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

Howard C. Berkowitz hcb at gettcomm.com
Wed Oct 12 17:28:13 BST 2005

At 11:06 AM -0400 10/12/05, docrickfry at aol.com wrote:
>Yes--precisely--you should first read the citations and get the 
>books, then ask your questions!  In fact you will find that thru the 
>years and hundreds upon hundreds of disaster responses described in 
>the literature, communications has always been at the top of the 
>list in after action accounts of the major problems--what that tells 
>us of course is that we just do not learn!

Looking at your other message, I note that some of the references 
were from 1956, and the latest 1991. Communications has advanced a 
bit since then, and it's not at all obvious that some of the latest 
initiatives, such as nonblocking special access to wired and cellular 
phones, or backup alternatives using mobile Internet services, would 
be covered. Indeed, speaking as a commuications engineer as well as a 
medical informaticist, some of these have come out literally in the 
last few months.  Also, some emergency communications measures are 
not necessarily publicized.

The references certainly have valid content, but my question is 
whether they have a structure that fits current emergency management, 
policy, and technology structures.  I've written textbooks, but I 
don't expect every networking project will neatly follow their 

>-----Original Message-----
>From: Howard C. Berkowitz <hcb at gettcomm.com>
>To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
>Sent: Wed, 12 Oct 2005 10:57:36 -0400
>Subject: Re: [ccm-l] Management People, Principles, Policies, 
>Issues(Formerly Disaster)
>At 10:49 AM -0400 10/12/05, docrickfry at aol.com wrote:
>>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 
>>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 
>>Ammons MA et al: The role of a regional trauma system in 
>>the >management of a mass disaster. J Trauma 1988;28:1468-1471.
>These appear all to be references to the mass casualty effort 
>itself. Yes, there is much out there in this area.
>But is equivalent information available for defining both the 
>requirements and implementation of communications, of recent lessons 
>learned in providing for possibly stranded hospital staff as well as 
>communications among shifts/teams, about defining both medical and 
>logistic information flow?
>>-----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 
>>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 
>>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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