INTRODUCTION TO
DISASTERS
Definitions,
Classification
and Response Structure
Daniel Kollek, MD, CCFP(EM)
Director, Centre for Excellence in Emergency Preparedness
Chair – CAEP Disaster Committee
Associate Professor, Division of Emergency Medicine,
McMaster University
Disaster
 The Merriam-Webster dictionary
definition of disaster is:
"a sudden or great misfortune."
 The Medical definition if a
disaster is:
"when the destructive effects of
an event overwhelm the ability of
a given area or community to meet
the demand for health care."
How have
health care systems
dealt with disaster
in the past?
September 11, 2001- NYC
September, 2002 - Jerusalem
2003-Toronto
What kind of
disasters
might we face
and how do we
assess our risk?
Natural disaster
Natural Events
 Hurricane/Tornado
 Severe Thunderstorm
 Snowfall
 Blizzard
 Ice Storm
 Earthquake
 Tidal wave
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Drought
Flood - external
Wild fire
Landslide
Volcano
Epidemic
Extreme temperature
Technological disaster
Technological events
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Electrical failure
Generator failure
•
Transportation failure •
Fuel Shortage
•
Natural gas failure
•
Water failure
•
Sewage failure
•
Steam failure
•
Structural damage
Fire alarm failure
Communications failure
Medical gas failure
Medical vacuum failure
Info. systems failure
Fire – internal
Flood – internal
Hazmat exposure –
internal
• Supply failure
Man-made disasters
Anthrax envelope - 2001
Human events
 MCI – Trauma
 MCI - Medical
 MCI – Hazmat
 Hazmat – external
 Terrorism – chemical
 Terrorism – biological
 Terrorism - radiological
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VIP situation
Infant abduction
Hostage situation
Civil disturbance
Labor action
Forensic admission
Bomb threat
For each event
you must assess risk
 What is the probability of occurrence?
 What impact would it have?
 What is your preparedness?
A formal risk assessment tool
is available at www.ceep.ca
What are the
characteristics
of disasters?
A disaster can have
multiple settings
A disaster often has
multiple patients
The Patients:
Tokyo Sarin attack 1995:
 >5800 victims
 12 deaths
 17 critical patients
 37 severe patients
 984 moderate patients
 4793 “worried well”
A disaster always has
multiple players
The Players:
 Police
 Elected officials
 Fire
 Civil servants
 EMS
 Utilities
 Hospitals
 Transit
 Volunteers
 Provincial / Federal
agencies
 Public health
 Media
A disaster can have
variable timelines
Static timeline
Dynamic timeline
Whatever the case,
and despite the range
of possible events,
disaster response has
more commonality
than event specific
characteristics.
What do you need in a disaster?
• Information
• Supplies
• Guidance
• Equipment
• Human Resources • Money
and……
A system to deliver
this to you in a useful
fashion
IMS is the system
IMS
Incident Management System
Incident Management System is
a method of coordinating parts of one
agency or many agencies in a
unified command structure to
use all available resources
in the effective and efficient response
to an emergency.
The Eight Components
of Incident Command Systems
IMS - Components
1. A unified command structure
2. Common terminology
3. Modular organization
4. Integrated communication
5. Consolidated action plans
6. Manageable and sensible span of control
7. Designated facilities
8. Comprehensive resource management
IMS Basic Structure
Incident Commander
Operations
Planning
Logistics
Finance
Incident
Commander
Incident Commander
Operations
Planning
Logistics
Most senior trained responder
2. As incident develops, falls back to
established command on-site
3. Eventually may fall to Senior Command off
site (Emergency Operations Centre)
1.
Finance
Incident Commander
Operations
1.
2.
3.
Operations
Planning
Logistics
Implements response activities as determined by
Incident Manager
Maintains communication between Command and
site
Requests and assigns resources as directed
Finance
Incident Commander
Logistics
Operations
Planning
Support Operations
2. Allocate resources and provide all
materials, equipment, and personnel
required
3. Application of additional resources
provided by Mutual Aid
1.
Logistics
Finance
Incident Commander
Planning
1.
2.
3.
4.
Operations
Planning
Control and flow of all information
Data collection, analysis and forecasting
Development of response and recovery
objectives and strategies
Mutual Aid Requests
Logistics
Finance
Finance
Incident Commander
Operations
Planning
 Tracking of expenses
 Funding
 Government Financial Aid requests
 Financial Aid distribution
Logistics
Finance
IMS - Components
1. A unified command structure
2. Common terminology
3. Modular organization
4. Integrated communication
5. Consolidated action plans
6. Manageable and sensible span of control
7. Designated facilities
8. Comprehensive resource management
Job Action Sheets
IMS Structure
Incident Commander
Operations
Security
Transportation
Planning
Data collection
& forecasting
Logistics
Staffing
Finance
Equipment &
Supplies
IMS Expanded Structure (1)
Incident Manager
(CEO / designate)
Operations
Public Information
Officer
Liaison Officer
Health & Safety
Officer
Medical Officer
Planning
Logistics
Finance
IMS Expanded Structure (2)
Incident Manager
(CEO / designate)
Public Information
Officer
Liaison Officer
Health & Safety
Officer
Medical Officer
Operations
Facility
Treatment areas
Planning
Logistics
Operational Services
Support Services
Finance
BOARD
Incident Manager (CEO or Senior Administrator)
Execuitve Officer (s)
(Other Executives, Medical Directors)
Liaison Officer (s)
(Risk Manager/Emergency Preparedness Manager)
Facilities Officer
(Security, Facilities)
Safety Officer
(Liase with Infection Control, Occ. Health & Safety)
Public Information Officer
(Internal/External)
Operations
Clinical Support
Planning
Human Resources
Diagnostic Imaging
Psych Support
Pharmacy
Staff Support
Cardio Respiratory Therapy
Dependant Care
Infection Prevention
& Control
Finance
Patient Tracking
Facility Operations
(Security, Damage Assessment,
Sanitation, Air)
Compensation/Claims
Situation Status
(Contingency plans)
Nutrition Services/Food
Cost
Demobilization/Recovery
(Recovery plan)
Transportation
Procurement
(Equipment, material/supplies)
Research/Scientific Expertise
(Data collection and analysis)
Materials Management
(Medical Supplies)
Time
(Staff, Agency, etc.....)
Labour Pool
Information Technology
(Telecommunications)
Occ Health
Laboratory
Services
Medical Care
Director
Emergency Treatment Areas
Logistics/Support
Bio Medical Devices
Medical Staffing
Nursing
Inpatient Areas
Family Info Services Centre
Triage (Patient Tracking)
Critical Care
Immediate Care
Surgical Services (O.R.'s)
Delayed Care
Inpatient Care
Minor Care
Maternal/Child Care
Discharge
Ambulatory Care
Morgue
Documention (Registration)
Decon/HAZMAT (Perimeter)
Proposed Hospital IMS Structure For Ontario Hospitals
Legend:
The Colour Code Triage (Yellow, Red, Green, Black) is universally
accepted and consistent with Triage Codes used by EMS in the field when
addressing large scale emergencies
IMS - Components
1. A unified command structure
2. Common terminology
3. Modular organization
4. Integrated communication
5. Consolidated action plans
6. Manageable and sensible span of control
7. Designated facilities
8. Comprehensive resource management
Designated Facilities
Emergency Operations Centre (EOC)
2. On-site Command Post
3. Staging Areas
4. Triage Area
5. Resource Storage
6. Morgue
1.
Primary Response Command
(Initial Command Centre)
On-site Command
(Secondary)
EOC
Off-site Command
(Final)
Summary
We need
to formally
review our
disaster risks
in order to
prepare a plan
There are common
threads in all
disaster responses
IMS
is the system
used for command
and control
of a disaster
response
IM Systems
have
standard
components
IM Systems
have a
standard
command
structure
IMS will have
job action sheets
and a
planning cycle
Do it right and
you will become
the…
www.ceep.ca