DISASTER PREPAREDNESS FOR PRIMARY HEALTHCARE PROVIDERS by o262mlx9

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									 GENERAL DISASTER
 PREPAREDNESS FOR
PRIMARY HEALTHCARE
     PROVIDERS



 California Preparedness Education Network

             Revised March 2007
      Funded by ASPR Grant T01HP01405
                 Outline
• What is a disaster?

• Disaster response in California

• Your disaster preparedness

• Disaster response

• Resources
WHAT IS A DISASTER?
     WHAT IS A DISASTER?
• Webster’s def: “any happening that
  causes great harm or damage; calamity.”

• Practical def: any situation where the
  numbers of patients or severity of illness
  exceeds the ability of the facility or system
  to care for them, requiring external
  assistance.
Disaster Events “All Hazards”
               Earthquakes
               Emerging infections
               Fires
               Floods
               Hurricanes
               Hazardous Materials
               Mudslides
               Riots
               Terrorism (CBRNE)
               Transportation
               Tsunamis
               Volcanoes
“ALL HAZARDS” APPROACH

• Principles of preparation for human-
  made or natural disasters overlap
  with those of dealing with a chemical
  or biological event.
              Examples
• Preparedness for anthrax improved SARS
  response nationally
• Pandemic Influenza preparedness will
  enhance response to BT and emerging
  infectious diseases
• Earthquake preparedness and principles
  assisted with wildfire response
      PROVIDER ASSUMPTIONS
      PREPARING FOR THE RARE
• This won’t happen near my home
• They’ll die before I see them
• Specialists will be called in
• They’ll be decontaminated before I see them
• I’ll have time to ask the experts for help
• There is no risk to me as a provider
AUM SHINRIKIYO
   Shoko Asahara
 TOKYO
MARCH, 1995
 TOKYO
MARCH, 1995
     LESSONS FROM TOKYO
• Coordinated terrorist attack on 5
  subway cars with sarin gas
   – 12 persons killed, more than 5,500 affected

• 641 seen in nearest ER
   – Most were “walk-ins”
   – 2 deaths, 4 severe cases, 107 moderate
     cases
Ann Emerg Med 1996; 28: 129
  PUBLIC HEALTH EMERGENCY
• Less than 20% patients likely to be triaged
  or decontaminated in the field

• Patients will go to the nearest facility
• Any clinic can become a response center
• Facilities are likely to be overwhelmed
• We are not accustomed to response
            WHY DO I CARE?

• Disasters are unpredictable!

•   A disaster may occur near you
•   Disaster victims may come to you
•   May involve you or your family
•   May involve your clinic or staff
•   Expert help may not be available
DISASTER RESPONSE
 CALIFORNIA IS A NATIONAL
         MODEL
• We have disasters (lead the nation)

• “All disasters are local” mantra has been
  adopted nationally

• Standardized Emergency Management System
  (SEMS) is California creation the led to…

• National Incident Management System (NIMS)
OAKLAND HILLS
     1991
           WHAT IS NIMS?
• Standardized system for managing
  disasters within from the local to federal
  level

• Structured to aid local authorities with
  mutual aid and resource assistance

• Local governments (agencies), states, and
  federal agencies use NIMS
         NIMS ELEMENTS
•   Command and Management
•   Preparedness
•   Resource Management
•   Communications
        NIMS ELEMENTS
• Command and Management
 – Incident Command
   • Operational area (local) approach
 – Multi-organization coordination
 – Public Information Systems
OPERATIONAL AREA CONCEPT
              Chain of Command


•   Federal
•   State
•   Region
•   County
•   Local Gov’t
•   Field
OPERATIONAL AREA CONCEPT

• California is divided into regions, then
  counties, then local governments

• These are the functional units that make
  up each level on the chain of command in
  California
• The US is also divided into regions for
  response in a similar manner
SOUTHERN CALIFORNIA
        1970
 INCIDENT COMMAND SYSTEM
• Tool used for the command, control, and
  coordination of resources at the scene of an
  emergency

• Now used by military and fire services
  INCIDENT COMMAND SYSTEM
         AT A GLANCE
 Incident Command: Leads the response, appoints team
       leaders; sets tone and standards for response

• Operation Team: Handles key actions including first aid,
  search and rescue, fire suppression, securing the site
• Planning Team: Gathers information, thinks ahead and
  keeps all team members informed and communicating
• Logistics Team: Finds, distributes, and stores all
  necessary resources (supplies and people)
• Finance Team: Tracks all expenses, claims and
  activities and is the record keeper for the incident.
         NIMS ELEMENTS
• Preparedness
  – Planning
  – Exercises
  – Training
  – Personal Certification (ICS 100/700)
  – Equipment allocation and certification
  – Mutual aid
        NIMS ELEMENTS
• Resource management
 – Tracking and following of resources from
   federal to local level during response
 – Tracking will allow utilization of resources
   in best manner
         NIMS ELEMENTS
• Communications
  – Incident management commands
    communication response
  – Information management is managed over
    local to federal response
    • Equipment
    • Personnel
    • Technologies
   WHY DOES NIMS MATTER?

• Understand the response system

• Know your position

• Understand how resources can get to you

• Know that your clinic, local, and county
  gov’t will not bear costs of a disaster
ORGANIZATIONAL LEVELS OF
          NIMS
 CHAIN OF COMMAND CONCEPT
              Federal




                                 RESOURCES
               State
             Regional*
         Operational Area*
 REQUESTS




      Local Gov’t (city, town)
       Field Command Post
GETTING PREPARED
BASICS OF DISASTER PLANNING
                   STATE REQUIREMENTS

• Clinics and Hospitals must have a written
  disaster plan
  (CA Code of Regulations – Title 22, Div 5, Section 78423)
  (Joint Commission requirement)


• Administrator / Command staff
      •   Oversees development of the disaster plan
      •   Direct overall response to the disaster/emergency
      •   Ensure drills/exercises conducted semi-annually
      •   Evaluate & update the plan annually
      •   Decides who has authority to activate disaster plan
“ALL HAZARDS” APPROACH

• Principles of preparation for human-made
  or natural disasters overlap with those of
  dealing with a chemical or biological event.
BASICS OF DISASTER PLANNING
• Four phases of disaster response
    • Mitigation*
    • Preparedness*
    • Response
    • Recovery
BASICS OF DISASTER PLANNING
                HAZARD MITIGATION

• Risk assessment
    Potential for natural disasters
     (e.g., earthquakes, fires, avalanches)

    Potential for man-made disasters
     (e.g., chemical plants, nuclear facilities)

    Portals of entry
     (e.g., airports, populations in your community)

    Terrorist threats difficult to assess = all communities
     are at risk
BASICS OF DISASTER PLANNING
                 HAZARD MITIGATION

• Capabilities / capacity evaluation
     Available resources
      (e.g., drugs, beds, ventilators, surgical equip)

     Staff
      (e.g., physicians, PAs, nurses, nonmedical)

     Physical limitations
      (e.g., size, location, isolation/decon facilities)

     Vulnerabilities
BASICS OF DISASTER PLANNING
                    PREPAREDNESS

• Develop a disaster and surge plan
  – Personal / family disaster plans
  – Command & Control System
     • Limit confusion!
     • ICS = standardized command structure
     • Clinic emergency response team
  – Facility protection
     • Clinic security, patient flow, crowd control
     • Patient decon, staff protection (PPE)
     • Evacuation
BASICS OF DISASTER PLANNING
                   PREPAREDNESS

• Develop a disaster plan (cont)
  – Supplies
     • Impossible to stock all possible supplies
     • Plan for loss of power, light, phones, etc.
  – Notification plans
  – Recovery
     • Facility decontamination, resupply
     • Psych support
     • Financial reimbursement
BASICS OF DISASTER PLANNING
                   PREPAREDNESS

• Communications
  – Review available clinic communications

  – Plan redundant sources

  – One of the most difficult to plan
     • Internet & phone sole source in most clinics
     • Cell phone circuits may become overloaded
     • Satellite/aux communications costly
BASICS OF DISASTER PLANNING
                     PRACTICE


• Plan is no good without practice!
• Knowledge based training
  – Cal-Pen Modules
• Skills based Training & Exercises
  – Table top – low cost, convenient
  – Functional – tests staff capabilities
  – Full-scale – simulate an actual emergency
     FAMILY DISASTER PLAN
• Important for provider to know that family
  members are OK – allows them to perform

•   Create a specific plan for your family
•   Common contact or meeting place
•   Supplies and evacuation plan
•   Plan childcare if unable to get home
BASICS OF DISASTER PLANNING
              DEVELOPING A PLAN

• Many resources available
• No established “best” plan (no data)
• Assemble key stakeholders
• Use job actions, not people
• Make sure plans don’t overlap
• Write it down – review it - modify
DISASTER MEDICINE
                TRIAGE
• Important concept in disaster medicine

• Initial triage for patients in disaster
  situation may be the most important role
  for a primary healthcare provider

• Priority change from providing best care to
  every patient to maximizing number of
  survivors
             START TRIAGE
• Triage must be continually repeated as
  patient conditions will change

• Triage categories
    •   Green
    •   Yellow
    •   Red
    •   Black
            Sustained Care
• Emergency mass care, in a sustained
  event like an influenza pandemic, will lead
  to sustained disaster response
• Principles will be different
  – More likely to deplete resources and staff
  – More likely to lead to austere care and
    allocation of resources
  – Requires community planning
  – Many providers will practice out of scope
                        Regional
      Floor/med-surge   facilities
                        Alternate sites
        Step-down
                        SNF
            ICU
                        Home Care




EMC Approach to Critical Care
       DECONTAMINATION
• Important for plans to include decon
• In the event of a CBRNE event we may
  have to decontaminate patients
• Basic principles
     • PPE (Personal Protective Equipment)
     • Clothing removal = 90% decon
     • Soap & water OK
                  PPE
• In the event of CBRNE event PPE may
  become important

• Should be addressed in your disaster plan

• No standard level

• Consider in risk assessment

• EMSA clinic PPE (about level C)
           CONCLUSIONS
• Disaster Preparedness is important for
  primary care providers, regardless of
  location and size of clinic
• A well developed plan will augment the
  state’s disaster response under NIMS
• A well organized plan will provide care to
  the staff, patients and community in a time
  of crisis
           CONCLUSIONS
• Your plan will provide safety to your staff
  and unaffected patients
• Assess your risk and community needs
• Develop your plan based on these risks
  and needs with job action sheets
  describing each position’s role
• Teach your plan
• EXERCISE YOUR PLAN
CONTACT NUMBERS

								
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