1101Disaster planning

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Disaster Planning, Part I Overview of Hospital and Emergency Department Planning for Internal and External Disasters : 

Disaster Planning, Part I Overview of Hospital and Emergency Department Planning for Internal and External Disasters 研究生:蔡卓城

前言及概述: 

前言及概述 1.Disaster :an event that results in risk of injury or loss of life or property and results in a demand or services that exceeds available resources 2.Mass casualty incidents(MCI) : disaster where human injuries are predominantly involved

前言及概述: 

前言及概述 3. Disaster classified 3 levels: Level 1 ~disaster is manageable within region ~local EMS can provide adequate triage, stabilization,transport ~local health care facilities can diagnose and treat Level 2 local medical response capabilities exceeded multijurisdictional aid required Level 3 local regional resource overwhelmed state or federal support need

前言及概述: 

前言及概述 4. Disaster planning: ~consider resources available locally & options available from outside sources ~initial sorting(triage),extrication of the injured,decontamination, initial treatment 5. Disaster medicine principles: ~ vital part of emergency medicine ~ an approach to medical care that emergency specialists should be prepared to exercise

前言及概述: 

前言及概述 6. Emergency medical service(EMS) personnel & hospital: the community-based resource responsible for the initial response to a disaster 7. Emergency physicians: crucial role in disaster planning

前言及概述: 

前言及概述 8. Hospital disaster plan: internal & external disaster External disaster : ~occur within the community and may or may not affect the hospital directly ~may due to natural or man-made causes ~upon on the type of disaster,increased patient numbers may be expected during the event, in the hours, days, weeks or months to follow

前言及概述: 

Internal disaster: ~conditions affecting the hospital directly and may be an extension of an external disaster ~resulting in immediate concern for the safety of hospitalized patients and hospital personnel ~to prevent injury to individuals, to limit further damage,to restore normal operations as soon as possible 前言及概述

前言及概述: 

前言及概述 ~causes of internal disaster: external natural:earthquake, tornado, hurricane, flood,storm,fire manmade:terrorism,transportation, chemical/radiation accident,mass gathering- hysteria/unrest

前言及概述: 

前言及概述 internal power failure, flood, water loss , chemical/radiation accident/fumes, fire/explosion, loss of medical gases, violence/bomb threat, inability of staff to reach hospital, elevator emergency

Preparing For Disaster: 

1. Initial response of H. personnel: to an unexpected event ~based on awareness of the overall hospital disaster plan ~acted out realistically during drills 2. Command and communication are established using incident command system(ICS) principles Preparing For Disaster

Preparing For Disaster: 

Preparing For Disaster 3. Ext. disaster plan :address how increased numbers of patients will be triaged, decontaminated ,transported,treated

Preparing For Disaster: 

Preparing For Disaster 4. Int. disaster plan : ~must contain individual plans for all possible hospital calamities ,evacuation routes and procedures. ~command post location-primary and an alternate location,including one outside of the structure ~evacuation routes-alternate routes

Features Of The Disaster Plan: 

1. Features of a hospital disaster plan: Definition Treatment areas Plan activation Specialized areas notification family chain of command volunteers phase media Command center morgue command post Individual departmental plans reporting center Internal disaster plan Traffic flow individual disaster Triage evacuation Decontamination Features Of The Disaster Plan

Features Of The Disaster Plan: 

Features Of The Disaster Plan 2.A hospital treatment capacity will vary depending on the resources available and the type of injury 3.Three types of plans: one for immediate disaster preparation one to use during the actual event one to be used in the recuperative, post disaster period

Features Of The Disaster Plan: 

Features Of The Disaster Plan 4. Inventories established,needs anticipated and H. should have lists of items anticipated supplies anticipated power failure anticipated water loss battery-powered lighting portable suction cellular phone bottled water disposable surgical supply disposable cups/plates heating/cooling needs filled ‘bladder bags’ extra generators adequate battery ventilators/suction anticipated transportation restrictions mattresses for staff adequate bedding/linens extra food supply adequate pharmaceutical portable oxygen tanks

Features Of The Disaster Plan: 

Features Of The Disaster Plan 5.Notification : proper channel, caller & contact phone No, description & location of disaster, estimated No. & type of casualties & expected means of arrival

Features Of The Disaster Plan: 

Features Of The Disaster Plan 6.Informed ER physician,nurse coordinators,hospital director,chief of staff,director of public safety--this communication cascade is critical and should be tasted by unannounced communication drills

Features Of The Disaster Plan: 

Features Of The Disaster Plan 7.Three phases of implementing disaster plan: phase I(alert) - currently on duty remain on duty phase II - increasing staff by keeping off going shift late to overlap with oncoming shift phase III - additional staff who are not scheduled on duty,be called to the H.

Command Center: 

Command Center 1.Command center function ,location ,personnel should be clearly identified.

Command Center: 

Command Center 2.Command post: ~staffed with key management personnel-- H.director,chief of staff,senior nursing supervisor,a representative from public affairs,engineering,public safety,secretarial department. ~function : relay information; keep contacting with ER,police,fire,EMS; evaluating engineer report; ordering evacuation; reducing hospital service; coordinating manpower pool; requesting outside assistance

Command Center: 

Command Center 3.Reporting center: 4.Traffic flow: for ambulances,employees,visitors and press; the job of security personnel; ‘convergence phenomenon’ 5.Triage : ~3 color-coded triage categories:red,yellow,green ~important aspect: triage is a dynamic process and must be continually reassessed 6.Decontamination : ~for chemical,nuclear accident ~consideration of the possibility of exposure of victims & treating facility

Command Center: 

Command Center 7.Special needs of family,media,volunteers ,social worker, hospital staff. Plan must include provisions for temporary or expanded morgue facilities. 8.All departments must have individualized disaster plans with a clear chain of command, phone tree, specific disaster phase assignments. ~Take inventory--wards,pharmacy,blood bank, central supply, operating room. ~dialysis,intensive care nursery, surgery, recovery,CCU/ICU, cardiac catheter room require specialized planning.

Features of An Internal Disaster Plan: 

Features of An Internal Disaster Plan 1.an extension of the hospital’s ext. disaster plan with individual plans for a wide variety of potential int. calamities. 2.Situations should be detailed in the plan with an overview of the problem expected, immediate consequence to critical patient areas,anticipated impact on other patient areas. 3.Guidelines for finding solutions to each incident should be provided with emphasis on security and safety consideration.

Features of An Internal Disaster Plan: 

Features of An Internal Disaster Plan 4. Evacuation planning is an integral part of the int. disaster plan. ~ horizontal : on the same floor ~ vertical : up or down floors ~ triaged by the nursing staff before any evacuation ~ routes: consider the size,limitation of elevators,doors,hallways and provide manual back-up to replace power-driven equipment during transport.

Role of the Emergency Department During Disaster: 

Role of the Emergency Department During Disaster 1.Emergency department play a key role in any disaster plan. 2.Increased patient visits for 2 to 3 months following a disaster. Due to three factors: 1) injuries will be seen directly from the disaster itself 2) injuries sustained during clean-up activities 3) stress-related illness weeks and months following a disaster

Role of the Emergency Department During Disaster: 

Role of the Emergency Department During Disaster 3.Important for emergency depart. to have increased social supports available in the weeks,months following a community disaster 4.The safety of all family members of emergency department even all hospital personnel should be addressed.This will reduce staff anxiety which will hinder patent care. 5.To discharge as many patients from he ER as possible before unknown numbers of disaster victims arrive.

Lessons Learned: 

Lessons Learned 1.Experiences encountered during actual disaster form the basis for teaching disaster medicine and disaster planning. Each disaster situation is unique, any one type of disaster may be complicated by other events

Lessons Learned: 

Lessons Learned 2.No single disaster plan will answer all questions and always ensure that all needs can be met. But ,if the “plans” within disaster plan are flexible and comprehensive ,various needs can be addressed as the situation changes.

Lessons Learned: 

Lessons Learned 3. 1) damage assessment responsibilities 2) criteria for structural integrity 3) telephone-independent communication 4) generator security(bolted or otherwise secured) 5) generator fuel sources 6) protected storage of hazardous materials 7) secured cabinetry

Lessons Learned: 

Lessons Learned 8) radio equipment 9) secured overhead medial equipment and TV set 10) staff transportation needs 11) alternative vendors for food ,pharmaceutical,others 12) adequate sleeping facilities ,linens,scrubs for staff 13) establish sleep/work rosters early

Lessons Learned: 

Lessons Learned ~Loma Pieta earthquake in 1989 ~Northridge earthquake in 1994 ~Civil disturbances L.A. in 1992 ~Hurricane Andrew southern Florida

Conclusion: 

Conclusion 1.Disasters occur more frequently with greater impact because of the world’s increasing population density 2.Hospitals, expected to provide for a community’s health care needs, too are vulnerable structures, highly dependent on technologic support to function.

Conclusion: 

Conclusion 3.Emergency physicians must embrace their leaders role in hospital disaster planning, because they interface with EMS, the community, and the hospital other department personnel.

Conclusion: 

Conclusion 4.Hospital disaster plans must account for the limits of the community resources and establish systems to assess damages and anticipate needs.There must be a network of comprehensive plans for all expected losses,such that they can be replaced as the events surrounding a disaster unfold.

Disaster planning—Part 2 Disaster problems, issues, and challenges identified in the research literature: 

Disaster planning—Part 2 Disaster problems, issues, and challenges identified in the research literature 研究生:蔡卓城

A. Failure of coordination : 

A. Failure of coordination 1.Traditionally, medical disaster planning has been based on the belief that the primary need is to rapidly augment the capacity to care for life threatening trauma. 2.The trend toward increasing population and the progressive movement of these populations to disaster-prone area, means our potential for catastrophic disaster is increasing.

A. Failure of coordination : 

3.The ability to mobilize large numbers of resources is also being recognized as a problem at one time or another in most disaster. 4.The response of too many resources is also being recognized as a problem at one time or another in most disasters. A. Failure of coordination

A. Failure of coordination : 

A. Failure of coordination 5.Because these units have different operating procedures, levels of training and equipment, and incompatible radio frequencies and terminology.

B. Hospital off-ground: 

B. Hospital off-ground Volunteers: An administrative challenges when no policies or procedures exit to verify the credentials, insurance coverage, or skills of these volunteers, to integrate them into the organizational response, or to feed and house them.

B. Hospital off-ground: 

B. Hospital off-ground Donations: Too many donators would divert personnel to unneeded work.

B. Hospital off-ground: 

B. Hospital off-ground Medical personnel: Loss of available hospital and medical personnel in disaster impacted communities.

B. Hospital off-ground: 

B. Hospital off-ground Patients: 1.A substantial proportion of the patients seen at hospital are not with critical injuries, but rather those who lost access to their routine medical source. 2.Without having received triage or stabilizing field first aid. 3.Large number of casualties with minor conditions will show up at first.

Disaster Plans:: 

Disaster Plans: 1.Do not have the plan coordinated, community-wide plan, and national- wide plan for disaster medical care. 2.Do not have adequate training program. 3.Spontaneous volunteers carry out most initial disaster search and rescue. Therefore, field first aid and triage stations are often bypassed.

Disaster Plans:: 

Disaster Plans: 4.“ Disaster syndrome “ 5.Apathy toward disaster planning; public’s perception of risk shows no correlation to actual risk and widespread trust in technology protection against disasters. 6.Budget

Selected disaster-planning principles : 

Selected disaster-planning principles 1.Develop strategies to overcome resistance to preparedness a.Flexibility for unexpected challenges. b.Set up certain patterns and problems that occur with such regularity that they are virtually predictable. 2.Take measures to ensure that your medical response facilities will survive and function

Selected disaster-planning principles : 

Selected disaster-planning principles 3.Participate in a community- wide disaster planning and training program. 4.Ensure the capability of sharing information when telephone lines are busy or damaged.

Selected disaster-planning principles : 

Selected disaster-planning principles 5.Plan for modular expandability. Having a plan that can activate selectively, depending on circumstances and expanded in a modular fashion as needed, can reduce managerial problems.

Selected disaster-planning principles : 

Selected disaster-planning principles 6.Plan for large numbers of unsolicited volunteers and donations. 7.Plan to integrate with the federal response plan.

Disaster preparedness resources : 

Disaster preparedness resources 1.The incidence command system 2.The ACEP community medical disaster planning and evaluation guide

Disaster preparedness resources : 

Disaster preparedness resources a.Disaster plan cannot develop by someone else. b.The process of disaster planning is more important than the written document. 1.Legitimacy 2.Knowledge 3.Familiarity 4.Local variation

Slide51: 

ICS乃是1970年美國南加州原野大火之後,消防單位發展出來利用有系統的程序來整合處理災難救助時各種不同資源的方法,利用迅速的狀況分析作為進一步可靠的計劃與行動的依據。在ICS架構下基本有幾個重大的任務分組:指揮部門(command section)、執行部門(operation)、計劃部門(planning)、後勤部門(logistic)及財務或行政部門(financial,administration)。

Slide52: 

ICS的目的主要是使混亂的情況能穩定下來,而且在不同的災難應變上均能使用,並且可以隨著狀況的不同隨時加以修正,以維持一個有效應變處理的方式。利用ICS建立一個可靠的指揮協調範圍,也就是所謂的span of control (例如,一個人指揮3-7人,平均5人最理想)對於災難時混亂狀況控制是很有用的。

Slide53: 

至於ICS中主要的指揮者則以事件當時投入最大的資源的單位擔任,例如在美國Oklahoma市聯邦大樓的爆炸案中,消防隊長就是總指揮官,其他如工程、醫療、FEMA等單位均受他的指揮協調,而所有的消防工作則由消防副隊長負責。相對於我國目前在救災時候的指揮狀況,這種指揮架構,是值得我們更進一步了解參考的。

The Hospital Emergency Incident Command System: 

The Hospital Emergency Incident Command System INCIDENT COMMANDER -PUBLIC INFORMATION OFFICER -LIAISON OFFICER -SAFETY & SECURITY OFFICER -MEDICAL STAFF DIRECTOR -LOGISTICS CHIEF -PLANNING CHIEF -FINANCE CHIEF -OPERATIONS CHIEF

The Hospital Emergency Incident Command System: 

The Hospital Emergency Incident Command System LOGISTICS CHIEF -FACILITY UNIT LEADER -DAMAGE ASSESSMENT AND CONTROL OFFICER -SANITATION SYSTEMS OFFICER -CONNUNICATIONS UNIT LEADER -TRANSPORTATION UNIT LEADER -MATERIALS SUPPLY UNIT LEADER -NUTRITIONAL SUPPLY UNIT LEADER

The Hospital Emergency Incident Command System: 

The Hospital Emergency Incident Command System PLANNING CHIEF -SITUATION STATUS UNIT LEADER -LABOR POOL UNIT LEADER -MEDICAL STAFF OPPL UNIT LEADER -NURSING UNIT LEADER -PATIENT TRACKING OFFICER -PATIENT INFORMATION OFFICER

The Hospital Emergency Incident Command System: 

The Hospital Emergency Incident Command System FINANCE CHIEF -TIME UNIT LEADER -PROCURMENT UNIT LEADER -CLAIMS UNIT LEADER -COST UNIT LEADER

The Hospital Emergency Incident Command System: 

The Hospital Emergency Incident Command System OPERATIONS CHIEF -MEDICAL CARE DIRECTOR -ANCILLARY SERVICES DIRECTOR -NUMAN SERVICES DIRECTOR

The Hospital Emergency Incident Command System: 

The Hospital Emergency Incident Command System MEDICAL CARE DIRECTOR - IN-PATIENT AREAS SUPERVISOR -SURGICAL SERVICES UNIT LEADER -MATERNAL CHILD UNIT LEADER -CRITICAL CARE UNIT LEADER -GENERAL NURSING CARE UNIT LEADER -OUTPATIENT SERVICES UNIT LEADER

The Hospital Emergency Incident Command System: 

The Hospital Emergency Incident Command System MEDICAL CARE DIRECTOR - TREATMENT AREAS SUPERISOR -TRIAGE UNIT LEADER -IMMEDIATE TREATMET UNIT LEADER -DELAYED TREATMENT UNIT LEADER -MINOR TREATMENT UNIT LEADER -DISCHARGE UNIT LEADER -MORGUE UNIT LEADER

The Hospital Emergency Incident Command System: 

The Hospital Emergency Incident Command System ANCILLARY SERVICES DIRECTOR -LABORATORY UNIT LEADER -RADIOLOGY UNIT LEADER -PHARMACY UNIT LEADER -CARDIOPUMONARY UNIT LEADER

The Hospital Emergency Incident Command System: 

The Hospital Emergency Incident Command System HUMAN SERVICES DIRECTOR -STAFF SUPPORT UNIT LEADER -PSYCHOLOGICAL SUPPORT UNIT LEADER -DEPENDENT CARE UNIT LEADER

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