EDMG541Wk3
3 years ago 6
Mass-CasualtyIncidentManagement_ClinicalIssues.pdf
PersonalProtectiveEquipment_USEPA.pdf
AnAnalysisoftheRelationshipBetweentheHeatIndexandArrivalsintheEmergencyDepartment-PubMed.pdf
Mass-CasualtyIncidentManagement_ClinicalIssues.pdf
Mass-Casualty Incident Management: Clinical Issues In Week 3 we examine logistical, organizational, and communication issues in the clinical management of Mass Casualty Incidents.
When we think of clinical issues, we must start at the event site and work our way to recovery. To do this, we will have a network of paths that will work independently and interdependently to recover patients, scene, community, and disaster responders.
From a scene perspective, we now have fire, EMS, and police, as well as the potential for nurses and doctors to all converge upon the scene and operate to rescue, treat, and transport mass casualty victims. As noted in content 2, this organization will occur under the ICS system, but because we can have physicians, nurses, and other medical professionals working in the field, the protocols and medical actions may contraindicate the normal ICS structure and pre-arranged protocols utilized by police, fire, and EMS. This coordination will become important as decisions made at the scene will have downstream effects on hospitals, police investigations, and community recovery efforts.
Currently there are various thoughts on where the centralization of command should reside in a mass casualty event. This is further complicated by the use of unified command needed for active shooter/active violence events. The best practice involves the use of an emergency operations center to allow coordination of the various centralized command structures that will exist at the scene, in the hospitals, and in community government. Attendance at the FEMA G191 EOC/ICS interface course can help to understand the coordination needed to keep all parts of a mass casualty coordinated.
Patient Flow issues are related to surmounting a large patient influx and the communication process necessary to determine resource allocation and forecast patient volumes. The knowledge of patient flow patterns is critical to disaster planning. Recent funding challenges due to no elective surgeries have places some hospitals in a position that creates subpar staffing daily.
In Mass Casualty Incidents, the creation of the Discharge Unit should be on the same level of importance as the delineation of the Command Center. Without the Discharge Unit the patients will languish and the hospital will compromise the ability to provide further care for incoming patients. In a disaster, no patient should leave the hospital without passing through Discharge unit.
Without a properly planned physical plant design for the emergency department, the performance of a successful disaster mitigation strategy is challenged. Failure to take the special requirements for Mass Casualty Incidents into account will present unanticipated problem when a Mass Casualty Incident occurs. The key in disaster management architectural planning is whiter the proposed design will allow for appropriate patient flow.
The new information management systems enhance patient management and allow hospitals and other health care and emergency services provides to communicate with hospital core Health Information System. It also enable the implementation of the National Network for Real-time Syndromic and Bioterrorist Surveillance Systems.
Victim lists are essential tools for hospital response. Victim lists are required, not only to identify victims that have come into the hospital but also to identify casualties brought to multiple other sites during a disaster. Lists are often electronic in nature and require the systems to function at the time of a disaster. Plan accordingly.
PersonalProtectiveEquipment_USEPA.pdf
Related Topics: Emergency Response <https://epa.gov/emergency- response>
CONTACT US <https://epa.gov/emergency-response/forms/contact-us-about-emergency-response>
Personal Protective Equipment Vapors, gases, and particulates from hazardous substance response activities place response personnel at risk. For this reason, response personnel must wear appropriate personal protective clothing and equipment whenever they are near the site. The more that is known about the hazards at a release site, the easier it becomes to select personal protective equipment. There are four levels of personal protective equipment.
Level A protection is required when the greatest potential for exposure to hazards exists, and when the greatest level of skin, respiratory, and eye protection is required. Examples of Level A clothing and equipment include:
positive pressure, full face-piece self contained breathing apparatus (SCBA) or positive pressure supplied air respirator with escape SCBA;
totally encapsulated chemical- and vapor-protective suit;
inner and outer chemical-resistant gloves; and
An o�icial website of the United States government
MAIN MENU
Search EPA.gov
disposable protective suit, gloves, and boots.
Level B protection is required under circumstances requiring the highest level of respiratory protection, with lesser level of skin protection. At most abandoned outdoor hazardous waste sites, ambient atmospheric vapors or gas levels have not approached su�iciently high concentrations to warrant level A protection. Examples of Level B protection include:
positive pressure, full face-piece self contained breathing apparatus (SCBA) or positive pressure supplied air respirator with escape SCBA;
inner and outer chemical-resistant gloves;
face shield;
hooded chemical resistant clothing;
coveralls; and
outer chemical-resistant boots.
Level C protection is required when the concentration and type of airborne substances is known and the criteria for using air purifying respirators is met. Typical Level C equipment includes:
full-face air purifying respirators;
inner and outer chemical-resistant gloves;
hard hat;
escape mask; and
disposable chemical-resistant outer boots.
Level D protection is the minimum protection required. Level D protection may be su�icient when no contaminants are present or work operations preclude splashes, immersion, or the potential for unexpected inhalation or contact with hazardous levels of chemicals. Appropriate Level D protective equipment may include:
gloves;
coveralls;
safety glasses;
face shield; and
chemical-resistant, steel-toe boots or shoes.
While these are general guidelines for typical equipment to be used in certain circumstances, other combinations of protective equipment may be more appropriate, depending upon specific site characteristics.
Contact Us <https://epa.gov/emergency-response/forms/contact-us-about-emergency-response> to ask a question, provide feedback, or report a problem.
LAST UPDATED ON OCTOBER 5, 2023
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AnAnalysisoftheRelationshipBetweentheHeatIndexandArrivalsintheEmergencyDepartment-PubMed.pdf
An official website of the United States government Here's how you know
. 2015 Oct 29:7:ecurrents.currents.dis.64546103ed4fa0bc7c5b779dd16f5358. doi: 10.1371/currents.dis.64546103ed4fa0bc7c5b779dd16f5358.
An Analysis of the Relationship Between the Heat Index and Arrivals in the Emergency Department
Matthew Levy , Morgan Broccoli , Gai Cole , J Lee Jenkins , Eili Y Klein
Affiliations PMID: 26579329 PMCID: PMC4635022 DOI: 10.1371/currents.dis.64546103ed4fa0bc7c5b779dd16f5358 Free PMC article
���� ���� �����
PLoS Curr
1 2 1 1 3
Abstract
Background: Heatwaves are one of the most deadly weather-related events in the United States and account for more deaths annually than hurricanes, tornadoes, floods, and earthquakes combined. However, there are few statistically rigorous studies of the effect of heatwaves on emergency department (ED) arrivals. A better understanding of this relationship can help hospitals plan better and provide better care for patients during these types of events.
PubMed Disclaimer
Methods: A retrospective review of all ED patient arrivals that occurred from April 15 through August 15 for the years 2008 through 2013 was performed. Daily patient arrival data were combined with weather data (temperature and humidity) to examine the potential relationships between the heat index and ED arrivals as well as the length of time patients spend in the ED using generalized additive models. In particular the effect the 2012 heat wave that swept across the United States, and which was hypothesized to increase arrivals was examined.
Results: While there was no relationship found between the heat index and arrivals on a single day, a non-linear relationship was found between the mean three-day heat index and the number of daily arrivals. As the mean three-day heat index initially increased, the number of arrivals significantly declined. However, as the heat index continued to increase, the number of arrivals increased. It was estimated that there was approximately a 2% increase in arrivals when the mean heat index for three days approached 100°F. This relationship was strongest for adults aged 18-64, as well as for patients
Additionally, a positive relationship was noted between the mean three-dayarriving with lower acuity. heat index and the length of stay (LOS) for patients in the ED, but no relationship was found for the time from which a patient was first seen to when a disposition decision was made. No significant relationship was found for the effect of the 2012 heat wave on ED arrivals, though it did have an effect on patient LOS.
Conclusion: A single hot day has only a limited effect on ED arrivals, but continued hot weather has a cumulative effect. When the heat index is high (~90°F) for a number of days in a row, this curtails peoples activities, but if the heat index is very hot (~100°F) this likely results in an exacerbation of underlying conditions as well as heat-related events that drives an increase in ED arrivals. Periods of high heat also affects the length of stay of patients either by complicating care or by making it more difficult to discharge patients.
Figures
Figure 1: Boxplot of Arrivals per Day…
Figure 2: Histogram of Daily Maximum Heat…
Figure 3: Scatterplot of arrivals per day…
Figure 4: Generalized Additive Model Analysis of…
Figure 5: Generalized Additive Model Analysis of…
Figure 6: Generalized Additive Model Analysis of…
All figures (8)
Related information
PMC images
LinkOut - more resources
Full Text Sources
Europe PubMed Central PubMed Central Public Library of Science
Research Materials
NCI CPTC Antibody Characterization Program
Miscellaneous
NCI CPTAC Assay Portal
Mass-CasualtyIncidentManagement_ClinicalIssues.pdf
Mass-Casualty Incident Management: Clinical Issues In Week 3 we examine logistical, organizational, and communication issues in the clinical management of Mass Casualty Incidents.
When we think of clinical issues, we must start at the event site and work our way to recovery. To do this, we will have a network of paths that will work independently and interdependently to recover patients, scene, community, and disaster responders.
From a scene perspective, we now have fire, EMS, and police, as well as the potential for nurses and doctors to all converge upon the scene and operate to rescue, treat, and transport mass casualty victims. As noted in content 2, this organization will occur under the ICS system, but because we can have physicians, nurses, and other medical professionals working in the field, the protocols and medical actions may contraindicate the normal ICS structure and pre-arranged protocols utilized by police, fire, and EMS. This coordination will become important as decisions made at the scene will have downstream effects on hospitals, police investigations, and community recovery efforts.
Currently there are various thoughts on where the centralization of command should reside in a mass casualty event. This is further complicated by the use of unified command needed for active shooter/active violence events. The best practice involves the use of an emergency operations center to allow coordination of the various centralized command structures that will exist at the scene, in the hospitals, and in community government. Attendance at the FEMA G191 EOC/ICS interface course can help to understand the coordination needed to keep all parts of a mass casualty coordinated.
Patient Flow issues are related to surmounting a large patient influx and the communication process necessary to determine resource allocation and forecast patient volumes. The knowledge of patient flow patterns is critical to disaster planning. Recent funding challenges due to no elective surgeries have places some hospitals in a position that creates subpar staffing daily.
In Mass Casualty Incidents, the creation of the Discharge Unit should be on the same level of importance as the delineation of the Command Center. Without the Discharge Unit the patients will languish and the hospital will compromise the ability to provide further care for incoming patients. In a disaster, no patient should leave the hospital without passing through Discharge unit.
Without a properly planned physical plant design for the emergency department, the performance of a successful disaster mitigation strategy is challenged. Failure to take the special requirements for Mass Casualty Incidents into account will present unanticipated problem when a Mass Casualty Incident occurs. The key in disaster management architectural planning is whiter the proposed design will allow for appropriate patient flow.
The new information management systems enhance patient management and allow hospitals and other health care and emergency services provides to communicate with hospital core Health Information System. It also enable the implementation of the National Network for Real-time Syndromic and Bioterrorist Surveillance Systems.
Victim lists are essential tools for hospital response. Victim lists are required, not only to identify victims that have come into the hospital but also to identify casualties brought to multiple other sites during a disaster. Lists are often electronic in nature and require the systems to function at the time of a disaster. Plan accordingly.
PersonalProtectiveEquipment_USEPA.pdf
Related Topics: Emergency Response <https://epa.gov/emergency- response>
CONTACT US <https://epa.gov/emergency-response/forms/contact-us-about-emergency-response>
Personal Protective Equipment Vapors, gases, and particulates from hazardous substance response activities place response personnel at risk. For this reason, response personnel must wear appropriate personal protective clothing and equipment whenever they are near the site. The more that is known about the hazards at a release site, the easier it becomes to select personal protective equipment. There are four levels of personal protective equipment.
Level A protection is required when the greatest potential for exposure to hazards exists, and when the greatest level of skin, respiratory, and eye protection is required. Examples of Level A clothing and equipment include:
positive pressure, full face-piece self contained breathing apparatus (SCBA) or positive pressure supplied air respirator with escape SCBA;
totally encapsulated chemical- and vapor-protective suit;
inner and outer chemical-resistant gloves; and
An o�icial website of the United States government
MAIN MENU
Search EPA.gov
disposable protective suit, gloves, and boots.
Level B protection is required under circumstances requiring the highest level of respiratory protection, with lesser level of skin protection. At most abandoned outdoor hazardous waste sites, ambient atmospheric vapors or gas levels have not approached su�iciently high concentrations to warrant level A protection. Examples of Level B protection include:
positive pressure, full face-piece self contained breathing apparatus (SCBA) or positive pressure supplied air respirator with escape SCBA;
inner and outer chemical-resistant gloves;
face shield;
hooded chemical resistant clothing;
coveralls; and
outer chemical-resistant boots.
Level C protection is required when the concentration and type of airborne substances is known and the criteria for using air purifying respirators is met. Typical Level C equipment includes:
full-face air purifying respirators;
inner and outer chemical-resistant gloves;
hard hat;
escape mask; and
disposable chemical-resistant outer boots.
Level D protection is the minimum protection required. Level D protection may be su�icient when no contaminants are present or work operations preclude splashes, immersion, or the potential for unexpected inhalation or contact with hazardous levels of chemicals. Appropriate Level D protective equipment may include:
gloves;
coveralls;
safety glasses;
face shield; and
chemical-resistant, steel-toe boots or shoes.
While these are general guidelines for typical equipment to be used in certain circumstances, other combinations of protective equipment may be more appropriate, depending upon specific site characteristics.
Contact Us <https://epa.gov/emergency-response/forms/contact-us-about-emergency-response> to ask a question, provide feedback, or report a problem.
LAST UPDATED ON OCTOBER 5, 2023
Discover. Accessibility Statement <https://epa.gov/accessibility/epa-accessibility-statement>
Budget & Performance <https://epa.gov/planandbudget>
Contracting <https://epa.gov/contracts>
EPA www Web Snapshot <https://epa.gov/utilities/wwwepagov-snapshots>
Grants <https://epa.gov/grants>
No FEAR Act Data <https://epa.gov/ocr/whistleblower-protections-epa-and-how-they-relate-non-disclosure-agreements-signed-epa>
Plain Writing <https://epa.gov/web-policies-and-procedures/plain-writing>
Privacy <https://epa.gov/privacy>
Privacy and Security Notice <https://epa.gov/privacy/privacy-and-security-notice>
Connect. Data.gov <https://www.data.gov/>
Inspector General <https://www.epaoig.gov/>
Jobs <https://epa.gov/careers>
Newsroom <https://epa.gov/newsroom>
Open Government <https://epa.gov/data>
Regulations gov htt // l ti /
Regulations.gov <https://www.regulations.gov/>
Subscribe <https://epa.gov/newsroom/email-subscriptions-epa-news-releases>
USA.gov <https://www.usa.gov/>
White House <https://www.whitehouse.gov/>
Ask. Contact EPA <https://epa.gov/home/forms/contact-epa>
EPA Disclaimers <https://epa.gov/web-policies-and-procedures/epa-disclaimers>
Hotlines <https://epa.gov/aboutepa/epa-hotlines>
FOIA Requests <https://epa.gov/foia>
Frequent Questions <https://epa.gov/home/frequent-questions-specific-epa-programstopics>
Follow.
AnAnalysisoftheRelationshipBetweentheHeatIndexandArrivalsintheEmergencyDepartment-PubMed.pdf
An official website of the United States government Here's how you know
. 2015 Oct 29:7:ecurrents.currents.dis.64546103ed4fa0bc7c5b779dd16f5358. doi: 10.1371/currents.dis.64546103ed4fa0bc7c5b779dd16f5358.
An Analysis of the Relationship Between the Heat Index and Arrivals in the Emergency Department
Matthew Levy , Morgan Broccoli , Gai Cole , J Lee Jenkins , Eili Y Klein
Affiliations PMID: 26579329 PMCID: PMC4635022 DOI: 10.1371/currents.dis.64546103ed4fa0bc7c5b779dd16f5358 Free PMC article
���� ���� �����
PLoS Curr
1 2 1 1 3
Abstract
Background: Heatwaves are one of the most deadly weather-related events in the United States and account for more deaths annually than hurricanes, tornadoes, floods, and earthquakes combined. However, there are few statistically rigorous studies of the effect of heatwaves on emergency department (ED) arrivals. A better understanding of this relationship can help hospitals plan better and provide better care for patients during these types of events.
PubMed Disclaimer
Methods: A retrospective review of all ED patient arrivals that occurred from April 15 through August 15 for the years 2008 through 2013 was performed. Daily patient arrival data were combined with weather data (temperature and humidity) to examine the potential relationships between the heat index and ED arrivals as well as the length of time patients spend in the ED using generalized additive models. In particular the effect the 2012 heat wave that swept across the United States, and which was hypothesized to increase arrivals was examined.
Results: While there was no relationship found between the heat index and arrivals on a single day, a non-linear relationship was found between the mean three-day heat index and the number of daily arrivals. As the mean three-day heat index initially increased, the number of arrivals significantly declined. However, as the heat index continued to increase, the number of arrivals increased. It was estimated that there was approximately a 2% increase in arrivals when the mean heat index for three days approached 100°F. This relationship was strongest for adults aged 18-64, as well as for patients
Additionally, a positive relationship was noted between the mean three-dayarriving with lower acuity. heat index and the length of stay (LOS) for patients in the ED, but no relationship was found for the time from which a patient was first seen to when a disposition decision was made. No significant relationship was found for the effect of the 2012 heat wave on ED arrivals, though it did have an effect on patient LOS.
Conclusion: A single hot day has only a limited effect on ED arrivals, but continued hot weather has a cumulative effect. When the heat index is high (~90°F) for a number of days in a row, this curtails peoples activities, but if the heat index is very hot (~100°F) this likely results in an exacerbation of underlying conditions as well as heat-related events that drives an increase in ED arrivals. Periods of high heat also affects the length of stay of patients either by complicating care or by making it more difficult to discharge patients.
Figures
Figure 1: Boxplot of Arrivals per Day…
Figure 2: Histogram of Daily Maximum Heat…
Figure 3: Scatterplot of arrivals per day…
Figure 4: Generalized Additive Model Analysis of…
Figure 5: Generalized Additive Model Analysis of…
Figure 6: Generalized Additive Model Analysis of…
All figures (8)
Related information
PMC images
LinkOut - more resources
Full Text Sources
Europe PubMed Central PubMed Central Public Library of Science
Research Materials
NCI CPTC Antibody Characterization Program
Miscellaneous
NCI CPTAC Assay Portal