Transcript The Drill Scenario 8:00 am – 12:00 pm

Drill Scenario by
State of California
Emergency Medical Services Authority
Amy Kaji, MD, MPH
November 16th, 2005
Acute Care College
Medical Student Seminar
Background Scenario
• Politician to speak on controversial topic at a large
public forum
– Nationally televised
• Pre-allocated resources
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First aid stations and onsite ALS and BLS ambulances
Security and traffic control personnel
Designated media area
Shuttle buses
On/off site parking areas with attendants
• 7:30 a.m. Opening commentary
• 8:00 a.m. Speech to begin
8:00 a.m. The Exercise Begins
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Patients and hospital staff watch TV commentary
8:00 a.m. – Speaker introduced
As speaker reaches podium, explosion occurs
Mass hysteria and panic ensue
Number of casualties unknown
ED anticipates arrival of victims
Cellular and landline 9-1-1 calls begin flooding
local dispatch centers
Considerations and Decisions
• Should you consider implementing security
measures at your facility?
• What are the triggers that implement
HEICS in your facility?
• When, and who activates the high-census
(surge) plan to free up or add patient beds to
accommodate the anticipated influx of
patients?
8:02 a.m.
• At 8:02 a.m., a second explosion occurs in
one of the on-site medical aid stations
• News reports estimate numerous casualties
• Hospital staff watch in horror
Considerations and Decisions
• Does the hospital have an emergency callback procedure to increase ED and essential
hospital staff ?
• Does the hospital have a security of
lockdown procedure to protect the hospital
and staff ?
• Will your hospital activate HEICS now?
8:04 a.m.
• 8:04 a.m. – A third explosion on a main
thoroughfare to the event detonates
• Staff exhibits signs of distress at possibility
of loved ones being casualties of event
Considerations and Decisions
• How does your hospital deal with staff concerns at
the possibility of family members being casualties
of the event?
• How does the hospital allocate scarce resources
when confronted by this potential mass casualty
incident?
• How does the hospital procure additional
resources?
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Additional staffing
Blood, trauma, and burn supplies
Body bags and morgue refrigeration units
Inpatient beds, ED beds, OR beds
8:10 a.m.
• 8:10 a.m. – Law enforcement establishes
secure perimeter around the auditorium
• Residents living within perimeter evacuated
• Fire and EMS crews arrive at staging areas
outside auditorium
• News reporters surround area
• FAA contacted to declare area a no-fly zone
8:15 a.m.
• 8:15 a.m. - EMS establishes nearby off-site
staging areas
• During the panic, fleeing victims mob
offsite staging area and demand medical aid
• Immediate EMS resources overwhelmed
• Patients arrive at ED and clinics with blast
injuries, in shock and panic
Considerations and Decisions (for
on-scene first responders)
• Are evidence preservation protocols in place?
• Does ambulance agency dispatch a medical
supervisor to large scale incidents?
• Are potential communication contingency plans in
place?
• Have designated egress routes been identified?
• Does the ambulance provider have an in-field resupply plan?
• Does the ambulance provider have chain of
command procedures?
Considerations and Decisions
• Clinics may be just opening for business
• Is the hospital’s emergency plan in place for
obtaining additional staff ?
• Does your hospital have a credentialing
procedure for convergent volunteers?
8:20 a.m.
• 8:20 a.m. – Local Department Operations Center (DOC)
and Operational Area EOC are activated
• Landline and cellular circuits overloaded
• Your hospital activates back-up communications system
• High census plans activated and in-patients assessed for
early discharge or transfer
• Elective surgeries and procedures cancelled
• Hospital is short staffed
• Plans to augment staff are activated
– Calk-back of staff
– Implementation of 12-16 hour shifts
8:50 a.m.
• 8:50 a.m. - Local health officer declares local
medical emergency based on large and
increasing number of patients and need for
additional resources
• ED and corresponding clinics are impacted
• Physicians order blood products for patients
Considerations and Decisions
• How does the clinic communicate with the hospital to alert
them of incoming patients?
• What resources does the clinic require until EMS arrives to
transport patients to the acute care hospital?
• Does the clinic use the ICS?
• Do clinics have procedures for dealing with mental health
concerns?
• Does the clinic have procedures for canceling scheduled
appointments?
• Does the clinic have a protocol for notifying the blood
supplier?
8:55 a.m.
• 8:55 a.m. - Mayor’s office receives a call from
the Universal Adversary (a known terrorist
organization) claiming responsibility
• Media demands information at hospitals,
clinics, and the local health department
• Press conference is scheduled for 11:00 a.m.
Considerations and Decisions
• What information should be presented to the public?
• Does you hospital have pre-scripted risk communication
messages?
• What steps have been taken to ensure a consistent message
among the healthcare community and levels of
government?
• What community or government agencies will participate
in the press conferences?
• Who will represent the hospital at the press conference?
• Where will the press conferences be convened, and who
decides on the location?
• Who is the “lead” agency for the press conference?
9:05 a.m.
• 9:05 a.m. - The Operational Area reports Statistics
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Numbers of patients with blast injuries
Number of patients waiting to be seen
Number of persons that may require hospitalization
Available beds, operating rooms, emergency department beds
Number of patients being seen at clinics
Number of clinic patients awaiting transport to the hospitals
Number of deceased, capacity for refrigeration units in morgues
Anticipated need for blood products
• Communications with California Health Alert Network
(CAHAN) is lost
– Hospitals, clinics, EMS, and Operational area EOC unable to
place/receive calls
• Bomb squad with K-9s arrive
Considerations and Decisions
• What other redundant communications
systems exist?
• What agencies can be contacted to provide
additional security for the hospitals?
• What community resources can be utilized
to assist, including with mental health
issues?
• How is your hospital addressing the mental
health concerns of the staff and the public?
10:00 a.m.
• 10:00 a.m. - Bomb squad clears venue of
other IEDs
• Medical Operational Coordinator requests a
status update from hospitals
– Bed availability
– Estimated numbers of patients
– Equipment status and anticipated needs
10:15 a.m.
• 10:15 a.m. - Hospital nearly depletes blood products as well
as trauma and burn supplies
• Clinics call local hospitals for supplies (IV tubing,
bandaging supplies, & burn sheets)
• Hospitals lack spare supplies and a means to transport
supplies to clinics
• Vendors contacted to provide supplies and equipment
• Blood center advised of needs
• ICU is at capacity with no additional beds
• ED us holding ____ patients awaiting inpatient beds (insert
appropriate number of ED patients to increase strain on
resources), including ICU, telemetry, and medical-surgical
Considerations and Decisions
• Is there a plan to ration resources?
• What mechanisms are available to procure the
needed supplies and equipment, and what agency
is contacted to provide those resources?
• What non-medical resources may be needed
(sanitation, water, transportation, security)?
• What is the internal plan for maintaining security
and containing the influx of patients?
• Are agreements in place to provide additional
security?
10:15 a.m. continued…
• 10:15 a.m. continued… Influx of patients
continues
• Resources are overwhelmed
– Insufficient staff (all levels of healthcare
providers)
– Lack of ED space
– Depleted patient care equipment and supplies
• Gurneys, oximeters, ventilators
• Medications and medical-surgical supplies
Considerations and Decisions
• What procedure does the hospital have to expand
treatment areas?
• What is the procedure for exempting the facility
from DHS licensing and certification for nurse
staffing ratios during this emergency?
• What additional areas within or outside the
hospital can be used to provide patient care?
• What is your procedure for notifying DHS
Licensing and Certification about using alternate
care sites?
• Have patient tracking procedures been adequate?
10:15 a.m. continued…
• 10:15 a.m. continued…
• ____ patients (insert number to stress the facility
and coroner system) have died and await coroner
to investigate and remove bodies
• Hospital must identify a secure area to hold bodies
• Law enforcement and FBI demand access to
medical records and to interview victims and
family
Considerations and Decisions
• What are your hospital policies on
interacting with law enforcement, evidence
collection, and protecting patient privacy?
• Where will you stage law enforcement
officials to allow for interviews but not
congest patient care areas?
• What is the backup plan to store bodies
when the morgue is not of adequate size?
• Are the bodies considered “evidence”?
10:30 a.m.
• 10:30 a.m. – Many patients will need weeks
to months of supportive care before
recovery
• Scarce resources will be long-term issues for
the facility and community
• Hospitals, clinics, and EMS will need to
construct contingency plans to address
shortages
• Vendors will need to be contacted to provide
additional supplies and equipment
Considerations and Decisions
• What are the extended care implications for your
hospital?
• What recovery and mitigation efforts can you take
now to reduce the impact of this event?
• Have you integrated long-term care facilities into
your disaster plans?
• Do the nearby ancillary care facilities coordinate
with hospitals to accommodate a surge of longterm care patients in the community?
10:45 a.m.
• 10:45 a.m. – FBI states they have received a
credible threat that an IED was placed in the
hospital (optional participation)
• What are the procedures for notifying law
enforcement?
• Who is in charge until law enforcement arrives?
• What is your policy regarding the use of radios
and pagers while searching for an IED?
• What recovery and mitigation efforts can you take
now to reduce the impact of this event, should an
IED detonate?
11:00 a.m.
• 11:00 a.m. - Influx of patients presenting to the ED
continues
• Mayor’s press conference is held
– Cause of IED is attributed to Universal Adversary
terrorist group
– Public is asked to report all suspicious packages and
behavior
• Status reports from hospitals, clinics, & EMS
compiled
• Regional EOC begins to receive resource requests
which are relayed to the State Operations Center
12:00 p.m.
• 12:00 p.m.
– The Exercise Ends!
Reference
• www.emsa.org. 2005 Statewide Medical and
Health Disaster Exercise Guidebook
(accessed September 25, 2005).