Disaster Medicine

INTRODUCTION

• What is a Disaster (Health)

• Epidemiology of Disaster Response

• ED and Hospital response– Phases of disaster response– What we will do here

• Pre-Hospital Response

What is a Disaster?

Health Disaster

When the type and / or number of casualties exceed the normal operating capacity of the affected health system

5 tonne truck

Detonates bomb

Murrah BuildingMurrah BuildingOklahoma City (1993)Oklahoma City (1993)

Forrest Place

RPH

Disaster Medicine Epidemiology

Hospital Response

• Code BrownCode Brown– External emergency with Mass Casualties

Code Brown

• Planned, rehearsed, coordinated response– All hospital areas have sub-plans

• Hierarchy of Command & Communication– Ensure the right resources get to the right place

at the right time– ED, Hospital, Metropolitan, State, and

Commonwealth.

Hospital Response

1. Notification

2. Preparation

3. Receival of Casualties

4. Stand down

1 - Notification

• ED Ambulance phone– Standby

– Activate Code Brown

• Duty Consultant phones ‘55’ • (WEBEOC)• Switch activates ‘Emergency Control Group’• All hospital areas apply Code Brown Sub-plans

2 - Preparation

• Empty and expand ED– Immediate disposition decisions and movement– Rearrange geography

• Triage in WR and beyond

• ED and Obs for Category Red and Yellow

• Category Green to Outpatient E Block

– Allocate roles as per Sub-plan (‘Action Cards’)

2 - Preparation

• Empty and expand Hospital– Early Discharge– Discharge area located in Outpatients

• Operating Theatres

• ICU & HDU– Use of “Altered Standards of Care”– Additional monitoring and ventilators

2 - Preparation

• Additional staff– All staff that are normally required– Need to maintain 24/7 capacity– Manage volunteers

• Use Community capacity (Private Hospitals, Silver Chain, etc.)

3 - Receival of Casualties

• Advanced ‘Disaster’ Triage• Doctor / Nurse teams• Disaster paperwork and EDIS registration• Rapid turnover of patients• Fast-track work practices• One-way flow• Life & Limb threat take priority• Delayed non-life/limb threatening Ix & Mx

3 - Receival of Casualties

• Surgical Triage

• Radiology Triage

• ICU Triage

• No one will be expected to perform roles they are not trained for

Bottlenecks

Bottlenecks

• Ward– “Reverse Triage”

– Early discharge

– Patient transfers

– Over-census

– Use of non-clinical areas

Bottlenecks

• OT– Life & Limb threats only

– ‘Damage Control’ surgery

– Surgical triage

Bottlenecks

• ICU– More ventilators

– Altered Standards of Care

– Critical Care triage

Bottlenecks

• Radiology

– Delay non-essential imaging

– Prioritisation of imaging

4 - Stand down

• Workload returns to normal

• Restock

• Staff defuse

• Staff debriefing

Hospital Response Team

• Triage

• Treatment

• Transport

• Destination

Pre-Hospital

Pre-Hospital

• Unfamiliar environment– Exposed to elements– Variable light, noisy, dirty– Terrain rough and uneven– Difficult to access and egress

Pre-Hospital

• Working on casualties on the ground

• Hazards of incident may still seem apparent

• Site appears disorganised - disorientating

• Information unavailable or incorrect

Pre-Hospital

• Inadequate medical equipment and supplies

• High expectation placed on health workers

• Lack of transport and stretcher bearers

• Inadequate health staff – “you’re on your own”

1. Triage

2. Treatment

• The minimum required to keep the casualty alive till they reach hospital

3. Transport & 4. Destination

Summary

A medical disaster is a complex situation that requires us to abandon standard operating procedures and to adopt a pre-planned response to deliver limited resources in a timely, efficient and equitable manner

Questions?