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2451106539230Types Of Disaster00Types Of Disaster15481306538596External / internal (to hospital); 1Y / 2Y; acute / gradual onset; short / long duration; unifocal / multifocalNatural: widespread damage to people / property / communications / transport / hospitals; most survivors extricated in 24hrs; air transport important; psychological problems of patients and staff; shelter, hygiene, water supply, nutrition, infectious diseaseHuman: complex (government instability, macroeconomic collapse, civil military violence, population displacement; globally associated with most deaths)Mild (>25 injuries, 10 admissions); mod (>100 injuries, 50 admissions); major (>1000 injuries, 250 admissions)Terrorist: purposefully produced to cause terrorAcute: in narrow and well-defined time frameNonacute: no well-defined start point or continuous production of casualties over prolonged time frame (eg. Pandemic)Disaster severity score: based on services needed, cause, duration, radius of area, casualtiesDisaster levels: I (escalated local response), II (regional response), III (national / international response)Internal: within hospital Red = fire Blue = cardiac arrest Yellow = internal disaster Brown = external disaster Purple = bomb threat (treat as genuine, keep caller talking, ask type, location of device, reason for placement, planned detonation time and method), Black = personal threat / illegal occupancy Orange = evacuation of ED needed00External / internal (to hospital); 1Y / 2Y; acute / gradual onset; short / long duration; unifocal / multifocalNatural: widespread damage to people / property / communications / transport / hospitals; most survivors extricated in 24hrs; air transport important; psychological problems of patients and staff; shelter, hygiene, water supply, nutrition, infectious diseaseHuman: complex (government instability, macroeconomic collapse, civil military violence, population displacement; globally associated with most deaths)Mild (>25 injuries, 10 admissions); mod (>100 injuries, 50 admissions); major (>1000 injuries, 250 admissions)Terrorist: purposefully produced to cause terrorAcute: in narrow and well-defined time frameNonacute: no well-defined start point or continuous production of casualties over prolonged time frame (eg. Pandemic)Disaster severity score: based on services needed, cause, duration, radius of area, casualtiesDisaster levels: I (escalated local response), II (regional response), III (national / international response)Internal: within hospital Red = fire Blue = cardiac arrest Yellow = internal disaster Brown = external disaster Purple = bomb threat (treat as genuine, keep caller talking, ask type, location of device, reason for placement, planned detonation time and method), Black = personal threat / illegal occupancy Orange = evacuation of ED needed245110965200Definitions00Definitions15481303550285Other00Other24841203550920Disaster medical services: health care systems designed to attempt to meet health care needs of disaster victims and respondersEmergency; event which endangers/threatens to endanger property / enviro and which requires significant co-ordinated responseAccident: destructive event that doesn’t require mobilisation of extra medical resourcesSurge: a sudden increase in patient care demands on health systemED surge: significant increase in demands place on ED, given the normal capacity, within which an ED can reasonably maintain standards of care; may be reflected in waiting times, rate of presentations, ambulance diversions etc…Surge capacity: ability of health system to respond to markedly increased number of patients from usual daily operations (depends on staff, stuff, structure, space); ability to provide acute care to critical and non-critical mass casualties simultaneously; marker of ability to provide emergency care in disaster situation; ability to receive, stabilise, provide emergency OT, transfer; number of ICU/HDU beds and OT rooms important; bed / isolation / pharmaceutical / decontamination capacitySurge capability: ability to manage unusual or highly specialised medical needs (eg. Infectious disease)00Disaster medical services: health care systems designed to attempt to meet health care needs of disaster victims and respondersEmergency; event which endangers/threatens to endanger property / enviro and which requires significant co-ordinated responseAccident: destructive event that doesn’t require mobilisation of extra medical resourcesSurge: a sudden increase in patient care demands on health systemED surge: significant increase in demands place on ED, given the normal capacity, within which an ED can reasonably maintain standards of care; may be reflected in waiting times, rate of presentations, ambulance diversions etc…Surge capacity: ability of health system to respond to markedly increased number of patients from usual daily operations (depends on staff, stuff, structure, space); ability to provide acute care to critical and non-critical mass casualties simultaneously; marker of ability to provide emergency care in disaster situation; ability to receive, stabilise, provide emergency OT, transfer; number of ICU/HDU beds and OT rooms important; bed / isolation / pharmaceutical / decontamination capacitySurge capability: ability to manage unusual or highly specialised medical needs (eg. Infectious disease)24841203016250Incident with so many live casualties that special arrangements necessary to deal with them00Incident with so many live casualties that special arrangements necessary to deal with them15513053016250Major Incident00Major Incident15525751908175Disaster Medicine00Disaster Medicine24841201908810Prevention: regulatory and physical measuresPreparedness: hazard identification, vulnerability analysis, risk assessment, services which can be rapidly mobilised; provide framework for helping at-risk populations avoidResponse: during and afterRecovery: provide framework for helping at-risk populations recover00Prevention: regulatory and physical measuresPreparedness: hazard identification, vulnerability analysis, risk assessment, services which can be rapidly mobilised; provide framework for helping at-risk populations avoidResponse: during and afterRecovery: provide framework for helping at-risk populations recover1551305965200Disaster00Disaster2485390965200A serious disruption to community life and health care system which presents immediate threat to public health and damage to property / environment which is beyond the day-to-day capacity of the prescribed statutory authorities and which requires special mobilisation and organisation of resources (external help) other than those normally available to those authorities00A serious disruption to community life and health care system which presents immediate threat to public health and damage to property / environment which is beyond the day-to-day capacity of the prescribed statutory authorities and which requires special mobilisation and organisation of resources (external help) other than those normally available to those authorities246380330200Disaster Preparation00Disaster Preparation2959104551680Disaster Plans00Disaster Plans15989304551681Objectives: save life, prevent escalation, relieve suffering, protect environment / property, restore normalityDefinition: development by community of comprehensive strategy to manage and respond to disastersAim to achieve greatest good for greatest number of potential survivors; plan for disaster most likely to occur; multi-disciplinaryForm team: public safety, engineering, logistics, pharmacy, transportation, doctors, media, communications officer, non-clinical patient care, radiation and infection safety officer; split into: incident command, operations, planning, logistics, finance; hospital/community co-ordinations; integration with national response assetsDetermine capabilities of different hospitalsDefine responsibilities: charges government departments with specific responsibilities (eg. Police, communications, water, gas, transport, ambo, medical, public works, HAZMAT etc…); co-operation between different services required (networks); hospital-community co-ordinationDetermine risk (hazard vulnerability analysis) – different disasters have different mortality and morbidity patterns; also consider less likely disastersDefine reason for activationPrevention and risk reduction: Create public warning systems, disaster plansQA: continuous review and update by hospital disaster planning groupDisaster exercises: perform regularly, familiarise with roles, test response, provide training opportunity, QA; should be of disaster most likely to occur; can be desktop / realistic moulageIssues to plan for: water and sanitation, food aid, nutrition, shelter, health services, infectious disease control and surveillance, occupational health and safety measures00Objectives: save life, prevent escalation, relieve suffering, protect environment / property, restore normalityDefinition: development by community of comprehensive strategy to manage and respond to disastersAim to achieve greatest good for greatest number of potential survivors; plan for disaster most likely to occur; multi-disciplinaryForm team: public safety, engineering, logistics, pharmacy, transportation, doctors, media, communications officer, non-clinical patient care, radiation and infection safety officer; split into: incident command, operations, planning, logistics, finance; hospital/community co-ordinations; integration with national response assetsDetermine capabilities of different hospitalsDefine responsibilities: charges government departments with specific responsibilities (eg. Police, communications, water, gas, transport, ambo, medical, public works, HAZMAT etc…); co-operation between different services required (networks); hospital-community co-ordinationDetermine risk (hazard vulnerability analysis) – different disasters have different mortality and morbidity patterns; also consider less likely disastersDefine reason for activationPrevention and risk reduction: Create public warning systems, disaster plansQA: continuous review and update by hospital disaster planning groupDisaster exercises: perform regularly, familiarise with roles, test response, provide training opportunity, QA; should be of disaster most likely to occur; can be desktop / realistic moulageIssues to plan for: water and sanitation, food aid, nutrition, shelter, health services, infectious disease control and surveillance, occupational health and safety measures159893038322252 surges: at 90 mins (50-80%; arrive at nearest medical facility; ambulant, non-triaged, not decontaminated, not treated) at in 2-3hrs (critical patients)002 surges: at 90 mins (50-80%; arrive at nearest medical facility; ambulant, non-triaged, not decontaminated, not treated) at in 2-3hrs (critical patients)2959103832860Surges in A Disaster00Surges in A Disaster1598930567055External / internal (to hospital); 1Y / 2Y; acute / gradual onset; short / long duration; unifocal / multifocalNatural: widespread damage to people / property / communications / transport / hospitals; most survivors extricated in 24hrs; air transport important; psychological problems of patients and staff; shelter, hygiene, water supply, nutrition, infectious diseaseHuman: complex (government instability, macroeconomic collapse, civil military violence, population displacement; globally associated with most deaths)Mild (>25 injuries, 10 admissions); mod (>100 injuries, 50 admissions); major (>1000 injuries, 250 admissions)Terrorist: purposefully produced to cause terrorAcute: in narrow and well-defined time frameNonacute: no well-defined start point or continuous production of casualties over prolonged time frame (eg. Pandemic)Disaster severity score: based on services needed, cause, duration, radius of area, casualtiesDisaster levels: I (escalated local response), II (regional response), III (national / international response)Internal: within hospital Red = fire Blue = cardiac arrest Yellow = internal disaster Brown = external disaster Purple = bomb threat (treat as genuine, keep caller talking, ask type, location of device, reason for placement, planned detonation time and method), Black = personal threat / illegal occupancy Orange = evacuation of ED needed00External / internal (to hospital); 1Y / 2Y; acute / gradual onset; short / long duration; unifocal / multifocalNatural: widespread damage to people / property / communications / transport / hospitals; most survivors extricated in 24hrs; air transport important; psychological problems of patients and staff; shelter, hygiene, water supply, nutrition, infectious diseaseHuman: complex (government instability, macroeconomic collapse, civil military violence, population displacement; globally associated with most deaths)Mild (>25 injuries, 10 admissions); mod (>100 injuries, 50 admissions); major (>1000 injuries, 250 admissions)Terrorist: purposefully produced to cause terrorAcute: in narrow and well-defined time frameNonacute: no well-defined start point or continuous production of casualties over prolonged time frame (eg. Pandemic)Disaster severity score: based on services needed, cause, duration, radius of area, casualtiesDisaster levels: I (escalated local response), II (regional response), III (national / international response)Internal: within hospital Red = fire Blue = cardiac arrest Yellow = internal disaster Brown = external disaster Purple = bomb threat (treat as genuine, keep caller talking, ask type, location of device, reason for placement, planned detonation time and method), Black = personal threat / illegal occupancy Orange = evacuation of ED needed295910567690Types Of Disaster00Types Of Disaster2946403481070Disaster Response00Disaster Response16008358773795Phase B 00Phase B 28225758788400Confirmation and details of numbers and types of patientsDispatch site team: site medical officer (no role in treatment; communication, allocation of resources); site teams (2 docs, 4 nurses; do 2Y triage and treatment); assess appropriateness of sending team (ie. Training, not junior, ensure ED will be appropriately staffed)ED: staff (call in staff; allocate roles; food and drink) Area (ask all ED patients to leave if able (if stay, incorporated into response); clear outpatients and wards; visitors asked to leave; admit patients)00Confirmation and details of numbers and types of patientsDispatch site team: site medical officer (no role in treatment; communication, allocation of resources); site teams (2 docs, 4 nurses; do 2Y triage and treatment); assess appropriateness of sending team (ie. Training, not junior, ensure ED will be appropriately staffed)ED: staff (call in staff; allocate roles; food and drink) Area (ask all ED patients to leave if able (if stay, incorporated into response); clear outpatients and wards; visitors asked to leave; admit patients)16008354820920Phase A Standby and Prepare Phase00Phase A Standby and Prepare Phase28251154820920All staff remain on dutyED: staff (all staff remain on duty, security; allocate roles; notify pathology, radiology, SW, pastor etc…) area (removal of non-urgent cases, admission, decontamination area, media liason area, triage area (large eg. Ambo bay), diversion area outside ED for ambulant patients; prepare treatment areas equipment (eg. PPE), disaster triage ID labels, communications systems, re- stocking systems / operations (divert inbound patients, ward rounds to help clinical decision making, consider designated teams for specific tasksHospital: staff (form disaster management team, ensure hospital teams prepared (surgeons remain in OT, no new surgery starts); media, admin, personnel, SW) Area (temporary morgue, assess bed status / capacity, arrange discharges and create surge capacity; double beds in rooms, create alternative ICU; set up patient discharge centre, patient information centre (remote from treatment area; volunteer co-ordination centre) Equipment (communications system, establish supplies)Region: regional disaster co-ordinator, other hospitals, bypass usual workload, walking wounded to different hospital than resus, police, fire brigade, HAZMATEstablish control centre: in hospital board room; assemble control team (CEO, medical director, admin, nursing, safety officer, support staff); acts as communications hub, manages media; feeds to health minister; assigns jobs; terminates disaster mode of operation00All staff remain on dutyED: staff (all staff remain on duty, security; allocate roles; notify pathology, radiology, SW, pastor etc…) area (removal of non-urgent cases, admission, decontamination area, media liason area, triage area (large eg. Ambo bay), diversion area outside ED for ambulant patients; prepare treatment areas equipment (eg. PPE), disaster triage ID labels, communications systems, re- stocking systems / operations (divert inbound patients, ward rounds to help clinical decision making, consider designated teams for specific tasksHospital: staff (form disaster management team, ensure hospital teams prepared (surgeons remain in OT, no new surgery starts); media, admin, personnel, SW) Area (temporary morgue, assess bed status / capacity, arrange discharges and create surge capacity; double beds in rooms, create alternative ICU; set up patient discharge centre, patient information centre (remote from treatment area; volunteer co-ordination centre) Equipment (communications system, establish supplies)Region: regional disaster co-ordinator, other hospitals, bypass usual workload, walking wounded to different hospital than resus, police, fire brigade, HAZMATEstablish control centre: in hospital board room; assemble control team (CEO, medical director, admin, nursing, safety officer, support staff); acts as communications hub, manages media; feeds to health minister; assigns jobs; terminates disaster mode of operation16008353480435Ambulance head calls medical co-ordinator medical co-ordinator activates plan and runs it from control room notification of hospital Receive call: METHANE (major incident, exact location, type, hazards, access, no. of casualties, emergency services present and needed)Notification and activation of disaster plan: of hospital disaster controller (medical director / ED consultant) switchboard activates plan00Ambulance head calls medical co-ordinator medical co-ordinator activates plan and runs it from control room notification of hospital Receive call: METHANE (major incident, exact location, type, hazards, access, no. of casualties, emergency services present and needed)Notification and activation of disaster plan: of hospital disaster controller (medical director / ED consultant) switchboard activates plan295910685800Respons-ibilities00Respons-ibilities28251152912745Science of locating, reaching, treating and safely extracting survivors who remain trapped following structural collapse00Science of locating, reaching, treating and safely extracting survivors who remain trapped following structural collapse16008352912745Search and Rescue00Search and Rescue16008352533015HAZMAT00HAZMAT28251152533015Initial incident command if hazardous materials00Initial incident command if hazardous materials16008352163445Public Works00Public Works28251152163445Support equipment and personnel; structural safety expertise00Support equipment and personnel; structural safety expertise16008351798320Fire00Fire28251151798320Overall scene command; victim rescue and hazard control00Overall scene command; victim rescue and hazard control16008351423670Police00Police28251151423670Establish perimeter and govern access to site; security of site; traffic management00Establish perimeter and govern access to site; security of site; traffic management16008351053465Medical00Medical282511510534652Y triage and immediate treatment002Y triage and immediate treatment1600835685800Ambulance00Ambulance2825115685800Triage in field; decontamination in field; stabilization and transfer00Triage in field; decontamination in field; stabilization and transfer2959107873365Surge Response00Surge Response15970257873365Recommendation provided by Australasian working group in 2009. Recognise surge initial action manage patient flow (diversion, decant other areas, discharge selected patients) set clinical goals (doing most for most, change in standard of service, advance triage, security, control patient entry to ED, divert non clinical visitors, ambulatory patients to designated area etc…)00Recommendation provided by Australasian working group in 2009. Recognise surge initial action manage patient flow (diversion, decant other areas, discharge selected patients) set clinical goals (doing most for most, change in standard of service, advance triage, security, control patient entry to ED, divert non clinical visitors, ambulatory patients to designated area etc…)2959102469515Disaster Triage00Disaster Triage51225457366000P200P251225456622415P100P1487553074104500048755306677025003521075638746500377190070402450033597856972300Yes 00Yes 40462207203440RR <10/>20CRT <2HR <12000RR <10/>20CRT <2HR <12040462206451600RR <10/>20CRT >2HR >12000RR <10/>20CRT >2HR >120461073560585350048755306005830Dead00Dead391223560585350041992556005830No00No32721555915660Airway patent?00Airway patent?298894560585350032721555497830P4 00P4 2997835559498500232219558337450016008355772150Walking?00Walking?25984206005830No00No25984205497830Yes 00Yes 16002004955540P31-3 points 00P31-3 points 26739854955540BLACK = survival unlikely with best care (eg. GCS 3, needing CPR, >60yrs and >50% burns, elderly with severe injury)00BLACK = survival unlikely with best care (eg. GCS 3, needing CPR, >60yrs and >50% burns, elderly with severe injury)16008354407535P412 points 00P412 points 26708104407535GREEN = with minimal care, unlikely to deteriorate within several hours; walking wounded00GREEN = with minimal care, unlikely to deteriorate within several hours; walking wounded16008353867785P211 points 00P211 points 26708103867785YELLOW = needs care within 45-60mins without immediate risk; significant injury, but not immediately life threatening00YELLOW = needs care within 45-60mins without immediate risk; significant injury, but not immediately life threatening16008353335655P14-10 points 00P14-10 points 26708103335655RED = immediate care needed; critical injury but good chance of survival with simple treatment (eg. Tension PTX, >40% TBSA burns)00RED = immediate care needed; critical injury but good chance of survival with simple treatment (eg. Tension PTX, >40% TBSA burns)16002002469515Most important medical activity at disaster site; first senior ambulance officer to arrive at scene solely responsible (performed by casualty collection officer); dynamic process, repeated examinations, take into account patient’s age / health status etc…; determine who should be taken to which treatment area in which order00Most important medical activity at disaster site; first senior ambulance officer to arrive at scene solely responsible (performed by casualty collection officer); dynamic process, repeated examinations, take into account patient’s age / health status etc…; determine who should be taken to which treatment area in which order295910591819Disaster Response(cntd)00Disaster Response(cntd)27965401765935Restoration of normal function; organisational (identify problems with system function, lessons learned, future training), clinical, psych, immediate vs delayed, coronial findings; identify staff needs00Restoration of normal function; organisational (identify problems with system function, lessons learned, future training), clinical, psych, immediate vs delayed, coronial findings; identify staff needs16008351765935Debrief/Audit 00Debrief/Audit 1600835582295Phase CPatients Phase 00Phase CPatients Phase 2796540582295Re-triage on arrival; receive and treat: decontaminate prior to entry; re-triage ID labels around necks send to designated treatment area (ED for serious injuries, outpatients/GP for walking wounded); judicious use of labs and XR (no peripheral limb XR); increase nursing staff responsibilities; then discharge / transfer / admit; increased role of USS and DPL as CT is limited resource; path limited to Hb, ABG, K, XM; 1Y skin closure only00Re-triage on arrival; receive and treat: decontaminate prior to entry; re-triage ID labels around necks send to designated treatment area (ED for serious injuries, outpatients/GP for walking wounded); judicious use of labs and XR (no peripheral limb XR); increase nursing staff responsibilities; then discharge / transfer / admit; increased role of USS and DPL as CT is limited resource; path limited to Hb, ABG, K, XM; 1Y skin closure only ................
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