6 disaster medical services

8/7/2019 6 Disaster Medical Services

1/19

Disaster Medical Services

Tintinalli Ch. 6

Ken Goodell, PGY2


2/19

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


3/19

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


4/19


5/19

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


6/19

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)


7/19

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 )


8/19

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


9/19


10/19

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


11/19

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)


12/19

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


13/19

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


14/19

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


15/19

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


16/19

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


17/19

Triage CategoriesTriage CategoriesRed

Resuscitaitonareas, crashrooms

Yellow

Majortrauma-medicalarea

Green Minortrauma-medicalarea

Black

Morgue

Red

Resuscitaitonareas, crashrooms

Yellow

Majortrauma-medicalarea

Green Minortrauma-medicalarea

Black

Morgue


18/19

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


19/19

ReferencesReferences TintinalliCh. 6

http://www.bt.cdc.gov/masscasualties/preparedness.asp

TintinalliCh. 6

http://www.bt.cdc.gov/masscasualties/preparedness.asp

6 disaster medical services

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