The document discusses considerations for surgical services to prepare for mass casualty events, including identifying event types that could impact capacity or capabilities and developing a culture of continual readiness. It identifies objectives such as recognizing event characteristics, considerations for capacity and specialized needs, and recommends three actions like planning communication systems and conducting drills to test preparedness plans.
Internal Disaster Preparedness and Management in HospitalsLallu Joseph
This presentation deals on the following
1. Disaster definition- Internal and external
2. Learning from Disasters- Case Studies- AMRI, Chennai Floods
3. Four phases of emergency management
5. Risk assessment
6. 5 steps of emergency preparedness
7. Emergency management and evacuation plan for hospitals
8. Mock drills and how to conduct them
9. Table top exercises
Purpose of the call:
•Review current data and state of the SSCL
•Discuss the role of communications and team work in patient safety
•Discuss and define how we can measure the effectiveness of the SSCL.
Read more and watch the webinar recording: http://bit.ly/1sXDqaZ
This presentation is from an AORN webinar that helps guide perioperative team members through the evidence appraisal and rating process using the AORN appraisal tools and evidence-rating model. The webinar replay is available for free at http://bit.ly/1i9r4En. Get the 2014 edition of Perioperative Standards and Recommended Practices at http://bit.ly/1bJmXAT.
Internal Disaster Preparedness and Management in HospitalsLallu Joseph
This presentation deals on the following
1. Disaster definition- Internal and external
2. Learning from Disasters- Case Studies- AMRI, Chennai Floods
3. Four phases of emergency management
5. Risk assessment
6. 5 steps of emergency preparedness
7. Emergency management and evacuation plan for hospitals
8. Mock drills and how to conduct them
9. Table top exercises
Purpose of the call:
•Review current data and state of the SSCL
•Discuss the role of communications and team work in patient safety
•Discuss and define how we can measure the effectiveness of the SSCL.
Read more and watch the webinar recording: http://bit.ly/1sXDqaZ
This presentation is from an AORN webinar that helps guide perioperative team members through the evidence appraisal and rating process using the AORN appraisal tools and evidence-rating model. The webinar replay is available for free at http://bit.ly/1i9r4En. Get the 2014 edition of Perioperative Standards and Recommended Practices at http://bit.ly/1bJmXAT.
To increase the the quality of health care.......... Risk management in labour is vital as it is connected with two lives. So it is the responsibility of the health care providers to assure it.........
Disaster management-TRANSPORTATION AND HOSPITAL EMERGENCY CAREselvaraj227
TRANSPORTATION AND HOSPITAL EMERGENCY CARE, EFFECTS OF DISASTERS CONSEQUENCES OF DISASTERS ON HEALTH SERVICES DISASTERS AND HEALTH SECTOR RISK OF A DISASTER Role of Hospitals in Disasters/ Mass Casualty Incident (MCI) MENTAL HEALTH WAYS MANAGE YOUR STRESS FRAMEWORK FOR HEALTH PROFESSIONALS DISASTER MANAGEMENT PLAN HOSPITAL NETWORKING INCIDENT COMMAND SYSTEM
Discover evidence-based practices to prevent sharps injuries and to reduce blood borne pathogen exposure to perioperative patients and personnel. This presentation is from a recent AORN webinar. Listen to the replay for free at http://bit.ly/1asAKXx. When registering for the replay, you can also earn one contact hour through June 27, 2014.
Speaker: Michael Loehr, Preparedness Director, Seattle/King County Public Health
Public Health - Seattle King County (PHSKC) and regional healthcare partners have developed
and tested Alternate Care Facility (ACF) capability to support medical surge needs during
disasters. The ACF design is modular, scalable, and mobile ranging from a 50-bed minimal care
site to three 250-bed inpatient care facilities. PHSKC coordinated with numerous healthcare,
emergency management, EMS, law enforcement and facilities partners to identify appropriate
roles, responsibilities and resources necessary to implement this capability. Plans have been
developed addressing medical supplies management, medical and non-medical staffing, scope of
care, site layout, coordination with EMS and local EOCs, communications and security. ACF modules are designed to address four levels of care, and include acute care, walk-in care,
pharmacy, pediatrics, lab, palliative care, limited behavioral health services and oxygen delivery.
Through this presentation, we will describe the partners involved in planning, share details
regarding the modular design, types of equipment acquired, the flow of patient care, medical
staffing model, and approximate costs for developing this capability
Discover what it takes to be a Perioperative Clinical Nurse Specialist. This presentation is from AORN's webinar which describes the role of the perioperative CNS, RN. Receive 0.5 contact hours by registering for the webinar replay and successfully completing the evaluation. The webinar is available at http://bit.ly/1aROqKI.
Interested in obtaining the new CNS-CP nursing credential? Learn valuable test-taking strategies and more through a CNS-CP Certification Exam Preparation Course: http://bit.ly/GQ5Yy0.
A "bundle" is a
group of evidence-based care components
for a given disease that, when executed together, may result in better outcomes than if implemented individually.
Patient safety is the cornerstone of high-quality healthcare services. In the presentation, A summary of the frameworks & practical approaches to improve safety of patient care.
To increase the the quality of health care.......... Risk management in labour is vital as it is connected with two lives. So it is the responsibility of the health care providers to assure it.........
Disaster management-TRANSPORTATION AND HOSPITAL EMERGENCY CAREselvaraj227
TRANSPORTATION AND HOSPITAL EMERGENCY CARE, EFFECTS OF DISASTERS CONSEQUENCES OF DISASTERS ON HEALTH SERVICES DISASTERS AND HEALTH SECTOR RISK OF A DISASTER Role of Hospitals in Disasters/ Mass Casualty Incident (MCI) MENTAL HEALTH WAYS MANAGE YOUR STRESS FRAMEWORK FOR HEALTH PROFESSIONALS DISASTER MANAGEMENT PLAN HOSPITAL NETWORKING INCIDENT COMMAND SYSTEM
Discover evidence-based practices to prevent sharps injuries and to reduce blood borne pathogen exposure to perioperative patients and personnel. This presentation is from a recent AORN webinar. Listen to the replay for free at http://bit.ly/1asAKXx. When registering for the replay, you can also earn one contact hour through June 27, 2014.
Speaker: Michael Loehr, Preparedness Director, Seattle/King County Public Health
Public Health - Seattle King County (PHSKC) and regional healthcare partners have developed
and tested Alternate Care Facility (ACF) capability to support medical surge needs during
disasters. The ACF design is modular, scalable, and mobile ranging from a 50-bed minimal care
site to three 250-bed inpatient care facilities. PHSKC coordinated with numerous healthcare,
emergency management, EMS, law enforcement and facilities partners to identify appropriate
roles, responsibilities and resources necessary to implement this capability. Plans have been
developed addressing medical supplies management, medical and non-medical staffing, scope of
care, site layout, coordination with EMS and local EOCs, communications and security. ACF modules are designed to address four levels of care, and include acute care, walk-in care,
pharmacy, pediatrics, lab, palliative care, limited behavioral health services and oxygen delivery.
Through this presentation, we will describe the partners involved in planning, share details
regarding the modular design, types of equipment acquired, the flow of patient care, medical
staffing model, and approximate costs for developing this capability
Discover what it takes to be a Perioperative Clinical Nurse Specialist. This presentation is from AORN's webinar which describes the role of the perioperative CNS, RN. Receive 0.5 contact hours by registering for the webinar replay and successfully completing the evaluation. The webinar is available at http://bit.ly/1aROqKI.
Interested in obtaining the new CNS-CP nursing credential? Learn valuable test-taking strategies and more through a CNS-CP Certification Exam Preparation Course: http://bit.ly/GQ5Yy0.
A "bundle" is a
group of evidence-based care components
for a given disease that, when executed together, may result in better outcomes than if implemented individually.
Patient safety is the cornerstone of high-quality healthcare services. In the presentation, A summary of the frameworks & practical approaches to improve safety of patient care.
Sandy to Migrants; How Preparedness brings Hope!.pdfBLeo0001
Beacon Christian Community Health Center Presentation shared at the 4/13/23 8th Annual Community Health Care Association of New York State (CHCANYS) Emergency Management Conference held at Baruch College NYC.
F-M Area Stop the Bleeding Community InitiativeAdam Hohman
An idea I have proposed in the past based on the Hartford Consensus. I'm open to F-M area organizations who would like to pursue the initiative as a collaborative effort.
Chapter 7 Assuring Safety and Security in Healthcare Insti.docxmccormicknadine86
Chapter 7: Assuring Safety and
Security in Healthcare Institutions
Safety and Security – Risk?
• Health facilities that experience adverse
events due to safety or security issues can
incur penalties ranging from large fines to loss
of accreditation.
• An aggressive and well-organized safety and
security management program can help
minimize risk of and adverse event.
Regulation and Accreditation
• Medicare and Medicaid require a participating
healthcare organization to satisfy the
Conditions of Participation (CoP) relevant to
the management of safety and security.
– Accreditation by the Joint Commission, DNV
Healthcare Inc. or HFAP ensures that the facility
meets the CoP requirements
• State Departments of Health also regulate
safety and security in healthcare organizations
Safety vs. Security
• Safety can be a broad category with standard
policies and procedures throughout a facility or
system.
– Hand-washing policy
– Use of Personal protective gear
– Hazardous waste disposal
• Security must be more site specific.
• Safety and security policies sometimes conflict.
High Risk Events
• A facility may incur major penalties if a
“never” adverse event occurs (an event that
should not occur if appropriate safety/security
measures were in place)
• CMS may not reimburse costs of a never event
and many third party payers have a non-
reimbursement program as well.
Techniques for Managing
Safety and Security
• Risk Assessment Estimate
• Failure Modes and Effects Analysis (FMEA)
• Root-cause Analysis (RCA)
• Technological Redundancy
• Crew Resource Management
• Red Rules
Potential Environmental Hazards
• OSHA has a list of the types of hospital-wide
hazards and provides information on how to
prevent and respond to them
• Three categories of hazardous materials
– Biological
– Chemical
– Radioactive
Security: Unwanted Intruders
• Use of high-tech solutions to manage visitor
and employee access
– Automated turnstiles with card swipe readers for
employee entrances
– Visitor areas/desk where all visitors enter and
sign-in.
– Employee ID badges
– Secured areas
Potential Security Hazards
• Theft of Patient Valuables/Employee theft
• Infant abduction
• Workplace Violence
• Gangs
Patient Valuables
• Provide a safe in the building to house
valuables
• Provide receipts for any valuable stored by
facility
• Encourage patients to leave valuables at
home or give to family to take home
Violence in the Workplace
• Patients have a right to treatment but staff
have a legal right to a safe workplace
• Watch for signs that may lead to violence
(in patients, visitors and staff)
– Anger
– Stress
– Under the influence of drugs/alcohol
Gangs
• Many health facilities treat victims of gang
violence and occasionally the dispute
continues upon arrival at the facility.
• Use of metal detectors is increasing to prevent
entrance of weapons into the health facility
Information ...
GEMC- Pediatric Trauma: Special Considerations- Resident TrainingOpen.Michigan
This is a lecture by Ruth S. Hwu, MD 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/.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Adversarial Attention Modeling for Multi-dimensional Emotion Regression.pdf
In A Moments Notice
1. In a Moment’s Notice:
Preparing Surgical Services for Mass
Casualty Events
Barb Bisset, PhD MPH MS RN
Executive Director
Emergency Services Institute
WakeMed Health & Hospitals
At least three people have been killed and another 100 maimed or injured after two "powerful" bombs were detonated at the finish line of the Boston
marathon. The coordinated blasts, the worst attack on US soil since the September 11 terror atrocities, transformed a site of celebration on a public
holiday afternoon into a scene of carnage and destruction. This is the moment one of the bombs detonated near the finish line of the Boston Marathon.
Picture: DAN LAMPARIELLO/DOBSONS http://www.telegraph.co.uk/news/picturegalleries/worldnews/9996842/In-pictures-Boston-Marathon-
bombing-several-die-and-more-than-130-injured.html
2. Objectives
• Identify the types of mass casualty events that can impact
the capacity (volume) and service capabilities (specialized
interventions) in the provision of patient care
• Identify Surgical Services considerations for developing a
culture of continual readiness
• Identify three actions that should be taken to prepare
Surgical Services to manage mass casualty events
3. Mass Casualty Considerations:
Event’s Point of Origin
• Community-based
School event, transportation accident, mass gathering
• Hospital-based – hospital is the only facility affected, e.g.
Hospital fire, plumbing break, IS downtime
• Community and hospital are both victims
Weather events
4. Mass Casualty Considerations:
Event’s Point of Origin
4
Photo:
http://c.ymcdn.com/sites/www.leadingagemissouri.org/resource/resmgr/annual_conferenc
e/wednesday_joplin_tornado_les.pdf
5. Mass Casualty Considerations:
Event’s Point of Origin
• 2011 Joplin, Missouri
– Tornado EF 5
– 1000 casualties in community; 8000 structures
damaged
– 5 hospitalized patients died and 1 visitor killed
– Unidentified number of employees injured
– Several hospital fires; broken natural gas lines;
loss of power, broken piped medical gases
– 183 patients evacuated from St John’s Medical
Center within 90 minutes
6. Mass Casualty Considerations:
Source – Cause of Event
• Blast / Fire / Explosion
• Building Collapse
• Hazardous Materials
– Chemical Spills
• High Security Risks
– Active Shooter
– Bomb Threat
– Hostage
• Man-Made
– Civil Disturbance
• Severe Weather
– Flooding
– Hurricanes
– High Winds
– Tornadoes
– Hyper/hypothermic events
• Transportation Accidents
– Airplane
– Bus
– Motor Vehicle Crashes
– Train
7. 7
Mass Casualty Considerations:
Source – Cause of Event
• Consider origin of source for
injuries – e.g. blast injuries
• Impact in OR, PACU and ICU
likely to last for days or weeks
• May need to care for burn
patients on an inpatient basis
• Prepare for multiple open /
closed fractures
• Occult blast injuries may not be
discovered until the patient
reaches the ICU (or other
departments)
• Majority of ICU patients will
require ventilation
• Plan for event related surgeries
concurrently to occur for at least
72 hours
– Identify emergency, critical
interventions (death likely without
intervention; extensive resources
may not be available
• Positive pressure ventilation and
anesthesia cause greater
mortality in those with blast lung
injuries
– Postpone surgery 24-48
hours whenever possible
8. Mass Casualty Considerations:
Capacity and Capability
• Capacity Surge (Volumes of Patients)
– Ability to evaluate and care for a markedly
increased volume of patients exceeding normal
capacity
– Surge requirements extend beyond direct patient
care
• e.g. laboratory studies, imaging services, food and
nutrition, case management, care of public and
families
9. Mass Casualty Considerations:
Capacity and Capability
• Capability Surge (Types of Patients)
– Ability to manage patients requiring unusual or very specialized
medical evaluation and care
e.g. blast injuries, gunshot wounds, pediatrics, chemical
contamination
– Intervention may include procedures that are not performed on a
regular basis
– Expertise, information, procedures, equipment and personnel are
normally not located where they are needed
11. Mass Casualty Considerations:
Capacity and Capability
• Some or all casualties may be pediatric
• Accompanied or unaccompanied by family / care providers
– Children may have been in different location at the time of the event,
e.g. school
– Children and parents may have initially be together, but got
separated at time of event
– Children may be uninjured, but with injured parent
– Children may be injured, parent is not injured
– Both children and parents may be injured
– Children may be unidentified; parent may be unidentified
– Children may be orphaned due to loss of parents
12. Mass Casualty Considerations
Capacity and Capabilities
• Trauma Centers
• Burn Centers
• Non-trauma hospitals
• Hospitals with general services, but without intensive
care units
• Hospitals with/without age specific services, such as
pediatrics, geriatrics
13. Mass Casualty Considerations:
Timing and Arrival of Victims
• Initial Rapid Influx
– Victims will start to arrive in minutes
– Most severely injured arrive after minor injuries
– In acute event, plan for 50% to arrive within the first hour
– 85% will bypass emergency services and will self direct
• Secondary Influx
– There may be victims from event days or weeks later
14. Mass Casualty Considerations:
Timing and Arrival of Victims
Madrid Bombing Data
– Between 7:37 am and 7:42 am, 10 bombs were detonated on four
trains
– 177 people killed instantly
– Greater than 2000 injured
– 966 patients taken to 15 hospitals
– Closest hospital
• Received 312 patients
• 272 arrived between 7:42 am and 10:00 am
• Hundreds of radiographs, CTs, ultrasounds
• Multiple surgical procedures
15. 15
Mass Casualty Considerations:
Crime Event
• Community may have curfew, e.g. Boston Bombing
• Control internal and external environment
– Controlled Access
• Identify traffic patterns
• If criminal investigation, event requires collection of
evidence and maintenance of chain of custody
– All items removed from patients could be considered evidence
– All items, including shrapnel, nails, etc that are surgically removed
must be preserved
17. Continual Readiness
Acts of Random Preparedness*
versus
Methodical Planning & Practice & Prepare
=
Continual Readiness
*(Dodgen, Don, PhD, (2009, May 12th), Planning and Preparedness for Children’s Needs in Public Health Emergencies,
http://archive.ahrq.gov/prep/childneeds/chneedslidestst.htm)
18. Mass Casualty Continual Readiness
18
Approaches to training suggest “random
acts of preparedness”.
Multi-casualty Incident drills, irrespective of
populations, appear to be retraining every
time.
Improved training methods to embed
responses, behaviors and actions should
be developed and applied.
Johnson, Kelly & Dodgen, Daniel, (2009, May 12th) Planning and
Preparedness for Children’s Needs in Public Health
Emergencies, Agency for Healthcare Research and Quality
Those who fail to plan, plan to fail.
Benjamin Franklin
19. Mass Casualty Continual Readiness
• Mass casualty patients of all ages may present to
ANY hospital
• Critically ill patients may present to ANY hospital
• Transfer of patients to specialized hospitals may
not be possible
• All mass casualty patients at all hospitals require:
– Emergency Evaluation (EMTALA)
– Surgical Services
– Critical and/or Acute Inpatient Care
– Psychological Support
21. Mass Casualty Continual Readiness
• Communication Systems
• Equipment
• Supplies
– PAR Levels
– Critical Resources
• Pharmaceuticals
• Transportation
• Staffing
– Specialties
– Support Departments
• Imaging
• Lab
• Transporters
– Force Multiplier
22. Mass Casualty Continual Readiness
• Ability to rapidly activate emergency operations plans
– Identify authority 24/7 in building
– May have less than 10 minutes to get things into place
• Plan resources to cover multiple shifts
– Staffing, supplies, equipment
• Plan method to track all patients associated with event
– Patient Registration icon
• Incident Management Team to set objectives for multiple
phases when indicated
– Monitor activities to determine when facility can start to demobilize
23. Mass Casualty Continual Readiness
• Notifications
– Staff contact information needs to be kept current
– Rapid and robust notification system
– Plan for actions staff should take should communication
system fail
– Staff communications systems
• Social media, recorded voice mail, emails, scheduling software
capability
24. Mass Casualty Continual Readiness
• Involve Administration, Strategic Sourcing and Pharmacy in
planning – agree to inventory
• Develop Critical Resource Document – documents number of
hours of available resources
• Identify specialty equipment/supplies for capability events
− Pediatrics, burns, ortho injuries, vascular injuries
− Mass casualty caches need to be mobile; easily moved
between departments
• Confirm who is checking emergency supplies and equipment
• Determine how mass casualty inventory use will be tracked
25. Mass Casualty Continual Readiness
• Rapid discharge procedure system
• Emergency Department patients take priority for admissions
• Operating Room needs to plan to potentially function 24/7
for several days
• Clinical and Support departments need to have plan to
increase capacity/productivity: e.g. Lab, Imaging Services,
Case Management, Respiratory Care, Environmental Services
, Food and Nutrition
26. Mass Casualty Continual Readiness
• Emergency Departments need to identify method for rapid
patient triage and registration
– Triage locations)
– Triage method
– Initial and secondary patient assessment
– Rapid Registration
– Log in everyone
• Identify who will triage resources, e.g. Operating Rooms, CT
scans
– Suggest trauma team leader
• Suggest OR leadership presence in the ED
27. Mass Casualty Continual Readiness
• Policy to delay or cancel elective interventional procedures or
elective surgeries
• Consider the following spaces for alternate functions:
– Day Surgery
– Endoscopy
– Cath Labs
– Interventional Procedure Holding Areas
28. Mass Casualty Continual Readiness
• Identify casual pool capabilities
• Departments should review their role in mass casualty events on an
annual basis
• Integrate many mass casualty principles into normal operations capacity
management
• Take care to keep staff in “reserve” should event last multiple shifts.
• Incident Management Team – pre-assign 3 levels of experts; individuals
should be familiar with their part of the plan
• Consider Staff Force Multiplier Models: experts can supervise others
• Staff must always practice within scope of license
29. Mass Casualty Continual Readiness
• Know where competency based data is kept
• Policy that all staff are considered essential to emergency/disaster
events
• Personal preparedness blitzes; confirm with staff their plans are in place
• Develop checklists to provide direction
• Incorporate emergency training into competency blitzes
30. Mass Casualty Continual Readiness
• Staff and/or families may be victims of event
• May be exposed to difficult situations that are not
within their “usual” practice
• Staff may fear responding
• Duties may need to be altered
• Staff fatigue
31. Mass Casualty Continual Readiness
Staff Care
• Psychological First Aid
• Spiritual Care
• Critical Incident Stress Management
– Review “normal” reactions
– Review healthy coping skills
– Identify “red flags” that more in-depth support or counseling is
needed
32. Mass Casualty Continual Readiness
• Staff Training
– High Level Awareness
– Specialist
– Experts
• Drills / Exercises
- Tabletop
- Functional
- Full Scale
• Evaluation – After Action Reports
– Identify Opportunities for Improvements
• Corrective Actions
– Follow progress monthly basis
33. Mass Casualty Continual Readiness
• Drills & Exercises
– Set objectives
– Test weakest points
– Everyone participates
– Everyone provides feedback
– Develop After Action Report
– Follow Action Plans through closure
34. Mass Casualty Continual Readiness
• After Action Reports are important
• Take time to close identified gaps
– e.g. Freeman Healthcare System After Action
Report
Type of injuries – 200 mph winds cause deep wound injuries
• OR emergency lighting very limiting
• Not enough emergency power outlets
• Only used Imaging Services for life threatening cases
• Just-in-Time deliveries could not keep up with demand for resources
• Orthopedic supplies were critically short
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35. Mass Casualty Continual Readiness
• What you practice is what you will do
• Select one objectives
• No one should get out of planning and drilling – everyone counts
• Practice, practice, practice plans!
• Drill until you fail
• Drill with hospital departments
• Drill with community partners
• As leadership goes, so goes staff
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36. Mass Casualty Continual Readiness
• Freeman Healthcare System Response- Joplin
Tornado
– 130 patients immediately presented to 40 bed ED
– Staff lounges converted to treatment space
– Total of 1,000 patients treated at the ED and the Alternate Care Site
– 22 life saving surgeries performed within first 12 hours when facility
was on emergency power
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37. Mass Casualty Continual Readiness• Capability Surge (Types of Patients: Blast Injuries – Boston Marathon Bombing –
• Brigham and Women’s Hospital Timeline, April 15, 2013
• 08:00 Per standard Marathon Day procedures, the Brigham and Women’s Hospital Emergency Operations
• Center is partially activated.
• 14:49 Scan of the emergency department (ED) shows 66 patients in the 55-bed ED and 30 of 42 operating
• rooms (ORs) active or in use.
• 14:50 Reports of the explosion heard over Boston EMS/Fire radio frequencies.
• 14:54 Hotline from Centralized Medical Emergency Dispatch (CMED) rings in ED, reporting 2 explosions
• and incoming patients.
• Emergency medicine physician, nurse in charge, and emergency-management director huddle to
• implement “Code Amber,” the hospital’s mass casualty incident plan.
• Call from the Medical Intelligence Center (MIC) at the Boston Public Health Commission informs
• hospital that it will soon receive 8 patients from the scene.
• 14:59 Nurse in charge mobilizes providers to ready multiple operating rooms.
• 15:00 Trauma Service notified of explosion. Phone tree notifies orthopaedic surgeon, neurosurgeon, chief
• resident in surgery, OR front desk, and all 7 trauma surgeons in the hospital that day.
• 15:08
• to 15:38
• Nineteen bombing patients arrive, each of whom is assigned a multidisciplinary team to conduct
• trauma surveys and perform resuscitations, intubations, and blood transfusions if necessary.
• 15:15 OR medical director huddles with orthopaedic, emergency medicine, and trauma team leaders to
• coordinate direct flow into ORs for most seriously injured patients, bypassing preoperative areas.
• 15:30 Core leaders of orthopaedics, trauma, and anesthesiology assembled.
• 15:39
• to 16:38
• Brigham and Women’s Hospital receives 7 more bombing patients.
• 16:00 Senior general surgeon positioned in ORs to facilitate surgical administrative issues.
Overall, Brigham and Women’s Hospital treated 40 Marathon patients. Nine required immediate operative intervention.
38. Mass Casualty Continual Readiness
“We Fight Like We Train”
Success came from “colleagues working alongside familiar teammates performing
familiar tasks.”
Drs Eric Goralnick and Jonathan Gates
“We Fight Like We Train,” NEJM, May 1, 2013.
39. Mass Casualty Continual Readiness
• Incorporate into daily operations
– Daily capacity reports
– Daily huddles; increase as needed
– Written guides/ checklists specific to each
department
– Establish paging and e-mail groups
– Test specific indicators on a regular basis
40. In a Moment’s Notice : Preparing
Surgical Services
• Identify the types of mass casualty events that can
impact the capacity (volume) and service capabilities
(specialized interventions) in the provision of patient
care
• Identify Surgical Services considerations for
developing a culture of continual readiness
• Identify three actions that should be taken to prepare
Surgical Services to manage mass casualty events
41. Resources
• Agency for Healthcare Research and Quality (AHRQ), (Archive as of June 30th
2011), Pediatric Terrorism and Disaster Planning
http://archive.ahrq.gov/research/pedprep/pedtersum.htm
• Agency for Healthcare Research and Quality (AHRQ), (no date) Preparation by
General Healthcare Facilities for a Surge of Critically Ill Children, U.S. Department
of Health & Human Services,
http://archive.ahrq.gov/prep/pedhospital/pedhospital6.htm
• Gawande, Atul (2013, April 17th), Why Boston Hospitals were Ready,
http://www.newyorker.com/news/news-desk/why-bostons-hospitals-were-ready
• Medical Response to Joplin Tornado May 22, 2011 Report (2011, August 2nd)
• Resnick, Lloyd, A Special Report From the Publishers of The Journal of Bone & Joint
Surgery and the Journal of Orthopaedic & Sports Physical Therapy (2014, March) It
Takes a Team: The 2013 Boston Marathon, Preparing for and Recovering from a
Mass Casualty Event, http://sites.jbjs.org/ittakesateam/2014/report.pdf