Biomedical Engineering Reference
In-Depth Information
scheduled “training day” could be crafted so that no
one clinician's experience of a bio-mass-casualty
event is more than six months old.
In the second scenario, the world of the simu-
lation is the entire treatment facility that is
contending with an outbreak of a bio-contaminant
like SARS, but the exercise itself takes place
in the facility's Emergency Operations Command
Center (EOCC). If a real EOCC is unavailable
this scenario can be produced in a typical confer-
ence room. For the simulation to be an effec-
tive learning experience at least one member of
each “tribes” required during a real disaster in
the EOCC must attend the simulated one; thus
there will be administrators, network operators,
nurses, physicians, public information and secu-
rity personnel, support staff, technicians, etc. This
kind of simulation uses an acute and overwhelming
health problem of the kind that Alfred Hitch-
cock called “The McGuffin”—something around
which the story is built and that drives the action
but the specific nature of which is irrelevant.
Those who function in the EOCC do not treat
the infected patients; they are responsible for the
command, control, communication, collaboration,
and overall resource allocation that determines how
effective those who do the hands-on treatment
will be.
It is mostly through their interaction with other
students that exercise participants will learn how
to become crisis-management experts. It is the
responsibility of the simulation “ringmaster” to
gently emphasize that the students' learning should
be focused upon behaviors that improve alloca-
tion of resources in a crisis and reduce frictions.
Also, this kind of simulation is ideal for cross-
training personnel between the different tribes
that send representatives to manage a disaster
response.
In the third scenario, the world of the simulation
is the surroundings (e.g., parking lots) of the treat-
ment facility that are flooded with mass casualties
seeking help during a bioterror outbreak. For the
simulation to be an effective learning experience,
those playing the would-be patients must be very
persistent in seeking their goal—access to the ED
for treatment.
A primary objective for the students in this
scenario is to learn the consequence of poor crowd
control. Dry runs should be held in a typical confer-
ence room prior to execution outdoors with all
the actual equipment and clothing. These dry runs
will help the students familiarize themselves with
not only their immediate area of responsibility,
but also the value for communication across the
different segments of the entire process of crowd
control. The subsequent wet runs (and real water
is a requirement) will clearly illuminate logjams
and inadequacies in preparations by any treat-
ment facility for the onslaught of large numbers of
contaminated casualties.
21.6.1 Real World Mass Casualty
Decontamination General Principles
Expect no less than a 5:1 ratio of unaffected to
affected casualties;
Decontaminate casualties as soon as possible;
Decontamination is disrobing—more removal is
better, total is best;
Copious water flushing is a good mass decontami-
nation method, although soap may also be neces-
sary to remove oily liquids (and washing with
soap is a way casualties will expect to cleans
themselves).
All responders in contact with casualties should
observe standard precautions;
Collection and disposal of “Dirty” clothing and the
dead is critical;
All treatment facilities down-wind of disaster sites
become part of the problem.
21.7 Example 1: Clinical Students
Clinicians diagnose and treat patients with viral
hemorrhagic fever (VHF) in an emergency depart-
ment. See CDC Viral Hemorrhagic Fever Fact
Sheet in Appendix.
21.7.1 Students
Clinical ED personnel and all other clinical
personnel called to augment the ED.
