Response Preparation - Medical Considerations

Medical considerations for an interagency response must integrate the EMS, Fire and Law enforcement communities as well as the local hospitals, clinics, public health departments and traditional healthcare venues including physician offices, dentists as well as veterinarians. The National Incident Management System (NIMS) uses a unified approach to incident management with standard command and management structures utilizing the incident command structure paradigm. The hospital planning will need to address the critical need of capacity and capability to expand for a surge of multiple casualties or ill patients. Inclusion of an NIMS paradigm with knowledge of bed availability, staffing considerations and needs, communication and notification procedures as well as who is capable and how a terrorism incident response plan is activated. Checklists or protocol lists may ease the specific steps necessary to activate the various needed steps and procedures. The HICS job action lists address the various action steps in the first 30 minutes of an all hazards disaster including the various roles and responsibilities of hospital clinical staff and administrative personnel. A designated operations center can facilitate in addressing strategic placement and location of the leadership personnel just as a command post provides this function on a fire or accident scene.

Communications into and out of these command centers are critical to the ongoing response requirements of a disaster. Interoperability has become a frequently used word in disaster planning and includes the concept of both technical capability for people to communicate with each other such as 800 megahertz compatible radios or ultrahigh or very high frequency band emergency communications. The importance lies in the ability for personnel to communicate with each other and share needed information and resource requirements while not overwhelming existing communication channels. If communications are interrupted or destroyed contingency planning and redundancy will be important to allow for ongoing notifications of resource and personnel needs. Satellite phone capability for command personnel and or ham radio operations may assist in addressing these issues and challenges.

Pre-event training, protocols and education will assist in the recognition and early treatment and of ill patients. The self-triaged concerned patient will also need to be addressed in hospital and emergency department, physician office/clinic, or public health department planning. Triaging, decontamination and potential seclusion and scene control of afflicted patients may be necessary in emergency disaster plans.  Current disaster plans may include addressing the treatment and triage of a patient with a cough, fever and/or rash. Public information is also important to address citizens’ fears and concerns and to dispel rumors or misinformation.

 Hospitals and healthcare facilities need to develop and utilize daily a method to share their capability and capacity for patient assignment and surge capacity. This may involve shared electronic/computerized bulletin boards with redundancy for power outages or technical malfunctions.  Decisions of capability and capacity for patient treatment need to be addressed as well as diversion concerns while creating emergency healthcare plans.  The National Disaster Medical System addresses surge capability and capacity concerns and hospitals which participate in it are tested by notification through the public health system.  Recent hurricanes in 2005 showed the enormous challenges and logistics of hospital evacuation and the movement of large numbers of critically ill hospitalized patients.  These events can be utilized to serve as lessons in disaster preparation and illustrate on the challenges to optimal healthcare when everyday healthcare equipment and capability is interrupted or nonfunctional.  Unscheduled discharges of existing hospital patients may be necessary to create bed space for incoming patients.  Inclusion of home health services will facilitate this process for ongoing care.

Local or Regional Sheltering need to consider the type and quantity of victims. Food services restroom and shower considerations are important for patient comfort as well as concerns for the pediatric, geriatric and special needs patients.  Acquisition and administration of chronic medications such as: insulin, antihypertensives, and psychiatric medications may be necessary with prolonged sheltering.  Protocols or plans will be important for the medical care, personal protection logistical and personnel support of the shelters.  Who will staff the shelters and how many are necessary should also be considered in the medical community planning.  Allied health personnel need to be included in these staffing considerations as well as pharmaceutical personnel and social needs. The Red Cross, Salvation Army as well as local religious and community kitchens will be valuable resources in shelter plans.

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