Crisis Standards of Care A Toolkit for Indicators and Triggers (2013) / Chapter Skim
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7: Toolkit Part 2: Emergency Medical Services
7: Toolkit Part 2: Emergency Medical Services
Pages 145-158
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From page 145... ...
This individual is a physician with a solid foundation of knowledge and expertise in emergency medical dispatch, EMS, emergency medicine, public health, triage, and appropriate allocation of resources who can serve in a leading role during an emergency or catastrophic incident. The continuous partnership of the EMS medical director with the EMS agency supervisor as a unified team during all aspects of the response cannot be understated.
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From page 146... ...
Significant alterations in response procedures and allocation of resources may be required at the contingency level, with the primary goal of avoiding a transition into the crisis level. Important elements that must accompany these procedures include training and disaster exercises that actively include emergency medical dispatch, EMS, and EMS medical direction; community engagement and education; repeated and frequent dissemination of timely and accurate information to the community and the Joint Information Center; and appropriate regulatory relief and liability protection for the parameters included in both contingency and CSC.
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From page 147... ...
• EMS agencies; • EMS medical directors; • Emergency medical dispatch centers; • Call centers and medical resource control centers; • Public and private prehospital transport agencies (including first response agencies) ; • Local hospitals and long-term care facilities; • Local public health agencies;2 • Local emergency management agencies; • Mutual aid network participants; • Local emergency planning committees; • Public and private evacuation transportation partners; • Local and regional medical supply agencies; • Law enforcement agencies; • Local or regional legal representative; and • State EMS office liaison.
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From page 148... ...
• State EMS offices; • State emergency management agencies; • State medical disaster committee; • State EMS/trauma committees; • State public health agencies; • State hospital and long-term care associations; • State trauma offices; • State health and human services agencies; • State law enforcement agencies; • Regional and local EMS advisory councils; • Regional and local health care coalitions; • Regional and local trauma advisory councils; • State and local disaster response network members; and • Regional and local law enforcement agencies. Key Questions: Slow-Onset Scenario The questions below are focused on the slow-onset influenza pandemic scenario presented in Chapter 3:3 1.
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From page 149... ...
4. What information is needed to activate the EMS agency's mass casualty plan and request additional medical resources?
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From page 150... ...
Prompted by discussion of the key questions above, discussion participants should fill out a blank table, focusing on key system indicators and triggers that will drive actions in their own organizations, agencies, and jurisdictions. As a reminder: indicators are measures or predictors of changes in demand and/or resource availability; triggers are decision points (refer back to the toolkit introduction [Chapter 3]
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From page 151... ...
incidence of patients with similar signs and advise the emergency care system • Continue to advise local health officials and symptoms stakeholders of this action command (or, as applicable, base station or online • Provide incident command with frequent medical direction) of the observed reports and ongoing trends using increase in activity or increased incidence surveillance data of patients with similar signs and • Engage regional and state surveillance symptoms systems to follow trends and expanse of • Work with mutual aid agencies to revise the mass casualty incident or pandemic and/or implement call triage • Engage mutual aid partners as required continued 151
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From page 152... ...
and EMS triage and transport • Maximize frequent use of emergency • Revise dispatch and transport measures broadcast system and media outlets protocols to normalize operations • Engage with media outlets to disseminate • Implement call triage models to target information on mitigation measures highest priority calls for response • Work with emergency management and crews in the field to obtain situational awareness regarding access and damage reports • Consider partnering to establish nurse call triage lines to mitigate requests for EMS transport Staff Indicators: Indicators: Indicators: • Members of the EMD and EMS workforce • Overwhelming number of patient with • Approaching normal baseline levels of (Refer also to the worker unable to report for duty due to insufficient staff to meet the demand for staffing. functional capacity table impassable roads, incapacitated personal triage, treatment, and transport • Return to normal shift level and staffing in Toolkit Part 1 [Table vehicles, or other direct effects • Significant portion of the emergency • Some emergency medical dispatch and 3-1]
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From page 153... ...
followed by batched transport of stable • Request additional EMS units through the patients to health care facilities local emergency operations center (EOC) • Encourage mitigation measures, e.g., • Use public and private mass mass vaccination, within EMD and EMS transportation resources for patients with workforce minor injuries or illnesses • Transport essential EMS and emergency • Integrate transportation resources from medical dispatch workers to the out of state and through the Emergency workplace via National Guard or other Management Assistance Compact or agency National Disaster Medical System • Provide support to families of EMS and • Secure federal, state, regional, and local emergency medical dispatch personnel EMS staffing resources and non-EMS to facilitate the maintenance of the staffing resources (e.g., National Guard)
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From page 154... ...
engaging law enforcement assistance if to transport patients with minor injuries necessary • Use disaster triage guidelines • Designate ambulance transport solely for moderately/seriously ill or injured patients • Use alternative vehicles (e.g., aircraft if weather conditions permit, all terrain vehicles, motorcycles, bicycles, watercraft) to access moderately or severely ill or injured patients when routes of travel that are conducive to ambulances are no longer passable
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From page 155... ...
Supplies Indicators: Indicators: Indicators: • EMS agencies report increased use of • EMS reports inadequate or depleted • Demand for PPE for EMS personnel is PPE, medical supplies, medications, or supply of PPE, medical supplies, subsiding airway management equipment medications, or airway management • Demand for medical supplies or airway • Manufacturers of PPE, medical supplies, equipment management equipment is reduced vaccines, medications, or ventilators • Manufacturers of PPE, medical supplies, • Manufacturers of PPE, medical report decreased stock available vaccines, medications, or ventilators supplies, medications, or airway • Fuel shortages reported report insufficient or depleted stock management equipment report Triggers: • Manufacturers of disaster supplies and improving product availability • The available PPE is less than what is recovery equipment report factory Triggers: needed for the EMS workforce closures and/or halted production due to • Incident command is receiving reduced • The use of medical supplies, medications, loss of workforce requests for additional PPE and vaccines, and antidotes begins to exceed Crisis Triggers: medical supplies from EMS personnel their replacement • PPE is no longer available • Emergency departments, emergency Tactics: • Vaccinations, medications, or antidotes care facilities, and hospitals have • Conservation of PPE are depleted to the point that equivalent reduced requests for medications, • Conservation of supplies treatment cannot be provided antidotes, vaccinations, and ventilators • Provide medications and vaccinations to • Hospitals can no longer provide supplies • Manufacturers of disaster supplies and designated at-risk populations or medications to restock ambulances recovery equipment report a return to • Determine alternate vendors and sources Tactics: production of supplies • Activate crisis standards of care Tactics: prehospital patient care protocols • Assess the current status of the • Secure federal, state, regional, and local supplies of medications, medical emergency response assets equipment, and PPE • Request a limited volume of PPE and supplies to prepare for a potential resurgence and to begin replenishing the normal stock of supplies • Adjust supply allocation guidance toward normal 155
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From page 156... ...
4 The blank table for participants to complete can be downloaded from the project's website: www.iom.edu/crisisstandards. 156 CRISIS STANDARDS OF CARE: A TOOLKIT FOR INDICATORS AND TRIGGERS
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From page 157... ...
Scope and Event Type: __________________________________ Indicator Category Contingency Crisis Return Toward Conventional Surveillance data Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Communications and Indicators: Indicators: Indicators: community infrastructure Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Staff Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Space/infrastructure Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Supplies Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Other categories Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: 157
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From page 158... ...
2012. Crisis standards of care: A systems framework for catastrophic disaster response.
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