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Disaster Medicine

Disaster Medicine. Sarah McPherson Dr. A. Anton April 18, 2002. What is a disaster????. Any event that overwhelms local capabilities Internal: event occurs within hospital grounds Eg: power failure, flood, fire/explosion, water loss External: event occurs in the community

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Disaster Medicine

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  1. Disaster Medicine Sarah McPherson Dr. A. Anton April 18, 2002

  2. What is a disaster???? • Any event that overwhelms local capabilities • Internal: event occurs within hospital grounds • Eg: power failure, flood, fire/explosion, water loss • External: event occurs in the community • Eg: earthquake, tornado, flood, civic unrest, airplane crash

  3. PICE nomenclature • Prefixes: • A: static vs dynamic • Little potential for further harm vs evolving potential • B: controlled, disruptive, or paralytic • Whether local resources are sufficient, need augmentation, or need to be totally reconstituted • C: local, regional, national, international • Extent of geographic involvement

  4. PICE stages Stage Need for Aid Status of Aid 0 None Inactive I Small Alert II Moderate Standby III Large Dispatch

  5. Describe the disaster • MVC with 8 critically injured patients on Highway 1 near Golden • Pine Lake tornado • Los Angeles riots • All of the Foothills elevators decide to quit at the same time

  6. Prehospital Response: organizational structure • Incident Command System: • Incident Command • Overall responsibility of event • Operations Section • Manages all tactical activities (police, fire, medical) • Planning Section • Collect and analyze data of event, develop plans • Logistics Section • Provide equipment for operations • Finance Section

  7. Phases of Response • Activation: • event is first discovered • Scene assessed • Command established • Implementation: • Search and rescue • Triage • Stabilization • Transport • Definitive management of patients and scene

  8. Phases of Response • Recovery • Withdrawal from scene • Resume normal operations • Debriefing • Analysis of event

  9. The Disaster Site – How is it organized? • Scene secured • Command Post • Staging area for incoming personnel and supplies • Landing Zone • Casualty collection point • Morgue

  10. Triaging Patients • Basic goal is to do the most good for the most people • Priority is given to the most salvageable patients with the most urgent problems • Transport patients first who have problems treatable in hospital but fatal in the field

  11. START protocol (simple treatment and rapid assessment) • Based on the respirations, radial pulse, and mental status PATIENT BLACK GREEN: “walking wounded” RED Able to walk away from the scene YELLOW Reassessed after critical patients are triaged

  12. START TRIAGE Respirations? NO YES Position airway > 30 <30 No Yes RED Radial Pulse? BLACK RED

  13. START TRIAGE Radial Pulse? No Yes Control Bleeding Follows commands? RED No Yes RED YELLOW

  14. SAVE TRIAGE • Used when treating multiple patients and there is a delay in accessing definitive management • 3 categories of patients: • Will die regardless of how much care is received • Will live whether or not they receive care • Will benefit from field interventions

  15. Patient triage • Only 70 % sensitive • Casualties require frequent reassessment and retriaging as appropriate

  16. Components of a hospital disaster plan • Plan activation • Notification • Chain of command • Command Center • Traffic flow • Triage • Decontamination • Treatment areas (designated for red, yellow and green patients) • Specialized areas (family, volunteers, media, morgue)

  17. Role of the ED during disaster • Receiving area for patients • Decontamination • Triage • Stabilization • Initial treatment • Expect increased volume of patients for up to 2-3 months post event

  18. First steps in the ED after disaster notification • Discharge as many patients from the ED as possible • Quick inventory of existing supplies • Stock extra supplies needed for patient treatment and to restock ambulances that will return to the disaster scene

  19. Role of the physician in a disaster • Medics are best trained for initial triage, stabilization and transport • Trained physicians may help with triage and in the field treatment • Only physicians trained to work in the field should do so • Physicians should be sent to the field only if there is a surplus in the hospital • Provide definitive care in the hospital setting

  20. How to optimize disaster care • Have a pre-made plan • Have clear role definitions • Have a clear chain of command • Clear communication • Practice

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