EMERGENCY MEDICINE
EMERGENCY MEDICINE
IN DISASTER PLANNING
IN DISASTER PLANNING
DEPARTEMENT OF EMERGENCY MEDICINE
DEPARTEMENT OF EMERGENCY MEDICINE
PRINCE OF SONGKLANAKARIND UNIVERSITY HOSPITAL
PRINCE OF SONGKLANAKARIND UNIVERSITY HOSPITAL
HATYAI, SONGKLA, THAILAND
HATYAI, SONGKLA, THAILAND
PRASERT VASINANUKORN M.D.
WHAT IS DISASTER :
WHAT IS DISASTER :
MASSIVE DESTRUCTION OUT
MASSIVE DESTRUCTION OUT
OF CONTROL OF LOCAL
OF CONTROL OF LOCAL
GOVERNMENT
DISASTERS
DISASTERS
Natural : Earthquake Natural : Earthquake Flood Flood Land Slide Land Slide Tsunami Tsunami Hurricane HurricaneMan Made : World trade center hit by plane
Man Made : World trade center hit by plane
: Terrorism war fair
: Terrorism war fair
: Weapon of mass destruction
: Weapon of mass destruction
: Chemical war
Trimodal Distribution of Medical
Problems in Large Scale Disaster
The Initial Phase
The Initial Phase : Seconds to minutes after disaster : Seconds to minutes after disaster high mortality due to inju
high mortality due to injuries ries incompatible with life
incompatible with life
drowning, suffocation entr
drowning, suffocation entrapped in apped in destroyed building
destroyed building
Second Phase
Second Phase : Minutes to hours after incidence : Minutes to hours after incidence early trauma management, ATLS
early trauma management, ATLS
First Responder
First Responder Triage, Resuscitation, StabilizationTriage, Resuscitation, Stabilization Transportation
Transportation Definitive treatment, Air way care Definitive treatment, Air way care Local Hospital
Third
Third
Phase
Phase
:: Days WeeksDays Weeks Month or After Month or After prevent and treatprevent and treat
complications sepsis, multip
complications sepsis, multiple organ failure le organ failure reconstructive surgery
reconstructive surgery
psychological support
psychological support
EFFECTS OF DISASTER : ACUTE STAGE
EFFECTS OF DISASTER : ACUTE STAGE
Dead and injuries
Dead and injuries
Mass destruction of building, community
Mass destruction of building, community
Destroy communication system : Telephone, Radio station
Destroy communication system : Telephone, Radio station
Major interruption in transportation, bridge
Major interruption in transportation, bridge
Destroy food supply and contamination of water supply
Destroy food supply and contamination of water supply
Famine and poverty
Famine and poverty
Psychological impact on survivors and relative
FACTORS INDICATE INCREASE
FACTORS INDICATE INCREASE
PROBABLY OF MASS CASUALTY
PROBABLY OF MASS CASUALTY
1. Increasing population in flood plain, seismic zone,
1. Increasing population in flood plain, seismic zone,
hurricane
hurricane
2. Production and transportation of toxic and hazardous
2. Production and transportation of toxic and hazardous
material
material
3. Increase nuclear and chemical facilities
3. Increase nuclear and chemical facilities
4. Terrorist activity
4. Terrorist activity
5. Catastrophic fires, explosions
FACTS ABOUT DISASTERS WORLDWIDE
FACTS ABOUT DISASTERS WORLDWIDE
(WHO)
(WHO)
In the past 20 Years
In the past 20 Years
Claimed About 3 Millions Lives
Claimed About 3 Millions Lives
Affected 800 Millions People
Affected 800 Millions People
Exceeding $ 500 Billion Property Damage
Reported
Reported deadsdeads after tsunami over 8 after tsunami over 8 richterrichter since 1990since 1990
283,922
Total 283,543
283,543
9.0
9.0
Off West Coast of Northern Sumatra
Off West Coast of Northern Sumatra
2004 12 26 2004 12 26 0 0 8.1 8.1
North of Macquarie Island
North of Macquarie Island
2004
2004 12 2312 23 0
0
8.3
8.3
Hokkaido, Japan Region
Hokkaido, Japan Region
2003 09 25
2003 09 25 138
138
8.4
8.4
Near Coast of Peru
Near Coast of Peru
2001 06 23 2001 06 23 2 2 8.0 8.0
New Ireland Region, P.N.G.
New Ireland Region, P.N.G.
2000 11 16 2000 11 16 0 0 8.1 8.1 Balleny
Balleny Islands RegionIslands Region 1998 03 25 1998 03 25 166 166 8.2 8.2 Irian
Irian JayaJayaRegion, IndonesiaRegion, Indonesia 1996 02 17 1996 02 17 49 49 8.0 8.0 Near Coast of
Near Coast of JaliscoJalisco, Mexico, Mexico 1995 10 09 1995 10 09 3 3 8.0 8.0
Near Coast of Northern Chile
Near Coast of Northern Chile
1995 07 30 1995 07 30 11 11 8.3 8.3 Kuril
Kuril IslandsIslands 1994 10 04 1994 10 04 10 10 8.2 8.2 Northern Bolivia Northern Bolivia 1994 06 09 1994 06 09 Number Killed* Number Killed* Magnitude Magnitude Region Region Date UTC Date UTC
6,000 6,000 Cyclone Cyclone 1986 1986 Cook Island Cook Island 25,000 25,000 Earthquake Earthquake 1988 1988 USSR USSR 500 500 Flood Flood 1988 1988 Bangkdesh Bangkdesh 1,200 1,200 300 300 Toxic Gas Toxic Gas 1986 1986 Cameroon Cameroon 138 138 90,000 90,000 Cyclone Cyclone 1986 1986 Solomon Solomon 24,000 24,000 170,000 170,000 Volcanic Eruption Volcanic Eruption 1985 1985 Columbia Columbia 7,000 7,000 40,000 40,000 Earthquake Earthquake 1985 1985 Mexico Mexico -5.8 5.8 Cyclone Cyclone 1984 1984 Ethiopia Ethiopia Deads Deads Injured Injured Disaster Disaster Country Country 1984 1984--19891989
Servere
Servere EI NinoEI Nino--Related Related
Flooding 1997
Flooding 1997
Hurricane Mitch 1998
Hurricane Mitch 1998
Bombing of federal building Bombing of federal building Oklahoma 1995 Oklahoma 1995 6,000 6,000 300,000 300,000 20,000 20,000 1,000,000 1,000,000 World Trade Building Plane World Trade Building Plane Crash 2001 Crash 2001 Indian Ocean 2004 Indian Ocean 2004 Tsunami Tsunami Bombing of Olympic Games Bombing of Olympic Games in Atlanta in Atlanta 19961996 Earthquake Kobe Japan 1995 Earthquake Kobe Japan 1995 Earthquake in Northridge Earthquake in Northridge California USA 1994
California USA 1994
Flooding in Midwest USA 1993 Flooding in Midwest USA 1993 63 63 3,800 3,800 Earthquake Earthquake San Francisco 1989 San Francisco 1989
DISASTER PLANNING
DISASTER PLANNING
SURVEY
SURVEY -- Community hazards analysisCommunity hazards analysis
-- Regional, Geographic, NationalRegional, Geographic, National Prevention of possible disaster
Prevention of possible disaster
Public education, organized disaster team
Public education, organized disaster team
Health care resource management
Health care resource management
EMS, Ambulance service, EMT
EMS, Ambulance service, EMT
Hospital beds, critical care, ICU
Hospital beds, critical care, ICU
Health
Health personnelspersonnels M.D, Nurses, AIDM.D, Nurses, AID Blood bank, Drug stock, Water supply
Blood bank, Drug stock, Water supply
Electrical supply, Communication systems
PREVENTION OF POSSIBLE DISASTER
PREVENTION OF POSSIBLE DISASTER
Survey of possible hazards and disaster
Survey of possible hazards and disaster
Public education
Public education -- prevention, managementprevention, management Warning system
Warning system -- with back up system with back up system
Disaster information management system (DIMS)
Disaster information management system (DIMS)
Seek international co
Seek international co--operation operation UNDRO, JICA,
UNDRO, JICA,
Prepared, Readiness, Training
Opportunity for Successful Disaster
Opportunity for Successful Disaster
Management
Management
¾
¾
Warning System Management Dims
Warning System Management Dims
¾¾
Resource
Resource
¾¾
Strategic Planning System
Strategic Planning System
¾¾
Subgroup Distribution
Subgroup Distribution
¾¾
Regularity of Refreshing Knowledge and
Regularity of Refreshing Knowledge and
Action
Action
¾
Strategic Plans
Strategic Plans
-- Responder and CommanderResponder and Commander
-- Communicating SystemCommunicating System
-- Traumatic Traumatic SupportationSupportation Network Network
-- SupportationSupportation TeamTeam
-- Instruments and Equipment Instruments and Equipment
Implementation of Emergency
Implementation of Emergency
Medicine and Disaster Planning
Medicine and Disaster Planning
in Medical Curriculum
Incidence of Terrorism
Incidence of Terrorism
¾¾ 9 September 20019 September 2001 World Trade BuildingWorld Trade Building
¾ ¾ In 2001In 2001 348 events348 events ¾ ¾ In 2003In 2003 175 events175 events ¾ ¾ In 2004In 2004 650 events650 events ¾
¾ August 2005August 2005 London Bomb London Bomb
¾
EMERGENCY MEDICAL SERVICE
EMERGENCY MEDICAL SERVICE
FOR DISASTER
FOR DISASTER
Well prepared and ready for possible disaster
Well prepared and ready for possible disaster
Prehospital
Prehospital –– EMS system protocol, disaster sconceEMS system protocol, disaster sconce Incident command system, planning section
Incident command system, planning section
Logistics section, hospital facilities, resource
Logistics section, hospital facilities, resource
Comprehensive planning for hospital response in emergency
Comprehensive planning for hospital response in emergency
Review hospital and community disaster response
Review hospital and community disaster response
Disaster stress management plan
FACTORS INFLUENCING GOOD EMS
FACTORS INFLUENCING GOOD EMS
การกอการราย
การกอการราย
/
/
การตอสู
การตอสู
IRELAND, IRELAND,ภาคใต
ภาคใต
DISEASES RPEVALENCEDISEASES RPEVALENCE--CHD, PECHD, PE
อุบัติเหตุ
อุบัติเหตุ
( (TRAUMA),MASS CASUALTIESTRAUMA),MASS CASUALTIES DISASTERDISASTER
Earthquake
Earthquake
,
,
Tsunami
Tsunami
PUBLICPUBLIC AWAREENESS,AWAREENESS,
ความรับผิดชอบของรัฐบาล
ความรับผิดชอบของรัฐบาล
SOCIOECONOMIN CEED
PATIENT CARE IN TRAUMA AND
PATIENT CARE IN TRAUMA AND
EMERGENCY
EMERGENCY
At
At
Scence
Scence
of the accident
of the accident
–
–
Triage
Triage
Emergency medical service
Emergency medical service
–
–
EMS
EMS
Transfer and referring system
Transfer and referring system
Care during transfer
Care during transfer
–
–
air way, c
air way, c
-
-
spine protection
spine protection
Analgesic administration
Analgesic administration
Air transportation
Good EMS System in Developed Country
Good EMS System in Developed Country
USA, Japan, Singapore
USA, Japan, Singapore
Patient reach hospital in 3
Patient reach hospital in 3--5 minutes5 minutes
Two way communication, Good ambulance service
Two way communication, Good ambulance service
Good
Good prehospitalprehospital care and resuscitationcare and resuscitation Specialist on duty 24 hours
Specialist on duty 24 hours
Good co
Good co--ordinatingordinating system between hospitalsystem between hospital Good referring and transfer system
Good referring and transfer system
Central office co
EMS System
EMS System in Japanin Japan
EMERGENCY TRAUMA PUBLIC TELEPHONE COMMUNICATION TOKYO FIRE STATION M.D.,24 HRS COMMANDER AMBULANCEE CLOSE TO THE SCONCE
REPORT-PREPARE RESUSCITATION
AMBULANCE 1500 HELICOPTER, BOAT, FIRE ENGINES, AIR PLANE LIFE
SAVING EQUIPMENT
Tokyo road map Apartment, Home name,
age, sex of residence regular, holiday
Specialist on call for receiving consultations
(RESPONDER)
MANANGEMENT
Emergency Medicine in Disaster Planning
Emergency Medicine in Disaster Planning
Axiom : Planning for small scale simple disaster isAxiom : Planning for small scale simple disaster is
possible in small hospital
possible in small hospital
For large scale and complex is impossible
For large scale and complex is impossible
Emergency medical care has inadequate personal
Emergency medical care has inadequate personal
Appropriate critical care must available
Appropriate critical care must available
First responder and
First responder and prehospitalprehospital care is important care is important Triage Resuscitated Transp
Triage Resuscitated Transportort Command
Our Pitfalls in Management of
Our Pitfalls in Management of
Tsunami Disaster 24 December 2004
Tsunami Disaster 24 December 2004
Tsunami, December 26, 2004
Tsunami, December 26, 2004
Sumatra Earthquake 9.0 Richter
Sumatra Earthquake 9.0 Richter’’s s Wave Height 7
Wave Height 7--15 Meters15 Meters Wave Speed 500 Km/Hr
Wave Speed 500 Km/Hr
The most powerful wave in 40 years
The most powerful wave in 40 years
310,000 Reported dead and loss
310,000 Reported dead and loss
Million Injured
Million Injured
34,000 Severe Injured
Causes
Causes
1. Lack of First Responder
1. Lack of First Responder
--
Knowledge for Disaster Sequence
Knowledge for Disaster Sequence
--
Experience
Experience
--
Communicating
Communicating
--
Human Resource Team
Human Resource Team
Supportation
Supportation
--
Team Action
Team Action
2. Lack of Commander
2. Lack of Commander
--
Who ? Suitable ?
Who ? Suitable ?
--
Commander Roles ?
Commander Roles ?
3. Lack of work Cooperation
3. Lack of work Cooperation
--
Team Work
Team Work
--
Individualization
Individualization
--
Communicating
Communicating
--
Knowledge
Knowledge
--
Experience
Experience
Lack of Triage and
Lack of Triage and
Prehospital
Prehospital
Care
Care
--
Place ? Area ?
Place ? Area ?
--
Team Work
Team Work
--
Optimal
Optimal
Prehospital
Prehospital
Care ?
Care ?
--
Experience
Experience
--
Instrument for Primary Care
Instrument for Primary Care
Lack of In Hospital Cooperation
Lack of In Hospital Cooperation
¾
¾
Emergency Room
Emergency Room
¾¾
Operating Theater
Operating Theater
¾¾
Radiology Department
Radiology Department
¾¾
Intensive Care Unit
Intensive Care Unit
¾¾
Ward
Ward
¾¾
Blood Bank
Blood Bank
¾¾
Human Resource
Human Resource
¾Lack of Transferring Network System
Lack of Transferring Network System
¾
¾ Doctor to Doctor DiscussionDoctor to Doctor Discussion
¾
¾ Patients Details InformationPatients Details Information
¾
¾ In Adequacy of ICU CareIn Adequacy of ICU Care
¾
Lack of Management System
Lack of Management System
¾
¾ Human ResourceHuman Resource
¾
¾ Medical Instruments Medical Instruments
¾
¾ Food and water supply Food and water supply
¾
¾ Prevention of secondary disaster Prevention of secondary disaster
epidemic, psychiatric problem
epidemic, psychiatric problem
¾
Lack of Rehabilitation System and
Lack of Rehabilitation System and
Protecting System for Repeated Events
Protecting System for Repeated Events
Problems of Evacuation and Transportation
Problems of Evacuation and Transportation
Destruction of bridge and roadDestruction of bridge and road
Failure of communication
Failure of communication –– telephone telephone Ambulance
Ambulance -- inadequate numberinadequate number
-- inadequate equipmentinadequate equipment Traffic difficulty due to mass gathering
Traffic difficulty due to mass gathering
Traffic police not function properly
Traffic police not function properly
No commander, No organized system
Long Distance Air Transportation : Requirement
Long Distance Air Transportation : Requirement
Air bus 310 MRT Med
Air bus 310 MRT Med EvacEvac (Germany)(Germany) Full Equipped ICU Instrument 6 Stations
Full Equipped ICU Instrument 6 Stations
2 Pressure gas bottle
2 Pressure gas bottle –– 100% oxygen, 8 hours100% oxygen, 8 hours Ventilators, monitor, 25 highly train specialist
Ventilators, monitor, 25 highly train specialist
Able to carry another 38 PT. Less injuries
PITFALLS IN WOUND
PITFALLS IN WOUND
MANAGEMENT
Synopsis of injuries sustained 18 3 Other 18 3 Head 24 4 Fractures (open) 29 5
Large-scale soft-tissue injury, upper extremity
35 6
Fractures (closed)
41/18 7/3
Thoracic trauma/ hemopneumothorax
88 15
Large-scale soft-tissue injury, lower extremity/hip
% No.
Type of Injury
A pattern of severe large
A pattern of severe large
-
-
scale
scale
soft tissue damage including high
soft tissue damage including high
-
-level contamination was common to
level contamination was common to
all tsunami victims evacuated to this
all tsunami victims evacuated to this
medical facility
medical facility
Resistance patterns for isolates from wound swabs and respirator
Resistance patterns for isolates from wound swabs and respiratory tract specimens y tract specimens
R R Fosfomycin Fosfomycin R R S S I I S S R R Ciprofloxacin Ciprofloxacin R R R R S S R R S S Cotrimoxazol Cotrimoxazol R R S S S S R R R R Levofloxacin Levofloxacin R R Aztreonam Aztreonam S S S S R R S S R R Meropenem Meropenem S S S S R R S S R R Imipenem Imipenem R R R R R R R R R R Ceftazidim Ceftazidim R R R R R R R R R R Cefotaxim Cefotaxim R R R R R R R R R R Gentamicin Gentamicin R R R R R R Tobramycin Tobramycin I I S S R R S S R R Amikacin Amikacin R R Netilmicin Netilmicin R R R R R R R R R R Cefuroxim Cefuroxim R R R R R R R R R R Cefazolin Cefazolin R R R R R R R R R R Ampicillin/sulbactam Ampicillin/sulbactam R R R R R R R R R R Piperacillin
Piperacillin/ / tazobactamtazobactam
R R R R R R R R R R Ampicillin Ampicillin R R R R R R R R R R Piperacillin Piperacillin S S S S Colistin Colistin Klebsilella Klebsilella pneumoniae pneumoniae Escherichia Escherichia colin(ESBL colin(ESBL+ + Stenotrophomo Stenotrophomo nas
nas maltophiliamaltophilia Pseudomonas Pseudomonas aeruginosa aeruginosa Acinetobacter Acinetobacter baumanil baumanil Antibiotic Agent Antibiotic Agent Isolates Isolates
Definitions
Definitions
¾
¾ EmergencyEmergency -- Urgent TreatUrgent Treat
¾
¾ Mass CasualtyMass Casualty -- Large NumberLarge Number
¾
¾ Multiple CasualtyMultiple Casualty -- Many CasualtyMany Casualty
¾
Role of Doctors and Nurses
Role of Doctors and Nurses
In
In
Disaster and Emergencies
Disaster and Emergencies
Confusing Busy
The Roles of Doctors and Nurses
The Roles of Doctors and Nurses
In
In
This Sequence Situations
This Sequence Situations
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