All-Hazards Preparation in the 6th Edition of CCST

1. All-Hazards Preparationin the 6th Edition of CCST Grant Wilson, CST, M.Ed. Kevin Frey, CST, M.A. AST Instructor�s Forum February 11, 2012

2. Background on CCST All-Hazards Mandate by CAAHEP AST Joins AMA NDLSEC AST Uses Information Published by AMA NDLSEC as Research Material Draft of All-Hazards Preparation Went Thru 4 Drafts

3. Teaching Philosophy Intention Not to Have as a Stand-Alone Course Incorporate within another course Give the Student the Basics Will learn more thru continuing education Near Future Revising �Tech Sci� Book Even though not really a �technical� subject, will include All-Hazards Prep

4. Thought you might like to see photo without interference � ship outside wall of hurricane

5. Lightening Starting a Fire in WY

6. Overview Relevance of the topic When to teach Motivating student interest in topic Some examples/stats Some basic concepts of All-Hazards The need for healthcare providers to have a family emergency plan Group projects and assignment ideas Mock Drill Resources Your Ideas/Thoughts

7. Relevance The obvious Increased occurrence in natural disasters. World-wide instability while increased globalization. Did you know? The biggest killers of 2007 was heat waves. FAA forecast that by 2017 American air carriers will transport over 1 billion people per year world-wide.

8. Relevance Government interest/funding. The amount of government funding for emergency preparedness has increased significantly.

9. Relevance Opportunity for unity among healthcare providers. Education can be the impetus for unifying the response of various healthcare providers. All groups of healthcare providers need to be educated as to what role they would play in a disaster. Increases skills in areas of teamwork and critical thinking.

10. Motivating Students Interest Help them to relate to the topic List recent top disasters Review maps and trends of the local area Discuss personal experiences Discuss local experiences Use team/group projects

11. Top 10 Natural Disasters of 2007 Bangladesh Cyclones Southeast US drought Mexico Floods Hurricane Felix Indonesia Mud Volcanoes South Asia Floods North Korean Floods Earthquake in Peru Greece Forrest Fires China Floods

12. Top 10 Man-Made Disasters 0f 2007 Global Warming Brazil Plane Crash Southern California Forrest Fires Yangtze River Dolphin Extinction. Minneapolis Bridge collapse Utah mine collapse. North Korea oil pipe explosion. Siberia Mine Explosion. Mozambique munitions explosion. Congo train derailment.

13. Top 10 Natural Disasters of 2009 Philippines Typhoon Earthquake Indonesia and Samoa September - India Earthquake/Floods Australia Floods Hurricane Ida � El Salvador Cyclone Laurence � Australia Tennessee and Kentucky EF4 tornado. Earthquake � Italy July - India floods 2009 Winter storm - Europe

14. Top 10 Natural Disasters of 2010 Haiti Earthquake Iceland volcano Chile Earthquake Pakistan Floods Guatemala sinkhole Machu Picchu Landslide Nashville Floods China Earthquake East coast blizzard Russia wildfires

15. Top US Disasters 1. American Civil War � 620,000 2. Galveston Hurricane of 1900 � 6,000-12,000 3. 1906 San Francisco Earthquake � 3 to 6,000 4. Trail of Tears � 4,000 5. 1928 Hurricane Okeechobee - Bahamas, Puerto Rico, and Florida � 3,000

16. Top US Disasters 6. September 11, 2001 Attacks � 2,973 7. Pearl Harbor Attacks � 2,458 8. Johnstown, Pennsylvania Floods � Dam break � 2,209 9. 1893 Hurricane � Louisiana � 2,000 10. 2005 Hurricane Katrina � 1,836

17. HEAT

18. TORNADOS

19. Earthquake

20. When to teach Make opportunities throughout curriculum to discuss emergency preparedness topics. Reinforce basic skills. Teamwork and communication skills are taught throughout curriculum. One possible way to help cover �all hazards� is to assign research/group projects.

21. When to teach Discuss more specific components after students have a base of knowledge about how they will function in the healthcare environment. Consider mock drill towards end of program to bring together skills and knowledge. Emergency preparedness draws on multiple critical thinking, teamwork, and practical skills.

22. Things to Teach Individual Roles and Expectations Appropriate level of skills How to apply knowledge and skills in a variety of challenging conditions. Manual/Basic skills Remain in scope of practice Basic content/terminology of emergency response.

23. Things to Teach How is the surgical environment affected. Utilization of personal. Time of day/surgery schedule. Supplies. Mental/Physical endurance. The necessity of having a family emergency plan which will provide for loved ones while away from them. Types of patients expected for different types of disasters. Possibility of injuries secondary to the disaster. Ex. Power outage from storms resulting in increased MVA�s due to lack of working traffic signals.

24. Things to Teach Psychological response of patients Psychological response of healthcare providers

25. Some Basics Natural disaster � Affects more than 100 people with 10 or more dead. Some define disaster as any event that overwhelms the system. Risk = Hazard x Vulnerability Goal is to reduce excess death. All Hazards approach. Students prepared for all possible hazards. Reality

26. Some Basics Phases of Disaster Response Planning Mitigation Disaster Occurs Response Rehabilitation

27. Phases of Emergency Management

28. Effective Disaster Assistance Prepared community Careful preplanning Ability to quickly implement a plan Effective communication among responders The application of triage skills Ability to organize quickly and fully utilize emergency personnel Ability to adapt the plan to meet special conditions. A contingency plan for shelter and transportation of people in an entire area. Doing greatest good for the greatest number. Avoid relocating the disaster from the scene to the local hospital.

29. Basics - Definitions NRF � National Response Framework NIMS � National Incident Management System START � Simple Triage and Rapid Treatment The National Response Framework presents the guiding principles that enable all response partners to prepare for and provide a unified national response to disasters and emergencies - from the smallest incident to the largest catastrophe. The Framework establishes a comprehensive, national, all-hazards approach to domestic incident response. NIMS � National Incident Management System - provides a systematic, proactive approach to guide departments and agencies at all levels of government, nongovernmental organizations, and the private sector to work seamlessly to prevent, protect against, respond to, recover from, and mitigate the effects of incidents, regardless of cause, size, location, or complexity, in order to reduce the loss of life and property and harm to the environment. START The National Response Framework presents the guiding principles that enable all response partners to prepare for and provide a unified national response to disasters and emergencies - from the smallest incident to the largest catastrophe. The Framework establishes a comprehensive, national, all-hazards approach to domestic incident response. NIMS � National Incident Management System - provides a systematic, proactive approach to guide departments and agencies at all levels of government, nongovernmental organizations, and the private sector to work seamlessly to prevent, protect against, respond to, recover from, and mitigate the effects of incidents, regardless of cause, size, location, or complexity, in order to reduce the loss of life and property and harm to the environment. START

30. Family Emergency Plan Major consideration for healthcare providers. During an emergency you will not be home to take care of your family. You may very well be separated from your family for an extended period of time. Will they be safe? Who will take care of them? Will there be sufficient provisions? How will they cope emotionally?

31. Protect Your Family While You Protect Your Community FEMA Ready Responder promotional picture.FEMA Ready Responder promotional picture.

32. Group Projects and Assignments Draw map of home and neighborhood. Include escape routes and meeting places Use maps of local area. Note potential hazards and find alternate routes. Demonstrate treatment of water Boiling Chlorination Distillation

33. Group Projects and Assignments Complete evaluation of local risk Complete Family Communication Plan Compile a disaster kit Easiest for students would be automotive but encourage all three. Discuss/Role play thought processes that occur during an emergency.

34. Hazard Risk Evaluation Are You Ready pp 16 and 17.Are You Ready pp 16 and 17.

35. Family Communication Plan Are You Ready Appendix CAre You Ready Appendix C

36. Disaster Kit

37. Disaster Kit See Are You Ready Appendix B for a check list.See Are You Ready Appendix B for a check list.

38. It is important to know how to do things in the absence of technology or full use of normal operations. It is important to know how to do things in the absence of technology or full use of normal operations.

39. Mock Drill Mock drills are a good opportunity to bring together the students practical skills, critical thinking, communication skills, and ability to work as a team in one exercise. Consider placing towards end of program so that the level of independence is highest. Include other healthcare programs.

40. Mock Drill Have pre-drill conference. Include opportunities in the drill for making difficult decisions. Post drill conference and counseling. Consider including a post-counseling session led by trained personnel.

41. Mock Drill set-up Patient scenario How many/type patients will the OR receive? Grouping/Assignment of Students. Simulator prep Pre/Post Conference

42. Drill - Patients If drill is large scale more patients will need to be admitted to the OR than is needed for drill. Select best cases/scenario(s) to match lab capabilities. Coordinate with other program faculty your needs/expectations for the patient(s) that will continue to the OR portion of the drill. Meet with the volunteer patient(s) during setup/moulage to prepare them for their role.

43. Drill - Students Class before Review all-hazards and discuss expected patient types. Prepare for possible cases Use case study/prep reports. Exploratory Laparotomy (blunt/penetrating trauma) ORIF Lacerations/Wound management Make tentative role assignments.

44. Drill - Students Pre-conference Overview expectations and answer questions from assigned case studies. Assignments Finalize assignments Make sure all roles are covered. Have students that are capable of leadership roles to be the coordinator and assistant coordinator. Consider assigning some students to observe other program/department roles.

45. Drill - Students Performance Consider having students working on another mock case that will need to be brought to a close and turned over. Announce disaster after occurrence. Try to keep the actual disaster a secrete until this time. There will be a delay. Attempt to keep students engaged without letting them get ahead of themselves. Performance will not be perfect. Be prepared to lead students. They will be learning more than you think. Exploratory Laparotomy Entry Pack off liver Remove spleen Repair liver with felt pledgets Repair section of bowel

46. Drill - Students Post-conference Participate in drill post-conference with other teams. Also have a separate post-conference with ST students only. Items for discussion What went well. What did not work or needs to be improved. Frustrations/feelings experienced. How can the drill be improved in the future. How do you see yourself using the experience. Others

47. Drill � Simulator Prep Delletec Laparotomy simulator with metal basin underneath. Cover Laparotomy simulator pad on both side with incise drape to protect from fluids or use other tissue. Deer or other animal liver and spleen. Natural casing for bowel. Fake blood and lots of it.

48. Health occupation students from area high schools were utilized as �patients� for the drill.Health occupation students from area high schools were utilized as �patients� for the drill.

49. Our 2011 drill was based on the explosion at the Olympic park in Atlanta.Our 2011 drill was based on the explosion at the Olympic park in Atlanta.

53. START tagging system.START tagging system.

54. Communications is a significant part of drill. Consider having radio communication among OR personnel involved in the drill. Communications is a significant part of drill. Consider having radio communication among OR personnel involved in the drill.

57. Nursing students learned about paperwork. Nursing students learned about paperwork.

58. Get lots of video and pictures.Get lots of video and pictures.

59. Multiple school and local departments can be involved in the drill.Multiple school and local departments can be involved in the drill.

61. Some students played the role of family members seeking information about the �injured�.Some students played the role of family members seeking information about the �injured�.

63. Surgery patient arrives in �ED�.Surgery patient arrives in �ED�.

64. Minor injuries area.Minor injuries area.

65. Patient heading to the OR.Patient heading to the OR.

67. Transport to OR.Transport to OR.

69. Arrival to OR. Make sure student �patient� knows what to expect and when the switch will be made to the simulator.Arrival to OR. Make sure student �patient� knows what to expect and when the switch will be made to the simulator.

70. The simulator was covered with an incise drape to reduce the amount of fluid absorbed by the foam or staining the simulator.The simulator was covered with an incise drape to reduce the amount of fluid absorbed by the foam or staining the simulator.

73. Student in role of anesthesiologist. Student in role of anesthesiologist.

74. The student got nervous and had trouble loading the blade. I choose to remain calm at this point and helped her get back on track.The student got nervous and had trouble loading the blade. I choose to remain calm at this point and helped her get back on track.

76. Packing off liver with laps.Packing off liver with laps.

77. �Spleen� removed.�Spleen� removed.

78. Repairing liver lacerations with suture and felt pledgets. Pledgets were cut from craft felt.Repairing liver lacerations with suture and felt pledgets. Pledgets were cut from craft felt.

79. April 27, 2011 The Next Day The 2011 drill was on April 26. I discussed the predictions for tornados for the next day and how similar the predicted patterns were to the 1974 tornados. I suggested to the students that they should be prepared for the possibility that they may be preparing for an actual event. The students were in clinical when the first tornados hit. Some of the students were involved in the response within the facilities where they were located. The tornado pictured was in Tuscaloosa.The 2011 drill was on April 26. I discussed the predictions for tornados for the next day and how similar the predicted patterns were to the 1974 tornados. I suggested to the students that they should be prepared for the possibility that they may be preparing for an actual event. The students were in clinical when the first tornados hit. Some of the students were involved in the response within the facilities where they were located. The tornado pictured was in Tuscaloosa.

80. Limestone county. Near campus.Limestone county. Near campus.

81. North Alabama Tornado tracks for April 27, 2011. The historical tracts of tornados in Alabama have a lot of common patterns. Very helpful to study and be aware of areas of greater likelihood and typical direction of travel.North Alabama Tornado tracks for April 27, 2011. The historical tracts of tornados in Alabama have a lot of common patterns. Very helpful to study and be aware of areas of greater likelihood and typical direction of travel.

82. We took a day to help with cleanup efforts at the residence where one of the grandmother of one of the students was killed. This was a good way for the students to connect with the reality of the disaster and to have an opportunity to work together on a recovery effort.We took a day to help with cleanup efforts at the residence where one of the grandmother of one of the students was killed. This was a good way for the students to connect with the reality of the disaster and to have an opportunity to work together on a recovery effort.

83. Remains of house mixed with trees and shrubs deposited over 75 yards from foundation.Remains of house mixed with trees and shrubs deposited over 75 yards from foundation.

84. Evidence of the life lived at this home. Note Bard-Parker scalpel blade.Evidence of the life lived at this home. Note Bard-Parker scalpel blade.

85. Textbook Resource Emergency Preparedness for Allied Health Professionals � Linda Young Landesman, Dr.PH, MSW Published by Paradigm Includes both general information and area specific information.

86. Topics covered by this Text Impact of disasters on public health and healthcare. How responses are organized Personal preparedness Orientation to emergency procedures Continuity of care

87. Training FEMA Ready.gov Ready Responder Community College Citizen Preparedness Program

88. Ready.gov Part 1 � Basic Preparedness Part 2 � Natural Hazards Part 3 � Technological Hazards Part 4 � Terrorism Part 5 � Recovering from Disaster Preface....................................................................................................................1 Why Prepare ..........................................................................................................7 Part 1 Basic Preparedness .....................................................................................13 Section 1.1 Getting Informed............................................................................15 Section 1.2 Emergency Planning and Checklists...............................................23 Section 1.3 Assemble a Disaster Supplies Kit ...................................................31 Section 1.4 Shelter ...........................................................................................37 Section 1.5 Hazard-Specific Preparedness ........................................................43 Section 1.6 Practicing and Maintaining Your Plan ............................................45 Part 2 Natural Hazards ..........................................................................................47 Section 2.1 Floods ...........................................................................................49 Section 2.2 Tornadoes .....................................................................................57 Section 2.3 Hurricanes ....................................................................................65 Section 2.4 Thunderstorms and Lightning ........................................................73 Section 2.5 Winter Storms and Extreme Cold ..................................................79 Section 2.6 Extreme Heat ................................................................................85 Section 2.7 Earthquakes ...................................................................................93 Section 2.8 Volcanoes ...................................................................................101 Section 2.9 Landslides and Debris Flow (Mudslide) .......................................105 Section 2.10 Tsunamis ..................................................................................111 Section 2.11 Fires ..........................................................................................115 Section 2.12 Wildfires ...................................................................................123 Part 3 Technological Hazards ..............................................................................127 Section 3.1 Hazardous Materials Incidents......................................................129 Section 3.2 Household Chemical Emergencies ...............................................133 Section 3.3 Nuclear Power Plants ...................................................................139 Part 4 Terrorism..................................................................................................145 Section 4.1 General Information about Terrorism...........................................147 Section 4.2 Explosions ...................................................................................151 Section 4.3 Biological Threats........................................................................155 Section 4.4 Chemical Threats .........................................................................159 Section 4.5 Nuclear Blast ...............................................................................163 Section 4.6 Radiological Dispersion Device (RDD)........................................169 Section 4.7 Homeland Security Advisory System...........................................173 Part 5 Recovering from Disaster ..........................................................................179 Appendix A: Water Conservation Tips ................................................................191 Appendix B: Disaster Supplies Checklist.............................................................195 Appendix C: Family Communications Plan .........................................................201Preface....................................................................................................................1 Why Prepare ..........................................................................................................7 Part 1 Basic Preparedness .....................................................................................13 Section 1.1 Getting Informed............................................................................15 Section 1.2 Emergency Planning and Checklists...............................................23 Section 1.3 Assemble a Disaster Supplies Kit ...................................................31 Section 1.4 Shelter ...........................................................................................37 Section 1.5 Hazard-Specific Preparedness ........................................................43 Section 1.6 Practicing and Maintaining Your Plan ............................................45 Part 2 Natural Hazards ..........................................................................................47 Section 2.1 Floods ...........................................................................................49 Section 2.2 Tornadoes .....................................................................................57 Section 2.3 Hurricanes ....................................................................................65 Section 2.4 Thunderstorms and Lightning ........................................................73 Section 2.5 Winter Storms and Extreme Cold ..................................................79 Section 2.6 Extreme Heat ................................................................................85 Section 2.7 Earthquakes ...................................................................................93 Section 2.8 Volcanoes ...................................................................................101 Section 2.9 Landslides and Debris Flow (Mudslide) .......................................105 Section 2.10 Tsunamis ..................................................................................111 Section 2.11 Fires ..........................................................................................115 Section 2.12 Wildfires ...................................................................................123 Part 3 Technological Hazards ..............................................................................127 Section 3.1 Hazardous Materials Incidents......................................................129 Section 3.2 Household Chemical Emergencies ...............................................133 Section 3.3 Nuclear Power Plants ...................................................................139 Part 4 Terrorism..................................................................................................145 Section 4.1 General Information about Terrorism...........................................147 Section 4.2 Explosions ...................................................................................151 Section 4.3 Biological Threats........................................................................155 Section 4.4 Chemical Threats .........................................................................159 Section 4.5 Nuclear Blast ...............................................................................163 Section 4.6 Radiological Dispersion Device (RDD)........................................169 Section 4.7 Homeland Security Advisory System...........................................173 Part 5 Recovering from Disaster ..........................................................................179 Appendix A: Water Conservation Tips ................................................................191 Appendix B: Disaster Supplies Checklist.............................................................195 Appendix C: Family Communications Plan .........................................................201

89. Ready.gov

90. Ready.gov

91. Ready.gov

92. Internet Resources Department of Homeland Security www.dhs.gov American Red Cross www.redcross.org Disability Preparedness www.disabiltyprepaedness.gov www.nobodyleftbehind2.org CERT www.citizencorp.gov/cert FEMA www.fema.gov Are YOU Ready www.fema.gov/areyouready FEMA Independent Study Program www.training.fema.gov/IS

93. Your Ideas

94. Contact Information Grant Wilson, CST, M.Ed. sgw@calhoun.edu 256/306-2950 Kevin Frey, CST, M.A. Kfrey@ast.org Thank You!!!

95. References Italo Subbaroa, DO, MBA; James M. Lyznicki, MS, MPH; Edbert B. Hsu, MD, MPH; Kristine M. Gebbie, DrPH, RN; David Markenson, MD, FAAP, EMT-P; Barbara Barzansky, PhD; et al.� (2008). �A Consensus-based Educational Framework and Competency Set for the Discipline of Disaster Medicine and Public Health Preparedness.� Disaster Medicine and Public Health Preparedness, 2 (1), 57-68.� Joseph Mistovich, M.Ed., NREMT-P: Keith J. Karren, PhD, EMT-B (2010) Prehospital Emergency Care. American Red Cross Centers for Disease Control and Prevention FEMA Are You Ready Ready Responder Community College Citizen Preparedness Program Department of Homeland Security National Weather Service US Geological Survey