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PubMed1996

Disaster nomenclature--a functional impact approach: the PICE system.

A standard nomenclature that concisely describes any disaster is currently lacking. This article describes a model taxonomy system. Instead of the term "disaster," a root word "PICE," "potential injury-creating event," is used. Descriptive modifiers to account for all possible scenarios surround this root word, as illustrated. [table: see text] A modifier is chosen from each column and a stage is assigned to each PICE. Column A describes the potential for additional casualties. Column B describes whether resources are overwhelmed and, if so, whether they must simply be augmented (disruptive) or they must first be reconstituted (paralytic). Column C describes the extent of geographic involvement. "Stage" refers strictly to the likelihood that outside medical assistance will be needed. Stage 0 means there is little chance, stage I means there is a small chance (place outside help on "alert"), stage II means there is a moderate chance (place on "standby"), and stage III means local medical resources are clearly overwhelmed (immediately dispatch outside resources, commit personnel, prepare remote hospitals). For example, a multiple vehicle crash in a large city would be a "static, controlled, local PICE, stage 0." In conclusion, a new nomenclature for describing disasters is reported. A short phrase describes the incident and communicates the need for outside assistance. The model may be useful for disaster planning, management, and research.

Disasters↗
PubMedDate not supplied

Public relations in disaster management and planning for emergency physicians.

The goal of this article is to serve as a primer of disaster public relations. It will explain the requirements of the media and how best to incorporate their ubiquitous presence to the advantage of the disaster team, including how to give an effective interview, how and where to establish a media center, and the importance of sensing what will make the strongest visual or textual impact. In any disaster response, the media will play a large role. Their presence is condoned by the law and expected by the public. In reality, a reporter will probably arrive at the scene of a disaster before the first health care professional. It is only through the knowledge of the media's needs, and an appreciation of the ways in which it can assist the disaster team, that planners can best forge a relationship with the media that will confer the greatest mutual benefit.

Disaster Planning↗
PubMed2002

Does EMTALA apply during a disaster?

A statement from Medicare says that disaster plans for transferring triaged patients may supercede the usual EMTALA requirements, but this is true only in certain scenarios. During a disaster, it's unacceptable to transfer a patient to a more appropriate facility if doing so amounts to refusal of lifesaving care. Don't assume that patients will be diverted successfully to appropriate facilities after a large-scale disaster. The required level of documentation under EMTALA may not be possible during a disaster, but some type of documentation is necessary.

Bioterrorism↗
PubMed2005

Disaster management teams.

PURPOSE OF REVIEW: All disasters, regardless of cause, have similar medical and public health consequences. A consistent approach to disasters, based on an understanding of their common features and the response expertise they require, is becoming the accepted practice throughout the world. This strategy is called the mass casualty incident response. The complexity of today's disasters, particularly the threat of terrorism and weapons of mass destruction, has increased the need for multidisciplinary medical specialists as critical assets in disaster response. A review of the current literature emphasizes the expanding role of disaster management teams as an integral part of the mass casualty incident response. RECENT FINDINGS: The incident command system has become the accepted standard for all disaster response. Functional requirements, not titles, determine the organizational hierarchy of the Incident Command System structure. All disaster management teams must adhere to this structure to integrate successfully into the rescue effort. Increasingly, medical specialists are determining how best to incorporate their medical expertise into disaster management teams that meet the functional requirements of the incident command system. SUMMARY: Disaster management teams are critical to the mass casualty incident response given the complexity of today's disaster threats. Current disaster planning and response emphasizes the need for an all-hazards approach. Flexibility and mobility are the key assets required of all disaster management teams. Medical providers must respond to both these challenges if they are to be successful disaster team members.

Disasters↗
PubMedDate not supplied

The Gulf War: the experience of a department of anesthesiology in the management of Scud missile casualties.

BACKGROUND: The pivotal role of anesthesiologists in the implementation of disaster plans is not widely appreciated. OBJECTIVE: To describe the role of anesthesiologists as managers in the operating room (OR) especially during hospital disaster management. METHODS: On 25 February 1991, King Fahd Hospital of the University in Eastern Saudi Arabia, was alerted, received, triaged, and treated the victims of a Scud missile attack on a United States military barracks which killed 28 and injured more than 100 service personnel. RESULTS: There were 47 males and 15 females admitted to the hospital. Their initial triage categories of injuries were: 1) red, 23; 2) yellow, 27; and 3) green, 7. The flow of patients through the main operating rooms occurred in two peaks: 1) treated within nine hours (60%); and 2) during the next 11 hours (40%). A total 101 units of blood and blood products were consumed. The role of the Chief of Anesthesiology was vital in the dynamics of the situation regarding appropriate deployment of staff and ensuring an orderly throughput of victims in the operating room. He also was required to keep track of resources and supply levels in the operating room, so that he could advise the hospital administration appropriately. CONCLUSION: The successful management of a large multi-casualty incident, which involved use of the operating rooms, depended upon the efficient coordination of clearly defined functions with the Chief of Anesthesiology Service as the team leader.

Adult↗
PubMedDate not supplied

Planning for burn disasters: lessons learned from one hundred years of history.

The terrorist attacks of September 11th have prompted interest in developing plans to manage thousands of burn casualties. There is little actual experience in the United States in managing disasters of this magnitude. As an alternative, lessons may be learned from the historical experiences of previous civilian burn or fire disasters occurring in this country. A review of relevant medical, fire service, and popular literature pertaining to civilian burn or fire disasters occurring in the United States between the years 1900 and 2000 was performed. In the 20th century, 73 major U.S. fire or burn disasters have occurred. With each disaster prompting a strengthening of fire regulations or building codes, the number of fatalities per incident has steadily decreased. Detailed examination of several landmark fires demonstrated that casualty counts were great but that most victims had fatal injuries and died on the scene or within 24 hours. A second large cohort comprised the walking wounded, who required minimal outpatient treatment. Patients requiring inpatient burn care comprise a small percentage of the total casualty figure but consume enormous resources during hospitalization. Burn mass casualty incidents are uncommon. The number of casualties per incident decreased over time. In most fire disasters, the majority of victims either rapidly die or have minimal injuries and can be treated and released. As a result, most disasters produce fewer than 25 to 50 patients requiring inpatient burn care. This would be a rational point to begin burn center preparations for mass casualty incidents. A robust outpatient capability to manage the walking wounded is also desirable.

Burns↗
PubMed2006

Are regional hospital pharmacies prepared for public health emergencies?

INTRODUCTION: In the event of a major chemical, biological, radiological, nuclear, or explosive (CBRNE) attack or a natural disaster, large quantities of pharmaceuticals and medical supplies may be required with little or no warning. Pharmaceutical surge capacity for immediate response, before Strategic National Stockpile (SNS) supplies become available, remains a significant gap in emergency preparedness. To date, limited attempts have been made to assess collective regional hospital pharmaceutical response capabilities. In this project, we characterized the level of hospital pharmaceutical response preparedness in a major metropolitan region. METHODS: The Johns Hopkins Office of Critical Event Preparedness and Response (CEPAR) convened a collaborative partnership to assess hospital pharmaceutical response capabilities. A survey was developed to characterize pharmaceutical response preparedness to CBRNE threats. RESULTS: All 22 acute care hospitals in the Maryland region were sent pharmaceutical response surveys, and responses were received from 86% (19/22). Within the past year, 84% (16/19) of hospitals had implemented an exercise with pharmacy participation. More than half of the hospitals expect to receive assistance from the SNS in 48 hours or less. Seventy-four percent (14/19) of the hospitals reported an additional dedicated reserve supply for biological events, 74% (14/19) for chemical events, and 58% (11/19) for radiological events. CONCLUSION: Many hospitals in this metropolitan region have taken important steps toward enhancing pharmaceutical preparedness. However, hospitals generally remain underprepared for CBRNE threats and collectively have limited supplies of antibiotics to provide prophylaxis or treatment for hospital staff, their families, and patients in the event of a significant biological incident.

Disaster Planning↗
PubMedDate not supplied

Shelter in the storm: disasters put hospitals to the test.

If disaster response is the ultimate test of our health care delivery system, California hospitals over the past three years have been subjected to what seems like final exams. Beginning with the Loma Prieta earthquake in 1989 and continuing with the Oakland firestorm in October 1991, the I-5 dust storm in November 1991, the Cape Mendocino quake in April, the Los Angeles riots in May, the Landers and Bear Lake quakes in June, and forest fires throughout the summer, California hospitals have risen to each and every occasion, showing consistent dedication to quality care while under tremendous stress. During these disasters, hospitals served as shelters in the storm for their communities, as thousands of wounded, sick and frightened poured through their doors. Staff performed more than their usual duties during these crises. Some worked double shifts. Others came to work and pitched in even though they were off duty. Many comforted patients while they worried about the safety of their own families and homes. Following are the experiences of some of these individuals.

California↗
PubMed1994

Special report. The 1994 Southern California earthquake: its continuing impact on area hospitals and some lessons it can teach all hospitals on disaster preparedness.

The massive earthquake that rocked Southern California on January 17 left area hospitals facing both an influx of patients and heavily damaged facilities. Several hospitals were forced to shut down temporarily, although in most cases not before quake victims were triaged and other patients were safely transferred to other facilities. With damage totals still being calculated and repair projects just under way, several hospitals already are evaluating their response to the quake in an effort to be even more prepared should another disaster of that magnitude occur. This special report will provide an overview of the damages suffered by several hospitals; describe the role played by administrators and staff--particularly the security department--in the aftermath of the quake; and offer advice from hospital officials on how to best prepare for an earthquake or another natural disaster and how to function most effectively in the aftermath.

California↗
PubMedDate not supplied

Tsunami aftermath.

Explore the source record for details and available documents.

Adult↗
PubMed1980

Medical coordination in airport disasters.

The goals of an Airport Disaster Plan includes the care, treatment and transportation of the wounded with the quality and quantity of care that minimizes the mortality and morbidity of the survivors of a crash. Coordination of the medical aspects of these plans requires participation by physicians, nurses, ambulance and hospital personnel, psychologists, and psychiatrists. To maintain these divers groups in a state of readiness for a potential disaster which may have a frequency of 5-20 years is a challenging problem. This paper addresses methods of accomplishing this goal.

Aircraft↗