Lessons from Hurricane Katrina: A Risk Based Approach to Hospital Evacuation

Presentation Transcript

Lessons from Hurricane Katrina: A Risk Based Approach to Hospital Evacuation Chris Johnson Boyd Orr: Julia Appleby, Peter Cooper, Andrew Foss, Stephen Hailey, Benjamin Jenks, Western Infirmary: Fouria Ashraf, Graham McKinlay, Chris McAdam, Jody Johnson, Martin Wilson University of Glasgow, Scotland. http://www.dcs.gla.ac.uk/~johnson

Strathclyde Fire Brigade. BFRL, US NIST.

Hurricane Katrina Several antecedents (Tropical Storm Alison). East Jefferson General Hospital: impromptu clearings of elderly patients; swam from crisis division incline; elderly care home that was being immersed. Clinicians and bolster staff at New Orleans' University Hospital: convey patients down 4 flights of stairs; take them to an ad libbed ICU when generators overflowed. Administrator of drug at Tulane University Hospital: compelled to utilize a partner's kayak; facilitate with New Orleans' University Hospital and Charity Hospital; telephone lines fizzled.

Hurricane Katrina Investigations into different fatalities amid departure of Memorial Medical Center. Patients on seventh floor helped through healing facility. Numerous invested significant energy sitting tight for pontoon. Clinic chairman said passings because of 'frameworks disappointment'. Scrutinized absence of direction on arrangement for mass clearings.

Legislation International Building Code in 40+ US states - indicate " development, measure & character of method for departure" and numbers in every space. OSHA - managers 'guarantee courses prompting to ways out are available and free from materials or things that would hinder departure '. UK Fire Precautions (Workplace) Regulations meet EC Directives 89/391 and 89/654 - bosses in charge of result of unfavorable occasion. Chance based approach - must exhibit any safety measures are suitable to the probability and results of any risk. Departure measures could be use to exhibit alleviation of the potential results of an antagonistic occasion.

2001 Department of Health " NHS Trusts must have a successful fire security administration framework" They should "guarantee crisis departure techniques for all zones and attempt fire chance appraisals" Specialist Fire Officers concentrate on " fire wellbeing review and fire hazard evaluations and helping with reports to administration"

But How Do We Do It? There are few authority procedures. Hazard appraisal for flame: Only consider clearing as a moderating element? Can we reason about danger of clearing risks? Enactment is questionable around there… Slight change in accentuation, concentrate on departure 1. consider danger of perils that require clearing; 2. consider dangers of directing effective departure.

Plan of Munich Lowenbraukeller (April, 1973)

Evacuation of Summerland Bar, Isle of Man: 51% utilize the passage (37 visitors, 1 staff part); - 49% utilize crisis leave (23 visitors, 14 staff).

Woolworths fire in Manchester: - 9 out of the 10 fatalities in bottle; - didnt leave before completing or paying for dinner?

Hospital Fires Edleman et al (1980) examine mind home fire. 95% (85) drove down one staircase, 3 others accessible. Typical course for staff and patients between floors. Other 3 were departure courses with section cautions. Hesitance to utilize them notwithstanding when fire legitimized it. Clearing longer than architect & Fire Officers think.

Brooklyn Fire breaks oxygen hoses treating understanding. Divider outlets now permit free-stream oxygen. Smoke into lobby and patient floor. Must empty numerous bed-bound patients. Medical attendants deferral to close territory valves: leftover weight before treatment stops; Could use move down packaged oxygen; But bottles make another fire risk.

Virginia Fire 5 bite the dust, all around outlined building, very much prepared staff. Less night staff, day staff extremely occupied. Alert to flame dept out of administration. Principle point is understanding consideration not fire security? Oxygen enhanced environment. Entryways wedged open in numerous wards. Smoke in roof space, casualty dissemination. No sprinkler framework additionally a hazard in itself.

Operating Room Fires Joint Commission on Accreditation of Healthcare Organizations 100-200 working room fires every year in US. Oxygen-advanced environment. Start sources eg lasers and burning units. Clearing dangers for patients - ICU sedation. Prepare for quenchers in sterile situations.

Tropical Storm Alison 3 doctor's facilities near new patients. 2 cleared most basic patients. 1 doctor's facility totally emptied. Closing down 2000+ beds. 500+ ICU beds for the City of Houston. Alison additionally shut 1 of Houston's 2 level I injury healing centers - serves 4 million individuals.

Lack of Incident Reporting But no national or Federal registers for these occasions. Scots NHS reports fires including passing or genuine harm to HSE. Fires including passing, genuine harm or genuine harm to Dept of Health. No data on less genuine occasions or fruitful departures; 1994-2001 just 6 reports. 5 included smoking, 1 "resolute" fire raising. Notwithstanding for genuine occasions, prosecution keeps lessons from being scholarly. Fire Officers depend on 'war stories', informal exchange in gatherings and activities. Stand out from lawful reporting prerequisites for gadget disappointment in medicinal services.

US Hospital Fire Drills 3 taunt fire drills amid a 6-week time frame. E lectrosurgical pencil touches off wrap. Staff expel cover from patient, toss onto floor, utilize quencher. Coordinators then say fire spread. Recreate move of intubated patients OR bed with a sack valve cover. Pack wounds with sterile wipes; e.g. try not to move anesthesia machine. Gridlock, rooms empty at same time.

US Hospital Fire Drills Debrief sessions particularly if issues. poor crisis reaction agenda; delays in reinforcement if patient and anesthetist "harmed" in work out. Anesthetist clear by OR indirect access: soak slant over a bustling street; Hospital posts signs on entryways. "Systemic" issues: healing facility paging facilitates reaction; declarations couldn't be listened; staff leave presents on check; No arrangements in the event that it were harmed; delivery person post opened & purchase radios.

Case Study Hospital

Horizontal Evacuation Does development make more serious dangers than peril? Check area of flame, secure asylum & leave course: Refuges inside 12 meters of every patient's room; 70 secs to move patient to place of wellbeing; 30 secs more for staff to come back to patient's room. Patients in impending threat moved first. Non-walking before portable patient & guests; Wheelchair patients assembled together ; Staff lead versatile patients in a solitary excursion. Patients must not hinder crisis staff. 3 individuals, 5 mins to detach/reconnect units; 15 mins, cognizant patient bed to wheelchair.

But… Wisconsin urges staff not to utilize "even" clearing: departures ought to move all patients outside the building; 'required, paying little mind to building development'; 'may not utilize shield set up approachs' drills as well; utilization of patients in drills is discretionary. Bureau of Health in Scotland: "less yearly fire preparing if chance appraisal completed"; "fire security preparing fitting to obligations of the staff"; "at any rate every year for staff required in patient departure".

Limitations of Drills Sustained Costs. Constrained Accuracy. Short 'Timeframe of realistic usability'. Absence of Design Focus. Threat. Poor Reliability.

Crowd Density and Velocity Thompson and Marchant (1995)

Simulation comes about: more than 20 runs; Blocking exits; Lower figures are SDs .

Faster clearing under model conditions: North exit shut and far to principle exit; BUT stand out bottleneck/way to primary exit.

Modeling Nurse Behavior Coding of nursing staff conduct in light of simultaneous strings. program makes a free procedure for every person. Correspondence through a type of message passing; Reactive course finding for every medical caretaker utilizing A* calculation: Simulated attendant positions every conceivable moves from their present area; Only go ahead to consider the following arrangement of accessible moves from the top positioned contiguous position; arranged course bit by bit develops by continually picking best next stride for further thought; if potential course blocked then consider second course in the rundown of inclinations. Calculation relies on upon proper heuristic: Euclidian separation or point by point data about healing facility format; Recall: medical caretakers demonstrated as free strings and every utilizations claim autonomous route technique; dispute will happen if 2 attendants move 2 beds along restricted hallway. Pro arrangement calculations expected to determine bottleneck.

Patient Preparation and Evacuation

Simplifying Assumptions Timings for gear on one story of a specific doctor's facility. No hindrances – is this feasible in a bustling ward? Bed development did not require complex turns for sharp corners. Beds developments relies on upon model and upkeep gave: Beds approx. 1 meter (38 inches) by 2.2 meters (86 inches). Wheelchairs 0.75 meters (30 inches) by 0.75 meters (30 inches). Nonetheless, there were a few unique models. A few wheelchairs upholstered like a moveable easy chair. others were based around more ordinary metal edges. No smoke, no aggregate weakness impacts and so forth

Input and Output to G-HES

Summary

Further Work RPDN on clearing reaction. Crisis entrance not simply departure.

Questions? Much obliged are expected to Julia Ap