review of medical operations in ics

REVIEW OF

MEDICAL OPERATIONS

IN ICS

August 7, 2015

Purpose

To provide medical professionals with an efficient

Incident Command System response of notification,

transportation and advanced life support resources

during the most prevalent challenges of a Multi-

Casualty Incident.

Accreditation

Texas EMS: BorderRAC is recognized as a Texas

Department of State Health Services provider of continuing

education (Course Number 101792). This activity is

recognized through BorderRAC as an ongoing Continuing

Education Program as qualifying for continuing education in

the Clinically Related Operations category. It is the

individual’s responsibility to retain documentation of

attendance and claim only those hours actually attended.

New Mexico EMS: Reviewed and approved by the New

Mexico EMS Bureau for continuing education qualifying for

continuing education in the Clinically Related Operations

category.. (Approval Number 217167).

Please set your cell phone, pager/beeper to silent or vibrate at all times

while in the conference. Any and all phone calls should be taken outside of

the conference rooms. Thank you.

On-Line Evaluation Survey

Upon completion of the on-line survey and verification of

attendance by signature on the sign-in sheet, a continuing

education certificate will be sent via e-mail.

You will receive an a-mail with the web link to complete

the on-line evaluation survey.

https://www.surveymonkey.com/r/2015ICSMCI

The on-line evaluation survey will be closed on

08/21/2015.

https://www.surveymonkey.com/r/2015ICSMCI

Medical Operations

Tabletop Simulation of On-Scene

Coordination and Structure

____________________

Friday, August 14, 2015

08:00 to 13:00

Register Today!!

BorderRAC Mission Statement

To provide the leadership

necessary to sustain high

quality, professional services

required of an inclusive

trauma and emergency

healthcare system.

REVIEW OF

MEDICAL OPERATIONS

IN ICS

August 7, 2015

Common Problems with

Disasters

Too few resources

Lack of or difficulties with communication

Lack of control

Poor resource management

Organizations working independently rather than one cohesive organization

Common Problems with

Disasters

No life threat stabilization

Poor triage

Transport issues

Not enough resources to transport all patients

Moving the “scene” to just one facility

Self-Dispatching

Why?

National EMS curriculum

Objectives

“Given a simulated table top MCI , with 5 10 patients, conduct a

scene survey.”

“Scene safety/BSI/# of patients/MOI/Resources”

Taught on white board

Did you sweat and feel challenged?

Do You Feel Prepared To

Respond To This

Do You Feel Prepared To Respond To

This

Medical ICS at Disasters

Incident Commander

Operations

Medical Branch

TreatmentTriage Transport

Medical ICS at DisastersMedical Branch

Director

Triage Officer Treatment Officer Transport Officer

Medical

Logistics /

Staging Officer

DispatchHospitals

Medical Group

Supervisor

RMOC

Medical ICS at Disasters

Medical Branch

Director


Medical

Logistics /

Staging Officer

DispatchHospitals

Medical Group

Supervisor

RMOC

Medical Branch Director• Key part of a unified command

• Command and control over all patient care

activities and all EMS operations

Medical Branch Director• Coordinates the medical needs with

operations and conducts this strategic

position for the duration of the incident.

• No hands-on tactical operations or patient care

• Go to person for EMS resources for triage,

treatment and transport


Director


Medical

Logistics /

Staging Officer

DispatchHospitals

Medical Group

Supervisor

RMOC

Medical Group Supervisor

• Remain in contact with the medical branch

director for the duration of the incident

• Directs EMS operations at the incident site,

managing situational issues and resources

Medical Group Supervisor

• Tactical aspects of triage, treatment and

transport divisions report to this level

• Coordinates closer to the activity at the

incident while the medical branch director is

in closer proximity to the incident commander

at the command post for quick intervention at

a command level


Director

Triage

OfficerTreatment Officer Transport Officer

Medical

Logistics /

Staging Officer

DispatchHospitals

Medical Group

Supervisor

RMOC

Triage Group Leader

• Determines the location of triage areas.

• Utilizes an approved triage system.

Triage Group Leader

• Communicates resource requirements to

the medical group supervisor, who ensures

resources through the medical branch

director.

Triage Exercise


Director


Medical

Logistics /

Staging

Officer

DispatchHospitals

Medical Group

Supervisor

RMOC

Medical Logistics / Staging

Leader

• Designate the location

to collect available

resources near the

incident area (more

than one may be

necessary)

• Select a location that is

easy for arriving

resources to locate


Director

Triage Officer

Treatment

OfficerTransport Officer

Medical

Logistics /

Staging Officer

DispatchHospitals

Medical Group

Supervisor

RMOC

Treatment Group Leader

• Determines treatment location and coordinates

efforts with the triage group to move patients

from the triage division to the treatment division

• Maintains communications with the medical

group supervisor

Treatment Group Leader

• Reassesses patients and conducts secondary

triage to match patients with resources in

relationship to transportation groups and

divisions


Director

Triage Officer Treatment Officer

Transport

Officer

Medical

Logistics /

Staging Officer

DispatchHospitals

Medical Group

Supervisor

RMOC

Transport Group Leader

• Manages patient movement and accountability

from the scene to receiving hospitals, or

alternative care sites, in disasters where the

infrastructure has been incapacitated


• Works with the treatment group to establish

adequately sized, easily identifiable patient-

loading areas; designates an ambulance staging

division


• Maintains record of patients from incident site

to assigned destination

• Maintains communication with the medical

group supervisor for situation briefings and

resource allocation

Case StudyApril 15, 2013 14:49

What went right?

What went wrong?

Time Line

14:49 – First bomb detonates

14:53 – Hospitals receive notification of MCI

14:55 – Boston EMS requests mutual aid

14:57 – Most hospitals have activated their EOC’s

14:58 – First ambulance leaves scene

15:22 – Boston EOC operational

15:37 – Last critical patient transported

20:50 – Last patient transported

Regional Health and

Medical Operations

Center

Regional Health and Medical

Operations CenterA coordination, communication and information center allowing for the immediate determination of available healthcare resources at the time of a disaster.

Integrates acute healthcare and public health concerns and provides consensus-driven advice and input to the Health District, DSHS and the EOC.

Coordinates acute health care issues for the hospitals, EMS, public health, and other healthcare entities.


Operations Center

The RHMOC consists of multiple aspects of health and

medical expertise and utilizes a multi-disciplinary approach to

problem solving, hazard mitigation, and decision making.

Using a “team approach” the RHMOC is managed using a

Unified Command Structure.

Management and control are based out of necessity and

efficiency concerns rather than from any formal or informal

rank structure.

The RHMOC must be ready for 24 hour a day operations and

requires routine maintenance.

Operational Status

Level Operational Status

Green All RHMOC functions and staff are fully operational and able to

undertake sustained operations with minimal notice.

Yello

w

Some RHMOC functions not yet operational or RHMOC has limited

capability or capacity to operate for an extended period or RHMOC

will require more than 2 hours to become operational

Oran

ge

RHMOC has significant operational deficits or does not have the

capacity or capability to operate for more than a day; RHMOC will

require more than 24 hours to become operational

Red RHMOC not operational. Unable to conduct emergency operations.


Operations Center

Branches can be

functional or geographic.

Established when the

number of divisions or

groups exceed the span of

control.

Initial Notification and

Information Sharing

Incidents that clearly indicate the need for notification include large scale, sudden onset incidents, and requests from the Texas Department of State Health Services. Examples of these are: tornado, wild fire explosions, terrorist attacks, and transportation crashes. Notification is made, even if limited information is available.

Incidents that do not clearly indicate the need for notification will be evaluated prior to notification. Examples include: limited chemical spills and weather advisory. Clarifying information will sought; however, the HCC maintains a low threshold for recognizing anomalies as incidents. Early recognition has critical implications for the remaining states of incident response.

Incident Operations and

Activation ActivitiesInformation processing

Situational reports on the operating status of individual ESF-8 entities, including but not limited to surge levels, patient tracking, and resource needs.

Dissemination of pertinent information to the ESF-8 entities such as IAP, specific public health information, epidemiological data, treatment protocols, updates, advisories, and transportation disruption.

Resource support

Facilitating mutual aid by notifying the Coalition member organization when assistance is needed or anticipated by one or several Coalition members.

Facilitating outside assistance by coordination of these requests through the respective jurisdictional authorities (Tier 3).

Facilitating the placement of patients to promote the via a medically sound priority scheme.

Facilitating resource support from Coalition organizations to jurisdictional authorities

Facilitate a coordinated response among healthcare organizations

Incident RecognitionActivation of a healthcare organization (Tier 1)

Any situation becomes an incident when it requires a healthcare organization to activate their EOP. Almost any declared incident (and subsequent EOP activation) for a coalition member is, by default, an incident for the Coalition.

If it is determined that ESF-8 entities can handle the incident independently, there is no need to activate the RHMOC.

Activation of a Healthcare Coalition/RHMOC (Tier 2)

If it is determined that the incident and resources needs are beyond the capacity of individual ESF-8 entities, the RHMOC procedures will be enacted.

Activation of a nearby Healthcare Coalition

Activation of one Coalition may signal the need for partial activation by less directly impacted Coalitions. This will enable neighboring coalitions to maintain situational awareness for its HCOs and anticipate requests for assistance.

Standard Operating Procedures

Regional standard operating procedures achieve uniformity

across the coalition member organization and clearly define

processes for how the Coalition might support within context of

a hazard or incident specific annex:

Medical Surge Management

Patient Evacuation

Communications

Continuity of Operations

Fatality Management

Resource Support

Patient Tracking

Public Information

Examples of RHMOC actions

Katrina 2005

Placement of patients from the DAAG to nursing homes

Managed operation of on-site medical services in convention center to include:

Coordination of medical and dental services, optometry visits and pediatric clinic

Facilitated the establishment of on-site pharmacy at convention center

Coordination of office visits for evacuees

Floods 2006

Coordinated medical area in shelter at the convention center

Coordinated replacement of shelteree prescriptions

Examples of RHMOC actions

Freeze of 2010

Coordinated rolling black out procedures with utility companies for hospitals

Negotiated clearance for one laundry service to be allowed to process hospital linen

Prepared plans for the evacuation of nursing homes and assisted living facilities should heat not be restored. This included planning for shelters and hospital placement of specific patients.

Coordinated with DME companies to contact 100% of home ventilator patients

SMC Evacuation 2012

Deployed AmBus

Obtained hospital capability and provided such to SMC Operations Chief

Communicated situational awareness and transfer information to other hospitals

Patient Tracking

Thank You

review of medical operations in ics

Documents