Biomedical Engineering Reference
In-Depth Information
Chief of Surgical
Services
Surgical Subspecialty
Chiefs
Operating Room Chief
Chief of Anesthesia
Chief of OR Nursing
Chief PACU
Figure 13.2
Operating room hierarchy.
occasionally reset their priorities and rapidly provide
only the minimal acceptable care. Providing care
in this manner and moving those patients quickly
through treatment will maximize care to as many
patients as possible”. [8,9]
Upon notification by HEOC:
•
Briefly coordinate with Chief of OR Nursing to
assess status (number of ORs available: immedi-
ately, in 30 minutes, and in 60 minutes)
Further elective surgery should be cancelled and
patients sent back to their units or discharged, as
appropriate. It is expected that surgical patients
will not arrive for a period of time (transport,
decontamination, triage) allowing some prepara-
tion to ensue. As ORs empty, they should be
restocked with equipment and supplies. The mili-
tary uses a form of “push” logistics, whereby
supplies are sent automatically to the zone of
anticipated fighting without needing to be specif-
ically requested. A similar approach is warranted
here. Fluids, drugs, sterile supplies and instruments
should automatically be overstocked. Coordination
should occur with Pharmacy, Blood Bank, and
Central Sterile Supply to, likewise, push matériel
towards “the front.”
While the PACU and ORs are cleared of
patients, augmentation of staff should occur. Tele-
phone callback lists (disaster lists) should be acti-
vated. Telephone “trees” are much more effective
when large numbers of personnel must be called.
At three minutes per call, a 60-person list takes
•
Notify all surgical teams of disaster (including perti-
nent information such as WMDs), instruct them to
finish in the most expeditious manner, and prepare
to receive trauma patients
•
Activate disaster call-in tree to expand personnel
•
Notify PACU and ICU to reduce patient load and/or
expand capacity
•
Instruct supply personnel to restock/overstock all
locations
•
Coordinate with Blood Bank, Pharmacy, and CMS
to expect increased demands
•
Coordinate with Surgical Chief
to assess avail-
ability of surgeons
•
Send liaison to ED to assess situation and report
back (number and types of cases)
•
Consider assembling contingency teams for “off-
floor” response (airway emergency management,
ED and ICU assistance)
•
If airborne infectious disease is suspected, coor-
dinate with Security and Facilities Management to
institute isolation procedures
Figure 13.3
Operating room chief priority tasks for mass-
casualty.
