Best Practices in Disaster Preparedness: Coordinating Care During Crisis

1. Best Practices in Disaster Preparedness: Coordinating Care During Crisis Presentation to: Templeton Pediatric Trauma Symposium Presented by: Kelly H. Nadeau, MN, RN Date: 2 March 2013

2. 2013 Events Nevada-California Earthquakes Feb 2013 New England Snow Feb 2013 Meteor Feb 2013 Hattiesburg, MS Feb 2013 Solomon Islands Earthquake Jan 2013 Adairsville, GA Jan 2013

3. Basic Disaster Assumptions • Definition varies • Can occur at any moment • “All Hazards” approach to planning • All disasters are local 1-16, Laurens County, GA, February 2013

4. National Preparedness Goal • “A secure and resilient nation with the capabilities required across the whole community to prevent, protect against, mitigate, respond to, and recover from the threats and hazards that pose the greatest risk.”- FEMA September 2011

5. Disaster Declarations • The Stafford Act (§401) requires that: "All requests for a declaration by the President that a major disaster exists shall be made by the Governor of the affected State." Presidential declaration Governor makes request to Regional FEMA office State declaration Local event -1988, amended 2007

6. National Response Framework • All hazards approach • Emergency Support  Functions • ESF1    Transportation • ESF2    Communications • ESF3    Public Works and Engineering • ESF4    Firefighting • ESF5    Emergency Management • ESF6    Mass Care, Housing, and Human Services • ESF7    Resources Support • ESF8    Public Health and Medical Services • ESF9    Urban Search and Rescue • ESF10  Oil and Hazardous Materials Response • ESF11  Agriculture and Natural Resources • ESF12  Energy • ESF13  Public Safety and Security • ESF14  Long-term Community Recovery and Mitigation • ESF15  External Affairs • www.fema.gov/nrf

7. Challenges Personal preparedness Access to education Time to train Exercises Community partners Attitude Joplin, MO, May 2011

8. “It can’t happen here” Atlanta, March 2008

9. Is the Scene Safe? • Electrical and power outages • Food and water • Heat/cold • Fire • Confined spaces • Falls • Air quality Tuscaloosa, AL 2011

10. …..really safe?…… • Chemicals • Carbon monoxide • Stress and fatigue • Chainsaws • Mosquito borne diseases, ex. West Nile, Dengue • Animals • Snakes Sumter Regional, Americus, GA 2007

11. …..are you sure? • Mold • Mental health • Preexisting conditions Americus, GA 2007

12. Pre-event Assessment • Nutrition • Water supply • Immunization status • Access to healthcare • Literacy rate Haiti, 2010

13. American College of Surgeons • Surgical community has an obligation to participate in the multidisciplinary planning, triage, and medical management of victims following a mass casualty event. • Trauma centers have an obligation to participate in disaster preparedness and management. • A surgeon from trauma panel should participate on the hospital’s disaster committee. Resources for the Optimal Care of the Injured Patient

14. Link to Homeland Security • An effective trauma system is most certainly an essential ingredient for Homeland Security. A trauma system can be key infrastructure in our preparedness efforts not only for the un-natural acts of terrorism, but also for those natural disasters such as tornadoes, floods, hurricanes, and newly emerging infectious challenges such as SARS or monkeypox. An integrated, statewide trauma system is crucial in our efforts to improve Homeland Security. Georgia Office of EMS and Trauma

15. Emergency Nurse Perceptions of Individual and Facility Emergency PreparednessWhetzel, et al, Journal of Emergency Nursing, Feb 2013 • Survey to assess nurses’ perception of their role in a disaster and their perceived susceptibility to a disaster. • Results reflect that many emergency nurses have not taken basic actions to prepare themselves for a disaster either personally or professionally.

16. Healthcare Preparedness Funding HPP Healthcare Preparedness PHEP Public Health Emerg Prep Health and Human Services Centers for Disease Control Division of State and Local Readiness Public Health Preparedness Program • Health and Human Services • Assistant Secretary for Preparedness and Response • Hospital/Healthcare Preparedness Program in each state

17. Dept of Health and Human Services

18. Capabilities

19. Capabilities

20. Healthcare Coalitions • Healthcare Coalitions serve as a multi-agency coordinating group that assists Emergency Management and Emergency Support Function (ESF) #8 with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations.

21. DISASTER CYCLE Healthcare Coalitions: Assist HCOs within their region to assist the community with their return to normal healthcare delivery operations Healthcare Coalitions: Address areas in critical infrastructure and key resource allocation planning that decreases the vulnerability of the healthcare delivery system Recovery Mitigation Response Healthcare Coalitions: Integrate with ESF#8 and incident management to provide healthcare situational awareness in order to inform the decision making process for the allocation of resources Healthcare Coalitions: Follow the steps of the Preparedness Cycle to effectively mitigate, respond to and recover from a disaster Preparedness Disaster Disaster Cycle

22. National Disaster Medical System • Designed to move patients quickly from one part of the country to another during a large disaster • Activated at 9/11 but no patients to move • Activated after Hurricanes Katrina and Rita to move patients (and evacuees, family members, pets, etc.) • Coordinated by VA Medical System • Utilizes Dept of Defense transport assets • Federal Coordinating Centers designated • Federal funds released if activated

23. NDMS “like” Activation February 2010 • Reasons Atlanta was chosen • Previous experience with NDMS • Flight distance from Haiti • Refugee Resettlement Office • Governor agreed to the mission • State Emergency Management Agency involved • Dept of Public Health - ESF8 lead in Georgia • Healthcare Preparedness Program involvement

24. Flight Day in Haiti • Approval Board in Haiti • Approved patient records copied and report given to Transcom RN • Patient packaged and moved to deck of USNS Comfort • Patient airlifted from USNS Comfort to ground in Haiti • Held at field hospital until C-130 lands • Loaded onto C-130 with CCATT team, patient records and non medical attendants • Flight left Haiti around 5:30 p.m. • Flight arrived Dobbins Air Reserve Base 9:30-10:30 p.m.

25. Flight Day in Atlanta • 6:00 a.m., first e-mail of the day • By 9:00 a.m., preliminary manifest via e-mail, patient reports from Transcom RN to Kelly • 9:00 a.m. Conference call with Transcom • 9:00-2:00 p.m. Patient placement calls by Kelly and GHA colleague • 2:00-5:00 p.m. Communication, faxes, etc. to Team Georgia and Transcom • 6:00-8:00 p.m. PR Team assembles at Dobbins • 9:30-10:30 p.m. Flight lands • Around 11:00 p.m. – last message from Transcom

26. Challenges • International mission • Culture • Language • Patient placement • New partners • Business • Payment • Discharge • Travel back to Haiti

27. Patient Challenges • Multiple trauma three weeks plus after the earthquake • Tetanus • Open extremity fractures, infected, external fixators, needing debridement and flaps • Spinal cord injuries • Amputations

28. Summary from Atlanta • 11 missions total • 51 patients • 21 non-medical attendees • 21 receiving hospitals • 41 NDMS hospitals

29. Atlanta March 2011 • 110 residents were evacuated from an assisted living center

30. Superstorm Sandy 2012

31. Care for Responders • Difficult circumstances • Unthinkable decisions • Unforgettable sights, smells, sounds, experiences

32. To Do List • Personal Preparedness Plan for you and your family www.ready.gov • Know the emergency plans of your facility and your community • Be involved in the emergency preparedness planning • Mass casualty planning must have trauma involvement • It’s all about relationships……find your coalition

33. Kelly H. Nadeau, M.N., R.N.khnadeau@dhr.state.ga.us