WHAT'S ALL THIS ABOUT

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• WHAT'S ALL THIS ABOUT
• EMERGENCY PREPAREDNESS?
• Ralph M. Shealy, M.D.
• South Carolina Area Health Education Consortium
• Disaster Preparedness Response Training Network
• Commission on Accreditation of Allied Health
  Education Programs
• Orlando, Florida
• January 26, 2007

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• Funded by a grant from
• Health Resources Services Administration
• U.S. Department of Health and Human Services

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IMAGINE
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Something very bad happens in your community .
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There is a sudden calamity killing many people,

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There is a sudden calamity killing many people,
but injuring many, many more.
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IMAGINE
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Within a span of hours or days, people start
becoming very sick,
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Within a span of hours or days, people start
becoming very sick, and begin to die,
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Within a span of hours or days, people start
becoming very sick, and begin to die, in
increasing numbers.
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IMAGINE
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Medical facilities and personnel are OVERWHELMED.
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TOO MANYCASUALTIES
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TOO MANYREMAIN AT RISK
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TOO MANYWORRIED WELL
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NOT ENOUGHCAREGIVERS!
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DISASTER!
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Natural Disasters

• Weather
• Flood
• Hurricane
• Tornado
• Winter storm
• Geophysical
• Earthquake
• Tsunami
• Volcanic Eruptions

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Man Made Disasters Unintentional

• Structural Collapse
• Transportation Accident
• Hazardous Material Spill
• Industrial Accident
• Explosion

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Man Made DisastersIntentional

• Civil Disturbance
• War
• Terrorism

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Types of Terrorism

• Small Arms
• Explosive
• Incendiary
• Chemical
• Biological
• Radiation

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• Natural
• Weather
• Flood
• Hurricane
• Tornado
• Winter storm
• Geophysical
• Earthquake
• Tidal wave
• Volcanic Eruption
• TAXONOMY of
• CATASTROPHE

• Man-made
• Unintentional
• Structural Collapse
• Transportation Accident
• Hazardous Material Spill
• Industrial Accident
• Explosion
• Intentional
• Crime
• Civil disturbance
• War
• Terrorism
• Small arms
• Explosive
• Incendiary
• Chemical
• Biological
• Radiation

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At some time during your professional career, you
will experience a COMMUNITY HEALTH EMERGENCY!
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Threatens public health safety
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Threatens public health safetyDisrupts
essential services
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Threatens public health safetyDisrupts
essential services May destroy infrastructure
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Threatens public health safetyDisrupts
essential services May destroy infrastructure
Demands extraordinary measures
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Too many patients
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Too many patients coming too fast.
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Too many patients coming too fast.Not
enough clinicians.
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Too many patients coming too fast.Not
enough clinicians.Not enough critical skills.
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Too many patients coming too fast.Not
enough clinicians.Not enough critical
skills.Not enough resources.
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• Every disaster is LOCAL!

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• Every disaster is LOCAL!
• Its OURS for 72 hours!

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• Now IMAGINE
• that your ENTIRE REGION
• is in the same predicament.
• Today, were talking about
• the BIG ONE!

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• On 911, there were massive
• fatalities
• and FEW SURVIVORS.
• Imagine a thousand critical
• BURNS and CRUSH INJURIES!

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• During KATRINA
• there was massive DAMAGE
• but few INJURIES.
• Suppose the CASUALTIES
• had been proportionate
• to the DAMAGE.

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Everyone involved in acute medical care would be
OVERWHELMED. Where would we get HELP!
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• A major disaster in a community disrupts
  everybodys life.
• BUSINESS AS USUAL comes to a stop.

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Will anybody show up for an elective procedure?
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In a large scale disaster, health professionals
who routinely provide elective services will
be idled.
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How do we tap this resource to relieve the
critical shortage of acute care providers in a
health emergency?
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The Message to Allied Health ProfessionalsYOU
are a FRONT-LINE DEFENDER of your communitys
HEALTH and SAFETY!
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• Because YOU can
• step into the breach and help fill the gap!

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• Health professionals
• have much more knowledge
• than is used in daily practice.

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• Health professionals
• have many more skills
• than are used in daily practice.

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• ALL of your abilities will be needed in a
  disaster, because

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• ALL of your abilities will be needed in a
  disaster, because
• EXTRAORDINARY MEASURES are required to resolve
  the crisis.

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• ALL of your abilities will be needed in a
  disaster, because
• EXTRAORDINARY MEASURES are required to resolve
  the crisis.
• SCOPE OF PRACTICE CHANGES
• Health Professionals need to do things that they
  ordinarily dont do.

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• ALL of your abilities will be needed in a
  disaster, because
• EXTRAORDINARY MEASURES are required to resolve
  the crisis.
• SCOPE OF PRACTICE CHANGES
• Health Professionals need to do things that they
  ordinarily dont do.
• STANDARD OF CARE CHANGES because circumstances
  are grossly abnormal.

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• In a community health emergency
• HEALTH PROFESSIONALS
• may have to play
• UNACCUSTOMED ROLES
• in UNFAMILIAR SURROUNDINGS

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• In a community health emergency
• HEALTH PROFESSIONALS
• may have to play
• UNACCUSTOMED ROLES
• in UNFAMILIAR SURROUNDINGS
• BECAUSE THERE IS
• NO ONE ELSE TO DO IT!

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Allied Health Professionals may have to THINK
OUTSIDE THE BOX to meet their responsibility
to the public in a disaster.
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• Health professionals
• often do not see
• how they can serve
• because they dont really know
• whats needed in a disaster.

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• A creative collaboration between
• health professionals
• and disaster experts
• is often needed
• to define an optimum role
• for disaster service.

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• These are things
• I have been trained to do.
• These are things
• that need to be done.

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I can

• Take a medical history
• Give an injection
• Provide patient education
• Lend emotional support
• Identify allergies
• Identify contraindications
• Communicate with relatives

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I can

• Process medical records
• Identify pills
• Suggest alternative drugs for prescription
  refills
• Staff shelters
• Purify water
• Defuse tensions

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EXAMPLES

• Dentists
• Forensics
• Histories
• Allergies
• Contraindications
• Prescriptions
• Injections
• Simkovich

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• Pharmacists
• Manage Strategic National Stockpile
• Mass immunization and treatment clinics
• Recommend alternative script renewals

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• Medics
• Emergency Department Techs
• Hospital Techs
• Mass immunization clinics

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• THERAPEUTIC MASSAGE revitalizes weary rescuers!

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Job Requirements

• REASONABLE INTELLIGENCE
• HIGHLY MOTIVATED
• CAN FOLLOW INSTRUCTIONS
• CAN BE A TEAM PLAYER

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• There will be a CRITICAL need for professional
  volunteers
• during a widespread
• infectious disease OUTBREAK!

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• Health Departments has insufficient staff to
  operate mass clinics
• that would be required to control
• a widespread outbreak
• of dangerous communicable disease.

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• Using protocols and
• backed by public health experts,
• many health professionals possess
• skills required to staff a
• mass immunization clinic or a pharmaceutical
  dispensing center.

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Regardless of where you chose to volunteer, there
are a few things EVERY disaster volunteer needs
to know.
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• Gain an understanding
• of what a large scale disaster
• may be like.

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• Disasters destroy infrastructure.
• Health Professionals
• need to be able to perform
• their critical skills
• WITH MINIMAL DEPENDANCE
• ON TECHNOLOGY.

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• Untrained and unorganized free-lance
  volunteers, regardless of good intentions, create
  avoidable problems during a disaster.

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• DISASTER VOLUNTEERS
• Become EFFECTIVE more quickly
• if they have already SIGNED UP and undergone
  BASIC TRAINING.

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How do I fit in with existing systems for
managing COMMUNITY HEALTH EMERGENCIES?
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You will be a small part of a very large response.
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• Community Health Professionals
• Public Health
• Hospitals
• Emergency Management
• Law Enforcement
• Fire Service
• EMS
• Rescue
• Public Works
• Business and Industry
• Local, State and Federal Government
• Military

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A communitys success in a disaster will depend
on EFFECTIVE RELATIONSHIPS across disciplines and
between jurisdiction.
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A communitys success in a disaster will depend
on EFFECTIVE RELATIONSHIPS across disciplines and
between jurisdiction.These relationships must be
formed IN ADVANCE.
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Somebody will be in charge.
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Somebody will be in charge.It will not be you.
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National Incident Management System

• Common Structure
• Common Language
• Common Organization
• Interchangeability
• Interoperability

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Incident Command System

• Incident Commander or Joint Command
• Operations
• Logistics
• Planning
• Administration and Finance

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Emergency Operations Center

• Every county has a secure site where county
  government, community leaders, and key decision
  makers gather during a crisis to make and
  implement critical decisions when a crisis
  threatens the community.

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Family Plan

• In order to be able to take care of others
  during a crisis, you first need to know that your
  own family is safe and secure

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Family Plan

• Learn what disasters are most likely.
• Consider where each family member might be when
  disaster strikes.

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Family Plan

• Store necessary supplies.
• Decide what each family member should do.
• Anticipate failure of communications.

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Preparing Your Workplace

• How will you secure your offices?
• How will you communicate with staff?
• Make and discuss Practice Disaster Plan with
  staff in advance.

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Preparing Yourself

• Immunizations
• Go Bag
• Medical Kit

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ImmunizationsRequired for deployment by NDMS

• Hepatitis A
• Hepatitis B
• Influenza Annual
• MMR (measles, mumps, rubella)
• Polio (IPV)
• Tetanus-diphtheria (Td) 
• Varicella (chickenpox)
• Pneumococcal polysaccharide (PPV) vaccine
• Small Pox

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California DMAT Personal Equipment List

• http//www.armymars.net/ArmyMARS/EmergencyOps/Res
  ources/DMAT/dmat-ca6-pers-equiplist.pdf

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Laws Governing a Public Health Crisis

• Emergency Health Powers Act
• HIPPA
• OSHA

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Mitigating Personal Risks

• How Am I Protected Against Civil Liability?

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Principles of Triage

• A Different Paradigm for Delivering Care

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Principles of Triage

• Focuses on the welfare of a population, rather
  than the welfare of an individual

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Principles of Triage

• Allocation of resources is prioritized to enhance
  the overall survival of the population

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Principles of Triage

• In a large scale disaster,
• allocation of scarce resources
• among the sick and injured
• may lead to
• profound ethical emotional dilemmas.

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Role in Public Information

• Health Professionals are
• opinion leaders
• who define the situation
• for their neighborsDemonstrate reassurance and
  resolve.

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SUMMARY

• We currently do not have the
• capability to respond to a large scale disaster
  with massive casualties.
• PANDEMIC INFLUENZA?

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SUMMARY

• Allied Health Professionals
• will be desperately needed
• to support
• overwhelmed clinicians.

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SUMMARY

• Some BASIC TRAINING
• is necessary
• to prepare them
• for this role.

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SUMMARY

• Although there may be some variation in
  curriculum
• among the various professions,
• there is a core of information
• that everyone should know.

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QUESTIONS?