Chapter 51 Disaster Response. National EMS Education Standard Competencies EMS Operations Knowledge of operational roles and responsibilities to ensure

Chapter 51Chapter 51

Disaster Response

National EMS Education Standard CompetenciesNational EMS Education Standard Competencies

EMS Operations

Knowledge of operational roles and responsibilities to ensure patient, public, and personnel safety.

National EMS Education Standard CompetenciesNational 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.

IntroductionIntroduction

• 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

IntroductionIntroduction

• Disaster management requires: − Preparedness

− Planning training

− Response

− After-action review

Disaster Response Planning Disaster Response Planning

• EMS agencies should have plans suited to:− Geography

− Population

− Potential risks specific to the area

Disaster Response Planning 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

Phases of a Disaster Response Plan

• Three phases of any response plan:− Before the event preplanning

− During the event

− After the event

Before the EventBefore the Event

• Planning − Process of

preparing for potential events

− Evaluate emergency incident factors that responders may or may not have control over.


• Geography of response area− Area prone to a

particular type of disaster?

− Obstacles and terrain features that affect response?

© Gina Jacobs/ShutterStock, Inc.


• Population− Spread out, dense, or mixed?

− Same in daytime as nighttime?

− Language or culture differences?

− Facilities that may present hazards?


• EMS resources− Items needed may include:

• Additional staff or personnel

• Specialized staff

• Medical supplies

• Equipment to handle tasks


• 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.


• Access to business assets− What expertise is

available from the private sector?

• Nongovernmental organizations and disaster relief agencies− May arrange

training or planning sessions


• Fire and police response− Disaster response

plan will outline fire and police response.

− Have drills for unified command system

© Larry St. Pierre/ShutterStock, Inc.


• 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.


• 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.


• 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.


• Immunizations of personnel− Keep up to date.

− Be familiar with agency’s plan.

• Sheltering− Food

− Water

− Bath facilities

© Reuters/Mike Blake/Landov.


• 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 EventDuring the Event

• Best to stick to a plan. − Modification may

be required.


• 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.


• 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.


• 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.


• Triage and classification− May be disaster

dependent

− Constant and ongoing

© Roger Nomer/AP Photos


• 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


• 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


• Personnel physical needs− Eat, drink, use of

bathroom facilities

− In long-lasting incidents, sleep areas are required.

© AP Photo/Ross D. Franklin.


• 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.


• 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.


• Media− Members of your

agency may be trained to respond to the press.

− Use press to your advantage.

© Karin Hildebrand Lau/ShutterStock, Inc.


• 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 EventAfter the Event

• There are specific measures to take after an 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.


• Inventory− Needed after resupply and repair

• Stress reaction review− Consider critical stress management teams.

− Note changes in behavior.

− Report concerns immediately.


• 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-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.


• Acknowledgment− Good performance should be praised.

− Praise often, immediately, and honestly.

Forest and Brush FiresForest and Brush Fires

• Can be man-made or natural

© Harald Høiland Tjøstheim/ShutterStock, Inc.


• 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.


• 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 StormsSnow 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


• Clothing should be weather ready.

• Your agency may have snowmobiles, snow blowers, and plows.

• Take your time.


• Look for snow and ice slides before entering a structure.

• If your company is on standby, prepare portable warm-up shelters.

TornadosTornados

• 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.

TornadosTornados

• 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.

TornadosTornados

• 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.

HurricanesHurricanes

• 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.


• 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.


• 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.

TsunamisTsunamis

• 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

TsunamisTsunamis

• 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.

EarthquakesEarthquakes

• There may be little or no warning.

• Can cause thousands of deaths and billions of dollars in damage within minutes

• Aftershocks occur regularly.


• 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.


• 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.


• 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.



• 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.



• Equipment that may be planned for in advance includes:− Backhoes

− Earth movers

Cave-InsCave-Ins

• Can be caused by:− Rapid freezing and

thawing

− Heavy rain

− Excess vibration

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Cave-InsCave-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-InsCave-Ins

• There are three ways to secure the area of evacuation:− Sloping

− Benching

− Shoring

Cave-InsCave-Ins

• The atmosphere is generally toxic.− Assume that patients have been in an oxygen-

deficient atmosphere.

• Sewer and chemical gases can be released.

Volcanic EruptionsVolcanic Eruptions

• Rescue workers may be affected by secondary problems.

• Identify buildings that are “volcano proof.” © David Falconer/AP Photos


• Panic may spread.

• Expected injuries include:− Burns

− Respiratory problems

− Crush trauma injuries

− Respiratory, eye, and skin problems


• 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.

FloodingFlooding

• 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

FloodingFlooding

• 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 StormsSandstorms and Dust Storms

• Sensory input becomes difficult.

• Eye protection should be worn.

• Do not rub eyes, nose, or skin during storm.

Sandstorms and Dust StormsSandstorms and Dust Storms

• Respiratory protection should be worn.

• Driving is a challenge.

• Blowing sand may hide objects.

Prolonged Cold WeatherProlonged 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 WeatherProlonged 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

DroughtDrought

• 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 WaveHeat 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 WaveHeat 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 DebrisMeteors 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.

PandemicsPandemics

• Personal protection is the most important consideration.

• The best method of detection is direct observation.− If someone appears to be sick, pull from duty.

PandemicsPandemics

• 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.

PandemicsPandemics

• 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 FiresStructural Fires

• Much higher death and injury rate than wildfires

• Let the fire fighters fight the fire.

© Sergey Toronto/ShutterStock, Inc.

Structural FiresStructural 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.



• Consider what special PPE you might need:− Helmets

− Steel toe boots

− Eye protection

− Knee pads

− Heavy-duty gloves

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• 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.



• 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 DisruptionsPower 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.


• Have battery-powered backup devices.

• Have an ample supply of batteries.

• Make a list of all patients who use electrically powered life-saving devices.


• 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



• 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.



• Police escort is crucial.

• Consider wearing body armor, a helmet, and an APR.

• Document everything thoroughly.

Strikes and Labor DisputesStrikes 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 DisputesStrikes 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.



• 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.

ExplosionsExplosions

• Secondary and tertiary explosives may have been placed.− Keep your eyes open and stay alert.

• Record anything a seriously injured patient has to say.

ExplosionsExplosions

• Ear injuries are common.− Speak loudly and face the patient.

• Air particles are probably contaminated.− Wear your APR during patient care.

IT (Cyber) DisruptionsIT (Cyber) Disruptions

• Hackers can penetrate EMS security to steal patient information.

• Agencies must use the latest security patches and systems.

• Test your system relentlessly.


• Use of your system should be limited to your agency.

• Password protect systems.

• Appoint a cyber security officer.


• If you recognize a cyber threat:− Immediately report it to your supervisor.

− Stop using the threatened browser or program.

SummarySummary

• 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.

SummarySummary

• 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.

SummarySummary

• 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.

CreditsCredits

• 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.

Documents

Chapter 51 Disaster Response. National EMS Education Standard Competencies EMS Operations Knowledge of operational roles and responsibilities to ensure