Disaster medicine Flashcards
Discuss causality based classification of disaster
Mild
->25 injured or 10 requiring admission
Moderate
>100 injured or 50 requiring admission
Major
>1000 injured or 250 requiring admission
Problems with this classifications
- does not consider size or capabilities of receiving hospital
- Actual number of potential patients often not known at time of disaster
Discuss Natural disasters
Widespread damage to person and property - communications often destoryed and transport system interrupted
Generally no pre hospital triage
- most severely injured reach hospital later than those withi minor injuryes
- do not commit resources to the patients who arrive first - instead prepare for the second wave of the seriously injured
- most survivors extracted in 24 hours
Discuss disaster severity score
Serviced need
0- regional
1- national
2- internatiponl
Cause
0 - man made
1- natural
Duration
0- <1 hour
1 <24 hour
2 >24 hours
Radias of area (0/1/2)
Casualities
0- 25-100
1- 100-500
2- >500
Discuss disaster levels
Level 1
-escalated response from local EMS system
Level 2
-requires regional response
Level 3
Requires national or international repsonse
Discuss counter disaster planning
Objective
- save life
- prevent escalation
- prevent suffering
- protect environement
- protect property
- restore normality
Disaster planning 😎
- prevention
- preparation
- –training and exercises
- –communications systems
- –stockpiling of resources’
- response
- recovery
Discuss operational assumptions that are mare in major incidents
1) most EDs are already operating at full capcity
2) there will be little or no advance warning of a major incident
3) most patients presenting following a generalised incident will not arrive via EMS
- these have not been triaged, decontaminated or received any treatment
4) 50-80% of the acute casualites will arrive at the closest medical facilities usually within 90 minutes of the event
5) there will be limited option ofr patient diversion or transfer to another hosptial
6) bypass is usually not an option
7) all attempts will be made to maintain normal standrads of care
Discuss stages of hospital response to disaster
Notification
- usually via QAS
- to the hospital disaster controller
Stage A (standy by)
- hospital advised of disaster
- prepartion for implementation
- all staff to remain on duty
- surgeons in theatre must remain there no new surgery to start
- ED prepares for removal of non urgent cases and admission of those needed
- Hospital controlled assesses bed state arranges discharges
Stage B (activation)
- Confirmation and details of number and tupe of casualities
- all non uregent ED patients asked to leave if able
- new non urgent ED patients are assessed informed of disaster and requested to leave
- – if they stay they are incorporated into the disaster resposne
- clear outpatients and wards
- visitors asked to leave
Stage C (patients arriving and triages or retriaged)
- large triage area requried - ambulance bay is commonly used
- identification lables attached around wrist and neck
- ID card for each patients triaged is kept and transferred to the patient information centre
Establish control centre
- usually hospital board room
- assemble control team
- -CEO, medical directer, diercter of admin serves, director of nursing, saftey officer
Reception of patients
- ED for serioursly injured
- OPD for walking wounded
- area set aside for mortuary
Discuss information management in a disaster
Patent info centre
- usually remote site from treatment area
- should receive continual updates on admissions and patient status
New media liaison
- usually in main auditorium
- keep press from disturbing patient acre
Debrief
- organisational/clinical
- psychological
- immediate vs delayed
- follow-up after investigation e.g coronial finding
Discuss key elements of on site management of mass cas
Key elements C-command and controle S- saftey C- communications A- assessment T -triage T- treatment T- transport
Discuss communication in mas cas
M - major incident declared, activate plan
E- exact location
T- type of incident
H-Hazards
A- access
N- number and type of casualties
E- emergency services present and required
Discuss control and saftey
Police
- usually responsible for command and control in Australia
- secure the incident scene
- establish routes into and out of
- control bystanders
- activate voluntary aid societies and local aurthrotis
- set up a casualty burea to collate information regarding
- identify dead and organise for their removal from the scene in conjunction with the local coroner
Discuss triage in a mas causality scenario
Difference fomr day to day - do the most good for the most number of patients
-usually performed by the first senior ambulance officer at the site
Red (p1)
- RR <10 or >29
- unable to maintain patent airway
- cap refill > 2seconds
- Pulse 120/min
- highest priority for transport to casualty clearing station
Yellow (p2)
- no criteria for P1
- capillary filling <2 seconds or pulse <120
- second priority for transport
Green (p3)
- walking
- potentioanl discharge at scene or move to alow acuity casualty clearing point for mass transport
Black
- no resp depsite airway patency
- dead
- no moved from scene
Discuss disaster zones
Hot
- area immediatley surrounding hazardous material
- personnel not specifically trained in the use of slef contained breathing apparatus and fully protective suits should not enter this zone
Warm
- area of decontamination between hot and cold zone
- all personnell and patients must traverse this zone from hot to cold
Cold
- does not require personal protective clothing
- medical personnel usually only operate in this zone
Discuss tirage tags
Placed around the patients neck and wrist
unique identifier for the patient and a barcord
Red/pink
- immediate care
- critical injury but with good chance of survical if simple life saving measures provided
- may only need relief of airway obsturction or tension pneuothorax >40% TBSA burns
Orange/yellow
- signfiiacnt injury not immediatly life threatening
- likley to survive if simple care given within hours
- requires definitive care
Green
- walking
- minor injuries
Blue
- survival unlikley even with best care
- expectant management and analgeisa only
- exampls
- GCS 3
- -CPR required
- AGE >60 and >50% burns
- -elderly patient wtih shocke and multiple severe injuries
Black
-dead
Discuss casuality clearing station
- Re triages
- immediate stabilisation of injuries
- -basic airway manoeuvres
- -decompression of tension
- -haemhorrage control
- -splinting of fractures
- determine priorities of transport
- -order of transport of victims
- -destination hospital of victims
Site selection
- uphill and up wind of diaster
- safe distance
- large flat site
