Tag: PBHE413

The following post was originally written in response to a classroom forum:

For what natural disaster is your local community at highest risk? Considering this information, answer these questions: what are the triage, mass casualty care and public health challenges involved in a response to this disaster? 

If you have had experience in natural disaster response, please share your stories and insights with the class.

It would seem that Harrison County, her two cities, and sparsely distributed communities are at greater risk of flooding events, with other meteorological events following close in ranking. Frequently our communities are faced with flooding events, with the areas of primary concern being Cynthiana, the county seat.  At least once a year Cynthiana is faced with waters rising near, if not above, flood-stage. Often-times the rising waters become more of a hindrance and nuisance rather than a disaster; the closing of one commonly traveled roadway is practically guaranteed, and the potential of damages to structures and land alongside said road is equally frequent.

Floodwaters also provide the potential of rising higher with decent frequency, and causing problems with the lower west-side of Cynthiana, commonly overtaking storm sewers and backfilling into intersections and roadways a few blocks away that lie at a lower elevation than the river banks. At times, this backfill enters into basements, creeps toward homes on the surface, and reduces/removes street access to certain residential areas; similar situations occur in rural areas of the county. Fifteen years ago, however, flood waters challenged the boundaries of the 100-year floodplain, and created quite a bit of trouble for the entire county and her emergency services.

With the threats of flooding—and most natural disasters—there generally occurs issues with transportation; heavily traveled roads may become more congested due to the closing of secondary routes, or vice-versa. In flooding events that are “normal” for this area, congestion is seen on our main highways due to the closing of some secondary streets; during the extraordinary flooding event of 1997, congestion was seen on many single-lane, two-way roads outside of the city limits, due to the closure of two main highways. The blockage of these roadways made travel difficult for emergency vehicles and increased response time. Since that event, measures are taken to stage a temporary “station” for fire and ambulance on the opposing side of the river; both the city fire department and ambulance service take extra precautions to verify that they are equipped and stocked slightly above normal capacity when operating out of this satellite location. Additionally, crews sent to operate in this area are familiarized with alternate routes back to the city and hospital, so as to limit the needs of asking dispatch for directions.

When the potential threat of flooding exists, plans are made in advance—typically two days, up to one week—for the coordinating, opening and operations of shelters for potential victims; these efforts are another example of lessons learned from 1997. Voluntary evacuation of the potentially affected areas occurs 4-12 hours before the expected flood-crest. During these planning and preparation phases all emergency and medical services are notified of the potential risks. Further medical response and preparation for these events has not been tested—to my knowledge—as none of the events since 1997 have caused issues that would specifically impact the local hospital, outside of their concerns of staffing.

Another potential disaster concern for the entire community is that of winter storms bringing large amounts of snow and/or ice. Similar to the effects of flooding, snow/ice have the potential of closing roadways. Again, this issue does not seem to cause the local hospital much concern, other than the potential impact on staffing. Frequently, members of the emergency community volunteer to aid in the transport of nursing staff to the hospital—typically transport is volunteered by the members of Harrison County’s volunteer fire department and the Harrison County Sheriff. As I understand it, the hospital encourages employees to find a location in town to spend the night, or find alternate transportation methods; no other efforts or accommodations are made by the hospital for their staff.

Finally, the most common potential for disaster lies in damages associated with thunderstorm activity. Any thunderstorm may potentially bring damaging winds or tornadic activity, which would again cause issues with transportation and utilities. Similar to the other previously mentioned events, all emergency services plan accordingly.

I realize that I have failed to discuss the challenges associated with a mass casualty event during these potential disasters; I’ve done so, in part, due to the ignorance of the local medical community. To the best of my knowledge, the local hospital has never truly planned for any potential for a disaster beyond the concerns of whether there will be enough staff on hand, “just-in-case”. In my experience of observing a number of disaster exercises—all dealing with other extraordinary hazards outside the norms mentioned—the hospital has never exercised anything other than processing the list of staff and calling off-duty personnel to see if they would be able to give an ETA for response. Not once have I seen or heard of an instance where the hospital has truly tested their abilities beyond their routine operations.

In reality, even the more mundane of events—such as the norms I have listed—have the potential of creating a mass-casualty event. Every disaster mentioned has an effect on transportation to some degree; every transportation issue has the potential of creating any number of traffic accidents. During any one of these events, the potential exists for a traffic accident to involve any number of victims with a variety of injuries and the potential involvement of any chemical; one fully occupied mini-van could potentially inundate our hospital’s emergency room. Unfortunately, it seems that our medical community—save those that respond on-scene—is ignorant of these possibilities, and takes for granted the time for transport locally and involvement of flight-crews from regional hospitals; time associated with ambulance response and transport allows for calling additional staff, while patients being air-lifted are the responsibility of another hospital.

Not meaning to sound grim, or wanting to wish ill upon others, but I would thoroughly enjoy seeing a true mass-casualty event befall our community, just so that the local hospital could see how idiotic and dangerous their smugness truly is.

The following was originally published in response to a classroom forum:

One of the concerns in the emergency preparedness community relates to the ability to rapidly recognize a biological event if it were to occur in a community. This can involve recognition of an unusual cluster of illnesses, such as those spread by contaminated food (salmonella, e. coli, etc). Once recognized, then a determination must be made regarding whether this public health event was a natural occurrence or a man-made, deliberately caused outbreak. Does your community have mechanisms in place for early detection? What are the reporting procedures? Have they been practiced or drilled?

Please note that the majority of this response is speculative and based on assumed or third-hand knowledge, and has not been verified for accuracy…

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To the best of my knowledge, there are not any facilities or agencies within Harrison County equipped or prepared for the early detection of biological terrorism, beyond the normal expectations of doctors and associated clinicians performing general diagnostics and evaluations of symptoms. Our hospital laboratory can process a variety of tests, however many samples are processed at larger metropolitan facilities; I would have to assume that certain biological agents would be amongst these. I will say that I have heard from reliable sources involved in the local medical community that when an initial need for testing occurs, our laboratory evaluates the need for materials and procedures necessary to conduct the tests in house.

Reporting procedures are likely unclear, with respect to alerting the public. Normal procedures of health concerns eventually reach the public in the form of an article published in the weekly newspaper, a memorandum passed along to school-children and discussion on the local radio station’s Monday through Friday morning hour-long talk show. Within recent history our E-911 dispatch center has gained the ability to contact citizens that have opted into an auto-dialing program for notification of varied public concerns; our medical community has not yet had a need to pass along a message to dispatch, though the opportunity exists. All agencies and organizations within the community know that it is possible to contact the broadcast media in Lexington in order to relay the message on their televised newscasts and social media channels. I believe that the medical community knows that notification of the local EM, dispatch center, and government officials are required; whether this would be practiced as policy dictates is unknown—to my knowledge there has never been a drill or exercise related to a bio-terror incident. There have, however been notifications to the public in years past concerning MRSA—notification came in the form of an article in the local paper and memos from the local board of education.

Reporting to higher medical authorities are routinely practiced per policies and regulations; there are, however, frequent hiccups—according to my sources—in the order to which these procedures are to be carried out.

I do know that there are plans in place for possible bio-terroristic events, with the expectation that the event would take place in a different area, and that our community would have to take preventative action. In late 2002, early 2003, our nation became concerned about the possibility of the terroristic release of the variola virus—smallpox—into the population. The entire medical and EM community responded by planning for such an instance, developing plans for distribution centers and prioritizing sectors of officials and the public for inoculation should the President order the release and distribution of the vaccine. In a three-part informational column then Public Health Administrator of the Wedco District Health Department, Dr. Julie W. McKee, described the plans for Harrison County (Barnes, 2003). In the plans, McKee stated that Wedco would initially be responsible for its own staff as would Harrison Memorial Hospital; following the inoculation of respective medical staff, Wedco and HMH would proceed to inoculating members of local emergency services and government. Once the local medical and emergency communities were supplied, two named locations would be opened, staffed by Wedco and HMH personnel, for the purposes of reaching the general public. Fortunately, the need never came; unfortunately—to my knowledge—the plan was never tested.

I do know that this specific plan did bring about discussion amongst emergency services personnel, with many of the agency leaders asking their respective personnel whether they would receive the vaccine should the voluntary inoculation take place—I had been asked if I would partake. Though I cannot remember my exact response, I wouldn’t doubt that I made a joke about the federal cataloging of citizens through smallpox vaccination that had been dreamed up in The X-Files.

Similar plans are in place for other vaccination possibilities—I had heard that the local hospital had established a plan based on the aforementioned smallpox plan during the 2009 H1N1 scare. It would be safe to assume that similar plans would be applied for other incidents, with modifications to include the addition of other vaccination stations—most likely separated by school or voting district.

References

Barnes, B. (2003) Health Officials Plan for Threat of Small Pox. The Cynthiana Democrat. Retrieved October 30, 2012 from: http://harrisonema.com/2003/01/29/officials-plan-for-threat-of-small-pox/

 

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I have no clue if I referenced the articles properly, considering I pulled the three of them from a single page that I published seven years ago… When I re-published the articles I failed to note the exact date of publication; additionally, the Cynthiana Democrat does not offer an online archive for articles prior to December 2007…

The following was written in response to a classroom forum:

Respond to one or both of these questions (respond to the second one only if you have experience with this):

Experience has shown that the hospitals nearest the scene of a disaster are often overwhelmed with self-triaged patients before the first EMS transports are dispatched from the scene. In your opinion, why do the “worried well” seek emergency services during these times, even if they are not sick or injured? How can organizations prepare for this expected influx of non- or mildly injured patients while still retaining the ability to care for the truly injured?

OR

Does your local law enforcement community have a program such as Tactical Emergency Medical Support (TEMS) in place? Have you had experience with it? What are some of the challenges tactical medics face?

There are many reasons as to why anyone classified amongst the “worried well” might seek care during a disaster situation; the most common reasons likely being connected to some incarnation of fear, misinformation, ignorance, or a combination of these elements. If we were to take an individual off the street and poll them on how they would respond to a given scenario, we might find that their response is one that differs from what we—varying members of the emergency community—would necessarily expect or recommend; this is simple ignorance of the proper methods, procedures or actions. The individual would, however, likely supply some sort of response based on the level of knowledge they possess of the given scenario, or some similar situation, referring to their simplest and most basic training in life—which, in this case, would likely be to seek immediate assistance from a professional.

To the medical professionals in this course—you have likely seen, responded, or worked on cases where a patient did not need treatment—or if they did, it could have came from a first-aid kit or a trip to the corner drugstore. Many of these patients may have been ignorant to the simplicity of their injury/ailment; some may have been knowledgeable—or would have been—had they not been influenced by the situation in some manner, triggering a flash of fear and confusion.

[Fear, confusion and other emotional responses can come at odd times and have quite an effect on our behavior. I had known a person that had broken their arm, and responded to it with an “Awe, cool!” mentality, chasing their siblings with a wildly flailing arm. Later in life, that very same person fainted from the sight of the pinkish skin he revealed on a finger after pulling back and ripping off a nail-cuticle. An odd tale–but one that shows how an individual can react differently to varying stimuli. In this tale, we can see how a single person may calmly respond and await treatment—arm flailing—or seek immediate treatment—cuticle—based upon their reaction to the event.]

To the parents of multiple children in this course—how many times did you rush your first-born infant or toddler to the hospital? Did you transport the child in your personal vehicle or await an ambulance? Did your next child make as many trips to the ER, or had you changed your perception of an emergency? Initial responses to a new situation, such as the care of a child are heightened, where there may not be a base of comparison or a personal knowledge-bank.

[Picture this one—your first-born infant is spiking a nice temperature. You do have knowledge that Tylenol can bring it down; you even have a bottle or two in the medicine cabinet; yet the sight and sounds of the baby in discomfort wipes your memory of this information. What do you do?—you likely respond by seeking a professional, either through calling a doctor, a family member, or by loading the babe in the car and driving to the hospital—and if you drove, it’s because you ‘knew’ that an ambulance wouldn’t come fast enough. Now, with the third or fourth kid, you simply mutter to yourself, grab a doser, and sigh when that sticky pink fluid drips down junior’s chin and all over that clean Onesie…]

With these examples of everyday possibilities to facing the “worried well”, we can understand how the numbers may grow in disaster situations—when people may be relatively fine or unharmed. Facilities must expect that there will be a greater influx of these patients as well as patients in true dire need of assistance. In order to prepare for these scenarios, the involved organizations must work to establish a triage system in which all patients can be evaluated and prioritized according to medical condition. Unfortunately, these efforts are only as effective in relation to the numbers of staff and personnel available, the size of any facilities involved, and the number of patients that arrive. Additionally, efforts will be affected by the communication between any agencies involved, whether any plans laid out are followed, and the unknowns involving the patients/public themselves/itself.

In communities where more than one hospital or medical center exist, multiple locations can be coordinated and organized for the receipt of the varying levels of trauma; clinics and related facilities may be used for low-priority trauma and first-aid, while larger hospitals are reserved for high-priority cases. Organizing, designating and publicizing such locations in such a manner would greatly reduce some of the headaches associated with a massive event; however, there would still be issues related to members of the public incorrectly identifying their injuries to either extreme, or bypassing a designated location out of personal preference. Staffing requirements and transportation may become an issue as well.

With regard to those persons who are more-or-less in a state of shock, suffering little to no injury at all, medical centers would need to respond with staffing persons able to handle the psychological aspects of disaster. Supplying a psychological support staff might be easier than it seems—as many of the patients are in a shock state and not necessarily psychotic, it would be possible to train additional staff in disaster psychology—support staff such as secretaries, housekeeping and maintenance, as well as staff from other supporting emergency services could be utilized to calm and speak with the patients.

In every aspect of the disaster situation, the medical community might benefit from establishing a medical reserve corps or nurses auxiliary; keeping in good contact with such reserves and inclusion of these additional resources in planning and exercises would be mandatory for successful operation and organization, however.

The following was originally written in response to a class forum:

In this Forum, please introduce yourself to the class. You may include such things as the type of work you do, your organization or branch of service, where you live, how far along you are on your degree path, family, interests, etc.–anything that will allow us to know you better.

Secondly, please tell me about your goals for this course. What did you think about when you saw the title of this course and registered?

Your initial Forum post must be a minimum of 250 words, and must be submitted by Sunday of Week 1.

Call me Ishmael.

No, actually, don’t call me Ishmael—that’s not my name; but it’s a catchy first line! It’s also the extent of what I know of Moby Dick…

My name is Jeremiah—if you somehow missed seeing the title and author lines of this post. I’m in my early thirties, and haven’t done much with my life, aside from raising a family and attending school. I live in a quiet little town in Kentucky, called Cynthiana—maybe you’ve heard of it, there’s some sort of fictional cop turned zombie hunter from here.

I play around with the local EM from time to time, maintaining all the social media outlets as best as I can—voluntarily, and frequently from my phone. I’ve helped out in a few disasters—potential ones, more than actual ones—usually in a clerical or “gopher” capacity. I’ve been volunteering with the local EM for about ten years, became interested through my dad—he’s been attached to the agency for about twenty, director for the past eight.

Honestly, when I first saw this course, I thought something along the lines of, “Aw, cool! Mom’s gonna like this one!” My mother is an RN at the local hospital—ICU and TCU, with the fun of pulling house every couple of weeks and the occasional ER duties. Though she’s enjoyed hearing me speak about the varying topics I’ve covered in previous courses, I thought she might find it entertaining to hear me speak about a class that has a dose of medical information included.

I really can’t think of much more to say about myself, family or schooling, so feel free to Google me if you’re curious; the full name is Jeremiah Hall Palmer and the Internet handle is my amateur license, KG4VMA.