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Lesson 1 Disasters and Public Health Emergencies

Learn the key elements of disaster response, emergency management, and public health interventions in the context of public health emergencies. Understand the DISASTER Paradigm™ and the shift in perspective towards population-based care.

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Lesson 1 Disasters and Public Health Emergencies

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  1. Lesson 1Disasters andPublic Health Emergencies

  2. Learning Objectives • Discuss rationale for including public health emergencies as operational elements of modern disaster classification • Explain need to evaluate, describe, and monitor public health impact of disasters • Discuss elements of DISASTER Paradigm™ in context of providing mass casualty and population-based care

  3. D I S A S T E R + Widespread geography + Large population size and density + Prolonged exposure + Compromised public health capacity + Existing environmental decay Public Health Emergency

  4. Shift in Perspective Population Individual

  5. Natural Event High population density Limited health system Lack of coordination Disaster Public Health Emergency

  6. Unintentional Collateral damage Indirect consequences Human Systems Failure Bob McMillan/FEMA Disaster Public Health Emergency

  7. Deliberate Indirect mortality Infrastructure destruction Conflict CDC Public Health Emergency Disaster

  8. Public Health Interventions • Shelter in place • Mass evacuation • Mass sheltering • Mass feeding • Mass prevention • Mass health care Logistics

  9. Disaster Management

  10. Elements of Disaster Response Emergency Management Public Health Clinical Care

  11. Detection Incident Management Safety and Security AssessHazards Support Triage and Treatment Evacuation Recovery Andrea Booher/FEMA

  12. Incident and community survey Casualty management Recovery/Restoration

  13. Detection DI S A S T E R • Sustain situational awareness • Maintain appropriate personal safety • Assess basic needs • Alert authorities

  14. Needs Assessment DI S A S T E R Inter-Agency Standing Committee, World Health Organization

  15. Incident Management DI S A S T E R • Links local, state, and federal response under NIMS • Defines roles, functions, and lines of communication • Chain of command

  16. Adapted from Burkle, Disaster Medicine and Public Health Preparedness, 2007;1:135-141.

  17. Safety and Security DI S A S T E R • Survey environment • Secure scene and facilities • Define routes in and out • Anticipate natural environment • Weather • Terrain • Wind direction • Daylight

  18. Priorities Protect self and team Protect uninjured public Protect casualties Protect scene and environment DI S A S T E R

  19. Assess Hazards Identify and mitigate secondary events Bombs and snipers Exposed utilities Structural collapse Fires and explosions Crowd surge DI S AS T E R

  20. Support Define resource needs Determine resource availability Mobilize surge capability Local Regional, state, then federal DI S A ST E R

  21. Triage Principles Save those most likely to benefit from care Minimize additional casualties Maximize combined survival of existing casualties DI S A S T E R

  22. Scene Triage Sort based on ability to follow commands DI S A S T E R

  23. Expanded Triage Population Triage Triage of the entire at risk community for the protection of the population (e.g., shelter in place, when to seek medical care) Tertiary Triage/rationing of resources Ventilators Vaccinations Medication prophylaxis DI S A S T E R

  24. TreatmentCrisis Standards of Care Context of care Minimal acceptable care Functional shift in disaster DI S A S T E R

  25. Tourniquets Stop life-threatening extremity bleeding Effective application Bleeding stopped Distal pulse absent Document time of application Remove after direct control in hospital DI S A S T E R

  26. Evacuation Move casualties from scene to safety and care Casualty collection points Consider non-traditional transport Considerations Special needs populations Hospital evacuation consideration DI S A S T E R Tina Maddock/U.S. Air Force

  27. Recovery DI S A S T E R • Minimizes physical and psychosocial impact • Begins with acute scene restoration and continues long term • Depends on resiliency

  28. Question 1 Which of the following events is most likely to become a public health emergency? • Homicide bombing • Levee breech • Single tornado • 2-car passenger train derailment

  29. Question 2 Which is not a step of the disaster management cycle? • Response • Recovery • Triage • Preparation • Mitigation

  30. Question 3 Generation of surge capacity occurs under which part of the DISASTER Paradigm™? • Detection • Assess hazards • Support • Triage & treatment

  31. Summary Disaster response shifts care from individual to casualty population DISASTER Paradigm™ applies to clinical care, public health, and emergency management Disaster triage: greatest good for greatest number of casualties and population

  32. Questions?

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