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8/8/2019 Threats That Face Our Nation and Viable Solutions - Medical Perspective
1/421
The Texas A&M University System Health Science Center
Office of Homeland Security
Threats That Face Our Nationand Viable Solutions -
Medical PerspectivePaul K. Carlton, Jr., MD, FACS
Lt. Gen, USAF, Ret
Director, Homeland SecurityThe Texas A&M University System
Health Science Center
12 September 2005
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The Texas A&M University System Health Science Center
Office of Homeland Security
Overview
Threat
Solutions
Katrina
8/8/2019 Threats That Face Our Nation and Viable Solutions - Medical Perspective
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The Texas A&M University System Health Science Center
Office of Homeland Security
Worst Nightmare
Lose whole localhealth care
network!
Katrina
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4/421The Texas A&M University System Health Science Center
Office of Homeland Security
Disaster Preparedness:Its All About Me!
Three deadly misconceptions:
1. It will not happen here!
2. It will not happen to me!
3. Someone else will be thereto take care of the problem!Jay A Johannigman
Crit Care Med Vol 33, No1
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Office of Homeland Security
LEARNERS
In a time of drastic change it
is the learners who inheritthe future. The learned
usually find themselvesequipped to live in a world
that no longer exists!Eric Hoffer
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Office of Homeland Security
LEARNERS
ALL OF US
MUST BELEARNERS!
8/8/2019 Threats That Face Our Nation and Viable Solutions - Medical Perspective
7/421The Texas A&M University System Health Science Center
Office of Homeland Security
Dont be learned!
8/8/2019 Threats That Face Our Nation and Viable Solutions - Medical Perspective
8/421The Texas A&M University System Health Science Center
Office of Homeland Security
You may obtain a copy of thispresentation at:
www.tamhsc.edu/homeland/
8/8/2019 Threats That Face Our Nation and Viable Solutions - Medical Perspective
9/421The Texas A&M University System Health Science Center
Office of Homeland Security
America is inDanger!
8/8/2019 Threats That Face Our Nation and Viable Solutions - Medical Perspective
10/421The Texas A&M University System Health Science Center
Office of Homeland Security
Danger Always Present,Just Beneath the Surface
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11/421The Texas A&M University System Health Science Center
Office of Homeland Security
Facing Reality is Difficult
None of us
Want to FaceWhat Lies
Ahead of Us
We Must!
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Change Is Hard
Every revolutionary idea evokes
three stages of reaction
1.Youre nuts!
2.It would work, but no reason tochange!
3.You like it? It was MY idea!
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The Texas A&M University System Health Science Center
Office of Homeland Security
Response
Chain
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The Texas A&M University System Health Science Center
Office of Homeland Security
Response Chain
LINKS:
Prevention
MitigationConsequence
Management
Recovery
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Response Chain
All of these have some part of the
response chain-Police
Fire
EMS
Medical
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Weak Link
Medicine maybe theWeakest Link!
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Response Chain
It all comes to life
or death!
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Response Chain
ITS ALL ABOUT PEOPLE
Not about bricks or lumber ina pile, not about concrete
destroyedIt is the dead and injured.
Medical Must BeConsidered
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Weak Link
We could see collapse of ourhealth care system in any bio
event!
Chuck Ludlam, Chief of Staff
Senator Lieberman15 April 05
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Weak Link
We are totally unprepared medically!
We have none of the vaccines norantibiotics that we would need in a bioevent.
Defense Contract model will not work in thissituation.
Chuck Ludlam, Chief of StaffSenator Lieberman
15 April 05
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Weak Link
Medicine is our weak linkand that is where we will
break.Ed Eberhart
CINC NORTHCOMMay 3, 2004
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These people could be wrong
butI doubt it
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Medical Response
95%
Public
PoliceFireEMS
95%
Private
Medical
Capabilities
Why?
Different worlds they do not understand each other
M di l R
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Medical Response
95%Public
PoliceFire
EMS
95%
Private
Medical
Capabilities
Different worlds they do not understand each other
R
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Medical Response
NO OWNED ASSETS
ALL PRIVATE
REQUIRES BETTER COOPERATIONand UNDERSTANDING THAN WEHAVE EVER SEEN!
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Threats
95%Private
MedicalCapabilities
Medicine, aswe know it, isin danger of
failing.
The Current Hospital
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The Current HospitalEnvironment
Key component of consequence management is timely medicalcare for victims of mass casualty incidents
Incorrect assumptions made about existing medicalcapabilities to treat mass casualties
Hospital surge capacity has never been more restricted
Medical community struggling just to
maintain everyday capacity
Majority of preparedness issues arefinancially (revenue vs cost) based
Without prompt action, the nation carries the risk thatvictims of a mass-casualty disaster might end up in ambulancesto nowhere."
Source: Barbera, Macintyre, and DeAtley
Mar 2002
A b l t N h
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Ambulances to Nowhere
Funding shortfalls
Decline in government support for public and privatehospitals
Increasing number of expensive, unfunded, or under-fundedregulatory mandates
Continued expectation that hospitals will maintain high
levels of charity medical care National shortage of nurses for acute
care hospitals, resulting in need for specialcompensation packages to attract personnel
Results -- closure, downsizing, consolidation,reconfiguration, and partnering
Abolition or downsizing of specialty services crucial to
disaster preparedness! Source: Barbera, Macintyre, and DeAtley , Mar 2002
A b l N h
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Ambulances to Nowhere
Delivery of acute medical care evolved beyond ordinary businessrelationship to "trust" with patients
Trust has extended to current threat environment
Move from individual patient to community as a whole
Financial support to hospitals by community create expectationhospitals will address community's health/medical needs, includingdisaster preparedness
Reasonable cost for hospital preparedness for mass casualtieswas assumed to be necessary cost of doing business
Financing costs
Old Medicare and fee for service
New Managed care payment system (capitation)
Bottom line: Disconnect between expectations and funding!
Source: Barbera, Macintyre, and DeAtley , Mar 2002
T bl d M di l S t
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Troubled Medical System
Growing concern over projected shortage of healthcareproviders in coming years
Other factors: aging population, increased demand, andincreased costs
Troubled specialties -- orthopedics, radiology, dermatology,cardiology, ophthalmology and anesthesiology
Bleak future forecast
Shortage of 200,000 doctors,
157,000 pharmacists
20% shortfall in nursing
requirements by 2020
Kiplinger, Mar 05
Quality of life greatest deterrent
A Strained System
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A Strained System
Hospital capacity continues to be main limiting factor in disastermedical response
Critical care services and intensive care units most affected Recent examples
Only 25 ICU beds usable for 27 patients in Madrid bombing
Only 12 ICU beds available for 20 patients in Bali bombing
2001 Houston floods reduced ICU capacity by 75%
More challenges
Toxic chemical scenario: 1200 bed hospital could handle only two
patients at one time Poor staffing levels for critical care areas
Dara, Ashton Farmer, Feb 05
A St i d S t
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A Strained System
Possible surge solutions
Pre-emptive education Increased disaster response awareness,improved skill sets, comprehension of roles and responsibilities,alternate communication styles, and expertise in cooperationduring chaos
Interfacility cooperation Creation of flexibleplans for interchanging resources to supplementexisting capacity of hospitals
Dual usage of resources Critical care
units respond outside geographicallocations; merge training and education
Dara, Ashton Farmer, Feb 05
A St i d S t
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A Strained System
Its an unsustainable situation. Withoutsome major fix this system will self-implode.
Ted Epperly, M.D., Board Member
American Academy of
Family Physicians
A Strained System
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A Strained System
These are the facts!
Everyone is entitled to his
opinions. He is notentitled to his own facts!
Senator Daniel Patrick Moynihan, NY
Modular Medical Response Capability:
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A Possible Future
AeromedicalEvacuation
Time
Local Infrastructure BaselineCapability
Emergency RoomOperating RoomsICU BedsInpatient BedsPhysical Space
Local Response
FederalQRP
Regional Center Response
(NG and AHC Medical Center led)
Units ofMedicalCapability
Day toDayPatientCapacity
Modular Medical Response Capability:
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A Possible Future
AeromedicalEvacuation
Time
Local Infrastructure BaselineCapability
Day toDayPatientCapacity
Units ofMedicalCapability
Disaster
Occurs!
Emergency RoomOperating RoomsICU BedsInpatient BedsPhysical Space
Local Response
FederalQRP
Regional Center Response
(NG and AHC Medical Center led)
Tools
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Must have response units to solve problems
Requires Tools in the Toolbox
NO Tools
NO Response
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Means military-civilian cooperation!AndCivilian- civilian cooperation!
5 Ps
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5 Ps
1. Prior
2. Planning
3. Prevents4. Poor
5. Performance
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TEAM
Preparation for the Nation
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Making the Pieces Fit
FirstPreparers
FirstReceivers
FirstResponders
Trauma & Critical Care
Pararescue Course
Trauma & Disaster Course
Mental Health Aspects Course
Public Health Course
Bio-Terrorism Course
Mental Health Aspects Course
Trauma & Dusaster Course
Critical Infectious Diseases Course
Trauma & Critical Care
Pararescue Course
Mental Health Aspects Course
Trauma & Disaster Course
Public Health Course
Eye Trauma Course
Critical Care Transport
Bio-Terrorism Course
Bio-Terrorism Course
Public Health Course
WE
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All Hazard
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Forward Operation Base Marez
Mosul, Iraq
24 December 04
Forward Operation Base Marez,
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Mosul, Iraq
12:15 pm Explosion in dining facility
Evacuation begins
12:25 pm 12 casualties arrive at
medical facility
Medical Fights OnTo Save Lives
Forward Operation Base Marez,
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Mosul, Iraq
12:25 pm Triage begins
12:40 pm Mortar attack hits hospital
Hospital hard and no casualties
Full speed for 12 hours
11:30 pm Breath
2:00 am CCATTs arrive- medical tune up for flight4:00 am CCATTs fly away 12 patients to Germany
Statistics
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Statistics
9 OR cases
7 Open laparotomies
10 surgeries in hallway8 pts mechanical ventilation
14 chest tubes placed
39 CT scans done
200 plain radiographs
294 lab tests
40 units of blood products
217 IV meds given
91 patients
18 DOA
4 DOW
69 left
20 to other militaryhospitals
49 to treat
Statistics
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Statistics
91 patients
18 DOA
4 DOW
69 left
20 to other militaryhospitals
49 to treat
9 OR cases
7 Open laparotomies
10 surgeries in hallway8 pts mechanical ventilation
14 chest tubes placed
39 CT scans done
200 plain radiographs
294 lab tests
40 units of blood products
217 IV meds given
Good Job Army!
A Busy Day
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y y
Attack by suicide bomber on food tent in Forward Operating BaseMarez created numerous casualties
91 casualties in 11 hours
22 died in attack; 18 were American
17 dead on arrival; 5 with nonsurvivable wounds
A busy day for casualties
Highest number of casualties treated atmilitary hospital in Iraq during war
9 surgeries performed in OR; 10 performed outside OR
Mortuary established in parking lot
NY Times, Dec 04
Standard of Care/
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Sufficiency of Care
Standard ofCare
Sufficientcare
Dem
ands
Care Capability
Standard of Care/Sufficiency of Care
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Standard ofCare
Sufficiency of Care
Sufficientcare
9 operations in OR
7 Open laparotomies
10 surgeriesin hallwaySmooth transition
Dem
ands
Care Capability
The interface of standard ofcare and sufficiency of care
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care and sufficiency of care
??????
GOLD STANDARD
Graceful Degradation
of Care
Plan B OperationsCareSta
ndards
DemandMORAL IMPERATIVEMORAL IMPERATIVE
Lessons learned for U.S. from this
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Triage needs work
Training saves lives
Resource allocation is critical!
Must have graceful degradation ofcare well planned
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care well planned
??????
GOLD STANDARD
Graceful Degradation
of Care
Plan B OperationsCareSta
ndards
DemandMORAL IMPERATIVEMORAL IMPERATIVE
A Change in Standards
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g
Popular belief health care organizations/public health agenciesstructured to handle surge
Wrong! Terrorist attack could compromise current system
We must identify, plan, and prepare to make adjustments in currenthealth and medical care standards!
DHS and several key agencies recently met to discuss U.S. abilityto respond to attack
Purpose of meeting:
Examine current standards
Recommend specific actions for Federal,State, regional, community, and health systems planners
Health Systems Research, Aug 05
What to Address?
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Critical questions discussed
What knowledge must planners possess to develop effective
health and medical care response plans to mass casualty event? What key principles guide planning for health/medical response
to mass casualty event?
What issues must be considered/addressedin planning for health and medical care inmass casualty event?
What information, tools, models, and other
resources are available to address plannersneeds?
Health Systems Research, Aug 05
The Results
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Key findings
Goal of mass casualty response -- maximize number of lives
saved Must change process to allocate scarce resources
Many health systems do not provide adequate planning andguidance to direct change in current standards
Allocating health and medical resources in a mass casualty eventshould be fair and equitable
Protocols for triage based size and nature of event and speed of
development Must have adequate number of staff, equipment, and
pharmaceuticals on hand for any event
Health Systems Research, Aug 05
What Next?
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Proposed actions
Develop overarching/specific guidance for distributing scarce
health and medical care resources during mass casualty event Develop and implement method to address nonmedical (i.e.,
finance, communication,etc.) issues during event
Develop strategy for risk communication for public
Develop practical tools for medical personnel
Develop strategies for leadership/coordination on-site
Continue/expand response personnel training
Develop Community-Based Planning Guide for Mass CasualtyCare for planners
Health Systems Research, Aug 05
Mass Casualty Events
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y
Man Made
Natural
?Not Applicable?
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pp
I will never see that number of
casualties
I dont have to worry aboutthese things!
COMMON COMMENTS TO ME!
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ComplaintswithoutSolutions =
Whining
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SOLUTIONSCurrently under way at A&M Health Science Center
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1. Education and Training2. Menu Brief3. Medical Student Education4. Leadership Program for
Disaster Response5. Master Plans6. Plan B7. Triage8. Mobile Solutions9. Surge Hospitals or
Community Health Centers10. Veterinary School SurgeHospital
11. VA Proposal
12. Incentives CarrotCredentials
13. Medical OperationsCenter Proposal
14. NORTHCOM15. Diabetic Retinopathy
Screening16. Isolations Rooms17. Scancorder18. Ventilators
19. Hospital Flow
7 April 05
Texas A&M University System
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Austin, TexasHow to Build a
Surge Hospital for a Song
Austin, TexasAugust 2005
This Plan Protects
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Staff
Patients
Victims of MCIState Capitol
Football Stadium
Requirement by Department ofState Health Services
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112 Bed Surge Facilityin place
St. Davids requirement from
the DSHS as fair share forAustin community
The Red Wedge Concept
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Standard ofCare
Sufficient
care At some point we will goto sufficient care , notstandard of care
Surge from outside sources
Peacetime Surge - within
Soft sided solutions may apply
Plan B
Demand
Care Capability
The interface of standard ofcare and sufficiency of care
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??????
GOLD STANDARD
Graceful Degradation
of Care
Plan B Operations
This plan stays within SOC
Double the numbers moves to Sufficient Care
CareStandards
DemandMORAL IMPERATIVEMORAL IMPERATIVE
De
Entry
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Decontam
ination
I
D
E
M
1. Control hospital
2. Not allowed into facility until decon isdone
3. Allow time for preparation of day surgery
for mass casualty incident (MCI)4. Allows isolation from rest of facility
5. Central to downtown
Key
Sequence:1. Notification of MCI2. Decon and Triageprepared3. Day surgery empties4. Opens beds for MCI
Photo by: Salvador Monastra-SeBasocSt. Davids Safety Officer
Decont
Flow Pattern in Triage Area
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ontamination
Imme
diate
Minim
al
Expecta
ntDelay
ed
Triage entirelydependent on
resources and loadfrom MCI
Sequence:1. Notification of
MCI2. Decon and Triageprepared3. Day surgeryempties
4. Opens beds forMCI
Day surgery patients go
Whole separate HVAC system protected by Isolate Filter
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ImmediateRX area
straight to centralhospital
ToOR
ICU
Holding
b
eds
Sequence:1. Notification of MCI2. Decon and Triageprepared3. Day surgery empties
4. Opens beds for MCI
Photo by: Salvador Monastra-SeBasocSt. Davids Safety Officer
The Red Wedge Concept
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Standard ofCare
Sufficient
care At some point we will goto sufficient care , notstandard of care
Surge from outside sources
Peacetime Surge - within
Soft sided solutions may apply
Plan B
Demand
Care Capability
The interface of standard ofcare and sufficiency of care
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??????
GOLD STANDARD
Graceful Degradation
of Care
Plan B Operations
This plan stays within SOC
Double the numbers moves to Sufficient Care
CareStandards
DemandMORAL IMPERATIVEMORAL IMPERATIVE
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The Battle of New Orleans
2005Not January 1815
But
August 2005
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The Battle of New Orleans2005
Medical Perspective
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KATRINA:
A Rain of Terror
Ambulances to Nowhere
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Funding shortfalls
Decline in government support for public and privatehospitals
Increasing number of expensive, unfunded, or under-fundedregulatory mandates
Continued expectation that hospitals will maintain highlevels of charity medical care
National shortage of nurses for acutecare hospitals, resulting in need for specialcompensation packages to attract personnel
Results -- closure, downsizing, consolidation,reconfiguration, and partnering
Abolition or downsizing of specialty services crucial todisaster preparedness!
Source: Barbera, Macintyre, and DeAtley , Mar 2002
Ambulances to Nowhere
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Delivery of acute medical care evolved beyond ordinary businessrelationship to "trust" with patients
Trust has extended to current threat environment
Move from individual patient to community as a whole
Financial support to hospitals by community create expectationhospitals will address community's health/medical needs, includingdisaster preparedness
Reasonable cost for hospital preparedness for mass casualtieswas assumed to be necessary cost of doing business
Financing costs
Old Medicare and fee for service New Managed care payment system (capitation)
Bottom line: Disconnect between expectations and funding!
Source: Barbera, Macintyre, and DeAtley , Mar 2002
A Strained System
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Possible surge solutions
Pre-emptive education Increased disaster response awareness,
improved skill sets, comprehension of roles and responsibilities,alternate communication styles, and expertise in cooperationduring chaos
Interfacility cooperation Creation of flexible
plans for interchanging resources to supplementexisting capacity of hospitals
Dual usage of resources Critical careunits respond outside geographicallocations; merge training and education
Dara, Ashton Farmer, Feb 05
Jim Lehrer Newshour 8 September
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Blame Amid the Tragedyby Bob Williams
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Who is to blame for the inadequate response?
The primary responsibility for dealing withemergencies does not belong to the federal
government. It belongs to local and state officialswho are charged by law with the management ofthe crucial first response to a disaster.
Source: opinionjournal.com7 September 2005
Blame Amid the Tragedyby Bob Williams
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Hurricane Katrina - New Orleans September 2005
Failure of implementation of established evacuation plan by Gov.
Blanco and Mayor Nagin
Problems that were identified in hurricane simulation in October2004 were not corrected
New Orleans contingency plan that states: the safe evacuation ofthreatened populations is one of the principle reasons fordeveloping a Comprehensive Emergency Management Plan
PLAN WAS APPARENTLY IGNOREDSource: opinionjournal.com
7 September 2005
Blame Amid the Tragedyby Bob Williams
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The federal government does not
have the authority to intervene in astate emergency without the requestof a governor.
It must be made clear that thegovernor and locally elected officials
are in charge of the first response.Source: opinionjournal.com
7 September 2005
Hurricane Katrina
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Medical Victory Due to:
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Ingenuity Dedication to patient care
Volunteerism
Good planning!
Good
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1. Waiver of Louisiana license
2. Surge
3. Regional and national plan
4. Thinking about this for long term
5. Exercises 2004 and August 2005 levees failed6. Attitude
7. Strike team into Baton Rouge day #18. Member of National Disaster Life Support
(NDLS) consortium so well educated
Bad
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1. Communication
2. Transportation
3. Deaths
4. Complacency to sit through thestorm
5. Lack of execution of evacuationplan
Ugly
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1. Lawlessness
2. Chaos
3. Looting
4. Media
Katrina Timeline
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
The Story Does Not Start Here
Story Begins
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Begin 4 years ago with National Disaster LifeSupport Consortium (NDLSC) first formed
LSU charter member
2001 - 2005 DLS family of courses written and
given to thousands, including LSU and BatonRouge
-medical aspects of disastermanagement and care
Katrina Timeline
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
Katrina Timeline - 23-27 August
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
23 - 27 Aug tropical storm Katrina strengthens into Hurricane Katrina and hits
Florida. It then weakens and moves to the Gulf of Mexico gathering strength into aCategory 3. New Orleans declares state of emergency with evacuation.
Medical: All patients discharged who can go, Shelters set up, Baton Rouge PeteMaravich Center made into shelter
Katrina Timeline 28 August
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
Katrina grows into a Category 5 New Orleans issued mandatory evacuation. 10
shelters are set up
Katrina Timeline 29 August
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
Katrina- Category 4 hits Louisiana President Bush makes emergency disasterdeclarations
Medical: No change, levees breakdown had not impacted health care
Katrina Timeline 30 August
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Two levees break in New Orleans people began to escape
Medical: New Orleans Hospitals begin to flood, 72 hour backup power startsLa EOC debate about what will happen to the levees and its impact on medical, StrikeTeam from UTSW arrives to augment EOC/MOC
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
Katrina Timeline 31 August
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
Announcement death toll in hundreds maybe thousands
Medical: New Orleans Hospital begin to transfer to airport for evacuation, floodingworsens
La EOC options weighed if full evacuation of New Orleans needed
Geography
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Baton Rouge
is only landtransportation
option!
Katrina Timeline 1 September
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Thousands of people without food and water hospitals plead for help
Medical: New Orleans Hospitals continue transfer to airport and out of town, floodingworsening, USAF EMEDS arrives, National Guard begins air evacuation of patients andevacuees.La EOCit is clear levees will not be repaired, full medical evac of New Orleans mustoccur, Surge Hospitals decided upon and orders given to begin
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
Katrina Timeline 2 September
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
President Bush tours relief efforts are unacceptable
Medical: New Orleans Hospitals flooded and out of fuel for emergency power,thousands of pts at airport, NG continues evacuation to surrounding statesLa EOC Surge Hospitals building K-Mart 1000 beds, PMac 800 beds, Field House250 beds, Earl K. Long surge in place by 200 bedstotal 2250 extra bedsSufficiency of Care
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
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Geography
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Baton Rouge
is only landtransportation
option!
Katrina Timeline 3 September
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Additional soldiers, marines and National Guard arriveMedical: New Orleans airport1500 litter pts in squalid conditions, Strike Team sent
by LaEOC to clean it out, USAF AE arrives,--2,600 pts and evacuees moved out by airand groundLaEOC/Baton Rouge- Surge Hospitals receive waves of hospital pts and evacuees bybus, PMAC-filled up and 17 vent pts, Field House- special needs, K-Mart-hundreds of ptsand evacuees, Earl K. Long filled up
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
Katrina Timeline 4 September
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Superdome emptied, paramedics begin removing dead, Governor Blanco declares astate of public health emergency
Medical: New Orleans airport empty of pts, Strike Team comes back to LaEOC,AF/EMEDS up and running, USA/FST up and running on airportLaEOC/Baton Rouge Surge Hospitals running full speed, PMAC triaging into stateand surrounding states
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
Katrina Timeline 5 September
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
Some are allowed to returned for a short period
Medical: New Orleans some people remain, NG and USA restore order, multipleshoot outs occurLaEOC/Baton Rouge- demand begins to subside, expecting second peak of patients
Katrina Timeline 6 September
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
New Orleans pumping begins, investigations into Federal response
Medical: New Orleans two hospitals reopen, order restoredLaEOC/Baton Rouge begin to close sufficient care Surge Hospitals, demandabates
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
Katrina Timeline 7 September
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8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
Medical: New Orleans- more hospitals reopen
LaEOC/Baton Rouge K-Mart transfers all pts to other facilities, PMAC and FieldHouse slowFull Federal Response arrives and begins to be effective
Geography
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Baton Rouge
is only landtransportationoption!
Tabletops
2004 l b h d d N O l
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2004 levee breached and New Orleansflooded how to handle
August 2005 New Orleans leveebreached on Mississippi side and New
Orleans flooded, all health care facilitiesare lost!
BATON ROUGE YOU ARE UP!
Facing Reality is Difficult
N f
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None of us
Want to FaceWhat Lies
Ahead of Us
We Must!
Modular Medical Response Capability:A Possible Future
AeromedicalLocal Infrastructure BaselineC
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Evacuation
Time
Capability
Emergency RoomOperating RoomsICU BedsInpatient BedsPhysical Space
Local Response
FederalQRP
Regional Center Response
(NG and AHC Medical Center led)
Units ofMedicalCapability
Day toDayPatientCapacity
Modular Medical Response Capability:A Possible Future
AeromedicalLocal Infrastructure BaselineC bili
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Evacuation
Time
Capability
Day toDayPatientCapacity
Units ofMedicalCapability
Disaster
Occurs!
Emergency RoomOperating RoomsICU BedsInpatient BedsPhysical Space
Local Response
FederalQRP
Regional Center Response
(NG and AHC Medical Center led)
Surge Hospital/ Facility
Definition
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Definition
A facility that can be used to providesufficient medical care when a primarymedical facility is:
-destroyed
-contaminated and thus denied
-overwhelmed
SURGETRATEGIC
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TRATEGICHARED
TILIZATION OF
ESOURSES FOR
EOGRAPHICAL
MERGENCIES
SURGE CONCEPTS
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Surge Hospital/ Facility
Definition
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Definition
A facility that can be used to providesufficient medical care when a primarymedical facility is:
-destroyed
-contaminated and thus denied
-overwhelmed
Hospital Requirements
Space
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Ingenuity
Nice to have
ACPower
Gases
Back up power
Worst Nightmare
Lose whole local
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Lose whole local
health carenetwork!
Katrina
Tabletops
2004 levee breached and New Orleans
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2004 levee breached and New Orleansflooded how to handle
August 2005 New Orleans leveebreached on Mississippi side and New
Orleans flooded, all health care facilitiesare lost!
BATON ROUGE YOU ARE UP!
Baton Rouge Area
Kmart
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Kmart
LSU
EOC
SURGE CONCEPTS
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Fall 2004 College of Architecture Project
College ofArch fall of Who would
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Arch fall of2004 class
project surge
hospitals
Who wouldbuild a
hospital in asports
facility?
WHOEVERNEEDS TO!
What isheresy one
year is
reality thenext year!
Fall 2004 College of Architecture Project
College ofArch fall of Who would
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Arch fall of2004 class
project surge
hospitals
Who wouldbuild a
hospital in asports
facility?
WHOEVERNEEDS TO!
What isheresy one
year is
reality thenext year!
Fall 2004 College of Architecture Project
College ofArch fall of Who would
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Arch fall of2004 class
project surge
hospitals
Who wouldbuild a
hospital in asports
facility?
WHOEVERNEEDS TO!
What isheresy one
year is
reality thenext year!
Fall 2004 College of Architecture Project
College ofArch fall of Who would
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Arch fall of2004 class
project surge
hospitals
Who wouldbuild a
hospital in asports
facility?
WHOEVERNEEDS TO!
What isheresy one
year is
reality thenext year!
Fall 2004 College of Architecture Project
Triage
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Triagecategories
are labeled
This isexactly whathappened inthe PeteMaravich
Center
Baton Rouge Area
Kmart
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a t
LSU
EOC
LSU Campus
Field HouseMaravich Coliseum
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Maravich Coliseum
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SURGE CONCEPTS
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Standard of Care/Sufficiency of Care
Move out of circleas neededSophisticated
care done in
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Standard
of Care
Move backas quickly
as possible
hospitals
Less sophisticatedcare done in
surge hospitals
Standard of Care/Sufficiency of Care
Sophisticatedcare done in
h i l
Move out of circleas needed
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Standard
of Care
hospitals
Less sophisticatedcare done in
surge hospitals
Move backas quickly
as possible
The interface of standard ofcare and sufficiency of care
Graceful Degradation
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??????
GOLD STANDARD
of Care
Plan B OperationsCareS
tandards
DemandMORAL IMPERATIVEMORAL IMPERATIVE
Maravich Coliseum
LabPharmacy
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MIC U
Wards
SIC U
DialysisSurgical
Ward
Registration
Peds Isolation
Entrance
Red toYellow level
patients
Maravich Coliseum
LabPharmacy
SIC U
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MIC U
Wards
Dialysis
SurgicalWard
Registration
Peds Isolation
Entrance
Red to
Yellow levelpatients
Maravich Coliseum
LabPharmacy
MIC USIC U
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Wards
Dialysis
SurgicalWard
Registration
Peds Isolation
Entrance
Red to
Yellow levelpatients
Maravich Coliseum
LabPharmacy
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Dialysis
SurgicalWard
Registration
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Entrance
Red to
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Dialysis
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Registration
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Entrance
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SurgicalWard
Registration
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Entrance
Red to
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Dialysis
SurgicalWard
Registration
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Entrance
Red to
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Maravich Coliseum
LabPharmacy
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SurgicalWard
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Entrance
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SurgicalWard
Registration
Peds Isolation
Entrance
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Registration
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Entrance
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Entrance
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Entrance
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Entrance
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SurgicalWard
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Entrance
Red to
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Maravich Coliseum
LabPharmacy
MIC USIC U
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Wards
Dialysis
SurgicalWard
Registration
Peds Isolation
Entrance
Red to
Yellow levelpatients
Maravich Coliseum
LabPharmacy
MIC USIC U
Di l i
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Wards
DialysisSurgical
Ward
Registration
Peds Isolation
Entrance
Red to
Yellow levelpatients
Maravich Coliseum
LabPharmacy
MIC USIC U
Dialysis
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Wards
DialysisSurgical
Ward
Registration
Peds Isolation
Entrance
Red to
Yellow levelpatients
Maravich Coliseum
LabPharmacy
MIC USIC U
Dialysis
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Wards
DialysisSurgical
Ward
Registration
Peds Isolation
Entrance
Red to
Yellow levelpatients
Maravich Coliseum
LabPharmacy
MIC USIC U
Dialysis
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Wards
DialysisSurgical
Ward
Registration
Peds Isolation
Entrance
Red to
Yellow levelpatients
Maravich Coliseum
LabPharmacy
MIC USIC U
Dialysis
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Wards
DialysisSurgical
Ward
Registration
Peds Isolation
Entrance
Red to
Yellow levelpatients
Maravich Coliseum
LabPharmacy
MIC USIC U
Dialysis
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Wards
ySurgical
Ward
Registration
Peds Isolation
Entrance
Red to
Yellow levelpatients
Maravich Coliseum
LabPharmacy
MIC USIC U
DialysisS i l
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Wards
ySurgical
Ward
Registration
Peds Isolation
Entrance
Red to
Yellow levelpatients
Maravich Coliseum
LabPharmacy
MIC USIC U
DialysisSurgical
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WardsSurgical
Ward
Registration
Peds Isolation
Entrance
Red to
Yellow levelpatients
Baton Rouge Area
Kmart
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LSU
EOC
SURGE CONCEPTS
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Field House (Special Needs)
Med IPeds
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Entrance
Surgical
Med II
Yellow to Green Level Patients
SURGE CONCEPTS
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Standard of Care/Sufficiency of Care
Move out of circleas needed
Move back
Sophisticatedcare done in
hospitals
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Standard
of Care
as quicklyas possible
Less sophisticatedcare done in
surge hospitals
Standard of Care/Sufficiency of Care
Sophisticatedcare done in
hospitals
Move out of circleas needed
Move back
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Office of Homeland Security
Standard
of Care
Less sophisticatedcare done in
surge hospitals
as quicklyas possible
The interface of standard ofcare and sufficiency of care
Graceful Degradationof Care
s
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Office of Homeland Security
??????
GOLD STANDARD
Plan B OperationsCareStandard
DemandMORAL IMPERATIVEMORAL IMPERATIVE
Field House (Special Needs)
Med IPeds
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Office of Homeland Security
Entrance
Surgical
Med II
Yellow to Green Level Patients
Field House (Special Needs)
SurgicalMed I
M d II
Peds
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Office of Homeland Security
Entrance
Med II
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
M d II
Peds
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Office of Homeland Security
Entrance
Med II
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Med II
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Med II
Yellow to Green
Level Patients
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Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Med II
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Med II
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Med II
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Yellow to Green
Level Patients
Field House (Special Needs)
SurgicalMed I
Med II
Peds
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Office of Homeland Security
Entrance
Yellow to Green
Level Patients
Baton Rouge Area
Kmart
LSU
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Office of Homeland Security
LSU
EOC
SURGE CONCEPTS
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Office of Homeland Security
Standard of Care/Sufficiency of Care
Move out of circle
as needed
Move back
as quicklyibl
Sophisticatedcare done in
hospitals
Less sophisticatedcare done in
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The Texas A&M University System Health Science Center
Office of Homeland Security
Standard
of Care
q yas possiblesurge hospitals
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The interface of standard ofcare and sufficiency of care
GOLD STANDARD
Graceful Degradationof Care
dards
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Office of Homeland Security
??????
GOLD STANDARD
Plan B OperationsCare
Stand
DemandMORAL IMPERATIVEMORAL IMPERATIVE
Empty Building (formerly Kmart)
No Power
No AC
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Office of Homeland Security
No AC
Filthy
104,992 sq. ft.
Vacant Building Set Up
Storage area
Acute
CareICUMed IMed IIPediatrics
Pediatric
Play area
Bath
rooms
Truck loading
DEC
ON
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Office of Homeland Security
PharmacyMentalHealth
Registration
Dining
Area
Nursing
supplies
Dialysis
Dis
charge
OverflowArea
Entry Control Point ToiletsPortable generators & ac
Donated
clothing
Patient/family
sleeping
Vacant Building Set Up
Storagearea
Mental
Registration
AcuteCare
ICU
Med IMed IIPediatricsPediatricPlay area
Bath
rooms
Dining
Nursingsupplies
Dialysis
D
ischarge
OverflowArea
Truck loading
Donated
Patient/family
sleeping
DECON
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Office of Homeland Security
PharmacyMentalHealthArea
Entry Control PointToiletsPortable generators & ac
Donatedclothing
Vacant Building Set Up
DECON
Storagearea
PharmacyMentalH lth
Registration
AcuteCare
ICU
Med IMed IIPediatricsPediatricPlay area
Bath
rooms
DiningArea
Nursingsupplies
Dialysis
Discharge
OverflowArea
Truck loading
Donated
Patient/family
sleeping
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The Texas A&M University System Health Science Center
Office of Homeland Security
yHealthArea
Entry Control PointToiletsPortable generators & ac
clothing
Vacant Building Set Up
Storagearea
PharmacyMentalHealth
Registration
AcuteCare
ICU
Med IMed IIPediatricsPediatricPlay area
Bath
rooms
DiningArea
Nursingsupplies
Dialysis
Discharge
OverflowArea
Truck loading
Donated
Patient/family
sleeping
DECON
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Office of Homeland Security
HealthArea
Entry Control PointToiletsPortable generators & ac
clothing
Vacant Building Set Up
Storagearea
PharmacyMental
Registration
AcuteCare
ICU
Med IMed IIPediatricsPediatricPlay area
Bath
rooms
DiningArea
Nursingsupplies
Dialysis
Discharge
OverflowArea
Truck loading
Donated
Patient/family
sleeping
DECON
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Office of Homeland Security
PharmacyHealthArea
Entry Control PointToiletsPortable generators & ac
Donatedclothing
Vacant Building Set Up
Storagearea
PharmacyMental
Registration
AcuteCare
ICU
Med IMed IIPediatricsPediatricPlay area
Bath
rooms
DiningArea
Nursingsupplies
Dialysis
Discharge
OverflowArea
Truck loading
Donated
Patient/family
sleeping
DECON
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Office of Homeland Security
PharmacyHealthArea
Entry Control PointToiletsPortable generators & ac
clothing
Vacant Building Set Up
Storagearea
PharmacyMentalHealth
Registration
AcuteCare
ICU
Med IMed IIPediatricsPediatricPlay area
Bath
rooms
DiningArea
Nursingsupplies
Dialysis
Discharge
OverflowArea
Truck loading
Donatedclothing
Patient/family
sleeping
DECON
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Office of Homeland Security
Health
Entry Control PointToiletsPortable generators & ac
clothing
DECON
Storagearea
PharmacyMentalHealth
Registration
AcuteCare
ICU
Med IMed IIPediatricsPediatricPlay area
Bath
rooms
DiningArea
Nursingsupplies
Dialysis
Discharge
OverflowArea
Truck loading
Donated
Patient/family
sleeping
Vacant Building Set Up
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Office of Homeland Security
yHealthArea
Entry Control PointToiletsPortable generators & ac
clothing
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DECON
Storagearea
PharmacyMentalHealth
Registration
AcuteCare
ICU
Med IMed IIPediatricsPediatricPlay area
Bath
rooms
DiningArea
Nursingsupplies
Dialysis
Discharge
OverflowArea
Truck loading
Donatedclothing
Patient/family
sleeping
Vacant Building Set Up
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The Texas A&M University System Health Science Center
Office of Homeland Security
Entry Control PointToiletsPortable generators & ac
g
DECON
Storagearea
PharmacyMentalHealth
Registration
AcuteCare
ICU
Med IMed IIPediatricsPediatricPlay area
Bath
rooms
DiningArea
Nursingsupplies
Dialysis
Discharge
OverflowArea
Truck loading
Donatedclothing
Patient/family
sleeping
Vacant Building Set Up
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