Question 12

College answer

Syllabus topic/section:

2.3.1 Leader and Manager / Intensive care administration: L1

Discussion:  

The CICM international fellowship covers many diverse regions and geography. An awareness of the different environments and challenges in which we practice intensive care is required.
To display the standard of competence required of a transitional fellow, candidates are reminded to provide an organised answer, use headings and subheadings, group common themes together and provide sufficient detail. The better answers understood that ICU is not a standalone service and is part of the hospital therefore local and state hospital policies apply. Many candidates forgot to consider the implications of communications breakdown, and the effects of this on the ICU, the hospital and families. The superior answers detailed staffing, energy supplies, equipment, drugs and oxygen requirements.

Discussion

From what appears to be a constant battery of tropical storms beating down on the grim rocks of Far North Queensland, one might expect that CICM or QLD Health might have some kind of "shelter in place" protocol for their ICUs, but if they do, they are keeping them safe and secret. The trainees would have had to create this answer from nothing other than their own imagination.

Staffing

• Allocate roles for specific aspects of the preparation, eg. "roster person", "family liaison", "SITREP monitor", "pathology/blood bank runner", "electronic medical record downtime record keeper"
• Assess the disaster staffing. Ask staff members about their plans. " Most staff found the decision difficult, balancing the needs of their own families with that of the community", Sexton et al remark about their doctor's and nurses response to Cyclone Yasi, preparing to work double shifts as the Queensland government were telling them to grab their loved ones and run.
• Allow for storage space and personal space for staff who are likely to be cut off from their homes by weather/water
• Source additional meals for trapped staff

Internal communication

• Develop an internal mechanism of distributing information to the staff- ideally not reliant on landline phone services 

Equipment

• Charge removable power sources and stock reserves of bottled water for staff and patients
• Create paper copies of electronic medical records and reference texts (eg. pharmacy manuals) for the eventuality of power failure
• Create a reserve of torches and batteries

Consumables

• Ensure pharmacy is well stocked and estimate several weeks of stock for common drugs, expecting prolonged disruption to supply chains and increased demand
• Share a pool with the other remaining services (ED, ward) to centralise ordering
• Liaise with gas suppliers and acquire excess stock of oxygen and compressed air cylinders

Infrastructure

• If possible, relocate vital systems (pathology department analysers, ICU, backup generators ) out of easily flooded basements and to higher floors
• Move patient beds away from windows

Patient care

• Establish a patient manifest: decide who needs to stay and who can be evacuated
• Send out anyone who can be retrieved safely, to decrease the workload of the remaining staff

Families and visitors

• Establish the identities of all next of kin and secure contact details
• Discorage visiting
• Determine which family plan to evacuate and which plan to remain local

External communication

• Disaster-proof devices (emergency landlines, satellite phones, radio) need to be located checked and distributed to key staff
• Maintain open lines (avoid unnecessary phone calls on critical protected phones)

Facility level support

• Recommend for the closure of non-emergency theatres and cancellation of elective surgery
• Recommend for the retrieval of any patient for whom it would be safe and appropriate
• Listen for communication from central disaster control 

Media and public engagement

• Observe for updates from media sources regarding the progress of the disaster and the prospects of improvement or new challenges (eg. access limitations due to rising water)

Debrief

• Engage with the post-disaster debrief with staff and hospital leadership 
• Ensure counselling services and leave/rest are available for staff who were imposed upon during the period of upheaval.

Preparedness

• Simulated tabletop exercises involving other departments
• Internal position of disaster preparation officer, to maintain documents and revise plans as infrastructure changes