Transcript Chapter 51: Disaster Response

Chapter 51
Disaster Response
National EMS Education
Standard Competencies
EMS Operations
Knowledge of operational roles and
responsibilities to ensure patient, public, and
personnel safety.
National EMS Education
Standard Competencies
Mass-Casualty Incidents Due to Terrorism
and Disaster
• Risks and responsibilities of operating on
the scene of a natural or man-made
disaster.
Introduction
• Responding to
disasters is a main
function of EMS.
• Disasters can
overwhelm EMS
and community
resources.
Courtesy of Petty Officer 2cnd Class Kyle Niemi/U.S. Coast Guard. Photo
courtesy of U.S. Army
Introduction
• Disaster management requires:
− Preparedness
− Planning training
− Response
− After-action review
Disaster Response Planning
• EMS agencies should have plans suited to:
− Geography
− Population
− Potential risks specific to the area
Disaster Response Planning
• All-hazards approach: Conducting planning
for all types of disasters
• General considerations:
− Number of personnel needed
− Equipment required
− Which hospital(s) to transport to
Phases of a Disaster
Response Plan
• Three phases of any response plan:
− Before the event preplanning
− During the event
− After the event
Before the Event
• Planning
− Process of
preparing for
potential events
− Evaluate
emergency
incident factors
that responders
may or may not
have control
over.
Before the Event
• Geography of
response area
− Area prone to a
particular type of
disaster?
− Obstacles and
terrain features
that affect
response?
© Gina Jacobs/ShutterStock, Inc.
Before the Event
• Population
− Spread out, dense, or mixed?
− Same in daytime as nighttime?
− Language or culture differences?
− Facilities that may present hazards?
Before the Event
• EMS resources
− Items needed may include:
• Additional staff or personnel
• Specialized staff
• Medical supplies
• Equipment to handle tasks
Before the Event
• EMS resources (cont’d)
− Mutual aid agreements (MAAs)
• Relationships between two or more agencies or
municipalities
− Agencies may have a “disaster stash” or access
to special transportation equipment.
Before the Event
• Access to business
assets
− What expertise is
available from the
private sector?
• Nongovernmental
organizations and
disaster relief
agencies
− May arrange
training or
planning sessions
Before the Event
• Fire and police
response
− Disaster response
plan will outline fire
and police
response.
− Have drills for
unified command
system
© Larry St. Pierre/ShutterStock, Inc.
Before the Event
• Training standards
− Training is usually
done in phases:
• Individual tasks
• Crew training
• Agency training
• Interagency training
• Infrastructure
− Be familiar with
your agency’s
communication
backup plan.
Before the Event
• Hospitals
− Be familiar with the
level of care
available.
− There may be
agreements to
share personnel.
• Internal
communication
− Plan to maintain
communication
with all members
of your agency.
− Backup methods
will be in place.
Before the Event
• Liaison to the next
higher level
− Know when and
how to contact next
level of authority.
− System should be
tested at least
semiannually.
• Media
− There should be a
public information
officer within your
agency.
Before the Event
• Immunizations of
personnel
− Keep up to date.
− Be familiar with
agency’s plan.
• Sheltering
− Food
− Water
− Bath facilities
© Reuters/Mike Blake/Landov.
Before the Event
• Animal control
− Address animals that must be left behind.
− Have precautions to manage carcasses.
− Have plans concerning zoos, wildlife refuges, or
veterinarian facilities.
During the Event
• Best to stick to a
plan.
− Modification may
be required.
During the Event
• Inventory
− Take immediately.
− Anticipate what
you will need.
− Determine
available space.
• Mobilization of
personnel
− Personnel must be
notified of plan
changes.
− Agencies will
assign jobs.
− IS-211 form tracks
personnel.
During the Event
• Command setup
or response
− Command must
be visible.
− All personnel must
be assimilated into
ICS properly.
• Unification of
command
− A lead agency
directs the efforts.
− Cooperation is
essential.
During the Event
• Protective and
safety equipment
− Replace as
needed.
− Do not take
shortcuts or
neglect to wear
assigned gear.
• Equipment
resupply
− Plans should be in
place.
− New incoming
personnel may
need to be trained.
During the Event
• Triage and
classification
− May be disaster
dependent
− Constant and
ongoing
© Roger Nomer/AP Photos
During the Event
• Patient tracking
− Make a record for every patient.
− Information you must collect includes:
• Patient names
• Injury categories
• What units transported
• Where the patient was transported
During the Event
• Assignment of personnel
− Assessment must be done before personnel
begin working.
− Choosing appropriate personnel depends on:
• Level of training
• Duration of event
• Stress related to the event
During the Event
• Personnel physical
needs
− Eat, drink, use of
bathroom facilities
− In long-lasting
incidents, sleep
areas are required.
© AP Photo/Ross D. Franklin.
During the Event
• Personnel mental
needs
− Use a “buddy
system.”
− Provide downtime.
− Talk about
experiences.
• Hospital updates
− Maintain
communication.
− Hospitals may
resupply
equipment.
− Personnel may be
needed on either
side.
During the Event
• Providing and
accepting relief
− Ensure coverage
before relieving.
− Make sure
equipment is
compatible.
• Surveillance
− Report suspicious
people, packages.
− Report evolving
trends to assist
with disease
monitoring.
During the Event
• Media
− Members of your
agency may be
trained to respond
to the press.
− Use press to your
advantage.
© Karin Hildebrand Lau/ShutterStock, Inc.
During the Event
• Legal issues
− Documentation
during is essential.
− All patients who are
transported should
have a patient care
report written.
• Unit leadership
reinforcement
− Field checks help:
• Stay aware of
conditions.
• Bolster morale.
After the Event
• There are specific
measures to take
after an event.
After the Event
• Accountability
− Needed for every
worker and patient
− Duty rosters must be
completed.
− A patient care report
or triage tag is
required for every
patient.
• Resupply and repair
− All equipment used
must be replaced.
− Check that equipment
was not weathered or
contaminated.
− Service vehicles that
were used.
After the Event
• Inventory
− Needed after resupply and repair
• Stress reaction review
− Consider critical stress management teams.
− Note changes in behavior.
− Report concerns immediately.
After the Event
• Physical examination
of personnel
− A physician should
examine all injured
personnel.
− Counseling should be
available.
• Brainstorm
− Solicit input.
• Makes providers
stakeholders.
• Provides input for
after-action review
After the Event
• After-action report
− Official internal report
of event
− Can be used to
provide retraining in a
specific area
• Finance and
reimbursement
− “Declaration of
disaster” may open
the door to relief funds
and low-interest loans.
After the Event
• Acknowledgment
− Good performance should be praised.
− Praise often, immediately, and honestly.
Forest and Brush Fires
• Can be man-made or natural
© Harald Høiland Tjøstheim/ShutterStock, Inc.
Forest and Brush Fires
• You are not there to fight fire.
• Remain inside your vehicle or in another
safe spot during lightning strikes.
• Try to predict what injuries you’ll be treating.
Forest and Brush Fires
• PPE should include proper gear in addition
to infection control gear.
• Follow directions of fire command.
• Expect cardiac events in fire fighters.
Snow and Ice Storms
• Make sure agency
vehicles are “snow
ready.”
• Coordinate with
local municipal or
state departments
to get to unplowed/
unsalted streets
safely.
© Mark C. Ide
Snow and Ice Storms
• Clothing should be weather ready.
• Your agency may have snowmobiles, snow
blowers, and plows.
• Take your time.
Snow and Ice Storms
• Look for snow and ice slides before entering
a structure.
• If your company is on standby, prepare
portable warm-up shelters.
Tornados
• Before the event:
− Disperse supplies and store vehicles in shelters.
• During the event:
− Keep crews in shelters until declared safe.
• After the event:
− Be ready to stage in a directed area.
Tornados
• Use lights to direct displaced people toward
emergency services.
• Helicopters will probably not be available.
• EMS should be represented both in the
emergency operations center (EOC) and in
the unified command center.
Tornados
• Situational awareness is essential.
• Be prepared for foul weather and winds.
• Dignitaries may visit the site of the incident.
• Consider leaving landmarks in the field.
• You may need to help set up field hospitals.
Hurricanes
• Five categories for hurricanes:
− Category 1: minimal damage expected.
− Category 5: severe damage expected.
• Always plan for at least one level higher
than the worst category predicted.
Hurricanes
• Frustrations can lead to feelings of fear and
abandonment.
− If the situation is possibly dangerous, do not go
out without a security presence.
− Safety is always first.
Hurricanes
• In addition to PPE make sure you have:
− Wet weather gear
− Personal flotation devices
− Access to boats and specialized equipment
• After the storm has passed:
− Stay updated on post-storm failures.
Tsunamis
• Large waves that
travel thousands of
miles and hit at
speeds of 250 to
600 mph or more
• Can come in a
series
© Atsushi Taketazu/AP Photos
Tsunamis
• Pay attention to warning systems.
• Prepare for trauma patients who have been
struck or entangled in debris.
• Plan to set up a temporary morgue site.
Earthquakes
• There may be little or no warning.
• Can cause thousands of deaths and billions
of dollars in damage within minutes
• Aftershocks occur regularly.
Earthquakes
• If you have advanced warning, secure your
building and vehicle contents.
• Roads will likely be damaged or cut off.
• Dust suffocation can occur.
− Facemasks, at the very least, should be worn.
Earthquakes
• Leave rescue to trained rescue personnel.
• Rescuers will need ongoing rehabilitation.
• Have extra food and water on board.
• Call local hospitals to find out if they are
able to receive patients.
Earthquakes
• When out in the field, take note of hazards.
− Make a list and report to the EOC.
• Try to become a part of drills with:
−
−
−
−
−
Hospitals
Schools
Businesses
Government offices
Fire departments
Landslides, Avalanches, and
Mudslides
• Anything in the path of gravity is in the
danger area.
• Can cause such a buildup that streams or
rivers become blocked
− Consider water rescue procedures.
Landslides, Avalanches, and
Mudslides
• Underground piping, conduit for electrical
lines, and telephone lines can be damaged.
• EMS may assist in evacuation efforts.
• Mudslides or mudflows are similar to a river
of concrete.
Landslides, Avalanches, and
Mudslides
• Equipment that may be planned for in
advance includes:
− Backhoes
− Earth movers
Cave-Ins
− Rapid freezing and
thawing
− Heavy rain
− Excess vibration
Courtesy of Cecil V. "Buddy" Martinette, Jr.
• Can be caused by:
Cave-Ins
• Make sure power
lines are not
severed/unstable.
• Watch for loose
rock in the area.
• Be prepared to
treat patient(s) for
hypothermia.
Courtesy of Cecil V. "Buddy" Martinette, Jr.
Cave-Ins
• There are three
ways to secure the
area of evacuation:
− Sloping
− Benching
− Shoring
Cave-Ins
• The atmosphere is generally toxic.
− Assume that patients have been in an oxygendeficient atmosphere.
• Sewer and chemical gases can be
released.
Volcanic Eruptions
• Rescue workers
may be affected by
secondary
problems.
• Identify buildings
that are “volcano
proof.”
© David Falconer/AP Photos
Volcanic Eruptions
• Panic may spread.
• Expected injuries include:
− Burns
− Respiratory problems
− Crush trauma injuries
− Respiratory, eye, and skin problems
Volcanic Eruptions
• Ashfall: Residue left behind
− Masks should be issued to everyone in
downrange positions.
• Try to make the public aware of the
importance of respiratory protection.
Flooding
• Agencies should identify the amount of time
needed to execute response plans.
• Issues to watch out for include:
−
−
−
−
Overtopping
Slow degradation of levees and banks
Debris flow
Sudden degradation of levees
Flooding
• Wear proper gear and use personal
flotation devices and tag lines.
• Make sure you use only high-axle vehicles.
• Contaminates and residue can cause
serious health problems.
Sandstorms and Dust Storms
• Sensory input becomes difficult.
• Eye protection should be worn.
• Do not rub eyes, nose, or skin during storm.
Sandstorms and Dust Storms
• Respiratory protection should be worn.
• Driving is a challenge.
• Blowing sand may hide objects.
Prolonged Cold Weather
• Cold stress can develop.
− Monitor for changes in personality and work
habits.
• If maintenance or repair issues can wait
until warmer weather, let them.
• Try to limit physical demands if possible.
Prolonged Cold Weather
• Dress loosely and in layers.
• Try to switch crews frequently.
• Keep an eye on:
− Older EMS providers
− Providers with minor medical issues
− Pregnant EMS providers
Drought
• Causes problems for medical community:
− Heat injuries
− Dust storms and wildfires
− Snake migration and subsequent injuries
− Reduced water quality and quantity
− Infections and surface contamination
Heat Wave
• If possible work in pairs.
• Water must be consumed at all times.
• Small meals are better than large ones.
• Set up “water trains.”
Heat Wave
• Use air conditioning.
• Place wet towels on the head or body.
• Try to break up work schedules during the
hottest part of the day.
Meteors and Space Debris
• Most can be detected.
− The problem is ascertaining:
• Where they will land
• How great the impact will be
• Keep an open mind when a patient has a
history of sudden sharp pain with local
bruising.
Pandemics
• Personal protection is the most important
consideration.
• The best method of detection is direct
observation.
− If someone appears to be sick, pull from duty.
Pandemics
• The full work force will not be present.
− Continuity of operations plan (COOP) should be
in effect.
• The public should be instructed on how to
care for sick people.
Pandemics
• Set up guidelines for which emergencies to
respond to.
• May have to set up field hospitals
• May become a point of distribution (POD)
for medicine or vaccination
Structural Fires
• Much higher death
and injury rate than
wildfires
• Let the fire fighters
fight the fire.
© Sergey Toronto/ShutterStock, Inc.
Structural Fires
• Watch for falling or collapsing items.
• Prepare for burns and respiratory problems.
• Stay upwind.
• Be prepared to evacuate quickly.
• Be ready for cardiac events.
Construction Failures and
Building Collapse
• As part of preplanning, check out new
construction in your area.
− Plan access and egress routes.
− Update plans frequently.
Construction Failures and
Building Collapse
© cloki/ShutterStock, Inc.
• Consider what
special PPE you
might need:
− Helmets
− Steel toe boots
© mihalec/ShutterStock, Inc.
− Eye protection
− Knee pads
− Heavy-duty gloves
Construction Failures and
Building Collapse
• If there is a lock out/tag out information
sheet on site, review it.
• Crews may be called to do a perimeter
search for patients.
− Get victims to a safe area and start the
accountability and triage processes.
Construction Failures and
Building Collapse
• When victims are brought to you, try to elicit
information from them.
• You may need to supply backboards,
straps, and Stokes baskets to the rescuers.
• Be wary of triage or treatment locations.
Power Failures or Disruptions
• If squad building has electric locks, consider
getting a manual override device.
• Have alternate sources for heating or
cooling fluids and medications.
• Backup generators must be checked on a
regular basis.
Power Failures or Disruptions
• Have battery-powered backup devices.
• Have an ample supply of batteries.
• Make a list of all patients who use
electrically powered life-saving devices.
Power Failures or Disruptions
• You will not be able to download electronic
patient care reports.
• Cell phones and GPS may be out of
service.
Riots, Civil Disturbances, and
Stampedes
• Plan and expect for
the worst.
• Get as much
information as
possible about the
scene.
© Jane Tyska/AP Photos
Riots, Civil Disturbances, and
Stampedes
• Do not report to or set up a staging area
until you are sure the scene is safe.
• Determine what is happening and what
could happen.
• Situational awareness is paramount.
Riots, Civil Disturbances, and
Stampedes
• Police escort is crucial.
• Consider wearing body armor, a helmet,
and an APR.
• Document everything thoroughly.
Strikes and Labor Disputes
• Crossing the picket line does not mean you
are taking sides.
− Ask, “What is in the best interest of the patient?”
− Failure to care for an ill or injured patient
because you support the cause of the strikers
constitutes abandonment and gross negligence.
Strikes and Labor Disputes
• If the patient is ambulatory, he or she might
be safely brought to you.
• Television coverage can act as a deterrent
to verbal or physical attacks.
• Document and record all findings.
Sniper, Shooter, and Hostage
Situations
• EMS should be staged out of gun range.
− If victims are exposed, do not go to help them.
• Trained people will get them under cover or
eliminate the threat.
• Do not say anything to the press about the
incident.
− Refer them to the public information officer.
Sniper, Shooter, and Hostage
Situations
• Try to anticipate the type of injuries that you
may need to treat.
• If it is a long standoff, do not lose your
sense of urgency regarding security.
Explosions
• Secondary and tertiary explosives may
have been placed.
− Keep your eyes open and stay alert.
• Record anything a seriously injured patient
has to say.
Explosions
• Ear injuries are common.
− Speak loudly and face the patient.
• Air particles are probably contaminated.
− Wear your APR during patient care.
IT (Cyber) Disruptions
• Hackers can penetrate EMS security to
steal patient information.
• Agencies must use the latest security
patches and systems.
• Test your system relentlessly.
IT (Cyber) Disruptions
• Use of your system should be limited to
your agency.
• Password protect systems.
• Appoint a cyber security officer.
IT (Cyber) Disruptions
• If you recognize a cyber threat:
− Immediately report it to your supervisor.
− Stop using the threatened browser or program.
Summary
• A disaster is a calamitous event that causes
or has potential to cause injury or death,
destruction, and distress.
• Disaster management requires
preparedness, planning, training, response,
and an after-action report.
• EMS agencies must have a comprehensive
plan in place to address all potential
disasters.
Summary
• Three phases of a plan of response: before
the event (planning), during the event, and
after the event.
• Planning should take into account general,
predictable factors.
• If possible, during a disaster, it is best to
stick to the planned measures.
Summary
• Specific measures to take after a disaster
include ensuring accountability, resupply,
repair, stress reaction review, retraining,
reimbursement, the after-action report, and
acknowledging EMS providers.
• A disaster can be man-made or natural.
• Natural and man-made disasters should be
handled with the all-hazards measures.
Credits
• Chapter opener: © John Giles/PA/AP Photos
• Backgrounds: Orange—© Keith Brofsky/
Photodisc/Getty Images; Blue—Courtesy of
Rhonda Beck; Green—Courtesy of Rhonda Beck;
Purple—Courtesy of Rhonda Beck.
• Unless otherwise indicated, all photographs and
illustrations are under copyright of Jones & Bartlett
Learning, courtesy of Maryland Institute for
Emergency Medical Services Systems, or have
been provided by the American Academy of
Orthopaedic Surgeons.