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PubMed2001

Warning: are you prepared to lose your ED after a natural disaster?

Natural catastrophes that can lead to loss of the ED itself are often overlooked in disaster plans and drills. Plans should address evacuation of patients, including transportation and equipment to take, and drills should include these scenarios. You should have alternatives to cope with loss of power and communications, such as oxygen-powered backup generators. To prepare for a deluge of individuals coming to the ED after a disaster, decide how to utilize volunteers, and limit access by using disaster identification vests. New Environment of Care standards from the Joint Commission on Accreditation of Healthcare Organizations require you to perform a hazard and vulnerability analysis.

California↗
PubMedDate not supplied

Developing a regional and national burn disaster response.

The supplement on burns by the National Disaster Medical System (NDMS) requires an evaluation of burn centers' and burn hospitals' capabilities for treating seriously burned victims. The American Burn Association (ABA) and its members, as experts in burn care, should take the lead in working with local, state, and federal disaster planners. Proposals based on standards adopted by the ABA support classification of facilities (levels I, II, III), identify minimum and maximum bed availability, require minimum training for personnel (e.g., ABLS), and encourage enrollment of all burn centers and burn hospitals as contract hospitals in the National Disaster Medical System. Periodically, the ABA should verify that the burn care facilities identified in the disaster plan meet its standards. Once the burn disaster system is developed, drills should be held locally on a regular basis and nationally on an annual basis.

Burn Units↗
PubMed1994

Earthquake!

Previous disaster planning and drills became a stark reality in only 31 seconds as an earthquake, 6.8 on the Richter Scale, hit Southern California. Acting as a healthcare team with clear managerial leadership alleviates panic, facilitates a calm evacuation, and accomplishes the ultimate goal--patient safety.

Disaster Planning↗
PubMed1992

Medical response to catastrophic events: California's planning and the Loma Prieta earthquake.

The threat of a great earthquake has compelled California to develop a disaster plan for catastrophic medical events that calls for local response with state-coordinated mutual aid and casualty evacuation, if necessary. During the 1989 Loma Prieta earthquake that killed 63 people and injured 3,700, local emergency medical services systems were busy but not stressed excessively. The medical mutual aid system delivered medical personnel, supplies, and blood. One hospital suffered severe nonstructural damage, but it was able to treat large numbers of casualties. Our system performed admirably in this limited response, but was hampered by difficulties with disaster intelligence, communications, emergency medical services dispatch, patient care records, hospital damage, and inadequate disaster training. We describe our state's mutual aid system, the Loma Prieta response, and lessons and recommendations for the future.

California↗
PubMed1989

Emergency health impact of a severe storm.

A severe, premature snow storm resulted in widespread loss of power, communications, and transportation in a populous region of the Northeast. Staff in hospital emergency departments centered in the path of the storm reported a large number of injuries and many unexpected health effects related to the storm. A retrospective survey of the five major hospital emergency departments serving the most heavily affected urban and suburban areas was undertaken to determine the emergency health impact of the storm and resulting operational problems. Expected findings included a decrease in emergency department visits the day of the storm, followed by a sharp increase the day after. Clean-up activities accounted for a large number of the injuries, most of which were preventable. Unexpected findings include a large number of carbon monoxide poisonings and disposition and staffing problems created by caring for many patients who lost access to customary home health care services. Emergency department staff are encouraged to engage in public education efforts that may reduce serious illness or injury related to severe weather and its aftermath. Moreover, traditional disaster plans may need to be supplemented in anticipation of the disposition and staffing problems created by a growing population of elderly patients who will be cut off from vital home health care services by severe weather.

Aged↗
PubMedDate not supplied

Sentinel markers for industrial disasters.

Workers, managers, and occupational health and safety inspectors can be trained to detect or recognize and promote action to correct sentinel markers for industrial disasters. A sentinel marker is defined as a pre-disaster warning sign of impending failure in prevention. Administrative sentinel markers are: a weak occupational health and safety program; lack of spontaneous access to top management; failure to accept responsibility for subcontractors; the absence of written disaster plans and drills for emergency response in the factory and the adjacent community; noninvestigation of prodromal leaks, exposures, spills or injuries; punishment of "troublesome" individuals reporting such prodromal events; nonuse or misuse of data on illness, injury and absenteeism; and suboptimal work conditions and supervision of shift workers. Information sentinel markers include absence of worker and community right-to-know programs, nonuse of data on earlier mishaps from similar technologies, and failure to provide toxicologic data to hospitals in the pre-disaster phase. Technological sentinel markers are: absence of fail-safe controls, interlocks and automated alarm systems driven by real-time monitoring. Transportation sentinel markers include suboptimal vehicle standards, and drink, drugs and fatigue in drivers. Preventive programs based on identification of all sentinel markers by workers are suggested to be more effective than selective action based on risk assessment analysis.

Accidents, Occupational↗
PubMed1993

Impact of a major hurricane on surgical services in a university hospital.

Hurricane Hugo struck Charleston, South Carolina, on September 21, 1989. This report analyzes the impact this storm had upon surgical care at a university medical center. Although disaster planning began on September 17, hurricane damage by high winds and an 8.7-foot tidal surge led to loss of emergency power and water. Consequently, system failures occurred in air conditioning, vacuum suction, steam and ethylene oxide sterilization, plumbing, central paging, lighting, and refrigeration. The following surgical support services were affected. In the blood bank, lack of refrigeration meant no platelet packs for 2 days. In radiology, loss of electrical power damaged CT/MRI scanners and flooding ruined patient files, resulting in lost information. In the intensive care unit, loss of electricity meant no monitors and hand ventilation was used for 4 hours. In the operating room, lack of temperature and humidity control (steam, water, and suction supply) halted elective surgery until October 2. Ground and air transportation were limited by unsafe landing sites, impassable roads, and personnel exhaustion. Surgical planning for a major hurricane should include: 1) a fail-safe source of electrical power, 2) evacuation of as many critically ill patients as possible before the storm, 3) cancellation of all elective surgery, and 4) augmented ancillary service staffing with some, although limited, physician support.

Disaster Planning↗
PubMed2006

Temblor drives ED staff, patients into outdoor tent.

Just because some disasters come without warning does not mean you shouldn't have an adequate response once it occurs. Be sure your disaster plan is in good order, and that you have a procedure in place for ensuring additional staff is available. If the is a threat to the structural integrity of your building, evacuate patients as quickly as possible. Ask maintenance and central supply to help with alternative facilities and portable equipment. Be prepared to function in less-than-ideal conditions for several days after the event.

Disaster Planning↗
PubMed2001

Disaster warning and evacuation responses by private business employees.

When people are advised that their place of employment is threatened with disaster, how do they respond? Interviews with employees (n = 406) of 118 businesses affected by one of seven recent disasters provide the first answers to this question. Multivariate analyses document the key variables that best predict variation are: 1) emergent perceptions of risk; 2) time of evacuation from work; 3) time of evacuation from home; 4) multiple evacuations; and 5) tension between work and family commitments. When warned of impending disaster, most employees initially responded with denial. Gradually, however, emergent perceptions of risk intensified especially among those living in communities in which the least amount of disaster planning had occurred or who resided in a mobile home or apartment. Highest levels of work and family tensions during these evacuations were reported by racial minority employees who had children living at home. Policy implications for these and other findings are discussed so as to pin-point changes business managers should make that will enable them to provide the leadership and compassion expected by employees.

Adolescent↗
PubMed2001

Meeting psychological needs after Chernobyl: the Red Cross experience.

The explosion that took place in reactor number 4 of the Chernobyl Nuclear Power Plant on April 26, 1986 triggered the worst civilian nuclear disaster ever reported. Following requests for assistance by the Red Cross National Societies of Belarus, Ukraine, and Russia, the International Federation of Red Cross Societies set up the Chernobyl Humanitarian Assistance and Rehabilitation Program in 1990. Although the initial needs assessment mission mentioned psychological needs as an area of interest, it was not until 1997 that the first Psycho-Social Support pilot project started in Belarus. Objectives and strategy for the psycho-social support program are detailed, as well as the challenges currently faced by the program. The specific role of the media is also reviewed. Finally, the lessons learned from this experience are reviewed, and suggestions are made for future disaster planning.

Anxiety↗
PubMed1983

Medical aspects of the 'Ash Wednesday bushfires'.

In the Dandenong mountains, within 30 kilometres of Melbourne, natural bush and Eucalypt forest hide the homes and narrow roadways of townships which were destroyed in one of the worst series of fires in Victoria's history--the 'Ash Wednesday bushfires' on 16 February 1983. In this article the medical aspects of that holocaust are classified similarly to a counter disaster plan.

Australia↗
PubMed2001

Hospital preparedness for weapons of mass destruction incidents: an initial assessment.

STUDY OBJECTIVE: We performed an assessment of hospital preparedness for weapons of mass destruction (WMD) incidents in Federal Emergency Management Agency (FEMA) Region III. METHODS: Interviews of hospital personnel were completed in 30 hospitals. Data collected included level of preparedness, mass decontamination capabilities, training of hospital staff, and facility security capabilities. RESULTS: No respondents believed their sites were fully prepared to handle a biologic incident, 73% (22/30) believed they were not prepared to manage a chemical weapons incident, and 73% believed they were unprepared to handle a nuclear event. If a WMD incident were to occur, 73% of respondents stated a single-room decontamination process would be set up. Four (13%) hospitals (all rural) reported no decontamination plans. WMD preparedness had been incorporated into hospital disaster plans by 27% (8/30) of facilities. Eighty-seven percent (26/30) believed their emergency department could manage 10 to 50 casualties at once. Only 1 facility had stockpiled any medications for WMD treatment. All facilities had established networks of communication. No hospital had preprepared media statements specific to WMD. Nearly one fourth (7/30) stated that their hospital staff had some training in WMD event management. All reported need for WMD-specific training but identified obstacles to achieving this. Seventy-seven percent (23/30) of hospitals had a facility security plan in place, and half were able to perform a hospital-wide lock down. Ninety-six percent (29/30) reported no awareness regarding the threat of a secondary device. CONCLUSION: Hospitals in this sample do not appear to be prepared to handle WMD events, especially in areas such as mass decontamination, mass medical response, awareness among health care professionals, health communications, and facility security. Further research is warranted, including a detailed assessment of WMD preparedness using a statistically valid sample representative of hospital emergency personnel at the national level.

Biological Warfare↗