A robust and extensive guide describes mass casualty planning in the essential areas of emergency medical services, hospital/acute care, alternative care settings, palliative care, and legal/ethical issues. A pandemic influenza case study is included to assist planners in preparing for a pandemic event.
Mass Care
Background
The importance of caring for children plays a significant role in emergency planning; however, children's medical needs are often drastically different than the needs of adults. Children have different vital sign norms and anatomical/physiological characteristics that require a specific age-appropriate approach to emergency care. Children also have mental health and communication needs that correspond to their level of development, and they depend on adults for basic necessities.
Recent public health emergencies in the United States, such as the H1N1 outbreak and Hurricane Katrina, highlighted the important role pharmacists and pharmacies can play in reaching medically at-risk populations. Pharmacists bring a unique set of skills to all-hazards preparedness activities, including accessibility within communities, extended hours of availability, and the ability to identify high-risk patients based on their medication history. Pharmacists are seen as trustworthy health professionals, said Mitchel C.
Background
More than half the US population lives in cities and metropolitan areas. If a public health emergency, such as a bioterrorist attack or a disease epidemic, were to affect one of these areas, a significant number of people would require treatment and/or prophylaxis. CDC’s Cities Readiness Initiative (CRI) funds 72 metro areas to develop plans for providing antibiotics or antivirals to their entire population in the event of a large-scale emergency.
Specific issues
A shortage of healthcare workers is a constant challenge for rural areas of the United States, yet it also may hinder the level of care hospitals and clinics can provide during an emergency. While retired health professionals and other volunteers may be available to augment a healthcare system response, barriers to implementing a volunteer program often include liability concerns and hospitals' ability to meet training requirements.
On May 10, 2010, a massive tornado outbreak occurred in Oklahoma. Over 50 tornadoes touched down within a 36-hour period, and more than 200 homes were destroyed in Pottawattomie County alone. Evening storms and tornadoes resulted in significant human injury, damage to property, and 3 deaths. More than 1,000 people were affected by these storms, including those who lost their homes or sources of income.
In 2010, Tennessee experienced the worst flooding emergency since 1937. Floods had dramatic effects on Tennessean communities, considering that 52 counties were declared disaster areas. Homes and businesses were damaged or destroyed, and 24 citizens lost their lives.
In 2009, the Chicago Fire Department (CFD) identified a need to simultaneously treat multiple stable fire and inhalation victims who require oxygen, whether due to a previous medical condition or as the result of an acute event, such as evacuation of any building, hospital, health care facility or treatment facility, due to fires or other hazards. The solution needed to be mobile, allowing responders to provide oxygen services during emergencies anywhere in the Chicago area.
Community and retail pharmacists possess significant skills that can be useful during an emergency response, including vast knowledge about pharmaceutical effects and interactions and the ability to clinically assess illness. Pharmacy involvement in emergency preparedness and response varies between jurisdictions due to differences in state statutes that define how far a pharmacist's clinical reach can extend.
Wales' report contains useful algorithms and protocols for health care workers who will be performing initial triage during a pandemic. Flow charts of care pathways move toward specific clinical goals for particular populations, including pediatrics, pregnant women, and residents of long-term care facilities. The flow charts and protocols are designed to evaluate the specific needs of individuals in order to provide an optimum level of care with available resources.
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