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Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared for the 15 th Annual Emergency Management Higher Education Conference
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Page 1: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Not Your Father’s M*A*S*H:Establishing Alternate Medical

Treatment Sites

K.C. Rondello, M.D., M.P.H.Adelphi University

June 6, 2012

A presentation prepared for the15th Annual Emergency Management Higher Education Conference

Page 2: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Defining Our Terms

Alternate Medical Treatment Site (AMTS) or Alternate Care Facility (ACF) ◦A non-medical facility temporarily

adapted to render medical care in a disaster

Point of Distribution/Dispensing (POD)◦A non-medical facility temporarily

adapted to administer vaccines or prophylactic medications in a disaster

Page 3: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Hurricane Ike AMTSSpecial Needs Shelter

(formerly Albertsons Supermarket)

Page 4: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Recent AMTS/POD Usage in the U.S.

Joplin Tornado (May 2011)Great Tennessee Flood (May 2010)Hurricanes Gustav, Hanna and Ike (September

2008)California Wildfires (October 2007)Hurricane Katrina (August 2005)Anthrax Attacks (October 2001)Terrorist Attacks (September 2001)

So… why do Emergency Managers in higher education need to know?

Page 5: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

A University Campus as an AMTSMost universities have a mission to support

their communitiesCampuses are designed with space to

accommodate many peopleCampuses often also have large parking

areas, widespread utility availability and many support personnel

“If we could change ourselves, the tendencies in the world would also change. As a man changes his own nature, so does the attitude of the world change towards him. ... We need not wait to see what others do.” - Mahatma Ghandi

Page 6: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

ConsiderationsLogistical IssuesClinical IssuesAdministrative Issues

Challenges and Pitfalls

Page 7: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Logistical Site Issues

SizeSecurity & SafetyUtility SupportLocationMedication and MaterielWaste Disposal and SanitationFatality Management

Page 8: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Size(it turns out it matters after all…)

Clinical AreasAdministrative AreasSupply Areas

◦Unsecured / SecuredNutrition/Hydration/Sleeping

AreasMental Health/Quiet AreasMedia Area

Page 9: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Pre-Disaster PreparationA Federal Medical Shelter

Page 10: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Security & SafetyStructural integrityProtection of stockpile and staff

◦Magnetometers?Fire SuppressionEmergency Exits/Evacuation

RoutesEffect on behaviorLarge numbers in confined space

Page 11: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Security Support

Page 12: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Utility SupportElectricityWater

◦Potable /Non-PotableSanitation

◦Handwashing/Disinfecting Gel◦Bathrooms/Latrines◦Infectious /Non-Infectious

Climate ControlCommunications

◦Redundancy!

Page 13: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Climate Control

Page 14: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Communications

Page 15: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Location, Location, Location!

FamiliarityPhysical AccessParkingRoutesModes

Page 16: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Medication and Medical Materiel

Disaster Stockpile (Federal, State, Local)

Strategic National StockpileLocal Hospitals and Pharmacies

Page 17: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Strategic National Stockpile

Page 18: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Waste Disposal and Sanitation

Infectious vs. Non InfectiousHuman ExcretaBathing FacilitiesLaundering Clothes and Linens

Page 19: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Laundry and Waste Disposal

Page 20: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Bathing Facilities

Page 21: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Fatality ManagementRemoved from clinical care areasRefrigeration for long term storageCDC/FBI involvement

Page 22: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Clinical Issues

Infection ControlPatient FlowRecordkeepingMental Health

Page 23: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Infection Control

Surfaces◦Nonabsorbent

Air Filtration◦HEPA standard

Anti-microbials◦For hands◦For surfaces

Page 24: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Power-free Hand Washing Station

Page 25: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Patient FlowFlow ControllersSignageUnidirectionalPatient Management

Page 26: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Bed Board

Page 27: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Record Keeping

Less robust than usual

Must be able to track them down!

Electronic vs. PaperEpidemiologic needs

Page 28: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Electronic Medical Record

Page 29: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Mental Health Monitoring

For staff and patientsAssigned personnelMonitoring system

Page 30: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Quiet Room

Page 31: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Administrative IssuesPersonnelPolicies for OperationsNutrition / Hydration /

Sleeping Accommodation

Page 32: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Personnel

Clinical◦MD, RN, EMT, NA, etc.

Non-Clinical◦Security, Reception/Records, Flow

Controllers, Logistics, PIO, Volunteer Coordinator, etc.

CredentialingMunicipal and Non-municipal

sources

Page 33: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Policies for Operations

SimplicityStandardizationTestedDisseminated

Page 34: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Nutrition / Hydration / Sleeping Accommodation

Available 24/7◦Scheduled meal times

Isolated from clinical careLogging in and out

Page 35: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Mass Feeding

Page 36: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Home Sweet Home

Page 37: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Challenges and Pitfalls

Special Needs PatientsPolitical IssuesAdverse Environmental

ConditionsPublic RelationsComplianceTimeline

Page 38: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Special Needs Patients

Limited Mobility / Non-Ambulatory

Sensory deficitsLanguage barriersPatients with dependents

Page 39: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Political Issues

Regular communication with decision makers is key!

Use of layman’s termsDistilled informationCharts, graphs, maps

Page 40: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Adverse Environmental Conditions

Road/Rail/Airport closuresUtility outagesFlooded facilitiesCommunications failures

Page 41: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Public Relations

Manage them or they will manage you!

Specific briefing areaSingle source of informationScheduled, frequent updates

Page 42: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Compliance

Use the mediaMulti-pronged approachCommunicate honestly

Page 43: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Timeline

Always less time than you wantEarly identification and

inspection of potential sites helps

Pre-training and drills are key for personnel

Page 44: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

SummaryLogistical IssuesSizeSecurity & SafetyUtility SupportLocationMedication and

MaterielWaste Disposal and

SanitationFatality

Management

Clinical IssuesInfection ControlPatient FlowRecordkeepingMental Health

Page 45: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Summary

Challenges & PitfallsSpecial Needs

PatientsPolitical IssuesAdverse

EnvironmentPublic RelationsComplianceTimeline

Administrative Issues

PersonnelPolicies for

OperationsNutrition /

Hydration / Sleeping Accommodation

Page 46: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Questions? Comments?

Page 47: Not Your Father’s M*A*S*H: Establishing Alternate Medical Treatment Sites K.C. Rondello, M.D., M.P.H. Adelphi University June 6, 2012 A presentation prepared.

Thank You!

K.C. Rondello, M.D., M.P.H.Academic Director, Department of Emergency

ManagementAdelphi University1 South AvenueGarden City, NY [email protected]


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