Introduction to Disaster Management National EMS Medical Director s Course and Practicum Conflict of Interest Disclosure NONE A conflict of interest exists when an individual is in a position to profit directly or indirectly through application of authority, influence, or knowledge in relation to the affairs of ABC. A conflict of interest also exists if a relative benefits or when the organization is adversely affected in any way. Objectives 1. Definitions 2. Types 3. Phases 4. National Organizations and Structure 5. a. Casualty Collection and Triage b. Prehospital Care c. Public health 1
Definitions Disaster A situation in which the severity of damage or the number of patients exceeds the ability to provide immediate management Any event that overwhelms the resources available at that time in a jurisdiction Catestrophic Event Disaster World Health Organization Definitions A sudden ecological phenomenon of sufficient magnitude to require external assistance Disrupts regional functions and activities Affects lives, property, health Definitions Disaster Results in loss of: Communication Transportation Infrastructure Adequate food and water Shelter Sanitary conditions Propagates: Disease Post-traumatic stress Prolonged suffering 2
Definitions Disaster Classification a. Open Occurs over a large geographic area and is usually natural in origin b. Closed Occurs within a small or confined area and is usually technologic, occurs without warning, and urban Definitions Disaster Classification 1. Etiology: Natural or Man-made 2. Location: Single or multiple sites 3. Occurrence: Single or multiple 4. Predictability: Expected, unexpected 5. Onset: Gradual, sudden 6. Duration: Brief, prolonged 7. Magnitude: Local, State, Federal resources Definitions Multiple Casualty Incident A situation with numerous patients that does not overwhelm the routine capacity of a system. Any event that causes a large number of individuals to become ill or injured. 3
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Definitions Terrorism The unlawful use of force against persons or property to intimidate or coerce government, the civilian population, or any segment thereof, in the furtherance of political or social objectives 8
Definitions Weapons of Mass Destruction Nuclear, biological, or chemical materials, weapons, or devices deliberately used by terrorists that produce a nuclear yield or disseminates significant quantities of biological or chemical agent over a wide area for purposes of maiming or killing populations. Incendiary devices should also be included for completeness C B I R N Disaster Management 4 Phases of a Disaster: Mitigation Preparedness Response Recovery Disaster Management Mitigation Pre-event planning and actions which aim to lessen the effects of potential disaster Hazards Vulnerability Assessment (HVA) Tool Identifies direct and indirect effects of hazards Estimates and ranks the probability of occurrence and potential severity of various events Performed every 3 to 5 years Required for JCAHO accreditation 9
Disaster Management Mitigation Preparedness Actions taken before an emergency to prepare the organization for a response Examples: 1. Hospital Preparedness Program (ASPR) 2. Metropolitan Medical Response System (MMRS) 3. Emergency System for the Advanced Registration of Volunteer Health Professionals (ESAR-VIP) Elements: Planning Organizing Exercising Evaluating-Improving Disaster Management Mitigation Preparedness Response Activities to address the immediate and short-term effects of a disaster to save lives, protect property, and to meet basic needs Disaster Management Mitigation Preparedness Response Recovery Activities that occur following a response designed to help organizations and communities return to a pre-disaster lever of function 10
Disaster Management Homeland Security Presidential Directive - 5 Management of Domestic Incidents February 28, 2003 Policy To prevent, prepare for, respond to, and recover from terrorist attacks, major disasters, and other emergencies, the United States Government shall establish a single, comprehensive approach to domestic incident management Homeland Security Presidential Directive - 5 With regard to domestic incidents, the United States Government treats crisis management and consequence management as a single, integrated function, rather than as two separate functions. The Secretary shall develop and implement a National Response Plan that shall integrate Federal Government domestic prevention, preparedness, response, and recovery plans into one all-discipline, all-hazards plan 11
National Response Framework Replaces National Response Plan (Dec. 2004; ammended May, 2006) Guide to how the Nation conducts all-hazards response Delineates the Nation s response: doctrine, responsibilities, and structure Guiding principals that enable all agencies to prepare for and provide a unified national response to disasters Establishes comprehensive national, all-hazards approach to domestic incident response http://www.fema.gov/emergency/nrf/ National Response Framework Components Core document Emergency Support Functions (ESF) Support Annexes Incident Annexes Partner Guides Core document National Response Framework Guidelines for: National response Roles and responsibilities Response actions Response organizations Planning requirements to achieve an effective national response to any incident that occurs 12
National Response Framework Core document Emergency Support Functions (ESF) Federal resources and capabilities Grouped into functional areas frequently needed in a national response Provides concept of operations, procedures, and structures for achieving response objectives Coordinates capabilities and resources provided by Federal agencies, private-sector, and nongovernmental organizations National Response Framework Core document Emergency Support Functions (ESF) Example: State requests assistance with evacuation JFO requests staff from ESF-1 (Transportation), ESF-6 (Mass Care, Emergency Assistance, Housing and Human services), ESF-8 (Public Health and Medical) All become integrated into a single branch or group within Operations Section to ensure effective coordination of evacuation services National Response Framework ESF-1 Transportation Primary Agency: Department of Transportation 13
National Response Framework ESF-2 Communication Primary Agency: Department of Homeland Security National Communications System National Response Framework ESF-3 Public Works and Engineering Primary Agency: Department of Defense U.S. Army Corps of Engineers Department of Homeland Security FEMA National Response Framework ESF-4 Firefighting Primary Agency: Department of Agriculture U.S. Forest Service 14
National Response Framework ESF-5 Emergency Management Primary Agency: Department of Homeland Security FEMA National Response Framework ESF-6 Mass Care, Emergency Assistance, & Health and Human Services Primary Agency: Department of Homeland Security FEMA National Response Framework ESF-7 Logistics Management & Resource Support Primary Agency: General Services Administration\ Department of Homeland Security FEMA 15
National Response Framework ESF-8 Public Health & Medical Services Primary Agency: Department of Health and Human Services National Response Framework ESF-9 Urban Search & Rescue Primary Agency: Department of Homeland Security FEMA United States Coast Guard Department of the Interior National Park Service Department of Defense National Response Framework ESF-10 Oil & Hazardous Materials Primary Agency: Environmental Protection Agency Department of Homeland Security United States Coast Guard 16
National Response Framework ESF-11 Agriculture & Natural Resources Primary Agency: Department of Agriculture Department of the Interior National Response Framework ESF-12 Energy Primary Agency: Department of Energy National Response Framework ESF-13 Public Safety & Security Primary Agency: Department of Justice 17
National Response Framework ESF-14 Long-Term Community Recovery Primary Agency: Department of Agriculture Department of Homeland Security Department of Housing and Urban Development Small Business Administration National Response Framework ESF-15 External Affairs Primary Agency: Department of Homeland Security FEMA National Response Framework Core document Emergency Support Functions (ESF) Support Annexes Essential supporting aspects common to all incidents Financial Management Volunteer and Donations Management Private-Sector Coordination 18
National Response Framework Core document Emergency Support Functions (ESF) Support Annexes Incident Annexes Address the unique aspects for response to various incident categories: Biological Nuclear Radiological Cyber Mass Evacuation National Response Framework Core document Emergency Support Functions (ESF) Support Annexes Incident Annexes Partner Guides References describing key roles and actions for local, tribal, State, Federal, and private-sector response partners National Response Guidelines Establishes framework for the Nation to be prepared for all hazards Organizes / synchronizes National preparedness efforts Incorporates lessons-learned from previous disasters Facilitates capability and risk-based planning process Establishes readiness metrics to measure a system s preparedness 4 critical elements: National Preparedness Vision National Planning Scenarios Universal Task List Target Capabilities List 19
National Response Guidelines National Preparedness Vision Statement on core preparedness goal for the nation National Response Guidelines National Preparedness Vision National Planning Scenarios 15 broad range of natural and man-made threats facing the nation Guides homeland security planning efforts at all levels of government and private sector Basis for national planning, training, investments, and exercises needed to prepare National Response Guidelines National Preparedness Vision National Planning Scenarios Universal Task List 1600 unique tasks that prevent, protect against, respond to, and recover from major events 20
National Response Guidelines National Preparedness Vision National Planning Scenarios Universal Task List Target Capabilities List 37 specific capabilities that states and communities and private sector should collectively develop to effectively respond Homeland Security Exercise and Evaluation Program Exercises based on capabilities and performance Sets exercise policy and guidance to achieve national standards Outlines common practices for exercise management, design, development, conduct, evaluation, and improvement planning Provides tools and resources including policy and guidance, training, technology, and direct exercise support Web-based toolkit enables implementation of the corrective action program National Incident Management System (NIMS) Establishes a systematic approach for managing incidents nationwide Situational Awareness Continuous monitoring of relevant sources of information regarding actual and developing incidents 21
National Incident Management System (NIMS) Establishes a systematic approach for managing incidents nationwide Activation / Deploying Resources Assess the situation Identify and prioritize requirements Establish incident objectives Activate available resources and capabilities to save lives, protect property and the environment, and meet basic human needs National Incident Management System (NIMS) Establishes a systematic approach for managing incidents nationwide Manage Response Actions Incident Command System Multiagency Coordination Systems Public Information National Incident Management System (NIMS) Establishes a systematic approach for managing incidents nationwide Initialize and Coordinate Response Actions Activating people, resources, and other capabilities Requesting additional resources and capabilities Identifying needs and pre-positioning resources 22
National Incident Management System (NIMS) Establishes a systematic approach for managing incidents nationwide Demobilization Early planning for demobilization facilitates accountability and makes the logistical management of resources efficient in terms of both costs and time of delivery National Incident Management System (NIMS) Establishes a systematic approach for managing incidents nationwide Recovery Assisting individuals, households, critical infrastructure, and business in meeting basic needs Providing essential public health and safety services Restoring interrupted utility and other essential services Reestablishing transportation routes Providing food and shelter for those displaced National Incident Management System (NIMS) 4 levels of training: ICS-100 ICS-200 ICS-300 ICS-400 Introduction Basic Intermediate Advanced ICS-700 ICS-800 National Incident Management System National Response Framework www.fema.gov/nims 23
National Incident Management System (NIMS) National Incident Management System (NIMS) Incident Commander Responsible for all incident activities Overall authority and responsibility for conducting and approving incident operations Develops strategies and tactics, and sets priorities Orders the release of resources Ensures incident safety Authorizes information released to the media Establishes Incident Command System needed to manage the incident Coordinates Command and General Staff activities National Incident Management System (NIMS) Command Staff 24
National Incident Management System (NIMS) Command Staff Safety Officer Monitors conditions and develops measures for assuring the safety of all assigned personnel Public Information Officer Conduit for information to internal and external stakeholders Liaison Primary contact for supporting agencies assisting at an incident National Incident Management System (NIMS) Command Staff General Staff National Incident Management System (NIMS) General Staff: Section Chiefs Operations Directs all actions to meet incident objectives Planning Collects incident information, primarily status of resources and overall status of the incident Logistics Provides all resources, services, and support required by the incident Finance / Administrative Tracks costs, personnel records, requisitions, and administers procurement contracts 25
National Incident Management System (NIMS) Unified Command Used when incident expands in complexity Individuals designated by their jurisdictional or organizational authorities (or by departments within a single jurisdiction) Develops a single Incident Action Plan Executes integrated incident operations and maximizes the use of assigned resources National Incident Management System (NIMS) Area Command Structure that oversees the management of multiple incidents that are each being handled by a separate command organization Only activated if necessary Depends on the complexity of the incident and span-ofcontrol considerations National Incident Management System (NIMS) Incident Command Post Location of Incident Command Located near incident site All emergency management and response personnel report to and check in, and receive assignments 26
National Incident Management System (NIMS) Emergency Operations Center Coordinates information and resources to support incident management (on-scene operations) Located off-site Supports on-scene response by relieving the burden of external coordination and securing additional resources Core functions include: Coordination Communications Resource allocation and tracking Information collection, analysis, and dissemination National Incident Management System (NIMS) Joint Information Center Established to coordinate the release of information and other public affairs functions Serves as a focal point for coordinated and timely release of incident-related information to the public and the media Provides victim and family information in an accessible format and in appropriate languages Stafford Act (Public Law 100-707) Mechanism by which the Federal Government provides support to State, tribal, and local governments Primary Federal law to promote planning and response to a major disaster Designed to bring an orderly and systematic means of Federal natural disaster assistance for State and local governments in carrying out their responsibilities to aid citizens Creates the system by which a Presidential Disaster Declaration of an emergency triggers financial and physical assistance through FEMA 27
Emergency Management Assistance Compact When additional resources are required Interstate mutual aid and assistance agreement Administered by National Emergency Management Agency Provides form / structure to interstate mutual aid process Disaster Resources National Disaster Medical System Disaster Medical Assistance Teams (DMATs) Disaster Mortuary Teams (DMORTs) Veterinary Medical Assistance Teams (VMATs) Other Specialty Teams Disaster Resources National Disaster Medical System 55 Disaster Medical Assistance Teams 4 National Medical Response Teams 5 Burn Team 2 Pediatric Teams 1 Crush Medicine Team 3 International Medical/Surgical Teams 3 Mental Health Teams 3 Veterinary Medical Assistance Teams 11 Disaster Mortuary Operational Response Teams 1 Joint Management Team 3 Nurse/Pharmacist National Response Teams 28
Disaster Resources Disaster Medical Assistance Team Description 35-person volunteer health and medical professionals Cadre of logistical and administrative staff Federalized to provide medical care during a disaster or other event Disaster Resources Disaster Medical Assistance Team Mission Rapidly deploy to disaster site Provide primary and acute care, triage of mass casualties, initial resuscitation Stabilize and preparation sick or injured patients for evacuation Disaster Resources Disaster Medical Assistance Team Deployment Criteria Deploy within 6-hrs of activation (14-day deployment) Emergent care: 30-min of arrival Operational: 6-hrs of arrival Sustain 72-hrs without support 29
Disaster Resources National Medical Response Team Description 50-person volunteer health, medical, and Haz Mat Cadre of logistical and administrative staff Disaster Resources National Medical Response Team Mission Rapidly deploy to a disaster site Physician-supervised: Advanced medical services Decontamination Agent detection Assist in hazardous material environments Disaster Resources National Medical Response Team Deployment Criteria Deploy within 4-hrs of activation (14-day deployment) Fly / drive capability Operational: 30-min of arrival 30
Disaster Operations Scene Mitigation - Situational Awareness 1. Evaluate current response configuration a. Law enforcement b. Fire c. Medical (EMS, Public Health, Hospitals) 2. Augmentation for a contaminated incident a. Activation of the EOC b. Public health notification c. Mutual Aid support Scene Mitigation - Situational Awareness 3. Considerations a. Activation protocols for a terrorist incident response b. Scene security and crowd control c. Establishing incident command d. Designating contamination zones e. Patient extrication 31
Scene Mitigation - Situational Awareness 3. Considerations f. Establishing zones or sectors: i. Casualty collection ii. Decontamination (if applicable) iii. Triage iv. Treatment v. Transportation g. Controlling inbound resources and staging Casualty Collection 1. Rapid scene assessment a. Evaluate for casualty-causing risks b. Secondary devices c. Signs of haz mat exposure 2. Designating contamination zones 3. Search and Rescue 32
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Casualty Collection 4. Rapid categorization for mass casualties a. Ambulatory b. Nonambulatory 35
Casualty Collection 4. Rapid categorization for mass casualties a. Ambulatory b. Nonambulatory Remember: Hearing impairment following explosions is common, may lead to incorrect triage Triage 1. Initial triage methods Various systems: METTAG START Triage 2. Initial assessment a. Ambulatory vs nonambulatory b. Suspect multiple mechanisms of injury c. Similar symptoms or signs? d. Consider occult blast injuries 36
Triage 3. Categorize a. Non-moving: Immediate or Expectant b. Non-ambulatory: Immediate or Delayed c. Ambulatory: Delayed or Minimal d. Obvious death: Expectant Triage 3. Categorize Immediate / Red Severe, may be life-threatening High likelihood of survival Mechanical airway obstruction Sucking chest wounds Tension pneumothorax Exsanguinating hemorrhage Incomplete amputations Triage 3. Categorize Can tolerate delay prior to intervention Stable abdominal wounds Soft tissue wounds requiring debridement Crush injuries Traumatic amputation with controlled bleeding Immobilized cervical-spine injuries Major orthopaedic injuries Most eye injuries 37
Triage 3. Categorize Minimal / Green Requires little more than first aid Should be triaged to secondary treatment area Superficial fragment wounds Closed fractures Minor burns (< 15% TBSA) Auditory blast injury Psychiatric / emotional disorders Triage 3. Categorize Expectant / Black Requires unjustifiable expenditure of limited resources Unresponsive with open head wounds High spinal cord injuries Mutilating explosive wounds Second, third degree burns (> 60% TBSA) Profound shock with multiple injuries Agonal respirations Decontamination 1. How good are we in understanding decon? a. What do we know b. Are models in place (contamination & decontamination) c. Are standards developed d. How clean do we want e. What are the personnel / PPE issues 38
Decontamination 2. Types a. Gross decontamination The process of quickly removing potentially harmful contaminants from exposed individuals in order to reduce the spread and amount of contamination absorbed by an individual Decontamination 2. Types a. Gross decontamination i. Powder: Brush or vacuum material off Routine decontamination ii. Vapor and liquid : Routine decontamination Routine decontamination The quickest and most effective procedure Decontamination 2. Types a. Gross decontamination Undress Lots of water 39
Decontamination Decontamination Decontamination 40
Decontamination 2. Types b. Technical decontamination Ambulatory versus nonambulatory Gender specific Decontamination 2. Types b. Technical decontamination Ambulatory Decontamination 2. Types b. Technical decontamination Nonambulatory 41
Decontamination 3. Deceased a. Crime scene preservation b. Minimal disruption is important c. Deceased patients may contain valuable evidence d. Do not move remains or alter surroundings until cleared to do so by Incident Command e. Deceased must be decontaminated Prehospital Care 1. Incident Command System (ICS) 2. Triage 3. Treatment 4. Transportation 5. Personnel and equipment 6. Communications (internal and external) Prehospital Care 1. Incident Command System (ICS) Incident Commander (Unified Command?) Operations Planning Logistics Finance Law Enforcement Fire EMS Triage Treatment Transportation 42
Prehospital Care 2. Triage a. Personnel b. Interventions c. Initial categorization likely to change Prehospital Care 3. Treatment a. Interventions i. Delayed signs or symptoms Prehospital Care 4. Transportation a. Entrance and egress routes b. Staff c. Record keeping and information i. Agency transporting ii. Patient name or identifier iii. Decontamination status iv. Time of departure v. Destination d. Hospital communications 43
Prehospital Care 5. Personnel and equipment a. Internal personnel for disaster operations b. External mutual aid personnel for routine i. Protocols ii. State reciprocity iii. Scope of practice Hospital Care 1. ED Disaster Plan 2. Hospital Disaster Plan Public Health 1. Hospital surge capacity Health care system s ability to expand quickly beyond normal services to meet an increased demand for medical care. 2003: 113.9 million ED visits (26% increase from 90.3 million visits in 1990 s) 1990s: Number of U.S. EDs decreased 14% Lost 103,000 staffed medical-surgical beds Lost 7,800 ICU beds 44
Public Health 1. Hospital surge capacity Reductions in hospitals with EDs Regionalization of surgical care Increases in non-emergency patient visits to EDs Diversion of EMS Personnel shortages ED Overcrowding 45
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Equipment Environmental Environmental 48
Medications Beds Physicians and Nurses 49
Allied Health Dietary Public Health 1. Hospital surge capacity 2. Alternate care facilities 50
Historical Historical Historical 1906 San Francisco Earthquake 51
Historical 1918 Great Flu Pandemic Historical 1950-1972: Packaged Disaster Hospitals (2500) Historical 1950-1972: Packaged Disaster Hospitals (2500) 200 bed mobile hospitals Equipped with supplies for 30 days 15,000 square feet 15 KW generator 1,500 gal ion water tank Laboratory Pharmacy X-Ray Operating rooms Patient wards Admitting and sorting Central supply 52
Historical 1950-1972: Packaged Disaster Hospitals (2500) Staffing: 10 physicians 4 administrators 34 nurses 18 practical nurses 6 anesthetists 2 pharmacists 128 medical aides 124 other personnel Historical 1990s: US Army Soldiers and Biological Chemical Command and the Domestic Preparedness Program Acute Care Center Inpatient treatment without mechanical ventilation or likely to die Neighborhood Emergency Health Center High volume casualty reception center, triage, meds, information Modular Emergency Medical System Historical 2005: Hurricane Katrina 53
Issues No single model exists Various thoughts and standards Limited guidance Low probability events Limited funds to procure, plan, or exercise Required for The Joint Commission accreditation Types 1. Surge hospitals: Facilities designed to supplement existing hospitals in the case of an emergency Types 1. Surge hospitals a. Facilities of opportunity Nonmedical buildings that can be adapted Veterinary hospitals Day surgery centers Convention centers High schools Warehouses Airport hangars Hotels 54
Types 1. Surge hospitals a. Facilities of opportunity Pros May be proximate to existing health care facilities Environmentally sound Utilities exist Cons Requires movement of equipment and supplies No medical infrastructure Types 1. Surge hospitals b. Mobile medical facilities Structures that can be mobilized to any location Tents Tractor trailers Limited service trailers Types 1. Surge hospitals b. Mobile medical facilities Modular, fully-equipped, self-contained ASSTC (Advanced Surgical Suite for Trauma Casualties) 55
Types 1. Surge hospitals b. Mobile medical facilities NC State Medical Assistance Team (SMAT) Western Shelters Types 1. Surge hospitals b. Mobile medical facilities Pros May be proximate to existing health care facilities Provides infield emergent care Mobile, lightweight Cons Requires team familiar to set up Limited capability Cost Types 2. Surge in place: Capability to expand the surge capacity of a functioning health care facility 56
Types 2. Surge in place: a. Closed wards b. Hospital campus buildings c. Shuttered hospital Pros Health care environment Space & ancillary services should be present or proximate Cons May be environmentally unsound Many infrastructure systems or utilities may be damaged and unrecognized 57
Mecklenburg County Jail Carolinas Medical Center Mecklenburg County Jail Weekender Pod 58
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Planning Not just the number of beds Ability to handle a public health emergency Staffing Equipment resources Supplies and pharmaceuticals Ancillary services Requires connectivity to community leaders and planning organizations to ensure compatibility with community thinking, expectations, and initiatives Where to begin.. Planning Matrix tool for appropriate site selection Characteristics are assigned a weighted score of 0-5 www.ahrq.gov/research/altsites.htm 5 = Equal to or same as a hospital 4 = Similar to that of a hospital, but has minor limitations 3 = Similar to that of a hospital, but has major limitations 2 = Not similar to that of a hospital; requires minor modifications 1 = Not similar to that of a hospital, requires major modifications 0 = Does not exist in this facility or is not applicable to this the event 60
Planning Staffing 1. Existing pool Some may require alternative scope of practice Reallocating nonemergency providers into emergency roles 2. Retired or unemployed volunteers Medical Reserve Corps Red Cross, AmeriCorps, SeniorCorps 3. Reserve military medical personnel 4. Others Veterinarians, Dentists and assistants, pharmacists, students Federal: NDMS (7000) and USPHS (6000) Planning Supplies and Equipment 1. Federal Strategic National Stockpile, ASPR 2. Local donated materials Physician practices, medical schools, medical supply houses Pharmaceuticals 1. Federal Strategic National Stockpile, ASPR 2. Local donated materials Retail pharmacies, pharmaceutical distributers 61
Planning Administration Local, State, Federal Communication Typically the weakest link Sporadic cellular access EMS communications may be problematic Solutions may include: Telephone systems 2-way radios Satellite communications Planning Patient care Care in surge facility may not sustain high levels seen in fixed facilities May only reach sufficiency of care Limited privacy Crowded conditions Limited access to medical records Inadequate testing Goal is to treat each patient, then transfer to a facility with full capability at an ideal level of care Planning Legal During disasters, State and Federal Governments have mechanisms for the law to be changed to provide liability protection Katrina: Gov. Blanco waived State of LA licensing restrictions US Dept. of HHS afforded liability protection to volunteer health care workers treating hurricane victims ESARVHP: (Emergency System for Advanced Registration of Volunteer Health Professionals) 62
Planning Legal During disasters, State and Federal Governments have mechanisms for the law to be changed to provide liability protection EMTALA and HIPAA typically waived Transfer may be most expedient action Public Health 1. Hospital surge capacity 2. Alternate care facilities 3. Notification algorithms a. Local b. State c. Federal Public Health 1. Hospital surge capacity 2. Alternate care facilities 3. Notification algorithms 4. Resources Strategic National Stockpile (SNS) a. National repository of pharmaceuticals and medical materials delivered to a site to support local resources b. Contains antibiotics, antidotes, other pharmaceuticals, and medical / surgical supplies 63
Public Health 1. Hospital surge capacity 2. Alternate care facilities 3. Notification algorithms 4. Resources Strategic National Stockpile (SNS) c. Request procedures i. Local and State channels to Federal (CDC) resources ii. Each state must establish procedures d. Logistics on arrival (LRS) i. Equipment and supplies ii. Location iii. Personnel 64
Public Health 1. Hospital surge capacity 2. Alternate care facilities 3. Notification algorithms 4. Resources 5. Surveillance a. Fundamental responsibility of Public Health b. Increased need to continuously monitor community health and provide early warning of any change in health indicators c. Characteristics: i. Community-wide ii. Multiple indicators It is not a question of IF it will happen. It is a question of WHEN it will happen, AGAIN? 65