Disaster Medicine Education - RCCbc · • Disasters will not wait for an appropriate time • They...
Transcript of Disaster Medicine Education - RCCbc · • Disasters will not wait for an appropriate time • They...
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Disaster Medicine Education
• Canada:
– < 15% of Canadian trained MD’s - DM education (Dodd, 2010)
– Formal DM education does not exist in Canada
• Less since 9-11 (Cummings etal., 2005, CJEM)
• Canada: DM = Public health
– Public health education also lacking in medical schools (Johnson etal., 2008; Acad. Med.)
• Perhaps not surprising that DM does not exist in
Canada
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• AMA (2006) - all medical schools /
residencies to provide formal disaster
education
• US, Australia, UK, Europe - Disaster
medicine = formal specialty
• US Govt - >$4 billion in hospital
emergency preparedness last 6 yrs
• GAO (2010)
• US - Disaster exercises (not just plans) -
required for hospital accreditation
– JCAHO
• Canada ??
Outside Canada: HC and DM (Emer Prep)
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Are we prepared ?
• 1153 am Friday
• Major train derailment
outskirts of town
• Several tankers rupture
– Toluene
– Propane
– Caustic soda
– Chlorine
• Explosion, fire
• Hospital is told to
“standby, prepare for
unknown #’s casualties
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What do you do ?
A. Quickly sign out to your colleague (Hoping he/she has not heard the news)
B. Rush to the scene to get the first video on
YouTube
C. Call for someone to initiate the hospital
disaster plan – there must be one
D. Initiate the disaster plan you have rehearsed
and are familiar with
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Start with knowing the risks in your
area
• Interface Fires
– 1998 Salmon Arm Fire
– 2003 Kelowna Firestorm
– 2003 Kamloops / Barriere
– 2009 Lillooet
• Flooding
• Avalanches
• MVA’s
• Chemical spills / Industrial
– railway
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Next steps...
• Health administrators - understand the importance of emergency preparedness ?
– Safety of your community / your family
– Implications / concerns with providing clinical care
– Societal expectation of expertise
• Collaborate with community preparedness groups
– Fire , ambulance; community & provincial emergency programs
– They all have plans – part of which is “you”
• FL-HCP’s have an invaluable pro-active contribution
– Valuable in “operationalizing” strategic level plans
• Create / support clinical champions
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Why we should become more involved
– lessons from our recent past
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H1N1
• Retrospectively minor “nuisance”– Fatality index <0.1%
• Opportunity
• Lesson:
• Our HC system has little additional surge capacity
– Even a mild outbreak clogged our ED’s and ICU’s
– “Our system” – we must have input
– Public health – valuable – but NOT clinicians
• Underestimated the demand placed upon HC system
– Did not replace existing demand – added to
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– Need for Planners (PH) and Responders (FL-
HCP‟s) to better collaborate – not be separate
• Huge gap between PH and clinical medicine
– Strategic planning ≠ operational planning
• just assumed HC would be available and would manage
• Resources (equipment, supplies, personnel)
• In all aspects (i.e. vaccination, patient care)
• Need for physician – patient contact (worried-well)
H1N1
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Revelstoke / Salmon Arm / Lillooet /
Kelowna
• Risk of disaster / emergency is in our back
yards
• The potential is always there
• Lesson:
• Know your local hazards / risks
• Incorporate those into your plans
– Forest fire, avalanche, Rail / industrial hazards...
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Hurricane Katrina /
Haiti• Response is one thing
• Recovery is another
• Much of DM is not all trauma
– Huge component = exacerbation of chronic disease / mental
health
– Large role for Primary Care
– What happens after the “response is over”
• Lesson:
• HCP‟s must do more than „reactively respond”
– Recovery often more important
– Recovery = planning, mitigation for next
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9-11 / Revelstoke
avalanche
• Hospital ED‟s are “First Responders”
– Sick / injured patients arrive directly / suddenly
• Lesson:
– HCP‟s / Hospitals must collaborate / integrate
with other FR‟s
• Not just health based
• But all community Emerg. Prep. resources
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All emergencies
• Lesson:
• Disasters will not wait for an appropriate time
• They will add to existing demand – not replace
• Emergency preparedness = insurance
– May cost to plan – will cost a lot more not to plan
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Summary - 3 Things Required - Disaster /
Emergency Preparedness
1. Know the Hazards and Vulnerabilities of your
area
Health impacts
2. Have a Emergency / Disaster Plan - Be involved
Operational level – not just strategic
3. Exercises / Training
Need to have regular exercises – what works, what doesn’t
“Unfortunately there are not enough wars and we
must resort to exercises to prepare the men”
General George Patton
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What next ?
• Get involved
• Do you have an emergency plan at home?
• How safe is your family ?
• More prepared at home – more able to effectively function at work
• How prepared are your patients ?
• Health preparedness = community preparedness
• = preventative health
• Resource to you community (principle CCFP)
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Next
• Are you aware of your hospital‟s
plan ?
– Yes - Up to date
– No – get one
– And then test the plan
• Disaster Medicine
– Develop / deliver education (all levels)
– Build those bridges between CM / PH / DEM
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• All emergencies / disasters will
involve HCP‟s, hospitals...
• Many will be affected / involved in some aspect of healthcare– Hospitals
– Physicians / HCP’s
• And so will many of your families, friends...
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Preparedness increases chances of effective response
“Failing to plan is just planning to fail”
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Why Care ?Because history always repeats itself
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Thank you