Public Health and Healthcare Issues
Public Health and Healthcare
Mass Casualty Events
Produce large number of patients quickly
Surge of patients with severe and minor injuries can rapidly stress the healthcare system and first receivers
The majority of injured self report to healthcare facilities
Injured report to the closest hospitals to the event
Radiation Mass Surge Event
Radiation further complicates response and adds additional stress to a stressful situation
Radiation raises the fear of contamination in staff who have little understanding of radiation
Radiation increases the number of worried well wanting medical evaluation and monitoring
Perspective on Mass Surge
It is estimated that 10% of the total population will want to be screened for radioactivity exposure
Psychological trauma is the driving force
Fukushima, Japan 2011
200,000 of a population of 2 million people were scanned and evaluated for contamination
Fear of contamination Fear of health consequences
Goiania, Brazil 1987 249 people found significantly
contaminated112,000 were evaluated and
screened
Tokyo Sarin Attack
Saint Luke’s International Hospital 27% of staff contaminated 526 victims Over 5000 evaluated Majority psychological
CDC Guiding Principles First priority is to save lives and treat the
injured first
Contamination with radioactive materials is not immediately-life treating
Initial population monitoring activities should focus on preventing acute radiation health effects
Scalability and flexibility are an important part of the planning process
CDC Guiding Principles Continued
Fear of radiation is high, higher than with other agents of terrorism
Radiological decontamination differs from those for chemical agents
Law enforcement agencies will be involved in response to a radiological terrorism event
Roles and Responsibilities of
Public Health CDC lists 15 responsibilities for federal,
state and local Public Health “As a general rule, during the initial stages of
the incident local and state officials should be prepared to handle the crisis without federal
assistance”
(CDC Population monitoring in Radiation Emergencies)
Roles and Responsibilities
Protecting the public’s health
Monitoring workers health and safety
Ensuring safe shelters for the population Ensuring the safety of food and water
Coordinating sampling and laboratory analysis of bio and environmental samples
Conducting field investigations
Monitoring people who may have been contaminated with radioactive materials or exposed to radiation
Conducting or assisting in decontamination
Recommending management protocols for affected populations or individuals
Hospital Mass Surge Issues
Patients arrive before the event is recognized as radiological by first responders
Contamination of the ER occurs before the event is recognized as radiological
Staff ill prepared to deal with radiological effected patients
Correct staff not presentSurge of worried well stresses facility’s
ability to care for the seriously injured
Hospital Mass Surge Issues
Hospital staff lack the ability to communicate with the massive crowds of people
Staff fearful of radiation and the large crowds seeking care
Limited decon capabilities and limited ability to scan patients for radiation
Traffic management issues, abandoned cars, contaminated cars
The Role of Community Reception Centers
To divert people with minor or no injuries away from the hospital for scanning and counseling
To decrease the impact of surge on patient care and hospital staff
To identify people who may need immediate assistance----decontamination, medical attention, psychosocial needs
Objectives of MonitoringIdentify individuals whose health is in
immediate dangerIdentify people who may need medical
treatment for contamination or exposureTo try to minimize future health for long term
health monitoringRegister potentially affected populations for
long term health monitoring
Security NeedsTraffic management at hospitals and
Reception CentersSecurity of facilities inside and on groundsRisk of facility contaminationThreatening environment to staff responding
to the incidentRisk as a secondary target
Why Security for Hospitals
Represent critical infrastructure in their community
Symbols of safety and security for a community being affected by a mass casualty event
To ensure safety of staff while providing care to the surge of patients
To facilitate traffic flow, campus lock down, facility lock down
Why Reception Center Security
Traffic managementCrowd containment and managementSafety of staff and patientsSecondary targetLimit access to the facility and groundsSecurity of personal belongings