GETTING DOCS into the DISASTER PREPAREDNESS LOOP Joanne Selkurt MD, FAAP.

GETTING DOCS into the

DISASTER PREPAREDNESS

LOOPJoanne Selkurt MD, FAAP

Introduction

The Reality:

September 11, 2001

“9 - 11”

“All-Hazards”Man-made

• Fires

• Explosive devices

• Firearms

• Structural collapse

• Transportation event– Air, Rail, Roadway, Water

• Industrial HAZMAT

• WMD – NBC events

• Etc…

Natural

• Earthquake

• Landslides

• Avalanche

• Volcano

• Tornado

• Hurricanes, floods

• Fires

• Meteors

• Etc…

Are We Prepared?• Is the US healthcare system prepared?• We appear to be… each Hospital, EMS agency, Law

enforcement agency, Fire department, and Community has…

… a disaster plan

… properly documented drills

… annual training documented

• But...

Are We Prepared?

• KATRINA

Are We Prepared?

• Interagency communication failures!

• Why do we all treat a cardiac arrest the same?

• …because there is an agreed-upon approach.

Are We Prepared?

• Critical to healthcare preparedness – uniform– coordinated approach – mass casualty management from any cause

• NEED: A nationally standardized training program

Course Description BDLS

– Didactic - 8 hours

– Distance learning option

– For healthcare providers

• Physicians, Nurses, Paramedics, EMTs

• Mid-level providers, Allied health, Public health

– Provider status & course credit awarded

• Course completion

• Written examination passage– BDLS providers are eligible to take ADLS

BDLS Course Outline

• Overview & Concept• DISASTER Paradigm• Natural Disasters • Explosive & Traumatic• Nuclear & Radiological• Biological Agents• Chemical Agents• Psychosocial Aspects• Public Health System

• Examination• Course evaluations

Course Description

ADLS• 16 hour class (8-didactic, 8-practical)• Advanced practicum “hands on” course • Meets Hazmat Operations-level training

requirement (CFR 1910.120)• Must have completed

BDLS course• Provider status &

course credit awarded

ADLS Course Outline

Day-One:Classroom & Interactive:• DISASTER Paradigm• Casualty Decontamination• Legal Issues• Media & Communications• Community and Hospital Disaster

Planning• Community, State and Federal

Resources• Mass Fatality Management

Day-Two:

Skills Lab “hands on”

• MASS Triage

• Clinical Scenarios

• Human simulator use

• Disaster Skills

• Personal Protective Equip

• Decontamination

What is a “Disaster”?

• Disaster- dis·as·ter n.

a. An occurrence causing widespread destruction and distress; a catastrophe.

b. A grave misfortune.

c. Informal- A total failure

“Disaster” Definition• A disaster is present when need exceeds resources!

Disaster = Need > Resources

• A response need that is greater than the response available!

Mass Casualty Incident (MCI)

• “Is this an MCI ?”

• The first step in identifying an MCI is knowing your own capabilities.

• Any incident that exceeds the responder’s or receiving hospital’s capability to treat or transport is a Mass Casualty Incident

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

D: Detection

I: Incident Command

S: Safety & Security

A: Assess Hazards

S: Support

T: Triage & Treatment

E: Evacuation

R: Recovery

D-I-S-A-S-T-E-R Paradigm Incident Command

Incident Command System (ICS)• Born in Fire Service

– Managing wildfires in early 1970’s

– Interagency task force collaborative effort

• Uniform structure• Clearly delineated roles/responsibilities• Clear chain of command/ communication

Incident Command System

The Basics

Unified CommandUnified Command

PlanningPlanning OperationsOperations FinanceFinanceLogisticsLogistics

““Commander”Commander”

““Thinkers”Thinkers” ““Getters”Getters” ““Doers”Doers” ““Payers”Payers”

Incident Command System Operations

M edical Direction Com m unications

Triage Treatm ent Transportation Extrication/Rescue Staging

EM S Operations Fire Operations LE Operations

Surveillance

Clinic 1 Clinic 2 Clinic 3

Im m unizationClinics

Public Health

OPERATIONS

D-I-S-A-S-T-E-R ParadigmAssess Hazards

• Be Aware of Secondary Devices!– Bombs, Shrapnel devices, Incapacitating Devices, Multiple

Snipers/Terrorists, Delay Devices

D-I-S-A-S-T-E-R ParadigmAssess Hazards

• Be Aware of Secondary Devices!– Bombs, Shrapnel devices, Incapacitating Devices, Multiple

Snipers/Terrorists, Delay Devices

D-I-S-A-S-T-E-R ParadigmSupport

Unexpected Volunteers and Donations:

• Positive intentions, often negative impact

• Does your preparedness plan include them?– ICS, Identify needed skills and needed supplies

• Negatives:– Time to sort large, poorly labeled goods

– Storage space used

– Unplanned personnel are a liability

– At risk of injuries, require food, water and shelter

VolunteersNeed to Address…

Licensure in state Credentialing for specific responder organization

“Just-in-Time” Training Management: logistics, supervision, transportation,

medical & other care needs

Well-Meaning Volunteers Can… Overwhelm, Interfere, Confuse, Burden & Even Endanger themselves and others

•Best if a member of a recognized, organized response team that has been invited in

•DON’T JUST SHOW UP !!

M.A.S.S. Triage

M – MoveA – AssessS – SortS – Send

• M.A.S.S. Triage is a disaster triage system that utilizes US military triage categories with a proven means of handling large numbers of casualties in a mass casualty incident (MCI).

“ID-me”!

I – Immediate

D – Delayed

M - Minimal

E – Expectant

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.I –Immediate

D – Delayed

M - Minimal

E – Expectant

D - DEAD 

• M – Minimal

• D –Delayed

• I – Immediate

• E – Expectant

• D - Dead

Tips for talking to children after a disaster• Provide opportunities to talk about what they are

seeing on television and to ask ?• Don’t be afraid to admit you don’t know all the answers• Answer ? At a level the child can understand• Establish a family emergency plan (Sense of doing

something is helpful)• Monitor children’s TV watching..don’t need to see

event over & over) Watch with children• Help kids to understand there are no bad emotions• Try to not focus on blame• In addition to tragic things seen, also help kids focus

on good things such as heroic actions, reuniting of families, assistance offered by people throughout the world

For children closer to disaster• Disasters often reawaken a child’s fear of loss of

own parents when parents are preoccupied with own fears … consider family counseling

• Families may permit some regressive behavior weaning off by leaving bedroom door open, night lights, extra time with parents

• Parents may have trouble leaving child after a disaster,,,may be able to use child’s problem as a way of asking for help themselves

• Get the children into some sense of routine of school and play even if displaced

• Teachers can help kids with art, and play activities, encouraging group discussions and presentations about the disaster

For more information on

children & disasters:•Child Health Alliance of

Wisconsin (CHAW)www.chawisconsin.orgClick ProgramsClick Trauma preparedness

A

A stuffed animal can help a lot