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Thu Apr 19 16:13:58 BST 2007

You're so correct, Dr. Mattox.

Having been directly, right smack in the middle of SARS at NYGH in '03,
it was a horror to be doing the planning during that type of situation.
We already had a disaster plan for things like accidents etc, and it
required lots of people to get it going, lots of education, "races" to
get even the gear on properly. The gear itself..tents, all that, take up
a lot of space in a hospital and require a big space, and someone to
take care of it all. We have a CBRN team. We teach staff, physicians in
our area fairly regularly, and have practice ourselves to get into the
equipment, put up the tent. All this, I'd say from experience, plans for
about 70% of the disaster. The other 30% comes from the little things
locally..ie, quaratined staff.. How do they eat, go to the washroom and
where, staff to take over in the equipment/masks, because no one should
be in those more than 60-90 minutes. I agree with learning from others'
pitfalls and difficulties.

Here in Ontario/Canada, our hearts go out to you and we are thinking of
all of you during this horrible time at VT. It affects us all. Our
sympathies.  

cathy   

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
Sent: Thursday, April 19, 2007 11:04
To: hammond at umdnj.edu; ladybear_4me at yahoo.com; ccm-l at ccm-l.org
Cc: trauma-list at trauma.org
Subject: Re: [ccm-l] disaster managemant policies

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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[ccm-l] disaster managemant policies