Overview and the Importance of EMS and the Community Hospital

RandyD.KearnsDHAMSAFACHEFRSPHCEMAssistantProfessorforHealthcareManagementCollegeofBusinessAdministrationUniversityofNewOrleans

6THMCSWAINEMSTRAUMAINTERNATIONALSYMPOSIUM

NOVEMBER16TH2018

Areaofresearch◦ SurgeCapacity– focusedonBurnCare,RoleofEMSandCommunityHospital

Background◦ EMS,ParamedicInstructor,RetiredAsstProfessorSchoolofMedicineattheUniversityofNorthCarolina

Author(17articlespast6yearsincludingDr.JeffCarter,BurnCenterMedicalDirectorUMCNO)◦ AnnalsofBurnsandFireDisasters(1Published)◦ EMSWorld(5Published)◦ Burns(1Published)◦ JournalofBurnCareandResearch(4Published)◦ PrehospitalandDisasterMedicine (1Published)◦ SouthernMedicalJournal(3Published)◦ BiosecurityandBioterrorism (1Published)◦ AmericanJournalofDisasterMedicine (1Published)

History orPotentialDisasterswithaThermalComponent– priorevents,whatlessonshavebeenlearned,whatisapplicable,andwhathasbeenretained

Planning– includesgeneralplanningconsiderationsforbothburncenterandlocalEMSandhospitals◦ SurgePlanning– importantforboththeburncenterandlocalhospitals

Education – basicburneducation,hospitalsandEMS

TransportationResources– distributionandredistributionofpatients

Finance – howdoyoupayforaburndisaster

FivepatientsWhatwouldyoudo?Airway

Breathing◦ Oxygen

Circulation◦ FluidResuscitation

SecondarySurvey

PainManagement

BurnCenter

PatientOne

PatientTwo

PatientThree

PatientFour

PatientFive

Yoursceneisoneofthosepatients?Yoursceneisallofthosepatients?Yoursceneincludes20morepatients?

TheRoleofEMSandtheCommunityHospital isVital9-1-1CallerSo,that’swherewestart.

Burn– isatimesensitiveinjury/illness

Small– butmanageablepatientpopulation

Dataquality– small,easiertroubleshoot,bettertounderstandgapsandanomaliesScalability– lessonslearnedhaveapplicabilityinotherspecialtiesLimitedSupplyofCriticalFacilities◦ Howlimitedyouask?

LimitedSupplyofCriticalFacilities◦Changeoverthepastsixyears(x)

131BurnCenters(+8or15.4%)123(4BurnCentersLouisiana)◦5534Hospitals(-71or1.24%)(5795in2012)

◦ 2000BurnBeds◦894,574StaffedBeds(-49,703or5.26%)(944,277in2012)

327,550,750 USPopulation(+4.34%)(313,914,040)http://www.aha.org/research/rc/stat-studies/fast-facts.shtml

http://www.aha.org/aha/resource-center/Statistics-and-Studies/fast-facts.html

◦ TypeIIIBurnDisaster– BurnCareSystemImpact◦ IsolatedburndisastersuchastheStationorKissNightClubFires◦ Impact:BurnCareSystem

◦ TypeIIBurnDisaster– HealthcareSystemImpact◦ Multipleaspectdisaster,suchasanexplosionwithsignificantnumbersoftraumaticaswellasburn injuredpatientssuchasthe2013Boston,2005London or2004MadridBombings

◦ Impact:HealthcareSystem

TypeIBurnDisaster– InfrastructureImpact◦ Catastrophic/widespreadevent,multi-statesuchas9/11attacksorEarthquakessuchasNorthridge, LomaPrieta,Haiti*

◦ Impact:CriticalInfrastructure

KearnsRD,Holmes4thJH,ConlonKH,Valenta AL,Matherly AF,CairnsCB,Lord,G,SawyerD,Johnson IIDT,SkaroteMB,SilerSM,Helminiak C,CairnsBA.DisasterPlanning:TheBasicsofCreatingaBurnMassCasualtyDisasterPlanforaBurnCenter.JournalBurnCareResearch.PubAheadofPrintJBCR:Jul2013.

Disasterplansshouldreflectanextensionofdailyactivities.

Planningfromtheburncenterperspectiveshouldreflect(minimally)threelevels;

Local: Intrafacility(yourhospital/system)

State: Interfacility/instrastate(burnandtraumacenters)(stateESF-8)

Regional:Interstate(burnandtraumacenters)NDMSorEMACthroughstateESF-8

KearnsRD,Conlon KH,Valenta AL,Matherly AF,Holmes4thJH,Cairns CB,Lord,G,SawyerD,Johnson IIDT,Skarote MB,SilerSM,Helminiak C,CairnsBA.DisasterPlanning:TheBasicsofCreatingaBurnMassCasualtyDisasterPlanforaBurnCenter.Journal BurnCareResearch.PubAheadofPrintJBCR:Jul2013.

Planningfromthegovernmentalperspectiveshouldreflect:

Local: FirstResponder(EMSsystem)

FirstReceiver(s)(localhospital[s])

State: MutualAidEMS,Intrastateregionalresponseteams,

burnandtraumacenters

Regional: InterstateBurnCenters,Regionalor

FederalResponseTeamsthrough

EMACorNDMS

KearnsRD,Holmes4thJH,ConlonKH,Valenta AL,Matherly AF,Cairns CB,Lord,G,SawyerD,Johnson IIDT,Skarote MB,SilerSM,Helminiak C,CairnsBA.DisasterPlanning:TheBasicsofCreatingaBurnMassCasualtyDisasterPlanforaBurnCenter.Journal BurnCareResearch.PubAheadofPrintJBCR:Jul2013.

StatePlan

Immediate:bestyoucanwithwhatyouhaveandknowwhotocallforwhatyouneed(alsoreferredtoasaNo-noticeEvent)

6-120hrs:leaningforwardwithresponseteams,transportagencies,andpushpacksofequipment( :staff,space,stuff)(special)

>72-120hrs:highcensusbutnormaloperation

KearnsRD,Conlon KH,Valenta AL,Matherly AF,Holmes4thJH,Cairns CB,Lord,G,SawyerD,Johnson IIDT,Skarote MB,SilerSM,Helminiak C,CairnsBA.DisasterPlanning:TheBasicsofCreatingaBurnMassCasualtyDisasterPlanforaBurnCenter.Journal BurnCareResearch.PubAheadofPrintJBCR:Jul2013.

Burn Center, Co-Located with a Level I Trauma Center

Designated Burn Center

CasestudyonFire inasmallspacewithlimitedfireprotection

NationalInstituteofStandardsandTechnology(NIST)Simulation

TheValueofModeling:◦ Testmultiplehypotheses◦ Injectvariability◦ Increasedfrequencyofexercise

ThreeTypesofSimulation◦ DiscreteEvent◦ Continuous

PlanFatigue/Failure◦ Planvs.Framework

Descriptiveanalysis◦ Selfdesignatedandselfreportedbedcapacity◦ BurnCenterSurgecapacity(50%abovestatedcapacity)◦ TraumaCenterstaticcapacity(temporary)

MonteCarloSimulation(NorthCarolinaJayceeBurnCenter2009-10todetermineadistributioncurve)◦ ReportedStaffedCapacity– Avg.DailyCensus

=BedAvailability◦ Randomlyperform10,000iterationsusing@Risk

KearnsRD.BurnsurgecapacityinthesouthwhatisthecapacityofburncenterswithintheAmericanBurnAssociation southernregionto absorbsignificantnumbersofburninjuredpatientsduringamedicaldisaster?MedicalUniversity ofSouthCarolina:ProQuest DissertationsandTheses;2011.

ConfirmedTriggerpointsforplanningtools

Activationpointsfortransportationassets/resources

Betterunderstandingofcapacitiesandcapabilities

6:5:6TriggertoactivatePlan

20-60patients=IntrastatePlanFailure

425-450patients=InterstatePlanFailure(Regional)

LouisianaESF-8

AllDisastersareLocal!

BURNCENTER

TRAUMACENTER

§ SufficientResources§ tothescenetocareforandmovepatients

toappropriatedestinations§ Upstreamnotification

§ Receivinghospitals§ Mutualaidground/airambulances

§ DependingonyourDestinationandTriageplanwilldependonyourinitialdestination

BurnPrevention◦ElementarySchools(16,033Students)

StatewideProtocols◦CommonApproachtoCare

LocalDeliveryBurnCareCoreConcepts◦Coursesoffered(154courses)

LocalandRegionalDelivery,AdvancedBurnLifeSupport◦Coursesoffered(93courses)

§ Knowyourlimits,whendoyouneedmutualaidandwhodoyoucall?

§ DoestheBurnCenterhavean“AlwaysOpen”philosophy?

§ WhatareyourregionalorStateAgencyinvolvement?

SurgeCapacity(andCapability)includesthe◦Staff◦Space◦Stuff(Supplies,Pharmaceuticals&Equipment)(Special)

requiredtomeettheneedsofthepatients.

ThemostimportantcontributingfactoroutsideofS3ismedicaltransportationresources.

KearnsRD,Holmes4thJH,ConlonKH,Valenta AL,Matherly AF,CairnsCB,Lord,G,SawyerD,Johnson IIDT,SkaroteMB,SilerSM,Helminiak C,CairnsBA.DisasterPlanning:TheBasicsofCreatingaBurnMassCasualtyDisasterPlanforaBurnCenter.JournalBurnCareResearch.PubAheadofPrintJBCR:Jul2013.

Civilian◦ Ambulances–◦ AmbulanceStrikeTeams–◦ AmBuses Units–◦ SCT/CCTUnits–◦ Helicopters–◦ FixedWing–

GovernmentalorMilitary◦ NationalGuardvs.ReservesorRegularAirForce◦ CoastGuard,ForestService,ParkService

Plans–Relationships◦ Local,State,Regional

Whotocallandwhatcanyoubring?◦ Staff,Space,Stuff– Transportresources

Plans– Scalability,TriggerPoints,Activity,FailureAlldisastersarelocal,soareallsolutions

Educationisagamechanger

RandyD.Kearns,DHArkearns@uno.edu

JeffreyE.Carter,MDFACSjeffrey.carter@lcmchealth.org

1. KearnsR,HolmesJt,CairnsB.Burndisasterpreparednessandthesouthern regionoftheUnitedStates.SouthMedJ.Jan2013;106(1):69-73.2. KearnsRD,HolmesJHt,Alson RL,CairnsBA.DisasterPlanning:ThePast,Present,andFutureConceptsandPrinciplesofManagingaSurgeofBurnInjuredPatientsforthoseInvolved inHospitalFacilityPlanningandPreparedness.JBurnCareRes.Jan-Feb2014;35(1):e33-42.3. KearnsRD,CairnsCB,HolmesIVJH,RichPB,CairnsBA.Blastinjuries&burncare.EMSWorld.May2013;42(5):34-40.4. KearnsRD,CairnsBA,Hickerson WL,HolmesJHt.ABASouthernRegionBurnDisasterPlan:TheProcessofCreatingandExperiencewiththeABASouthernRegionBurnDisasterPlan.JBurnCareRes.Jan-Feb2014;35(1):e43-48.5. KearnsRD,ConlonKM,ValentaAL,etal.Disasterplanning:thebasicsofcreatingaburnmasscasualtydisasterplanforaburncenter.JBurnCareRes.Jan-Feb2014;35(1):e1-e13.6. KearnsRD,HubbleMW,HolmesJHt,CairnsBA.Disasterplanning:transportationresourcesandconsiderationsformanagingaburndisaster.JBurnCareRes.Jan-Feb2014;35(1):e21-32.7. KearnsRD,HolmesJHt,SkaroteMB,etal.Disasters;the2010HaitianearthquakeandtheevacuationofburnvictimstoUSburncenters.Burns:journaloftheInternationalSocietyforBurnInjuries.Jan72014.8. KearnsRD,MyersB,CairnsCB,etal.HospitalBioterrorismPlanningandBurnSurge,WhenBioterrorismPlanningandBurnSurgePreparednesscomefacetofacewithanIndustrialPlantExplosion; theEffectivenessofa21stcenturyBurnSurgeDisasterPlan.Biosecurityandbioterrorism:biodefensestrategy,practice,andscience.20142014;12(1).9. KearnsRD,HubbleMW,LordGC,Holmes4thJH,CairnsBA,Helminiak C.DisasterPlanning:FinancingaBurnDisaster,Wheredoyou turnandwhatareyouroptionswhenyourhospitalhasbeenimpactedbyaBurnDisasterintheUnitedStates?TheJournalofburncare&rehabilitation.2013:1-74.10. KearnsRD,Holmes4thJH,CairnsBA.BurnInjury:What’sinaName?LabelsUsedforBurnInjuryClassification;AReviewoftheDatafrom2000-2012.Annalsofburnsandfiredisasters.2013;8(3):6.11. KearnsRD,Ortiz-PujolsSM,CraigCK,etal.DisasterPlanning:UsingaBurnCareEducationProgramtoimprovedisasterpreparednessforaBurnDisaster.JournalBurnCareResearch2013:1.12. KearnsRD.Burnsurgecapacityinthesouth:WhatisthecapacityofburncenterswithintheAmericanBurnAssociationSouthernRegiontoabsorbsignificantnumbersofburninjuredpatientsduringamedicaldisaster?2011.