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Mass Casualty Mass Casualty SituationsSituations
An Educational An Educational FrameworkFrameworkCharles Stewart MD Charles Stewart MD
EMDMEMDM
Why?
Unthinkable…Unthinkable…Won’t happen here…Won’t happen here…
That’s other places…That’s other places… (like California!) (like California!)
The Study Of Disaster Medicine Is The Study Of Disaster Medicine Is Easy In Oklahoma… Easy In Oklahoma…
We are ‘blessed’ with disasters…We are ‘blessed’ with disasters… This presents abundant ‘opportunity to This presents abundant ‘opportunity to
excel’excel’ But…. It’s difficult to excel… without But…. It’s difficult to excel… without
preparation.preparation.
Lone Grove, OK
What I’m going to talk What I’m going to talk aboutabout
I’ll talk aboutI’ll talk about DefinitionsDefinitions TriageTriage Ethics of triageEthics of triage Triage categoriesTriage categories Where you can get education Where you can get education
about disaster medicineabout disaster medicine
This is a HUGE topic… and we This is a HUGE topic… and we could talk for hourscould talk for hours
First… reality testingFirst… reality testing
Why?As a health care facility… YOU
ARE REQUIRED TO MAKE THESE PLANS
Unless, of course, you don’t get any federal money and your health care facility isn’t JCAHO certified…
12. The plan provides processes for evacuating the 12. The plan provides processes for evacuating the entire building (both horizontally, and when entire building (both horizontally, and when applicable, vertically) when the environment applicable, vertically) when the environment cannot support adequate care, treatment, and cannot support adequate care, treatment, and services.services.
13.13. The plan provides processes for establishing an The plan provides processes for establishing an alternate care site that has the capabilities to alternate care site that has the capabilities to meet the needs of patients when the environment meet the needs of patients when the environment cannot support care, treatment, and services cannot support care, treatment, and services including processes for the following:including processes for the following:
1.1. Transporting patients, staff, and equipment to the Transporting patients, staff, and equipment to the alternative care site(s)alternative care site(s)
2.2. Transferring to and from the alternative care site(s) Transferring to and from the alternative care site(s) the necessities of patients (for example, the necessities of patients (for example, medications, medical records)medications, medical records)
3.3. Tracking of patientsTracking of patients4.4. Inter-facility communication between the hospital Inter-facility communication between the hospital
and the alternative care site(s)and the alternative care site(s)
JCAHO Standard EC.4.10JCAHO Standard EC.4.10
What is a MassCal?What is a MassCal?
A Mass Casualty Situation occurs A Mass Casualty Situation occurs when the call comes in and it when the call comes in and it becomes rapidly obvious that there becomes rapidly obvious that there are more of them than there are of are more of them than there are of you.you.
MassCal in MassCal in OklahomaOklahoma
Hazardous weatherHazardous weather Tornado/heavy weatherTornado/heavy weather Ice storm – with extended service Ice storm – with extended service
disruption.disruption. FiresFires
Internal firesInternal fires WildfiresWildfires
FloodsFloods Hazardous Materials Release Hazardous Materials Release Human Threat Human Threat Utility Failure Utility Failure
Hazardous WeatherHazardous Weather
May be the most likely May be the most likely reason for involvement reason for involvement of a health care facility of a health care facility in Oklahoma in ain Oklahoma in aMass Cal.Mass Cal.
^ Sumter Regional Hospital Americus, GA
< Picher, OK tornado
Oklahoma Ice StormsOklahoma Ice Storms
Nursing Home Fires:Nursing Home Fires: Small fire leads to nursing home Small fire leads to nursing home
evacuationevacuation Thursday, November 12, 2009Thursday, November 12, 2009 Pittsburgh Post-GazettePittsburgh Post-Gazette
About 40 elderly people had to be About 40 elderly people had to be evacuated from a nursing home in evacuated from a nursing home in Cranberry this morning after a fire, but Cranberry this morning after a fire, but no one was hurt.no one was hurt.
The fire started just before 9 a.m. in a The fire started just before 9 a.m. in a heating and air conditioning unit in the heating and air conditioning unit in the east wing of UPMC Cranberry Place and east wing of UPMC Cranberry Place and filled the facility with smoke.filled the facility with smoke.
Nursing Home FiresNursing Home Fires
Hartford CT Convalescent Home
Colorado Wild fire
FloodsFloods
Some of the most shocking scenes from Some of the most shocking scenes from Hurricane Katrina came from hospitals and Hurricane Katrina came from hospitals and nursing homes. nursing homes.
In Louisiana, about 100 residents died In Louisiana, about 100 residents died when they were trapped or abandoned in when they were trapped or abandoned in retirement centers.retirement centers. We really need to talk about ethics later!We really need to talk about ethics later!
FloodsFloods St. Rita's Nursing Home in St. Bernard St. Rita's Nursing Home in St. Bernard
Parish was flooded during Hurricane Parish was flooded during Hurricane Katrina, killing 34 residents. Katrina, killing 34 residents. Louisiana's attorney general charged the Louisiana's attorney general charged the
owners of the home, Salvador A. Mangano owners of the home, Salvador A. Mangano and Mable B. Mangano, with negligent and Mable B. Mangano, with negligent homicide. (Subsequently acquitted)homicide. (Subsequently acquitted)
Erich Schlegel / Dallas Morning News / Corbis (Dina Rudick / The Boston Globe)
Types of Mass Types of Mass CasualtiesCasualties
Resources challenged
Do the best for each individual
(P = Patient)
Types of Mass Types of Mass CasualtiesCasualties
DisasterDisaster Destroys the regional emergency systemDestroys the regional emergency system Usually it’s a disaster in multiple areasUsually it’s a disaster in multiple areas JOINT ICS activated (and needed)JOINT ICS activated (and needed)
Extra resources may be neededExtra resources may be needed Federal or State resources activatedFederal or State resources activated
Do the greatest good for the Do the greatest good for the greatest numbergreatest number
(P = Patient)
GOALS OF MCI GOALS OF MCI MANAGEMENTMANAGEMENT
Greatest good for greatest numberGreatest good for greatest number
Management of Resources (usually scarce)Management of Resources (usually scarce)
DON’T RELOCATE THE DISASTER!DON’T RELOCATE THE DISASTER!
Why is this important?Why is this important?
Long term care facilitiesLong term care facilities May be involved in the disaster?May be involved in the disaster? May be recipients of patients from the May be recipients of patients from the
disaster?disaster? May be unable to use ‘normal’ resources for May be unable to use ‘normal’ resources for
their own patients.their own patients.
Must be self sufficientMust be self sufficient YOYO96 is a very good rule.YOYO96 is a very good rule.
Healthcare FacilitiesHealthcare Facilities
May be involved in the disaster?May be involved in the disaster? Tornado?Tornado? Flood?Flood? Ice storm?Ice storm? Snow storm?Snow storm? Hazardous materials?Hazardous materials?
SitREPSitREP
Situation Report.Situation Report. Who you are.Who you are. Where you are.Where you are. What you have.What you have. How many are affected.How many are affected. What you have done.What you have done. What you need.What you need.
Triage…Triage…
Most medical providers know the origins of Most medical providers know the origins of triage…triage… In many cases, the term is misused… for In many cases, the term is misused… for
example: example: A waiting list for organs may be ‘triaged’ by A waiting list for organs may be ‘triaged’ by
survivability of the patients on the list. survivability of the patients on the list. The same would apply to allocation of The same would apply to allocation of
ventilators in a flu epidemic.ventilators in a flu epidemic.
Why we make the Why we make the decisions we make in decisions we make in
triage…triage…
When Do Fatalities Occur When Do Fatalities Occur in MCI?in MCI?
Immediate phase…Phase 1- within seconds to Immediate phase…Phase 1- within seconds to minutes after the incidentminutes after the incident The largest number of deaths occurs in phase 1 The largest number of deaths occurs in phase 1
due to injuries incompatible with survival.due to injuries incompatible with survival. You are not likely to save these patients.You are not likely to save these patients.
Death within seconds to minutes at the disaster Death within seconds to minutes at the disaster site results from head injuries and thoracic injuries site results from head injuries and thoracic injuries involving the heart, aorta or large blood vessels. involving the heart, aorta or large blood vessels.
We can only save those who have large vessel We can only save those who have large vessel external bleeds.external bleeds.
Some folks have an acronym… DRT.Some folks have an acronym… DRT.
When Do Fatalities Occur When Do Fatalities Occur in MCI?in MCI?
Immediate phase…Phase 1- within seconds to Immediate phase…Phase 1- within seconds to minutes after the incident does have some minutes after the incident does have some preventable deaths!preventable deaths! The United States Military has found that there The United States Military has found that there
are significant gains to be made by rapidly are significant gains to be made by rapidly evaluating and treating potentially exsanguinating evaluating and treating potentially exsanguinating hemorrhage.hemorrhage.
Likewise, they have found that needle chest Likewise, they have found that needle chest decompression may save significant numbers of decompression may save significant numbers of casualties.casualties.
Note that these are both IMMEDIATE therapies.Note that these are both IMMEDIATE therapies.
When Do Fatalities Occur When Do Fatalities Occur in MCI?in MCI?
Phase 2 - within minutes to hours after the Phase 2 - within minutes to hours after the incidentincident Death occurring within minutes to hours following Death occurring within minutes to hours following
the primary injuries due to subdural and epidural the primary injuries due to subdural and epidural hematomas, hemopneumothorax, lacerations of hematomas, hemopneumothorax, lacerations of large organs such as liver, spleen, gut, pelvic large organs such as liver, spleen, gut, pelvic fractures or other multiple injuries with significant fractures or other multiple injuries with significant occult blood loss.occult blood loss.
Most of these injuries require operative time to Most of these injuries require operative time to fix. fix. We need to get them to a hospital equipped to We need to get them to a hospital equipped to
handle the casualties.handle the casualties.
When Do Fatalities Occur When Do Fatalities Occur in MCI?in MCI?
The largest number of preventable deaths The largest number of preventable deaths occurs in the second phase of fatalities.occurs in the second phase of fatalities. Patients who will probably die even with Patients who will probably die even with
appropriate treatment and those who will live appropriate treatment and those who will live WITHOUT treatment become lower priority.WITHOUT treatment become lower priority.
The key medical issues during the Second The key medical issues during the Second Phase are:Phase are: Rescue of victimsRescue of victims Provision of timely immediate careProvision of timely immediate care Evacuation of patients with life/limb Evacuation of patients with life/limb
threatening injuries to medical facilitiesthreatening injuries to medical facilities
When Do Fatalities Occur When Do Fatalities Occur in MCI?in MCI?
Phase 3 - Within days to weeks after the Phase 3 - Within days to weeks after the incidentincident Death occurs several days or weeks after the Death occurs several days or weeks after the
incident due to sepsis or multiple organ system incident due to sepsis or multiple organ system failure. failure.
The quality of patient care during the first two The quality of patient care during the first two phases corresponds directly to the outcome of the phases corresponds directly to the outcome of the third phase… our efforts at the scene have effects third phase… our efforts at the scene have effects on the long-term outcome.on the long-term outcome.
Preventive medicine during the days to weeks Preventive medicine during the days to weeks following the disaster is another issue…following the disaster is another issue…
Return to TriageReturn to Triage
TriageTriage
There are multiple versions of triage...There are multiple versions of triage... I'm NOT going to talk about one of the many I'm NOT going to talk about one of the many
acronyms... but rather the science and acronyms... but rather the science and philosophy behind the schemes.philosophy behind the schemes.
Some folks talk about primary and secondary Some folks talk about primary and secondary triage… triage… I think you need to re-evaluate everybody on a I think you need to re-evaluate everybody on a
regular basis… after all, we really do under and regular basis… after all, we really do under and over-triage.over-triage.
It is NOT an exact scienceIt is NOT an exact science
TriageTriage
The main concept behind triage is not to save The main concept behind triage is not to save everyone right away, but: everyone right away, but: to prioritize patients based on their likelihood to to prioritize patients based on their likelihood to
benefit from treatmentbenefit from treatment to provide greatest benefits to the largest number to provide greatest benefits to the largest number
of people.of people.
The underlying assumption here is that this The underlying assumption here is that this triage method is applied only when resources triage method is applied only when resources are limited. are limited. You don’t need triage when you have enough You don’t need triage when you have enough
help!help!
Military TriageMilitary Triage
Military triage recognizes the limitations of Military triage recognizes the limitations of availability and supports the overall mission availability and supports the overall mission of the military to win battles.of the military to win battles. The motto of the Army medical corps is “To The motto of the Army medical corps is “To
Preserve the Fighting Strength.”Preserve the Fighting Strength.”
Triage in the Military… is a ‘bit’ differentTriage in the Military… is a ‘bit’ different It is based on that motto…more than you It is based on that motto…more than you
thinkthink
Speaking of The Speaking of The MilitaryMilitary
Military triage divides casualties into three Military triage divides casualties into three categories:categories: MinimalMinimal–ambulatory with superficial wounds –ambulatory with superficial wounds
that can be treated in the field and returned to that can be treated in the field and returned to duty.duty. The LEAST injured are first to receive medical The LEAST injured are first to receive medical
attention, attention, consistent with the need to return soldiers to consistent with the need to return soldiers to battle quickly so as to “preserve the fighting strength.battle quickly so as to “preserve the fighting strength.
SeriousSerious–requires field treatment with evacuation –requires field treatment with evacuation to field or base hospital. to field or base hospital. Those with serious but potentially survivable injuries Those with serious but potentially survivable injuries
are treated next.are treated next. Based on resources and transportationBased on resources and transportation
ExpectantExpectant–dying with injuries incompatible with –dying with injuries incompatible with life despite maximal therapy; surgery futile life despite maximal therapy; surgery futile (hopelessly wounded).(hopelessly wounded). These folks are given palliative careThese folks are given palliative care
Disaster TriageDisaster Triage
Whew… Whew… We can’t follow the military guidelines in the We can’t follow the military guidelines in the
civilian world.civilian world. Political suicidePolitical suicide May be career suicide – Katrina, Mercy Medical May be career suicide – Katrina, Mercy Medical
CenterCenter Expectant patients are a foreign concept to the Expectant patients are a foreign concept to the
medical provider… and often unpalatable to the medical provider… and often unpalatable to the community at large. community at large.
Most of the Minimal category patients are NOT Most of the Minimal category patients are NOT going to go back to the war/disaster. going to go back to the war/disaster.
Civilian Disaster CareCivilian Disaster Care
There isn’t any “Universal” Triage System. There isn’t any “Universal” Triage System.
Four big categories are common… and a Four big categories are common… and a possible 5possible 5thth.. You need to do something NOW.You need to do something NOW. REDRED You need to do something right soon.You need to do something right soon. YellowYellow It’s not a bit cool in the hot place…It’s not a bit cool in the hot place…GreenGreen We need for them to wait…We need for them to wait…BlackBlack Maybe….Maybe….BlueBlue
Civilian Disaster CareCivilian Disaster Care
While the principles of triage are the same While the principles of triage are the same throughout different levels of care… throughout different levels of care… Application of triage categories must be Application of triage categories must be flexible depending on the type of disaster, flexible depending on the type of disaster, availability of resources, transportation availability of resources, transportation problems, and a myriad of other factors.problems, and a myriad of other factors.
Triage is Dynamic! - Expect Triage is Dynamic! - Expect Change!Change!Semper Gumby! (Always flexible)Semper Gumby! (Always flexible)
UndertriageUndertriage
Undertriage is underestimating the severity Undertriage is underestimating the severity of an illness or injury. of an illness or injury. An example of this would be categorizing a An example of this would be categorizing a
Priority 1 (Immediate) patient as a Priority 2 Priority 1 (Immediate) patient as a Priority 2 (Delayed) or Priority 3 (Minimal). (Delayed) or Priority 3 (Minimal).
We want to keep undertriage to about 5% if We want to keep undertriage to about 5% if possible.possible. Undertriaged patients often have a worse Undertriaged patients often have a worse
outcome because they had delay of care.outcome because they had delay of care.
OvertriageOvertriage
Overtriage is overestimating the level to Overtriage is overestimating the level to which an individual has experienced an which an individual has experienced an illness or injury. illness or injury. An example of this would be categorizing a An example of this would be categorizing a
Priority 3 (Minimal) patient as a Priority 2 Priority 3 (Minimal) patient as a Priority 2 (Delayed) or Priority 1 (Immediate). (Delayed) or Priority 1 (Immediate).
Most acronym systems expect 50% Most acronym systems expect 50% overtriage in the fieldovertriage in the field Overtriage diminishes as you get closer to Overtriage diminishes as you get closer to
definitive care/diagnosis.definitive care/diagnosis.
OvertriageOvertriage
Overtriage means that you are sending easy Overtriage means that you are sending easy problems to the difficult hospitals… which problems to the difficult hospitals… which means that they may not have the means that they may not have the ability/resources to manage the difficult ability/resources to manage the difficult patientspatients Overtriage may be less likely when performed Overtriage may be less likely when performed
by hospital medical teams. by hospital medical teams.
Overtriage appears to be more common as Overtriage appears to be more common as you use inexperienced people in triage.you use inexperienced people in triage.
How does this affect How does this affect Me?Me?
While the disaster is ongoing…While the disaster is ongoing… The 90+ year old patient may (likely WILL The 90+ year old patient may (likely WILL
NOT) be EMS highest priority patient.NOT) be EMS highest priority patient. The Long Term Care Facility surely won’t be The Long Term Care Facility surely won’t be
the highest priority UNLESS you are part of the highest priority UNLESS you are part of the disaster.the disaster. Not having power… is inconvenient…Not having power… is inconvenient… Not having heat… is inconvenient…Not having heat… is inconvenient… Not having water… is inconvenient…Not having water… is inconvenient… None of these are really an emergency problem.None of these are really an emergency problem.
Ethics in triage…Ethics in triage…
EthicsEthics
The ethical principles pertinent triage are:The ethical principles pertinent triage are: FidelityFidelity VeracityVeracity AutonomyAutonomy JusticeJustice Beneficence Beneficence
Only two of these areas are a little grey for Only two of these areas are a little grey for Triage.Triage.
FidelityFidelity
Fidelity is the establishment of trust Fidelity is the establishment of trust between the medical provider and the between the medical provider and the patient.patient. Fidelity should not be broken by triage… Fidelity should not be broken by triage…
if the individual patient understands that if the individual patient understands that the medical provider has delayed care for the medical provider has delayed care for the purpose of caring both for sicker the purpose of caring both for sicker patients and for the group as a whole.patients and for the group as a whole.
VeracityVeracity
Veracity means the medical provider will Veracity means the medical provider will tell them the truth.tell them the truth. Without veracity, there can be no fidelity.Without veracity, there can be no fidelity. Veracity does not mean that all dying Veracity does not mean that all dying
patients need to be told that they are patients need to be told that they are going to die. going to die.
Veracity does mean that hard questions Veracity does mean that hard questions require difficult but completely true require difficult but completely true answers at all times. answers at all times.
AutonomyAutonomy
Autonomy is a number of different concepts Autonomy is a number of different concepts including free choice, accepting responsibility including free choice, accepting responsibility for one’s own choices, and respect of for one’s own choices, and respect of thoughts, will and actions of others.thoughts, will and actions of others. UnfortunatelyUnfortunately, respect for individual , respect for individual
autonomy cannot always be honored… such autonomy cannot always be honored… such as when a single patient places their needs as when a single patient places their needs above other more seriously ill patientsabove other more seriously ill patients
Respect of autonomy is relative to the Respect of autonomy is relative to the situation.situation.
JusticeJustice
Justice is fairness… Triage must be Justice is fairness… Triage must be equitable. equitable. Equitable triage does not mean equal Equitable triage does not mean equal
treatment, but rather that equal treatment, but rather that equal conditions will be treated equivalently conditions will be treated equivalently despite race, color, creed, or religion. despite race, color, creed, or religion.
Example is the Geneva Convention regarding Example is the Geneva Convention regarding wounded prisoners.wounded prisoners.
BeneficenceBeneficence
Beneficence is the requirement of benefit Beneficence is the requirement of benefit for the patient. for the patient. In triage, clearly, the benefit is for society In triage, clearly, the benefit is for society
as a whole, rather than simply for the as a whole, rather than simply for the potential good of a single human being. potential good of a single human being.
This means that when care is rationed by This means that when care is rationed by triage, the medical provider is violating triage, the medical provider is violating the principle of beneficence for the single the principle of beneficence for the single patient to ensure it for others or the patient to ensure it for others or the group as a whole.group as a whole.
Daily EmergenciesDo the best for each individual.
Disaster SettingsDo the greatest good for the greatest number. Maximize
survival.
Beneficence
How does that apply to How does that apply to me?me?
Hmmm…Hmmm… If I’ve got to decide the fate of folk based on If I’ve got to decide the fate of folk based on
the information available…the information available… Where does the multiple co-morbidity Where does the multiple co-morbidity
potentially septic patient fit in?potentially septic patient fit in? Where should I put my available resources?Where should I put my available resources?
Return to Topic…Return to Topic…
Patient MovementPatient Movement
Management of patient movement from the scene to the Management of patient movement from the scene to the receiving Hospitals requires that YOU know :receiving Hospitals requires that YOU know : Who is able to accept patients, Who is able to accept patients, How many they are able to acceptHow many they are able to accept What kind of casualties they can handle. What kind of casualties they can handle.
If you send a patient with brain injuries to a hospital If you send a patient with brain injuries to a hospital without a neurosurgeon, you can easily cause delay that without a neurosurgeon, you can easily cause delay that kills the patient. kills the patient.
I can give multiple other examples, but generally you I can give multiple other examples, but generally you need to send the patient to a place where best care can need to send the patient to a place where best care can be given (priority), adequate care can be given be given (priority), adequate care can be given (acceptable, but not optimum), or where stabilization can (acceptable, but not optimum), or where stabilization can occur (generally suboptimal).occur (generally suboptimal).
This is a complex dance…
Far-FirstFar-First
Coordinating patient destination is one of Coordinating patient destination is one of the more complicated functions. the more complicated functions. There are a lot of variations here...There are a lot of variations here... I like the Israeli FAR-FIRST technique... I like the Israeli FAR-FIRST technique...
Send your serious people out of the area if you Send your serious people out of the area if you can.can.
You will still have Urgent and Minors in the local You will still have Urgent and Minors in the local areaarea
Don’t relocate the disaster to the nearest Don’t relocate the disaster to the nearest hospital!hospital!
MERCMERC
In many areas, you won’t have much choice of In many areas, you won’t have much choice of hospitals… In many cities there are only one or two hospitals… In many cities there are only one or two hospitals… this limits your choices considerably. hospitals… this limits your choices considerably.
In areas where there are more than one hospital, In areas where there are more than one hospital, it’s imperative that we not relocate the disaster to it’s imperative that we not relocate the disaster to the closest hospital. the closest hospital. In other cities, such as Tulsa, there may be 5 or more In other cities, such as Tulsa, there may be 5 or more
hospitals and a central coordinating system that will hospitals and a central coordinating system that will help you manage transportation decisions. help you manage transportation decisions. A system for the distribution of patients to area A system for the distribution of patients to area
hospitals must be established in advanced and utilized hospitals must be established in advanced and utilized properly by emergency personnel. properly by emergency personnel.
Ours is the MERC Ours is the MERC
Where can I get education about Where can I get education about disasters and emergency disasters and emergency management functions?management functions?
OU Courses OU Courses http://www.oudem.org/
Core Disaster Life Support Core Disaster Life Support coursecourse
Recommended for all Recommended for all nursing home staffnursing home staff 4 hour course4 hour course May be done onlineMay be done online
Basic Disaster Life Support Basic Disaster Life Support coursecourse Recommended for all Recommended for all
patient care professionalspatient care professionals RN, LPN, pharmacy, RN, LPN, pharmacy,
EMS, PA, Physicians…EMS, PA, Physicians… 8 hour course OU offers 12 8 hour course OU offers 12
times per year.times per year. AMA CME offered for AMA CME offered for
professionalsprofessionals
More TrainingMore Training
Advanced Disaster Life Support CourseAdvanced Disaster Life Support Course 16 hour (2 day course) for medical providers16 hour (2 day course) for medical providers Hands on experienceHands on experience
SimulationsSimulations Disaster drillsDisaster drills Protective gear introductionProtective gear introduction
16 hours CME – AMA.16 hours CME – AMA. OU – 4 times per year.OU – 4 times per year.
FEMA CoursesFEMA Courses
FEMA CoursesFEMA Courses Available at:Available at:
Both online and in-house courses are available.Both online and in-house courses are available. Incident Command Structure ICS 100 (basic), 200 Incident Command Structure ICS 100 (basic), 200
(more basic)(more basic) Hospital incident command structure courses Hospital incident command structure courses
available.available. Exercise planning courses (3 day) HSEEP Exercise planning courses (3 day) HSEEP
available .available .
http://training.fema.gov/
Oklahoma Department of Oklahoma Department of Emergency ManagementEmergency Management
Available at: Available at: http://www.ok.gov/OEM/ Training opportunitiesTraining opportunities
Help with mitigation, Help with mitigation, Warnings about weather, hazards, and even Warnings about weather, hazards, and even
road conditions.road conditions. Daily brief availableDaily brief available
American Red CrossAmerican Red Cross
Chapters in most large cities in OklahomaChapters in most large cities in Oklahoma
Not just aid after the emergency, but teaching Not just aid after the emergency, but teaching BEFORE the emergency.BEFORE the emergency. ‘‘The Red Cross helps people prevent, prepare for The Red Cross helps people prevent, prepare for
and respond to emergencies.’ and respond to emergencies.’ First AidFirst Aid CERT - (Tulsa’s CERT authority is the Tulsa chapter CERT - (Tulsa’s CERT authority is the Tulsa chapter
of ARC).of ARC).
(OKC’s CERT authority is (OKC’s CERT authority is Oklahoma City Emergency Oklahoma City Emergency Management)Management)
http://www.citizencorps.gov/cert/index.shtmhttp://www.citizencorps.gov/cert/index.shtm
Really… really involved in thinking Really… really involved in thinking about disasters?about disasters?
OSU offers a Masters and a PhD in Emergency OSU offers a Masters and a PhD in Emergency Management.Management. OSU offers a fellowship in Disaster and EMS for OSU offers a fellowship in Disaster and EMS for
DO’sDO’s European educational consortium offers the European educational consortium offers the
European Master of Disaster MedicineEuropean Master of Disaster Medicine OU offers a MPH with disaster preparedness OU offers a MPH with disaster preparedness
specialtyspecialty OU offers a Disaster Medicine rotation for OU offers a Disaster Medicine rotation for
Medical, Nursing, Pharmacy, and PA students.Medical, Nursing, Pharmacy, and PA students.
Oklahoma Disaster Oklahoma Disaster InstituteInstitute
Our very own Oklahoma Disaster Institute Our very own Oklahoma Disaster Institute offers a yearly symposium on one aspect of offers a yearly symposium on one aspect of disaster medicine each year.disaster medicine each year. This year’s symposium will be on Austere This year’s symposium will be on Austere
Medicine… Medicine… “what to do when the lights go out.”“what to do when the lights go out.”
OU is planning a 15 credit Certificate in OU is planning a 15 credit Certificate in Disaster MedicineDisaster Medicine
SummarySummary
I’ve talked aboutI’ve talked about DefinitionsDefinitions Healthcare Facility Healthcare Facility
involvementinvolvement Fatality phases in a disasterFatality phases in a disaster Ethics of triageEthics of triage Triage categoriesTriage categories Educational opportunitiesEducational opportunities
GOALS OF MCI GOALS OF MCI MANAGEMENTMANAGEMENT
Greatest good for greatest numberGreatest good for greatest number
Scarce resource managementScarce resource management
DON’T RELOCATE THE DISASTER!DON’T RELOCATE THE DISASTER!
Questions?Questions?
Final Thoughts…. Final Thoughts…. The feds are at least 24 hours away… The feds are at least 24 hours away…
and probably 72 hours.and probably 72 hours.
YOYO 96!YOYO 96!
Plan to be self-sufficient Plan to be self-sufficient
IF YOU DON’T PLAN FOR FAILURE, IF YOU DON’T PLAN FOR FAILURE, YOU HAVE FAILED TO PLAN YOU HAVE FAILED TO PLAN
