Grand Rounds Recap 5.3.17

EMS Disaster Day

Triage in a Multiple Casualty Incident:

• Highest Priority- RED (immediate or critical)
  • Critical patients with life threatening conditions
  • Have a good chance of recovery after immediate definitive care
• Second Priority- YELLOW (Delayed or Urgent)
  • Do not have systemic signs of shock
  • Injuries may cause death if do not recieve care soon
• Lowest Priority- GREEN (Minor or Delayed)
  • No life threatening injuries
  • Generally ambulatory
  • Constant reassessment is necessary
• Last Priority- BLACK (Deceased or expectant)
  • Found without signs of life or with obvious mortal injuries

Where to start

• Scene Safety
• Walking Wounded "Anyone need help? Okay go over there." (<-- go look at people who got themselves out of the way, tag them as GREEN) 
• Then assess the remaining patients one at a time with the pneumonic RPM
  • Respirations
    • Are they breathing? No-Black
    • Yes- how fast are they breathing? >30 then tag RED and move on
  • Perfusion- assess circulation
    • Perfusion abnormal then tag RED and move on
  • Mental Status- assess alertness
    • Unconscious, altered or cannot follow commands tag as RED and move on
    • If they can follow commands, YELLOW and move on 

Have a question about any disasters? Know where your information sits - for UCMC the yellow binder by the charge nurse desk, which contains:

• MCI procedures and job action sheets
• Alternative Care Center activation procedures
• HazMat procedures and contacts
• Radiation incident procedures and contacts
• Severe weather procedures
• Evacuation procedures
• Loss of power procedures

Red binder contains highly infectious disease plans

Other codes... what do they mean to you? Look on your badge. 

• Physicians often without specific designated tasks
• Coordinate with the charge nurse
• Maintain ownership of your patients, keep them informed
• Code Grey (weather) - shoes and blankets; evacuate lobby; patients can't leave; tunnels?
• Code Red (fire) - shelter in place facility
• Code Adam (missing person) - observe and minimize movement of people
• Power outage- utilize special back-up red outlets; find the flashlights in the SRU

Communications

• Intra-hospital radios
  • ED to County-based command
• Disaster New Radios
  • Net Control (dispatch) to ED / County command
• MARCS Radio
  • EMS to EMS; EMS to ED
• BRICS Radio (WCH only)
  • Butler County (MARCS)
• Everbridge Online Warnings
  • ED / County Command to Hospital personnel

What HazMat incidents do hospitals see?

• Low toxicity flammable hydrocarbon 70%
• Highly toxic: Mercury, Pesticides 7%
• Lit review of healthcare worker injury due to secondary exposure, low risk overall
  • Highest risk is organophosphate, usually related to not using appropriate or any PPE
• Webwiser: Internet resource & app on your phone, to help identify what symptoms to look for and PPE needed for each exposure, can work backwards from symptoms as well

Definition of Disaster:

• An event outside the normal daily experience that stresses your resources
• Serious disruption of the functioning of society causing widespread human, material, or environmental losses
• Unexpected number of deaths, injuries and illness that exceed available health resources
• May destroy local health infrastructure and emergency response capabilities
• May cause adverse effects to the environment
• May cause large populations to move 

Types of Disasters

• Natural
  • Tornadoes
  • Floods
  • Fires
  • Earthquakes
  • Hurricanes
  • Pandemics
• Human Caused
  • HAZMAT, terrorism, accidents, war, riot 

What do people need in a disaster? Priorities are different for everyone

• Medicine
• Food
• Water
• Clothing
• Safety
• Garbage pick-up
• Toilets
• Transportation
• Heat
• Electricity
• Shelter 
• Communication
• Evacuation

Factors that influence a disaster:

• Geography
• Weather
• Time of Year
• Population
• Building Construction
• EMS Response
• Communication System 
• Planning
• Fire & Rescue
• Public Transportation
• Power Grid
• Water Supply