Download 1/4/2013 1 Introduction to Disaster Management

1/4/2013
Introduction to
Disaster Management
National EMS Medical Director’s Course
and Practicum®
Objectives
1.
2.
3.
4.
5.
Definitions
Types
Phases
National Organizations and Structure
Disaster Operations
a. Casualty Collection and Triage
b. Prehospital Care
c. Public health
Definitions
Disaster
A situation in which the severity of damage or the
number of patients exceeds the ability to provide
immediate management
Any event that overwhelms the resources
available at that time in a jurisdiction
“Catestrophic Event”
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Definitions
Disaster
World Health Organization
A sudden ecological phenomenon of sufficient
magnitude to require external assistance
Disrupts regional functions and activities
Affects lives, property, health
Definitions
Disaster
Results in loss of:
Communication
Transportation
Infrastructure
Adequate food and water
Shelter
Sanitary conditions
Propagates:
Disease
Post-traumatic stress
Prolonged suffering
Definitions
Disaster
Classification
a. Open
Occurs over a large geographic area and is usually
natural in origin
b. Closed
Occurs within a small or confined area and is usually
technologic, occurs without warning, and urban
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Definitions
Disaster
Classification
1.
2.
3.
4.
5.
6.
7.
Etiology:
Location:
Occurrence:
Predictability:
Onset:
Duration:
Magnitude:
Natural or Man-made
Single or multiple sites
Single or multiple
Expected, unexpected
Gradual, sudden
Brief, prolonged
Local, State, Federal resources
Definitions
Multiple Casualty Incident
A situation with numerous patients that does not
overwhelm the routine capacity of a system.
Any event that causes a large number of
individuals to become ill or injured.
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Definitions
Terrorism
The unlawful use of force against persons or
property to intimidate or coerce government, the
civilian population, or any segment thereof, in the
furtherance of political or social objectives
Definitions
Weapons of Mass Destruction
Nuclear, biological, or chemical materials,
weapons, or devices deliberately used by
terrorists that produce a nuclear yield or
disseminates significant quantities of biological
or chemical agent over a wide area for purposes
of maiming or killing populations.
Incendiary devices should also be included for
completeness
CBIRN
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Disaster Management
4 Phases of a Disaster:
Mitigation
Preparedness
Response
Recovery
Disaster Management
Mitigation
Pre-event planning and actions which aim to lessen
the effects of potential disaster
Hazards Vulnerability Assessment (HVA) Tool
• Identifies direct and indirect effects of hazards
• Estimates and ranks the probability of occurrence
and potential severity of various events
• Performed every 3 to 5 years
• Required for JCAHO accreditation
Disaster Management
Mitigation
Preparedness
Actions taken before an emergency to prepare the
organization for a response
Examples:
1. Hospital Preparedness Program (ASPR)
2. Metropolitan Medical Response System (MMRS)
3. Emergency System for the Advanced Registration of Volunteer
Health Professionals (ESAR-VIP)
Elements:
Planning
Organizing
Exercising
Evaluating-Improving
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Disaster Management
Mitigation
Preparedness
Response
Activities to address the immediate and short-term
effects of a disaster to save lives, protect property, and
to meet basic needs
Disaster Management
Mitigation
Preparedness
Response
Recovery
Activities that occur following a response designed
to help organizations and communities return to a
pre-disaster lever of function
Disaster Management
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Homeland Security Presidential Directive - 5
Management of Domestic Incidents
February 28, 2003
Policy
To prevent, prepare for, respond to, and recover from
terrorist attacks, major disasters, and other emergencies,
the United States Government shall establish a single,
comprehensive approach to domestic incident
management
Homeland Security Presidential Directive - 5
With regard to domestic incidents, the United States
Government treats crisis management and consequence
management as a single, integrated function, rather than
as two separate functions.
The Secretary shall develop and implement a National
Response Plan that shall integrate Federal Government
domestic prevention, preparedness, response, and
recovery plans into one all-discipline, all-hazards plan
National Response Framework
Replaces National Response Plan
(Dec. 2004; ammended May, 2006)
• Guide to how the Nation conducts
all-hazards response
• Delineates the Nation’s response:
doctrine, responsibilities, and structure
• Guiding principals that enable all agencies to prepare for
and provide a unified national response to disasters
• Establishes comprehensive national, all-hazards
approach to domestic incident response
http://www.fema.gov/emergency/nrf/
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National Response Framework
Components
Core document
Emergency Support Functions (ESF)
Support Annexes
Incident Annexes
Partner Guides
National Response Framework
Core document
Guidelines for:
• National response
• Roles and responsibilities
• Response actions
• Response organizations
Planning requirements to achieve an effective national
response to any incident that occurs
National Response Framework
Core document
Emergency Support Functions (ESF)
Federal resources and capabilities
• Grouped into functional areas frequently needed in a
national response
• Provides concept of operations, procedures, and
structures for achieving response objectives
• Coordinates capabilities and resources provided by
Federal agencies, private-sector, and nongovernmental
organizations
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National Response Framework
Core document
Emergency Support Functions (ESF)
Example:
• State requests assistance with evacuation
• JFO requests staff from ESF-1 (Transportation), ESF-6
(Mass Care, Emergency Assistance, Housing and
Human services), ESF-8 (Public Health and Medical)
• All become integrated into a single branch or group
within Operations Section to ensure effective
coordination of evacuation services
National Response Framework
ESF-1
Transportation
Primary Agency:
Department of Transportation
National Response Framework
ESF-2
Communication
Primary Agency:
Department of Homeland Security
National Communications System
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National Response Framework
ESF-3
Public Works and Engineering
Primary Agency:
Department of Defense
U.S. Army Corps of Engineers
Department of Homeland Security
FEMA
National Response Framework
ESF-4
Firefighting
Primary Agency:
Department of Agriculture
U.S. Forest Service
National Response Framework
ESF-5
Emergency Management
Primary Agency:
Department of Homeland Security
FEMA
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National Response Framework
ESF-6
Mass Care, Emergency Assistance,
& Health and Human Services
Primary Agency:
Department of Homeland Security
FEMA
National Response Framework
ESF-7
Logistics Management & Resource
Support
Primary Agency:
General Services Administration\
Department of Homeland Security
FEMA
National Response Framework
ESF-8
Public Health & Medical Services
Primary Agency:
Department of Health and Human
Services
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National Response Framework
ESF-9
Urban Search & Rescue
Primary Agency:
Department of Homeland Security
FEMA
United States Coast Guard
Department of the Interior
National Park Service
Department of Defense
National Response Framework
ESF-10
Oil & Hazardous Materials
Primary Agency:
Environmental Protection Agency
Department of Homeland Security
United States Coast Guard
National Response Framework
ESF-11
Agriculture & Natural Resources
Primary Agency:
Department of Agriculture
Department of the Interior
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National Response Framework
ESF-12
Energy
Primary Agency:
Department of Energy
National Response Framework
ESF-13
Public Safety & Security
Primary Agency:
Department of Justice
National Response Framework
ESF-14
Long-Term Community Recovery
Primary Agency:
Department of Agriculture
Department of Homeland Security
Department of Housing and Urban
Development
Small Business Administration
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National Response Framework
ESF-15
External Affairs
Primary Agency:
Department of Homeland Security
FEMA
National Response Framework
Core document
Emergency Support Functions (ESF)
Support Annexes
Essential supporting aspects common to all incidents
Financial Management
Volunteer and Donations Management
Private-Sector Coordination
National Response Framework
Core document
Emergency Support Functions (ESF)
Support Annexes
Incident Annexes
Address the unique aspects for response to various
incident categories:
Biological
Nuclear
Radiological
Cyber
Mass Evacuation
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National Response Framework
Core document
Emergency Support Functions (ESF)
Support Annexes
Incident Annexes
Partner Guides
References describing key roles and actions for local,
tribal, State, Federal, and private-sector response partners
National Response Guidelines
• Establishes framework for the Nation to be prepared for
all hazards
• Organizes / synchronizes National preparedness efforts
• Incorporates lessons-learned from previous disasters
• Facilitates capability and risk-based planning process
• Establishes readiness metrics to measure a system’s
preparedness
• 4 critical elements:
National Preparedness Vision
National Planning Scenarios
Universal Task List
Target Capabilities List
National Response Guidelines
National Preparedness Vision
Statement on core preparedness goal for the nation
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National Response Guidelines
National Preparedness Vision
National Planning Scenarios
15 broad range of natural and man-made threats facing
the nation
Guides homeland security planning efforts at all levels
of government and private sector
Basis for national planning, training, investments, and
exercises needed to prepare
National Response Guidelines
National Preparedness Vision
National Planning Scenarios
Universal Task List
1600 unique tasks that prevent, protect against, respond
to, and recover from major events
National Response Guidelines
National Preparedness Vision
National Planning Scenarios
Universal Task List
Target Capabilities List
37 specific capabilities that states and communities and
private sector should collectively develop to effectively
respond
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Homeland Security Exercise
and Evaluation Program
• Exercises based on capabilities and performance
• Sets exercise policy and guidance to achieve national
standards
• Outlines common practices for exercise management,
design, development, conduct, evaluation, and
improvement planning
• Provides tools and resources including policy and
guidance, training, technology, and direct exercise
support
• Web-based toolkit enables implementation of the
corrective action program
National Incident Management System (NIMS)
Establishes a systematic approach for managing incidents
nationwide
Situational Awareness
• Continuous monitoring of relevant sources of
information regarding actual and developing
incidents
National Incident Management System (NIMS)
Establishes a systematic approach for managing incidents
nationwide
Activation / Deploying Resources
•
•
•
•
Assess the situation
Identify and prioritize requirements
Establish incident objectives
Activate available resources and capabilities to save
lives, protect property and the environment, and meet
basic human needs
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National Incident Management System (NIMS)
Establishes a systematic approach for managing incidents
nationwide
Manage Response Actions
• Incident Command System
• Multiagency Coordination Systems
• Public Information
National Incident Management System (NIMS)
Establishes a systematic approach for managing incidents
nationwide
Initialize and Coordinate Response Actions
•
•
•
Activating people, resources, and other capabilities
Requesting additional resources and capabilities
Identifying needs and pre-positioning resources
National Incident Management System (NIMS)
Establishes a systematic approach for managing incidents
nationwide
Demobilization
• Early planning for demobilization facilitates
accountability and makes the logistical management of
resources efficient – in terms of both costs and time of
delivery
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National Incident Management System (NIMS)
Establishes a systematic approach for managing incidents
nationwide
Recovery
• Assisting individuals, households, critical
infrastructure, and business in meeting basic needs
• Providing essential public health and safety services
• Restoring interrupted utility and other essential services
• Reestablishing transportation routes
• Providing food and shelter for those displaced
National Incident Management System (NIMS)
4 levels of training:
•
•
•
•
ICS-100
ICS-200
ICS-300
ICS-400
• ICS-700
• ICS-800
Introduction
Basic
Intermediate
Advanced
National Incident Management System
National Response Framework
www.fema.gov/nims
National Incident Management System (NIMS)
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National Incident Management System (NIMS)
Incident Commander
• Responsible for all incident activities
• Overall authority and responsibility for conducting and
approving incident operations
• Develops strategies and tactics, and sets priorities
• Orders the release of resources
• Ensures incident safety
• Authorizes information released to the media
• Establishes Incident Command System needed to
manage the incident
• Coordinates Command and General Staff activities
National Incident Management System (NIMS)
Command
Staff
National Incident Management System (NIMS)
Command Staff
Safety Officer
Monitors conditions and develops measures for assuring the
safety of all assigned personnel
Public Information Officer
Conduit for information to internal and external stakeholders
Liaison
Primary contact for supporting agencies assisting at an incident
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National Incident Management System (NIMS)
Command
Staff
General
Staff
National Incident Management System (NIMS)
General Staff: Section Chiefs
Operations
Directs all actions to meet incident objectives
Planning
Collects incident information, primarily status of resources and
overall status of the incident
Logistics
Provides all resources, services, and support required by the
incident
Finance / Administrative
Tracks costs, personnel records, requisitions, and administers
procurement contracts
National Incident Management System (NIMS)
Unified Command
Used when incident expands in complexity
• Individuals designated by their jurisdictional or
organizational authorities (or by departments within a
single jurisdiction)
• Develops a single Incident Action Plan
• Executes integrated incident operations and maximizes
the use of assigned resources
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National Incident Management System (NIMS)
Area Command
Structure that oversees the management of multiple
incidents that are each being handled by a separate
command organization
• Only activated if necessary
• Depends on the complexity of the incident and span-ofcontrol considerations
National Incident Management System (NIMS)
Incident Command Post
• Location of Incident Command
• Located near incident site
• All emergency management and response personnel
report to and check in, and receive assignments
National Incident Management System (NIMS)
Emergency Operations Center
• Coordinates information and resources to support
incident management (on-scene operations)
• Located off-site
• Supports on-scene response by relieving the burden of
external coordination and securing additional resources
• Core functions include:
Coordination
Communications
Resource allocation and tracking
Information collection, analysis, and dissemination
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National Incident Management System (NIMS)
Joint Information Center
• Established to coordinate the release of information and
other public affairs functions
• Serves as a focal point for coordinated and timely
release of incident-related information to the public and
the media
• Provides victim and family information in an accessible
format and in appropriate languages
Stafford Act
(Public Law 100-707)
• Mechanism by which the Federal Government provides
support to State, tribal, and local governments
• Primary Federal law to promote planning and response
to a major disaster
• Designed to bring an orderly and systematic means of
Federal natural disaster assistance for State and local
governments in carrying out their responsibilities to aid
citizens
• Creates the system by which a Presidential Disaster
Declaration of an emergency triggers financial and
physical assistance through FEMA
Emergency Management Assistance Compact
• When additional resources are required
• Interstate mutual aid and assistance agreement
• Administered by National Emergency Management
Agency
• Provides form / structure to interstate mutual aid process
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Disaster Resources
National Disaster Medical System
Disaster Medical Assistance Teams (DMATs)
Disaster Mortuary Teams (DMORTs)
Veterinary Medical Assistance Teams (VMATs)
Other Specialty Teams
Disaster Resources
National Disaster Medical System
55 Disaster Medical Assistance Teams
4 National Medical Response Teams
5 Burn Team
2 Pediatric Teams
1 Crush Medicine Team
3 International Medical/Surgical Teams
3 Mental Health Teams
3 Veterinary Medical Assistance Teams
11 Disaster Mortuary Operational Response Teams
1 Joint Management Team
3 Nurse/Pharmacist National Response Teams
Disaster Resources
Disaster Medical Assistance Team
Description
• 35-person volunteer health and medical professionals
• Cadre of logistical and administrative staff
• Federalized to provide medical care during a disaster or
other event
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Disaster Resources
Disaster Medical Assistance Team
Mission
• Rapidly deploy to disaster site
• Provide primary and acute care, triage of mass casualties,
initial resuscitation
• Stabilize and preparation sick or injured patients for
evacuation
Disaster Resources
Disaster Medical Assistance Team
Deployment Criteria
•
•
•
•
Deploy within 6-hrs of activation (14-day deployment)
Emergent care: 30-min of arrival
Operational: 6-hrs of arrival
Sustain 72-hrs without support
Disaster Resources
National Medical Response Team
Description
• 50-person volunteer health, medical, and Haz Mat
• Cadre of logistical and administrative staff
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Disaster Resources
National Medical Response Team
Mission
• Rapidly deploy to a disaster site
• Physician-supervised:
Advanced medical services
Decontamination
Agent detection
Assist in hazardous material environments
Disaster Resources
National Medical Response Team
Deployment Criteria
• Deploy within 4-hrs of activation (14-day deployment)
• Fly / drive capability
• Operational: 30-min of arrival
Disaster
Operations
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Disaster Operations
Scene Mitigation - Situational Awareness
1. Evaluate current response configuration
a. Law enforcement
b. Fire
c. Medical (EMS, Public Health, Hospitals)
2. Augmentation for a contaminated incident
a. Activation of the EOC
b. Public health notification
c. Mutual Aid support
Disaster Operations
Scene Mitigation - Situational Awareness
3. Considerations
a. Activation protocols for a terrorist incident
response
b. Scene security and crowd control
c. Establishing incident command
d. Designating contamination zones
e. Patient extrication
Disaster Operations
Scene Mitigation - Situational Awareness
3. Considerations
f. Establishing zones or sectors:
i.
ii.
iii.
iv.
v.
Casualty collection
Decontamination (if applicable)
Triage
Treatment
Transportation
g. Controlling inbound resources and staging
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Disaster Operations
Casualty Collection
1. Rapid scene assessment
a. Evaluate for casualty-causing risks
b. Secondary devices
c. Signs of haz mat exposure
2. Designating contamination zones
3. Search and Rescue
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Disaster Operations
Casualty Collection
4. Rapid categorization for mass casualties
a. Ambulatory
b. Nonambulatory
Disaster Operations
Casualty Collection
4. Rapid categorization for mass casualties
a. Ambulatory
b. Nonambulatory
Remember:
Hearing impairment following explosions is
common, may lead to incorrect triage
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Disaster Operations
Triage
1. Initial triage methods
Various systems:
• METTAG
• START
Disaster Operations
Triage
2. Initial assessment
a. Ambulatory vs nonambulatory
b. Suspect multiple mechanisms of injury
c. Similar symptoms or signs?
d. Consider occult blast injuries
Disaster Operations
Triage
3. Categorize
a. Non-moving:
b. Non-ambulatory:
c. Ambulatory:
d. Obvious death:
Immediate or Expectant
Immediate or Delayed
Delayed or Minimal
Expectant
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Disaster Operations
Triage
3. Categorize
Immediate / Red
Severe, may be life-threatening
High likelihood of survival
Mechanical airway obstruction
Sucking chest wounds
Tension pneumothorax
Exsanguinating hemorrhage
Incomplete amputations
Disaster Operations
Triage
3. Categorize
Can tolerate delay prior to intervention
Stable abdominal wounds
Soft tissue wounds requiring debridement
Crush injuries
Traumatic amputation with controlled bleeding
Immobilized cervical-spine injuries
Major orthopaedic injuries
Most eye injuries
Disaster Operations
Triage
3. Categorize
Minimal / Green
Requires little more than first aid
Should be triaged to secondary treatment area
Superficial fragment wounds
Closed fractures
Minor burns (< 15% TBSA)
Auditory blast injury
Psychiatric / emotional disorders
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Disaster Operations
Triage
3. Categorize
Expectant / Black
Requires unjustifiable expenditure of limited resources
Unresponsive with open head wounds
High spinal cord injuries
Mutilating explosive wounds
Second, third degree burns (> 60% TBSA)
Profound shock with multiple injuries
Agonal respirations
Disaster Operations
Decontamination
1. How “good are we” in understanding decon ?
a. What do we know …
b. Are models in place (contamination &
decontamination) …
c. Are standards developed …
d. How clean do we want …
e. What are the personnel / PPE issues …
Disaster Operations
Decontamination
2. Types
a. Gross decontamination
The process of quickly removing potentially harmful
contaminants from exposed individuals in order to
reduce the spread and amount of contamination
absorbed by an individual
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Disaster Operations
Decontamination
2. Types
a. Gross decontamination
i. Powder:
Brush or vacuum material off
Routine decontamination
ii. Vapor and liquid :
Routine decontamination
“Routine decontamination”
The quickest and most effective procedure…
Disaster Operations
Decontamination
2. Types
a. Gross decontamination
Undress
Lots of water
Disaster Operations
Decontamination
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Disaster Operations
Decontamination
Disaster Operations
Decontamination
Disaster Operations
Decontamination
2. Types
b. Technical decontamination
Ambulatory versus nonambulatory
Gender specific
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Disaster Operations
Decontamination
2. Types
b. Technical decontamination
Ambulatory
Disaster Operations
Decontamination
2. Types
b. Technical decontamination
Nonambulatory
Disaster Operations
Decontamination
3.
a.
b.
c.
d.
Deceased
Crime scene preservation
Minimal disruption is important
Deceased patients may contain valuable evidence
Do not move remains or alter surroundings
until
cleared to do so by Incident Command
e. Deceased must be decontaminated
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Disaster Operations
Prehospital Care
1.
2.
3.
4.
5.
6.
Incident Command System (ICS)
Triage
Treatment
Transportation
Personnel and equipment
Communications (internal and external)
Disaster Operations
Prehospital Care
1. Incident Command System (ICS)
Disaster Operations
Prehospital Care
2. Triage
a. Personnel
b. Interventions
c. Initial categorization likely to change
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Disaster Operations
Prehospital Care
3. Treatment
a. Interventions
i. Delayed signs or symptoms
Disaster Operations
Prehospital Care
4. Transportation
a. Entrance and egress routes
b. Staff
c. Record keeping and information
i. Agency transporting
ii. Patient name or identifier
iii. Decontamination status
iv. Time of departure
v. Destination
d. Hospital communications
Disaster Operations
Prehospital Care
5. Personnel and equipment
a. Internal personnel for disaster operations
b. External mutual aid personnel for routine
i. Protocols
ii. State reciprocity
iii. Scope of practice
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Disaster Operations
Hospital Care
1. ED Disaster Plan
2. Hospital Disaster Plan
Disaster Operations
Public Health
1. Hospital surge capacity
Health care system’s ability to expand quickly beyond
normal services to meet an increased demand for
medical care.
2003:
113.9 million ED visits
(26% increase from 90.3 million visits in 1990’s)
1990s:
Number of U.S. EDs decreased 14%
Lost 103,000 staffed medical-surgical beds
Lost 7,800 ICU beds
Disaster Operations
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Disaster Operations
Public Health
1. Hospital surge capacity
Reductions in hospitals with EDs
Regionalization of surgical care
Increases in non-emergency patient visits to EDs
Diversion of EMS
Personnel shortages
ED Overcrowding
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Equipment
Equipment
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Environmental
Environmental
Medications
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Beds
Physicians and Nurses
Allied Health
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Dietary
Disaster Operations
Public Health
1. Hospital surge capacity
2. Alternate care facilities
Disaster Operations
Historical
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Disaster Operations
Historical
Disaster Operations
Historical
1906
San Francisco Earthquake
Disaster Operations
Historical
1918
Great Flu Pandemic
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Disaster Operations
Historical
1950-1972: Packaged Disaster Hospitals (2500)
Disaster Operations
Historical
1950-1972: Packaged Disaster Hospitals (2500)
200 bed mobile hospitals
Equipped with supplies for 30 days
15,000 square feet
15 KW generator
1,500 gal ion water tank
Laboratory
Pharmacy
X-Ray
Operating rooms
Patient wards
Admitting and sorting
Central supply
Disaster Operations
Historical
1950-1972: Packaged Disaster Hospitals (2500)
Staffing:
10 physicians
4 administrators
34 nurses
18 practical nurses
6 anesthetists
2 pharmacists
128 medical aides
124 other personnel
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Disaster Operations
Historical
1990s:
US Army Soldiers and Biological Chemical
Command and the Domestic Preparedness
Program
• Acute Care Center
Inpatient treatment without mechanical
ventilation or likely to die
• Neighborhood Emergency Health Center
High volume casualty reception center,
triage, meds, information
• Modular Emergency Medical System
Disaster Operations
Historical
2005:
Hurricane Katrina
Disaster Operations
Issues
No single model exists
Various thoughts and standards
Limited guidance
Low probability events
Limited funds to procure, plan, or exercise
Required for The Joint Commission accreditation
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Disaster Operations
Types
1. Surge hospitals:
Facilities designed to supplement existing hospitals in
the case of an emergency
Disaster Operations
Types
1. Surge hospitals
a. Facilities of opportunity
Nonmedical buildings that can be adapted
Veterinary hospitals
Day surgery centers
Convention centers
High schools
Warehouses
Airport hangars
Hotels
Disaster Operations
Types
1. Surge hospitals
a. Facilities of opportunity
Pros
May be proximate to existing health care facilities
Environmentally sound
Utilities exist
Cons
Requires movement of equipment and supplies
No medical infrastructure
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Disaster Operations
Types
1. Surge hospitals
b. Mobile medical facilities
Structures that can be mobilized to any location
Tents
Tractor trailers
Limited service trailers
Disaster Operations
Types
1. Surge hospitals
b. Mobile medical facilities
Modular, fully-equipped, self-contained
ASSTC (Advanced Surgical Suite for Trauma Casualties)
Disaster Operations
Types
1. Surge hospitals
b. Mobile medical facilities
NC State Medical Assistance Team (SMAT)
Western Shelters
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Disaster Operations
Types
1. Surge hospitals
b. Mobile medical facilities
Pros
May be proximate to existing health care facilities
Provides infield emergent care
Mobile, lightweight
Cons
Requires team familiar to set up
Limited capability
Cost
Disaster Operations
Types
2. Surge in place:
Capability to expand the surge capacity
of a functioning health care facility
Disaster Operations
Types
2. Surge in place:
a. Closed wards
b. Hospital campus buildings
c. Shuttered hospital
Pros
Health care environment
Space & ancillary services should be present or proximate
Cons
May be environmentally unsound
Many infrastructure systems or utilities may be damaged
and unrecognized
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Mecklenburg County Jail
Carolinas Medical Center
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Mecklenburg County Jail
Weekender Pod
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Disaster Operations
Planning
Not just the number of beds……
Ability to handle a public health emergency
Staffing
Equipment resources
Supplies and pharmaceuticals
Ancillary services
Requires connectivity to community leaders and planning
organizations to ensure compatibility with community
thinking, expectations, and initiatives
Where to begin…..
Disaster Operations
Planning
Matrix tool for appropriate site selection
Characteristics are assigned a weighted score of 0-5
www.ahrq.gov/research/altsites.htm
5 = Equal to or same as a hospital
4 = Similar to that of a hospital, but has minor limitations
3 = Similar to that of a hospital, but has major limitations
2 = Not similar to that of a hospital; requires minor modifications
1 = Not similar to that of a hospital, requires major modifications
0 = Does not exist in this facility or is not applicable to this the event
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Disaster Operations
Planning
Staffing
1. Existing pool
Some may require alternative scope of practice
Reallocating nonemergency providers into emergency roles
2. Retired or unemployed volunteers
Medical Reserve Corps Red Cross, AmeriCorps, SeniorCorps
3. Reserve military medical personnel
4. Others
Veterinarians, Dentists and assistants, pharmacists, students
Federal: NDMS (7000) and USPHS (6000)
Disaster Operations
Planning
Supplies and Equipment
1. Federal
Strategic National Stockpile, ASPR
2. Local donated materials
Physician practices, medical schools, medical supply houses
Pharmaceuticals
1. Federal
Strategic National Stockpile, ASPR
2. Local donated materials
Retail pharmacies, pharmaceutical distributers
Disaster Operations
Planning
Administration
Local, State, Federal
Communication
Typically the weakest link
Sporadic cellular access
EMS communications may be problematic
Solutions may include:
Telephone systems
2-way radios
Satellite communications
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Disaster Operations
Planning
Patient care
Care in surge facility may not sustain high levels seen
in fixed facilities
May only reach “sufficiency of care”
Limited privacy
Crowded conditions
Limited access to medical records
Inadequate testing
Goal is to treat each patient, then transfer to a facility
with full capability at an ideal level of care
Disaster Operations
Planning
Legal
During disasters, State and Federal Governments have
mechanisms for the law to be changed to provide
liability protection
Katrina: Gov. Blanco waived State of LA licensing
restrictions
US Dept. of HHS afforded liability protection
to volunteer health care workers treating
hurricane victims
ESARVHP: (Emergency System for Advanced
Registration of Volunteer Health
Professionals)
Disaster Operations
Planning
Legal
During disasters, State and Federal Governments have
mechanisms for the law to be changed to provide
liability protection
EMTALA and HIPAA typically waived
Transfer may be most expedient action
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Disaster Operations
Public Health
1. Hospital surge capacity
2. Alternate care facilities
3. Notification algorithms
a. Local
b. State
c. Federal
Disaster Operations
Public Health
1.
2.
3.
4.
Hospital surge capacity
Alternate care facilities
Notification algorithms
Resources
Strategic National Stockpile (SNS)
a. National repository of pharmaceuticals and medical
materials delivered to a site to support local
resources
b. Contains antibiotics, antidotes, other
pharmaceuticals, and medical / surgical supplies
Disaster Operations
Public Health
1.
2.
3.
4.
Hospital surge capacity
Alternate care facilities
Notification algorithms
Resources
Strategic National Stockpile (SNS)
c. Request procedures
i.
ii.
Local and State channels to Federal (CDC) resources
Each state must establish procedures
d. Logistics on arrival (LRS)
i. Equipment and supplies
ii. Location
iii. Personnel
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Disaster Operations
Disaster Operations
Public Health
1.
2.
3.
4.
5.
Hospital surge capacity
Alternate care facilities
Notification algorithms
Resources
Surveillance
a. Fundamental responsibility of Public Health
b. Increased need to continuously monitor community
health and provide early warning of any change in
health indicators
c. Characteristics:
i.
ii.
Community-wide
Multiple indicators
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“It is not a question of IF
it will happen.
It is a question of WHEN
it will happen,”
AGAIN ?
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