disaster management principles
TRANSCRIPT
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DISASTER MANAGEMENT PRINCIPLESJAMES WINTONMAY 2016
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DISASTER MANAGEMENTProvide a framework of how disasters are managed• Pre-hospital• In Hospital
MIMMS approachSCGH Emergency Department disaster plan
2015 ASM: Victims & Responders; Christchurch Earthquake — Prof. Mike Ardagh
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WHAT IS A DISASTER?Disaster• Event • Threat actual or potential• Extraordinary resources• Coordination across services
Classified by type• Trauma vs Medical• Natural vs Man-made• Simple vs compound• Compensated vs uncompensated
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DISASTERS IN AUSTALIANATURAL• Bushfires• Cyclones• Floods• Drought• Earthquake• Heat wave
MAN MADE• Granville train• Westgate bridge• Kemspey bus• Port Arthur• Childers fire• Eureka stockade• Maritime• Air accidents
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DISASTER MANAGEMENT IN WAGoverning body – DPMU
• All hazards approach• Comprehensive approach (Prevention, Preparedness,
Response, Recovery)• All agencies (integrated) approach• Graduated response• Community risk management• Prepared community
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PHASES OF A MAJOR INCIDENTPreparationResponse Recovery
Both prehosptal and in hospital follow these phasesA major incident in Perth may involve hospital based team as part of the coodinated prehospital response
MIMMS course provides an approach to prehospital management
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PRE-HOSPITAL RESPONSE
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SERVICES INVOLVEDAmbulance service Police serviceFire servicesUrban search and rescue teamsLocal authorities – emergency servicesHealth
Organisation and coordination are crucial
All hazards All service
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PREPARATION FOR THE SCENEPersonal equipment• Clothing/phone/torch/camera/map/rationsMedical equipment• Triage/First aid/advance life support/specialist
equipment/transport equipmentCommunication equipment• Radio/phone/other methods – runners, media, loud hailer
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SCENE MANAGEMENTC – Command and controlS – SafetyC – CommunicationA – AssessmentT – TriageT – TreatmentT – Transport
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COMMAND AND CONTROL ZONES
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Casualty clearing post (CCP)• Safe• Large• Sheltered• Acessible
SCENE SET UP
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TRIAGEDisaster triageDynamic process Priorities• 1 – Immediate – RED• 2 – Urgent – YELLOW• 3 – Delayed – GREEN• 4 – Expectant – BLACK/BLUE
Triage Sieve – at incident siteTriage Sort – at casualty clearing post
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TRIAGE SIEVEWALKING Priority 3 (Delayed)
DEADBREATHING
When Airway opened
RESPIRATORY RATE PRIORITY 1(Immediate)
PRIORITY 2 (Urgent)CAPILLARY REFILL
Yes
No
No
Yes
< 10 or >29
10 - 29
< 2 sec
> 2 sec
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TRIAGE SORT
Labels• Visible/attachable
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TRIAGE LABELS
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TREATMENTWhat can be doneWhat should be done
Treatment at scene usually confined to A/B/C
Priority is to get casualties away from the scene
Triage takes priority to treatment
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TRANSFEROrganisation is imperativeTreatment impacts on ability to transport
Destination considerationsMethod of transport
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HOSPITAL RESPONSE
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HOSPITAL PLANSCGH response to an external disaster is “Code Brown”Each area has its specific subplanDo you know where it is?
Details of the contents are available elsewhere
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PREPARATIONHave a planTest the plan• Locally• Regionaly• All agencies• DPMU• Hospital• Emergotrain• Meetings
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NOTIFICATIONMay come from different sources• Ambulance• Media• Self presenters• Hospital Emergency Control Group (ECG)• DPMU – on call duty officer• WebEOC
• Many theories and stories on how patients present
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PREPARATIONSurge capacity• Clearing the ED• Clearing the hospitalTiered responseDepartment layout• Locations• ResourcesClerical involvement
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SCGH ED Mass Casualty layout
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RESPONSEStaff allocated to triage priorititesEach priority has a team leader which liases with duty consultantOther staff may be utilised• Duty surgeon • Duty intensivist• Duty radiologist
• Limit Xrays • Limit operative treatment• “Damage control”
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RECOVERYPotentially huge undertakingResumption of normal functionRestockingDebriefingReviewingPreparation
Hours to days to weeks
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DISASTER MANAGEMENT PRINCIPLESPlanningPreparationPractice
Prehospital responseHospital response
MIMMS – www.mimms.org.au HMIMMS
Thanks to Dr Roger Swift FACEM SCGH ED