sloan_scenarios_icep
TRANSCRIPT
Edward P. Sloan, MD, MPH
Emergency Medical Emergency Medical Services & Potential Services & Potential
BioterrorismBioterrorismEventsEvents
Edward P. Sloan, MD, MPH
ICEP On Our Watch IIICEP On Our Watch II
Chicago, IllinoisChicago, IllinoisSeptember 14, 2004September 14, 2004
Edward P. Sloan, MD, MPH
Edward P. Sloan, MD, MPH
Professor
Department of Emergency Medicine
University of Illinois College of MedicineChicago, IL
Edward P. Sloan, MD, MPH
Attending Physician:Emergency Medicine
University of Illinois HospitalOur Lady of the Resurrection Hospital
Chicago, IL
Edward P. Sloan, MD, MPH
Global ObjectivesGlobal Objectives
• Maximize patient outcomeMaximize patient outcome• Enhance preparednessEnhance preparedness• Improve system performanceImprove system performance
• Consider possibilitiesConsider possibilities• Relate efforts to potential eventsRelate efforts to potential events• Make efforts more fruitfulMake efforts more fruitful
Edward P. Sloan, MD, MPH
Session ObjectivesSession Objectives
• Present overviewPresent overview• Describe overwhelming eventsDescribe overwhelming events• Consider relevant questions Consider relevant questions • Force creative thoughtForce creative thought• Enhance systems approachEnhance systems approach• Allow for local variabilityAllow for local variability
Edward P. Sloan, MD, MPH
OverviewOverview
• US Office for Domestic PreparednessUS Office for Domestic Preparedness• Five terrorist threat categories identified Five terrorist threat categories identified • Described by the acronym CBRNE Described by the acronym CBRNE • Chemical, biological, radiological, Chemical, biological, radiological,
nuclear, and explosive threats nuclear, and explosive threats • Could occur as a result of a terrorist Could occur as a result of a terrorist
attack on US soilattack on US soil
Edward P. Sloan, MD, MPH
Chemical EventChemical Event
• Chemical exposureChemical exposure• Thousands of burn victimsThousands of burn victims• Need for immediate EMS careNeed for immediate EMS care• Must avoid EMS worker exposureMust avoid EMS worker exposure• Requires long-term burn unit careRequires long-term burn unit care
Edward P. Sloan, MD, MPH
BiologicalBiological Event Event
• Smallpox exposureSmallpox exposure• Thousands of infected personsThousands of infected persons• More infected until quarantine existsMore infected until quarantine exists• Unavoidable EMS worker exposureUnavoidable EMS worker exposure• Requires in-hospital isolationRequires in-hospital isolation• Fear caused by related viral illnessFear caused by related viral illness
Edward P. Sloan, MD, MPH
RadiologicalRadiological Event Event
• Dirty bomb Dirty bomb • Tens of thousands of exposuresTens of thousands of exposures• Need for immediate EMS careNeed for immediate EMS care• Uncertain acute Dx manifestationsUncertain acute Dx manifestations• Possible health care worker exposurePossible health care worker exposure• Hysteria possible Hysteria possible
Edward P. Sloan, MD, MPH
NuclearNuclear Event Event
• Nuclear weaponNuclear weapon• Ill and injures patientsIll and injures patients• Infrastructure destroyedInfrastructure destroyed• Uncertain EMS capabilitiesUncertain EMS capabilities• Dire consequences locallyDire consequences locally• Difficult external assistanceDifficult external assistance
Edward P. Sloan, MD, MPH
ExplosiveExplosive Event Event
• Thermobaric weaponThermobaric weapon• Thousands of injured personsThousands of injured persons• Concussive head, torso traumaConcussive head, torso trauma• Trauma center overload acutelyTrauma center overload acutely• Need for long-term TBI managementNeed for long-term TBI management• Acute and chronic system stressAcute and chronic system stress
Edward P. Sloan, MD, MPH
Acute Acute ConsequencesConsequences
• 10,000 to 100,000 patients10,000 to 100,000 patients• EMS system overloadEMS system overload• Emergency Departments overloadEmergency Departments overload• Hospitals overloadHospitals overload• Inability to meet acute needsInability to meet acute needs• Inability to meet ongoing needsInability to meet ongoing needs
Edward P. Sloan, MD, MPH
The Individual PractitionerThe Individual Practitioner
• If you are working in a 15-bed Emergency If you are working in a 15-bed Emergency Department when a catastrophic event Department when a catastrophic event occurs, and 5,000 ill or injured patients occurs, and 5,000 ill or injured patients present themselves for emergency present themselves for emergency medical care, what will you do? medical care, what will you do?
• For how long? To what end?For how long? To what end?
Edward P. Sloan, MD, MPH
Clinical, Operations QuestionsClinical, Operations Questions• How would hospital security effectively be able How would hospital security effectively be able
to block access to the ED?to block access to the ED?• How would patients waiting to be seen be How would patients waiting to be seen be
effectively managed outside of the hospital?effectively managed outside of the hospital?• How would a limited number of patients be How would a limited number of patients be
allowed to peacefully gain access to the allowed to peacefully gain access to the Emergency Department for immediate Emergency Department for immediate emergency medical care?emergency medical care?
• What would happen to the patients who are What would happen to the patients who are currently in the ED and in the hospital? Where currently in the ED and in the hospital? Where would they go? Over what time period?would they go? Over what time period?
Edward P. Sloan, MD, MPH
Clinical, Operations QuestionsClinical, Operations Questions• How would contaminated or infected patients How would contaminated or infected patients
be cleaned or quarantined prior to and after the be cleaned or quarantined prior to and after the initial Emergency Department assessment?initial Emergency Department assessment?
• How would the emergency health care How would the emergency health care providers be protected both acutely and over providers be protected both acutely and over time?time?
• How would effective triage be accomplished? How would effective triage be accomplished? Using what system of triage?Using what system of triage?
• How would support staff and extra ED staff be How would support staff and extra ED staff be able to get to the hospital?able to get to the hospital?
Edward P. Sloan, MD, MPH
Clinical, Operations QuestionsClinical, Operations Questions• Would the police send a squad car to each ED for Would the police send a squad car to each ED for
security support?security support?• Would the National Guard be mobilized to provide Would the National Guard be mobilized to provide
security at each hospital’s ED? How long would it security at each hospital’s ED? How long would it take for this support to be effectively provided?take for this support to be effectively provided?
• What would happen if stockpiles of all effective What would happen if stockpiles of all effective antibiotic or antidote therapies are exhausted? What antibiotic or antidote therapies are exhausted? What is the plan for providing additional supplies to is the plan for providing additional supplies to hospitals?hospitals?
• What if the nature of the exposure is unknown? What What if the nature of the exposure is unknown? What will be the protocol for expectant management?will be the protocol for expectant management?
Edward P. Sloan, MD, MPH
Clinical, Operations QuestionsClinical, Operations Questions
• What if the onset is more insidious and the What if the onset is more insidious and the exposure of emergency health care providers exposure of emergency health care providers occurs before it is known to have occurred?occurs before it is known to have occurred?
• How will patients be transported away from the How will patients be transported away from the site of the disaster in situations when quarantine site of the disaster in situations when quarantine is required?is required?
• How will patients be identified? How will families How will patients be identified? How will families be notified?be notified?
Edward P. Sloan, MD, MPH
Clinical, Operations QuestionsClinical, Operations Questions
• How would EMS be able to handle all of the calls?How would EMS be able to handle all of the calls?• How will communications occur? Who will How will communications occur? Who will
assume medical command external to each assume medical command external to each hospital? What if normal communications are hospital? What if normal communications are compromised? compromised?
• How will all of the many organizations that interact How will all of the many organizations that interact in the provision of safe and effective emergency in the provision of safe and effective emergency medical care maximize efficiency in this situation?medical care maximize efficiency in this situation?
Edward P. Sloan, MD, MPH
Impact assessmentImpact assessment
• Bioterrorism risk is real• TOPOFF, Dark Winter, TOPOFF II drills
• Much has been learned
• Unknown problems and solutions• Need to discuss relevant issues• Need to search out opportunities and
potential solutions
Edward P. Sloan, MD, MPH
ConclusionsConclusions
• CBRNE events could occur• The EMS system will be overwhelmed• Some rational decisions must be made• Making those decisions now is optimal
• Opportunity to maximize pt outcome• Positive effect on current EMS practice
Edward P. Sloan, MD, MPH
Thank you.Thank you.
Enjoy the show!Enjoy the show!
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