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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.

(2)

WHAT IS DISASTER :

WHAT IS DISASTER :

MASSIVE DESTRUCTION OUT

MASSIVE DESTRUCTION OUT

OF CONTROL OF LOCAL

OF CONTROL OF LOCAL

GOVERNMENT

(3)

DISASTERS

DISASTERS

Natural : Earthquake Natural : Earthquake Flood Flood Land Slide Land Slide Tsunami Tsunami Hurricane Hurricane

Man 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

(4)

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

(5)

Third

Third

Phase

Phase

:: Days WeeksDays Weeks Month or After Month or After prevent and treat

prevent and treat

complications sepsis, multip

complications sepsis, multiple organ failure le organ failure reconstructive surgery

reconstructive surgery

psychological support

psychological support

(6)

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

(7)

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

(8)

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

(9)

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

(10)

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

(11)

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

(12)

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

(13)

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

(14)

Opportunity for Successful Disaster

Opportunity for Successful Disaster

Management

Management

¾

¾

Warning System Management Dims

Warning System Management Dims

¾

¾

Resource

Resource

¾

¾

Strategic Planning System

Strategic Planning System

¾

¾

Subgroup Distribution

Subgroup Distribution

¾

¾

Regularity of Refreshing Knowledge and

Regularity of Refreshing Knowledge and

Action

Action

¾

(15)

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

(16)

Implementation of Emergency

Implementation of Emergency

Medicine and Disaster Planning

Medicine and Disaster Planning

in Medical Curriculum

(17)

Incidence of Terrorism

Incidence of Terrorism

¾

¾ 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

(18)

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

(19)

FACTORS INFLUENCING GOOD EMS

FACTORS INFLUENCING GOOD EMS

การกอการราย

การกอการราย

/

/

การตอสู

การตอสู

IRELAND, IRELAND,

ภาคใต

ภาคใต

DISEASES RPEVALENCE

DISEASES RPEVALENCE--CHD, PECHD, PE

อุบัติเหตุ

อุบัติเหตุ

( (TRAUMA),MASS CASUALTIESTRAUMA),MASS CASUALTIES DISASTER

DISASTER

Earthquake

Earthquake

,

,

Tsunami

Tsunami

PUBLICPUBLIC AWAREENESS,

AWAREENESS,

ความรับผิดชอบของรัฐบาล

ความรับผิดชอบของรัฐบาล

SOCIOECONOMIN CEED

(20)

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

(21)

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

(22)

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

(23)

Emergency Medicine in Disaster Planning

Emergency Medicine in Disaster Planning

Axiom : Planning for small scale simple disaster is

Axiom : 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

(24)

Our Pitfalls in Management of

Our Pitfalls in Management of

Tsunami Disaster 24 December 2004

Tsunami Disaster 24 December 2004

(25)
(26)
(27)
(28)
(29)

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

(30)
(31)

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

(32)

2. Lack of Commander

2. Lack of Commander

--

Who ? Suitable ?

Who ? Suitable ?

--

Commander Roles ?

Commander Roles ?

(33)

3. Lack of work Cooperation

3. Lack of work Cooperation

--

Team Work

Team Work

--

Individualization

Individualization

--

Communicating

Communicating

--

Knowledge

Knowledge

--

Experience

Experience

(34)

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

(35)

Lack of In Hospital Cooperation

Lack of In Hospital Cooperation

¾

¾

Emergency Room

Emergency Room

¾

¾

Operating Theater

Operating Theater

¾

¾

Radiology Department

Radiology Department

¾

¾

Intensive Care Unit

Intensive Care Unit

¾

¾

Ward

Ward

¾

¾

Blood Bank

Blood Bank

¾

¾

Human Resource

Human Resource

¾

(36)

Lack 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

(37)

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

(38)

Lack of Rehabilitation System and

Lack of Rehabilitation System and

Protecting System for Repeated Events

Protecting System for Repeated Events

(39)

Problems of Evacuation and Transportation

Problems of Evacuation and Transportation

Destruction of bridge and road

Destruction 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

(40)

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

(41)

PITFALLS IN WOUND

PITFALLS IN WOUND

MANAGEMENT

(42)
(43)
(44)
(45)
(46)

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

(47)

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

(48)

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

(49)

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

(50)

Role of Doctors and Nurses

Role of Doctors and Nurses

In

In

Disaster and Emergencies

Disaster and Emergencies

(51)

Confusing Busy

(52)

The Roles of Doctors and Nurses

The Roles of Doctors and Nurses

In

In

This Sequence Situations

This Sequence Situations

(53)

รศ.นพ.อติเรก ณ ถลาง ผศ

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