Mass Gatherings Medical Strategies for Weapons of Mass Destruction

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1 Mass Gatherings Medical Strategies for Weapons of Mass Destruction Kristi L. Koenig, MD, FACEP Professor of Clinical Emergency Medicine Director of Public Health Preparedness Co-Director, EMS and Disaster Medical Sciences Fellowship University of California, Irvine Orange, California, USA

2 Mass Gathering No standard definition > 1,000 spectators Group or up to 25,000 people U.S. State Law (Connecticut) Types At least 3000 persons, at least 18 hours, stated location Political Religious Sports Entertainment

3 Medical Care at Mass Gatherings Organized care exists > 30 years in the U.S. and Europe Emergency/primary care for large, transient population Illness, injury, infectious disease outbreak, mass casualty incident Software tools to estimate requirements Organization, Personnel, Equipment, Supplies, Communication, Transportation Uncontrollable factors Weather Terrorist attacks

4 Planning Principles Event characteristics Venue and geographic considerations Environmental considerations Coordination between agencies Communications systems

5 Event Specific Considerations Spectator composition Elderly, children, teenagers, disabled Illicit substances and alcohol High-risk behavior (moshing) Environmental Heat, humidity, sun, ventilation

6 Venue and Geography Open or closed arena Access and egress route Air medical evacuation assets On-site facilities Mobile medical resources Provider protocols Expanded scope of practice

7 Interagency Coordination Incident Command System Joint Command Medical infrastructure within community May be >100 organizations involved U.S. Secret Service (National Special Security Event), Federal Bureau of Investigation, Disaster Medical Assistance Teams, American Red Cross, Fire, EMS, Department of Homeland Security Communications infrastructure Most common cause for failure

8 WMD? Weapons of Mass Effect

9 Terrorist Weapons CBRNE Chemical Biolological Radiologic Nuclear High Explosive (Conventional)

10 Terrorist Weapons Chemical Lights and siren Immediate symptoms Single site Detection possible Secondary contamination Biological Public Health Emergency Symptoms delayed Initial cases may be unrecognized Detection more difficult Only a few contagious

11 Radiologic Terrorist Weapons Detection possible Geiger Mueller Survey Meter Personal and Pocket Dosimeters Treat traumatic injuries first Most deaths/significant injuries not caused by radiological materials Most deaths delayed Psychological effects

12 Terrorist Weapons Combination Weapons Radiological Dispersal Device (RDD) Airplanes Infectious shrapnel from suicide bomber with hepatitis

13 Terrorist Weapons High Explosive (Conventional) Most likely Suspicious packages Suicide bombers

14 Managing a Terrorist Incident Terrorism Unique Features Specialized Training Scene Safety Recognition of Toxidromes Unconventional Treatments Ready access to treatment guidelines Personal Protective Equipment/Decontamination Collapsed Structures Search and Rescue Management of Crush Injury Field Amputations Specialized Equipment Antidotes (Mark I kits) Personal Protective Equipment/Decontamination

15 Managing a Terrorist Incident Terrorism Unique Features Potential for Mass Casualties Disaster Triage do the most good for the most people Casualty Distribution System for Communication with Receiving Hospitals Patient Tracking Mortuary Affairs Fear/Psychological Casualties Crime Scene/Evidence Collection Non-traditional partners Law Enforcement, Public Health, Media, Military

16 Managing a Terrorist Incident The Basics Incident Command System Finance Logistics Operations Planning Are resources exceeded? Mutual Aid Transportation (buses?) Bomb Squad/Explosive Ordnance Disposal Hazardous Materials Units System to Manage Incoming Resources Staging

17 Managing a Terrorist Incident Safe perimeter Scene Safety Upwind/uphill, traffic flow, perimeter control Structural Integrity Utilities Hazardous Materials Secondary contamination and exposure Fires Blood Borne Pathogens Secondary Terrorist Devices

18 Managing a Terrorist Incident Communications Intra and Inter Agency Resource Coordination Rarely a lack of resources Management of Volunteers Triage and Casualty Distribution Self referrals EMS delivers patients to closest hospital or specialty center (trauma or burn facility)

19 Media Managing a Terrorist Incident Friend or foe? Public service announcements Public Health Surveillance Risk Communications/Public Affairs Credible medical spokesperson Evolving facts

20 Managing a Terrorist Incident Additional Considerations Integration with State and Federal Responders Disaster Medical Assistance Teams National Response Plan Personnel Veterinary Medical Assistance Teams Mortuary Affairs Disaster Mortuary Operational Response Teams Psychological Effects Victims Responders

21 Key Concepts Medical Strategies for WMD Incident Command System Interagency Coordination Communications Scene Safety Disaster Triage

22 Key Concepts Medical Strategies for WMD Event Specific Characteristics WMD Conventional = most likely Secondary terrorist devices Chemical secondary contamination Biological public health surveillance Radiological suspect to detect Crime Scene

23 Questions?

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