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DISASTER MANAGEMENT PRINCIPLESJAMES WINTONMAY 2016
DISASTER MANAGEMENTProvide a framework of how disasters are managed• Pre-hospital• In Hospital
MIMMS approachSCGH Emergency Department disaster plan
2015 ASM: Victims & Responders; Christchurch Earthquake — Prof. Mike Ardagh
WHAT IS A DISASTER?Disaster• Event • Threat actual or potential• Extraordinary resources• Coordination across services
Classified by type• Trauma vs Medical• Natural vs Man-made• Simple vs compound• Compensated vs uncompensated
DISASTERS IN AUSTALIANATURAL• Bushfires• Cyclones• Floods• Drought• Earthquake• Heat wave
MAN MADE• Granville train• Westgate bridge• Kemspey bus• Port Arthur• Childers fire• Eureka stockade• Maritime• Air accidents
DISASTER MANAGEMENT IN WAGoverning body – DPMU
• All hazards approach• Comprehensive approach (Prevention, Preparedness,
Response, Recovery)• All agencies (integrated) approach• Graduated response• Community risk management• Prepared community
PHASES OF A MAJOR INCIDENTPreparationResponse Recovery
Both prehosptal and in hospital follow these phasesA major incident in Perth may involve hospital based team as part of the coodinated prehospital response
MIMMS course provides an approach to prehospital management
PRE-HOSPITAL RESPONSE
SERVICES INVOLVEDAmbulance service Police serviceFire servicesUrban search and rescue teamsLocal authorities – emergency servicesHealth
Organisation and coordination are crucial
All hazards All service
PREPARATION FOR THE SCENEPersonal equipment• Clothing/phone/torch/camera/map/rationsMedical equipment• Triage/First aid/advance life support/specialist
equipment/transport equipmentCommunication equipment• Radio/phone/other methods – runners, media, loud hailer
SCENE MANAGEMENTC – Command and controlS – SafetyC – CommunicationA – AssessmentT – TriageT – TreatmentT – Transport
COMMAND AND CONTROL ZONES
Casualty clearing post (CCP)• Safe• Large• Sheltered• Acessible
SCENE SET UP
TRIAGEDisaster triageDynamic process Priorities• 1 – Immediate – RED• 2 – Urgent – YELLOW• 3 – Delayed – GREEN• 4 – Expectant – BLACK/BLUE
Triage Sieve – at incident siteTriage Sort – at casualty clearing post
TRIAGE SIEVEWALKING Priority 3 (Delayed)
DEADBREATHING
When Airway opened
RESPIRATORY RATE PRIORITY 1(Immediate)
PRIORITY 2 (Urgent)CAPILLARY REFILL
Yes
No
No
Yes
< 10 or >29
10 - 29
< 2 sec
> 2 sec
TRIAGE SORT
Labels• Visible/attachable
TRIAGE LABELS
TREATMENTWhat can be doneWhat should be done
Treatment at scene usually confined to A/B/C
Priority is to get casualties away from the scene
Triage takes priority to treatment
TRANSFEROrganisation is imperativeTreatment impacts on ability to transport
Destination considerationsMethod of transport
HOSPITAL RESPONSE
HOSPITAL PLANSCGH response to an external disaster is “Code Brown”Each area has its specific subplanDo you know where it is?
Details of the contents are available elsewhere
PREPARATIONHave a planTest the plan• Locally• Regionaly• All agencies• DPMU• Hospital• Emergotrain• Meetings
NOTIFICATIONMay come from different sources• Ambulance• Media• Self presenters• Hospital Emergency Control Group (ECG)• DPMU – on call duty officer• WebEOC
• Many theories and stories on how patients present
PREPARATIONSurge capacity• Clearing the ED• Clearing the hospitalTiered responseDepartment layout• Locations• ResourcesClerical involvement
SCGH ED Mass Casualty layout
RESPONSEStaff allocated to triage priorititesEach priority has a team leader which liases with duty consultantOther staff may be utilised• Duty surgeon • Duty intensivist• Duty radiologist
• Limit Xrays • Limit operative treatment• “Damage control”
RECOVERYPotentially huge undertakingResumption of normal functionRestockingDebriefingReviewingPreparation
Hours to days to weeks
DISASTER MANAGEMENT PRINCIPLESPlanningPreparationPractice
Prehospital responseHospital response
MIMMS – www.mimms.org.au HMIMMS
Thanks to Dr Roger Swift FACEM SCGH ED