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Nursing home during 

Emergency/Disaster 

to evacuate or not?
Knowhow to take a sound decision
About the lecturer
• Chief Medical Officer & Administrator of CHAG de Pacy/Eure (founded 1267)

• Member of the Strategic Steering Committee of GHT Eure-Seine-Pays d’Ouche

• Member and cofounder of Espace de Reflexion Ethique de Normandie (EREN)

• Member of Commissions & Working Groups fo Agence Régionale de Santé (ARS) de Normandie

• Associate Board Member of Société Française de Médecine de Catastrophe (SFMC)

• Administrator of Caribbean OnCall

• Administrator of StratAdviser Ltd

• Member of the Global Health Security Alliance (GloHSA)

• Cofounder of the International Commission on Disaster Medicine

• Registered Cindynician Expert-Auditor for the CBRN Risk Mitigation CoE Initiative of the
European Commission under EX2016D276660

• Lecturer on Crisis Strategic Steering, Hospital/Home Care Management & Ethics in several 

public and private Universities and Engineering Schools
Dr jan-cedric Hansen april 2018
No known conflict of interest regarding the present lecture
!2
Nursing home during 

Emergency/Disaster 

to evacuate or not?
I - I must have some plans somewhere!
Samples of Plans
!4
Dr jan-cedric Hansen april 2018
1
Care Home Guidance for managing
outbreaks of Acute Respiratory
Illness
Updated October 2015
Disaster Planning Guide for
Home Health Care Providers
EMERGENCY
Disasters in
Homecare
Guide to fire safety and disaster planning
EMERGENCY PREPAREDNESS PACKET
FOR HOME HEALTH AGENCIES
Prepared by
The National Association for Home Care & Hospice
228 Seventh Street, SE Washington, DC 20003
©2008, Permission is granted by the National Association for Home Care & Hospice
to reproduce for educational and training purposes.
A Handbook to Assist Home Health Care
Providers in Emergency Preparedness
Planning
HOME CARE EMERGENCY PREPAREDNESS
A Handbook to Assist Home Care Providers in Emergency Preparedness Planning
2012
Home Care and Hospice
Emergency Preparedness
Is your Agency Prepared for an Emergency?
Colleen Bayard PT, MPA, COS-C
Director of Regulatory and Clinical Affairs
Home Care Alliance of Massachusetts
Suzanne Clark, PT, DPT, GCS, COS-C,
Staff Development Coordinator
NVNA & Hospice,
Andrea Foley, MSN, RN, CWCN
Director of PI/Education
NVNA and Hospice
LOUISIANA MODEL HOME HEALTH/HOSPICE
EMERGENCY PLAN
Revised June 2015
________________________________________________________________ (agency name)
_____________________________________________________________________ (address)
_____________________________________________________________________________
______________________________________________________________________ (phone)
FORWARDED TO THE FOLLOWING PARISH OFFICES OF EMERGENCY
PREPAREDNESS
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
DATE OF ORIGINAL PLAN ____________________________
DATE OF UPDATES ___________________________________
______________________________________________________
______________________________________________________
Many plans, many templates
Plans’ contents
Dr jan-cedric Hansen april 2018
Inhomogeneous help/support, sometimes complex
From basic insights
Emergency Reference Card for Individuals with Medical Needs Living at Home & Their Caregivers
Name: DOB: Blood Type:
Street Address: City: State: Zip Code:
Personal medical information that emergency responders need to know:
Allergies I have:
Medications I take:
Prescription Name: Dosage (for example, 50 mg) Frequency (for example, twice per day)
Vaccination Type: Dose/Units: Date Given (month/year)
Special needs (e.g., eye glasses, hearing aids, mobility assistive devices, language translation needs, etc.):
Emergency Phone Numbers (if not 911)
Local Dept: Phone # Emergency Contacts / Name Phone #
Ambulance Doctor
Fire Doctor
Police Doctor
County Health Clinic/Facilty
Emergency Mgmt Pharmacist
Local Red Cross Dentist
Local Shelters Veterinarian
Family and Friends - Emergency Contacts
Name Phone Name Phone
Family Member
Home:
Work:
Cell:
Friend/Neighbor
Home:
Work:
Cell:
Family Member
Home:
Work:
Cell:
Friend/Neighbor
Home:
Work:
Cell:
Family Member
Home:
Work:
Cell:
Friend/Neighbor
Home:
Work:
Cell:
Family Member
Home:
Work:
Cell:
Friend/Neighbor
Home:
Work:
Cell:
Family Member
Home:
Work:
Cell:
Friend/Neighbor
Home:
Work:
Cell:
EMERGENCY REFERENCE INFORMATION S E C T I O N T H R E E D I S A T E R P L A N N I N G
©2011 SEIU E&SF
Important items for My plan
My Disaster Plan Would Include:
1._____________________________
2._____________________________
3._____________________________
4._____________________________
5._____________________________
6._____________________________
7._____________________________
8._____________________________
36
Via helpless To comprehensive
Home Health Emergency Preparedness
9 | P a g e
Hazard Risk
Analysis
Plan
Development
Plan Evaluation
Chapter 4
Step 1: How Prepared is the Agency?
The next step in emergency preparedness involves assessing the agency against regulations
and best-practice benchmarks. Knowing, in advance, how an agency stacks up will make it
easier to mitigate any possible gaps in the emergency plan.
For purposes of this handbook, there are three basic steps that can be followed in developing
an emergency plan:
Step 1: Conducting a hazard/risk analysis and determining planning priorities
Step 2: Plan development and education
Step 3: Plan evaluation and plan updates
This handbook will provide guidance through the process of developing or updating the
emergency preparedness plan in later chapters. The focus of this chapter, however, is the
process of conducting a hazard analysis and determining planning priorities in advance of
actually developing a plan.
As part of this first step, two important tools for self-assessment are identified: a hazard analysis
worksheet and the Agency Preparedness Assessment and Planning Checklist (see Table 3).
Hazard Analysis Worksheet
Home care agencies should work with local emergency management coordinators, local emergency
management directory http://www.michigan.gov/documents/msp/LocalDir_external_320561_7.pdf, to
understand potential local hazards.
Whether an agency is developing its first emergency plan, or updating an existing plan, it is
important to understand both what the agency risks are and how prepared it is to respond
successfully to any and all of those potential incidents. A separate analysis should be conducted
for every agency office location, with differences being reflected in each location’s plan. This
hazard/vulnerability:
Guides development/review of the emergency plan
Identifies critical risks
Figure 3
Nursing home during 

Emergency/Disaster 

to evacuate or not?
II - Hey, how do I recognise it’s an 

Emergency/Disaster?
Emergency/Disaster specificities
• Limits/boundaries (geophysical,
administrative, social, psychic, …) are more
or less preserved
• Limited number of casualties
• Psychic/socioeconomic impact limited to
relatives/community
• Assets adapted to needs
• Routine response
• Management (preparedness plans)
• “Protect – Alert – Rescue”
• Deserves mainly Tactical reactions
• Limits/boundaries (geophysical,
administrative, social, psychic, …) are
disrupted
• Immediate/delayed mass casualties
• Psychic/socioeconomic impact extends to
society/nation
• Assets insufficient to cover needs
• Continuous reinvention of response
• Steering (extemporaneous rules)
• “Confront – Regulate – Overcome”
• Deserves mainly Strategic decisions
Both Coexist (scale/point of view +++)
Dr jan-cedric Hansen april 2018
Emergency = Crisis Disaster
!7
Crisis/Disasters taxonomy
Natural
• Epidemiological
• Geophysical
• Hydrological
• Meteorological
• …
Industrial
• Infrastructure
failures
• Human
overconfidence
• …
Intentional
• Terrorist attack
• Act of War
• …
10 effectors CBRN-esbdti*
*explosion/blast (e); shooting/shrapnel (s); burial/landslide (b); drowning (d); thermal (t); internet/IT; (i)
Dr jan-cedric Hansen april 2018
!8
x
120 Different displays for casualties
3 modes
=
x 2 kinetics (Slow/Fast)
x 2 energizing (Outburst/Sustained)
Nursing home during 

Crisis/Disaster 

to evacuate or not?
III - Okay, so what are the actual issues?
Residents’ resilience assessment 
• Frailty elderly

• Present polypathology 

• Multiple mandatory treatment

• Higher sensitivity to heat or cold
stress

• Less vital ressource

• Tolerance to malnutrition

• Intolerance to dehydration

• Benefice/risk ratio of evacuation vs
containment
Dr jan-cedric Hansen april 2018
Saint-Martin post IRMA
10
Residual structure competency
• Building collapse resistance

• Remnant protection against
meteorological threats (heat,
cold, rain, damp, wind …)
Dr jan-cedric Hansen april 2018
Saint-Martin post IRMA
11
Reliable water, food & care/med stocks
• Potability of tab water

• Estimated days supply of bottled
water in regard to the population
needs (1.5 L/d for hydration - 5 L/d
for cooking)

• Anticipated days supply of water
for other purpose (15 L/d for
hygiene)

• Anticipated days supply of caloric
intake (2500 Cal/d)

• Anticipated days supply of Oxygen,
medication, protections, medical
device consumables
Dr jan-cedric Hansen april 2018
Saint-Martin post IRMA
12
Realistic expected logistics support 
• Useable roads, railways,
harbors, airports …

• Distance to nearest support
base

• Available running Generators
(expected autonomy before
fuel shortage)

• Procurement and distribution
of equipment, spares,
technical information, trained
personnel …
Dr jan-cedric Hansen april 2018
Saint-Martin post IRMA
13
Readiness of evacuation vectors
• Available planes, helicopters,
trains, boats, cars, buses … in
regard of number of victims to
evacuate

• Load capacity of vectors

• Anticipated duration of
evacuation process in regard
of water/food/medication
current stock

• Distance to nearest facility
able to take care of patients
Dr jan-cedric Hansen april 2018
Saint-Martin post IRMA
14
Nursing home during 

Crisis/Disaster 

to evacuate or not?
IV - So, what inspirational response to chose?
Medical responses mapping
Community
Withstand
Limited 

Casualties
Mass 

Casualties
Community
Overwhelmed
Organized

Environment
Disasters’ Characteristics
Disorganized

Environment
(Chaos)
Dr jan-cedric Hansen april 2018
!16
Community
Withstand
Limited 

Casualties
Mass 

Casualties
Community
Overwhelmed
Organized

Environment
Emergency

Medicine
Medicines’ Fields
Coverage
Disorganized

Environment
(Chaos)
Dr jan-cedric Hansen april 2018
Medical responses mapping
Lines delineate the weight
of most common situation
!17
Community
Withstand
Limited 

Casualties
Mass 

Casualties
Community
Overwhelmed
Organized

Environment
Emergency

MedicineHumanitarian

Medicine
Medicines’ Fields
Coverage
Disorganized

Environment
(Chaos)
Lines delineate the weight
of most common situation
Dr jan-cedric Hansen april 2018
Medical responses mapping
!18
Community
Withstand
Limited 

Casualties
Mass 

Casualties
Community
Overwhelmed
Disorganized

Environment
(Chaos)
Organized

Environment
Emergency

MedicineHumanitarian

Medicine
Medicines’ Fields
Coverage
Military

Medicine
Lines delineate the weight
of most common situation
Dr jan-cedric Hansen april 2018
Medical responses mapping
!19
Community
Withstand
Limited 

Casualties
Mass 

Casualties
Community
Overwhelmed
Organized

Environment
Emergency

MedicineHumanitarian

MedicineMilitary

Medicine
Disaster

Medicine
Medicines’ Fields
Coverage
Lines delineate the weight
of most common situation
Disorganized

Environment
(Chaos)
Dr jan-cedric Hansen april 2018
Medical responses mapping
!20
It all depends on Disasters’ Characteristics
Nursing home during 

Emergency/Disaster 

to evacuate or not?
V - Is there a situational analysis model for me?
Cindynics define
Environment Context
Organisation Documentation Production Actors
Flows &

Interactions
Organism
Dr jan-cedric Hansen april 2018
!22
Cindynics recognize
Environment Context
Organisation Documentation Production Actors
Flows &

Interactions
Vulnerability
Organism’s
Distortions
Dr jan-cedric Hansen april 2018
• Epidemiologica
l
• Geophysical
• Hydrological
• Infrastructure
failures
• Human
overconfidence
• Terrorist
attack
• Act of War
• …
CBRN-esbd
!23
Cindynics Acknowledge
• Vulnerabilities are key 

• “Anything that can go wrong will go wrong”

• Murphy’s law (as well as Entropy/second law of thermodynamics)
• Prevention/Preparedness/Safety are of asymptotic
nature

• Dynamic of context, environment, flows, …influence
the vulnerability of any organism

• Actors’ play role at “Global”, “Individual”,
“interpersonal” & “Organisational” levels are critical
!24
Dr jan-cedric Hansen april 2018
Cindynics Clarify
Global level (organism) Systemic Cindynogenic Deficits
Actor’s level Individual Cindynogenic Deficits
Individual interactions’ level Cindynogenic Dissonances
Organisational level Organisational Cindynogenic Deficits
All are qualified and possibly quantified, using documentary analysis, observation of practices and direct or semi-
directive interviews, individually or in groups, through the themes suggested by the qualifiers of the 5 axes
!25
Dr jan-cedric Hansen april 2018
Nursing home during 

Crisis/Disaster 

to evacuate or not?
VI - Is there a sound decision making process?
Tactical/Strategic decisions
• Paratelic mind-set
• Doxa drives actions
• Preparedness state
• Coping with field findings
• Manage local and simple adaptations
• Limited or immediate purpose/end in
view
• Telic mind-set
• Episteme drives decisions
• Planning & conduct kinetic
• Imagining the unthinkable
• Steer broad and complex adaptations
• Anticipated goals and criteria of
success
Both interact constantly
Dr jan-cedric Hansen april 2018
Tactical Strategic
!27
Key decision making meta model
Confront
Disruptions during the length
of time
Multiple problems emerging
simultaneously
constant changes of situation
Multiple and unstable partners
Non stop demands for aids and
reliefs
Regulate
Numerous skids about:
Aims, Priorities
Roles and positions
Information (given or requested),
Communication systems
Procedures
Overcome
Consequences of Risky choices
Responsibility, guilt problems
Subjectivities, bias
Clear shortages
Cindynics help to clarify both understanding & tasks
Dr jan-cedric Hansen april 2018
!28
Victims
Who confronts
• Field Professionals
• Firemen
• Police
• Army
• Emergency Unit
• NGO
• …
• Key Decision makers
• CEO, Mayor, Governor, …
Field
Professionnals
Spectators
Key Decision
makers
29
Dr jan-cedric Hansen april 2018
What is to be confronted?
• Disruptions during the course of time 

• Multiple problems emerging simultaneously

• Constant situational changes

• Multiple and unstable partners

• Non stop demands for aids and reliefs (from third parties)
30
Dr jan-cedric Hansen april 2018
How to confront?
• Regulate information

• Evaluate reliability and obsolescence of any given
information

• Imagine several possible evolutions scenarios

• Decide what strategy to be kept

• Prioritize goals to be reached with specified success
criteria
31
Dr jan-cedric Hansen april 2018
Who regulates?
• Decision makers

• Elected people

• State representatives

• Companies, organisations,
and their specific cells
PublicMedia
Field
Professionals
Decision
makers
32
Dr jan-cedric Hansen april 2018
What is to be regulated?
• Numerous skids about:

• Aims

• Priorities

• Roles and positions

• Information (given or requested)

• Communication systems 

• Procedures
33
Dr jan-cedric Hansen april 2018
Outgoing
data
How to regulate
data	
acquisition
data	checking
Target	
identification
Needs	
assessment
Definition	of	
goals
Preparation	
of	messages
Impact	
scenario
real	impact
gap	
assessment
DoCR
Incoming
data
• Stay at a strategic level
• Maintain doctrines and
objectives
• Adapt the cycle of the
DoCR as needed
34
Dr jan-cedric Hansen april 2018
Who overcomes?
• Third party players (insurance
companies, communities)

• Analysts (experts,
researchers), 

• Civil society (lawyers,
parlement, ...), 

• Collective unconsciousness
Third parties
Collective
unconscious-
ness
Civil Society
Analysts
35
Dr jan-cedric Hansen april 2018
What is to be overcome?
• Consequences of risky choices
• Responsibility, guilt problems,
• Subjectivities, bias,
• Clear shortages
36
Dr jan-cedric Hansen april 2018
How to overcome?
ENDING

(FINEX)
+ RETEX
Goals
achievement
Success
criteria
achievement
Stabilized
situation
37
Dr jan-cedric Hansen april 2018
Nursing home during 

Crisis/Disaster 

to evacuate or not?
VII - What to do with all that knowledge?
Follow
1. Assess the situation (Crisis or Disaster?)

2. Categorise mode(s), effector(s), kinetic & energising 

3. Identify best medical response type

4. Appraise damage/vulnerability using Cindynics approach

5. Steer strategically by using the decision making meta
model: confront-regulate-overcome
Dr jan-cedric Hansen april 2018
Special focus on evacuation
Advanced Strategic Medical Triage
Event
VV
V
V
Ambulance Noria

+/- medical supervision
Damage Control

+/- resuscitation
ASMT
VV VV
V
V
V
V
V
V
V
VV VV
VV VV
Hospital
Emergenc
y Ward
Triage
operating theatre
Resuscitation ward
Hospital
Emergenc
y Ward
Triage
operating theatre
Resuscitation ward
Hospital
Emergenc
y Ward
Triage
operating theatre
Resuscitation ward
Hospital
Emergency
Ward Triage
operating theatre
Resuscitation ward
MSD
ASMT: Advanced Strategic Medical Triage

MSD: Medical Strategic Dispatch
Orthopaedic
Neurosurgery
Chest
Abdomen
Dr jan-cedric Hansen april 2018
!41
Conclusion

to evacuate or not?

There is no predetermined answer

It depends on a contextual & situational analysis

It is a strategic decision which requires
experience, expertise & experiment

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Lecture georgetown university on disaster resilience

  • 1. Nursing home during 
 Emergency/Disaster 
 to evacuate or not? Knowhow to take a sound decision
  • 2. About the lecturer • Chief Medical Officer & Administrator of CHAG de Pacy/Eure (founded 1267) • Member of the Strategic Steering Committee of GHT Eure-Seine-Pays d’Ouche • Member and cofounder of Espace de Reflexion Ethique de Normandie (EREN) • Member of Commissions & Working Groups fo Agence Régionale de Santé (ARS) de Normandie • Associate Board Member of Société Française de Médecine de Catastrophe (SFMC) • Administrator of Caribbean OnCall • Administrator of StratAdviser Ltd • Member of the Global Health Security Alliance (GloHSA) • Cofounder of the International Commission on Disaster Medicine • Registered Cindynician Expert-Auditor for the CBRN Risk Mitigation CoE Initiative of the European Commission under EX2016D276660 • Lecturer on Crisis Strategic Steering, Hospital/Home Care Management & Ethics in several 
 public and private Universities and Engineering Schools Dr jan-cedric Hansen april 2018 No known conflict of interest regarding the present lecture !2
  • 3. Nursing home during 
 Emergency/Disaster 
 to evacuate or not? I - I must have some plans somewhere!
  • 4. Samples of Plans !4 Dr jan-cedric Hansen april 2018 1 Care Home Guidance for managing outbreaks of Acute Respiratory Illness Updated October 2015 Disaster Planning Guide for Home Health Care Providers EMERGENCY Disasters in Homecare Guide to fire safety and disaster planning EMERGENCY PREPAREDNESS PACKET FOR HOME HEALTH AGENCIES Prepared by The National Association for Home Care & Hospice 228 Seventh Street, SE Washington, DC 20003 ©2008, Permission is granted by the National Association for Home Care & Hospice to reproduce for educational and training purposes. A Handbook to Assist Home Health Care Providers in Emergency Preparedness Planning HOME CARE EMERGENCY PREPAREDNESS A Handbook to Assist Home Care Providers in Emergency Preparedness Planning 2012 Home Care and Hospice Emergency Preparedness Is your Agency Prepared for an Emergency? Colleen Bayard PT, MPA, COS-C Director of Regulatory and Clinical Affairs Home Care Alliance of Massachusetts Suzanne Clark, PT, DPT, GCS, COS-C, Staff Development Coordinator NVNA & Hospice, Andrea Foley, MSN, RN, CWCN Director of PI/Education NVNA and Hospice LOUISIANA MODEL HOME HEALTH/HOSPICE EMERGENCY PLAN Revised June 2015 ________________________________________________________________ (agency name) _____________________________________________________________________ (address) _____________________________________________________________________________ ______________________________________________________________________ (phone) FORWARDED TO THE FOLLOWING PARISH OFFICES OF EMERGENCY PREPAREDNESS ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ DATE OF ORIGINAL PLAN ____________________________ DATE OF UPDATES ___________________________________ ______________________________________________________ ______________________________________________________ Many plans, many templates
  • 5. Plans’ contents Dr jan-cedric Hansen april 2018 Inhomogeneous help/support, sometimes complex From basic insights Emergency Reference Card for Individuals with Medical Needs Living at Home & Their Caregivers Name: DOB: Blood Type: Street Address: City: State: Zip Code: Personal medical information that emergency responders need to know: Allergies I have: Medications I take: Prescription Name: Dosage (for example, 50 mg) Frequency (for example, twice per day) Vaccination Type: Dose/Units: Date Given (month/year) Special needs (e.g., eye glasses, hearing aids, mobility assistive devices, language translation needs, etc.): Emergency Phone Numbers (if not 911) Local Dept: Phone # Emergency Contacts / Name Phone # Ambulance Doctor Fire Doctor Police Doctor County Health Clinic/Facilty Emergency Mgmt Pharmacist Local Red Cross Dentist Local Shelters Veterinarian Family and Friends - Emergency Contacts Name Phone Name Phone Family Member Home: Work: Cell: Friend/Neighbor Home: Work: Cell: Family Member Home: Work: Cell: Friend/Neighbor Home: Work: Cell: Family Member Home: Work: Cell: Friend/Neighbor Home: Work: Cell: Family Member Home: Work: Cell: Friend/Neighbor Home: Work: Cell: Family Member Home: Work: Cell: Friend/Neighbor Home: Work: Cell: EMERGENCY REFERENCE INFORMATION S E C T I O N T H R E E D I S A T E R P L A N N I N G ©2011 SEIU E&SF Important items for My plan My Disaster Plan Would Include: 1._____________________________ 2._____________________________ 3._____________________________ 4._____________________________ 5._____________________________ 6._____________________________ 7._____________________________ 8._____________________________ 36 Via helpless To comprehensive Home Health Emergency Preparedness 9 | P a g e Hazard Risk Analysis Plan Development Plan Evaluation Chapter 4 Step 1: How Prepared is the Agency? The next step in emergency preparedness involves assessing the agency against regulations and best-practice benchmarks. Knowing, in advance, how an agency stacks up will make it easier to mitigate any possible gaps in the emergency plan. For purposes of this handbook, there are three basic steps that can be followed in developing an emergency plan: Step 1: Conducting a hazard/risk analysis and determining planning priorities Step 2: Plan development and education Step 3: Plan evaluation and plan updates This handbook will provide guidance through the process of developing or updating the emergency preparedness plan in later chapters. The focus of this chapter, however, is the process of conducting a hazard analysis and determining planning priorities in advance of actually developing a plan. As part of this first step, two important tools for self-assessment are identified: a hazard analysis worksheet and the Agency Preparedness Assessment and Planning Checklist (see Table 3). Hazard Analysis Worksheet Home care agencies should work with local emergency management coordinators, local emergency management directory http://www.michigan.gov/documents/msp/LocalDir_external_320561_7.pdf, to understand potential local hazards. Whether an agency is developing its first emergency plan, or updating an existing plan, it is important to understand both what the agency risks are and how prepared it is to respond successfully to any and all of those potential incidents. A separate analysis should be conducted for every agency office location, with differences being reflected in each location’s plan. This hazard/vulnerability: Guides development/review of the emergency plan Identifies critical risks Figure 3
  • 6. Nursing home during 
 Emergency/Disaster 
 to evacuate or not? II - Hey, how do I recognise it’s an 
 Emergency/Disaster?
  • 7. Emergency/Disaster specificities • Limits/boundaries (geophysical, administrative, social, psychic, …) are more or less preserved • Limited number of casualties • Psychic/socioeconomic impact limited to relatives/community • Assets adapted to needs • Routine response • Management (preparedness plans) • “Protect – Alert – Rescue” • Deserves mainly Tactical reactions • Limits/boundaries (geophysical, administrative, social, psychic, …) are disrupted • Immediate/delayed mass casualties • Psychic/socioeconomic impact extends to society/nation • Assets insufficient to cover needs • Continuous reinvention of response • Steering (extemporaneous rules) • “Confront – Regulate – Overcome” • Deserves mainly Strategic decisions Both Coexist (scale/point of view +++) Dr jan-cedric Hansen april 2018 Emergency = Crisis Disaster !7
  • 8. Crisis/Disasters taxonomy Natural • Epidemiological • Geophysical • Hydrological • Meteorological • … Industrial • Infrastructure failures • Human overconfidence • … Intentional • Terrorist attack • Act of War • … 10 effectors CBRN-esbdti* *explosion/blast (e); shooting/shrapnel (s); burial/landslide (b); drowning (d); thermal (t); internet/IT; (i) Dr jan-cedric Hansen april 2018 !8 x 120 Different displays for casualties 3 modes = x 2 kinetics (Slow/Fast) x 2 energizing (Outburst/Sustained)
  • 9. Nursing home during 
 Crisis/Disaster 
 to evacuate or not? III - Okay, so what are the actual issues?
  • 10. Residents’ resilience assessment  • Frailty elderly • Present polypathology • Multiple mandatory treatment • Higher sensitivity to heat or cold stress • Less vital ressource • Tolerance to malnutrition • Intolerance to dehydration • Benefice/risk ratio of evacuation vs containment Dr jan-cedric Hansen april 2018 Saint-Martin post IRMA 10
  • 11. Residual structure competency • Building collapse resistance • Remnant protection against meteorological threats (heat, cold, rain, damp, wind …) Dr jan-cedric Hansen april 2018 Saint-Martin post IRMA 11
  • 12. Reliable water, food & care/med stocks • Potability of tab water • Estimated days supply of bottled water in regard to the population needs (1.5 L/d for hydration - 5 L/d for cooking) • Anticipated days supply of water for other purpose (15 L/d for hygiene) • Anticipated days supply of caloric intake (2500 Cal/d) • Anticipated days supply of Oxygen, medication, protections, medical device consumables Dr jan-cedric Hansen april 2018 Saint-Martin post IRMA 12
  • 13. Realistic expected logistics support  • Useable roads, railways, harbors, airports … • Distance to nearest support base • Available running Generators (expected autonomy before fuel shortage) • Procurement and distribution of equipment, spares, technical information, trained personnel … Dr jan-cedric Hansen april 2018 Saint-Martin post IRMA 13
  • 14. Readiness of evacuation vectors • Available planes, helicopters, trains, boats, cars, buses … in regard of number of victims to evacuate • Load capacity of vectors • Anticipated duration of evacuation process in regard of water/food/medication current stock • Distance to nearest facility able to take care of patients Dr jan-cedric Hansen april 2018 Saint-Martin post IRMA 14
  • 15. Nursing home during 
 Crisis/Disaster 
 to evacuate or not? IV - So, what inspirational response to chose?
  • 16. Medical responses mapping Community Withstand Limited 
 Casualties Mass 
 Casualties Community Overwhelmed Organized
 Environment Disasters’ Characteristics Disorganized
 Environment (Chaos) Dr jan-cedric Hansen april 2018 !16
  • 17. Community Withstand Limited 
 Casualties Mass 
 Casualties Community Overwhelmed Organized
 Environment Emergency
 Medicine Medicines’ Fields Coverage Disorganized
 Environment (Chaos) Dr jan-cedric Hansen april 2018 Medical responses mapping Lines delineate the weight of most common situation !17
  • 18. Community Withstand Limited 
 Casualties Mass 
 Casualties Community Overwhelmed Organized
 Environment Emergency
 MedicineHumanitarian
 Medicine Medicines’ Fields Coverage Disorganized
 Environment (Chaos) Lines delineate the weight of most common situation Dr jan-cedric Hansen april 2018 Medical responses mapping !18
  • 19. Community Withstand Limited 
 Casualties Mass 
 Casualties Community Overwhelmed Disorganized
 Environment (Chaos) Organized
 Environment Emergency
 MedicineHumanitarian
 Medicine Medicines’ Fields Coverage Military
 Medicine Lines delineate the weight of most common situation Dr jan-cedric Hansen april 2018 Medical responses mapping !19
  • 20. Community Withstand Limited 
 Casualties Mass 
 Casualties Community Overwhelmed Organized
 Environment Emergency
 MedicineHumanitarian
 MedicineMilitary
 Medicine Disaster
 Medicine Medicines’ Fields Coverage Lines delineate the weight of most common situation Disorganized
 Environment (Chaos) Dr jan-cedric Hansen april 2018 Medical responses mapping !20 It all depends on Disasters’ Characteristics
  • 21. Nursing home during 
 Emergency/Disaster 
 to evacuate or not? V - Is there a situational analysis model for me?
  • 22. Cindynics define Environment Context Organisation Documentation Production Actors Flows &
 Interactions Organism Dr jan-cedric Hansen april 2018 !22
  • 23. Cindynics recognize Environment Context Organisation Documentation Production Actors Flows &
 Interactions Vulnerability Organism’s Distortions Dr jan-cedric Hansen april 2018 • Epidemiologica l • Geophysical • Hydrological • Infrastructure failures • Human overconfidence • Terrorist attack • Act of War • … CBRN-esbd !23
  • 24. Cindynics Acknowledge • Vulnerabilities are key • “Anything that can go wrong will go wrong” • Murphy’s law (as well as Entropy/second law of thermodynamics) • Prevention/Preparedness/Safety are of asymptotic nature • Dynamic of context, environment, flows, …influence the vulnerability of any organism • Actors’ play role at “Global”, “Individual”, “interpersonal” & “Organisational” levels are critical !24 Dr jan-cedric Hansen april 2018
  • 25. Cindynics Clarify Global level (organism) Systemic Cindynogenic Deficits Actor’s level Individual Cindynogenic Deficits Individual interactions’ level Cindynogenic Dissonances Organisational level Organisational Cindynogenic Deficits All are qualified and possibly quantified, using documentary analysis, observation of practices and direct or semi- directive interviews, individually or in groups, through the themes suggested by the qualifiers of the 5 axes !25 Dr jan-cedric Hansen april 2018
  • 26. Nursing home during 
 Crisis/Disaster 
 to evacuate or not? VI - Is there a sound decision making process?
  • 27. Tactical/Strategic decisions • Paratelic mind-set • Doxa drives actions • Preparedness state • Coping with field findings • Manage local and simple adaptations • Limited or immediate purpose/end in view • Telic mind-set • Episteme drives decisions • Planning & conduct kinetic • Imagining the unthinkable • Steer broad and complex adaptations • Anticipated goals and criteria of success Both interact constantly Dr jan-cedric Hansen april 2018 Tactical Strategic !27
  • 28. Key decision making meta model Confront Disruptions during the length of time Multiple problems emerging simultaneously constant changes of situation Multiple and unstable partners Non stop demands for aids and reliefs Regulate Numerous skids about: Aims, Priorities Roles and positions Information (given or requested), Communication systems Procedures Overcome Consequences of Risky choices Responsibility, guilt problems Subjectivities, bias Clear shortages Cindynics help to clarify both understanding & tasks Dr jan-cedric Hansen april 2018 !28
  • 29. Victims Who confronts • Field Professionals • Firemen • Police • Army • Emergency Unit • NGO • … • Key Decision makers • CEO, Mayor, Governor, … Field Professionnals Spectators Key Decision makers 29 Dr jan-cedric Hansen april 2018
  • 30. What is to be confronted? • Disruptions during the course of time • Multiple problems emerging simultaneously • Constant situational changes • Multiple and unstable partners • Non stop demands for aids and reliefs (from third parties) 30 Dr jan-cedric Hansen april 2018
  • 31. How to confront? • Regulate information • Evaluate reliability and obsolescence of any given information • Imagine several possible evolutions scenarios • Decide what strategy to be kept • Prioritize goals to be reached with specified success criteria 31 Dr jan-cedric Hansen april 2018
  • 32. Who regulates? • Decision makers • Elected people • State representatives • Companies, organisations, and their specific cells PublicMedia Field Professionals Decision makers 32 Dr jan-cedric Hansen april 2018
  • 33. What is to be regulated? • Numerous skids about: • Aims • Priorities • Roles and positions • Information (given or requested) • Communication systems • Procedures 33 Dr jan-cedric Hansen april 2018
  • 34. Outgoing data How to regulate data acquisition data checking Target identification Needs assessment Definition of goals Preparation of messages Impact scenario real impact gap assessment DoCR Incoming data • Stay at a strategic level • Maintain doctrines and objectives • Adapt the cycle of the DoCR as needed 34 Dr jan-cedric Hansen april 2018
  • 35. Who overcomes? • Third party players (insurance companies, communities) • Analysts (experts, researchers), • Civil society (lawyers, parlement, ...), • Collective unconsciousness Third parties Collective unconscious- ness Civil Society Analysts 35 Dr jan-cedric Hansen april 2018
  • 36. What is to be overcome? • Consequences of risky choices • Responsibility, guilt problems, • Subjectivities, bias, • Clear shortages 36 Dr jan-cedric Hansen april 2018
  • 37. How to overcome? ENDING
 (FINEX) + RETEX Goals achievement Success criteria achievement Stabilized situation 37 Dr jan-cedric Hansen april 2018
  • 38. Nursing home during 
 Crisis/Disaster 
 to evacuate or not? VII - What to do with all that knowledge?
  • 39. Follow 1. Assess the situation (Crisis or Disaster?) 2. Categorise mode(s), effector(s), kinetic & energising 3. Identify best medical response type 4. Appraise damage/vulnerability using Cindynics approach 5. Steer strategically by using the decision making meta model: confront-regulate-overcome Dr jan-cedric Hansen april 2018
  • 40. Special focus on evacuation
  • 41. Advanced Strategic Medical Triage Event VV V V Ambulance Noria
 +/- medical supervision Damage Control
 +/- resuscitation ASMT VV VV V V V V V V V VV VV VV VV Hospital Emergenc y Ward Triage operating theatre Resuscitation ward Hospital Emergenc y Ward Triage operating theatre Resuscitation ward Hospital Emergenc y Ward Triage operating theatre Resuscitation ward Hospital Emergency Ward Triage operating theatre Resuscitation ward MSD ASMT: Advanced Strategic Medical Triage
 MSD: Medical Strategic Dispatch Orthopaedic Neurosurgery Chest Abdomen Dr jan-cedric Hansen april 2018 !41
  • 42. Conclusion
 to evacuate or not?
 There is no predetermined answer
 It depends on a contextual & situational analysis
 It is a strategic decision which requires experience, expertise & experiment