Download presentation
Presentation is loading. Please wait.
Published byKelley Horn Modified over 9 years ago
1
1 A Series of Regional Workshops ENA Leadership 2010 – Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
2
Consider the scenarios Pandemic Bioterrorism Natural disaster/catastrophes Regional IOM workshop descriptions Participants Locations Agenda Goals Outcomes 2 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
3
Addresses – Related work on standards of care Crisis standards of care protocol development The surge capacity continuum of care Clinical operations Provider involvement and engagement Public engagement and education Developing intra and interstate cooperation and consistency Role of the Federal government and national leadership Ethical considerations Legal issues for crisis standards of care 3 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
4
Agency for Health Resource and Quality (AHRQ) Altered Standards of Care in Mass Casualty Events Mass Casualty Care with Scare Resources – A Community Planning Guide Institute of Medicine (IOM) Guidance for Establishing Crisis Standards of Care in Disaster – A Letter Report 4 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
5
Collaboration between AHRQ and ASPR Ethical Considerations in Community Disaster Planning Assessing the Legal Environment Prehospital Care Hospital/Acute Care Alternative Care Sites Palliative Care Avian Influenza Pandemic Case Study 5 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
6
6 Who makes the plan? Nurses Physician assistants Physicians Pharmacists Administrators Morticians Academia Government Many others ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
7
Conventional Capacity – Spaces, staff and supplies are consistent with daily practices within the institution Contingency Capacity – Spaces, staff and supplies used are not consistent with daily practices but maintain or have minimal impact on usual patient care practices. Crisis Capacity – Adaptive spaces, staff, and supplies are not consistent with usual standards of care. Space Usual patient care space or area are fully utilized Patient care areas repurposed (ex. PACU or monitored units for ICU-level care) Facility damaged/ unsafe or non-patient care areas (ex. classrooms, etc.) used for patient care Staff Usual staff called in and utilized Staff extension (ex. brief deferrals of non-emergent service, supervision of broader group of patients, change in responsibilities, documentation, etc.) Trained staff unavailable or unable to adequately care for volume of patients even with extension techniques Supplies Cached and usual supplies used Conservation, adaptation, and substitution of supplies with occasional reuse of select supplies Critical supplies lacking. Possible reallocation of life-sustaining resources. Standard of Care Usual CareFunctionally equivalent careCrisis standards of care Usual Operating Conditions Austere Operating Conditions Capacity Continuum of Care 7 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
8
NORTH DAKOTA’S EXAMPLE: Stage 1: Small Outcome Impact Stage 2: Moderate Outcome Impact Stage 3: Severe Outcome Impact 8 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
9
Those with a critical roles include EMS Physicians Hospital officials Nurses Engagement challenges cited Time Funding Culture - resistant to crisis standards concepts 9 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
10
Engagement challenges Public is generally uneducated History of distrust Changing the Culture of preparedness Use awareness from recent disaster events Include in educational curriculum Elected officials and media as allies 10 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
11
Reasons for consistency Approaches by states Massachusetts Virginia Regional applications FEMA Region 4 Capital region’s “All-hazards” consortium Interstate Disaster Medical Cooperative Village-to-Village Communication 11 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
12
Guide and facilitate AHRQ/ASPR “Altered Standards of Care in Mass Casualty Events” (AHRQ, 2004) “Mass Medical Care with Scarce Resources: A Community Planning Guide” (AHRQ, 2005) “Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations” (IOM, 2009) VHA DOD 12 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
13
Requirements for ethical crisis standards of care planning and development Fairness Duty to care Duty to steward resources Transparency Proportionality Accountability 13 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
14
Liability Addressing the problem Deputizing physicians Enacting liability protections Credentialing Scope-of-practice EMTALA and HIPPA Legal triage Education and training 14 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
15
Indicators Triggers Triage Alternate care facilities EMS, community health & other components Resource availability and distribution Pediatrics and other “at risk” populations Palliative care Mental health Training 15 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
16
HOSPITAL OUTSIDEIN A WAREHOUSE 16 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
17
Actual or impending resource shortfalls: Ventilators Oxygen and delivery devices ICU beds Healthcare providers Hospitals Pharmaceuticals Other 17 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
18
Should be: Consistent Based on disaster declaration Driven by front-line providers 18 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
19
Triage and the Sequential Organ Failure Analysis (SOFA) score. Cardiovascular Coagulation Hepatic Neurological Renal Respiratory Triage across the health system 19 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
20
Creating surge capacity outside the hospital Planning by: North Dakota Facility capabilities Staffed by volunteers Delaware Modular medical expansion NEHCs – act as gateways Legislation enacted 20 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
21
Considerations for: EMS Community Health The private sector 21 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
22
Identifying resources Resource acquisition 22 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
23
POPULATIONS Children Elderly Mental health patients Others Challenges – matching resources to needs 23 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
24
Expected Need Despite the best efforts… Concern for lack of palliative care protocols and standards Reluctance to discuss Planning for care No one left to die Care is never withdrawn 24 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
25
The need for grief management Consider Ceasing pediatric resuscitations Discontinuing (DC’ing) vent assistance Running out of life-sustaining medications or oxygen Impact on Care-givers Family and individuals Planning – Missouri School of Medicine – Center for Health Ethics - just-in-time, Pandemic Grief Training course. 25 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
26
Need for effective training and relationship building across organizational boundaries. Forums include Exercises Actual event responses 2009 Presidential inauguration Maryland and District of Columbia 26 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
27
Four Regional Workshops Highlighted work ongoing around the nation More work needed for: Palliative care planning Mental/behavioral health Vulnerable populations Public and provider engagement Consistency How far do we go? 27 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
28
Sally Phillips, RN, PhD Director, Public Health Preparedness Agency for Health Research and Quality Rockville, Maryland Sally.phillips@ahrq.hhs.gov Knox Andress, RN, FAEN Designated Regional Coordinator Louisiana Region 7 Hospital Preparedness Department of Emergency Medicine LSU Health Sciences Center – Shreveport Louisiana Poison Center wandr1@lsuhsc.edu 28 ENA Leadership 2010 - Chicago Stds of Care in Mass Casualty Events - A Workshop Report ; Phillips/Andress
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.