GETTING DOCS

into the
DISASTER PREPAREDNESS
LOOP
Joanne Selkurt MD, FAAP

Introduction
The Reality:
September 11, 2001
9 - 11
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?

KATRINA

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 responders or
receiving hospitals capability to treat or
transport is a Mass Casualty Incident
D-I-S-A-S-T-E-R
Paradigm

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 1970s
Interagency task force collaborative effort
Uniform structure
Clearly delineated roles/responsibilities
Clear chain of command/ communication
Incident Command System
The Basics

Unified Command
Planning Operations Finance Logistics
Commander
Thinkers Getters Doers Payers
Incident Command System
Operations
Medical Direction Communications
Triage Treatment Transportation Extrication/Rescue Staging
EMS Operations Fire Operations LE Operations
Surveillance
Clinic 1 Clinic 2 Clinic 3
Immunization
Clinics
Public Health
OPERATIONS
D-I-S-A-S-T-E-R Paradigm
Assess Hazards
Be Aware of Secondary Devices!
Bombs, Shrapnel devices, Incapacitating Devices, Multiple
Snipers/Terrorists, Delay Devices

D-I-S-A-S-T-E-R Paradigm
Assess Hazards

Be Aware of Secondary Devices!
Bombs, Shrapnel devices, Incapacitating Devices, Multiple
Snipers/Terrorists, Delay Devices
D-I-S-A-S-T-E-R Paradigm
Support
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
Volunteers
Need 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, I nterfere, Confuse, Burden &
Even Endanger themselves and others

est if a memb

M.A.S.S. Triage
M Move
A Assess
S Sort
S 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 ?
Dont be afraid to admit you dont know all the answers
Answer ? At a level the child can understand
Establish a family emergency plan (Sense of doing something
is helpful)
Monitor childrens TV watching..dont 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
Disasters often reawaken a childs 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 childs 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
Child Health Alliance of
Wisconsin (CHAW)
www.chawisconsin.org
Click Programs
Click Trauma preparedness

A

A stuffed animal can help a lot