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Chapter 51Chapter 51
Disaster Response
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National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
EMS Operations
Knowledge of operational roles and responsibilities to ensure patient, public, and personnel safety.
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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.
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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
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IntroductionIntroduction
• Disaster management requires: − Preparedness
− Planning training
− Response
− After-action review
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Disaster Response Planning Disaster Response Planning
• EMS agencies should have plans suited to:− Geography
− Population
− Potential risks specific to the area
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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
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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
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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.
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Before the EventBefore the Event
• Geography of response area− Area prone to a
particular type of disaster?
− Obstacles and terrain features that affect response?
© Gina Jacobs/ShutterStock, Inc.
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Before the EventBefore the Event
• Population− Spread out, dense, or mixed?
− Same in daytime as nighttime?
− Language or culture differences?
− Facilities that may present hazards?
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Before the EventBefore the Event
• EMS resources− Items needed may include:
• Additional staff or personnel
• Specialized staff
• Medical supplies
• Equipment to handle tasks
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Before the EventBefore the Event
• 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.
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Before the EventBefore the Event
• Access to business assets− What expertise is
available from the private sector?
• Nongovernmental organizations and disaster relief agencies− May arrange
training or planning sessions
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Before the EventBefore the Event
• Fire and police response− Disaster response
plan will outline fire and police response.
− Have drills for unified command system
© Larry St. Pierre/ShutterStock, Inc.
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Before the EventBefore the Event
• 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.
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Before the EventBefore the Event
• 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.
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Before the EventBefore the Event
• 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.
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Before the EventBefore the Event
• Immunizations of personnel− Keep up to date.
− Be familiar with agency’s plan.
• Sheltering− Food
− Water
− Bath facilities
© Reuters/Mike Blake/Landov.
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Before the EventBefore the Event
• Animal control− Address animals that must be left behind.
− Have precautions to manage carcasses.
− Have plans concerning zoos, wildlife refuges, or veterinarian facilities.
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During the EventDuring the Event
• Best to stick to a plan. − Modification may
be required.
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During the EventDuring the Event
• 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.
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During the EventDuring the Event
• 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.
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During the EventDuring the Event
• 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.
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During the EventDuring the Event
• Triage and classification− May be disaster
dependent
− Constant and ongoing
© Roger Nomer/AP Photos
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During the EventDuring the Event
• 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
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During the EventDuring the Event
• 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
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During the EventDuring the Event
• Personnel physical needs− Eat, drink, use of
bathroom facilities
− In long-lasting incidents, sleep areas are required.
© AP Photo/Ross D. Franklin.
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During the EventDuring the Event
• 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.
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During the EventDuring the Event
• 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.
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During the EventDuring the Event
• Media− Members of your
agency may be trained to respond to the press.
− Use press to your advantage.
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During the EventDuring the Event
• 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.
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After the EventAfter the Event
• There are specific measures to take after an event.
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After the EventAfter the 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.
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After the EventAfter the Event
• Inventory− Needed after resupply and repair
• Stress reaction review− Consider critical stress management teams.
− Note changes in behavior.
− Report concerns immediately.
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After the EventAfter the Event
• 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
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After the EventAfter the Event
• 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.
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After the EventAfter the Event
• Acknowledgment− Good performance should be praised.
− Praise often, immediately, and honestly.
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Forest and Brush FiresForest and Brush Fires
• Can be man-made or natural
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Forest and Brush FiresForest and Brush Fires
• 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.
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Forest and Brush FiresForest and Brush Fires
• PPE should include proper gear in addition to infection control gear.
• Follow directions of fire command.
• Expect cardiac events in fire fighters.
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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
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Snow and Ice StormsSnow and Ice Storms
• Clothing should be weather ready.
• Your agency may have snowmobiles, snow blowers, and plows.
• Take your time.
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Snow and Ice StormsSnow and Ice Storms
• Look for snow and ice slides before entering a structure.
• If your company is on standby, prepare portable warm-up shelters.
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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.
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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.
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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.
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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.
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HurricanesHurricanes
• 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.
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HurricanesHurricanes
• 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.
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TsunamisTsunamis
• Large waves that travel thousands of miles and hit at speeds of 250 to 600 mph or more
• Can come in a series
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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.
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EarthquakesEarthquakes
• There may be little or no warning.
• Can cause thousands of deaths and billions of dollars in damage within minutes
• Aftershocks occur regularly.
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EarthquakesEarthquakes
• 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.
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EarthquakesEarthquakes
• 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.
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EarthquakesEarthquakes
• 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
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Landslides, Avalanches, and Mudslides
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.
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Landslides, Avalanches, and Mudslides
Landslides, Avalanches, and Mudslides
• 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.
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Landslides, Avalanches, and Mudslides
Landslides, Avalanches, and Mudslides
• Equipment that may be planned for in advance includes:− Backhoes
− Earth movers
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Cave-InsCave-Ins
• Can be caused by:− Rapid freezing and
thawing
− Heavy rain
− Excess vibration
Cou
rtesy o
f Cecil V
. "Bud
dy" M
artin
ette
, Jr.
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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.
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Cave-InsCave-Ins
• There are three ways to secure the area of evacuation:− Sloping
− Benching
− Shoring
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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.
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Volcanic EruptionsVolcanic Eruptions
• Rescue workers may be affected by secondary problems.
• Identify buildings that are “volcano proof.” © David Falconer/AP Photos
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Volcanic EruptionsVolcanic Eruptions
• Panic may spread.
• Expected injuries include:− Burns
− Respiratory problems
− Crush trauma injuries
− Respiratory, eye, and skin problems
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Volcanic EruptionsVolcanic Eruptions
• 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.
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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
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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.
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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.
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Sandstorms and Dust StormsSandstorms and Dust Storms
• Respiratory protection should be worn.
• Driving is a challenge.
• Blowing sand may hide objects.
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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.
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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
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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
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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.”
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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.
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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.
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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.
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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.
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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
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Structural FiresStructural Fires
• Much higher death and injury rate than wildfires
• Let the fire fighters fight the fire.
© Sergey Toronto/ShutterStock, Inc.
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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.
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Construction Failures and Building Collapse
Construction Failures and Building Collapse
• As part of preplanning, check out new construction in your area.− Plan access and egress routes.
− Update plans frequently.
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Construction Failures and Building Collapse
Construction Failures and Building Collapse
• Consider what special PPE you might need:− Helmets
− Steel toe boots
− Eye protection
− Knee pads
− Heavy-duty gloves
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Construction Failures and Building Collapse
Construction Failures and Building Collapse
• 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.
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Construction Failures and Building Collapse
Construction Failures and Building Collapse
• 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.
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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.
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Power Failures or DisruptionsPower Failures or Disruptions
• Have battery-powered backup devices.
• Have an ample supply of batteries.
• Make a list of all patients who use electrically powered life-saving devices.
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Power Failures or DisruptionsPower Failures or Disruptions
• You will not be able to download electronic patient care reports.
• Cell phones and GPS may be out of service.
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Riots, Civil Disturbances, and Stampedes
Riots, Civil Disturbances, and Stampedes
• Plan and expect for the worst.
• Get as much information as possible about the scene.
© Jane Tyska/AP Photos
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Riots, Civil Disturbances, and Stampedes
Riots, Civil Disturbances, and Stampedes
• 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.
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Riots, Civil Disturbances, and Stampedes
Riots, Civil Disturbances, and Stampedes
• Police escort is crucial.
• Consider wearing body armor, a helmet, and an APR.
• Document everything thoroughly.
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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.
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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.
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Sniper, Shooter, and Hostage Situations
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.
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Sniper, Shooter, and Hostage Situations
Sniper, Shooter, and Hostage Situations
• 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.
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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.
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ExplosionsExplosions
• Ear injuries are common.− Speak loudly and face the patient.
• Air particles are probably contaminated.− Wear your APR during patient care.
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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.
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IT (Cyber) DisruptionsIT (Cyber) Disruptions
• Use of your system should be limited to your agency.
• Password protect systems.
• Appoint a cyber security officer.
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IT (Cyber) DisruptionsIT (Cyber) Disruptions
• If you recognize a cyber threat:− Immediately report it to your supervisor.
− Stop using the threatened browser or program.
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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.
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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.
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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.
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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.