Slides - cme.ucsf.edu

Planning for
Disaster Management
90.04.32w
29.57.18n
Lessons learned
Katrina, Rita, Ike and
Gustav
Norman McSwain , MD
Professor of Surgery
Tulane University
Trauma director
Spirit of Charity Trauma Center
Medical Director
PreHospital Trauma Life Support
Kyle F. Dickson, M.D. M.B.A.
Professor Baylor College of Medicine
Southwest Orthopaedic Group, Houston, Texas
[email protected] cell 713-208-4168
Katrina 8 Years Later: Have We
Learned Anything Yet?
Kyle Dickson MD, MBA
Professor of Orthopaedics Baylor College of Medicine
Southwest Orthopaedic Group
1
• Proper
Summary
emergency management
planning (Get Involved-ask?)
–Food, water, generators, personnel,
patient evacuations
• Military
–Security
–Communications
Disaster (sudden onset of
unexpected circumstances)
• Natural
(hurricane, earthquake, etc)
• Mechanical (bus rollover, tanker
hitting casino, multi vehicle collisions,
explosions, wind, etc.)
• Biochemical (government most
concerned)
Kyle F. Dickson, M.D.
Professor and
Director of Orthopaedic Trauma,
Tulane University
Chief of Orthopaedics, Charity Hospital
Clinical Assistant Professor, LSU
“Explosions and bombings remain the
most common deliberate cause of
disasters involving large numbers of
casualties'”
Sherma, Am J disaster Med
2008
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3
Beautiful Lakeview
House for Sale
4
New Orleans Hurricanes
August 1779
Lessons learned from ground zero
5
“New
90.04.32w
29.57.18n
Orleans has dodged a bullet”
Wind
6
Wind
Hurricane
Mark Twain 1883
• “There
is nothing but that frail
breastwork of earth between the
people and destruction”
9:50am Monday August 29, 2005
Surge >50 feet, Lake Ponchartrain elevated 15 feet
18th Street Canal
7
Levee Breaks
Before
After
8
Flood
Industrial Canal Break
Water comes and stays
Tulane
Charity Hospital
University
Hospital
VA
After
9
80% of the city was underwater 90%of the homes
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11
12
On the Streets
Prisoners on the Interstate
A diabetic
Days without water or food while the world
watched and FEMA trucks drove by
13
Canal St.
Six Flags -- Jazzland
Power
14
Power
Emergency (generator ) power (24 hours
vs 80 hours, basement)
• Red plugs
• Ventilators, Operating Room, Selected
lights
• EMR, Radiology, Lab, Pharmacy,
Communication
15
16
• Proper
Lesson 1
Lesson 1
Emergency planning
–Worst case scenario planning
(Munich –F.E.M.A.)
–Hundreds of school buses
underwater (use of resources)
–Common sense construction
(generators in the basement or filled
on the first floor, fuel two blocks
away -80 hours)
–Triage (who lives and who dies)
Planning and Management
Problems
Inappropriate planning
not
Carresi
Disaster 2008
Madrid bombing
mistakes in field-level decision making
Successes
Initiatives in front line medics
compensated for lack of clear command
by senior managers
Critical thinking by field personnel
•
Immediate
Response
– 2-5 days
– Local resources only
– Preparation
– Storage
– Communication
– Command & control
– Security
– Evacuation
Sanitation
Water
Kitty liter
Disposal bags
Cleanser
17
NEXT TIME, LET’S ALL BE BETTER PREPARED
Toilet paper…Check
Budweiser…Check
Bud Light…Check
Red Dog…Check
Keystone Ice…Check
Misc. Other bottles of Alcohol…Check
Piece of Plywood to Float Your Chick and Booze on…Check
18
• Security
Lesson 2
is number one issue
–Lawless society (superdome – rape,
murder, pillaging, vandalism, etc.)
–Military presence ASAP ( “national
valued asset”)
–Hospital lockdown (inundated with
health care providers 4-5/1)
Response
In a grab and run test, Heineken
was the number one choice of beer
for looters in the New Orleans
metropolitan area. When asked,
most agreed that Colt 45 or Red Dog
was their main beer of purchase,
but when money doesn’t matter,
they grab for the finest beer around,
Heineken.
Thank you, New Orleans, for making us number one.
Reliable communication – Satellite phones (Ham radio system)
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•
Immediate
Response
– 2-5 days
– Local resources only
– Preparation
– Storage
– Communication
– Command & control
– Security
– Evacuation (planned arrangements)
21
Hemingway called courage
“grace under pressure”
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Lesson 3
• Communications
–Between hospital and helicopters
(other hospitals or the outside world)
–Military
–Orthopedic surgeons should be in
charge (a lot less “dickin around”)
•
Immediate
Response
– 2-5 days
– Local resources only
– Preparation
– Storage
– Communication
– Command & control
– Security
– Evacuation
Towers down or damaged
Batteries run out
without recharging
24
“Lagniappe (spanish) …is the
equivalent of the thirteenth
roll in a “baker’s dozen”
Mark Twain
25
A beached boat on Napoleon?
Fats Domino’s Living Room
(The Fat Man – “Bluberry Hill”)
Before
After
26
• The
Individual Lessons
water was toxic (admitted with
sepsis)
• The water didn’t just come and go but
stayed for 4 weeks
• Insurance companies are crooks
(maximum allowable flood only 1/3
cost of the house – no home owners)
Long Black Line
Spencer Bohrren
Rescue evacuation
1300 found in the attic
27
Myths
of disaster management
Debris
I’m from the government
I am here to help you
You are on your own for 72 hours
There is no help
34 Normal
Years of
Garbage in 3
Months
Hurricanes Gustav and Ike
A new challenge – two hurricanes – two
coasts - back to back
• Orleans Parish hospitals evacuate prestorm
•
– LSU evacuated to other LSU hospitals
– Tulane evacuates to other HCA hospitals
– Ochsner Baptist evacuates to other
Ochsner hospitals
Command and Control
Most important change from Katrina to
Gustav
• Coordinated
command
control
We must
fend forand
ourselves
The government is NOT here to help
• Leadership
• Power and control
• Private (HCA) and Public ( Charity) worked
• Government system (FEMA) did not work
•
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Disaster aftermath
The US Third World
Human Resources
•
•
•
•
•
Medical
Administration
Infrastructure workers
Fatigue
Shift work
Non Human Resources
•
•
•
•
•
•
•
•
•
Power
– Electricity
– Gas
Water
– Potable
– Non Potable
Sanitation
Food
Medication
Equipment
Supplies
Communication
Transportation
29
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• Get
My Plea
involved! Orthopaedist are
needed (IGOT-OTI)
–Hospital emergency preparedness
–Third World volunteerism
Time
Money
Sponsorship
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32
• Proper
Summary
emergency management
planning (Get Involved)
–Food, water, generators, personnel,
patient evacuations, family
• Military
–Security
–Communications
33
New Orleans 2 Years Later
Minimal Rebuilding in Lakeview
• No guarantee levee can with stand level
5 hurricane
• Insurance paid one third of the cost of
the house
• ? Return of the “Soul” of New Orleans
•
What I Wish I Knew
• Planning
(2-3 days to prepare not
plan)
• Indentification/Badge for disaster
• Water/Food
• Family safe
• Communication (satellite phones, ham
radios)
Year 2 “I Wish I …”
Backed up thousands of patients in research
studies
• Taken a greater role in Emergency
Management for the hospital (satellite
communications, evacuation plans, power,
water, security, and staffing)
• Personal emergency preparedness
•
• Ran
Guilty
form New Orleans, ran from
Baton Rouge to Houston
–Appreciation for my patients
34
Guilty
“finddoctordickson.com”
Nice
to see friendly faces in hostile
lands
–Art of medicine (not the business or
science of medicine)
35
Studs Terkel wrote, “Hope
has never trickled down. It
has always sprung up”
36
“Let the city return to the swamp”
Music – The beginnings of Jazz, Blues,
Zydeco, Gospel, Cajun and Creole (Louis
Armstrong “What a Wonderful World”,Fats
“Blueberry Hill”, Aaron Neville “Louisiana
1927”)
• Food – The amalgamation of all countries of
the world
The sounds and the flavors that are yet to be created
•
Although a third of the
population lived below the
poverty line, a culture of free
and collective amusement has
emerged
Mardi Gras 2009
• 1699
French explorer Iberville
• ?Largest preplanned disaster in the
U.S. (maybe world)
• Population 350,000 to 10 million over
2 weeks
37
Final Lesson
•
The best and the worst of humanity
• What
really is Important
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Thank You
40