Disaster Plans Oslo University Hospital

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1 Preparedness for disasters -the Oslo experience Dag Jacobsen MD, PhD, FAACT Director & professor Department of Acute Medicine Oslo University Hospital Disclosures: Born, raised, educated & trained at OUH Disposition National & local disaster planning Types of disasters Infrastructure damage NBC (CRBN) incidents Mass poisonings Twin attacks - Oslo July 22, 2011 Government district bombing Utøya shooting incident Take home message Preparedness - definition Preparedness principles - Norway Measures to prevent, minimize & improve handling of disasters and other unwanted events Responsibility principle Same chain of command on a daily basis as in a disaster Local principle Treat what you can at the lowest possible level Similarity principle Business as usual the management principles & organization during disasters should mimic the daily routines as much as possible 1

2 Disaster Plans Oslo University Hospital Same/one patient flow regardless of type of disaster ED OR/PO ICU/OR/PO local hospital Everybody else are supporting this patient stream In medical disasters the medical clinic/micu will take over surgical pts so the PO/surgical ICU can focus on disaster victims 2 out of 8 daycare units are part of the disaster plan 24/7 Infrastructure failures are part of plans It is predictable that the unpredictable will happen Aristotle, BC Inge.J.Solheim@ous-hf.no Accidents & disasters May occur suddenly & unexpected May develop more slowly (SARS epidemic) May involve many persons - also the worried well May involve few or only one may be hospitalized He who saves one life is as one who has saved a whole world (Talmud). Types of accidents & disasters (Oslo) Fire & explosions Road accidents Train accidents Shipping accidents Plane crash CBRN & mass poisonings (Mass shootings)* * It is predictable that the unpredictable will happen 2

3 Preparedness what about hospital infrastructure? Hospitals depend on water from the public system Ullevål m 3 water per day National hospital ca 600 m 3 Food Dialysis Lab. X-ray Laundry Major disasters with many casualties requiring hospitalization are relatively rare. Failure in our Infrastructure Last 3 years: 4 critical failures in our hospital water supplies 2009: Bilbrann bygning 16 Svikt i kritisk infrastruktur Noen hendelser: 2010: Påtenning pasientseng bygning : Kortslutning med påfølgende brann i IT skap bygning 15 Brannbilder 2005: Kortslutning med påfølgende brann i varmeskap bygning : Kortslutning med påfølgende brann i gammelt uranlegg bygning : Vannlekkasje medførte kortslutning og påfølgende brann i PC bygning 05 Inge.J.Solheim@ous-hf.no 3

4 Failure in Critical Infrastructure March 3, 2011: Total collapse of all data systems due to failure in the reserve electricity system NBC-Medicine what is it? Nuclear (Atomic) Biological Chemical Therefore, possible failures in hospital infrastructure must be part of our disaster plans (or CBRN) 4

5 Management of C-events (nerve gases) Decontamination (often overemphasized) Fire department Civil defense Hospital Protection of helpers & caregivers Establish effective treatment & evacuation lines Medical treatment On the scene Hospital Tokyo 1995 Ambulances transported 688 patients Nearly five thousand people ( the worried well ) reached hospitals by other means. Hospitals saw 5,510 patients: 17 critically ill 37 severely ill 984 moderately ill 9 dead the day of the attack, rose to 12 The cases classified as moderately ill mainly complained about vision problems. Most of those reporting to hospitals were the "worried well," who had to be distinguished from those that were ill. Okumura T et al. Acad Emerg Med 1998; 5: In summary: It is predictable that the unpredictable will happen Make plans & be prepared (practice) Take the lead & improvise Think ahead Always enough people skills may be lacking Also focus on the waiting personnel 5

6 And don t forget: Also focus on the waiting personnel. Every disaster becomes an even bigger disaster without proper reports/publications Hovda KE et al. J Int Med 2005; 258: Gaarder T et al. J Trauma, in press. Sollid J et al. SJTREM 2012; 20:3 Paasma R et al MetOH outbreak in Estonia 2001 Admitted to hospital n=147 Dead outside hospital n=43 No n=36 Confirmed n=111 Total poisoned n=154 Total dead n=68 Survived without n=66 (60%) Survived with n=20 (18%) Died n=25 (23%) Paasma R et al. Clin Toxicol 2007; 45: Pärnu 9-17 september 2001: 111 patients hospitalized over one week with confirmed poisoning 46 patients on one day 5 beds in ED and ICU in total 100% sold as illicit alcohol in rural areas Patient transport around the whole of Estonia to find HD and ICU facilities Patients algoritm during follow-up study 2007 Admitted to hospital with confirmed N = 111 Founddead outside hospital N = 43 The outbreak 2001 The follow-up 2007 Group I Survived without N = 66 Group II Survived with N = 20 Group III Died in hospital N = 25 Total dead 2001 N = 68 19/66 (29%) 8/20 (40%) 7/20 (35%) 22/66 (33%) 5/20 (25%) 25 (38%) Pasma R et al. BMC Clin Pharmacol 2009; 9:5 Dead before followup N = 26 (30%) Lost to follow-up N = 33 (38%) Tracked and examined N = 27 (31%) 6

7 Risk factors related to poor outcome after poisoning and the relation between outcome and antidotes a multicenter study. Disaster management: Teamwork is it! Paasma R 1, Hovda KE 2, Hassanian-Moghaddan H 3, Brahmi N 4, Afshari R 5, Jacobsen D 6 (Estonia, Norway, Iran, USA & Tunisia) Greetings from Oslo and thanks for your attention! 7