Baltimore City Health Department's All Hazards Plan for Mass Casualty Triage, Treatment, and Transpo

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Baltimore City Health Department's All Hazards
Plan for Mass Casualty Triage, Treatment,
and Transport

• June 3, 2009
• Steven A. Hankins, M.D.
• LCDR, US Public Health Service
• HRSA Ready Responder Program

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Introduction, Disclaimer, and Disclosures

• The views presented are not those of the U.S.
  Public Health Service, DHHS, or those of any of
  its Agencies.
• Any mention of a commercially available product
  by trade name does not represent an endorsement
  of that product.
• No relevant financial disclosures

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Meeting Objectives

• At the end of the session, participants will be
  able to
• 1. Describe Baltimore City Health Department's
  all hazards surge capacity plan.
• 2. Identify key considerations in developing an
  all hazards surge capacity plan.
• 3. Identify ways similar plans might be adapted
  to other localities.

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A brief history ....

• 1997 Defense Authorization Act, Title XIV,
  Defense Against WMD created the Domestic
  Preparedness Program
• Department of Defense through the US Army Soldier
  and Biological Chemical Command _at_ Aberdeen
  Proving Grounds ? established the Chemical
  Weapons Improved Response Program
• CWIRP formed the Health and Safety functional
  group chaired by Baltimore City Health
  Department's Director of Field Health Services ?
  recognized need and developed OST3C concept
• Multiple BALTEX Table Top and Functional
  exercises have examined the use of temporary
  alternate care facilities for off site triage,
  treatment, and transport in the event of a
  chemical weapons incident.

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So, what's new?

• Further adaptation and expansion of the concept
  to be all hazards applicable
• NIMS compliant structure, language, and job
  titles
• Identification of specific fixed locations for
  default T3C sites utilizing Super Fire Stations
  and potentially BCHD clinics.

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From 10,000 Feet ....

• To be successful, a All Hazards Surge Capacity
  Mass Casualty Plan must be
• Flexible
• Scalable
• Rapidly Deployable
• Efficient
• Practical
• Economically Feasible/Sustainable

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Objectives of the T3C Plan

• Supplements to existing and yet to be developed
  private, local, and regional surge capacity plans
• Allows rapid establishment of site(s) capable of
  handling large numbers of patients
• Patient sources triaged from incident scene, ER,
  or self-referred
• Capabilities decontamination, triage, treatment
  and/or observation of minimally injured,
  transport seriously injured to definitive care,
  provide psychological support, crisis
  intervention, and link victims needed resources
  (shelters, reunification centers, FEMA, etc.)
• Process 80 -125 patients/hour
• (up to 3,000 per 24 hours)

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Assumptions

• 5 psychologically1 physically injured
• Most patients self-present within one hour to
  nearest ER, clinics, and T3C
• Mass Decontamination may be required
• Health Department has lead role in any situation
  requiring coordination of surge capacity
• Well established frequently exercised MOUs are
  requisite for adequate staffing and rapid
  deployment
• Short operational periods of hours to days.
• Mass sheltering will take place at other sites if
  needed

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Location Requirements

• Large floor space on ground level
• Quickly and easily emptied
• Excellent communications infrastructure
• Robust office space/meeting areas
• Adequate bathroom/shower/kitchen facilities
• Storage capacity
• Central location, known to public, adequate
  thoroughfares, inherently perceived as safe
  places by public
• Ability to rapidly establish Decon
• Reasonable environmental control

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BCHD Clinic Sites

• Advantages -
• Clinical set already in place
• Large waiting rooms
• Mass educational media setup
• Some storage capacity for supplies and equipment
  again can be rotated with stock
• Staff adept at patient oriented processing
• Robust IT and fair telecom capabilities
• Easily Mass Transit accessible
• Disadvantages
• Lengthier setup times (have to clear patients)
• Loss of important public health services
• Establishing Decon very challenging
• Floor plans makes one-way traffic flow difficult
  to setup and maintain

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Disadvantages to Fixed Locations

• Loss of primary functionality of site
• Potential for contamination of facility
• Not always convenient to incident or transit
• One possible alternative under consideration is a
  deployable truck loaded with a temporary shelter
  based packet similar to FMS model

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Pt. Entrance
Forms
Medical Care Isolation
Education Briefing Area
Isolation/Medical
Vaccination Meds
Pharmacy
Initial Screening
2nd Screen
Observation
First Aid
Out-processing
Transport Staging
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2nd Floor Admin Offices Kitchen/RR Counseling
Media Services Conference RMs
ENTRY
2nd Triage
Ambulance Transport
Immediate Care
Minor
Delayed Care
DECON
Mental Health
Observation
Supplies Pharmacy
Expectant
Morgue
Support Services
Transportation
Veterinary Care
Transportation Staging
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Staffing Organization

• ICS Command Structure and Positions
• Estimated approx. 120 persons to fully staff all
  positions for maximal patient throughput
• Reliance on multi-agency and response partner
  staffing via MOUs
• Scalable with smaller setup possible with lower
  patient through put

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Issues for Further Discussion

• Authorization and triggers
• Integration with other plans
• Maximal capacities and limitations
• Ownership Responsibility for equipment and
  supplies

• Trainings, exercises
• When and how to involve non-governmental response
  partners
• Specific MOUs
• Logistical/Financial Issues
• Documentation/Pt tracking, etc.

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Questions, Comments, Discussion