Cost – lose flexibility & control over logistics & resupply stocks
Principles for Improved Disaster Supply Chain MGMT.
Disasters = sudden and irregular demands for services and supplies
Facilities may try to optimize ability to care for patients and increase surge capacity by:
maximizing stores of critical resources using preexisting or rapidly determined estimates need
Easy to underestimate need
Resource use is variable on a good day
“Every hospital for itself” strategy will fail
Suppliers tend to contract with many hospitals
Leads to hoarding & crippling own system
Need systematic command and control, & centralized authority for critical resource allocation and reallocation decisions
Risk Communication and Media Relations
Risk Communication Lessons from Katrina
Addressing the needs of vulnerable populations
Unclear lines of authority
Inadequate media strategy
Failure to refute rumors
Risk Communication Theories
Four prevailing theories :
risk perception theory
mental noise model
trust determination theory
theory of negative dominance
Theory 1: Risk Perception
Cause identifiable victims
Affect small children and pregnant women
Difficult to Understand
Originate from untrustworthy sources
Cause irreversible and hidden damage
Ethical and Moral nature
16 “outrage factors” influence public’s perception of risk.
Theory 2: Mental Noise
When people’s values are threatened, their emotions and thought processes are affected.
It addresses how people process information during a crisis.
When people are alarmed, their ability to assimilate and use information is severely impaired.
Theory 3: Trust Determination
Messengers must become trusted sources & keep trust
Four factors have been shown empirically to determine the public’s trust for organizations:
Perceptions of caring and empathy
openness and honesty
competence and expertise
dedication and commitment
Theory 4: Negative Dominance
If must release a negative message, a min of 3 positives are needed to counteract it
Social Amplification of Risk and Vicarious Rehearsal
News spreads rapidly around the globe
Given this media exposure, those distant from the emergency’s epicenter experience anxiety (social amplification)
To cope with this anxiety, they mentally rehearse the courses of action recommended for disaster victims (vicarious rehearsal)
Serial Position Effect
Materials Development and Media Relations
Health literacy and Numeracy
Considerations in Media Relations
Conflict in Public Health and Media Perspectives
Elements of Newsworthiness
Developing Media Contacts
Identify and Train a PIO or Spokesperson
Correcting Media Errors
Writing News Releases
Preparing for a Press Conference
Reach out to reporters early
During a Press Conference
Moderate the conference
Keep it brief and on-time
After a Press Conference
Have staff on hand
Follow up with the media
Preparing for a Press Conference
Preparing for Interviews
What is the subject or topic of the interview
What are the reporters deadlines
Who will be conducting the interview
What is the interview format
Use bridging statements
Admit when you don’t know the answer
Remember body language
Phases of a Public Health Emergency
Phase 1: Pre-crisis phase
Develop a communications plan
Coordination with partners
Communications audiences, channels, materials, and protocols.
Exercise and evaluation strategies
Phase 2: Initial Phase
If your organization is involved, break the story before someone else does
shape the news coverage rather than playing catch up and correcting misinformation later
Public responds best when organizations are quick to announce a problem
Phase 3: Crisis Maintenance Phase
The media will want updates on the situation
They also may experience casualties and be short–staffed
Keep in mind that a report of no change is still worth sharing
If the crisis is lengthy, schedule daily briefings
Continue updating your organization’s Web site, hotline scripts, and FAQs
Phase 4: Recovery Phase
As the crisis winds down, media and public begin to examine who is to blame and how effective the crisis response was
Communication may also need to focus on addressing the media’s analysis of your organization’s response
Your communication plan should be updated with lessons learned
Security and Physical Infrastructure Protections
Major vulnerability is open access to the public
Emergency Operations Plan
Resources and Assets
Security and Safety
Patient Clinical and Support Activities
Security Structure within ICS
The security structure of HICS falls under the operations section chief.
The security branch director manages and coordinates the activities of the following unit leaders:
Access Control Unit
Crowd Control Unit
Traffic Control Unit
Law Enforcement Interface Unit
Hospital Infrastructure Security Measures
Issue Identity Badges
Issue Visitor Passes
Issue Vendor Badges and Passes
Security Staff Training
General Staff Training
Interaction with Law Enforcement
Hospital Decontamination and Worker Safety
Industrial accident vs. mass or intentional exposure
Increasing incidents of unknown substances brought into hospitals
Difficult to prepare for 1 vs. multiple contaminated victims
Basics of Hazardous Substances
A hazardous substance can be defined as any substance that is capable of causing harm to life, health, or property.
Toxic industrial chemicals
Toxic industrial materials
Weapons of mass destruction
Exposure versus contamination
Volatility versus persistency
Referral Patterns of Patients
Self-referred versus EMS initiated transports
Non-exposed “Worried Well”
Challenges of identifying sick versus not sick patients
Acute versus gradual onset
Common symptom clusters or “syndromes”
Building Capacity For Hospital Decontamination
Internal versus external subject matter experts
Trained and available workforce
Written and updated plans
Regular drills and exercises
Regulations and Guidelines
29 CFR 1910
Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances
Principal Emergency Response and Preparedness: Requirements and Guidance
Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers
Guidance on Preparing Workplaces for an Influenza Pandemic
Guidance Update on Protecting Employees from Avian Flu (Avian Influenza) Viruses
Health Care at the Crossroads: Strategies for Creating and Sustaining Communitywide Emergency Preparedness Systems.
Hospital Decon Planning Process
Develop written plan
Team member selection
Drills and Exercises
Pharmaceutical Systems Management in Disasters
Determining Pharmaceutical Needs
Specific factors influencing pharmaceutical needs include:
Type and phase of the disaster
Epidemiological patterns of diseases of the region
Conditions influencing or enhancing communicable diseases
Consider HazMat; different treatments may be needed if specific hazards, such as chemical manufacturers or nuclear plants are in the region.
Ideally, known antidotes, treatments, and protective agents should be stockpiled in advance.
Identification of Pharmaceutical Agents
Consider expiration & storage requirements
Plan for pharmacy to be supported by nontraditional pharmacy staff
The identification of medications in simple and easily understood ways
Proper packaging will help ensure that the labels remain on the items and undamaged
Identifying a medication and its usage is difficult & further compounded by untrained persons sorting and dispensing
Dispensing Pharmaceutical Agents
Difficulties and Challenges
Relocation of Pharmacy to a Temporary Site
Alternative Packaging and Labling
Hospital Staff Dispensing
Alterations in Standard Practice
Pharmaceutical agents may exceed the available supply
transient while awaiting resupply or long-term shortage
Requires planned monitoring
May need to alter dispensing practices, change formulary, or impose new restrictions on the usage
Role of the Laboratory in Emergency Preparedness
Public health laboratories, state and local, = first line of defense
provide diagnostic and surveillance testing
Laboratory Response Network (LRN)
Global network established by the Centers for Disease Control and Prevention (CDC) in 1999
in response to the Homeland Security Presidential Decision Directive 39.
To strengthen the preparedness of the U.S. to prevent and respond to threatened or actual domestic terrorist attacks, major disasters, and other public health emergencies
The other founding members of the LRN are the Federal Bureau of Investigation (FBI) and the Association of Public Health Laboratories (APHL).
Role of the Laboratory Response Network
Maintains an integrated network of state and local public health, federal, military, and international laboratories that can respond to bioterrorism and chemical terrorism as well as other public health emergencies.
Divisions of the LRN
biological terrorism (BT), chemical terrorism (CT), radiation terrorism (RT).
The main federal agency = CDC with the U.S. Army Medical Research Institute for Infectious Diseases (USAMRIID), and the Naval Medical Research Center (NMRC) as backup
Facilities located in Australia, Canada, and the United Kingdom serve as back-up laboratories abroad.
Hospital-based units, are considered “sentinel laboratories” and play a key role in the early detection of biological infectious agents.
These sentinel laboratories provide routine diagnostic services.
Principles of Disaster Triage
The most common categories that are utilized are based upon those U.S. military.
Casualties are divided into five categories:
Need immediate medical attention because of an obvious threat to life or limb.
unresponsive, an altered mental status, respiratory distress, uncontrolled hemorrhage, sucking chest wounds, unilateral absent breath sounds, or absent peripheral pulses.
In need of definitive medical care, but are unlikely to decompensate rapidly if care is delayed.
deep lacerations with controlled bleeding and good distal circulation, open fractures, abdominal injuries with stable vital signs, amputated fingers, or hemodynamically stable head injuries with an intact airway.
Minor injuries that require medical attention, but this care can be delayed for days, if necessary, without an adverse effect.
abrasions, contusions, and minor lacerations.
Little or no chance for survival despite maximum therapy.
95% total body surface area burns or multiple trauma with exposed brain matter.
In systems with only four triage categories, the expectant category is not used and these patients are triaged as either immediate or dead.
The final category is dead, which is used for those patients who are not breathing.
Because of resource limitations, no CPR in a MCE
Except a child: cardiac arrest most commonly = respiratory not cardiac.
However, whether the patient is a child or an adult, the responder will need to provide only limited interventions before considering the patient to be dead;
a full attempt at resuscitation is not recommended unless there are more resources at the scene than are needed.
No complex medical care
intubation, chest tube insertion, or traction splinting
Keep sight of their goal during triage, which is to prioritize patients for treatment and/or transport
Otherwise may incorrectly apply resources
However, there are some cases where simple rapid lifesaving procedures should be provided during the triage process.
May include commercial triage tags, marking the patient with some type of pen or marker, or placing the patient in a geographic area that has been designated for a specific triage category.
One system not better than the others
However, proposed national standard for mass casualty triage is called SALT triage
SALT stands for: Sort, Assess, Lifesaving interventions, Treatment and/or Transport
Any citation style (APA, MLA, Chicago/Turabian, Harvard)
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