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Disaster List?
Bjorn, Pret trauma-list@trauma.orgMon, 11 Feb 2002 07:18:26 -0500
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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_01C1B2F6.35114DF0 Content-Type: text/plain; charset="iso-8859-1" Greg, I've learned much from the thread, and enjoyed the largely civil and academic exchange. At this point, however, I am finally and officially blue in the face (a colloquialism, not a toxopathy). Clearly you and I have our own assumptions, and our own projections of reality. Future catastrophes will probably prove each of us partially correct. God help us all. Thanks for a good discussion. Pret -----Original Message----- From: GregV3@aol.com [mailto:GregV3@aol.com] Sent: Saturday, February 09, 2002 1:10 AM To: trauma-list@trauma.org Subject: Re: Disaster List? Pret, Thank you for your thoughtful reply. Let me respond to your comments as presented. 1. "Are you comfortable blaming Japanese nurses for not being day-to-day experts in chemical weaponry?" No, not at all. My statement was actually based on a quote from one of the physicians in Tokyo who has written and lectured extensively about the incident. There is a difference between being an "expert in chemical weaponry" and having adequate training to regocnize a mass of patients presenting with a common toxidrome. 2. Yes, I can appreciate the number of ED staff there are in the US. Do I think they all need training? Yes, to some degree. Am I suggesting they all be trained to HM Technician level, of course not. If they are not trained to recognize potentially contaminated patients, you have already lost the battle because once they're in, you've got a problem. 3. "All this assumes that there's any predictable "benefit" to hazmat training for clinical personnel who, like as not, will NEVER see practical experience in the course of their careers." - Are you telling me you have not had patients present to your facility with HM contaminiation? I can think of 3 times we have recently. The latest involved 15 workers from an industrial facility. Presented without warning. Recognized by our triage nurse who implemented ICS and directed self-decon. All patients decontaminated, admitted, and treated without undue risk to staff or facility. (Do they all go this well? No, but we have been working on it) 4. "How much do you want to spend?" I'm not sure where you got $10,000 per hospital but if you could spend $10,000 to prevent you hospital from being shut-down, you staff not be contaminated, and your patients treated in a timely manner. I'd say that is a good buy. What is it going to cost your facility to be shut down? How long would you have to be shut down to lose 10K? Incidentally, we spend much more than that on security. 5. "My response--especially in the case of WMD--would be to lock down the facility until appropriate decontamination can be assured." - When are you going to lock it down? We are not talking only about WMD incidents. HM incidents carry many of the same risks, but typically on a smaller scale. My point is somebody has to recognize the threat early. This requires training. If this regocnition occurs late, you are going to lock down a contaminated facility. 6. "The whole point of this thread is that I think your exercises and incidents have suffered from a flawed response paradigm. Hazmat cannot be depended on, because it has not been properly tasked. Reconsider your scenarios, but imagine that a solid portion of the hazmat response is assigned downstream, to the bottom of the funnel: to the hospital. Any of your exercises structured that way?" - Yes we have had our regional HM team at the hospital. We have also seen how limited the resources are when they are not available, and how unrealistic that scenario is. There is one team available in our region. I take it you are suggesting that if there is an incident, they should respond to our hospital and let the event run it's natural course. If the team were to respond to the hospital, it would likely be AFTER contaminated patients began to arrive. Reconsidering our scenarios to imagine more resources is unlikely to make us better prepared, although it would look great on paper. 7. "...a disaster management plan which acknowledges both a) how little can be clinically accomplished at the scene, and b) how vulnerable the hospital is to secondary catastrophe." - By "clinically accomplished" are you referring to the initial victims, or the incident? Both can benefit from an appropriate scene response. Faster decon - less dose received, less contamination spread, safer incident operations, less product released, less property damage, and less environmental damage, to list a few. As for part "b" - the reason we are vulnerable is because we aren't trained to recognize situations which endanger our facilities. 8. "...the first priority is to shut off the chain of exposure" - Agreed, except on methods. The best way to shut off the chain is to have a mechanism in place to deal with the contaminated victims. Simply locking them out, will not contain the hazard, they will look for a way in, or go elsewhere, further expanding the scale of the incident. Greg ------_=_NextPart_001_01C1B2F6.35114DF0 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=680475611-11022002>Greg,</SPAN></FONT></DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=680475611-11022002></SPAN></FONT> </DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=680475611-11022002>I've learned much from the thread, and enjoyed the largely civil and academic exchange. At this point, however, I am finally and officially blue in the face (a colloquialism, not a toxopathy). </SPAN></FONT><FONT color=#800000 face=Arial size=2><SPAN class=680475611-11022002>Clearly you and I have our own assumptions, and our own projections of reality. Future catastrophes will probably prove each of us partially correct.</SPAN></FONT></DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=680475611-11022002></SPAN></FONT> </DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=680475611-11022002>God help us all.</SPAN></FONT></DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=680475611-11022002></SPAN></FONT> </DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=680475611-11022002>Thanks for a good discussion.</SPAN></FONT></DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=680475611-11022002></SPAN></FONT> </DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=680475611-11022002>Pret</SPAN></FONT></DIV> <BLOCKQUOTE> <DIV align=left class=OutlookMessageHeader dir=ltr><FONT face=Tahoma size=2>-----Original Message-----<BR><B>From:</B> GregV3@aol.com [mailto:GregV3@aol.com]<BR><B>Sent:</B> Saturday, February 09, 2002 1:10 AM<BR><B>To:</B> trauma-list@trauma.org<BR><B>Subject:</B> Re: Disaster List?<BR><BR></DIV></FONT><FONT face=arial,helvetica><FONT size=2>Pret, <BR>Thank you for your thoughtful reply. Let me respond to your comments as presented. <BR>1. <I>"Are you comfortable blaming Japanese nurses for not being day-to-day experts in chemical weaponry?"</I> No, not at all. My statement was actually based on a quote from one of the physicians in Tokyo who has written and lectured extensively about the incident. There is a difference between being an "expert in chemical weaponry" and having adequate training to regocnize a mass of patients presenting with a common toxidrome. <BR><BR>2. Yes, I can appreciate the number of ED staff there are in the US. Do I think they all need training? Yes, to some degree. Am I suggesting they all be trained to HM Technician level, of course not. If they are not trained to recognize potentially contaminated patients, you have already lost the battle because once they're in, you've got a problem. <BR><BR>3. <I>"</FONT><FONT face=Arial lang=0 size=2 FAMILY="SANSSERIF">All this assumes that there's any predictable "benefit" to hazmat training for clinical personnel who, like as not, will NEVER see practical experience in the course of their careers."</I> - Are you telling me you have not had patients present to your facility with HM contaminiation? I can think of 3 times we have recently. The latest involved 15 workers from an industrial facility. Presented without warning. Recognized by our triage nurse who implemented ICS and directed self-decon. All patients decontaminated, admitted, and treated without undue risk to staff or facility. (Do they all go this well? No, but we have been working on it) <BR><BR>4. <I>"How much do you want to spend?" </I> I'm not sure where you got $10,000 per hospital but if you could spend $10,000 to prevent you hospital from being shut-down, you staff not be contaminated, and your patients treated in a timely manner. I'd say that is a good buy. What is it going to cost your facility to be shut down? How long would you have to be shut down to lose 10K? Incidentally, we spend much more than that on security. <BR><BR>5. <I>"My response--especially in the case of WMD--would be to lock down the facility until appropriate decontamination can be assured."</I> - When are you going to lock it down? We are not talking only about WMD incidents. HM incidents carry many of the same risks, but typically on a smaller scale. My point is somebody has to recognize the threat early. This requires training. If this regocnition occurs late, you are going to lock down a contaminated facility. <BR><BR>6. <I>"The whole point of this thread is that I think your exercises and incidents have suffered from a flawed response paradigm. Hazmat cannot be depended on, because it has not been properly tasked. Reconsider your scenarios, but imagine that a solid portion of the hazmat response is assigned downstream, to the bottom of the funnel: to the hospital. Any of your exercises structured that way?"</I> - Yes we have had our regional HM team at the hospital. We have also seen how limited the resources are when they are not available, and how unrealistic that scenario is. There is one team available in our region. I take it you are suggesting that if there is an incident, they should respond to our hospital and let the event run it's natural course. If the team were to respond to the hospital, it would likely be AFTER contaminated patients began to arrive. Reconsidering our scenarios to imagine more resources is unlikely to make us better prepared, although it would look great on paper. <BR><BR>7. <I> "...a disaster management plan which acknowledges both a) how little can be clinically accomplished at the scene, and b) how vulnerable the hospital is to secondary catastrophe." </I>- By "clinically accomplished" are you referring to the initial victims, or the incident? Both can benefit from an appropriate scene response. Faster decon - less dose received, less contamination spread, safer incident operations, less product released, less property damage, and less environmental damage, to list a few. As for part "b" - the reason we are vulnerable is because we aren't trained to recognize situations which endanger our facilities. <BR><BR>8. <I>"...the first priority is to shut off the chain of exposure"</I> - Agreed, except on methods. The best way to shut off the chain is to have a mechanism in place to deal with the contaminated victims. Simply locking them out, will not contain the hazard, they will look for a way in, or go elsewhere, further expanding the scale of the incident.</FONT><FONT face=Arial lang=0 size=2 FAMILY="SANSSERIF"> <BR><BR>Greg</FONT> </FONT></BLOCKQUOTE></BODY></HTML> ------_=_NextPart_001_01C1B2F6.35114DF0--
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