powerpoint presentation…• 2008 afghanistan blizzard: 100,000 deaths • 2010 haiti earthquake:...

7/27/2019

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Where Disaster Planning and Healthcare Intersect

W. Britt Zimmerman, DO, FACOSAssociate Professor, Director of Trauma and Reconstructive UrologyMichigan State University- College of Osteopathic Medicine7/27/2019

Learning Objectives

1. Define emergency management

2. Construct the four phases of emergency management and describe activities associated with each phase

3. Distinguish the organization of emergency management at the local, state and federal levels

4. Examine the ways in which emergency management at the local, state and federal levels work together and form a partnership

Disclosures

• W. Britt Zimmerman, DO, FACOS

• None

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Poll Questions

• Who are you?

• Where are you located?

• Do you have experience providing care in austere environments?

Please type your answers directly into the chat box in the lower left corner of your screen.

Objectives

WHAT IS A DISASTER?

What is a disaster?

• “A sudden calamitous event bringing great damage, loss, or destruction” (Merriam Webster)

• An event that overwhelms all local resources (Coursera-Disaster Preparedness)

• “A disaster is a sudden, calamitous event that seriously disrupts the functioning of a community or society and causes human, material, and economic or environmental losses that exceed the community’s or society’s ability to cope using its own resources. Though often caused by nature, disasters can have human origins.” (International Federation of Red Cross and Red Crescent Societies)

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What is a disaster?

(VULNERABILITY+ HAZARD / CAPACITY =DISASTER

A disaster occurs when a hazard impacts vulnerable people.

The combination of hazards, vulnerability and inability to reduce the potential negative consequences of risk results in disaster.

Types of Disasters

• Natural hazards

• Geophysical

• Earthquakes

• Landslides

• Tsunamis

• Volcanic activity

• Hydrological

• Avalanche

• Floods

• Climatological

• Extreme temperatures

• Drought

• Wildfires

▪ Meteorological

• Cyclones

• Storms/wave surges

▪ Biological

• Disease Epidemics

• Insect/animal plagues

▪ Technological or man-made hazards▪ Complex emergencies/conflicts

▪ Famine

▪ Displaced populations

▪ Industrial accidents

▪ Transportation accidents

Accessed: 10/7/2018: https://www.ifrc.org/en/what-we-do/disaster-management/about-disasters/definition-of-hazard/

2018 Atlantic Hurricane Season

Accessed: 10/18/2018: https://en.wikipedia.org/wiki/2018_Atlantic_hurricane_season#/media/File:2018_Atlantic_hurricane_season_summary_map.png

https://www.ifrc.org/en/what-we-do/disaster-management/about-disasters/what-is-a-disaster/what-is-vulnerability/

https://www.ifrc.org/en/what-we-do/disaster-management/about-disasters/definition-of-hazard/

https://www.ifrc.org/en/what-we-do/disaster-management/preparing-for-disaster/

https://www.ifrc.org/en/what-we-do/disaster-management/about-disasters/what-is-a-disaster/

https://www.ifrc.org/en/what-we-do/disaster-management/about-disasters/definition-of-hazard/

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2018 Pacific Hurricane Season

Accessed: 10/7/2018: https://en.wikipedia.org/wiki/2018_Pacific_hurricane_season

US Nuclear Power Plant Map

Accessed: 10/7/2018: https://en.wikipedia.org/wiki/Nuclear_power_in_the_United_States#/media/File:NRC_regions_and_plant_locations_2008.jpg

National Seismic Hazard Maps

Accessed: 10/7/2018: https://earthquake.usgs.gov/hazards/learn/

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Disaster Cycle: Ten Deadliest Natural Disasters of the 21st Century• 2000 Mozambique Flood: 800 deaths

• 2001 Gujarat Earthquake: 20,000 deaths & 167,000 injuries

• 2003 European Heat Wave: 70,000 deaths

• 2004 Indian Ocean Tsunami: 150,000 deaths

• 2005 Kashmir Earthquake: 100,000 deaths, 70,000 injuries & 4,000,000 homeless

• 2005 Hurricane Katrina: 1833 deaths

• 2008 Afghanistan Blizzard: 100,000 deaths

• 2010 Haiti Earthquake: 220,000 deaths & 300,000 injuries

• 2011 Tohoku Earthquake and Tsunami: 15,889 deaths, 6,152 injuries & 2,600 missing

• 2011 East Africa Drought: Thousands dead

Terrorists Attack Location: US State Department August 2018 - Soft Targets

• High-profile public events (sporting contests, political rallies,

demonstrations, holiday events, celebratory gatherings, etc.)

• Hotels, clubs, and restaurants

• Places of worship

• Schools

• Parks

• Shopping malls and markets

• Tourism infrastructure

• Public transportation systems

• Airports

What is a disaster?

• An event that overwhelms all local resources

• Mass causality does not necessarily constitute a disaster

• Normal no longer exists

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Objectives

THE DISASTER CYCLE

What is a disaster?

Accessed: 10/7/2018: https://training.fema.gov/emiweb/downloads/is10_unit3.doc

What is a disaster?


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Mitigation - Disaster CyclePreventing future emergencies or minimizing their effects

• Occurs before and after the event

• Risk assessments

• Gulf Coast

• Pacific Ocean: Ring of Fire

• Pandemics

• Terrorism

▪ Important to remember▪ Relax and Breathe

▪ Do not become paranoid or anxious

▪ Must keep a positive attitude

▪ Use you time wisely

▪ Examples▪ Buying insurance: Flood,

Fire, Loss revenue, Fallen tree policy

What is a disaster?


Preparedness – Disaster Cycle

Preparing to handle an emergency:

• Personal plan

• Local assistance

• County assistance

• State assistance

• Federal assistance

• International assistance

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What is a disaster?


Disaster Cycle

• Response

• Begins during or immediately after the event• Self rescue

• Local agencies

• County agencies

• State resources

• Federal resources Local

County

State

Federal

Accessed 10/7/2018: Adapted from Disaster Preparedness, Coursera.org

Disaster Cycle

• Response

• Self• Save yourself

• Save your neighbor

• Need to be prepared to survive for 3 – 7days

Accessed: 10/7/2018: https://www.ready.gov/

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Disaster Cycle

• Response

• Local volunteer and government• Law Enforcement

• Emergency Medical Services

• Fire

Accessed: 10/7/2018: https://www.nhrmc.org/healthcare-professionals/new-hanover-regional-ems

https://www.facebook.com/WilmingtonPD/

https://www.wilmingtonnc.gov/departments/fire-department/stations-apparatus/fire-apparatus

Disaster Cycle

• Response

• County level response• Emergency services

• Law enforcement

• Public Health

– Spray for Mosquitos

• Schools

Accessed: 10/7/2018 https://twitter.com/newhanoverso

https://em911.nhcgov.com/

Disaster Cycle

• Response

• State• State Police

• National Guard

• State Sponsor Aid

Accessed: 10/7/2018: https://med-1partners.com/katrina/

https://twitter.com/ncnationalguard

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Disaster Cycle

• Response - Federal

• National Guard

• Federal Emergency Management Agency

• Disaster Medical Assistance Teams• Strategic Stockpiles

– Food

– Water

– Pharmaceuticals

Accessed: 10/7/2018: https://en.wikipedia.org/wiki/Federal_Emergency_Management_Agency

https://www.cdc.gov/phpr/stockpile/SNSMedicalLogistics.htm

Disaster Cycle


• U.S. Department of Health & Human Services• Office of the Assistant Secretary for Preparedness and Response

Accessed: 10/7/2018: https://www.phe.gov/Preparedness/responders/ndms/ndms-teams/Pages/dmat.aspx

https://mrc.hhs.gov/HomePage

Disaster Cycle


• U.S. Department of Health & Human Services

Accessed: 10/8/2018: https://chemm.nlm.nih.gov

https://www.remm.nlm.gov/

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Disaster Cycle

• Response

• World wide response• Non-governmental Agencies

– International Federation of Red Cross and Red Crescent Societies

• Friendly Governmental aid

Accessed: 10/7/201: https://en.wikipedia.org/wiki/International_Federation_of_Red_Cross_and_Red_Crescent_Societies

https://www.facebook.com/GodsPitCrew/

What is a disaster?


Recovery – Disaster Cycle

• Transition from Response to Recovery• The long slow process

• Housing

• Services

• Financial aid

• Businesses

• Physical and psychological help

• Utilities

• Groceries

• Garbage pickup

• Restaurants

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• What happens to the homeless when the shelters shut down?

• What happens when the volunteer organizations leave?

• What happens when aid stops?


• New Normal• Can and should we rebuild?

• What protections can be offered?

• Who will pay for rebuilding?

• Will we rebuild next time this occurs?

• How can we improve our plans to mitigate the effects of the next event?

• Do we rebuild near the water, river, flood prone areas?

What is a disaster?


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Surgical Correlation

• Like surgery, but not really (In a disaster all resources have been exceeded)

• Patient workup = Mitigation

• Time out = Preparedness

• Illness = Surgery

• Surgery = Response

• Post Operative Course = Recovery

What is a disaster?


Mitigation – Disaster Cycle

• Complete a Full Circle

• Answering the last question brings us the full circle to Mitigation

• We begin the process all over again

• Maybe a little wiser – Maybe not

• Examples:• Evacuation plans for Hurricane Katrina, 8/23/2005, followed by

Hurricane Rita, 9/18/2005.

• Hurricane Florence, 9/14/2018, and Hurricane Michael, 10/10/2018

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Southeastern North Carolina Experience

Retrieved 10/13/2018: http://www.ncse.org/maps

• New Hanover Regional Medical Center

• 855 bed, community teaching institution

• 108 bed ED

• Level II trauma and certified stroke center

• 4 Physician residencies and pharmacy residencies

• 125,000 ED visits per year

Retrieved 10/19/2018: https://www.nhrmc.org/locations/new-hanover-regional-medical-center

Southeastern North Carolina Mitigation

Count

Stat

e

Feder

al


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• Mitigation

• Preventing future emergencies or minimizing their effects

• Occurs before and after the event

• Risk assessments

– Gulf Coast

• Important to remember

– Relax and Breathe

– Do not become paranoid or anxious

– Must keep a positive attitude

– Use you time wisely


Retrieved 10/13/2018: https://www2.ncdhhs.gov/dhsr/ems/aspr/index.html


Retrieved 10/13/2018: https://southeasternhpr.org/sehpc

https://southeasternhpr.org/sehpc/who-we-are/who-we-are-overview

https://southeasternhpr.org/sehpc/who-we-serve/

WHO WE ARE OVERVIEW

Mission

The mission of the Southeastern Healthcare Preparedness Region is to facilitate

coordination and cooperation throughout the Southeast region to ensure partners

have the capability to mitigate against, prepare for, respond to, and recover from

emergent health and medical events.

The SHPR facilitates a regional healthcare preparedness program that enables Local,

Regional, and State partners to collectively improve response to and recovery from

major emergencies.

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• All decisions were made based on receiving a direct hit by a CAT 4

• 120 to landfall algorithm

• 120 hours prior to event

10/18/2018: Telephone interview with Paull Carr: Hospital and Regional Disaster Operation Manager


10/18/2018: provided by Paull Carr: Hospital and Regional Disaster Operation Manager


Retrieved 10/14/2018: https://www.cbsnews.com/news/hurricane-florence-flood-hog-manure-pits-coal-ash-dumps-north-carolina

https://qz.com/1395700/hurricane-florence-drowns-3-4-million-poultry-birds-and-5500-pigs-in-north-carolina/

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QUESTIONS?

South East North Carolina Experience


Disaster Preparedness

Count

Stat

e

Feder

al


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• Executed our 120 to land fall timeline.

• Planned for and requested a state mobile hospital to standup for our Pender hospital while it was closed because it was not rated for a CAT 2

• Planned for and maintained 14 days of food, water, fuel, and medical supplies to include meds, prior to tropical storm force winds.

• Decision to decompress or evacuate• More difficult with closure of Grand Strand Medical Center

• More difficult without mandatory evacuation


Southeastern North Carolina Preparation• Mandatory evacuation

• Numerous counties and towns along the coast in North Carolina and South Carolina• Not New Hanover county

• University of North Carolina – Wilmington: Closed

• Power companies: anticipated up to 3 million people without power

• 40,000 workers from across the UA and Canada came to help

Southeastern North Carolina Preparation

• Local hospital closures

• Dialysis center closures

• Shortage of medication

• Loss of electricity

• Loss of access

• Road closure• Before

• During

• After

• Activation of State Medical Assistance Team (SMAT)


10/17/2018: Telephone interview with Hans Edwards, Healthcare Preparedness Manager

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QUESTIONS?

The event/disaster

Hurricane Florence

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Hurricane Florence the Event

Retrieved: 10/13/2018:https://en.wikipedia.org/wiki/Hurricane_Florence#/media/File:Florence_2018-09-10_Suomi_NPP.jpg

https://en.wikipedia.org/wiki/Hurricane_Florence#/media/File:Florence_radar_20180914_1526_UTC.jpg


Accessed: 10/7/2018:https://noaa.maps.arcgis.com/apps/MapSeries/index.html?appid=6b647b589ba84930b7ff17322dedba3b


Retrieved 10/13/2018:https://en.wikipedia.org/wiki/Hurricane_Florence#/media/File:Hurricane_Florence_rainfall.png

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Hurricane Florence the Event• Made landfall Wrightsville Beach, NC: 9/14/2018 at 07:15

• Category I

• 27.2 inches of rain dropped

• 90% of New Hanover County residents without power

• State of North Carolina: 2200, primary and secondary roads closed

• Wilmington became an island

• Wilmington International Airport closed

Retrieved : 10/13/2019

"River or road? Amazing images show I-40 completely flooded". CBS17. Reuters. September 18, 2018. Retrieved September 18, 2018."NC road closures and reopenings: I-40, I-95 affected by Florence". WTVD. September 19, 2018. Retrieved September 19, 2018.

Armstrong (October 3, 2018). Post Tropical Cyclone Report...Tropical Storm Florence (Report). National Weather Service Wilmington, North Carolina. Retrieved October 4, 2018.

National Weather Service Wilmington, North Carolina Weather Forecast Office (September 16, 2018). "NOUS42 KILM 161405". National Weather Service Raw Text Product. Wilmington, North Carolina: Iowa State University. Retrieved September 16, 2018.

Patricia Sullivan and Katie Zezima (September 16, 2018). "Florence has made Wilmington, N.C., an island cut off from the rest of the world". The Washington Post. Retrieved September 17, 2018."Emergency crews throw supply lifeline to isolated Wilmington". Townhall. Associated Press. September 17, 2018. Retrieved September 19, 2018.

"Storm Florence: Heavy flooding cuts off Wilmington". BBC. September 17, 2018. Retrieved September 17, 2018.

Port of Wilmington closed


• 30 direct deaths, humans

• 23 indirect deaths, humans

• 3.4 million deaths, turkeys

• 5,500 deaths, hogs

• 5 million gallons of partially treated wastewater spilled into the Cape Fear River, after water treatment plant lost power

• 2000 cubic yards of coal ash swept into the riverRetrieved: 10/13/2018

Michael Biesecker (September 19, 2018). "Florence flooding kills 3.4 million poultry, 5,500 hogs, NC officials say". WTVD. Associated Press. Retrieved September 19, 2018.

Matthew Diebel (September 20, 2018). "A disgusting side effect of Florence: Escaped pig poop. Lots of it". usatoday.com. USA Today. Retrieved September 20, 2018.

"Florence update: 'nightmare that won't end,' evacuees can't return yet". Newsweek. 2018-09-18. Retrieved 2018-09-20.

Michael Biesecker (September 16, 2018). "Rains from Florence cause collapse at NC coal ash landfill". The Oakland Press. Associated Press. Retrieved September 19, 2018.

Retrieved 10/13/2018: https://www.northcarolinahealthnews.org/2018/09/26/florence-nasty-water-mounting-damage/

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Retrieved 10/13/2018: https://www.northcarolinahealthnews.org/2018/09/26/florence-nasty-water-mounting-damage/


Retrieved 10/13/2018: https://weather.com/photos/news/2018-09-11-hurricane-florence-photos


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Response

• Begins during or immediately after the event

• Self rescue

• Local agencies

• County Agencies

• State resources

• Federal resources

sttttcLocal

County

State

Federal


Hospital activities

• Made 96,000 meals over 6 days

• 2500 Sheltered patients, staff, and visitor’s height of the storm• 1800 Staff

• 500 Patients

• Visitors/Family

• 42 Babies born during the storm

• 120 Children housed during the storm• Supervised by the athletic trainers

• GI bug outbreak

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Southeastern North Carolina Response

• Hospital

• Only functional pharmacy

• Outpatient

– Filling 700-800 scripts per day

» Antibiotics

» Chronic medications

• Inpatient

– TPN

• Hot drop of medications in the parking lot

• County

• Hospital supplied fuel to water department for generations

• Public schools - Became shelters, triage facilities, discharge Areas

STATE MEDICAL ASSISTANCE TEAM(SMAT)

Mobile Hospital Unit

Retrieved: 10/14/2018: https://www.northcarolinahealthnews.org/2018/09/17/mobile-hospital-headed-to-florence-affected-areas-to-provide-support/


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Photos taken by Britt Zimmerman


Retrieved 12/13/2018: NHRMC Facebook posts





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QUESTIONS?



Southeastern North Carolina Recovery• Transition from Response to Recovery

• The long slow process

• Housing

• Services

• Financial Aid

• Businesses

• Physical and Psychological Help

• Utilities

• Groceries

• Garbage pickup

• Restaurants

• Normal hospital operation

• 1500 cases cancelled; revenue lost

• 1 week following hurricane OR closed to non emergent cases

10/15/2018: Interview with Jeff Roos, Administrator Surgical Services, NHRMC

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• What happens to the homeless when the shelters shut down?

• What happens when the volunteer organizations leave?

• What happens when aid stops?

Southeastern North Carolina Recovery

Hospital management invited FEMA into the hospital.



• New Normal

• Can and Should we rebuild?

• What protections can be offered?

• Who will pay for rebuilding? Will we rebuild next time this occurs?

• How can we improve our plans to mitigate the effects of the next event?

• Do we rebuild near the water, river, flood prone areas?


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• Storm Recovery Assistance Center• An outreach project of Mission Corps

• Opened Sept. 24. Set to close Friday, Oct. 12. Three weeks of operation

• From 7 a.m. to 8 p.m. to the first week. Now two shifts: 7-10 a.m. and 3-8 p.m.

• Provided weekend hours for the first weekend

• Dozens of employees, possibly hundreds, donated various items. Some went to stores and bought items, using their hurricane relief gift cards

• About 70 volunteers helped our staff run the store. This includes NHRMC volunteers, students with UNCW Schools of Health and Human Services, employees’ children, and community members



• Codington Shelter

• Decompress NHRMC by finding a place for patients who would have been discharged

• The Hoggard shelter had numerous patients, especially those on dialysis and oxygen, who need higher level of medical care, but did not need to be in the hospital


QUESTIONS?

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LESSONS LEARNED

Lessons Learned

• What I learned:• In times of true disaster

• Normal does not exist

• Ethics are the same, but health care delivery will be redefined

• “You must go with the flow.”

• Concerns for healthcare staff• Financial - 200 families lost everything

• Mental

• Burnout

• 2 POST storm Critical Incident Stress Management (CISM) teams and therapy dogs for 3 weeks great help with recovery of staff

• Family - kids are not back in school


10/18/20018: Telephone interview with Jennifer Clem, Atlantic Urology

Lessons Learned

• Decompression versus Evacuation

• Concerned about abandonment of residents• County never decided to call for mandatory evacuation

• Traditionally hospitals have not prepared for disasters• Practice is a massive undertaking

• Costly with time perspective

• Marathon (not a race)

• Financial Department needs to involved (FEMA paperwork)


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Lessons Learned

• Need to assess the team that you have in place

• Strong people to handle the stress

• Need to prepare for the PTSD

• Thunderstorms after the storm, few day following the hurricane

• Communication

• Backup

• Backup to the backup

• Request for assets frequently and be persistent

Disaster Medicine

What are treatment standards in the time of disaster?

Disaster Medicine

1. The body is a unit; the person is a unit of body, mind, and spirit.

2. The body is capable of self-regulation, self-healing, and health maintenance.

3. Structure and function are reciprocally interrelated.

4. Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.

Retrieved 10/201/2018: https://osteopathic.org/about/leadership/aoa-governance-documents/tenets-of-osteopathic-medicine/

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QUESTIONS?

Learning Objectives

1. Define emergency management

2. Construct the four phases of emergency management and describe activities associated with each phase

3. Distinguish the organization of emergency management at the local, state and federal levels

4. Examine the ways in which emergency management at the local, state and federal levels work together and form a partnership

Where Disaster Planning and Healthcare Intersect

W. Britt Zimmerman, DO, FACOSAssociate Professor, Director of Trauma and Reconstructive UrologyMichigan State University- College of Osteopathic Medicine7/27/2019

powerpoint presentation…• 2008 afghanistan blizzard: 100,000 deaths • 2010 haiti earthquake:...

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