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This caused the development of SEMS which is the management

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This caused the development of SEMS which is the management tool we use in California for disaster management and NIMS was modeled after this. – PowerPoint PPT presentation

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Title: This caused the development of SEMS which is the management


1
DISASTER PREPAREDNESS FOR HEALTHCARE PROVIDERS
  • California Preparedness Education Network
  • Revised January 2008
  • Funded by ASPR Grant T01HP01405

2
Outline
  • What is a disaster?
  • Disaster response locally and nationally
  • NIMS training
  • ICS 100
  • Institutional disaster preparedness
  • Triage
  • Resources

3
WHAT IS A DISASTER?
4
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5
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6
WHAT IS A DISASTER?
  • Websters def any happening that causes great
    harm or damage calamity.
  • Practical def any situation where the numbers of
    patients or severity of illness exceeds the
    ability of the facility or system to care for
    them, requiring external assistance.

7
Disaster Events All Hazards
Earthquakes Emerging infections Fires
Floods Hurricanes Hazardous Materials Mudslides R
iots Terrorism (CBRNE) Transportation Tsunamis Vol
canoes
8
ALL HAZARDS APPROACH
  • Principles of preparation for human-made or
    natural disasters overlap with those of dealing
    with a chemical or biological event.

9
COMMON ASSUMPTIONS IN HEALTHCARE DISASTER
PREPAREDNESS
  • The response will be clear and coordinated (I
    dont need NIMS and ICS)
  • We will meet the needs of our patients by just
    focusing on patient care
  • If we just worry about our facility, we will be
    OK
  • There is no need to understand the public health
    response since we are the medical response

FALSE!
FALSE!
FALSE!
FALSE!
10
AUM SHINRIKIYO Shoko Asahara
11
TOKYO MARCH, 1995
12
LESSONS FROM TOKYO
  • Coordinated terrorist attack on 5 subway cars
    with sarin gas
  • 12 persons killed, more than 5,500 affected
  • 641 seen in nearest ER
  • Most were walk-ins
  • 2 deaths, 4 severe cases, 107 moderate cases
  • Ann Emerg Med 1996 28 129

13
PUBLIC HEALTH EMERGENCY
  • We will often be the first presenting facility,
    regardless of facility
  • We can become the disaster
  • We may go to the disaster
  • Facilities are likely to be overwhelmed and
    communication with local response teams essential
  • We are accustomed to outside coordination and
    internal emergency response

14
DISASTER RESPONSE
15
CALIFORNIA IS A NATIONAL MODEL
  • We have disasters (lead the nation)
  • All disasters are local mantra has been adopted
    nationally
  • Standardized Emergency Management System (SEMS)
    is California creation the led to
  • National Incident Management System (NIMS)

16
WHAT IS NIMS?
  • Standardized system for managing disasters within
    from the local to federal level
  • Structured to aid local authorities with mutual
    aid and resource assistance
  • Local governments (agencies), states, and federal
    agencies use NIMS

17
NIMS ELEMENTS
  • Command and Management
  • Preparedness
  • Resource Management
  • Communications

18
NIMS ELEMENTS
  • Command and Management
  • Incident Command
  • Operational area (local) approach
  • Use of Incident Command System (ICS) at all
    levels
  • Multi-organization coordination
  • Public Information Systems

19
OPERATIONAL AREA CONCEPT Chain of Command
  • Federal
  • State
  • Region
  • County
  • Local Govt
  • Field

20
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21
INCIDENT COMMAND SYSTEM Purposes
  • Using management best practices, ICS helps to
    ensure
  • The safety of responders and others
  • The achievement of tactical objectives
  • The efficient use of resources

22
ICS Requirements
  • ICS is a key feature of NIMS and thus is a
    requirement for all state, county, and local
    officials and employees
  • May be used for events, disasters, terrorism, or
    other large scale responses
  • Represents best practices across country

23
Basic Features of ICS (1)
  • Common terminology
  • Modular organization
  • Management by objectives
  • Reliance on Incident action plan
  • Chain of command unity of command
  • Unified command
  • Manageable span of control

24
Basic Features of ICS (2)
  • Manageable span of control
  • Predesignated locations and facilities
  • Resource management
  • Information intelligence management
  • Integrated communications
  • Accountability
  • Mobilization

25
IC and Command Staff
  • IC Provides overall leadership for response and
    delegates authority
  • May have a command staff to include
  • Public Information officer
  • Functions
  • Liaison officer
  • Functions
  • Safety officer
  • Functions

Incident Commander
Public Information Officer
Liaison Officer
Safety Officer
26
INCIDENT COMMAND SYSTEM AT A GLANCE
  • Incident Command Leads the response, appoints
    team leaders sets tone and standards for
    response
  • Operation Section Handles key tactical actions
    including casualty care, search and rescue, fire
    suppression, securing the site
  • Planning Section Gathers information, thinks
    ahead and keeps all team members informed and
    communicating
  • Logistics Section Finds, distributes, and stores
    all necessary resources (supplies and people)
  • Finance/Administration Section Tracks all
    expenses, claims and activities and is the record
    keeper for the incident.

27
ICS Facilities
  • Incident command post
  • Staging area
  • Base
  • Camps
  • Helibase/Helispots

28
Incident command post
  • Site where commander oversees all operations
  • May change locations
  • Includes vehicle, trailer, tent or building
  • Located outside of the present hazard zone but
    close enough to maintain command

29
Staging area
S
  • Location where personnel and equipment are kept
    while waiting
  • Close enough to response for timely delivery
  • Many locations possible

30
Base
  • Location of primary logistics and administrative
    functions
  • Only one base per incident, may be located in the
    IC Post
  • Managed by logistics section

B
31
Camps
C
  • Place where resources are kept for incident
    operations if not at Base
  • Usually the location where housing, staff, food,
    and sanitary services are kept

32
Helibase
H
  • Location from which helicopters may be parked,
    maintained, fueled loaded

33
Helispots
H-3
  • Temporary locations where helicopters can
    safely land, load, unload and take off

34
Common Responsibilities
  • Mobilization
  • Responsibilities of the incident
  • Accountability responsibilities
  • Demobilization responsibilities

35
Mobilization Responsibilities
  • Only mobilize to an incident when requested or
    dispatched by an appropriate authority
  • You must make sure you receive a complete
    deployment briefing
  • Incident reporting locations
  • Assignment
  • Reporting time
  • Communications instructions
  • Support requirements
  • Travel arrangements

36
Incident Responsibilities
  • Check in as directed
  • Obtain initial Incident Briefing
  • Maintain accurate Incident Records
  • Supervisor actions
  • Maintain a Unit Log for your team
  • Provide briefings to subordinates, adjacent
    units/facilities, and replacement personnel

37
Accountability
  • Maintain chain and unity of command
  • Communicate hazards and changing conditions
  • Act professionally, even when on down time

38
Demobilization
  • Complete all work assignments documentation
  • Brief replacements, subordinates, and supervisors
  • Evaluate performance of subordinates
  • Check out using prescribed process
  • Return any issued equipment
  • Upon arrival at home, notify your facility

39
NIMS ELEMENTS
  • Preparedness
  • Planning
  • Exercises
  • Training
  • Personal Certification (ICS 100/700)
  • Equipment allocation and certification
  • Mutual aid

40
NIMS ELEMENTS
  • Resource management
  • Tracking and following of resources from federal
    to local level during response
  • Tracking will allow utilization of resources in
    best manner

41
NIMS ELEMENTS
  • Communications
  • Incident management commands communication
    response
  • Information management is managed over local to
    federal response
  • Equipment
  • Personnel
  • Technologies

42
Why does NIMS matter to me?
  • If I work in a clinic or hospital, why would I
    need this?

43
GETTING PREPARED
44
BASICS OF DISASTER PREPAREDNESS
  • Clinics and Hospitals must have a written
    disaster plan
  • (CA Code of Regulations Title 22, Div 5,
    Section 78423)
  • Joint Commission requirement of healthcare
    facilities
  • Must define community, including risk and special
    needs populations
  • Must have goals, objectives with planning
  • Need plan
  • Must have someone in charge of plan
  • Must train, exercise, and have after action of
    plan

45
BASICS OF DISASTER PREPAREDNESS
  • Four phases of disaster response
  • Mitigation
  • Preparedness
  • Response
  • Recovery

46
BASICS OF DISASTER PREPAREDNESS HAZARD MITIGATION
  • Risk assessment
  • Potential for natural disasters
  • (e.g., earthquakes, fires, avalanches)
  • Potential for man-made disasters
  • (e.g., chemical plants, nuclear facilities)
  • Portals of entry
  • (e.g., airports, populations in your community)
  • Terrorist threats difficult to assess all
    communities are at risk

47
BASICS OF DISASTER PREPAREDNESS HAZARD MITIGATION
  • Capabilities / capacity evaluation
  • Available resources
  • (e.g., drugs, beds, ventilators, surgical equip)
  • Staff
  • (e.g., physicians, PAs, nurses, nonmedical)
  • Physical limitations
  • (e.g., size, location, isolation/decon
    facilities)
  • Vulnerabilities

48
BASICS OF DISASTER PREPAREDNESS PREPAREDNESS
  • Develop a disaster and surge plan
  • Personal / family disaster plans
  • Command Control System
  • Limit confusion!
  • ICS standardized command structure
  • Facility emergency response team
  • Facility protection
  • Security, patient flow, crowd control
  • Patient decon, staff protection (PPE)
  • Evacuation

49
BASICS OF DISASTER PREPAREDNESS PREPAREDNESS
  • Develop a disaster plan (cont)
  • Supplies
  • Impossible to stock all possible supplies
  • Plan for loss of power, light, phones, etc.
  • Notification plans
  • Recovery
  • Facility decontamination, resupply
  • Psych support
  • Financial reimbursement

50
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51
BASICS OF DISASTER PREPAREDNESS PREPAREDNESS
  • Communications
  • Review available communications
  • Plan redundant sources
  • Must be able to work within ICS structure with
    common terminology

52
BASICS OF DISASTER PLANNING PRACTICE
  • Plan is no good without practice!
  • Knowledge based training
  • Cal-Pen Modules
  • Skills based Training Exercises
  • Table top low cost, convenient
  • Functional tests staff capabilities
  • Full-scale simulate an actual emergency

53
FAMILY DISASTER PLAN
  • Important for provider to know that family
    members are OK allows them to perform
  • Create a specific plan for your family
  • Common contact or meeting place
  • Supplies and evacuation plan
  • Plan childcare if unable to get home

54
Triage
55
TRIAGE
  • Important concept in disaster medicine
  • Initial triage for patients in disaster situation
    may be the most important role for a primary
    healthcare provider
  • Sites may vary and method will thus vary
  • Sites include field, E.D. alternate care site,
    within hospital
  • Priority change from providing best care to every
    patient to maximizing number of survivors

56
START TRIAGE
  • Simple Triage and Rapid Treatment
  • Triage must be continually repeated as patient
    conditions will change
  • Triage categories
  • Green
  • Yellow
  • Red
  • Black

57
START
  • Step 1 Delayed Patients- GREEN
  • If they can walk, they are delayed
  • Step 2 Respiration Check (non-walkers)
  • No RR- dead
  • RR gt30- red, highest priority
  • RRlt30- green
  • Step 3 Perfusion Check
  • Radial pulse poor- red
  • Good pulse- yellow
  • Step 4 CNS eval
  • Follows directions- yellow or green
  • No directions- red

58
Sustained Care
  • Emergency mass care, in a sustained event like an
    influenza pandemic, will lead to sustained
    disaster response
  • Principles will be different
  • More likely to deplete resources and staff
  • More likely to lead to austere care and
    allocation of resources
  • Requires community planning
  • Many providers will practice out of scope

59
Regional facilities Alternate sites SNFs Home
Care
Floor/med-surge
Step-down
ICU
EMC Approach to Critical Care
60
Triage in Healthcare Facility
  • May have to employ triage within hospital or
    healthcare based facilities due to scarce
    resources
  • No consensus on triage mechanism, but SOFA may be
    best
  • Sequential Organ Failure Assessment Score
  • PaO2/FiO2 ratio (respiratory)
  • Glasgow Coma Score (CNS)
  • Mean Arterial Pressure/vasopressor (CV system)
  • Bilirubin (Liver)
  • Platelets (coagulation)
  • Creatinine (renal system)

61
Next Steps (1)
  • Disaster Preparedness is important for primary
    care providers, regardless of location and size
    of clinic
  • A well developed plan will augment the states
    disaster response under NIMS
  • A well organized plan will provide care to the
    staff, patients and community in a time of crisis

62
Next Steps (2)
  • Your plan will provide safety to your staff and
    unaffected patients
  • Assess your risk and community needs
  • Develop your plan based on these risks and needs
    with job action sheets describing each positions
    role
  • Teach your plan
  • EXERCISE YOUR PLAN

63
Final Note
  • With commitment, all things are possible.
    Without commitment, nothing else matters.

64
CONTACT NUMBERS
65
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