2 Catastrophic Incident Response Community Emergency OperationsEMSHospitalsHighImpactIncidentLawEnforcementFirePublicAdministrationPublic WorksCitizenVolunteersPublic Health
3 Catastrophic Incidents TIME (min)1530456090>120Self-evacuee’s% bypasspublic safety“Upside down triage”Bystanders transport 80% ofcasualties (11% of admits)EMS transports 20% ofcasualties (88% of admits)EMSApprox. 20%of causalitiesPublicSafetyArrivalSource: Davis, 2004
4 Catastrophic Incidents TIME (min)1530456090>120Self-evacuee’s% bypasspublic safety“Upside down triage”Bystanders transport 80% ofcasualties (11% of admits)EMS transports 20% ofcasualties (88% of admits)EMSApprox. 20%of causalitiesPublicSafetyArrivalGOAL - Protect The HospitalsSource: Davis, 2004
5 Psychological vs. Medical “Footprint” The size of the psychological “footprint” greatly exceeds medical “footprint”psychological“footprint”> 4:1medical“footprint”“Not all victims should beevaluated in theemergency department”!
6 Statewide Catastrophic Health Incident Response Plan (CHIRP) “Chance favors the prepared mind.”Louis Pasteur
7 CHIRP Scope A catastrophic incident may result from: natural events (hurricanes, floods, etc.)large-scale accidents such as a plane crashmanmade/terrorism eventsSize of incident is not the determining factor, capacity and capability to respond is most important factor
8 CHIRP Provisions Provides for: Incident response strategy Preparedness, prevention, response, recoveryRoles and responsibilitiesCoordination of regional responseAlternate Care SitesExpansion of medical care capacity and capability
9 Statewide CHIRP All hazards plan utilizing principles from; National Response Framework (NRF)National Incident Management System (NIMS)National Preparedness Guidance (NPG)Incorporate plans and resource from regional:Law enforcement, emergency management, EMS, fire/rescue, hospitals, and public health
10 Catastrophic Incident Response Plans reside at the regional level Statewide CHIRPConcept of operationsDevelop, exercise and maintain regional catastrophic response plans which support local plans, and draw on regional, state, and federal assetsCatastrophic Incident Response Plansreside at the regional level
12 Operational Goals Provide chain of command Attend to all victims Minimize injury/illness, damage/loss of property & recordsProvide maximum safetyIntegrate with community emergency plansMaintain and restore normal servicesProvide supportive actionAll operational goals are built into the Emergency Operations Plan (EOP)
13 Statewide and Federal Assets Concept of OperationsStatewide and Federal AssetsCoordinatesRegionalCatastrophic Incident Response PlansEnhancesLocal/CountyCommunicationsRisk/Public InformationSpecial Needs PopulationsVolunteer CredentialingPatient TrackingAlternate Treatment SitesTraining/ExercisesLocal/CountyEmergencyResponse Plans
14 Concept of Operations Statewide Regional Local Ambulance Response Plan HospitalResponsePlanPublicHealthResponsePlanBehavioralHealthResponsePlanMassFatalityResponsePlanRegionalCatastrophic Incident Response Plans& Multi-Agency Coordinating TeamsLocalCommunicationsRisk/Public InformationSpecial Needs PopulationsVolunteer CredentialingPatient TrackingAlternate Treatment SitesTraining/ExercisesLocal EmergencyResponse Plans
15 Planning Targets Rural Areas Smaller Urban Areas Major Urban Areas Minimum 100 total casualties per incidentSmaller Urban AreasMinimum 250 total casualties per incidentMajor Urban Areas500 casualties per million population
16 Planning AssumptionsCHIRP will knit together existing plans, not replace them.Agency Mass Casualty PlansFire Departments and EMS AgenciesHospitalsLaw Enforcement AgenciesField Operations Guide (FOG)Medical Examiner Disaster PlansMMRS Regional MCI Plans
17 Assumptions Triage / Treatment Standards Basic Principles of Disaster Medicine must applyLevel of care will be less than day to day medicine as we know itStandardsWill see and care for larger patient / staff ratios
18 Regional Catastrophic Health Incident Response Plan Components Prehospital (MCI) Response PlanAlternate Medical Treatment Site PlanHospital Response PlanMass Fatality Plan (FEMORS)Lab Surge Capacity PlanHealthcare Professional Surge Capacity PlanDisaster Behavioral Health Plan
19 Injury Severity Of those surviving: 10 percent immediate deaths 20 percent emergent (severe multi-system injuries)30 percent urgent (able to defer definitive treatment once stabilized)50 percent mild or moderate (the “walking wounded’)1234
20 Practical OptionsExpand viaMobile facilities-expand in place or deploy to incident siteConvert existing buildings to temporary hospitalsUse of shuttered hospitals [closed, obsolete,mothballed, bankrupt, etc.]Add beds to existing facilitiesBuild temporary facilitiesDevelop protocols addressing emergency standard of care procedures
21 Alternative Care Sites Plan Region 5 Domestic Security TaskforceCentral Florida MMRSCentral Florida UASI
22 Funding Sources State Homeland Security Grants (DHS) Centers for Disease Control Grants (CDC)DHHS – ASPR Grants (ASPR)Urban Area Security Initiative Grants (UASI)Metropolitan Medical Response System Grants(MMRS)
44 Federal Health and Medical Response Natural DisastersTransportation DisastersTerrorismTechnological Disasters
45 National Disaster Medical Systems (NDMS) A “federal asset” who’s major components are:Medical ResponsePatient Evacuation.Definitive Medical Care
46 National Disaster Medical Systems (NDMS) Purpose A Nationwide Medical Response System to:Supplement state and local medical resources during disasters or major emergencies to deliver definitive medical care to victims of a disasterProvide backup medical support to the DOD/VA medical care systems during an overseas conventional conflict.
47 National Disaster Medical Systems (NDMS) Managed by a VA or DOD Federal Coordinator (FCC).Can be activated by State (caution when doing this).Brings those like assets which mirror the state: DMATS, DMORT, and NVAT.Funded by HHS.Participating civilian hospitals are reimbursed.
48 Disaster Medical Assistance Teams (DMATs) A “federal AMTS”Designed to deliver medical care to victims of - and responders to - a domestic disasterCo-located with existing facility or stand alone
49 PartnershipsThe NDMS is an interagency partnership between the Department of Health and Human Services (HHS), the Department of Defense (DoD), Department of Homeland Security (HS) and the Department of Veteran’s Affairs (VA).
50 Importance of NDMS Improves Federal Mission Readiness Ability to Mobilize and Deploy MedicalTeams, Supplies, and EquipmentAbility to Provide Patient EvacuationSystemAbility to Provide Definitive Medical CareAdds Value to America