“Preparing Our Communities”

1® BDLS is a registered trademark of the American Medical Association® BDLS is a registered trademark of the American Medical AssociationV 2.9 04/07V 2.9 04/07

®®

““Preparing Our Communities”Preparing Our Communities”

Welcome!Welcome!

2V 2.9 04/07V 2.9 04/07

Faculty DisclosureFaculty Disclosure

• For Continuing Medical Education (CME) purposes as For Continuing Medical Education (CME) purposes as required by the American Medical Association (AMA) required by the American Medical Association (AMA) and other continuing education credit authorizing and other continuing education credit authorizing organizations:organizations:– In order to assure the highest quality of CME programming, In order to assure the highest quality of CME programming,

the AMA requires that faculty disclose any information relating the AMA requires that faculty disclose any information relating to a conflict of interest or potential conflict of interest prior to to a conflict of interest or potential conflict of interest prior to the start of an educational activity. the start of an educational activity.

– The teaching faculty for the BDLS course offered today have The teaching faculty for the BDLS course offered today have no relationships / affiliations relating to a possible conflict of no relationships / affiliations relating to a possible conflict of interest to disclose. Nor will there be any discussion of off interest to disclose. Nor will there be any discussion of off label usage during this course. label usage during this course.

3® BDLS is a registered trademark of the American Medical Association® BDLS is a registered trademark of the American Medical AssociationV 2.9 04/07V 2.9 04/07

®®

All Hazards Course Overview and All Hazards Course Overview and DISASTERDISASTER Paradigm Paradigm

Chapter 1Chapter 1

Part APart A

4V 2.9 04/07V 2.9 04/07

ObjectivesObjectives

• Discuss the importance of a nationally Discuss the importance of a nationally standardized disaster education and standardized disaster education and training program training program

• Describe the National Disaster Life Describe the National Disaster Life Support (NDLS) coursesSupport (NDLS) courses

• Define disaster, Mass CasualtyDefine disaster, Mass Casualty Incident Incident (MCI) and related terms(MCI) and related terms

• Identify the components of the Identify the components of the D-I-S-A-S-T-E-R paradigmD-I-S-A-S-T-E-R paradigm

5V 2.9 04/07V 2.9 04/07

BDLSBDLS Course Outline Course Outline

• Overview & ConceptOverview & Concept• DISASTER ParadigmDISASTER Paradigm• Triage Triage • Natural Disasters Natural Disasters • Explosive & TraumaticExplosive & Traumatic• Nuclear & RadiologicalNuclear & Radiological• Biological AgentsBiological Agents• Chemical AgentsChemical Agents• Psychosocial AspectsPsychosocial Aspects• Public Health System / Your local systemPublic Health System / Your local system

• ExaminationExamination• Course evaluationsCourse evaluations

Replace pictureReplace picture

6V 2.9 04/07V 2.9 04/07

Disaster PreparednessDisaster Preparedness

The Reality of … The Reality of …

September 11, 2001 (“9-11”)September 11, 2001 (“9-11”)

7V 2.9 04/07V 2.9 04/07

Disaster PreparednessDisaster Preparedness

The Reality of…The Reality of…

September 2005September 2005 Hurricanes “Katrina” & “Rita”Hurricanes “Katrina” & “Rita”

Photo Source: Phillip L. Coule, MDPhoto Source: Phillip L. Coule, MD

8V 2.9 04/07V 2.9 04/07

NDLS ConceptNDLS Concept

• Critical to healthcare preparedness:Critical to healthcare preparedness:

• Uniform, coordinated approach to Uniform, coordinated approach to mass casualty management from all-mass casualty management from all-hazardshazards

• Seamlessly integrated Seamlessly integrated • Scaleable responseScaleable response

• Best accomplished by standardized Best accomplished by standardized education and trainingeducation and training

9V 2.9 04/07V 2.9 04/07

NDLS MissionNDLS Mission

• To implement and To implement and maintain a nationwide maintain a nationwide foundation in foundation in education and training education and training resulting in a resulting in a measurable impact in measurable impact in disaster preparedness disaster preparedness to a critical mass of to a critical mass of the healthcare the healthcare workforceworkforce

Photo Source: Raymond Swienton, Photo Source: Raymond Swienton, MDMD

10V 2.9 04/07V 2.9 04/07

NDLSNDLS

A comprehensive, A comprehensive, nationally-standardized nationally-standardized family of all-hazards family of all-hazards training programs training programs developed by the NDLS developed by the NDLS consortium of academic, consortium of academic, state, and federal centers.state, and federal centers.

Local Preparedness, Global Response!Local Preparedness, Global Response!

11V 2.9 04/07V 2.9 04/07

DISASTERDISASTER Paradigm Paradigm

DD DetectionDetectionII Incident ManagementIncident ManagementSS Security and SafetySecurity and SafetyAA Assess HazardsAssess HazardsSS SupportSupportTT Triage / TreatmentTriage / TreatmentEE EvacuationEvacuationRR RecoveryRecovery

Photo Source: Phil Jones, Medical College of GeorgiaPhoto Source: Phil Jones, Medical College of Georgia

12V 2.9 04/07V 2.9 04/07

NDLS CoursesNDLS Courses are Practical are Practical

Photo Source: Phillip L. Coule, MDPhoto Source: Phillip L. Coule, MD

13V 2.9 04/07V 2.9 04/07

DefinitionsDefinitions

• DisasterDisaster– A disaster is present when need exceeds A disaster is present when need exceeds

resourcesresources– A response need that is greater than the A response need that is greater than the

resources available defines a disaster.resources available defines a disaster.

Disaster = Need > ResourcesDisaster = Need > Resources

14V 2.9 04/07V 2.9 04/07


• Mass Casualty IncidentMass Casualty Incident– A healthcare disaster where the number of A healthcare disaster where the number of

casualties is greater than the ability of the casualties is greater than the ability of the healthcare system to care for themhealthcare system to care for them

Healthcare need > ResourcesHealthcare need > Resources– May result from natural or man-made May result from natural or man-made

incidentincident– Requires a clear understanding of your own Requires a clear understanding of your own

capabilities and capacitiescapabilities and capacities

15V 2.9 04/07V 2.9 04/07


• All-Hazards PreparednessAll-Hazards Preparedness– Plans and training for incidents regardless Plans and training for incidents regardless

of the cause, man-made or naturally of the cause, man-made or naturally occurringoccurring

• Man-made Man-made – Terrorism, Bioterrorism, Structural Terrorism, Bioterrorism, Structural

collapse, Fires, Explosions etc.collapse, Fires, Explosions etc.

• NaturalNatural– Hurricanes, Floods, Tornadoes, Emerging Hurricanes, Floods, Tornadoes, Emerging

Infectious Diseases, etc.Infectious Diseases, etc.

16V 2.9 04/07V 2.9 04/07


• TerrorismTerrorism– An act intended to inflict harm upon a civilian An act intended to inflict harm upon a civilian

population to coerce or intimidatepopulation to coerce or intimidate• BioterrorismBioterrorism

– An act of terrorism using biological agents (e.g. An act of terrorism using biological agents (e.g. anthrax).anthrax).

• WMDWMD– Weapons of Mass DestructionWeapons of Mass Destruction

• WMEWME– Weapons of Mass EffectWeapons of Mass Effect

• CBRNECBRNE– Chemical, Biological, Radiological, Nuclear, Chemical, Biological, Radiological, Nuclear,

ExplosiveExplosive

17V 2.9 04/07V 2.9 04/07

DISASTERDISASTER Paradigm Paradigm

DD DetectionDetectionII Incident Incident

ManagementManagementSS SecuritySecurityAA Assess HazardsAssess HazardsSS SupportSupportTT Triage / TreatmentTriage / TreatmentEE EvacuationEvacuationRR RecoveryRecovery

Does your need exceed Does your need exceed your resources in any your resources in any of these areas?of these areas?

18V 2.9 04/07V 2.9 04/07

DD-I-S-A-S-T-E-R -I-S-A-S-T-E-R ParadigmParadigmDetectionDetection

• Not all disasters are obviousNot all disasters are obvious• Onset of the event may be insidiousOnset of the event may be insidious

– Biological eventBiological event– Important to communicate effectively with public Important to communicate effectively with public

health officials early in eventhealth officials early in event

• Awareness that resources are being Awareness that resources are being overwhelmedoverwhelmed

• Detection of potential cause of the event (e.g. Detection of potential cause of the event (e.g. biological vs. Chemical, etc)biological vs. Chemical, etc)

• Must communicate “Disaster” status to others Must communicate “Disaster” status to others

19V 2.9 04/07V 2.9 04/07

D-D-II-S-A-S-T-E-R -S-A-S-T-E-R Paradigm Paradigm Incident ManagementIncident Management

• National Incident Management System (NIMS)National Incident Management System (NIMS)– Command and controlCommand and control– Information managementInformation management– Equipment and training standardsEquipment and training standards

• Mandated by Homeland Security Presidential Mandated by Homeland Security Presidential Directive (HSPD #5)Directive (HSPD #5)

• Incident Command is major component of Incident Command is major component of Command and ControlCommand and Control

• Provides orderly chain of commandProvides orderly chain of command• Clearly delineated roles / responsibilitiesClearly delineated roles / responsibilities• Manageable “span of control”Manageable “span of control”

20V 2.9 04/07V 2.9 04/07

D-D-II-S-A-S-T-E-R -S-A-S-T-E-R Paradigm Paradigm Incident Command SystemIncident Command System

The BasicsThe Basics

Unified CommandUnified Command

PlanningPlanning OperationsOperations FinanceFinanceLogisticsLogistics

21V 2.9 04/07V 2.9 04/07 Image source: California EMS Authority, Public DomainImage source: California EMS Authority, Public Domain

22V 2.9 04/07V 2.9 04/07

D-D-II-S-A-S-T-E-R -S-A-S-T-E-R Paradigm Paradigm Incident ManagementIncident Management

• Hospital Emergency Incident Command Hospital Emergency Incident Command System (HICS)System (HICS)

• Incident Command System specific for Incident Command System specific for hospitalshospitals

• Meets JCAHO requirements for disaster Meets JCAHO requirements for disaster management command and control management command and control schemescheme

• Clearly defined roles, responsibilities Clearly defined roles, responsibilities and lines of communicationand lines of communication

23V 2.9 04/07V 2.9 04/07

D-I-D-I-SS-A-S-T-E-R -A-S-T-E-R Paradigm Paradigm Security and SafetySecurity and Safety

• Secure ingress and egress Secure ingress and egress – SceneScene– HospitalHospital

• Prevent self transportPrevent self transport– ~80% will self transport unless provided care on ~80% will self transport unless provided care on

scenescene

• Identify and mitigate obvious threats to Identify and mitigate obvious threats to SecuritySecurity– Secondary devices? (e.g. second bomb)Secondary devices? (e.g. second bomb)– Ongoing action by perpetrator?Ongoing action by perpetrator?– Power lines, gas leaks, building collapsePower lines, gas leaks, building collapse– Crowd surgeCrowd surge

24V 2.9 04/07V 2.9 04/07

D-I-S-D-I-S-AA-S-T-E-R-S-T-E-R Paradigm ParadigmAssess HazardsAssess Hazards

• Priority OnePriority One– Protect yourself and your team first!Protect yourself and your team first!– Don’t become part of the problem!Don’t become part of the problem!– Utilize personal protective equipmentUtilize personal protective equipment– Medical decontamination methodsMedical decontamination methods

• Your next prioritiesYour next priorities– Protect the publicProtect the public– Protect the patientsProtect the patients– Protect the environmentProtect the environment

• Avoid tunnel vision on the ill and injuredAvoid tunnel vision on the ill and injured

25V 2.9 04/07V 2.9 04/07

D-I-S-D-I-S-AA-S-T-E-R-S-T-E-R Paradigm ParadigmAssess HazardsAssess Hazards

• Secondary devices / threats?Secondary devices / threats?– Second bombSecond bomb– Sniper etc.Sniper etc.

• Hazardous Materials?Hazardous Materials?– CBRNE Event?CBRNE Event?– Personal Protective EquipmentPersonal Protective Equipment

• Consider potential future hazardsConsider potential future hazards– Shifting winds? Darkness? Crowd surge?Shifting winds? Darkness? Crowd surge?– Continual reassessment of the sceneContinual reassessment of the scene

26V 2.9 04/07V 2.9 04/07

D-I-S-A-D-I-S-A-SS-T-E-R-T-E-R Paradigm ParadigmSupportSupport

• What resources are needed?What resources are needed?

• Who has them?Who has them?– LocalLocal– RegionalRegional– State State – FederalFederal

• When will they arrive?When will they arrive?– Minutes, Hours, or Days Minutes, Hours, or Days


27V 2.9 04/07V 2.9 04/07


• PharmaceuticalsPharmaceuticals– Local Stockpiles (30 min – 1 hr)Local Stockpiles (30 min – 1 hr)– Regional Stockpiles Regional Stockpiles

(Chempack) (1 – 2 hrs)(Chempack) (1 – 2 hrs)– Strategic National Stockpile Strategic National Stockpile

(12 – 48 hrs*)(12 – 48 hrs*)

• EquipmentEquipment– Local Stockpiles / mutual aid (30 Local Stockpiles / mutual aid (30

min – 1 hr)min – 1 hr)– Regional Stockpiles (1 – 2 hrs)Regional Stockpiles (1 – 2 hrs)– Strategic National Stockpile Strategic National Stockpile

(12 – 48 hrs*)(12 – 48 hrs*)

* SNS will be delivered within 12 hrs after agreement of the order to send it. Photo Source: CDC.govPhoto Source: CDC.gov

28V 2.9 04/07V 2.9 04/07


• PersonnelPersonnel• Clear chain of command defined in plan Clear chain of command defined in plan • Activation communication system Activation communication system

– Activate back-up and call in personnelActivate back-up and call in personnel• Plan a realistic mobilization timetablePlan a realistic mobilization timetable

– Mutual aid scene response (30 min – 1 hr)Mutual aid scene response (30 min – 1 hr)– Off-duty personnel (1 hr – 2 hrs)Off-duty personnel (1 hr – 2 hrs)– Regional or State Teams (4 – 8 hrs)Regional or State Teams (4 – 8 hrs)

• Medical Reserve Corps (MRC)Medical Reserve Corps (MRC)– Federal Disaster Teams (48 – 72 hrs)Federal Disaster Teams (48 – 72 hrs)

• Disaster Medical Assistance Teams (DMAT)Disaster Medical Assistance Teams (DMAT)

Photo Source: DMAT GA-4Photo Source: DMAT GA-4

29V 2.9 04/07V 2.9 04/07


Unexpected Volunteers and Donations:Unexpected Volunteers and Donations:• Does your preparedness plan include them?Does your preparedness plan include them?

– Ability to identify needed skills and needed suppliesAbility to identify needed skills and needed supplies

• Positive intentionsPositive intentions– Community reaching out to help others in needCommunity reaching out to help others in need

• Can have a negative impactCan have a negative impact– Time to sort large and label goodsTime to sort large and label goods– Storage space usedStorage space used– Unplanned personnel are a liabilityUnplanned personnel are a liability

• At risk of injuries, require food, water and shelterAt risk of injuries, require food, water and shelter

30V 2.9 04/07V 2.9 04/07

D-I-S-A-S-D-I-S-A-S-TT-E-R-E-R Paradigm ParadigmTriageTriage

• Sorting of patients into severity of injury AND Sorting of patients into severity of injury AND likelihood of survivallikelihood of survival– Consider disposition and available transportationConsider disposition and available transportation

• Several different triage systems currentlySeveral different triage systems currently• Long term vision of one triage system used Long term vision of one triage system used

by all healthcare providers, facilities and by all healthcare providers, facilities and agenciesagencies

31V 2.9 04/07V 2.9 04/07


• M.A.S.SM.A.S.S. Triage System. Triage System

MM – Move – MoveAA – Assess – AssessSS – Sort – SortSS – Send – Send


32V 2.9 04/07V 2.9 04/07


Triage CategoriesTriage Categories• ““ID-me”!ID-me”!

– A mnemonic for sorting patients during A mnemonic for sorting patients during triagetriage

I –I – ImmediateImmediateD – D – DelayedDelayedM – M – MinimalMinimalE – E – ExpectantExpectantD -D - DEADDEAD

33V 2.9 04/07V 2.9 04/07

D-I-S-A-S-D-I-S-A-S-TT-E-R-E-R Paradigm ParadigmTreatmentTreatment

• Treatment continues until:Treatment continues until:– All patients transported to healthcare areasAll patients transported to healthcare areas– Resources unavailable to provide treatmentResources unavailable to provide treatment– Comfort is Care!Comfort is Care!

• Treatment locationsTreatment locations– Scene, hospitals, secondary treatment areasScene, hospitals, secondary treatment areas

• DocumentationDocumentation– Patient Identification / Triage TagPatient Identification / Triage Tag– Medical RecordMedical Record

34V 2.9 04/07V 2.9 04/07

D-I-S-A-S-T-D-I-S-A-S-T-EE-R-R Paradigm ParadigmEvacuationEvacuation

• Patient evacuation from scene Patient evacuation from scene to hospital or treatment areato hospital or treatment area– Consider routes, vehicles, Consider routes, vehicles,

staging areasstaging areas

• Public evacuation of elderly, Public evacuation of elderly, poor, nursing homes, etc.poor, nursing homes, etc.– Special needs patientsSpecial needs patients

• Hospital evacuation during a Hospital evacuation during a catastrophic eventcatastrophic event– Flooding, power outagesFlooding, power outages– Facility contaminationFacility contamination

• Essential part of your plan!Essential part of your plan!

Photo Source: Phillip Coule, MDPhoto Source: Phillip Coule, MD

35V 2.9 04/07V 2.9 04/07

D-I-S-A-S-T-E-D-I-S-A-S-T-E-RR Paradigm Paradigm RecoveryRecovery

• Long-term goal of the event!Long-term goal of the event!

• Minimize event’s impactMinimize event’s impact – Injured victims, families, rescue personnelInjured victims, families, rescue personnel– Community, state, and nationCommunity, state, and nation– EnvironmentEnvironment

• Preparedness Plan must includePreparedness Plan must include

• Begins…Begins… when the incident occurred when the incident occurred

• Ends…Ends… often years later often years later

36V 2.9 04/07V 2.9 04/07


• Operational and Logistic considerations:Operational and Logistic considerations:– PersonnelPersonnel::

• Fed, hydrated, rested and released ASAPFed, hydrated, rested and released ASAP• Many personnel may have been injuredMany personnel may have been injured• Tendency to down-play importanceTendency to down-play importance• Pre-release medical examsPre-release medical exams

– VehiclesVehicles::

• Clean, disinfect, restock, refuel unitsClean, disinfect, restock, refuel units– EquipmentEquipment::

• Repair / replace equipment (and evaluate)Repair / replace equipment (and evaluate)• Inventory & order supplies (and evaluate)Inventory & order supplies (and evaluate)

37V 2.9 04/07V 2.9 04/07


• PsychosocialPsychosocial– Identifying those at risk Identifying those at risk

is challengingis challenging• Survivor GuiltSurvivor Guilt• Feelings of helplessnessFeelings of helplessness• Haunting imagesHaunting images• Sleep disturbanceSleep disturbance• Substance abuseSubstance abuse• Depression / suicideDepression / suicide

– Facilitate appropriate Facilitate appropriate interventionsinterventions

Photo Source: Photo Source: www.indystar.com, public domain

38V 2.9 04/07V 2.9 04/07


• Community infrastructure impactedCommunity infrastructure impacted– Basic needs: Food, water, shelter, clothingBasic needs: Food, water, shelter, clothing– Financial: Reestablish businesses Financial: Reestablish businesses

• Reestablish local healthcare accessReestablish local healthcare access

• Recognize hospital as critical Recognize hospital as critical infrastructure asset in planninginfrastructure asset in planning

• Sharing After Action Reviews (AAR) to Sharing After Action Reviews (AAR) to improve local, regional, state and federal improve local, regional, state and federal future planningfuture planning

39V 2.9 04/07V 2.9 04/07

SummarySummary

Now you can:Now you can:• Discuss the importance of a nationally Discuss the importance of a nationally

standardized disaster education and standardized disaster education and training program training program

• Describe the National Disaster Life Describe the National Disaster Life Support (NDLS) coursesSupport (NDLS) courses

• Define disaster, Mass CasualtyDefine disaster, Mass Casualty Incident Incident (MCI) and related terms(MCI) and related terms

• Identify the components of the Identify the components of the D-I-S-A-S-T-E-R paradigmD-I-S-A-S-T-E-R paradigm

40V 2.9 04/07V 2.9 04/07

Thank You!Thank You!

Questions?Questions?

Documents

“Preparing Our Communities”