VI. Implementation of the Plan
A. Response Triggers
The following situations will activate this plan:
Any disaster occurring within the jurisdiction of Prevent Blindness Texas and Houston Ophthalmological Society which requires eye services;
Transportation disasters that occur outside of the jurisdiction, but where the families of a victim or victims reside within the jurisdiction of Prevent Blindness Texas and Houston Ophthalmological Society;
Any pending disaster, e.g., hurricane or severe weather watch; or
Any major sheltering of evacuees from another jurisdiction: Call out by Emergency organization requesting eye service aid to Harris County Medical Society (Houston Ophthalmological Society). The Houston Eye Disaster Response Coordinator will contact Eye Disaster Team members.
B. Notification of Prevent Blindness Texas
The 24-hour Eye Disaster number is the primary means used by the Harris County Medical Society or other local emergency management departments to alert the Eye Disaster Response Coordinator contact person of pending or actual events and requests for emergency eye care assistance. The President of HOS and/or his designee will be notified. The Director on Call and Captain from the Emergency Response Team will carry cell phones for incidents requiring immediate activation of the collaborative vision services. The following team members will be alerted:
PBT and HOS Chairs
Board of Directors
PBT and HOS Executives or Manager
PBT Program Director
PBT Emergency Response Committee
HOS Emergency Response Committee
PBT Staff Usually Activated
Full Emergency Response Team (DAT)
Liaisons to local government; e.g., Incident Command and/or emergency operations center (EOC)
C. Emergency Notification Planning Template
The following information will be obtained by the eye disaster coordinator after discussion with the local emergency response manager in order to plan eye care and to disseminate information to the eye volunteer community.
Type of disaster
Location of disaster
Number of victims
Anticipated type of eye injuries (chemical, crush, penetrating, smoke, etc)
Equipment/medications list
Number of volunteers needed with medical, surgical, or administrative training for each work shift
Open transportation access routes
Safety at disaster site; availability of electrical outlets/power at disaster site
Closest eye hospitals or clinic triage areas for staffing of triage sites
Contact information (phone number, websites) for volunteers to check-in on site and to contact for updates and changes in plans
Anticipated volunteer schedule
Duration of eye services
Governmental agency in charge of disaster relief operation
D. Eye Disaster Team Volunteer "Call-out"
Disaster Committee Members Review the volunteer data base and call out individuals who can fill the medical need; determine what equipment is needed and how it will be delivered
PBT staff, volunteers
Ophthalmology
E. Medical Equipment and Supplies are delivered (see planning lists below)
Eye Vans (Mobile eye clinic, University of Houston College of Optometry; PBT equipment vans); and portable eye equipment delivered without eye vans per EMS instructions
F. Plan on-going schedule
4 hour shifts; ophthalmologist, optometrist, PBT staff, community volunteer teams. Scheduling will be done through the Prevent Blindness Texas office. Schedules will be filled out via telephone call and via email. A web-based sign-up sheet will be developed.
G. Volunteer Command Structure and Responsibilities at Disaster Site
Ophthalmologists: assess, treat, and triage patients
Optometrists: assess and triage patients–therapeutic optometrists treat as per licensure
Volunteers, PBT staff: set up care area with chairs, post signs, staff check- in, provide badges for volunteers, organize patient flow, sterilize treatment area and equipment, scribe, replenish supplies, copy records, telephone and e-mail support and communication, implement doctors' triage plans.
H. Emergency Supply Lists
Eye team and city emergency management will share in planning the eye treatment area and in stocking supplies for disasters.
The City of Houston Emergency Management Department will be responsible for supplying gloves, masks, perishable drugs and irrigation solution/tubing as part of their emergency drug stocks and will be responsible for transporting medications to the disaster site for use by eye care providers. These supplies are listed in red print.
The Houston Eye Disaster Response Team will be responsible for bringing diagnostic eye equipment to the disaster site.
Depending on the nature of the disaster and road access, the UHCO Eye Van will be deployed to the disaster site.
If roads and parking prohibit the safe use of the Eye Van, the Houston Eye Disaster Response team will work with the emergency management agency to bring portable equipment to the disaster site by alternative transportation and establish eye care for evacuees away from the primary disaster site.
Supplies Per group of 25 victims
1. Power Source: for equipment, lighting, and computers (the eye van has a generator)
2. Medical Equipment
3 near cards
3 penlights
2 portable slit lamps; 1 mounted slit lamp in eye van if used
2 direct ophthalmoscopes
1 indirect ophthalmoscope (available in eye van if used )
1 Tonopen with covers (Goldmann tonometer in eye van)
2 jeweler's forceps, 1 .3 forceps, 1 0.5 forceps, locking micro needle holder
bandage scissors
Micro scissors
25 large paper clips to create lid retractors; 2 Desmarres retractors
1 magnifier / loupes
1 hemostat
For non-urgent, long-term mass population evacuee care in an evacuee shelter setting: spectacle prescription and distribution on site
3. Medical Supplies
Nonsterile disposable gloves - 3 boxes (100 each)
Sterile gloves, size 8 - 25
Masks - 2 boxes of surgical masks
Protective goggles, protective gear as deemed necessary by EMS
Irrigation solution - 30 bags of sterile irrigation solution (normal saline, ringers lactate, or other isotonic crystalloid solution)
Sterile eye wash - 10 bottles
IV tubing for irrigation - 30 lines
Sterile cotton tip applicators - 1 box of 100
Oval eye pads - 3 boxes
4x4 sterile gauze - 3 boxes
Tape: 5 rolls each of ½ inch plastic, ½ inch paper
Tb syringes with 30 g needles - 25
5 cc syringes with 20 g needles - 25
Eye shields - 20 metal or plastic
Contact lens cases - 20
6-0 vicryl suture - 8
8-0 nylon suture - 8
4. Medications/drugs
Betadine 5% solution - 2 bottles
Antiseptic hand and instrument wipes
Medical grade (isopropyl) alcohol - 3 bottles
Wound, hand/instrument cold sterilization
Proparicane 0.5% anesthetic drops - 3 bottles
Xylocaine 2% with epinephrine solution for injection, multidose bottle - 3
Fluorescein-impregnated paper strips - 1 box
Litmus paper
Antibiotic drops and ointment (levofloxacin/gatifloxacin/ moxifloxacin/bactitracin ointment, neodecadron ointment),
Steroid drops (prednisolone acetate 1%) - 3 bottles
Dilating (mydriatic/cycloplegic) drops (homatropine 5%, atropine 1%, mydriacyl 1%), - 1 bottle each
Glaucoma drops (pilocarpine 2%, timolol 0.5%) - 1 bottle each
Acetazolamide (diamox), 250 mg - 50 tablets
5. Office and Logistical Supplies:
Medical record templates (see template below)
Patient and volunteer sign-in sheets
Schedule sheets
Black pens, clipboards, carbon paper, extra blank paper
Cell phones, wireless computers and PDAs (check with city/red cross about plans to communicate)
List of volunteers and triage resources
Signs for check-in area, waiting area, exam stations, checkout area
Badge holders
Containers and locks for supplies
6. Specific disaster supply requirements
Chemical: anesthetic drops, irrigation solution and IV lines, lid retractors, cotton tip applicators, litmus paper, bandages and tape, topical cycloplegic agents, antibiotics, glaucoma medication
Smoke: irrigation, topical anesthetic, bandages, tape, lid speculum
Trauma: perforating, penetrating, contusion, rupture, intraocular foreign body, lid and adnexal injury: plan for triage to medical center off site for globe, lid or adnexal repair unless the patient is unstable for transport and immediate primary ocular intervention is deemed essential to save the eye: topical or systemic antibiotics, eye shield, tape, anesthetics, suture, forceps, and scissors
Displaced population: eye care at large-scale evacuee shelters will provide basic eye care, including glasses, and then refer off site for follow-up
a. Plan for network of referral to eye care centers for surgery, advanced diagnostic testing.
b. Access to and from disaster site (note accessible roads, air, boat): plan with main coordinating disaster team, note accessible triage centers
I. Treatment Area Design:
Eye van parking area near power source if possible
Triage/waiting area:
Curtains, tent, or partition with signage
Check-in table, chairs
Eye exam/treatment stations
Check-out /triage table (determine what is available on site, what needs to be brought in to disaster site)
Re-supply drug/office supply stock area
J. Medical Template Form
This form is used to record patient encounters at the disaster site.
Print and store duplicate/carbon triage forms at Prevent Blindness Texas (electronic template storage to reprint).
One copy for patient chart, one copy for PBT records (HPPA compliant).
Includes:
Demographics
Name
Social security #
Address, phone
Chief complaint/allergies/significant medical and eye history
Examination
Vision
External
Slit lamp
Other: pressure, visual field, retina, neurological
Assessment
Plan
Treatment plan
Triage site, urgency of triage
Transportation mechanism
K. Ongoing Actions
Opening up a Vision Emergency Relief Operation
Providing individual assistance
Coordinating with government agencies
Coordinating with voluntary agencies
Coordinating with other emergency units
Requesting local external resources
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