oxford american handbook of disaster medicine

Medicine, Emerson HospitalConcord, Massachusetts and Medicine, Rhode Island Hospital Clinical Associate Professor of Offi ce of the Assistant Secretary of Preparedness and Response Depart

Oxford American Handbook of

Disaster Medicine

About the Oxford American Handbooks in Medicine

The Oxford American Handbooks are pocket clinical books, providing practical guidance in quick reference, note form Titles cover major medical specialties or cross-specialty topics and are aimed at students, residents, internists, family physi-cians, and practicing physicians within specifi c disciplines

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Medicine, Emerson Hospital

Concord, Massachusetts and

Medicine, Rhode Island Hospital

Clinical Associate Professor of

Offi ce of the Assistant Secretary

of Preparedness and Response

Department of Health and Human

Washington Hospital CenterGeorgetown University School of Medicine

Washington, DC

Ira Nemeth, MD, FACEP

Assistant Professor and Director

of EMS and Disaster MedicineSection of Emergency Medicine, Department of MedicineBaylor College of MedicineHouston, Texas

Kathryn Brinsfi eld, MD

Department of Homeland Security

Washington, DC and

Associate Professor of Emergency Medicine, Boston UniversityAssociate Medical Director, Boston EMS

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by the United States government Dr Kathryn Brinsfi eld was not an

employee of the US government while serving as co-editor of this book

Library of Congress Cataloging in Publication Data

Oxford American handbook of disaster medicine / edited by Robert A Partridge [et al.]

p ; cm — (Oxford American handbooks in medicine)

Handbook of disaster medicine

Includes bibliographical references and index

This material is not intended to be, and should not be considered, a stitute for medical or other professional advice Treatment for the con-ditions described in this material is highly dependent on the individual circumstances Although this material is designed to offer accurate infor-mation with respect to the subject matter covered and to be current as of the time it was written, research and knowledge about medical and health issues is constantly evolving, and dose schedules for medications are being revised continually, with new side effects recognized and accounted for regularly Readers must, therefore, always check the product informa-tion and clinical procedures with the most up-to-date published prod-uct information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation Oxford University Press and the authors make no representations or warranties to readers, express or implied, about the accuracy or completeness of this material, including without limitation that they make no representation or warran-ties about the accuracy or effi cacy of the drug dosages mentioned in the material The authors and the publishers do not accept, and expressly disclaim, any responsibility for any liability, loss, or risk that may be claimed

sub-or incurred as a consequence of the use and/sub-or application of any of the contents of this material

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Dedicated to my parents, Raymond and Alison, and my beloved wife and children, Karen, Rachel, Sarah, and Alexander You have all given me endless support, encouragement, and love.

Robert Partridge

This book is dedicated to the mentors who have been role models in my professional career, and to all those who selfl essly respond to help others when disaster strikes

David Marcozzi

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Foreword

With the incidence of natural and intentional disasters–and the number

of people affected by such events–on the increase, the importance of disasters as a public-health problem has captured the attention of the world This situation represents an unprecedented challenge to the medi-cal and public-health community Ten years have now passed since the catastrophic events of September 11, 2001 Since then, periodic reviews

of the medical and public-health impact of disasters have appeared in a number of publications, with updates on the “state of the art” of disaster science As a result, a considerable body of knowledge and experience related to the adverse health effects of disasters is now accumulating that requires regular updating so that we can apply the lessons learned during one disaster to the management of the next These historical lessons will not be implemented, however, unless they are supported by adequate preparedness planning, coordination, communications, logistics, personnel management, and training of physicians and other health-care providers

By blending the comprehensiveness of a weighty full-length text with

the convenience of a fi eld guide, the Oxford American Handbook of Disaster Medicine skilfully addresses these challenges and more With years of

experience, editors Robert Partridge and Lawrence Proano, along with a distinguished list of co-authors, give the reader ample technical descrip-tions of each kind of disaster, pertinent summaries of previous disasters, and copious information useful for health-care providers in the fi eld, the classroom, or the ward Unique chapters address topics such as the politi-cal and ethical issues in disaster response; urban versus rural approaches; effective media relations; interfaces between disaster medicine and mili-tary, operational, and wilderness medicine; and the evolving priorities of the Department of Homeland Security (example, the NRP and an NIMS)

In view of recent catastrophic events and newly recognized threats, cifi c elements such as tsunamis and pandemic infl uenza that are usually included as part of other chapters (for example, earthquakes and com-municable diseases) are now covered in their own chapters Deserving of special attention are crosscutting chapters in the handbook that integrate information across hazards, such as communications, lessons learned, exercises and drills, and disaster informatics

spe-In addition, while always emphasizing the use of proven and based medical methods and practices, Drs Partridge and Proano challenge health professionals with questions that must still be answered for them

evidence-to respond effectively in emergency situations Approached from a world perspective, designed and written by clinical and public-health pro-viders with disaster experience, this handbook provides realistic, hands-on experiences that challenge the reader to apply information provided in every chapter The inclusion of “key messages” and “essential concepts” that introduce each chapter, plus practical information such as protocols, clinical tools, and unique case studies, has resulted in the creation of a major resource that will serve as a timely and comprehensive text for

health providers It will be an important resource in the education of pital, community, state, and national health and emergency managers, as well as medical students and residents who will assume mass emergency preparedness responsibilities soon, if not immediately after graduation.All disasters are unique because each affected community has differ-

hos-ent social, economic, cultural, and baseline health conditions The Oxford American Handbook of Disaster Medicine will serve as the most up-to-date

fi eld manual and course textbook available not only for medical sionals responsible for preparing their hospitals to respond effectively to disasters, pandemics, and other public health crises, but also for emer-gency managers and other decision makers charged with ensuring that disasters are well managed

profes-Eric K Noji, MDWashington, DC

Preface

Disasters happen—anywhere, anytime, and frequently In the United States, in response to numerous recent man-made and natural catastro-phes, disaster preparation efforts have become widespread Over time, they have also become more complex and broader in scope

Added layers of complexity make it more diffi cult to stay on top of best practices, but it is essential to do so The public expects a rapid, well-coordinated and effective response when disaster strikes The media will cover the disaster and the response with extensive detail and analysis After a disaster, recovery and mitigation of future disasters are critical ele-ments of the disaster cycle that will be an ongoing challenge for disaster planners and providers

Preparation for disasters has occurred at the federal, state, and regional levels, with active involvement of health professionals, law enforcement, rescue and recovery personnel, and relief organizations, as well as ordi-nary citizens However, even with the most careful preparation and plan-ning, a disaster will overwhelm all standard resources Responders have an opportunity to save lives, limit damage and maintain public confi dence by doing their jobs well To manage a disaster effectively, health practitioners must be ready to think on the fl y, make rapid and unfamiliar decisions and know where to obtain key knowledge and resources

This handbook is intended to be one such resource It can be pulled out of a pocket, off a desktop, or out of the glove compartment of a rescue vehicle, to provide immediate, accessible information on a wide range of topics By covering critical areas of disaster preparation, planning, and response for the types of disasters that are most likely to occur in the United States and around the world, this book gives health-care respond-ers a fi rst-line tool for ensuring their own preparedness It is designed to assist involved health practitioners on any aspect of disaster management

at any point along the disaster timeline

Although this handbook is thorough, it is not comprehensive Readers are encouraged to consult other texts, peer-reviewed literature, web sites and suggested readings at the end of each chapter for additional informa-tion and detail It is our hope that this handbook will be an essential part of

a larger library of information to help health practitioners limit the impact

of disasters through effective preparation and response

Robert PartridgeLawrence Proano

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Acknowledgments

The authors are grateful for the efforts of many people who worked very hard to make this book possible Foremost, we would like to thank all of our co-authors The depth and quality of this book are a testament to their dedication and interest in the study of disaster medicine

Thanks also go out to our co-editors, David Marcozzi, Alex Garza, Kathy Brinsfi eld, Ira Nemeth, and Eric Weinstein, whose vision guided the development of this project

In addition, we are indebted to the team at Oxford University Press, particularly Andrea Seils and Staci Hou, who have worked diligently to bring this book to fruition

Finally, we would like to acknowledge disaster responders everywhere, whom we all rely on but often don’t have the opportunity to thank Their work has not only informed and inspired us but also left us better pre-pared to respond to the next disaster

Robert PartridgeLawrence Proano

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Part 2: General Concepts

Components of Disaster Response

Hospital Components of Disaster Response

17 Hospital administration disaster response 131

18 Hospital ancillary services disaster response 141

19 Hospital medical staff disaster response 146

Part 3: Pre-disaster Considerations

Part 4: Fundamental Principles of

Disaster Management

Part 5: Special Considerations in

Disaster Management

51 Seasonal risks and variations of an

Part 6: Specifi c Hazards in Disasters

Human Caused Disasters

Chemical Disasters

Part 7: Post-disaster Considerations

95 International disaster response organizations 785

Index 803

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Contributors

D Adam Algren, MD

Assistant Professor of Emergency

Medicine and Pediatrics

Truman Medical Center/Children’s

University of Kansas Hospital

Poison Control Center

Kansas City, KS

Evan Avraham Alpert, MD

Attending Physician

Emergency Department

Sheba Medical Center, Israel

Michael Sean Antonis, DO,

MedStar Health: Washington

Hospital Center and Georgetown

Associate Director, Offi ce for

Multicultural Faculty Careers

Brigham and Women’s Hospital

Assistant Professor of Medicine

Harvard Medical School

Wright State UniversityDayton, OH

Kavita Babu, MD

Assistant ProfessorDivision of Medical ToxicologyDepartment of Emergency Medicine

Warren Alpert Medical School of Brown University

Staten Island, NY

Jeff Beeson, DO, FACEP

Medical DirectorEmergency Physicians Advisory Board

Fort Worth, TXand

Clinical Assistant Professor Emergency MedicineUniversity of Texas Southwestern Medical

Dallas, TX

Jason Bellows, MD, FACEP

Lutheran Medical Center

Division of Emergency Medicine

Duke University Health System

Associate Professor of Surgery

Harvard Medical School

Co-Director, Offi ce of Disaster

Response, Center for Global

University of Massachusetts Medical School

UMass Memorial Medical CenterWorcester, MA

Tracy Buchman, DHA

Adjunct Assistant Professor of Emergency MedicineWarren Alpert Medical School of Brown University

andDirector, Global Health Fellowship

Senior Attending in Infectious Disease & Emergency MedicineSaint Luke’s Roosevelt Hospital Center

New York, NY

Dinah Cannefax

Cannefax ConsultingEmergency Management in Healthcare

Dallas, TX

John T Carlo, MD, MS

Program Director

Chemical and Biological Early

Detection (BioWatch) Program

Center for Infectious Disease

Research and Policy (CIDRAP)

The University of Minnesota

Minneapolis, MN

Jimmy Cooper, MD, FACEP

San Antonio, TX

Peter John Cuenca, MD

Lieutenant Colonel, Medical

Corps

United States Army

Assistant Professor of Military/

Emergency Medicine

Uniformed Services University of

the Health Sciences

Department of Emergency

Medicine

Brooke Army Medical Center

Fort Sam Houston, TX

Attending Physician Rhode Island

The Miriam and Hasbro Children’s

Warren Alpert Medical School of Brown University

Rhode Island HospitalProvidence, RI

Diane DeVita, MD, FACEP

Assistant Chief, Administration and Operations

Department of Emergency Medicine

Madigan Healthcare SystemTacoma, WA

Constance J Doyle, MD, FACEP

Core FacultyUniversity of Michigan/St Joseph Mercy Emergency

Medicine ResidencyDeputy Medical DirectorWashtenaw/ Livingston Medical Control

Authority Attending Emergency Physician

St Joseph Mercy HospitalAnn Arbor, MI

Brenda O’Connell Driggers,

Department of Emergency Medicine

Boston University School of Medicine

Boston MA

Daniel B Fagbuyi, MD,

FAAP

Medical Director, Disaster

Preparedness and Emergency

The George Washington

University School of Medicine

John L Foggle, MD, MBA

Assistant Professor, Department

Ray Fowler, MD, FACEP

Professor of Emergency Medicine, Surgery, Health Professions, and Emergency Medical EducationChief of EMS OperationsCo-Chief in the Section on EMS, Disaster Medicine, and Homeland Security

The University of Texas Southwestern Medical Centerand

Attending Emergency Medicine Faculty

Parkland Memorial HospitalDallas, TX

Tyeese Gaines Reid, DO, MA

Attending PhysicianRaritan Bay Medical CenterPerth Amboy, NJ

Justin S Gatewood, MD

Assistant Professor of Emergency Medicine

Department of Emergency Medicine

Georgetown University School of Medicine

Washington Hospital CenterWashington, DC

James Geiling, MD

Professor of MedicineDartmouth Medical SchoolHanover, NH

andChief, Medical Service

VA Medical CenterWhite River Junction, VT

at Dartmouth Medical School

Director, Northern New England

MMRS

Dartmouth Medical School

Hanover, NH

Matthew Gratton, MD

CAPT MC USN (ret)

Associate Professor and Chair

Emergency Medicine

University of Missouri at Kansas

City School of Medicine

Truman Medical Center

Ian Greenwald, MD, FACEP

Chief Medical Offi cer

Duke Preparedness and Response

Warren Alpert Medical School of Brown University

Attending Physician, Department

of Emergency MedicineRhode Island Hospital, Miriam Hospital

Providence, RI

Lori L Harrington, MD, MPH

Associate Medical DirectorBoston EMS

Assistant Professor of Emergency Medicine

Department of Emergency Medicine

Boston Medical CenterBoston, MA

Alison Schroth Hayward, MD

Department of Emergency Medicine

Mayo Clinic College of MedicineRochester, MN

Kwa heri Heard, MA

Metropolitan Medical Response System Program ManagerEmergency Management SpecialistCity of Dallas Offi ce of Emergency Management

Dallas, TX

Georgetown University Hospital &

Washington Hospital Center

Washington, DC

Alexander P Isakov, MD,

MPH

Executive Director

Offi ce of Critical Event

Preparedness and Response

Associate Professor of Emergency

Medicine

Emory University

Atlanta, GA

Irving “Jake” Jacoby, MD

Clinical Professor of Medicine and

Associate Professor and Vice Chair

Department of Emergency Medicine

Yale School of MedicineNew Haven, CT

Ashika Jain, MD

Emergency Ultrasound FellowDepartment of Emergency MedicineMaimonides Medical CenterBrooklyn, NY

Department of Emergency MedicineMission Hospital Regional Medical Center

Mission Viejo, CA

Jerrilyn Jones, MD

Emergency Medicine ResidentBoston Medical CenterBoston, MA

Robert A Jones, MD

Department of Emergency Medicine

Madigan Army Medical CenterTacoma, WA

Peter Kemetzhofer, MD, FACEP

Department of Trauma SurgeryUniversity of Vienna

Vienna, Austria

Washington Hospital Center and

Georgetown University Hospital

Emergency Medicine Residency

Hofstra School of Medicine

North Shore University Hospital

University of California, IrvineIrvine, CA

David C Mackenzie, MD, CM

Assistant Clinical InstructorDepartment of Emergency Medicine

Warren Alpert Medical School of Brown University

Boston Medical CenterBoston, MA

COL John McManus, MD, MCR, FACEP, FAAEM

Director, U.S Army EMSEMS Fellowship Program DirectorSan Antonio Uniformed Services Health Education ConsortiumMedical Clinical Associate Professor, Emergency MedicineUniversity of Texas Heath Science Center

San Antonio, TX

Department of Emergency MedicineMassachusetts General HospitalBoston, MA

Kobi Peleg, PhD, MPH

Director, National Center for Trauma & Emergency Medicine Research

The Gertner Institute for Health Policy & Epidemiology

Head, Disaster Medicine Department

Head, The Executive Master Program for Emergency and Disaster ManagementSchool of Public Health, Tel-Aviv University

Tel-Aviv, Israel

Zaffer Qasim, MBBS, MRCS, MCEM

Specialty Registrar in Emergency Medicine/Critical Care MedicineManchester, United Kingdom

Lou E Romig, MD, FAAP, FACEP

Pediatric Emergency PhysicianMiami Children’s HospitalMiami, FL

Megan L Salinas, MD

Division of Emergency MedicineHuntington Memorial HospitalPasadena, CA

Joseph A Salomone, III,

MD, FAAEM

Associate ProfessorDepartment of Emergency MedicineEMS Medical Director

Truman Medical Centers/UMKC School of Medicine

Kansas City, MO

Carl H Schultz, MD, FACEP

Professor of Emergency Medicine

Director of Research, Center for

Disaster Medical Sciences

Director, EMS and Disaster

Medical Sciences Fellowship

University of California Irvine

Professor and Chairman

Department of Emergency Medicine

Georgia Health Sciences

Division of Emergency Medicine

Department of Internal Medicine

University of Washington School

of Medicine

Seattle, WA

Wayne Smith, BSc, MBChB,

EMDM, FCEM (SA)

Head, Disaster Medicine

Division of Emergency Medicine

Stellenbosch University &

University of Cape Town

Provincial Government of the

Truman Medical Center

University of Kansas City-Missouri

Kansas City, MO

Payal Sud, MD

Medical Toxicology FellowDepartment of Emergency MedicineNorth Shore University HospitalManhasset, NY

Ramona Sunderwirth, MD, MPH, FAAP

Director, Global Health Fellowship

Attending, Pediatric Emergency Medicine

Department of Emergency Medicine

St Luke’s/Roosevelt HospitalNew York, NY

Selim Suner, MD, MS, FACEP

Associate Professor of Emergency Medicine, Surgery and EngineeringWarren Alpert Medical School of Brown University

Instructor of Clinical MedicineColumbia University College of Physicians and SurgeonsNew York, NY

Anthony J Tomassoni, MD,

MS, FACEP, FACMT

Department of Emergency MedicineYale University School of MedicineMedical Director

Yale New Haven Health System Center for Emergency Preparedness and Healthcare Solutions

New Haven, CT

Associate Professor of Emergency Medicine (Clinical)

Department of Emergency Medicine

Warren Alpert Medical School of Brown University

Kirkland, WA

Richard D Zane, MD, FAAEM

Associate ProfessorHarvard Medical SchoolDepartment of Emergency Medicine

Brigham and Women’s HospitalBoston, MA

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Defi nition of a disaster

Peter Moffett

Overview 4

“Basic” defi nition of a disaster 4

Internal versus external disaster 5

CHAPTER 1 Defi nition of a disaster

4

Overview

Defi ning a disaster is not a simple academic exercise A “disaster” to

one organization could be a routine event for others In addition, there is a distinction between the medical defi nition of a disaster and the lay defi ni-tion of a disaster What is often defi ned as a “disaster” by the layperson might be better described as “tragic.”

Defi ning a disaster is important for any organization planning on when and how to initiate its disaster plans Only after defi ning the problem can

a plan be formulated The defi nition of the disaster dictates the degree of response and will often be communicated across a variety of specialties and agencies

As Gregory Ciottone mentions in his textbook on disaster medicine,

“Unlike other areas of medicine the care of casualties from a disaster requires the healthcare provider to integrate into the larger, predomi-nantly non-medical multidisciplinary response.”

“Basic” defi nition of a disaster

There is no one single defi nition of a disaster that has been agreed upon

by experts or groups A quick glance at the Emergency Management Institute’s document that defi nes terms for their training lists 79 separate defi nitions for a disaster The following list suggests some basic defi nitions

of a disaster

Disaster

A disaster is an event that results in a demand for services that exceeds available resources

Example: A single-vehicle collision with three serious casualties may be

a disaster for a small rural emergency department with single-physician coverage However, this situation would be easily managed in an urban trauma system

UN Disaster Management Training Program’s defi nition

A disaster is a serious disruption of the functioning of a society, causing widespread human, material, or environmental losses that exceed the abil-ity of the affected society to cope using only its own resources

The Joint Commission (TJC) defi nition

A disaster is a natural or man-made event that suddenly or signifi cantly disrupts the environments of care; disrupts care or treatment; or changes

or increases demands for the organization’s services

Internal versus external disaster

This hospital-centered model of disasters distinguishes between an nal” and an “external” disaster The advantages of this distinction include the ability for an institution to determine if their infrastructure has been affected by the disaster if there is an immediate threat to the safety of the patients and employees The disadvantages of this defi nition are that

“inter-it is not useful to other agencies, and many events are both internal and external (e.g., an earthquake, fl ood, or hurricane)

CHAPTER 1 Defi nition of a disaster

A disadvantage is that there may be little crossover between ent types of disasters and the resources required may be different Furthermore, extensive and complex plans for each disaster are required

Multijurisdictional aid is needed.

Several local hospitals activated

•

Level III

State or federal aid is needed

Request for aid based on state and federal regulations

•

CHAPTER 1 Defi nition of a disaster

8

Potential injury-causing event (PICE)

This is a relatively new term that has been suggested as a way of ing the broad term “disaster” and using a multi-tiered system to instead focus on the needed response The nomenclature is somewhat complex but may suit some institutional needs

eliminat-An event is described on the basis of three different prefi xes and by

a PICE stage, which includes the projected need for outside aid and the status of outside aid

Prefi x A—potential for additional casualties

Static:

• no more potential for additional casualties

Motor vehicle accident

•

Dynamic:

• potential for additional casualties

Continuing wildfi res

• a hospital emergency department (ED) is destroyed

by fl ooding (will need to be rebuilt or completely relocated to become controlled

• No need for outside aid and aid is inactive

Three-car motor vehicle collision in an urban setting

• : Moderate chance that outside aid is needed and aid should be

on standby (prepared to dispatch quickly)

Riots that close several regional hospitals

•

Only after defi ning a disaster can an organization move into the disaster

cycle With a variety of systems to classify a disaster, an organization can

tailor defi nitions to meet its needs

The etiological descriptor of disaster fi ts easily into the all-hazards approach discussed in Chapter 2

However an organization defi nes a disaster, it must be consistent, cable, and well understood by all participants in the disaster plan

appli-Suggested readings

Ciottone G (2006) Introduction to disaster medicine In Ciottone G, ed Disaster Medicine

Philadelphia: Elsevier Health Sciences, pp 3–6

Dallas CE, et al., eds (2007) Chapter 1: All hazards course overview and DISASTER paradigm

In: Dallas CE, eds Basic Disaster Life Support Provider Manual Version 2.6 Chicago: American

Medical Association, pp 6–7.

Koenig K, Dinerman N, Kuehl A (1996) Disaster nomenclature—a functional impact approach: the PICE system Acad Emerg Med 3:723–727.

Schultz C, Koenig K, Noji E (2006) Disaster preparedness In Marx J, ed Rosen’s Emergency

Medicine Concepts and Clinical Practice, 6th ed., Vol 3 Philadelphia: Elsevier Health Sciences,

pp 3010–3021.