FIELD TREATMENT SITES

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FIELD TREATMENT SITES

• Another PIECE of the PUZZLE

Presented by Doug Buchanan www.DisasterDoug.com
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OBJECTIVES

• After this course, you should be able to answer

1- WHAT?

• What Are They?Identify several resources
  available to help augment current Treatment
  Facilities

2- WHY?

• Why Do We Need Them?Describe the purpose and
  function of a Field Treatment Site.

3- WHO?

• Who Decides When We Need to Activate an
  FTS?Describe the Decision Process for Activation
  of an FTS.

4- HOW?

• How Do We Activate an FTS?Outline the Activation
  and Set-up Process for an FTS.

5- WHERE?

• Where Do We Get the Equipment/Supplies ?Describe
  the Logistics and Support Process for an FTS.

6- WHEN?

• What Happens at the End of 3 Days?
• List the options for Demobilization of an FTS.

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What is an EMS Field Treatment Site?
How does this relate to other facility types?

• An EMS Field Treatment Site is a temporary
  facility, designed to provide Triage and
  Treatment of patients awaiting transportation,
  for up to 72 hours.

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Dont We Already Have Options?.. like

• Mobile Field Hospitals

• The California EMS Authority currently has three
  200-bed Mobile Field Hospitals available for
  deployment.

• Alternate care sites

• Many Operational Areas have already developed
  plans for establishing Alternate Care Sites as
  part of the local Medical Surge plan.

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YES.

• Local and State Government agencies currently
  have Assets and Plans to help augment Treatment
  locations during a Medical Surge.

• However most of these plans require a minimum of
  72 hours to fully activate.
• An EMS FTS is designed to use Paramedics, EMTs,
  and EMRs to provide care up to 72 hours.

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Field Treatment Sites

• Filling in the Gap.

• Establishing an EMS Field Treatment Site to fill
  in the gap between the onset of a local Medical
  Surge event, and the time it takes to activate a
  Mobile Field Hospital or an Alternate Care Site
  is one possible scenario (i.e. Medical Surge).

• Another reason why an EMS Field Treatment Site
  may be activated is that Transportation of
  patients to definitive care is not possible, due
  to
• Unavailable Transportation Routes
• Unavailable Transport Resources

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TEST YOUR KNOWLEDGE

• Lets examine what weve learned so far

• Scenario A bridge on the local highway had
  partially collapsed during a mud slide earlier
  today. At 6pm, a 50 passenger bus and several
  automobiles didnt notice the problem until it
  was too late. This highway is the primary route
  to local hospitals. Taking alternate routes
  could take hours. You now have 58 patients, and
  the weather forecast is calling for freezing
  temperatures tonight. You anticipate that
  getting adequate transport resources here could
  take until morning. You decide to

1. Request a Mobile Field Hospital
2. Request an Alternate Care Site
3. Request a Field Treatment Site

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TEST YOUR KNOWLEDGE

• Lets examine what weve learned so far

• If you answered C. Request a Field Treatment
  Site, youre correct.
• Our problem is not places to send our patients,
  it is that the transportation routes are
  significantly affected, and transport resources
  are significantly delayed.
• Requesting an FTS should allow us to getpatients
  out of the environment, andprovide facilities to
  maintain patients overnight.

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Deciding to Activate

• Requests for FTS Activation come to the MHOAC
  from a local Incident Commander or the OA EOC.

• An Incident Commander may decide to contact the
  MHOAC to request an FTS Activation when it
  appears that patients will have to be cared for
  greater than 12 hours on scene.
• T he OA EOC may elect to activate an FTS due to a
  Healthcare Surge event.

• The MHOAC may use the FTS Decision Checklist and
  tools found in the FTS Planning Guide to
• Evaluate Resource Options
• Determine number, type, and locations of FTSs
• Sign an FTS Activation Order
• Appoint an FTS Activation Team Leader

• FTS Activation Team Leader oversees the
  Activation and set-up of the FTS.

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FTS Decision Checklist

• Designed for use by the MHOAC

• A Medical / Health Technical Advisory Committee
  may be convened to help assess the available
  alternatives or Medical Surge strategies, prior
  to FTS activation.

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Assessment Factors

• To assist the MHOAC or the EOC MH Branch in
  evaluating the need for an FTS, many factors
  should be considered. This tool is available in
  the FTS Planning Guide.

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FTS Options

• Considering what is available.

• Pre-Surveyed Facility
•  If the County has a pre-designated FTS within
  the area , this location should be considered
  first. A list of Pre-designated sites can be
  found in the Appendix of the FTS Planning Guide.
  
•  
• Non-Surveyed Facility
•  If no pre-designated sites in the target area
  are available, other non-surveyed facilities
  should be considered, such as halls, community
  centers, etc.
•  
• Non-Fixed Site
•  If there are no targetable facilities within the
  area, an FTS will need to be identified and
  established in close proximity to the incident,
  which may require assets such as tents, portable
  water / sanitation, and generators, etc.

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FTS Activation Order

• After Identifying the Site

• This is the first part of the form, designed to
  be used by the MHOAC or Med/Health Branch
  Director at the EOC.

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FTS Activation Order

• After Identifying the Site

• The second portion of the FTS Activation Order is
  designed to list the Team Leader, appointed by
  the MHOAC or Med/Health Branch Director of the
  EOC.

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Decision to Demobilize or Transition

• Thinking ahead

• The MHOAC or MH Branch needs to consider when,
  and how the FTS might be demobilized. Planning
  must begin as early as possible to ensure a
  smooth transition. The options for consideration
  may be

• Maintain the FTS until all patients are
  disbursed, then demobilize the site.
• Utilize the FTS for initial care and treatment,
  then transition the care of patients to an FTS or
  ACS at different location.
• Utilize the FTS for initial care and treatment,
  then transition the FTS into an ACS at the same
  location.

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Decision to Demobilize or Transition

• Thinking ahead

• The following graphic provides examples of
  transitioning an on-scene Treatment Area to an
  FTS and transitioning an FTS into an ACS for
  longer term care.

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Decision to Demobilize or Transition

• Once an FTS is Activated

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Activating an EMS Field Treatment Site

• FTS Activation Team Leader Checklist

• Once the decision has been made to activate a
  Field Treatment Site (FTS), and an FTS Activation
  Team Leader has been assigned, the team leader is
  responsible to

• Assign the Activation Team staff,
• Secure the selected FTS location,
• Acquire the necessary resources to staff and
  equip the site, and
• Set-up the site.

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Activation Team Leader Checklist

• This tool from the FTS Planning Guide is meant to
  assist the FTS Activation Team Leader.
• Additional supporting tools are listed in the
  column to the right.

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FTS ACTIVATION TEAM

• Planning Tool

• This tool is intended to give the FTS Activation
  Team leader an overview of the tasks and
  responsibilities involved in the FTS activation
  process, and shows how these tasks may be
  assigned to various Section Chiefs and Unit
  Leaders.

• Team Leader (Command and Control) 
• Logistics Section Chief
• Facility Procurement Unit (Select and Secure a
  Site) 
• Staffing Unit (Establish Initial Operational
  Period Staffing)
• Equipment / Supply Unit (Order of Equipment and
  Supplies)
• Communications Unit (Establish Communication
  Systems)
• Operations Section Chief
• Staging Manager (Receive and inventory incoming
  equipment / supplies)
• Site Set-up Unit (Site Set-up)
• Security Unit (Establish Site Security Plan)

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FTS Activation Org Chart

• Example of how the Activation Team may be
  organized.

• This chart utilizes Smart Art which is feature in
  PowerPoint 2007. If you wish to make charts like
  this and dont have PPT 2007, we have provided
  the graphical elements to help you build this
  yourself.
• Here is the description of the chart. You may
  change or delete this text as you wish.

FTS logistics will by managed by, or in
cooperation with, the OA EOC
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Job Action Sheets

• The right tool for the right job.

• Job Action Sheets are included in the FTS
  Planning Guide for each position on the FTS
  Activation Team.
• In addition to the Job Action Sheets, the
  supporting tools, such as the ICS Forms, can be
  found in the Attachments section.

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FTS Equipment / Supplies Tool

• And Recommended Quantities for a 50 patient FTS

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FTS Equipment / Supplies Tool

• How do we use this form?

PHD 50 PHD 150 PHD 200 OES 100 OES 200

• Example Available in Local Cache?This is
  designed to be filled out in advance, based upon
  known local assets.

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FTS Equipment / Supplies Tool

• How do we use this?

PHD 50 PHD 150 PHD 200 OES 100 OES 200
30 90 30 6 20

• Example Select for OrderingThis is designed to
  be filled out to reflect the actual need during
  an incident (e.g. if your incident requires care
  for only 30 patients, the column should reflect
  that.)

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FTS Equipment / Supplies Tool

• How do we use this?

PHD 50 PHD 150 PHD 200 OES 100 OES 200
30 90 30 6 20
10 0 0 2 2
20 90 30 4 18

• Example Have Need These columns are designed
  to indicated what items we already HAVE, versus
  what we still NEED (e.g. We have 10 cots, 2
  Tables, 2 Chairs we need everything else).

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FTS Equipment / Supplies Tool

• How do we use this?

PHD 50 PHD 150 PHD 200 OES 100 OES 200
30 90 30 6 20
10 0 0 2 2
20 90 30 4 18
20 90 30 4 18

• Example Requested Order FilledThe last two
  columns are meant to help us track what has been
  requested, and if an order has been filled.

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FTS Layout

• Sample Layout of a Field Treatment Site

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TEST YOUR KNOWLEDGE

• Lets examine what weve learned so far

• Scenario You have been assigned as an FTS
  Activation Team Leader, and are tasked with
  activating this facility for 50 patients.
  Besides patient cots, bedding, and food, what
  additional items might need to be considered?

1. Portable toilets.
2. Storage area for medical supplies.
3. Nothing.

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TEST YOUR KNOWLEDGE

• Lets examine what weve learned so far

• If you answered C. Nothing, you might need to
  restart this lesson.
• If you answered A. Portable toilets, you have
  begun thinking like an FTS Activation Team
  Leader.
• Caring for 50 people will likely require more
  than one toilet. You might also consider
  additional handwash stations.A good rule of
  thumb is 20/1

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FTS Operations

• The FTS Organization Chart is largely modeled
  after the current FIRESCOPE MCI organization
  chart.

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FTS Operations

• Job Action Sheets, Forms, other Tools

• Job Action Sheets are included in the FTS
  Planning Guide for each position in the FTS
  organization.
• In addition to the Job Action Sheets, the
  supporting tools, such as the ICS Forms and FTS
  Report Forms can be found in the Attachments
  section.

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FTS Tools

• Several forms have been developed to assist the
  personnel with FTS operations, including the
• FTS Report Form
• FTS Staffing Roster
• FTS Time Sheet
• FTS Patient Record

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FTS Site Surveys/Diagrams

• Developed through HPP Grant Funding

• Most Operational Areas in California have had the
  opportunity to conduct FTS Assessments on local
  target facilities.
• The FTS Assessment allows us to identify in
  advance what services or features already exist
  at a target facility, and what will likely need
  to be brought in to make a facility functional as
  an FTS.

• In addition to the county specific FTS Surveys
  and Site Diagrams, a generic FTS Diagram has been
  included in the Appendix of the FTS Planning
  Guide that demonstrates an FTS set-up at or near
  the site of an incident, using Tents, Cots, etc.

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Field Treatment Sites

• Another piece of the puzzle.

You have completed the FTS Overview. -Thank you.