The Story of Mercy and Joplin - Regional EMS Response and Hospital Recovery- Sustainability

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Marianna Neal
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1 The Story of Mercy and Joplin - Regional EMS Response and Hospital Recovery- Sustainability

2 Bob Patterson EMS Director Mercy Central Region Jeff Hamilton, Emergency Management Coordinator Mercy Hospital St. Louis

3 Objectives Identify the importance of a statewide EMS Mutual Aid plan to include an effective communications plan and EMS Strike Team Leader standards. Identify the importance of EMS Leadership interaction in the Incident Command Structure and review the challenge of patient tracking in a large scale event Recognize hospitals that at risk for failure from a devastating disaster Introduce strategies to assist at-risk hospitals during the disaster response phase

6 May 22, 2011

7 Impact Statistics TIME: Sunday, May 22, 5:41 PM HOSPITAL PATIENTS: 183 inpatients including 25 ED patients CO-WORKERS: 117 STORM RATING: EF5 tornado with 200 mph winds, 6 miles long, 1 mile wide band of complete destruction AFTERMATCH:162 Fatalities, 750+ injuries

8 Impact Statistics STRUCTURES DAMAGED: 1.Catastrophic Extensive Moderate POPULATION AFFECTED: 12,375 / 9200 displaced 96% Students returned to school. 86% of those affected have relocated within 20 miles of Joplin

13 Hospital Destruction Direct hit to St. John s Windows and walls blown out Portions of roof pulled off Building infrastructure severely damaged Massive debris 86 physicians offices Destroyed or severely damaged

19 The Evacuation Patients Locations 1 surgery in progress 1 patient in PACU 24 ER patients 28 critical care patients Three Evacuation Points West side of building outside emergency department East side of building Conference Center later to Rehab Building Patients carried down dark stairways on doors, backboards, wheelchairs, wooden chairs and mattresses - 90 min

23 Triage Ambulatory and wheel chairs to Rehab Building Critical to Freeman Health System emergency dept. Emergency tornado injuries treated at street outside St. John s

25 Triage Tags - Tracking Criticism over lack of use of triage tags and tracking Scanners and tags not available trailer and supplied destroyed Lack of experience with scanners Outdated technology

26 Triage Opportunities Triage tags on each ambulance Receiving Hospitals report patients received in the EMSystem Tethered scanners Use triage tags on a regular basis

27 Local EMS Normal Operations Rusty Tinney Director Newton Co. EMS Jason Smith Director Metro Emergency Transport System (METS) EMS Share Medical Director, protocols, use same equipment and ambulances Normal ambulance staffed 11.

28 The Path of the Tornado Downtown Joplin St. John s I-44

29 EMS Operations Available - Post Incident 7 EMS Co-workers, numerous PD and FD personnel lost homes Staffed 21 ambulances 2 Fire Stations Destroyed Transported 250 patients in the first hour

32 Local EMS Challenges Limited radio communications Intermittent/unreliable cell phone service Severity underestimated initially Injured drawn to emergency lights like moths to a flame. Via text message send ambulances Assign a scribe to EMS Sector

33 Emergency Care Memorial Hall emergency - operational for 1 week with EMS Strike Team McAuley High School overflow operation for 48 hours Brady Rehabilitation Center Medications, medical supplies and personnel deployed

34 Memorial Hall

35 Staging Memorial Hall

36 Regional EMS Response Over 100 different ambulances from 7 states were in the area for the first two weeks 13 Helicopters in the area after weather pattern cleared

37 Forward Staging Area - North Mutual Aid Ambulances and Medical personnel staged in Springfield Fair Grounds EMS Strike Teams deployed to Joplin from staging delayed response due to weather pattern and access to the area

38 I-44 Closed 40 Semi s Overturned

39 EMS Strike Team Leader Training Important to success of mission Maintain a roster of trained EMS providers who are credentialed Strike Team Leaders take responsibility of the personnel under their team. Also ensure adequate equipment, communications, demobilization Identification of key roles

40 Staging Areas Local Initially a Lowes Store near I-44I 12 hours later moved to: Old Ford Dealership (no power) Freeman Hospital East METS EMS Headquarters

41 Staging Areas Plan for needs early 1.Communications while in staging 2.Shelter 3.Briefing location 4.Facilities 5.Nutritional needs

42 Staging METS Headquarters

43 Alternative Modes of Transportation

44 Air Medical Response Communications Issues Integration into IC Operations (NIMS education for flight crews) Logistics (Fuel, O2, Duty Time, Medical Supplies, Maintenance, Crew Quarters) Safety (LZ locations, collision avoidance, auto launch, Media A/C) Utilization Air Branch Director Training

45 Statewide Mutual Aid Plan Regional Coordinators Communications Plan Forward Staging areas Upstream and Downstream communications with State EMS Bureau. EMS must have a seat at the State Emergency Operations Center

46 Missouri Hospital Association Response Roles Activation of the Hospital Mutual Aid Agreement Patient Tracking Communication Coordination with MO1-DMAT Emergency Preparedness Coalitions

47 Challenges for EMS Providers Communications Situational Awareness - GPS Presence in the ICC Ongoing weather conditions Crowd control - traffic Pharmacy Recovery IT - Server Recovery Safety and Security Escorts for Senior Leadership Dignitary Visits

48 Communications Alerting systems helpful for rapid notification EMS Mutual Aid Frequency Better use of Federal designated frequencies i.e. MTAC, VTAC etc. Ham Radio Operators not utilized effectively Communications trailers, equipment beneficial

51 Ham Station

52 Situational Awareness Magnitude of the event Landmarks not recognizable Mapping important GPS devices and smart phones Spray paint street names on curbs

53 Incident Command Centers EMS is an important function of the Operation Division of ICS EMS representative in the IC must have good working knowledge of assets in the staging areas both air and ground. Additional Command Sites Joplin City Command Center St. John s Mercy Springfield Freeman Health Systems

54 Traffic impacting Responder access

55 Photo courtesy: AP/Tulsa World Adam Wisneski

56 Hospital Based EMS Non-traditional activities 1.Building security 2.Security of pharmaceuticals 3.Recovery of servers

58 Within the Week

59 Stage One Hospital Rebuild 60-bed tent-based hospital the St. John s s campus Full imaging capabilities Operating Room Intensive Care Emergency Room

62 Master Patrolman Jeff Taylor Riverside PD, Missouri

Marin County EMS Agency. Attachment B Position Checklists

Marin County EMS Agency. Attachment B Position Checklists Marin County EMS Agency Multiple Patient Management Plan Attachment B s Excellent Care Every Patient, Every Time April 2015 *Denotes Marin Specific Additions Medical Group Incident Commander "IC" Operations