Disaster Preparedness

=Objectives=

Definitions

 * Disaster -
 * “A sudden ecological phenomenon of sufficient magnitude to require external assistance.” . “Disasters are exceptional events which suddenly kill or injure large numbers of people.”  A disaster is any event that requires a local jurisdiction to request aid from an external source.


 * Hospital Disaster
 * A hospital disaster is any event that overwhelms the resources of a hospital or overwhelms a hospital’s ability to appropriately care for patients. A "disaster" activates a centralized planning committee.  May occur 30 time per year at a regional hospital like OHSU.


 * Disaster Planning
 * Systematic approach to disaster response using the most likely or devastating events as a template for the design of an emergency operations plan, education, training, and exercises.


 * Surge Capacity
 * The ability to manage a sudden, unexpected increase in patient volume that would otherwise severely challenge or exceed the current capacity of the health care system. For example, an ICU may have 4 negative pressure rooms, however, to meet a surge, the entire 12K ward can become negative pressure at surge capacity.


 * Bioterrorism
 * use of micro-organisms (pathogens) or the products of living organisms (toxins) to inflict harm on a wider population, including animals and crops.

Compare and contrast the community response to natural disasters, man-made disasters, and a pandemic

 * Natural disaster
 * threat is rapidly identified, enact preformed response plan (ie earthquake, flood)
 * requires health workers cooperation and commitment
 * importantly, unaffected communities can extend support
 * Man-made disaster
 * Nature of threat is unknown (ie will terrorist strike again)
 * Unknown whether treat will continue (ie if one gas line exploded, could other gas lines explode, too?)
 * spokespersons must provide clear, consistent messages
 * Pandemic
 * spokespersons must provide clear, consistent messages about the disease including actions to contain and treat the illness
 * homecare can be important as hospitals can be overwhelmed
 * similar to natural disasters, health workers are essential
 * in contrast to natural disasters, all communities may be affected at once

Ethical issues/dilemmas during a pandemic

 * shortage of pharmaceuticals, ventilators, respirators must be prepared to ration in an equitable fashion
 * planning for production increases and stockpiling drugs and equipment can prevent some ethical dilemmas from surfacing
 * communication strategy must balance the need to inform citizens and help them take action without alarming or causing mayhem.
 * patients need to be discharged from the hospital to accomodate the influx of critically injured patients in a disaster
 * health care workers face the dilemma of staying on their shift versus going home to make sure their family members are safe (eg in an earthquake).

Describe the significance of H5N1 virus

 * (This objective was obviously written before knowledge of H1N1)
 * H5N1 also known as "bird flu", is a subtype of the Influenza A virus which can cause significant illness in humans and many other animal species. It is considered an avian disease, but evidence exists for limited human-to-human transmission of the virus at this point.  When it infects humans it's associated with significant morbidity and mortality.  The first is that H5N1 may mutate or re-assort into a strain capable of efficient human-to-human transmission, posing a significant risk of pandemic due to the high mortality and low immunity in the population.

Describe the classification system used by the CDC for defining bioterror agents

 * A complete description is succinctly reproduced at The CDC website for bioterror agent classification
 * Infectious agents are classified from A (greatest threat) to C (lowest threat)
 * Example: Class A agents
 * The U.S. public health system and primary healthcare providers must be prepared to address various biological agents, including pathogens that are rarely seen in the United States. High-priority agents include organisms that pose a risk to national security because they
 * can be easily disseminated or transmitted from person to person;
 * result in high mortality rates and have the potential for major public health impact;
 * might cause public panic and social disruption; and
 * require special action for public health preparedness.

What happens at OHSU in a big disaster

 * OHSU Emergency Management Committee:
 * Multi-disciplinary group
 * Designs and implements all aspects of OHSU health system’s disaster planning
 * Purchase/funding for equipment
 * Design and implementation of education, training, and exercises
 * Design, updating, optimizing the EOP •Hazard Vulnerability Analysis
 * Hazard Vulnerability Analysis – systematic evaluation of threats that are:
 * Most likely to occur or…
 * Most likely to inhibit OHSU’s ability to care for patients
 * Threats to OHSU
 * Little threat from natural disasters – earthquakes?
 * Influenza
 * Loss of essential utilities: water, telecommunications, Internet, phone, medical
 * Who do I report to?
 * Administrator on duty (AOD), Office manager/disaster planner, County Public Health Officer on call Gases
 * OHSU Medical Students
 * Students in the 3rd and 4th years who are assigned to clinical responsibilities should report to that clinical area
 * Students in the lecture-based years (1st and 2nd) should assume that classes are continuing unless notified otherwise
 * In a disaster that overwhelms the resources of OHSU, students in lecture-based years may be permitted to volunteer ONLY by declaration of the Dean of the SOM
 * In short, stay out of the way. Leave disaster work to employed professionals.

=Links & References=