Preparedness & Disaster Mgmt

/in /by

Today’s Agenda (date)

Chapter 18

Managing an Infectious Disease
Disaster

Principles of Outbreak Management

  • ACTIVATE AND FORM INTERNAL PLANNING COMMITTEES
  • FORM PARTNERSHIPS AND DEVELOP GOAL-DRIVEN LOCAL PROTOCOLS
  • INTERNAL SURVEILLANCE SYSTEMS AND EARLY RECOGNITION OF THREATS
  • ENHANCE THE INSTITUTION’S COMMUNICATION CAPABILITIES
  • STAFFING CONCERNS
  • CONCERNS FOR THE “EVERYDAY PATIENT”

Specific Planning for Hospitals in Containment,
Control, and Treatment

  • UNIVERSAL PRECAUTIONS
  • RESPIRATORY AND COUGH ETIQUETTE
  • ISOLATION
  • QUARANTINE
  • COHORTING AFFLICTED PATIENTS
  • PROVIDING ADDITIONAL AND DEDICATED EQUIPMENT
  • SURGE CAPACITY
  • LIMITING VISITORS
  • SECURITY ISSUES

Chapter 19

Vulnerable Populations and
Public Health Disaster
Preparedness

Defining and Understanding Vulnerable
Populations

  • People with acute medical conditions, chronic diseases, and the medically fragile/frail
  • People with disabilities
  • Age specific
  • Low income
  • Immigrant (both documented and undocumented)
  • Non-English speaking/English proficiency
  • Homeless

DEFINING DISABILITY

  • Disability, because it comes with specific legal definitions, rules, and guidance materials, should be evaluated as a unique entity.
  • Physical
  • Sensory
  • Cognitive
  • Co-existing
  • Age/disability overlap
  • 14 million+ >65y

DEFINING DISABILITY

  • Medically vulnerable
  • People who are homebound and not receiving services
  • People receiving home-based care services
  • People in care facilities
  • Those dependent on caretakers or life-sustaining equipment
  • Those with mental illness
  • Homeless populations
  • overlap with mental illness and/or health-related illness
  • Alcohol/substance abuse

LEGAL STATUS, VULNERABLE POPULATIONS, AND DISASTERS

  • The following list identifies legislation and the population segment it protects:
  • Americans with Disabilities Act (ADA), 1990 and 2008
  • Post-Katrina Emergency Management Reform Act of 2006
  • Older Americans Act of 1965 (OAA)
  • Health Insurance Portability and Accountability Act (HIPAA)
  • U.S. Health and Human Services (HHS) and the Pandemic and All-Hazards Preparedness Act, 2006

PKEMRA (2006) – established:

Disability coordinator

Transportation assistance for relocation/return

Family reunification

Recovery case management

PAHPA (2013)- established:

Hospital Preparedness Program grant, Public Health Emergency Preparedness grant, Emergency Use Authorizations of pharmaceuticals

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IMPACT OF DISASTER ON VULNERABLE POPULATIONS

  • Transfer trauma and other unique issues
  • Disconnection from services/providers
  • Need for medication, equipment, and supplies, etc.
  • The medically fragile and those with disabilities are often reliant upon specialty services and support
  • These are often the first to be diverted for disaster surge

Healthcare Facility Considerations

  • Hospitals
  • Residential healthcare facilities (i.e., nursing homes)
  • Other care facilities, such as dialysis centers, methadone clinics, and day treatment centers

Preparedness for Vulnerable Populations

  • Planning with, not for vulnerable populations
  • Vulnerable population advisory panels and working groups
  • Assumptions and impact on the vulnerable community
  • Community Preparedness and Disaster Education
  • Developing Plans Based on the Four Phases: Mitigation, Planning, Response, and Recovery
  • Working with the Community
  • Collaborate with other agencies
  • Volunteer support

Chapter 20

Altered Standards of Care in Disasters and Public Health Emergencies

Standard of Care

  • Standards that dictate the manner in which health care is to be provided by a prudent clinician
  • Basis lies in factors including:
  • local, state, and federal case law
  • local standards
  • Protocol
  • statutory requirements
  • consideration of how another individual of equal qualifications would act

Altered Standards of Care

  • For healthcare delivery systems to remain viable and effective, resource changes must occur with respect to delivery
  • Hence, the term altered standard of care
  • Lack of a standardized definition for the term
  • Modification in the level of health care provided under austere versus routine conditions
  • Should not imply a subjective restriction of service or rationing of resources related to clinical care

Clinical Alterations in Standards of Care

  • Limitations on certain procedures (i.e., elective surgery, outpatient, etc.)
  • Modifications in formularies
  • Less care by attending-level physicians
  • Triage of scarce resources (ventilators)
  • Expanded/modified scope of practice

Operational Standards of Care

  • Higher patient to staff ratios
  • Extended shifts
  • Early discharges
  • Canceling outpatient and elective procedures
  • Ambulance diversion and/or bypass
  • Changes in triage or admission criteria
  • Rationing of medical equipment, gasses and other supplies including pharmaceuticals

Medical, Legal and Ethical Considerations

  • Federal, State and Local Laws regulations and statutes.
  • Issues with modified and/or expanded scope of practice
  • Ethical considerations

Chapter 21

Mass Fatality Management

Definition of a Mass Fatality Incident

  • Any event having the potential to produce 10 or more fatalities
  • Any situation in which there are more human bodies or human remains to be recovered and examined than can be routinely handled by available resources
  • Any situation in which remains are contaminated
  • An incident or other special circumstances requiring a multiagency response in support of mortuary operations
  • An incident involving a protracted or complex remains recovery operation

Jurisdiction Authority and Roles

  • Fatality management falls within the jurisdiction of the local authority
  • Medical examiner or coroner and department of health will direct and manage operations with assistance from supporting agencies
  • local agencies, such as police and fire departments
  • state and federal agencies, depending on the magnitude of the incident
  • https://www.youtube.com/watch?v=j7F77MmV69w

Key Planning Issues

  • Health and safety plans including decontamination and personal protective equipment
  • Command and control (ICS)
  • Personnel notification systems
  • Staffing and operational periods

Functional Areas of Mass Fatality Management

  • CENTRALIZED MISSING PERSONS REPORTING
  • SCENE OPERATIONS
  • Contaminated Remains
  • Fragmentation
  • Remains Transport
  • DISASTER MORTUARY OPERATIONS
  • FAMILY ASSISTANCE CENTER OPERATIONS
  • LONG-TERM STORAGE
  • FINAL DISPOSITION

Chapter 22

Research in Emergency and Disaster Medicine

Health Care: Impact of Disasters and Importance of Disaster Research

  • Most disasters, or at least the casualties they bring, are preventable.
  • Credible data about the disasters should be acquired before, during & after, so logical conclusions and feasible recommendations can be made

Epidemiological Profile of Disasters

  • There are major differences in the epidemiological profile (levels and types of mortality and morbidity) of different disasters
  • Hospital preparedness will differ among geographic regions, because most disasters are particular to specific regions
  • Injuries are the most immediate outcome of disasters
  • long-term outcomes, such as contagious decease and PTSD could be present
  • Disasters could also aggravate existing chronic conditions, such as cardiovascular problems, or cause miscarriages and premature births in pregnant women

Issues of Interest in Disaster Research

  • There are a number of issues, generally common to disaster research, differentiating this field of research from others
  • The main reason is the low level of control the researcher has, leading to compromises in accepted method of data collection and statistical analysis

Issues of Interest in Disaster Research

  • RESEARCH METHODS
  • TIME FRAME
  • AVAILABILITY OF DATA
  • REGIONAL PECULIARITIES

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PKEMRA (2006) – established:

Disability coordinator

Transportation assistance for relocation/return

Family reunification

Recovery case management

PAHPA (2013)- established:

Hospital Preparedness Program grant, Public Health Emergency Preparedness grant, Emergency Use Authorizations of pharmaceuticals

*

 
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