Dec 082014
 

Both the Hospital Incident Command System (HICS) and a Myocardial Infarction (MI) are managed by addressing key objectives.  In fact I think they use the same prioritize activities identically.  Read on and see if you agree.

Hospitals are often challenged when it comes to understanding the value of using of the HICS to manage events since they already have hierarchies with reporting chains. I’ll use the example of an MI patient presenting to their Emergency Department (ED) to show the concepts of the HICS are firmly in use in the hospital setting when it comes to managing critical events.  The ICS uses one set of objectives and they are consistently addressed in order of:

Life Safety

Incident Stabilization

Property/Environmental Conservation

Return to Normalcy

Now follow my example of a middle aged man patient presenting to your busy ED complaining of crushing sub-sternal chest pain. He’s pale, diaphoretic and says he “feels like he’s going to die.  At this point, someone steps up to take charge (the Incident Commander) and they conduct a more focused assessment to determine the extent of the problem. In the ICS we call this assessing the scene to help determine the immediate issues and formulate our initial action plan.

With our MI patient we must ask ourselves do we have a life safety issue?  The answer in this case is we obviously do therefore we need to immediately assign resources to manage this patent or risk the patient’s condition deteriorating further.  We don’t ignore patients already in the ED and we don’t assign more resources than necessary.  One of the key benefits of using the ICS is our ability to assign and manage resources.

Next we need to stabilize the patient by placing them on oxygen, starting a line, taking vitals, hooking up the EKG and managing pain.  This sounds an awful lot like “incident stabilization in ICS terms.

We’re very concerned about trying to conserve heart muscle in this case.  The more heart muscle we can conserve at this point and re-oxygenate, the better our patient’s prognosis to survive the immediate event.  I’d say this is identical to the ICS task of property conservation.

Lastly the patient is managed and a care plan initiated so upon discharge the patient returns to as near as possible their pre-existing health condition, if not better.  In ICS terms, we ensure a return to normalcy as soon as possible.  Not just for the victims in the event but also the resources we had assigned to manage the event.  When the ED personnel hand off the patient’s care to the unit, they return to their work in the ED.  It’s all about resource management.

In summary when you think about it, ICS concepts are used every day to prioritize resources based upon a set of standardized objectives. Adopting the HICS makes sense for a major teaching hospital or a critical access facility.  If you’d like to explore institutionalizing a customized HICS within your organization contact me at abetteremergency@gmail.com, it just may be easier than you thought.

Jun 082014
 

A recently published paper claims that the gender of the name given to individual hurricanes is linked to the public’s perception of the risk posed by that storm. In short, this study claims that hurricanes given female-sounding names are perceived to be less dangerous than those given male-sounding names.  The author concludes that more deaths result from “female” hurricanes.

Having grown up with the name Jan, many people have wrongly assumed I was female. I can appreciate that gender discrimination does in fact accompany names.  However, I can’t quite make the leap that Hurricane Betty would cause more deaths than Hurricane Butch given they were of equal strength and a population would be of equal risk upon landfall.  Would both males and females downplay the risk or is it only men who are more at risk of falling victim to a Hurricane Betty? The study does seem to indicate a problem.

Regardless, it raises the issue of why current storm naming conventions exist and whether they still serve a purpose. Today, we hear a male or female storm name followed by the current and projected strength of the storm.  I suspect the meaning of the storm ranking scale is probably lost on most. Certainly, the need for action is not always clear.

If storm names are a problem, then this is a simple and cheap fix to make: develop names which engage the public and include intuitive descriptors of danger. Optimally, new storm names would also take into account the demographics and language preferences of those at risk upon landfall and be crafted to be heard and understood.

Let’s redesign storm rankings which include a description of how to react. For example, “Storm Rain on Your Parade” would clearly be less severe than “Storm Run for Your Life.” Let’s hope we never see “Storm Kiss Your Ass Goodbye,” but we should have the name just in case.

Simple, more informative names could actually improve our storm warning system. As an added benefit, more generic names won’t stigmatize men and women whose name happens to be the same as a killer storm — think of the poor Andrews and Katrinas!

With hurricane season underway, any improvements to raise awareness and educate people about preparedness measures is a good thing.  Now is a great time to dust off hurricane plans and make sure triggers are gender-neutral.

Thoughts? Please share!

May 092014
 

I once thought that a disturbed ants nest was a great example of high entropy. It’s not.  Don’t believe me? Go kick a fire ant nest and stand there.  A wave of ants emerges to search and destroy the disruption; another gathers up young and critical supplies; some protect the hierarchy. Almost immediately, workers set to rebuild. Ants recover quickly from disaster — natural or man-made. If you don’t know, entropy is a measure of the unavailability of a system’s energy to do work. It’s also a measure of disorder — the higher the entropy, the greater the disorder.  In the world of humans, certain problems consistently come to the surface in after action reports: communications; command and control; resource management and coordination. All of these problems raise entropy in major events. In 2005, adoption of the National Incident Management System (NIMS) was mandated by Presidential directive as a solution for these reoccurring problems.  Yet, as 2005’s Hurricane Katrina and 2012’s Hurricane Sandy demonstrated, we still have the same issues and entropy remains high. We’ve added complexity to how we address major events, and personnel continue to be vexed by how to best manage resources and reporting requirements. The NIMS approach raises entropy and takes the focus away from solving actual problems. I think it’s time we admit these recurring problems will be present in events and concentrate pre-planning efforts on keeping entropy as low as possible.  How? We need to simplify planning factors and accept that we cannot address every contingency. Pre-plan, train, and drill at the community level to undertake these immediate efforts:

  • To stabilize the threat, even if these methods are not perfect.
  • To rescue those unable to do so themselves. This includes children, the elderly, and those who are mobility challenged. It does not include able-bodied persons. They can take care of themselves or assist in one of the areas of stabilization, rescue, critical resource management, or restoration.
  • To protect key resources or obtain resources necessary to maintain basic living needs.
  • To re-open impacted community services. Partial opening is better than waiting for full service recovery.

In all pre-planning efforts, crowd-sourcing should be utilized to look for innovative ideas in meeting the above objectives. Ants understand entropy and the need to keep disorder to a minimum.  Rebuilding a nest is pre-planned and works very well because everyone knows their simple assignment.  I have never seen ants with incident command boards, expensive inter-operable communication suites, or a reliance on FEMA to provide grants and guidelines. Planning like an ant colony may sound nutty, but they control entropy and get the job done. Why must humans make everything so hard and complicated?  It’s time to revisit our whole planning process and focus on activities that help keep entropy as low as possible.