List Archives

Wed, 6 Feb 2002 14:09:14 -0500

This message is in MIME format. Since your mail reader does not understand
this format, some or all of this message may not be legible.

------_=_NextPart_001_01C1AF41.C46DF4C0
Content-Type: text/plain;
	charset="iso-8859-1"

Rick,

Your response in fact provides a perfect prologue for my question--and makes
me wonder how you'll respond.  

My major hesitation was that my issues are hazmat-related: not trauma in the
conventional sense.  Here 'goes anyway.

Our current hospital disaster plan assumes that the hospital alone can and
should protect itself from nuclear, chemical, and biological
cross-contamination from exposed patients.  It directs that victims should
be decontaminated by hospital staff, using hospital-based facilities and
equipment.  The challenge, of course, is figuring out how such a directive
can be practically accomplished...

I'm aware that this is a common characteristic of hospital disaster plans.
I nonetheless think it's crazy.  

The practical upshot is that we're going to spend great heaps of money
building a decontamination area, buying environment suits, and providing
periodic hazmat training to any number of ED nurses and techs, with the
understanding that some day five or six of them may be responsible for
defending themselves, their colleagues, and a 400-bed hospital from
secondary toxic exposure.  To me, this is like training them to treat burn
victims AND put out the blaze, or dress the gunshot wounds while subduing
the assailant: WAY beyond the scope of their training, experience, or
ability to practice with any confidence.

In a community with scores of thoroughly-trained, well-equipped municipal
and military hazmat professionals, I'm wondering why protection of the
hospital isn't a primary element of the community disaster plan:
prophylactic triage on an industrial scale.   If even ten per cent of our
regional hazmat personnel and resources were devoted to the hospital, it
seems to me that we'd have a much cheaper, safer, and more effective
decontamination process than a cluster of night shift nurses who haven't
recerted in hazmat since their one-hour inservice last summer, and can
barely remember how to tape their seams.  

Not to diminish the dedication or intelligence of my ED colleagues--but at
what point do we admit that this is simply not a role that they can
reasonably be expected to maintain competence in?   

Please, somebody agree with me...?  It's so lonely being the only
loud-mouthed imbecile on the Emergency Preparedness Committee.

Pret

 -----Original Message-----
From: DocRickFry@aol.com [mailto:DocRickFry@aol.com]
Sent: Wednesday, February 06, 2002 8:20 AM
To: trauma-list@trauma.org
Subject: Re: Disaster-List?

In a message dated 2/6/2002 7:45:54 AM Eastern Standard Time, pbjorn@emh.org
writes:

Anyone aware of a list server for the discussion of disaster management?

Pret Bjorn

What about right here on this list?????
What do you want to talk about?
Trauma physicians, nurses and prehospital workers are the natural leaders in
this area, but in fact have largely abrogated this role--at least in the
U.S.--to nonmedical agencies.  Disaster planning and command in most
communities in this country is run by public health, city government and
emergency management agencies, with the military planned to come in as
backup along with other state and federal agencies (FEMA, OEP, etc). The
docs and nurses are relegated to subservient roles to the administrators and
bureaucrats. This is crazy, but largely our own fault.  Look at your own
hospital disaster plan and see how little it relates to the reality of a
true disaster--the literature makes very clear what kind of problems we will
face in a true mass casualty event, but the planners clearly are not aware
of this surprisingly abundant literature from past disasters.  Unlike most
areas of trauma we normally discuss, which all of us are familiar with
because we all deal with it daily, disasters are downright rare--that is why
we are so ignorant about them--and the only way for us to learn about them
is to read what others have encountered, and the only way for this to happen
is that those involved in a disaster put together their experience and
results in a coherent way to teach the rest of us what to expect.  This has
been done, but I would bet money very few on this list are aware of this
literature--who has read the JAMA study from 1996 on the Oklahoma City
bombing, or the Arch Surg article in 1997 on the Olympics bombing in
Atlanta, or the 4 papers published 1986-1989 on the bombing of the US Marine
barracks in Beirut, the 1988 colllective review of terrorist bombings
worldwide in Annals of Surgery, or of the Bologna train terminal bombing in
1980, or John Weigelt's review of the lessons he learned in disaster
planning following 3 aircraft disasters in Dallas, or Len Jacobs' two papers
in 1979 and 1983 on the role of trauma centers in mass casualty management
and planning?  
We cannot handle a few hundred casualties all at once in the same way we
handle the usual handful we see on a busy night--we must be aware of the
basic change in approach and mindset such an event requires--a change from
the greatest good for each individual (impossible in a true disaster) to the
greatest good for the greatest number--from treating individuals to treating
populations.  Doing away with lab test, x-rays, etc and developing a true
understanding of what field and scene triage really is--something few of us
know anymore.  What is an expectant injury?  If you don't know, you are not
prepared to deal with a disaster
There's a start for a discussion
ERF 

------_=_NextPart_001_01C1AF41.C46DF4C0
Content-Type: text/html;
	charset="iso-8859-1"

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD>
<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=iso-8859-1">

<META content="MSHTML 5.00.2919.6307" name=GENERATOR></HEAD>
<BODY>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002>Rick,</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=890102313-06022002>Your 
response in fact provides a perfect prologue for my question--and makes me 
wonder how you'll respond.&nbsp; </SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=890102313-06022002>My 
major hesitation was that my issues are hazmat-related: not trauma in the 
conventional sense.&nbsp; </SPAN></FONT><FONT color=#800000 face=Arial 
size=2><SPAN class=890102313-06022002>Here 'goes anyway.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002></SPAN></FONT><FONT color=#800000 face=Arial 
size=2><SPAN class=890102313-06022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=890102313-06022002>Our 
current hospital disaster plan assumes that the hospital alone can and should 
protect itself from nuclear, chemical, and biological cross-contamination from 
exposed patients.&nbsp; It directs that victims should be decontaminated by 
hospital staff, using hospital-based facilities and equipment.&nbsp; The 
challenge, of course, is figuring out how such a directive can be practically 
accomplished...</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002></SPAN></FONT><FONT color=#800000 face=Arial 
size=2><SPAN class=890102313-06022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=890102313-06022002>I'm 
aware that this is a common characteristic of hospital disaster plans.&nbsp; I 
nonetheless think it's crazy.&nbsp; </SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002></SPAN></FONT><FONT color=#800000 face=Arial 
size=2><SPAN class=890102313-06022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=890102313-06022002>The 
practical upshot is that we're going to spend great heaps of money 
building&nbsp;a decontamination area, buying environment suits, and providing 
periodic hazmat training to any number of ED nurses and techs, with the 
understanding that some day five or six of them may be responsible for defending 
themselves, their colleagues, and a 400-bed hospital from secondary toxic 
exposure.&nbsp; </SPAN></FONT><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002>To me, this is like training them to treat burn victims 
AND put out the blaze, or dress the gunshot wounds while subduing the assailant: 
WAY beyond the scope of their training, experience, or ability to practice with 
any confidence.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002></SPAN></FONT><FONT color=#800000 face=Arial 
size=2><SPAN class=890102313-06022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=890102313-06022002>In a 
community with scores of thoroughly-trained, well-equipped municipal and 
military hazmat professionals, I'm wondering why protection of the hospital 
isn't a primary element of the <U>community</U> disaster plan: prophylactic 
triage on an industrial scale.&nbsp;&nbsp; If even ten per cent of our regional 
hazmat personnel and resources were devoted to the hospital, it seems to me that 
we'd have a much cheaper, safer, and more effective decontamination process than 
a cluster of night shift nurses who haven't recerted in hazmat since their 
one-hour inservice last summer, and can barely remember how to tape their 
seams.&nbsp; </SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=890102313-06022002>Not to 
diminish the dedication or intelligence of my ED colleagues--but at what point 
do we admit that this is simply not a role that they can reasonably be expected 
to maintain competence in?&nbsp;&nbsp; </SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002>Please, somebody agree with me...?&nbsp; It's so lonely 
being the only loud-mouthed imbecile on the Emergency Preparedness 
Committee.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002>Pret</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=890102313-06022002></SPAN></FONT><FONT color=#800000 face=Arial 
size=2><SPAN class=890102313-06022002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT face=Tahoma><FONT size=2><SPAN 
class=890102313-06022002>&nbsp;</SPAN>-----Original Message-----<BR><B>From:</B> 
DocRickFry@aol.com [mailto:DocRickFry@aol.com]<BR><B>Sent:</B> Wednesday, 
February 06, 2002 8:20 AM<BR><B>To:</B> 
trauma-list@trauma.org<BR><B>Subject:</B> Re: 
Disaster-List?<BR><BR></DIV></FONT>
<BLOCKQUOTE></FONT><FONT face=arial,helvetica><FONT color=#0000ff 
  face="Comic Sans MS" lang=0 size=2 FAMILY="SCRIPT"><B>In a message dated 
  2/6/2002 7:45:54 AM Eastern Standard Time, pbjorn@emh.org 
  writes:<BR><BR></FONT><FONT color=#000000 face=Arial lang=0 size=2 
  style="BACKGROUND-COLOR: #ffffff" FAMILY="SANSSERIF"></B><BR></FONT><FONT 
  color=#800000 face=Arial lang=0 size=2 style="BACKGROUND-COLOR: #ffffff" 
  FAMILY="SANSSERIF">
  <BLOCKQUOTE 
  style="BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px" 
  TYPE="CITE">Anyone aware of a list server for the discussion of disaster 
    management?<BR><BR>Pret Bjorn<BR><BR></BLOCKQUOTE><BR></FONT><FONT 
  color=#0000ff face="Comic Sans MS" lang=0 size=2 
  style="BACKGROUND-COLOR: #ffffff" FAMILY="SCRIPT"><B><BR>What about right here 
  on this list?????<BR>What do you want to talk about?<BR>Trauma physicians, 
  nurses and prehospital workers are the natural leaders in this area, but in 
  fact have largely abrogated this role--at least in the U.S.--to nonmedical 
  agencies.&nbsp; Disaster planning and command in most communities in this 
  country is run by public health, city government and emergency management 
  agencies, with the military planned to come in as backup along with other 
  state and federal agencies (FEMA, OEP, etc). The docs and nurses are relegated 
  to subservient roles to the administrators and bureaucrats. This is crazy, but 
  largely our own fault.&nbsp; Look at your own hospital disaster plan and see 
  how little it relates to the reality of a true disaster--the literature makes 
  very clear what kind of problems we will face in a true mass casualty event, 
  but the planners clearly are not aware of this surprisingly abundant 
  literature from past disasters.&nbsp; Unlike most areas of trauma we normally 
  discuss, which all of us are familiar with because we all deal with it daily, 
  disasters are downright rare--that is why we are so ignorant about them--and 
  the only way for us to learn about them is to read what others have 
  encountered, and the only way for this to happen is that those involved in a 
  disaster put together their experience and results in a coherent way to teach 
  the rest of us what to expect.&nbsp; This has been done, but I would bet money 
  very few on this list are aware of this literature--who has read the JAMA 
  study from 1996 on the Oklahoma City bombing, or the Arch Surg article in 1997 
  on the Olympics bombing in Atlanta, or the 4 papers published 1986-1989 on the 
  bombing of the US Marine barracks in Beirut, the 1988 colllective review of 
  terrorist bombings worldwide in Annals of Surgery, or of the Bologna train 
  terminal bombing in 1980, or John Weigelt's review of the lessons he learned 
  in disaster planning following 3 aircraft disasters in Dallas, or Len Jacobs' 
  two papers in 1979 and 1983 on the role of trauma centers in mass casualty 
  management and planning?&nbsp; <BR>We cannot handle a few hundred casualties 
  all at once in the same way we handle the usual handful we see on a busy 
  night--we must be aware of the basic change in approach and mindset such an 
  event requires--a change from the greatest good for each individual 
  (impossible in a true disaster) to the greatest good for the greatest 
  number--from treating individuals to treating populations.&nbsp; Doing away 
  with lab test, x-rays, etc and developing a true understanding of what field 
  and scene triage really is--something few of us know anymore.&nbsp; What is an 
  expectant injury?&nbsp; If you don't know, you are not prepared to deal with a 
  disaster<BR>There's a start for a discussion<BR>ERF</B></FONT> 
</FONT></BLOCKQUOTE></BODY></HTML>

------_=_NextPart_001_01C1AF41.C46DF4C0--

List Archives

For your convenience, find the Trauma List Archive Below

Disaster List?