INTERHANDS III June 2003 Miami, FL Initial Medical Health Assessment

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INTERHANDS IIIJune 2003Miami, FLInitial
Medical (Health) Assessment

• United States Southern Command
• Col. Miguel A. Montalvo USAF MC FS
• Command Surgeon

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Assessments(Defining How Bad Is Bad)
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When does the assessment process begin???

• Right Away

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Disaster Assessments
Purpose To provide decision makers the
information they require to determine the
appropriate USG response

• Decision Makers
• On-scene Military Commander
• U. S. Ambassador
• Combatant Commander
• National Command Authority

• Considerations
• Requirements
• Resources Available
• National Interests
• Legal Authority
• Funding

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Objectives

• Recognize the wide variety of resources available
  to support assessments
• Understand the criticality of gathering
  political, economic, military, cultural,
  engineering, health and other essential
  information
• ID the capacity and status of the HN
• Everyone is responsible for gathering information

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United States AmbassadorRoles and
Responsibilities
Role The U.S. Ambassador to the affected nation
is responsible for declaring the occurrence of a
disaster or emergency in a foreign country that
requires U.S. foreign humanitarian assistance
support.

• Responsibilities
• Declaration via Cable to DoS
• Recommends appropriate USG response
• Focal Point for USG agencies responding to
  disaster

• Considerations
• Country desires U.S. assistance
• Capability of the country to respond is exceeded
• Impact of disaster

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Combatant CommanderRoles and Responsibilities
Role The combatant commander establishes
theater strategic objectives required to
transform national strategic policy and guidance
into operational level activities.

• Responsibilities
• Transform policy and guidance into operational
  plans and activities
• Structures the force necessary to conduct and
  sustain HA operations

• Considerations
• Immediate employment of intra-theater assets
• Mission and magnitude of the response
• Force Protection
• Logistical Support

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On-Scene Military CommanderRoles and
Responsibilities
Role A military commander at the immediate
scene of a foreign disaster may undertake prompt
relief operations when time is of the essence and
when humanitarian considerations make it
advisable to do so.

• Responsibilities
• Report action at once
• Request guidance
• Track costs
• Request reimbursement IAW DoDD 5100.46

• Considerations
• Immediate threat to life
• U.S. Military response required
• Reimbursement not assured

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Spectrum of HA Operations
Natural Disasters hurricanes, floods,
earthquakes, volcanic eruptions, drought,
fire Man-made Disasters civil violence, CBRNE
incidents and accidents

• Types of Aid Provided
• Immediate response to save life/prevent
  destruction
• Shelter, clothing, bedding
• Food and water
• Medical care, sanitation
• Transportation, communications

• Types of Missions
• Immediate disaster assistance
• Dislocated civilian support
• Security missions
• Technical assistance and support
• Consequence management

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Initial AssessmentWhat Happened? What Does it
Mean?
Description of the event type of incident,
location, time, cause, casualties, ongoing threat

• Magnitude of the event
• Area affected
• Number of people affected
• Damage to infrastructure

• Immediate Needs
• Most vulnerable population
• Emergent requirements
• Chronic vs. acute needs

• Impact of the event
• Baseline capabilities
• Remaining capabilities
• Response of other nations, IOs, NGOs

• Other Considerations
• Ethnic
• Religious
• Political
• Economic

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Initial AssessmentPlanning Considerations

• Force Deployment
• Available food, water, sanitation
• Displaced civilian population and location
• Disease risk assessment
• Local medical capabilities
• Status of roads and bridges
• Available logistic facilities for air and
  sea-lift
• Threat and security requirements

• Coordination
• Status of host nation government
• Host nation relief efforts
• Outside relief efforts
• Points of contact
• Continuously update as situation and information
  requirements change

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Intelligence and Information Gathering
Politics
Religion
Military
Business
Ethnic
Economic
Criminal
Medical
Environmental
Infrastructure
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How do YOU define BAD????
Baseline Data
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Baseline Data

• Population
• Infrastructure
• Water
• Electric Power
• Communications
• Roads
• Bridges
• Food
• Health Statistics

• Assets
• Public
• Private
• Distribution capabilities
• Agriculture
• Industries
• Ports
• Transportation

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Baseline Data

• Climate
• Terrain
• Natural Hazards
• Environmental issues
• Government
• Type
• Leaders
• Ministries
• Relationships

• Economy
• Communications
• Telephone
• Cellular
• Radio
• TV
• Internet Service Providers

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Where do I find the information I need?
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SOURCE
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Needs Assessment

• Identifies resources and services for
  immediate emergency measures to save and sustain
  the lives of the affected population. It is
  conducted at the site of a disaster or at the
  location of a displaced population.
• Quick response based on this information should
  help reduce excessive death rates, and stabilize
  the nutritional, health, and living conditions
  among the population at risk.
• A quick response to urgent needs must never be
  delayed because a comprehensive assessment has
  not yet been completed.

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Assessment Goals

• Provide timely and comprehensive information on
  the scope and impacts of a disaster
• Support effective emergency decision making at
  local, state and federal levels
• Keep the public accurately informed
• Develop and support requests for disaster
  resources and recovery assistance

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Provide information so that timely decisions can
be made

• Impact a disaster has had on a society and its
  ability to cope
• Most vulnerable populations that need to be
  targeted for assistance
• Most urgent requirements
• Levels of response by affected country (by other
  players)
• Make recommendations

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Keys to a Successful Assessment

• Identify who needs your data
• Potential users will specify their data
  requirement
• Identify the information needed to plan specific
  action
• What information is vital
• Best method for collecting
• How detailed does the information have to be
  useful
• What is your mission, task (implied or specified)
  
• 
  

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Keys to a Successful Assessment

• Consider the Timing
• May effect the accuracy since situation and needs
  can change dramatically from day to day
• Determine the best place to get accurate
  information
• Distinguish between emergence needs and Chronic
  needs
• 
  

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Situation/Disaster Assessment

• ID areas affected (size/location)
• Numbers affected by the disaster
• Mortality / Morbidity rate
• Characteristics and condition of the affected
  population
• Emergency
• Medical / Health / Nutrition / Water / Sanitation
  
• Levels of continued / emerging threats
• (natural and human)

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Priority Health Status Assessment

• How many deaths have occurred
• From the Disaster
• From Diseases
• Children/Adults/Gender/Age
• Main cause of death for each group.
• Vaccinations (measles) have been or will be
  provided Determine the incidence of diarrhea
  among adults and children.
• Determine the most common diseases among
  children and adults.

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Priority Health Status Assessment

• Affected Country(s)
• Population at risk
• Health Infrastructure
• Clinics, Dispensaries, Hospitals
• Supportive Roads, Shelter, Water, Food
  Sanitation
• Medicines
• Health Care Workers

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Providing Water

• Information you might need

• What is the demand
• What are the sources
• Road network like
• Transportation availability
• Fuel
• Storage

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Tools of the Trade

• Field Operations Guide
• Camcorder
• Digital Camera
• Camera
• Access to a computer
• Maps

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Main Points

• Only a snapshot in time
• Information changes over time
• The significance of the information changes over
  time
• What you cant see is often more important than
  what you can see
• Goal to save and sustain the lives of the
  affected population

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Main Points

• Vital to use the first assessment to establish an
  ongoing data collection and analysis system
• The initial assessment should provide information
  that feeds directly into the program planning
  process
• Timing is vital without a point of reference
  most assessments data is of little value
• Disasters are traumatic events to individuals
  Mental Health intervention will be needed

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Hurricane Mitch - Overview
THE MOST DEVASTATING STORM TO HIT CENTRAL AMERICA
IN OVER 200 YEARS.
Guatemala City
Tegucigalpa
Eastern
San Salvador
Dead 8,209
Missing 9,397
Displaced-Homeless 2,747,640 Bridges Damaged
356
Managua
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Phase I - Emergency
Life saving missions and emergency delivery of
relief supplies and medical assistance
26-Nov-98
2,102
San Pedro Sula
La Ceiba
Guatemala City
39 A/C 440 Sorties 1686 hrs
Soto Cano
6 A/C 200 Sorties 385 hrs
Lives Saved
1,052 Food Distributed
3,245,100 Lbs Medical Supplies
Distributed 131,000 Lbs
Water Distributed
120,000 Gals
Managua
42,500,000
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Phase II - Rehabilitation
Repairs to infrastructure required to reestablish
national capabilities to provide for health and
basic welfare of the populace
5,400
San Pedro Sula
La Ceiba
219 (Sorties)
Guatemala City
11
Soto Cano
Comalapa
53
Managua
10
112,500,000
4
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Phase III - Restoration
12 / 39
Clinics and Medical Outreach
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Wells
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Roads Bypasses and Bridges
90 km / 26 / 2
Schools
70,000,000
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Medical Priorities in Phase I

• Safety of rescuers
• Saving of life
• Distribution of water food

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Medical Priorities in Phase II

• Force health protection
• Controlling disease outbreaks
• Vector control consultation
• Food and water surety
• Sanitation consultation
• Restoration of general public health measures
• Consultation on the disposal of remains
• Epidemiological surveillance
• Functional HN medical infrastructure

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Lessons Learned

• Early and accurate assessments a must
• Infrastructure needs
• Size and type of units
• Deployment priorities
• Regional disaster office overwhelmed
• Disaster relief often creates competing
  priorities
• Military Support to Civil Authorities is a
  different animal--Training a must
• SOUTHCOM both a supported and supporting Command
• Knowledge of ground rules-- Imperative!!!

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Finding a Balance
Balanced Surge Capacity Scale
Efficient
Effective
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Rhode Island Nightclub FireThe Facts

• 20 Feb 03, West Warwick, RI
• The Station nightclub caught fire with 250-300
  people inside
• Results
• 99 dead
• 150 injured
• Deadliest U.S. nightclub fire since 1977

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Rhode Island Nightclub FireMedical Response

• Burn patients sent to 11 regional hospitals
  including
• Rhode Island Hospital, RI
• Kent Co. Memorial Hospital, RI
• Mass. General Hospital, MA
• Response teams delivered on scene medical care
• EMT
• Fire
• Off-duty doctors/nurses

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Rhode Island Nightclub Fire

• Validated theory of Surge Capacity
• Local hospitals overwhelmed
• Patients sent to other states for care
• Tested response plans to possible terrorists
  attacks

Source Boston Globe, The Phoenix
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Rhode Island Nightclub FireLessons Learned

• Patient surge must be addressed!
• Can happen in peace time
• Terrorist attack is not only cause
• Use of all available resources is a must!
• Hospital beds
• Response personnel
• Bottom Line We must prepare for all possible
  disasters. We should organize, train, and equip
  to meet the surge dilemma in any crisis!

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The Dilemma!

• No solution currently exists to meet a surge in
  patients during crisis!
• 2001 Presidential Inauguration -- 7 ICU beds in
  DC
• Demolition of Mile High Stadium Exercise -- 7 ICU
  beds in Denver
• 2002 weekend in Dayton and Cincinnati -- 1 ICU
  bed in area
• Hospitals face fiscal constraints in national
  crisis
• Limited resources and manpower
• Fear factor
• Who will arrive for second shift once bio/chem
  has been detected?

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Preparation for the NationMaking the Pieces
Fit
Source Dr. Paul K. Carlton
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QUESTIONS?