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  • Federal Emergency Management Agency (FEMA) -Incident command in public health disasters

  • Department of Homeland Security

  • Center for Disease Control (CDC)

  • State governor - Authority to declare health emergency; requests federal assistance, responsible for public safety

  • State health department - Authorized by the governor to cordinate disaster response

  • State emergency management association - State level equivalent of FEMA

  • Police, Fire, & EMS services

  • Hazardous materials - HAZMAT teams

  • Emergency Management Institute - Certification organization

  • Michigan Department of Public Health

  • Region 2 south (Medical Bio-Defense Network)

  • Core Disaster Life Support (CDLS)

  • Basic Disaster Life Support (BDLS)

  • Advance Disaster Life Support (ADLS)

The Basics

In response to the attacks on September 11, 2001, the President of the United States issued the following Homeland Security Presidential Directives (HSPDs):

  • HSPD - 5 identified ​steps for improved coordination in response to incidents, it requires the Department of Homeland Security (DHS) to coordinate with other federal departments, agencies, State, local, and tribal governments to establish a National Response Framework (NRF) and a National Incident Management Response system (NIMS). 

  • HSPD - 8 directed DHS to lead a national initative to develop a National Prepareness System; a common, unified approached to "strenghten the preparedness of the United States to "strenghten the preparedness of the United States to prevent and respond to threatened or actual domestic terrorist attacks, major disasters, and other emergencies.

Federal Response Resources

  • U.S. Public Health Service/Office of Emergency Response; An office within DHHS. Management and coordnitation of both federal health and medical services related to preparation, response, and recovery from major emergencies or presidentially declared disasters.

  • Centers for Disease Control and Prevention (CDC); Leading federal agency in developing and applying disease prevention and control. Advisory agency in bioterrorism response.

  • National Disaster Medical System; Asset sharing program between DHHS, Federal Emergency Agency, U.S. Department of Defense, U.S. Department of Veterans Affairs, and public/private organizations-developed to provide surge capacity for natural disasters, wartime military casualties, and large-scale bioterrorism event.

  • Federal Bureau of Investigation (FBI) - Lead federal agency for crisis management. Has authority to conduct law enforcement investigations into acts of terrorism.

National Preparedness System

The National Preparedness System is an intergrated set of guidance, programs, and processes that enables the nation to achieve the National Preparedness goals. National Preparedness core capabilities include; prevention, protection, mitigation, response & recovery that requires planning, resulting in community based resilience. The benefits include; it guarantees continued survival, it sets recovery priorities, it encourages better communication, it helps control insurance premiums, and increase business value.

Emergency Management

Emergency management is an organization responsible the management of resources for dealing with all the humanitarian aspects of emergencies (preparedness, response, mitigation, and recovery). The expressed purpose is to reduce the harmful effects of all hazards, including disasters.


*Disaster- a disaster is present when need exceeds resources.

*Mass Casualty Incident (MCI)- when health care needs exceed resources.


  • Improved Communication

  • Improved early warning systems

  • Improved tracking systems

  • Hazardous Material Training

  • Asses “All-Hazard” emergency preparedness

  • Chemical Biological Radiological Nuclear and Explosive emergency preparedness

Incident Command System Origins

The Incident Command System (ICS) was developed in the 1970's following a series of catastrophic fires in California. Property damage ran into the millions, and many people died or were injured. Results of the case stuides showed the need for a system that would improve response times. ICS can be used to manage any type of incident, including a planned event (e.g., a training conference, charity fundraising event, ect.). The use of ICS can be applied to all hazards, including: 

  1. Natural Hazards - Disasters, such as fires, tornadoes, floods, ice storms, earthquakes, foodborne illnesses, or epidemics.

  2. Technological Hazards - Dam breaks, radiological or hazmat releases, power failures, or medical device defects.

  3. Human-caused Hazards - Criminal or terrorist acts, school violence, or other civil disturbances.

The ICS is a standardized approach to incident management that:

  • Enables a coordinated response among various jurisdictions and agencies.

  • Establishes common processes for planning and managing resources.

  • Allows for the integration of facilities, equipment, personnel, proceedures, and communications operating within a common organizational structure.



*Incident Commander/ Number of casualties/ Operations/ Scene Priorities/ *Protect yourself/ Personal protection equipment.



*As a result of 9/11, the way we see the world has forever changed

  • Weapons of mass destruction

  • Man-made hazardous materials/ natural disaster

  • Terrorism

  • Chemical Biological Warfare

  • Problems with communication failure



I-incident command                

S-safety & security                

A-assess hazard           


T-triage & treatment              






  • MASS Triage (move, access, sort, send)

  • IMED (immediate, delayed, minimal, expectant, delayed)

  • Normal response vs. abnormal responses

  • First Aid Families/reactions of children

  • Common Stress Disorders

  • Safe evacuation 72-hour post exposure infections


Biological Events

Bioterrorism- intentional use of pathogen or bacterial release






West Nile

Overt (known) Release 

Covert (unknown) Release    

Notice of release                     

No notice of threat                          

Contain a threat                      

Difficult to detect

Create panic or fear                         

Early symptoms may not be detectable

Credible threat/ or a hoax              

Astute clinician may make diagnosis

White powder hoaxes             

Notify health department

Natural Disasters

All Hazards Approach


Natural & Unintentional disasters

  • Earthquakes                           a) Structural collapse of building

  • Volcanic eruptions                   b) Industrial catastrophes

  • Tornados                               c) Transportation mishaps

  • Hurricanes                             d) Electrical disruptions

  • Floods                                   e) Bacterial/ bio-hazardous materials

  • Wildfires                                f) Explosions, fires, hazardous material release



*” Golden 24 hours”

*3-7 days following a natural disaster acute injury are controlled.

All federal, state, & local, government agencies





Primary, secondary, tertiary, & quandary quaternary

3 factors   

  1. Size of charge               

  2. Distance from blast       

  3. Air or water


Explosion solid or liquid

Exploded material into gas causing energy release

Low vs. high explosive

Size of blast

Primary Blast Injuries            

  • Blast lung                                 

  • Middle ear damage                

  • Abnormal hemorrhage           

  • World rupture?

Public Health/ Disaster Health




Conventional blunt & penetrating trauma, blast injuries, burns, and crushing injuries.

  • Traumatic asphyxia

  • Vascular obstruction

  • Multi-facial hemorrhage

  • Pneumothorax

  • Traumatic emphysema           

  • Systemic air embolism                     

  • Traumatic rhabdomyolysis

  • Release intracellular toxins

*In crush injuries; decompression is often immediate & the use of (PPV) positive pressure ventilation after endotracheal intubation is necessary.

Heart Healthy Eating

Are You Ready For a Change?

Defeat your greatest fears and acheive your greatest goals in 2021. Start with a healthy eating meal plan that will help you gain strenght, lose weight, and even live longer!

Choose a meal plan>

Heart Healthy Meal Plans

Deciding to eat a plant-based diet which excludes or limits animal-based foods requires only a small shift in how you view food. Building your meal plan around plants dosen't mean that plants has to be the only thing on your plate but simply considering plants as the base for your meal planning. For example; instead of having a T-bone steak and potatoes for dinner then having a side salad, make a big salad with mixed greens, one cup of protein rich chickpeas, with two onces of steak strips on top. You will still get the 30 grams of protein you'll need to build muscle while using the animal protein as a condiment and not as the main course. Ultimately, a well-done plant-based diet is one that includes lots of plant foods but dosen't entirely exclude animal protien that in important in muscle building and weight loss. 

According to the American Heart Association, healthy food habits can help you reduce three risk factors for heart attack or stroke as a result of high blood cholesterol, high blood pressure and excess body weight. 

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