Dr. MarkAlain Déry

DocwireNews

According to the World Health Organization, mass casualty incidents are &#8220;disasters and major incidents characterized by quantity, severity, and diversity of patients that can rapidly overwhelm the ability of local medical resources to deliver comprehensive and definitive medical care.&#8221; A hurricane easily falls under this definition, making incident triage mission critical. In part four of an eight-part interview, MarkAlain Déry, DO, spoke to DocWire News about mass casualty protocols and how they are implemented during severe disasters, such as hurricanes.
DWN: What are mass casualty protocols, and how are they implemented when a hospital is overwhelmed during a natural disaster?
MD: One of the biggest concerns during the wrath of a hurricane is always power failures. In a health care facility setting, loss of power can have a profoundly negative impact on patient care, staff, and vital medical equipment.
Editor&#8217;s note: In part three of an eight-part interview, DocWire News spoke with MarkAlain Déry, DO, about the dangers associated with power failures at a health care facility during a hurricane.
When we&#8217;re talking about mass casualty protocols, we&#8217;re talking about several issues here. They are part of the pre-planned procedures that hospitals would implement when faced with a sudden influx of patients that, of course, exceed their normal capacity, such as during a natural disaster–a hurricane, as we&#8217;re mentioning here. [In] the triage system, patients are rapidly assessed and categorized based on the severity of their condition and urgency of care needs. Certainly, when I was in Haiti about three days after the earthquake in 2010, part of my medical responsibilities were to triage individuals fairly rapidly.
Next is resource allocation. Staff, supplies and space need to be redistributed to handle the surge in patients. A communication plan is so important, so clear channels are established for internal and external communication. Staff mobilization is also very important. Of course, when needed, additional personnel are called in so that roles ultimately may be reassigned. And of course, patient flow management is important. So procedures need to be in place for efficiently moving patients through the hospital system. These are all the things that we would see implemented during a natural disaster.
One, activation, so the incident command system is going to be activated and a designated leader does take charge of coordinating the response, as I said.
Then we move into triage. Patients are quickly assessed and designated to an area, usually outside the main emergency department, using things like a color coded system or a numerical system that will help prioritize care. Space utilization is important, so these are non-essential areas that are going to be converted to the patient care spaces. For example, cafeterias or conference rooms could become treatment areas. Staff deployment, personnel are reassigned based on need, and with non-clinical staff potentially taking on support roles, we all have to pitch in at that time. Supply management, emergency caches of supplies are going to be accessed, and conservation measures for critical resources are implemented. External coordination, communication is established with other hospitals, emergency services and health departments to coordinate patient distribution and resource sharing.
Of course, you&#8217;re going to have documentation adaptation. I can&#8217;t tell you, going back to my Haiti experience, how we documented. There&#8217;s lots of pictures on the internet, they all went viral. If you look up &#8220;American Hospital, Haiti 2010,&#8221; you&#8217;ll see they were just scraps of paper. We had nothing. We had no EMR, obviously we responded. There was no electricity, there was no nothing. So we had scraps of paper literally that we just tore and then just taped onto people&#8217;s bed. And we just wrote the essential of notes.
And so documentation adaptation is important. Streamlined documentation processes are used to ensure essential information is recorded without slowing patient care. And going back to the Haiti example, that&#8217;s actually what we did. We just [wrote notes like], &#8220;Patient pregnant. These meds should not be utilized as a result of pregnancy.&#8221; Or, &#8220;Fractured femur. Status post op. Pain meds. Look out for infection.&#8221; And that would just be the note. It would be very, very succinct, but it just got the information across and helped all the clinicians; all the health care workers know exactly what was happening with that patient.
Certainly during Katrina, family reunification was incredibly important. And Katrina was [2005], so it was still before the days [before apps]. And the internet was still new-ishish.. But it was these big, big boards, family reunification. I think now with apps being what they are, I think family reunification is definitely a lot easier. But certainly, seeing the pain in people&#8217;s eyes, just trying to find their family was very difficult. People looking for their parents or their children, it was very hard to see that. So we were trying to be very creative by putting up very, very large boards and just allowing people just to scroll through, looking for family members or for loved ones.
And then of course, continuous reassessment. The situation is constantly monitored. Certainly, we did that in the Astrodome. Protocols are adjusted as needed based on patient volume and available resources. And then recovery planning, even while managing the immediate crisis, plans are made for returning to, at some point, normal operations.
So these are the sort of things that we really need to think about. Power outages require reliance on backup generators. Communication disruptions happen. Staff may be personally affected by the disaster, impacting availability. I mean, staff still have family members. They still have homes that they&#8217;re still concerned about. Of course, we&#8217;re seeing this right now with IV fluids, but supply chain disruptions limit access to essential medical supplies. And then eventually, evacuation plans may need to be implemented if the hospital itself is compromised by the disaster. And certainly, we saw that during Hurricane Katrina.

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How Mass Casualty Protocols Save Lives Amid Major Hurricanes

Hurricanes & Health Care

Dr. MarkAlain Déry talks about mass casualty protocols and how they are implemented during hurricanes. 

Dr. MarkAlain Déry Breaks Down the Importance of Mass Casualty Protocols Amid Major Hurricanes

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