The Realities of Rural Emergency Medical Services Disaster Preparedness

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The Realities of Rural Emergency Medical Services
Disaster Preparedness

• Teri L. Sanddal
• Critical Illness Trauma Foundation, Inc.
• August 19, 2006 Big Sky MT

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Other Authors

• Paul M. Furbee
• Jeffery H. Coben
• Sharon K. Smyth
• William G. Manley
• Daniel E. Summers
• Nels D. Sanddal
• James C. Helmkamp
• Rodney L. Kimble
• Ronald C. Althouse
• Aaron T. Kocsis

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Funding

• Funded by Department of Health and Human
  Services, Health Resources and Services
  Administration
• Grant 1D1ARH00981

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Disaster Planning???????
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Introduction

• Emergency healthcare is not prepared for
  disasters, either terrorist or natural
• Emergency medical services will be among the
  first to respond in the event of MCI
• No standard that requires EMS to have a disaster
  plan
• Few studies have addressed the preparedness of
  rural EMS organizations

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Purpose

• To assess the attitudes and experiences of rural
  EMS organizations regarding emergency
  preparedness and responses to multi-casualty
  events.

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Survey Instrument

• West Virginia IRB
• Mailed to EMS Agency's Training Officer
• With terminology page
• Designed by team of Subject Matter Experts
• Likert scale 1 to 5
• 1 very prepared
• 5 very unprepared

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Methods

• Mailed written survey
• Rural zip codes according to USDA
• FEMA Regions 3 and 8
• Region 3 PA, MD, VA, WV
• Region 8 MT, ND, SD, WY, UT, CO
• 4 Western States
• NV, AZ, NM, ID

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Participants

• 34 Rural counties
• 1,815 EMS agencies

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Survey Questions

• Agency self-assessment of preparedness
• Actual experience with and participation in
  disaster response
• Expenditure of time and money for disaster
  training
• Training activities completed
• Rate level of preparedness
• Organizational characteristics

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Results --

• Final response rate 43
• 768/1801
• 14 addresses undeliverable

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Results Surge Capacity Number of Patients
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Results Perceived Response Capabilities

• Confident dealing with
• Cardiac emergencies
• Motor vehicle trauma
• Less confident and prepared for
• Victims of chemical weapons

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Results EMS ExperienceIn the past 2 years

• 293 (38) had MCI that overwhelmed
• 186 (24) Disaster plan invoked
• 200 (26) Assisted with State declared disaster
• 27 (4) Worked with DMAT
• 25 (3) Worked with CST
• 65 (8) Worked with CERT

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Results Training Activities

• Over 220 of increased training was
• Structural collapse
• Terrorism
• Other areas of increased emphasis
• Respond to infectious disease outbreaks
• Explosions, riots, earthquakes, and bombings
• Decreased training
• In all areas other than disaster
• Structure Fire 74

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Results Training Priorities

• Rank top 5 priorities
• Ability to attract and retain personnel
• Preparedness to respond to common MCI events
• Ability to communicate with other responders
• Areas of improvement least important
• Ability to recognize expose to radiological
  contaminations
• Interaction and relationship with local health
  departments

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If You Were Given 100K for Training
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Discussion

• Realities of rural EMS
• Limited resources
• Limited surge capacities
• Limited abilities to response to mass casualty
• Limited/no abilities to response to large urban
  populations displaced.

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Discussion

• Most important
• Maintaining an all hazards approach to disaster
  recognition, containment and response
• Improve inter-agency communication skills and
  capabilities
• Increase involvement in regional planning, that
  include roles, and responsibilities of EMS with
  others

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Conclusion

• Rural EMS discover how to maintain adequate and
  sustainable training levels
• Train for an all hazards instead of specific
  threats
• Training should focus on common elements in
  disaster
• Communications
• Command and control and inter-agency cooperation.
  
• Prehospital, hospitals, public healthcare must
  address surge capacity
• MUST prepare together not in isolation