Best Practices in Disaster Preparedness:Coordinating Care During Crisis

Presentation to: Templeton Pediatric Trauma SymposiumPresented by: Kelly H. Nadeau, MN, RNDate: 2 March 2013

2013 Events

Solomon Islands Earthquake Jan 2013

New England Snow Feb 2013Nevada-California Earthquakes Feb 2013

Meteor Feb 2013

Hattiesburg, MS Feb 2013

Adairsville, GA Jan 2013

Basic Disaster Assumptions• Definition

varies• Can occur

at any moment

• “All Hazards” approach to planning

• All disasters are local

1-16, Laurens County, GA, February 2013

National Preparedness Goal• “A secure and resilient nation

with the capabilities required across the whole community to prevent, protect against, mitigate, respond to, and recover from the threats and hazards that pose the greatest risk.”

- FEMA September 2011

Disaster Declarations• The

Stafford Act (§401) requires that: "All requests for a declaration by the President that a major disaster exists shall be made by the Governor of the affected State."

Presidential declaration

Governor makes request to Regional

FEMA office

State declaration

Local event -1988, amended 2007

National Response Framework• All hazards approach• Emergency Support 

Functions– ESF1    Transportation – ESF2    Communications – ESF3    Public Works and Engineering – ESF4    Firefighting – ESF5    Emergency Management – ESF6    Mass Care, Housing, and Human

Services – ESF7    Resources Support – ESF8    Public Health and Medical Services – ESF9    Urban Search and Rescue – ESF10  Oil and Hazardous Materials Response – ESF11  Agriculture and Natural Resources – ESF12  Energy – ESF13  Public Safety and Security – ESF14  Long-term Community Recovery and

Mitigation – ESF15  External Affairs

• www.fema.gov/nrf

ChallengesPersonal preparednessAccess to educationTime to trainExercisesCommunity partnersAttitude

Joplin, MO, May 2011

“It can’t happen here”

Atlanta, March 2008

Is the Scene Safe?• Electrical and power

outages• Food and water• Heat/cold• Fire• Confined spaces• Falls• Air quality

Tuscaloosa, AL 2011

…..really safe?……• Chemicals• Carbon monoxide• Stress and fatigue• Chainsaws• Mosquito borne

diseases, ex. West Nile, Dengue

• Animals• SnakesSumter Regional, Americus, GA 2007

…..are you sure?

• Mold• Mental health• Preexisting

conditions

Americus, GA 2007

Pre-event Assessment• Nutrition• Water supply• Immunization status• Access to healthcare• Literacy rate

Haiti, 2010

American College of Surgeons• Surgical community has an obligation to

participate in the multidisciplinary planning, triage, and medical management of victims following a mass casualty event.

• Trauma centers have an obligation to participate in disaster preparedness and management.

• A surgeon from trauma panel should participate on the hospital’s disaster committee.

Resources for the Optimal Care of the Injured Patient

Link to Homeland Security• An effective trauma system is most certainly

an essential ingredient for Homeland Security. A trauma system can be key infrastructure in our preparedness efforts not only for the un-natural acts of terrorism, but also for those natural disasters such as tornadoes, floods, hurricanes, and newly emerging infectious challenges such as SARS or monkeypox. An integrated, statewide trauma system is crucial in our efforts to improve Homeland Security.

Georgia Office of EMS and Trauma

Emergency Nurse Perceptions of Individual and Facility Emergency Preparedness

Whetzel, et al, Journal of Emergency Nursing, Feb 2013

• Survey to assess nurses’ perception of their role in a disaster and their perceived susceptibility to a disaster.

• Results reflect that many emergency nurses have not taken basic actions to prepare themselves for a disaster either personally or professionally.

Healthcare Preparedness Funding

HPP Healthcare Preparedness• Health and Human

Services• Assistant Secretary for

Preparedness and Response

• Hospital/Healthcare Preparedness Program in each state

PHEPPublic Health Emerg Prep• Health and Human

Services• Centers for Disease

Control• Division of State and

Local Readiness• Public Health

Preparedness Program

Dept of Health and Human ServicesDept of Healthand Human

Services (HHS)

Office of the Assistant Secretary for Preparedness

and Response (ASPR)

Office of Preparedness and Emergency Operations

Hospital

Preparedness

Program

National

Disaster

Medical

System

Emergenc

y Registration of

Volunteer Healt

h Professionals

Regional

Emergenc

yCoordinators

Centers for Disease Control

Office of Public Health PreparednessAnd Response

Division of State

And Local

ReadinessState

Public Healt

hEmergency Preparedne

ss

Strategic

NationalStockpil

e

Division of

Emergency

Operations

Capabilities

Public Health Preparedness Capabilities

Healthcare Preparedness Capabilities

1 Community Preparedness 1 Healthcare System Preparedness2 Community Recovery 2 Healthcare System Recovery3 Emergency Operations Coordination 3 Emergency Operations Coordination

4 Emergency Public Information and Warning 4

5 Fatality Management 5 Fatality Management6 Information Sharing 6 Information Sharing7 Mass Care 78 Medical Countermeasure Dispensing 8

9 Medical Materiel Management and Distribution 9

10 Medical Surge 10 Medical Surge11 Non-Pharmaceutical Interventions 1112 Public Health Laboratory Testing 12

13 Public Health Surveillance and Epidemiological Investigation 13

14 Responder Safety and Health 14 Responder Safety and Health 15 Volunteer Management 15 Volunteer Management

Capabilities

Healthcare Coalitions• Healthcare Coalitions serve as a multi-

agency coordinating group that assists Emergency Management and Emergency Support Function (ESF) #8 with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations.

Disaster Cycle

Preparedness

Mitigation

Recovery

Response

Disaster

Healthcare Coalitions: Follow the steps of the Preparedness Cycle to effectively mitigate, respond to and recover from a disaster

DISASTER CYCLEHealthcare Coalitions: Assist HCOs within their region to assist the community with their return to normal healthcare delivery operations

Healthcare Coalitions: Integrate with ESF#8 and incident management to provide healthcare situational awareness in order to inform the decision making process for the allocation of resources

Healthcare Coalitions: Address areas in critical infrastructure and key resource allocation planning that decreases the vulnerability of the healthcare delivery system

National Disaster Medical System

• Designed to move patients quickly from one part of the country to another during a large disaster– Activated at 9/11 but no patients to move– Activated after Hurricanes Katrina and Rita

to move patients (and evacuees, family members, pets, etc.)

• Coordinated by VA Medical System• Utilizes Dept of Defense transport assets• Federal Coordinating Centers designated• Federal funds released if activated

NDMS “like” Activation February 2010• Reasons Atlanta was chosen

– Previous experience with NDMS– Flight distance from Haiti– Refugee Resettlement Office

• Governor agreed to the mission• State Emergency Management Agency

involved• Dept of Public Health - ESF8 lead in Georgia• Healthcare Preparedness Program

involvement

Flight Day in Haiti• Approval Board in Haiti• Approved patient records

copied and report given to Transcom RN

• Patient packaged and moved to deck of USNS Comfort

• Patient airlifted from USNS Comfort to ground in Haiti

• Held at field hospital until C-130 lands

• Loaded onto C-130 with CCATT team, patient records and non medical attendants

• Flight left Haiti around 5:30 p.m.

• Flight arrived Dobbins Air Reserve Base 9:30-10:30 p.m.

Flight Day in Atlanta• 6:00 a.m., first e-mail of the

day• By 9:00 a.m., preliminary

manifest via e-mail, patient reports from Transcom RN to Kelly

• 9:00 a.m. Conference call with Transcom

• 9:00-2:00 p.m. Patient placement calls by Kelly and GHA colleague

• 2:00-5:00 p.m. Communication, faxes, etc. to Team Georgia and Transcom

• 6:00-8:00 p.m. PR Team assembles at Dobbins

• 9:30-10:30 p.m. Flight lands• Around 11:00 p.m. – last

message from Transcom

Challenges

• International mission

• Culture• Language• Patient placement• New partners • Business

– Payment– Discharge– Travel back to Haiti

Patient Challenges• Multiple trauma three weeks plus after

the earthquake• Tetanus• Open extremity fractures, infected,

external fixators, needing debridement and flaps

• Spinal cord injuries• Amputations

Summary from Atlanta• 11 missions total• 51 patients • 21 non-medical attendees• 21 receiving hospitals• 41 NDMS hospitals

Atlanta March 2011

• 110 residents were evacuated from an assisted living center

Superstorm Sandy 2012

Care for Responders

• Difficult circumstances

• Unthinkable decisions

• Unforgettable sights, smells, sounds, experiences

To Do List• Personal Preparedness Plan for you and your

family www.ready.gov• Know the emergency plans of your facility

and your community• Be involved in the emergency preparedness

planning• Mass casualty planning must have trauma

involvement• It’s all about relationships……find your

coalition

Kelly H. Nadeau, M.N., R.N.khnadeau@dhr.state.ga.us