MINE MEDICAL
PROFESSIONALS’ ASSOCIATION
14TH ANNUAL CONGRESS
20 – 22 May 2011
Emergency Preparedness
presented by
Mike Emmerich
Nexus Medical
Emergency Planning and
Medical Response in the
Mining Industry in
South Africa
Overview:
• Fundamentals
• Where we have come from?
• What we currently have in place
• What we need in place
• Where too from here?
• Strategies
• References
Fundamentals of Medical Incident
Management
•Every (medical) incident represents
different challenges and nothing can
replace “hands-on”
experience/practice.
What is an Incident?
An event that could….
•Have (serious) financial impact.
•Attract media, public and/or
political attention.
•Have the potential to
cause personal injury,
property and/or
environmental damage.
What is a Disaster?
An event/incident that:
•Extends your resources.
•When normal community and
organisational arrangements are
overwhelmed
•More than 1 patient
could constitute
a disaster.
Phases of a Disaster
•The Disaster Management Act of
SA (No.57 of 2002) describes the
following phases of a disaster:
•Pre-Disaster Risk Reduction:
•Prevention
•Mitigation
•Preparedness
•Early Warning
Phases of a Disaster
•The Disaster Management Act of
SA (No.57 of 2002) describes the
following phases of a disaster:
•Post-Disaster Risk Reduction:
•Response
•Recovery
•Rehabilitation
•Reconstruction
Where Have We Come from?
• Rescue teams have been around
since the late 1920's
• Specialised medical response teams
only emerged post the Kloof Mine
1994 accident.
• Training of Mine Medics was then
formally started under the guidance
of GFTS in 1996 and Nexus Medical
was the subcontractor to GFTS from
1999
Where Have We Come from?
• MRS took over the supervision in
2001 and it was still managed by
Nexus Medical
• In 2006 the College was formally
accredited with the HPCSA until
2009 (with a contracted college
principal) when MRS closed their
college and stopped all medical
training, due to HPCSA Pending
resolutions.
Where Have We Come from?
Research/Legislation
During this Period
• SIMRAC 801 2001 and its follow up
study scheduled for 2006
• Draft Guideline for the Compilation
of a Mandatory COP on Emergency
Medical Care and First Aid:
2008/04/18
• The Draft COP is based on the
findings of the original SIMRAC 801
2001 report.
What We Currently Have in Place:
• No effective COP
• Less than 200 BLS medics still in the
system, with very few new medics
being trained
• No clear guidance from HPCSA re
BLS training
• No clear guidelines from industry
leaders re Chamber, DME etc...
• Individual mines seeking their own
solutions.
What We Currently Have in Place:
• “Service Providers” offering cover at
most mines, with many mines
experiencing problems.
• Mines now seeking solutions based
on international best practice
guidelines/standards/protocols.
What We Currently Have in Place:
• Service Providers” offering cover at
most mines, with many mines
experiencing problems.
• A void exists in the training of BLS
medics on the traditional short course
training programmes.
• Mines now seeking solutions based
on international best practice
guidelines/standards/protocols.
What We Need in Place:
• A working COP that covers new best
practice international guidelines
• A COP that articulates the thinking in
current medical training and
qualification terminology
• Medics trained under an international
standardised training programme
• Medics who are both competent and
can show “currency of competency”.
Where too from here?
• Industry standard protocols at the
various levels of care (FA, BLS, ILS,
ALS) at the pre-hospital and inhospital phase of care, including
additional short course skills training
for medical doctors (ITLS, ATLS,
ACLS)
Where too from here?
• Medical Staff available both above
and below ground
• Skill levels on key treatment areas to
be highlighted (as per guidelines in
draft COP)
• Appropriate equipment and drug
therapies to be kept current with
changes in ECC guidelines and other
areas of patient care; eg: HCN in
underground fires
Where too from here?
• Plan where medical teams,
equipment are positioned (both
above and below ground) as per
guidelines from SIMRAC 801 re risk
assessment.
• Plan where medical stations and
clinic are positioned above ground
• Have clear “patient evacuation plans”
with the relevant service providers,
who are trained in the mining
environment.
Where too from here?
• Dry run exercises of the entire
rescue/extrication/treatment/transport
continuum
• From site of possible accident to last
possible point of treatment
• Continual alignment of protocols with
international best practice
benchmarking and research so as to
remain current and competent.
Strategies:
• Dr William Haddon developed a framework by
which we can identify interventions to address
fatal mining injuries (Haddon, 1970).
• By applying Haddon's theories - ten
technical strategies for injury control and
the targeting of interventions at the three
phases of an injury event: pre-injury, injury,
and post-injury (Robertson, 1992)
• We can readily identify several interventions
that may be useful in reducing the number of
fatalities and injuries among South Africa's
miners.
Strategies:
Haddon's ten technical strategies for injury
prevention. (Haddon, 1972):
9. Begin to counter the damage already done
by the environmental hazard:
Locate emergency response teams closer to
mining sites to expedite rescue efforts.
10. Stabilize, repair, and rehabilitate the object
of the damage:
Offer comprehensive medical and
rehabilitative services to miners who
experience non-fatal injuries.
Example of “Prevention Strategies or
Countermeasures”
Strategies for Injury
Prevention
Move rapidly to detect and
evaluate damage that has
occurred and counter its
continuation and extension.
Action
Train people in First Aid, with
specific attention to entrapment
Train medics (mine and service
providers) in the acute care of
entrapped patients
Stabilize, repair, and rehabilitate Develop a standardised trauma
the damaged object.
management and treatment
system.
Be Proactive!
•Plan ahead – Disaster/Incident
Management Plan
•Be prepared: Design a ERP
•Do a Risk Assessment
•Incident Management Plan
•Emergency Management Plan
•Appropriate training and testing.
Proactive not reactive
Closing Comments:
• We need to fast track the finalisation
of an EMS COP
• The various industry role players
need to be more vocal in the obvious
shortfalls in the current system
• If need be we must look outside the
current programmes and go beyond
our borders for best practice
international programmes.
• The longer we wait the fewer medics
there will be left in the system!
For more information please contact:
Mike Emmerich
CCA-ALS, ACLS-EP, PALS, ATLS, ITLS, FMA, AMR
eACLS, ACLS, ITLS, PALS & AT&T Instructor
ESCI Instructor
Advanced Life Support Paramedic
082-557-1870
www.nexusmedical.co.za
mike@nexusmedical.co.za
nexusmedical@iafrica.com