Global & Disaster Medicine

Archive for the ‘First Responders’ Category

Aaron Titus’s PrepTalk “Let the Community Lead: Rethinking Command and Control Systems.”

You are help until help arrives: FEMA

Audio can be found at: Soundcloud Link


FEMA 9/3/2019 SitRep


Situation Projected Impacts:

• Wind: hurricane conditions are expected within the hurricane warning area in Florida by today; hurricane conditions are possible in the hurricane watch area beginning Wednesday

• 4-7 feet of Storm Surge north of Deerfield Beach to Lantana, FL 2-4 feet; water levels could begin to rise well in advance of the arrival of strong winds and will be accompanied by large and destructive waves

• Rainfall accumulations: coastal Carolinas 5-10 inches, isolated 15 inches; Atlantic coast from the Florida peninsula through Georgia 4 – 8 inches, isolated 10 inches; may cause life-threatening flash floods

• Surf: large swells are affecting the Florida east coast and will spread northward along the southeastern U.S. coast during the next few days; likely to cause life-threatening surf and rip current conditions

• Tornadoes: isolated tornadoes are possible through Tuesday along the eastern coast of Florida


• Storm Surge Warning for Lantana to Altamaha Sound

Storm Surge Watch from north of Deerfield Beach to south of Lantana; Altamaha Sound to South Santee River

• Hurricane Warning for Jupiter Inlet to Ponte Vedra Beach

• Hurricane Watch from north of Deerfield Beach to Jupiter Inlet; north of Ponte Vedra Beach to South Santee River

• Tropical Storm Warning for north of Deerfield Beach to Jupiter Inlet

• Tropical Storm Watch for north of Golden Beach to Deerfield Beach and for Lake Okeechobee

Lifeline All lifelines remain GREEN

Safety and Security

• FL: Mandatory evacuations for 11 counties; voluntary evacuations 6 counties

• GA: Mandatory evacuations for 6 counties • SC: Mandatory evacuations for 8 counties

• NC: Mandatory evacuations for 2 counties

Food, Water, Shelter  *

• FL: 52 shelters open with 6,271 occupants

• GA: 10 shelters open with 283 occupants

• SC : 19 shelters open with 290 occupants

Health and Medical

FL: Hospital Evacuation: (3 in progress, 3 complete, 3 planned); Nursing Home (5 in progress, 11 completed, 3 planned); Health Care Facilities (24 in progress, 20 completed, 24 planned


• FL: retail fuel availability continues to improve as state expedites resupply shipments

Transportation • Airports: FL: Vero Beach Regional, Palm Beach International, Ft. LauderdaleHollywood International and Orlando-Melbourne International closed

• Ports: FL: Miami, Everglades, West Palm, Jacksonville, and Canaveral closed; Key West, and Fernandina open with restrictions

• Train: Amtrak will not operate south of VA between Sept 3-5

• GA DOT will begin contraflow operations for I-16 and I-75


Local Preparations/Response

• FL, GA, SC, NC, and Seminole Tribe of Florida EOCs at Full Activation

• TN, MS and VA EOCs at Monitoring

• NC Governor requested an Emergency Declaration on September 2

• VA Governor declared a state of emergency on September 2

Federal Preparations/Response

• FEMA-3421-EM-SC approved September 1, 2019

• FEMA-3422-EM-GA approved September 1, 2019

• FEMA-3420-EM-STOF approved August 31, 2019

• FEMA-3419-EM-FL approved August 30, 2019

• NRCC at Level I, 24/7 with all LNOs and all ESFs

• Region IV RRCC at Level I, 24/7

• Region III RWC at Enhanced watch; RRCC activated to Level II, day shift only

• IMAT Teams deployed: o National IMAT East deployed to FL o Region III IMAT will re-deploy from WV to VA EOC at 9:00 a.m. today o Region IV IMAT-1 to FL; IMAT-2 to GA o Region VII IMAT to SC o Region VIII IMAT to deployed to NC

• Region IV LNOs deployed to FL, GA, Seminole Tribe of Florida, SC and NC • Region III LNO deployed to VA • ISB Teams deployed to AL, GA, NC and SC • ISB Charlie Team restaging to Fort A.P. Hill, VA; ISB established at Fort Bragg, NC

See the source image

EMS Mobile Integrated Health & Disasters


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.


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



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.


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