ECRN Packet: Disaster Activity Responsibilities of the ECRN

1
ECRN PacketDisaster Activity Responsibilities
of the ECRN

• Condell Medical Center EMS System
• Prepared by Sharon Hopkins, RN, BSN, EMT-P
• EMS Educator
• Information contribution Debbie Semenek, RN,
  RMT-P
• Region X Multiple Victims Mass Casualty Plan,
  July 2006

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Objectives

• Upon successful completion of this module, the
  ECRN should be able to
• Define the differences between the Multiple
  Victim Policy from the Mass Casualty Plan
• State the responsibilities of the ECRN based on
  being an Associate Hospital (LFH) versus Resource
  Hospital (CMC)
• Identify resources utilized in-house
• Successfully complete the quiz with a score of
  80 or greater

3
Disaster Plans

• Multiple Victim and Mass Casualty Plan
• Local plan with local resources used
• Resource Hospital for the fire department of the
  disaster site serves as communication link
• Emergency Medical Disaster Plan
• State response plan
• POD hospitals serve as communication link
• National Disaster Medical Systems (NDMS)
• Large scale national response utilized

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IDPH Regions

• State of Illinois divided into 11 Regions
• Geographically, Lake County is Region 10
• 4 Resource Hospitals in Region 10
• Condell Medical Center (CMC)
• Highland Park Hospital (HPH)
• St. Francis - Evanston
• Vista Health East (Victory Memorial)
• POD Hospital for Region X is Highland Park
  Hospital (for activation of State Disaster Plan)

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CMC - As A Resource Hospital

• Affiliated departments
• Countryside ?Libertyville
• Grayslake ? Mundelein
• Knollwood Ambulance ? Round Lake
• Lake Bluff ? Wauconda
• Lake Forest Fire
• Associate Hospital
• Lake Forest Hospital

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What Is A Disaster?

• Difficult to use a number for declaring a
  disaster
• 15 patients at 2 pm may not be as big a problem
  as 15 patients at 2 am based on immediate
  availability of resources
• A disaster is any incident that overwhelms your
  available resources at that particular time or
  for the particular circumstances of the disaster

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Disaster Plans

• EMS personnel need to declare and activate one of
  the plans early
• Without early activation, hospitals have a hard
  time getting prepared hospitals feel behind the
  eight ball
• It is easier to cancel additional help summoned
  than to try to work short handed

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• MULTIPLE
• VICTIM
• INCIDENT

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Multiple Victim Incident

• Responding EMS personnel can handle the situation
  with adequate numbers of additional personnel and
  equipment available within a short period of
  time. Normal levels of care and transportation
  can be provided.
• Attempts are made to evenly distribute patients
  to receiving hospitals by field personnel
• Hospitals may need to activate their internal
  disaster plan

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Multiple Victim Incident

• Field application
• triage tags are not required
• if possible, one patient per ambulance (normal
  transport conditions)
• radio report called to the receiving hospital as
  normal
• run reports completed by the transporting
  ambulance personnel

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Multiple Victim Incident

• Note
• The first critically injured victims most likely
  would be transported to the nearest, most
  appropriate hospital before or while the first
  communications are being established with the
  Resource Hospital
• Bottom line
• When you hear of a disaster in your region,
  prepare immediately as if you are receiving
  patients (because you just might be!!!)

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Multiple Victim Incident

• Radio reports must be given on all transported
  patients
• This means every transporting ambulance will be
  communicating about their individual patient with
  the receiving hospital and this will take
  coordination between the field and the ED
• With coordination from hospitals and field
  personnel, goal is to avoid overwhelming any one
  hospital

13
Multiple Victim Incident

• Think of these incidents as mini-disasters
• similar to the busiest day you have had in the ED
• just more patients with same or similar
  complaints are showing up within a tight time
  frame from of each other

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• MASS
• CASUALTY
• PLAN

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Mass Casualty Plan

• Number of patients and nature of injuries make
  normal level of stabilization and care in field
  unachievable and/or
• Number of EMS providers and ambulances that can
  be quickly brought to the scene is not enough
• All attempts are to be made to evenly distribute
  the patients to receiving hospitals

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Mass Casualty Plan

• Practical application for a MCI
• Triage tags will be used on all patients
• Ambulances may transport more than one a patient
  at a time
• No radio reports to receiving hospitals care is
  delivered via SOPs
• Run reports are not necessary

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Field Contact With Hospitals

• Multiple Victim Incident
• EMS to contact their specific Resource Hospital
  (CMC) ASAP
• Mass Casualty Plan
• EMS to contact their specific Resource Hospital
  (CMC) ASAP
• Coordination of patient transportation will be
  done via the Resource Hospital

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First Communications From Field

• Radio report may be initially minimal
• Type/nature of incident (MVC, explosion, building
  collapse, etc)
• Incident location
• Closest hospitals that could receive patients
• Estimated number of victims categories (red,
  yellow, green)
• Types of injuries/illnesses (blunt, penetrating,
  burns, etc)
• Special needs (ie decontamination)
• ETA for the 1st victims
• Call back number name to contact the scene
  (VERY IMPORTANT TO GET THIS NUMBER!)

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The Green Disaster Victim

• Important information to obtain from the field
  regarding the number of green patients
• what number of green patients can be placed in a
  wheelchair or otherwise left sitting up
• what number of green patients will need a cart
• these patients are categorized green but may need
  transportation with a cervical collar and/or
  backboard due to the nature of their injuries

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Activities In The Field

• Field personnel performing
• triage first
• injuries sorted patient categories assigned
  (red, yellow, green, black)
• followed by treatment
• performed in the field in areas set up to provide
  treatment based on acuity levels (red is the most
  critical patient)
• and finally transportation off the site

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Triaging of Patients

• Red - victims who are most critically injured in
  need of immediate care for life-threatening
  injuries or illness
• Yellow - those less critically injured non-life
  threatening injuries
• Green - those with injuries that are not life or
  limb threatening
• Black - those who have died or whose injuries do
  not support survival

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METTAG SAMPLE
FRONT
BACK
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Disaster Tags - General Guidelines

• Red
• Treatable life-threatening illness or injures
• Patient has a altered mental status - unable to
  follow simple commands
• Carotid pulse present radial pulse absent
• if both carotid radial pulses are present,
  categorized considering respiratory rate and
  mental status
• Respirations lt 10 or gt 30

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Disaster Tags - General Guidelines

• Yellow
• Serious but not life-threatening illness or
  injury
• Delayed care
• Patient is alert
• Patient has a radial pulse
• Respirations less than 30 per minute

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Disaster Tags - General Guidelines

• Green
• Minor musculoskeletal injuries, minor soft tissue
  injuries
• Patient may or may not be able to walk
• Patient is alert
• Patient has a radial pulse
• Respirations less than 30 per minute

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Disaster Tags - General Guidelines

• Black
• Dead or fatally injured patients
• Resources limited and cannot be devoted to these
  patients
• If resources are unlimited, arrested patients may
  become a Red (in very unique situations would
  this occur)

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Hospital Use of Disaster Tags

• Disaster tag should become a permanent part of
  the patients chart
• EMS and ED staff can use the tags to initiate
  documentation
• during Mass Casualty Plan, EMS run reports are
  not necessary so all the information from the
  field is most likely on the disaster tags

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Resource Hospital Responsibilities (CMC)

• Once notified, serves as medical control of the
  incident
• Collaborate with field personnel to identify
  possible receiving hospitals based on
• incident location
• transport routes open
• volume/acuity of patients
• ECRN to notify Charge Nurse immediately of the
  situation

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ECRN at Resource Hospital

• Begin filling out Mass Casualty Incident Log
• Establish inter-facility communication
• describe nature location of incident,
• approximate number of patients
• acuity type of patients
• Continually monitor receiving hospital
  capabilities
• Resource Hospital also is a receiving hospital

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ECRN at Resource Hospital

• Assess receiving hospitals resources
• ability to receive patients divided into the
  number of red, yellow, green that can be accepted
• blood inventory
• ability to decontaminate patients
• ability to send medical personnel and supplies

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ED Bed Capacity

• All staff need to remember
• This is a DISASTER.
• This is a unique situation
• It is a short term unusual operation
• Take your numbers to the max - EMS in the field
  need all available beds, wheelchairs, hallways in
  order to transport patients off the scene

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Excessive Casualty Load

• ECRN must be prepared and anticipate notification
  of additional receiving hospitals when casualty
  load exceeds capabilities in closest receiving
  hospitals
• May need to obtain status of specialized
  facilities as needed (ie burn units, pediatrics,
  etc) for additional transport of patients with
  special needs

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Communication With The Scene

• ECRN at Resource Hospital (CMC) stays in
  communication with scene contact (usually
  Transportation but could be Incident Commander
  or designee)
• ECRN relays to the field the receiving hospitals
  capabilities
• Assists with transport management
• If casualties imply need for transfusions, may
  need to coordinate with lab to notify LifeSource
  for blood

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Communication From the Resource Hospital (CMC)

• Transportation communicates with ECRN at Resource
  Hospital (CMC)
• ECRN at Resource Hospital (CMC) communicates with
  ECRN at Associate hospital (LFH)
• ECRN at Resource Hospital (CMC) is the one
  communication link for all hospitals
• Maintaining consistent ECRN at the radio
  minimizes lost information

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Communication Pathway

• Transportation Officer
• ? ?
• Resource Hospital (CMC)
• ? ?
• Associate Hospital (LFH)
• Communication contact from the scene to the
  hospital is most often made with Transportation
  Officer at the site

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Receiving Hospital

• In Mass Casualty Plan, notification triggered by
  Resource Hospital (CMC)
• Report to Resource Hospital (CMC) ability to
  receive what number of red, yellow, green
  patients
• Need to think big
• Doesnt help a mass casualty situation to say
  youll accept a small number of patients -
  everyone needs to think big and switch to
  disaster mode of operating/thinking/responding

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Receiving Hospital

• May need to activate internal plan depending on
  the situation
• Maintain communication log with the Resource
  Hospital (CMC)
• Report increases or limitations in capabilities
  to Resource Hospital (CMC) ASAP
• Be prepared to send pre-assembled medical supply
  bags to the scene

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Patient Flow

• Most critical victims from the scene may be
  transported to closest appropriate hospital
  before sophisticated communication network
  established
• DO NOT attempt to stop patient flow from
  individual ambulances not associated with the
  disaster activity
• These ambulances will carry on normal
  communication practices

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Communication

• All communication must go through the Resource
  Hospital (CMC)
• Associate Hospitals (LFH) are not to contact the
  scene directly
• Associate Hospitals (LFH) are not to divert
  individual ambulances
• Associate Hospital (LFH) receiving 1st field call
  from EMS needs to direct EMS to contact the
  Resource Hospital (CMC)

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Medical Personnel To The Scene

• May be requested by Incident Command at the site
• Team assembled based on need at the scene
• Supplies specific to the incident should be
  brought with
• Police escort to be provided
• coordinated between Resource Hospital Incident
  Command (or designee) at the site
• Team to report to Command Post for assignment
• Should be uniformed for easy identification

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Dispatch To The Scene

• Self-dispatching of medical personnel to a
  disaster site is strictly prohibited
• Causes additional chaos due to additional
  undisciplined and unmonitored persons congesting
  at the scene
• For safety, need organized method to know who the
  rescuers are and where they are functioning

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After Action Report

• All hospitals and fire departments involved in
  the Region X multiple victim/mass Casualty plan
  to to complete a written report following any
  incident or scheduled mass casualty drill
• Helps during the critique process

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After-Incident ReportThe Critique

• Form utilized for post-incident critiques by the
  Region X DMSC committee with intent of
  continually reviewing and improving the multiple
  victim/mass casualty plan as well as the
  education of fire/rescue/hospital and
  communication personnel

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• HOSPITAL
• DISASTER
• PLAN
• ACTIVATION

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Internal Hospital Plan

• Better to call for additional help and turn them
  away than not to have them and wish you did!

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Internal Disaster Plan

• ECRN needs to coordinate with
• ED MD
• Administrator on duty
• authorizes the activation of the internal
  disaster plan and authorizes the cancellation of
  the plan

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Hospital Incident Command

• Typical lines of authority in-house
• Administration on-duty on-call
• Nursing Supervisor on duty
• ED MD
• The identified person of authority makes and
  implements decisions to handle the situation
• Often located in a Command Center manned by
  personal with phone access

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Additional Resources

• You need to know when to get help and where to
  find the help at your facility
• Decontamination capabilities
• Trained staff to man key areas of the ED or
  alternate treatment areas
• will serve as a resource for float personnel
• how will you identify an ED staff member?
• ie vests, arm bands

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Additional Resources

• RNs - especially experienced or comfortable in
  the ED
• MDs - based on nature of illness or injury
• Support personnel - clerks/secretaries/registrars
• Runners/transporters
• Persons to man phones
• Security - control flow of traffic

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CMC versus LFH Disaster Plans

• The following pages are more specific for CMC
  staff
• The following information can be applied to most
  facilities any of us could be working at
• LFH staff need to determine specific language and
  locations for their facility based on the
  information given in the following slides

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Hospital Disaster Plans

• Many principles and practices are generic across
  most hospitals
• Know where your hospital manual resources are
  kept (usually close to the radio)
• Where are your manuals and what do they look
  like?
• When is the last time you opened looked at
  yours?

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CMC Paging of Disaster

• Code Green External
• influx of patients from external source
• Code Green Internal
• Need to recruit man-power for unusual activity
  related to unusual working conditions
• power outage
• lack of functioning emergency generators
• evacuation is needed
• need for all personnel on duty or off duty to be
  called in
• damage to patient care areas (ie flood, fire,
  contamination)

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Manpower Resource Center

• Under direction of VP of Human Resources
• Located in patient Registration waiting area off
  main lobby
• Able to deploy staff to areas of need
• If called from home, hospital personnel respond
  to this area (unless preassigned to respond
  elsewhere)
• ED staff called from home respond to the ED
  Disaster charge nurse

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Manpower Resource Center and Additional Resources

• When you need additional help, you inform the
  charge person for your area
• Charge person needs to contact Command Center for
  additional help
• Additional help to be assigned as needed/requested

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Responding Staff Members

• If called from home
• Respond to area assigned or Manpower Resource
  Center if none given
• Wear hospital ID badge
• If on-duty at time of disaster page
• Return to your work unit
• Await reassignment if necessary
• Do not respond to an area unless assigned there
  adds confusion and does not help tracking of
  resources

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Security

• To control access points and flow of traffic by
  foot and vehicle
• onto the campus
• into the facility
• at key points within the building

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Internal Communication

• Walkie talkies are provided by Security
• Key persons need to have easy and quick access
  for communication to each other
• Communication support (ie walkie talkies) need
  to be requested through the Command Center

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ED Charge RN

• Makes assignment of on-duty and responding staff
• Coordinates ED activity
• Communicate need for additional resources to the
  Command Center
• Need to continue to take care of non-disaster
  involved patients that will still be arriving by
  personal car and ambulance

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ECRN Radio Nurse

• Preferably have one person assigned to the radio
• continuity of conversation decreases missed and
  mixed messages
• Use runner to get messages to the Charge RN
• Keep Charge RN apprised of incoming messages
• Keep Triage RN apprised of incoming type and
  number of patients

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Treatment Areas

• Triage
• At ambulance bay entrance
• Patients assigned a location based on condition
• Main ED
• Red, critically ill/injured patients
• Lower level dining room
• Additional treatment area for yellow and green
  categorized patients

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Decontamination

• If 10 or less patients (lt10) can be provided in
  the ED decon room
• If more than 10 patients (gt10) to be provided in
  the locker room at the Centre Club - Libertyville
• Manpower Resource Center to disseminate supplies
  as needed

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Infection Control

• Remember to consider proper use of PPEs
  (personal protective equipment) based on the
  situation
• If patients are coughing, think of an airborne
  problem
• Provide and help place surgical masks on the
  patient (surgical mask helps contain spread)
• The medical personnel should also put on a mask
• The N95 mask will protect the medical provider
  from inhaling microscopic matter

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Clerical Support

• Assigned to areas of need
• triage
• patient registration
• manning phones
• Registrars have patient chart packets at main
  desk that need to be given out at Triage
• Disaster log maintained

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Media

• Public Relations personnel to serve as liaison
  between hospital and media
• No staff member should provide ANY kind of
  information to any persons not privileged to have
  the information
• Public Relations to coordinate with the Command
  Center information being provided
• Goal - keep media as far away as possible from
  victims family

65
System Wide Crisis Preparedness

• A Region X policy to enhance communication
  between EMS System Resource Hospital, Associate
  Hospital, EMS providers and community agencies
• To be used for potential or actual area-wide
  crisis such as
• overcrowding events for patients with same or
  similar signs and symptoms
• weather related problems
• special events

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System Wide Crisis Preparedness

• Purpose of activating this plan is to help all
  agencies involved be prepared for a crisis that
  may impact any or all parties
• ie summer heat wave in Chicago resulting in
  large number of deaths
• Any individual involved can identify a potential
  or actual crisis
• The agencies supervisor is contacted
• Resource Hospital EMS Coordinator or designee is
  contacted

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System Wide Crisis Preparedness

• The decision is made to activate this policy
• POD hospital is notified (HPH for this area)
• POD hospital member will contact IDPH if
  necessary
• Communications continued between all applicable
  parties

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Surge Capacity

• Remember to anticipate a larger number of victims
  than you think you are getting
• Not all patients come by ambulance where you
  receive an advanced call
• Many victims will self-transport (ie private
  car)
• Often, the worried well think they have
  symptoms that they want evaluated
• How are you going to handle this surge?

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• SO,,,,
• WHAT DO THESE DISASTER PLANS MEAN TO ME?

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Example 1

• Non-CMC sponsored fire department calls with
  information regarding a disaster in their town
  (ie Gurnee, Lake Villa, Highland Park,
  Lincolnshire)
• The ECRN should direct the fire department to
  their Resource Hospital

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Example 1

• The respective Resource Hospital (ie Vista East
  or Highland Park Hospital) would call potential
  receiving hospitals (ie CMC, LFH) to report
  pertinent information

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Example 2

• LFH receives a call from Lake Forest Fire that
  they are responding to an incident involving 50
  plus students from a local school overcome with
  fumes
• LFH should direct Lake Forest Fire Department to
  contact CMC (Resource Hospital) with the
  information and assistance with patient
  distribution

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Example 3

• Lake Forest Fire calls Lake Forest Hospital with
  report of 10 persons injured in a 2 vehicle
  crash.
• Lake Forest Hospital directs Lake Forest Fire to
  contact the Resource Hospital (CMC) to assist in
  patient distribution

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Example 4

• Grayslake Fire contacts CMC with information
  regarding an incident involving 30 persons
  injured in a bleacher collapse
• CMC, as the Resource Hospital, will coordinate
  location of receiving hospitals
• CMC will also function as a receiving hospital
• Each hospital decides if they need to activate
  their own internal disaster plan for resources

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Example 5

• A mass casualty incident occurs in the southern
  end of Lake County
• Highland Park Hospital (Resource Hospital for
  that fire department) will be the communication
  link between incident and receiving hospitals
• HPH contacts CMC, LFH, and other indicated
  hospitals to determine patient capabilities
• HPH does the communication to the incident site
  back and forth to hospitals

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Example 6

• Libertyville Fire Department responds to an
  incident on the tollway involving 7 patients
• Libertyville Fire Department calls CMC
• CMC can take all 7 victims
• No additional involvement with other receiving
  facilities is necessary - CMC can handle all the
  injuries with minimal use of some additional
  resources in-house

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Example 7

• CMC receives a call from NWCH stating we are
  going to be receiving patients from an incident
  in Buffalo Grove
• What is CMCs response?
• CMC is functioning as a receiving hospital
• Communication will occur through NWCH to the site
  and NWCH to the receiving hospitals
• CMC does not function as a Resource Hospital
• Communication to LFH would be from NWCH, if LFH
  would be receiving patients

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Bottom line...

• Know where your Disaster Manuals are and how to
  use them
• Review the disaster manuals often enough to be
  comfortable to respond without much prompting
• Be familiar with your own facilities resources,
  know who functions in the charge role, and know
  how to get the disaster response activated