Earthquakes and fires and Obstetrics and Gynecology floodsOH MY!! - - PowerPoint PPT Presentation

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Earthquakes and fires and Obstetrics and Gynecology floodsOH MY!! - - PowerPoint PPT Presentation

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6/8/2018 Kay Daniels MD Clinical Professor Earthquakes and fires and Obstetrics and Gynecology floodsOH MY!! Disaster Preparedness I have nothing to disclose for OB Units Kay Daniels MD Clinical Professor Obstetrics and Gynecology

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Earthquakes and fires and floods…OH MY!!

Disaster Preparedness for OB Units

Kay Daniels MD Clinical Professor Obstetrics and Gynecology Co-Director of Disaster Planning at the Johnson Center for Pregnancy and Newborns Stanford University School of Medicine

Kay Daniels MD Clinical Professor Obstetrics and Gynecology I have nothing to disclose

Learning Objectives

1) Recognize the unique needs of obstetric units during a disaster 2) Recognize the specific needs for evacuation, shelter in place, surge and active shooter. 3) Describe OB specific tools used for disasters 4) Discuss future vision of disaster preparedness

  • n a regional, statewide and national level

Disaster Planning

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Mass Casualty Disaster The Hospital as “the injured”

Joplin Regional Medical Center, Joplin, MO 2011

“As I hurtled through space, one thought kept crossing my mind

  • every part of this rocket* was supplied by the lowest bidder”

John Glenn (*think…your hospital)

Earthquake Risk in Next 20 Years?

8

  • The chance of a 6.7 magnitude temblor, equal to the

1994 Northridge Quake, is:

  • 97% in southern CA
  • 93% in northern CA
  • The likelihood of a 7.5 magnitude quake, 16X more

intense, is:

  • 37% in southern CA
  • 15% in northern CA

https://i.ytimg.com/vi/-si7R9KRJOY/maxresdefault.jpg http://www.iii.org/issue-update/earthquakes-risk-and-insurance-issues

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Video from Oklahoma Why Moms and their Babies are at Risk in Disasters?

  • >97% of all births in the US occur in a hospital or clinical

setting…which may not be accessible or may be severely damaged during a disaster event

Why Moms and their Babies are at Risk in Disasters?

  • Pregnant women are subject to the usual risks of injury at

a disaster, but with more complicated care

Learning Objectives

1) Understand the unique needs of obstetric units during a disaster 2) Recognize the specific needs for evacuation, shelter in place, surge and active shooter. 3) Describe OB specific tools used for disasters 4) Discuss future vision of disaster preparedness

  • n a regional, statewide and national level
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OB is Unique

One size ≠ all in a disaster setting for OB

Within the same footprint of any OB unit there exists a large variety of patient acuity and needs

  • Laboring women
  • Intra op and post operative patients
  • Healthy postpartum patients with their newborns

Why is OB unique?

We always have 2 patients

  • Antepartum = mom + fetus
  • Postpartum = mom + newborn

thavibe.com

Keeping Mom and Baby Together…

  • In the days after Hurricane Katrina struck Louisiana,

125 critically ill newborn babies and 154 pregnant women were evacuated to Woman's Hospital in Baton Rouge It was at least 10 days before some of the infants and mothers were reunited Washington Post 2006

www.neworleans.va.gov/images/evacuate2_lg.jpg

Learning Objectives

1) Recognize the unique needs of obstetric units during a disaster 2) Recognize the specific needs for evacuation, shelter in place, surge and active shooter. 3) Describe OB specific tools used for disasters 4) Discuss future vision of disaster preparedness

  • n a regional, statewide and national level
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Concepts: Hospital Response

 Evacuation  Shelter in Place  Surge Active shooter

Evacuation Being Prepared to Evacuate L&D Because when you got to go….. You have got to go!!

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We need a universal common language for evacuation

  • Disaster triage tool designed for

hospitalized OB patient movement

  • Based on the needs of patient to

determine appropriate level of transport for evacuation

  • Created by expert opinion and aligned

with local EMS protocols for transport

Disaster Planning for OB: A Triage Algorithm

OB TRAIN* = Triage by Resource Allocation for IN patient

*Based on the triage system created by Dr. Ron Cohen for the NICU at LPCH and adapted for OB

OB TRAIN for AP + L&D

(S) Specialized = must be accompanied by MD or Transport RN * Able to rise from a standing squat ** Epidural catheter capped off

Basis of Triage for OB TRAIN for L&D/AP  Blue = Car  Green = BLS  Yellow = ALS  Red = Specialized

http://www.parsippany.net/Departments/Ambulance-Squads/images/IT.jpg

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Basis of Triage System for OB TRAIN

 Labor status  Mobility  Anesthesia status  Maternal risk factors/fetal risk factors

http://sd.keepcalm-o-matic.co.uk/i/keep-calm-and-triage.png

OB TRAIN Triage - Example

32 yr @ 31 weeks with severe preeclampsia undergoing induction of labor

  • Early labor: 2 cm
  • Non-ambulatory
  • Epidural in place < 1 hr
  • Cat 1 FHR
  • Intermittent IV labetalol

for BP control

  • On 2 g of IV

magnesium sulfate

Specialized Levels of Maternity Care ACOG Consensus Feb 2015

  • 1. Levels:

Birthing Centers Basic Care (Level l) Specialty Care (Level ll) Subspecialty Care (Level lll) Regional Perinatal Health Care Centers (Level lV)

  • 2. Capabilities
  • 3. Types of providers

SEND THE RIGHT PATIENT TO THE RIGHT HOSPITAL

Obstet Gynecol 2015:125:502-15

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Hospital Levels of Care and Distance List

Distance (mi)

Hospital City

Neonatal Maternal Hospital Phone number

0.0 LPCH Palo Alto 4 4 (650) 497-8000 18.4 Santa Clara Valley Medical Center San Jose 3 3 (408) 885-5000 34.6 UCSF SF 4 4 (415) 476-9000 36.0 CPMC SF 3 3 (415) 600-6000 38.6 Kaiser Oakland Oakland 3 3 (510) 752-1000 17.0 Kaiser: Santa Clara Santa Clara 3 4 (408) 851-1000 19.8 Good Samaritan San Jose 3 3 (408) 559-2011 36.4 Kaiser: San Francisco San Francisco 4 (415) 833-6353 53.0 John Muir Walnut Creek 3 3 (925) 939-3000 9.0 El Camino Mountain View 3 2 (650) 940-7000 32.3 SF General SF 2 2 (415) 206-8000 42.7 Alta Bates Berkeley 2 3 (510) 204-4444 45.5 Dominican Santa Cruz 2 2 (831) 462-7700 78.5 Natividad Medical Center Salinas 3 2 (831) 647-7611 81.2 Salinas Valley Memorial Salinas 2 2 (831) 757-4333 205 Sierra Vista Regional Medical Center San Luis Obispo 2 2 (805) 546-7600 8.2 Sequoia Redwood City 2 2 (650) 369-5811 17.9 Washington Fremont 2 1 (510) 797-1111 19.9 O’Connor San Jose 2 1 (408) 947-2500 22.7 Regional Medical Center San Jose 2 1 (408) 259-5000 57.0 Watsonville Watsonville 2 1 (831) 724-4741 6.8 Kaiser: Redwood City Redwood City 1 1 (650) 299-2015

Reality testing

Fox news

Hospitals’ Best-Laid Plans Upended By Disaster

  • The Tubbs Fire roars through

neighborhoods Oct. 9 in Santa Rosa, Calif.

  • It was 3:35 a.m. and flames from a massive

Northern California wildfire licked at the back of a Santa Rosa hospital.

From Richard O Johnson MD California Pediatric Surge Project 2018

31

  • Within three hours, staffers evacuated 122

patients to other facilities — something they’d never come close to doing before. Ambulances sped off with some of the sickest patients; city buses picked up many of the rest.

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Shelter in Place Shelter in Place/Evacuation: Grab & Go Bags COMMUNICATION: Peds OB

How will peds know where OB is evacuating to?

  • Is there a system in place for notification?

Who from peds has been designated to go with OB?

  • To care for ‘shelter in place’ in deliveries

Surge

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Definition : Surge

A Surge Event is a significant event or circumstances that impact the healthcare delivery system resulting in excess demand over capacity and/or capability

CNN 2013

Specifics for Surge : Types

  • 1. Conventional/crowding capacity: Spaces, staff,

and supplies used are consistent with daily practices within the institution

  • 2. Contingency capacity: Spaces, staff, and supplies

used are not consistent with daily practices but maintain or have minimal effect on usual patient care practices

  • 3. Crisis capacity: Adaptive spaces, staff, and supplies

are not consistent with usual standards of care but provides sufficiency of care in the setting of a catastrophic disaster

Surge Type : Conventional/crowding

  • Your hospital is intact
  • You are receiving a large influx of patients

(We have all been here!!)

  • Because there is a full moon
  • Because some one dared to say

“It sure is quiet tonight”

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Conventional/Crowding surge

  • You have the ability to flex up to accommodate influx
  • No gubernatorial waiver of existing

regulations Surge Type : Contingency Influx above usual census and resources are inadequate

  • Any hospital can internally declare a disaster
  • You are expected to:
  • Follow the rules outlined in the pre-approved

Emergency Operations Plan (EOP)

Surge Type : Crisis Influx with simultaneous severe damage to the hospital

  • Catastrophic disaster
  • Damage to the entire area and your hospital is

severely damaged yet you are receiving a surge

  • f patients
  • State has declared a disaster
  • Gubernatorial Waiver of existing regulations

Governor’s Suspension: Government code section 8571

  • The Governor can suspend any regulatory statue if

he/she determines that compliance would prevent/delay the mitigation of the effects of a state emergency

California Department of Public Health Standards and Guidelines for HealthCare Surge during an Emergency

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Active Shooter

Prime medical training

One more thing to plan for……

An#cipate First Responders 911 Dispatch will ask:

  • Law Enforcement will:
  • Fire and EMS will not:
  • You should:
  • Ac#ve Shooter Preparedness & Response

at Stanford Health Care & Stanford Children’s Health

Overview ac#ve killer or shooter Prepare ! ! ! See Something, Say Something Your Response " Call (9) 9-1-1, then Security at 650-723-7222 " Overhead announcement of killer’s loca#on will be made so that you can determine your ac#ons ! Run – If you can get out, do! " " ! Hide – if you can’t get out safely " " " ! Fight – only as a last resort " " " Prime medical training University News,University of Missouri

Learning Objectives

1) Recognize the unique needs of obstetric units during a disaster 2) Recognize the specific needs for evacuation, shelter in place, surge and active shooter. 3) Describe OB specific tools used for disasters 4) Discuss future vision of disaster preparedness

  • n a regional, statewide and national level
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How to Avoid Chaos?

Image credit: Robert Gauthier/LA Times

We all need a plan…

“In preparing for battle I have always found that plans are useless, but planning is indispensable” ~ Dwight D. Eisenhower

Flexibility is our only hope

Lifeofjoy.me

Planned Unit Response

 Designate someone to be in charge

  • This may be the charge nurse + /- hospitalist
  • Decide before the disaster who this should be

 Provide “just in time” tools

  • Use job aids to assist with roles and tasks – we do

not use the disaster process often

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L&D Disaster Plan: Job Action Sheets Disaster Essentials: Binder and Equipment Box Learning Objectives

1) Recognize the unique needs of obstetric units during a disaster 2) Recognize the specific needs for evacuation, shelter in place, surge and active shooter. 3) Describe OB specific tools used for disasters 4) Discuss future vision of disaster preparedness

  • n a regional, statewide and national level

Next steps: Collaborative Network on a Regional, Statewide and National Level

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Why do we need a Preexisting Regional Collaboration?

Lessons from Katrina

  • Communication is essential but is always a challenge
  • Phone lines may be down
  • Internet may be off
  • All disaster response is local for the first 48–96 hours

The ability to mobilize resources depends on a pre-existing local collaborative network

Mattox KL. Critical Care 2006;10:205 (doi:10.1186/cc3942)

What can we do?

  • Let’s educate
  • Let’s plan
  • Let’s talk

Let’s educate

  • Our hospital administrators and OEM

(Office of emergency management)

  • OB is different and needs special

consideration

  • Prepare our staff
  • Begin yearly training

Let’s plan

  • Begin a statewide OB disaster coalition

tasked with :

  • Creation of consensus driven

standardized OB response to hospital based disasters

  • Disperse information
  • Including ACOG maternal levels of

care/OBTRAIN

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Let’s talk

  • To our local and statewide hospitals
  • How do we best communicate in a disaster?
  • To insure there are the needed resources in

place on a state and federal level for

  • bstetrical patients

OB disaster planning Webinars

  • Quarterly meetings
  • What we hope to do:
  • Create the first OB disaster collaborative
  • Define standards for OB disaster planning
  • Communicate with other coalitions, state and national
  • rganizations
  • Share real life experiences/lessons learned
  • Santa Rosa Fires
  • Houston Flooding

If interested in joining : email kdaniels@Stanford.edu

Are YOU Ready???

www.Entrepreneur.com

Resources

  • Join our OB disaster webinars:

Quarterly on line discussions and OB disaster planning coalition contact : kdaniels@Stanford.edu

  • Stanford Disaster Website for OB Tools:

http://obgyn.stanford.edu/divisions/mfm/disaster-planning.html

  • Want more information including Peds and NICU TRAIN

https://stanforduniversity.qualtrics.com/SE/?SID=SV_aeBdl uNgaCcizFb

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Thank you for your attention

kdaniels@stanford.edu