Disaster Preparedness in your school - Arkansas Coordinated ...

Disaster Preparedness in
your school
A introduction to disaster planning and implementation
in your school district
Christine Duellman, RN, BSN
Little Rock School District

Learning Objectives
►Participant will be able to:
• Identify the 4 phases of a disaster.
• Identify critical components in the disaster
phases.
• Define “triage” and identify the four colors and
criteria by which a person is issued a color.
• Recognize and know how and when to utilize
the START and JumpSTART algorithms.

Mission
►Train Train public health professionals, including
professionals in related organizations, to
respond to a disaster in a coordinated, time-
critical way using specific, and precisely
targeted interventions against demonstrated
public health threats and emergencies.

Acronyms
ICS
MCI
NIMS
START
JumpSTART
Incident Command Center
Multi-Casualty Incident (disaster)
National Incident Management System
Simple Triage and Rapid Treatment
(adult system)
System for pediatric triage

Disaster Definition
Any incident that results in multiple human casualties
or disruption of essential public health services or any
incident that requires an increased level of response
beyond the routine operating procedures, including
increased personnel, equipment, or supply
requirements.
Maloney, Fitzgerald, Elam, and Doyle (2000)

Natural Disasters
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Tornados
Floods
Fires
Earthquakes
Drought
Wind Storms
Heat waves
Winter Storms
Pandemic Outbreak

Manmade Disasters
► Fires
► Civil Unrest
► Terrorism
► Transportation
accidents
► Hazardous material
spills
► Pandemic outbreak

Medical Disaster
A medical disaster is commonly
defined as an incident in which
patient care needs overwhelm
local response resources.

Abundant resources relative to demand
(P = Patient)
Do the best for each individual

Resources challenged
(P = Patient)
Do the best for each individual

Do the greatest Resources good overwhelmed
for the greatest number
(P = Patient)

Phases of Disasters
Mitigation
Preparedness
Disaster
Recovery
Response

The Good News
A disaster plan following
the 4 phases system
will cover all of your
emergencies and
disasters.

Mitigation
►Hazard Hazard / Vulnerability assessment
►Safe Safe physical environment
• Facility
• Security
►Violence Violence Prevention
►Policies Policies and procedures
►Community collaboration

Preparedness

Critical Elements
►Updated Updated student roster including parental
information
►Updated Updated staff roster
►Maps Maps and / or blueprints of the schools
►Means Means of communication
►Readily Readily accessible written Disaster Plan

Who should be involved:
School superintendent / principal
School Physician / School Nurse
Law enforcement
EMS
Hospital representatives
Parent Liaison
Mental Health Professionals
Local government representatives
Special Needs representative

How to become a Team
►Develop Develop and recruit your NIMS Team prior
to a disaster—KNOW YOUR ROLE!!
►Include Include your local police, fire departments,
and hospitals at all levels including drills
►Know Know how you will communicate during a
disaster
►Have Have disaster kits dispersed around campus
with the knowledge of where they are
►Practice Practice and make changes when needed

National Incident Management
System

Incident Command System
►Developed in the 1970s to respond to rapidly
moving wildfires
►Standardizes terminology, communications,
response structures, and lines of authority
among different organizations

Response

Activation
►Decide Decide if a true emergency exists
►Decide Decide the type of emergency
►Activate Activate the critical response team
►Activate Activate the Incident Command System

Critical Elements
►Call Call tree
►Updated Updated student and staff rosters
►Evacuation routes and maps
►Transportation
►First First Aid supplies
►SecuritySecurity

Triage

What is Triage?
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“Triage” means “to sort”
Looks at medical needs and
urgency of each individual patient
Sorting based on limited data
acquisition
Also must consider resource
availability

Triage is a dynamic process and
is usually done more than once.

Goal of Multicasualty Triage
“To do the best for the most
using the least.”

Primary Disaster Triage
► Goal: to sort patients based on
probable needs for immediate
care. Also to recognize futility.
► Assumptions:
• Medical needs outstrip immediately
available resources
• Additional resources will become
available with time

START
►Simple
Triage
And
Rapid
Treatment
►Gold Gold standard for field adult multiple
causality (MCI) triage in the US and
numerous countries around the world
►Utilizes Utilizes the standard four triage
categories
►Used Used for primary triage

►
►
NATO Guidelines
Red
Airway obstruction, cardiorespiratory
failure, significant external hemorrhage,
shock, sucking chest wound, burns of
face or neck
Yellow
Open thoracic wound, penetrating
abdominal wound, severe eye injury,
avascular limb, fractures, significant
burns other than face, neck or perineum

►
NATO Guidelines
Green
Minor lacerations, contusions,
sprains, superficial burns, partial-
thickness burns of < 20% BSA
►
Black
Head injury with GCS85% BSA, multisystem trauma,
signs of impending death
Burkle FM, Orebaugh S, Barendse BR, Ann Emerg Med 23:742-747, 1994

Ambulatory = Green
START Triage
RESPIRATIONS
NO
YES
Over 30/min
Under 30/min
PERFUSION
Position Airway
Immediate
Cap refill
> 2 sec
Cap refill
< 2 sec.
NO
Dead or
Expectant
YES
Immediate
Control
Bleeding
Immediate
Failure to follow
simple commands
MENTAL
STATUS
Can follow
simple commands
Immediate
Delayed

Pediatric Multicasualty
triage may be
affected by the
emotional state of
triage officers.

The physiology of adults and
children are not the same.
Primary MCI triage is based on
physiology

JumpSTART: Age
Current recommendation:
If a victim appears to be a child, , use
JumpSTART.
If a victim appears to be a young
adult, , use START.

The “Jumpstart” Part
If no breathing after airway opening, check
for peripheral pulse. If no pulse, tag patient
deceased/nonsalvageable and move on.
If there is a peripheral pulse, give 5 mouth to
barrier ventilations. If apnea persists, tag
patient deceased/nonsalvageable and move
on.
►
If breathing resumes after the “jumpstart”,
tag patient immediate and move on.

JumpSTART Goals
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Modify an existing tool for use with
children
Utilize decision points that are flexible
enough to serve children of all ages
and reflective of the unique points of
pediatric physiology
Minimize over- and under-triage
Accomplish triage within 30 second/pt
goal

Advantages
►JumpSTART provides a rapid triage
system specifically designed for
children, taking into consideration their
unique physiology.
►The The algorithm is modified from an
existing system widely accepted for
adult triage.
►For For most patients, triage can be
accomplished within the 30 second
goal.

Advantages
►Objective Objective triage criteria for
children will help to eliminate
the role of emotions in the
triage process.
►Objective Objective triage criteria will
provide emotional support for
triage personnel forced to
make life or death decisions
for children in the MCI setting.

Patients’ limitations in
ambulation and
communication and
differentiation between
acute and chronic
neurological conditions
are the main challenges
in the triage of children
with special needs and
disabilities.
Photo Lou Romig MD

Modification for nonambulatory
children
►Infants Infants who normally can’t t walk yet
►Children Children with developmental delay
►Children Children with acute injuries preventing
them from walking before the incident
►Children Children with chronic disabilities

Modification for nonambulatory children
► Evaluate using the JS algorithm
► If any RED criteria, tag as RED.
► If pt satisfies YELLOW criteria:
• YELLOW if significant external signs of
injury are found (i.e.. deep penetrating
wounds, severe bleeding, severe burns,
amputations, distended tender abdomen)
• GREEN if no significant external injury

JumpSTART: Ambulatory
Identify and direct all ambulatory patients
to designated Green area for secondary
triage and treatment. Begin assessment
of nonambulatory patients as you
come to them.

Note for Black Category Victims
Unless clearly suffering from injuries
incompatible with life, victims tagged in the
BLACK category should be reassessed once
critical interventions have been completed for
RED and YELLOW patients.

Recovery

Short Term Recovery
►Restore Restore crucial services
►Provide Provide for basic needs
• Don’t t forget your mental health needs
►Includes Includes you, staff, and students
►Reunification with parents / caregivers
►Maintain Maintain contact with students / staff
►Funerals Funerals / Memorials

Long Term Recovery
►Focus Focus on restoring school community to
normal or improved state.
• Recognize and address the reactions to stress.
►ReferralsReferrals
►Return Return to school
• Update health information
►Change Change in 504 students?
• Develop health plans
• Support children / families

Conclusion

►www.fema.gov
►www.osha.gov
►www.redcross.org
►www.ed.gov
►www.arkansased.org
Resources
► Christine.Duellman@lrsd.org