Region X Disaster Preparation

1. Region XDisaster Preparation ECRN 2012 CE Mod II Condell Medical Center EMS System Site Code: 107200E -1212 2 hours CE credit Prepared by: Sharon Hopkins, RN, BSN, EMT-P

2. Objectives Upon successful completion of this module, the ECRN will be able to: 1. Define the concept of disaster. 2. Define a small, medium and large scale incident and emergent evacuation of a healthcare facility as described by Region X 3. Describe the communication process of the different levels of incidents 4. List report writing obligations based on the level of disaster declared 5. Define reverse triage and START triage processes

3. Objectives cont’d 6. Describe patient categorization of red, yellow, green, and black 7. Describe the role of the Resource Hospital 8. Describe the role of the Associate Hospital 9. Describe the role of a receiving hospital 10. Describe use of the disaster tag

4. Objectives cont’d 11. Review the Region X disaster response paperwork used in the hospital 12. Identify where resource material can be found in your ED 13. Review scenarios presented in a power point. 14. Successfully complete the post quiz with a score of 80% or better

5. Abbreviations • ACOND – Advocate Condell • CMC EMS– Condell Medical Center EMS • HPH – Highland Park Hospital • NLFH – Northwestern Lake Forest Hospital • NGEC - Northwestern Grayslake Emergency Center

6. What is a disaster? • An event that occurs suddenly • A crisis event that causes widespread damage of a scale that overwhelms the immediate resources that respond • Event with potential loss of life, damage to property, and capability to create a hardship

7. Effects of a Disaster • It is the consequences of the event and the inability of the victims to cope that constitutes the disaster; not necessarily the event itself • Declaring a situation a “disaster” is specific to those involved • This may be reflected by what fire department is affected, by time of day based on available resources

8. Lessons Learned • Disastrous events are not scheduled • Reason why you need to be prepared every day • Training is done to help prepare for the unthinkable situation • Flexibility is key • Effective communication is essential • Need to keep appropriate persons linked together so they can function together • Functioning in a vacuum will be a disaster in itself!

9. Region X Multiple Patient Management Plan • A formalized plan drafted by representation of Region X members • Constantly being reviewed and revised as needed • Drafted to be flexible based on level of involvement of resources needed

10. Components of Region X Plan • Region X plan response components • Business as usual • Small scale incident • Medium scale incident • Large scale incident • Emergent evacuation of a healthcare facility

11. Components of the Region Plan • Plan describes its components • Definition of the incident • Initial communication from the field • Initial information provided from the field • Patient disbursement process from the field • Use of triage tags in the field • Triage method used in the field • Ambulance to hospital communication process • Patient care reports to be written or not

12. Business as Usual • When less than 3 ambulances are required at the scene, EMS to conduct business as usual • Typical receiving hospital contacted • Report provided by each ambulance • Normal patient care run reports to be left at receiving hospital(s)

13. Small Scale Incident • 3-6 ambulances respond to the scene • EMS to contact closest appropriate hospital to determine maximum patient availability • Typical communication from EMS: • “We are on the scene of a small scale multiple patient incident”

14. Small Scale Incident • Initial information • Event description • Actual number of patients • Brief description of patient conditions • Patient disposition • Field command coordinates transportation management and destination of patients based on input from hospital contacted

15. Small Scale Incident • Triage tags are not used (required) by EMS • Triage of patients performed in usual rapid assessment process to categorize the patient • Each transporting ambulance to contact the receiving hospital and provide report • Normal patient care run reports will be completed on all patients as usual

16. Medium Scale Incident • 7-10 ambulances respond to the scene • EMS to contact their Resource Hospital • Typical communication from EMS: • “We are on the scene of a medium scale multiple patient incident”

17. Medium Scale Incident • Initial information • Event description • Estimated number of patients • Estimated patient acuities • Red, yellow, green categories • Closest hospitals to the scene listed • Patient disbursement • Resource Hospital coordinates transportation management and destination of patients • Reports this information to scene contact

18. Medium Scale Incident • Triage tags MUST be used (required) by EMS • Triage of patients performed following START triage process • Described later in power point • NO contact between transporting ambulance and the receiving hospital • Limited report from Resource Hospital • Normal patient care run reports will be completed on all patients as usual

19. Large Scale Incident • More than 10 ambulances needed to respond to the scene • EMS to contact their Resource Hospital • Typical communication from EMS: • “We are on the scene of a large scale multiple patient incident”

20. Large Scale Incident • Initial information • Event description • Estimated number of patients • Estimated patient acuities • Red, yellow, green • Closest hospitals to the scene listed • Patient disbursement • Resource Hospital coordinates transportation management and destination of patients • Reports this information to scene contact

21. Large Scale Incident • Triage tags MUST be used (required) by EMS • Triage of patients performed following START triage process • Described later in power point • NO contact between transporting ambulance and the receiving hospital • Limited report from the Resource Hospital • SMART triage tags will serve as the written report • Patient care run reports will NOT be completed on any patient

22. Emergent Evacuation of a Healthcare Facility • These involve patients that require medical care • EMS to contact their Resource Hospital • Typical communication from EMS: • “We are on the scene of an emergent evacuation of a healthcare facility”

23. Emergent Evacuation of a Healthcare Facility • Initial information • Event description • Estimated number of patients • Closest hospitals to the scene listed • Potential alternative receiving facilities • Patient disbursement • Resource Hospital works in conjunction with field command and administration of affected facility to determine where patients will be transported

24. Emergent Evacuation of a Healthcare Facility • SMART triage tags MUST be used (required) by EMS • Within facility reverse triage performed • Prior to transport START Triage of patients performed • Described later in power point • NO contact between transporting ambulance or vehicle and the receiving hospital • Triage tags will serve as the written report • Patient care run reports will NOT be completed on any patient

25. Reverse Triage • A form of triage in which the more critical patients are attended to first • In a Healthcare facility, these patients cannot remove themselves from the danger • Rescuers must care for the sickest first and then go back to remove the less ill

26. START Triage • Simple Triage and Rapid Transport • A widely recognized and used triage process • Does not require a specific diagnosis • Is a process that follows a diagram and progresses based on patient’s physiological responses

27. Triage • The practice of sorting • General accepted definition: • To do the most good for the most persons • Determine: • Which patients need immediate care to live • Which patients will survive despite a delay in care • Which patients will die regardless of what we do for them

28. START Triage • Step wise fashion of assessment in the adult population • First assessment is ability of patient to walk • Respiratory effort assessed next • Then pulse/perfusion evaluated • Lastly, neurologic status is evaluated

29. START Triage • Helpful process to sort (triage) those less severely injured from those that are more critically injured • Assessment/sorting/triage continues and patient status can be modified as needed • START process categorizes patients into red, yellow, green, black categories

30. Red Categorization • Most critically injured patient • Requires immediate lifesaving attention • Ideally should be some of the first patients to be transported from the scene • Hospitals should be prepared to immediately receive 1-2 reds while transportation issues being finalized for the majority of the incident

31. Yellow Categorization • Patients with injuries that do not require immediate lifesaving interventions • Patients with conditions that have the possibility of deterioration without medical care

32. Green Categorization • Patients with minor injuries • Patients who can tolerate a delay in care without increasing their risk of mortality • In the past, referred to as “walking wounded” • Remember: they may not be walking if there are lower leg injuries; yet, injuries are still minor

33. Black Categorization • Patients who are found apneic and pulseless or • Patients with injuries incompatible with life and inadequate resources to provide in depth care to patient • An emotional situation for rescuers to deem a patient “black” who has not yet expired

34. START Triage Process • A process typically used in the field for adults but can be used for a surge at the hospital • Evaluates patients in 4 categories • Ability to walk • Respiratory effort • Pulse or perfusion status • Neurologic status • Takes seconds to minutes per person to complete

35. START Triage Process • Any patient that can walk is directed to move from the incident site and regroup to a designated spot • “If you can hear my voice and can walk, go to the tall tree by the shed” • The assumption is that if the patient can walk and remove themselves from the scene, there are less patients to walk through to find the true “reds” • “Walkers” are retriaged for appropriate categorizing

36. START Triage Process – Next Step : Respirations • If respirations are absent, open airway • If still no respirations, patient tagged BLACK • If respirations return, tagged RED

37. START Triage Process – Respirations Present • If over 30 per minute for the adult, tag them RED • If under 30 per minute, move to assessing perfusion

38. START Triage Process – Next: Perfusion Status • If no radial pulse or capillary refill is >2 seconds, tag patient as RED • Control life threatening bleeding

39. START Triage Process – Perfusion Status Adequate • If radial pulse is present or capillary refill <2 seconds, move on to assessing neurologic status

40. START Triage Process – Lastly Neurologic Status • If the patient cannot follow simple commands, tag them RED • If the patient can follow simple commands, tag them YELLOW

41. START Triage • At any point in the triage process that the patient is deemed to be RED, the triage process stops • There is no need to waste time, they won’t get any redder! • Time to move onto the next patient

42. START Triage ProcessFlow chart used in the adult

43. JumpStart Pediatric Triage • Modifications made to START triage to accommodate physiological differences in children • Similar flow chart in the assessment algorithm • Guidelines: If patient appears to be a child, using JumpStart triage • If patient appears to be a young adult, use START

44. JumpStart Triage

45. Differences START from JumpStart • If breathing is absent in peds patient, can attempt 5 rescue breaths and evaluate effectiveness • In adult, you only open airway and if not breathing, tagged black • Pediatric respiratory rate is range of 15-45 as normal • Adult respiratory rate “normal” is <30/min • Only peripheral pulses palpated in peds • Adults assessed with capillary refill OR peripheral pulses • Uses AVPU process for neurological eval

46. AVPU Neurological Assessment • A – awake and alert; not necessarily oriented • V- responds to voice • May only be small muscle movement • P- no response until tactile stimulation added • “Pain” response DOES NOT have to be to some “painful” stimulation • U – unresponsive with NO response to any stimuli – not even an eye lash flicker

47. Resource Hospital Functions • Contacted by scene personnel when number of ill or injured exceeds routine transport to nearest facility • Resource Hospital to coordinate patient distribution with scene personnel • Acts as “Hospital Command” for medium or large scale incidents

48. Resource Hospitals • This determination is specific to the fire department relationship • EMS making initial contact will contact THEIR Resource Hospital • EMS Systems as Resource Hospitals in Region X • Condell EMS System • Highland Park Hospital EMS System • North Lake EMS System (Vista) • St. Francis EMS System

49. Resource Hospital cont’d • To collaborate with scene personnel to identify potential receiving hospitals • Contact potential hospitals • Assess their capability • To receive patients by categories red, yellow, green • Blood inventory • Ability to decontaminate patients • Ability to send medical teams & supplies to scene

50. Resource Hospital Functions • Maintain communications with scene personnel • Get a call back number and name • Need to prepare to also function as a receiving hospital