Disaster Management/Emergency Preparedness in Maine Matthew Sholl, - - PDF document

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Disaster Management/Emergency Preparedness in Maine

Matthew Sholl, MD, MPH Brian S. Dougher, M.S. Marc Minkler, NREMTP

Expectations/Objectives

• What are the types of disasters most likely in the state of Maine?
• What emergency preparedness activities that are on going in the

state?

• What is the “All Hazards” approach to disaster preparedness?
• What are the various roles – between local, state, and federal

responders?

• What is the Emergency Medical Services for Children’s grant Maine

recently received and how does it play a role in emergency preparedness?

What is a Disaster?

Massachusetts-1 Disaster Medical Assistance Team, Response to New York City, September 2001

US Army Base Ft. Devens, Massachusetts, 1918

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Risk = Probability (Likelihood) x Severity (Magnitude – Mitigation)

Known Risk? Historical Data Timeframe – Within 5 years Future Scientific Projections (including impact of climate change) Human Impact Property Impact Business Impact Preparedness Internal Response External Response

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Opioid Epidemic Chronic ED Overcrowding Chronic Shortage Mental Health Beds Existing Communicable Disease Outbreak River or Street Flooding (Regional) Coastal Flooding Food Supply Contamination Large Scale Mold Contamination (Building) Large Scale Cyber Attack (power systems or business systems) Electrical Failure of Regional Infrastructure including plants and or delivery failure (grayout) Water Supply Disruption Windstorm/Microb urst (Multiple sites across Region) Wild Fire (>100 acres and smoke across Region) Ice Storm (Regional) Emergent Disease Industrial Plant explosion/fire Blizzard (Regional) Severe Thunderstorm Temperature Extremes Coldwave Cellular Network Failure (partial or full) Explosion Tornado (Regional several landings) Snow Fall (Regional) Temperature Extremes Heatwave Pandemic Flu Water supply contamination Mass Casualty Hazmat Incident ( > 20 victims) Large Scale Chemical Inhalations Mass Casualty Incident (trauma) Large Scale Chemical Exposure Tidal Wave/Tsunami Cable Network Failure Pharmaceutic al + or Medical Supply shortage Mass Evacuations (whole Facility) Nuclear Power Plant Leak (NH) Drought Heating Fuels/Oil/Pro pane/Natural Gas Hurricane (Cat 3-4 regional) Earthquake (3-5 causing some structural … Catastrophic systems Failure (EMP/Suns… Blister Agent Ricin Groundwater Contaminatio n Terrorism, Nuclear Legionella Sewer Failure Mass Shooting Event Dam Inundation (single Dam) Intentional Food Contaminati

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Nerve Agent Mass Casualty Incident (medical/in… Regional Bomb Threat Radiologic al Dispersal Device Pneumoni c Plague Smallpox Tularemia Vectorbor ne Disease Large Scale Urban Fires VIP Situation Populati

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Displace ment-… Intention al Water Contami nation Airports (blocking service,

• r

… Telecomu nications Failure … Transporta tion Fuels/Ga… Aerosoliz ed Anthrax Agroterrori sm Botulism Highways and roads (blockin… Food Shortage/ Perishab… Climate Change and … Medical Gas … Radio syste… Civil Disturba nce Marine Ports/…

SMRRC 2018 Regional HVA

Opioid Epidemic, 89% Chronic ED Overcrowding, 89% Chronic Shortage Mental Health Beds, 89% Existing Communicab le Disease Outbreak, 61% River or Street Flooding (Regional), 56% Coastal Flooding, 56% Food Supply Contaminati

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Large Scale Mold Contaminati

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(Building), … Large Scale Cyber Attack (power systems … Electrical Failure of Regional Infrastructu… Water Supply Disruption, 48% Windstorm/M icroburst (Multiple sites across … Wild Fire (>100 acres and smoke … Ice Storm (Regional), 41% Emergent Disease, 41% Industrial Plant explosion/f ire, 41% Blizzard (Regional), 39% Severe Thunderstor m, 39% Temperatur e Extremes Coldwave, 39% Cellular Network Failure (partial … Explosion, 37% Tornado (Regional several landing… Snow Fall (Regional) , 33% Temperat ure Extremes Heatwav… Pandemic Flu, 33% Water supply contamina tion, 33% Mass Casualty Hazmat Incide… Large Scale Chemical Inhalatio… Mass Casualty Incident (traum…

SMRRC 2018 HVA - Events > 30% Risk

Opioid Epidemic Chronic ED Overcrowding Chronic Shortage Mental Health … Existing Communicable Disease … River or Street Flooding (Regional) Coastal Flooding Food Supply Contamination Large Scale Mold Contamination … Large Scale Cyber Attack (power … Electrical Failure of Regional … Water Supply Disruption Windstorm/Microburst (Multiple … Wild Fire (>100 acres and smoke … Ice Storm (Regional) Emergent Disease Industrial Plant explosion/fire Blizzard (Regional) Severe Thunderstorm Temperature Extremes Coldwave Cellular Network Failure (partial or … Explosion Tornado (Regional several landings) Snow Fall (Regional) Temperature Extremes Heatwave Pandemic Flu Water supply contamination Mass Casualty Hazmat Incident … Large Scale Chemical Inhalations Mass Casualty Incident (trauma) Large Scale Chemical Exposure Tidal Wave/Tsunami Cable Network Failure Pharmaceutical + or Medical … Mass Evacuations (whole Facility) Nuclear Power Plant Leak (NH) Drought Heating Fuels/Oil/Propane/Natural … Hurricane (Cat 3-4 regional) Earthquake (3-5 causing some … Catastrophic systems Failure … Blister Agent Ricin Groundwater Contamination Terrorism, Nuclear Legionella Sewer Failure Mass Shooting Event Dam Inundation (single Dam) Intentional Food Contamination Nerve Agent Mass Casualty Incident … Regional Bomb Threat Radiological Dispersal Device Pneumonic Plague Smallpox Tularemia Vectorborne Disease Large Scale Urban Fires VIP Situation Population Displacement-Mass … Intentional Water Contamination Airports (blocking service, or injury … Telecomunications Failure … Transportation … Aerosolized Anthrax Agroterrorism Botulism Highways and roads (blocking … Food Shortage/Perishable issues … Climate Change and disruption … Medical Gas Shortage Radio systems failure Civil Disturbance Marine Ports/Ferry Services failure 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

SMRRC 2018 Regional HVA

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SMRRC 2018 HVA with > 30% Risk

United State Border Patrol, Search Trauma and Rescue Team Response to Hurricane Harvey, Houston, TX, Fall 2017

Themes and Characteristics of Disaster Response/Emergency Preparedness

Common Themes

• Incident Command System/HICS
• Principles of Triage
• Management of Surge on the

Health Care System

• Phases of Disaster Response
• The Federal Response to Disasters

– the National Response Framework

• Resiliency in Disaster Response

“Unique” Themes

• Decontamination/PPE and Levels of

Personal Protection

• Toxidrome Recognition and

Management

• Management of Radiation

Emergencies

• Management Priorities to Victims
• f Active Shooting and Blast

Events/Pre-Hospital Control of Massive Hemorrhage

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History of the Incident Command System

• 1970’s – AZ & CA wildfire response
• Local, State and Federal responders noted several issues:
• Lack of common organization
• Poor on-scene and inter-agency communications
• Inadequate joint planning
• Lack of valid and timely “intelligence”
• Inadequate resource management
• Limited prediction capability
• All agencies joined under the FIRESCOPE program and created the

Incident Command System (ICS)

What is the ICS?

• ICS is a management system
• Utilizes management concepts and therefore:
• Improves effectiveness, accountability, and communication
• Provides a common organizational structure and language
• Allows multiple agencies (including local, state, federal) to work effectively

during the response efforts

General Principles of the Incident Command System

• Chain of Command
• Orderly line of authority within the ranks of the organization
• Every responder has a designated superior
• Span of Control
• No one supervisor as too many subordinates
• Range is generally 3 – 7 personnel to one supervisor
• Important where safety and accountability have top priority

Single Command vs. Unified Command

Primary Structure of the Basic ICS

Incident Command System and Hospitals

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Learning More…

• Federal Emergency Management Agency On-Line Courses

https://training.fema.gov/emiweb/is/icsresource/trainingmaterials.htm

• IS 100 Introduction to ICS
• IS 200 ICS for Initial Action Incidents
• IS 700 National Incident Management System
• IS 800 National Response Framework

Triage - Background

• Past experience suggests that of initial survivors of MOST disasters 80% will

be NON-CRITICAL while 20% will be CRITICAL

• Need to identify those most critical patients and prioritize their care first

ALSO

• In any disaster – there exists the possibility for the NEEDS of the event to
• utstretch the RESOURCES AVAILABLE.
• Once this occurs – focus shifts from care for the individual to care for the

population

• Also known as Disaster Standards of Care
• How to offer the greatest good for the greatest number?
• May need to ration resources

Triage Systems

SALT Triage System

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United States Border Patrol, Search Trauma and Rescue Team, Response to Hurricane Irma, Florida, Fall 2017

Maine-Based Resources: MEMA Task Force 1 and the Maine CDC

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Federal Emergency Support Function #8

• Core Capabilities Include:
• Public Information and Warning
• Critical Transportation
• Environmental Response/Health and Safety
• Fatality Management Services
• Mass Care Services
• Logistics and Supply Chain Management
• Public Health, Healthcare and Emergency

Medical Services

ESF 8 - Direct Medical Care

• National Disaster Medical System
• DHHS Lead
• DHS/DOD/DVA support
• Three Major Components

1. Emergency Medical Response – including personnel, equipment and supplies 2. Movement of ill or injured patients from a disaster site to area unaffected by the disaster 3. Definitive care of patients at hospitals in an area NOT affected by the disaster

• Deployable Teams – Disaster Medical Assistance

Teams, Disaster Mortuary Operational Response Teams, National Veterinary Response Teams, etc.

Thank You