EMS Special Operations

CHAPTERCHAPTER

Management of EMS

EMS Special Operations

19

Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Learning Objectives

19.1 Explain the new mission of customer service in an all-hazards environment.

19.2 Describe the risk analysis process.

19.3 Describe the mitigation role of local community officials as it relates to EMS response.


Learning Objectives (Cont.)

19.4 Define an all-hazards approach and apply a checklist to preparing special events.

19.5 Given a medical evacuation of a patient by helicopter, identify the elements that affect or support local EMS special operations.



19.6 Identify existing documentation resources to use for special operations during a special event.

19.7 Identify the methods for developing and accessing state or statewide regional resource pools.

19.8 Contrast the missions of tactical EMS.



19.9 Analyze the role of EMS in a special- operations environment as it relates to the medical support of hazardous materials operations.

19.10 Explain the medical-legal issues involved in spectator care at mass gatherings.

19.11 Discuss the process for implementing care systems at mass gatherings.


Importance of Special Operations

• Often EMS is asked to provide care at events that require unique resources, system management, and control

• EMS managers need to prepare their organizations to respond to such events by:– Identifying potential hazards– Determining potential resource needs


Importance of Special Operations (Cont.)

• EMS managers need to prepare their organizations to respond to such events by:– Determining how those resources may be

acquired– Developing a plan that enables the

effective, specialized control of these events in concert with law enforcement and fire services resources


Special Operations

• When creating special operations within an organization, three common characteristics must be identified:– Purpose

Will require a tremendous commitment of personnel and money


Special Operations (Cont.)

• When creating special operations within an organization, three common characteristics must be identified:– Resources

Are human, physical, or financial

– Structure Incident Command System (ICS) Pre developed response plans Ability to form unified command structures


Emergency Medical Services Pre-Event Planning

• EMS pre-event planning activities– Hazard

A situation or event that can cause a loss

– Vulnerability The people, places, or things likely to incur a

loss, should the hazard actually occur, if no protective action is taken to minimize or eliminate the loss

– Risk Risk is that vulnerability that remains


Risk Assessment

• Hazard/risk assessment– The analysis of hazards, vulnerabilities, and

risks– Determination is made as to who is

vulnerable and the likelihood of harm is assessed


Managing EMS Special Operations

• Four steps for managing the effect of hazards upon communities:– Mitigation

Proactive, protective measures used to reduce the vulnerabilities or potentials for loss

– Preparedness Identifying at-risk populations, prioritizing their

EMS needs, and developing, in advance, the resources necessary to meet those needs


Managing EMS Special Operations (Cont.)

• Four steps for managing the effect of hazards upon communities:– Response

Activities that we implement as a direct result of the occurrence of the hazard

– Recovery Restore the infrastructure and social and

economic stability to the community after the effect of the hazard


EMS "All-Hazards" Approach

• All-hazards approach is a process by which we identify within our communities the hazards that we will face

• Identify and quantify those persons or segments of the population that are vulnerable to the hazards

• Refine the projected vulnerabilities after mitigation actions have been identified


Pre-Event Planning Matrix

• Choose the risks, hazards, or functions that are likely to be required by an event– Assign each to a primary agency (P) or a

secondary or support agency (S)– The functions and responsibility

assignments must be discussed and decided in the planning stages, not when an incident occurs

– Additional room is provided in the matrix to add agencies or risks/functions as they may apply


FIGURE 19.1Pre-Event Matrix Worksheet.


FIGURE 19.1 (Cont.)Pre-Event Matrix Worksheet.


TABLE 19.1 Legal Influences on EMS Response to Special Operations


Plan Components

• Plans have common characteristics that include:– Hazards analysis;– Vulnerability analysis;– Basic plan consideration;– Resource identification;– Support functions or mechanisms for

resource deployment; – Recovery activities


Customer Expectations

• Demands upon organizational resources are constantly increasing because of increased customer expectations

• There is a requirement to assemble greater and greater resources to manage special operations and unique events that may occur in our communities


Customer Expectations (Cont.)

• We must identify in advance additional resources that we can bring to bear on virtually any type of event to which we may be called to assist



• In order to accomplish this, EMS leadership must:– Identify potential hazards– Determine the at-risk populations for each

of those hazards– Identify the resources that would be

required to manage events caused by those hazards



• In order to accomplish this, EMS leadership must:– Determine what assets and voids are in the

resources we have– Find resources to fill those voids– Develop a methodology for deploying those

resources to a particular event


Mutual-Aid Agreements

• Mutual aid– Command officers required to make

specific requests for special-operations equipment In many areas these resources will take time to

assemble or will have to travel long distances to get to the scene


Mutual-Aid Agreements (Cont.)

• Automatic aid– Inter-local or mutual-aid agreement in

which the dispatch center without a command officer’s input can send or request equipment based on the information from the call to the public-safety answering point


Disaster Condition

• A disaster or emergency may overwhelm the capabilities of a state and its local governments, preventing them from providing a timely and effective response to meet the needs of the situation


Disaster Conditions (Cont.)

• A disaster or emergency has the potential to cause substantial health and medical problems, with hundreds or thousands of deaths and injuries, depending on factors such as time of occurrence, severity of impact, existing weather conditions, area demographics, and the nature of building construction


Disaster Conditions (Cont.)

• A disaster or emergency may cause significant damage particularly to the economic and physical infrastructure


Level of Care

• Levels of care at special events or mass gatherings may include: – Basic first-aid or pre-EMS certifications – Intermediate first aid plus IV therapy and

oxygen– Advanced care and life support and early

management of severe trauma– Site hospital full monitoring and ventilation;

a surgical facility may be required depending on the level/type of event


Level of Care (Cont.)

• Other level-of-care concerns including training staff, specialized rescue teams (i.e., Justin Sports Medicine for PRCA rodeo events, paramedic standby for the International Speed Boat Racing Association, extrication team for CART professional racing)


Main Concerns in Planning Medical Care

• Factors to be considered in an event setting: – Indoor versus outdoor – Access routes to and from the site– Size of the crowd– Duration of the event


Main Concerns in Planning Medical Care (Cont.)

• Factors to be considered in an event setting: – Extremes in temperature– Mobility of the crowd– Number and visibility of the aid stations and

medical-treatment facilities


Logistics

• Consider staffing a medical logistics position when planning a large event– Arrangements for facilities will be needed

for medical personnel to operate in an environment in which the injured must make their way to that location

– Make sure medical teams that patrol spectator areas are clearly identifiable

– Alternative vehicles need to be available to transport spectators to the medical facility


Logistics (Cont.)

• Consider staffing a medical logistics position when planning a large event– Determine how medical personnel will be

notified of, or summoned to, spectators requiring assistance in public areas


Medical Access to Venue

• Agreements must be reached among medical service providers on how medical teams will be able to locate individuals in need of attention

• Agree on the use of a common reference map or grid system


Medical Access to Venue (Cont.)

• Determine how medical teams will reach or rescue individuals in distress; for example, in crowded areas or through fixed seating

• The mechanism of how patients will be transported on site should be worked out


Medical Requirements

• Should prepare for the most critical injury or illness foreseeable, such as cardiac arrest

• Assessments should be made for the needs for a mobile team– Mobile teams may require pre-packed

medical kits– A determination should be made as to

which mobile teams will provide care for the audience, any VIPs, and performers


Medical Requirements (Cont.)

• The boundaries of what kind of care and services will be provided to the event should be defined


Medical-Aid Stations

• Mobile teams will often move patients to the medical-aid stations prior to the arrival of a transport vehicle

• Consider the establishment of medical- aid posts at large events or events that may take a significant amount of time for an ambulance to arrive


FIGURE 19.4Characteristics of a Medical-Aid Station


Site Hospital

• Depending on the nature of the event, a site or field hospital may be needed to provide care for the number of casualties anticipated

• You should also make contingency plans in case of a major incident, for which the resources of the field hospital may not be sufficient


Site Hospital (Cont.)

• Failure to plan for large numbers of casualties or severely injured patrons can result in long delays in providing medical treatment

• It is important to provide a communications link between the site hospital and local hospitals


Medical Equipment

• The requirement for basic or advanced life support equipment depends on the type of event and the assessed risk of illness or injury

• Equipment considerations include identifying where the equipment should be mobile versus fixed and arrangements to resupply aid posts as required


Medical Equipment (Cont.)

• Compatibility of on-site equipment with equipment used by ambulance and other health-care providers should be evaluated for inter-operability


Documentation

• A post incident analysis of the event and review of the number of requests for medical assistance that occurred at the event should be completed by EMS management

• Tracking should be done of biological, chemical, and infectious-disease exposures should they occur


Documentation (Cont.)

• Medical-legal issues, which must be addressed prior to the preparation of any documents, are as follows:– Who has access to records?– Who keeps the data and for how long?– Who can give consent for treatment?

• Every patient contact should be documented and recorded


Legal Issues

• Legislation usually governs or restricts public events or aspects of them

• Some events that are extremely large or high impact require special state or local legislation

• Local ordinances provide health and medical guidelines


Legal Issues (Cont.)

• An event should cover a variety of liabilities that warrant consideration, including:– Liability for injuries– Liability for acts or omissions– Liability for financial obligations incurred in

responding to major emergencies occasioned by the event

– Potential liability for the resultant effects of the event on normal emergency operations


Site

• Finding a suitable venue or set of venues can be difficult; the following questions will aid in the selection of an appropriate event site:– Will staging the event require multiple

venues?– Is this kind of event normally conducted at a

fixed facility?– Will a fixed facility be used in ways that may

not be considered normal for that facility?


Site (Cont.)

– Is the event regularly conducted at a temporary venue?

– Is the event a “one-of-a-kind” project at a temporary venue?

– What services/utilities are available at the venue?

– What additional services and utilities will be required at the venue?

– Is there a need for backup services or utilities?


Site (Cont.)

– What shelter facilities are available at the following locations: Transport pick up and drop off areas Spectator and official viewing areas Seated eating areas Pedestrian thoroughfares First aid and medical centers Marshaling areas for competitors and officials


Contingency Planning

• Unfortunately, not every event runs smoothly

• Incidents occur that are beyond the control of the planning team– Contingency plans for every event should

be in place


Contingency Planning (Cont.)

• An emergency-response plan requires a comprehensive hazard and vulnerability analysis

• Consultation among all parties who may respond to an emergency situation during the event is essential


FIGURE 19.6Factors Influencing ICS Planning At Events


FIGURE 19.7 (Con't)Sample Special Events Registration Form. (Source: County of Santa Clara Emergency Medical Services

Agency.)


Mass-Gathering Crush Load

• Crush load is the assembly of persons inside or outside a facility that overwhelms the capacity of a given area, resulting in gridlock, limited access, and a surge in the crowd, which pins people against a fixed object, compromising life safety


EMS Operations at Mass- Gathering Events

• Supplies and equipment to provide immediate emergency medical treatment to all should be staged or pre positioned at the scene

• Mobile rescue and medical teams, the American Red Cross, and security services need to work in conjunction for maximum safety


EMS Operations at Mass- Gathering Events (Cont.)

• EMS personnel operating in this environment should have special training, equipment, policies, and procedures and have previously practiced the techniques needed to accomplish this mission

• EMS organizations should develop their plans using an established incident command system (ICS) compliant with NIMS


Minimizing EMS System Burdens

• Cooperative planning by both EMS and OES can greatly reduce the planning burden on any one agency


Minimizing EMS System Burdens (Cont.)

• Partner with local agencies to develop a People with Special Needs (PSN) program– Allows for people with specific medical

needs to register with local EMS or emergency-management officials well in advance of the need to shelter

– Resources and needs that will be required in a disaster situation can be assessed better


EMS Special Teams

• Tactical Emergency Medical Support– The comprehensive out-of-hospital medical

support of law enforcement's tactical teams during training and special operations


EMS Special Teams (Cont.)

• Bike teams and alternative response programs– Bike medics have been incorporated in to a

variety of agencies including county and city fire agencies, villages, military bases, colleges, and hospital-based EMS

• Protective operations– Dignitary protection


FIGURE 19.13Types of Dignitary Protection


Organization of Protective Details

• The purpose of the protective detail is to safeguard the protectee from harm and from situations likely to endanger his or her person or liberty

• Concentric ring of safety

• At each security perimeter, a check point should be established to ensure proper access


Organization of Protective Details (Cont.)

• Screening at the checkpoint can be as restrictive as requiring a person to:– Provide positive identification– Submit to a name check through police

records or a visitor list– Undergo a search by a walk‑through or

hand-held metal detector



• Security for the protectee in residence– Greatest opportunity to control the

environment

• The command post– EMS will be managed by a team in the

command post or residence that is a self‑contained room in the protectee's residence, which serves as the perimeter ring



• The safe haven– Another room in the residence within the

perimeter of security Provides temporary refuge to the protectee and

family when additional time is needed for police or security personnel to respond to the residence under attack


Figure 19.14Safe Haven Criteria


Direct Contact with the President or VIP

• President of the United States, in addition to traveling with a physician and a nurse, is afforded 24-hour EMS protection

• Vice president is generally provided EMS stand by only when in public places or when threat levels are high

• EMS may be asked to provide any variety of protective arrangements


Direct Contact with the President or VIP (Cont.)

• Secret Service advance team – Will do everything possible to ensure that

local community concerns are addressed– Response routes, availability of resources,

impact of motorcades on traffic can all be identified

– EMS must remember to pay strict attention to the orders of the Secret Service to ensure their own personal safety


General Dignitary Protection

• Keys to successful involvement– Communicate with the Secret Service to let

them know your goals early– Never sacrifice your level of service to the

community– Make sure your personnel are well-briefed

and know the rules– When the protectee is near, it is “all

business”


EMS Special Teams

• Helicopter teams

• Medical support in hazmat operations


USAR and Technical Rescue

• There are nine classifications of technical-rescue incidents according to the National Fire Protection Association – Water rescue– Rope rescue – Rescue from confined spaces – Wilderness search and rescue – Trench rescue


USAR and Technical Rescue (Cont.)

– Vehicle and machinery rescue – Dive search and rescue – Collapse rescue – Any other rescue operations requiring

specialized training

• It is important to establish interagency cooperation and train with technical- rescue teams before an incident



• Minimum qualifications require rescuers to be certified at the BLS level and have rescue-awareness training

• All personnel at the site must operate under an incident-management system


FEMA Rescue Resources

(Reprinted with permission of City of Vernon Fire Department.)



Summary

• EMS is constantly being challenged to provide services in environments as part of a special-operations team

• The all-hazards approach to emergency services is now creating an expectation that EMS can deliver services to patients during events that require technical rescue, hazardous materials response, and law-enforcement scenarios


Summary (Cont.)

• More specialty teams will be needed in the future, and as it becomes necessary to regionalize these resources, EMS managers will be required to design and implement services within these units and establish procedures for interfacing with special operations


Summary (Cont.)

• Today’s EMS leadership must have some knowledge of EMS special operations

• Planning is the key to success in special events; the better the plan, the less chance for problems

Documents

EMS Special Operations