Emergency Prepardness & Response: the Geneva Model

Transcription

1 Emergency Prepardness & Response: the Geneva Model Hôpitaux Universitaires de Genève Dr Cl. Mathieu- Thiébaud, MD,MBA Etre les les premiers pour vous pour vous Geneva University Hosptials

2 Geneva at the heart of Europe, open to the world One of the world s most active hubs for multilateral diplomacy Second UN Headquarters : 193 foreign states represented 250 registered non-governmental organizations 48 international organizations, of which 33 UN related

3 Geneva as a Capital for Health Hub for an international health network Geneva Uni. Hospitals, WHO partner : 6 Collaborating Centres E-health & Telemedicine Therapeutic Patient Education Patient safety & Infections prevention Research & Training in Mental Health Research in Public Health History Vaccine Immunology

4 The Swiss Healthcare System Decentralized: five University hospitals for a population of 8 Mio (4.8 beds/1000) High density of physicians (3.9/1000 inhabitants) Cost (2012): 11.5% of GDP, 68 billion CHF or CHF 8460 per capita Important economic sector: 12.9% of working population in the sector of Health Funded by: compulsory insurance 35.8%, state 20.2%, households 25%, others (private insurance...) Basel Zurich Bern Lausanne Geneva University Hospitals HUG Network of 8 hospitals 40 healthcare facilities From acute care to rehabilitation

5 Our staff Total staff : professions 1638 physicians 4620 nurses Median Age 44

6 Geneva University Hospitals: our capacity 1800 beds days spent in hospital > surgical operations > consultations/year

7 Type of risk of major events: infrastructure in Geneva International Airport Main railway station (person and freight transport) Dense net of highways Lake navigation Nuclear plant within 110 km Stocking tanks (oil, chemicals)

8 Classification of major risks Technological dangers Health Natural dangers Industrial accident Transport accident Fire in buildings Pipline accident (oil, gaz) Electricity accident Pandemics Epizootics Climate disorders (cold or heat wave, air pollution, snow, hail, flooding ) Earthquake Socio-political dangers Mass gathering Criminal acts: robbery/burglary,hostage taking, terrorism Refugee arrival

9 Geneva University Hospitals Emergencies at the hospital 1 emergency every 6 minutes 85,145 emergency consultations/ year 60,816 adults 24,329 children

10 3 octobre persons implicated 15 transferred to the hospital of which 9 on mechanical ventilation 1 person died 17 Novembre persons implicated 43 with medical aid needed 40 hospitalized 1 person died

11 Multiple casualty incidents (MCI) in Geneva patients 3-5 patients >5 patients Data SMUR HUG,

12 : type of incidents:victims to the hospital 22% 8% 3% 31% Fire homes 33% Feu immeuble habitation Transport terrestre Autres Accident chimique Feu entrepôt / industrie Police / GI Feu de villa Rivières et lac Circulation accident 105 incidents 3 patients N = 535 patients

13 Organization of routine prehospital care Emergency centralized call center 144 Information analysis Appropriate assistance dispatch (ambulance, paramedics, physicians, helicopter, fire brigade) Within < 10 min, assistance arrives on the accident site In most cases, time spent on site < 30 min

14 Assistance organization for major events A legal o b ligation: protection of the population u n d er the command of civil authorities OSIRIS A coordinated model in case of major events Firf Police Fire Brigade Pre-hospital Medicine Strengthening Infrastructure, Electricitytransports Civil protection

15 A Major emergencies: constraints Environment Time Assistance Means/logistics: Lack of coordination/communication/training Major risk of chaos Evolution

16 Assistance organization for major events Fire brigade 118 Police 117 Health emergency 144

17 Role of the first medical assistance on site Many actors on site Many witnesses Risk of panic/chaos Pressure on first team on site Main role of the first team: Evaluation, communication, organization

18 Transport Grading of the intervention 3 steps Zone 1 First sorting out/classifying First aid secured Zone 2 Sorting out/screening Treatment Orientation/traceable Zone 3 Hospital Organization HOCA plan Non injured PICA

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20 Goals of first medical aid outside the hospital Integrated assistance; avoid transferring chaos to the hospital Offer emergency care to all patients in order to save their lives and preserve functional capacities Care should be: fast appropriate sufficient equal

21 Summary Planned and coordinated intervention of all stakeholders (police, fire brigade, medical team...) Coordinated and integrated command Well trained professionals Well defined processes Sufficient staff «on hold» reliable to be called up Structured pre-hospital medical assistance Planned in- hospital procedure in case of major events

22 Take home message Prepardness needs planning and anticipation Prepardness needs the integration and coordination of all stakeholders

23 THANK YOU MERCI

24 An international Forum in Global Health: Sustainable and affordable innovation in healthcare ghf2016.org