"DISASTER PREPAREDNESS FOR PRIMARY HEALTHCARE PROVIDERS"
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