Biomedical Engineering Reference
In-Depth Information
achieved. Hospital leadership must be committed
from the very top if mass-casualty training is to be
effective.
Periodic drills should be conducted on a small
scale at the departmental level as part of routine
“in-service” training. Setting aside one OR for
simulation can allow large numbers to rotate
through during the day. Multi-departmental scale
exercises should occur at the bi-annual JCAHO
mandated hospital disaster drill. This is the ideal
time to test communications and coordination
between hospital departments. Most critical is the
identification and resolution of issues impeding the
smooth flow of patients along the surgical axis:
from the ED to the OR and on to the ICU, PACU,
and surgical ward.
As with any infrequently performed skill, knowl-
edge rapidly decreases with time. One innova-
tive way to keep mass-casualty plans and WMD
treatment protocols fresh is to post a laminated
summary on the inside of every restroom stall.
This virtually guarantees that every staff member
will have to look at the plan at least once a day.
Job Action Sheets, describing necessary tasks can
be stored with the disaster plan and distributed
when the initial alert is called. Each specialty in the
surgical services should have a designated training
officer assigned to ensure that periodic training is
effective.
be effective in an actual crisis. Most professional
communicators require all messages to be written
first before being passed to a central point for trans-
mission. In many locations, Amateur Radio Emer-
gency Services (ARES) volunteers are available
to assist hospitals with both internal and external
communications during an emergency. Ultimately,
a runner with a written message is the final fall-
back option.
13.8 Security/Crowd Control
Most hospital operating suites are considered
restricted areas and already have means to control
access. During a crisis, there is a greater poten-
tial for unauthorized access to occur. Coordina-
tion with the Hospital Security Department should
occur to maintain an appropriate balance between
physical security and access for authorized indi-
viduals. At lease on security officer should be
stationed in the OR. This officer can also serve as
an alternate communicator if necessary.
13.9 Conclusion
A mass-casualty situation is simply an intensified
version of what many ORs experience on a daily
basis. Appropriate planning and frequent training
will allow the staff to adapt and successfully treat
the casualty surge. Fully decontaminated radia-
tion and chemical exposed trauma patients can be
treated in the usual manner. Partially decontami-
nated patients can be safely managed with proper
precautions. Casualties exposed to airborne infec-
tious agents may require extraordinary measures
during transport and surgery to prevent dissemina-
tion of infectious agents throughout the facility.
13.7 Communications
Small operative suites function well with face-
to-face verbal communications. Larger facilities
rely on telephones. Interdepartmental communica-
tions are usually by telephone or intranet (email).
Prudent planning requires alternative communica-
tions in anticipation of disruption of these services.
Cellphones and Internet/Intranet communications
represent the two most vulnerable systems today.
They can be expected to fail early in any large-
scale disaster. Most hospitals maintain numbers of
two-way radios for use during a communications
crisis. These radios may be configured as discrete
point-to-point lines or as parts of a network. In any
case, proper radio and net procedure must be taught
and practiced during every exercise if radios are to
References
1. A. Beasley, S. Kenenally, et al. Treating patients
with smallpox in the operating room,
AORN Journal
,
Oct., 2004.
2. D. J. Baker and J. M. Rustick. Anesthesia for Casual-
ties of Chemical Warfare Agents, Textbook of Mili-
tary Medicine, Part IV, Anesthesia and Perioperative
Care of the Combat Casualty, Office of the Surgeon
General, 1995.
