9/11/2019

Skills Station: Surge

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

Objectives

 Utilize the four primary support elements that 
contribute to surge efficiency and effectiveness
 Implement the various strategies that provide for 
contingency and crisis surge capacity for health care 
facilities

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

D I S A S T E R
D etection
I ncident management
S afety and security
A ssess hazards
S upport [surge]
T riage and treatment
E vacuation
R ecovery

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

1
 9/11/2019

Surge

ability to expand space for casualty 
Capacity flow, routine patient flow, staff, and 
supplies

ability to provide necessary casualty 
Capability care phased over time

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

Surge Capacity

 Conventional
 Contingency
 Crisis 
Space, staff, supplies, systems

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

Goals

 Minimize mortality in critically injured
 Maximize care delivered to casualty population
– Injured by disaster

– Regular emergencies 

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

2
 9/11/2019

Situation

 Afternoon explosion  500 beds
 2,000 casualties – 100 ICU

 200 dead – 40 pediatric

 Closest hospital  20 OR, 20 PACU
 Near‐full capacity

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

You have 10 minutes before first casualties arrive.

What are your priorities?

What are your goals?

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

Special Considerations and Pitfalls

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

3
 9/11/2019

Surge Capability Special Considerations
 Special needs populations: 
– Children
– Elderly
– Medical needs
– Disabled
– Access
– Psychiatric 
 Special casualty needs
– Burn care
– Critical care with ventilators

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

Time‐Limited Mass Casualty

 First wave: walking wounded and 
psychiatric arrive without EMS
– Instant bottleneck

– Security with redirected flow Screen casualties 
outside of ED
 Second wave: critically injured 
arrive via EMS

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

Minimize Hospital Contamination

 Secondary contamination risk
 Solutions:
– Receive and screen casualties outside of ED

– Decontaminate outside facility 

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

4
 9/11/2019

Outcome
 Total casualties = ???
 Critically injured = ??
– Musculoskeletal

– TM rupture

– Blast lung

– Head trauma

 Operations in 24 hours = ??

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

Pitfalls

 Mass provider, media, or worried‐well incidents
 Casualty flow bottlenecks
 Definitive, rather than phased care process
 No documentation (or over‐documentation)

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2

Summary
 Four elements to surge capacity include:
1. Space
2. Staff
3. Supplies
4. Systems

 Manage surge demand and supply
 Drills identify and avoid pitfalls 

©2015 National Disaster Life Support Foundation, Inc. All rights reserved. 
ADLS® v.3.2