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[ccm-l] Management People, Principles, Policies, Issues(Formerly Disaster)

docrickfry at aol.com docrickfry at aol.com
Wed Oct 12 15:49:03 BST 2005

You make this too complicated, altho your basic premise is sound--the data needs to be learned, but it is all out there and has been for years.  Try some excellent recent textbooks on Disasters:
Disaster Medicine, Hogan, Burnstein eds 
Disaster Principles, Eric Auf der Heide, ed
A classic paper and more on major barriers and aids to effective disaster response:
Klein J, Weigelt J: Disaster management: lessons learned. Surg Clin North Am 1991;71:257-266.
Berry FB: The medical management of mass casualties (the only Scudder Oration on Trauma to deal with disaster management--what does that tell us?!). Bull Am Coll Surg 1956;41:60-66.
Ammons MA et al: The role of a regional trauma system in the management of a mass disaster. J Trauma 1988;28:1468-1471.
-----Original Message-----
From: Howard C. Berkowitz <hcb at gettcomm.com>
To: trauma-list at trauma.org; ccm-l at ccm-l.org
Sent: Wed, 12 Oct 2005 09:34:07 -0400
Subject: Re: [ccm-l] Management People, Principles, Policies, Issues(Formerly Disaster)

At 8:21 AM -0400 10/12/05, ken wrote: 
>I have been aware of what has been available on the net. I >recently had the need to review what is in texts and on the net. I >am aware of differing perceptions of local and federal governments >perceived roles during disasters. I am very aware of the many >medical and health needs and responses during any disaster. One >big problem is the disconnect between what is written, what is >perceived, and what really happens and what works and what does not. >We have four huge disasters this last 8 months to analyze and more >than 30 in the last 4 years to analyze. I am amazed at the >disconnects, the misinformation, and the wastes of personnel, money, >supplies, and energies because of turf, politics, and lack of >communication. > 
>We all can do much better. 
I've been thinking of the mechanics of capturing the information on what works and doesn't work, and simultaneously evolving our tools. Have you had any ideas on how best to structure the data acquisition? 
As a strawman, let me suggest beginning with some existing, written doctrine on Incident Command System at levels from local to National Response. At this level, one can look at various experiences Management People Principles Policies Issues (Formerly Disaster), or MP3IFD to be acronym rich, and record them under various ICS policies. In the process of the exercise, it will be likely that certain real-world activities don't neatly fit under ICS doctrine, which means that the doctrine needs to be updated. 
Again as a strawman at the next level of detail, could the experience be mapped to information management, as with DM-Services? Information management, at this level, absolutely must include near-real-time message flow (message, voice, video, etc.), real-time telemetry, and both reference and statistical databases. It's again likely that the existing software, even as a conceptual model, doesn't cover the experience, and this should translate into new software requirements. 
Below this level are tools and standard operating procedures. An example of the former are communications systems, mostly electronic, with their applicability and their need for supporting infrastructure. I could easily start SOPs with some of your memos to BTGH, as well as what you learned in practice -- such as the overuse of family refuge intended primarily for single parents. 
I am not wedded to any of the architectures, software, or procedures mentioned above, but I see them as a starting point. Other starting points are welcome. 
>-----Original Message----- 
>From: "Eric Dobkin" <Edobkin at harthosp.org> 
>Date: Wed, 12 Oct 2005 07:45:34 
>To:<KMATTOX at aol.com>, <dchalfin at applied-decision.com>, ><arthurmorgan2 at gmail.com> 
>Cc:trauma-list at trauma.org, ccm-l at ccm-l.org 
>Subject: Re: [ccm-l] Management People, Principles, Policies, Issues 
> (Formerly Disaster) 
>Bravo, Don 
>Eric Dobkin MD, FACS 
>Director, SICU 
>Hartford Hospital 
>Hartford, CT 
>>>> "Donald B. Chalfin, MD, MS, FCCM" >>>><dchalfin at applied-decision.com> 10/11/2005 10:29:52 PM >>> 
>At 12:36 PM -0400 10/11/05, KMATTOX at aol.com wrote: 
>>In a message dated 10/11/2005 10:57:51 AM 
>>Central Standard Time, arthurmorgan2 at gmail.com 
>>All this is on the Net. Study what is available instead of re-inventing 
>>the wheel. 
>>Disaster management has been around for many years, as has been pointed 
>>out before. 
>>Arthur Morgan 
>>Anaesthesiologist, Johannesburg, South Africa 
>>I have read what is on the net and what is in 
>>the texts, and the material in the manuals. I 
>>can tell you that much of what is there is top 
>>down management and a lot of outside people 
>>telling the local people just how to run their 
>>business and it often has no similiarity to 
>>reality. Local Integrated Collaborative 
>>Networks is NOT on the net and in the textbooks 
>>and that is what I am trying to communicate. 
> > 
>One of the shortcomings of medicine at times is 
>its inability to look beyond the medical and 
>"scientific" realms and disciplines. Critical 
>care, trauma, emergency medicine, and related 
>fields are unique in the sense that these fields 
>are not limited to a single organ system or set 
>of diseases and also are defined by a large 
>administrative and organizational component. 
>In this vein, and in this thread devoted in part 
>to management, organization, and systems issues, 
>perhaps we should consider going to the 
>textbooks, tomes, writings, and teachings outside 
>of medicine, and look at what the industrial 
>engineers, the management gurus in business 
>schools and industry, and the organizational 
>theorists are saying and writing. From a 
>personal standpoint, going back to graduate 
>school for my master's degree (health management, 
>thesis in decision theory) during my fellowship 
>illustrated this to me. All one has to do is 
>look at issues related to Errors and Safety in 
>medicine and how much has been learned by careful 
>and close study of the avaition industry. 
>Donald B. Chalfin, MD, MS, FCCP, FCCM 
>Associate Professor of Medicine 
>Associate Professor of Epidemiology and Population Medicine 
>Albert Einstein College of Medicine, Bronx, New York 
>Director, Critical Care Outcomes Research 
>Director, Critical Care Consults 
>Montefiore Medical Center 
>Bronx, New York 
>Chief Scientific Officer 
>Analytica International 
>450 Park Avenue South 
>New York, NY, USA 10016 
>tel: +1-212-686-4100 ext 8201 
>mobile: +1-516-448-0047 (preferred) 
>emails: dchalfin at analyticaintl.com 
> dchalfin at applied-decision.com 
>European Office: 
>Untere Herrenstraße 25 
>D-79539 Lorrach 
>tel: +49-7621-9339-0 
>fax: +49-7621-9339-1039 
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