Medical Management in different MCI Scenarios Life-saving in every way

Transcription

1 Deutsche Gesellschaft für KatastrophenMedizin e.v. German Society of Disaster Medicine r.a. Medical Management in different MCI Scenarios Life-saving in every way Jürgen Schreiber Secretary General DGKM e.v. / October2018 / Jürgen Schreiber 1

2 Tactical operational conditions of a particular event Events with tactical-operational challenges Special hazards / risks on site Special medical treatment-procedures MCI CBRN-MCI Attack-MCI Mass Casualty Incident MCI with CBRN-contaminated affected or sick / injured casualty MCI with affected or sick / injured casualty in an attack-scenario Hazard / Risk Identification Responders Safety & Security Medical Treatment-Security Hazard & Response Management DGKM e.v. / October2018 / Jürgen Schreiber 2

3 Dilemma of a particular event with a mass of affected casualty... This is the discussion about overall management versus individual treatment All injured and affected persons at the same time have the right of suitable medical supplies! DGKM e.v. / October2018 / Jürgen Schreiber 3

4 Tactical operational conditions of a particular event COMPENSATION?!? - Earliest possible onset of medical management - Prioritizing the affected related measures - Planning of aerea, personnel, equipment and time - Qualification based personnel ressource management qualitative management-reliability qualitative supply- reliability capacitative supply- reliaibility Availability of the medical care... MCI-dimension... (e.g. EMS) Numbers of affected persons / victims DGKM e.v. / October2018 / Jürgen Schreiber 4

5 General Medical Treatment Chain in MCI events emergency call EVENT Or any other medical treatment center alerting-period alert, drive up response-actions hot zone response-actions warm zone response-actions cold zone Allocation hospital & transports Hospital admission Self-help Section of pre-hospital medical management Hospital Medical Management is to be done in the framework of responders, e.g.: Fire, Police, EMS, CPC, DRU, CIMIC, etc... to provide medical care in the lifesaving phase of a MCI means that all first responders govern MCI-Triage and LSM in the same way in terms of networked collaboration a joint command&control structure is required to co-ordinate the medical-process-chain DGKM e.v. / October2018 / Jürgen Schreiber 5

6 Tactical operational conditions of a particular MCI event Hot-Zone Warm-Zone Cold-Zone Hospital Transportation of T1-affected affected / victims MP (medical post) AMP (advanced) Self-safety of responders Life Saving Measures (LSM) Rescue out of hot-zone Establish and operate MP (pre)triage and basic medical treatment of all sick and injured affected LSM / vitality-safing / and transportation-preperation of vital threatened victims Establish and operte AMP (e.g. WHO Type 2 EMT) Advanced medical treatment on scene Nursing and transportation-preparation for victims to hospital Command & Control-Post / BoO / Logistics / etc Entrance-Triage Shockroom-Care / Surgeon-Theatre / ICU Clinical diagnosis, medical treatment, nursing, etc... (Field)Hospital DGKM e.v. / October2018 / Jürgen Schreiber 6

7 Tactical operational conditions of a particular CBRN-MCI event Uncontrolled spread of contamination is one of the most important hazards Initially each person that has been unprotected against the CBRN-exposition counts as a casualty Therefore it is necessary to deviate from usual medical treatment procedures Lifesaving measures must be done before exposure therapy performing the medical prioritization, be aware on "Walking Wounded" and sick persons Fotos: Cwojzinski, Schild, Schreiber Comprehensive medical treatment follows after decontamination of affected persons DGKM e.v. / October2018 / Jürgen Schreiber 7

8 Tactical operational conditions of a particular CBRN-MCI event Hot Zone Warm Zone Cold Zone Contaminated Addected contaminated aeria Contaminated Medical Post Self-safety of responders (e.g. special PPE) Life Safing Measires (LSM) Rescue out of hot-zone Decont-Post for injured affected clean aeria Establish and operate CMP and Decont-Post of injured victims (DEKON-V) CMP Decontamination-line for walking injured Decontamination line für lying injured Take over of contaminated injured Disrobe contaminated affected, LSM, SPOT-DECONT DECONT-Triage (line of DECONT and basic-treatment-measures until DECONT ) DECON-V Handover to response and medical treatment in the Cold Zone Advanced Medical Post Hospital Relocation of DECONT-Post Transportation of contaminated T1 Patients DGKM e.v. / October2018 / Jürgen Schreiber 8

9 Tactical operational conditions of a particular ATTACK-MCI event Unpredictable Automatic rifle explosive device incendiary means of transport Single offender Offender-community Several individual offenders Multible offender communities local Multi-local Completed event Dynamic event Injuries caused by gunfire, explosions, hostages, stress Explosions burnings Pneumothorax Gunfires-victms PTSS Primary threats Ongoing attack situation Blood loss to the outside Blood loss into body cavities Unconsciousness, respiratory disorders Primary Life Saving Event-stoppage & scenery-safety Hemostasis / LSM Rescue into the Warm-Zone (partly secured) Transport in damage-control-surgery DGKM e.v. / October2018 / Jürgen Schreiber 9

10 Tactical operational conditions of a particular ATTACK-MCI event Hot-Zone un-secured Warm-Zone partly-secured Cold-Zone secured Hospital Secured by police static situation Transportation of T1 affected Betroffene Patientenablage Behandlungsplatz Krankenhaus Self-safety and security of responsers Life-Safing-Measures (stop bleeding) Rescuing out of Hot-Zone Establish and operate MP (pre)triage and basic medical treatment of all sick and injured affected LSM / vitality-safing / and transportation-preperation of vital threatened victims Establish and operte AMP (e.g. WHO Type 2 EMT) Advanced medical treatment on scene Nursing and transportation-preparation for victims to hospital Command & Control-Post / BoO / Logistics / etc Entrance-Triage Shockroom-Care / Surgeon-Theatre / ICU Clinical diagnosis, medical treatment, nursing, etc... DGKM e.v. / October2018 / Jürgen Schreiber 10

11 Rule Nr.1: Situation Awareness and Medical Assessment Aspects of medical status (Pre) Triage Hazards on scene Impact / Target Event Hazards and Damages Situation Assessment Order Command/Control Assessment Situation analysis Hazards managementt Capacity and Options Assessment Management Organization Functions? Communications? Intervention Planning Judgement / Planning / Decisions Operativ Hazard-Management who? what? where? how? when? DGKM e.v. / October2018 / Jürgen Schreiber 11

12 Thank you for your kind attention I m looking foreward to your questions and remarks Jürgen Schreiber E: juergen.schreiber@dgkm.org M: W: I hereby certify: There are no financial or economic conflicts of interest with the participants. There is no commercial support for the submitted work / presentation in any form/way DGKM e.v. / October2018 / Jürgen Schreiber 12