DISASTER MANAGEMENT PRINCIPLESJAMES WINTONMAY 2016

DISASTER MANAGEMENTProvide a framework of how disasters are managed• Pre-hospital• In Hospital

MIMMS approachSCGH Emergency Department disaster plan

2015 ASM: Victims & Responders; Christchurch Earthquake — Prof. Mike Ardagh

WHAT IS A DISASTER?Disaster• Event • Threat actual or potential• Extraordinary resources• Coordination across services

Classified by type• Trauma vs Medical• Natural vs Man-made• Simple vs compound• Compensated vs uncompensated

DISASTERS IN AUSTALIANATURAL• Bushfires• Cyclones• Floods• Drought• Earthquake• Heat wave

MAN MADE• Granville train• Westgate bridge• Kemspey bus• Port Arthur• Childers fire• Eureka stockade• Maritime• Air accidents

DISASTER MANAGEMENT IN WAGoverning body – DPMU

• All hazards approach• Comprehensive approach (Prevention, Preparedness,

Response, Recovery)• All agencies (integrated) approach• Graduated response• Community risk management• Prepared community

PHASES OF A MAJOR INCIDENTPreparationResponse Recovery

Both prehosptal and in hospital follow these phasesA major incident in Perth may involve hospital based team as part of the coodinated prehospital response

MIMMS course provides an approach to prehospital management

PRE-HOSPITAL RESPONSE

SERVICES INVOLVEDAmbulance service Police serviceFire servicesUrban search and rescue teamsLocal authorities – emergency servicesHealth

Organisation and coordination are crucial

All hazards All service

PREPARATION FOR THE SCENEPersonal equipment• Clothing/phone/torch/camera/map/rationsMedical equipment• Triage/First aid/advance life support/specialist

equipment/transport equipmentCommunication equipment• Radio/phone/other methods – runners, media, loud hailer

SCENE MANAGEMENTC – Command and controlS – SafetyC – CommunicationA – AssessmentT – TriageT – TreatmentT – Transport

COMMAND AND CONTROL ZONES

Casualty clearing post (CCP)• Safe• Large• Sheltered• Acessible

SCENE SET UP

TRIAGEDisaster triageDynamic process Priorities• 1 – Immediate – RED• 2 – Urgent – YELLOW• 3 – Delayed – GREEN• 4 – Expectant – BLACK/BLUE

Triage Sieve – at incident siteTriage Sort – at casualty clearing post

TRIAGE SIEVEWALKING Priority 3 (Delayed)

DEADBREATHING

When Airway opened

RESPIRATORY RATE PRIORITY 1(Immediate)

PRIORITY 2 (Urgent)CAPILLARY REFILL

Yes

No

No

Yes

< 10 or >29

10 - 29

< 2 sec

> 2 sec

TRIAGE SORT

Labels• Visible/attachable

TRIAGE LABELS

TREATMENTWhat can be doneWhat should be done

Treatment at scene usually confined to A/B/C

Priority is to get casualties away from the scene

Triage takes priority to treatment

TRANSFEROrganisation is imperativeTreatment impacts on ability to transport

Destination considerationsMethod of transport

HOSPITAL RESPONSE

HOSPITAL PLANSCGH response to an external disaster is “Code Brown”Each area has its specific subplanDo you know where it is?

Details of the contents are available elsewhere

PREPARATIONHave a planTest the plan• Locally• Regionaly• All agencies• DPMU• Hospital• Emergotrain• Meetings

NOTIFICATIONMay come from different sources• Ambulance• Media• Self presenters• Hospital Emergency Control Group (ECG)• DPMU – on call duty officer• WebEOC

• Many theories and stories on how patients present

PREPARATIONSurge capacity• Clearing the ED• Clearing the hospitalTiered responseDepartment layout• Locations• ResourcesClerical involvement

SCGH ED Mass Casualty layout

RESPONSEStaff allocated to triage priorititesEach priority has a team leader which liases with duty consultantOther staff may be utilised• Duty surgeon • Duty intensivist• Duty radiologist

• Limit Xrays • Limit operative treatment• “Damage control”

RECOVERYPotentially huge undertakingResumption of normal functionRestockingDebriefingReviewingPreparation

Hours to days to weeks

DISASTER MANAGEMENT PRINCIPLESPlanningPreparationPractice

Prehospital responseHospital response

MIMMS – www.mimms.org.au HMIMMS

Thanks to Dr Roger Swift FACEM SCGH ED