john h. armstrong, md, facs university of florida, gainesville
DESCRIPTION
National Emergency Management Summit The Medical Disaster Planning & Response Process Developing a Disaster Mindset: Myths & Stereotypes of Disasters. Committed to excellence in trauma care. John H. Armstrong, MD, FACS University of Florida, Gainesville. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/1.jpg)
John H. Armstrong, MD, FACSUniversity of Florida, Gainesville
National Emergency Management Summit
The Medical Disaster Planning & Response Process
Developing a Disaster Mindset: Myths &
Stereotypes of DisastersCommitted toexcellence intrauma care
![Page 2: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/2.jpg)
Armstrong JH, NEMS, Mar 07 2
Those who cannot remember the past are condemned
to repeat it.
George Santayana
![Page 3: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/3.jpg)
Armstrong JH, NEMS, Mar 07 3
Medical Disaster Planning & Response Process
• 1.02: Developing a disaster mindset
• 2.02: Pre-event disaster planning
• 6.02: Joining forces to tackle disasters
![Page 4: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/4.jpg)
Armstrong JH, NEMS, Mar 07 4
Objectives
• Identify common myths of disasters
• Discuss how to overcome the common myths of disasters
![Page 5: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/5.jpg)
Armstrong JH, NEMS, Mar 07 5
6 P’s of disaster response• Preparation [1]• Planning [2]• Pre-hospital [2]• Processes for hospital care [2]• Patterns of injury [1]• Pitfalls [2]
American College of Surgeons Committee on TraumaDisaster Response and Emergency Preparedness Course
![Page 6: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/6.jpg)
Armstrong JH, NEMS, Mar 07 6
Preparation
• Myth #1: disasters are not preventable– Disaster = “evil star”
• Reality: most disasters are “predictable surprises”– Events may not be preventable– Crises and consequences may be ↓↓
![Page 7: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/7.jpg)
Armstrong JH, NEMS, Mar 07 7
Marine barracks, Beirut, 1983
![Page 8: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/8.jpg)
Armstrong JH, NEMS, Mar 07 8
Oklahoma City 1996
![Page 9: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/9.jpg)
Armstrong JH, NEMS, Mar 07 9
WTC bombing 1993
![Page 10: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/10.jpg)
Armstrong JH, NEMS, Mar 07 10
Lower Manhattan 2001
![Page 11: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/11.jpg)
Armstrong JH, NEMS, Mar 07 11
Mississippi flood of 1927
![Page 12: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/12.jpg)
Armstrong JH, NEMS, Mar 07 12
Gulf Coast 2005
![Page 13: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/13.jpg)
Armstrong JH, NEMS, Mar 07 13
Predictable surprises
• Leaders know a problem exists that will not solve itself
• The problem is getting worse over time
Bazerman MH & Watkins, MD, Predictable Surprises, 2004
![Page 14: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/14.jpg)
Armstrong JH, NEMS, Mar 07 14
Predictable surprises
• Fixing the problem– Certain (and large) upfront costs– Uncertain (and larger) future costs
• Natural human tendency = status quo
Bazerman MH & Watkins, MD, Predictable Surprises, 2004
![Page 15: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/15.jpg)
Armstrong JH, NEMS, Mar 07 15
Predictable surprises
• Small vocal minority benefits from inaction
• Leaders can expect little credit from prevention
Bazerman MH & Watkins, MD, Predictable Surprises, 2004
![Page 16: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/16.jpg)
Armstrong JH, NEMS, Mar 07 16
Planning
• Myth #2: disasters are freak occurrences that don’t happen in all communities
• Reality: disasters happen with greater frequency than perceived in all communities
![Page 17: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/17.jpg)
Armstrong JH, NEMS, Mar 07 17
“All-hazards”Man-made• Explosion• Fire• Weapon violence• Structural collapse• Transportation event (air,
rail, road, water)• Industrial HAZMAT event• NBC event
Natural• Hurricane• Flood• Earthquake• Landslide/avalanche• Tornado• Wildfire• Volcano• Meteor
“All-hazards” = mechanism of disaster
![Page 18: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/18.jpg)
Armstrong JH, NEMS, Mar 07 18
Hazard vulnerability analysis• Events identified
– Likelihood– Severity– Level of preparedness
• “Connects the dots” for emergency planning
• Shared community understanding
![Page 19: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/19.jpg)
Armstrong JH, NEMS, Mar 07 19
Hazard vulnerability analysis
![Page 20: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/20.jpg)
Armstrong JH, NEMS, Mar 07 20
Hurricane Charley 2004
Gainesville
![Page 21: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/21.jpg)
Armstrong JH, NEMS, Mar 07 21
Train derailment 2002
![Page 22: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/22.jpg)
Armstrong JH, NEMS, Mar 07 22
School bus crash 2006
![Page 23: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/23.jpg)
Armstrong JH, NEMS, Mar 07 23
Tornadoes 2007
![Page 24: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/24.jpg)
Armstrong JH, NEMS, Mar 07 24
UF & the Swamp
![Page 25: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/25.jpg)
Armstrong JH, NEMS, Mar 07 25
Crystal River nuclear power plant
![Page 26: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/26.jpg)
Armstrong JH, NEMS, Mar 07 26
Planning: risks• ↑ population density
• ↑ settlement in high risk areas
• ↑ hazardous materials
• ↑ threat from terrorism
↓ risks with prevention and planning
![Page 27: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/27.jpg)
Armstrong JH, NEMS, Mar 07 27
Planning
• Myth #3: disaster = single event
• Reality: disasters often are dynamic chain events– Situational awareness key– Scene safety paramount
![Page 28: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/28.jpg)
Armstrong JH, NEMS, Mar 07 28
… after the storm took an eastward turn,sparing flood-prone New Orleans a
catastrophe.
USA Today, August 30, 2005
New Orleans 2005
![Page 29: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/29.jpg)
Armstrong JH, NEMS, Mar 07 29
Lower Manhattan 2001
418 first responders dead
Beware 2nd hit!
![Page 30: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/30.jpg)
Armstrong JH, NEMS, Mar 07 30
Oklahoma City, 1996
Scene = danger
![Page 31: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/31.jpg)
Armstrong JH, NEMS, Mar 07 31
D Detection I Incident commandS Safety & securityA Assess hazardsS SupportT Triage & treatmentE EvacuationR Recovery
Shared tactical model
First, do no harm
Then, do good
National Disaster Life Support Program, American Medical Association
![Page 32: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/32.jpg)
Armstrong JH, NEMS, Mar 07 32
Planning: safety & security• Protect responders and caregivers
• Protect the public
• Protect the casualties
• Protect the environment
![Page 33: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/33.jpg)
Armstrong JH, NEMS, Mar 07 33
Prehospital
• Myth #4: ideal human behavior occurs in disasters
• Reality: people are people
![Page 34: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/34.jpg)
Armstrong JH, NEMS, Mar 07 34
Real human behavior
• Most first responders self-dispatch
• Survivors carry out initial search & rescue
• Casualties bypass on-site services
• Casualties move by non-ambulance vehicles
Auf der Heide, Annals of Emergency Medicine, April 06
![Page 35: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/35.jpg)
Armstrong JH, NEMS, Mar 07 35
Real human behavior
• Most casualties go to closest hospital
• Least serious casualties arrive at hospitals first
• Most information about event comes from arriving patients and television
Auf der Heide, Annals of Emergency Medicine, April 06
![Page 36: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/36.jpg)
Armstrong JH, NEMS, Mar 07 36
Pre-hospital reality
• Planning should take into consideration– how people & organizations are likely
to act– rather than expecting them to change
their behavior to conform to the plan
Disaster Research CenterUniversity of Delaware
![Page 37: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/37.jpg)
Armstrong JH, NEMS, Mar 07 37
Pre-hospital
• Myth #5: most survivors at the scene are critically injured
• Reality: most survivors at the scene are walking wounded
![Page 38: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/38.jpg)
Armstrong JH, NEMS, Mar 07 38
Disaster triage• Initial survivors at scene of most disasters
• 80% non-critical• 20% critical
• Challenge• Identify & prioritize critical 20% • Minimize critical mortality rate
![Page 39: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/39.jpg)
Armstrong JH, NEMS, Mar 07 39
Disaster triage system
Scene(1o triage)
Triage coordinating
hospital(1o triage)
TraumaCenter
(2+o triage)
Inju
red
Hospital(2+o triage)
Casualtycollection
area(2o triage)
Hospital(2+o triage)
Error-tolerant system
![Page 40: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/40.jpg)
Armstrong JH, NEMS, Mar 07 40
In the middle of difficulty lies opportunity.
Albert Einstein
![Page 41: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/41.jpg)
Armstrong JH, NEMS, Mar 07 41
(Hospital) processes
• Myth #6: mass casualty care = doing more of the usual care
• Reality: mass casualty care = minimal acceptable care
![Page 42: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/42.jpg)
Armstrong JH, NEMS, Mar 07 42
Mass casualty care
Greatest good for the greatest number based on available resources . . .
. . . while protecting responders and providers
Not simply doing more of the usual
![Page 43: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/43.jpg)
Armstrong JH, NEMS, Mar 07 43
Minimal acceptable care
• Large casualty numbers
• Multidimensional injuries
• Healthcare needs > resources
• Severity, urgency, survival probability
• Occurs from scene to initial hospital +
![Page 44: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/44.jpg)
Armstrong JH, NEMS, Mar 07 44
Casualty population
CASUALTIES
onemultiple
limited mass mass
RESOURCES
![Page 45: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/45.jpg)
Armstrong JH, NEMS, Mar 07 45
Hospital casualties
Centers for Disease Control, 2003
![Page 46: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/46.jpg)
Armstrong JH, NEMS, Mar 07 46
Surges
• Surge capacity: ↑ space + resources
• Surge capability: ↑ ability to manage presenting injuries & medical problems
• Not business as usual
![Page 47: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/47.jpg)
Armstrong JH, NEMS, Mar 07 47
Triage
• Undertriage• Critical casualty assigned to delayed care
• Overtriage• Noncritical casualties assigned to urgent care• Normally only a logistical problem• In disasters, distraction from critically injured
![Page 48: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/48.jpg)
Armstrong JH, NEMS, Mar 07 48
Over-triage ↓↓ outcomes
Frykberg, Journal of Trauma, 2002
![Page 49: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/49.jpg)
Armstrong JH, NEMS, Mar 07 49
(Hospital) processes
• Myth #7: disasters trigger massive blood supply shortages
• Reality: blood supply has surge capacity
![Page 50: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/50.jpg)
Armstrong JH, NEMS, Mar 07 50
Calls for blood
• Lower Manhattan 2001– 475,000 units donated– 258 used
• Madrid 2004– 17,000 units donated– 104 used
![Page 51: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/51.jpg)
Armstrong JH, NEMS, Mar 07 51
(Hospital) processes
• CNN effect is real
• A story will be reported
• Shape the story for the media– Ongoing media relationships key
![Page 52: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/52.jpg)
Armstrong JH, NEMS, Mar 07 52
Patterns
• Myth #8: most disasters generate high volume acute care needs
• Reality: most disasters – Expose high volume chronic care needs– Generate ongoing psychosocial needs
![Page 53: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/53.jpg)
Armstrong JH, NEMS, Mar 07 53
Chronic > acute care
![Page 54: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/54.jpg)
Armstrong JH, NEMS, Mar 07 54
Acute + chronic stress
![Page 55: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/55.jpg)
Armstrong JH, NEMS, Mar 07 55
Pitfalls
• Myth #9: effective initial disaster response requires a local federal response
• Reality: all disaster response is local for 72 hours
![Page 56: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/56.jpg)
Armstrong JH, NEMS, Mar 07 56
Personal preparedness
• Individual
• Family
• Home
• Work
![Page 57: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/57.jpg)
Armstrong JH, NEMS, Mar 07 57
Resource response• I: Local resources only
• II: Local + regional resources
• III: Local + regional + national resources
![Page 58: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/58.jpg)
Armstrong JH, NEMS, Mar 07 58
Local before national
![Page 59: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/59.jpg)
Armstrong JH, NEMS, Mar 07 59
Pitfalls
• Myth #10: disaster plan = full preparation
• Reality: disaster plans are relevant when– they are created across all stakeholders– they promote awareness of roles– they are practiced with realism
![Page 60: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/60.jpg)
Armstrong JH, NEMS, Mar 07 60
#1 pitfall: communication
• Starts with planning
• Continues through execution
• Cycles through post-event review and plan revision
“Train as you fight”
![Page 61: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/61.jpg)
Armstrong JH, NEMS, Mar 07 61
Long-term goal: recovery
![Page 62: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/62.jpg)
Armstrong JH, NEMS, Mar 07 62
Science is the great antidote to the poison
of enthusiasm & superstition.
Adam Smith
Best practice evidence exists!
![Page 63: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/63.jpg)
Questions?
Chance favors the prepared mind.
Louis PasteurCommitted toexcellence intrauma care
![Page 64: John H. Armstrong, MD, FACS University of Florida, Gainesville](https://reader035.vdocuments.net/reader035/viewer/2022070500/56816839550346895dde00bb/html5/thumbnails/64.jpg)
Armstrong JH, NEMS, Mar 07 64
Summary• Myths and stereotypes = false assumptions
– Memories fade with time
• Overcome myths with evidence and relevance– Translate for the community– Make it sticky & ongoing
Thank [email protected]