Mass Casualty + HazChem

Dr Chris Cresswell

2013

Lessons from Terrorist attacks Chch earthquake Tasman Tanning

Still learning and developing systems

Key points for docs

Consider “Lock down”Get more staff including SMOsConsider diversionConsider early transferConsider decontamination

Clear ED as much as possible Do what you would normally do (but skip some

of the finer details like Family Hx and CRP, BNP). Documentation. Emergency ID

Write ID on the patient Reverse triage is controversial ED teams with outside assistance Senior docs: logistics, overview, consultation

Surge out to PACU, Day unit, Outpatients Morgue Social work

Emergency Management Plan Red Folder located in ED Drug Room Service Profile Contingency Plan Reduction/Readiness/Response/Recovery Mass Casualty Plan Pandemic Plan Hazardous Substance Exposure Plan

Mass Casualty Plan One section of Emergency Plan Response staged into 3 tiers dependent on

magnitude of event Stage 1 = ED only Stage 2 = ED + Hospital Stage 3 = ED + WDHB wide + EOC +/-

local, regional or national support

Mass Casualty Plan To establish which stage is required refer to

the MCP Flowchart Located ED Drug Room with explanation of

Stage 1, 2 & 3 Flowchart allows for MCP to be escalated

as event unfolds

What Will it Do?

What Won’t it Do?

Activating Mass Casualty Plan Information of event

received D/W DNM / ED Team Decide on Stage of MCP

required DNM is the only one who

can activate MCP Notify Switchboard

Operator of activation of Stage 1,2 or 3 of MCP

What Happens Then? Switchboard Operator follows a list of

instructions and calls in and notifies the listed staff

Staff and services activated at Stage 1,2,3 can be seen on the wall of the ED Drug Room and also in the Coord Pack of the Mass Casualty Box

Open Mass Casualty Box

Mass Casualty Box & Vests Mass Casualty Box

and vests are stored in the ambulance store room

Open the Box Elect a Coord Follow the instructions

in the Coord Pack

Signage Coord point by Rm3

ED outside of staff station

Triage (backdoor) outside Resus 2

Orderly & Transport Nurse @ Coord point

Info point at reception

More Signage

Allocating Roles & Areas Vests are for ED staff

only Each role comes with

a job card Consider allocating

areas/rooms to ED staff and further dividing as more staff arrive

ED Staff with Vests and Job Cards ED staff manage their

area and helper staff that are allocated to them

Creation of small teams allows ED staff to focus on their area and helper staff to be supported

Non ED Staff Non ED staff who

come to help are also given a job card, allocated to a ED staff member and given a title tag

ED and non ED staff are easily differentiated

Job Cards All staff receive a job

card when they check in

Gives a guide of what their role is and who to report to

Many titles – take a look and familiarize yourselves

Calling in ED Staff Coord decides how

many of each discipline required

Call in or delegate task to colleague

Call in until required number on way and record on Staff Log

Preparing ED Liase with DNM and clear ED as much as

possible Consider Pts for discharge / TX to WR / TX

to WAM / TX to Ward Possible surge capacity SDU / PACU /

OPD / ATR (All require DNM to arrange) Clear trauma beds

Documentation Do what you normally

do ID pts ASAP Use Unknown ID if

delays in registering All pts need to go on

Pt Log This is basis for

tracking pts in system

Supplies Pre ordered supply

of pharmacy items, linen and consumables will arrive within the first hour of a Stage 2 or 3 of MCP

List in Coord Pack

Emergency Operations Centre EOC manage the

overall response to event

Send Status Report to EOC hourly PRN

Can request staff, services and equipment via EOC

HAZCHEM Protect

yourself and the hospital

2 people to gown up

Everyone from scene goes thru shower by ambulance bay

Keep faces out of pools of water!

CPR etc could continue in shower

Then patient goes through to triage etc and is considered “clean”

References Thanks for those staff who kindly ‘volunteered’ as models for the

photos of this presentation Coordinated Incident Management Systems, 26/08/11.

http://www.emergencymanagement.co.nz/training/in-house-training/192-cims-premier-package.html

Thanks to Midcentral DHB, Hawkes Bay DHB, Capital & Coast DHB sharing their Emergency Management Plans, 2010.

Thanks to RN Michelle Battarbee and Katie Edmonds for developing the plan and Michelle for writing the first version of this presentation