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Emergency Preparedness

Emergency Preparedness. Emergency Preparedness. David McCann BSc MD CCFP FAASFP Centre for Excellence in Emergency Preparedness Flu Assessment Centre Coordinator, City of Hamilton Chair, American Board of Disaster Medicine Incident Commander, Ontario EMAT Chief Medical Officer, FL-1 DMAT.

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Emergency Preparedness

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  1. Emergency Preparedness Emergency Preparedness David McCann BSc MD CCFP FAASFP Centre for Excellence in Emergency Preparedness Flu Assessment Centre Coordinator, City of Hamilton Chair, American Board of Disaster Medicine Incident Commander, Ontario EMAT Chief Medical Officer, FL-1 DMAT

  2. Sept 11, 2001—We Will Never Forget

  3. NEW ORLEANS 17th STREET CANAL BREACH COURTESY OF KATRINA

  4. What happens when you don’t prepare....

  5. Office Emergencies—Prepared? • 1985 US survey of FPs—more than 40% had encountered each of eight different emergencies • Only 11% had the equipment to deal appropriately with these office emergencies Kobernick M. Management of emergencies in the medical office. J Emerg Med 1985; 4:71-74. • 1989 study of FPs and paediatricians  more than 80% had an office emergency in the previous 3 months • In most cases, staff were unprepared & ill-equipped Fuchs S, Jaffe DM, Christoffel KK. Paediatric emergencies in office practices: prevalence and office preparedness. Pediatrics 1989; 83: 931-9.

  6. FLORIDA ONE DMAT 2008 Hurricane Ike @ Houma, LA My MASH Unit

  7. Step-wise Approach to Office Emergencies • Simple approach  can work with 2 person team or an entire office staff • Organization and planning with a pro-active team-based approach will work well • 4 phase step-wise approach Sempowski IP, Brison RJ. Dealing with office emergencies: stepwise approach for family physicians. Canadian Family Physician 2002; 48: 1464-72.

  8. Phase 1  Triage Phase • Call 9-1-1 to alert EMS • Primary Survey  Check ABCs and support appropriately • Triage after brief history & physical • Verify diagnosis (if possible) • Assess severity • Maintain safe, secure environment

  9. New Orleans/St Bernard’s Parish, Post Hurricane Rita 09/2005

  10. Phase 2 Management Phase • Establish leadership • Obtain assistance within office • Start flowsheet • Collateral history from family  keep them updated • Communicate with/relocate other patients • Old chart, gather info • Get needed equipment • Move patient if needed • Secondary survey • Do additional investigations • Assess need for immediate treatment • O2, IV, Meds • Re-evaluate status in response to therapy

  11. Katrina—It Rained Cats and Dogs and Cars....(9/29/05)

  12. Phase 3  Transfer Phase • Direct EMS to patient • Call hospital ED • Sign over to EMS • Gather written transfer materials, flowsheet/summary • Transfer to definitive care

  13. The TOXIC SLUDGE in St Bernard’s Parish/New Orleans

  14. Phase 4  Debriefing • Debrief team immediately • Hold delayed team meeting and debriefing • How did we do? • What did we do well? • What could we have done better?

  15. Barricade Erected by Sheriffs Between New Orleans’ Lower 9th Ward and St Bernard’s Parish

  16. Stonechurch • Considered “moderate to high risk” office • Why? • Invasive procedures done in office • Parenteral meds frequently given (allergy shots) • High volume, large group practice • High risk population (e.g. Elderly) • That’s why we need an AED and a “Crash Cart”...

  17. The New Crash Cart • Oxygen tank + nasal cannulae, face masks, non-rebreather masks (to provide 100% oxygen) • Suction device • Nebulizer • Pulse oximeter • IV fluids and IV cannulae • Meds

  18. Meds on the Cart • Epinephrine (1/1000) • Diazepam 10 mg/2 ml • Lorazepam 1 mg (s/l) • Benadryl (oral 50 mg, 25 mg); 50 mg/ml IV • Glucagon 1 mg/vial • Furosemide 10 mg/ml • Ventolin inhaler & neb solution • Atropine 0.6 mg/ml • Decadron 4 mg/ml • ASA 81 mg • NTG • D50 • Glucose tabs

  19. 800 LB MAN BROUGHT BY ARMY DUMP TRUCK TO DMAT COMPOUND—FOUND FLOATING ON A DOOR IN THE FLOODWATERS OF BAY ST LOUIS, MISSISSIPPI (08/05)

  20. Anaphylaxis • Oxygen • Epinephrine 1/1000 0.3-0.5 mg (0.3-0.5 ml) SQ or IM  children 0.01 mg/kg SQ or IM (max 0.5 mg) • May be given q 15-20 min • Benadryl 50-100 mg IM/PO; child 1-2 mg/kg IM/PO • IV Normal Saline—Adults 1 L bolus; children 10 ml/kg may repeat bolus x 1 • Consider tourniquet above allergen

  21. Louis Armstrong International Airport in New Orleans Hospital to 5000 patients after Katrina....

  22. Automatic External Defibrillator • Fully automatic and gives (loud) verbal instructions • Attach pads to R sternal border and cardiac apex in a patient who is PULSELESS AND BREATHLESS • Follow verbal cues and do CPR between shocks: SHOCK2 min CPRSHOCK2 min CPR etc • “New CPR” 30 compressions to 2 ventilations to the rhythm of “Another One Bites the Dust...” (Queen, 1980) • Will only shock Ventricular Fibrillation and Pulseless Ventricular Tachycardia (VF & VT)

  23. CPR Training • Stonechurch—two of our staff are becoming CPR Instructors • We will begin offering CPR Certification/Recertification in-house in the Fall

  24. ONTARIO EMAT DEPLOYMENT

  25. Where Do We Keep This Stuff? • In the alcove beside the team assistants’ area between Rooms 4 & 5 at Stonechurch • Come hither and look at our AED and cart....

  26. QUESTIONS?

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