ED Disaster Preparedness: Tertiary Medical Center Perspective Alisa Murchek, RN, MS, CEN Associate Director of Nursing, Critical Care and Emergency Services

University of Illinois Medical Center A Tertiary Care Center A Tertiary Care Center Eye Trauma Center for Chicago Eye Trauma Center for Chicago Specialty Neuro-Sciences Intensive Care Unit Specialty Neuro-Sciences Intensive Care Unit Pediatric Intensive Care Unit Pediatric Intensive Care Unit

UIC Plans & Protocols are modeled on the Emergency Management System Illinois State Medical Disaster Plan and Hospital Emergency Incident Command System (HEICS) using: Illinois State Medical Disaster Plan and Hospital Emergency Incident Command System (HEICS) using: –Organizational Charts –Job actions sheets Plan is flexible to adapt to each incident Plan is flexible to adapt to each incident

Activating the Plan Based on Type of Incident Based on Type of Incident –Biological –Chemical/Decontamination –Mass Casualties (Trauma)

Biological Incident Victims may present intermittently over a period of days to weeks. Victims may present intermittently over a period of days to weeks. –Infectious Disease Service –Toxicology Services –Pharmacy Services –Facilities Personnel

Chemical/Decontamination Victims will arrive by personal transportation (walk-ins) or by ambulance. Victims will arrive by personal transportation (walk-ins) or by ambulance. Victims may not enter through ED but through various hospital entrances Victims may not enter through ED but through various hospital entrances –Activate UIC Police for Lock-down –Environmental Health and Safety Office to coordinate decontamination team efforts

Mass Casualty Incident (Trauma) Victims present rapidly usually via ambulance. Victims present rapidly usually via ambulance. Hospital must flex staffing levels upward until all victims are treated. Hospital must flex staffing levels upward until all victims are treated. Usually in active Disaster Plan for hours not days. Usually in active Disaster Plan for hours not days. –Activate incident command, additional staffing, facilities, ITS and finance

Current Capabilities ED treatment rooms 31 ED treatment rooms 31 ED Isolation Rooms 2 fixed, 6 hepa- filtration systems. ED Isolation Rooms 2 fixed, 6 hepa- filtration systems. Hospital Isolation Rooms 11 fixed, 16 hepa-filtration systems Hospital Isolation Rooms 11 fixed, 16 hepa-filtration systems ED Decontamination – 6 pts per hour surging to pts per hour. ED Decontamination – 6 pts per hour surging to pts per hour.

Surge Space 10 treatment carts on ground floor of Hospital building utilizing meeting room space for minor treatment. 10 treatment carts on ground floor of Hospital building utilizing meeting room space for minor treatment. Activate family waiting area staffed with social workers. Activate family waiting area staffed with social workers. Activate American Red Cross Information Services. Activate American Red Cross Information Services. Activate Media Center with PR personnel. Activate Media Center with PR personnel.

Lessons from E2 Media Media Security Security Inter-hospital communications Inter-hospital communications

Addressing Large Numbers of Casualties

Staff Response Immediate Response is excellent Immediate Response is excellent Sustaining response is challenging Sustaining response is challenging

Available Healthcare Workers 835 Attending Physicians 835 Attending Physicians 875 Residents/Fellows 875 Residents/Fellows 900 Nurses (RN/LPN) 900 Nurses (RN/LPN) How do we distribute staff to sustain disaster response? How do we distribute staff to sustain disaster response?

Plan for a 10% surge Use average daily census 320 Use average daily census 320 Increase by 10% 64 Increase by 10% 64 Plan a caregiver ratio of 1:4 16/shift Plan a caregiver ratio of 1:4 16/shift A team approach is best A team approach is best –MD/RN/Tech

Decontamination Single shower unit = 6 ambulatory patients per hour Single shower unit = 6 ambulatory patients per hour 3-line unit = 36 ambulatory patients per hour 3-line unit = 36 ambulatory patients per hour Combination = 42 ambulatory patients per hour Combination = 42 ambulatory patients per hour

Surge Space Within the Hospital Within the Hospital Campus Resources/Buildings Campus Resources/Buildings Community Resources Community Resources

Future Plans Increase Surge Space Increase Surge Space Sustain Response for 72 hours Sustain Response for 72 hours Away Teams Away Teams Decontamination Teams Decontamination Teams Pharmaceutical Cache Pharmaceutical Cache Hospital Vaccination Response Team Hospital Vaccination Response Team Educational offerings of many types Educational offerings of many types

Summary Communicate! Resources are often available in unexpected places. Communicate! Resources are often available in unexpected places. The media is in itself a disaster! Plan appropriately. The media is in itself a disaster! Plan appropriately. Disaster Planning is an Organizational undertaking not the sole responsibility of the ED. Disaster Planning is an Organizational undertaking not the sole responsibility of the ED.