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FIFA World CupFIFA World CupDisaster PreparednessDisaster Preparedness

NY Institute For All Hazard PreparednessDepartment of Emergency Medicine

SUNY Downstate Medical CenterBrooklyn, NY, USA

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DisclosuresDisclosures

Project funded by the Provincial Government of the Western Cape, South Africa

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Long Distance Table TopLong Distance Table TopGather information electronically

– Feasible?– Effective?– Reliable?– Remotely?

Simulate a likely scenario– Adaptable to any place/situation

Identify weaknesses/strengths Develop an improvement plan

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Our ProgramOur ProgramInternet basedTest preparednessSend, Receive, Respond and

Evaluate Weekly “scenarios” 10 weeksResultsAnalysis

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Our ProgramOur Program

Time sensitive questions– 1 week

Numerical

Tables

Text responses

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What’s Unique?What’s Unique?

Real Time data collection

Immediate Feedback

Help

Follow up

Scalable

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Hospitals InvolvedHospitals Involved

Milnerton Mediclinic HospitalVincent Pallotti HospitalNetcare Blaauwberg HospitalNetcare N1 City HospitalNew Somerset HospitalGroote Schuur HospitalTygerberg HospitalChristian Barnard Melomed Hospital

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ScenarioScenarioSoccer gameFight in stands

– Harare, ZimbabweLocal security respondsPolice respondTear gasMass exodusInjuries/deathsPatients evacuatedPresent to ED

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Topics TestedTopics Tested

1. Patient care capacity (surge)2. Communications3. Equipment4. Major incident plan (EOP)5. Hazard vulnerability analysis6. Public relations/media 7. Safety, security and supplies

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Patient Care CapacityPatient Care Capacity

How many?Specialty care

ICU, burn, vent unit, OT, recovery room

How sick?DoctorsNursesSupport staffTriage spaceEvaluation space

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Surge CapacitySurge CapacityWhat can be found?Borrowed?Who can be sent away?Call in staff?Other help?

– Bordering towns– Govt.– International

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CommunicationsCommunicationsPhones?

– Lines go down– Cell towers out

Walkie talkiesRunnersHam radiosHow to?

– Notify facilities– Notify staff

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EquipmentEquipment

How long will you last?Back up generators

– Working?StretchersVentsOxygen tanksPPE

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Major Incident PlanMajor Incident Plan

Written documentKnown locationCan be followedPatient trackingAdditionally

– Mass fatalities– Evidence collection– Staff mental health

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Public Relations/Media IntegrationPublic Relations/Media Integration

Public wants to know– Their right?

Media will try to get into hospitalCurb hysteria

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Safety, Security and SuppliesSafety, Security and Supplies

Hospital security organizedLock downSupply linesPharmacy stocks

– AntidotesFood stocks

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Hazard Vulnerability AnalysisHazard Vulnerability AnalysisHuman eventsNatural eventsTechnological eventsDecontamination

– Before transportation– Tents– Showers

HAZMAT suitsRadiation detectorsLabs level

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RESULTSRESULTS

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Analysis of LDTT CapabilitiesAnalysis of LDTT Capabilities

163 questions

1500 data points

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Data InterpretationData InterpretationPositive response = hospital able

to provide service or equipment

Negative response = hospital unable to provide service, equipment or unknown

Hard numbers (eg. patient beds, equipment available, staff availability)

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Overview by CategoryOverview by Category

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CommunicationsCommunications

Staff Notification– Updated and tested – Call Down List

Staff Notification results varied across the board with 57% positive response rate

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CommunicationsCommunications

Communications– Walkie talkies, runners

Communications showed 67% positive response rate– Scored well on low-tech comms

(runners and short wave radio)– Low scores on internet comms and

walkie talkies

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EquipmentEquipmentEmergency Power

– Generators and essential service availability

Logistics and Facilities– Back-up power– Fuel availability

Facility Readiness– HAZMAT training

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Equipment ResultsEquipment Results

Total A B C D E F G H I

Emergency Power 87% 40% 100% 80% 80% 100% 100% 100% 100% 80%

Logistics56% 50% 50% 50% 50% 50% 50% 50% 100% 50%

Facility Readiness

44% yes no no yes no no no yes yes

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Hazard Vulnerability AnalysisHazard Vulnerability AnalysisResultsResults

4 OUT OF 9 HOSPITALS SUBMITED

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Major Incident Plan (M.I.P)Major Incident Plan (M.I.P)

Preparedness– Surge

MitigationResponse

– Transport– Integration of services

Recovery– Outpatient follow-up

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M.I.P ResultsM.I.P ResultsAreas of strength:

– Surge staffing– Scheduling of non-emergent surgery– Preprinted ED charts– Rapid disposition of ED patients

Critical areas of weakness:– Mental health and clergy– Surge planning

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Public Information, Media Public Information, Media RelationsRelations

Public Information– All hospitals have Public Information

Officer (PIO) – Staff know where to refer media

inquiries– 4 hospitals have media facility off-site

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Risk ManagementRisk ManagementMass Fatalities Management

– 2/9 hospitals registered low or no preparation for mass fatalities management

– Only 3 hospitals have plans to handle a Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE) event

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Surge CapacitySurge Capacity

Other Hospital Capacities

Patient Triage

Patient Tracking

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Surge CapacitySurge Capacity

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Hospital Capacities

Total A B C D E F G H I

Portable Cardiac Monitors

115 38 4 5 8 6 12 15 8 19

Ventilators 271 12 14 80 1 9 12 17 108 18

Paediatric Capable Ventilators

150 12 8 5 1 2 8 1 108 5

Morgue Capacity

70 0 0 0 4 4 0 2 60 0

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Triage Triage A B C D E F G H I

Alternate Triage Area

100% yes yes yes yes yes yes yes yes yes

Color Code Triage System Match EMS

89% yes yes yes yes yes yes yes no yes

Patient Volume Trigger

44% yes yes no yes yes no no no no

Pediatric Triage Tape

44% no yes no yes no yes no no yes

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Patient Tracking Patient Tracking

8 of 9 hospitals are able to provide and track care for unknown/unidentified patients

7 of 9 hospitals have a method for casualty tracking

5 of 9 hospitals have a back-up casualty tracking system

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Patient Care Capacity ResultsPatient Care Capacity Results

ED Total A B C D E F G H I

Licensed Bed

Capacity163 15 7 15 10 11 8 16 73 8

Average Staffed Beds

147 0 7 15 12 11 5 16 73 8

Surge Capacity

69 15 4 5 10 6 2 4 15 8

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Safety, Supplies, SecuritySafety, Supplies, Security

Patient DeconLaboratory ServicesPharmacy ServicesBiological Agent ReadinessSyndromic SurveillanceHospital Safety and Security

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Safety, Supplies, SecuritySafety, Supplies, Security

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Safety, Supplies, Security Safety, Supplies, Security ResultsResults

Patient Decontamination– 44% had plans to handle

weapons found on patients undergoing decon

– 33% had plans for handling pediatric patients and male/female privacy

– 0% had trained decon team

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Safety, Supplies, Security Safety, Supplies, Security ResultsResults

Laboratory Services

– 100% have protocol on reporting suspicious isolates to health department

– 8 of 9 have 24hr Lab availability

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Safety, Supplies, Security Safety, Supplies, Security ResultsResults

Pharmacy Services– 100% report having the following

drugs available in appropriate amounts

Epinephrine, beta-agonist, dopamine, silvadine, steroids, morphine, demerol, aspirin

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Safety, Supplies, Security Safety, Supplies, Security ResultsResults

Safety and Security– 100% have full time security force

– 8 of 9 have entrances that can be controlled and monitored

– 7 of 9 have a plan for crowd control and crowd communication

– 7 of 9 can perform a lock-down within minutes

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Thank YouBonnie Arquilla DO

Lee Wallis MD, Wayne Smith MD, Mark Silverberg MD, Brian Gillett

MDWalter Valesky MD

John Adeline, Patricia Roblin MS,

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Questions?

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Dedicated to Edward R.Arquilla MD, PHd

1922-2010