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Emergency Preparedness. Emergency Preparedness. David McCann BSc MD CCFP FAASFP Centre for Excellence in Emergency Preparedness Flu Assessment Centre Coordinator, City of Hamilton Chair, American Board of Disaster Medicine Incident Commander, Ontario EMAT Chief Medical Officer, FL-1 DMAT. - PowerPoint PPT Presentation
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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
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.
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
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
Phase 3 Transfer PhaseDirect EMS to
patientCall hospital EDSign over to EMSGather written
transfer materials, flowsheet/summary
Transfer to definitive care
Phase 4 DebriefingDebrief team immediatelyHold delayed team meeting and debriefingHow did we do?What did we do well?What could we have done better?
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
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
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....