What do fires, avalanches, multi-MVA‟s

and pandemics have in common ?

Dr. Graham Dodd, MSc.,MD.,CCFP(EM), MaDEM(c)

Disaster Medicine / Management Physician

Emergency Physician

Master’s Disaster/Emergency Management

Royal Roads University

Royal Inland Hospital, Kamloops, BC

They have the potential to

cause “disaster”

Disclosures

• No financial disclosures

Managed well or Got lucky ?

Boulder Mtn, Revelstoke, March 13, 2010 - CTV

Last 12 months...

What was common to all

these disasters or potential

disasters ?

All involved Front-Line

Healthcare professionals

Summer 2009 March-Dec.2009

January 2010 – Haiti

February 2010 - Chile

March 2010

Everyday

• We (HCP‟s) are „reactive‟

– We think we can respond when needed... And then move on.

• Will that continue to be enough ?

• What if ....

– Boulder Mountain avalanche = 50 critically injured ?

– H1N1 had fatality index of 1% (not 0.1%)

• Can we continue to just rely upon “reactive

response” ?

• How prepared are we as HCP‟s ?

• How prepared are our hospitals... ?

Introduction to Disaster Medicine

• What are disasters / disaster

management ?

• Why should we (FL-HCP’s) become

more involved

– Because already involved

– Expertise is already expected

– Could be more important in rural locations

• What have recent events taught us –

tried to tell us ?

• If Disaster Medicine exists in other

countries ... Why not in Canada ?

What are disasters ?

• Many attempts to define– Size

– Fatalities

– Type of events (i.e. Earthquakes, terrorism)

– Location around the world

– ...

• There is no universally accepted definition of a

disaster (WADEM, 2003)

Serious events or conditions that are beyond

the normal local community capacity to

cope and so require external assistance

Disasters vs. Emergencies (mass casualties) ?

• exceeds local capacity = disaster

• within local capacity = emergency

• Mass-casualties = either “disasters” or “emergencies”

• Continuum of the same process

• Local Capacity is the key

Therefore disasters are Relative

• What may be an emergency to some, may

be a disaster to others (contextual)

– 2 arriving multi-trauma MVA victims arriving to a small rural

hospital, outpost... Vs. Regional centre

• Definitions are important

• Shifting our thinking is more important:

– Most disasters are defined retrospectively

– But disaster preparedness is a process that

requires prospective thought and action

From PEPBC website

Disaster / Emergency Management

– Last 15 years – shift from reaction to

pro-action → DEM profession–

– Business, critical infrastructure

– Multi-organizational

– Pillars of Disaster Management

• Prevention

• Preparedness

• Mitigation

• Response

• Recovery

Health is an important part – but often just assumed

From PEPBC website

September 11, 2001

• Hospital’s recognized as “first

responders”– majority of victims arrived by private

vehicle

• No longer just “receivers” from

EMS

• ↑ need for front-line HCP’s to

become more involved in DEM

– Initially EMS MD’s

– That’s only part (pre-hospital)

– What about once in hospital

– What about community planning

– Public health ?

• Haiti (Jan 2010)– > 200,000 deaths

– > million injured

• Tsunami (2004)

– Southeast Asia– Killed > 250,000

9/11 (2001) – New YorkKilled > 6000

•Still think of as large catastrophic events - elsewhere in the world

Not the event – It‟s the impact

Reality is... All Disasters start locally

Local communities

Local Healthcare systems

Local physicians

Often “isolated” for some time

The potential for disaster always

exists

Disasters are more than just events

• Common oversight - describe disasters

as a physical event – not impact event • ( eg. magnitude 7.2 earthquake rocked Haiti

yesterday)

• Who’s been affected

• What’s been affected

• What is the local capacity to manage

• Vulnerable / Resilient

• Risk (both public and responders)

•

Most healthcare = Reactive Responsevery little planning / preparedness

recovery = complacency

Where does FL Health Care Fit ?

“Disasters – that‟s everyday in most ED‟s”

• No question our current

system is stressed

– ER overcrowding

– Wait-times

– Lack of resources, beds, etc

• Failure to understand /

appreciate disaster planning

as a priority

Overcrowded emergency rooms harm patients: reportLast Updated: Tuesday, May 9, 2006 | 10:54 PM ET CBC News

Response ≠ preparedness

Why do we need to be

prepared ?

• Society expects hospitals and HCP‟s– Be available

– Be prepared

– Be knowledgeable

– Be effective in their response

• Hard to be ready if never planned to be ready

• Scope of practice

– EM is the clinical

aspect of DM

– but that is only one

component of DM

• DM is

multidisciplinary

What is Disaster Medicine ?What makes it different from Emergency

Medicine ?

Front-Line Medicine / HCP’s

Disaster ManagementPublic Health