Comprehensive Disaster Plan Research Articles

Chemical, Biological, Radiological, and Nuclear Preparedness of Public Hospitals in Riyadh.

Chemical, biological, radiological, and nuclear (CBRN) incidents are those that involve chemical or biological warfare agents or toxic radiological or nuclear materials. These agents can cause disasters intentionally or accidentally. Hospitals play a crucial role in handling CBRN disasters. This study aimed to assess the CBRN preparedness of government hospitals in Riyadh. A descriptive cross-sectional study was conducted across government hospitals in Riyadh. All government hospitals with more than 100 inpatient beds and an emergency department met the inclusion criteria. Hospital preparedness was assessed using an adaptation of the CBRNE (chemical, biological, radiological, nuclear, or explosive event) Plan Checklist. This adaptation was chosen due to the inclusion of explosive events in hospital disaster readiness, and its structural composition of key clinical guidelines necessary for a comprehensive disaster and readiness plan. Results were described in frequencies across several domains such as foundational considerations and planning which are used to assess plan preparedness using readiness tools, training, and awareness among staff members in accordance to a pre-established emergency plan, placed procedures and their implementation, and modules for preparing for a biological incident, a chemical incident, and a radiological or nuclear incident. Of the 11 eligible hospitals, 10 participated in the study. Furthermore, CBRN considerations were included in the disaster plans of 7 hospitals. Drills had been conducted in collaboration with local agencies in only 2 hospitals. The staff had been trained to recognize the signs and symptoms of exposure to class (A) biological agents in less than half of the hospitals. Eight of the hospitals had antidotes and prophylactics to manage chemical incidents, but only half of them had radiation detection instruments. Personal protective equipment was available in all hospitals, but rapid access to stockpiles of medications was available in only half of them. Government hospitals in Riyadh demonstrated insufficient CBRN preparedness as per the CBRNE Plan Checklist. Overall, there was a lack of preemptive planning, application of pre-established policies and procedures, and adequate staff training. Furthermore, several hospitals had insufficient stockpiles of medications and in concrete plans on accessing government stockpiles in the case of an emergency. Therefore, their staffs should be trained to manage CBRN emergencies, and local drills should be conducted to improve their preparedness.

Access to Care for VA Dialysis Patients During Superstorm Sandy.

Introduction: This study examines the use of dialysis services by end-stage renal disease (ESRD) patients following the Superstorm Sandy–related, months-long closure of the New York campus of the US Department of Veterans Affairs (VA) New York Harbor VA Healthcare System (NYHHS, Manhattan VAMC). Methods: Outpatient visits, dialysis care, emergency department visits, and hospitalizations at VA and non-VA facilities for 47 Manhattan VAMC ESRD patients were examined 12 months pre- and post-Sandy using VA administrative and clinical data. Results: The Brooklyn campus of NYHHS, which is within ten miles of Manhattan VAMC, experienced the largest increase in the number of dialysis encounters after the closure. Dialysis encounters for VA patients also increased at non-VA facilities, rising on average, to 106 per month. For the James J Peters Bronx VAMC, the number of total dialysis encounters for Manhattan VAMC patients fluctuated between 39 and 43 per month, dropping to less than 30 after the Manhattan VAMC dialysis unit reopened. Conclusion: Manhattan VAMC ESRD patients used nearby alternate VA sites and non-VA clinics for their care during the closure of the Manhattan VAMC dialysis unit. The VA electronic health records played an important role in ensuring continuity of care for patients who exclusively used VAMC facilities post-Sandy because patient information was immediately accessible at other VA facilities. The events related to Superstorm Sandy highlight the need for dialysis providers to have a comprehensive disaster plan, including nearby alternate care sites that can increase service capacity when a dialysis facility is closed because of a disaster.

IMPLEMENTING GIS TO IMPROVE HOSPITAL EFFICIENCY IN NATURAL DISASTERS

Abstract. Over the past decades, the number of natural disasters has been growing around the world. In addition to damaging communities and infrastructures, unexpected disasters also affect service providers such as hospitals and health centers. Markedly, hospital safety from disasters is a challenge in all countries. With disaster damage to health systems resulting in human tragedy, huge economic losses, devastating blows to developmental goals, and shaken social confidence. Ensuring that hospitals and health facilities are safe and secure from disasters depend on implementing an appropriate method to mitigate adverse impacts on hospitals during incidents. Thus, disaster management becomes even more significant, as the health sector has been particularly vulnerable to damages. So, it is crucial to develop appropriate mitigation and adoption method for healthcare facilities, to withstand the natural disasters such as earthquakes and floods. A comprehensive disaster plan is required to ensure a prompt disaster response and coordinated management of a multi causality incident. The aim of this research is to systemically and critically review the importance of hospitals in disaster events and this research attempts to reach a basic understanding to mitigate the risk of disasters in hospitals and improve the continuity of health services during or after disaster events. For this study, secondary information was retrieved from the literature review and document review on sudden-onset natural disasters in different parts of the world was collected. This study found some challenges and deliverables for disaster managers that could mitigate the risk of a natural disaster’s impact on a hospital. Accordingly, this research will evaluate the importance of disaster management for hospitals and the challenges that need to be considered during the disaster response.

Terrorist Bomb Blasts: Emergency department management of multiple incidents

Objective: To assess the preparedness of the hospital emergency system and medical personnel’s in dealing trauma victims of terrorist bomb blasts in Accident and Emergency. Patients and Methods: Four major terrorist bomb blasts incidents occurred in Karachi from December 2012 to May 2014. All patients of these 4 incidents were brought to Accident and emergency of Jinnah Postgraduate Medical Center. Place and type of bomb blast, their initial search and rescue, transfer and transportation noted. Data collected of these patients at Accident and emergency of Jinnah Post Graduate Medical Center, regarding triage, primary and secondary survey with adjuncts performed. Data was also collected from emergency operation theatres, Intensive care unit and admissions in wards. Time taken for early and effective management and disposal to different departments noted. Results: Total victims of these four bomb blast incidents were 179. Nineteen were brought dead, 8 more died within two hours, due to multiple system involvement which made total deaths 27 (15%). The patients were triaged with color coding, 44% of these patients were red and yellow, and 41% patients were of minor injuries and were labeled green. Total 67 (41.8%) underwent damage control surgery within two hours of arrival at accident and emergency. Most of the admissions were of Orthopedics and Chest surgery. Conclusion: Effective and early disposal of patients from Accident and Emergency needs collaborative efforts of hospital administration following comprehensive disaster plan & preparedness. Trained triage team with quick surgical response needs trauma training, disaster management courses and drill exercises for doctors and health workers. Keywords: Terrorist bombing, Preparedness, Triage, mass casualties, management.

The Prehospital Care of Children With Special Health Care Needs

There is an ever-growing population of children with special health care needs ranging from children with pervasive developmental disorders to technology-dependent children. The prehospital provider, local emergency medical services agencies, and the state and federal entities involved in the prehospital care of children require focused programs to ensure safe and effective care and transport of these children. This article discusses the key factors involved in the prehospital care of these children including the use of registries to identify these patients in the community, the use of caregivers and emergency information forms as resources, and the existence of specialized training programs to educate prehospital providers about the special care needs of this population. Additional discussion includes the importance of medical homes for these children and special considerations regarding their transport. Finally, we will discuss the issues that arise in this community during a disaster and show how all the previously discussed aspects of care can be integrated into a comprehensive disaster plan.

Musculoskeletal Injuries Among Victims of the Battagram, Pakistan Earthquake in October 2005

This study was conducted to assess the type, pattern, and severity of musculoskeletal injuries, as well as the type of simple orthopedic surgical procedures, that can be performed at the site of a disaster. This was a cross-sectional study conducted in Battagram, located in the North West Frontier Province of Pakistan after the October 2005 earthquake. Researchers arrived in the affected area during the second week after the earthquake, and remained there for one week. During this period, patients were received from distant areas of the district. These patients were admitted to a tent hospital because the district headquarters hospital was completely damaged. Those requiring orthopedic surgical intervention or closed manipulation and plaster of paris casts were included in the study. Of 110 patients, 61 were female and 49 were male, and 140 bones were involved. In this series, 92 fractures were closed, while 48 were open. A total of 67.3% of the patients were <40 years of age. The tibia was involved in 32.1% of cases and the femur 16.4%. No cases of compartment syndrome were found. Wound debridement was performed in 35 cases. An external fixator was applied to 10 cases of open tibia fractures. Four humerus fractures and a fracture to the radius and ulna were fixed with the Rashnail method. One open femur fracture was repaired with external fixation. Pre- and post-operative antibiotics were administered in all cases. Thirty patients sustained injuries in addition to orthopedic trauma: 13 vertebral injuries, eight head injuries, six fractured ribs, three blunt injuries to the abdomen, and 10 significant soft tissues injuries without bony involvement. After the earthquake in Battagram, young persons, especially females, were prone to orthopedic injuries, mainly involving the extremities. A comprehensive disaster plan would have helped to manage these emergencies, and further experience is needed for on-site surgical interventions.

(A282) Comparison of Safety Index in Iranian Hospitals

IntroductionHospitals are highly complex facilities that play a key role in the medical response to disasters. However, they are susceptible to the impact of disasters with respect to their structural, non-structural and functional elements. Many hospitals have collapsed or been damaged and rendered nonfunctional as a consequence of disasters. The resilience of a hospital along with the capability of effective medical response to disasters is a key part of a community based disaster plan.ObjectiveThe objective of this study was to evaluate and compare hospitals in Iran with respect to safety.MethodsThis study was performed as a survey in four hospitals in Iran. The Hospital Safety Index package from WHO was used as an evaluation tool. The evaluation team consisted of: a PhD in structural engineering, an architect with a Master's degree, a specialist in electrical and mechanical maintenance, a medical doctor, a specialist in disaster management, and an expert in health care planning. The hospitals were evaluated in three elements; structural, non-structural, and organizational. The hospital safety calculator was used.ResultsThe most important hazard for these hospitals was earthquakes. The structural safety at three hospitals was inadequate or at risk; and consequently needs intervention in a near future. Also, the administrative and organizational element of these hospitals was inadequate or at risk. All hospitals need intervention in the near future due to non-structural safety being inadequate. The overall safety index at one hospital was A (functional); in two hospitals B (at risk); and in one hospital C (inadequate).ConclusionsThe Iranian hospitals which had been assessed were on the whole unsafe. Also, these hospitals do not have a disaster management plan. Implementing a comprehensive disaster plan, including mitigation and a preparedness plan, would most likely enhance the safety of these hospitals.

Long-term care and disaster preparedness: A study of organizational types and levels of preparedness for a disaster or emergency

Objectives: Although the consequences of Hurricane Katrina motivated considerable research into long-term care (LTC) facility preparedness, many questions still remain. This study examines the characteristics of LTC facility in relation to the level of preparedness to discern whether there are patterns that can inform future planning efforts. The data from PREPARE, a federally funded disaster preparedness program for LTC staff, are used in the analysis.Methods: More than 400 PREPARE participants completed both baseline and impact surveys as well as a demographic survey, allowing for an analysis of the characteristics and levels of disaster preparedness among participating LTC facilities. Crosstabs were run for the baseline and impact surveys against the demographic survey that the participants completed. Cluster analysis was performed to fit organizations into distinct groups based on their baseline responses to key preparedness domains.Results: The results of the crosstabs reveal the specific areas where LTC facilities have a more comprehensive disaster plan. For example, skilled nursing facilities appear to be more prepared than continuing care retirement communities (CCRCs); rural facilities seem to be more prepared than urban facilities; and facilities that are part of a chain did not emerge as being better equipped than independent facilities. Cluster analysis found three groups of organizations: “Resourceful but Hesitant,” “Unprepared,” and “Model Preparedness.”Conclusions: These findings have important implications for public health efforts surrounding disaster preparedness in LTC. The findings suggest that CCRCs deserve special attention in preparedness planning and that consideration in disaster planning is required in both rural and urban areas.

Disaster planning in a health sciences library: a grant-funded approach

Recent events, such as the outbreak of H1N1 influenza and natural disasters like Hurricane Katrina, have raised awareness of the need for disaster preparedness and service continuity. During the last few years, disaster planning resources have become readily available. However, the reality is that many health sciences libraries still do not have comprehensive disaster plans in place. Because the preparation and execution of a disaster plan is labor intensive and time consuming, the writing of a comprehensive disaster plan is often relegated to the “back burner.” This was the case at the University of South Carolina (USC) School of Medicine (SOM) Library, until recently. The SOM Library is a relatively small operation with 15 staff members serving approximately 530 medical and graduate students and more than 250 faculty. Faculty, staff, and students have 24/7 access privileges. The library has been fortunate to have never experienced a significant disaster; however, South Carolina is vulnerable to natural disasters such as hurricanes and earthquakes. In addition, collections and services are at risk for damage from roof leaks, pest infestations, mold blooms, theft, fire, burst pipes, security breakdowns, and accumulation of dust and dirt. Having determined the need for a disaster plan, library faculty examined disaster planning resources and brainstormed possible approaches. It was decided that outside guidance from experts would be beneficial because no single staff member boasted significant disaster planning experience. This would require funds that simply were not available. Hence, library faculty sought out grant opportunities and were awarded a Preservation Assistance Grant from the National Endowment for the Humanities in the amount of $4,500. The grant allowed the SOM Library to hire 2 consultants to aid in developing a comprehensive disaster plan and to purchase emergency supplies.

Treatment Management in Disaster: A Review of the Bam Earthquake Experience

In the early morning of 26 December 2003, Bam, an old city in southeastern Iran, was devastated by an earthquake measuring 6.6 on the Richter scale. Managing such situations always brings about many problems. In the case of the Bam Earthquake, two of the most serious problems were rescue operations and provision of appropriate treatment within a short period of time. By conducting an opinion survey, this study aims to assess different aspects of treatment management, including personnel, the transfer of the injured, equipment, facilities, and treatment planning. Questionnaires containing open questions regarding the management of treatment at five levels were prepared. Those engaged in treatment at different levels, including physicians, treatment workers, military personnel, and executives, were questioned. Several problems were revealed concerning the composition of the treatment forces dispatched, into the region, distribution of the tasks among treatment workers, and the transferring of equipment, and facilities. The most significant problem was a lack of coordination among the organizations responsible for the management of the disaster. A comprehensive disaster plan is required if prompt handling of mass-casualty incidents and coordinating the management of such large-scale disasters are to be ensured.

Strategies in Evaluation and Management of Bam Earthquake Victims

On 26 December 2003, an earthquake measuring 6.5 on the Richter scale occurred in the city of Bam in southeastern Iran. Bam was destroyed completely, > 43,000 people were killed, and 30,000 were injured. The national and international responses were quick and considerable. Many field hospitals were created and large numbers of patients were evacuated from their homes and transported to hospitals throughout Iran. Nearly 700 patients were transferred to Chamran hospital in Shiraz within the first 48 hours after the earthquake. This is a retrospective study based on the medical records of earthquake casualties dispatched to Chamran Hospital. A screening tunnel composed of multiple stations was prepared before patients entered to facilitate the large influx of patients. Each of the victims was passed through this screening tunnel and assigned into one of three groups: (1) those needing emergency surgical intervention; (2) those needing less urgent surgery; and (3) those needing elective operations, supportive care, observation, and/or rehabilitation. Among the 708 patients, 392 were male (male/female ratio: 1.24) with a mean value of their ages of 30.5 years. (range: 1.5 months-70 years). Extremity fractures (136, 19%) were more common than were axial skeleton fractures (28, 4%). Out of the total 708 patients, 152 (21.5%) patients needed emergency operations, 26 (4%) needed less urgent surgery, and 530 (74.5%) required wound care or antibiotic therapy and other forms of supportive care. Some complications occurred, such as two patients with compartment syndromes of the leg, three required below-the-knee amputation, eight suffered acute renal failure, two developed fat emboli syndrome, and one had a brain injury that resulted in death. A comprehensive disaster plan is required to ensure a prompt disaster response and coordinated management of a multi-casualty incident. This can influence the outcomes of patients directly. A patient screening tunnel has advantages in rapid and effective evaluation and management of victims in any multi-casualty incident.

Disaster medicine and the emergency medicine resident

Disaster medicine and the emergency medicine resident

Ready or Not, Disasters Happen

The New York State Nurses Association was - as was the entire country - plunged into disaster response mode by 9:30 am on the morning of Tuesday, September 11, 2001. Although the association had engaged in limited disaster planning prior to this event, that planning was in terms of an internal disaster such as a fire in our headquarters building. There was no plan for responding to a community catastrophe of the magnitude being experienced. The association faced unique challenges - including the fact that our New York City offices are located near ground zero - but was fortunate in having expert resource persons on staff and available to organize a response. Since September, the association has applied the lessons learned from this experience and developed a comprehensive disaster plan for the future. The purpose of this article is to share those lessons learned with the community of nursing associations in the hope that others can use the information to build effective disaster plans of their own.

Civil Defense Agency

SIGNIFICANT FACTORS IN THE DEVELOPMENT OF A HOSPITAL DISASTER PLANThe tornado in June, 1953, required the hospitals in the vicinity of Worcester, without warning, to mobilize immediately, giving them an unprecedented opportunity to evaluate the effectiveness of their disaster plans. They successfully mobilized their personnel and facilities to care for thousands of casualties.Successful mobilization of a hospital to combat any sudden disaster can best be accomplished by previous detailed preparation. Disaster preparedness can only be developed and maintained by persistent awareness of the specific problems to be encountered.Every hospital can develop its own comprehensive disaster plan for . . .