Global & Disaster Medicine

Archive for the ‘First Responders’ Category

EMS Mobile Integrated Health & Disasters

USFA

In many communities across the country, Emergency Medical Services (EMS) provide preventative health care to help reduce unnecessary and costly trips to the emergency room and ensuing hospital admissions. EMS operating in a Mobile Integrated Health (MIH) role help patients with chronic conditions in their homes, divert ambulance calls to outpatient providers, and in some communities, use telemedicine to connect their patients with physicians from their homes.

But what if a disaster should strike? How might MIH providers best assist in the response effort?

A recent study1 was the first to examine the work of MIH providers — Richland County (South Carolina) EMS — during an October 2015 response to severe flooding.wheelchair patients



Study findings

MIH providers were able to meet vulnerable patients’ health needs in severe flooding conditions by:

  1. Reconnecting individuals in emergency shelters with:
    • Lost medications.
    • Alternative housing or social services.
    • Transportation to relocate them with family outside of the affected area.
    • Other essential health care.
  2. Readily identifying to local authorities those patients who required in-person wellness checks.
  3. Delivering food and water to patients they knew were unable to leave their homes due to a disability.
  4. Providing uninterrupted power supply for home ventilators, left ventricular assist devices, and other medical equipment.

EMS physicians augmented MIH services during the flood response by performing telephone triage and self-care instruction to patients cut off from EMS. They responded to the field and provided consultation to MIH as needed.

Research takeaways for MIH providers

  • Include disaster response in the MIH training curriculum.
  • Help patients prepare for disasters by emphasizing the need for an evacuation plan and to safeguard adequate supplies of medications and durable medical equipment.
  • Identify ahead of time community members with complex medical needs, such as people who require access to uninterrupted power for life-sustaining medical equipment.

1Gainey C., Brown H., Gerard W. (2018). Utilization of Mobile Integrated Health Providers During a Flood Disaster in South Carolina. Prehospital and disaster medicine: 33(4), 432-435.

 


Healthcare delivery after Florence

Modern Health

When Atrium Health’s mobile hospital unit arrived into Burgaw, N.C., on Tuesday from its home-base in Charlotte, residents of the rural area had been without medical care for days in the wake of Hurricane Florence. They lined up for help even as the medical team was setting up in a Family Dollar parking lot.

The area’s Pender Memorial Hospital, a critical access hospital, was evacuated ahead of the storm and remained closed because of flooding. The nearest open hospital sat at least 50 miles to the south in Wilmington, N.C., a city unreachable by ground transportation after rising floodwaters cut if off from the rest of the state.

Within 18 hours Atrium Health’s Med-1 mobile hospital team of 32 physicians, nurses and other clinicians had treated more than 50 patients, many with chronic diseases, such as heart disease or diabetes. Their conditions had been exacerbated by the stress of the hurricane, loss of electricity or homes and the lack of medical care. Others suffered minor injuries that turned major after becoming infected by unclean water and debris…..Hospitals prepared extensively for the hurricane by stocking up on fuel, water, food and medical supplies as part of emergency plans that had been tested and honed by past disasters.

Many had evacuated patients well enough to be moved to make room for the injured they expected to see after the storm.

Others had sheltered in place—their nurses, physicians, management and other essential staff working in shifts day after day to care for their communities. Once the winds subsided, hospitals worked with their suppliers to get additional food, water and medicine before flooding became worse……”

 


The Fire Brigades Union is demanding more money for its members before it agrees they should be called upon to rescue casualties from the scene of a massacre.

Daily Mail

Militant union blocks plan to put firemen on terror front line after fierce criticism in Manchester atrocity inquiry

  •  The Fire Brigades Union is now demanding more money for its members 
  • Fire brigades now rely on volunteers and senior officers to man specialist teams 
  • Comes after last week’s critical report into the Manchester Arena atrocity

 

A militant trade union has been accused of blocking Government plans for more firefighters to respond to terrorist attacks.

The Fire Brigades Union is demanding more money for its members before it agrees they should be called upon to rescue casualties from the scene of a massacre.

Deadlock in the long-running dispute means fire brigades are having to rely on volunteers and senior officers to man the specialist teams that are on standby to tackle Marauding Terrorist Firearms Attacks (MTFA).

It comes after last week’s critical report into the Manchester Arena atrocity found that ‘risk-averse’ chiefs kept specialist fire crews away from the scene for two hours. Last night a Whitehall source said the FBU was ‘dragging its feet’ on the vital issue, adding: ‘It’s disappointing they have chosen to use this as a bargaining tool.’

And a new briefing by the National Fire Chiefs Council admitted: ‘The overall operating environment in terms of the national FBU position on the undertaking of the MTFA role continues to provide a challenge to a small number of fire and rescue services.’

The Fire Brigades Union is demanding more money for its members before it agrees they should be called upon to rescue casualties from the scene of a massacre. Pictured: The FBU’s Andy Dark

Fire brigades were first asked to set up specialist teams to help respond to terror attacks in 2011 and there are currently 15 around England. They are on call round the clock and equipped with stretchers so they can carry the injured out of the ‘warm zone’ where a terror attack has taken place and into safety, where paramedics can treat them.

But because there has been no agreement with the FBU to make it a contractual requirement, all those who take part are volunteers and in some brigades only senior officers or non-union members are on the teams.

Last year, the FBU advised its members there was ‘no obligation’ for them to take part in any training exercises for terror attack response.

Assistant General Secretary Andy Dark has said it is only fair for the Home Office to provide more money when firefighters were being asked to do work which is more skilled and more dangerous, insisting: ‘We haven’t used it as a bargaining chip.’

Lord Harris of Haringey, who investigated London’s preparedness for a terror attack, urged the Home Office and the FBU to resolve the issue.

The Home Office said: ‘The Government is clear that responding to this type of attack falls within the duty of firefighters. This position has been strongly supported by fire and rescue services which have an MTFA capability and the National Fire Chiefs Council.’

Police and other emergency services are seen near the Manchester Arena after reports of an explosion

Police and other emergency services are seen near the Manchester Arena after reports of an explosion

 


Emergency responses to Manchester Arena attack (5/22/2017)

The Guardian

Manchester Arena bombing report: the key points

• The Greater Manchester fire and rescue service did not arrive at the scene and therefore played “no meaningful role” in the response to the attack for nearly two hours.

•  A “catastrophic failure” by Vodafone seriously hampered the set-up of a casualty bureau to collate information on the missing and injured, causing significant distress to families as they searched for loved ones and overwhelming call handlers at Greater Manchester police.

•  Complaints about the media include photographers who took pictures of bereaved relatives through a window as the death of their loved ones was being confirmed, and a reporter who passed biscuit tin up to a hospital ward containing a note offering £2,000 for information about the injured.

•  A shortage of stretchers and first aid kits led to casualties being carried out of the Arena on advertising boards and railings.

•  Armed police patrolling the building dropped off their own first aid kits as they secured the area.

•  Children affected by the attack had to wait eight months for mental health support.


Department of Homeland Security: Austere Emergency Medical Support Field Guide.

DHS


A fire swept through Sejong Hospital in southeastern South Korea on Friday, killing more than 30 people and injuring over 80.

CBS

 


Operation LENTUS: Canadian Armed Forces (CAF) contingency plan

Operation Lentus

CAF response to forest fires, floods, and natural disasters in Canada

Operation LENTUS is the Canadian Armed Forces (CAF) contingency plan that outlines the joint response to provide support for Humanitarian Assistance and Disaster Response (HADR) to provincial and territorial authorities in the case of a major natural disaster that overwhelms their capacity to respond.

Support to civilian authorities during a crisis such as a natural disaster is one of the six core missions of the CAF identified in the Canada First Defence Strategy.

The objectives of Op LENTUS are:

  • to provide assistance to provincial and territorial authorities;
  • to provide timely and relevant response to a disaster relief operation; and
  • to stabilize the natural disaster situation.

The task force

Operation LENTUS can draw personnel and assets from across Canada, and may be drawn from any or all of the primary force-generators of the Canadian Armed Forces:

  • the Royal Canadian Navy (RCN);
  • the Canadian Army; and
  • the Royal Canadian Air Force (RCAF).

In addition, specialized abilities such as engineering, health services, force protection, transport, aviation or logistics may also be employed.

Once tasked, Canadian Joint Operations Command coordinates the personnel, vehicles, equipment, crews and aircraft to be employed in the region affected by the disaster, in coordination with the respective regional joint task force.


BBC: A breakdown in communication led to a near two-hour delay in sending fire crews to the scene of the Manchester Arena attack on May 22.

BBC

Fire crews were deployed to the Ariana Grande gig 1 hour 47 minutes after Salman Abedi killed 22 and injured 512.

“…..The BBC understands the document includes:

  • County Fire Officer Pete O’Reilly was not informed the bomb had gone off for 35 minutes
  • Fire brigade bosses followed protocol by not deploying crews due to the potential risk of a second terrorist incident
  • The brigade claims it did not know until nearly two hours after the attack that the threat had been lifted….”

 

 


CDC recommendations to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas during the period of September 2017 – March 2018.

CDC

Advice for Providers Treating Patients in or Recently Returned from Hurricane-Affected Areas, Including Puerto Rico and US Virgin Islands

Distributed via the CDC Health Alert Network
October 24, 2017, 1330 ET (1:30 PM ET)
CDCHAN-00408

Summary
The Centers for Disease Control and Prevention (CDC) is working with federal, state, territorial, and local agencies and global health partners in response to recent hurricanes. CDC is aware of media reports and anecdotal accounts of various infectious diseases in hurricane-affected areas, including Puerto Rico and the US Virgin Islands (USVI). Because of compromised drinking water and decreased access to safe water, food, and shelter, the conditions for outbreaks of infectious diseases exist.

The purpose of this HAN advisory is to remind clinicians assessing patients currently in or recently returned from hurricane-affected areas to be vigilant in looking for certain infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. Additionally, this Advisory provides guidance to state and territorial health departments on enhanced disease reporting.

 

Background
Hurricanes Irma and Maria made landfall in Puerto Rico and USVI in September 2017, causing widespread flooding and devastation. Natural hazards associated with the storms continue to affect many areas. Infectious disease outbreaks of diarrheal and respiratory illnesses can occur when access to safe water and sewage systems are disrupted and personal hygiene is difficult to maintain. Additionally, vector borne diseases can occur due to increased mosquito breeding in standing water; both Puerto Rico and USVI are at risk for outbreaks of dengue, Zika, and chikungunya.

Health care providers and public health practitioners should be aware that post-hurricane environmental conditions may pose an increased risk for the spread of infectious diseases among patients in or recently returned from hurricane-affected areas; including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. The period of heightened risk may last through March 2018, based on current predictions of full restoration of power and safe water systems in Puerto Rico and USVI.

In addition, providers in health care facilities that have experienced water damage or contaminated water systems should be aware of the potential for increased risk of infections in those facilities due to invasive fungi, nontuberculous Mycobacterium species, Legionella species, and other Gram-negative bacteria associated with water (e.g., Pseudomonas), especially among critically ill or immunocompromised patients.

Cholera has not occurred in Puerto Rico or USVI in many decades and is not expected to occur post-hurricane.

 

Recommendations

These recommendations apply to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas (e.g., within the past 4 weeks), during the period of September 2017 – March 2018.

  • Health care providers and public health practitioners in hurricane-affected areas should look for community and healthcare-associated infectious diseases.
  • Health care providers in the continental US are encouraged to ask patients about recent travel (e.g., within the past 4 weeks) to hurricane-affected areas.
  • All healthcare providers should consider less common infectious disease etiologies in patients presenting with evidence of acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection, or other febrile illness. Some particularly important infectious diseases to consider include leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza.
  • In the context of limited laboratory resources in hurricane-affected areas, health care providers should contact their territorial or state health department if they need assistance with ordering specific diagnostic tests.
  • For certain conditions, such as leptospirosis, empiric therapy should be considered pending results of diagnostic tests— treatment for leptospirosis is most effective when initiated early in the disease process. Providers can contact their territorial or state health department or CDC for consultation.
  • Local health care providers are strongly encouraged to report patients for whom there is a high level of suspicion for leptospirosis, dengue, hepatitis A, typhoid, and vibriosis to their local health authorities, while awaiting laboratory confirmation.
  • Confirmed cases of leptospirosis, dengue, hepatitis A, typhoid fever, and vibriosis should be immediately reported to the territorial or state health department to facilitate public health investigation and, as appropriate, mitigate the risk of local transmission. While some of these conditions are not listed as reportable conditions in all states, they are conditions of public health importance and should be reported.

 

For More Information


Paramedics, Stress & the Las Vegas Mass Shooting

EMS1

“…..Weber said the green-tagged patients had minor injuries, the yellow-tagged patients had non-life-threatening injuries, and those with red tags needed to be transported to the hospital immediately. The black-tagged individuals were expected to die.
“We had to take the red-tagged patients first,” Weber said. “But it’s not always that easy. People were begging me to take them because they were in so much pain. One woman grabbed at my ankle and we locked eyes. All she could say was ‘please.’ She had tears all over her face. But she was tagged in yellow, and there were people in red. So I had to say, ‘I’m so sorry. Someone will be back for you soon.’”
Weber said patients were growing more desperate on their second round of pickups.
“They’d been waiting for maybe 20-30 minutes at that point, and they’re hurt and they’re bleeding,” Weber said. “So as you walked past them, they’d be like, ‘Help me, please. Help me.’ There was a man tagged yellow who said, ‘I have a new baby. Please save me.’”
“There were officers helping us triage, but there was still some discretion,” Weber added. “Do I pick up this red tag or that red tag? Which patient do we take? What if we choose the wrong one? It can be agonizing.”
Weber said that patients with green tags suffered injuries such as broken limbs and waited for hours to be transported to the hospital. He added that some of the green patients were with people who had already been transported to the hospital and had no idea if their loved ones were alive or dead…..”


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