Public Health and Healthcare Issues

Public Health and Healthcare

Mass Casualty Events

Produce large number of patients quickly

Surge of patients with severe and minor injuries can rapidly stress the healthcare system and first receivers

The majority of injured self report to healthcare facilities

Injured report to the closest hospitals to the event

Radiation Mass Surge Event

Radiation further complicates response and adds additional stress to a stressful situation

Radiation raises the fear of contamination in staff who have little understanding of radiation

Radiation increases the number of worried well wanting medical evaluation and monitoring

Perspective on Mass Surge

It is estimated that 10% of the total population will want to be screened for radioactivity exposure

Psychological trauma is the driving force

Fukushima, Japan 2011

200,000 of a population of 2 million people were scanned and evaluated for contamination

Fear of contamination Fear of health consequences

Goiania, Brazil 1987 249 people found significantly

contaminated112,000 were evaluated and

screened

Tokyo Sarin Attack

Saint Luke’s International Hospital 27% of staff contaminated 526 victims Over 5000 evaluated Majority psychological

CDC Guiding Principles First priority is to save lives and treat the

injured first

Contamination with radioactive materials is not immediately-life treating

Initial population monitoring activities should focus on preventing acute radiation health effects

Scalability and flexibility are an important part of the planning process

CDC Guiding Principles Continued

Fear of radiation is high, higher than with other agents of terrorism

Radiological decontamination differs from those for chemical agents

Law enforcement agencies will be involved in response to a radiological terrorism event

Roles and Responsibilities of

Public Health CDC lists 15 responsibilities for federal,

state and local Public Health “As a general rule, during the initial stages of

the incident local and state officials should be prepared to handle the crisis without federal

assistance”

(CDC Population monitoring in Radiation Emergencies)

Roles and Responsibilities

Protecting the public’s health

Monitoring workers health and safety

Ensuring safe shelters for the population Ensuring the safety of food and water

Coordinating sampling and laboratory analysis of bio and environmental samples

Conducting field investigations

Monitoring people who may have been contaminated with radioactive materials or exposed to radiation

Conducting or assisting in decontamination

Recommending management protocols for affected populations or individuals

Hospital Mass Surge Issues

Patients arrive before the event is recognized as radiological by first responders

Contamination of the ER occurs before the event is recognized as radiological

Staff ill prepared to deal with radiological effected patients

Correct staff not presentSurge of worried well stresses facility’s

ability to care for the seriously injured

Hospital Mass Surge Issues

Hospital staff lack the ability to communicate with the massive crowds of people

Staff fearful of radiation and the large crowds seeking care

Limited decon capabilities and limited ability to scan patients for radiation

Traffic management issues, abandoned cars, contaminated cars

The Role of Community Reception Centers

To divert people with minor or no injuries away from the hospital for scanning and counseling

To decrease the impact of surge on patient care and hospital staff

To identify people who may need immediate assistance----decontamination, medical attention, psychosocial needs

Objectives of MonitoringIdentify individuals whose health is in

immediate dangerIdentify people who may need medical

treatment for contamination or exposureTo try to minimize future health for long term

health monitoringRegister potentially affected populations for

long term health monitoring

Security NeedsTraffic management at hospitals and

Reception CentersSecurity of facilities inside and on groundsRisk of facility contaminationThreatening environment to staff responding

to the incidentRisk as a secondary target

Why Security for Hospitals

Represent critical infrastructure in their community

Symbols of safety and security for a community being affected by a mass casualty event

To ensure safety of staff while providing care to the surge of patients

To facilitate traffic flow, campus lock down, facility lock down

Why Reception Center Security

Traffic managementCrowd containment and managementSafety of staff and patientsSecondary targetLimit access to the facility and groundsSecurity of personal belongings