1. Public Health Preparedness for Mass Casualty Crises in Urban Hospital Systems
Robert McCreight, DPA
George Mason University
Donald A. Donahue, DHEd, MBA, FACHE
University of Maryland University College
McCreight/Donohue

2. Mass Casualty Overview {MCI}
Scope and scale [catastrophic planning]
Understanding the Urban Environment
Population Concentrations
The Isolated Patient
Evacuation//shelter//resupply
The mystery patient (Lincoln, 1991 NYC Marathon)
Special issues and unpleasant surprises
The Clean Area Myth
Definitional boundaries [MCI]
What do we already know?
McCreight/Donohue

3. Thinking the Unthinkable
The Lateral
Parallax
The Lateral Parallax
The Lateral Parallax
McCreight/Donohue

4. MCI: Toward an Operational Definition
An incident or major catastrophe involving simultaneous,
subsequent, and recurrent casualties, possibly
of a widely diverse nature, where the number of victims
entering urban health facilities substantially
exceeds the expected crisis intake capacity
of the entire health system for a significant period
of time, thereby imposing major staffing,
resource, critical care, and logistics
burdens of severe complexity and undermining
the effective functional performance of
the overall health system
200 new patients
Per hour for 3 days
McCreight/Donohue

5. MCI and the urban context
How much, how many, when, and what type…
Kinetic
Communicable Disease
Radiological
Psychological
Specificity and ambiguity
CW—BW—radiological—[critical care plans?]??
Not all MCIs are sudden
What does experience demonstrate?
McCreight/Donohue

6. Implications for Urban MCI Planning
You don’t know what you don’t know….
Drills and exercises
Happy endings and Unrealistic expectations
Worst vs best case scenarios// black swans
Unintended consequences
Consequence management [inside and outside hospitals]
The Logistical Tail
Meds, IV Fluid, Supplies, ID Tags O2
Ventilators and other equipment
Infectious Waste
Mortuary Support
Access- Egress--Security
McCreight/Donohue

7. MCI Exercises and Drills
Fatal Collision: Planning Assumptions vs Reality
Proximity to MCI risk zones
Unlimited surge staffing? Resources? Logistics?
Gaps between
Biosurveillance/detection/confirmation /response
Public Health and Medical Care Systems
Decontamination puzzle and protocols
Degraded communications [inside/outside]
Special admissions protocols: CW-BW-rad-outbreak
McCreight/Donohue

8. MCI : Other Issues Worth Noting
CW-BW agent detection/confirmation [foolproof?]
What does accreditation mean?
RAND ‘No-Notice Drills’-- 92% failed [2012]
High # sustained/repetitive acute care demands
Regional partners/EMAC/EMS/SWAT/Military
Lab backup support/staff
Evidentiary/chain of custody issues
Worker exposure guidelines
Crisis standards of care [for entirety of crisis period]
Fido and Fluffy
McCreight/Donohue

9. Location, Location, Location
Is Urban Hospital Proximity Golden??
Average
Crisis Patient
Intake Surge was
33 persons
Per
Assigned
Hospital
What if that
Number
Tripled? Or
continued for
another
six days?
McCreight/Donohue

10. Decon and Triage Tasks Vary
BW decon
Suspicious Disease Outbreak decon
CW decon
Radiological decon
Toxic exposure decon
Exactly when and how is ‘clean’ achieved? Render safe complete?
McCreight/Donohue

11. MCI—Some Afterthoughts
Medical countermeasures [rad//bio/chem]
Hospital incident command [Tested? Stressed?]
Bio-Chem-Rad annex to Emergency Plan [Realistic?]
Victim Tracking/Notification
Decon Zone/Triage zone/treatment zone
Hospital staff health & safety measures [PPE]
Accuracy of clinical decision making
Insights from prior drills/other urban hospitals?
McCreight/Donohue

12. Questions? Comments? Thanks Don Donahue 202-607-4718
Bob McCreight
McCreight/Donohue