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PubMed1985

Mass evacuation in disasters.

The emergency physician plays an important role in disaster planning and management. Some disasters will require the removal of a segment of the population for their own safety; this removal is referred to as mass evacuation. This aspect of disaster planning is frequently ignored or, at best, given a few short sentences in overall plans for coping with disasters. Very little has been written on this important aspect to permit one to make intelligent evacuation plans. This article summarizes previous studies on the reactions of people to, and their behavior during, actual mass evacuations. The information is used to outline important points that must be addressed by all those involved in disaster plans so that people may be removed from danger quickly, with as few problems as possible.

Communication↗
PubMedDate not supplied

Strange bedfellows? Reflections on bioethics' role in disaster response planning.

This essay considers the potential role of bioethics in disaster response planning and preparedness. Bioethicists can make substantial contributions, by ensuring that decision-making and distribution of resources during crises is carried out in a fair and just manner, as well as by examining the assumptions upon which disaster planning are based. Bioethicists should also be aware of potential pitfalls of overly-hasty engagement with this new field.

Bioethical Issues↗
PubMedDate not supplied

Hospital planning for weapons of mass destruction incidents.

As terrorists attacks increase in frequency, hospital disaster plans need to be scrutinized to ensure that they take into account issues unique to weapons of mass destruction. This paper reports a review of the literature addressing hospital experiences with such incidents and the planning lessons thus learned. Construction of hospital disaster plans is examined as an ongoing process guided by the disaster planning committee. Hospitals are conceived as one of the components of a larger community disaster planning efforts, with specific attention devoted to defining important linkages among response organizations. This includes the public health authorities, political authorities, prehospital care agencies, and emergency management agencies. A review is completed of six special elements of weapons of mass destruction incidents that should be addressed in hospital disaster plans: incident command, hospital security, patient surge, decontamination, mental health consequences, and communications. The paper closes with a discussion of the importance of training and exercises in maintaining and improving the disaster plan.

Decontamination↗
PubMed1985

Preparing an emergency public relations plan.

Many hospital disaster plans, while containing detailed procedures for dealing with an emergency situation, fail to include a well thought out emergency public relations plan. This omission can prove extremely troublesome in an actual emergency when there is little time to decide who is to serve as spokesperson for the institution, what policies should be followed and what conflicts or problems may arise. In this article, the author spells out what is required in advance to develop such a public relations plan.

Disaster Planning↗
PubMed1984

The Ash Wednesday bushfires in South Australia. Implications for planning for future post-disaster services.

Adequate disaster management depends on the incorporation of experience and research findings into future disaster plans. To assist in this process, a series of psychiatric patients examined after the Ash Wednesday bushfires in South Australia are described. The level of handicap experienced was often substantial and interfered with these people's attempts to overcome the losses they experienced in the disaster. Some people had to go to considerable lengths to seek psychiatric help because their general practitioners and bushfire relief workers did not understand the quality of their symptoms and had not arranged referral for them. The types of disorder, the time of presentation and the role played by the disaster in the onset of these disorders are described. The need for an educational and consultative psychiatric service for general practitioners and welfare workers who have contact with disaster victims is discussed.

Adult↗
PubMed1996

Hazardous materials. Disaster medical planning and response.

Hazardous materials offer a variety of unique challenges to emergency personnel. These agents have immense economic impact, but when mishandled, they become notorious for turning contained accidents into disasters involving the entire community. During a hazmat accident, the victims often ignore the rules of the disaster plan by seeking out the nearest hospital for medical care, regardless of that institution's capabilities. Health care workers rushing to the aid of contaminated individuals, without taking appropriate precautions (i.e., donning PPE), potentially make themselves victims. Disaster preparedness requires planning, policy, and procedure development, hazard analysis, training, and the availability of personal protective equipment for all responding personnel. Presently, the level of hazmat preparedness varies greatly among different hospitals, EMS and fire services, and disaster response teams. These differences in hazmat preparedness can be linked to a variety of factors (lack of awareness, funding, and support) and controversies (types of PPE and level of training required) which have prevented the establishment of a national hazmat policy for most of these organizations. Despite these difficulties, emergency departments continue to be the primary provider of care to contaminated individuals. As a result, emergency physicians must work with their hospital to implement a hazmat decontamination program in order to appropriately care for these individuals. The appendix to this article presents a list of recommendations for hospital hazmat preparedness. It is modeled after existing CDC and OSHA guidelines.

Decontamination↗
PubMed1975

Disaster alert plan for a hospital pharmacy.

A disaster alert plan for the department of pharmacy of a large hospital is described. The plan is intended to effectively and efficiently alert and mobilize pharmacy personnel in the event that the hospital should re required to deal with mass casualties.

Communication↗
PubMed2005

A multiphase disaster training exercise for emergency medicine residents: opportunity knocks.

BACKGROUND: Disaster planning is a core curriculum requirement for emergency medicine (EM) residency programs. Few comprehensive training opportunities in disaster planning incorporating the appropriate competencies have been reported. OBJECTIVES: To design, pilot, and evaluate a combination interactive Web-based disaster planning curriculum and real-time multidisciplinary full-scale disaster exercise. METHODS: Residents were assigned to groups led by a faculty mentor. Each group used an Internet-based platform to review the literature pertaining to their component of a disaster plan. The groups then used the platform to redesign an existing institutional disaster plan. Finally, they implemented their disaster plan for 80 simulated casualties resulting from a police, fire department, and emergency medical services multiple-casualty rescue exercise. All health professions then participated in a joint debriefing session. All aspects of the program were supervised by specialty EM faculty, and the exercise was evaluated using a five-point Likert scale with specific anchored descriptors. RESULTS: Sixteen residents and 17 faculty members participated in the exercise. Trained volunteers and high-fidelity simulations represented casualties varying in age from 6 months to 65 years, and in severity from ambulatory to moribund. Residents found the exercise enjoyable (4.9/5), relevant (4.6/5), and educational (4.8/5). CONCLUSIONS: Emergency medicine residency programs can benefit from participating in high-quality medical disaster exercises coordinated with local disaster response agencies. Residents report high satisfaction and learning from realistic simulations of disasters, and from collaboration with other community services.

Computer-Assisted Instruction↗
PubMedDate not supplied

Hospital disaster preparedness in Osaka, Japan.

PURPOSE: To investigate the adequacy of hospital disaster preparedness in the Osaka, Japan area. METHODS: Questionnaires were constructed to elicit information from hospital administrators, pharmacists, and safety personnel about self-sufficiency in electrical, gas, water, food, and medical supplies in the event of a disaster. Questionnaires were mailed to 553 hospitals. RESULTS: A total of 265 were completed and returned (Recovery rate; 48%). Of the respondents, 16% of hospitals that returned the completed surveys had an external disaster plan, 93% did not have back-up plans to accept casualties during a disaster if all beds were occupied, 8% had drugs and 6% had medical supplies stockpiled for disasters. In 78% of hospitals, independent electric power generating plants had been installed. However, despite a high proportion of power-plant equipment available, 57% of hospitals responding estimated that emergency power generation would not exceed six hours due to a shortage of reserve fuel. Of the hospitals responding, 71% had reserve water supply, 15% of hospitals responding had stockpiles of food for emergency use, and 83% reported that it would be impossible to provide meals for patients and staff with no main gas supply. CONCLUSIONS: No hospitals fulfilled the criteria for adequate disaster preparedness based on the categories queried. Areas of greatest concern requiring improvement were: 1) lack of an external disaster plan; and 2) self-sufficiency in back-up energy, water, and food supply. It is recommended that hospitals in Japan be required to develop plans for emergency operations in case of an external disaster. This should be linked with hospital accreditation as is done for internal disaster plans.

Accreditation↗
PubMed2004

Psychiatry and terrorism: the profession's role in disaster response planning.

While America wages the "war" on terrorism and endeavors to protect the physical safety of its citizens, it is imperative to plan for the population's mental health needs in future terrorist/disaster scenarios. The importance of psychiatry's potential role in preparing the community for the psychological impact of terrorism is underscored against the historical backdrop of the field being "carved out" from the organization, delivery, and financing of health services in our society. A practical framework is offered for designing an organization's mental health disaster plan, including recommendations for strategic infrastructure and tactical response capabilities. Finally, the unique features of clinical practice with disaster victims are noted, including intra-clinician conflicts between professional/community interests and personal/family obligations during acute disaster events.

Disaster Planning↗
PubMed1996

The federal response plan and disaster medical assistance teams in domestic disasters.

Through a variety of processes over the last 30 years, an organized federal plan has emerged for the response to domestic disasters. This plan incorporates several aspects of medical response into two areas: (1) health and medical and (2) urban search and rescue. This article discusses the development of the federal response plan with emphasis specifically on medicine. Highlighted are disaster medical assistance teams, urban search and rescue task forces, and roles and responsibilities of emergency physicians and other emergency health professionals in a federal disaster response.

Disaster Planning↗
PubMed2004

Function and response of nursing facilities during community disaster.

OBJECTIVES: We sought to describe the role and function of nursing facilities after disaster. METHODS: We surveyed administrators at 144 widely dispersed nursing facilities after the Los Angeles Northridge earthquake. RESULTS: Of the 113 (78%) nursing facilities that responded (11 365 beds), 23 sustained severe damage, 5 closed (625 beds), and 72 lost vital services. Of 87 nursing facilities implementing disaster plans, 56 cited problems that plans did not adequately address, including absent staff, communication problems, and insufficient water and generator fuel. Fifty-nine (52%) reported disaster-related admissions from hospitals, nursing facilities, and community residences. Nursing facilities received limited postdisaster assistance. Five months after the earthquake, only half of inadequate nursing facility disaster plans had been revised. CONCLUSIONS: Despite considerable disaster-related stresses, nursing facilities met important community needs. To optimize disaster response, community-wide disaster plans should incorporate nursing facilities.

Community Health Planning↗