Harvard University Disaster & Mass Casualty Management in A Hospital Reflection Paper Write your Implications and Reflections on the TWO pages article atta

Harvard University Disaster & Mass Casualty Management in A Hospital Reflection Paper Write your Implications and Reflections on the TWO pages article attached here.write about one page and expand as needed, make sure you cover everything and give new ideas, argue with the author, give your opinions, ADD more knowledge into the article, disagree if you want and support your side of the argument.Write as a STUDENT, Make sure you write naturally like you are speaking, don’t make it so official, make it informal. �
Disaster and mass casualty management in a hospital:
How well are we prepared?
Mehta S
Emergency Medicine
Section, Department of
Internal Medicine, Seth
G.S. Medical College &
K.E.M. Hospital, Parel,
Mumbai – 400 012,
Sanjay Mehta
PubMed ID
J Postgrad Med 2006;52:89
isaster scenarios once seemed merely theoretical have become a disturbing reality. Disasters
in the communities come in all the shapes and sizes. Some impact a small number of
people and put intense demands on the health system for a short period. Others may involve a
large number of casualties but reach a plateau only after a latent period, placing heavy continuing
demands on the health system. For some natural disasters like hurricanes, floods and volcanoes—
hospitals are likely to receive advance warning and be able to activate their disaster plan before the
event. For other natural disasters, such as earthquakes and tsunami, there is no advance warning,
as of now. Many man-made disasters also provide no advance warning; these include chemical
plant explosions, industrial accidents, building collapses and acts of terrorism.[1] The emergence of
state-sponsored terrorism, proliferation of chemical and biological agents, availability of materials
and scientific weapons expertise all point toward a growing threat of a mass casualty incident
(MCI). Preparing for MCIs is a daunting task, as unique issues must be considered with each type
of event.[2] For example, the systemic stress of a bio-threat is entirely different from that of a chemical
disaster. These differences hold challenging implications for the hospital preparedness and training.
The hospital disaster preparedness has therefore taken on an
increased importance at local, state and national levels.
Hospitals would be among the first institutions to be affected
after a disaster, natural or man-made. Because of the heavy
demand placed on their services at the time of a disaster,
hospitals need to be prepared to handle such an unusual
workload. This necessitates a well documented and tested
disaster management plan (DMP) to be in place in every
hospital. To increase their preparedness for mass casualties,
hospitals have to expand their focus to include both internal
and community-level planning. The disaster management plan
of a hospital should incorporate various issues that address
natural disasters; biological, chemical, nuclear-radiological and
explosive-incendiary terrorism incidents; collaboration with
outside organizations for planning; establishment of alternate
care sites; clinician training in the management of exposures
to weaponizable infectious diseases, chemicals and nuclear
materials; drills on aspects of the response plans; and
equipment and bed capacity available at the hospital.[3] The
most important external agencies for collaboration would be
state and local public health departments, emergency medical
services, fire departments and law enforcing agencies. The key
hospital personnel should be trained to implement a formal
incident command system, which is an organized procedure
for managing resources and personnel during an emergency.
The hospitals should also have adequate availability of personal
protective hazardous materials suits, negative pressure isolation
rooms and decontamination showers. A hospital’s emergency
response plan has to be evaluated whether that plan addresses
these issues. The hospitals in USA are required to have disaster
response plans to be accredited by the Joint Commission on
J Postgrad Med April 2006 Vol 52 Issue 2
Accreditation of Healthcare Organizations (JCAHO). [4] In
India and probably in many other countries, there is no
statutory body to regulate and accredit this requirement.
While responding to a mass casualty event, the goal of the
health and medical response is to save as many lives as possible.
Rather than doing everything possible to save every life, it will
be necessary to allocate limited resources in a modified manner
to save as many lives as possible. When a hospital responds to
a large number of victims presenting over a short time, often
without a prior warning, delivering care to the level of usual
hospital standards or benchmarks may not be possible and
“altered standards” may have to be acceptable. The term
“altered standards” has not been defined, but generally is
assumed to mean a shift to providing care and allocating scarce
equipment, supplies and personnel in a way that saves the
largest number of lives in contrast to the traditional focus on
saving individuals. For example, it could mean applying
principles of field triage[5] to determine who gets what kind of
care. It could mean changing infection control standards to
permit group isolation rather than single person isolation units.
It could mean limiting the use of ventilators to surgical
situations. It could mean creating alternate care sites in the
waiting area, lobby or corridors which are not designed to
provide medical care; minor surgical procedures in victims in
these areas could mean altered level of asepsis. It could also
mean changing who provides various kinds of care like
enhancing the scope of nurses, physician assistants and hospital
paramedics. Secondary triage also may be necessary within
hospital, as demands on the system grow. Hospital DMP should
consider the possibility that a hospital might need to evacuate
partially or wholly, quarantine, or divert incoming patients. For

Mehta S: Disaster and mass casualty management in a hospital
example in the event of flooding, the ground floor services may
need shifting to higher floors or a make shift operation theatre
may be needed. Spare capacities for such contingencies should
be included in the DMP.
One of the key components of an effective health and medical
care response is ensuring adequate supplies of a broad array of
qualified health care providers who are available and willing to
serve in a MCI.[6] This could mean re-allocating non emergency
and non-clinical doctors to emergency area of the hospital and
recruiting retired or unemployed providers for temporary
service. The traditional separation between the medical care
community (e.g, hospitals, physicians and nursing homes) and
the public health community needs to be bridged in
preparation for mass casualty incidents. Mass casualties will
provide more work than any organization itself can address.
Coordination is the key and the historic separation is a genuine
disadvantage. Several strategies help ensure protection of staff
handling disasters e.g. safety measures including personal
protective equipment, prophylaxis, training specific for
different events, adequate back-up staff for rotation to prevent
burnout and fatigue related errors and care of families of staff.
A wide range of training of hospital staff is needed to ensure
an effective health and medical response to a mass casualty
event.[6] Training should include, but not limited to, general
disaster response, including an introduction to altered
standards of care; legal and ethical basis for allocating scarce
resources in a MCI; orientation to how an incident command
system would work in a mass casualty event; how to recognize
the signs and symptoms of specific hazards and treat specific
conditions; basic and advanced life support; hazardous
materials (HAZMAT) life support; decontamination and
isolation protocols, triage protocols; personal protection gears;
and use and maintenance of emergency equipment.
Preparedness for disasters is a dynamic process. In addition to
having a well documented DMP in place, it is prudent to have
regular drills to test the hospital’s DMP. The drills may be hospital
disaster drills, computer simulations and tabletop or other
exercises.[2] In India, hospitals rarely have a documented DMP
and even rarely conduct disaster drills or publish the reports of
such drills. The JCAHO actually requires hospitals to test their
emergency plan twice a year, including at least one community­
wide drill.[7] The purpose of the hospital disaster drills is to train
hospital staff to respond to an MCI, to validate the readiness
and effectiveness of the hospital’s DMP, to make new hospital
staff to become aware of procedures in disaster response, to
incorporate advancements in knowledge and technology into
the DMP and to use the reports from the drill to reinforce the
DMP. Hospital disaster drills should test various components
viz incident command, communications, triage, patient flow,
drugs and consumables stock, reporting, security and other
issues. Survey of some published articles on disaster drills[8-10]
have highlighted that internal and external communications
were the key to effective disaster response; a well-defined incident

command center reduced confusion; conference calls were an
inefficient way to manage disaster response; accurate phone
numbers for key players were vital and regular updating was
necessary; disaster drills appeared to be an effective way to
improve clinicians’ knowledge of hospital disaster procedures;
computer simulation may be an economical method to educate
key hospital decision makers and improve hospital disaster
preparedness before implementation of a full-scale drill; a
tabletop exercise can help to motivate hospital staff to learn
more about disaster preparedness and can help to teach staff
about aspects of disaster-related patient care in a way that
simulates the practice setting; a regional exercise involving top
government officials can help to increase awareness of the need
for better disaster response planning; and video demonstrations
may be an inexpensive, convenient way to educate a large
number of staff about disaster procedures and equipment use
in a short time.
The hospital’s patient care role begins with and follows the
disaster. The hospital’s community service role begins long
before the disaster as the hospital develops, tests and
implements its disaster plan.[1] The objective is to prepare
the hospital through the development of emergency response
systems, staff training and purchase of equipment and
materials so that it can continue caring for its present patients,
protect its own staff and respond to the needs presented by
the disaster. Finally, hospital preparedness can be enhanced
more rapidly if standardized state and national guidelines for
model hospital DMP, staff training, disaster drills and
accreditation of hospitals based on DMP are developed and
widely disseminated.
Hospital Preparedness for Mass Casualties, Final Report, by the American
Hospital Association with the support of the Office of Emergency
Preparedness, U.S. Department of Health and Human Services, August 200;
accessed 2006, April 3.
Hsu EB, Jenckes MW, Catlett CL, Robinson KA, Feuerstein CJ, Cosgrove SE,
et al. Training of Hospital Staff to Respond to a Mass Casualty Incident.
Summary, Evidence Report/Technology Assessment No. 95. (Prepared by
The Johns Hopkins University Evidence based Practice Center.) AHRQ
Publication No. 04-E015-1. Rockville, MD: Agency for Healthcare Research
and Quality. April 2004; accessed 2006, April 3.
Niska RW, Burt CW. Bioterrorism and mass casualty preparedness in
hospitals: United States, 2003. Advance data from vital and health statistics;
no 364. Hyattsville, MD: National Center for Health Statistics. 2005; accessed
2006, April 2.
Joint Commission on Accreditation of Healthcare Organizations.
Comprehensive Accreditation Manual for Hospitals: The Official Handbook.
Joint Commission Resources: Oakbrook Terrace, IL; 2003. p. EC-21.
Burkle FM. Mass casualty management of a large-scale bioterrorist event:
an epidemiological approach that shapes triage decision. Emer Med Clin N
Am 2002;20:409-36.
Altered Standards of Care in Mass Casualty Events. Prepared by Health
Systems Research Inc. under Contract No. 290-04-0010. AHRQ Publication
No. 05-0043. Agency for Healthcare Research and Quality: Rockville, MD;
2005: p. 7-13; accessed 2006, April 3.
Joint Commission on the Accreditation of Healthcare Organizations.
“Standard EC.1.6: Emergency Preparedness Plan.”
Cook L. Hospital disaster drill game: a strategy for teaching disaster protocols
to hospital staff. J Emerg Nurs 1990;16:269-73.
Levi L, Bregman D, Geva H, Revach M. Hospital disaster management
simulation system. Prehosp Dis Med 1998;13:29-34.
Inglesby TV, Grossman R, O’Toole T. A plague on your city: observations
from TOPOFF. Clin Infect Dis 2001;32:436-45.
J Postgrad Med April 2006 Vol 52 Issue 2

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