Disaster Preparedness: Disaster Preparedness: Baylor Baylor s - PDF document

Disaster Preparedness: Disaster Preparedness: Baylor Baylor’ ’s experience and Impact on Learners s experience and Impact on Learners Faye Faye Chiou Chiou Tan, MD Tan, MD Professor PMR, Baylor Professor PMR, Baylor Chief PMR, Ben Taub Chief PMR, Ben Taub/Quentin /Quentin Mease Mease Hurricane Katrina Hurricane Katrina – category 4 hurricane – struck New Orleans on August 29, 2005 – evacuated to the Houston Astrodome three days later on September 1, 2005. – 27,000 persons were eventually housed and fed in the Astrodome. – “Operation Dome Shelter” 1

Creation of Astrodome Clinic Creation of Astrodome Clinic • The Astrodome Medical Clinic was created with 12 hours notice. • The Harris County Hospital District was charged with the organization and implementation of this clinic. • The Harris County Hospital District physicians and staff were expected to be first line disaster relief personnel in this disaster. • 11,245 patients were seen in the Astrodome Clinic. – Gavagan, TF, et. al., Southern Med J. 2006: 99(9). Preparation Preparation • Education on disasters – – Student orientation during Hurricane Season • Preparation list for home – supplies, etc. • Contact list – phones, pagers, email • Hierarchy = Incident Command (IC) • Disaster drills – bomb threat, fire drill, code blue drill 2

Permission Permission • Medical legal insurance coverage for learners • Catching those who circumvent credentialing • Medical students participated as volunteers in Katrina • Medical students participated under faculty supervision as part of their medical team in Ike 3

Compel Compel • “We cannot compel (learners) to stay in a disaster – we usually have more doctors than we need” Dr. Ken Mattox • Psychiatric and emotional issues • Child and elderly care issues Educational Benefits for Learners Educational Benefits for Learners • Allowing learners to participate is disaster education for future disasters • Everyday emergency management (car accidents, train wrecks, petroleum explosions, etc. ) is good preparation for larger disasters. • Logistics management is educational Specialty Educational Benefits Specialty Educational Benefits • How do we fit in with Triage/ Acute Trauma? • What does our specialty contribute to the disaster? • What supplies do we need to let the administrators know about specific to our field of knowledge? – Cath kits, mobility devices, dressing, pain pump refill issues 4

PMR Astrodome Data PMR Astrodome Data ( (Chiou Chiou- -Tan, Am J PMR, 2007:86(9) Tan, Am J PMR, 2007:86(9) 50 2500 Frequency of PMR 40 2000 Frequency of All Conditions Conditions 30 1500 20 1000 10 500 0 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 / / / / / / / / / 1 1 1 1 1 1 9 9 9 9 9 9 9 9 9 / / / / / / 9 9 9 9 9 9 Date of Visit PMR Clinic Total Astrodome Clinic Types of PMR Diagnoses Types of PMR Diagnoses (Chiou Chiou- -Tan, Am J PMR, 2007:86(9) Tan, Am J PMR, 2007:86(9) ( 70 63 60 Number of Patients 50 with Diagnosis 50 36 40 30 30 16 15 14 13 12 10 20 8 6 5 10 4 4 3 0 g s n l r e s c s s e s s e a e C I e e p h i r m i m m k t i m e l m a w c u h o i S t / c p l e t e e s e u t a a u c t l a l l r r l o a r b b b t u b p o r d k d n a p s c a c r o o o o b o m f a h i f r r n / e t k p r p r r a n h b i s u p p e i w e a k / m g S k l l p / n e / n o c s r M g e d a l u w S e n e S r t r s l m / e / M S M h n t / o M a i p Diagnostic Category Clinical Preparation Clinical Preparation • Chief and Asst. Chief are painfully busy. • Transportation of persons with disability out of harm’s way – QM closes and moves to Ben Taub – Discharge team (QM) / Receiving team (BT) • Resident / Student coverage for disaster – Set up extra on call beds, cots, rooms – FEMA food, water conservation education, toilets • Simultaneous coverage for hospital functions still open (inpatient, outpatient, clinics, consults) • Clinics are filled with patients needing Rx. 5

The Storm The Storm • Safest place to be is in the hospital • Hopefully boring – – Eat like you are on a Cruise Ship – Bring an (educational) book to read • Extra students and residents • Extra family members and pets Post Disaster Post Disaster • Post disaster is the hardest, longest part • Where is everyone? Are they OK? • Lights, water, petro gas, airconditioning, food, medicine • Electronic communication devices – Everyone comes in for comfortable AC and to power their electronic gadgets – Learners competing for the on-call rooms Post Disaster Post Disaster • 25% of disaster relief workers experience post traumatic stress disorder • Debriefing – What did you learn? – How did that make you feel? Councilors – What can you do to prepare for next time? 6

Post Disaster Post Disaster • Follow through – Communicate with your chief residents and residency directors on improvements • Call schedules • Site specific needs • Educational aspects – Study the data scientifically in a paper. Recognition of Learners Recognition of Learners • Recognize exemplary behavior of the learner and let the residency directors and Chairman know. • Write about it in your letter of reference for the learner. • Do something nice for everyone when it’s all over – T-shirt, ice-cream social, hero list, etc. Adoption of Tulane students Adoption of Tulane students • Baylor, UTMB, UTHSC, TAMU adopted 620 medical students (310 clinical) and 526 house officers • Started Sept 8 th , 2005 - 8 months duration – Searle, Acad. Med. 2007 82(8):733-44. 7

Adoption of Tulane Students Adoption of Tulane Students • Safety – where are the students? • IT – Website created by BCM in 4d, contact lists, links (eg. to FEMA) • Lodging –on Website, taking in students (200 matches in 3 days) • Faculty offices in small group teaching rooms. • Student lounge in former cafeteria area- student lockers, pool table, TV, etc. Adoption of Tulane Students Adoption of Tulane Students • Finances – Tulane acct set up in each academic department to bill Tulane • ID badges – Tulane/Baylor badges made • Counseling services – provided by Dept. of Psychiatry – 170 student visits. Tulane reimbursed Baylor for services. • Obtaining flooded records – registrar’s office often worked 16hr days. More Drama More Drama • Sept 23, 2005 – Hurricane Rita (last 2000 Astrodome residents moved to Arkansas) • Oct 3, 2005 – Start of academic year for Tulane students at Baylor. • Oct 3, 2005 - Baylor Liason Committee for Medical Education (LCME) site visit. • Match Day celebrations – Separate match day locations for each school • Tulane sponsored “Baylor Thank You Day” – Mardi Gras crawfish boil 8

Other issues Other issues • Recruitment season – full class recruited at Tulane with similar GPA, MCAT. • Donations in support of Tulane students - $176,045 – used for metro passes, emergency housing, scholarships, lost revenue from foreign students. • Tulane faculty/residents received temporary Texas licenses. Thank You Thank You • I wish to acknowledge: – All my brave learners, residents and faculty partners – All my brave staff and building support – Incident command leaders who are always brave ☺ • Dr. Ken Mattox • Dr. Thomas Gavagan 9