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Not Your Father’s M*A*S*H:Establishing Alternate Medical
Treatment Sites
K.C. Rondello, M.D., M.P.H.Adelphi University
June 6, 2012
A presentation prepared for the15th Annual Emergency Management Higher Education Conference
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Defining Our Terms
Alternate Medical Treatment Site (AMTS) or Alternate Care Facility (ACF) ◦A non-medical facility temporarily
adapted to render medical care in a disaster
Point of Distribution/Dispensing (POD)◦A non-medical facility temporarily
adapted to administer vaccines or prophylactic medications in a disaster
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Hurricane Ike AMTSSpecial Needs Shelter
(formerly Albertsons Supermarket)
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Recent AMTS/POD Usage in the U.S.
Joplin Tornado (May 2011)Great Tennessee Flood (May 2010)Hurricanes Gustav, Hanna and Ike (September
2008)California Wildfires (October 2007)Hurricane Katrina (August 2005)Anthrax Attacks (October 2001)Terrorist Attacks (September 2001)
So… why do Emergency Managers in higher education need to know?
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A University Campus as an AMTSMost universities have a mission to support
their communitiesCampuses are designed with space to
accommodate many peopleCampuses often also have large parking
areas, widespread utility availability and many support personnel
“If we could change ourselves, the tendencies in the world would also change. As a man changes his own nature, so does the attitude of the world change towards him. ... We need not wait to see what others do.” - Mahatma Ghandi
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ConsiderationsLogistical IssuesClinical IssuesAdministrative Issues
Challenges and Pitfalls
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Logistical Site Issues
SizeSecurity & SafetyUtility SupportLocationMedication and MaterielWaste Disposal and SanitationFatality Management
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Size(it turns out it matters after all…)
Clinical AreasAdministrative AreasSupply Areas
◦Unsecured / SecuredNutrition/Hydration/Sleeping
AreasMental Health/Quiet AreasMedia Area
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Pre-Disaster PreparationA Federal Medical Shelter
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Security & SafetyStructural integrityProtection of stockpile and staff
◦Magnetometers?Fire SuppressionEmergency Exits/Evacuation
RoutesEffect on behaviorLarge numbers in confined space
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Security Support
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Utility SupportElectricityWater
◦Potable /Non-PotableSanitation
◦Handwashing/Disinfecting Gel◦Bathrooms/Latrines◦Infectious /Non-Infectious
Climate ControlCommunications
◦Redundancy!
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Climate Control
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Communications
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Location, Location, Location!
FamiliarityPhysical AccessParkingRoutesModes
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Medication and Medical Materiel
Disaster Stockpile (Federal, State, Local)
Strategic National StockpileLocal Hospitals and Pharmacies
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Strategic National Stockpile
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Waste Disposal and Sanitation
Infectious vs. Non InfectiousHuman ExcretaBathing FacilitiesLaundering Clothes and Linens
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Laundry and Waste Disposal
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Bathing Facilities
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Fatality ManagementRemoved from clinical care areasRefrigeration for long term storageCDC/FBI involvement
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Clinical Issues
Infection ControlPatient FlowRecordkeepingMental Health
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Infection Control
Surfaces◦Nonabsorbent
Air Filtration◦HEPA standard
Anti-microbials◦For hands◦For surfaces
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Power-free Hand Washing Station
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Patient FlowFlow ControllersSignageUnidirectionalPatient Management
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Bed Board
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Record Keeping
Less robust than usual
Must be able to track them down!
Electronic vs. PaperEpidemiologic needs
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Electronic Medical Record
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Mental Health Monitoring
For staff and patientsAssigned personnelMonitoring system
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Quiet Room
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Administrative IssuesPersonnelPolicies for OperationsNutrition / Hydration /
Sleeping Accommodation
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Personnel
Clinical◦MD, RN, EMT, NA, etc.
Non-Clinical◦Security, Reception/Records, Flow
Controllers, Logistics, PIO, Volunteer Coordinator, etc.
CredentialingMunicipal and Non-municipal
sources
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Policies for Operations
SimplicityStandardizationTestedDisseminated
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Nutrition / Hydration / Sleeping Accommodation
Available 24/7◦Scheduled meal times
Isolated from clinical careLogging in and out
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Mass Feeding
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Home Sweet Home
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Challenges and Pitfalls
Special Needs PatientsPolitical IssuesAdverse Environmental
ConditionsPublic RelationsComplianceTimeline
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Special Needs Patients
Limited Mobility / Non-Ambulatory
Sensory deficitsLanguage barriersPatients with dependents
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Political Issues
Regular communication with decision makers is key!
Use of layman’s termsDistilled informationCharts, graphs, maps
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Adverse Environmental Conditions
Road/Rail/Airport closuresUtility outagesFlooded facilitiesCommunications failures
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Public Relations
Manage them or they will manage you!
Specific briefing areaSingle source of informationScheduled, frequent updates
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Compliance
Use the mediaMulti-pronged approachCommunicate honestly
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Timeline
Always less time than you wantEarly identification and
inspection of potential sites helps
Pre-training and drills are key for personnel
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SummaryLogistical IssuesSizeSecurity & SafetyUtility SupportLocationMedication and
MaterielWaste Disposal and
SanitationFatality
Management
Clinical IssuesInfection ControlPatient FlowRecordkeepingMental Health
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Summary
Challenges & PitfallsSpecial Needs
PatientsPolitical IssuesAdverse
EnvironmentPublic RelationsComplianceTimeline
Administrative Issues
PersonnelPolicies for
OperationsNutrition /
Hydration / Sleeping Accommodation
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Questions? Comments?
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Thank You!
K.C. Rondello, M.D., M.P.H.Academic Director, Department of Emergency
ManagementAdelphi University1 South AvenueGarden City, NY [email protected]