PDLS © : Disaster Planning and Organization

Learning Objectives Steps of disaster planning Steps of disaster planning Concepts in management planning and interventions Concepts in management planning and interventions

Steps of Disaster Planning Planning Planning Resource assessment Resource assessment Risk and hazard analysis Risk and hazard analysis

Risk and Hazard Analysis Assessment of threats to the locality Assessment of threats to the locality - Geographic - Building - Population cluster Children groups Children groups - Day care or schools - Summer camps - Field trips

Risk and Hazard Analysis Environmental Hazards Weather Weather - Winter storms - Hurricanes Geographic Geographic - Earthquakes - Flood plains

Risk and Hazard Analysis Man-made Hazards Chemicals Chemicals - Production, storage and transport Biologic hazards Biologic hazards Terrorism Terrorism Transportation Hazards Materials Materials Mass transit centers Mass transit centers

Resource Assessment Local resources Local resources - EMS - Police - Fire department Volunteers Volunteers - Boy Scouts - Rotary, Shriners Children’s advocacy groups Children’s advocacy groups

Resource Assessment National National - Red Cross - FEMA - DMAT - Department of Defense Agencies and unions Agencies and unions - AMA - ENA

Resource Needs Personnel Personnel - Pediatric specialists (if available) Equipment Equipment Supplies: water, food, blankets Supplies: water, food, blankets Shelter Shelter Suppliers with contact source Suppliers with contact source - Back-up suppliers and contact sources

Resource Needs Communications Communications - Equipment and personnel - Telephone company/cell phones often overload - Ham radio / alternative methods

Resource Needs Transportation Transportation - Roads - Vehicles, public and private Maintaining access for emergency vehicles often problematic Maintaining access for emergency vehicles often problematic

Planning is a Dynamic Process Plan before, during and after Plan before, during and after Contingency planning Contingency planning Continued revising Continued revising

Plan Ahead Resource assessment Resource assessment - Be realistic about resources not already committed to the disaster - Know local limits When and how to call for outside resources - Scale of response - Medication and Immunization stockpiles Pediatric specific!

Plan Ahead Children with special needs Children with special needs - Medications - Psychological/emotional Support/coping mechanisms - Specialized equipment Ventilators, suctioning equipment, wheelchairs Displaced Children Displaced Children

Plan Ahead Discuss with groups / individuals Discuss with groups / individuals - Schools, daycare centers, pediatrician offices - Identify problems - Find options - Keep updated on response abilities Resources and personnel Vary by incident

Plan Ahead Involve all potential participants Involve all potential participants - Don’t overlook potential resources - Avoid improper assumptions Regular planning meetings Regular planning meetings - Risks of area - Unforeseen events

Planning Exercises Look for deficiencies Look for deficiencies Single components vs. multi-group Single components vs. multi-group - Moulage useful but complex - Inter-group cooperation

Planning after Exercise Debriefing after exercise Debriefing after exercise - Share information - Improve plan - Ensure dissemination of changes to plans Honest not defensive feedback from all Honest not defensive feedback from all

During the Disaster Constant revision of plan Constant revision of plan - New risks and resources - Loss of resources Flexibility Flexibility - Alternate uses of resources - Alternate ways of transporting patient to resources or resources to patient

History of ICS 1970s 1970s Review of catastrophic wildfires Review of catastrophic wildfires Inadequate management: Inadequate management: - Lack of accountability - Poor communication - Lack of systematic planning process - Overloaded Incident Commanders - No method to integrate interagency requirements

History of ICS Fire Fire Other agencies Other agencies HICS HICS

February 2003: HSPD-5 President Bush President Bush In response to Sept 11 th WTC attacks In response to Sept 11 th WTC attacks Called for a National Incident Management System (NIMS) Called for a National Incident Management System (NIMS) Improve coordination of federal, state, local and private industry responders Improve coordination of federal, state, local and private industry responders Preparedness Preparedness

March 2004: NIMS Developed and administered by Secretary of DHS Developed and administered by Secretary of DHS The Incident Command System is a key feature of The National Incident Management System The Incident Command System is a key feature of The National Incident Management System Prior to this: no standards for domestic incident response applicable to all levels of government and emergency response agencies Prior to this: no standards for domestic incident response applicable to all levels of government and emergency response agencies

Incident Command System IncidentCommander Planning CommandStaff Finance LogisticsOperations

Identified central commander with limited scope of control Identified central commander with limited scope of control - leave chain of command for smaller groups intact Unified command Unified command Modular system Modular system Expand as needed Expand as needed

ICS for Hospitals and Healthcare Systems Benefits of adopting ICS: Benefits of adopting ICS: - Greater efficiency - Better coordination - More effective communication Comply with Joint Commission Standards Comply with Joint Commission Standards Meet NIMS requirements: $$$ Meet NIMS requirements: $$$ HICS HICS

Hospital Incident Command System Ensure preparedness within and around Ensure preparedness within and around 48 hour supply pediatric equipment & meds 48 hour supply pediatric equipment & meds Pediatric specific disaster risk assessment Pediatric specific disaster risk assessment - School district, EMS, day cares, mental health facilities Develop resources and training for biologic, chemical and radiological terrorism Develop resources and training for biologic, chemical and radiological terrorism Designation of pediatric trauma, burn, hyperbaric and critical care centers Designation of pediatric trauma, burn, hyperbaric and critical care centers Communication among hospital facilities Communication among hospital facilities

Medical control - Decisions for children Disaster interventions differ from everyday Disaster interventions differ from everyday - less information - more victims - different priorities Stress for responders Stress for responders “Greatest good to greatest number” “Greatest good to greatest number” - may not be optimal care for each person Triage/treatment protocols for children Triage/treatment protocols for children will help providers

Documentation Need to provide permanent record Need to provide permanent record Transfer of information from field to base hospital Transfer of information from field to base hospital Limit information Limit information - will lose some details

Documentation problems Data loss / inaccuracies Data loss / inaccuracies Patient limitations - unable to obtain / convey accurate information Patient limitations - unable to obtain / convey accurate information Multicopy permanent record Multicopy permanent record Deterioration of record Deterioration of record Identifying the nameless victim Identifying the nameless victim

Documentation uses To track patient movements To track patient movements To reunite families To reunite families Epidemiological studies Epidemiological studies Evaluation and post disaster critique Evaluation and post disaster critique Long term sequelae and resupply Long term sequelae and resupply

Security “Situational awareness” “Situational awareness” Concerned/interested parties Concerned/interested parties Contamination Contamination Proper identification Proper identification Evidence Evidence Perimeter preservation Perimeter preservation

Conclusion Planning Planning - pediatric specific concerns - risk / hazard analysis - resource assessment - planning is a dynamic process Incident Command System Incident Command System

PDLS © : Train the Trainers

Learning Objectives At the end of this lecture participants will be able to: Make logistical arrangements for conducting the program Make logistical arrangements for conducting the program Deliver an effective presentation Deliver an effective presentation Use principles of adult learning Use principles of adult learning

Preparing for a Course Identify an audience by level of training and experience Identify an audience by level of training and experience Select a proper facility Select a proper facility Obtain appropriate audiovisual equipment Obtain appropriate audiovisual equipment Identify faculty with effective presentation skills: Identify faculty with effective presentation skills: - Lecture - Skills station teaching - Simulation drill instruction

Principles of Adult Learning: Establish the need to know Establish the need to know Past experiences both positive and negative influence the adult learner Past experiences both positive and negative influence the adult learner Adults learn best when information is practical and useful Adults learn best when information is practical and useful A non-judgmental, non-threatening environment supports learning A non-judgmental, non-threatening environment supports learning

Principles of Adult Learning Learning depends on motivation Learning depends on motivation Learning is based on the capacity to learn Learning is based on the capacity to learn Education must be meaningful Education must be meaningful

Adult Learning (cont) Active participation increases learning Active participation increases learning Learning must be experience based Learning must be experience based Goals must be clearly set Goals must be clearly set Feedback is required Feedback is required

Facilities Lecture Hall/Auditorium Lecture Hall/Auditorium Physical Plant Physical Plant - Table Top Exercises - Group discussions Personnel Personnel - Support staff, mock patients Logistics Logistics - Certificates & record keeping

Audiovisual Equipment Equipment failure – Be prepared Equipment failure – Be prepared Contingency plans Contingency plans Communications Communications

Presentation Skills: Lecture Tell them what you are going to say Tell them what you are going to say Say it Say it Tell them what you said Tell them what you said

Presentation Skills: Skills Station Teaching Conceptualization: Conceptualization: - Describe when, how, precautions and considerations Visualization: Visualization: - Instructor demonstration of the technique Verbalization: Verbalization: - Student to describe steps of the technique

Presentation Skills: Skills Station Teaching Practice: Practice: - Student to perform skill with correction and reinforcement from instructor Skills mastery Skills mastery

Presentation Skills: Group Discussion Establish the goals of the discussion Establish the goals of the discussion Facilitate discussion Facilitate discussion Provide closure Provide closure

Presentation Skills: Minitalks Participant Preparation: Participant Preparation: - 5 minute presentation by participants - Videotape or verbal feedback Critique by class, instructor and self Critique by class, instructor and self

Presentation Skills: Case Studies as a Teaching Tool Review of Cases Review of Cases Group Discussion Group Discussion Problem Students: Problem Students: - Lack of preparation - Lack of participation - Aggressive or defensive behavior

PDLS © : Train the Trainers

Thank you! Thank you!