Transcript Document

LEARNING FROM DISASTERS
(Focus on Nephrology Experience on Crush Syndrome)
FILOTEO C. FERRER, MD
Section of Nephrology
Makati Medical Center
March 24, 2011
Outline
• Lessons from past disasters
(Objectives)
– Be aware
–Understand
–Prepare
SCIENTIFIC METHODOLOGY
NO EXPERIMENTAL MODEL OF DISASTERS
• Only way to collect information and draw conclusions
is by:
– Retrospective analysis of past disasters
– And have a good understanding of these lessons
NO EXPERIMENTAL MODEL OF DISASTERS
• Lessons learned from these unfortunate experiences
can contribute
– Minimize number of mistakes
– Implement an effective response
– Decrease death toll in future catastrophes
MAJOR EARTHQUAKES DURING THE
LAST 50 YEARS
Location
Date
Magnit
ude
Number of
Injured
Deaths
Crush
Syndrome
Dialyzed
Tangshan, China
1976
8.0
165,000
255,000
2.5%
?
Southern Italian,
Italy
1980
6.8
202
19
7
Tyre,Lebanon
1982
-
80
7
1
Spitak,Armenia
1988
6.8
25,000
600
225-385
Northern,Iran
1990
-
>40,000
-
156
Kobe,Japan
1995
6.8
5,530
372
123
Chi-Chi,Taiwan
1999
-
2,405
52
32
Marmara,Turkey
1999
7.6
>40,000
17,000
639
477
Bam,Iran
2003
-
>20,000
26,000
124
96
Kashmir,Pakistan
2005
7.6
>100,000
>80,000
118
65
Sichuan,China
2008
7.9
69,000
?
?
Haiti
2010
7.0
220,000
92
62
>40,000
INCIDENCE OF CRUSH INJURY AFTER
DISASTRERS
•
•
•
•
•
Intensity of the disaster
Population density of the region
Structural characteristics of the buildings
Timing of disaster
Efficacy of rescue
• Crush injury is defined as a direct injury
caused by collapsing material and debris
resulting in manifest muscle swelling and/or
neurological disturbances in the affected parts
of the body.
• Crush Syndrome on the other hand is defined
as patients with crush injury and systemic
manifestation due to muscle cell damage
which would include:
–
–
–
–
–
–
–
–
–
acute kidney injury
Sepsis
acute respiratory distress syndrome
diffuse intravascular coaugulation
Bleeding
hypovolemic shock
cardiac failure
arrhythmias
electrolyte disturbances.
Crush syndrome
• Second most frequent cause of disaster
related mortality after earthquakes (after
direct trauma)
• Incidence may increase up to 2-5% overall in
disaster victims
• But according to general perception:
•
they constitute a relatively minor group requiring a complex
labor- intensive therapeutic measures and are rarely included in
governmental or local disaster plans (emergency teams
concentrate on housing and primary health )
Sever M.S., et al Renal disaster relief: from theory to practice
NDT (2009)
Crush Syndrome (CS)
• It takes a lot of effort to extricate victims from
the rubble
• Hence, it would be deplorable and even
counter productive if proper therapeutic
possibilities would not be prepared and
offered
Sever M.S., et al Renal disaster relief; from
theory to practice; NDT (2009)
Bywaters
described
four(4) cases in
1941
1st case seen on Sun. Sept. 16, 1940 at
Hammersmith Hosp. 17 yr, old girl with crush
injury involving L leg. Initially responded to
fluid but became oliguric with rising urea,
died suddenly on the 8th day with K 34 mg%
(8.7 mEq/L).
British Medical Journal 1941 March
Pathophysiology of CS
Prolonged pressure on the limbs
Ischemic insult
(endothelium)
Stretch insult
(myocytes)
Ischemia reperfusion injury
F
A
S
C
I
O
T
O
M
Y
-oxygen free radicals
-Leukocyte activation
-calcium influx
-Other body reactions
Extreme tension Inc Symp activity
Inc cathecholamines
Release
of pressure
on the
limb
(rescue)
Systemic deterioration
Hypovolemia
Cardiac arrest
Interstitial edema/cell swelling
Hyperkalemia
Hypocalcemia
Compartment syndrome
ARF
DIC,SIRS/MOF
myoneuroopathy
JMAJ July 2005-Vol 48. 7
RHABDOMYOLYSIS
Flow of Solutes and water across
Skeletal – Muscle- Cell membrane
in Rhabdomyolyisis
Consequences
Influx from extracellular compartment
into muscle cells
Water,NaCl,and Calcium
Hypovolemia and hemodynamic
shock,pre-renal and
ATN,hypocalcemia,aggravated
hyperkalemic cardiotoxicity;increased
cysolic Ca++, activation of cytotoxic
proteases
JMAJ July 2005-Vol 48. 7
Flow of Solutes and water across
Skeletal – Muscle- Cell membrane
in Rhabdomyolyisis
Consequences
Efflux from damaged muscle cell
potassium
hyperK and cardiotoxicity aggravated by
hypocalcemia and hypotension
purines from disintegrating cell
nuclei
Hyperuricemia,nephrotoxicity
Phosphate
Hyperphosphatemia,aggravation of
hypocalcemia and metastatic calcification
Flow of Solutes and water across
Skeletal – Muscle- Cell membrane
in Rhabdomyolyisis
Consequences
Efflux from damaged muscle cell
Lactic and other organic acids
Metabolic acidosis and aciduria
myoglobin
Nephrotoxicity,particularly with coexisting oliguria,aciduria and uricusuria
Thromboplastin
Disseminated intrvascular coagulation
Creatinine
Elevated creatinine
Crush Syndrome
MAJOR EARTHQUAKES DURING THE
LAST 50 YEARS
Location
Date Magni Number of
tude
Injured
Deaths
Crush
Syndrome
Dialyzed
Tangshan, China
1976
8.0
255,000
2.5%
?
Southern Italian,
Italy
1980
6.8
202
19
7
Tyre,Lebanon
1982
-
80
7
1
Spitak,Armenia
1988
6.8
25,000
600
225-385
Northern,Iran
1990
-
>40,000
-
156
Kobe,Japan
1995
6.8
5,530
372
123
Chi-Chi,Taiwan
1999
-
2,405
52
32
Marmara,Turkey
1999
7.6
17,000
639
477
Bam,Iran
2003
-
26,000
124
96
Kashmir,Pakistan
2005
7.6
>80,000
118
65
Sichuan,China
2008
7.9
69,000
?
?
Haiti
2010
7.0
220,000
92
62
165,000
>40,000
>100,000
TANGSHAN (CHINA) EARTHQUAKE
Year: 1976 Intensity 8 Deaths 242K injured 165K CS 2-5 %
• Any patient with crush injury is a major
casualty
• CS patients may suddenly die
hyperkalemia
SOUTHERN ITALIAN EARTHQUAKE
Year 1980 Intensity 6.8 Deaths 202 CS 19
• Acute Kidney injury was not necessarily
observed in all CS victims (12/19= 63%)
• Rescued victim who were seemingly well
under the rubble deteriorated or even died as
soon as after extrication
Rescue
Death
Santangelo et al Surg and Gyne 1982
Severe metabolic acidosis
Fatal hyperkalemia
Lebanon Experience
Year 1982 Deaths 80 CS 7 Dialysed 1
Archives of Int Med 1984 : 144 : p277-280
1979
# PXs
with
Crush
Injury
under the
rubble
(hours)
Time to IV
fluids
(hours)
AKI
Fascioto Fluid balance
my
in 60 hrs
7
12.5
0
O
0
1
5.5
24
1
1
6-10
7
5
7
12
positive 12.5
kg
Positive 11
kg
Lebanon Experience
Year 1982 Deaths 80 CS 7 Dialysed 1
• Immediate fluid resuscitation is of vital
importance to prevent crush syndrome
complications
ARMENIAN EARTHQUAKE
Year: 1988 Intensity 6.8 deaths 25K- 150K CS 600 Dialysis 225
600 cases of AKI, 225 cases of which needed
dialysis
created second catastrophe/disaster
(“RENAL DISASTER”)
Despite availability of 36 tons of dialysis supplies, 100
dialysis machines and volunteer personel from many
countries the response was ineffective
Worsened the chaos
“Third disaster “
ARMENIAN EARTHQUAKE
Year: 1988 Intensity 6.8 deaths 25K- 150K CS 600 Dialysis 225
• “Disaster within in a disaster”
– No organized international structure with
appropriate training and deployment strategies
Disappointing experience
• International Society of Nephrology
• Logistic organization to avoid similar problems in the
future disasters
• Headquarters are informed immediately of all
disasters
• Logistic support from NGOs such as Medicins Sans
Frontieres (MSF)
• Since the organization, it had intervened in several
disasters (Marmara,Bam,Kashmir,Kobe)
Disaster
US Geological Survey
detects earthquake
Chairperson of RDRTF is
informed
Decision to intervene
Chief Disaster Relief Coordinator
Visiting disaster area
Assessing extent of the problem
Estimation of the needs for support
(i.e., medications, blood products)
Asking for local support
Dispatching of scouting team
Support offered
Accessing of local conditions
G L O B A L C O O R D I N AT I O N
DISASTER RESPONSE
L O C A L C O O R D I N AT I O N
Major Steps in Global and Local Coordination of Renal-Disaster Relief Efforts
NDT (2009) 24 : 1730 -1735
Renal Disaster Response
PREPARATIONS BEFORE DISASTER
•
Composing Disaster Response Team
–
–
–
•
Organizing Educational activities for
–
–
–
–
–
•
Directors
Assessment team members
Rescuers and medical personnel
MEASURES AFTER DISASTER
•
External Intervention
•
Local Intervention
–
–
The acute phase (action plan)
The maintenance phase
Public
Rescue teams
Non-nephrological medical personnel
Nephrological (para) medical personnel
Chronic dialysis patients
Planning the interventions
–
–
External planning and preparations
Local planning
•
•
•
•
Overall disaster planning
Material planning
Planning of dialysis services
Collaboration with external bodies
Major Steps in Renal Disaster Response
NDT (2009) 24 : 1730 -1735
PSN DISASTER RESPONSE TO CRUSH
INJURY/CRUSH SYNDROME
• The Philippines being situated in the Pacific ring of fire is at increased risk
of major earthquakes.
• Situated in a geotectonically active region
PSN DISASTER RESPONSE TO CRUSH
INJURY/CRUSH SYNDROME
The1,200-km-long Philippine
fault zone (PFZ) is a major
tectonic
feature
that
transects
the
whole
Philippine archipelago from
northwestern
Luzon
to
southeastern Mindanao. This
arc-parallel, left-lateral strike
slip fault is divided into
several segments and has
been the source of largemagnitude earthquakes in
recent years, such as the
1973 Ragay Gulf earthquake
(M 7.0), 1990 Luzon
earthquake (Mw 7.7) , and
2003 Masbate earthquake
(Ms 6.2).
Northern Luzon Earthquake
Year 1990 Intensity 7.7 Deaths > 1000 CS ?? AKI ??
•Doctors working under umbrellas and
sheets of plastic had treated nearly
800 of the injured
•? Medical publications/experience
•Philvolcs and DOST has been mapping the
1200 Km fault zone
•Greatly improved earthquake monitoring
system from 12 stations now we have 66
seismic stations nationwide,release
announcement in less than 10 minutes
PSN DISASTER RESPONSE TO CRUSH
INJURY/CRUSH SYNDROME
• Most doctors and even nephrologists have no
regular experience with CS
• Thus, there is a need for guidance
• “recommendations only” due to lack of
evidence
PRE-EXTRICATION MANAGEMENT OF POTENTIAL
CRUSH INJURY VICTIM
Immediate fluid
resuscitation is of vital
importance to prevent
crush syndrome
complications
PSN Disaster Response to CRUSH Injury
POST-EXTRICATION MANAGEMENT OF POTENTIAL CRUSH INJURY VICTIM
(PRE-HOSPITAL PHASE)
•Any patient with crush
injury is a major
casualty
•CS patients may
suddenly die
Avoid K containing fluid !!!
PSN Disaster Response to CRUSH Injury
VICTIM MAY BE DISCHARGED WITH PROPER ADVICE
Victims who are deemed stable with no signs of dehydration, and without
significant risk for crush injury/crush syndrome may be discharged or sent
home due to limitation of hospital beds should be instructed to:
• watch for their color of urine (dark-colored or reddish-colored urine)
• monitor the volume of urine (Note for oliguria <400 ml/24 hours)
• Watch-out-for symptoms of crush syndrome such as acute weight gain,
edema, dyspnea,
Seek medical care as soon as possible
POST-EXTRICATION MANAGEMENT OF POTENTIAL
CRUSH INJURY VICTIM
Once the victim is admitted to the
hospital, a thorough ‘comprehensive
secondary survey’ is done which
includes complete history taking,
detailed physical examination and
reassessment of all vital signs.
(HOSPITAL PHASE)
PSN Disaster Response to CRUSH Injury
POST EXTRICATION MANAGEMENT
(HOSPITAL PHASE):
Continue Hydation:
May shift NSS to Alkaline saline hydration:
1L half-isotonic saline with 50 meqs NaHCO3
every 2nd or 3rd cycle of 1L isotonic saline at 0.5 – 1L/hr
-theoretically ideal fluid to use as
alkalinization of
plasma may reduce plasma K and eventually the
urine to promote uric acid excretion and
increase solubility of myoglobin
- but may also promote calcium phosphate
deposition inducing or worsening manifestation of
hypocalcemia
Closely monitor
patients and adjust IVF
rate accordingly
POST EXTRICATION MANAGEMENT
(HOSPITAL PHASE):
Continue Hydation:
OR May just continue NSS 0.5- 1 lit/day
( If laboratory monitoring is not possible and HCO3 solution is not available)
Closely monitor
patients and adjust IVF
rate accordingly
MAJOR EARTHQUAKES DURING THE
LAST 50 YEARS
Location
Date
Magnit
ude
Number of
Injured
Deaths
Crush
Syndrome
Dialyzed
Tangshan, China
1976
8.0
165,000
255,000
2.5%
?
Southern Italian,
Italy
1980
6.8
202
19
7
Tyre,Lebanon
1982
-
80
7
1
Spitak,Armenia
1988
6.8
25,000
600
225-385
Northern,Iran
1990
-
>40,000
-
156
Kobe,Japan
1995
6.8
5,530
372
123
Chi-Chi,Taiwan
1999
-
2,405
52
32
Marmara,Turkey
1999
7.6
17,000
639
477
Bingol, Turkey
2003
6.4
177
16
4
Kashmir,Pakistan
2005
7.6
>80,000
118
65
Sichuan,China
2008
7.9
69,000
?
?
Haiti
2010
7.0
220,000
92
62
>40,000
>40,000
>100,000
Bingol (Turkey) Earthquake
Year 2003 Intensity 6.4 Deaths 177 CS 16 Dialysis 4
Non Dialyzed
Victims (12 Px)
Mean +/- SD
Dialyzed Victims
(4 Px)
Mean +/- SD
P value
Volume of fluids (L)
Day 1
21.8 +/- 2.7
11 +/- 2.5
0.002
Day 2
20 +/- 7.6
9 +/- 11
NS
Day3
9.2 +/- 5.8
4 +/- 0.7
0.05
Day 1
8.8 +/- 2.3
1.8 +/- 2.4
0.002
Day 2
10.2 +/- 2.9
0.7 +/- 1.3
0.001
Day3
8.1 +/_ 3.2
0.11 +/- 0.16
0.002
Urine output (L)
Bingol (Turkey) Earthquake
Year 2003 Intensity 6.4 Deaths 177 CS 16 Dialysis 4
• Early adequate fluid administration helps prevent dialysis
Bam Iran Earthquake
Year2003 Intensity 6.6 Deaths 25K Injured 30K
AKI defined as crea > 1.6 mg/dl or dialysis need
Kobe (Hanshin-Awaji) Japan Earthquake
Year 1995 Intensity 7.2 Deaths 5325 CS 372 AKI 202 Dialysed 123
• Mortality in patients with AKI
– Overall 24 .8 % (50 deaths out of 202)
• Mortality in patients with AKI and dialysed
– 41% ( 50 out of 123 needed dialysis)
Most of these patients received only 2 to 3 liters
per day during the initial 3 days
The journal of trauma 42 (3)
March 1997
Marmara Earthquake
Year 1999 Intensity 7.4 Deaths 17K Injured 44K AKI 639 Dialysed 477
• Mean volume of fluid given on the first day of
admission : 5109+/- 1711 ml
• Survivors vs. non survivors: NS
• Dialyzed: 5407+/- 1623 ml
» VS.
• Non dialyzed : 3825+/- 1539 ml
P=.01
Marmara Earthquake
Year 199 Intensity 7.4 Deaths 17K Injured 44K AKI 639 Dialysis 477
• Many victims were admitted to reference hospitals
may have already established ATN
• Conservative fluid management for late rescued
victims to avoid fluid overload and need for dialysis
POST EXTRICATION MANAGEMENT
(HOSPITAL PHASE):
Conservative Hydration:
if close monitoring is impossible
late rescued victims as ATN have
developed already
The following factors should be considered
in hydration
• age
– (Caution should be exercised in the elderly.)
• body mass index
–
(More fluid is needed for the victims with larger body mass.)
• trauma pattern
– (More fluid is needed in patient with third spacing)
– Edema due to compartment syndrome does not necessarily reflect fluid overload.)
• amount of presumed fluid loss
– (More fluid should be given to victims with bleeding, and in those in hot climates)
• position of the victim
– (Those who are on upside down or in a prone position are at higher risk of developing
respiratory difficulties following aggressive fluid resuscitation.)
•
Renal Disaster Response
PREPARATIONS BEFORE DISASTER
•
Composing Disaster Response Team
–
–
–
•
Organizing Educational activities for
–
–
–
–
–
•
Directors
Assessment team members
Rescuers and medical personnel
MEASURES AFTER DISASTER
•
External Intervention
•
Local Intervention
–
–
The acute phase (action plan)
The maintenance phase
Public
Rescue teams
Non-nephrological medical personnel
Nephrological (para) medical personnel
Chronic dialysis patients
Planning the interventions
–
–
External planning and preparations
Local planning
•
Overall disaster planning
• Material planning
•
•
Planning of dialysis services
Collaboration with external bodies
Major Steps in Renal Disaster Response
NDT (2009) 24 : 1730 -1735
Marmara Earthquake
Year 199 Intensity 7.4 Deaths 17K Injured 44K AKI 639 C Dialysis 477
No of patients dialyzed
477
Total HD sessions
5137
HD sessions per patient who required HD
11.2 =/- 8
No of blood transfusions
2981
No. of FFP transfusions
2594
No. of human albumin transfusions
2594
Ratio of dialysis sessions required over all
patient
8.2 +/-10.3
Ratio of blood transfusion requiring
patient over all patient
4.6=/- 9
No. of days a patient with ARF needed
dialysis
13-18 days
Sever MS, et al, NEJM 2006;354:1052-63
Marmara Earthquake
Year 199 Intensity 7.4 Deaths 17K Injured 44K AKI 639 C Dialysis 47
• For each potential patient with crush
syndrome
– 8 to 10 sets of dialysis equipment
– At least 5 liters of non K containing crystalloids
– 15 grams of polysterene or equivalent K binder
– 4 to 5 units of blood
• Scenario : 1000 crush injury victims
– 1000 x 5 liters NSS x 7 days = 35,000 Liters
– 1000 x 15g x 7 days = 105,000 grams kayexalate or
equivalent
– 1000 x 5 = 5000 units of blood
– 1000 x 1o= 10,000 sets of HD needs
– Plus antibiotic , surgical , mechanical ventilator
needs
Other lessons
• Not to do Fasciotomy routinely to prevent
compartment syndrome
– Increases risk for sepsis
• Avoid administration of succinylcholine during
operation/procedures as it may exacerbate
hyperkalemia causing cardiac arrest.
Other lessons
A higher mortality rate was observed in the patients who were treated in
hospitals of affected area compared with those transferred to undamaged
hospitals.
Renal Disaster Response
PREPARATIONS BEFORE DISASTER
•
Composing Disaster Response Team
–
–
–
•
•
Public
Rescue teams
Non-nephrological medical personnel
Nephrological (para) medical personnel
Chronic dialysis patients
Planning the interventions
–
–
External planning and preparations
Local planning
•
•
•
•
External Intervention
Contact list
?(RDRTF)
? Military
Organizing Educational activities for
–
–
–
–
–
•
Directors
Assessment team members
Rescuers and medical personnel
MEASURES AFTER DISASTER
•
Local Intervention
– The acute phase (action plan)
• First 3 days
– The maintenance phase
• First month
Overall disaster planning
Material planning
Planning of dialysis services
Collaboration with external bodies
Major Steps in Renal Disaster Response
NDT (2009) 24 : 1730 -1735
There is no substitute for public awareness and
preparedness as Diasaters can rarely be
anticipated, much less prevented.
the Filipino value of communal effort
“The Children of Adam
are limbs of each other
Having been created of
one essence.
When the calamity of
time afflicts one limb
The other limbs cannot
remain at rest.
If thou hast no
sympathy for the
troubles of others
Thou art unworthy to
be called by the name
of a man”
Saadi ( Persian poet)
In times of disaster it is a universal instinct of a man to be of help.
"Triangle of Life":
THANK YOU!!!
References
– PSN disaster response guide
– Sever and Vanholder Lecture ASN 2010
A combination of pictures shows earthquake survivor, middle school student
Liao Bo under the rubble in Beichuan County, Sichuan Province, May 13,
2008, left, and in a hospital in Chongqing Municipality, on his 17th birthday,
May 24, right. Liao Bo lost his left leg in the earthquake.
EMERGENCY PREPAREDNESS
AND TRANSPORT OF
THE SICK AND INJURED
(Patient/ Casualty Handling)
by:
Bernardo C. Cueto,MD
( Emergency Preparedness Officer)
PURPOSE
The purpose of this lecture is to
orient MMC medical personel how
to prepare for possible emergencies
that may occur in the hospital. It
also intends to inform the
participants how to properly
transport patients
OBJECTIVES
At the end of this module, participants will
be able to
• Describe the Hospital Emergency
Preparedness Committee Structure
• Enumerate the Hospital Emergency
Codes
• Enumerate the Hospital Evacuation Code
OBJECTIVES
• Define Emergency Rescue and Transfer
• Demonstrate technique of Emergency
Transfer
• Describe the hospital plan for the different
possible disasters
Emergency Preparedness Officer
DEPUTY EP
OFFICER
PUBLIC INFORMATION
OFFICER
BFP / DILG / PNP
MEDICAL
OFFICER
TRAUMA
TEAM 1
TRAUMA
TEAM 2
FLOOR BRIGADE
MANAGER
UNIT BRIGADE
MANAGER
FIRE
EXTINGUISHER
DETAIL
EVACUATION
DETAIL
MANPOWER
&
TRACKING
FIRE
BRIGADE
FACILITIES
OFFICER
FINANCE
OFFICER
FIRE
SUPRESSION
COMMUNICATION
DETAIL
SEARCH AND
RESCUE
FIRE SAFETY
OFFICER
SECURITY
OFFICER
UTILITY
DETAIL
FOOD
DETAIL
CLEARING
OPERATION
DETAIL
FLOOR BRIGADE MANAGER
Organizes and coordinates emergency response in
their area of responsibility.
DUTIES AND RESPONSIBILITIES:
1. Responsible for matters relative to Emergency Preparedness in
his/her floor.
2. Responsible for the enforcement of safety rules and regulations in
his/her floor
3. Organizes Floor Brigade in his/her floor composed of unit brigades
in the different areas of the front rectangular ,rear rectangular,
wing and circular. ( The new building will have a different set of
Floor Brigade Manager)
FLOOR BRIGADE MANAGER
4.
Acts as incident commander in his area of responsibility
when an Emergency Incident arises.
a) Directs fire fighting and if necessary direct initial
evacuation
b) Assures and calms down and assists patients and
visitors in her floor to avoid panic
c) Supervises the evacuation of his/her floor when so
ordered and return his/her evacuees in accordance
with the established procedure.
5. Communicates and updates Emergency Incident
Commander during an incident.
FLOOR BRIGADE MANAGER
6. Informs the EPO, any situation likely to abate
the effectiveness and readiness of the operation
of the Emergency Preparedness Committee.
7. Carries out other responsibilities that may be
assigned upon him/her by the Emergency
Incident Commander as to aspect of emergency
response.
UNIT BRIGADE MANAGER
Organizes and directs emergency operations
in the unit level
DUTIES AND RESPONSIBILITIES:
1. Responsible for enforcing safety rules and regulations in
his/her unit.
2. Ensures that fire fighting equipments in his/her area of
responsibility are in proper condition.
3. Ensures that the telephone operators are informed
when there is an emergency in his/her area of
responsibility.
UNIT BRIGADE MANAGER
4. In case of actual Emergency Incident,
a) Directs fire fighting and if necessary direct initial
evacuation
b) Assures, calms down and assists patients and visitors in
his/her
unit to avoid panic
c) Supervises the evacuation of his/her floor when so
ordered return his/her evacuees in accordance with the
established procedure.
d) Oversees accounting of evacuated patients
UNIT BRIGADE MANAGER
5. Informs the Floor Brigade Manager of any situation
likely to abate the effectiveness and readiness of
the operation of the Emergency Preparedness
Committee
6. Carries out other responsibilities that may be
assigned to him/her in aspect of emergency
response.
COMPOSITION OF THE UNIT BRIGADE
1. Fire extinguisher detail
2. Evacuation detail
A. Personnel evacuation detail
B. Property evacuation detail
3. Manpower and tracking
GUIDELINES IN EMERGENCY
RESPONSE
1. PLAN
2. GATHER NEEDED MATERIALS
3. FOLLOW THE FOLLOWING INITIAL ACTION
A – ASK FOR HELP
I – INTERVENE
D – DO NOT ADD INJURIES
Patient Assessment
GUIDELINES IN EMERGENCY
RESPONSE
SCENE ASSESSMENT
ELEMENTS OF SCENE ASSESSMENT
1. CHECK FOR SAFETY ?
2. WHAT HAPPENED ?
3. HOW MANY ARE INJURED/SICK ?
4. ARE THERE PEOPLE WHO CAN HELP ?
5. WHAT IS THE MODE OF INJURY/ILLNESS
GUIDELINES IN EMERGENCY
RESPONSE
SCENE ASSESSMENT
1. Safety of the rescuer/ responder
2. Safety of the By Stander
3. Safety of the patient
CALL FOR HELP
1. Local Emergency Number : Loc 1000
2. Direct Emergency Number: 888 89 00
3. Makati C3 Number 168
GUIDELINES IN EMERGENCY
RESPONSE
HOSPITAL EMERGENCY CODE
1. Doctor Red
2. Doctor Blue
3. Doctor Pink
4. Doctor Orange
5. Maxicart
GUIDELINES IN EMERGENCY
RESPONSE
INITIAL ASSESSMENT – Check for Immediate
threats to life
R – Responsiveness
A – Airway
B – Breathing
C - Circulation
GUIDELINES IN EMERGENCY
RESPONSE
SECONDARY ASSESSMENT – Check for possible
threats to life
1. Check Vital Signs
2. Get Patient History
3. Do head to toe assessment (for trauma
patient)
EVACUATION
The process of moving a persons or things
from a place to another, as a dangerous place
or disaster area, for reason of safety or
protection
TWO TYPES OF EVACUATION BASED
ON AREA OF RELOCATION
HORIZONTAL EVACUATION-means moving
away from the area of danger to a safe place
on the same floor where the individual is, at
the time of the alarm or emergency. In this
case, the individual should move away from
the area of eminent danger.
TWO TYPES OF EVACUATION BASED
ON AREA OF RELOCATION
VERTICAL EVACUATION - using a
stairway is the preferred method to exit a
building. All exit passageways are marked
with "EXIT" signs. Stairways can be used by
those who are able to evacuate with or
without assistance.
TWO HOSPITAL EVACAUATON CODE
E1- is a partial vertical evacuation
where the affected area is evacuated
to the Emergency room while the
adjacent floors evacuates horizontally
away from the area of eminent
danger. Other floors are on stand by
alert.
TWO HOSPITAL EVACAUATON CODE
E2- is a complete evacuation of the
entire hospital (both towers) and the
primary evacuation area is Ayala
parking . Another evacuation area
may be assigned if the primary
evacuation area is found not to be
safe.
EMERGENCY RESCUE AND TRANSFER
Emergency Rescue – it is the moving of a
sick or injured person from unsafe
place to a place of safety
Transfer – it is the moving of a sick or
injured person after giving treatment
SELECTION OF TRANSFER METHOD
WILL DEPEND ON THE FOLLOWING:
1.
2.
3.
4.
Nature and severity of the injury.
Size of the victim.
Physical capabilities of the responder.
Number of personnel and equipment
available.
5. Nature of evacuation route.
6. Distance to be covered.
7. Gender of the victim (Last Consideration).
THINGS TO OBSERVED WHILE CARRYING
1.
2.
3.
4.
5.
Victim’s airway must be maintained open.
Hemorrhage is controlled.
Victim is safely maintained in the correct position.
Regular check of the victim’s condition is made.
Supporting bandages and dressing remain
effectively applied
6. The method of transfer is safe, comfortable and as
speedy as circumstances permit.
THINGS TO OBSERVED WHILE CARRYING
6. The patient’s body is moved as one unit.
7. The taller first aiders stay at the head side of the
victim.
8. First Aiders/bearers must observed ergonomics in
lifting and moving of patient.
METHODS OF TRANSFER
ASSIST TO WALK
CARRY IN ARMS
METHODS OF TRANSFER
TWO MAN SIT CARRY
EXTREMITY CARRY
METHODS OF TRANSFER
BEARERS
ALONG SIDE
GROUP CARRY
BEARERS ALONG SIDE
BLANKET CARRY
DISASTER
It is an event resulting in great loss and
misfortune.
TWO TYPES
INTERNAL DISASTER- Is an uncontrollable
crisis that originated in the facility.
EXTERNAL DISASTER – Is an uncontrollable
crisis that happened outside the facility and
the hospital is tapped as an emergency
facility.
HOW DO WE IDENTIFY HAZARD
HAZARD VULNERABILITY ASSESSMENT
A process of identifying all hazards and
identifying which one should be given
priority in the preparedness planning. It is
has three categories namely:
1. Natural Event
2. Human Event
3. Technological event
DRILLS
1. To acquaint/refresh the hospital personnel on the
correct courses of action under different emergency
situation.
2. To achieve an orderly and safe evacuation under proper
discipline.
3. To prevent panic, confusion, injury, and loss of life in case
of emergency.
4. To monitor the time for evacuation and fire response.
5. To identify training and emergency plan strengths and
weaknesses.
6. To test the effectiveness of the alarm system,
communication system, and the fire fighting apparatus
and other safety equipment.
MAKATI MED DRILLS
1.
2.
3.
4.
Fire Drill(announced or unannounced)
Earthquake Drill( announced or unannounced)
Hazardous Material Drill (announced or unannounced)
Personnel Evacuation and rescue Drill (partial or general)
BEFORE EARTHQUAKE
1.
2.
3.
4.
5.
CHECK FOR HAZARDS IN THE WORK PLACE
BE AWARE OF THE DIFFERENT EXITS IN YOUR AREA
IDENTIFY SAFE PLACES INDOOR AND OUTDOOR
EDUCATE YOURSELF AND YOUR CO – WORKERS
PREPARE DISASTER SUPPLIES
a) First Aid Kit
b) Flashlight and Whistle
c) Drinking water
d) Ready to eat food
DURING EARTHQUAKE
1.
2.
3.
4.
5.
DROP to the ground, take COVER and HOLD on until the shaking
stops
Stay away from glass, windows, outside doors and walls, and
anything that could fall, such as lighting fixtures or furniture.
Use a doorway for shelter only if it is in close proximity to you and if
you know it is a strongly supported, loadbearing doorway.
Stay inside until shaking stops and it is safe to go outside. Research
has shown that most injuries occur when people inside buildings
attempt to move to a different location inside the building or try to
leave.
DO NOT use the elevators.
AFTER EARTHQUAKE
1. Check evacuation route if safe
2. Evacuate and proceed to primary evacuation site for
complete evacuation (wait for evacuation order)
3. Stay away from debris and objects that may fall
4. Keep a safe distance away from the building
5. Don’t return to area unless ALL CLEAR has been
announced and return to work area has been ordered
ALGORITHM FOR BIOTERRORISM
Suspected Infectious Agent
Infection Control
Committee (ICC)
Emergency Preparedness
Committee (EPC)
Investigate
Containment
Confirm if true
incident of biological
agent
FALSE
TRUE
Recommend
clearance to EPC
Recommend
specific action
to EPC
Security
Engineering
Control access
to infected
area
Shut down
ventilation in
infected area
Wait for advice from EPC
for next action
ALGORITHM FOR BIOTERRORISM
Advice from EPC for
next action
TRUE case of
biological agent
Continue
containment.
Activate
Hazmat team
Non-medical
Advice
communication
to LGU about
incident
Medical
FALSE case of
biological agent
Order clearance
and cleaning
BE SAFE
GOOD DAY !!!