developing a disaster mindset: myths & stereotypes of disasters · 2007-03-27 · george...
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![Page 1: Developing a Disaster Mindset: Myths & Stereotypes of Disasters · 2007-03-27 · George Santayana Those who cannot remember the past are condemned to repeat it. George Santayana](https://reader034.vdocument.in/reader034/viewer/2022042923/5f7335b8760f060dd6241511/html5/thumbnails/1.jpg)
John H. Armstrong, MD, FACS
University of Florida, Gainesville
National Emergency Management Summit
The Medical Disaster Planning & Response Process
Developing a Disaster Mindset: Myths &
Stereotypes of DisastersCommitted toexcellence intrauma care
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Armstrong JH, NEMS, Mar 07 2
Those who cannot remember the past are condemned
to repeat it.
George Santayana
Those who cannot remember the past are condemned
to repeat it.
George Santayana
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Armstrong JH, NEMS, Mar 07 3
Medical Disaster Planning & Response Process
Medical Disaster Planning & Response Process
• 1.02: Developing a disaster mindset
• 2.02: Pre-event disaster planning
• 6.02: Joining forces to tackle disasters
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Armstrong JH, NEMS, Mar 07 4
ObjectivesObjectives
• Identify common myths of disasters
• Discuss how to overcome the common myths of disasters
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Armstrong JH, NEMS, Mar 07 5
6 P’s of disaster response6 P’s of disaster response
• Preparation [1]• Planning [2]• Pre-hospital [2]• Processes for hospital care [2]• Patterns of injury [1]• Pitfalls [2]
American College of Surgeons Committee on TraumaDisaster Response and Emergency Preparedness Course
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Armstrong JH, NEMS, Mar 07 6
PreparationPreparation
• Myth #1: disasters are not preventable– Disaster = “evil star”
• Reality: most disasters are “predictable surprises”– Events may not be preventable– Crises and consequences may be ↓↓
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Armstrong JH, NEMS, Mar 07 7
Marine barracks, Beirut, 1983Marine barracks, Beirut, 1983
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Armstrong JH, NEMS, Mar 07 8
Oklahoma City 1996Oklahoma City 1996
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Armstrong JH, NEMS, Mar 07 9
WTC bombing 1993WTC bombing 1993
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Armstrong JH, NEMS, Mar 07 10
Lower Manhattan 2001Lower Manhattan 2001
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Armstrong JH, NEMS, Mar 07 11
Mississippi flood of 1927Mississippi flood of 1927
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Armstrong JH, NEMS, Mar 07 12
Gulf Coast 2005Gulf Coast 2005
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Armstrong JH, NEMS, Mar 07 13
Predictable surprisesPredictable surprises
• Leaders know a problem exists that will not solve itself
• The problem is getting worse over time
Bazerman MH & Watkins, MD, Predictable Surprises, 2004
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Armstrong JH, NEMS, Mar 07 14
Predictable surprisesPredictable surprises
• Fixing the problem– Certain (and large) upfront costs– Uncertain (and larger) future costs
• Natural human tendency = status quo
Bazerman MH & Watkins, MD, Predictable Surprises, 2004
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Armstrong JH, NEMS, Mar 07 15
Predictable surprisesPredictable surprises
• Small vocal minority benefits from inaction
• Leaders can expect little credit from prevention
Bazerman MH & Watkins, MD, Predictable Surprises, 2004
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Armstrong JH, NEMS, Mar 07 16
PlanningPlanning
• Myth #2: disasters are freak occurrences that don’t happen in all communities
• Reality: disasters happen with greater frequency than perceived in all communities
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Armstrong JH, NEMS, Mar 07 17
“All-hazards”“All-hazards”Man-made• Explosion• Fire• Weapon violence• Structural collapse• Transportation event (air,
rail, road, water)• Industrial HAZMAT event• NBC event
Natural• Hurricane• Flood• Earthquake• Landslide/avalanche• Tornado• Wildfire• Volcano• Meteor
“All-hazards” = mechanism of disaster
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Armstrong JH, NEMS, Mar 07 18
Hazard vulnerability analysisHazard vulnerability analysis• Events identified
– Likelihood– Severity– Level of preparedness
• “Connects the dots” for emergency planning
• Shared community understanding
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Armstrong JH, NEMS, Mar 07 19
Hazard vulnerability analysisHazard vulnerability analysis
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Armstrong JH, NEMS, Mar 07 20
Hurricane Charley 2004Hurricane Charley 2004
Gainesville
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Armstrong JH, NEMS, Mar 07 21
Train derailment 2002Train derailment 2002
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Armstrong JH, NEMS, Mar 07 22
School bus crash 2006School bus crash 2006
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Armstrong JH, NEMS, Mar 07 23
Tornadoes 2007Tornadoes 2007
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Armstrong JH, NEMS, Mar 07 24
UF & the SwampUF & the Swamp
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Armstrong JH, NEMS, Mar 07 25
Crystal River nuclear power plantCrystal River nuclear power plant
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Armstrong JH, NEMS, Mar 07 26
Planning: risksPlanning: risks
• ↑ population density
• ↑ settlement in high risk areas
• ↑ hazardous materials
• ↑ threat from terrorism
↓ risks with prevention and planning
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Armstrong JH, NEMS, Mar 07 27
PlanningPlanning
• Myth #3: disaster = single event
• Reality: disasters often are dynamic chain events– Situational awareness key– Scene safety paramount
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Armstrong JH, NEMS, Mar 07 28
… after the storm took an eastward turn,sparing flood-prone New Orleans a
catastrophe.
USA Today, August 30, 2005
New Orleans 2005New Orleans 2005
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Armstrong JH, NEMS, Mar 07 29
Lower Manhattan 2001Lower Manhattan 2001
418 first responders dead418 first responders dead
Beware 2nd hit!
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Armstrong JH, NEMS, Mar 07 30
Oklahoma City, 1996Oklahoma City, 1996
Scene = danger
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Armstrong JH, NEMS, Mar 07 31
D DetectionI Incident commandS Safety & securityA Assess hazardsS SupportT Triage & treatmentE EvacuationR Recovery
Shared tactical modelShared tactical model
First, do no harm
Then, do good
National Disaster Life Support Program, American Medical Association
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Armstrong JH, NEMS, Mar 07 32
Planning: safety & securityPlanning: safety & security
• Protect responders and caregivers
• Protect the public
• Protect the casualties
• Protect the environment
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Armstrong JH, NEMS, Mar 07 33
PrehospitalPrehospital
• Myth #4: ideal human behavior occurs in disasters
• Reality: people are people
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Armstrong JH, NEMS, Mar 07 34
Real human behaviorReal human behavior
• Most first responders self-dispatch
• Survivors carry out initial search & rescue
• Casualties bypass on-site services
• Casualties move by non-ambulance vehicles
Auf der Heide, Annals of Emergency Medicine, April 06
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Armstrong JH, NEMS, Mar 07 35
Real human behaviorReal human behavior
• Most casualties go to closest hospital
• Least serious casualties arrive at hospitals first
• Most information about event comes from arriving patients and television
Auf der Heide, Annals of Emergency Medicine, April 06
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Armstrong JH, NEMS, Mar 07 36
Pre-hospital realityPre-hospital reality
• Planning should take into consideration– how people & organizations are likely
to act– rather than expecting them to change
their behavior to conform to the plan
Disaster Research CenterUniversity of Delaware
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Armstrong JH, NEMS, Mar 07 37
Pre-hospitalPre-hospital
• Myth #5: most survivors at the scene are critically injured
• Reality: most survivors at the scene are walking wounded
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Armstrong JH, NEMS, Mar 07 38
Disaster triageDisaster triage• Initial survivors at scene of most disasters
• 80% non-critical• 20% critical
• Challenge• Identify & prioritize critical 20% • Minimize critical mortality rate
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Armstrong JH, NEMS, Mar 07 39
Disaster triage systemDisaster triage system
Scene(1o triage)
Triage coordinating
hospital(1o triage)
TraumaCenter
(2+o triage)
Inju
red
Hospital(2+o triage)
Casualtycollection
area(2o triage)
Hospital(2+o triage)
Error-tolerant system
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Armstrong JH, NEMS, Mar 07 40
In the middle of difficulty lies opportunity.
Albert Einstein
In the middle of difficulty lies opportunity.
Albert Einstein
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Armstrong JH, NEMS, Mar 07 41
(Hospital) processes(Hospital) processes
• Myth #6: mass casualty care = doing more of the usual care
• Reality: mass casualty care = minimal acceptable care
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Armstrong JH, NEMS, Mar 07 42
Mass casualty careMass casualty care
Greatest good for the greatest number based on available resources . . .
. . . while protecting responders and providers
Not simply doing more of the usual
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Armstrong JH, NEMS, Mar 07 43
Minimal acceptable careMinimal acceptable care
• Large casualty numbers
• Multidimensional injuries
• Healthcare needs > resources
• Severity, urgency, survival probability
• Occurs from scene to initial hospital +
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Armstrong JH, NEMS, Mar 07 44
Casualty populationCasualty population
CASUALTIES
onemultiple
limited mass mass
RESOURCES
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Armstrong JH, NEMS, Mar 07 45
Hospital casualties
Centers for Disease Control, 2003
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Armstrong JH, NEMS, Mar 07 46
SurgesSurges
• Surge capacity: ↑ space + resources
• Surge capability: ↑ ability to manage presenting injuries & medical problems
• Not business as usual
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Armstrong JH, NEMS, Mar 07 47
TriageTriage
• Undertriage• Critical casualty assigned to delayed care
• Overtriage• Noncritical casualties assigned to urgent care• Normally only a logistical problem• In disasters, distraction from critically injured
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Armstrong JH, NEMS, Mar 07 48
Over-triage ↓↓ outcomesOver-triage ↓↓ outcomes
Frykberg, Journal of Trauma, 2002
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Armstrong JH, NEMS, Mar 07 49
(Hospital) processes(Hospital) processes
• Myth #7: disasters trigger massive blood supply shortages
• Reality: blood supply has surge capacity
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Armstrong JH, NEMS, Mar 07 50
Calls for bloodCalls for blood
• Lower Manhattan 2001– 475,000 units donated– 258 used
• Madrid 2004– 17,000 units donated– 104 used
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Armstrong JH, NEMS, Mar 07 51
(Hospital) processes(Hospital) processes
• CNN effect is real
• A story will be reported
• Shape the story for the media– Ongoing media relationships key
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Armstrong JH, NEMS, Mar 07 52
PatternsPatterns
• Myth #8: most disasters generate high volume acute care needs
• Reality: most disasters – Expose high volume chronic care needs– Generate ongoing psychosocial needs
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Armstrong JH, NEMS, Mar 07 53
Chronic > acute careChronic > acute care
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Armstrong JH, NEMS, Mar 07 54
Acute + chronic stressAcute + chronic stress
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Armstrong JH, NEMS, Mar 07 55
PitfallsPitfalls
• Myth #9: effective initial disaster response requires a local federal response
• Reality: all disaster response is local for 72 hours
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Armstrong JH, NEMS, Mar 07 56
Personal preparednessPersonal preparedness
• Individual
• Family
• Home
• Work
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Armstrong JH, NEMS, Mar 07 57
Resource responseResource response
• I: Local resources only
• II: Local + regional resources
• III: Local + regional + national resources
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Armstrong JH, NEMS, Mar 07 58
Local before national Local before national
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Armstrong JH, NEMS, Mar 07 59
PitfallsPitfalls
• Myth #10: disaster plan = full preparation
• Reality: disaster plans are relevant when– they are created across all stakeholders– they promote awareness of roles– they are practiced with realism
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Armstrong JH, NEMS, Mar 07 60
#1 pitfall: communication#1 pitfall: communication
• Starts with planning
• Continues through execution
• Cycles through post-event review and plan revision
“Train as you fight”
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Armstrong JH, NEMS, Mar 07 61
Long-term goal: recoveryLong-term goal: recovery
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Armstrong JH, NEMS, Mar 07 62
Science is the great antidote to the poison
of enthusiasm & superstition.
Adam Smith
Science is the great antidote to the poison
of enthusiasm & superstition.
Adam Smith
Best practice evidence exists!
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Questions?
Chance favors the prepared mind.
Louis PasteurCommitted toexcellence intrauma care
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Armstrong JH, NEMS, Mar 07 64
SummarySummary
• Myths and stereotypes = false assumptions– Memories fade with time
• Overcome myths with evidence and relevance– Translate for the community– Make it sticky & ongoing
Thank [email protected]