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Lessons learned from the Brussels Attacks : intra ...Department of Emergency Medicine UZ Brussel and...
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Lessons learned from the Brussels Attacks : intra – hospital organisation Ives Hubloue, MD, MSc, PhD Department of Emergency Medicine UZ Brussel and Research Group in Emergency and Disaster Medicine Brussels
Transcript of Lessons learned from the Brussels Attacks : intra ...Department of Emergency Medicine UZ Brussel and...
Lessons learned from the Brussels Attacks :
intra – hospital organisation
Ives Hubloue, MD, MSc, PhDDepartment of Emergency Medicine UZ Brussel and
Research Group in Emergency and Disaster Medicine Brussels
22 march 2016 (Brussels)
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22 march 2016 (Brussels)
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22 march 2016 (Brussels)
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Days after Paris attacks.....
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Admission capacity first hour...
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4 T2
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l 08h20 End daily briefingl 08h29 Deputy head nurse informs about attacks Zaventem l 08h30 Confirmation by 112 dispatch
l 08h45 Trainees and staff briefing about tasksg Clearing ED (home or admission)g Sectorisation ED according priorities
g Distribution MD in different care unitsg Brief reminder START triage and Mettag chart
l 08h47 Admission first patient (T3)l Contact ICU and OR
g OR asked to prepare 4 rooms within 1hour and to have another 4 after one hourg ICU asked to prepare 4 beds immediately and 4 within one hourg Security present and checking every entrance in the ED (outside ED)
l 09h07 Informal meeting with CEO, CMO, CNO
g Crisismeeting to be organised quicly g List of available beds in the hospitalg At that moment second attack announced
g Meeting senior staf EDl 09h30 Official meeting CEO, CMO, CNO,...
g Normal activities of the hospitalg Suspicious package at the entrance OR
g Arrival of first T1.....
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First hour
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l 08h20 End daily briefingl 08h29 Deputy head nurse informs about attacks Zaventem l 08h30 Confirmation by 112 dispatch
l 08h45 Trainees and staff briefing about tasksg Clearing ED (home or admission)g Sectorisation ED according priorities
g Distribution MD in different care unitsg Brief reminder START triage and Mettag chart
l 08h47 Admission first patient (T3)l Contact ICU and OR
g OR asked to prepare 4 rooms within 1hour and to have another 4 after one hourg ICU asked to prepare 4 beds immediately and 4 within one hourg Security present and checking every entrance in the ED (outside ED)
l 09h07 Informal meeting with CEO, CMO, CNO
g Crisismeeting to be organised quicly g List of available beds in the hospitalg At that moment second attack announced
g Meeting senior staf EDl 09h30 Official meeting CEO, CMO, CNO,...
g Normal activities of the hospitalg Suspicious package at the entrance OR
g Arrival of first T1.....
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First hour
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l 08h20 End daily briefingl 08h29 Deputy head nurse informs about attacks Zaventem l 08h30 Confirmation by 112 dispatch
l 08h45 Trainees and staff briefing about tasksg Clearing ED (home or admission)g Sectorisation ED according priorities
g Distribution MD in different care unitsg Brief reminder START triage and Mettag chart
l 08h47 Admission first patient (T3)l Contact ICU and OR
g OR asked to prepare 4 rooms within 1hour and to have another 4 after one hourg ICU asked to prepare 4 beds immediately and 4 within one hourg Security present and checking every entrance in the ED (outside ED)
l 09h07 Informal meeting with CEO, CMO, CNO
g Crisismeeting to be organised quicly g List of available beds in the hospitalg At that moment second attack announced
g Meeting senior staf EDl 09h30 Official meeting CEO, CMO, CNO,...
g Normal activities of the hospitalg Suspicious package at the entrance OR
g Arrival of first T1.....
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First hour
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Casualties Zaventem
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Casualties Maalbeek
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Lessons learned (1)
l Provide good communication between all partners.
Keep in mind that failure of the mobile and TETRA-network is most likely and think about alternative means of communication.
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Lessons learned (2)
l Don't write a specific hospital terror plan, you can't prepare for everything.
l Keep the plan simple.
l Work on the mindset. What really requires attention is adapting to another way of looking to (pre)hospital care.g DAMAGE CONTROL
g HYPOTENSIVE RESUSCITATION
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Lessons learned (3)
l A good plan is important, but more important is that everybody has, and knows, its own place within the plan.
l Learn to know the other disciplines and know your assignment.
l Do not interfere with the assignment of the other.
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Lessons learned (4)
l Prepare the medical responders for the collective incidents and war injuries.
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Lessons learned (5)
l There must be a lot of attention for follow-up care for the emergency services and survivors.
l The ability to be able to bring these two groups into contact with each other should be considered.
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Victim and rescuer......
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Lessons learned (6)
l Put your money on training and logistics.
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Manage the visit of VIP’s....
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Workshop France – Belgium – Israëlseptember 2016 at SAMU Paris
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Reasons for such a meeting......
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l More and more well developped medical systems experience terrorism-related medical incidents
l In spite of extended literature, there are many differences in how different countries manage critical components of such incidentsg What can we learn from each other?
g Is there room for evidence in this area?
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Pre-hospital organisation
1. Can the event scene be made “sterile”?
2. Should EMS wait until the event scene is declared “safe” by police?3. Principles for the safety of the rescue team
4. Coordination with the police
5. Should we allow or even encourage bystander help on scene?6. Should we allow or even encourage bystander transportation to
hospitals?7. What care can/should be provided on scene ? in which system ?
Scoop and RunStay and Play
Advanced Medical Post
8. What about Medical Military-Civil Cooperation ?
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Regulation of casualties
1. What is the optimal hospital destination?
The nearest?The reference trauma center?
2. Hospitals information and notification of casualties arrival?
3. How should we distribute casualties when there is asymmetricaldistance and hospital competence distribution?
4. What is the role of a triage hospital?5. Strategy for multiple ongoing events, in different regional context
and hospital’s capability. Should we keep hospital’s capability ?6. What could be the organization with a large number of children
among victimsTreatment capacity and competence for children?
TCCC for children?
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Emergency department (1)
1. Process of declaration of MCE / large MCE for the hospital and theemergency department
2. Securing the hospitals and the emergency/trauma department involved, from overattacks. Should injured people be controlled bysafety guard without wasting precious time ?
3. What technologies can PRACTICALLY help in patient and asset tracking and control?
4. Registration of patients ; research of non identified injured people
5. Coordination between professionals at the emergency rooms6. Standard procedures of radiological and biological exams at the
emergency rooms
7. Safety of the hospital and the emergency department
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Emergency department (2)
8. What is the role of the media in disseminating correct and timely medical information during and after the event?
9. What is the role of social media and should physicians and managers use it and how?
10. Hospital-internal problems The (trauma) surgical point of view
Are surgeons well prepared? (Damage Control Surgery)Need for a stock of materials
….11. Information for families : giving information, assuring safety,
answering the families looking for lost people
12. Training program and drills for the medical teams
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Thepaperisopenfordiscussion.....
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