Preplanning for EMS

205 Pages·2009·8.76 MB·English

AAOS
Warren Porter, MS, BA, NREMT-P, PNCCT
Garland, Texas
World Headquarters American Academy of Orthopaedic Surgeons
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Copyright © 2011 by Jones and Bartlett Publishers, LLC
All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including
photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner.
This textbook is intended solely as a guide to the appropriate procedures to be employed when rendering emergency care to the sick and injured. It is not
intended as a statement of the standards of care required in any particular situation, because circumstances and the patient’s physical condition can vary
widely from one emergency to another. Nor is it intended that this textbook shall in any way advise emergency personnel concerning legal authority to
perform the activities or procedures discussed. Such local determinations should be made only with the aid of legal counsel.
The AAOS and the publisher have made every effort to ensure that contributors toPreplanning for EMS materials are knowledgeable authorities in their
fi elds. Readers are nevertheless advised that the statements and opinions are provided as guidelines and should not be construed as offi cial AAOS policy.
The recommendations in this publication or the accompanying resource manual do not indicate an exclusive course of treatment. Variations taking into
account the individual circumstances, nature of medical oversight, and local protocols may be appropriate. The AAOS and the publisher disclaim any
liability or responsibility for the consequences of any action taken in reliance on these statements or opinions.
Additional illustration and photo credits appear on page 195, which constitutes a continuation of the copyright page.
Library of Congress Cataloging-in-Publication Data
Porter, Warren J.
Preplanning for EMS / Warren J. Porter, American Academy of Orthopaedic Surgeons. —1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-7637-4661-2
1. Disaster medicine—Planning. 2. Emergency medical services—Planning. I. American Academy of Orthopaedic Surgeons. II. Title.
[DNLM: 1. Disaster Planning—methods. 2. Emergency Medical Services—methods. 3. Planning Techniques. 4. Rescue Work—methods. WX 185
P849p 2010]
RA645.8.P67 2010
362.18—dc22
2 009040339
6048
Printed in the United States of America
13 12 11 10 09 10 9 8 7 6 5 4 3 2 1
Contents
Chapter 1: Introduction to Preplanning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Overview of Preplanning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
The “First Look” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
A Matter of Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Why Should EMS Be Responsible for Preplanning? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
How Preplanning Can Save Lives and Protect EMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
The World Is Changing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Principles to Live By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Chapter 2: Fire Department Experience in Preplanning . . . . . . . . . . . . . . . . . 9
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Gathering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Basic Preplanning Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Additional Benefi ts of Preplanning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Room for Improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Other Planning Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
A Word on EMS Preplanning Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
NIMS, Incident Command System, and Preplanning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Learning From Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Chapter 3: The Preplanning Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Beginning the Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Reaching Out to Other Response Agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Planning With the Goal in Mind . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
The Basic Principles of Preplanning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Making Plans Accurate and Accessible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Being Proactive in EMS Preplanning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Roadblocks to Preplanning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
The Need for EMS Preplanning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Use of Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
General Steps of the Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Chapter 4: Medical Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
EMS Preplanning for Medical Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Internal Disaster Plans for Medical Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Logistics Planning for Medical Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Incorporating Patient Tracking into an EMS Preplan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Coordination With External Agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Hazard Vulnerability Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Medical Facility Hazards Requiring Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
C hapter 5: Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Introduction to Preplanning for Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
Childhood Development and Cognitive Abilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
Planning for Emergencies Within the School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
Planning Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
Security Situations and Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
iii
iv Contents
Other Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Preparing for School Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72
Chapter 6: Mass Gatherings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
Introduction to Planning for Medical Care at Special Events . . . . . . . . . . . . . . . . . . . . . . . . .74
Goal of Providing Event Medical Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75
Negotiations for Event Medical Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76
Liability and Risk Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77
Level of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77
Planning Documents, Forms, and Record Keeping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78
Event Reconnaissance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
EMS Delivery: Point of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83
Accessing EMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
Contingency Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86
Preplanning Considerations for Special Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Chapter 7: Planning for Mass Medical Transportation . . . . . . . . . . . . . . . . . 89
Transportation Considerations During Emergency Response . . . . . . . . . . . . . . . . . . . . . . . .90
Evacuation Planning Assumptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90
Preplanned Transportation Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93
National Disaster Medical System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
Incident Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97
Standard of Care and EMS System Saturation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
Preplanning to Facilitate Effective Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101
Chapter 8: Shelters and Mass Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103
Introduction to Shelters and Mass Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103
Legal Authority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103
Shelter Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107
Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
Planning Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
Creating a Medical Needs Shelter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119
Incorporating Shelters into Preplans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127
Chapter 9: Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
Why Coordinate? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
Factors Impeding Preincident Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130
Facilitating Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131
Benefi ts of Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
Logistical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
Requesting Outside Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134
Coordinating With the Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137
Methods of Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137
The Importance of Effective Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
Chapter 10: Logistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
Introduction to Logistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
Assessing Current Logistics Capabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141
Logistics Preplanning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .144
Chapter 11: Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Administrative Buy-In and Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
The Preplanning Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152
Identifying Preplanning Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153
Evaluating Short- and Long-Term Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154
Contents v
Plan Developmental Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154
Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159
Current Administrative Posture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160
Unexpected Consequences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160
Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
Fulfi lling the Needs of EMS Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162
Chapter 12: Disaster and Pandemic Management . . . . . . . . . . . . . . . . . . . . .164
Planning for the Unimaginable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164
Common Elements of WMD Incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166
Responding to WMD Incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .168
Coordination for Disasters and Pandemics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169
Ongoing Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173
Planning for Mass Disasters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
References and Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187
Photo Credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .195
Acknowledgments
Jones and Bartlett Publishers would like to thank the following individuals for their contributions
to the manuscript:
Contributors
Raphael Barishansky, MPH, EMT-B Daniel Kane, M.Ed., RN, CEN, CCRN,
Chief, Public Health Emergency Preparedness CFRN, EMT-P
Prince George’s County Health Department Clinical Assistant Professor
Largo, Maryland MGH Institute of Health Professions
Boston, Massachusetts
Julia Diane R. Fox, M.Sc., NREMT-P, PI
EMS Preparedness and Training Manager, Christopher Maeder, EMT-P, CIC
State EMS Training Officer Captain
Indiana Department of Homeland Security Fairview Fire District
Indianapolis, Indiana Poughkeepsie, New York
Benjamin Gulli, MD Joe McConomy, MICP, EMT-B(I)
Northwest Orthopedic Surgeons Senior EMT Instructor
Minneapolis, Minnesota Burlington County Emergency Services
Training Center
J. Kevin Janney, BA, NREMT-P
Westhampton, New Jersey
Assistant Chief
Emergency Medical Services Program Manager John Slider
Navy Region Mid Atlantic Fire & Emergency CEO, Instructor/Coordinator
Services Matrix Training Center, LLC
Norfolk, Virginia Carson City, Nevada
Brian J. Williams, BS, NREMT-P, CCEMT-P Dean Vokey, B.Ed., ACP
EMS Chief Operations Supervisor Western, Field
Pembina Ambulance Operations
Pembina, North Dakota Emergency Medical Care, Inc.
Yarmouth, Nova Scotia
Reviewers Canada
Christopher Black Tim Witten, CSP, CFPS
Division Chief EMT-B Instructor
Gila River EMS Kentucky Fire and Safety Compliance
Gila River Indian Community, Arizona Bowling Green, Kentucky
Jon S Cooper, Paramedic, NCEE
Lieutenant
Baltimore City Fire Department
Baltimore, Maryland
vi
Author Biography
Warren Porter has over 30 years of experience with emergency medical services (EMS), in a
variety of positions. He has worked in the military as an infantryman and medic, and his work
experience includes positions at paid and volunteer fire departments as well as thirdservice
organizations in rural and suburban agencies. Positions held include field paramedic and
continuing education trainer. He has also worked as an educator and administrator in college and
fire services settings. Aside from his regular EMS duties, Warren directed mobile public health
clinics for Hurricanes Katrina and Rita, and served as the Evacuee Shelter Medical Operations
Director for Hurricanes Gustav and Ike. He has taught numerous EMS and disaster courses
internationally, is on theTexas EMS Magazine editorial board, presented at EMS conferences, is a
continuing education reviewer, has written several chapters for EMS textbooks, and was a subject
writer for the New EMS Education Standards. He holds a Master’s degree in Emergency Health
Services from the University of Maryland, Baltimore County.
vii

Chapter
Introduction to
Preplanning
Overview of Preplanning
To begin a discussion of preplanning in the emergency medical services (EMS), it is necessary to
first define preplanning and discuss its importance for emergency response at incidents or events.
Preplanning, simply put, is the process of planning before an incident or event occurs. This term
generally applies to larger events and incidents, rather than individual EMS calls. As a means of
ensuring efficient responses to future incidents, EMS personnel must consider the five “Rights” of
preplanning: The right response to the right incident, with the right resources for the right tasks
for the right patient.
Preplanning allows EMS to evaluate emergency incident factors that responders may or may
not have control over. Through the preplanning process, responders can develop logical steps to
follow to effectively deal with potential incidents. Although not every call for assistance is exactly
the same, many calls for similar events have common characteristics that allow EMS personnel to
plan ahead.
A common example from the patient care arena is a call for cardiac chest pain. Although not
all patients experiencing chest pain will require the same care, certain steps are routinely taken
in response to calls associated with chest pain. A patient assessment must be performed, oxygen
administered, an electrocardiogram (ECG) reading taken, and intravenous (IV) fluids possibly
administered for patients presenting with chest pain. Medications should also be administered to
effectively treat the patient: Bradycardic patients may receive atropine or transcutaneouspacing;
tachycardic patients with narrow complex waveforms may receive adenosine (Adenocard).
Regardless of which type of cardiac chest pain the patient has, the basis for
care is well established.
Preplanning takes into consideration commonly performed tasks,
Preplanning Practices
as well as the potential for specific patient or victim needs, and then asks
responders to evaluate the best way to accomplish care for a specific The fi ve “Rights” of
patient or group of patients. preplanning:
1. Right response
2. Right incident
The “First Look”
3. Right resources
4. Right tasks
Preplanning allows those who will respond to a specific event, such as a
5. Right patient
large concert or a large sporting event, to look at the site before they are
called to respond at the venue. This first look provides crews a chance