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EMERGENCY PREPAREDNESS

 

• 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)

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The Basics

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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.

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Federal Response Resources

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• U.S. Public Health Service/Office of Emergency Response; http://www.hhs.gov/emergency. 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); http://www.cdc.gov. Leading federal agency in developing and applying disease prevention and control. Advisory agency in bioterrorism response.

• National Disaster Medical System; http://ndms.dhhs.gov. 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.

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National Preparedness System

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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.

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Emergency Management

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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.

Purpose:

• 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

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Incident Command System Origins

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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.

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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.

 

Priorities:

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

 

Concern

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*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

 

D-disaster                      

I-incident command                

S-safety & security                

A-assess hazard           

S-support                      

T-triage & treatment              

E-evacuation                  

R-recovery

 

Response

       

• 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

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Bioterrorism- intentional use of pathogen or bacterial release

Intentional           

Natural

Anthrax                

SARS/COVID-19

Smallpox              

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

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Natural Disasters

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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

 

Recovery

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*” Golden 24 hours”

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

All federal, state, & local, government agencies

 

Explosions

                           

Blast

Primary, secondary, tertiary, & quandary quaternary

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3 factors   

1. Size of charge               

2. Distance from blast       

3. Air or water

Events

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Explosion solid or liquid

Exploded material into gas causing energy release

Low vs. high explosive

Size of blast

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Primary Blast Injuries            

• Blast lung                                 

• Middle ear damage                

• Abnormal hemorrhage           

• World rupture?

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Public Health/ Disaster Health

                  

 

Injuries

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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

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