Nationwide Response Issues After an Improvised Nuclear Device Attack Medical and Public Health Considerations for Neighboring Jurisdictions: Workshop Summary (2014) / Chapter Skim
Currently Skimming:
Pages 213-240
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 213... ...
I Role of Regional Health Care Coalitions in Managing and Coordinating Disaster Response A white paper prepared for the January 23–24, 2013, workshop on Nationwide Response to an Improvised Nuclear Device Attack, hosted by the Institute of Medi cine's Forum on Medical and Public Health Prepared ness for Catastrophic Events together with the National Association of County and City Health Officials. The au thor is responsible for the content of this article, which does not necessarily represent the views of the Institute of Medicine.
|
From page 214... ...
214 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK rings the city. There is no quick and easy way into the city during rush hour.
|
From page 215... ...
APPENDIX I 215 notice catastrophic event. The public health and health care issues and challenges that are forced upon the "collar communities," those areas that are located outside of the blast zone but are geographically adjacent to the affected region, will require close coordination and prioritization of available resources within the emergency response system.
|
From page 216... ...
216 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK (HMARS) , developed what became the prototypical hospital mutual aid agreement that linked DC hospitals as response partners in event of an overwhelming crisis, [9]
|
From page 217... ...
APPENDIX I 217 that no single institution was left unpaired. This DC hospital memorandum of understanding (MOU)
|
From page 218... ...
218 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK pharmaceutical and materials acquisition, storage, and logistics plan, including the development of a warehouse capacity, to ensure availability of key resources separate from state or federal stockpiles. The NVHA remains a robust and vital planning and response organization to the present time, led by an Executive Director and governed by an active Board of Directors comprised of the CEOs or senior most administrators of each of the region's 14 hospitals.
|
From page 219... ...
APPENDIX I 219 attacks, these efforts developed in parallel with the hospital-specific planning efforts of the DCHA and EMS focused disaster planning occurring in northern VA. MIEMSS created a seamless statewide radio network linking the state's hospitals that has been in operation for nearly three decades.
|
From page 220... ...
220 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK disaster. This agreement allows all participating hospitals to work together during an emergency to share staff, beds, equipment, and supplies.
|
From page 221... ...
TABLE I-1 NCR Health Care Coalition Communications Network Operational Coordination Communications Coalition Center Capabilities On-Call Linkages DCEHC (regional) Coalition Notification Hospital Mutual Aid Radio Duty Officer Coordinates with DC Dept.
|
From page 222... ...
222 APPENDIX I Coordinating Across the NCR Because so many planned events occur in the Nation's Capital -- the presidential inauguration every 4 years, the yearly State of the Union presidential address, and July 4 celebration -- and because Washington's buildings and their occupants remain high threat targets for terrorists seeking to inflict damage, coordinating communications and response activities across the NCR is of critical importance. FEMA's after-action report detailing the planning and response activities related to the 2009 Presidential Inauguration of Barack H
|
From page 223... ...
APPENDIX I 223 coordinating planning and response to this year's 2013 Presidential Inauguration. One area in which the FEMA report noted a need for improvement was in developing consistency among NCR hospitals with regards to sharing a common set of terms and definitions to describe their ability to accept patients.
|
From page 224... ...
224 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK x An event involving a suspected or confirmed Category A biological agent. x A fire/EMS agency has activated a Mass Casualty Unit, Task Force or equivalent, for an event occurring in the NCR.
|
From page 225... ...
APPENDIX I 225 Including Health as Part of the Emergency Response System As described in the IOM report detailing the development of crisis standards of care, coordination of the entire emergency response system is required in order to best mitigate the consequences arising from a catastrophic disaster event.
|
From page 226... ...
226 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK nate basic public health, EMS, and related public safety issues among multiple jurisdictional agency partners. Given that the health care coalitions also chiefly represent privatesector entities, more latitude in the procurement process can often hasten acquisition of key planning resources.
|
From page 227... ...
APPENDIX I 227 Core Mission Areas Examples Training, education, and exercises Focus areas: incident command; me dia and crisis communications; active shooter; decontamination procedures; burn and trauma care; radiological response, others Personal protective equipment (PPE) Regional acquisition of biological (N-95 masks, elastomeric masks, gowns, gloves)
|
From page 228... ...
228 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK Core Mission Areas Examples HEPA air scrubbers; colocation of CHEMPACK cache Security Augmentation of security protocols and information sharing among coali tion members Mass fatality management Procurement of materiel and equip ment to support mass fatality man agement, coordinated planning to help mitigate placement of decedents in setting of large numbers of casual ties Organization and leadership Leadership, both administrative and clinical (with incorporation of subject matter experts to help lead policy development) ; focus on fiduciary goals and fiscally prudent and defen sible decisions Development of a regional health care operations policy, one that details the allocation and sharing of key resources, and plans for their utilization across the rainbow of potential scenarios, will be an important step taken in the direction of codifying the basic procedures that will govern a response to mass-casualty, mass-exposure, and public health emergency.
|
From page 229... ...
APPENDIX I 229 tance, deployment of regional stockpiles (see Table I-3) , governmental assistance, and the management of spontaneous volunteers or donations.
|
From page 230... ...
230 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK Basic Medical Supplies: suture kits, splints, bandages, dressings; divided into 5 identical "caches" that are each subdivided into rolling hospital carts for improved mobility and deployment. Ventilator Supplies: ventilator circuits that can be used to support the disaster EMS/transport ventilators deployed to coalition member hospitals.
|
From page 231... ...
APPENDIX I 231 spontaneously located triage and treatment sites, but based upon their location, utilizing predetermined assembly sites based on geographical proximity to render more definitive stabilizing care and initiate transport to definitive medical facilities.
|
From page 232... ...
232 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK such as describing the specific needs of suspected or confirmed irradiated patients. Such information would be particularly important to share with outlying communities who are likely to see the migration of patients away from the epicenter of the event and toward those communities, and could begin to prepare for the arrival of irradiated patients.
|
From page 233... ...
APPENDIX I 233 formation will be authenticated, broadcast, and updated. The progression of health care coalition development and cross-jurisdictional coordination, as exemplified in the progress being made by the DC, suburban Maryland, and northern Virginia health care coalitions, demonstrates the importance of pursuing the concept of "networks of networks" in achieving the capabilities required for robust and resilient community response to catastrophic disaster.
|
From page 234... ...
234 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK Those close-in communities that are geographically adjacent to the ground zero impact zone will struggle to accomplish the emergency response functions related to security, fire suppression, search and rescue, patient care delivery, and other fundamental response efforts. Those communities that are farther away from ground zero, the unaffected "collar communities," will have an enormous responsibility to support command and control functions, both hierarchical and vertical, and to support the lost infrastructure in the affected communities.
|
From page 235... ...
APPENDIX I 235 such data will need to occur with the support of affiliated emergency management agencies. Such efforts will be critically important to the public health and health care response faced by communities that are geographically situated immediately outside of the blast zone following an IND attack.
|
From page 236... ...
236 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK Implementation Core Coalition Priorities in IND Functions Response Potential Challenges resource procurement via coordination with lo cal/regional/state EOCs; lo cal/regional/state government leadership in establishing key crisis messaging regarding life-saving and sustaining actions Communication Report bed, staff and Communications networks and information resource availabilities; for both voice and data may management coordinate with local, be significantly impaired regional and state EOCs Personal protective Establish uniform pro- Relatively limited supplies of equipment (PPE) tocols for staff protec- PPE may be rapidly exhaust tion from radiological ed; tactical decisions regard hazards; coordinate ing greatest need for PPE with other members of may occur amongst emergen emergency response cy response system partners, system (public safety possibly resulting in re agencies)
|
From page 237... ...
APPENDIX I 237 Implementation Core Coalition Priorities in IND Functions Response Potential Challenges health care institutions care facilities have portal (portal or hand-held) ; radiation detectors, hand held ensure that staff are survey monitoring will be appropriately decon- time consuming taminated, and priori tize public safety staff decontamination, if needed Surge capacity and Implement surge Health care facilities will capabilities response strategies face unprecedented demands accounting for crisis for service care delivery, yet standards of care must also maintain services response -- transition to existing patients and those to contingency and who present with other emer crisis surge response gencies unrelated to the im protocols mediate effects of the detonation event Pharmaceuticals Access and distribute Transportation infrastructure and materials available local/regional may impede physical move management equipment, supplies ment of materiel from central and pharmaceuticals; warehouse to health care fa initiate requests for cilities; ability to develop additional materiel demand forecasting based on based on actual and projected needs limited projected patient care needs Security Need to establish secu- Limited personnel will not be rity of health care fa- able to be augmented by law cilities; need to enforcement agencies, which promote passage of will be otherwise engaged in hospital staff, both the response; staff without direct health care pro- proper credentialing may viders and non-health have difficulty crossing po care support service lice lines; spontaneous vol employees, across unteers will require police lines to be able management and coordina to report to work tion, including credentialing (numbers of volunteers may be limited due to concern
|
From page 238... ...
238 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK Implementation Core Coalition Priorities in IND Functions Response Potential Challenges regarding potential exposure to radiation) Mass fatality Prepare for mass fatal- May be overwhelming de management ities that result from mand for external service IND attack support; health care facilities will have to be prepared to store and catalogue decedents from an event, including those that may have radiolog ical contamination, on site REFERENCES 1.
|
From page 239... ...
APPENDIX I 239 6. Gostin LO, Hanfling D, National preparedness for a catastrophic emergency: crisis standards of care.
|
From page 240... ...
240 NATIONWIDE RESPONSE ISSUES AFTER AN IND ATTACK 20. Committee on Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations, Institute of Medicine.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.