Mass Casualty Incident Management Whitepaper By
Introduction It is the responsibility of governments to ensure safety of the public and provide emergency relief whenever the situation demands it. This alone is a solid justification for investing time, money, and considerable effort in preparing for mass casualty incidents. Besides this, the issue of public health is at stake. This becomes more apparent when the need for emergency preparedness is measured against the increasing amount of evidence pertaining to mass casualty incidents. Mass casualty incidents can make even the most hardened of first responders shiver. Weather emergencies, such as tornadoes, can develop and arrive quickly or slowly like floods. Sports events generally give ample time for emergency response departments to plan ahead; however, a car crash involving multiple cars on a highway happens unexpectedly. Steps taken in advance for better planning and preparedness can mean the difference between life and death. Types of Mass Casualty Incidents (MCI) Mass casualty incidents can take on a number of forms, both natural and man-made. For instance, transportation systems (aircraft, road traffic, railroads, shipping) make up a fair share of incidents. The same holds true for industrial incidents involving factory fires and chemical spills. Buildings collapse and burn while poisonings resulting from water supplies and restaurants can encompass mass populations. Similarly, outbreaks of diseases can test the healthcare facilities ability to control the spread of the diseases. Natural disasters endanger not only populations, but also entire environments. Windstorms, floods, and earthquakes can result in immense damage to structures as well as human life. 1
Emergency Preparedness: WHO Policy In 1981, the World Health Assembly, the decision-making body of the World Health Organization (WHO), passed a resolution stating despite the undoubted importance of relief in emergencies, preventive measures and preparedness are of fundamental importance. According to historical statistics, the numbers of natural disasters that have been recorded since 1900 have significantly increased, along with the number of people affected by them. Figure 1: Number of disasters since 1900 as documented in the International Disaster Database Figure 2: Number of deaths, number of people affected and the number of disasters since 1900 as documented in the International Disaster Database The importance and need of MCI preparedness has been emphasized repeatedly ever since. For instance, during the International Decade on Natural Disaster Reduction (from 1990 to 2011), many resolutions were approved and implemented on the importance of the health sector being prepared for any calamaties. In the year 1995, it was recognized that disaster reduction is an integral part of sustainable development and each country bears the primary responsibility for strengthening its capacity. The Assembly clearly distinguished between WHO s role in emergency preparedness and disaster reduction and its other responsibilities related to emergency response and humanitarian action. In 2005, the necessity of being prepared for mass causality incidents was further emphasized, including the need of strengthening the ingenuity and resilience of communities, the capacities of local authorities, and the preparedness of health systems. 2
Member states of the World Health Organization were urged (excerpt from WHO resolution 48.2 (2005): The 120 th Executive Board approved a resolution on the emergency-care systems that were scheduled to be considered by 60 th World Health Assembly in the latter part of 2007. This resolution called for, among various other things, for the WHO to provide guidance for the creation and strengthening of mass-casualty management systems. The Ground Reality To engage actively in the collective measures to establish global and regional preparedness plans that integrate risk reduction into the health sector and build-up capacity to respond to health-related crises AND To formulate national emergencypreparedness plans that give due attention to public health, including health infrastructure Whenever an MCI occurs, all the responding units have to thoroughly manage organizational and medical tasks that are typically not a part of their day-to-day routine. In the case of MCIs, the personnel responsible for responding to the crisis have to perform numerous functions, many of which are unique to MCI scenarios. The information about the incident has to be collected and provided to the concerned dispatch center. The patients have to be divided into categories based on the severity of their injuries as well as the urgency of their transport and treatment. These results are documented and tagged onto the respective individual and shared with personnel at the appropriate facilities by the MCI Coordinator. While all of this goes on, the MCI Coordinator is handling multiple forms of communications hampering the efficiency of MCI management. Streamlining MCI Management Processes One thing that never changes regardless of what the MCI protocol and policy is is the chaotic nature and norm of managing these large scale mass casualty incidents. It has to be ensured that the situation is managed as effectively as possible so that patient care is not compromised. 3
One of the most critical weaknesses of effective MCI management lies in the lack of communication between paramedics, hospitals, and Public Service Answering Point (PSAP). All segments of EMS response, ranging from the transport process to the arrival has to be in synchronization so as to properly assign as well as distribute the various individuals involved in the MCI. Hence, a lack of coordination and communication between the concerned segments is the causal reason that can put the lives of people at risk. The Problems Analyses of various disasters have been carried out to isolate and identify common procedural problems. Many of such reports have described these as the lessons learned so as to derive solutions to procedural problems so that they are not repeated. However, the implementation has been far from sufficient. Lessons are only learned when strategies are developed and solutions implemented successfully. Some of the most common problems that have surfaced in previous mass casualty incidents are outlined below. Lack of Communication Communication, or rather the lack of it, has been the number one problem that has been identified when numerous disasters and incidents were reviewed. Improper communication can result due to a number of problems with the message, the medium, or the messenger or all of these together can contribute towards miscommunication. It is imperative to understand that communication is not limited to broadcasting information in fact, it is a two-way lane in the sense that steps need to be taken so that information is able to be received. It can be impossible to avoid all of the communication problems, but with advance preparation and reliable tools, the issues can be minimized. Relying on a single mode of communication is a recipe for disaster it is very likely that this medium becomes overloaded or it simply fails. Additionally, it has been observed that a lack of coordination between EMS teams and hospitals has been prevalent in the past MCIs. Command, Coordination, Control Command, coordination and control arrangements have become a central point of focus, particularly after the 1970 s California wildfires. This documented that there are restricted 4
spans of control and a clear need for command that makes it necessary to have strong coordination and sharing of information between hospitals & first responders. The Emergency Department (ED) triage status information and emergency room diversion status has to be made available to first responders in the field to keep them updated as the event unfolds. The command, coordination and control have both direct and indirect reliance on quality communication. For example, a system has to be in place where the dispatch information is passed on to relevant authorities, such as Hospital EDs, 9-1-1 call takers, and others. Activation Procedures In order to be able to effectively deal with a mass casualty incident, it is imperative that clear activation procedures be defined that can be initiated at any time, twenty four hours a day seven days a week (24/7). The most common causes that lead to a delay of activation of procedures is often the staff not receiving the activation information in a timely manner, their lack of ability to locate a person who has the authority to activate the procedures along with problems in broadcasting of an activation message. Patient Distribution When it comes to responding to a mass casualty event or multi-casualty event, quick and effective response, treatment, patient allocation and transportation are vital components in providing an efficient life-saving response. Hospital bed availability and hospital status are vitally important factors in determining where to transport injured patients. Dispatchers must be able to manage and prioritize ambulance routing based on the severity of patient conditions and the availability of hospital resources. A hospital may be temporarily full or have reduced capabilities due to equipment failure/maintenance. Awareness of ongoing incidents provides insight into the current load on EMS and hospital resources. Although an MCI requires a significant set of resources and attention, other incidents are still going to occur and must be attended to by the same EMS agency. Access to this information should be shared on a daily basis so that when an MCI occurs everyone is prepared to support the entire community. 5
An Overview of StatusNet911 MCI Management Software To be able to deal with MCIs in a timely manner with the minimum possible problems, it is crucial to devise a well-laid out strategy and implement MCI management solutions. StatusNet911 is a powerful MCI management solution that connects hospital, dispatch staff and first responders with real-time data. The solution enables local, regional and state views of resource availability, system outages, and triage status to support the real-time response to any multi-casualty incidents. Coordinate Organizational Response Whether or not an organization is prepared to handle a mass casualty incident or not depends on the strategy, equipment, and the level of coordination amongst those involved regardless of which area of emergency services they belong to. As previously mentioned, effective communication is the key to avoiding confusion and the lack of coordination between a particular municipality s health department, hospitals, first responders, and EMS personnel. StatusNet911 links dissimilar platforms together to give a clear, unambiguous picture of the entire response operation in real-time. Efficient MCI Response Coordination Platform StatusNet911 is a coordination platform utilized to assign patients to units, units to hospitals, add temporary facilities (parking lots, temporary shelters, etc.), add temporary units (i.e., cars, busses, etc.). The information is seamlessly linked across EMS agencies, hospitals, and personnel through a single application. Whenever an MCI is declared, the StatusNet911 disaster management system automatically alerts and passes information to all applicable member facilities. This ensures that hospitals have the necessary information about the victims available even before the arrival of the actual patient hence this approach streamlines the coordination of triage efforts. The cloud-based nature of the application makes the monitoring and communication possible 24/7 from anywhere on the Internet. StatusNet911 information is stored on a secure cloud server, allowing first responders timely access to information even when they are in the field. 6
Tracking Software for Timely MCI Patient Information The tracking of mass casualty patients through StatusNet911 makes it easier for concerned individuals to track patient movement right from the point when the dispatchers receive the first 9-1-1 call to the point when the patient arrives at a healthcare facility. This tracking enables medical staff to better manage mass volume of patients by getting information prior to the arrival of the victims of a mass causality incident. Reunification It has often been observed in mass causality incidents that there is major confusion among family members who are trying to gain information about their loved ones involved in the incident. The reunification feature that comes built-in to StatusNet911 provides the ability to simultaneously request information on lost family members across all participating facilities. This allows them to swiftly identify the people involved in the incident. In addition to this, the reunification feature ensures that crucial emergency lines of communication remain free for first responders and other members of the EMS team. Real-Time Information Every second carries utmost importance during a mass casualty incident. An MCI management system such as StatusNet911 can provide concise communication ability in real time. This can be used to gain access to maps and reports containing near real time actionable information. This information can be crucial for members of EMS teams. Dispatch information for all the EMS incidents is automatically forwarded to respective hospital EDs as soon as the 9-1-1 call is taken. This allows hospitals to prepare in advance for MCI demands while concurrently handling daily EMS incidents. Continuous Operation The StatusNet911 cloud platform comprises redundant networks, servers and data storage to guarantee continuous operation as long as required. The redundancy protocols and emergency backup systems provide emergency service providers peace of mind. No Change Needed to Any Existing Procedures StatusNet911 can be easily implemented within your current EMS without any additional hardware or without needing to change currently established processes, procedures, or protocols. 7
Conclusion It is clear that the nations of the world have learned from their past mistakes and continue to do so by implementing strategies and technologies to better cope with disasters both natural and man-made. The need for timely response cannot be undervalued. The complex mixture of factors that lead to disasters today consist of climate change, socioeconomic factors, global warming, and many others. Lack of proper disaster preparedness increases the number of deaths that could otherwise have been prevented if an effective MCI management solution and disaster preparedness strategy was in place. Multi-casualty incidents are no less than a litmus test that pushes an emergency response center to its limits, testing its capability as to how it handles the situation. However, efficient management of a multi casualty incident remains to be in shambles in many areas of the country, primarily due to a lack of monitoring and coordination between those on the field and those overlooking the operations from emergency response centers. StatusNet911 is an MCI management solution designed to provide EMS teams, first responders, and emergency departments access to real time status updates, diversion information, and resource availability. It helps to bridge the communication gap, particularly when multiple response teams are involved. Due to the cloud-based nature of the software, these updates can be easily made available to all team members as long as they have an internet-enabled device. StatusNet911 is software that can be implemented in an existing EMS system to enhance its functionality and efficiency. It effectively sends out critical information to hospitals and first responders and does not require any changes to the existing procedures or policies. With the ability to be integrated with existing CAD systems, it can provide enhanced communications and disaster responses if an incident were to take place. Disaster preparedness is not a choice; in fact, it is obligatory on all concerned healthcare professionals to play their part to ensure the readiness of all EMS teams. An MCI management software makes the entire task easier. For more information on how StatusNet911 can enhance your EMS team, please contact us at 301-486-0600 or info@datatech911.com for a free consultation. 8