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Thu Apr 19 16:03:30 BST 2007

In a message dated 4/19/2007 5:53:34 A.M. Pacific Daylight Time,  
hammond at umdnj.edu writes:

Writing  or updating a disaster plan is not:
a) something that should be undertaken by just 2 people or 

b) something readily achieved by adopting off-the-shelf material. 

Some templates exist (e.g. JCAHO, ANA, etc) but they just offer a place  to 
begin. In the long run they have limited utility. I would start by doing a  lot 
of reading (learn from others' pitfalls) and talking (interview others who  
have thought this through). It will take considerable time.  

Hold a bona fide drill/exercise and look critically at your flaws and  warts. 
Do a thorough institutional HVA (hazard vulnerability analysis) to guide  
your process. 

If you are part of a health network your plan should be coordinated with  
your partners. 

K Mattox responds: 

I find Dr. Hammond's suggestions very insightful.   We in health  care see 
disaster planning and response totally differently from those in EOCs  and 
Unified Command governmental and public health structures.   We in  trauma and 
critical care focus on the small number of patients with acute  clinical problems, 
but the public health and governmental infrastructure (spell  that silos) 
focuses on many broader issues of sheltering, evacuation,  feeding, clothing, 
security, relocation, etc.      The most successful disaster structures 
recognize, respect and  integrate the talents of ALL of the local community resources, 
and have a plan  to ask for and utilize regional, state, and even federal or 
military  resources if needed.    

>From a clinical standpoint, most acute disaster response occurs within the  
first 48 hours, and ALL such resources are LOCAL.       Whatever your status, 
learn the incident command structures in your  local area and work towards 
integrating all of those into one integrated  collaborative network.    

In most countries of the world, the mandate for disaster planning and  
response for a catchment of people rests with LOCAL  GOVERNMENT.    This mandate is 
by law in most cities, states, and  countries of the world.   The EMS 
availability and response are  also assumed to be governed by the LOCAL governmental 
incident command, which  usually does NOT have an active clinical person in 
this EOC.   The  medical personnel in the EOC are most frequently public  health 
persons.    The hospital, trauma center, etc.  care for patients they receive, 
often without knowledge of the regional problem,  regional dispatch and 
dispersion, and EOC command  decisions.      

Thus, in many communities, the trauma system, the hospitals, the EMS, in  
their immediacy of response become SILOs of their own. 

We are quite prepared for disasters in terms of federal organizations,  state 
organizations, policies, and local EOC web sites.   We actually  have almost 
twice the number of independently operating silos than we had  per-Katrina.   
In my humble observation, there is LESS integration of  these silos than 
BEFORE Katrina.    

We have a complex of Local vs State vs Federal vs EMS vs Public  Health vs 
Hospital vs Trauma Center vs Volunteer organization need for  corporate and 
individual recognition.    It is assumed that  organizations, especially 
nationally named funding or policy organizations  (NDMS, FEMA, ACS, ACEP, DMAT, HRSA, 
etc. etc. ) have made recommendations and  decisions based on evidence based 
medicine principles.   NOT.   Just look for data to support some of the gadgets  
recommended to be present in the hospital, EMS and trauma centers.    Total 
non standardization and differences in recommendation among agencies, with  
open questions as to whether or not industry has made some of the  
recommendations for grants, based on sales potential.    

Organizations are positioning themselves to be in "control" of evacuee  
distribution and assignment, not fully understanding trauma, infections disease,  
chemical, burn, radiation capacity evaluation and treatment of health care  
facilities.   During Rita, some hospitals lost their ability to  care for REAL 
emergency patients because they became a SHELTER for special  needs evacuees 
(with the needs not being medical).    Such  special needs evacuees do need 
sheltering and evaluation and support, but  NOT at an understaffed, overcrowded 
regional Trauma, Heart, Infections Disease,  Burn (etc.) resource.  

Jeff Hammond is now capably leading the ACS COT Disaster Subcommittee and I  
am sure we can see new directions and policies which will help us all 
integrate  our capabilities and resources

k 

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