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Unformatted text preview: Mass Casualties and Incident Mass Casualties and Incident Command System
Elizabeth Bridges, PhD RN CCNS Assistant Professor Biobehavioral Nursing and Health Systems University of Washington School of Nursing Planning for an Emergency Planning for an Emergency ≠ Planning for a Disaster “Good disaster management is not merely an extension of everyday emergency procedures. It is more than just the mobilization of additional personnel, facilities and supplies. Disasters often pose unique problems rarely faced in daily emergencies.” Auf der Heide E. Disaster Response http://coedmha.org National Incident Management National Incident Management System (NIMS) Developed by Homeland Security (Mar 04) Core set of principles, doctrines, terminology and organizational processes to enable effective, efficient, and collaborative incident command Incident Command System Multiagency coordinating systems Public information systems HSPD5 states that: "Beginning in Fiscal Year 2005, Federal departments and agencies shall make adoption of the NIMS a requirement, to the extent permitted by law, for providing Federal preparedness assistance through grants, contracts, or other activities. Hospital Emergency Incident Hospital Emergency Incident Command System (HEICS)
An emergency management system Logical management structure Defined responsibilities Clear reporting channels A common nomenclature to help unify hospitals with other emergency responders http://www.fema.gov/nims/ Hospital Emergency Incident Command System http://www.emsa.ca.gov/dms2/heics3.htm St Vincent’s Medical Center St Vincent’s Medical Center September 11, 2001 Kirschenbaum, CCM 2005 Job Action Sheets Job Action Sheets Job Action Sheets Job Action Sheets Nursing Unit Response Nursing Unit Response Activate unit recall roster Unit specific information Number of patients who can be discharged or transferred
Procedure for discharge/transfer Agreements with other facilities to accept patients Method/route to transport patients Staff on duty/available What care/procedures can be delayed? Number of ambulatory patients Oxygen/monitordependent patients Lifesupport requirements HEICS Activation: SARS HEICS Activation: SARS Tsai, MC, et al. J Emerg Med 2005, 28(2), 185196 Job Sheet: Infection Control Officer Job Sheet: Infection Control Officer Tsai, MC, et al. J Emerg Med 2005, 28(2), 185196 Disaster plans are an illusion of preparation unless accompanied by training “PaperPlan Syndrome” Make sure key personnel KNOW/PERFORM their roles Do not focus solely on patient treatment Test patient tracking/documentation Practice interorganizational agreements Resource (time/money) the training plan Involve all key personnel (e.g., nurse managers, public affairs, engineers, nutritional medicine, security) Practice, Practice, Practice!!! Hospital Drills Hospital Drills *Disaster Drills based on material from Col Boaz Tadmor MD and Maj Israel Hendler MD, Medical Department, Home Front Command, Israeli Defense Force Hospital Drills Hospital Drills
Year 1: Military Scenarios Chemical warfare Hospital under a chemical cloud Earthquake Secondary evacuation of casualties Known Scenario & Date Year 2: Peacetime Scenarios HAZMAT MIC Chemical terrorism Conventional mass casualty Radiation accident Unknown Scenario & Date Year 3 Scenario based on hospital performance in previous drills Leadership Drills Preparation for a Drill Preparation for a Drill
Weeks in Advance 52 Activity Select date of drill Determine type of drill Coordinate “casualties”/supporting organizations Review hospital disaster response plan Approve hospital disaster response plan Coordination meeting – all key players Alert supporting organization Coordination meeting #2 – all key players Meet with supporting organizations Identify evaluation team inspectors Coordination meeting #3 (regional response) Supplement equipment needed for drill Lectures for hospital personnel 18 16 12 8 6 4 Preparation for Drill (con’t) Preparation for Drill (con’t)
Weeks in Advance 3 Activity Leadership – table top drill Present planned drill to medical treatment center executive Tour hospital site Fine tuning Last chance for improvement Predrill guidance for the integrated medical team 2 1 DDay Postdrill After action analysis Implementation/Changes based on lessons learned Example: HAZMAT Scenario Example: HAZMAT Scenario Aerosolizing plane crashes near population center Hospital notified to expect conventional casualties Hospital personnel must detect/diagnose probable chemical exposure (e.g., malathion) Hospital converts to chemical casualty (HAZMAT) response Evaluation Criteria Evaluation Criteria Transition from routine daily response to a masscasualty incident? Transition from conventional to HAZMAT phase Staff knowledge/performance of roles and care requirements A plan for secondary triage Administration & Management Evaluation Criteria Evaluation Criteria Inhospital communication/public information Resource utilization Information gathering and processing Decision making Coordination Medical Management External collaboration Manpower Equipment Blood supply Operating rooms First responders Security Governmental agencies/NGOs Lessons Learned Lessons Learned Early identification of masscasualty incident Early identification/communication of HAZMAT condition Medical information Inadequate transfer of relevant medical information Intubation point Underutilization of intubation point Inefficient artificial ventilation during transportation Disregarding synergistic effects of combined injuries Underdecontamination Insufficient pediatric resources Lessons Learned Control & Coordination
Difficult to communicate/coordinate Megaphones/flags/signs in protective attire Difficult to perform realtime assessment of dynamic activities Need to maintain law & order in facility Medical charting Maintain patient privacy Collaborate with firstresponders Realtime ? Intranet Police reinforcement Private security Different color for each status Different color for each status Benefits Benefits Collective memory and confidence in how to respond Decrease staff fear and anxiety Implement and practice the use of simple criteria and procedures for assessment, diagnosis, and treatment Other Lessons Other Lessons Training will help bring order to a masscasualty incident Training must include Tasks should parallel normal daily activities Avoid activities you have not trained for Secure/clearly identify triage areas Standardize/practice triage method Use of personal protective equipment Patient decontamination Antidote therapy (as appropriate) Handson and tabletop exercises Other Lessons Other Lessons Plan for medical needs of unaffected population Rotate staff Train frequently Train on realistic scenarios Use Crisis Intervention Teams Plan for simultaneous performance of procedures •Anteau CM, Williams LA. Crit Care Nurs Clin North Am 1997, 9(2):231 6 •Auf der Heide E. Disaster Response. http://coedmha.org •Auf der Heide, E. Emerg Med Clin NA, 1996, 14(2), 45380 •CDC. Bioterrorism Readiness Plan. http://www.cdc.gov/ncidod/dhqp/pdf/bt/13apr99APIC CDCBioterrorism.PDF •deBoisblanc, BP. Black Hawk: Please Come Down. Am J Resp Crit Care, 2005, 172, 123940 •Disaster Psychiatry. http://www.psych.org/disasterpsych/ •Hospital Emergency Command System (HEICS) http://www.emsa.ca.gov/dms2/download.htm •Hospital Preparedness for Mass Casualties. http://www.mipt.org/pdf/aha082000062001.pdf •JCAHO Perspectives. Special Issue: Emergency Management in the New Millennium http://www.jcrinc.com/subscribers/printview.asp?durki=1122 •Jurkovich, T. September 11th – The Pentagon Disaster: Response and Lessons Learned, Crit Care Nurs Clin North Am, 2003, 15(2): 143148 •OSHA Best Practices for HospitalBased First Receivers of Victims (Jan 2005) http://www.osha.gov/dts/osta/bestpractices/firstreceivers_hospital.html Walden J, Kaplan EH. Estimating time and size of bioterror attack. Emerg Infect Dis [serial on the Internet]. 2004 Jul [date cited]. http://www.cdc.gov/ncidod/EID/vol10no7/030632.htm . ...
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