Global & Disaster Medicine

Archive for the ‘First Responders’ Category

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…..”


Las Vegas’ trie first responders: Volunteers combed the grounds for survivors and carried out the injured. Strangers used belts as makeshift tourniquets to stanch bleeding, and then others sped the wounded to hospitals in the back seats of cars and the beds of pickup trucks.

NY Times


Lessons from Las Vegas: “…..The first step is to expose the skin so you can see where the bleeding is coming from. Use one or both hands to maintain firm, steady pressure directly on the bleeding site. You can also use your knee, if necessary, to maintain the pressure. A second option is to use a bandage or commercial dressing designed to stop bleeding, called a hemostatic dressing, if available, or clothing, to apply firm, steady pressure to the site. If the bleeding persists, place a tourniquet on a limb two to three inches closer to the torso from the bleeding and tighten until the bleeding stops…”

NY Times

 

 


Triage in Las Vegas

People

“…..The injured had been tagged with color-coded stickers on their bodies by a first responder team doing triage. Patients tagged in green had minor injuries. Those with yellow tags had non-life threatening injuries. A red tag meant that the patient had life-threatening injuries and needed to be transported immediately to a hospital. Those tagged in black were dying or expecting to die.

“We had to take the red-tagged patients first,” he says. “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.’

There was another man who was tagged green sitting next to a yellow,” he continues. “He said, ‘please help my girlfriend,’ but I couldn’t.”

The first patient they took was a woman with a gunshot wound to the chest. “She wasn’t able to breathe,” he says. “She was in really bad condition. We took her to the [ambulance] and to the hospital. Dispatch told us to go right back for more patients.”

He does not know if the woman survived or not…..”


Las Vegas: Dodging bullets, first responders respond to a crisis

NY Times

“……At the medical tent, people lay everywhere. He saw his medical technicians applying pressure to chest and leg wounds, using tourniquets to try to stop the bleeding.

“I saw my personnel checking for pulses, realizing the person did not have a pulse, and we literally had to push the body out of the tent and make room for another patient,” he said.

People Mr. Simpson assumed were family members or friends begged the medical workers to perform CPR. But they were following principles of disaster triage, which, in the most extreme circumstances, call for bypassing those whose hearts have already stopped. So in some cases, family members began CPR themselves…..”


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