MedSTAR Emergency Medical Retrieval Multi-Casualty Air Medical Capability in Asia Pacific Region Dr Jane Cocks Clinical Director, MedSTAR Kids MedSTAR

MedSTAR Emergency Medical Retrieval

Multi-Casualty Air Medical Capability in Asia Pacific Region

Dr Jane CocksClinical Director, MedSTAR KidsMedSTAR Emergency Medical Retrieval ServiceAdelaide, South Australia

ANZCA-HKCA Combined Scientific Meeting 2011Hong Kong May 14-17th 2011


Overview

> Multi versus Mass Casualty Events• Definitions• Issues

> Mass Casualty Management• Needs• Current Capability• Recent Disasters and responses• Issues

> Future Directions


Definitions

> Multi-Casualty• More than one victim• Numbers that can be managed by the

resources of the local region

> Mass Casualty• Large number of casualties• Produced in a relatively short period of time• Exceeds the capabilities of the local region


Asia Pacific Region


The Problem?






The Problem?

> Natural and Man-made events• Increasing frequency and victims

> Multiple victims• Alive (variable acuity) and dead• Health and Governmental Personnel

> Infrastructure decimated• Access, Power, Sanitation, Water, Space• Duration of disaster

> Lots of Willing Helpers• Politics, cultures, religions, language,

expectations

> Coordination of response• Local and External agencies


Changing Global Expectation

> Media coverage and the Global Village• ‘Do Something’

> Foreseeable events?> International disaster assistance is now

considered a humanitarian obligation> Relief claimed as a Right not a Charity> No longer an ‘ad hoc’ response> Political agendas> Military fears


What is required?

> Access to help• Rapid <24hours post event• Later and ongoing assistance

> Medical assistance• Advanced and wide range of skills• On scene and locally• Mobile – patients and staff• Destination – local victims vs travellers

> Infrastructure support and rebuilding> Central control and coordination> Clear communication


What can we do now?Levels of response

> Advance assessment teams> Urban search and rescue> Medical Assistance

• Critical care medical assistance• Acute care medical assistance• Subacute medical assistance• Management local victims• Evacuation and repatriation

> Humanitarian aid• Financial, infrastructure, supplies


What can we do now?Urban Search And Rescue (USAR)

> 11 countries in Asia Pacific Region registered with the International Search and Rescue Advisory Group (INSARAG)• Australia; China; Finland; Japan; Kazakhstan;

Korea; Malaysia; Saudi Arabia; Singapore; Slovenia; Tajikistan

> Medical components• Team and initial evacuation of victims

> Self sufficient for 10 days> Coordination and Communication

• United Nations Office for the Coordination of Humanitarian Affairs, Field Coordination Support Section (UN OCHA (FCSS)


What can we do now?Medical Assistance Teams> Military

• MedEvac, CCAT

> Government Civilian response• AUSMAT (Australian Medical Assistance

Team); DMAT (NZ); JDR (Japan)

> Non-Government Civilian response (NGO)• Red Cross, WHO, Private insurance companies

• Self tasking; personal agendas

> Coordination and Communication• Specific requests for assistance

• United Nations Disaster Relief Organisation (UNDRO)


Air Medical Capabilities

> Regional vs International

> Rotary Wing vs Fixed Wing

> Civilian vs Military


Rotary Wing

Military Rotary Wing

Fixed Wing

LearJet

Military Medium

Transport

Military Heavy

Transport

Speed (kph)

230 300 450 775 625 800

Range (km)

760 800 3300 4815 5100 4500

Alt (ft) 10,000 20,000 30,000 45,000 30,000 45,000

Stretcher Patients

2 12 2 1 76 90

Example Bell 412 NH90 Pilatus PC12

36A C130 Hercules

Boeing C17 Globmaster


Rotary Wing

BK 117


Black Hawk

MedSTAR Emergency Medical RetrievalBlack Hawk


NH90

MedSTAR Emergency Medical RetrievalNH90


Fixed Wing

Pilatus PC12

MedSTAR Emergency Medical RetrievalPilatus PC12


C130J Hercules

MedSTAR Emergency Medical RetrievalC130J Hercules


C17 Globemaster

MedSTAR Emergency Medical RetrievalC17 Globemaster

MedSTAR Emergency Medical RetrievalC17 Globemaster


Transport to the Airfield?


Recent Disasters and the Air Medical Responses> Bali Bombings – 12th October 2002

• 202 dead (including 88 Australians and 38 Indonesian), 240 wounded

• Private agencies• ADF

> Indonesian tsunami – 26th December 2004• 230,000+ dead, 125,000+ injured• USAR 11 countries (Australia, Singapore, US), AUSMAT

response

> Samoa tsunami – 29th September 2009• 170 dead, 140 injured• Australian AUSMAT and USAR• NZ response

> Pakistan floods – July 2010• 1980 dead, 2950 injured• USAR (UK); AUSMAT


Recent Disasters and the Air Medical Responses> QLD floods – 10th January 2011

• 18 dead• Australia USAR

> Cyclone Yasi, Queensland, Australia – 2nd Feb 2011• 1 dead• 333 pt moved within 24 hours to Brisbane; Boeing C17 and

C130J Hercules, ADF medical response augmented by specialist medical reservists

> Christchurch earthquake – 22nd Feb 2011• 182 dead, 1500-2000 injured• Australia (USAR and AUSMAT), Japan (USAR), Taiwan

(USAR), Singapore (USAR), US (USAR), UK (Fire SAR), China

> Japan earthquake and tsunami – 13th March 2011• 28,000 dead, 2800 injured• USAR – US, China, South Korea, Australia, NZ


Japanese urban search and rescue team in Christchurch, 24 February 2011




Issues

> Political agendas> Fears of Military involvement> Central Coordination/Control> Rapid response> Multiple roles> Repatriation vs Local management> Equipment and Supplies > Training – teams and locally> Costs


What do we Need?

> Politically independent> Centrally coordinated and controlled> Clear communication systems nationally

and internationally> Self sufficient> Extended period of time> Immediate response capability> Ongoing assistance capability> Self funded


What do we Need?International Rescue?



"Do not pray for tasks equal to your powers but for powers equal to your tasks.“

Reverend Dr. John Flynn


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References

> Disaster Medical Assistance Teams: A Literature Review. Health Protection Group, Anton Breinl Centre for Public Health and Tropical Medicine, James Cook University. April 2006. www.health.wa.gov.au/hpg Cited 9th May 2011

> INSARAG – USAR Directory. http://vosocc.uncha.org/USAR_Directory Cited 6th May 2011

> Civil-Military Coordination during humanitarian health action. Global Health Cluster – Position Paper, Provisional Version February 2011. http://www.who.int/hac/global_health_cluster/about/policy_strategy/position_paper_civilmilitary_coordination/en/index.html. Cited 6th May 2011


Documents

MedSTAR Emergency Medical Retrieval Multi-Casualty Air Medical Capability in Asia Pacific Region Dr Jane Cocks Clinical Director, MedSTAR Kids MedSTAR