Radiology MCI PLAN DEVELOPMENT
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1 Radiology MCI PLAN DEVELOPMENT Ronald Bilow, MD, FASER Director, MCI Response, Dept Diagnostic & Interventional Imaging
2
3 If you re, like me, the Department MCI/DMP/Response Director
4 Integrate with Hospital System Work with the hospital Emergency Manager Understand ICS Know your Capabilities Determine triggers for activation surge capacity Determine your bottlenecks Key Points Plan for ALL Reasonable Contingencies Stick to SOP where possible Run a HVA to determine likely scenarios and HOPE to operate within those constraints Assess Communication strengths and weaknesses Drill and Exercise Tabletop Simulations Adjust plan accordingly
5 Don t be a one man show
6 Don t be a one man show
7 Minimum Planners Director Assistant Director Key Stakeholders
8 Integrate with Hospital System Work with the hospital Emergency Manager
9 Integrate with Hospital System Work with the hospital Emergency Manager Vested Interest
10 Integrate with Hospital System Work with the hospital Emergency Manager Vested Interest Well Positioned for Success
11 Integrate with Hospital System Work with the hospital Emergency Manager Vested Interest Well Positioned for Success Knowledgeable
12 TRIAGE RTA DISASTER BEDS Memorial Hermann TMC Emergency Center RTA MEDICINE TRAUMA H H H H H H H H H H H H H EMS PEDIATRICS Legend RED = Emergent YELLOW = Delayed H H H H
13 LINEN LINEN Transportation Hermann Atrium Cullen Atrium Hallway 1 st floor Walking wounded follow arrows to Cullen Off-Site Area Registration Ambulance Bay Cullen Atrium Off-Site Area Disaster Map (Created April, 2016) MD RN Supplies Cullen Atrium
14 LINEN LINEN Transportation Hermann Atrium Cullen Atrium Hallway 1 st floor Ambulance Bay Cullen Atrium Off-Site Area Disaster Map (Created April, 2016) Walking wounded follow arrows to Cullen Off-Site Area Registration MD RN Supplies RADIOLOGIST HERE! (reading off portable unit, if necessary) Cullen Atrium
15 Integrate with Hospital System Work with the hospital Emergency Manager Meet with Trauma Surgery Meet with Emergency Medicine
16 Integrate with Hospital System Work with the hospital Emergency Manager Understand ICS
17 Integrate with Hospital System Work with the hospital Emergency Manager Understand ICS Incident Command System
18 Integrate with Hospital System Work with the hospital Emergency Manager Understand ICS Allows individual functional units to work together effectively
19 Integrate with Hospital System Work with the hospital Emergency Manager Understand ICS Allows individual functional units to work together effectively Provides mechanism to share resources
20 Integrate with Hospital System Work with the hospital Emergency Manager Understand ICS Allows individual functional units to work together effectively Provides mechanism to share resources Modularly expandable and collapsible
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23 Radiology
24 Radiologist Physician Response - WHO All Emergency Radiologists Interventional Radiologists other radiology faculty Body Imaging Neuro Chest Pedi Anyone else who wants to help labor pool Residents onsite or on call Chief Residents
25 Radiologist Physician Response - HOW Paging System Telephone Tree
26 Radiologist Physician Response - HOW Paging System Telephone Tree Electronic Alerting System such as Everbridge
27 Radiologist Physician Response - WHAT When and Where to show up Can be built into alert system
28 Radiologist Physician Response - WHAT When to show up Can be built into alert system Need to begin planning for relief
29 Radiologist Physician Response - WHAT How they re going to get there Road Access Road Closures
30 Radiologist Physician Response - WHAT How they re going to get there Road Access Road Closures Hospital Access
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32 Road, Gas, Hospital Access
33 Radiologist Physician Response - WHAT Where to Report Staging Area
34 Radiologist Physician Response - WHAT Where to Report Staging Area Labor Pool Timekeeping management
35 Radiologist Physician Response - WHAT Where to Report Staging Area Labor Pool Reading Area
36 SOP Standard Operating Procedures
37 MUST PLAN for ALL Contingencies No power > No imaging You re done!
38 Plan for ALL Contingencies Stick to SOP where possible
39 ASSUMPTIONS Imaging Services are Operational ALL Imaging Equipment power is supplied by system supported with backup generator
40 ASSUMPTIONS Imaging Services are Operational ALL Imaging Equipment power is supplied by system supported with backup generator Imaging Machines/Devices PACS Servers and Workstations ALL Integrated Program Servers EMR Reporting Tools Internal Communications/Tracking (eg, Primordial)
41 ASSUMPTIONS Imaging Services are Operational ALL Imaging Equipment power is supplied by system supported with backup generator Imaging Machines/Devices PACS Servers and Workstations ALL Integrated Program Servers EMR Reporting Tools Internal Communications/Tracking (eg, Primordial) VERIFY with PACS Support and/or Emergency Manager
42 Plan for ALL Contingencies Stick to SOP where possible Plan for Everything
43 Plan for ALL Contingencies Stick to SOP where possible Plan for Everything REASONABLE
44 Plan for ALL Contingencies Stick to SOP where possible Plan for Everything REASONABLE Run an HVA (hazard vulnerability analysis)
45 Hazard Vulnerability Analysis Considers Likelihood and Impact of Potential Threats Used to Formulate Plan of Action should these occur
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48 Know Your Capabilities Determine triggers for activation How many patients can you image per hour? How many exams can you read per hour?
49 Drill and Exercise Test individual functions Tabletop exercises Simulations
50 Drill and Exercise Test individual functions Tabletop exercises Simulations Adapt plan based on performance
51 Resources Manpower Equipment Communications Functional Operations
52 Functional Operations Resources Manpower Technologists Clerks Transporters Readers (attending, fellow and resident radiologists)
53 Functional Operations Resources Manpower Equipment Image Acquisition XR CT US IR Suites
54 Functional Operations Resources Equipment Image Acquisition XR CT Routine protocol Modified MCI protocol IV or no IV contrast PRELOAD on ALL potential SCANNERS
55 Functional Operations Resources Equipment Image Interpretation PACS Workstations
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57 Functional Operations Resources Equipment Image Interpretation PACS Workstations Onsite/offsite Network/connectivity issues Communication issues
58 Functional Operations Resources Equipment Image Interpretation PACS Workstations Reporting Electronic Paper Communication? Runners?
59 Functional Operations Head Resources Equipment Image Interpretation PACS Workstations Reporting Preliminary Checklists? Diagnoses only? Final Face Neck Chest Abdomen Pelvis Vascular Injury: Spine Epidural Subdural Subarachnoid Parenchymal Herniation Pneumocephalus Bullets/Shrapnel Skull Fracture Face Fracture Globe Rupture Intraconal Injury H&N Vascular injury Pneumothorax Pneumodediatinum Hemothorax/Effusion Rib Fractures Segmental Aortic injury Cardiac injury Diaphragm Rupture Torso Bullets/Shrapnel Liver Spleen Kidney Pancreas BowelMesentery Hemoperitoneum Ascites Free Air Bladder Rupture Fractures Hematoma Extravasation Site: Fracture/disruption: C / T / L No / R / L / Bilat No / R / L / Bilat No / R / L / Bilat No / R / L / Bilat No / Y / Impending No / Y No / Y Location >>> No / R / L / Bilat No / R / L / Bilat No / R / L / Bilat No / R / L / Bilat No / Y No / R / L / Bilat No / Y No / R / L / Bilat No / R / L / Bilat No / R / L / Bilat No / Y Type: No / Y / Pericardial Fluid No / R / L No / Y Location(s) >> No / Y Grade: No / Y Grade: No / R / L / Bilat No / Y No / Y Sm / Lg No / Y Location >>>> No / Y No / Y No / Intraper / Extraper No / Y Type: No / Y No / Y No / R / L / Bilat No / Levels: Comments
60 Functional Operations Resources Equipment Image Interpretation PACS Workstations Reporting Detail
61
62 Recovery Responder Relief Responder Compensation Continuation of Normal Operations Continuity Planning Don t forget about current hospital census
63 Post Event Debrief meeting ASAP (After Action) Determine what worked well Determine what did not work well Formulate plan to improve performance in future Critical Incident Stress Debriefing - UT EAP (Employee Assistance Program)
64 x + y + z =??? x + y + z =??? x + y + z =??? x + y + z =??? x + y + z =??? x + y + z =??? x + y + z =??? x + y + z =??? x + y + z =??? x + y + z =??? x + y + z =??? x + y + z =??? x + y + z =??? x + y + z =??? x + y + z =??
65 To Summarize Work within the system
66 To Summarize Work within the system Know your capabilities and limitations
67 To Summarize Work within the system Know your capabilities and limitations Anticipate scenarios
68 To Summarize Work within the system Know your capabilities and limitations Anticipate scenarios Practice, practice, practice and adapt
69 Thank you very much
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