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GENERAL DISASTER PREPAREDNESS FOR PRIMARY HEALTHCARE

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GENERAL DISASTER PREPAREDNESS FOR PRIMARY HEALTHCARE PROVIDERS California Preparedness Education Network Revised March 2007 Funded by ASPR Grant T01HP01405 – PowerPoint PPT presentation

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Title: GENERAL DISASTER PREPAREDNESS FOR PRIMARY HEALTHCARE


1
GENERAL DISASTER PREPAREDNESS FOR PRIMARY
HEALTHCARE PROVIDERS
  • California Preparedness Education Network
  • Revised March 2007
  • Funded by ASPR Grant T01HP01405

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Outline
  • What is a disaster?
  • Disaster response in California
  • Your disaster preparedness
  • Disaster response
  • Resources

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WHAT IS A DISASTER?
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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.

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

15
Examples
  • Preparedness for anthrax improved SARS response
    nationally
  • Pandemic Influenza preparedness will enhance
    response to BT and emerging infectious diseases
  • Earthquake preparedness and principles assisted
    with wildfire response

16
PROVIDER ASSUMPTIONS PREPARING FOR THE RARE
  • This wont happen near my home
  • Theyll die before I see them
  • Specialists will be called in
  • Theyll be decontaminated before I see them
  • Ill have time to ask the experts for help
  • There is no risk to me as a provider

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AUM SHINRIKIYOShoko Asahara
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TOKYOMARCH, 1995
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TOKYOMARCH, 1995
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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

21
PUBLIC HEALTH EMERGENCY
  • Less than 20 patients likely to be triaged or
    decontaminated in the field
  • Patients will go to the nearest facility
  • Any clinic can become a response center
  • Facilities are likely to be overwhelmed
  • We are not accustomed to response

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WHY DO I CARE?
  • Disasters are unpredictable!
  • A disaster may occur near you
  • Disaster victims may come to you
  • May involve you or your family
  • May involve your clinic or staff
  • Expert help may not be available

23
DISASTER RESPONSE
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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)

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OAKLAND HILLS1991
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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

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

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NIMS ELEMENTS
  • Command and Management
  • Incident Command
  • Operational area (local) approach
  • Multi-organization coordination
  • Public Information Systems

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OPERATIONAL AREA CONCEPTChain of Command
  • Federal
  • State
  • Region
  • County
  • Local Govt
  • Field

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OPERATIONAL AREA CONCEPT
  • California is divided into regions, then
    counties, then local governments
  • These are the functional units that make up each
    level on the chain of command in California
  • The US is also divided into regions for response
    in a similar manner

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SOUTHERN CALIFORNIA1970
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INCIDENT COMMAND SYSTEM
  • Tool used for the command, control, and
    coordination of resources at the scene of an
    emergency
  • Now used by military and fire services

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INCIDENT COMMAND SYSTEM AT A GLANCE
  • Incident Command Leads the response, appoints
    team leaders sets tone and standards for
    response
  • Operation Team Handles key actions including
    first aid, search and rescue, fire suppression,
    securing the site
  • Planning Team Gathers information, thinks ahead
    and keeps all team members informed and
    communicating
  • Logistics Team Finds, distributes, and stores
    all necessary resources (supplies and people)
  • Finance Team Tracks all expenses, claims and
    activities and is the record keeper for the
    incident.

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

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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

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

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WHY DOES NIMS MATTER?
  • Understand the response system
  • Know your position
  • Understand how resources can get to you
  • Know that your clinic, local, and county govt
    will not bear costs of a disaster

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ORGANIZATIONAL LEVELS OF NIMS CHAIN OF COMMAND
CONCEPT
  • Federal
  • State
  • Regional
  • Operational Area
  • Local Govt (city, town)
  • Field Command Post

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GETTING PREPARED
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BASICS OF DISASTER PLANNINGSTATE REQUIREMENTS
  • Clinics and Hospitals must have a written
    disaster plan
  • (CA Code of Regulations Title 22, Div 5,
    Section 78423)
  • (Joint Commission requirement)
  • Administrator / Command staff
  • Oversees development of the disaster plan
  • Direct overall response to the disaster/emergency
  • Ensure drills/exercises conducted semi-annually
  • Evaluate update the plan annually
  • Decides who has authority to activate disaster
    plan

43
ALL HAZARDS APPROACH
  • Principles of preparation for human-made or
    natural disasters overlap with those of dealing
    with a chemical or biological event.

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

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BASICS OF DISASTER PLANNINGHAZARD 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

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BASICS OF DISASTER PLANNINGHAZARD 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

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

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BASICS OF DISASTER PLANNINGPREPAREDNESS
  • 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

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BASICS OF DISASTER PLANNING PREPAREDNESS
  • Communications
  • Review available clinic communications
  • Plan redundant sources
  • One of the most difficult to plan
  • Internet phone sole source in most clinics
  • Cell phone circuits may become overloaded
  • Satellite/aux communications costly

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BASICS OF DISASTER PLANNINGPRACTICE
  • 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

52
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

53
BASICS OF DISASTER PLANNINGDEVELOPING A PLAN
  • Many resources available
  • No established best plan (no data)
  • Assemble key stakeholders
  • Use job actions, not people
  • Make sure plans dont overlap
  • Write it down review it - modify

54
DISASTER MEDICINE
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TRIAGE
  • Important concept in disaster medicine
  • Initial triage for patients in disaster situation
    may be the most important role for a primary
    healthcare provider
  • Priority change from providing best care to every
    patient to maximizing number of survivors

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

57
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

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Regional facilities Alternate sites SNF Home Care
Floor/med-surge
Step-down
ICU
EMC Approach to Critical Care
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DECONTAMINATION
  • Important for plans to include decon
  • In the event of a CBRNE event we may have to
    decontaminate patients
  • Basic principles
  • PPE (Personal Protective Equipment)
  • Clothing removal 90 decon
  • Soap water OK

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PPE
  • In the event of CBRNE event PPE may become
    important
  • Should be addressed in your disaster plan
  • No standard level
  • Consider in risk assessment
  • EMSA clinic PPE (about level C)

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CONCLUSIONS
  • 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

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CONCLUSIONS
  • 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

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CONTACT NUMBERS
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