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“All-Hazards”Man-made
• Fires
• Explosive devices
• Firearms
• Structural collapse
• Transportation event– Air, Rail, Roadway, Water
• Industrial HAZMAT
• WMD – NBC events
• Etc…
Natural
• Earthquake
• Landslides
• Avalanche
• Volcano
• Tornado
• Hurricanes, floods
• Fires
• Meteors
• Etc…
Are We Prepared?• Is the US healthcare system prepared?• We appear to be… each Hospital, EMS agency, Law
enforcement agency, Fire department, and Community has…
… a disaster plan
… properly documented drills
… annual training documented
• But...
Are We Prepared?
• Interagency communication failures!
• Why do we all treat a cardiac arrest the same?
• …because there is an agreed-upon approach.
Are We Prepared?
• Critical to healthcare preparedness – uniform– coordinated approach – mass casualty management from any cause
• NEED: A nationally standardized training program
Course Description BDLS
– Didactic - 8 hours
– Distance learning option
– For healthcare providers
• Physicians, Nurses, Paramedics, EMTs
• Mid-level providers, Allied health, Public health
– Provider status & course credit awarded
• Course completion
• Written examination passage– BDLS providers are eligible to take ADLS
BDLS Course Outline
• Overview & Concept• DISASTER Paradigm• Natural Disasters • Explosive & Traumatic• Nuclear & Radiological• Biological Agents• Chemical Agents• Psychosocial Aspects• Public Health System
• Examination• Course evaluations
Course Description
ADLS• 16 hour class (8-didactic, 8-practical)• Advanced practicum “hands on” course • Meets Hazmat Operations-level training
requirement (CFR 1910.120)• Must have completed
BDLS course• Provider status &
course credit awarded
ADLS Course Outline
Day-One:Classroom & Interactive:• DISASTER Paradigm• Casualty Decontamination• Legal Issues• Media & Communications• Community and Hospital Disaster
Planning• Community, State and Federal
Resources• Mass Fatality Management
Day-Two:
Skills Lab “hands on”
• MASS Triage
• Clinical Scenarios
• Human simulator use
• Disaster Skills
• Personal Protective Equip
• Decontamination
What is a “Disaster”?
• Disaster- dis·as·ter n.
a. An occurrence causing widespread destruction and distress; a catastrophe.
b. A grave misfortune.
c. Informal- A total failure
“Disaster” Definition• A disaster is present when need exceeds resources!
Disaster = Need > Resources
• A response need that is greater than the response available!
Mass Casualty Incident (MCI)
• “Is this an MCI ?”
• The first step in identifying an MCI is knowing your own capabilities.
• Any incident that exceeds the responder’s or receiving hospital’s capability to treat or transport is a Mass Casualty Incident
D: Detection
I: Incident Command
S: Safety & Security
A: Assess Hazards
S: Support
T: Triage & Treatment
E: Evacuation
R: Recovery
D-I-S-A-S-T-E-R Paradigm Incident Command
Incident Command System (ICS)• Born in Fire Service
– Managing wildfires in early 1970’s
– Interagency task force collaborative effort
• Uniform structure• Clearly delineated roles/responsibilities• Clear chain of command/ communication
Incident Command System
The Basics
Unified CommandUnified Command
PlanningPlanning OperationsOperations FinanceFinanceLogisticsLogistics
““Commander”Commander”
““Thinkers”Thinkers” ““Getters”Getters” ““Doers”Doers” ““Payers”Payers”
Incident Command System Operations
M edical Direction Com m unications
Triage Treatm ent Transportation Extrication/Rescue Staging
EM S Operations Fire Operations LE Operations
Surveillance
Clinic 1 Clinic 2 Clinic 3
Im m unizationClinics
Public Health
OPERATIONS
D-I-S-A-S-T-E-R ParadigmAssess Hazards
• Be Aware of Secondary Devices!– Bombs, Shrapnel devices, Incapacitating Devices, Multiple
Snipers/Terrorists, Delay Devices
D-I-S-A-S-T-E-R ParadigmAssess Hazards
• Be Aware of Secondary Devices!– Bombs, Shrapnel devices, Incapacitating Devices, Multiple
Snipers/Terrorists, Delay Devices
D-I-S-A-S-T-E-R ParadigmSupport
Unexpected Volunteers and Donations:
• Positive intentions, often negative impact
• Does your preparedness plan include them?– ICS, Identify needed skills and needed supplies
• Negatives:– Time to sort large, poorly labeled goods
– Storage space used
– Unplanned personnel are a liability
– At risk of injuries, require food, water and shelter
VolunteersNeed to Address…
Licensure in state Credentialing for specific responder organization
“Just-in-Time” Training Management: logistics, supervision, transportation,
medical & other care needs
Well-Meaning Volunteers Can… Overwhelm, Interfere, Confuse, Burden & Even Endanger themselves and others
•Best if a member of a recognized, organized response team that has been invited in
•DON’T JUST SHOW UP !!
M.A.S.S. Triage
M – MoveA – AssessS – SortS – Send
• M.A.S.S. Triage is a disaster triage system that utilizes US military triage categories with a proven means of handling large numbers of casualties in a mass casualty incident (MCI).
“ID-me”!
I – Immediate
D – Delayed
M - Minimal
E – Expectant
D - DEAD
• “ID-me”! - a mnemonic for sorting patients during MCI triage. It is utilized effectively in the M.A.S.S. Triage model.
“ID-me”! - a mnemonic for sorting patients during MCI triage. It is utilized effectively in the M.A.S.S. Triage model.I –Immediate
D – Delayed
M - Minimal
E – Expectant
D - DEAD
• M – Minimal
• D –Delayed
• I – Immediate
• E – Expectant
• D - Dead
Tips for talking to children after a disaster• Provide opportunities to talk about what they are
seeing on television and to ask ?• Don’t be afraid to admit you don’t know all the answers• Answer ? At a level the child can understand• Establish a family emergency plan (Sense of doing
something is helpful)• Monitor children’s TV watching..don’t need to see
event over & over) Watch with children• Help kids to understand there are no bad emotions• Try to not focus on blame• In addition to tragic things seen, also help kids focus
on good things such as heroic actions, reuniting of families, assistance offered by people throughout the world
For children closer to disaster• Disasters often reawaken a child’s fear of loss of
own parents when parents are preoccupied with own fears … consider family counseling
• Families may permit some regressive behavior weaning off by leaving bedroom door open, night lights, extra time with parents
• Parents may have trouble leaving child after a disaster,,,may be able to use child’s problem as a way of asking for help themselves
• Get the children into some sense of routine of school and play even if displaced
• Teachers can help kids with art, and play activities, encouraging group discussions and presentations about the disaster
For more information on
children & disasters:•Child Health Alliance of
Wisconsin (CHAW)www.chawisconsin.orgClick ProgramsClick Trauma preparedness