Presentation is loading. Please wait.

Presentation is loading. Please wait.

1 Our Healthcare Facilities at Risk! Closing the Gaps in Critical Preparedness Areas.

Similar presentations


Presentation on theme: "1 Our Healthcare Facilities at Risk! Closing the Gaps in Critical Preparedness Areas."— Presentation transcript:

1 1 Our Healthcare Facilities at Risk! Closing the Gaps in Critical Preparedness Areas

2 2 Working Together to Achieve Healthcare Preparedness Identifying critical gaps in PHE preparedness is an important area of focus.

3 3 Texas Motor Speedway Exercise Scenario: Aircraft explodes on race day Aircraft explodes on race day Result: > 10,000 victims Result: > 10,000 victims Included a dirty bomb Included a dirty bomb Stakeholders & Resources: All area Public Health departments All area Public Health departments Over 40 State and federal agencies Over 40 State and federal agencies Over 2,300 victim volunteers Over 2,300 victim volunteers Over 300 First Responders Over 300 First Responders 30 area hospitals participated 30 area hospitals participated

4 4 Texas Motor Speedway Exercise, November 2004 Three critical gaps identified: Casualty / Patient Triage Casualty / Patient Triage Medical Decontamination (Med Decon) Medical Decontamination (Med Decon) Personal Protective Equipment (PPE) Personal Protective Equipment (PPE)

5 5 Consequences of Non-preparedness Healthcare facilities closed Healthcare facilities closed Morbidity / mortality for healthcare providers Morbidity / mortality for healthcare providers Morbidity / mortality for our patients Morbidity / mortality for our patients

6 6 Working Together to Achieve Healthcare Preparedness Tarrant County APC established a collaborative agreement with nationally and regionally recognized leading stakeholders to meet the educational and training needs of the critical gaps identified.

7 7 NDLS Family of Courses A comprehensive, nationally-standardized family of all-hazards training programs developed by the NDLS consortium of academic, state, and federal centers.

8 8 Establishing a Standard

9 9 Academic Stakeholders NDLS Co-founders NDLS Co-founders Subject matter experts Subject matter experts AMA NDLS Text Editors AMA NDLS Text Editors Experienced in statewide and national educational program distribution Experienced in statewide and national educational program distribution

10 10 Texas State Guard unit Texas State Guard unit Uniformed MRC Uniformed MRC Mobilized by Governor Mobilized by Governor Subject matter experts Subject matter experts Experienced regional faculty Experienced regional faculty MRC Regional Stakeholders

11 11 NDLS-Decon 2 day, 16-contact hours 2 day, 16-contact hours Meets OSHA awareness and Meets OSHA awareness and operational training levels CDLS course, 4 hours CDLS course, 4 hours NDLS-Decon, 12 hours NDLS-Decon, 12 hours Includes 8 hours of Includes 8 hours of interactive-skills session

12 12 Establishing a Standard Recent course addition to the NDLS Family Recent course addition to the NDLS Family Internal validity assessment Internal validity assessment Beta-tested statewide in Georgia Beta-tested statewide in Georgia Currently in 2 nd year of distribution Currently in 2 nd year of distribution External validity assessment…Texas roll-out External validity assessment…Texas roll-out Tarrant Co. APC, first to offer in Texas Tarrant Co. APC, first to offer in Texas APC in collaboration with stakeholders are establishing a national standard APC in collaboration with stakeholders are establishing a national standard

13 RES ® 13 Preparing Our Communities Welcome!

14 14 Continuing Medical Education CME Faculty Disclosure In order to assure the highest quality of CME programming, the AMA requires that faculty disclose any information relating to a conflict of interest or potential conflict of interest prior to the start of an educational activity.In order to assure the highest quality of CME programming, the AMA requires that faculty disclose any information relating to a conflict of interest or potential conflict of interest prior to the start of an educational activity. The teaching faculty for the BDLS course offered today have no relationships / affiliations relating to a possible conflict of interest to disclose. Nor will there be any discussion of off label usage during this course.The teaching faculty for the BDLS course offered today have no relationships / affiliations relating to a possible conflict of interest to disclose. Nor will there be any discussion of off label usage during this course.

15 15 D-I-S-A-S-T-E-R Overview Overview

16 16 Objectives Identify the critical need to establish healthcare preparedness for disastersIdentify the critical need to establish healthcare preparedness for disasters Define disaster and Mass Casualty Incident (MCI)Define disaster and Mass Casualty Incident (MCI) Define All-hazards and list possibilitiesDefine All-hazards and list possibilities Identify the components of the D-I-S-A-S-T-E-R paradigmIdentify the components of the D-I-S-A-S-T-E-R paradigm Identify and apply a mass casualty triage model utilizing M.A.S.S. and ID-meIdentify and apply a mass casualty triage model utilizing M.A.S.S. and ID-me

17 17 What is a Disaster? Disaster- dis·as·ter n.Disaster- dis·as·ter n. a.An occurrence causing widespread destruction and distress; a catastrophe. b.A grave misfortune. c.Informal- A total failure

18 18 What is a Disaster? From another perspective… JCAHO: Something that disrupts the environment of care; disrupts care and treatment; changes or increases demand.JCAHO: Something that disrupts the environment of care; disrupts care and treatment; changes or increases demand.

19 19 A disaster is present when need exceeds resources In other words: the response need exceeds the resources available Disaster Definition Disaster = Need > Resources

20 20 Multiple/Mass/Major Casualty Incident An MCI is present when healthcare need exceeds available healthcare resources! MCI Definition MCI = Healthcare Need > Resources

21 21 MCI Management Goal: Do the greatest good for the greatest number of potential survivors! This is an important concept!

22 22 Are We Prepared? The Concern: Increased likelihood of weapons of mass destruction (WMD) noted for yearsIncreased likelihood of weapons of mass destruction (WMD) noted for years Worldwide arsenal of nuclear, biological and chemical (NBC) agents:Worldwide arsenal of nuclear, biological and chemical (NBC) agents: –Security, Political, Socioeconomic changes The threat to intentionally harm large civilian populations has never been greater than today!The threat to intentionally harm large civilian populations has never been greater than today!

23 23Terrorism The Reality: September 11,

24 24 Terrorism Use of force against persons or property:Use of force against persons or property: To intimidate or coerceTo intimidate or coerce To further political or social objectivesTo further political or social objectives Criminal actCriminal act

25 25 WMD / WME Weapons or devices that injure or kill large numbers Cause widespread destruction and/or panic Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) Weapons of Mass Destruction / Effect Definition

26 26 Man-made poisons spread as gases, liquids, or aerosols Cause illness or death in humans, animals, plants May be inhaled, ingested or absorbed Variety of disseminating devicesVariety of disseminating devices Chemical Weapons

27 27 Chemical Weapons Nerve agents: GA, GB, GD, VXNerve agents: GA, GB, GD, VX Blood agents: CyanideBlood agents: Cyanide Blister agents: Mustard, LewisiteBlister agents: Mustard, Lewisite Choking agents: Phosgene, ChlorineChoking agents: Phosgene, Chlorine Incapacitating agents: BZIncapacitating agents: BZ

28 28 Chemical Weapons Aum Shinrikyo Sarin Gas Release June 27, 1994March 20, 1995 Matsumoto, Japan Tokyo, Japan Courthouse/ResidenceSubway 4 dead12 dead 150 injured >5000 arrived at hospital AumShinrikyo

29 29 Catastrophic explosions Massive nuclear energy release through atom splitting Traumatic injuries, burns, fallout, delayed effects Nuclear Weapons

30 30 Devices to disperse radioactive substances Conventional explosive device (dirty bomb) Intentional radiation release: water, food, terrain Less energy & radiation release than a nuclear weapon Delayed detection: no scene Worried well & civilian panic Radiological Weapons

31 31 Aircraft as WMD September 11, 2001 World Trade Center Towers, NYCWorld Trade Center Towers, NYC Pentagon, Washington, DCPentagon, Washington, DC Somerset, PASomerset, PA

32 32 Are you the victim of a weapon of mass effect (WME)?

33 33 Anthrax as WME Asymmetric warfare:Asymmetric warfare: Small eventSmall event Widespread effectWidespread effect

34 34 Disseminate disease-causing microorganisms or biologically-produced toxins (poisons)Disseminate disease-causing microorganisms or biologically-produced toxins (poisons) Cause illness or death in humans, animals, or plantsCause illness or death in humans, animals, or plants Numerous agents could be usedNumerous agents could be used Biological Weapons

35 35 Biological Weapons Biological Weapons Smallpox Plague Anthrax

36 36 Biological Event Influenza

37 37 Epidemics Severe Acute Respiratory Syndrome 2003 SARS (Corona virus)

38 38 Natural Events The Reality: September 2005 Katrina Katrina&Rita

39 39 Natural Disasters The Concern: Numerous & widespreadNumerous & widespread Millions of fatalities worldwideMillions of fatalities worldwide Countless millions more injuredCountless millions more injured $ Billions per event$ Billions per event Common in the U.S.Common in the U.S. There WILL be a natural disaster in the U.S. this yearThere WILL be a natural disaster in the U.S. this year

40 40Katrina

41 41Rita

42 42 What causes the greatest number of fatalities in the U.S. from natural disasters?

43 43 Flash Floods Cause the greatest number of U.S. fatalities from natural disasters!Cause the greatest number of U.S. fatalities from natural disasters! Most deaths involve motor vehiclesMost deaths involve motor vehicles

44 44 Transportation Incidents More than 6 million per year in U.S. More than 6 million per year in U.S. More than 40,000 traffic fatalities More than 40,000 traffic fatalities Secondary hazards Secondary hazards Fire, explosion, chemical, radioactive Fire, explosion, chemical, radioactive All modes: All modes: Highway Highway Air Air Rail Rail Marine Marine

45 45 Industrial Hazmat Mostly minor spills, occasionally severe!Mostly minor spills, occasionally severe! Massive explosionsMassive explosions Hazardous materials releaseHazardous materials release Toxic fumes, radiation, biological agentsToxic fumes, radiation, biological agents Secondary disastersSecondary disasters Multiple casualtiesMultiple casualties Prolonged community impactProlonged community impact Loss of homes & jobsLoss of homes & jobs Emotional impactEmotional impact

46 46All-HazardsMan-made FiresFires Explosive devicesExplosive devices FirearmsFirearms Structural collapseStructural collapse Transportation eventTransportation event –Air, Rail, Roadway, Water Industrial HAZMATIndustrial HAZMAT WMD – NBC eventsWMD – NBC events Etc…Etc…Natural EarthquakeEarthquake LandslidesLandslides AvalancheAvalanche VolcanoVolcano TornadoTornado Hurricanes, floodsHurricanes, floods FiresFires MeteorsMeteors Etc…Etc…

47 47 All-Hazards Definition All-Hazards: Man-made or natural events with the destructive capability of causing multiple casualties All-Hazards Preparedness: Comprehensive preparedness required to manage the casualties resulting from All- Hazards

48 48 NDLS Concept Critical to healthcare preparedness:Critical to healthcare preparedness: UniformUniform Coordinated approachCoordinated approach Mass casualty management from all-hazardsMass casualty management from all-hazards Best accomplished by standardized training and practice guidelinesBest accomplished by standardized training and practice guidelines

49 49 NDLS Family of Courses A comprehensive, nationally-standardized family of all-hazards training programs developed by the NDLS consortium of academic, state, and federal centers.

50 50Stakeholders Research Triangle Institute CDP

51 51 Confidence and Teamwork!

52 52 D-I-S-A-S-T-E-R Paradigm

53 53 DISASTER Paradigm DetectionDetection Incident CommandIncident Command Safety & SecuritySafety & Security Assess HazardsAssess Hazards SupportSupport Triage & TreatmentTriage & Treatment EvacuationEvacuation RecoveryRecovery Natural & AccidentalNatural & Accidental Trauma & ExplosiveTrauma & Explosive Nuclear & RadiologicalNuclear & Radiological Biological AgentsBiological Agents Chemical AgentsChemical Agents

54 54 D-I-S-A-S-T-E-R Paradigm A standardized method to recognize and manage the scene and care for victimsA standardized method to recognize and manage the scene and care for victims Reinforced throughout all NDLS courses:Reinforced throughout all NDLS courses: A training tool…A training tool… Practical approach on scene! An organizational tool…An organizational tool… Utilize resources, assess needs A series of questions…A series of questions…

55 55 D-I-S-A-S-T-E-R Paradigm Do I detect something, what caused this?

56 56 D-I-S-A-S-T-E-R Paradigm Do we need an incident command, where?

57 57 D-I-S-A-S-T-E-R Paradigm Is a safety or security issue present?

58 58 D-I-S-A-S-T-E-R Paradigm Did we assess the hazards that could be here?

59 59 D-I-S-A-S-T-E-R Paradigm What support, people, supplies are needed?

60 60 D-I-S-A-S-T-E-R Paradigm Do we need to triage, how much treatment?

61 61 D-I-S-A-S-T-E-R Paradigm Can we evacuate/transport the victims?

62 62 D-I-S-A-S-T-E-R Paradigm What recovery issues are present?

63 63 D-I-S-A-S-T-E-R Paradigm Is my need greater than my resources? KEY!

64 64 D-I-S-A-S-T-E-R Paradigm Detection Goal assess: Is a disaster / MCI present?Is a disaster / MCI present?...Need > Resource? What caused this event?What caused this event? Detection is Awareness! TRAP! tunnel-vision on the injured patientstunnel-vision on the injured patients

65 65 D-I-S-A-S-T-E-R Paradigm Detection Sample Checklist: Are my capabilities or capacity exceeded?Are my capabilities or capacity exceeded? Does my need exceed available resources?Does my need exceed available resources? Before you step out of the vehicle, look around.Before you step out of the vehicle, look around. If a threat or agent is suspected, what is it?If a threat or agent is suspected, what is it? What do you see, smell or hear that is different?What do you see, smell or hear that is different? What are bystanders saying or doing?What are bystanders saying or doing? Is everyone coughing, crying, staggering or lying still?Is everyone coughing, crying, staggering or lying still?

66 66 D-I-S-A-S-T-E-R Paradigm Incident Command Incident Command System (ICS) Born in Fire ServiceBorn in Fire Service –Managing wildfires in early 1970s –Interagency task force collaborative effort Uniform structureUniform structure Clearly defined roles & chain of commandClearly defined roles & chain of command Allows for a scalable responseAllows for a scalable response Unified CommandUnified Command

67 67 Incident Command System The Basics Unified Command PlanningOperationsFinanceLogistics Commander ThinkersGettersDoersPayers

68 68 Incident Command System What does the Incident Command need to know?What does the Incident Command need to know? –Number and type of casualties –Substances involved –Estimated time of arrival to hospital –Time / location of the incident –Method of contamination (vapor or liquid) –Necessary decontamination –Updated information

69 69 Incident Command System The Basics Unified Command PlanningOperationsFinanceLogistics Commander ThinkersGettersDoersPayers

70 70 Incident Command System The Basics Unified Command PlanningOperationsFinanceLogistics Commander ThinkersGettersDoersPayers

71 71 Incident Command System The Basics Unified Command PlanningOperationsFinanceLogistics Commander ThinkersGettersDoersPayers

72 72 Incident Command System Operations

73 73 D-I-S-A-S-T-E-R Paradigm Incident Command Operations personnel and resources Medical Control– Responsibilities:Medical Control– Responsibilities: –On-scene Medical Direction –Difficult triage decisions –Emergent surgical procedures –Advanced level treatment when necessary –Assist Transportation Officer in decision making –Assist Operations Officer in decision making –Medical Control is NOT scene control

74 74 Incident Command System The Basics Unified Command PlanningOperationsFinanceLogistics Commander ThinkersGettersDoersPayers

75 75

76 76 D-I-S-A-S-T-E-R Scene Safety & Security Begins with Mental PreparationBegins with Mental Preparation TrainingTraining What could we encounter?What could we encounter? IF/THEN: Think through / Plan initial tasksIF/THEN: Think through / Plan initial tasks Be Flexible, only thing constant is changeBe Flexible, only thing constant is change Response to SceneResponse to Scene Avoid Siren PsychosisAvoid Siren Psychosis Safe Response –Safe Response – Do not Drive it like you stole it Routes in and out are plannedRoutes in and out are planned Consider terrain, weather,Consider terrain, weather, wind direction, time of day

77 77 D-I-S-A-S-T-E-R Scene Safety & Security Scene Priorities: Dont be foolish, protect yourself!Dont be foolish, protect yourself! –Protect Yourself and Your Team FIRST! –Protect the Public –Protect the Patients –Protect the Environment

78 78 Example: Scene Safety Casualty Collection Point WARM ZONE 60 ft RS 6,000 ft HOT ZONE 300 ft WIND DIRECTION HOT ZONE WARM ZONE RS= Release Site Minimum Site Boundaries Open Area Chemical Release Adapted from Illinois Emergency Management Agency Chem-Bio Handbook. April 2000 COLD ZONE Uphill if agent heavier than air, downhill or level if lighter than air Figure 5 CCP

79 79 D-I-S-A-S-T-E-R Paradigm Assess Hazards Power lines downedPower lines downed Debris / traumaDebris / trauma Fire / burnsFire / burns Blood and fluidsBlood and fluids Hazardous materialsHazardous materials Flooding / drowningFlooding / drowning ExplosionsExplosions Low light/visibilityLow light/visibility Smoke/toxic inhalationSmoke/toxic inhalation Natural gas linesNatural gas lines Structural collapseStructural collapse Weather conditionWeather condition NBC ExposuresNBC Exposures Dirty BombsDirty Bombs SnipersSnipers Secondary devicesSecondary devices

80 80 D-I-S-A-S-T-E-R Paradigm Assess Hazards Awareness is key to detection of hazardsAwareness is key to detection of hazards Training in All-hazards approachTraining in All-hazards approach Protection more valuable than identificationProtection more valuable than identification –Personal Protective Equipment (PPE) Continual reassessment of sceneContinual reassessment of scene Get the job done, and get out!Get the job done, and get out!

81 81 D-I-S-A-S-T-E-R Paradigm Assess Hazards Be Aware of Secondary Devices!Be Aware of Secondary Devices! –Bombs, Shrapnel devices, Incapacitating Devices, Multiple Snipers/Terrorists, Delay Devices

82 82 D-I-S-A-S-T-E-R Paradigm Support Bottom-line:Bottom-line: –What do I need to get the job done? What human resources or skilled teams?What human resources or skilled teams? What agencies are needed?What agencies are needed? What facilities will be needed?What facilities will be needed? What supplies do I need?What supplies do I need? What vehicles are needed?What vehicles are needed?

83 83 D-I-S-A-S-T-E-R Paradigm Support Review historical injury and ICS reportsReview historical injury and ICS reports –Vital to proper planning, logistics, etc.. Establish proper policies & protocolsEstablish proper policies & protocols –Human resources Personnel report automaticallyPersonnel report automatically –Supplies & Equipment Standing orders, passive implementationStanding orders, passive implementation Occurrence based, duration based, etc..Occurrence based, duration based, etc.. Vendors automatically ship pre-determined suppliesVendors automatically ship pre-determined supplies

84 84 D-I-S-A-S-T-E-R Paradigm Support Unexpected Volunteers and Donations: Positive intentions, can have negative impactPositive intentions, can have negative impact Does your preparedness plan include them?Does your preparedness plan include them? –Ability to identify needed skills and needed supplies Negatives:Negatives: –Time to sort large and label goods –Storage space used –Unplanned personnel are a liability At risk of injuries, require food, water and shelterAt risk of injuries, require food, water and shelter

85 85 D-I-S-A-S-T-E-R Paradigm Triage Sorting patients by the seriousness of their condition and the likelihood of their survivalSorting patients by the seriousness of their condition and the likelihood of their survival To achieve the greatest good for the greatest number possibleTo achieve the greatest good for the greatest number possible Dependent on resources availableDependent on resources available

86 86 D-I-S-A-S-T-E-R Paradigm Triage Triage methods and systems:Triage methods and systems: –Several different triage systems in use –Different triage methods/ tags/ categories / colors / symbols used IDEALIDEAL –One system used by all agencies + hospitals

87 87 M.A.S.S. Triage M – Move A – Assess S – Sort S – Send

88 88 D-I-S-A-S-T-E-R Paradigm MASS Triage Model MoveMove Anyone who can walk is told to MOVE to a collection areaAnyone who can walk is told to MOVE to a collection area Remaining victims are told to MOVE an arm or legRemaining victims are told to MOVE an arm or leg AssessAssess Remaining patients who didnt move (help these people first) Remaining patients who didnt move (help these people first) SortSort Categorize patients by ID-meCategorize patients by ID-me Immediate, Delayed, Minimal, Expectant, DeadImmediate, Delayed, Minimal, Expectant, Dead SendSend Transport IMMEDIATE patients firstTransport IMMEDIATE patients first Send to Hospitals and Secondary Treatment FacilitiesSend to Hospitals and Secondary Treatment Facilities

89 89ID-me! I –Immediate D – Delayed M - Minimal E – Expectant D - DEAD D - DEAD ID-me! - a mnemonic for sorting patients during MCI triage. It is utilized effectively in the M.A.S.S. Triage model.ID-me! - a mnemonic for sorting patients during MCI triage. It is utilized effectively in the M.A.S.S. Triage model.

90 90 D-I-S-A-S-T-E-R Paradigm MASS Triage Model MOVE Step 1:MOVE Step 1: GoalGoal Group - Ambulatory PatientsGroup - Ambulatory Patients Action:Action: Everyone who can hear me and needs medical attention, please move to the area with the green flagEveryone who can hear me and needs medical attention, please move to the area with the green flag ID-me CategoryID-me Category Minimal initial groupMinimal initial group

91 91 D-I-S-A-S-T-E-R Paradigm MASS Triage Model MOVEMOVE Minimal group, initial screeningMinimal group, initial screening –Airway, breathing, and circulation intact –Mental status: able to follow commands –Not likely low blood pressure or breathing trouble –Some conditions worsen, more urgent triage category –Must be reassessed and monitored –Limitations: not based upon individual assessment yet Actively managing this group will reduce self- transports and perhaps unnecessary overburdening of nearest hospital ERsActively managing this group will reduce self- transports and perhaps unnecessary overburdening of nearest hospital ERs Assess last, after Immediate and Delayed groupsAssess last, after Immediate and Delayed groups

92 92 D-I-S-A-S-T-E-R Paradigm MASS Triage Model MOVE Step 2:MOVE Step 2: GoalGoal –Group – cant walk, but awake and able to follow commands to MOVE an arm or leg Action:Action: –Ask the remaining victims everyone who can hear me please raise an arm or leg so we can come help you ID-me CategoryID-me Category –Delayed initial group

93 93 D-I-S-A-S-T-E-R Paradigm MASS Triage Model MOVEMOVE Delayed groupDelayed group –Airway, breathing, and circulation adequate to follow simple commands –Mental status: Conscious & able to follow simple commands May have low blood pressure or low oxygen levelMay have low blood pressure or low oxygen level Likely significant injuries presentLikely significant injuries present Limitations: not based upon individual assessment yetLimitations: not based upon individual assessment yet Assess second, after Immediate groupAssess second, after Immediate group

94 94 D-I-S-A-S-T-E-R Paradigm MASS Triage Model ASSESSASSESS GoalGoal –Group – Identify location of who is left, unable to ambulate and unable to follow simple commands Action:Action: –Proceed immediately to these patients and deliver immediate life-saving interventions ID-me CategoryID-me Category –Immediate initial group

95 95 D-I-S-A-S-T-E-R Paradigm MASS Triage Model ASSESSASSESS Immediate groupImmediate group –ABC status unknown, immediate assessment –Mental status: Unresponsive to verbal commands –Likely low blood pressure or low oxygen level –Life-threatening injuries present –Expectant and dead patients may be in this group –Minor injuries may be present due to: Ruptured ear drums, hearing impaired, chronically disabledRuptured ear drums, hearing impaired, chronically disabled –Limitations: not based upon individual assessment Assess these people FIRST!Assess these people FIRST!

96 96 D-I-S-A-S-T-E-R Paradigm MASS Triage Model ASSESS IMMEDIATE patientsASSESS IMMEDIATE patients Rapidly Assess ABCs :Rapidly Assess ABCs : –Is airway open? Open it manually –Is patient breathing? If not, EXPECTANT and go on –Is uncontrolled bleeding present? Assign direct pressure (do not hesitate to use tourniquet!) –Is likely fatal injury present? If yes, EXPECTANT Correct immediate life threatsCorrect immediate life threats Accurate count of immediate patientsAccurate count of immediate patients Is transport available for anyone now? …Move on!Is transport available for anyone now? …Move on!

97 97 D-I-S-A-S-T-E-R Paradigm MASS Triage Model SORT - ID-me:SORT - ID-me: I – Immediate D – Delayed M- Minimal E – Expectant D - DEAD SORT them based upon individual assessment, …continue lifesaving treatment

98 98 D-I-S-A-S-T-E-R Paradigm MASS Triage Model SORT ImmediateSORT Immediate Life or limb threatening injuryLife or limb threatening injury Usually persistent ABC problemUsually persistent ABC problem Examples:Examples: –Unresponsive, altered mental status, severe breathing trouble, uncontrollable bleeding, proximal amputations, turning blue, rapid and weak pulse…

99 99 D-I-S-A-S-T-E-R Paradigm MASS Triage Model SORT Delayed:SORT Delayed: Need definitive medical care, but should not worsen rapidly if initial care is delayedNeed definitive medical care, but should not worsen rapidly if initial care is delayed Examples:Examples: –Deep cuts or open fractures with controlled bleeding and good pulses; finger amputations; abdominal injuries with stable vital signs…

100 100 D-I-S-A-S-T-E-R Paradigm MASS Triage Model SORT Minimal:SORT Minimal: Walking WoundedWalking Wounded Treated and released (preferably without transport)Treated and released (preferably without transport) Source of volunteer helpSource of volunteer help Examples:Examples: –Abrasions, contusions, minor lacerations, no apparent injury

101 101 D-I-S-A-S-T-E-R Paradigm MASS Triage Model SORT ExpectantSORT Expectant Severely injured with little or no chance of survivalSeverely injured with little or no chance of survival Care resources not utilized initiallyCare resources not utilized initially Comfort resources used as availableComfort resources used as available Remember death could be hours or days away!Remember death could be hours or days away! Require reassessment and transport:Require reassessment and transport: –If alive after all immediate patients transported, resuscitate per available resources!

102 102 D-I-S-A-S-T-E-R Paradigm MASS Triage Model SORT is dynamic! Reassess!SORT is dynamic! Reassess! Who is left?Who is left? Expectant group could become new Immediate groupExpectant group could become new Immediate group Most serious injury present requires your immediate attention!Most serious injury present requires your immediate attention!

103 103 D-I-S-A-S-T-E-R Paradigm MASS Triage Model When all patients have been triaged and immediate life saving procedures complete:When all patients have been triaged and immediate life saving procedures complete: –Accurate count in each category –Advise incident commander/triage officer –Move all immediate to collection point –Prepare for immediate transport –Often marked with red flag/tarp

104 104 D-I-S-A-S-T-E-R Paradigm MASS Triage Model How to handle the dead patients:How to handle the dead patients: –Dead patients should not be moved –May aid in identification of the deceased Evidence is important!Evidence is important! –Finding and convicting perpetrators....and possibly... PREVENTING future attacks! – Excessive manipulation of human remains may destroy vital evidence

105 105 D-I-S-A-S-T-E-R Paradigm MASS Triage Model SENDSEND Traditional syntaxTraditional syntax Immediate Delayed Minimal ExpectantImmediate Delayed Minimal Expectant ObjectiveObjective Transport or release ALL living patients ASAPTransport or release ALL living patients ASAP Mission FocusedMission Focused Send Minimal(s) with each Immediate (if unused space available in vehicle), etc…Send Minimal(s) with each Immediate (if unused space available in vehicle), etc… ResourcefulResourceful Secondary treatment facilities for minimal pts (or on-scene treatment and release)Secondary treatment facilities for minimal pts (or on-scene treatment and release) Utilize buses, taxis, trains, boats, etc..Utilize buses, taxis, trains, boats, etc..

106 106 D-I-S-A-S-T-E-R Paradigm Treatment Treatment continues on-scene until:Treatment continues on-scene until: –All patients transported –Resources unavailable to provide treatment –Comfort is Care! All-Hazards treatment plansAll-Hazards treatment plans –Algorithms of care delivery DocumentationDocumentation –Patient Identification / Triage Tag –Medical Record

107 107 D-I-S-A-S-T-E-R Paradigm Evacuation Short-term goal of the event!Short-term goal of the event! Preparedness PlanPreparedness Plan –Evacuation of hospitals –High-rise office buildings –Egress route alternatives TransportationTransportation –SEND of MASS Triage Model More than patients, includes families..public…More than patients, includes families..public…

108 108 D-I-S-A-S-T-E-R Paradigm Recovery Long-term goal of the event!Long-term goal of the event! Minimize events impactMinimize events impact –Injured victims, families, rescue personnel –Community, state, and nation –Environment Preparedness Plan must includePreparedness Plan must include Begins… when the incident occurredBegins… when the incident occurred Ends… often years laterEnds… often years later

109 109 D-I-S-A-S-T-E-R Paradigm Recovery Operational and Logistic considerations:Operational and Logistic considerations: –Vehicles: Clean, disinfect, restock, refuel unitsClean, disinfect, restock, refuel units –Equipment: Repair / replace equipment (and evaluate)Repair / replace equipment (and evaluate) Inventory & order supplies (and evaluate)Inventory & order supplies (and evaluate) –Personnel: Fed, hydrated, rested and released ASAPFed, hydrated, rested and released ASAP Many personnel may have been injuredMany personnel may have been injured Tendency to down-play importanceTendency to down-play importance Pre-release medical examsPre-release medical exams

110 110 D-I-S-A-S-T-E-R Paradigm Recovery Psychosocial: Debriefing of personnelDebriefing of personnel –Commonly occurs when relieved from duty –Identify at risk potential Post-incident observationPost-incident observation –Observe for stress related problems –Withdrawal, depression, hyper-excitability, unusual behavior, etc.. Appropriate interventionAppropriate intervention –Minimize negative psychosocial impact

111 111 D-I-S-A-S-T-E-R Paradigm Recovery Immediate: food, water, shelter, clothingImmediate: food, water, shelter, clothing Recovery actions involve entire communityRecovery actions involve entire community –Local is most important! Churches, temples, stores, hotels, restaurants…Churches, temples, stores, hotels, restaurants… –Regional, State and Federal resources… DMAT – Disaster Medical Assistance TeamsDMAT – Disaster Medical Assistance Teams DMORT – Disaster Mortuary Assistance TeamsDMORT – Disaster Mortuary Assistance Teams VMAT – Disaster Veterinary Assistance TeamsVMAT – Disaster Veterinary Assistance Teams VA Teams – Department of Veterans AffairsVA Teams – Department of Veterans Affairs NMRT – National Medical Response TeamsNMRT – National Medical Response Teams FEMA – Federal Emergency Management Agency ($$)FEMA – Federal Emergency Management Agency ($$)

112 112 D-I-S-A-S-T-E-R Paradigm Recovery After-Action Reviews Forces us to ask questions:Forces us to ask questions: –How could this have been prevented? –How could our response be improved? Learn all you can from the incidentLearn all you can from the incident This is a DUTY, not an optionThis is a DUTY, not an option Goal: Update / revise disaster plansGoal: Update / revise disaster plans

113 113Summary Now You Can: Identify the critical need to establish healthcare preparedness for disastersIdentify the critical need to establish healthcare preparedness for disasters Define disaster and Mass Casualty Incident (MCI)Define disaster and Mass Casualty Incident (MCI) Define All-hazards and list possibilitiesDefine All-hazards and list possibilities Identify the components of the D-I-S-A-S-T-E-R paradigmIdentify the components of the D-I-S-A-S-T-E-R paradigm Identify and apply a mass casualty triage model utilizing M.A.S.S. and ID-meIdentify and apply a mass casualty triage model utilizing M.A.S.S. and ID-me

114 114 Thank You! Questions?

115 115 Contact information Ray E. Swienton, MD, FACEP Co-Director, EMS, Disaster Medicine & Homeland Security Section Associate Professor, Division of Emergency Medicine University of Texas Southwestern Medical Center 5323 Harry Hines Blvd. Dallas, Texas Voice: (817)


Download ppt "1 Our Healthcare Facilities at Risk! Closing the Gaps in Critical Preparedness Areas."

Similar presentations


Ads by Google