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Dan Hanfling

Publications and source records attributed to Dan Hanfling.

9 recordsLinked to original sources
PubMed2006

Equipment, supplies, and pharmaceuticals: how much might it cost to achieve basic surge capacity?

The ability to deliver optimal medical care in the setting of a disaster event, regardless of its cause, will in large part be contingent on an immediately available supply of key medical equipment, supplies, and pharmaceuticals. Although the Department of Health and Human Services Strategic National Stockpile program makes these available through its 12-hour "push packs" and vendor-managed inventory, every local community should be funded to create a local cache for these items. This report explores the funding requirements for this suggested approach. Furthermore, the response to a surge in demand for care will be contingent on keeping available staff close to the hospitals for a sustained period. A proposal for accomplishing this, with associated costs, is discussed as well.

Bioterrorism↗
PubMed2004

Screening for inhalational anthrax due to bioterrorism: evaluating proposed screening protocols.

Eleven known cases of bioterrorism-related inhalational anthrax (IA) were treated in the United States during 2001. We retrospectively compared 2 methods that have been proposed to screen for IA. The 2 screening protocols for IA were applied to the emergency department charts of patients who presented with possible signs or symptoms of IA at Inova Fairfax Hospital (Falls Church, Virginia) from 20 October 2001 through 3 November 2001. The Mayer criteria would have screened 4 patients (0.4%; 95% CI, 0.1%-0.9%) and generated charges of 1900 dollars. If 29 patients (2.6%; 95% CI, 1.7%-3.7%) with >or=5 symptoms (but without fever and tachycardia) were screened, charges were 13,325 dollars. The Hupert criteria would have screened 273 patients (24%; 95% CI, 22%-27%) and generated charges of 126,025 dollars. In this outbreak of bioterrorism-related IA, applying the Mayer criteria would have identified both patients with IA and would have generated fewer charges than applying the Hupert criteria.

Adult↗
PubMed2004

Health care facility and community strategies for patient care surge capacity.

Recent terrorist and epidemic events have underscored the potential for disasters to generate large numbers of casualties. Few surplus resources to accommodate these casualties exist in our current health care system. Plans for "surge capacity" must thus be made to accommodate a large number of patients. Surge planning should allow activation of multiple levels of capacity from the health care facility level to the federal level. Plans should be scalable and flexible to cope with the many types and varied timelines of disasters. Incident management systems and cooperative planning processes will facilitate maximal use of available resources. However, resource limitations may require implementation of triage strategies. Facility-based or "surge in place" solutions maximize health care facility capacity for patients during a disaster. When these resources are exceeded, community-based solutions, including the establishment of off-site hospital facilities, may be implemented. Selection criteria, logistics, and staffing of off-site care facilities is complex, and sample solutions from the United States, including use of local convention centers, prepackaged trailers, and state mental health and detention facilities, are reviewed. Proper pre-event planning and mechanisms for resource coordination are critical to the success of a response.

Community Networks↗
PubMed2003

Inhalational anthrax due to bioterrorism: would current Centers for Disease Control and Prevention guidelines have identified the 11 patients with inhalational anthrax from October through November 2001?

A panel of 10 physicians used the nominal group technique to assess the ability of the Centers for Disease Control and Prevention (CDC) interim guidelines for clinical evaluation of persons with possible inhalational anthrax (IA) to retrospectively identify the 11 patients with IA seen during the October 2001 bioterrorism outbreak. The guidelines would not have identified 10 of 11 of these patients, primarily because the guidelines were designed to address only those patients with a known history of exposure or clearly identified environmental or occupational risk. The panel suggested revisions to the guidelines, primarily consisting of broadening the criteria for evaluation to include either known exposure or environmental occupational risk, or to include clinical symptoms consistent with IA. These extensions of the guidelines retrospectively identified 8 of 11 of the patients with IA from October 2001.

Anthrax↗
PubMed2003

Establishing and training health care facility decontamination teams.

Recent terrorist events, changes in Joint Commission on Accreditation of Healthcare Organizations requirements, and availability of grant funding have focused health care facility attention on emergency preparedness. Health care facilities have historically been underprepared for contaminated patients presenting to their facilities. These incidents must be properly managed to reduce the health risks to the victims, providers, and facility. A properly equipped and well-trained health care facility team is a prerequisite for rapid and effective decontamination response. This article reviews Occupational Safety and Health Administration (OSHA) training requirements for personnel involved with decontamination responses, as well as issues of team selection and training. Sample OSHA operations-level training curricula tailored to the health care environment are outlined. Initial and ongoing didactic and practical training can be implemented by the health care facility to ensure effective response when contaminated patients arrive seeking emergency medical care.

Decontamination↗
PubMed2003

Protective equipment for health care facility decontamination personnel: regulations, risks, and recommendations.

After recent terrorist attacks, new attention has been focused on health care facility decontamination practices. This article reviews core issues related to the selection of appropriate personal protective equipment for health care facility decontamination personnel, with an emphasis on respiratory protection. Existing federal regulations focus primarily on scene response and not on issues specific to health care facility decontamination practices. Review of existing databases, relevant published literature, and individual case reports reveal some provider health risks, especially when the exposure involves organophosphate agents. However, reported risks from secondary exposure to contaminated patients at health care facilities are low. These risks should be adequately addressed with Level C personal protective equipment, including air-purifying respirator technologies, unless the facility determines that specific local threats require increased levels of protection.

Decontamination↗
PubMed2002

Healthcare system disaster preparedness, part 1: readiness planning.

Recent world events have raised the scope and intensity of disaster planning and readiness activities, including assessment, planning, implementation, and evaluation. In all efforts, the chief nurse executive is critical to the clinical operations and implementation of changes across a system, whether that system is a single hospital or a multiple site integrated healthcare system. In this article (part 1 of a 2-part series), the authors discuss the use of the nursing process as a framework to prepare for an all-hazards threat to disaster and mass casualty possibilities. They share one region's attempt to better integrate communication efforts across all care providers, including public health, county fire and rescue, state agencies, and hospital and service providers. Part 2 (October 2002) will discuss the role competencies of the nurse executive in disaster preparation.

Communication↗
PubMedDate not supplied

An evaluation of the use of guidelines in prehospital management of brain injury.

OBJECTIVES: The Brain Trauma Foundation (BTF) Guidelines for Prehospital Management of Traumatic Brain Injury (TBI) are intended to standardize treatment and improve outcomes in severe TBI patients. The key guideline components focus on airway management, blood pressure support, Glasgow Coma Score assessment, and transport. The purposes of this study were to determine if providers could learn and retain the guidelines (education), assess if providers would use the guidelines in practice (implementation), and evaluate the effect of guideline implementation on patients (outcomes). METHODS: Data were collected prospectively on all trauma patients for five months. Providers were then educated on the TBI guidelines over two months, and five additional months of data were collected. A knowledge test was given before and after the course and three months later to assess education. To assess implementation, data were analyzed to determine whether providers were using the key interventions more consistently after education. The clinical courses of TBI patients before and after guideline implementation were measured to assess outcomes. RESULTS: Knowledge of TBI care improved significantly after education and remained elevated at three months (62% vs. 82% vs. 79%, p < 0.001). For the 1,044 patients seen, providers demonstrated higher rates of appropriate care, resulting in lower rates of hypoxia (2.8% vs. 1.1%, p=0.010) and hypotension (4.8% vs. 2.0%, p=0.018). Mortality was significantly decreased (34.6% vs. 17.0%, p=0.039), and rates of patients with maximum functional scores at 14 days significantly increased (Glasgow Outcome Score 44.2% vs. 66.0%, p=0.025; Rancho Los Amigos Scale 55.9% vs. 77.3%, p=0.045). CONCLUSION: Providers were able to learn and implement the BTF guidelines, and outcomes in TBI patients were significantly improved. All emergency medical services providers should be trained in these potentially lifesaving guidelines.

Adult↗