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Healthcare Surge Capacity in Disasters Adapted from a presentation by John L. Hick, MD. Used with permission Barbara Dodge Virginia Helget Sharon Medcalf.

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Presentation on theme: "Healthcare Surge Capacity in Disasters Adapted from a presentation by John L. Hick, MD. Used with permission Barbara Dodge Virginia Helget Sharon Medcalf."— Presentation transcript:

1 Healthcare Surge Capacity in Disasters Adapted from a presentation by John L. Hick, MD. Used with permission Barbara Dodge Virginia Helget Sharon Medcalf

2 Overview Section 1 – Incidents and Incident Management Section 1 – Incidents and Incident Management Section 2 – Healthcare Facility and Community Surge Section 2 – Healthcare Facility and Community Surge Section 3 – Selected Surge Situations and Special Topics Section 3 – Selected Surge Situations and Special Topics

3 Section 1: Incidents and Incident Management

4 Overview Define disaster Define disaster Incident management and its importance in surge capacity Incident management and its importance in surge capacity The CST of surge The CST of surge Getting all Cs – Command, control, communications and coordination Getting all Cs – Command, control, communications and coordination

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6 What is a disaster? What is a disaster? Demand for resources acutely outstrips supply Demand for resources acutely outstrips supply May depend on day / time / facility May depend on day / time / facility Internal / External events Internal / External events Static vs. dynamic - timeline Static vs. dynamic - timeline Contagious events special sub-category Contagious events special sub-category Complex Incidents Complex Incidents

7 Key goal of planning and incident management: Get the… Right resources…to the Right resources…to the Right place…at the Right place…at the Right time…to prevent Right time…to prevent A special incident from becoming a… A special incident from becoming a… DISASTER DISASTER

8 Disasters – Reality Check Disasters – Reality Check Only 7 disasters in U.S. history have resulted in > 1000 fatalities Only 7 disasters in U.S. history have resulted in > 1000 fatalities Only incidents per year result in more than 40 injured victims Only incidents per year result in more than 40 injured victims

9 Historic Disasters Historic Disasters 1865 Steamship explosion1,547 deaths 1865 Steamship explosion1,547 deaths 1871 Peshtigo, WI fire1, Peshtigo, WI fire1, Jonestown, PA flood > 2, Jonestown, PA flood > 2, Steamship fire, NYC 1, Steamship fire, NYC 1, FL Okeechobee Hurricane 2, FL Okeechobee Hurricane 2, NYC WTC disaster2,795 (inexact) 2001 NYC WTC disaster2,795 (inexact) 2005 Hurricane Katrina 1697 (inexact) 2005 Hurricane Katrina 1697 (inexact)

10 Capabilities and Resources Federal Response Regional / Mutual Response Systems State Response Increasing magnitude and severity Local Response, Municipal and County Tiered Response Strategy MinimalLowMediumHighCatastrophic

11 Now, lets think about Planning Planning

12 What is most likely? What is most likely? Moderate sized disaster Moderate sized disaster > 120 injured is threshold for chaos > 120 injured is threshold for chaos Plan for victims Plan for victims Tie planning to Hazard Vulnerability Analysis Tie planning to Hazard Vulnerability Analysis

13 Planning Documents Planning Documents Hazard Vulnerability Analysis Hazard Vulnerability Analysis Emergency Management Plan Emergency Management Plan Emergency Operations Plan Emergency Operations Plan Departmental Plans Departmental Plans

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16 What is Surge Capacity?

17 Surge Capacity C S T The 4 Cs The 4 Cs Command Command Control Control Communications Communications Coordination Coordination * Surge capacity CANNOT occur if you dont get all Cs The 4 Ss Space Staff Stuff Special The 3 Ts Triage Treat Transport

18 Command What is Incident Command? What is Incident Command? Incident Management System Incident Management System Multi-agency Coordination System Multi-agency Coordination System Public Information Systems Public Information Systems Standard language Standard language Standardized job duties Standardized job duties Scalable and flexible Scalable and flexible

19 Basic HICS Structure MEDICAL TECHNICAL SPECIALIST

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21 Tools in the new HICS Job action sheets Job action sheets Position recommendations Position recommendations Incident Planning Guides Incident Planning Guides Incident Response Guides Incident Response Guides Forms – consistent with FEMA requirements Forms – consistent with FEMA requirements NIMS (compliance activities) NIMS (compliance activities)

22 Use it often Use it often Incident Command must be used as frequently as possible (daily responses) Incident Command must be used as frequently as possible (daily responses) Employee familiarity and comfort with system is dependent on exposure / practice Employee familiarity and comfort with system is dependent on exposure / practice

23 Surge Capacity Partners EMS EMS Emergency Management Emergency Management Public Health Public Health Public Safety/Law enforcement Public Safety/Law enforcement Hospitals and Healthcare Systems Hospitals and Healthcare Systems American Red Cross American Red Cross Behavioral health Behavioral health Jurisdictional legal authorities Jurisdictional legal authorities

24 Regional Coordination Medical Response Systems Medical Response Systems Trauma System Trauma System Public Health Districts Public Health Districts Regional Hospital Resource Center (RHRC) Regional Hospital Resource Center (RHRC) Multi-Agency Coordination Multi-Agency Coordination

25 Federal Assets National Disaster Medical System (NDMS) National Disaster Medical System (NDMS) Urban Search and Rescue (eg: Nebraska TF-1) Urban Search and Rescue (eg: Nebraska TF-1) Commissioned Corps Readiness Force Commissioned Corps Readiness Force Military (NORTHCOM) Military (NORTHCOM) Federal Medical Stations Federal Medical Stations CDC SNS and VMI CDC SNS and VMI

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27 Section 2: Healthcare Facility and Community Surge

28 Overview Initial Actions Initial Actions Facility-based surge Facility-based surge Space, staff, stuff, special Space, staff, stuff, special Triage, treatment, and transport Triage, treatment, and transport Community-based surge capacity Community-based surge capacity Partners and players Partners and players Alternate care sites Alternate care sites

29 Capacity vs. Capability Surge Capacity – the ability to manage increased patient care volume that otherwise would severely challenge or exceed the existing medical infrastructure Surge Capacity – the ability to manage increased patient care volume that otherwise would severely challenge or exceed the existing medical infrastructure Surge Capability – the ability to manage patients requiring unusual or very specialized medical evaluation and intervention, often for uncommon medical conditions Surge Capability – the ability to manage patients requiring unusual or very specialized medical evaluation and intervention, often for uncommon medical conditions Barbera and Macintyre Barbera and Macintyre

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32 Initial Actions – Notification and Communication Facility notified of event / recognizes event Facility notified of event / recognizes event Advisory Advisory Alert Alert Declaring an emergency – Declaring an emergency – Activation Activation Mobilize adequate resources based on intel Mobilize adequate resources based on intel Plan for next operational period (action planning cycles) Plan for next operational period (action planning cycles) Notifying Notifying Staff Staff Patients and their families Patients and their families General public General public Ongoing communications / information cycle Ongoing communications / information cycle

33 Different types of surge Pre-event surge (eg: pandemic, hurricane) Pre-event surge (eg: pandemic, hurricane) Healthcare facility-based Healthcare facility-based Discharges Discharges Admissions Admissions Community-based Community-based Ambulatory care Ambulatory care Existing sites Existing sites Field treatment sites Field treatment sites Non-ambulatory care (acute care center / off-site) Non-ambulatory care (acute care center / off-site) EMS EMS

34 Pre-event surge /actions If short warning time present: If short warning time present: Determine what service lines will be maintained Determine what service lines will be maintained Mobilize staff and resources Mobilize staff and resources If longer warning time: If longer warning time: Consider expanding services to take care of as much elective business as possible (eg; evening operative cases, expanded clinic hours) Consider expanding services to take care of as much elective business as possible (eg; evening operative cases, expanded clinic hours)

35 Facility-based Surge Hospitals may use HRSA dollars to purchase cots, lab equipment, and other supplies Hospitals may use HRSA dollars to purchase cots, lab equipment, and other supplies Nearly always preferred to off-site Nearly always preferred to off-site Comfort of staff Comfort of staff Expertise Expertise Off-site: designate what equipment can be taken and who can operate it Off-site: designate what equipment can be taken and who can operate it

36 Reality Check Reality Check Very rare to be overwhelmed in a disaster Very rare to be overwhelmed in a disaster Only 6% of hospitals in 29 disasters experienced supply issues, and 2% had staffing shortages... Only 6% of hospitals in 29 disasters experienced supply issues, and 2% had staffing shortages... Most had too many! Most had too many!

37 In the Real World... In the Real World... At least 50% arrive self-referred At least 50% arrive self-referred Upside down triage – least wounded arrive first Upside down triage – least wounded arrive first On average, 67% of patients in any given disaster are cared for at the hospital nearest the event (range 41-97%) On average, 67% of patients in any given disaster are cared for at the hospital nearest the event (range 41-97%)

38 Rule of Thumb Rule of Thumb Per 100 patients injured: Per 100 patients injured: 25 dead at scene 25 dead at scene 75 seek medical care 75 seek medical care 63 minor 63 minor 12 serious 12 serious Rule of 85/15% has applied to all disasters thus far inc NYC 9-11 (minor vs. serious) Rule of 85/15% has applied to all disasters thus far inc NYC 9-11 (minor vs. serious) In every catastrophic disaster, sustained pressure on the healthcare system is seen following the incident In every catastrophic disaster, sustained pressure on the healthcare system is seen following the incident

39 Critical Hospital Resources Critical Hospital Resources Physical Plant Physical Plant Personnel Personnel Supervision Supervision Supplies and Equipment Supplies and Equipment Communication Communication Transportation Transportation Koenig K et al. Acad Emerg Med 1996:3;723-7 Koenig K et al. Acad Emerg Med 1996:3;723-7

40 Surge Capacity C S T The 4 Cs The 4 Cs Command Command Control Control Communications Communications Coordination Coordination * Surge capacity CANNOT occur if you dont get all Cs The 4 Ss Space Staff Stuff Special The 3 Ts Triage Treat Transport

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42 Space ED and clinic triage protocols (evolve with event) ED and clinic triage protocols (evolve with event) Discharges and transfers (eg: nursing home) Discharges and transfers (eg: nursing home) Discharge holding area Discharge holding area Treat patients in halls / flat space areas (cots) Treat patients in halls / flat space areas (cots) Cancel elective procedures Cancel elective procedures Convert procedure/OR/PACU areas to ICU space Convert procedure/OR/PACU areas to ICU space Accommodate vents on floor Accommodate vents on floor Alternative ambulatory care areas / triage areas Alternative ambulatory care areas / triage areas

43 Space Dont forget surge space for: Dont forget surge space for: Family members / Family support center Family members / Family support center Tracking system (badge) Tracking system (badge) Media in separate space Media in separate space Consider traffic patterns and satellite space Consider traffic patterns and satellite space Behavioral health area Behavioral health area Staff respite Staff respite Labor pool Labor pool Staff housing / sleeping (family members?) Staff housing / sleeping (family members?)

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46 Staff Different events = different staff needs Different events = different staff needs Eg: HAZMAT vs. trauma vs. monkeypox Eg: HAZMAT vs. trauma vs. monkeypox Appropriate specialties Appropriate specialties Scope of event = scope of staff call-in Scope of event = scope of staff call-in Mechanism to reach staff Mechanism to reach staff Obligations of the staff Obligations of the staff Contract staff Contract staff What are they required to do? What are they required to do?

47 Staff Assign staff to specific areas when possible Assign staff to specific areas when possible Dont forget the support staff Dont forget the support staff Nursing staff often limiting factor Nursing staff often limiting factor Team nursing Team nursing Involve family in care Involve family in care What do specialists have to do? What do specialists have to do? Staff extenders / Staff roles Staff extenders / Staff roles Mentoring and supervision of extra staff Mentoring and supervision of extra staff Just in time training Just in time training

48 Staff Augmentation Staff Augmentation Hospital personnel Hospital personnel Clinic personnel Clinic personnel Medical Reserve Corps Medical Reserve Corps Non-clinical practice professionals Non-clinical practice professionals Retired professionals (eg: via Medical Society) Retired professionals (eg: via Medical Society) Trainees in health professions Trainees in health professions Civil Support Team, Civil Air Patrol Civil Support Team, Civil Air Patrol Lay public (CERT teams, etc) Lay public (CERT teams, etc) Federal / interstate personnel Federal / interstate personnel

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50 Stuff Provider protection Provider protection General patient care supplies General patient care supplies Specialty patient care supplies Specialty patient care supplies Support supplies Support supplies

51 Stuff – Provider Protection Personal Protective Equipment Personal Protective Equipment Medications – antidotes?, anti-virals? Medications – antidotes?, anti-virals? Consider: Consider: re-use re-use duration of use duration of use other risk-reducing strategies (UV light, ventilation, etc) other risk-reducing strategies (UV light, ventilation, etc)

52 Stuff – General Patient Care Airway – disposable intubation blades, bag/masks Airway – disposable intubation blades, bag/masks Surgical – chest tube trays Surgical – chest tube trays Medications – Morphine, Valium, Atropine Medications – Morphine, Valium, Atropine Other disposables – catheters, dressings, linens Other disposables – catheters, dressings, linens Durable – beds, vents, IV pumps, BP cuffs Durable – beds, vents, IV pumps, BP cuffs

53 Stuff – Specialty Patient Care Example – burn Example – burn Adaptic dressings Adaptic dressings Bacitracin Bacitracin Kerlix dressings Kerlix dressings 50% BSA burn needs 14 liters LR/NS in 1 st 24h, MS 250mg/24h) 50% BSA burn needs 14 liters LR/NS in 1 st 24h, MS 250mg/24h)

54 Persistent SBP < 90mmHg or age-appropriate hypotension unresponsive to fluids Occasional hypotension or other signs of poor perfusion No signs of shock Laboratory or clinical evidence of multiple (> 4) organ system failure* Laboratory evidence of 2-3 organ system failure Respiratory failure only Severe underlying disease with poor short-term prognosis** Severe underlying disease with poor long-term prognosis and/or ongoing resource demand No severe underlying disease Long duration – ARDS, infectious causes of respiratory failure, (estimate > 7 days on ventilator) Moderate duration – ARDS or infectious cause in healthy patient (estimate 3-7 days on ventilator) Short duration – flash pulmonary edema, chest trauma, other anticipating < 3 days on ventilator Worsening oxygenation index*** Stable oxygenation index over time (failure to improve after adequate disease-specific trial of mechanical ventilation) Improving oxygenation index Poor prognosis based upon epidemiology of specific disease (eg; pandemic influenza) for patient group. Indeterminate / intermediate prognosis based upon epidemiology of specific disease process Good prognosis based upon epidemiology of specific disease High potential for death according to predictive model Intermediate potential for death according to predictive model Low potential for death according to predictive model Ventilator re-allocated Patient keeps ventilator

55 Stuff – Support Supplies Food Food Water Water Office supplies Office supplies Utilities Utilities Communications Communications Oxygen supply Oxygen supply

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57 Surge Capability / Specialty Burn Burn Chemical / Decontamination Chemical / Decontamination Isolation Isolation Pediatric Pediatric Blast injury / mass trauma Blast injury / mass trauma Behavioral Health Behavioral Health

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59 Surge Capacity C S T The 4 Cs The 4 Cs Command Command Control Control Communications Communications Coordination Coordination * Surge capacity CANNOT occur if you dont get all Cs The 4 Ss Space Staff Stuff Special The 3 Ts Triage Treat Transport

60 T - Operations Triage Triage Treatment Treatment Transport Transport

61 Triage Hospital triage: The most critical patients first Hospital triage: The most critical patients first Mass Casualty triage: The greatest amount of good for the largest number of people. Resources used on the victims that have the best chance of survival Mass Casualty triage: The greatest amount of good for the largest number of people. Resources used on the victims that have the best chance of survival

62 Triage Location? Location? Triage officer Triage officer Triage tags / initial registration or tracking Triage tags / initial registration or tracking Locations of care – where are patients triaged TO? Locations of care – where are patients triaged TO? Key bottlenecks – decontamination, radiology (eg; CT), transportation, OR, ICU Key bottlenecks – decontamination, radiology (eg; CT), transportation, OR, ICU

63 Treatment What patients may be safely treated in what areas: What patients may be safely treated in what areas: ED, clinics, lobby areas, etc ED, clinics, lobby areas, etc Deal with life-threats only initially Deal with life-threats only initially Defer definitive wound closures, fracture reductions Defer definitive wound closures, fracture reductions Defer most xrays and labs until demand eases Defer most xrays and labs until demand eases Use your clinical skills! Use your clinical skills! What is the expectation for documentation / nursing orders during disaster? What is the expectation for documentation / nursing orders during disaster?

64 Transportation Capacity/Capability

65 Transport Internal Internal Transportation from ED to other in-hospital locations (CT, OR, etc) Transportation from ED to other in-hospital locations (CT, OR, etc) Personnel and resources (beds and wheelchairs, etc) Personnel and resources (beds and wheelchairs, etc) External External Transport resources – ground, rotor and fixed wing, alternative ground (WC vans, etc) Transport resources – ground, rotor and fixed wing, alternative ground (WC vans, etc) Referral centers – whats your backup when usual partners are full / unable to receive? Referral centers – whats your backup when usual partners are full / unable to receive?

66 Transport EMS issues EMS issues Few communities have adequate EMS resources Few communities have adequate EMS resources Many EMS personnel have competing demands during disaster (fire department, hospital, family) and may not be available Many EMS personnel have competing demands during disaster (fire department, hospital, family) and may not be available Few communities have process for allocation of scarce EMS resources Few communities have process for allocation of scarce EMS resources

67 Surge Capacity Coordination

68 Community- Based Surge Clinics Clinics Procedure centers (i.e. dialysis centers) Procedure centers (i.e. dialysis centers) Long Term Care Facilities (LTCFs) Long Term Care Facilities (LTCFs) Homecare Homecare Family-based care Family-based care Alternative care sites Alternative care sites Local / Regional referral / NDMS Local / Regional referral / NDMS

69 Clinic surge capacity Rural – scant ability to increase capacity Rural – scant ability to increase capacity Urban – larger ability to increase capacity Urban – larger ability to increase capacity Sub-specialty clinics Sub-specialty clinics Surgical centers Surgical centers Cancellation of elective appointments Cancellation of elective appointments Changes in hours / staffing Changes in hours / staffing Receiving referrals from hospital? Receiving referrals from hospital? Criteria Criteria Supplies Supplies

70 Professional Homecare Homecare agencies Homecare agencies Social workers Social workers Durable equipment suppliers Durable equipment suppliers Are agencies prepared to prioritize services to accommodate increased demands? Are agencies prepared to prioritize services to accommodate increased demands? Do homecare nurses have other commitments? Do homecare nurses have other commitments?

71 Family-based care Will be focus of most care in pandemics and Will be focus of most care in pandemics and General emergency preparedness critical General emergency preparedness critical Specific information Specific information

72 Alternate Care Sites / Community Action Neighborhood Emergency Help Center Neighborhood Emergency Help Center Screening and minimal care (for example – early pandemic symptoms requiring anti-virals) Screening and minimal care (for example – early pandemic symptoms requiring anti-virals) Population-based interventions Population-based interventions Acute Care Center / Off-site care facility Acute Care Center / Off-site care facility Non-ambulatory care (may also have role as special needs shelter – NH fire, widespread disaster) Non-ambulatory care (may also have role as special needs shelter – NH fire, widespread disaster) Hospital overflow –allows hospitals to focus on critical care Hospital overflow –allows hospitals to focus on critical care Many models – adjacent hospital, regional, self- supporting infrastructure vs. existing Many models – adjacent hospital, regional, self- supporting infrastructure vs. existing

73 Potential Alternative Care Sites Aircraft hangers Aircraft hangers Military facilities Military facilities Churches Churches National Guard armories National Guard armories Community/recreation centers Community/recreation centers Surgical centers / medical clinics Surgical centers / medical clinics Convalescent care facilities Convalescent care facilities Sports facilities / stadiums Fairgrounds Trailers Government buildings Tents Hotels/motels Warehouses Meeting halls

74 Factors to consider Ability to lock down/Security Ability to lock down/Security HVAC HVAC Lab/specimen handling Lab/specimen handling Lighting Lighting Laundry Laundry Loading Dock Loading Dock Equipment storage Equipment storage Oxygen delivery capability Oxygen delivery capability Waste disposal Waste disposal Parking Parking Communications capability Communications capability Patient decon Door size Pharmacy areas Electrical power with backup Proximity to hospital Family areas Toilets/showers/waste Food supply / prep area Water supply Wired for IT/Internet access Primary and Secondary sites Controlled access

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76 What will Happen at the Acute Care Alternate Sites? Triage / admission criteria Triage / admission criteria Level of care – basic nursing, drip meds, IVs, NG feeds Level of care – basic nursing, drip meds, IVs, NG feeds Medications Medications Documentation / order management Documentation / order management Laboratory Laboratory Food / water / sanitary Food / water / sanitary Linen and medical waste handling Linen and medical waste handling Oxygen? Oxygen?

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78 Sample Site

79 Food Food Restrooms Restrooms Staff rehab areas Staff rehab areas Secure Secure HVAC system specs HVAC system specs Paging /messaging /radio Paging /messaging /radio Power Power Phone, T1 lines, etc. Phone, T1 lines, etc. City owned! City owned!

80 HEAD CHAIR HEAD COT A12 2x2 zip-tied to folding chairs, shim across top 2x2 zip-tied to folding chairs, shim across top Nails for chart, IV bag Nails for chart, IV bag Cards show team color/letter (eg: green A) Cards show team color/letter (eg: green A) Other cards show pending orders (red = stat) Other cards show pending orders (red = stat) Clothespins/rubber bands hold cards Clothespins/rubber bands hold cards

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82 Ongoing Issues Clinic / outpatient care roles Clinic / outpatient care roles Legal and Regulatory Legal and Regulatory Reimbursement Reimbursement Workforce coordination with public health Workforce coordination with public health Credentials / HR issues Credentials / HR issues

83 Section 3: Selected Surge Situations and Special Topics

84 Overview – Section 3 Event-specific Event-specific Behavioral health Behavioral health Security Security Education and training Education and training

85 Scenario 23 year old presents to ED – just arrived from Africa Bleeding from everywhere – sclera, gums, GI tract, genitourinary tract, bruising skin noted Febrile to 101 Sister who traveled with her is also feeling ill but has no signs yet of her sisters illness What do you do?

86 Isolation Space Space Triage and screening – location, process Triage and screening – location, process Treatment areas – iso rooms, cohorting Treatment areas – iso rooms, cohorting Staff - training, call-in, monitor compliance with PPE, communications Staff - training, call-in, monitor compliance with PPE, communications Stuff – antibiotics, anti-virals, analgesia / sedation, ventilators, PPE supplies Stuff – antibiotics, anti-virals, analgesia / sedation, ventilators, PPE supplies Special – security, communications, family issues Special – security, communications, family issues Transport – internal and external issues - process Transport – internal and external issues - process

87 Scenario Workers at construction site unearth large jar of clear liquid – they pick the jar up and it shatters Both workers are splashed and have immediate respiratory distress as well. Much of the liquid vaporizes. EMS removes clothing and transports as no decon available and respiratory distress What do you do?

88 Chemical Space – decontamination, triage, treatment space Space – decontamination, triage, treatment space Staff – trained for decontamination, ED staff, ICU (if applicable), monitoring of PPE use / duties Staff – trained for decontamination, ED staff, ICU (if applicable), monitoring of PPE use / duties Stuff – antidotes (particularly atropine and 2PAM), analgesia, sedation, PPE, vents / ICU Stuff – antidotes (particularly atropine and 2PAM), analgesia, sedation, PPE, vents / ICU Special – decontamination equipment, runoff issues Special – decontamination equipment, runoff issues

89 Scenario Tornado watch issued at noon for your city Tornado warning at 4pm – staff and patients shelter in place Severe damage to large neighborhood in community, hospital multiple windows broken, reports of leaking roof in one unit, electricity out except emergency power What do you do?

90 Tornado Command – assess impact on facility / staff Command – assess impact on facility / staff Space – triage areas, treatment areas – expand capacity especially outpatient Space – triage areas, treatment areas – expand capacity especially outpatient Staff – shift staffing Staff – shift staffing Stuff – Tdap boosters, analgesia, sedation, local anesthetics, suture trays Stuff – Tdap boosters, analgesia, sedation, local anesthetics, suture trays Special – debris removal, utilities support, staff transportation Special – debris removal, utilities support, staff transportation Transportation – EMS resources Transportation – EMS resources

91 Scenario Office building explodes Several persons trapped in rubble, at least 2 fatalities – 2 of injured dragged out and brought by private car to hospital Multiple walking wounded including some people walking on the street / in cars and hit by debris Few windows broken in hospital complex

92 Bomb / Blast injury Command – facility assessment? Command – facility assessment? Space – triage area, treatment, OR Space – triage area, treatment, OR Staff – including specialty – ENT, eye, surgery Staff – including specialty – ENT, eye, surgery Stuff – analgesia, sedation, Tdap, burn supplies (adaptic, narcotics, ibuprofen, bacitracin), surgical supplies (suture trays, chest tube) Stuff – analgesia, sedation, Tdap, burn supplies (adaptic, narcotics, ibuprofen, bacitracin), surgical supplies (suture trays, chest tube) Special – security, behavioral health, family Special – security, behavioral health, family

93 Other Surge Challenges Upside down triage Upside down triage Family members Family members Communications / information Communications / information Media Media Psychological casualties Psychological casualties

94 IN-HOUSE Distressed Staff INPATIENT Distressed Inpatients Family Members of Inpatients INCOMING Behavioral Health Surge Demands MediaVolunteersOnlookers PsychologicalCasualties EMS-ProcessedMedicalCasualtiesSelf-Transported Medical Casualties Bystanders or FamilyMembers,Friends,Co-workers of Incoming Casualties Family Members Searching for Missing Loved Ones Injured,Exposed,DistressedDisaster/EmergencyWorkers

95 Behavioral Health Surge Sorting Sorting Triage psychological (or likely) to observation area Triage psychological (or likely) to observation area Supporting Supporting Quiet area Quiet area Food and liquids Food and liquids Family support area as well Family support area as well Services Services Chaplaincy, social work, psychology/psychiatry, CISM, psychological first aid Chaplaincy, social work, psychology/psychiatry, CISM, psychological first aid Observe, screen, refer as needed Observe, screen, refer as needed

96 Aftereffects Aftereffects Continued high ER and clinic volumes Continued high ER and clinic volumes Psychological stressors Psychological stressors Unique hazards may affect health after the event Unique hazards may affect health after the event

97 NYC post NYC post % increase in asthma over 5-9 weeks younger patients, 44% > 54 yrs 22.5% increase in asthma over 5-9 weeks younger patients, 44% > 54 yrs 75% in random phone survey reported adverse psychological effects 75% in random phone survey reported adverse psychological effects MMWR Sept. 6, 2002 MMWR Sept. 6, 2002

98 Security Lockdown Lockdown Ingress / egress control Ingress / egress control Staff: Staff: Hospital Hospital Contract Contract Public Safety Public Safety Community sources Community sources Policies and procedures – weapons, crowd control, use of force Policies and procedures – weapons, crowd control, use of force

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100 Education and Training Hospital Incident Command Training Hospital Incident Command Training Just-in-Time Training Just-in-Time Training Drills Drills Tabletop Tabletop Functional Functional

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102 What do I do now? Next Steps Review Review Your Emergency Operations Plan Your Emergency Operations Plan Incorporate Incident Command Incorporate Incident Command Clearly define what a hospital employee will DO Clearly define what a hospital employee will DO Have current job actions sheets and reporting forms Have current job actions sheets and reporting forms Request more training in Incident Command if needed Request more training in Incident Command if needed Imbed Incident Command in daily operations Imbed Incident Command in daily operations

103 Next Steps to Surge Define your Surge Capacity Partners Define your Surge Capacity Partners Make sure they know what you expect of them. Make sure they know what you expect of them. Identify federal assets Identify federal assets Acquire the needed bed-tracking program & training Acquire the needed bed-tracking program & training Create a Pre-surge plan Create a Pre-surge plan If time allows: If time allows:

104 Surge Capacity Space Space Evaluate your physical facility Evaluate your physical facility Space for cots, family, media, staff respite BH … Space for cots, family, media, staff respite BH … Evaluate near-by external facilities Evaluate near-by external facilities Create guidelines for early dismissals Create guidelines for early dismissals

105 Surging Personnel Staff Staff Determine ways to reallocate internal staff roles Determine ways to reallocate internal staff roles Determine external staffing options Determine external staffing options Determine process for assigning mentors/preceptors Determine process for assigning mentors/preceptors Plan Staff Extenders Plan Staff Extenders Just-In-Time Training Just-In-Time Training

106 Considering Supplies Stuff Stuff Create a plan for a quick inventory Create a plan for a quick inventory PPE PPE General Patient Care Supplies – include medications General Patient Care Supplies – include medications Specialty Patient Supplies Specialty Patient Supplies Support Supplies Support Supplies Food, water, office, communication Food, water, office, communication Create a plan to begin stockpiling Create a plan to begin stockpiling

107 Planning for the Ts Triage Triage Train in Mass-Casualty Triage Train in Mass-Casualty Triage Plan triage areas, internal and external Plan triage areas, internal and external Locate Vests and Tags Locate Vests and Tags Treatment Treatment Discuss and plan for temporary treatment of non- life-threatening injuries. Discuss and plan for temporary treatment of non- life-threatening injuries. Discuss alternative record-keeping Discuss alternative record-keeping

108 Transportation Transportation Internal Internal Determine number and location of wheelchairs/gurneys Determine number and location of wheelchairs/gurneys Plan for alternate modes of transportation Plan for alternate modes of transportation External External Know your local transport resources Know your local transport resources Plan for alternate modes of transportation Plan for alternate modes of transportation

109 Community Based Surge Coordinate with local Public Health Coordinate with local Public Health Determine your role Determine your role Identify existing plans Identify existing plans

110 Revisit Parking Lot Issues

111 Please fill out your evaluations and Please fill out your evaluations and Self Assessment Self Assessment Thank you for Coming!


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