Special Medical Response Team (SMRT) Training

1. Special Medical Response Team (SMRT) Training Epidemiologic and Clinical Implications of Post-Hurricane Health Care Workload Dr Craig Llewellyn, MD, MPH

2. Hazard Threat Vulnerability Assessment (HTVA) • Palm Beach County—Hurricane and tropical storms • Degradation or destruction of critical public infrastructure • Degradation or destruction of critical health care infrastructure • Electrical, water, communications, sanitation, transport, food supply, fuel and energy, medical supplies and equipment.

3. Impact on health care infrastructure • Facilities are degraded due to direct impact • Facilities unusable due to infrastructure impact • Impact across health care system • Hospitals - ED’s and OPC’s • Major impact on primary care: • Clinics, Urgent Care, Individual Physician, Inoperable facilities • Health care personnel with no place to practice • Disrupted patterns of seeking and delivering care

4. Possible Responses • Back up systems to maintain critical infrastructure • Mobilization of state, regional, and federal assistance • Reallocate resources in local area - focus on greatest need

5. Disaster Medical Assistance Teams (DMAT) • NDMS – Dept. of Homeland Security (DHA) • Medical professionals and para-professionals, • Administrative and logistical support personnel • Team structure, organization , leadership • Focused on Emergency Medicine, Trauma • Not prepared for primary care role • Usually unfamiliar with area of deployment and local health care facilities and personnel

6. Special Medical Response Team (SMRT) • Loosely patterned on DMAT model • Local - county based • Familiar with local health care personnel, facilities, practices • Integrated into county EOC and emergency response plan through ESF 8 • Employment within county - possibly adjacent counties

7. SMRT Medical Orientation • Should be focused on primary care to reduce non-emergency burden on ED’s • Primary care mission in shelters where medical care is offered • Rapid, flexible and sustained response in support of local personnel and facilities • Has characteristics, capabilities and relationships that DMAT does not possess

8. Post Hurricane Health Care Workload--Katrina • Sites: ED’s , DMAT’s, OPC’s • 16 categories of syndromes: • Major injury — minor injury • 3 GI syndromes • 3 respiratory syndromes • 2 skin syndromes • 2 mental health syndromes • 2 environmentally induced • Other medical: Meds Refill, ASCVD, Diabetes, Asthma, COPD, Mental Illness, Other…

11. Emergency Period - First Week • 11,500 visits - 15 sites (8 DMAT) • 1,600 visits per day • Illness: 57% • 20 % Meds Refill • Injury: 38 % mostly minor • 33% Tetanus immunization • Illnesses: • GI, URI, Skin Infections/rash • Injuries: • Lacerations, Sprains/Strains • Non-fatal carbon monoxide poisoning

12. Recovery Period - First Month • 27,000 visits — 7 to 13 sites • Average 900 visits per day • Injuries: 22% • Major 8%, minor 92% • Illness: 28% • Skin /Wound Infection • URI/LRI • Rashes and Stings • N&V, Diarrhea • Mental health • Chronic Disease & Other Illnesses: 50% • Decrease in Med Refills

15. Epidemiological and Clinical Implications SMRT should prepare for the types of health care workload that has been documented: • Minor injury • Medical illness acute • Medical illness chronic • Medication refills • Mental illness

16. Team preparation Must integrate administrative and logistical support with clinical care • How will representative cases actually be administratively managed, clinically treated, and logistically supported? • One approach is to discuss representative cases…

17. Minor Injury - Laceration • How will patient enter the SMRT area: • Patient data • History • Wound management until MD sees patient • What capability should SMRT have to manage lacerations: • Irrigation • Bleeding control • Wound Closure/Non-closure • Tetanus immunization • Who will perform these functions • Will there be a separate treatment area

18. Medical Illness - Acute Diarrhea • How does patient enter SMRT area • History & patient data • Clinical information and examination • Treatment: What medications, other Tx • What instructions and/or follow-up • Fecal specimen

19. Medication Refill • How will SMRT be prepared to manage these issues • Contact with major pharmacies • Confirm patient history of prescription • Stocks on hand • Instructions to patient

20. Chronic Medical Illness - Diabetes • How does patient enter SMRT area • History and administrative information • Clinical examination • Laboratory tests: • Urine dip sticks, • I-STAT • Treatment - medications provided (?? Insulin??) • Patient Instructions

21. Chronic Medical Illness - COPD • How does patient enter SMRT area • History • Clinical Examination and Treatment • Oxygen provision • Laboratory measurements: • Pulse Oximeter • I-STAT • Patient instructions

22. Discussion of Cases • Method to focus on processes and procedures: • Clinical • Administrative • Logistical • Management protocol development • Record keeping • Surveillance and reporting • Lay out of SMRT work area • Roles for team members: • From entry/triage through disposition

23. Questions