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

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Casualties may be transported by EMS or personal
vehicle to multiple hospitals
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Catastrophic / Mass CasualtyTriage Treatment
Procedures

• Save the MOST lives possible
• Efficient use of human resources, equipment,
  supplies
• START / JumpSTART Triage (lt 30 seconds)
• What is your role?

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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.

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Psychological vs. Medical Footprint
psychological footprint

• The size of the psychological footprint may
  greatly exceed the size of the medical
  footprint

medical footprint
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EVIDENCE
Chain of Custody
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Evidence Collection Handling

• Evidence may be clothing, lab specimens, or
  embedded objects
• Place in most appropriate container
• Know Your Hospital Policy Protocols

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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!

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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.

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Precautions Infection Control
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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.
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Chemical Agents

• Industrial
• Chemicals
• Choking Agents
• Blood Agents

• Warfare Agents
• Blister Agents
• Nerve Agents

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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

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Industrial Chemicals
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Blister Agent
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Nerve Agent
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Reaction to Nerve Agent
Nerve Agent
Pupils in dim light
Pupils in normal light
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Biological Agents

• Undetectable by human senses
• Prolonged incubation period
• Limited surveillance capability
  
• Unrecognized exposure

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Biothreat Agents

• Biological agents may be
• Bacteria
• Viruses
• Toxins
• They are naturally occurring and / or can be
  bioengineered as Weapons of Mass Destruction.

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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

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Vectors

• Letters / packages
• Insects / animals
• Contaminated food / water
• Contaminated clothing
• Air via aerosol dissemination device

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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)

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Bacteria Anthrax
Cutaneous Contact Precautions
Gastrointestinal Standard Precautions
Inhalational Standard Precautions
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Anthrax
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Plague Pneumonic Bubonic
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Tularemia
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Smallpox
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Do not be confused

• Chickenpox rash is
• Face and trunk

• Small pox rash is
• Face and limbs

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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

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Viral Hemorrhagic Fevers
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Ricin
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Botulinum
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Radiation Exposure

• External deposited on skin
• Internal inhaled, swallowed, absorbed through
  skin, or introduced through wounds
• Incorporation of radioactive materials uptake
  by body cells, tissues, or organs such as kidney,
  liver, and bone

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Symptoms of Radiation Exposure

• Nausea
• Vomiting
• Diarrhea
• Changes in mental status

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Self - Protection
TIME
DISTANCE
SHIELDING
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Review Questions True or False

• Medical casualties are expected to far exceed
  psychological casualties in a catastrophic
  incident.
• Lab specimens may be considered evidence in a law
  enforcement investigation and require special
  handling.
• When using START methodology, triage in a
  catastrophic incident will take a minimum of two
  minutes.
• Pandemic flu outbreaks are the result of nerve
  agents.

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Review QuestionsTrue or False

• Biological threats are naturally occurring and
  cannot be bioengineered in any way.
• If wearing protective gear from Level D, the
  lowest level of protection, it is ok because you
  can be partially protected from a contaminant.
• Many of the biological and chemical agents have
  similar presentation of symptoms and it is
  important to maintain a high index of suspicion.

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References Resources

• Centers for Disease Control
• www.bt.cdc.gov
• Office of Domestic Preparedness
• www.ojp.usdoj.gov/odp/training.htm
• National Institute for Occupational Safety
  www.cdc.gov/niosh/homepage.html
• Occupational Safety Health Administration
• www.osha.gov
• HEICS / HICS
• www.emsa.cahwnet.gov/dms2/heics_main.asp
• NIMS
• www.fema.gov/nims
• START JUMP START Triage
• www.citmt.org/start/background.htm