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Disaster Preparation Training


no triage tags necessary. usually 1 pt/1rig. radio reports to hospitals as usual ... safety boots/shoes. safety glasses or chemical splash goggles ... – PowerPoint PPT presentation

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Title: Disaster Preparation Training

Disaster Preparation Training
  • Condell Medical Center EMS System
  • Continuing Education
  • June, July 2004
  • Site Code 107200E1204
  • Prepared by Sharon Hopkins, RN, BSN, EMT-P

  • Upon successful completion of this program, the
    EMS provider should be able to
  • Describe the local Multiple Victim and Mass
    Casualty Plan and understand how to activate the
    plan and describe their role in the plan
  • Actively participate in a table top exercise

Objectives continued
  • Describe the State Medical Disaster Plan and
    understand when the plan is activated and
    describe their role in the plan
  • Describe the National Incident Management System
    (NIMS) and their role in the plan
  • Describe the appropriate level of personal
    protective equipment (PPE) to be utilized at a
    variety of disaster incidents
  • Successfully complete the post-quiz (80)

Variety of Plans Developed for Disaster Response
  • Local Plan Multiple Victim and Mass Casualty
  • Support MABAS, Resource Hospital
  • State Plan State Medical Disaster Plan
  • Support Governor, IDPH, POD hospitals
  • National Plan National Incident Management
    System (NIMS)
  • Support Federal, state, tribal, local

  • Multiple Victim
  • and
  • Mass Casualty Plan

Purpose of Local Mass Casualty Plan
  • Enables fire/EMS agencies hospitals to respond
    effectively efficiently to multiple victim/mass
    casualty situations
  • Avoids overtaxing resources of any single agency
    or facility
  • Provides optimal patient care
  • Supplements individual plans

Two Components of Local Plan
  • 1st component - Multiple Victim Incident
  • OR
  • 2nd component - Mass Casualty Plan

Multiple Victim Incident Plan
  • Followed when
  • responding EMS personnel can control life threats
    with their usual resources AND
  • within 10-20 minutes adequate numbers of
    responders ambulances can be at the site AND
  • surrounding hospitals can be accessed in timely
    manner they can provide patient stabilization

Mass Casualty Plan
  • Followed when
  • number of patients nature of injuries make the
    normal level of stabilization care unachievable
  • number of EMS personnel ambulances brought to
    the site within primary secondary response
    times are not enough AND/OR
  • stabilization capabilities of hospitals within 25
    minutes not adequate to handle all patients

Practical Applications for Local Plans
  • Multiple Victim Incident
  • no triage tags necessary
  • usually 1 pt/1rig
  • radio reports to hospitals as usual
  • run reports completed as usual
  • Mass Casualty Plan
  • triage tags to be used on all patients
  • ambulances may transport more than 1 pt/rig
  • No radio reports to hospitals treat per SOPs
  • No run reports necessary

Important Notation
  • Regarding Multiple Victim Incidents
  • The first critically injured victims may be
    transported to the nearest appropriate level
    hospital(s) while SIMULTANEOUSLY communicating
    with the Resource Hospital.
  • The Resource Hospital will assist in directing
    remaining victims to other hospitals
  • Avoid overwhelming any one hospital with patients
    from the same scene

Activation of Local Plan
  • The multiple victim incident or mass casualty
    plan must be activated as soon as possible

  • It takes time to activate mobilize resources.
  • The sooner resources are activated therefore, the
    sooner they can be mobilized and arrive at the
    site where they can be utilized.
  • Mutual goal to do the most good for the most
    people while trying to preserve life.

General Fire Department Responsibilities
  • Recognize that the 1st responding unit functions
    as Command and must initiate the appropriate plan
    as well as start triage until relieved by
    personnel recruited to the scene
  • Communicating with the Resource Hospital EARLY
    allows the hospital to mobilize their disaster
    plan and prepare for patient arrival
  • Think potential! - need to direct care to
    positively affect the greatest number of victims
  • Responders will generally move from triage to
    treatment to transportation

MABAS Dispatch Responsibilities
  • Box alarms are toned out as requested by on-scene
    Incident Commander
  • Maintains communication with ambulances
    transporting patients to area-wide hospitals
  • Maintains communication with Incident Commander
    for providing additional resources
  • Strikes out box alarm when last ambulance has
    arrived at site no more are needed

Hospital Command
  • The hospital communication link is assumed by the
    Resource Hospital affiliated with the fire
    department presiding over the incident site
  • Functions as the medical control gatekeeper for
    the incident
  • Collaborates with scene personnel to identify
    receiving hospitals

Initial Communication from the Field to the
Resource Hospital to Include
  • nature of the incident
  • incident site
  • closest hospitals
  • estimated number of patients
  • estimated patient acuity (red, yellow, green,
  • general age groups
  • types of injuries/illness
  • any special needs
  • ETA of first victims from the scene
  • call back number for contact back at the site

Expect the Resource Hospital to communicate
back to Transportation/designee at the site
  • For a multiple victim incident specific victim
    colors will be assigned to specific receiving
    hospitals (ie 1 red 2 yellows to XYZ
    hospital) Resource hospital provides transport
  • Upon activation of the mass casualty plan EMS
    will receive information regarding receiving
    hospital capacities for accepting victims and
    Transportation at the site determines who goes

Receiving Hospitals
  • Communicate with the Resource Hospital regarding
    all disaster activity
  • Will not receive radio reports from the field for
    mass casualty events EMS operates on SOPs
    during mass casualty events
  • Does not stop the flow of ambulances not
    associated with the disaster activity

Incident Management System Organization
Incident Commander
  • Communications

MCI Communications
  • Incident Command

Resource Hospital
Mutual Aid Departments
Receiving Hospitals
Mass Casualty Medical Sectors
  • Triage Officer
  • Treatment Officer
  • Transportation Officer

Triage Officer
  • Provides coordination necessary for effective
    categorization/sorting of patients
  • Supervises triage personnel
  • All patients are to be quickly tagged
  • Triage Officer oversees movement of patients from
    Triage into the Treatment area

Definition of Triage
  • To sort victims based on the severity of their
  • Goal To do the best for the most
  • Triage is interrupted only for airway problems
    /or severe bleeding airway must be opened with
    simple maneuvers and bleeding compressible or
    triage staff must move on

Triage Categories
  • Red survivable life threatening injuries needs
    immediate treatment transport
  • Yellow serious injuries that should not
    deteriorate if treatment transport are delayed
  • Green minor injuries, non-life threatening can
    hold treatment transportation
  • Black mortally injured or dead

Examples of Category Red
  • depressed level of consciousness
  • respiratory distress
  • facial burns with potential airway compromise
  • chest injuries - ie flail chest, pneumothorax
  • penetrating injuries to neck, chest, or abdomen
  • shock
  • uncontrollable bleeding

Examples of Yellow Category
  • uncomplicated, non-compromising burns
  • spinal cord/back injuries
  • major, open, or multiple fractures
  • stable abdominal injuries
  • eye injuries

Examples of Green Category
  • soft tissue wounds
  • lacerations
  • sprains, strains, fractures
  • formerly referred to as the walking wounded -
    was confusing because some green patients may not
    be able to walk but are still appropriately
    categorized as green

Examples of Black Category
  • victims in cardiac arrest
  • respiratory arrest not easily reversible with
    basic intervention (ie opening airway)
  • major bleeding not easily controllable with minor
    intervention (ie compression)
  • mortally injured patients (ie brain matter
    protruding from head injury)

Treatment Officer
  • Establishes treatment zone with personnel
  • Establishes areas that are clearly identified as
    red, yellow, green treatment areas and a
    separated area for morgue (black)
  • Prioritizes patients for transport to hospital
    (red goes first)
  • Maintains adequate levels of staff to allow for
    frequent reassessment of patients while awaiting

Transportation Officer
  • Establishes patient loading area to coordinate
    access egress of ambulances
  • Coordinates activity with Treatment Officer
  • Communicates with Resource Hospital
  • number of patients and triage categories
  • receiving hospital capabilities
  • Communicates with ambulance personnel
  • specific hospital destination
  • supplies maps from the scene to hospitals

Additional Important Roles
  • Safety Officer - monitors all scene
  • activities identifies hazardous
  • situations
  • Staging - assures orderly parking, sends
  • requested resources to the site
  • Supply Officer - obtains and distributes
  • needed supplies

Regarding Mass Casualty Events
  • Its been said that the success of running a mass
    casualty event is dependent on how the first few
    minutes are handled.
  • Handling the first few minutes of a disaster
    event is in the hands of the blue shirt - the
    staff members who are the first responding unit
    to most scenes.

  • State Medical
  • Disaster
  • Plan

State Medical Disaster Plan
  • Addresses preparedness, response recovery to an
    emergency medical situation within the State of
  • Goal of plan - provide assistance to allow EMS
    personnel health care facilities to work
    collaboratively where local resources are

Activation of State Disaster Plan
  • A local government official (mayor, county
    commissioner,etc) notifies Governor
  • Governor notifies Chief of Division of EMS
    Highway Safety to ?activate Phase I or Phase II
    of the Disaster Plan ?determine resources needed
    and ? request assistance from appropriate POD
    hospital (ie Highland Park Hospital for this

POD Hospital Role in State Plan
  • Lead hospital in a specific region (ie Region X
    POD is HPH)
  • Coordinates disaster medical response
  • Primary point of contact for communication
    coordination of disaster response with hospitals
    in their region
  • Would make the hospital contacts to deploy
    personnel to the disaster site

Hospital Communication in State Disaster Plan
  • POD hospital notifies Resource Hospitals to
    notify their respective Associate Participating
  • Associate participating hospitals complete
    required information worksheets worksheets
    forwarded to Resource Hospital, which then
    forwards the information to the POD hospital
  • POD hospital forwards information to IDPH

MABAS Role in State Plan
  • Recognized as a mechanism to mobilize mass
    resources in a swift coordinated manner
  • Once notified by IDPH/EMS, will facilitate
    requests for response from MABAS divisions
  • Will avoid significantly depleting any single
    MABAS division or geographic area

  • National
  • Response Plan
  • by
  • Homeland Security

National Response Plan (NRP) set up by Homeland
  • Purpose
  • ensure that all levels of government have
    capability to work efficiently effectively
  • uses a national approach to domestic incident
  • provides the core plan for prevention,
    preparedness, response, recovery mitigation
  • designed to the protect nation

Activation of the NRP
  • Governor is the States chief executive
  • Responsible for coordination of State and local
  • requests Federal assistance when States
  • capabilities have been exceeded or exhausted

National Incident Management System (NIMS)
  • What is it?
  • the Nations first standardized management
    approach to unify Federal, state, and local lines
    of government for incident response
  • developed for a homeland security incident (ie
    acts of terrorism, natural disasters, other
  • uses standardized processes, protocols,
    procedures for all responders
  • enhances national preparedness readiness in
    responding to recovering from an incident

Top Priorities for Incident Management at all
  • Save lives, protect health safety of responders
    the public
  • Ensure security of the homeland
  • Protect restore critical infrastructure
  • Mitigate damages impacts to individuals,
    communities, the environment

Components of NIMS
  • Five functional areas incorporated under the
    incident command system (ICS)
  • command
  • operations
  • planning
  • logistics
  • finance/administration

Responder Readiness Enhancement
  • Advanced preparedness measures to enhance
    response includes
  • planning
  • training
  • exercises
  • qualification certification
  • equipment acquisition certification
  • enforcement of building standards codes
  • preventive measures to lessen loss of life or

Communication Enhancement
  • proposes standardized communications for incident
    information management
  • proposes a common operating picture for a more
    efficient and effective incident response

Joint Information System (JIS)
  • enhancement of public communication efforts
  • provides public with timely accurate incident
    information unified public messages
  • ensures that the same information is released to
    the public from all involved parties during an

NIMS Integration Center (NIC)
  • to provide strategic direction oversight of
  • to assess proposed changes to NIMS
  • capture evaluate lessons learned
  • employ best practices
  • use collaborative process of variety of
    authorities to assess prospective changes
    assure continuity accuracy

NIC will also
  • develop facilitate national standards for NIMS
    education training
  • first responder communications equipment
  • typing of resources
  • qualification credentialing of incident
    management responder personnel
  • standardization of equipment maintenance

  • Specialized
  • Personal
  • Protective
  • Equipment

OSHA Standards
  • OSHA charged with responsibility to set standards
    for adequate protection of chemical protective
    clothing to the wearer at corresponding danger
  • Training required for donning equipment,
    equipment removal, user monitoring training,
    decontamination procedures

EPA Levels of Protection
  • Level A
  • chemicals identified have high hazard level to
    respiratory system, skin, eyes. Operations
    conducted in confined or poorly ventilated areas
  • protection necessary - highest available for
    respiratory, skin, eyes from solid, liquid
    gaseous chemicals

Level A
  • Equipment necessary
  • vapor protective suit
  • pressure-demand, full-face SCBA
  • Inner chemical resistant gloves,
    chemical-resistant safety boots, two-way radio

  • Level B
  • chemicals identified do not require a high level
    of skin protection. Primary hazards associated
    with entry into site are from liquid and not
    vapor contact.
  • Protection necessary - some level of respiratory
    protection as Level A but less skin protection.
    Liquid splash protection but no protection
    against chemical vapors or gases

Level B
  • Equipment necessary
  • liquid splash-protective suit
  • pressure-demand, full-facepiece SCBA
  • inner chemical-resistant gloves
  • chemical resistant safety boots
  • two-way radio communications
  • hard hat

  • Level C
  • contact with site chemicals will not affect skin.
    Air contaminants have been identified and
    concentrations measured. A canister is available
    to remove contaminant. The site and its hazard
    have been completely characterized.
  • Protection necessary - same level of skin
    protection as Level B, but a lower level of
    respiratory protection. Liquid splash protection
    but no protection to chemical vapors or gases

Level C
  • Equipment necessary
  • support function protective garment
  • full-facepiece, air-purifying canister-equipped
  • chemical resistant gloves and safety boots
  • two-way communications system
  • hard hat
  • Not acceptable for chemical emergency response

  • Level D
  • atmosphere contains no known hazards
  • work function precludes splashes, immersion,
    potential for inhalation, or direct contact with
    hazard chemicals
  • Protection necessary - no respiratory protection
    needed, minimal skin protection

Level D
  • Equipment
  • coveralls
  • safety boots/shoes
  • safety glasses or chemical splash goggles
  • Not acceptable for chemical emergency response

  • Table-top
  • exercises
  • geared to your
  • department and community

Directions for the Exercises
  • You may adapt the exercises to fit your community
    - act as if the call came in today
  • Start with the usual 2-3 man crew response to the
  • The group in attendance should be involved in
    working through your departments response based
    on your resources and additional resources that
    may need to be mobilized

Exercise 1
  • You have been dispatched for a motor vehicle
    incident at a major intersection in your town.
  • Upon your arrival, you have 2 vehicles involved
    with a total of 10 patients (divided between red
    and yellow categories)
  • Whats your plan of action?

Exercise 2
  • You are called to the scene of a truck versus
    train incident. You have 5 victims (red, yellow
    and green injuries)
  • The truck was carrying hazardous materials
  • What is your plan of action?

Exercise 3
  • A tornado has gone through a neighborhood in your
    response area
  • There is significant damage to homes and
    businesses in a 1 mile stretch (you pick the
    location in your town)
  • What is your plan of action?

  • MABAS Division I, III, IV Region X Multiple
    Victim and Mass Casualty Plan, revised April 2004
  • NIMS Fact Sheet, Department of Homeland Security
  • www.lakeland.com/standard.html
  • www.osha.gov/dts/osta/otm/otm_viii/otm_
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