Disaster Preparation Training

1
Disaster Preparation Training

• Condell Medical Center EMS System
• Continuing Education
• June, July 2004
• Site Code 107200E1204
• Prepared by Sharon Hopkins, RN, BSN, EMT-P

2
Objectives

• Upon successful completion of this program, the
  EMS provider should be able to
• Describe the local Multiple Victim and Mass
  Casualty Plan and understand how to activate the
  plan and describe their role in the plan
• Actively participate in a table top exercise

3
Objectives continued

• Describe the State Medical Disaster Plan and
  understand when the plan is activated and
  describe their role in the plan
• Describe the National Incident Management System
  (NIMS) and their role in the plan
• Describe the appropriate level of personal
  protective equipment (PPE) to be utilized at a
  variety of disaster incidents
• Successfully complete the post-quiz (80)

4
Variety of Plans Developed for Disaster Response

• Local Plan Multiple Victim and Mass Casualty
  Plan
• Support MABAS, Resource Hospital
• State Plan State Medical Disaster Plan
• Support Governor, IDPH, POD hospitals
• National Plan National Incident Management
  System (NIMS)
• Support Federal, state, tribal, local
  resources

5

• Multiple Victim
• and
• Mass Casualty Plan

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Purpose of Local Mass Casualty Plan

• Enables fire/EMS agencies hospitals to respond
  effectively efficiently to multiple victim/mass
  casualty situations
• Avoids overtaxing resources of any single agency
  or facility
• Provides optimal patient care
• Supplements individual plans

7
Two Components of Local Plan

• 1st component - Multiple Victim Incident
• OR
• 2nd component - Mass Casualty Plan

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Multiple Victim Incident Plan

• Followed when
• responding EMS personnel can control life threats
  with their usual resources AND
• within 10-20 minutes adequate numbers of
  responders ambulances can be at the site AND
• surrounding hospitals can be accessed in timely
  manner they can provide patient stabilization

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Mass Casualty Plan

• Followed when
• number of patients nature of injuries make the
  normal level of stabilization care unachievable
  AND/OR
• number of EMS personnel ambulances brought to
  the site within primary secondary response
  times are not enough AND/OR
• stabilization capabilities of hospitals within 25
  minutes not adequate to handle all patients

10
Practical Applications for Local Plans

• Multiple Victim Incident
• no triage tags necessary
• usually 1 pt/1rig
• radio reports to hospitals as usual
• run reports completed as usual

• Mass Casualty Plan
• triage tags to be used on all patients
• ambulances may transport more than 1 pt/rig
• No radio reports to hospitals treat per SOPs
• No run reports necessary

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Important Notation

• Regarding Multiple Victim Incidents
• The first critically injured victims may be
  transported to the nearest appropriate level
  hospital(s) while SIMULTANEOUSLY communicating
  with the Resource Hospital.
• The Resource Hospital will assist in directing
  remaining victims to other hospitals
• Avoid overwhelming any one hospital with patients
  from the same scene

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Activation of Local Plan

• The multiple victim incident or mass casualty
  plan must be activated as soon as possible

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• It takes time to activate mobilize resources.
• The sooner resources are activated therefore, the
  sooner they can be mobilized and arrive at the
  site where they can be utilized.
• Mutual goal to do the most good for the most
  people while trying to preserve life.

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General Fire Department Responsibilities

• Recognize that the 1st responding unit functions
  as Command and must initiate the appropriate plan
  as well as start triage until relieved by
  personnel recruited to the scene
• Communicating with the Resource Hospital EARLY
  allows the hospital to mobilize their disaster
  plan and prepare for patient arrival
• Think potential! - need to direct care to
  positively affect the greatest number of victims
• Responders will generally move from triage to
  treatment to transportation

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MABAS Dispatch Responsibilities

• Box alarms are toned out as requested by on-scene
  Incident Commander
• Maintains communication with ambulances
  transporting patients to area-wide hospitals
• Maintains communication with Incident Commander
  for providing additional resources
• Strikes out box alarm when last ambulance has
  arrived at site no more are needed

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Hospital Command

• The hospital communication link is assumed by the
  Resource Hospital affiliated with the fire
  department presiding over the incident site
• Functions as the medical control gatekeeper for
  the incident
• Collaborates with scene personnel to identify
  receiving hospitals

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Initial Communication from the Field to the
Resource Hospital to Include

• nature of the incident
• incident site
• closest hospitals
• estimated number of patients
• estimated patient acuity (red, yellow, green,
  black)

• general age groups
• types of injuries/illness
• any special needs
• ETA of first victims from the scene
• call back number for contact back at the site

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Expect the Resource Hospital to communicate
back to Transportation/designee at the site

• For a multiple victim incident specific victim
  colors will be assigned to specific receiving
  hospitals (ie 1 red 2 yellows to XYZ
  hospital) Resource hospital provides transport
  management

• Upon activation of the mass casualty plan EMS
  will receive information regarding receiving
  hospital capacities for accepting victims and
  Transportation at the site determines who goes
  where

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Receiving Hospitals

• Communicate with the Resource Hospital regarding
  all disaster activity
• Will not receive radio reports from the field for
  mass casualty events EMS operates on SOPs
  during mass casualty events
• Does not stop the flow of ambulances not
  associated with the disaster activity

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Incident Management System Organization
Incident Commander
Safety
Fire
Rescue
Medical
Staging
Media
Supplies

• Communications

Triage
Treatment
Transport
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MCI Communications

• Incident Command

Resource Hospital
MABAS
Mutual Aid Departments
Receiving Hospitals
22
Mass Casualty Medical Sectors

• Triage Officer
• Treatment Officer
• Transportation Officer

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Triage Officer

• Provides coordination necessary for effective
  categorization/sorting of patients
• Supervises triage personnel
• All patients are to be quickly tagged
• Triage Officer oversees movement of patients from
  Triage into the Treatment area

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Definition of Triage

• To sort victims based on the severity of their
  injuries
• Goal To do the best for the most
• Triage is interrupted only for airway problems
  /or severe bleeding airway must be opened with
  simple maneuvers and bleeding compressible or
  triage staff must move on

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Triage Categories

• Red survivable life threatening injuries needs
  immediate treatment transport
• Yellow serious injuries that should not
  deteriorate if treatment transport are delayed
• Green minor injuries, non-life threatening can
  hold treatment transportation
• Black mortally injured or dead

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Examples of Category Red

• depressed level of consciousness
• respiratory distress
• facial burns with potential airway compromise
• chest injuries - ie flail chest, pneumothorax
• penetrating injuries to neck, chest, or abdomen
• shock
• uncontrollable bleeding

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Examples of Yellow Category

• uncomplicated, non-compromising burns
• spinal cord/back injuries
• major, open, or multiple fractures
• stable abdominal injuries
• eye injuries

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Examples of Green Category

• soft tissue wounds
• lacerations
• sprains, strains, fractures
• formerly referred to as the walking wounded -
  was confusing because some green patients may not
  be able to walk but are still appropriately
  categorized as green

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Examples of Black Category

• victims in cardiac arrest
• respiratory arrest not easily reversible with
  basic intervention (ie opening airway)
• major bleeding not easily controllable with minor
  intervention (ie compression)
• mortally injured patients (ie brain matter
  protruding from head injury)

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Treatment Officer

• Establishes treatment zone with personnel
  equipment
• Establishes areas that are clearly identified as
  red, yellow, green treatment areas and a
  separated area for morgue (black)
• Prioritizes patients for transport to hospital
  (red goes first)
• Maintains adequate levels of staff to allow for
  frequent reassessment of patients while awaiting
  transportation

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Transportation Officer

• Establishes patient loading area to coordinate
  access egress of ambulances
• Coordinates activity with Treatment Officer
• Communicates with Resource Hospital
• number of patients and triage categories
• receiving hospital capabilities
• Communicates with ambulance personnel
• specific hospital destination
• supplies maps from the scene to hospitals

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Additional Important Roles

• Safety Officer - monitors all scene
• activities identifies hazardous
• situations
• Staging - assures orderly parking, sends
• requested resources to the site
• Supply Officer - obtains and distributes
• needed supplies

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Regarding Mass Casualty Events

• Its been said that the success of running a mass
  casualty event is dependent on how the first few
  minutes are handled.
• Handling the first few minutes of a disaster
  event is in the hands of the blue shirt - the
  staff members who are the first responding unit
  to most scenes.

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• State Medical
• Disaster
• Plan

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State Medical Disaster Plan

• Addresses preparedness, response recovery to an
  emergency medical situation within the State of
  Illinois
• Goal of plan - provide assistance to allow EMS
  personnel health care facilities to work
  collaboratively where local resources are
  overwhelmed

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Activation of State Disaster Plan

• A local government official (mayor, county
  commissioner,etc) notifies Governor
• Governor notifies Chief of Division of EMS
  Highway Safety to ?activate Phase I or Phase II
  of the Disaster Plan ?determine resources needed
  and ? request assistance from appropriate POD
  hospital (ie Highland Park Hospital for this
  area)

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POD Hospital Role in State Plan

• Lead hospital in a specific region (ie Region X
  POD is HPH)
• Coordinates disaster medical response
• Primary point of contact for communication
  coordination of disaster response with hospitals
  in their region
• Would make the hospital contacts to deploy
  personnel to the disaster site

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Hospital Communication in State Disaster Plan

• POD hospital notifies Resource Hospitals to
  notify their respective Associate Participating
  Hospitals
• Associate participating hospitals complete
  required information worksheets worksheets
  forwarded to Resource Hospital, which then
  forwards the information to the POD hospital
• POD hospital forwards information to IDPH

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MABAS Role in State Plan

• Recognized as a mechanism to mobilize mass
  resources in a swift coordinated manner
• Once notified by IDPH/EMS, will facilitate
  requests for response from MABAS divisions
• Will avoid significantly depleting any single
  MABAS division or geographic area

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• National
• Response Plan
• by
• Homeland Security

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National Response Plan (NRP) set up by Homeland
Security

• Purpose
• ensure that all levels of government have
  capability to work efficiently effectively
  together
• uses a national approach to domestic incident
  management
• provides the core plan for prevention,
  preparedness, response, recovery mitigation
• designed to the protect nation

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Activation of the NRP

• Governor is the States chief executive
• Responsible for coordination of State and local
  resources
• requests Federal assistance when States
• capabilities have been exceeded or exhausted

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National Incident Management System (NIMS)

• What is it?
• the Nations first standardized management
  approach to unify Federal, state, and local lines
  of government for incident response
• developed for a homeland security incident (ie
  acts of terrorism, natural disasters, other
  emergencies
• uses standardized processes, protocols,
  procedures for all responders
• enhances national preparedness readiness in
  responding to recovering from an incident

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Top Priorities for Incident Management at all
Levels

• Save lives, protect health safety of responders
  the public
• Ensure security of the homeland
• Protect restore critical infrastructure
• Mitigate damages impacts to individuals,
  communities, the environment

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Components of NIMS

• Five functional areas incorporated under the
  incident command system (ICS)
• command
• operations
• planning
• logistics
• finance/administration

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Responder Readiness Enhancement

• Advanced preparedness measures to enhance
  response includes
• planning
• training
• exercises
• qualification certification
• equipment acquisition certification
• enforcement of building standards codes
• preventive measures to lessen loss of life or
  property

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Communication Enhancement

• proposes standardized communications for incident
  information management
• proposes a common operating picture for a more
  efficient and effective incident response

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Joint Information System (JIS)

• enhancement of public communication efforts
• provides public with timely accurate incident
  information unified public messages
• ensures that the same information is released to
  the public from all involved parties during an
  incident

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NIMS Integration Center (NIC)

• to provide strategic direction oversight of
  NIMS
• to assess proposed changes to NIMS
• capture evaluate lessons learned
• employ best practices
• use collaborative process of variety of
  authorities to assess prospective changes
  assure continuity accuracy

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NIC will also

• develop facilitate national standards for NIMS
  education training
• first responder communications equipment
• typing of resources
• qualification credentialing of incident
  management responder personnel
• standardization of equipment maintenance
  resources

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• Specialized
• Personal
• Protective
• Equipment

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OSHA Standards

• OSHA charged with responsibility to set standards
  for adequate protection of chemical protective
  clothing to the wearer at corresponding danger
  levels
• Training required for donning equipment,
  equipment removal, user monitoring training,
  decontamination procedures

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EPA Levels of Protection

• Level A
• chemicals identified have high hazard level to
  respiratory system, skin, eyes. Operations
  conducted in confined or poorly ventilated areas
• protection necessary - highest available for
  respiratory, skin, eyes from solid, liquid
  gaseous chemicals

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Level A

• Equipment necessary
• vapor protective suit
• pressure-demand, full-face SCBA
• Inner chemical resistant gloves,
  chemical-resistant safety boots, two-way radio
  communication

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• Level B
• chemicals identified do not require a high level
  of skin protection. Primary hazards associated
  with entry into site are from liquid and not
  vapor contact.
• Protection necessary - some level of respiratory
  protection as Level A but less skin protection.
  Liquid splash protection but no protection
  against chemical vapors or gases

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Level B

• Equipment necessary
• liquid splash-protective suit
• pressure-demand, full-facepiece SCBA
• inner chemical-resistant gloves
• chemical resistant safety boots
• two-way radio communications
• hard hat

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• Level C
• contact with site chemicals will not affect skin.
  Air contaminants have been identified and
  concentrations measured. A canister is available
  to remove contaminant. The site and its hazard
  have been completely characterized.
• Protection necessary - same level of skin
  protection as Level B, but a lower level of
  respiratory protection. Liquid splash protection
  but no protection to chemical vapors or gases

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Level C

• Equipment necessary
• support function protective garment
• full-facepiece, air-purifying canister-equipped
  respirator
• chemical resistant gloves and safety boots
• two-way communications system
• hard hat
• Not acceptable for chemical emergency response

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• Level D
• atmosphere contains no known hazards
• work function precludes splashes, immersion,
  potential for inhalation, or direct contact with
  hazard chemicals
• Protection necessary - no respiratory protection
  needed, minimal skin protection

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Level D

• Equipment
• coveralls
• safety boots/shoes
• safety glasses or chemical splash goggles
• Not acceptable for chemical emergency response

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• Table-top
• exercises
• geared to your
• department and community

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Directions for the Exercises

• You may adapt the exercises to fit your community
  - act as if the call came in today
• Start with the usual 2-3 man crew response to the
  scene
• The group in attendance should be involved in
  working through your departments response based
  on your resources and additional resources that
  may need to be mobilized

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Exercise 1

• You have been dispatched for a motor vehicle
  incident at a major intersection in your town.
• Upon your arrival, you have 2 vehicles involved
  with a total of 10 patients (divided between red
  and yellow categories)
• Whats your plan of action?

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Exercise 2

• You are called to the scene of a truck versus
  train incident. You have 5 victims (red, yellow
  and green injuries)
• The truck was carrying hazardous materials
• What is your plan of action?

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Exercise 3

• A tornado has gone through a neighborhood in your
  response area
• There is significant damage to homes and
  businesses in a 1 mile stretch (you pick the
  location in your town)
• What is your plan of action?

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Resources

• MABAS Division I, III, IV Region X Multiple
  Victim and Mass Casualty Plan, revised April 2004
• NIMS Fact Sheet, Department of Homeland Security
• www.lakeland.com/standard.html
• www.osha.gov/dts/osta/otm/otm_viii/otm_
  1.html