[Lack of consideration of psychiatric aspects in hospital plans for medical disasters].
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Crisis Intervention↗
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Emergency health planning.
This paper outlines the development of emergency health planning as a function of government. Ten provinces have the basic responsibility for the organization, preparation and operation of medical, nursing, hospital and public health services in an emergency. The Department of National Health and Welfare is responsible for the provision of advice and assistance to the provincial and municipal governments in such matters. Eight provinces have now hired full-time planning staffs to co-ordinate the health planning of the Provincial Departments of Health and Provincial Emergency Measures Organization.Four major programs have been established. The first program provides for the continuity of leadership and guidance by health authorities at the federal, provincial and municipal level. Essential records have been developed and emergency legislation prepared. This program, however, will be of little use unless health services are organized at the municipal level. In this organizational program, advice and assistance have been provided to existing hospitals and departments of health in the conduct of disaster planning. The efforts of these agencies are co-ordinated by municipal health authorities into a community disaster plan. The third program deals with information and education of the general public and the health workers. This program is designed to make the family unit self-sufficient for up to seven days and the health worker prepared to undertake his emergency role. The first three programs are directed to the organization and training of manpower; the fourth program provides the necessary supplies. From the national medical stockpile of $18,000,000, some $12,000,000 has been received, packaged for long-term storage and distributed to regional depots across the country. To ensure their ready availability in time of emergency an agreement has been reached with seven provinces for the release of hospital disaster kits.
Civil Defense↗
Disaster preparedness of home health care agencies in San Diego County.
A questionnaire was sent to 53 home health care agencies in San Diego to assess their state of disaster readiness. Thirty agencies returned completed questionnaires. Of these, 90% have written disaster plans, but only 33% conduct regular drills to practice their written plans. A 24-h telephone number is available to patients at 96% of the agencies. One-fourth of the agencies serving ventilator-dependent patients do not make utility companies aware of their special needs. Of 11 hospital-sponsored agencies, 18% include backup agreements with other agencies, while 79% of non-hospital-sponsored agencies have planned such backup. The majority (92%) of "private-for-profit" agencies have backup arrangements, but only 38% of the public or nonprofit agencies have such arrangements. Additionally, 31% of the home health care agencies do not feel they would be able to meet the needs of their clients in the event of a disaster. Specific recommendations for such agencies in developing disaster plans, and exercising them, are made.
California↗
Testing emergency medical personnel response to patients with suspected infectious disease.
OBJECTIVES: In the United States (US), hospitals are required to have disaster plans and stage drills to test these plans in order to satisfy the Joint Accreditation Commission of Healthcare Organizations. The focus of this drill was to test if emergency response personnel, both prehospital and hospital, would identify a patient with a potentially communicable infectious disease, and activate their respective disaster plan. METHODS: Twelve urban/suburban emergency departments (ED) received patients via car and ambulance. Patients were moulaged to imitate a smallpox infection. Observers with checklists recorded what happened. The drill's endpoints were: (1) predetermined end time; (2) identification of the patient and hospital "lock-down"; and (3) breach of drill protocol. RESULTS: None of the ambulance personnel correctly identified their patients. Of the total 13 mock patients assessed in the ED, seven (54%) were identified by the ED staff as possibly being infected with a highly contagious agent and, in turn, the hospital's biological agent protocol was initiated. Of the correctly identified patients, five (71%) were placed in isolation, and the remaining two (29%), although not isolated, were identified prior to their ED discharge and the appropriate protocol was activated. The six remaining mock patients (46%) were incorrectly diagnosed and discharged. Of the hospitals that had correctly identified their "infected" patients, only two (29%) followed their notification protocol and contacted the local health department. CONCLUSION: This drill was successful in identifying this area's shortcomings, highlighted positive reactions, and raised some interesting questions about the ability to detect a patient with a possibly highly contagious disease.
Adolescent↗
Community medical response to the Fairchild mass casualty event.
BACKGROUND: On June 20, 1994, a discharged serviceman with a psychiatric history opened fire with a MAC-90 assault rifle at Fairchild Air Force Base in Spokane, Washington. The attack killed 5 people and wounded 22. This report reviews the communication, triage, transport, injuries, and the community medical response to this mass casualty. METHODS: Data for the review were obtained from city-wide debriefing sessions, medical records, and evaluation forms from prehospital agencies. RESULTS: A total of 19 patients were triaged to four community hospitals, while 3 victims with comparatively minor injuries stayed at the Base hospital. All fatalities except a child in utero died at the scene. All victims surviving to hospital were discharged recovered from their injuries. Two patients were undertriaged, 1 of whom sustained a pelvic and buttock wound. CONCLUSIONS: Rapid triage was possible due to: (1) initial treatment by military medical personnel; (2) an established and practiced disaster plan; (3) the use of disaster packs and triage tags; (4) the immediate initiation of triage and transport; and (5) coordinated ground and air transport.
Adolescent↗
The use of classroom training and simulation in the training of medical responders for airport disaster.
There is a dire need to have complementary form of disaster training which is cost effective, relatively easy to conduct, comprehensive, effective and acceptable. This will complement field drills training. A classroom-based training and simulation module was built by combining multiple tools: Powerpoint lectures, simulations utilising the Kuala Lumpur International Airport (KLIA) schematic module into 'floortop' model and video show of previous disaster drill. 76 participants made up of medical responders, categorised as Level 1 (specialists and doctors), Level 2 (paramedics), Level 3 (assistant paramedics) and Level 4 (health attendants and drivers) were trained using this module. A pre-test with validated questions on current airport disaster plans was carried out before the training. At the end of training, participants answered similar questions as post-test. Participants also answered questionnaire for assessment of training's acceptance. There was a mean rise from 47.3 (18.8%) to 84.0 (18.7%) in post-test (p<0.05). For Levels 1, 2, 3 and 4 the scores were 94.8 (6.3)%, 90.1 (11)%, 80.3 (20.1)% and 65 (23.4)% respectively. Nevertheless Level 4 group gained most increase in knowledge rise from baseline pre-test score (51.4%). Feedback from the questionnaire showed that the training module was highly acceptable. A classroom-based training can be enhanced with favourable results. The use of classroom training and simulation effectively improves the knowledge of disaster plan significantly on the back of its low cost, relatively-easy to conduct, fun and holistic nature. All Levels of participants (from specialists to drivers) can be grouped together for training. Classroom training and simulation can overcome the problem of "dead-document" phenomenon or "paper-plan syndrome".
Aviation↗
Medical planning for disaster in Israel. Evaluation of the military surgical experience in the October 1973 War, and implications for the organization of the civilian disaster services.
During its 27 years of existence, Israel has experienced four wars and dozens of mass casualty situations from various causes. This experience has led to the development of a plan for the management of mass casualties. This plan was put to the test in the October War of 1973 and proved successful. Although disasters and procedures vary widely in time and location certain principles of organization and management apply to most of them. In this paper the organization of the evacuation and management of the casualties in the October War is evaluated and its implications in the organization of civilian disaster services discussed.
Civil Disorders↗
Lessons learned from a nightclub fire: institutional disaster preparedness.
BACKGROUND: On February 20, 2003, a nightclub fire caused a multiple casualty disaster, with 215 victims requiring treatment at area hospitals. In this report, we describe the events, the surgical response at our trauma center, and the lessons learned in institutional disaster preparedness. METHODS: Information regarding the fire was obtained from public access media and state governmental and hospital reports. Patient information was obtained through review of our trauma registry, patient records, and questionnaires sent to regional hospitals. RESULTS: Four hundred thirty-nine patrons were in the building at the time of the fire, of whom 96 died at the scene. One hundred people ultimately died. Two hundred fifteen patients were evaluated at area hospitals: 64 at our trauma center and 151 at 15 other area facilities. Seventy-nine patients were admitted: 47 to our center and 32 to other hospitals. Eight patients were transferred from Rhode Island Hospital (RIH) to other Level I trauma centers. Twenty-eight (60%) of the patients admitted to RIH were intubated for inhalation injury. For patients admitted to RIH, the extent of the total body surface burn was less than 20% in 33 patients (70%), 21% to 40% in 12 patients (26%), and greater than 40% in 2 patients (4%). The average age was 31 years (range, 18-43 years). Previous disaster planning drills facilitated a quick institutional response directed by a surgeon. The trauma floor of the hospital, which normally consists of a 10-bed trauma intensive care unit (ICU), an 11-bed step-down unit, and a 22-bed medical-surgical floor, was cleared of patients and converted into a 21-bed burn ICU and a 34-bed acute burn ward. Surgical residents were mobilized into teams assigned to the emergency department, ICUs, and surgical floors. In addition to the in-house trauma attending already present, four additional surgical staff members were called in to help man the emergency department and burn wards. Two operating rooms became dedicated burn rooms where 23 cases were performed the first week. In total, 43 operative procedures and 9 bedside tracheostomies were performed over 8 weeks. Over the first 4 weeks, 132 bronchoscopies were performed for diagnostic purposes and pulmonary toilet. There were no deaths. CONCLUSION: Disaster planning as well as personnel and institutional commitment resulted in an optimal response to a multiple casualty incident. Still, lessons were learned that will further improve readiness for future disasters.
Adolescent↗
Willingness of staff to report to their hospital duties following an unconventional missile attack: a state-wide survey.
Adequate staffing of hospitals during a prolonged, potentially unconventional war is a key component in the disaster plan of institutions. In an attempt to determine policy regarding hospital staffing, a state-wide survey was conducted in Israel among hospital personnel during the recent Persian Gulf war. This survey aimed to explore the willingness of staff to report to their duties (WTR) following an unconventional missile attack described in a hypothetical scenario. Of the 2,650 questionnaires distributed among all categories of staff in 10 hospitals (42%) across the country, 51% were returned. Overall, 42% of the responding staff were WTR under the presented scenario. However, WTR would increase to 86% if safety measures were provided. Males, personnel with headquarter duty of hospital site managers, and parents of children older than 14 years of age, were the most WTR. The finding of extensive interhospital variation in WTR indicates the need for evaluating WTR on an institutional basis when establishing both the hospital and the regional disaster plan. Data are presented on the extent of WTR, the factors inhibiting WTR, and possible measures to improve WTR.
Absenteeism↗
[The Amsterdam air disaster--management and fate of casualties].
On Sunday, Oct. 4, 1992, an E1 A1 Boeing cargo plane crashed into a 10-story block of flats in the Bijmermeer, on the outskirts of Amsterdam. About 8 people died at the site of the disaster. 37 patients were treated in local hospitals within 90 minutes of the disaster, 16 of whom were admitted. 3 suffered severe, and 6 moderate burns (> 15% and 10-15% of body surface area, respectively). Although there were relatively few injured, a full-scale disaster response was evoked, providing an opportunity to study the effectiveness of current disaster plans. The rapid response of the ambulance service and the hospitals involved indicates that rehearsing disaster preparations is effective. The dispersal of the injured to several nearby hospitals prevented overloading of casualty departments. Secondary transfer of severely burned patients to the burn center was efficient and followed current guidelines. In retrospect, while communication between the various services might be subject to minor criticism, no problems were encountered which interfered with proper execution of the rescue operation. No one who survived the immediate impact died.
Accidents, Aviation↗
Top disaster priorities: staff education and preparedness, evacuation plans.
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Disaster Planning↗
Operation Bali assist--the Royal Darwin Hospital Intensive Care Unit.
On October 12, 2002 the Bali bombing resulted in 62 severely injured patients being evacuated to Royal Darwin Hospital. This paper describes the planning and execution of the Intensive Care Unit disaster plan in the wake of the Bali bombing. There were a total of 20 patients from the Bali blast admitted to the Intensive Care Unit. The disaster operation was successful with all patients admitted, resuscitated, emergency treatment performed and then evacuated to interstate burns units in a timely and efficient manner.
Adolescent↗
Disaster training for emergency physicians in the United States: a systems approach.
Disaster strikes more frequently and with greater impact than ever before, and the demand for improved community disaster preparedness rises. The American College of Emergency Physicians (ACEP), in collaboration with the Federal Emergency Management Agency (FEMA), has responded by developing a 16-hour course that prepares emergency physicians and other emergency providers to serve as knowledgeable members of their community's disaster team. The course was developed using a standard instructional design system to cover the basic components of disaster planning and emergency medical operations, including: disaster elements, general planning and organization, victim flow, communication, evacuation modalities, field and hospital management, documentation, public relations, and application to the local community. The 35 national faculty members present the course on a geographic basis across the United States. Further considerations for emergency medicine in the disaster domain include questions of education, research and the formation of a network to coordinate with other medical, health, and nonhealth care sectors nationally and internationally.
Curriculum↗
Worst tornadoes in years: how hospitals fared; critical lessons learned.
Tornado warnings have not been uncommon in many areas of the country this year and when twisters touch down, they can be extremely deadly. When tornadoes swept through Florida's Osceola County in late February, they caused 38 deaths and wide-spread damage. In April, tornadoes caused a number of deaths and considerable damage in Nashville, TN; Birmingham, AL; and Gainesville, GA. Hospitals in those areas that bore the brunt of treatment of victims activated disaster plans. This report relates their experiences and the lessons learned from them.
Communication↗
The local Red Cross in time of disaster: characteristics and conditions of organizational effectiveness during the Loma Prieta earthquake and central Texas floods.
This discussion demonstrates that three interrelated activities should improve volunteer organizations' disaster capabilities. These factors include improved disaster planning, learning from related experiences, and improving interorganizational networks. These three activities can dramatically improve the local chapter's emergency response. Networking ought to be the first priority. Through the development of both formal and informal contacts, planning and experience potential become enhances. Without the support and involvement of volunteer organizations, an effective community-wide disaster response would be difficult, if not impossible.
California↗
Disaster preparedness: institutional capacity building in the Americas.
Latin American and Caribbean countries are prone to natural, technological and "complex" disasters. This vulnerability to catastrophic events led the region to undertake the long journey away from an ad hoc response towards institutional preparedness and, more recently, to disaster prevention and mitigation. This article attempts to outline the definitions and basic principles of institutional emergency preparedness, including reliance on the more effective use of existing resources, rather than establishment of special stockpiles and equipment; the critical importance of general participation and awareness; and the interrelationship of the health sector with others and the potential for leadership. How to assess the level of preparedness is discussed. Stress is placed on the fact that preparedness is traditionally confused with the existence of a written disaster plan. Preparedness should be seen as a never-ending, complex process that can only be assessed through an in-depth review of coordination, planning, training and logistic elements. There is also a fundamental distinction between preparedness, i.e., "getting ready to respond" and disaster prevention/mitigation, which aims to reduce the health impact. The latter calls for the collaboration of engineers, architects, planners and economists with the health sector. It is illustrated by the regional initiative in the Americas to reduce the physical vulnerability of hospitals to earthquakes and hurricanes. In spite of the encouraging achievements, much remains to be done. Weak areas include preparedness for technological disasters, and a true inter-country preventive approach to common disasters across borders. Electronic communications through the Internet will also help to suppress borders and boundaries, contributing to a truly collective approach to emergency preparedness and disaster relief coordination.
Caribbean Region↗
Integration of disaster mental health services with emergency medicine.
Despite limited resources, emergency medical settings will be called upon to play many roles in the context of disasters and terrorist attacks that are related to preparedness, surveillance, mental health services delivery, and staff care. Such settings are a central capture site for those individuals likely to be at highest risk for developing mental health and functional problems. Because much of the potential harm to survivors of disaster or terrorism (and their families) will be related to their mental health and role functioning, preparedness requires the active integration of behavioral health into emergency medicine in every component of disaster response. There are many challenges of doing this including: (1) finding ways to integrate activities of the medical care, emergency response, and public health systems; (2) determining whether an incident has actually occurred; (3) making differential diagnoses and managing other aspects of initial medical needs; and (4) coping with the risks associated with system overload and failure. Delivery of direct mental health care must include: (1) survivor and family education; (2) identification and referral of those requiring immediate care and follow-up; (3) group education and support services; and (4) individual counseling. In order for effective response to occur, the integration of psychosocial care into disaster response must occur prior to the disaster itself, and will depend on effective collaboration between medical and mental health care providers. At workplaces, emergency medical care centers must ensure that staff and their families are properly trained and supported with regard to their disaster functions and encouraged to develop personal/family disaster plans.
Disaster Planning↗
Morbidity of Hurricane Frederic.
On September 12, 1979, Hurricane Frederic struck the Gulf Coasts of Mississippi and Alabama. A retrospective review of emergency department logs for a three-week period surrounding the storm was conducted to determine the amount and type of back up needed for an emergency department to cope with the results of such a disaster. There was a significant increase in the number of patients presenting to the emergency department for at least two weeks after the storm, with the greatest demand being for professionals skilled in outpatient trauma management. The nature of hurricanes is discussed, as are specific items to be considered in disaster planning for areas subjected to these storms.
Disaster Planning↗