Burn Cart Projects in PA Past, Present & Future

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Burn Cart Projects in PA Past, Present & Future June 2 nd, 2010 Pennsylvania Department of Health Annual Health Care Systems Emergency Preparedness

1 Burn Cart Projects in PA Past, Present & Future June 2 nd, 2010 Pennsylvania Department of Health Annual Health Care Systems Emergency Preparedness Conference Hershey, PA NE PA Regional Task Force + 2 Counties in EC Region Northeast / East Central Project Rollout 7/2009 OFFICE OF PUBLIC HEALTH PREPAREDNESS 1 of 13

2 SC PA Regional Task Force South Central Project Anticipated Rollout 7/2010 Burn Cart Expansion Interest 2 of 13

3 Outline Historical Overview of Burn Care MCIs Vulnerabilities NE TF Experience The 1st Regional Burn Cart Project History Repeats Itself Coconut Grove Fire Boston MA Saturday November 28 th, 1942; 10:15PM Every available nurse & house staff summoned to the emergency ward. (newspaper account of Mass General staff interview) 490 DAS 166 injured, most burned (2 nd 3 rd ) Boston.com 3 of 13

4 Massachusetts General Hospital archives Massachusetts General Hospital archives What was it like in 1942? Drs. Francis Daniels Moore & Oliver Cope treated dozens at Mass General using dressings process, smearing gauze with Vaseline. Innovation of necessity. City hospitals were well stocked [due to WWII] with excess supplies of bandages, oxygen tents, plasma & saline solution. Most patients were given morphine for pain upon arrival, before doctors had time to assess injuries. An enterprising nurse devised a system for putting a red M on the victim s forehead, indicating that they d received pain medication. Mass General s newly constructed Blood Bank one of the first in the region was tested. City-wide calls went out for blood / plasma donors. Survivors of the Coconut Grove were some of the first patients treated with the new drug, Penicillin. 4 of 13

History Always Repeats Itself Station Nightclub Fire, February 20 th, 2003; 11:07PM Of the 462 in attendance; 100 DAS, 273 treated at RI and MA hospitals >40% of injured suffered 3 rd degree burns of

5 History Always Repeats Itself Station Nightclub Fire, February 20 th, 2003; 11:07PM Of the 462 in attendance; 100 DAS, 273 treated at RI and MA hospitals >40% of injured suffered 3 rd degree burns of face, hands and/or upper body Smoke inhalation & airway burns; plus trauma (crushing injuries & lacerations to extremities) ~30 victims with critical 3 rd degree burns were rescued by firefighters from structure & egress points 5 of 13 Wikipedia.com (unattributed)

6 Wikipedia.com 2003 Response 65 EMS units + every helo in 150-mile radius 100% of injured reached the ED in 1.5hrs Communication problems led to hospital intake & overload problems (LL) Extent of injuries is key to determining how many critical patient hospital can accept Difficult to redirect helicopters once in route One hospital had 4 competing for same LZ Flight 232 Sioux City Iowa July 19 th, 1989 DC10: 285 souls on board + 11 crew crew member DAS survived 41 survivors seriously injured, many with airway burns 130 with minor injuries 13 walked away uninjured All the injured were treated at 2 hospitals Marian (Mercy) Health & St. Luke s (now one Sys) 6 of 13

historical slower season, hospitals were operating at < 70% max census You don t t use many memory

7 CBS News online Sioux City Journal online archives Des Moines Register Response Closed community, next TC >75 miles away Hosp surge capacity included dormitories at college nearby Mid-summer was historical slower season, hospitals were operating at < 70% max census You don t t use many memory items during emergencies. You stick with checklists and follow them. Capt. Al Hayes, Flight 232 heavy 7 of 13

8 Austin TX, 2/18/2010 Angry software engineer, Joseph Stack, flies his Piper Cherokee into the IRS building ONLY two people died, But... Total fuel load (unmodified) Piper Cherokee is 84 gals What if? Houston Chronicle Houston Chronicle 8 of 13

9 Houston Chronicle Planes, Trains & Automobiles Highly Combustible Materials Are Out There Air, rails, roadways... Fuel is available Scenarios for large-scale fires with dozens to hundreds injured are limitless New scenarios for all of us to consider are potentials for burn injuries associated with gas-drilling industry! How many can your hospital handle? How many can the closest Burn Center handle? 9 of 13

10 Marcellus-shale.us Sierra Club Testimony to NY State EPA Concerning Accidents: Even the most careful drilling operation can result in accidents causing chemical spills or injuries. A truck overturns; a worker forgets to close a spigot. Gas and oil companies, including Meridian, Gastar and Chesapeake list accidents, including fires, explosions and pipe failures, as inherent risks of drilling. The Durango Herald recently reported that a nurse fell gravely ill with heart, lung and liver failure, plus kidney damage and blurred vision. It was determined that she had breathed fumes from a hydraulic drilling worker s chemical laden clothing after treating him in the ER. Do we have any plan in place to deal with medical emergencies? Do rural areas have sufficient medical personnel, including EMTs, trained in responding to chemical accidents? Do we have a plan in place for training our fire departments in extinguishing chemical fires? Will fire departments receive additional funding to deal with these issues? Are burn carts needed? Are burn carts available? According to HAP 65 Beds PICU 10 of 13

11 NEPA Region Experience 8 County Planning Region; 1 of 9 PEMA Task Forces Serving and Protecting ~1.2 M residents M travelers / visitors Major Interstate Highway Interconnections Gateways to New York City & New England Critical Infrastructure Protection Vulnerabilities Sanofi Vaccine Production Facilities Tobyhanna Army Depot Two International & Multiple General Aviation Airports Wide Range of Industry (Farming, manufacturing & technology) Considerable HazMat Health & Medical / Hospitals & Healthcare Committee Twenty-four Acute & Specialty Hospitals and Health Systems 4 Trauma Centers 11 Community Hospitals 3 Critical Access Hospitals 2 For-profit Surgical Hospitals 4 Specialty Rehab Hospitals 4 FQHCs 3 EMS Council Regions Overlap PA-DOH Northeast District Office and Several County/Muni Health Offices NE TF Track Record Signed Mutual Aid & Assistance Agreement (MAA) (6/04) Developed & Implemented Regional Hospital Response and Coordination Plan (8/04) Standardized Hospital First Receiver PPE Ensemble (Level C PAPR) Hospital-based HazMat Technician Train-the-Trainer Program Standardized Regional Decon Tent System and Integration of Plans with County-based and Decon (FD) Engine Companies 11 of 13

1 st Regional Mobile Surge Hospital Challenges & Planning Gaps Mobile Surge Hospital components improve capacity, but CAPABILITIES challenged for specific victim / injury types

during PA-DOH / HAP Statewide Hospital Assessment Surveys, 02 03 & 03 04 2007 PA-DOH OPHP Regional Planning Grant $ 150,000 regional grant to address Surge Supplies and Burn

12 1 st Regional Mobile Surge Hospital Challenges & Planning Gaps Mobile Surge Hospital components improve capacity, but CAPABILITIES challenged for specific victim / injury types Our Mobile Surge Hospital is a structure, and relies on deployment on / near Hospital campus Burn CAPACITY & CAPABILITY identified as significant preparedness & response gaps during PA-DOH / HAP Statewide Hospital Assessment Surveys, & PA-DOH OPHP Regional Planning Grant $ 150,000 regional grant to address Surge Supplies and Burn Care gaps Trauma Supplies Caches = $17K Airway & Respiratory Caches = $56K Oxygen Distribution Systems = $12K Remainder of funds (~$65K) was earmarked for Burn Cart Project 12 of 13

13 Regional Burn Cart Project OPHP Funding partner Moses Taylor Hospital RFI /RFQs Lehigh Valley Hospital & Health Network Verified Burn Center Regional Center of Excellence / Expertise, Development & Purchaser Emergency Medical Services of NE PA Funding conduit (Banker) NEPA TF Acute Care Hospitals and remaining EMSNP Hospitals (adjacent ECTF Region) Recipients of the Burn Carts Thank You Don Strubeck Emergency Management / Organizational Improvement & Accreditation Moses Taylor Hospital & Health Care System 700 Quincy Avenue Scranton PA phone dstrubeck@mth.org 13 of 13

Statewide Emergency Preparedness in Rhode Island:

Statewide Emergency Preparedness in Rhode Island: Lessons Learned The Station Nightclub Fire Peter T. Ginaitt B.S. R.N. EMT-C C I/C Captain, City of Warwick Fire Department (retired) Director of Emergency