DR Mohd Zin Bidin CMO Malaysian GP

DISASTER MANAGEMENT IN F1 RACING By : DR MOHD ZIN BIDIN Chief Medical Officer Petronas Malaysian Grand Prix Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Introduction Disaster can occur anytime, anywhere without warning. The more you are prepared, the better you will be. When disaster occurs, our emergency response plan will determine the extent of injuries and damages sustained. Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Questions to ask How well prepared are we when disasters occur? What procedures do we have in place? Who activates the Emergency Response Plan? What potential emergency situations can occur? Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit AIM To describe a system for response to a mass casualty incident as a result of disaster in F1 Racing. Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Scope Definitions. Disaster -Causes -Declaration -Initiating a response Mass Casualty Incident Management Plan. The Triage System. Issues and Challenges. Dr. Mohd Zin Bidin CMO Sepang International Circuit

Dr. Mohd Zin Bidin CMO Sepang International Circuit DEFINITIONS Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Definition Disaster – “An extreme disruption of the functioning of a society that causes widespread human, material, or environmental losses that exceed the ability of the affected society to cope using only its own recourses”. Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Definition Mass Casualty Incidents (MCI) An event that results in a number of victims large enough to disrupt the normal course of emergency and health care services. Dr. Mohd Zin Bidin CMO Sepang International Circuit

Dr. Mohd Zin Bidin CMO Sepang International Circuit Definition of Triage 1. A process for sorting injured people into groups based on their need for or likely benefit from immediate medical treatment. Triage is used in hospital emergency rooms, on battlefields, and at disaster sites when limited medical resources must be allocated. 2. A system used to allocate a scarce commodity, such as food, only to those capable of deriving the greatest benefit from it. 3. A process in which things are ranked in terms of importance or priority. The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. Dr. Mohd Zin Bidin CMO Sepang International Circuit

DISASTER -Causes -Declaration -Initiating a response Dr. Mohd Zin Bidin CMO Sepang International Circuit

Possible Causes of Disaster in F1 Race cars flying onto spectators. Building collapse. Air crash during air shows. Bomb threat / explosions. Fire. Hazardous materials incidents. Civil disobedience / Riots. Terrorist incidents. Stampede. Dr. Mohd Zin Bidin CMO Sepang International Circuit

Declaration of Disaster / Mass Casualty Incident FIA / FOM and host country officials to assess severity of incidence. Levels of implementation: Alert – notification of incident Stand –by Full activation and deployment Stand-down Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Initiating a Response Recognize when an emergency response must be initiated. Notify officials, employees, spectators ,etc. Make sure a single individual is in charge as Incident Commander. Follow immediate emergency procedures. Establish an Emergency Command Post on site. Dr. Mohd Zin Bidin CMO Sepang International Circuit

Dr. Mohd Zin Bidin CMO Sepang International Circuit MCI MANAGEMENT PLAN Dr. Mohd Zin Bidin CMO Sepang International Circuit

Goals of MCI Management Doing the greatest good for the greatest number. Managing scarce recourses effectively. N/B Do not relocate the disaster – do not move the incidence to the hospital unless it is able to receive the types and numbers of patients. Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit MCI Levels Level 1 (Local) - EMS personnel able to deal with the MCI effectively. Level 2 (Regional) – Requires assistance and mutual aids from surrounding communities. Level 3 (National) – Of such a magnitude that local and regional assets are overwhelmed. National or International assistance is required. Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Medical Command Post Established at the Track or Public Medical Centre. CMO or DCMO becomes the Medical Incident Commander. Unified command system. Control, direct, coordinate. Dr. Mohd Zin Bidin CMO Sepang International Circuit 18

CMO Sepang International Circuit MCI Organization 1.Emergency Operation Center. Incident commander Chief operation officer Chief planning officer Chief logistic officer –medical supply and transport 2. Emergency Response Team (First team on site). Onsite commander Search and rescue personnel Triage officers Treatment officers Transport officers Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit MCI Medical Set Up Medical Command Post Effective Transportation for medical evacuation Effective communication facilities Onsite medical facilities Continuous Medical supply Extrications facilities and expertise Efficient Triage System Dr. Mohd Zin Bidin CMO Sepang International Circuit

Incident Scene Assessment Establish safety of the scene. Obtain briefing from Scene Commander Assess extent of damage ,number and types of casualties. Assess logistic requirements - Food, water, comm and tpt. Establish a command center. Identify onsite management areas. Working areas Collection points Medical posts N/B. First action need not be medical. Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit First EMS Provider Establish Medical Command Post Directs triage of all patients Assign tasks and responsibilities Assign resources to get key functions running Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Zoning System Red Zone Yellow Zone Green Zone Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Zone System Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Red Zone Incident site. Search and rescue teams. Fire, police, emergency services or those with certain expertise. Recommended distance (> 100m) Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Yellow Zone Mobile crisis centre Posts for the search and rescue teams and other supporting teams Recommended distance (>200m) Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Green Zone Media. Relatives waiting area. Counseling post. Food and refreshment. Mortuary and other voluntary agency. Recommended distance (>300m). Dr. Mohd Zin Bidin CMO Sepang International Circuit

Incident Management System List of ambulances who will respond. Contact hospitals. Hospitals should implement MCI plan. Identify ambulance who will cover regular emergency calls. All responders should report to IC first. Duties and responsibilities of staff Dr. Mohd Zin Bidin CMO Sepang International Circuit

Positioning Arriving Vehicles IC directs to appropriate sector. Report to sector officer. First ambulance on scene can be the Mobile Command Centre Designate with a flag or device Once task is completed report back to sector officer. Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Patient Tagging High Priority (1) = Red Second Priority (2) = Yellow Low Priority (3) = Green Priority 0 = Grey or Black Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Priority Levels Priority 1 Airway and breathing difficulties. Uncontrolled or severe bleeding. Decreased mental status. Severe medical problems. Poisoning, diabetic, cardiac Severe burns Shock (hypo perfusion) Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Priority Levels Priority 2 Burn without airway problems. Major or multiple bone or joint injuries. Back injuries with or without spinal cord injuries. Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Priority Levels Priority 3 Minor Burns or joint injuries. Minor soft tissue injuries. Obviously dead. Cardiac arrest lowest priority If EMS has enough personnel-highest priority. Dr. Mohd Zin Bidin CMO Sepang International Circuit

Dr. Mohd Zin Bidin CMO Sepang International Circuit THE TRIAGE SYSTEM Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Triage “To sort” Separates those requiring immediate care Rapid and simple life-saving intervention Reduces burden on capabilities Provides rational casualty distribution Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Goals of triage Assess the patient’s condition. Determine the urgency. Transport to appropriate hospital. Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Ideal Triage System Easy to perform Requires no advance skill No specific diagnosis Rapid and simple life-saving intervention Easily taught and learnt Dr. Mohd Zin Bidin CMO Sepang International Circuit

Doing the Greatest Good Greatest good for the greatest number Intensive care in shortest possible time at site Salvage the most number of patients possible Do not try heroic resuscitation Concentrate on those we can treat DO NOT RELOCATE THE DISASTER Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Managing a Triage Initial Assessment Airway open? If not, open manually. If patient responds move to next casualty. If patient is unresponsive, check breathing and pulse. Check bleeding, if severe, apply pressure. Then move to next patient. Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Managing a Triage Begin where you stand Move those that can walk away from site (green tag) – the walking wounded Not breathing? Open and maintain airway (Red tag) No radial pulse ? Perform CPR (red tag) Can stand a delay in treatment and transport (Yellow tag) Deceased or unresponsive with no circulation (Black tag) Dr. Mohd Zin Bidin CMO Sepang International Circuit

Dr. Mohd Zin Bidin CMO Sepang International Circuit ISSUES AND CHALLENGES Dr. Mohd Zin Bidin CMO Sepang International Circuit

CMO Sepang International Circuit Issues and Challenges No top management commitment Poor or no planning in Emergency Response Plan. Lack of coordination among agencies. Chaos in communication. Lack of training and practice Problem of selection of designated leaders. Procedures for shutting down critical functions and equipment. Accesibility to disaster areas Shortage of materials and logistics Crowd control VIP visitors Dr. Mohd Zin Bidin CMO Sepang International Circuit

Dr. Mohd Zin Bidin CMO Sepang International Circuit THANK YOU Dr. Mohd Zin Bidin CMO Sepang International Circuit