The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...
CBR Disaster Management
1. Dr Stephanie Schlueter/ Dr Deanne Chiu
CME 20th March 2014
Sir Charles Gairdner Hospital
Emergency Procedures
CODE: CBR
PPE
2. Outline
• Case presentation
• Brief review of the response of SCGH ED to a CBR incident
• Demonstrate PPE required for a CBR response
• Practice Donning & Doffing
3. Case
0810 hrs: RED Phone rings
“ This is T.S. from the Department of Health:
Canisters containing unknown substances have been detonated at Fraser
Restaurant during the CHOGM morning breakfast meeting.
Expect Mass Casualties
Symptoms range from D&V to full cardiac arrest “
Outline your approach
5. Emergency Department Process
Code Brown/ CBR
Phase 1- Notification
• Official phone call
• Name, Title and telephone number of caller
• Major incident declared or only potential
• Exact location of the incident
• Type of incident
• Hazards
• Access to site
• Number & type of casualties & expected arrival times
• Emergency services (present & required)
“ METHANE ”
6. Emergency Department Process
Code Brown/ CBR
• Confirmation
• DPMU/State Health coordinator
• Log onto WEBEOC- http://myeoc.health.gov.au/eoc7
• Activation
• Dial “55”- activate Code Brown
• Request to speak to Hospital Health Coordinator
• Switch will activate Emergency Response Team (ERT) and Emergency
Control Group (ECG)
• Code CBR announced over PA system
7. Emergency Department Process
Code CBR
Objectives:
– Modify workflow and resources
– Provide the greatest benefit for the most number of casualties
– To provide a Hospital Response Team (HRT) +/- Health Commander if
requested
– To return to a normal working environment as soon as possible
– To attend to welfare of relatives of patients and staff
8. Emergency Department Process
Code CBR
Phase 2- Preparation
• Meet with Emergency Response Team
• Review Code CBR Plans & Equipment
• Hospital Lockdown
• Brief ED staff
• Command and Communication
• Action Cards
• Prepare space
• Decanting ED safely
• Rearrangement of geographic function
• Teleconference
• Expand Resources
• Staff
• Hospital
• Equipment
9. Donning
PPE- CBR
• One Piece Positive Pressure Coverall
• Inner Butyl Gloves
• Pipe
• GIAT PAPR - Respirator C420
• Belt Assembly
• 2 Filter Cartridges per unit
• Lithium Battery
10. Before you get started
• Response Briefing - Know what you are going to do!
• Change into scrubs
• Drink 2 glass of water
• Go to the toilet
• Have your vital signs taken by the Safety Officer
11. PPE Heat Load Generation
- Body temperature rises 1.5 times as fast.
- Heart rate increases 80 per cent.
- Endurance times are reduced by 60 per cent.
- Weight loss is 40 per cent higher.
- Perspiration evaporation is halved
12. Heat related illness
• Warning signs will include:
• Changes in gait (staggering),
• Changes in speech (slurring)
• Changes in behaviour (erratic)
Many of these difficult to monitor in PPE – this makes
observation by “buddy” and use of a safety officer important.
13. PPE Hazards
• Impaired visibility
• Impaired mobility
• Impaired communication
• Sensory Impairment
• Psychological stresses (such as claustrophobia).
14. OHS- Requirements
• Maximum work time in PPE 30 minutes
• Minimum rest time 30 minutes
• Rest area
If any person is injured/unwell/feeling faint:
• Sit down where you are
• CODE WORD: NO DUFF
• All participants to stop what they are doing & await further instructions
• Exercise Controller to assess injured; and announces if exercise resumes if safe
to do so
15. Doffing
• Always self decontaminate in the suit first
• The suit and PAPR are waterproof
• Undo your boots and unzip the suit to your waist
• Undo your PAPR belt
• Remove your arms from the sleeves and lift your head off -
Try to touch the inside of the suit only
• Step out of the suit
• Continue decontaminating
17. Summary
• Challenging & overwhelming situation
• Be familiar with the Emergency Procedures Manual
• Regular practice of Donning & Doffing for medical staff is
essential
• Your safety 1st !!!
• Participate in any Disaster Exercise & MIMMS course
18. References
1. MIMMS Handbook, 2nd Edition
2. SCGH – CODE CBR , Emergency Procedures Manual, July 2009
3. Emergency Management Australia
Victoria DoH
Health Services Personal Protective Equipment and Decontamination
Hospital Staff Training Course Presenters Guide
A special thanks to
• Simone Thurkle (SDN)
• Gaby Hutchinson (SDN
• Emma Kubale (SDN)
for their time, experience and materials in preparation of this exercise.
Hinweis der Redaktion
response or activation occurs in stages
Code Brown- response or activation occurs in stagesStage 1: NotificationOfficial phone call: Which phone, Who, sources- where- BAT phonesources: SJA, FESA, Disaster & Preparedness Management Unit (DPMU), State Health Coordinator, Metropolitan Hospital Medical Coordinator- ED DC/ Senior Reg/ Duty Reg or Shift CoordinatorFill in CODE BROWN notification form & contact DC immediatelyALWAYS confirm !!!Unofficial calls MUST be confirmed by phoning the Hospital Health Coordinator On Call Duty officer, DPMU on 9328 0553 or Ambulance control center
What are your main objective during the preparation phase?Aim- to be able to deal with multiple or mass casualties from a disaster in a timely and effective manner
??? What do you want to prepare???Emergency Response Team:SRN & Area WardenShift EngineerSecurityHAS SupervisorReview Code CBR Plans- Activate and enact ED plansDisaster cupboard- contains all equipment required for a Disaster response in ED and for HRTBrief staff: Med, Nursing and auxillary staff are under the direction of the ED Consultant and ED nursing supervisor- should not take direction form any other hospital staffAction Cards:Easiest and most efficient way to organise individual staff to enact a plan they have never executed before= ALLOCATION OF ROLESStaff should be given roles they are familiar withClearing ED - Expediting admission- all admitted patients immediately to the ward - Discharges: Senior Registrar or Consultant to r/v all patients in WR- admit, other medical facility, GP or homeRearrangement of geographic function- Tiered response- as staff arrive areas areas can be expanded - Area file in Disaster Response Cupboard - Triage: ED Cons or Sen Reg, Senior ED nurses x2 - Resus 1-7, C 8,9 – ATS 1 & 2 - C 10-18- ATS 1,2,3 - C 19-28 & FT- ATS 3&4 - Obs: ATS 3 &4 once 19-28 full - Pain Clinic- ATS 3,4,5 - Plastics dressing clinic- Treatment areas for 4&5Resources- Call in staff but ensure adequate reserve to maintain 24/7 Hospital Lock downDC & SCO:Decanting ED