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PDLS :
EMS Response to Disaster
Prehospital Considerations
Jorge D. Yarzebski, NREMTP
Objectives
 To review EMS considerations in disaster
situations and the unique needs of children
 What to expect from prehospital providers
 Review the Incident Command System (ICS)
and Field Triage as it applies to prehospital
providers
Objectives
 Recognize and formally declare a MCI
 Communication
- Interagency
- Hospitals
Emergency Medical Services
 Network of multiple services and agencies
‘coordinated’ to provide aid and medical care
from 1º response to definitive care based on
training
- First Responder
- Basic
- Intermediate
- Paramedic
- RN’s/MD’s
Coordination
 Incident Command System
- Management system created to address
concerns of interagency compatibility and
interaction
- Direct
- Control
- Coordinate
ICS (Incident Command System)
 Senior on scene: command
- assess need for further resources and direct
incoming resources to where they are needed
- This starts with first to arrive
- Triage: initial fast assessment of every patient,
sort for evacuation and first in line for care when
additional resources arrive
 Responsibilites delegated through ICS
ICS
 Scene control
- limit access for civilians
- media cameras
- maintain in/out routes for vehicles which do need
entry
 Communications
-
notify hospitals of rough numbers, kinds of
injuries
When YOU are the first to arrive…
 Declaring the Multiple Casualty Incident
- Recognize the major incident
- Available resources are insufficient to manage
the number and nature of injuries and
environment
 Possibilities
- More than two ambulances required (dependent
on resources)
When YOU are the first to arrive…
- HAZMAT
- Special resources: Fire, Police, rescue with
specialized extrication equipment, SAR, Medivac
 Dispatch
- En route request for assistance, confirm upon
arriving on scene or cancel request*
*follow SOP for particular department
EMS ICS
 Coordinates EMS activities – Activates MCI
response plan
 Supervises
- TRIAGE, TAGGING, TREATMENT,
TRANSPORTATION
 Assigns personnel
 Guides difficult medical decisions
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First to Arrive
 Initial units assumes command
- Senior/most experience takes control
- Requests additional support
- Updates safety/mechanism/conditions
 Support
Support
Triage
 “to sort” or place in order
 Guides decisions about allocating scarce
resources and limited time
 “greatest good for greatest number”
 Protocol helps make decisions
 ICS separates triage from treatment
immediately: see everybody once briefly for
focus
START
 Most commonly used triage system across
country
 Initial eval –not final
 Time limited (plan 1 min/patient)
 Categorize and move on
START
 “If you can hear me and are able, walk over here”
GREEN triage done – still need individual
evaluation, but can await more staff, allows initial
rescuers to focus on more severely injured people.
 Avg 80% of victims will be green, self extricate (may
self transport – eases burden on field but hard on
hospitals)
 *Not applicable for under 8 years old*
Kids in triage
 Don’t follow commands
 May actually hide from rescuers in full gear
(spaceman look)
 May be extricated by GREEN parents/ adults
with delay in triage and treatment
 Need distraction and dedicated supervisor
able to run after wandering toddlers
JumpSTART (under 8)
 Kids more airway dependent – rescue
breaths attempted if pulse present (unlike
adults) Resp 15-40 instead of <30
 Vascular system clamps down sooner, so cap
refill less reliable
-
Use peripheral pulse instead
 Mental status AV/PU instead of follow/not
JumpSTART
 “If you can hear me and you are able, walk
over here for help.”
 GREENs are done. Screen GREEN adults
for RED/YELLOW kids carried out.
 Assess non-ambulatory patients as you find
them using RPM.
ICS
 Treatment: patients may outnumber
transport, leading to time in field where
treatment can be started.
 Sort patients by category (greens, yellow,
red, black) and treat within areas. If greens
self triaged, they need evaluation.
Treatment
 Limited initial treatment – don’t delay
evacuation if vehicle available
 Oxygen, dressings, splints
 Airway management? Remember, no
intubations during triage, and no codes
during mass casualty event, unless sufficient
personnel and equipment that no other care
is delayed
Treatment
 Kids will be mixed in – do you have enough
supplies in kid size (oxygen, IVs, splints)?
 Does your locality stock a “disaster truck”?
 Does it have kid size equipment and kid
sized doses of Hazmat antidotes?
 Do you have Broselow tapes to guide
dosing?
Treatment - airway
 Non breathing child (with pulse): rescue
breaths, then if no response, BLACK
 Non breathing child without pulse: BLACK
 Oxygen: how administered? Do you have
octopus adaptors to set more than one
NRBM off each nozzle? REDs first.
Treatment
 IV fluids? Depends on numbers: does
everyone need an IV? Are there enough IV
kits to give everyone an IV? Use triage to
guide => treat REDs first, then YELLOWs.
Do GREENs need IV?
 BLACK/expectant: pain control (if drugs
available) NO IV fluids, NO oxygen
Treatment:
 Dressings – rinse gross dirt with sterile fluids or tap
water if available, sterile cover to prevent further
contamination
 Pressure dressing for active bleeding
- Recruit neighbor to help hold pressure during triage while
awaiting transport/evacuation
- ARE KIDS CAPABLE OF THIS?
- IS IT APPROPRIATE PSYCHOLOGICALLY?
 Splint – extremity injuries
Treatment
 Medications: pain control, specific antidotes
with Hazmat event/team
 Monitoring: repeat assessment after triage,
re-categorize if necessary (to worse, never
better – even if they respond to treatment,
they have the same underlying injury)
ICS
 Transport: decides which patients leave
scene first and where they’re going
- Remember that helpful bystanders and self
transporters will fill nearest hospital first
- Includes decisions about longer transport times
for specialty care ( e.g. out of town for burn unit
straight from scene rather than to hospital for
transfer)
- PEDIATRIC SPECIALTY CENTERS
Communication
 Telephones
 Cellular Phones
 Pager System
 Radios
 Whistles
 Loudspeakers/Megaphones
Your Pedi First in Bag
 Is your ambulance equipped to handle a
Pediatric MCI?
 What is essential to your first in bag?
- Airway supplies
- Dressings
- Tags
 Do we include Broselow tapes to guide
dosing?
Ambulance / Disaster Preparedness
 Top to bottom
 BLS / ALS specific
 Pre-determined scope of practice rules
 Policy formulation
 Incident specific arrangements
 Sectioning shell - age specific
Supplies:
 Oral pharyngeal
airways
 Bag Valve Mask’s
 O2 / delivery devices
 Pulse oximeter
 P.O. ear probes
 CO2 monitors
 Trauma scissors
 Stethoscopes
 Blood pressure cuffs
 Cervical collars
 Portable suction
 Padded board splints
 Obstetrics kit
 Blankets
 Sheets
Supplies
 Car seats
 Needles
 Toys
 Sharps containers
 Airway rolls
 Glucometer
 O2 multiplexer
 I.O. needles
 Naso-gastric tubes
 Broselow Tape
 Chest tubes
 Adhesive tape
 Nebulizers
 Medications
 I.V. solutions
 Clean water / cups
Supplies
 Formula
 Ground clothes
 Purifier / preservative
 Paper / waterproof
pens
 hand lights with
batteries
 Disaster Tags
 Light sticks
 Disposable bags
 Candles / waterproof
 Chlorine bleach
matches
 Rain tarps/ poles
 Soap / towels
 Hand tools
Supplies
 Radio CB/am/fm
 Trauma dressings
 Whistle
 Gauze
 Meals Ready to Eat
 Hydrogen peroxide
 Bandage
 Alcohol
 Triangular bandage
 Cold / hot packs
 Kling
 Gloves
 Aluminum foil
 Instaglucose
 Vaseline gauze
 Sterile water /
saline
Supplies
 Backboards/ straps
 Optional / Monitors defibrillators
 AED / SAED
 Other regional specific adjuncts
Supplies
 Expanded practice
 Special needs
Thank you