New Challenges Unpredictable •In Numbers •In timing •In types of injury
Hospital Care Challenges & Solutions Part I Demand exceed Supply – Major Incident Plan – Triage Mumbai victim – ATLS Guidelines
Major Incident PlanSummon the medical and paramedical personnel and ask them to report to reception When to initiate… Action Card 1 – >20% of bed capacity Surgical Registrar Who does what… •Go to Resus room 1 •Take lead role – Action Card •Manage Victim as per ATLS •You will have 2 nurses Plan & Prepare….. •Treat critical & urgent cases •Transfer to OT/ICU – In Fine details •Ready for next case
Incident Controller (MD) Clinical Coordinator Administrative Coordinator Surgeon Radiologist Nursing Supervisor HR Manager Human Relations Staff Anesthetist Nurses Paramedical staff Police PressTreatment Priorities Public Lab ER Blood bank OT Pharmacy Wards Suppliers
Do the most to the most…. ABC of Triage By Whom…..: Senior Surgeon Where……….: Field Vs Hospital How………….: Colour stickersRed Immediate Airway obstruction Resus room Tension Pneumothorax Severe bleedingYellow Urgent Internal bleed Treatment Room (30min) Head Injury Long bone #Green Delayed Soft tissue injury Assessment Minor # UnitBlack Dead Brought dead Mortuary Triage Tag Treatment Transport
ATLS Guidelines Address the ‘Life threatening injuries’ First Primary Survey – Airway, Breathing, Circulation Secondary Survey – Head to foot evaluation – Scans and Tests….
Principle of Management ATLS Principle – Life saving vs. Limb or Look saving operations Thorough Evaluation – Clinical and radiological Debridement Damage control surgery Manage Hypovolumia, hypothermia, sepsis
Chemical and Bio Terrorism 1980s Sadam on Kurd population 1984 Rajneeshee Bioterror attack – With Salmonella typhimurium in Dallas, 2001 Anthrax scare in the letters – To US Senate offices How to prepare ourselves to tackle such catastrophe?….