This document provides an overview of emergency response to natural disasters since 9/11. It discusses key aspects of the disaster management cycle including preparation, mitigation, response, recovery and prevention. Specific natural disasters like floods, winds and earthquakes are examined. Injury patterns from collapsed buildings, winds and flooding are defined. The importance of preparation, having an incident command system and surge capacity plan are emphasized.
Everything you need to know about a disaster and their management. The slides start with an introduction of disaster their types, effects, and preventions to the initiatives taken by the government to manage reliefs and readiness.
A disaster can be defined as any occurrence that cause damage, ecological disruption, loss of human life, deterioration of health and health services on a scale, sufficient to warrant an extraordinary response from outside the affected community or area.
Everything you need to know about a disaster and their management. The slides start with an introduction of disaster their types, effects, and preventions to the initiatives taken by the government to manage reliefs and readiness.
A disaster can be defined as any occurrence that cause damage, ecological disruption, loss of human life, deterioration of health and health services on a scale, sufficient to warrant an extraordinary response from outside the affected community or area.
Disaster management (or emergency management) is the effort of communities or businesses to plan for and coordinate all personnel and materials required to either mitigate the effects of, or recover from, natural or man-made disasters, or acts of terrorism.
OUTLINES
1.Define disaster.
2.Types of disaster.
3.Phases of disaster and disaster management.
4.Consequences of disaster.
5.Disaster Nursing and role of nurses.
6.Disaster in Pakistan.
7.Conclusion
Integrating an intelligent tutoring system into a virtual worldParvati Dev
The project goal was to provide effective training to medical professionals on the SALT Triage Protocol, and to improve communication between medical professionals and military during disaster situations.
Disaster management (or emergency management) is the effort of communities or businesses to plan for and coordinate all personnel and materials required to either mitigate the effects of, or recover from, natural or man-made disasters, or acts of terrorism.
OUTLINES
1.Define disaster.
2.Types of disaster.
3.Phases of disaster and disaster management.
4.Consequences of disaster.
5.Disaster Nursing and role of nurses.
6.Disaster in Pakistan.
7.Conclusion
Integrating an intelligent tutoring system into a virtual worldParvati Dev
The project goal was to provide effective training to medical professionals on the SALT Triage Protocol, and to improve communication between medical professionals and military during disaster situations.
Pinned in a car for two hours, trapped in a building collapse for 12, fallen on the floor for 24. Each of these patients may be experiencing different, but deadly aspects of crush injury, compartment syndrome, and rhabdomyolysis. Why are some victims okay under pressure, but die suddenly when rescued and what, if anything, can EMS do about it? Real-world case-studies bring this presentation to life as it answers these questions and more by bringing you evidence based best practices, protocols and resources that you can use to treat these high-pressure and high-profile patients.
For More Information See:
www.RomDuck.com
www.RescueDigest.com
Learning Objectives: Students will be able to:
- Identify crush injury, compartment syndrome and injuries consistent with rhabdo-myolysis.
- Utilize model pre-hospital protocols for advanced care for crush injury, compart-ment syndrome and rhabdomyolysis patients.
- Integrate with trauma systems of care to provide crush injury, compartment syn-drome and rhabdomyolysis patients with the best chance of outcome.
GEMC- Crush Injury and Crush Syndrome- Resident TrainingOpen.Michigan
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
When a new security vulnerability is identified or during a large-scale attack, accurate and fast coordination is critical. While runbooks exist for many of the technical challenges, executing them in concert and filling the gaps between them requires creativity and quick thinking as well as discipline, a strong ability to read situations, and a willingness to make tough decisions.
As a content delivery network, Fastly operates a large internetwork and a global application environment, which face many security threats. Recognizing the impact security events can have, Fastly developed its Incident Command protocol, which it uses to deal with large-scale events. Maarten Van Horenbeeck, a lead on Fastly’s security team, and experienced incident commanders Lisa Phillips and Tom Daly explore how Incident Command was conceived and the protocols that were developed within Fastly to make it work. The three share a number of war stories that illustrate how Incident Command contributes to protecting Fastly, its customers, and the many end users relying on the service. Examples include a major software vulnerability that affected a Linux component in common use across Fastly and a large attack. Maarten, Lisa, and Tom cover in detail the typical struggles a company Fastly’s size runs into when building around-the-clock incident operations and the things Fastly has put in place to make dealing with security incidents easier and more effective.
This is my Grand Rounds for Nationwide Children's Hospital on 9/11/14 at 8am. This talk gives the background of National and Regional Preparedness in Columbus, OH post 9/11.
A disaster is a natural or man-made hazard resulting to physical damage or destruction, loss of life, or drastic change to the natural environment
Disaster Risk Management is a broad range of activities (as opposed to disaster management) designed to prevent the loss of lives, minimize human suffering, inform the public and authorities of risk, minimize property damage and economic loss, and speed up the recovery process
The primary objective of this research is to develop a self-organizing communication model for disaster risk management. The model should be able to provide improved communication services between individuals (or groups) during disasters. The model should be able to offer reduced latency, interruptions, and failures in communication
Background: The frequency and intensity of both natural and man-made disasters have increased substantially over the past few decades. Consequences include great suffering, massive mortality, enormous economic losses, environmental damage and lasting psychological disorders of the survivors. For this reason, community members and government agencies have high expectations regarding the quality of medical care provided during a disaster response. Disaster medicine covers all aspects of disaster response including: disaster management systems, triage, epidemiology and infectious diseases prevention and psychological management.
Objective: This study aims to asses familiarity of students of the University of Medicine/ Faculty of Technical Medical sciences with disaster medicine concepts, evaluate training needs and define the preferred teaching method. It is a cross-sectional study of 100 students selected at random. A self administered structured questionnaire was distributed to the students containing questions regarding triage categories, first aid steps, trauma treatment, biological and chemical weapons, procedures to follow in specific disasters and preferred learning method.
AAMC Table 92 Residency Readiness in the 4th Year of Medical School: Using ACGME Milestones to Assess & Prepare Medical Students for Residency
In many cases, the fourth year of medical school continues to be a lost opportunity for learning. The popularity of boot camps with an emphasis on the student’s specialty of choice continues to grow. At several institutions, the fourth year is designed to use specialty-specific milestones to improve the transition to residency. The senior year should be more robust with consideration for student assessment for selected ACGME milestones expected of an incoming resident in their designated specialty.
This lecture intended for Medical Students bound for Emergency Medicine will:
Map out 4th year for EM Applicants citing important dates and deadlines.
Discuss AAMC Standardized Video Interview and important dates associated with it’s completion.
Social Networking 201:Engaging Learners and Professional Networking with Tw...Nicholas Kman, MD, FACEP
Presentation from the Generalists in Medial Education with Larry Hurtubise (@hur2buzy) Kristina Dzara (@KristinaDzara)
Elissa Hall (@erhall1) Nicholas Kman (@DrNickKman) and Justin Kreuter (@kreutermd)
Discuss, Develop and Demonstrate strategies for leveraging social media networking sites (twitter) for dissemination of scholarly work and medical education
Compare and contrast the features and benefits of social media networking sites for development of a national reputation.
Use basic feature of Twitter like #, and @, as well as deleting tweets to best harness the potential reach of your profile, expand your social network, and develop a national reputation
1. Review background literature on:
Undergraduate Medical Education (UME) to Graduate Medical Education (GME) continuum
Competency based medical education
Current state of the 4th year of medical school
2. Describe how a clinical track based on ACGME competencies could bridge the chasm between UME and GME.
3. Identify strategies for creating specialty specific milestones reports at your institutions.
4. Identify barriers and derive solutions to these “feedforward” concepts.
Objectives
Describe how a clinical track based on ACGME competencies could bridge the chasm between UGME and GME.
Demonstrate how Clinical Tracks are improving the 4th year at our institution.
After watching this lecture, learners will be able to:
Describe the various etiologies of non-traumatic paralysis
Illustrate the neuro exam for the paralyzed patient
Recognize the signs and symptoms of acute peripheral neuropathies
Explain the treatment of acute peripheral neuropathies
Explain importance of early, consistent EM education for all medical students.
Discuss opportunities to engage & have impact throughout the 4 year curriculum.
Highlight learning communities, the “How to be a doctor course”, and EMIG.
Evaluate factors that influence a student’s choice of specialty as related to above.
Observation without Active Participation is an Effective Method of LearningNicholas Kman, MD, FACEP
Participants in team-based simulation are often assigned or self-selected to play active or passive roles
Limited data on impact of learner roles on the efficacy of simulation-based training
A few studies have suggested that observation alone may be as effective for learning as active participation in simulation
Clerkship Directors in EM has come a long way. This lecture will:
Describe the origins of CDEM
Show the progress that has been made in the past 8 years
Illustrate the challenges to the growth and success of CDEM
Offer some thoughts on the future direction of the organization
Brainstorm and discuss new frontiers.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Evolving a strategy for emergency response to natural disaster
1. Emergency Response to
Natural Disaster:
Floods, Winds, and
Earthquakes
Nicholas E. Kman, MD FACEP
Medical Team Manager, Ohio Task Force 1
The Ohio State University
Department of Emergency Medicine
Twitter @drnickkman
14. Objectives
Provide a background on Emergency Preparedness
and Disaster Response since 9/11/01.
Analyze the Disaster Response Paradigm.
Discuss Natural Disasters as they relate to
Preparedness.
Define the injury patterns from Collapsed Buildings:
crush injury, compartment syndrome, and crush
syndrome
Define the injury patterns from Wind Disasters.
Describe flooding dangers.
14
15. What we will not cover!
Ebola
Bomb and Blast
Infectious Agents of Bioterrorism
Chemical Agents of Terrorism
15
16. Disaster Defined
The United Nations Disaster Management Training
Program defines Disaster as:
A serious disruption of the functioning of society,
causing widespread human, material, or
environmental losses which exceed the ability of
affected society to cope using only its own resources.
Bonnett et al. Surge Capacity: A proposed conceptual framework.
Amer J of Emerg Med 2007; 25: 297-306.
Dominique Faget—AFP/Getty Images
17. A Disaster: more simply…
Any event that threatens or overwhelms the normal
operational capacities of the local healthcare system
and emergency medical services (EMS).
University of Wisconsin Cooperative Institute
for Meteorological Satellite Studies
20. Preparation
Getting people and equipment ready to quickly and
effectively respond to a disaster.
Conduct a Hazard Assessment
Actual and potential hazards
Develop a simple disaster plan (EOP)
Failing to plan is planning to fail!
Train all hospital staff in its application
Awareness
Technicians
Patient care
American College of Surgeons, 2008, Advanced Trauma Life Support for Doctors, American College of Surgeons. Eighth Edition.
American Medical Association, 2012, Basic Disaster Life Support, Course Manual. V. 3.0.
26. Preparation and JCAHO
6 focus areas for hospitals in disaster planning:
o Communications –internal and external to
community care partners, state/federal agencies
o Supplies
o Security – Enabling normal hospital operations and
protection of staff and property
o Staff – Roles and Responsibilities within a standard
Hospital Incident Command Structure
o Utilities – Enabling self-sufficiency for goal of 96
hours
o Clinical Activity – Maintaining care, supporting
vulnerable populations, alternate standards of care
26 http://www.jointcommission.org/emergency_management.aspx
29. Mitigation
Sustained actions taken to reduce or eliminate
long-term risk to people and property from
hazards.
Reducing effects before the event
Have an Incident Command System
HICS (Hospital Incident Command System):
organizational structure that provides direction for
management of disaster response within hospital.
Train all staff in its application and use
Plan in advance to ensure a coordinated response
American College of Surgeons, 2008, Advanced Trauma Life Support for Doctors, American College of Surgeons. Eighth Edition.
American Medical Association, 2012, Basic Disaster Life Support, Course Manual. V. 3.0.
32. Ohio Task Force-1
1 of 28 Urban Search and Rescue (US&R) teams in
National US&R Response System managed by
FEMA.
OH-TF1 also State of Ohio rescue response asset.
MA-TF1 Urban Search & Rescue Structural Collapse Tra
33. Ropes Training
Camp Ravenna Joint Military Training CenterFlorida State Fire College
Camp Atterbury, Muscatatuck Urban Training Center
35. Incident Command System (ICS)
Set of personnel, policies, procedures, facilities,
and equipment, integrated into common
organizational structure designed to improve
emergency response operations of all types.
May be used for planned events, natural
disasters, and acts of terrorism.
Is a key feature of the National Incident
Management System (NIMS 2004).
36. Incident Command System (ICS)
Based upon changeable, scalable response
organization providing hierarchy within which people
can work together effectively.
“First-on-scene" structure: First responder to scene
has charge until incident has been declared resolved
or more qualified responder arrives and receives
command.
Used by all levels of government—Federal, State,
local, and tribal—as well as by many private-sector
and nongovernmental organizations.
http://emilms.fema.gov/IS200b/ICS0102summary.htm
37. ICS
Structured to facilitate activities in 5 major
functional areas:
Command
Operations
Planning
Logistics
Finance and administration.
37 http://emilms.fema.gov/IS200b/ICS0102summary.htm
41. Response: Prehospital and Inhospital
Care
Saving life and property during and immediately
after a disaster.
Implement the planned response quickly
Decontaminate every patient
Avoid contamination of facility, quarantine
Disaster triage scheme (SALT)
Effective surge capability
Expect patient volume increased 20%
Don’t expect outside help for at least 24 hours
American College of Surgeons, 2008, Advanced Trauma Life Support for Doctors, American College of Surgeons. Eighth Edition.
American Medical Association, 2012, Basic Disaster Life Support, Course Manual. V. 3.0.
42. Response: SALT Triage
Image adapted from: “SALT mass casualty triage: concept endorsed by the American College of Emergency Physicians, American College of Surgeons Committee on Trauma,
American Trauma Society, National Association of EMS Physicians, National Disaster Life Support Education Consortium, and State and Territorial Injury Prevention Directors
Association.” Disaster medicine and public health preparedness, v. 2 issue 4, 2008, p. 245-6.
43. Response: Surge Capacity
If a mass casualty incident occurs, a healthcare
system may be suddenly faced with significant
increase of patients (Surge generating event).
44. Response: Surge Capacity
Surge capacity is the ability of healthcare facility or
system to expand operations to safely treat an
abnormally large influx of patients.
Surge Generating Event
Contained
Geographically Defined (tornado, flood, bombing)
Population Based
Infectious Diseases and Bioterrorism
http://buckeyextra.dispatch.com/
45. Inherent Response Problems
Sudden and unpredictable onset
Chaos
Loss of services
Disruption of gov’t
Loss of infrastructure
Transportation
Communications
Utilities
http://blogs.sacbee.com/photos/2010/08/hurricane-katrina-five-years-l.html
46. Inherent Response Problems (continued)
Variable mitigation and preparation for response
at local level
Loss of basic physiological necessities
Shelter
Food/water
Sanitation
Secondary hazards
Further structural
damage
Hazardous materials
47. Medical Response Obstacles
Medical system overwhelmed
Non-selective victim process
Unusual medical problems
Victims with previous problems
Delay in treatment
High risks to rescue personnel
http://video.foxnews.com/v/2674051681001/oklahoma-city-bombing-
missing-videos/?#sp=show-clips
55. Natural Disasters
Natural Disasters
Earthquakes
Landslides and Mudslides
Tsunamis
Volcanoes
Wildfires
Weather Emergencies
Extreme Heat
Floods
Hurricanes
Tornadoes
Tsunamis
Lightning
Winter Weather
An event of nature that
overwhelms local resources and
threatens the function and
safety of the community.
56. Wind Disasters
56
Marchigiani R, Gordy S, Cipolla J, et al. Wind disasters: A comprehensive review of
current management strategies. International Journal of Critical Illness and Injury
Science. 2013;3(2):130-142. doi:10.4103/2229-5151.114273.
57. Hurricanes
Most mortality originates from secondary disasters
(storm surges, flash flooding, and tornados)
triggered by original event.
In coastal regions, level of hurricane’s storm surge is
strong predictor of mortality.
Winds are 2nd deadliest aspect.
Most common non fatal traumatic injury pattern in a‑
hurricane consists of superficial lacerations from
airborne glass and/or other debris.
57
58. Tornados
Tornados usually develop during intense “supercell
thunderstorms”.
Result from updrafts created by solar warming of
earth’s surface. Updrafts then develop into vortex
with strong rotary winds and violent pressure
changes.
Due to brief or absent warning, community has little
time to prepare or seek shelter, and morbidity and
mortality is proportionally higher compared to other
WDs.
58
59. Tornado Associated Injuries
Most tornado fatalities die at scene and tend to be
either in exposed areas or in mobile homes.
Risk factors for injury and death during a tornado
include:
Poor building anchorage
Occupant location other than a basement
Age over 70 years
High wind strength
59
61. Crush Injury
Lactic acid produced
Myoglobin, Potassium and other electrolytes
released
Other toxins created/released (superoxides, O2 free
radicals)
Capillary leak
Thromboxane, prostaglandins, and other immune
system substances generated
Muscle cell enzymes released
62. Crush Injury
Effects are LOCAL ONLY until pressure released
and tissue reperfused
Reason that patients survive entrapment despite
severe crush injury
Adverse processes begin immediately upon
pressure release
63. Effects of Releasing Compressed Tissue
Immediate:
Capillary leak
Hypovolemia/Hypotension
Shock
Severe metabolic acidosis: dysrhythmias, V-fib
High serum potassium: cardiac dysrhythmia or arrest
Delayed:
Myoglobin/uric acid/renal toxins: kidney failure
Other toxins: lung/liver/renal injuries
64. Cause of Death
Major
Hypovolemia
Dysrhythmia
Renal failure
Other
Adult Respiratory Distress Syndrome (ARDS)
Sepsis
Other electrolyte disturbances
Ischemic tissue infection (gangrene)
65. EKG Abnormalities
Related to
Potassium levels and rate of rise
Acidosis
Other electrolyte abnormalities
Other injuries
Peaked T-waves, AV blocks, widened QRS, sine wave
Responds rapidly to effective intervention
66. Strategies to Prevent Renal Injury
Maximize renal perfusion
IV normal saline
Diuresis (brisk urine flow)
Careful alkalinization of urine (pH > 6.5)
Sodium bicarbonate
Monitor urine flow and pH (Bladder catheterization if
possible)
67. Initial Management “in the Rubble”
Maintain ABCs
Protect airway
Assess for crush injury potential
Provide psychological support
68. Initial Management “in the Rubble” (continued)
If crush potential is identified
Establish IV access
Fluid resuscitation prior to extrication
Pre-release alkalinization
Cardiac monitor (run baseline strip)
Be prepared during extrication to treat
Hypovolemia
Acidosis
Hyperkalemia
69. Floods-Preparedness
Recognize Flood Risk
Identify flood-prone or landslide-prone areas near
you.
Know your community’s warning signals, evacuation
routes, and emergency shelter locations.
Know flood evacuation routes near you.
69
www.dispatch.com
70. Floods-Response
Unplug appliances to prevent electrical shock when
power comes back on.
Gather emergency supplies and follow local radio or
TV updates.
Do NOT drive or walk across flooded roads.
Cars and people can be swept away
70 www.cdc.gov
71. Floods-Response and Recovery
Practice safe hygiene
Wash hands with soap and water to prevent germs.
Listen for information from local officials on how to
safely use water to drink, cook, or clean.
Use fans, air conditioning units, and dehumidifiers
for drying.
For cleanup, wear rubber boots and plastic gloves.
Clean walls, hard floors, and other surfaces with
soap and water. Use mixture of 1 cup bleach and 5
gallons water to disinfect.
71 http://emergency.cdc.gov/disasters/floods/readiness.asp
74. Final Pearls
Have a straightforward disaster plan and
educate everyone in its use.
Have an incident command structure and drill
often.
Have a disaster triage scheme, and mobilize
surge resources as needed.
Have a traffic control system and communication
system.
74
75. Final Pearls
Communications-Cell Phones Go Down!
Redundant modes / systems / equipment
Supplies-Bring your own
Ample supply stores / reliable supply chains
Security
Control traffic flow / patient, staff safety
Volunteers
Physician role is hospital-based patient care
75
76. What can you do?
Be Informed: Learn your Emergency Operations
Plan (EOP) and exercise it.
Find out where you would report in a disaster.
Make a Plan: Prepare yourself and your family (
www.ready.gov).
Build a kit.
76
http://www.costco.com/American-
Preparedness-Emergency-Backpack-
Kit.product.11100551.html
77. What can you do?
Get Involved: Join your Emergency Preparedness
Committee.
Go Regional, then National!
77
78. References
FEMA Medical Team Training Student Reference CD (2/2009)
FEMA WMD for Medical Specialist Training CD
Franco et al. The National Disaster Medical System: Past, Present, and Suggestions
for the Future. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, Science
2007; 5: 319-325.
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ATLS 8th
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Kman N, Rund D. “Disaster Preparedness 10 years after 9/11: The Experts Weigh In”.
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current management strategies. International Journal of Critical Illness and Injury
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comprehensive review of current management strategies." International journal of
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My career in Emergency Preparedness started on this day.
In total, almost 3,000 people died in the attacks, including the 227 civilians and 19 hijackers aboard the four planes. It also was the deadliest incident for firefighters and for law enforcement officers[4][5] in the history of the United States, with 343 and 72 killed respectively.
The U.S. Department of Homeland Security (DHS) is a cabinet department of the United States federal government, created in response to the September 11 attacks, and with the primary responsibilities of protecting the United States and its territories (including protectorates) from and responding to terrorist attacks, man-made accidents, and natural disasters. The Department of Homeland Security, and not the United States Department of the Interior, is equivalent to the Interior ministries of other countries. In fiscal year 2011, DHS was allocated a budget of $98.8 billion and spent, net, $66.4 billion.
Where the Department of Defense is charged with military actions abroad, the Department of Homeland Security works in the civilian sphere to protect the United States within, at, and outside its borders. Its stated goal is to prepare for, prevent, and respond to domestic emergencies, particularly terrorism.[1] On March 1, 2003, DHS absorbed the Immigration and Naturalization Service and assumed its duties. In doing so, it divided the enforcement and services functions into two separate and new agencies: Immigration and Customs Enforcement and Citizenship and Immigration Services. The investigative divisions and intelligence gathering units of the INS and Customs Service were merged forming Homeland Security Investigations. Additionally, the border enforcement functions of the INS, including the U.S. Border Patrol, the U.S. Customs Service, and the Animal and Plant Health Inspection Service were consolidated into a new agency under DHS: U.S. Customs and Border Protection. The Federal Protective Service falls under the National Protection and Programs Directorate.
With more than 200,000 employees, DHS is the third largest Cabinet department, after the Departments of Defense and Veterans Affairs.[2] Homeland security policy is coordinated at the White House by the Homeland Security Council. Other agencies with significant homeland security responsibilities include the Departments of Health and Human Services, Justice, and Energy.
On December 16, 2013, the U.S. Senate confirmed Jeh Johnson as the Secretary of Homeland Security.[3]
According to the Homeland Security Research Corporation, the combined financial year 2010 state and local homeland security (HLS) markets, which employ more than 2.2 million first responders, totaled $16.5 billion, whereas the DHS HLS market totaled $13 billion.[4] According to The Washington Post, "DHS has given $31 billion in grants since 2003 to state and local governments for homeland security and to improve their ability to find and protect against terrorists, including $3.8 billion in 2010".[5]
According to Peter Andreas, a border theorist, the creation of DHS constituted the most significant government reorganization since the Cold War,[6] and the most substantial reorganization of federal agencies since theNational Security Act of 1947, which placed the different military departments under a secretary of defense and created the National Security Council and Central Intelligence Agency. DHS also constitutes the most diverse merger of federal functions and responsibilities, incorporating 22 government agencies into a single organization.
Katrina: At least 1,833 people died in the hurricane and subsequent floods, making it the deadliest U.S. hurricane since the 1928 Okeechobee hurricane; total property damage was estimated at $108 billion (2005 USD),[1] roughly four times the damage brought by Hurricane Andrew in 1992.
Rescue workers and medical personnel, on hand to assist runners and bystanders, rushed available aid to wounded victims in the bombings' immediate aftermath. Additional units from Boston EMS and the Boston Fire Department were dispatched to assist responders already on-scene. [29][30] The explosions killed 3 spectators and injured 264 others, who were treated in 27 local hospitals. At least 14 people required amputations, with some suffering traumatic amputations as a direct result of the blasts.
Boko Haram killed more than 13,000 civilians between 2009 and 2015, including around 10,000 in 2014, in attacks occurring mainly in northeast Nigeria
I hope this helps you find ways to get involved as a physician
Happy to provide resources on these topics!
With much state apparatus still in tatters after its devastating civil conflict, Liberia is especially ill prepared to deal with a crisis of this unprecedented scale. At least 160 health workers have been infected with the virus and 79 have died, in a nation that counted a paltry single doctor per 100,000 inhabitants at its onset. Landgren pointed out that the challenge also goes beyond the medical response.
Mitigation is the effort to reduce loss of life and property by lessening the impact of disasters. Mitigation is taking action now—before the next disaster—to reduce human and financial consequences later (analyzing risk, reducing risk, insuring against risk). Effective mitigation requires that we all understand local risks, address the hard choices, and invest in long-term community well-being. Without mitigation actions, we jeopardize our safety, financial security, and self-reliance.
I’m going to frame my understanding of National Preparedness by discussing my role with OH TF1.
NDMS’s federal partners include the Federal Emergency Management Agency, Department of Defense (DOD), and the Department of Veterans Affairs (VA).
The overall purpose of the NDMS is to supplement an integrated National medical response capability for assisting State and local authorities in dealing with the medical impacts of major peacetime disasters and to provide support to the military and the Department of Veterans Affairs medical systems in caring for casualties evacuated back to the U.S. from overseas armed conventional conflicts.[1]
NDMS’s federal partners include the Federal Emergency Management Agency, Department of Defense (DOD), and the Department of Veterans Affairs (VA).
NDMS also interfaces with state and local Departments of Health, as well as private hospitals.
Team exists under oversight of Miami Valley Fire EMS Alliance & Ohio Emergency Management Agency.
I did this on-line!
The National Incident Management System (NIMS) is a systematic, proactive approach to guide departments and agencies at all levels of government, nongovernmental organizations, and the private sector to work together seamlessly and manage incidents involving all threats and hazards—regardless of cause, size, location, or complexity—in order to reduce loss of life, property and harm to the environment. The NIMS is the essential foundation to the National Preparedness System (NPS) and provides the template for the management of incidents and operations in support of all five National Planning Frameworks.
The Incident Command System (ICS) is a standardized approach to the command, control, and coordination of emergency response providing a common hierarchy within which responders from multiple agencies can be effective.
The Incident Command System (ICS) is a standardized approach to the command, control, and coordination of emergency response providing a common hierarchy within which responders from multiple agencies can be effective.
Command Staff: Consists of the Public Information Officer, Safety Officer, and Liaison Officer. Report directly to the Incident Commander.
Section: Has responsibility for primary segments of incident management (Operations, Planning, Logistics, Finance/Administration). The Section level is organizationally between Branch and Incident Commander.
Branch: Has functional, geographical, or jurisdictional responsibility for major parts of the incident operations. Branch level is organizationally between Section and Division/Group in the Operations Section, and between Section and Units in the Logistics Section. Branches are identified by the use of Roman Numerals, by function, or by jurisdictional name.
Division: That organizational level having responsibility for operations within a defined geographic area. The Division level is organizationally between the Strike Team and the Branch.
Group: Groups are established to divide the incident into functional areas of operation. Groups are located between Branches (when activated) and Resources in the Operations Section.
Unit: That organization element having functional responsibility for a specific incident planning, logistics, or finance/administration activity.
Task Force: A group of resources with common communications and a leader that may be pre-established and sent to an incident, or formed at an incident.
Strike Team: Specified combinations of the same kind and type of resources, with common communications and a leader.
Single Resource: An individual piece of equipment and its personnel complement, or an established crew or team of individuals with an identified work supervisor that can be used on an incident.
Image adapted from: “SALT mass casualty triage: concept endorsed by the American College of Emergency Physicians, American College of Surgeons Committee on Trauma, American Trauma Society, National Association of EMS Physicians, National Disaster Life Support Education Consortium, and State and Territorial Injury Prevention Directors Association.” Disaster medicine and public health preparedness, v. 2 issue 4, 2008, p. 245-6.
OH-TF 1 brings everything we need.
Injury patterns from tornados tend to involve multiple
systems.[12] Commonly injured anatomic regions included
the chest (45%), abdomen (27%), extremity (91%), and
head (45%).[12] Furthermore, trauma severity increases if
the victim is thrown rather than struck by flying debris.[12]
Most of the serious injuries and deaths are the result of the
victims or solid objects becoming airborne or structural
collapse, with mortality being most frequently attributed
to head trauma, followed by crush injuries to the chest,
abdomen, and pelvis.[11,12] Most tornado fatalities die at
the scene and tend to be either in exposed areas or in
mobile homes.
Muscle tissue vulnerable to sustained compression from debris or body weight
Timeframe: 1 to 6 hours
Amount of muscle tissue
Lower extremities
Buttocks
Entire upper extremity and pectoralis