Preparing your Team for Rough Seas: The Management of Hurricane Juan'

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Preparing your Team for Rough SeasThe
Management of Hurricane Juan.

• Michael McKeage BA ACP
• Vice President Operations
• Emergency Medical Care Inc.

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Nova Scotia An Overview

• Total landmass is 52, 840 km2, with approximately
  25,000 km of paved highways.
• Population is approximately 973,000
• 105,000 requests for ambulance transport, 95,000
  responses, 85,000 transports per year via ground
  ambulance
• We receive, co-ordinate and flight follow 900
  Aeromedical missions per year
• We initiate Medical First Response by Fire
  Departments 18,000 times per year

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Welcome to Canadas EHS Hot Lab

• Traditional funding 19??- 1993
• Royal Commission 1989
• Developing crii 1994
• New Deal P.U.M.ped 1995
• Consolidation
  1997
• New System
  2000
• New Accountability 2000-

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Chronology of Sentinel Events1996-1997

• Education program for 600 practitioners designed
  and delivered.
• Fleet designed and replaced.
• Central Communications designed, built and
  implemented.
• Provincial Medical Control Guidelines
  implemented.
• Air Program implemented.
• MFR Program Released to 317 fire departments.

5
Select Learning Experiences in Nova Scotia since
1997.

• Back Street Boys ..140
• Swissair Flight 111229
• Sunrise Manor fire.200
• Cornwallis Cadets..150
• Kosovo Refugees2,500
• Scotia Nursing Home...75
• Kingswood Fires.....1,800
• Aberdeen Bomb Scare..85
• Juan

• Stewiacke Derailment.150
• 9/11 Sleep over.5,000
• August 10 Forest Fires
• Russian Ship Mutiny.
• SARS
• Anthrax
• 4 Bus accident..40
• Oxford flooding....30
• White Juan

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Swissair Flight 111Incident Profile September
1998

• Event Characteristics
• No plan, or liaisons.
• Long time to find crash site.
• Remote easily controlled location.
• Simple disaster.
• No patients.
• Response period lasted four weeks.

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Swissair Flight 111Lesson Learned

• We were not ready.
• The first ten minutes set the tone.
• What can I do for you?
• Leave your ego at the door.
• All hands to the pumps.
• Infiltrate Command Posts
• Need the gear.
• Rocks are cold and wet, you need a home.
• Closure and thank yous are key for CIS.
• Lock the Communication Center door.

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Kosovo RefugeeIncident Profile May 1999

• Operation Parasol.
• Purpose to reduce stress on camps in Macedonia.
• Planned MCI every 2 Days.
• 5 Ambulances, 10 Triage Medics per flight,
• and Command staff.
• 2,387 required triage in 16 days.
• 94 treated.
• 150 Provincial staff trained and deployed.

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Kosovo RefugeeLessons Learned

• Size matters.
• Central coordination works.
• Incident Command System is the way to go.
• New triage system required.
• Ready your second watch.
• Learned need for accountabilitie.
• Flexibility is the norm.
• People are people.
• Thank your Creator for being Canadian.

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Stewiacke DerailmentIncident Profile April 12,
2001

• VIA Rail Passenger train leaves tracks in the
  town of Stewiacke.125 staff and passengers on
  board.
• First Key stroke 142527
• On scene 144037
• Code Yellow 151600
• First Patient Departs 152936
• Code Red 152000
• Last Patient Departs 172220
• 100 Triaged, 22 transported
• 21 staff 12 units 1 helicopter

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Stewiacke DerailmentLessons Learned

• Radio and cell systems can be easily overwhelmed
• Autopsying success is key.
• Dealing with daily business is essential
• Dont count on the pros 75 of VIA crew were
  injured and unable to assist responders.
• Incident Command Post is essential.
• Scene identification is needed for EHS Managers.

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Russian Mutiny

• A Case Study in First Principles of Incident
  Command.

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9-11 Sleep Over September 11-16, 2001 Incident
Profile

• Attack on World Trade Center grounded all
  aircraft worldwide.
• 47 aircraft diverted to Halifax International.
• No alert from airport.
• (intelligence from the Whitehouse was accurate.)
• 12 Patients transported ,5,000 assessed.
• Deployed to evacuation centers
• Established non-traditional support roles.

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9-11 Sleep OverLessons Learned

• The field leads not the EOC
• Be ready to fill the untraditional support role
  while the giant awakens.
• Relationships still the KEY TO SUCCESS
• Pre-planning of Volunteer roles and
  responsibilities is key for success.
• Need to establish airport reflex
• Television is a double edge sword.

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SARS a whole new world of nasty.March 2002 - ?

• February 11th
• BC identifies mystery illness in China
• March 5th
• First Toronto SARS death
• March 7th
• EMC becomes aware begins daily monitoring

• March 28th
• EMC hosts first national teleconference /
  telephone screening begins.
• March 30th
• EHS approves briefing of MFR agencies.
• April 3
• MFR SARS packs distributed

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SARS Lesson Learned

• Many EMS and Public Health agencies are
  disconnected. .
• Do your own homework.
• Deal with the the most experienced directly.
• Think outside the box, to protect your patients
  staff
• The Hospital Curb is a very dangerous place.
• Effective infiltration skills are essential.

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Hurricane JuanSeptember 2003

• Thursday 2100 SAT Notification of
  tropical depression.
• Friday 1400 Provincial OPS
  Briefing 1
• Saturday 0700 FEMA Lit search.
• 1000 FEMA called
• 1230 Preparation list sent out

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JuanThe Game Plan

• What is the likelihood of being hit?
• (What do the pros know?)
• How much time is available to prepare?
• What needs to be done?
• Who needs to be involved?

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Key Communications Decisions Before Juan

• We had a plan.
• We were watching and communicating.
• We chose trigger points.
• Teleconferences.
• Pre-game Liaisons
• FEMA
• Hospitals
• EMO

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Key Communication Decision During Juan

• Hourly ,standardized, teleconferences.
• ESC SITREPS Hourly.
• Group pages as required.
• Florida SLAM experience introduced.
• Delivering the bad news a judgment call.

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The SLAM

• Supervisors trapped under wires.
• House blown away.
• Back-up center lost
• 911- overwhelmed
• Building collapses 200 occupants no details.
• Johns Death.
• Tanker car in Harbour
• Ship sinking in Harbour
• Home oxygen supply running out.

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Managing the SLAM

• Understand what a SLAM feels like.
• The FOG of Disaster is real and constant.
• Know when you are experiencing a SLAM and it will
  pass.
• SLAMS can not be managed until they pass.
• Management starts with what makes sense and
  protects.
• Write everything down.
• Explain all of the above to your staff when
  SLAMS are predicted.

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Juan Lessons Learned

• Communicate, communicate communicate early and
  often.
• Escalate preparations hourly.
• John Wayne didnt have a family.
• Need for Volunteer organization MOUs.
• Need to listen to the pros re go, no go.
• Home care services must plan ahead.
• Need trained ECO staff.
• No power, no coffee, SAT team cranky!

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Lessons to bring.In Nova Scotian Dialect.

• Rest, eat your veggies, go to church
• Whats your fathers name?
• Oh for Gods sake come on in the tea is on!
• So what should we do when the arse goes out of
  her !
• Stay where youre at and Ill come where your to!
• How are ya now?
• Be ready, Me Son, the glass is falling quickly.

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Questions?

• Michael J. McKeage BA , ACP
• Vice President of Operations
• Emergency Medical Care Inc.
• 239 Brownlow Avenue, Suite 300
• Dartmouth, Nova Scotia
• B3B 2B2
• 1-902-832-8347
• mmckeage_at_emci.ns.ca