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PubMedDate not supplied

Anticipating wildcards.

Wildcards are simply events that have a low chance of materializing but have the potential to significantly change the operating environment. Every hospital has a well-established disaster plan that spells out the organization's response to an emergency condition that is unlikely to ever occur. Wildcard strategic planning is a logical extension of this concept, with the focus shifted to the organization's survival rather than medical care for individuals and communities.

Certificate of Need↗
PubMed2001

Use this proven system for disaster communications.

The Hospital Emergency Incident Command System (HEICS) system uses a logical management structure, defined responsibilities, and clear reporting channels to help the hospital communicate with outside emergency responders. The system is considered a benchmark for EDs to implement as an integral part of your disaster plan. Flow charts and job action sheets are used to clearly define responsibilities of individuals. The system uses the same terminology as other first responders, so communication is easier.

Benchmarking↗
PubMed1987

Evacuation of patients during a fire at a general hospital.

The epidemiology of hospital fires is described briefly, followed by a case report of the evacuation of 150 patients from a general hospital during a fire. A theoretical framework for the analysis and management of such situations is developed and illustrated. The need for flexibility in the development of disaster plans, the need to simplify plans and reduce the number of staff involved, the need to tailor plans to meet the demands of specific situations, and the need for immediate planning to reopen the facility are stressed. The development of "fire-safe" elevators to assist the evacuation of most patients is particularly important to future hospital design.

Disaster Planning↗
PubMedDate not supplied

The 1994 eruption of the Rabaul volcano, Papua New Guinea: injuries sustained and medical response.

On 19 September 1994, with little warning, two volcanoes erupted at the Rabaul caldera, affecting the heavily populated Gazelle Peninsula, East New Britain Province, Papua New Guinea. Local health services were able to deal with the disaster without additional external resources. The preparedness of the population and their knowledge of safe areas gained from a disaster plan widely publicized a decade earlier contributed to the low number of casualties.

Adult↗
PubMed1998

[The disaster preparedness concerning personnel at the hospitals in the Disaster Preparedness Region II: Viborg, Ringkjøbing and Aarhus counties].

The aim of this investigation was to describe the disaster preparedness concerning hospital staff members in Viborg, Ringkjøbing and Arhus county, and to describe the outcome of the disaster medicine-courses given in the region--in theory as well as practice. In the region a questionnaire was sent to the chief doctor and chief nurse for the involved departments, and a personal questionnaire was sent to all the doctors and nurses in the region, who had participated in one or more courses in disaster medicine during the period 1990-1995. Of the total number of doctors at the involved departments, 7% of the residents, 29% of the senior residents and 56% of the consultants had taken a course in disaster medicine, as had 33% of the nurses. Only 15% had taken more than one course, and as few as 2% had had a follow-up course to the primary one given in the region. Forty-one percent had used their acquired knowledge either in theory or practice: 55% for educational purposes, 11% for disaster planning and 12% for buying equipment for the hospital. In general an easier access to follow-up is desired, and there seems to be a need to give more consideration to the priorities of the individual departments concerning the selection of participants to the courses in disaster medicine.

Clinical Competence↗
PubMed2002

Overcrowding and fiscal pressures in emergency medicine.

Emergency departments in America are disappearing at an alarming rate. Those that remain face a daily ordeal of overcrowding and budgetary shortfalls. The reasons for this phenomenon include changes in reimbursement rates by managed care organizations, the nationwide reduction of hospital beds, the nursing shortage, a more acute patient mix, and a general deterioration of the healthcare safety net. Another reason--more vital today than ever before--is the uncompensated integration of EDs into governmental disaster planning and response. Despite their importance to society, the emergency department is the first to be cut. Emergency departments are much more than the nation's last line of defense for the medically indigent; they are the frontline caregivers to all of us, providing care during our most vulnerable times: emergencies and disasters.

Disaster Planning↗
PubMed1991

National medical response to mass disasters in the United States. Are we prepared?

Preparing for a resuscitation response to mass disasters, such as major earthquakes or industrial disasters, requires revisions of present local, regional, and national disaster plans. These should include the following: (1) life-supporting first aid and basic rescue capability of the lay public; (2) advanced trauma life support and advanced (heavy) rescue capability brought quickly to the scene from local and surrounding (regional) emergency medical services systems; and (3) trauma hospitals sending medical resuscitation teams to, and receiving casualties from, the disaster scene for resuscitative surgery and definitive care. Local and regional everyday emergency medical services systems would respond first. The armed forces should help, at least for transport and security. We propose that the National Disaster Medical System replace its civil defense model with an emergency medical services model, designed to mobilize rapid support for local emergency medical services systems from regional, state, and national resources. Coordination should be by one federal agency, such as the Federal Emergency Management Agency, which, however, needs to focus more on resuscitation through physician input.

Disaster Planning↗
PubMedDate not supplied

Vaccine administration by paramedics: a model for bioterrorism and disaster response preparation.

The events of 11 September 2001 have had a profound effect on disaster planning efforts in the United States. This is true especially in the area of bioterrorism. One of the major tenets of bioterrorism response is the vaccination of at-risk populations. This paper investigates the efficacy of training emergency medical services paramedics to administer vaccines in public health settings as preparation for and response to bioterrorism events and other disaster events. The concept of vaccination administration by specially trained paramedics is not new. Various programs to provide immunizations for emergency services personnel and at-risk civilian populations have been reported. Vaccination programs by paramedics should follow the guidelines of the National Vaccine Advisory Committee of the Centers for Disease Control and Prevention (CDC). This paper compares the seven standards of the CDC guidelines to routine paramedic practice and education. It is concluded that paramedics are adequately trained to administer vaccines. However, specific training and protocols are needed in the areas of administrative paperwork and patient education. A proposed outline for a paramedic-training program is presented.

Bioterrorism↗
PubMed1986

New concepts in triage.

The triage process is a valid concept in the initial approach to multiple casualties. Triage tags are, in theory, a reasonable adjunct to the process, but have proved to be a failure in practice. Based on the historical perspective and on the authors' experience with approximately 180 mass casualty drills and incidents, it is recommended that the "daily routine doctrine" be applied and that conventional, color-coded triage tags be replaced by a process of "geographical triage." A valid model for disaster planning is needed, and organizers must conduct drills that are based on the actual threat to the community in order to determine the most efficacious way to manage medical response.

Disaster Planning↗
PubMed1999

It's a disaster: emergency departments' preparation for a chemical incident or disaster.

Nurses in the Accident & Emergency (A&E) Department have a significant role to play in the treatment and resuscitation of victims of a chemical disaster. Chemical disasters are unique because casualties are contaminated. Nursing staff triage casualties and they have direct contact with contaminated patients, before and during decontamination. Consequently they require adequate personal protective equipment and information regarding isolation and decontamination. The use of chemicals has increased since the turn of the century. Hazardous chemical emergencies arise from accidents in production, storage, transportation and the disposal of chemical substances. Their illegal manufacture and use by terrorists makes the likelihood of a chemical disaster with mass casualties in Australia very real. Emergency departments are ill-prepared to deal with this scenario, and very few disaster plans include a comprehensive decontamination component. To achieve an effective response with the best utilisation of resources, it is vital for emergency services personnel and A&E departments to be prepared.

Accidents, Occupational↗
PubMed2001

Evaluation of trauma registry data in Asir region.

OBJECTIVE: To analyze and report trauma registry data; to assess the validity, reliability, and feasibility of the trauma registry; and to discuss lessons learned from this event. METHODS: A pre-designed trauma registry data was used for all injured patients admitted to Asir Central hospital after being involved in a major motor vehicle accident. A survey team registered and analyzed the trauma registry data using the statistics software SPSS for windows. RESULTS: Eighty-five patients were admitted to the hospital with different injuries. All victims were males with a mean age of 27 years. Injuries were dominated by musculo-skeletal trauma followed by neurotrauma, thoracic, and abdominal trauma respectively. Pre-hospital data was deficient and most of the hospital in-patient's information was taken from the nurse's notes. Standard elements of the trauma registry were found essential for optimal trauma care. Morbidity was related mainly to neurological trauma. Mortality was related to head injury followed by thoracic and abdominal injuries. CONCLUSION: Trauma registry was valid, reliable, and feasible. A national trauma registry program should be established. Trauma registry, prehospital care, and disaster planning and management should be integral parts of a regionalized trauma care system. Successful trauma care systems have shown significant reductions in morbidity and mortality from trauma.

Accidents, Traffic↗
PubMed1983

The Hyatt Regency skywalk collapse: an EMS-based disaster response.

The Hyatt Regency skywalk collapse (July 17, 1981) provided the emergency medical services system of Kansas City, Missouri, with its greatest challenge ever. Utilizing an EMS-based, centralized, city-wide disaster plan, the rescue operation encountered 113 dead and 188 multiply traumatized patients. The rescue operation could be divided into three areas: initial response, onset triage, and delayed extrication. Success of the operation was credited to several factors, including the centralized urban location of the collapse, short patient transport times, centralized ambulance dispatch, availability of ALS vehicles and personnel to the scene, and mutual aid response. Short-comings of the rescue that became apparent on critical review of the response included poor communications at the scene, lack of physician bystander control, and the need for identification of key personnel at the site. Success in responding to the health care needs of a disaster included a flexible and well-organized disaster response plan as well as the support of a health care system capable of picking up the pieces of the psychological aftermath.

Disasters↗
PubMed2001

Management of multiple burn casualties in a high volume ED without a verified burn unit.

The objective of the study was to evaluate the effectiveness of triage, treatment, and transfer interventions on multiple burn casualties managed in a high volume ED that does not have a verified in-hospital burn unit. The charts of 11 male patients injured in a 1999 foundry explosion and brought to Baystate Medical Center (BMC), a level I trauma center, were reviewed. All patients sustained deep partial and full thickness burns. The injury severity score (ISS) ranged from 9 to 75. Five patients had total body surface area (TBSA) burns of 10% to 50% and 6 patients had TBSA burns of 70% to 95%. Transfer times from the scene to BMC ranged from less than 5 minutes to 22 minutes. All 11 were initially triaged, resuscitated, and evaluated at BMC. Of the 9 patients transferred to verified burn units, 8 were intubated, 6 of 6 had negative abdominal ultrasounds, 4 had undergone escharatomies, and 1 had undergone bronchoscopy before transfer. Nine critically injured burn patients with ISS of 9 to 75 were transferred from BMC to verified burn units. For 8 of these patients, the average time from triage, evaluation, and treatment to transfer was 2 hours. The ninth patient was initially admitted overnight then promptly transferred after re-evaluation of his hand burns indicated a need for more specialized care. Two of 9 transferred patients, both with ISS of 75 died. Although 7 other patients had prolonged and complex courses, none of their subsequent complications were referable to missed injuries from this transferring facility. The resources and expertise of a high volume ED without an in-hospital burn unit can be effectively used in the initial resuscitation and treatment of multiple burn casualties. Coordinated responses among emergency medicine, trauma, anesthesia, and nursing personnel are instrumental to the rapid triage, resuscitation, and treatment of critically injured burn patients. Future disaster planning should incorporate a clearly demarcated, ED command center led by an easily identifiable "captain of the ship," as well as more accurate patient identification systems and improved communications with family members.

Adult↗
PubMed2003

Different medical needs between hurricane and flood victims.

OBJECTIVE: Through the review of patient records seen by the New Mexico-1 Disaster Medical Assistance Team (NM-1DMAT) after various disasters, we hoped to find patterns that might help in disaster planning. Our hypothesis was that flood and hurricane victims have different medical conditions and needs. METHODS: We conducted a retrospective review of patient records for NM-1DMAT deployments to Hurricane Andrew in Florida (August 1992) and the Houston, TX flood caused by Tropical Storm Allison (June 2001). We compared age, gender, chief complaint, medical history, diagnosis, diagnostic testing, treatment rendered, triage category, and patient disposition. RESULTS: We found several differences between the patients presenting after Hurricane Andrew and those presenting after Tropical Storm Allison. The chief complaint, diagnosis, presence of medical history, diagnostic testing, treatment rendered, triage category, and disposition all differed between the 2 disasters. The mean ages in both groups were similar. CONCLUSIONS: The needs of the patients differed in several areas between Hurricane Andrew and the Houston flood. This information should be tested in a future hurricane or flood and taken into account when planning for deployments.

Adult↗
PubMed1996

Disaster preparedness of poison control centers in the United States.

OBJECTIVE: To assess the state of disaster readiness of poison control centers, a survey questionnaire was sent to all 96 institutional poison control center members of the American Association of Poison Control Centers in the US, both certified and noncertified programs. DESIGN: The data reported are the results and responses from 76 of 96 (79.2%) poison control centers. RESULTS: Fifty-four percent of responding centers have written disaster plans, with 25% having drills to practice the plans. Of the centers that do not have a written plan, the majority have policies and procedures in place to address physical plant damage, increased phone traffic, loss of phone systems and malfunction of computers. Eighty-six percent of respondents have a back up generator, and 82% have an uninterruptable power supply in place. Fifty-four percent have a back up phone system and 33% have cellular phone capacity. Forty-six percent of responding centers have arrangements with other agencies in the event of a disaster. Only half of the managing directors of the responding centers believe their center can meet the public's needs in the event of a disaster.

Disaster Planning↗
PubMed1999

Dealing with school shootings, violence: how Jonesboro and Denver hospitals met this new challenge to emergency preparedness.

Acts of violence at schools across the country committed by gun-wielding students in recent years have all too frequently, as we know by now, resulted in multiple casualties and widespread community grieving. Two of the shooting rampages noted in this report that attracted national and international media attention--one at West-side Middle School, Jonesboro, AR, on March 24, 1998, and the other at Columbine High School, Littleton, CO, on April 20, 1999--illustrate the importance of hospital preparedness and quick implementation of emergency disaster plans. In both instances, officials say their administrative, clinical, and security personnel were well prepared to handle the physical and emotional trauma caused by the tragedies. Meanwhile, a leading criminologist warns that the trend toward school violence likely will continue and provides tips for hospitals and their security directors.

Adolescent↗
PubMed1990

Burns caused by the terrorist bombing of the department store Hipercor in Barcelona. Part I.

A retrospective study was made of the treatment of 20 of the 66 casualties resulting from the terrorist bombing of the department store Hipercor in Barcelona in June 1987. The additional pressure of the work imposed on several units in the Hospital including the Burn Centre, the Sterilization, Radiodiagnosis, Pharmacy and Medical Units, and nursing staff, and the Intensive Care unit is described. The types and volumes of fluid therapy administered are also reported. The results of the study indicated: (1) the need for a disaster plan; (2) that burn centres should be integrated in large hospitals able to provide assistance from several units, and (3) the management of burns should involve debridement and wound coverage as soon as possible.

Adult↗
PubMed1994

Investigation of the 1987 Indianapolis Airport Ramada Inn incident.

On October 20, 1987, a military reserve aircraft lost power during a transcontinental flight and attempted an emergency landing at The Indianapolis International Airport. The pilot ejected and the disabled and pilotless aircraft struck a bank building. It then skidded across the street and entered the lobby of The Airport Ramada Inn where it exploded. This incident was unusual in that the fatal injuries occurred in individuals on the ground and not in the occupant of the aircraft. Seven people were killed in the lobby area and two were trapped in a laundry where they died of smoke inhalation. A tenth person died of burns ten days later. Minor injuries were reported among four hotel guests, two firefighters and the Air Force pilot. A multiagency mass disaster-plan had been formulated and rehearsed in preparation for the Panamerican Games, which had been held in Indianapolis in August 1987. A number of volunteers arrived before a security perimeter was established. They began an undocumented removal of the bodies from the scene and were about to remove valuables for "safekeeping" when stopped by coroners' office personnel. Fatalities resulted from smoke inhalation, burns or a combination. Bodies were identified by a combination of dental records, personal effects and visual means within 24 hours. The problems encountered in managing this disaster scene will also be compared with previously reported incidents.

Accidents, Aviation↗