1. GETTING DOCS into the DISASTER PREPAREDNESS LOOP Joanne Selkurt MD, FAAP

2. Introduction The Reality: September 11, 2001 “9 - 11”

3. “All-Hazards” Man-made Fires Explosive devices Firearms Structural collapse Transportation event –Air, Rail, Roadway, Water Industrial HAZMAT WMD – NBC events Etc… Natural Earthquake Landslides Avalanche Volcano Tornado Hurricanes, floods Fires Meteors Etc…

4. Are We Prepared? Is the US healthcare system prepared? We appear to be… each Hospital, EMS agency, Law enforcement agency, Fire department, and Community has… … a disaster plan … properly documented drills … annual training documented But...

5. Are We Prepared? KATRINA

6. Are We Prepared? Interagency communication failures! Why do we all treat a cardiac arrest the same? …because there is an agreed-upon approach.

7. Are We Prepared? Critical to healthcare preparedness –uniform –coordinated approach –mass casualty management from any cause NEED: A nationally standardized training program

9. Course Description BDLS –Didactic - 8 hours –Distance learning option –For healthcare providers Physicians, Nurses, Paramedics, EMTs Mid-level providers, Allied health, Public health –Provider status & course credit awarded Course completion Written examination passage –BDLS providers are eligible to take ADLS

10. BDLS Course Outline Overview & Concept DISASTER Paradigm Natural Disasters Explosive & Traumatic Nuclear & Radiological Biological Agents Chemical Agents Psychosocial Aspects Public Health System Examination Course evaluations

11. Course Description ADLS 16 hour class (8-didactic, 8-practical) Advanced practicum “hands on” course Meets Hazmat Operations-level training requirement (CFR 1910.120) Must have completed BDLS course Provider status & course credit awarded

12. ADLS Course Outline Day-One: Classroom & Interactive: DISASTER Paradigm Casualty Decontamination Legal Issues Media & Communications Community and Hospital Disaster Planning Community, State and Federal Resources Mass Fatality Management Day-Two: Skills Lab “hands on” MASS Triage Clinical Scenarios Human simulator use Disaster Skills Personal Protective Equip Decontamination

13. What is a “Disaster”? Disaster- dis·as·ter n. a.An occurrence causing widespread destruction and distress; a catastrophe. b.A grave misfortune. c.Informal- A total failure

14. “Disaster” Definition A disaster is present when need exceeds resources! Disaster = Need > Resources A response need that is greater than the response available!

15. Mass Casualty Incident (MCI) “Is this an MCI ?” The first step in identifying an MCI is knowing your own capabilities. Any incident that exceeds the responder’s or receiving hospital’s capability to treat or transport is a Mass Casualty Incident

16. D-I-S-A-S-T-E-R Paradigm

17. D: Detection I: Incident Command S: Safety & Security A: Assess Hazards S: Support T: Triage & Treatment E: Evacuation R: Recovery

18. D-I-S-A-S-T-E-R Paradigm Incident Command Incident Command System (ICS) Born in Fire Service –Managing wildfires in early 1970’s –Interagency task force collaborative effort Uniform structure Clearly delineated roles/responsibilities Clear chain of command/ communication

19. Incident Command System The Basics Unified Command PlanningOperationsFinanceLogistics “Commander” “Thinkers”“Getters”“Doers”“Payers”

20. Incident Command System Operations

21. D-I-S-A-S-T-E-R Paradigm Assess Hazards Be Aware of Secondary Devices! –Bombs, Shrapnel devices, Incapacitating Devices, Multiple Snipers/Terrorists, Delay Devices

22. D-I-S-A-S-T-E-R Paradigm Assess Hazards Be Aware of Secondary Devices! –Bombs, Shrapnel devices, Incapacitating Devices, Multiple Snipers/Terrorists, Delay Devices

23. D-I-S-A-S-T-E-R Paradigm Support Unexpected Volunteers and Donations: Positive intentions, often negative impact Does your preparedness plan include them? –ICS, Identify needed skills and needed supplies Negatives: –Time to sort large, poorly labeled goods –Storage space used –Unplanned personnel are a liability –At risk of injuries, require food, water and shelter

24. Volunteers Need to Address… Licensure in state Credentialing for specific responder organization “Just-in-Time” Training Management: logistics, supervision, transportation, medical & other care needs Well-Meaning Volunteers Can… Overwhelm, Interfere, Confuse, Burden & Even Endanger themselves and others

25. Best if a member of a recognized, organized response team that has been invited in DON’T JUST SHOW UP !!

26. M.A.S.S. Triage M – Move A – Assess S – Sort S – Send M.A.S.S. Triage is a disaster triage system that utilizes US military triage categories with a proven means of handling large numbers of casualties in a mass casualty incident (MCI).

27. “ID-me”! I –Immediate D – Delayed M - Minimal E – Expectant D - DEAD “ID-me”! - a mnemonic for sorting patients during MCI triage. It is utilized effectively in the M.A.S.S. Triage model.

28. I –Immediate D – Delayed M - Minimal E – Expectant D - DEAD M – Minimal D –Delayed I – Immediate E – Expectant D - Dead

32. Tips for talking to children after a disaster Provide opportunities to talk about what they are seeing on television and to ask ? Don’t be afraid to admit you don’t know all the answers Answer ? At a level the child can understand Establish a family emergency plan (Sense of doing something is helpful) Monitor children’s TV watching..don’t need to see event over & over) Watch with children Help kids to understand there are no bad emotions Try to not focus on blame In addition to tragic things seen, also help kids focus on good things such as heroic actions, reuniting of families, assistance offered by people throughout the world

33. For children closer to disaster Disasters often reawaken a child’s fear of loss of own parents when parents are preoccupied with own fears … consider family counseling Families may permit some regressive behavior weaning off by leaving bedroom door open, night lights, extra time with parents Parents may have trouble leaving child after a disaster,,,may be able to use child’s problem as a way of asking for help themselves Get the children into some sense of routine of school and play even if displaced Teachers can help kids with art, and play activities, encouraging group discussions and presentations about the disaster

35. For more information on children & disasters: Child Health Alliance of Wisconsin (CHAW) www.chawisconsin.org Click Programs Click Trauma preparedness

36. A A stuffed animal can help a lot