This document outlines a hospital's mass casualty and hazardous chemical exposure plan. It discusses lessons learned from past events and key considerations for responding to a mass casualty incident. The plan details activating different response stages depending on the scale of the event and allocating roles and supplies. Triage, documentation, decontamination and expanding capacity to other hospital areas are addressed. The emergency operations centre coordinates the overall response and the hospital communicates regularly with them during an incident.

1. Mass Casualty +
HazChem
Dr Chris Cresswell
2013

2. Lessons from
 Terrorist attacks
 Chch earthquake
 Tasman Tanning
 Still learning and
developing systems

3. Key points for docs
Consider “Lock down”
Get more staff including SMOs
Consider diversion
Consider early transfer
Consider decontamination

4.  Clear ED as much as possible
 Do what you would normally do (but skip some
of the finer details like Family Hx and CRP,
BNP). Documentation. Emergency ID
 Write ID on the patient
 Reverse triage is controversial
 ED teams with outside assistance
 Senior docs: logistics, overview, consultation

5.  Surge out to PACU, Day unit, Outpatients
 Morgue
 Social work

6. Emergency Management Plan
 Red Folder located in ED Drug Room
 Service Profile
 Contingency Plan
 Reduction/Readiness/Response/Recovery
 Mass Casualty Plan
 Pandemic Plan
 Hazardous Substance Exposure Plan

7. Mass Casualty Plan
 One section of Emergency Plan
 Response staged into 3 tiers dependent on
magnitude of event
 Stage 1 = ED only
 Stage 2 = ED + Hospital
 Stage 3 = ED + WDHB wide + EOC +/-
local, regional or national support

8. Mass Casualty Plan
 To establish which stage is required refer to
the MCP Flowchart
 Located ED Drug Room with explanation of
Stage 1, 2 & 3
 Flowchart allows for MCP to be escalated
as event unfolds

9. What Will it Do?

10. What Won’t it Do?

11. Activating Mass Casualty Plan
 Information of event
received
 D/W DNM / ED Team
 Decide on Stage of
MCP required
 DNM is the only one
who can activate MCP
 Notify Switchboard
Operator of activation
of Stage 1,2 or 3 of
MCP

12. What Happens Then?
 Switchboard Operator follows a list of
instructions and calls in and notifies the
listed staff
 Staff and services activated at Stage 1,2,3
can be seen on the wall of the ED Drug
Room and also in the Coord Pack of the
Mass Casualty Box
 Open Mass Casualty Box

13. Mass Casualty Box & Vests
 Mass Casualty Box
and vests are stored in
the ambulance store
room
 Open the Box
 Elect a Coord
 Follow the instructions
in the Coord Pack

14. Signage
 Coord point by Rm3
ED outside of staff
station
 Triage (backdoor)
outside Resus 2
 Orderly & Transport
Nurse @ Coord point
 Info point at reception

15. More Signage

16. Allocating Roles & Areas
 Vests are for ED staff
only
 Each role comes with
a job card
 Consider allocating
areas/rooms to ED
staff and further
dividing as more staff
arrive

17. ED Staff with Vests and Job Cards
 ED staff manage their
area and helper staff
that are allocated to
them
 Creation of small
teams allows ED staff
to focus on their area
and helper staff to be
supported

18. Non ED Staff
 Non ED staff who
come to help are also
given a job card,
allocated to a ED staff
member and given a
title tag
 ED and non ED staff
are easily
differentiated

19. Job Cards
 All staff receive a job
card when they check
in
 Gives a guide of what
their role is and who to
report to
 Many titles – take a
look and familiarize
yourselves

20. Calling in ED Staff
 Coord decides how
many of each
discipline required
 Call in or delegate
task to colleague
 Call in until required
number on way and
record on Staff Log

21. Preparing ED
 Liase with DNM and clear ED as much as
possible
 Consider Pts for discharge / TX to WR / TX
to WAM / TX to Ward
 Possible surge capacity SDU / PACU /
OPD / ATR (All require DNM to arrange)
 Clear trauma beds

22. Documentation
 Do what you normally
do
 ID pts ASAP
 Use Unknown ID if
delays in registering
 All pts need to go on
Pt Log
 This is basis for
tracking pts in system

23. Supplies
 Pre ordered supply
of pharmacy items,
linen and
consumables will
arrive within the
first hour of a Stage
2 or 3 of MCP
 List in Coord Pack

24. Emergency Operations Centre
 EOC manage the
overall response to
event
 Send Status Report
to EOC hourly PRN
 Can request staff,
services and
equipment via EOC

25. HAZCHEM
 Protect
yourself and
the hospital
 2 people to
gown up

26.  Everyone from scene goes thru shower by ambulance
bay
 Keep faces out of pools of water!
 CPR etc could continue in shower
 Then patient goes through to triage etc and is
considered “clean”

27. References
 Thanks for those staff who kindly ‘volunteered’ as models for the
photos of this presentation
 Coordinated Incident Management Systems, 26/08/11.
http://www.emergencymanagement.co.nz/training/in-house-
training/192-cims-premier-package.html
 Thanks to Midcentral DHB, Hawkes Bay DHB, Capital & Coast
DHB sharing their Emergency Management Plans, 2010.
 Thanks to RN Michelle Battarbee and Katie Edmonds for
developing the plan and Michelle for writing the first version of this
presentation