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Drill Scenario by State of California Emergency Medical Services Authority

Drill Scenario by State of California Emergency Medical Services Authority. Amy Kaji, MD, MPH November 16 th , 2005 Acute Care College Medical Student Seminar. Background Scenario . Politician to speak on controversial topic at a large public forum Nationally televised

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Drill Scenario by State of California Emergency Medical Services Authority

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  1. Drill Scenario byState of California Emergency Medical Services Authority Amy Kaji, MD, MPH November 16th, 2005 Acute Care College Medical Student Seminar

  2. Background Scenario • Politician to speak on controversial topic at a large public forum • Nationally televised • Pre-allocated resources • First aid stations and onsite ALS and BLS ambulances • Security and traffic control personnel • Designated media area • Shuttle buses • On/off site parking areas with attendants • 7:30 a.m. Opening commentary • 8:00 a.m. Speech to begin

  3. 8:00 a.m. The Exercise Begins • Patients and hospital staff watch TV commentary • 8:00 a.m. – Speaker introduced • As speaker reaches podium, explosion occurs • Mass hysteria and panic ensue • Number of casualties unknown • ED anticipates arrival of victims • Cellular and landline 9-1-1 calls begin flooding local dispatch centers

  4. Considerations and Decisions • Should you consider implementing security measures at your facility? • What are the triggers that implement HEICS in your facility? • When, and who activates the high-census (surge) plan to free up or add patient beds to accommodate the anticipated influx of patients?

  5. 8:02 a.m. • At 8:02 a.m., a second explosion occurs in one of the on-site medical aid stations • News reports estimate numerous casualties • Hospital staff watch in horror

  6. Considerations and Decisions • Does the hospital have an emergency call-back procedure to increase ED and essential hospital staff? • Does the hospital have a security of lockdown procedure to protect the hospital and staff? • Will your hospital activate HEICS now?

  7. 8:04 a.m. • 8:04 a.m. – A third explosion on a main thoroughfare to the event detonates • Staff exhibits signs of distress at possibility of loved ones being casualties of event

  8. Considerations and Decisions • How does your hospital deal with staff concerns at the possibility of family members being casualties of the event? • How does the hospital allocate scarce resources when confronted by this potential mass casualty incident? • How does the hospital procure additional resources? • Additional staffing • Blood, trauma, and burn supplies • Body bags and morgue refrigeration units • Inpatient beds, ED beds, OR beds

  9. 8:10 a.m. • 8:10 a.m. – Law enforcement establishes secure perimeter around the auditorium • Residents living within perimeter evacuated • Fire and EMS crews arrive at staging areas outside auditorium • News reporters surround area • FAA contacted to declare area a no-fly zone

  10. 8:15 a.m. • 8:15 a.m. - EMS establishes nearby off-site staging areas • During the panic, fleeing victims mob offsite staging area and demand medical aid • Immediate EMS resources overwhelmed • Patients arrive at ED and clinics with blast injuries, in shock and panic

  11. Considerations and Decisions (for on-scene first responders) • Are evidence preservation protocols in place? • Does ambulance agency dispatch a medical supervisor to large scale incidents? • Are potential communication contingency plans in place? • Have designated egress routes been identified? • Does the ambulance provider have an in-field re-supply plan? • Does the ambulance provider have chain of command procedures?

  12. Considerations and Decisions • Clinics may be just opening for business • Is the hospital’s emergency plan in place for obtaining additional staff? • Does your hospital have a credentialing procedure for convergent volunteers?

  13. 8:20 a.m. • 8:20 a.m. – Local Department Operations Center (DOC) and Operational Area EOC are activated • Landline and cellular circuits overloaded • Your hospital activates back-up communications system • High census plans activated and in-patients assessed for early discharge or transfer • Elective surgeries and procedures cancelled • Hospital is short staffed • Plans to augment staff are activated • Calk-back of staff • Implementation of 12-16 hour shifts

  14. 8:50 a.m. • 8:50 a.m. - Local health officer declares local medical emergency based on large and increasing number of patients and need for additional resources • ED and corresponding clinics are impacted • Physicians order blood products for patients

  15. Considerations and Decisions • How does the clinic communicate with the hospital to alert them of incoming patients? • What resources does the clinic require until EMS arrives to transport patients to the acute care hospital? • Does the clinic use the ICS? • Do clinics have procedures for dealing with mental health concerns? • Does the clinic have procedures for canceling scheduled appointments? • Does the clinic have a protocol for notifying the blood supplier?

  16. 8:55 a.m. • 8:55 a.m. - Mayor’s office receives a call from the Universal Adversary (a known terrorist organization) claiming responsibility • Media demands information at hospitals, clinics, and the local health department • Press conference is scheduled for 11:00 a.m.

  17. Considerations and Decisions • What information should be presented to the public? • Does you hospital have pre-scripted risk communication messages? • What steps have been taken to ensure a consistent message among the healthcare community and levels of government? • What community or government agencies will participate in the press conferences? • Who will represent the hospital at the press conference? • Where will the press conferences be convened, and who decides on the location? • Who is the “lead” agency for the press conference?

  18. 9:05 a.m. • 9:05 a.m. - The Operational Area reports Statistics • Numbers of patients with blast injuries • Number of patients waiting to be seen • Number of persons that may require hospitalization • Available beds, operating rooms, emergency department beds • Number of patients being seen at clinics • Number of clinic patients awaiting transport to the hospitals • Number of deceased, capacity for refrigeration units in morgues • Anticipated need for blood products • Communications with California Health Alert Network (CAHAN) is lost • Hospitals, clinics, EMS, and Operational area EOC unable to place/receive calls • Bomb squad with K-9s arrive

  19. Considerations and Decisions • What other redundant communications systems exist? • What agencies can be contacted to provide additional security for the hospitals? • What community resources can be utilized to assist, including with mental health issues? • How is your hospital addressing the mental health concerns of the staff and the public?

  20. 10:00 a.m. • 10:00 a.m. - Bomb squad clears venue of other IEDs • Medical Operational Coordinator requests a status update from hospitals • Bed availability • Estimated numbers of patients • Equipment status and anticipated needs

  21. 10:15 a.m. • 10:15 a.m. - Hospital nearly depletes blood products as well as trauma and burn supplies • Clinics call local hospitals for supplies (IV tubing, bandaging supplies, & burn sheets) • Hospitals lack spare supplies and a means to transport supplies to clinics • Vendors contacted to provide supplies and equipment • Blood center advised of needs • ICU is at capacity with no additional beds • ED us holding ____ patients awaiting inpatient beds (insert appropriate number of ED patients to increase strain on resources), including ICU, telemetry, and medical-surgical

  22. Considerations and Decisions • Is there a plan to ration resources? • What mechanisms are available to procure the needed supplies and equipment, and what agency is contacted to provide those resources? • What non-medical resources may be needed (sanitation, water, transportation, security)? • What is the internal plan for maintaining security and containing the influx of patients? • Are agreements in place to provide additional security?

  23. 10:15 a.m. continued… • 10:15 a.m. continued… Influx of patients continues • Resources are overwhelmed • Insufficient staff (all levels of healthcare providers) • Lack of ED space • Depleted patient care equipment and supplies • Gurneys, oximeters, ventilators • Medications and medical-surgical supplies

  24. Considerations and Decisions • What procedure does the hospital have to expand treatment areas? • What is the procedure for exempting the facility from DHS licensing and certification for nurse staffing ratios during this emergency? • What additional areas within or outside the hospital can be used to provide patient care? • What is your procedure for notifying DHS Licensing and Certification about using alternate care sites? • Have patient tracking procedures been adequate?

  25. 10:15 a.m. continued… • 10:15 a.m. continued… • ____ patients (insert number to stress the facility and coroner system) have died and await coroner to investigate and remove bodies • Hospital must identify a secure area to hold bodies • Law enforcement and FBI demand access to medical records and to interview victims and family

  26. Considerations and Decisions • What are your hospital policies on interacting with law enforcement, evidence collection, and protecting patient privacy? • Where will you stage law enforcement officials to allow for interviews but not congest patient care areas? • What is the backup plan to store bodies when the morgue is not of adequate size? • Are the bodies considered “evidence”?

  27. 10:30 a.m. • 10:30 a.m. – Many patients will need weeks to months of supportive care before recovery • Scarce resources will be long-term issues for the facility and community • Hospitals, clinics, and EMS will need to construct contingency plans to address shortages • Vendors will need to be contacted to provide additional supplies and equipment

  28. Considerations and Decisions • What are the extended care implications for your hospital? • What recovery and mitigation efforts can you take now to reduce the impact of this event? • Have you integrated long-term care facilities into your disaster plans? • Do the nearby ancillary care facilities coordinate with hospitals to accommodate a surge of long-term care patients in the community?

  29. 10:45 a.m. • 10:45 a.m. – FBI states they have received a credible threat that an IED was placed in the hospital (optional participation) • What are the procedures for notifying law enforcement? • Who is in charge until law enforcement arrives? • What is your policy regarding the use of radios and pagers while searching for an IED? • What recovery and mitigation efforts can you take now to reduce the impact of this event, should an IED detonate?

  30. 11:00 a.m. • 11:00 a.m. - Influx of patients presenting to the ED continues • Mayor’s press conference is held • Cause of IED is attributed to Universal Adversary terrorist group • Public is asked to report all suspicious packages and behavior • Status reports from hospitals, clinics, & EMS compiled • Regional EOC begins to receive resource requests which are relayed to the State Operations Center

  31. 12:00 p.m. • 12:00 p.m. • The Exercise Ends!

  32. Reference • www.emsa.org. 2005 Statewide Medical and Health Disaster Exercise Guidebook (accessed September 25, 2005).

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