Mass cas & haz chem 2013

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Mass Casualty and Hazardous Chemicals / Materials for junior doctors

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  • Service Profile outlines what our service is ie location/ service/ equipment/ staff Contingency Plan outlines if any of the above are interrupted Based on CIMS 4 x r’s MCP is what we are looking at today and how the ED responds Pending but additional plans to be added are Pandemic and Hazardous Substance Exposure Plans
  • Plan is reference tool best read before any event, ie in orientation. Be familiar. The MCP is one section of the Emergency Plan. On the day information is best accessed from the mass casualty box. Talk Stage 123
  • The stage chosen reflects the resources at that moment – what may be able to be managed M-F 8-4 may overwhelm resources on Sunday 0300 hours.
  • A collective response with clinical and non-clinical services working in unison. Each area has its own Stage 123 instructions and they have further developed these within each unit to best fulfil their responsibilities. Personnel and services are activated automatically as per the plan.
  • Solve bed block – BUT gives strategies to utilise areas not used under normal conditions. Those areas are aware and have their own Stage 123 plan to manage overflow. Solve staff shortages – BUT authorises call in of staff to adequately manage influx of patients.
  • Info received from variety of sources. Police/ ambulance/ patients arriving/ bush telegraph. Decision to activate is jointly made between ED nurse in charge and DNM.
  • Reduces the need to spend time calling in so can focus on preparing ED to receive patients. Stage 1 quite reflective of a normal day with its peaks in volume. Can be activated for ‘slow leak’ of ED becoming overwhelmed without a single incident cause.
  • The box and vest holder are on wheels and easy to move.
  • Located outside of the staff station to allow this area for clinical functioning. Co-ord to take a phone for their use. Info Point to be set at middle window of ED Reception to take details of those seeking family. Initially ED closed to visitors to ensure all patients are assessed promptly, therefore important people aware and are able to be informed.
  • The tx and orderly points can be used to write up jobs pending in whiteboard on the glass. This cuts down the phone traffic and staff can return to this list for their next job.
  • Staff who do not normally work in ED are allocated to an ED staff member. This creates small teams with staff unfamiliar with ED supported and aware who they go to.
  • Non ED staff report only to their team leader. Prevents Coord from being overwhelmed and focuses the resources with everyone knowing their role.
  • ED staff have assistance they can oversee with their patient load. ED staff remain accountable for their patient load but delegate and direct the staff in their team.
  • ED doctors/nurses, triage front and back, HCA/Recep and Non ED doctors/nurses/HCA/admin and orderly, transport nurse, cleaner Security. These give a set of instructions on how to carry out their role.
  • Those being called should resist urge to ask questions and this will delay staff. Keep the calling brief.
  • Clear trauma beds. Label corridor beds. Consider double up in rooms. Consider lazyboys and chair area in AAU to increase ED capacity until surge areas ready to receive.
  • Don’t change for a new system! A patient log is in the Coord Pack. Important for tracking patients. Will be kept at Coord point and referred to by Info Point.
  • A list of contents is in the coord pack showing what will be delivered. Focus on trauma related medications and consumables.
  • Based on 3 rd Floor Lambie. Coordinate overall response. Receive status reports and act to place resources where most needed. Inform them early of problems.
  • Mass cas & haz chem 2013

    1. 1. Mass Casualty + HazChem Dr Chris Cresswell 2013
    2. 2. Lessons from  Terrorist attacks  Chch earthquake  Tasman Tanning  Still learning and developing systems
    3. 3. Key points for docs Consider “Lock down” Get more staff including SMOs Consider diversion Consider early transfer Consider decontamination
    4. 4.  Clear ED as much as possible  Do what you would normally do (but skip some of the finer details like Family Hx and CRP, BNP). Documentation. Emergency ID  Write ID on the patient  Reverse triage is controversial  ED teams with outside assistance  Senior docs: logistics, overview, consultation
    5. 5.  Surge out to PACU, Day unit, Outpatients  Morgue  Social work
    6. 6. Emergency Management Plan  Red Folder located in ED Drug Room  Service Profile  Contingency Plan  Reduction/Readiness/Response/Recovery  Mass Casualty Plan  Pandemic Plan  Hazardous Substance Exposure Plan
    7. 7. Mass Casualty Plan  One section of Emergency Plan  Response staged into 3 tiers dependent on magnitude of event  Stage 1 = ED only  Stage 2 = ED + Hospital  Stage 3 = ED + WDHB wide + EOC +/- local, regional or national support
    8. 8. Mass Casualty Plan  To establish which stage is required refer to the MCP Flowchart  Located ED Drug Room with explanation of Stage 1, 2 & 3  Flowchart allows for MCP to be escalated as event unfolds
    9. 9. What Will it Do?
    10. 10. What Won’t it Do?
    11. 11. Activating Mass Casualty Plan  Information of event received  D/W DNM / ED Team  Decide on Stage of MCP required  DNM is the only one who can activate MCP  Notify Switchboard Operator of activation of Stage 1,2 or 3 of MCP
    12. 12. What Happens Then?  Switchboard Operator follows a list of instructions and calls in and notifies the listed staff  Staff and services activated at Stage 1,2,3 can be seen on the wall of the ED Drug Room and also in the Coord Pack of the Mass Casualty Box  Open Mass Casualty Box
    13. 13. Mass Casualty Box & Vests  Mass Casualty Box and vests are stored in the ambulance store room  Open the Box  Elect a Coord  Follow the instructions in the Coord Pack
    14. 14. Signage  Coord point by Rm3 ED outside of staff station  Triage (backdoor) outside Resus 2  Orderly & Transport Nurse @ Coord point  Info point at reception
    15. 15. More Signage
    16. 16. Allocating Roles & Areas  Vests are for ED staff only  Each role comes with a job card  Consider allocating areas/rooms to ED staff and further dividing as more staff arrive
    17. 17. ED Staff with Vests and Job Cards  ED staff manage their area and helper staff that are allocated to them  Creation of small teams allows ED staff to focus on their area and helper staff to be supported
    18. 18. Non ED Staff  Non ED staff who come to help are also given a job card, allocated to a ED staff member and given a title tag  ED and non ED staff are easily differentiated
    19. 19. Job Cards  All staff receive a job card when they check in  Gives a guide of what their role is and who to report to  Many titles – take a look and familiarize yourselves
    20. 20. Calling in ED Staff  Coord decides how many of each discipline required  Call in or delegate task to colleague  Call in until required number on way and record on Staff Log
    21. 21. Preparing ED  Liase with DNM and clear ED as much as possible  Consider Pts for discharge / TX to WR / TX to WAM / TX to Ward  Possible surge capacity SDU / PACU / OPD / ATR (All require DNM to arrange)  Clear trauma beds
    22. 22. Documentation  Do what you normally do  ID pts ASAP  Use Unknown ID if delays in registering  All pts need to go on Pt Log  This is basis for tracking pts in system
    23. 23. Supplies  Pre ordered supply of pharmacy items, linen and consumables will arrive within the first hour of a Stage 2 or 3 of MCP  List in Coord Pack
    24. 24. Emergency Operations Centre  EOC manage the overall response to event  Send Status Report to EOC hourly PRN  Can request staff, services and equipment via EOC
    25. 25. HAZCHEM  Protect yourself and the hospital  2 people to gown up
    26. 26.  Everyone from scene goes thru shower by ambulance bay  Keep faces out of pools of water!  CPR etc could continue in shower  Then patient goes through to triage etc and is considered “clean”
    27. 27. References  Thanks for those staff who kindly ‘volunteered’ as models for the photos of this presentation  Coordinated Incident Management Systems, 26/08/11. http://www.emergencymanagement.co.nz/training/in-house- training/192-cims-premier-package.html  Thanks to Midcentral DHB, Hawkes Bay DHB, Capital & Coast DHB sharing their Emergency Management Plans, 2010.  Thanks to RN Michelle Battarbee and Katie Edmonds for developing the plan and Michelle for writing the first version of this presentation

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