Best Practices in Disaster Preparedness:Coordinating Care During Crisis
Presentation to: Templeton Pediatric Trauma SymposiumPresented by: Kelly H. Nadeau, MN, RNDate: 2 March 2013
2013 Events
Solomon Islands Earthquake Jan 2013
New England Snow Feb 2013Nevada-California Earthquakes Feb 2013
Meteor Feb 2013
Hattiesburg, MS Feb 2013
Adairsville, GA Jan 2013
Basic Disaster Assumptions• Definition
varies• Can occur
at any moment
• “All Hazards” approach to planning
• All disasters are local
1-16, Laurens County, GA, February 2013
National Preparedness Goal• “A secure and resilient nation
with the capabilities required across the whole community to prevent, protect against, mitigate, respond to, and recover from the threats and hazards that pose the greatest risk.”
- FEMA September 2011
Disaster Declarations• The
Stafford Act (§401) requires that: "All requests for a declaration by the President that a major disaster exists shall be made by the Governor of the affected State."
Presidential declaration
Governor makes request to Regional
FEMA office
State declaration
Local event -1988, amended 2007
National Response Framework• All hazards approach• Emergency Support
Functions– ESF1 Transportation – ESF2 Communications – ESF3 Public Works and Engineering – ESF4 Firefighting – ESF5 Emergency Management – ESF6 Mass Care, Housing, and Human
Services – ESF7 Resources Support – ESF8 Public Health and Medical Services – ESF9 Urban Search and Rescue – ESF10 Oil and Hazardous Materials Response – ESF11 Agriculture and Natural Resources – ESF12 Energy – ESF13 Public Safety and Security – ESF14 Long-term Community Recovery and
Mitigation – ESF15 External Affairs
• www.fema.gov/nrf
ChallengesPersonal preparednessAccess to educationTime to trainExercisesCommunity partnersAttitude
Joplin, MO, May 2011
“It can’t happen here”
Atlanta, March 2008
Is the Scene Safe?• Electrical and power
outages• Food and water• Heat/cold• Fire• Confined spaces• Falls• Air quality
Tuscaloosa, AL 2011
…..really safe?……• Chemicals• Carbon monoxide• Stress and fatigue• Chainsaws• Mosquito borne
diseases, ex. West Nile, Dengue
• Animals• SnakesSumter Regional, Americus, GA 2007
…..are you sure?
• Mold• Mental health• Preexisting
conditions
Americus, GA 2007
Pre-event Assessment• Nutrition• Water supply• Immunization status• Access to healthcare• Literacy rate
Haiti, 2010
American College of Surgeons• Surgical community has an obligation to
participate in the multidisciplinary planning, triage, and medical management of victims following a mass casualty event.
• Trauma centers have an obligation to participate in disaster preparedness and management.
• A surgeon from trauma panel should participate on the hospital’s disaster committee.
Resources for the Optimal Care of the Injured Patient
Link to Homeland Security• An effective trauma system is most certainly
an essential ingredient for Homeland Security. A trauma system can be key infrastructure in our preparedness efforts not only for the un-natural acts of terrorism, but also for those natural disasters such as tornadoes, floods, hurricanes, and newly emerging infectious challenges such as SARS or monkeypox. An integrated, statewide trauma system is crucial in our efforts to improve Homeland Security.
Georgia Office of EMS and Trauma
Emergency Nurse Perceptions of Individual and Facility Emergency Preparedness
Whetzel, et al, Journal of Emergency Nursing, Feb 2013
• Survey to assess nurses’ perception of their role in a disaster and their perceived susceptibility to a disaster.
• Results reflect that many emergency nurses have not taken basic actions to prepare themselves for a disaster either personally or professionally.
Healthcare Preparedness Funding
HPP Healthcare Preparedness• Health and Human
Services• Assistant Secretary for
Preparedness and Response
• Hospital/Healthcare Preparedness Program in each state
PHEPPublic Health Emerg Prep• Health and Human
Services• Centers for Disease
Control• Division of State and
Local Readiness• Public Health
Preparedness Program
Dept of Health and Human ServicesDept of Healthand Human
Services (HHS)
Office of the Assistant Secretary for Preparedness
and Response (ASPR)
Office of Preparedness and Emergency Operations
Hospital
Preparedness
Program
National
Disaster
Medical
System
Emergenc
y Registration of
Volunteer Healt
h Professionals
Regional
Emergenc
yCoordinators
Centers for Disease Control
Office of Public Health PreparednessAnd Response
Division of State
And Local
ReadinessState
Public Healt
hEmergency Preparedne
ss
Strategic
NationalStockpil
e
Division of
Emergency
Operations
Capabilities
Public Health Preparedness Capabilities
Healthcare Preparedness Capabilities
1 Community Preparedness 1 Healthcare System Preparedness2 Community Recovery 2 Healthcare System Recovery3 Emergency Operations Coordination 3 Emergency Operations Coordination
4 Emergency Public Information and Warning 4
5 Fatality Management 5 Fatality Management6 Information Sharing 6 Information Sharing7 Mass Care 78 Medical Countermeasure Dispensing 8
9 Medical Materiel Management and Distribution 9
10 Medical Surge 10 Medical Surge11 Non-Pharmaceutical Interventions 1112 Public Health Laboratory Testing 12
13 Public Health Surveillance and Epidemiological Investigation 13
14 Responder Safety and Health 14 Responder Safety and Health 15 Volunteer Management 15 Volunteer Management
Capabilities
Healthcare Coalitions• Healthcare Coalitions serve as a multi-
agency coordinating group that assists Emergency Management and Emergency Support Function (ESF) #8 with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations.
Disaster Cycle
Preparedness
Mitigation
Recovery
Response
Disaster
Healthcare Coalitions: Follow the steps of the Preparedness Cycle to effectively mitigate, respond to and recover from a disaster
DISASTER CYCLEHealthcare Coalitions: Assist HCOs within their region to assist the community with their return to normal healthcare delivery operations
Healthcare Coalitions: Integrate with ESF#8 and incident management to provide healthcare situational awareness in order to inform the decision making process for the allocation of resources
Healthcare Coalitions: Address areas in critical infrastructure and key resource allocation planning that decreases the vulnerability of the healthcare delivery system
National Disaster Medical System
• Designed to move patients quickly from one part of the country to another during a large disaster– Activated at 9/11 but no patients to move– Activated after Hurricanes Katrina and Rita
to move patients (and evacuees, family members, pets, etc.)
• Coordinated by VA Medical System• Utilizes Dept of Defense transport assets• Federal Coordinating Centers designated• Federal funds released if activated
NDMS “like” Activation February 2010• Reasons Atlanta was chosen
– Previous experience with NDMS– Flight distance from Haiti– Refugee Resettlement Office
• Governor agreed to the mission• State Emergency Management Agency
involved• Dept of Public Health - ESF8 lead in Georgia• Healthcare Preparedness Program
involvement
Flight Day in Haiti• Approval Board in Haiti• Approved patient records
copied and report given to Transcom RN
• Patient packaged and moved to deck of USNS Comfort
• Patient airlifted from USNS Comfort to ground in Haiti
• Held at field hospital until C-130 lands
• Loaded onto C-130 with CCATT team, patient records and non medical attendants
• Flight left Haiti around 5:30 p.m.
• Flight arrived Dobbins Air Reserve Base 9:30-10:30 p.m.
Flight Day in Atlanta• 6:00 a.m., first e-mail of the
day• By 9:00 a.m., preliminary
manifest via e-mail, patient reports from Transcom RN to Kelly
• 9:00 a.m. Conference call with Transcom
• 9:00-2:00 p.m. Patient placement calls by Kelly and GHA colleague
• 2:00-5:00 p.m. Communication, faxes, etc. to Team Georgia and Transcom
• 6:00-8:00 p.m. PR Team assembles at Dobbins
• 9:30-10:30 p.m. Flight lands• Around 11:00 p.m. – last
message from Transcom
Challenges
• International mission
• Culture• Language• Patient placement• New partners • Business
– Payment– Discharge– Travel back to Haiti
Patient Challenges• Multiple trauma three weeks plus after
the earthquake• Tetanus• Open extremity fractures, infected,
external fixators, needing debridement and flaps
• Spinal cord injuries• Amputations
Summary from Atlanta• 11 missions total• 51 patients • 21 non-medical attendees• 21 receiving hospitals• 41 NDMS hospitals
Atlanta March 2011
• 110 residents were evacuated from an assisted living center
Superstorm Sandy 2012
Care for Responders
• Difficult circumstances
• Unthinkable decisions
• Unforgettable sights, smells, sounds, experiences
To Do List• Personal Preparedness Plan for you and your
family www.ready.gov• Know the emergency plans of your facility
and your community• Be involved in the emergency preparedness
planning• Mass casualty planning must have trauma
involvement• It’s all about relationships……find your
coalition
Kelly H. Nadeau, M.N., [email protected]