EMS Special Operations

1. 19 EMS Special Operations

2. Learning Objectives 19.1 Explain the new mission of customer service in an all-hazards environment. 19.2 Describe the risk analysis process. 19.3 Describe the mitigation role of local community officials as it relates to EMS response.

3. Learning Objectives (Cont.) 19.4 Define an all-hazards approach and apply a checklist to preparing special events. 19.5 Given a medical evacuation of a patient by helicopter, identify the elements that affect or support local EMS special operations.

4. Learning Objectives (Cont.) 19.6 Identify existing documentation resources to use for special operations during a special event. 19.7 Identify the methods for developing and accessing state or statewide regional resource pools. 19.8 Contrast the missions of tactical EMS.

5. Learning Objectives (Cont.) 19.9 Analyze the role of EMS in a special- operations environment as it relates to the medical support of hazardous materials operations. 19.10 Explain the medical-legal issues involved in spectator care at mass gatherings. 19.11 Discuss the process for implementing care systems at mass gatherings.

6. Importance of Special Operations • Often EMS is asked to provide care at events that require unique resources, system management, and control • EMS managers need to prepare their organizations to respond to such events by: • Identifying potential hazards • Determining potential resource needs

7. Importance of Special Operations (Cont.) • EMS managers need to prepare their organizations to respond to such events by: • Determining how those resources may be acquired • Developing a plan that enables the effective, specialized control of these events in concert with law enforcement and fire services resources

8. Special Operations • When creating special operations within an organization, three common characteristics must be identified: • Purpose • Will require a tremendous commitment of personnel and money

9. Special Operations (Cont.) • When creating special operations within an organization, three common characteristics must be identified: • Resources • Are human, physical, or financial • Structure • Incident Command System (ICS) • Pre developed response plans • Ability to form unified command structures

10. Emergency Medical Services Pre-Event Planning • EMS pre-event planning activities • Hazard • A situation or event that can cause a loss • Vulnerability • The people, places, or things likely to incur a loss, should the hazard actually occur, if no protective action is taken to minimize or eliminate the loss • Risk • Risk is that vulnerability that remains

11. Risk Assessment • Hazard/risk assessment • The analysis of hazards, vulnerabilities, and risks • Determination is made as to who is vulnerable and the likelihood of harm is assessed

12. Managing EMS Special Operations • Four steps for managing the effect of hazards upon communities: • Mitigation • Proactive, protective measures used to reduce the vulnerabilities or potentials for loss • Preparedness • Identifying at-risk populations, prioritizing their EMS needs, and developing, in advance, the resources necessary to meet those needs

13. Managing EMS Special Operations (Cont.) • Four steps for managing the effect of hazards upon communities: • Response • Activities that we implement as a direct result of the occurrence of the hazard • Recovery • Restore the infrastructure and social and economic stability to the community after the effect of the hazard

14. EMS "All-Hazards" Approach • All-hazards approach is a process by which we identify within our communities the hazards that we will face • Identify and quantify those persons or segments of the population that are vulnerable to the hazards • Refine the projected vulnerabilities after mitigation actions have been identified

15. Pre-Event Planning Matrix • Choose the risks, hazards, or functions that are likely to be required by an event • Assign each to a primary agency (P) or a secondary or support agency (S) • The functions and responsibility assignments must be discussed and decided in the planning stages, not when an incident occurs • Additional room is provided in the matrix to add agencies or risks/functions as they may apply

16. FIGURE 19.1Pre-Event Matrix Worksheet.

17. FIGURE 19.1 (Cont.)Pre-Event Matrix Worksheet.

18. TABLE 19.1Legal Influences on EMS Response to Special Operations

19. Plan Components • Plans have common characteristics that include: • Hazards analysis; • Vulnerability analysis; • Basic plan consideration; • Resource identification; • Support functions or mechanisms for resource deployment; • Recovery activities

20. Customer Expectations • Demands upon organizational resources are constantly increasing because of increased customer expectations • There is a requirement to assemble greater and greater resources to manage special operations and unique events that may occur in our communities

21. Customer Expectations (Cont.) • We must identify in advance additional resources that we can bring to bear on virtually any type of event to which we may be called to assist

22. Customer Expectations (Cont.) • In order to accomplish this, EMS leadership must: • Identify potential hazards • Determine the at-risk populations for each of those hazards • Identify the resources that would be required to manage events caused by those hazards

23. Customer Expectations (Cont.) • In order to accomplish this, EMS leadership must: • Determine what assets and voids are in the resources we have • Find resources to fill those voids • Develop a methodology for deploying those resources to a particular event

24. Mutual-Aid Agreements • Mutual aid • Command officers required to make specific requests for special-operations equipment • In many areas these resources will take time to assemble or will have to travel long distances to get to the scene

25. Mutual-Aid Agreements (Cont.) • Automatic aid • Inter-local or mutual-aid agreement in which the dispatch center without a command officer’s input can send or request equipment based on the information from the call to the public-safety answering point

26. Disaster Condition • A disaster or emergency may overwhelm the capabilities of a state and its local governments, preventing them from providing a timely and effective response to meet the needs of the situation

27. Disaster Conditions (Cont.) • A disaster or emergency has the potential to cause substantial health and medical problems, with hundreds or thousands of deaths and injuries, depending on factors such as time of occurrence, severity of impact, existing weather conditions, area demographics, and the nature of building construction

28. Disaster Conditions (Cont.) • A disaster or emergency may cause significant damage particularly to the economic and physical infrastructure

29. Level of Care • Levels of care at special events or mass gatherings may include: • Basic first-aid or pre-EMS certifications • Intermediate first aid plus IV therapy and oxygen • Advanced care and life support and early management of severe trauma • Site hospital full monitoring and ventilation; a surgical facility may be required depending on the level/type of event

30. Level of Care (Cont.) • Other level-of-care concerns including training staff, specialized rescue teams (i.e., Justin Sports Medicine for PRCA rodeo events, paramedic standby for the International Speed Boat Racing Association, extrication team for CART professional racing)

31. Main Concerns in Planning Medical Care • Factors to be considered in an event setting: • Indoor versus outdoor • Access routes to and from the site • Size of the crowd • Duration of the event

32. Main Concerns in Planning Medical Care (Cont.) • Factors to be considered in an event setting: • Extremes in temperature • Mobility of the crowd • Number and visibility of the aid stations and medical-treatment facilities

33. Logistics • Consider staffing a medical logistics position when planning a large event • Arrangements for facilities will be needed for medical personnel to operate in an environment in which the injured must make their way to that location • Make sure medical teams that patrol spectator areas are clearly identifiable • Alternative vehicles need to be available to transport spectators to the medical facility

34. Logistics (Cont.) Consider staffing a medical logistics position when planning a large event Determine how medical personnel will be notified of, or summoned to, spectators requiring assistance in public areas

35. Medical Access to Venue • Agreements must be reached among medical service providers on how medical teams will be able to locate individuals in need of attention • Agree on the use of a common reference map or grid system

36. Medical Access to Venue (Cont.) • Determine how medical teams will reach or rescue individuals in distress; for example, in crowded areas or through fixed seating • The mechanism of how patients will be transported on site should be worked out

37. Medical Requirements • Should prepare for the most critical injury or illness foreseeable, such as cardiac arrest • Assessments should be made for the needs for a mobile team • Mobile teams may require pre-packed medical kits • A determination should be made as to which mobile teams will provide care for the audience, any VIPs, and performers

38. Medical Requirements (Cont.) • The boundaries of what kind of care and services will be provided to the event should be defined

39. Medical-Aid Stations • Mobile teams will often move patients to the medical-aid stations prior to the arrival of a transport vehicle • Consider the establishment of medical- aid posts at large events or events that may take a significant amount of time for an ambulance to arrive

40. FIGURE 19.4Characteristics of a Medical-Aid Station

41. Site Hospital • Depending on the nature of the event, a site or field hospital may be needed to provide care for the number of casualties anticipated • You should also make contingency plans in case of a major incident, for which the resources of the field hospital may not be sufficient

42. Site Hospital (Cont.) • Failure to plan for large numbers of casualties or severely injured patrons can result in long delays in providing medical treatment • It is important to provide a communications link between the site hospital and local hospitals

43. Medical Equipment • The requirement for basic or advanced life support equipment depends on the type of event and the assessed risk of illness or injury • Equipment considerations include identifying where the equipment should be mobile versus fixed and arrangements to resupply aid posts as required

44. Medical Equipment (Cont.) • Compatibility of on-site equipment with equipment used by ambulance and other health-care providers should be evaluated for inter-operability

45. Documentation • A post incident analysis of the event and review of the number of requests for medical assistance that occurred at the event should be completed by EMS management • Tracking should be done of biological, chemical, and infectious-disease exposures should they occur

46. Documentation (Cont.) • Medical-legal issues, which must be addressed prior to the preparation of any documents, are as follows: • Who has access to records? • Who keeps the data and for how long? • Who can give consent for treatment? • Every patient contact should be documented and recorded

47. Legal Issues • Legislation usually governs or restricts public events or aspects of them • Some events that are extremely large or high impact require special state or local legislation • Local ordinances provide health and medical guidelines

48. Legal Issues (Cont.) • An event should cover a variety of liabilities that warrant consideration, including: • Liability for injuries • Liability for acts or omissions • Liability for financial obligations incurred in responding to major emergencies occasioned by the event • Potential liability for the resultant effects of the event on normal emergency operations

49. Site • Finding a suitable venue or set of venues can be difficult; the following questions will aid in the selection of an appropriate event site: • Will staging the event require multiple venues? • Is this kind of event normally conducted at a fixed facility? • Will a fixed facility be used in ways that may not be considered normal for that facility?

50. Site (Cont.) • Is the event regularly conducted at a temporary venue? • Is the event a “one-of-a-kind” project at a temporary venue? • What services/utilities are available at the venue? • What additional services and utilities will be required at the venue? • Is there a need for backup services or utilities?