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DMAT at the New Orleans Airport: Triage and Command and Control in the Austere Environment DMAT at the New Orleans Airport: Triage and Command and Control.

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Presentation on theme: "DMAT at the New Orleans Airport: Triage and Command and Control in the Austere Environment DMAT at the New Orleans Airport: Triage and Command and Control."— Presentation transcript:

1 DMAT at the New Orleans Airport: Triage and Command and Control in the Austere Environment DMAT at the New Orleans Airport: Triage and Command and Control in the Austere Environment Richard V. King, PhD Kelly R. Klein, MD Section on EMS, Disaster Medicine and Homeland Security University of Texas Southwestern Medical Center at Dallas 2007 NDMS Conference, Nashville, Tennessee, March 20, 2007

2 Disaster Definition Wikipedia: A disaster (from Greek meaning, "bad star") is a natural or man-made event that negatively affects life, property, livelihood or industry often resulting in permanent changes to human societies, ecosystems and environment. Wikipedia: A disaster (from Greek meaning, "bad star") is a natural or man-made event that negatively affects life, property, livelihood or industry often resulting in permanent changes to human societies, ecosystems and environment. UN: Situation or event, which overwhelms local capacity, necessitating a request to national or international level for external assistance; an unforeseen and often sudden event that causes great damage, destruction and human suffering UN: Situation or event, which overwhelms local capacity, necessitating a request to national or international level for external assistance; an unforeseen and often sudden event that causes great damage, destruction and human suffering Medical: a situation with an imbalance between the acute needs and the locally available resources Medical: a situation with an imbalance between the acute needs and the locally available resources Regardless, it is when your system is overwhelmed to the point that you need outside assistance.

3 Katrina Disaster Hurricane Katrina caused the evacuation of a major U.S. city including >250,000 people after the hurricane hit. Hurricane Katrina caused the evacuation of a major U.S. city including >250,000 people after the hurricane hit. One of the evacuation centers for the people trapped was the Louis Armstrong International Airport, initially staffed by 3 DMATs. One of the evacuation centers for the people trapped was the Louis Armstrong International Airport, initially staffed by 3 DMATs.

4 DMAT Staffing Physicians (any kind) Physicians (any kind) Nurses (any kind) Nurses (any kind) Nurse practitioners Nurse practitioners Physician assistants Physician assistants Pharmacists (commercial to hospital based) Pharmacists (commercial to hospital based) Paramedics and EMTs Paramedics and EMTs Other health professionals Other health professionals Support staff Support staff

5 What does a DMAT do? Patient Triage/Treatment Site (PTS) Patient Triage/Treatment Site (PTS) Regional Evacuation Point (REP) Regional Evacuation Point (REP) Patient Reception Point (PRP) Patient Reception Point (PRP) Hospital augmentation Hospital augmentation Hospital evacuation Hospital evacuation Shelter care, standard or special-needs Shelter care, standard or special-needs Mass gatherings and special security events Mass gatherings and special security events Medical support of other response teams/Fed Agencies Medical support of other response teams/Fed Agencies Mass prophylaxis or immunization programs Mass prophylaxis or immunization programs But where is the science to support what we do?

6 Medical responders have had to adapt their practices for the austere medical environment No food or potable water No food or potable water No electricity No electricity No communications No communications No transportation No transportation No higher level of care immediately available No higher level of care immediately available

7 Do we know how to operate safely in this environment?

8 Do we know how to get people safely on and off a helicopter?

9 Triage Developed by the French military under Napoleon it is trauma based. Developed by the French military under Napoleon it is trauma based. The most good for the largest number of patients regardless of rank or status. The most good for the largest number of patients regardless of rank or status. It was originally based on It was originally based on Patient's severityPatient's severity Resources availableResources available Transportation availabilityTransportation availability

10 How do we triage nursing home residents, diabetics, and people with fractured hips?

11

12 How do we triage people who are dehydrated, or stroke patients?

13 How do you triage when there is no way to transport, and too few personnel?

14 Need for research Much of what we do is based on case studies and anecdotes. Much of what we do is based on case studies and anecdotes. Training and response practices often have limited scientific basis. Training and response practices often have limited scientific basis.

15 Need for research There is a paucity in the medical literature of published research on disasters that is not anecdotal. There is a paucity in the medical literature of published research on disasters that is not anecdotal. Trauma triage is different from medical triage, and it is not widely understood. Trauma triage is different from medical triage, and it is not widely understood. Although command and control is encouraged in federal response, in standard practice it does not seem to work well. Although command and control is encouraged in federal response, in standard practice it does not seem to work well.

16 Purpose of our research Conduct an exploratory, pilot study: Formulate key questions Formulate key questions Generate hypotheses and suggestions for further research Generate hypotheses and suggestions for further research

17 Study questions: Triage Is there a relationship between the number of deployments a person has been on and how they perform triage? Is there a relationship between the number of deployments a person has been on and how they perform triage? Are the majority of patients triaged classified as immediate? Are the majority of patients triaged classified as immediate? Does level of medical education affect the triage method used? Does level of medical education affect the triage method used? Is START the prevailing triage method? Is START the prevailing triage method?

18 Study questions: Command & Control How well does the command and control function given large groups who do not regularly train and work together? How well does the command and control function given large groups who do not regularly train and work together? Will perceptions of command and control vary with the number of deployments team members have experienced? Will perceptions of command and control vary with the number of deployments team members have experienced?

19 Method An IRB-approved questionnaire was provided to >100 DMAT team members who had been at the New Orleans airport during medical triage operations. An IRB-approved questionnaire was provided to >100 DMAT team members who had been at the New Orleans airport during medical triage operations. Results were summarized from the 16 questionnaires returned. Results were summarized from the 16 questionnaires returned.

20 Results

21 Who were our 16 DMAT respondents? Median age: 45 (Range: 37-59) Median age: 45 (Range: 37-59) 11 Male; 5 Female 11 Male; 5 Female 12 practice healthcare in civilian life 12 practice healthcare in civilian life 12 received triage training in past 12 received triage training in past 10 practiced triage in past 10 practiced triage in past 10 performed triage at the New Orleans Airport 10 performed triage at the New Orleans Airport

22 Roles of the DMAT members Medical Nurses5 Paramedics5 Physicians2 EMT1 PA1 Other Team Members Communication3 Logistics2 Security1 Leader1 Other-Unspecified2 Note: Several DMAT members played multiple roles.

23 Triage Training Type by Education Level Education Level STARTSAVEMilitaryTotal Physician1203 Nurse4116 Paramedic5229 EMT1001 PA0011 Communication2013 Logistics1001 Other/Unspecified1001 TOTAL1555

24 Triage methods used at the New Orleans Airport Of the 16 respondents, 10 performed triage, using the following methods: START5 SAVE1 Military0 Other3 Did not specify7

25 Number of deployments and triage method used # of Deployments STARTSAVEMilitary Other or Blank >133 TOTAL5109

26 Where was triage performed Area n Area n Flight line and baggage area (staging) 14 (Staffed by 1 DMAT w/augmentation) Departure area (medical treatment) 10 (Staffed by 2 DMATs)

27 The majority of patients triaged were labeled minimal not immediate Immediate13% Delayed13% Minimal64% Expectant 1% Expectant 1%

28 Adequacy of Command and Control Was command and control adequate? Was command and control adequate? Yes 2Yes 2 No13No13 During the deployment the command and control structure: During the deployment the command and control structure: Improved 4Improved 4 Stayed the same 4Stayed the same 4 Worsened 2Worsened 2

29 Number of deployments and perceptions of the adequacy of command and control # of DeploymentsAdequateNotAdequateImprovedWorsenedNoChange >13312 TOTAL213424

30 Challenges of doing research during a disaster Questionnaires Questionnaires What are the important questions to ask?What are the important questions to ask? How do you write a questionnaire that answers important questions without making it long and cumbersome?How do you write a questionnaire that answers important questions without making it long and cumbersome? How can you create reliable and valid instruments?How can you create reliable and valid instruments? How do you minimize bias in the questions you ask and how you ask them?How do you minimize bias in the questions you ask and how you ask them? When should you ask the questions?When should you ask the questions? How do you get a sufficient number of responses?How do you get a sufficient number of responses? What statistical tests are appropriate?What statistical tests are appropriate?

31 Challenges of doing research during a disaster Patient care Patient care How do you do patient care and research at the same time?How do you do patient care and research at the same time? IRB IRB Adequate protection of human subjectsAdequate protection of human subjects Timely approvalTimely approval

32 Suggestions for further research How does triage occur in actual disasters? How does triage occur in actual disasters? How can we incorporate resources and transport into triage models and algorithms? How can we incorporate resources and transport into triage models and algorithms? Does command and control work, and how can it be improved? Does command and control work, and how can it be improved? What is the right stuff that differentiates an effective disaster responder or leader? What is the right stuff that differentiates an effective disaster responder or leader? Do people have the skills and abilities they need to make decisions in the early part of a disaster? Do people have the skills and abilities they need to make decisions in the early part of a disaster?

33 Other suggestions for research?


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