David McCann BSc MD CCFP FAASFP

Centre for Excellence in Emergency Preparedness

Flu Assessment Centre Coordinator, City of Hamilton

Chair, American Board of Disaster MedicineIncident Commander, Ontario EMAT

Chief Medical Officer, FL-1 DMAT

Sept 11, 2001—We Will Never Forget

NEW ORLEANS 17th STREET CANAL BREACH COURTESY OF KATRINA

What happens when you don’t prepare....

Office Emergencies—Prepared?1985 US survey of FPs—more than 40% had

encountered each of eight different emergenciesOnly 11% had the equipment to deal appropriately

with these office emergenciesKobernick M. Management of emergencies in the medical office. J Emerg Med 1985; 4:71-

74.

1989 study of FPs and paediatricians more than 80% had an office emergency in the previous 3 months

In most cases, staff were unprepared & ill-equipped

Fuchs S, Jaffe DM, Christoffel KK. Paediatric emergencies in office practices: prevalence and office preparedness. Pediatrics 1989; 83: 931-9.

FLORIDA ONE DMAT 2008 Hurricane Ike @ Houma, LA

My MASH Unit

Step-wise Approach to Office EmergenciesSimple approach can work with 2 person

team or an entire office staffOrganization and planning with a pro-active

team-based approach will work well4 phase step-wise approach

Sempowski IP, Brison RJ. Dealing with office emergencies: stepwise approach for family physicians. Canadian Family Physician 2002; 48: 1464-72.

Phase 1 Triage PhaseCall 9-1-1 to alert EMSPrimary Survey Check ABCs and support

appropriatelyTriage after brief history & physicalVerify diagnosis (if possible)Assess severityMaintain safe, secure environment

New Orleans/St Bernard’s Parish, Post Hurricane Rita 09/2005

Phase 2 Management PhaseEstablish leadershipObtain assistance

within officeStart flowsheetCollateral history from

family keep them updated

Communicate with/relocate other patients

Old chart, gather info

Get needed equipmentMove patient if

neededSecondary surveyDo additional

investigationsAssess need for

immediate treatmentO2, IV, MedsRe-evaluate status in

response to therapy

Katrina—It Rained Cats and Dogs and Cars....(9/29/05)

Phase 3 Transfer PhaseDirect EMS to

patientCall hospital EDSign over to EMSGather written

transfer materials, flowsheet/summary

Transfer to definitive care

The TOXIC SLUDGE in St Bernard’s Parish/New Orleans

Phase 4 DebriefingDebrief team immediatelyHold delayed team meeting and debriefingHow did we do?What did we do well?What could we have done better?

Barricade Erected by Sheriffs Between New Orleans’ Lower 9th Ward and St Bernard’s Parish

StonechurchConsidered “moderate to high risk” officeWhy?

Invasive procedures done in officeParenteral meds frequently given (allergy

shots)High volume, large group practiceHigh risk population (e.g. Elderly)

That’s why we need an AED and a “Crash Cart”...

The New Crash CartOxygen tank + nasal cannulae, face masks,

non-rebreather masks (to provide 100% oxygen)

Suction deviceNebulizerPulse oximeterIV fluids and IV cannulaeMeds

Meds on the CartEpinephrine (1/1000)Diazepam 10 mg/2 mlLorazepam 1 mg (s/l)Benadryl (oral 50 mg,

25 mg); 50 mg/ml IVGlucagon 1 mg/vialFurosemide 10 mg/ml

Ventolin inhaler & neb solution

Atropine 0.6 mg/mlDecadron 4 mg/mlASA 81 mgNTGD50Glucose tabs

800 LB MAN BROUGHT BY ARMY DUMP TRUCK TO DMAT COMPOUND—FOUND FLOATING ON A DOOR IN THE

FLOODWATERS OF BAY ST LOUIS, MISSISSIPPI (08/05)

AnaphylaxisOxygenEpinephrine 1/1000 0.3-0.5 mg (0.3-0.5 ml)

SQ or IM children 0.01 mg/kg SQ or IM (max 0.5 mg)May be given q 15-20 min

Benadryl 50-100 mg IM/PO; child 1-2 mg/kg IM/PO

IV Normal Saline—Adults 1 L bolus; children 10 ml/kg may repeat bolus x 1

Consider tourniquet above allergen

Louis Armstrong International Airport in New Orleans Hospital to 5000 patients after Katrina....

Automatic External DefibrillatorFully automatic and gives (loud) verbal instructionsAttach pads to R sternal border and cardiac apex in

a patient who is PULSELESS AND BREATHLESSFollow verbal cues and do CPR between shocks:

SHOCK2 min CPRSHOCK2 min CPR etc“New CPR” 30 compressions to 2 ventilations to

the rhythm of “Another One Bites the Dust...” (Queen, 1980)

Will only shock Ventricular Fibrillation and Pulseless Ventricular Tachycardia (VF & VT)

CPR TrainingStonechurch—two of our staff are becoming

CPR InstructorsWe will begin offering CPR

Certification/Recertification in-house in the Fall

ONTARIO EMAT DEPLOYMENT

Where Do We Keep This Stuff?In the alcove beside the team assistants’ area

between Rooms 4 & 5 at StonechurchCome hither and look at our AED and cart....

QUESTIONS?