15 til 50 Webinar Draft. V6 Final FScdphready.org/wp-content/uploads/2016/03/15-til-50-Webinar.pdf3...
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15 ‘TIL 50 MASS CASUALTY INCIDENT RESPONSE March 9, 2016
Transcript of 15 til 50 Webinar Draft. V6 Final FScdphready.org/wp-content/uploads/2016/03/15-til-50-Webinar.pdf3...
15 ‘TIL 50 MASS CASUALTY INCIDENT RESPONSE
March 9, 2016
WELCOMEINTRODUCTIONS & LOGISTICS
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• Overview• Case Study• Initial Activities• Set-up• Roles• Patient Care• 15 ‘til 50 Toolkit• Full-Scale Exercise Video• Questions
AGENDA
OVERVIEW15 ‘TIL 50 MASS CASUALTY INCIDENT
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OVERVIEW
• What is 15 ‘til 50?
– Program designed to enable hospital staff to receive a surge of 50 or more patients within 15 minutes of notification of a MCI
– Rapid deployment of staff, supplies, and equipment to successfully activate and operate a MCI triage and treatment area
– The program utilizes HICS and can be initiated using existing supplies and equipment
– The 15 ‘til 50 model has been developed, tested, and modified over the past 10 years
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OVERVIEW - 15 ‘TIL 50 IN ACTION
OVERVIEW
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• Disaster Response Failures– Hospital Disaster Plan?– Unknown roles & tasks– Poor communications– Unclear patient pathways– Lack of relevant supplies– “That’s what it says, but that’s not what we do.”
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OVERVIEW
• “15 ‘til 50”
– Rapid deployment
– Designated response
– Tested/vetted through over 30 exercises and actual events
– Plug and play model
– Implemented in six southern California hospitals and counting
CASE STUDYDISASTERS WITH OVER 50 PATIENTS
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• Chatsworth Metrolink Crash– September 13, 2008– 25 deaths– 135 injured
CASE STUDY
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CASE STUDY
• 6.7 Northridge Earthquake– January 17, 1994– 33 dead on arrival or die in hospital
– 129 hospitalized non-trauma– 8,200 hospitalized, treated, and released
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CASE STUDY
• Boston Marathon Bombing– April 15, 2013– 3 deaths– 264 injured– City FAC activated– Multiple hospital FICs activated
INITIAL ACTIVITIESINCIDENT OCCURS
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INITIAL ACTIVITIES
Incident Occurs
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• Roles assigned– Triage (Internal) closed– FT emptied into waiting room– Patients processed for discharge or admit
– Floor RNs/CNAs come for immediate admissions
– Consolidate remaining patients– Count of available beds to Disaster Lead
– Emergency department doors secured
INITIAL ACTIVITIES
SET-UPTREATMENT AREAS
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SET-UP
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SET-UP
ImmediateDelayed
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SET-UP
Minor Treatment
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SET-UP
Ambulance Drop-Off
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• 10-20 gurneys to staging• 10-20 wheelchairs to staging• Decontamination trailer moved & set up
• Cots are set up• Canopies are set up• Signs posted
SET-UP
• Supply carts out• 20 IV lines ready• 20 oxygen tanks ready • PPE donned • Treatment area teams ready• Radio checks
ROLESHOSPITAL COMMAND CENTER & TREATMENT AREAS
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• Hospital Command Center activated and coordinates
– Equipment
– Personnel and labor pool
– Ancillary Support Services
– Patient flow into hospital departments
• Communicates with emergency department Disaster Lead directly and all Departments
ROLES
Simultaneous to set-up, within the first 15 minutes
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Emergency Department Code TRIAGE ResponseJob Action Sheet/ChecklistRole: ED Charge Nurse• ED Notified via MAC/ReddiNet• Notify House Supervisor• House Supervisor will Initiate Code TRIAGE with PBX• ED Charge Nurse/Nurse Manager to assign staff for response
• Distribute Treatment Area assignment tool boxes• ED staff to establish External Treatment Area• ED staff to establish Minor Treatment Area
Continued on next slide
ROLES
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Job Action Sheet/Checklist continued from previous slide
• Don Personal Protective Equipment• Internal ED Charge Nurse to clear out existing (Rapid Admission to be completed by Units) patients to be ready to receive “NEW” victims– Establish “Mini Inpatient Units” in department– Assign responding inpatient RNs to staff mini units
• Turn On Hand Held Radio and conduct radio check(s)• Update MAC and Incident Command as new info is received
ROLES
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• Emergency Department– Disaster Lead – RN – Charge – RN– Set up & Decontamination – Techs/CCTs– Triage – RN– Minor Treatment Team
• 2 RNs + MD + Reg + RT– Immediate Treatment Team
• 2 RNs + MD + Reg + RT– Delayed Treatment Team
• 2 RNs + MD + Reg + RT
ROLES
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ROLES
• ICU/Tele/Med-Surge
– Safe patient hand-off– Two RN’s from each unit report to emergency department lead (one to transfer emergency department patients to unit-one to assist in patient care in emergency department)
– Facilitate patient flow– Set-up
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• Pharmacy
– Pre Stocked Med Carts– Deploy equipment and staff to internal and external treatment area
– Pharmacy Tech to ED
– PYXIS in Bypass Mode
ROLES
• Radiology
– Deploy to Treatment Areas
• C-Arm– Internal Treatment Area
• Portable X-Ray
• PACS Carts– External Treatment Area
• Portable X-Ray
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ROLES
• Case Managers– Coordinate discharge of patients– Increase bed surge capacity from a low of 10% of the current bed inventory to a high of 35% of the current bed inventory
– Establish a patient discharge area– Coordinate activities to expedite discharge including transportation
– Assist by providing psychological first aid– Provide PsySTART assessments– Expedite discharge including transportation assist to Floors
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ROLES
• Public Safety
– Facility lockdown
– Access control
– Traffic control
– Monitor ingress/egress
– Crowd control
– Assist responding PD
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ROLES
• Assist with decontamination
• Assist with infection control
• Assist with patient transport
• Assist as runners
• Ensure utilities are viable
• Facilities/Plant Operations
– Immediate facilities structure evaluation (True assessment = 1.5-2 hours)
– Immediate utilities system check
– Report findings to HCC
– Operations Section Chief
– Utilize on-site construction personnel to assist
PATIENT CARETREATMENT AND RE-TRIAGE
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PATIENT CARE
Treatment and Re-triage
TOOLKIT15 ‘TIL 50 MASS CASUALTY INCIDENT TOOLKIT
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• 15 ‘til 50 MCI Toolkit– Comprehensive suite of resources to implement 15 ‘til 50
– Use existing supplies to minimize cost
– Simple implementation– Visit: cdphready.org/preparedness-tools
TOOLKIT
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• Toolkit Resources– MCI Guide and Template– Multimedia library– Toolkit Library
• Creating buy in• Sample exercise materials• Training material• Sample maps & forms• Much more
TOOLKIT
FULL-SCALE EXERCISEVIDEO
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FULL SCALE EXERCISE
QUESTIONS
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QUESTIONS
This project was sponsored by the Los Angeles County Emergency Medical Services Agency and funded in part by the Hospital Preparedness Program, U.S. Department of Health and Human Services (HHS), Assistant Secretary for Preparedness and Response (ASPR) grant funding. This award has been assigned the federal award identification number (FAIN)
U90TP000516.
THANK YOUChris Riccardi
Terry [email protected]
15 ‘TIL 50 MASS CASUALTY INCIDENT RESPONSEMarch 9, 2016
