Preparing Our Communities

Welcome!

V 2.9 04/07

BDLS is a registered trademark of the American Medical Association

Faculty Disclosure

For Continuing Medical Education (CME) purposes as required by

the American Medical Association (AMA) and other continuing
education credit authorizing organizations:
In order to assure the highest quality of CME programming, the AMA
requires that faculty disclose any information relating to a conflict of
interest or potential conflict of interest prior to the start of an
educational activity.
The teaching faculty for the BDLS course offered today have no
relationships / affiliations relating to a possible conflict of interest to
disclose. Nor will there be any discussion of off label usage during
this course.

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Natural Disasters
Chapter 2

V 2.9 04/07

BDLS is a registered trademark of the American Medical Association

Faculty Disclosure
For Continuing Medical Education (CME) purposes as
required by the American Medical Association (AMA)
and other continuing education credit authorizing
organizations:
In order to assure the highest quality of CME programming,
the AMA requires that faculty disclose any information relating
to a conflict of interest or potential conflict of interest prior to
the start of an educational activity.
The teaching faculty for the BDLS course offered today have
no relationships / affiliations relating to a possible conflict of
interest to disclose. Nor will there be any discussion of off
label usage during this course.

V 2.9 04/07

Objectives
List three important reasons why natural
disasters preparedness is important
Describe the importance of an allhazards approach in natural disaster
management
List the eight components of the
DISASTER Paradigm including relevant
items of natural disasters
Discuss experiences from historic
natural disasters impacting healthcare
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Introduction
Natural Disasters:
Occur annually throughout the USA
Common cause of disaster related
deaths and injures in the USA
Costs commonly in the billions of dollars
per significant event
Reinforce the importance of the allhazards approach to disaster events

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Introduction
Preparedness for natural disasters
requires planning for many different
possibilities

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Natural Disasters
Natural disasters reinforce the need for
standardized management approach
Large number of possible events
Wide variety of potential hazards
Multidisciplinary agencies and
organizations
Vast numbers of healthcare personnel
Large and often multiple scenes
The DISASTER Paradigm is the outline for
this standardized approach
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DISASTER Paradigm

Detection
Incident Management
Security & Safety
Assess Hazards
Support
Triage & Treatment
Evacuation
Recovery

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D-I-S-A-S-T-E-R Paradigm
Detection
Mitigation is possible if early detection and an
effective system response are in place
This is a key concept

Many natural disasters lend to early threat

identification and scientific tracking
National Weather Service for example

Effective warning methods are important

Local sirens and media releases are examples
Warning systems are vulnerable to hazards
Electrical power outage limiting media release access

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D-I-S-A-S-T-E-R Paradigm
Detection
The value of early
detection can clearly
be seen in tornados.
In the case of
tornados, advanced
warning and shelter
access are the two
most important
factors in decreasing
mortality.

tornadochaser.net

Tornado Alley
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D-I-S-A-S-T-E-R Paradigm
Incident Management
Incident management is critical to
natural disasters
Local, State, and Federal emergency
management integrated into a scalable
response

Photo source: Raymond E. Swienton, MD

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D-I-S-A-S-T-E-R Paradigm
Incident Management
Finance:
Local, state and federal agreements and
financial responsibilities defined
Establishing pre-event purchase orders
and service agreements

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D-I-S-A-S-T-E-R Paradigm
Incident Management
Planning:
Potential disruption of local
infrastructure is a key in planning

Photo source: Raymond E. Swienton, MD

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Photo source: Raymond E. Swienton, MD

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D-I-S-A-S-T-E-R Paradigm
Incident Management
Operations:
Communication is often disrupted
Vital healthcare facilities may be
damaged or nonfunctional
Hurricane Katrina, 2005
Northridge California Earthquake, 1994

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D-I-S-A-S-T-E-R Paradigm
Incident Management
Logistics:
Effective transportation and delivery of
personnel, equipment, vehicles, etc.
Many factors impact logistics
Accurate assessment of scene size
Ingress and egress routes
Ongoing environmental threats

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D-I-S-A-S-T-E-R Paradigm
Incident Management
Incident management
may involve the highest
levels of governmental
leadership in our nation
and states
Photo source: Raymond E. Swienton, MD

Incident management
involves effective
communication to the
general population
through the media
Photo source: Raymond E. Swienton, MD

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D-I-S-A-S-T-E-R Paradigm
Security & Safety
Natural disasters may contain unique
threats to scene security and safety
Evolving threats may be present
Flooding after hurricanes
Contaminated water sources
Electrical power outages

Conditions may be favorable to repeat

events in the early phases of response

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D-I-S-A-S-T-E-R Paradigm
Security & Safety
Threat level for a repeat
or second-pass event
must be considered
Earthquake
Significant aftershocks

Tornados
Additional tornados form

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D-I-S-A-S-T-E-R Paradigm
Security & Safety
Is it Secure & Safe to enter?
The scene of any natural disaster has
inherent dangers and risks
Assessment of the duty to perform
versus detectable presence of life
threatening conditions
Security and safety status may change
Large and poorly defined scene boundaries
Ingress and egress routes altered
Environmental conditions, time, temperature
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D-I-S-A-S-T-E-R Paradigm
Security & Safety
Security and safety are the responsibility
of each individual emergency responder
and healthcare provider
Confirm that it is secure and safe to
enter the environment or facility
Utilize appropriate personal protective
equipment
Awareness of dynamic conditions that
would require immediate exit
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D-I-S-A-S-T-E-R Paradigm
Security & Safety
Safety status change: Rising water
Flash floods are a serious threat and a
leading cause of mortality from natural
disasters in the USA
Rising water impedes vehicle control

6 inches of water limits car steering

2 feet of water can wash away most cars
Water flowing 6-12 miles per hour

Underwater debris may trap a car

Road surface may be disrupted under
rising water
Do not enter rising water !
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D-I-S-A-S-T-E-R Paradigm
Security & Safety
Hospitals and surge capacity facilities
have many security and safety challenges:
Volume of people seeking access
Patients, family, media, volunteers, etc.

Staff notification and identification

Ingress and egress routes established
Media coverage of events
Accuracy of information received

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D-I-S-A-S-T-E-R Paradigm
Assess Hazards
Natural disasters are
associated with many
hazards

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Structural Collapse
Fires
Explosions
Natural Gas Lines
Power Lines
Debris
Insects and animals
Hazardous Material
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D-I-S-A-S-T-E-R Paradigm
Assess Hazards

First priority protect yourself and your team

Casualties on scene at risk of new injuries
Injuries commonly occur in the early response
to a natural disaster

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Lacerations
Blunt trauma
Electrical shocks
Contamination
Animal Bites

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D-I-S-A-S-T-E-R Paradigm
Assess Hazards
Must consider evolving hazards after a natural
disaster
May not be immediately obvious during initial response

Hazardous materials
Chemical storage leakage or facility damage
Accumulation of toxic gases in low-lying areas

Contaminated water and food supply

Environmental stress (heat, cold, wet, etc.)
Human and animal waste management

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D-I-S-A-S-T-E-R Paradigm
Assess Hazards
Hospitals and surge capacity facilities must
continually assess hazards including:

Structural integrity of the facility

Electrical power supply
Medication contamination
Equipment failure
Water supply
Biological and medical waste management
Blood and bodily fluid contamination risks

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D-I-S-A-S-T-E-R Paradigm
Support
Natural disaster scenes impose significant
local logistic challenges including:

Transportation access
Personnel notification
Storage facility access
Accurate estimate of needs
Delay in ordering or shipment delivery

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D-I-S-A-S-T-E-R Paradigm
Support
Effective use of local resources is key
Personnel
Redundancy in notification alert methods
Ingress and egress routes established
Volunteers role defined

Transportation
Pre-established contractual agreements outlining
access to vehicles, fuel, and drivers
Staging locations well defined

Supplies
Use of historic events and after action reports to
validate selection of items and quantities

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D-I-S-A-S-T-E-R Paradigm
Support
Casualty survival outcomes are dependant
upon the local preparedness and response
Earthquakes are one of the most devastating
natural disasters
Golden 24 hours for Earthquakes
90% entrapped survivors extricated < 24 hours
After 24 hours mortality rates dramatic increase

Urban Search and Rescue (USAR) teams

Construction crews and heavy equipment
operators may be required to improve survival

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D-I-S-A-S-T-E-R Paradigm
Support
Local Preparedness !
How long before help arrives?
Local preparedness must include adequate
support for several days
Minimum of 3 days for life sustaining and
critical services delivery
A delay of up to 7 days for delivery of nonlocal resources could occur after significant
natural disasters

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D-I-S-A-S-T-E-R Paradigm
Support
Pre-existing medical conditions are a critical
support consideration for local preparedness
How many insulin dependant diabetic or oxygen requiring
pulmonary disease patients are in your local area?
Dialysis patients?

Disruption in pharmaceutical supplies to this

patient population is a factor in the next surge
of casualties
If the local pharmacies were not operational for 7
days, how many chronically ill patients would
deteriorate to a level requiring hospital access?

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D-I-S-A-S-T-E-R Paradigm
Support
Surge Capacity Facilities
Serves many different
patient and casualty
populations
Special needs patients
Reestablishing local
healthcare services
Unload demands on
hospitals & emergency
departments

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Photo source: Raymond E. Swienton, MD

Photo source: Raymond E. Swienton, MD

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D-I-S-A-S-T-E-R Paradigm
Support
Surge Capacity Facilities
Facilities of Opportunities
When the need exceeds
planned surge capacity
facilities resources
Photo source: Raymond E. Swienton, MD

Photo source: Jane Wigginton, MD

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Photo source: Raymond E. Swienton, MD

Photo source: Jane Wigginton, MD

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D-I-S-A-S-T-E-R Paradigm
Support
Hospitals and surge capacity facilities have
many unique support needs: Electrical Power
Electrical power back-up generators

Are they functional with adequate fuel reserves?

Are they placed in vulnerable positions?
Will they support the volume and types of patients?

Complete failure of electrical equipment

Manual resuscitation equipment sufficient quantity
Hands-free flashlights for key personnel
Evacuation equipment and plans operational

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D-I-S-A-S-T-E-R Paradigm
Triage and Treatment
A standardized triage approach, such as
MASS Triage, will likely improve casualty
management and outcomes
During large scale natural disasters multiple,
simultaneous triage sites will be operational
Many different EMS and healthcare facilities
will be utilizing triage information
Standardized triage approach is important to
healthcare resource utilization
Doing the greatest good for the greatest
number of survivable casualties
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D-I-S-A-S-T-E-R Paradigm
Triage and Treatment
Triage anticipate large numbers of
minimally injured casualties seeking
healthcare in the immediate area

Photo source: Paul E. Pepe, MD

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Photo source: Raymond E. Swienton, MD

Photo source: Raymond E. Swienton, MD

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D-I-S-A-S-T-E-R Paradigm
Triage and Treatment
Anticipating the healthcare needs of the
casualties and special patient populations is
challenging in surge capacity facilities

Sufficient general bed capacity

Resuscitation capabilities
Special clinical services, such as dialysis

Photo source: Jane Wigginton, MD

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Photo source: Raymond E. Swienton,

MD

Photo source: Raymond E. Swienton, MD

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D-I-S-A-S-T-E-R Paradigm
Triage and Treatment
Triage is a dynamic
process that may be
required for days in large
scale natural disasters
The reality of triage is
someone has to go last
Expectant patients
receive care, comfort
and appropriate
utilization of medical
resources

Photo source: Kelly Klein, MD

Photo source: Raymond E. Swienton, MD

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D-I-S-A-S-T-E-R Paradigm
Evacuation
Evacuation planning and operations in
natural disasters must be adaptable to
unexpected conditions and situations
Darkness, alternative transport vehicles

Photo source: Raymond E. Swienton, MD

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Photo source: Raymond E. Swienton, MD

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D-I-S-A-S-T-E-R Paradigm
Evacuation
Evacuation planning and operations in natural disasters
must be adaptable to unexpected conditions and
situations
Volunteers just-in-time trained
Modified patient transport methods

Photo source: Raymond E. Swienton, MD

V 2.9 04/07

Photo source: Raymond E. Swienton, MD

Photo source: Raymond E. Swienton, MD

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D-I-S-A-S-T-E-R Paradigm
Evacuation
Evacuation planning and operations in
natural disasters must be adaptable to
unexpected conditions and situations
Animal handling and transportation

Photo source: Raymond E. Swienton, MD

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Photo source: Raymond E. Swienton, MD

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D-I-S-A-S-T-E-R Paradigm
Evacuation
Evacuation must consider:
Scene access to casualties and preparation
for transportation
Transportation resource utilization

Ground transportation
Local air transportation (helicopter)
Distance air transportation (fixed wing)

Photo source: Raymond E. Swienton, MD

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Photo source: Kelly Klein, MD

Photo source: Kelly Klein, MD

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D-I-S-A-S-T-E-R Paradigm
Evacuation
Receiving healthcare facility readiness:
Effective communication is the key
How many patients are being transported?
Accurate and timely triage assessment?
When will they arrive?
Medical records available?
Identification of all patients?
Receiving healthcare facility may be several
states away.
Hurricane Katrina, 2005

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D-I-S-A-S-T-E-R Paradigm
Recovery
Reestablishing local healthcare access is a
top priority in early recovery efforts
Non-casualty patient surge expected
Cancellation of routine appointments and
specialty clinics (dialysis, etc.)
Non-casualty patients intentionally delayed
accessing emergency department care
Medication and medical supply needs

Utilization of state or federal resources, such

as Disaster Medical Assistance Teams
(DMAT), beneficial in early recovery period

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D-I-S-A-S-T-E-R Paradigm
Recovery
Documentation and data capture during the
disaster event is important to recovery
Sustaining available resources and funding
Media has a valuable role in recovery

Video and photographic assessment of damages

Surveillance of recovery efforts
Coordinated awareness and public education
impacting recovery of the community

Cost calculations and needs assessments

Insurance claims
Federal and State financial assistance

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D-I-S-A-S-T-E-R Paradigm
Recovery
Recovery period from large-scale natural
disasters is measured over years
Healthcare services are only one of several
important recovery efforts ongoing
Returning the impacted area to a functional
status as a community is important
Local, state and federal resources
seamlessly integrated during recovery

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Summary
Now you can:
List three important reasons why natural
disasters preparedness is important
Describe the importance of an all-hazards
approach in natural disaster management
List the eight components of the DISASTER
Paradigm including relevant items of natural
disasters
Discuss experiences from historic natural
disasters impacting healthcare
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Natural Disasters
Thank You !
Any Questions ?

V 2.9 04/07

BDLS is a registered trademark of the American Medical Association

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