6 disaster medical services
TRANSCRIPT
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Disaster Medical Services
Tintinalli Ch. 6
Ken Goodell, PGY2
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Definition of disasterDefinition of disaster Sudden ecologic phenomenon of sufficient
magnitude to require external assistance.
Number of patients presenting in a given timeare such that ED cannot give even minimal carewithout external assistance.
mass casualty incidents
Massive disruptive impact (small pox, anthrax)
External and/or Internal disasters
Sudden ecologic phenomenon of sufficientmagnitude to require external assistance.
Number of patients presenting in a given timeare such that ED cannot give even minimal carewithout external assistance.
mass casualty incidents
Massive disruptive impact (small pox, anthrax)
External and/or Internal disasters
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Difficulties in Disaster MedicineDifficulties in Disaster MedicineHospital shortcomings include
Delayed or improper notification
Poor delineation of command structure
Overloaded/ broken communications network
Improper or incomplete identification
Lack of supplies
Lack of public relations
Hospital shortcomings include
Delayed or improper notification
Poor delineation of command structure
Overloaded/ broken communications network
Improper or incomplete identification
Lack of supplies
Lack of public relations
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Walking woundedarrive
athospital beforethe
mostinjured. Within 90 min, 50-80%
ofacute patients will
likely arriveatclosest
medicalfacilities.
Walking woundedarrive
athospital beforethe
mostinjured. Within 90 min, 50-80%
ofacute patients will
likely arriveatclosest
medicalfacilities.
Difficultiesin Disaster MedicineDifficultiesin Disaster Medicine
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Severity Predictor for Mass Casualty EventsSeverity Predictor for Mass Casualty Events
*The following factors can change the pattern of casualties:
Use of manufactured weapons (i.e., military ordinance)
Explosion in a confined space
Collapse of buildings or other structures
*The following factors can change the pattern of casualties:
Use of manufactured weapons (i.e., military ordinance)
Explosion in a confined space
Collapse of buildings or other structures
All acute
casualty
victims
1/3 Critical
casualties
Black (dead/Expectant)
Red (Immediate)
Yellow (delayed-admitted)
2/3 Non-criticalcasualties Yellow (delayed-released)Green (Minimal)
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Federal Response ResourcesFederal Response Resources
DHHS (depthealthhuman services)
OEP (office emergency preparedness)
MMRS (metropolitan med responseteam)
Local responders - WMDs, bioterrorism
NDMS (national disaster medical system)
Large scale natural disasters/ bioterrorism
DMATs (disaster medical assistanceteams) Local responsetofederally declared disasters
CCRF(commissioned corps readinessforce)
DMORTs (disaster mortuary operations )
DHHS (depthealthhuman services)
OEP (office emergency preparedness)
MMRS (metropolitan med responseteam)
Local responders - WMDs, bioterrorism
NDMS (national disaster medical system)
Large scale natural disasters/ bioterrorism
DMATs (disaster medical assistanceteams) Local responsetofederally declared disasters
CCRF(commissioned corps readinessforce)
DMORTs (disaster mortuary operations )
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Federal Response ResourcesFederal Response Resources
DHHS cont.
CDC
Rapid responseteams
Laboratory response network
Rapid response and advtech lab
National electronic disease surveillance system
Health alertnetwork
National pharmaceutical stockpile
DHHS cont.
CDC
Rapid responseteams
Laboratory response network
Rapid response and advtech lab
National electronic disease surveillance system
Health alertnetwork
National pharmaceutical stockpile
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HEICS describes
HEICS describes
Activationofplan
Assessmentofhospitals capacity
Establishmentofa disaster control center
Communications
Supplies
Hospital disasteradministrativeandtreatmentareas
Training and drills
Security and crowd control
Activationofplan
Assessmentofhospitals capacity
Establishmentofa disaster control center
Communications
Supplies
Hospital disasteradministrativeandtreatmentareas
Training and drills
Security and crowd control
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Role of Disaster Control CenterRole of Disaster Control Center
Incident Command
Center
(remote from ED)
Disaster OperationsDisaster site
(fire, EMS, police)
Triage area
(patient-recieving)
Patient care area(ED)
Outside assistance
(other hospitals,
federal response)
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Disaster OperationsDisaster OperationsIn thefield
START (simple triage rapid treatment) Firstlevel of triage
Transportationcapacity overwhelmed Advancedfield med/surg treatment
Localhospitals overwhelmed SAVE: 2 assessment ofvictim endpoint
Prolongeddelay in accessing definitivecare
Distribution ofcasualties to receiving hosp
In thefield
START (simple triage rapid treatment) Firstlevel of triage
Transportationcapacity overwhelmed Advancedfield med/surg treatment
Localhospitals overwhelmed SAVE: 2 assessment ofvictim endpoint
Prolongeddelay in accessing definitivecare
Distribution ofcasualties to receiving hosp
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Hospital Disaster Adm& Rx AreasHospital Disaster Adm& Rx Areas
Disastercontrolcenter
Triage
Patientcare stations
Major trauma andmedicine Minor trauma andmedicine
Presurgicalholding
Surgery
Morgue Decontamination
Psychiatry
Fa
mily waiting/ discharge area
Disastercontrolcenter
Triage
Patientcare stations
Major trauma andmedicine Minor trauma andmedicine
Presurgicalholding
Surgery
Morgue Decontamination
Psychiatry
Fa
mily waiting/ discharge area
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Initial
ED response
Initial
ED response
Call toEDfrom disaster site
Disaster notificationform
Appropriatehospital administrator notified
(now disastercontrol) putsplan in effect
AdditionalED staffnotified
Notify otherdepartments (ICU, surgery, etc) Initial needs assessment by charge nurse/ Dr
EDphysician - on site incidentcommander
Communicatecprehospdisastercom center
Call toEDfrom disaster site
Disaster notificationform
Appropriatehospital administrator notified
(now disastercontrol) putsplan in effect
AdditionalED staffnotified
Notify otherdepartments (ICU, surgery, etc) Initial needs assessment by charge nurse/ Dr
EDphysician - on site incidentcommander
Communicatecprehospdisastercom center
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TriageTriage Prioritizationofpatientcare basedon
severity injury, prognosis, and resources.
Triageofficer ED physicianor qualifiednurse
Performssecondtriage upon patientarrival
Easily identified1. AssignsPtsto appropriatetreatmentareas
2. Institutes mostbasiclife-supportmeasures Manually opening airway,controlhemorrhage
Prioritizationofpatientcare basedonseverity injury, prognosis,andresources.
Triageofficer ED physicianor qualifiednurse
Performssecondtriage upon patientarrival
Easily identified1. AssignsPtstoappropriatetreatmentareas
2. Institutes mostbasiclife-supportmeasures Manually opening airway,controlhemorrhage
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Triage CategoriesTriage CategoriesRed
Life-threatening shock,hypoxia
Can bestabilizedandsurvive withimmediatecareYellow
Injurieshavesystemic effects,notyetlife-threatening
45-60 min waitbeforeimmediaterisk
Green
Localinjuries w/osystemic effects (walking wounded)
Black
Dead/ expectant;nospontaneousrespirnorcirculn
Red
Life-threatening shock,hypoxia
Can bestabilizedandsurvive withimmediatecareYellow
Injurieshavesystemic effects,notyetlife-threatening
45-60 min waitbeforeimmediaterisk
Green
Localinjuries w/osystemic effects (walking wounded)
Black
Dead/ expectant;nospontaneousrespirnorcirculn
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Triage CategoriesTriage CategoriesRed
Resuscitaitonareas, crashrooms
Yellow
Majortrauma-medicalarea
Green Minortrauma-medicalarea
Black
Morgue
Red
Resuscitaitonareas, crashrooms
Yellow
Majortrauma-medicalarea
Green Minortrauma-medicalarea
Black
Morgue
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Patient Care inEDPatient Care in
ED
Wounds
flushcopiously;delayed1 closure;Td
Considerdelayed injury
Crushsyndrome: arrhythmia,oK,RF
Fulminantpulmonary edema/ pneumonia
Delay x-rays24-48h (nonangulated,stable)
Consider XRalternatives (FAST)
Orderlabssparingly
Wounds
flushcopiously;delayed1 closure;Td
Considerdelayedinjury
Crushsyndrome: arrhythmia,oK,RF
Fulminantpulmonary edema/ pneumonia
Delay x-rays24-48h (nonangulated,stable)
Consider XRalternatives (FAST)
Orderlabssparingly
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ReferencesReferences TintinalliCh. 6
http://www.bt.cdc.gov/masscasualties/preparedness.asp
TintinalliCh. 6
http://www.bt.cdc.gov/masscasualties/preparedness.asp