Episode 100 Disaster Medicine

Disaster medicine is the “universal subspecialty”. Why? Because all physicians could be called upon to help their communities in times of crisis, and because disaster medicine is the ultimate team sport. Emergency Medicine is particularly well suited to take a lead in disaster medicine. We own this. A medical disaster is the response to an event that by definition is going to outstrip the resources you have. However, what constitutes a disaster may differ depending on hospital resources, the time of day, whether or not the hospital has been damaged by the disaster itself, and whether or not the impact of the disaster is contained or not. In this EM Cases podcast, with the help of Laurie Mazurik, Daniel Kollek and Joshua Bezanson we will help you become familiar with a general approach to mass casualties, how to handle critical infrastructure disruption in your ED, management of biohazards including airway management, chemical hazards including decontamination and finally evacuation principles in the case of a natural disaster... 0-25 mins  Overview: Tips on surviving a disaster 25-43 mins  Triaging and leadership in disaster medicine 43-59 mins  ED and hospital evacuation and transport considerations in natural disasters 59-1:19   Chemical threats and decontamination principles 1:17-1:23  Airway management in high risk biohazard threats 1:23-1:29  How do we get better?    . Podcast production by Joshua Beznason & Anton Helman, sound design & editing by Anton Helman Written Summary and blog post by Anton Helman, edited by Daniel Kollek & Laurie Mazurik Sept, 2017 Cite this podcast as: Helman, A, Mazurik, L, Kollek, D, Bezanson, J. Disaster Medicine. Emergency Medicine Cases. September, 2017. https://emergencymedicinecases.com/disaster-medicine/. Accessed [date]. Initial general approach to mass casualties in disaster medicine 1. Confirm that there are emergency casualties and get an estimate of the number of casualties. 2. Team huddle: Share the information that you have with your team. 3. Notified the hospital administrator on-call who will activate a hospital wide disaster plan (in Canada, a code Orange) so that all departments can halt all non-essential services, conserve resources, and prepare for the surge. 4. Deactivate nonessential and non-emergency services in order to create capacity. TDAD SAD mnemonic for disaster medicine preparedness When the surge arrives in your ED: Triage & Treat: Triage only CTAS (in Canada) or SALT (see below) 1 (red) and 2 (yellow) patients into the ED. Divert CTAS 3-5 or SALT Green to a non-ED area for assessment; preferably a family practice unit or urgent care unit. See the SALT categories and algorithm below. Discharge: Make an immediate determination about which patients are safe to be discharged from the ED either home or to another part of the hospital. This starts before people arrive and continues throughout the surge. Keep your discharge review cycle short e.g. round q1-4hrs to identify those ready for discharge. Admit: Any patients requiring admission in the ED go expeditiously to hospital floors and if necessary become their "hall" patients if no beds are available. All hospital floors should have a plan for surge capacity and open areas or increase the number of patients per room etc. in order to alleviate pressure on the ED. Demand: Demand that the rest of the hospital become involved. All departments need to open their plans for active participation in the disaster code. SAD: Spend less time per patient.