DISASTER PREPAREDNESS FOR HEALTHCARE PROVIDERS

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DISASTER PREPAREDNESS FOR HEALTHCARE PROVIDERS

• California Preparedness Education Network
• Revised January 2008
• Funded by ASPR Grant T01HP01405

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Outline

• What is a disaster?
• Disaster response locally and nationally
• NIMS training
• ICS 100
• Institutional disaster preparedness
• Triage
• Resources

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WHAT IS A DISASTER?
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WHAT IS A DISASTER?

• Websters def any happening that causes great
  harm or damage calamity.
• Practical def any situation where the numbers of
  patients or severity of illness exceeds the
  ability of the facility or system to care for
  them, requiring external assistance.

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Disaster Events All Hazards
Earthquakes Emerging infections Fires
Floods Hurricanes Hazardous Materials Mudslides R
iots Terrorism (CBRNE) Transportation Tsunamis Vol
canoes
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ALL HAZARDS APPROACH

• Principles of preparation for human-made or
  natural disasters overlap with those of dealing
  with a chemical or biological event.

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COMMON ASSUMPTIONS IN HEALTHCARE DISASTER
PREPAREDNESS

• The response will be clear and coordinated (I
  dont need NIMS and ICS)
• We will meet the needs of our patients by just
  focusing on patient care
• If we just worry about our facility, we will be
  OK
• There is no need to understand the public health
  response since we are the medical response

FALSE!
FALSE!
FALSE!
FALSE!
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AUM SHINRIKIYOShoko Asahara
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TOKYOMARCH, 1995
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LESSONS FROM TOKYO

• Coordinated terrorist attack on 5 subway cars
  with sarin gas
• 12 persons killed, more than 5,500 affected
• 641 seen in nearest ER
• Most were walk-ins
• 2 deaths, 4 severe cases, 107 moderate cases
• Ann Emerg Med 1996 28 129

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PUBLIC HEALTH EMERGENCY

• We will often be the first presenting facility,
  regardless of facility
• We can become the disaster
• We may go to the disaster
• Facilities are likely to be overwhelmed and
  communication with local response teams essential
• We are accustomed to outside coordination and
  internal emergency response

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DISASTER RESPONSE
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CALIFORNIA IS A NATIONAL MODEL

• We have disasters (lead the nation)
• All disasters are local mantra has been adopted
  nationally
• Standardized Emergency Management System (SEMS)
  is California creation the led to
• National Incident Management System (NIMS)

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WHAT IS NIMS?

• Standardized system for managing disasters within
  from the local to federal level
• Structured to aid local authorities with mutual
  aid and resource assistance
• Local governments (agencies), states, and federal
  agencies use NIMS

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NIMS ELEMENTS

• Command and Management
• Preparedness
• Resource Management
• Communications

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NIMS ELEMENTS

• Command and Management
• Incident Command
• Operational area (local) approach
• Use of Incident Command System (ICS) at all
  levels
• Multi-organization coordination
• Public Information Systems

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OPERATIONAL AREA CONCEPTChain of Command

• Federal
• State
• Region
• County
• Local Govt
• Field

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INCIDENT COMMAND SYSTEMPurposes

• Using management best practices, ICS helps to
  ensure
• The safety of responders and others
• The achievement of tactical objectives
• The efficient use of resources

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ICS Requirements

• ICS is a key feature of NIMS and thus is a
  requirement for all state, county, and local
  officials and employees
• May be used for events, disasters, terrorism, or
  other large scale responses
• Represents best practices across country

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Basic Features of ICS (1)

• Common terminology
• Modular organization
• Management by objectives
• Reliance on Incident action plan
• Chain of command unity of command
• Unified command
• Manageable span of control

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Basic Features of ICS (2)

• Manageable span of control
• Predesignated locations and facilities
• Resource management
• Information intelligence management
• Integrated communications
• Accountability
• Mobilization

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IC and Command Staff

• IC Provides overall leadership for response and
  delegates authority
• May have a command staff to include
• Public Information officer
• Functions
• Liaison officer
• Functions
• Safety officer
• Functions

Incident Commander
Public Information Officer
Liaison Officer
Safety Officer
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INCIDENT COMMAND SYSTEM AT A GLANCE

• Incident Command Leads the response, appoints
  team leaders sets tone and standards for
  response
• Operation Section Handles key tactical actions
  including casualty care, search and rescue, fire
  suppression, securing the site
• Planning Section Gathers information, thinks
  ahead and keeps all team members informed and
  communicating
• Logistics Section Finds, distributes, and stores
  all necessary resources (supplies and people)
• Finance/Administration Section Tracks all
  expenses, claims and activities and is the record
  keeper for the incident.

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ICS Facilities

• Incident command post
• Staging area
• Base
• Camps
• Helibase/Helispots

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Incident command post

• Site where commander oversees all operations
• May change locations
• Includes vehicle, trailer, tent or building
• Located outside of the present hazard zone but
  close enough to maintain command

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Staging area
S

• Location where personnel and equipment are kept
  while waiting
• Close enough to response for timely delivery
• Many locations possible

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Base

• Location of primary logistics and administrative
  functions
• Only one base per incident, may be located in the
  IC Post
• Managed by logistics section

B
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Camps
C

• Place where resources are kept for incident
  operations if not at Base
• Usually the location where housing, staff, food,
  and sanitary services are kept

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Helibase
H

• Location from which helicopters may be parked,
  maintained, fueled loaded

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Helispots
H-3

• Temporary locations where helicopters can
  safely land, load, unload and take off

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Common Responsibilities

• Mobilization
• Responsibilities of the incident
• Accountability responsibilities
• Demobilization responsibilities

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Mobilization Responsibilities

• Only mobilize to an incident when requested or
  dispatched by an appropriate authority
• You must make sure you receive a complete
  deployment briefing

• Incident reporting locations
• Assignment
• Reporting time

• Communications instructions
• Support requirements
• Travel arrangements

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Incident Responsibilities

• Check in as directed
• Obtain initial Incident Briefing
• Maintain accurate Incident Records
• Supervisor actions
• Maintain a Unit Log for your team
• Provide briefings to subordinates, adjacent
  units/facilities, and replacement personnel

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Accountability

• Maintain chain and unity of command
• Communicate hazards and changing conditions
• Act professionally, even when on down time

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Demobilization

• Complete all work assignments documentation
• Brief replacements, subordinates, and supervisors
• Evaluate performance of subordinates
• Check out using prescribed process
• Return any issued equipment
• Upon arrival at home, notify your facility

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NIMS ELEMENTS

• Preparedness
• Planning
• Exercises
• Training
• Personal Certification (ICS 100/700)
• Equipment allocation and certification
• Mutual aid

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NIMS ELEMENTS

• Resource management
• Tracking and following of resources from federal
  to local level during response
• Tracking will allow utilization of resources in
  best manner

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NIMS ELEMENTS

• Communications
• Incident management commands communication
  response
• Information management is managed over local to
  federal response
• Equipment
• Personnel
• Technologies

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Why does NIMS matter to me?

• If I work in a clinic or hospital, why would I
  need this?

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GETTING PREPARED
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BASICS OF DISASTER PREPAREDNESS

• Clinics and Hospitals must have a written
  disaster plan
• (CA Code of Regulations Title 22, Div 5,
  Section 78423)
• Joint Commission requirement of healthcare
  facilities
• Must define community, including risk and special
  needs populations
• Must have goals, objectives with planning
• Need plan
• Must have someone in charge of plan
• Must train, exercise, and have after action of
  plan

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BASICS OF DISASTER PREPAREDNESS

• Four phases of disaster response
• Mitigation
• Preparedness
• Response
• Recovery

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BASICS OF DISASTER PREPAREDNESSHAZARD MITIGATION

• Risk assessment
• Potential for natural disasters
• (e.g., earthquakes, fires, avalanches)
• Potential for man-made disasters
• (e.g., chemical plants, nuclear facilities)
• Portals of entry
• (e.g., airports, populations in your community)
• Terrorist threats difficult to assess all
  communities are at risk

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BASICS OF DISASTER PREPAREDNESSHAZARD MITIGATION

• Capabilities / capacity evaluation
• Available resources
• (e.g., drugs, beds, ventilators, surgical equip)
• Staff
• (e.g., physicians, PAs, nurses, nonmedical)
• Physical limitations
• (e.g., size, location, isolation/decon
  facilities)
• Vulnerabilities

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BASICS OF DISASTER PREPAREDNESSPREPAREDNESS

• Develop a disaster and surge plan
• Personal / family disaster plans
• Command Control System
• Limit confusion!
• ICS standardized command structure
• Facility emergency response team
• Facility protection
• Security, patient flow, crowd control
• Patient decon, staff protection (PPE)
• Evacuation

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BASICS OF DISASTER PREPAREDNESSPREPAREDNESS

• Develop a disaster plan (cont)
• Supplies
• Impossible to stock all possible supplies
• Plan for loss of power, light, phones, etc.
• Notification plans
• Recovery
• Facility decontamination, resupply
• Psych support
• Financial reimbursement

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BASICS OF DISASTER PREPAREDNESS PREPAREDNESS

• Communications
• Review available communications
• Plan redundant sources
• Must be able to work within ICS structure with
  common terminology

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BASICS OF DISASTER PLANNINGPRACTICE

• Plan is no good without practice!
• Knowledge based training
• Cal-Pen Modules
• Skills based Training Exercises
• Table top low cost, convenient
• Functional tests staff capabilities
• Full-scale simulate an actual emergency

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FAMILY DISASTER PLAN

• Important for provider to know that family
  members are OK allows them to perform
• Create a specific plan for your family
• Common contact or meeting place
• Supplies and evacuation plan
• Plan childcare if unable to get home

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Triage
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TRIAGE

• Important concept in disaster medicine
• Initial triage for patients in disaster situation
  may be the most important role for a primary
  healthcare provider
• Sites may vary and method will thus vary
• Sites include field, E.D. alternate care site,
  within hospital
• Priority change from providing best care to every
  patient to maximizing number of survivors

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START TRIAGE

• Simple Triage and Rapid Treatment
• Triage must be continually repeated as patient
  conditions will change
• Triage categories
• Green
• Yellow
• Red
• Black

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START

• Step 1 Delayed Patients- GREEN
• If they can walk, they are delayed
• Step 2 Respiration Check (non-walkers)
• No RR- dead
• RR gt30- red, highest priority
• RRlt30- green
• Step 3 Perfusion Check
• Radial pulse poor- red
• Good pulse- yellow
• Step 4 CNS eval
• Follows directions- yellow or green
• No directions- red

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Sustained Care

• Emergency mass care, in a sustained event like an
  influenza pandemic, will lead to sustained
  disaster response
• Principles will be different
• More likely to deplete resources and staff
• More likely to lead to austere care and
  allocation of resources
• Requires community planning
• Many providers will practice out of scope

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Regional facilities Alternate sites SNFs Home
Care
Floor/med-surge
Step-down
ICU
EMC Approach to Critical Care
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Triage in Healthcare Facility

• May have to employ triage within hospital or
  healthcare based facilities due to scarce
  resources
• No consensus on triage mechanism, but SOFA may be
  best
• Sequential Organ Failure Assessment Score
• PaO2/FiO2 ratio (respiratory)
• Glasgow Coma Score (CNS)
• Mean Arterial Pressure/vasopressor (CV system)
• Bilirubin (Liver)
• Platelets (coagulation)
• Creatinine (renal system)

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Next Steps (1)

• Disaster Preparedness is important for primary
  care providers, regardless of location and size
  of clinic
• A well developed plan will augment the states
  disaster response under NIMS
• A well organized plan will provide care to the
  staff, patients and community in a time of crisis

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Next Steps (2)

• Your plan will provide safety to your staff and
  unaffected patients
• Assess your risk and community needs
• Develop your plan based on these risks and needs
  with job action sheets describing each positions
  role
• Teach your plan
• EXERCISE YOUR PLAN

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Final Note

• With commitment, all things are possible.
  Without commitment, nothing else matters.

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CONTACT NUMBERS
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