Mass disaster management for ams


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Mass disaster management for ams

  1. 1. Mass Disaster/MajorAccident Management Dr.S.Easwaramoorthy MS FRCS (Edinburgh) FRCS (England) FRCS(Glasgow) Lotus Hospital Erode
  2. 2. Feb 14, 1998, Coimbatore
  3. 3. World Trade Centre, New York
  4. 4. London….
  5. 5. Attack on Indian Parliament
  6. 6. Mumbai Terrorist Attacks
  7. 7. Tranquility to ‘Terror’
  8. 8. New Challenges Unpredictable •In Numbers •In timing •In types of injury
  9. 9. Hospital Care Challenges & Solutions Part I Demand exceed Supply – Major Incident Plan – Triage Mumbai victim – ATLS Guidelines
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. ATLS Guidelines Address the ‘Life threatening injuries’ First Primary Survey – Airway, Breathing, Circulation Secondary Survey – Head to foot evaluation – Scans and Tests….
  14. 14. Primary SurveyTension Pneumothorax
  15. 15. Primary Survey Flail Chest
  16. 16. Primary SurveyTraumatic Diaphragmatic rupture
  17. 17. Hospital Care Challenges & Solutions Demand exceed Supply – Major Incident Plan – Triage – ATLS Guidelines Unique nature of Injuries
  18. 18. Hospital Care Challenges & Solutions Part II Means of Terrorism Conventional Agents – Bomb blasts, bullets, burns Biological Agents – Anthrax, Plague, Small Pox Chemical Agents – Nerve gas, Mustard gas Radiation Agents – Nukes, Dirty bombs
  19. 19. Bomb Blast
  20. 20. Bomb Blast Car bomb blast… Blast Wind Secondary Missiles Collapse of buildings Burns
  21. 21. Of course, Damage is proportional to amount of explosives..
  22. 22. Suicide Bomber in a bus… Bomb Blast in Closed space Vs Open space
  23. 23. Blast Injuries Ruptured ear drum… Contused Lungs…… Perforated Bowel….Ear Drum Lungs Bowels
  24. 24. Blast injury left upper arm…
  25. 25. Bilateral traumatic leg amputations…
  26. 26. Secondary Missiles
  27. 27. Role of Imaging Modalities
  28. 28. Burns
  29. 29. 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
  30. 30. 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?….
  31. 31. Tokyo: Sarin Gas
  32. 32. Chemical/Bio TerrorismGuidelines of Management 1. Protective Gear for the Staffs 2. Triage 3. Decontamination of patients 4. Isolation and treatment
  33. 33. Hospital Care Challenges & Solutions Demand exceed Supply – Major Incident Plan – Triage – ATLS Guidelines Unique nature of Injuries – Bombs & Bullets – Bioterrorism – Chemical Injuries Psycho social aspects
  34. 34. Kill One, Frighten Ten thousand!........ -Sun Tzu, 4thCentury BC Psycho Social Aspects Suicide Bomb: Sri Lanka Mass Hysteria Panic & Depression Multiple Unexplained symptoms
  35. 35. Delhi Bomb Blast.. Near Mumbai Airport…
  36. 36. Pre Hospital Care/Field Care Scoop & Run Vs Stay & Play Paramedical Vs Medical Personnel
  37. 37. Unique Role of Firemen & Police
  38. 38. Mass Disaster Management Key MessagesPlan, Practice and PerformTriage and TreatCommunication is the key
  39. 39. Change the world, we live…
  40. 40. Change the Way, we live….
  41. 41. Surely we can change the way, we work… Team work works!DoctorsFiremenPolicePublic
  42. 42. Kindly read further about Major Incident plan Triage Bioterrorism Bomb blast Injuries Primary and secondary survey (ATLS)