Community Emergency Response Teams - CERT - A National Strategy for Haiti Aldy Castor, M.D.

1. Community Emergency Response Teams - CERT - A National Strategy for Haiti Aldy Castor, M.D. President, Haitian Resource Development Foundation HRDF Director, Emergency Services, Association of Haitian Physicians Abroad (AMHE), Haiti Medical Relief Mission Prepared for the National Haitian American Health Alliance 7th Annual Conference, October 20-23, 2010Karibe Hotel, Port-au-Prince, Haiti

2. Modern society requires SAFETY - SECURITY - TRUST “When you’re out there lying dead on the road, you’ll want a coroner you can trust!” Old campaign slogan from Arkansas, USA where county coroners are elected officials.

3. Background The Haitian Resource Development Foundation (HRDF) was founded in 1987: - In the US, as a 501(c) 3 non-profit organization, with a United States Federal Tax I.D. Number - In Haiti, as a nongovernmental organization (NGO) that is registered in the archives of the Ministère de la Planification et de la Coopération Externe.

4. Since 2008, HRDF and its partners have trained Haitians in emergency medicine, primarily in the capital city area. Among the students have been medical and nursing emergency room staff of the Hôpital de la Communauté Haitienne [HCH] and emergency units of Haiti State University Hospital. Port-au-Prince firefighters have also received training.

6. COMMUNITY EMERGENCY RESPONSE TEAMS (CERT) The Creation of HRDF-CERT In 2009, HRDF began to create its own Community Emergency Response Teams (CERT) training program for Haitians. Four purposes of this program are to: 1. Educate communities about disaster preparedness for hazards that may impact their area, and trains them in basic disaster response skills, such as fire safety, search and rescue, team organization, and disaster medical operations.

7. 2. Use the training learned in the classroom and field to assist others in their neighborhoods and workplaces following an event when professional responders are not immediately available to help. 3. Encourage teams to complement emergency response agencies by taking a more active role in emergency preparedness projects in their community. 4. Inform their communities about the existing emergency services.

8. The Setting and the Need Community Emergency Response Teams are needed all across Haiti. The initial location for HRDF’s program was the south-central coastal community of Aquin, population approx. 100,000.

11. History For twenty-three years, HRDF has had a strong presence in civil defense and emergency response training, health and environmental research and development in Haiti’s southern peninsula.

12. Like many Haitian coastal cities, Aquin’s coastal zone is relatively narrow, only a couple of miles wide from the water’s edge to the deforested hills and mountains that rise above and surround the city. Rivers, streams and storm water ravines flow steeply from the mountains to the sea. Because of this, cloudbursts and seasonal storms often cause flash floods, with consequent loss of life and property.

15. Severe Mountain Trail Erosion

16. Severe Riverbank Erosion

17. The Flooding Consequence

18. And while there is a moderate-quality coastal road, it is not to highway standards. Thus, vehicular accidents are frequent, especially with trucks and buses, and evacuation routes during storms are few and far between.

19. Aquin-Miragoane Road

20. Four elements of a CERT program for Haitian communities are: 1. An academic and practical curriculum, 2. A training process, 3. Methods and operations that integrate with Haiti’s civil protection system for disaster preparedness, and 4. Adequate equipment and supplies, safely warehoused, to meet community emergency response needs during disasters.

21. The need is for local, first-response capabilities that include: - highly-trained and equipped staff and volunteers, - first aid supplies, - search and rescue tools and procedures, - all-terrain vehicles and boats, - communications equipment, - hand and power tools and electricity generators, - evacuation plans, - warehousing for equipment, supplies and inventory - planning, management and budgeting for comprehensive prevention, response and recovery.

22. The recommended training program: Duration: 3-4 consecutive months One three-day session every month The training program includes: - Safety - Search and rescue operations - Accidents - Basic medical care and CPR - Principles of organization: prevention, early alert, disaster management, mitigation - Simulation of disasters

24. Objectives: Community Emergency Response Teams will learn how to prevent and manage disasters and will be able to apply their expertise to: ü Support people in their neighborhood when professionals are not immediately available to assist them. ü Assist in various activities, such as public safety. ü Educate their community on how to prevent and manage disasters.

25. ü Inform their communities on the existing emergency services ü Serve as a support organization for the Direction of the Protection Civile, which is Haiti’s focal organization for emergency response.

26. Participants: Young residents of from 18 to 30 years old. The students will be recruited among these who had actively participated in social activities that had positively and objectively affected their community. Beneficiaries: The populations of Haiti’s communes [townships] who are chronically exposed to disasters, such as hurricanes, floods, drought, urban violence, etc.

27. Anticipated Results: To train fifty young Haitian men and women who, in turn, will serve as monitors to other local youth of the community to integrate a growing CERT team. Graduation and certification: At the completion of the course, an examination will be given. The passing students will be given a certificate recognized by the Ministry of Public Health and the Ministry of Interior.

28. Cost HRDF prefers that CERT training be offered at no cost to participants. By experience, each training program cycle (three, 3-day sessions) has cost HRDF approximately US$15,000, including staff expenses, teaching material, travel and student meals. These were paid for by tax deductible contributions and grants to HRDF.

29. Expansion potential With existing HRDF staff and format, sixteen training cycles a year are possible at a cost of approx. US$200,000. Additional teams can be formed to offer even more programs per year.

30. Limiting factors Proximate limiting factor - HRDF is willing and capable of conducting more CERT training, both in the southern region where it began and around the country if funds were available. US$ 200,000 would be enough to a) fully employ current staff, and b) graduate approx. 800 students per year. The investment is approx. US$250/student.

31. Ultimate limiting factor – Imagine a team of fifty HRDF-CERT graduates with the knowledge to protect their community, but without the requisite equipment, supplies, tools and replacement necessary to go into action. This is the ultimate limiting factor. Therefore, HRDF recommends adding a fourth session to its program cycle where the CERT team assembles, tests, uses and repairs a variety of vehicles, search and rescue equipment, emergency communications, computers, boats, earthmovers, bridges, drains, water filtration and sanitation apparatus, shelters, body bags, identification, etc.

32. This requires capital investment that is not only used for education purposes but also becomes lifesaving assets in the community. HRDF cannot turn a blind eye to this ultimate limiting factor. And as most emergency equipment and supplies are not manufactured in Haiti, another source can be through in-kind gifts, such as from the surplus and excess property of foreign governments and aid agencies.

33. Instructors: Qualified, candidate instructors may include: - HRDF volunteer physicians , nurses and volunteer firefighters from the United States, France and Haiti, - Instructors from Haiti’s Ministry of Health and from the Direction of Protection Civile of the Ministry of Interior.

34. After graduation The graduates will be able to support the Direction of the Protection Civile Office throughout Haiti in a program of prevention and management of disasters, and also assist their community in related activities.

35. Selected Components of HRDF’s CERT Training Curriculum

36. 1. Search and Rescue Search and Rescue is a broad topic that covers everything from searching for lost children to transporting disaster survivors to a treatment area. Every aspect of CERT training is used in Search and Rescue.

37. Search and Rescue involves three distinctly different actions: Scene Size Up – Assess the situation and build a safe plan of action. Search – Locate and document the location of survivors, or other items of interest. Rescue – Safely remove survivors from danger.

38. 2. Triage and Trauma Disaster medical assistance is based on two assumptions: - the number of victims will exceed the capacity for traditional response and treatment, and that - survivors will assist others. CERT increases the knowledge base to allow survivors to render additional assistance and possibly save lives while conserving community resources in time of disaster.

39. HRDF’s CERT teams are trained to provide: - Treatment for life-threatening conditions such as airway obstruction, bleeding and shock, and for other less-urgent conditions. - The greatest good for the greatest number of survivors by conducting simple triage and rapid treatment.

40. 3. Triage In a disaster, there will be more victims than rescuers, and immediate help may not be available. Haitian CERTs must be able to function quickly and efficiently to save lives. “Triage” is a French word that means “to sort.” During triage, survivors are evaluated, sorted by the urgency of the treatment needed, and classified as Minor (green), Delayed (yellow), Immediate (red), or Dead (black).

41. Triage has proven to be effective when - There are more survivors than rescuers - There are limited resources - Time is critical

42. 4. Medical Treatment After survivors have been triaged and taken to the medical treatment area, basic medical evaluation and treatment can begin. - Assess – head to toe - Alert - communicate with other rescuers, helpers and professionals - Attend – begin basic treatment, stabilize

43. 5. Disaster Psychology Disaster psychology is much more than caring for your victims. You will need to care for yourself and your team members as well. Know your limitations. Access - Scene size-up. “Are you in danger?” Alert - Prepare family and prepare to respond. Only respond if requested and if there is no danger to you, e.g. chemical, biological, radiological, geological. Attend - Be prepared to assist survivors.

44. 6. Organization Organization is a necessity in a mass-casualty situation. Organization is needed for every aspect of Haitian CERT, from the team approach to search and rescue to the organization of volunteers that show up on the scene. Being organized will keep rescuers and victims safe, provide clear leadership on the scene, and provide valuable information when professional responders arrive.

46. HRDF’s National Plan for Community Emergency Response Teams