Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites

1. Not Your Father’s M*A*S*H:Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared for the 15th Annual Emergency Management Higher Education Conference

2. Defining Our Terms • Alternate Medical Treatment Site (AMTS) or Alternate Care Facility (ACF) • A non-medical facility temporarily adapted to render medical care in a disaster • Point of Distribution/Dispensing (POD) • A non-medical facility temporarily adapted to administer vaccines or prophylactic medications in a disaster

3. Hurricane Ike AMTSSpecial Needs Shelter(formerly Albertsons Supermarket)

4. Recent AMTS/POD Usage in the U.S. • Joplin Tornado (May 2011) • Great Tennessee Flood (May 2010) • Hurricanes Gustav, Hanna and Ike (September 2008) • California Wildfires (October 2007) • Hurricane Katrina (August 2005) • Anthrax Attacks (October 2001) • Terrorist Attacks (September 2001) So… why do Emergency Managers in higher education need to know?

5. A University Campus as an AMTS • Most universities have a mission to support their communities • Campuses are designed with space to accommodate many people • Campuses often also have large parking areas, widespread utility availability and many support personnel “If we could change ourselves, the tendencies in the world would also change. As a man changes his own nature, so does the attitude of the world change towards him. ... We need not wait to see what others do.” - Mahatma Ghandi

6. Considerations • Logistical Issues • Clinical Issues • Administrative Issues • Challenges and Pitfalls

7. Logistical Site Issues • Size • Security & Safety • Utility Support • Location • Medication and Materiel • Waste Disposal and Sanitation • Fatality Management

8. Size(it turns out it matters after all…) • Clinical Areas • Administrative Areas • Supply Areas • Unsecured / Secured • Nutrition/Hydration/Sleeping Areas • Mental Health/Quiet Areas • Media Area

9. Pre-Disaster PreparationA Federal Medical Shelter

10. Security & Safety • Structural integrity • Protection of stockpile and staff • Magnetometers? • Fire Suppression • Emergency Exits/Evacuation Routes • Effect on behavior • Large numbers in confined space

11. Security Support

12. Utility Support • Electricity • Water • Potable /Non-Potable • Sanitation • Handwashing/Disinfecting Gel • Bathrooms/Latrines • Infectious /Non-Infectious • Climate Control • Communications • Redundancy!

13. Climate Control

14. Communications

15. Location, Location, Location! • Familiarity • Physical Access • Parking • Routes • Modes

16. Medication and Medical Materiel • Disaster Stockpile (Federal, State, Local) • Strategic National Stockpile • Local Hospitals and Pharmacies

17. Strategic National Stockpile

18. Waste Disposal and Sanitation • Infectious vs. Non Infectious • Human Excreta • Bathing Facilities • Laundering Clothes and Linens

19. Laundry and Waste Disposal

20. Bathing Facilities

21. Fatality Management • Removed from clinical care areas • Refrigeration for long term storage • CDC/FBI involvement

22. Clinical Issues • Infection Control • Patient Flow • Recordkeeping • Mental Health

23. Infection Control • Surfaces • Nonabsorbent • Air Filtration • HEPA standard • Anti-microbials • For hands • For surfaces

24. Power-free Hand Washing Station

25. Patient Flow • Flow Controllers • Signage • Unidirectional • Patient Management

26. Bed Board

27. Record Keeping • Less robust than usual • Must be able to track them down! • Electronic vs. Paper • Epidemiologic needs

28. Electronic Medical Record

29. Mental Health Monitoring • For staff and patients • Assigned personnel • Monitoring system

30. Quiet Room

31. Administrative Issues • Personnel • Policies for Operations • Nutrition / Hydration / Sleeping Accommodation

32. Personnel • Clinical • MD, RN, EMT, NA, etc. • Non-Clinical • Security, Reception/Records, Flow Controllers, Logistics, PIO, Volunteer Coordinator, etc. • Credentialing • Municipal and Non-municipal sources

33. Policies for Operations • Simplicity • Standardization • Tested • Disseminated

34. Nutrition / Hydration / Sleeping Accommodation • Available 24/7 • Scheduled meal times • Isolated from clinical care • Logging in and out

35. Mass Feeding

36. Home Sweet Home

37. Challenges and Pitfalls • Special Needs Patients • Political Issues • Adverse Environmental Conditions • Public Relations • Compliance • Timeline

38. Special Needs Patients • Limited Mobility / Non-Ambulatory • Sensory deficits • Language barriers • Patients with dependents

39. Political Issues • Regular communication with decision makers is key! • Use of layman’s terms • Distilled information • Charts, graphs, maps

40. Adverse Environmental Conditions • Road/Rail/Airport closures • Utility outages • Flooded facilities • Communications failures

41. Public Relations • Manage them or they will manage you! • Specific briefing area • Single source of information • Scheduled, frequent updates

42. Compliance • Use the media • Multi-pronged approach • Communicate honestly

43. Timeline • Always less time than you want • Early identification and inspection of potential sites helps • Pre-training and drills are key for personnel

44. Summary Logistical Issues • Size • Security & Safety • Utility Support • Location • Medication and Materiel • Waste Disposal and Sanitation • Fatality Management Clinical Issues • Infection Control • Patient Flow • Recordkeeping • Mental Health

45. Summary Challenges & Pitfalls • Special Needs Patients • Political Issues • Adverse Environment • Public Relations • Compliance • Timeline Administrative Issues • Personnel • Policies for Operations • Nutrition / Hydration / Sleeping Accommodation

46. Questions? Comments?

47. Thank You! K.C. Rondello, M.D., M.P.H. Academic Director, Department of Emergency Management Adelphi University 1 South Avenue Garden City, NY 11530 516-877-4544 Rondello@adelphi.edu