DMAT Deployment in a nutshell

1. DMAT Deployment in a nutshell Storage, packing, Moving, Setting up and running the operation

2. Team equipment • Team equipment must have a dedicated staff to maintain, organize, pack, load, unload, maintain inventory on site, reload, re-supply and make ready for the next one • A full time job !

3. Packing • Pack equipment in smaller units • Modularize • When packing, think of a grocery sack • Heavy items on the bottom • Label everything !!! • Weatherproof everything • Label HAZMAT items

4. Arrival • Pack your gear on the transport so that the most important gear is packed last (first to unload) • “Hit the ground running”

5. Site Selection • Consider established structures • Any damage from the disaster? • Is it safe for both staff and patients • Can you use the water, power, phone? • Can you hook a generator up and establish basic requirements? • Consider patient load and staffing numbers? • Can this facility expand with increased load

6. Field Site • May be the safest is structures are unstable due to damage or aftershock • Considerable more effort to set up • Consider access both in and out • consider power, water, sewage, etc.

7. Base of Operations (BoO)

8. Treatment Areas • Consider power, water, sewage removal • Consider ingress and egress of emergency vehicles • Triage area and entrance “labeled” and visible to walking wounded

9. Staff area • Allow for quiet area for night staff to sleep during the day • Allow for feeling of “personal space” • 6 man tents rather than 30 person tents • Staff area must be guarded at all times! • Never mingle staff sleeping with patient areas - infectious disease potential

10. Support • Command & commo area • Radio equipment and place for command group to meet • Supply • Centrally located • Food / Dining • Dedicate an area and establish a dining schedule - morale !!!!

11. The Incident Command System (ICS)

12. Incident Command System (ICS) • A nationally and internationally recognized system of on-scene management for large scale emergencies and disasters. • ICS was developed by FIRESCOPE for multi-agency firefighting response, but has been modified for use by EMS, law enforcement, hospital, and other emergency response agencies.

13. ICS is based on the following principles: • Common terminology • Modular organization • Integrated communications • Unified command structure • Consolidated action plan • Manageable span of control • Designated incident facilities • Comprehensive resource management

14. Geographical set-up of the Disaster Site • Immediate area around the catastrophe • Victims initially found within this area • Incident Command to determine safety level for personnel before Search and Rescue

15. INTERNAL PERIMETER • Patrolled boundary immediately surrounding disaster site • Keep media, looters, gawkers, etc. out - only rescue personnel into this perimeter

16. EXTERNAL PERIMETER • Immediate boundary surrounding Treatment Area, Transport Area, Staging Area • Staging area at edge of perimeter

17. COMMAND POST • A distinct, geographical location at a disaster site or in a hospital where specific officials, through a process of information-gathering, needs-assessing, and decision-making, exercise proper control over the catastrophe • Coordinating center for the major agencies involved at the disaster site • Principal officers located within

18. COMMAND OFFICERS • INCIDENT COMMAND • FIRE COMMAND in most cases • EMS Command • POLICE Command • Stays at COMMAND POST constantly

19. Determines type of disaster Determines exact location of the incident Overall command of disaster area Does not treat victims Determines scene safety Estimates number of victims Determines types of injuries or medical conditions Determines number and types of personnel and equipment needed immediately Reports above information to pertinent authorities Appoints certain officers under his/her direct command Determines location of other areas within External Perimeter Contains/controls on-going hazards Evaluates environmental and geographical conditions Determines best access to disaster site Directs Search & Rescue Incident Commander’s Duties

20. Staging Area • A designated zone in a disaster site where vehicles and personnel are directed and maintained until needed • Always keep 1 person with each vehicle and don't remove keys from vehicle • Easy to access • Ingress/egress distinct and separate • Distinct areas for personnel and equipment • In some circumstances, each incoming ambulance in staging area may be stripped of all soft medical supplies for use in the treatment area

21. STAGING OFFICER • Positions self at staging area • Easily identifiable • Maintains, organizes, and logs types of equipment, supplies, and personnel arriving • Determines ingress and egress at staging area. • Consider spare tires, mechanic, fuel

22. TRIAGE AREA • Within disaster site • May include area of Search & Rescue • Treatment resources limited (BLS) • Victim tagging with colored ribbons • (red, yellow, green, black)

23. TRIAGE OFFICER • Stationed at disaster site • Easily identifiable • Ensures BLS measures are being accomplished • Ensures initial triage is occurring • Determines what type of resuscitation and stabilization measures should be utilized given the set of circumstances (load and go vs. triage)

24. FIELD HOSPITAL / TREATMENT AREA • ALS commences here • Secure from secondary disaster complications (e.g. run-off, smoke, etc.); Protected from natural environmental complications (cold, rain, heat, etc.) • Easily identifiable (tall flags/lights) • Controlled access (police tape / snow fence) • Provides second triage of victims • At least three zones: • Red, Yellow, Green, Black zone near, but out of sight of Treatment Area • May have junior officers in charge of each zone in Treatment Area • Triage and treatment of victims is an on-goingprocess

25. TREATMENT OFFICER • Positions self at Treatment Area • Easily identifiable • Heads Treatment Area • May determine leaders of red, green, yellow, black zones • In close contact with TRANSPORT OFFICER • Oversees secondary triage tagging at entrance to TREATMENT AREA • Should not be personally involved in individual treatment • Coordinates with SUPPLY OFFICER to insure the provisions of needed supplies • Organizing abilities more important than treatment abilities

26. TRANSPORT AREA • Ambulance loading area • Adjacent to Treatment Area • Ingress/Egress distinct and separate • Vehicles arrive from Staging Area

27. TRANSPORT OFFICER • Positions self near TREATMENT AREA • Easily identifiable • Establishes ingress and egress for ambulances • Communicates with hospitals • Records capacity and resources of hospitals • Decides with Treatment Officer the destination and means of conveyance for each victim • Notifies hospital of the impending arrival of patient, patient condition and ETA

28. Transport Officer (Cont.) • Logs all pertinent information • patient I.D. • patient condition (red, yellow, etc.) • patient destination • patient transport vehicle • pertinent times • All this communication can be done through Radio Officer • Directs transport vehicles not to communicate to hospitals unless patient condition deteriorates • May have maps and pre-printed directions for transporters to hospitals

29. Safety & Security at the Disaster Site

30. Tasks in disaster security • Prevent looting • Decrease congestion (remove non-essential personnel) • Prevent further injury or victims or injury of bystanders during rescue efforts

31. Ways to keep people out / funnel victims for treatment • Issuance of passes • should be pre-planned • only one agency issuing passes • Barrier tape / snow fence • funnel ambulatory victims to triage area • All rescuers should carry some form of ID (badge, uniform, etc.)

32. Other security considerations • Lighting at night • Generator Safety • Connections / Ground • Disconnect main circuit breaker in your electrical service panel before connecting generator • Have a qualified electrician do installation • Can be installed to supply both 220 volt, 3-phase power, and 110 volt, single phase

33. Generator Safety (cont.) • Ventilation • Run generators outside, downwind of structures • carbon monoxide gas from the generators exhaust • install a carbon monoxide detector • Fire Safety • Fuel spilled on a hot generator can cause an explosion • If your generator has a detachable fuel tank - remove it before re-filling • Otherwise temporarily shut off the generator and let it cool before refilling

34. Generator Safety (cont.) • Overload • Do not exceed the rated capacity of your generator • Most of the small, home-use portable generators produce from 350 to 12,000 watts of power • Overloading your generator can damage the generator, the appliances connected to it and may cause a fire • Electrical motors, sump pumps, furnace circulators and refrigeration compressors draw a lot of power

35. Generator Safety (cont.) • Electric hot water heaters, electric clothes dryers, and electric heat draw large amounts of power and may not be able to be powered by a typical home generator • To determine your power requirements, simply add up the wattage ratings of the devices, including lights, that you wish to power • To avoid damage to the generator and your motors, unplug all appliances like refrigerators, freezers, heaters and other high wattage items. After the generator is running, turn appliances on one at a time. This also applies to sensitive electronic equipment like computers and televisions, which may be damaged by power surges

36. Personnel Safety • Personnel accounted for and always with buddy • During high stress times, people may not think straight • Pre-disaster stress factors may be intensified during a disaster • Law enforcement officers should provide security, not the lay public • Medical teams may be targets in some areas because of pharmaceuticals

37. Infection Control at the disaster site • A hazardous materials response ? • Increase in disease transmission during a disaster • Increase in promiscuity • refugee camps / tent cities - overcrowding • Deterioration of sanitary conditions • dependent on level of sanitation prior to disaster • Quality of water • Corpses are not vectors in transmission, the putrefaction germs are not particularly infectious • Interruption of normal primary health care and disease control activities

38. Diseases not present prior to disaster obviously will not be present after (i.e.: cholera) • Migration • Low local immunity to a pathogen brought into the community during migration • Post disaster: enhance surveillance of pre-disaster problem diseases • Mass post disaster vaccinations • false sense of security • poor record keeping • efforts should be focuses on non-disaster vaccinations of high risk populations

39. Infectious patients • WHO: "Natural disasters do not necessarily provoke epidemics, nor does the epidemiology of infectious illness vary from that before the disaster” • Cross contamination & Isolation issues • Timely identification of infectious diseases and isolation of the individual from the normal population • Special attention to the more vulnerable (old and young) • Aggressive control of enteric diseases (water, sewage, food handling)

40. Personal protection • Universal precautions are a must! • protective eye wear, clothing and gloves • The more forces involved in a disaster, relates to more trauma caused to victims and an increase in potential exposure to body fluids • All personnel must be aware of the infectious risk • disasters may occur in areas in which our suspicion of infectious potential is low • personnel should be monitored for adherence to universal precautions throughout the disaster response and recovery • Fatigue corresponds to increased risk of incidental exposure: Shorter shifts!