Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX D n Disaster Preparedness and Response
••
Execute pre-disaster agreements for
transporting casualties and/or inpatients to
other facilities should the local facility become
saturated or unusable.
••
Plan for mobilization of surge capabilities to
care for patients already in the hospital as well
as incoming disaster victims.
••
Provide training in nonmedical and medical
disaster management.
Planning must also anticipate the elements needed
in the actual disaster situation, and include these
procedures:
••
Institute security precautions, including
hospital lockdown if necessary.
••
Mobilize incident command staff to the
predesignated incident command center.
••
Notify on-duty and off-duty personnel.
••
Activate the hospital disaster plan.
••
Prepare decontamination, triage, and treatment
areas.
••
Activate previously identified hospital disaster
teams based on functional capacities.
••
Develop plans to ensure feasibility of
unidirectional flow of patients from the
emergency department to inpatient units. This
includes making emergency department beds
available for later-arriving patients. Often the
least-injured patients arrive at the hospital first;
triage them to areas outside the emergency
department to allow for the arrival of more
critical patients.
••
Evaluate in-hospital patient needs to determine
whether additional resources can be acquired
to care for them or whether they must be
discharged or transferred.
••
Check supplies (e.g., blood, fluids, medication)
and other materials (food, water, power, and
communications) essential to sustain hospital
operations, preferably for a minimum of
72 hours.
••
Establish a public information center and
provide regular briefings to hospital personnel
and families.
There are several types of disaster drills and exercises.
Tabletop exercises use written and verbal scenarios
to evaluate the effectiveness of a facility’s overall
disaster plan and coordination. Field exercise practical
drills employ real people and equipment and may
involve specific hospital departments/organizations.
Field exercises may be limited in scope (i.e., test of
decontamination facility or emergency department)
or involve the entire organization(s). Disaster
preparedness must include practical drills to ascertain
the true magnitude of system problems.
Mass-casualty drills must include three phases:
preparation, exercise management, and patient
treatment. During the preparation phase, functional
areas of responsibility are clearly defined so they can
be evaluated objectively. The exercise management
phase involves an objective evaluation of all key
functional roles in the ICS. The patient treatment
phase involves the objective evaluation of welldefined
functional capacities such as triage and
initial resuscitation.
Personal Planning
Family disaster planning is a vital part of pre-event
hospital disaster preparation for both the hospital
and its employees. Most healthcare providers have
family responsibilities, and if they are worried
about their family’s health and safety, they may
be uncomfortable—or even unable—to meet their
employment responsibilities during a disaster event.
Hospitals need to plan a number of ways to assist
healthcare providers in meeting their responsibilities
both to the hospital and to their families. Among these
needs are assistance in identifying alternative resources
for the care of dependent children and adults and
ensuring that all employees develop family disaster
plans. All hospital-specific response plans depend on
mobilization of additional staff, whose first duty in
any disaster will be to ensure the health and safety of
themselves and their families.
Search and Rescue
Many disasters, both natural and human-made, involve
large numbers of victims in collapsed structures. Many
countries, including the United States, have developed
specialized search and rescue teams as an integral
part of their national disaster plans. Local emergency
medical services (EMS) systems also have search and
rescue assets as part of their teams and often use
hospital personnel to assist with resuscitation and
field amputations. Members of search and rescue (SAR)
teams receive specialized training in confined-space
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