Emergency Medical Services At the Crossroads (2007) / Chapter Skim
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6 Preparing for Disasters
6 Preparing for Disasters
Pages 175-206
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. Emergency medical services (EMS)
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According to New York University's Center for Catastrophe Preparedness and Response, more than half of emergency medical technicians (EMTs) and paramedics have received less than 1 hour of training in dealing with biological and chemical agents and explosives since the terrorist attacks of September 11, and 20 percent have received no such training.
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PREPARING FOR DISASTERS Against this background, the committee details measures that can be taken to improve the nation's EMS-related disaster preparedness. THE ARRAY OF THREATS Worldwide, disasters occur almost daily; in the past 20 years, they have claimed nearly 3 million lives and adversely affected 800 million more (Waeckerle, 2000; Chan et al., 2004)
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EMERGENCY MEDICAL SERVICES AT THE CROSSROADS Naturally Occurring Disasters The nation is vulnerable to a wide range of natural disasters, including earthquakes, extreme heat, forest fires, wildfires, floods, hurricanes, mudslides, thunderstorms, tornadoes, tsunamis, volcanoes, and winter storms/extreme cold (DHS READYAmerica, 2005)
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In the event of an outbreak of pandemic influenza, emergency medical responders will potentially be called upon to treat and transport thousands of afflicted individuals. However, there are a number of concerns regarding the nation's preparedness for and potential response to such an event, including (1)
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0 EMERGENCY MEDICAL SERVICES AT THE CROSSROADS BOX 6-1 Examples of Major Terrorist Threats to the United States Explosives • Suicide bomber • Truck bomb • Subway bomb Chemical • Ricin • Sarin gas • Sulfur • Mustard gas Biological • Smallpox • Anthrax • Plague Radiological • Dirty bomb Nuclear • Nuclear bomb SOURCE: CDC, 2006a. ing our transportation systems, government institutions, and food supplies, among others.
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PREPARING FOR DISASTERS explosive attacks, the federal government recently eliminated the Health Resources and Service Administration's (HRSA) Trauma-EMS Systems Program and the grants it provided to states to develop and maintain trauma systems.
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EMERGENCY MEDICAL SERVICES AT THE CROSSROADS and Preent Potential Misuse of Adances in Life Sciences, asserted that intelligence agencies are too focused on specific lists of bacteria and viruses and should place more emphasis on dangerous emerging threats, such as RNA interference, synthetic biology, and nanotechnology (IOM and NRC, 2006)
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PREPARING FOR DISASTERS of reforms have been introduced subsequent to a number of major disaster events in U.S. history, including September 11 and the Oklahoma City bombing, as well as disasters that have taken place in foreign countries.
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government initiated a massive restructuring of the federal bureaucracy by establishing DHS. This restructuring involved the consolidation of dozens of federal agencies involved in homeland security functions (The White House, 2002)
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ESF-8 identifies four major necessities for a medical response effort: (1) facilities in which to provide care (which may require building field hospitals since other facilities may have been damaged)
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Its focus historically was on logistics and recovery distribution. However, Hurricane Katrina presented a number of additional challenges, including major evacuations and search and rescue operations, as well as issues of health care delivery and public health.
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PREPARING FOR DISASTERS to triage and treat up to 250 patients per day for up to 3 days without resupply. DMAT team members are community-based volunteers and can be federalized upon the team's activation.
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Some cities, such as Houston and Atlanta, were inundated with patients, while others, such as Winston Salem, North Carolina, and Augusta, Georgia, received very few. In Houston and Dallas, the Metropolitan Medical Response System (MMRS)
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However, hospitals receiving large numbers of NDMS evacuees likely were filled to capacity, causing crowding in hospital emergency rooms, ambulance diversions, and reductions in access to emergency and trauma care. After the initial blow and immediate aftermath of Hurricane Katrina, emergency health workers increasingly shifted their focus to the treatment of chronic illnesses.
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EMS personnel reportedly transported 186 seriously injured persons from the incident site to 10 Rhode Island hospitals in less than 2 hours (CNN.com, 2003; Suburban Emergency Management Project, 2005)
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Medical assets are closer to the front lines, and air medical capabilities have been improved (Miles, 2005)
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Air medical evacuations are now lighter and more adaptable; patient support pallets can be moved from one aircraft to another, and medical teams carry much of their equipment in backpacks. If a soldier is critically wounded, a critical care air transport (CCAT)
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SOURCE: Auf der Heide, 2006. ing the nation's trauma care system or its capacity to respond to terrorism involving conventional weapons.
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However, local emergency and trauma care systems across the country face sizable day-to-day challenges, even without the additional responsibilities that might be placed upon them in the event of a
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Even multivehicle highway crashes can with new type stretch local systems to their limit. The committee maintains that to be adequately prepared for disaster events, it isis fixed first to establish strong the image necessary and highly efficient emergency and trauma care systems that work smoothly to change must redraw on a day-to-day basis.
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prepared community today. Given the enormous deficiencies in preparation for disasters in communities throughout the United States, the committee maintains that DHS and other agencies should enhance the equipment, training, and surge capacity of local emergency and trauma care systems in order to prepare for both day-to-day spikes in demand and mass-casualty disaster events.
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2005. Emergency Medical Services: The Forgotten First Responder -- A Report on the Critical Gaps in Organization and Deficits in Resources for America's Medical First Responders.
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To address the serious deficits in health-related disaster preparedness, the committee recommends that Congress substantially increase funding for emergency medical services–related disaster preparedness through dedicated funding streams (6.2)
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The use of personal protective equipment (PPE) is one method of protecting providers from biological or chemical hazards, but very few emergency medical professionals have been provided with such equipment or trained in its proper use.
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Establishing effective training in disaster preparedness for EMS personnel will require a coordinated and well-funded national effort that involves both professional and continuing education. The committee therefore recommends that professional training, continuing education, and credentialing and certification programs for all the relevant professional categories of emergency medical services personnel incorporate disaster preparedness into their curricula and require the maintenance of competency in these skills (6.3)
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The adoption by states of the National EMS Scope of Practice Model, a component of NHTSA's Emergency Medical Serices Education Agenda for the Future, would be a major step in this direction (see Chapter 4)
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6.2: Congress should substantially increase funding for emergency medical services–related disaster preparedness through dedicated funding streams. 6.3: Professional training, continuing education, and credentialing and certification programs for all the relevant professional catego ries of emergency medical services personnel should incorporate di saster preparedness into their curricula and require the maintenance of competency in these skills.
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Academic Emergency Medicine 11(10)
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Realities of rural emergency medical services disaster preparedness. Prehospital and Disaster Medicine 21.
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Journal of Emergency Medical Serices 23(11)
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Academic Emergency Medicine 9(3)
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