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Daniel Kollek, MD, CCFP(EM) Director, Centre for Excellence in Emergency Preparedness Chair – CAEP Disaster Committee Associate Professor, Division of Emergency Medicine, McMaster University. Definitions, Classification and Response Structure. Introduction to Disasters. Disaster.

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Introduction to Disasters

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Daniel Kollek, MD, CCFP(EM)

Director, Centre for Excellence in Emergency Preparedness

Chair – CAEP Disaster Committee

Associate Professor, Division of Emergency Medicine,

McMaster University

Definitions, Classification and Response Structure

Introduction to Disasters


Disaster

  • The Merriam-Webster dictionary definition of disaster is:"a sudden or great misfortune."

  • The Medical definition if a disaster is: "when the destructive effects of an event overwhelm the ability of a given area or community to meet the demand for health care."


How have health care systems dealt with disaster in the past?


September 11, 2001- NYC


September, 2002 - Jerusalem


2003-Toronto


What kind of disasters might we face and how do we assess our risk?


Natural disaster


Natural Events

  • Hurricane/Tornado

  • Severe Thunderstorm

  • Snowfall

  • Blizzard

  • Ice Storm

  • Earthquake

  • Tidal wave

  • Drought

  • Flood - external

  • Wild fire

  • Landslide

  • Volcano

  • Epidemic

  • Extreme temperature


Technological disaster


Technological events

  • Fire alarm failure

  • Communications failure

  • Medical gas failure

  • Medical vacuum failure

  • Info. systems failure

  • Fire – internal

  • Flood – internal

  • Hazmat exposure – internal

  • Supply failure

  • Electrical failure

  • Generator failure

  • Transportation failure

  • Fuel Shortage

  • Natural gas failure

  • Water failure

  • Sewage failure

  • Steam failure

  • Structural damage


Man-made disasters

Anthrax envelope - 2001


Human events

  • MCI – Trauma

  • MCI - Medical

  • MCI – Hazmat

  • Hazmat – external

  • Terrorism – chemical

  • Terrorism – biological

  • Terrorism - radiological

  • VIP situation

  • Infant abduction

  • Hostage situation

  • Civil disturbance

  • Labor action

  • Forensic admission

  • Bomb threat


For each event you must assess risk

  • What is the probability of occurrence?

  • What impact would it have?

  • What is your preparedness?

A formal risk assessment tool is available at www.ceep.ca


What are the characteristics of disasters?


A disaster can have multiple settings


A disaster often has multiple patients


The Patients:

Tokyo Sarin attack 1995:

  • >5800 victims

  • 12 deaths

  • 17 critical patients

  • 37 severe patients

  • 984 moderate patients

  • 4793 “worried well”


A disaster always has multiple players


The Players:

  • Police

  • Fire

  • EMS

  • Hospitals

  • Volunteers

  • Public health

  • Elected officials

  • Civil servants

  • Utilities

  • Transit

  • Provincial / Federal agencies

  • Media


A disaster can have variable timelines


Static timeline


Dynamic timeline


and despite the range of possible events,

disaster response has more commonality

than event specific characteristics.

Whatever the case,


What do you need in a disaster?

  • Information

  • Guidance

  • Money

  • Supplies

  • Equipment

  • Human Resources

and……

A system to deliver this to you in a useful fashion


IMS is the system


IMSIncident Management System

Incident Management System is

a method of coordinatingparts of one agency or many agencies in a

unified command structureto

use all available resources

in the effective and efficient response to an emergency.


The Eight Components

of Incident Command Systems


IMS - Components

  • A unified command structure

  • Common terminology

  • Modular organization

  • Integrated communication

  • Consolidated action plans

  • Manageable and sensible span of control

  • Designated facilities

  • Comprehensive resource management


IMS Basic Structure


Incident Commander

  • Most senior trained responder

  • As incident develops, falls back to established command on-site

  • Eventually may fall to Senior Command off site (Emergency Operations Centre)


Operations

  • Implements response activities as determined by Incident Manager

  • Maintains communication between Command and site

  • Requests and assigns resources as directed


Logistics

  • Support Operations

  • Allocate resources and provide all materials, equipment, and personnel required

  • Application of additional resources provided by Mutual Aid


Planning

  • Control and flow of all information

  • Data collection, analysis and forecasting

  • Development of response and recovery objectives and strategies

  • Mutual Aid Requests


Finance

  • Tracking of expenses

  • Funding

  • Government Financial Aid requests

  • Financial Aid distribution


IMS - Components

  • A unified command structure

  • Common terminology

  • Modular organization

  • Integrated communication

  • Consolidated action plans

  • Manageable and sensible span of control

  • Designated facilities

  • Comprehensive resource management


Job Action Sheets


IMS Structure


IMS Expanded Structure (1)


IMS Expanded Structure (2)


Proposed Hospital IMS Structure For Ontario Hospitals

Legend:

The Colour Code Triage (Yellow, Red, Green, Black) is universally accepted and consistent with Triage Codes used by EMS in the field when addressing large scale emergencies


IMS - Components

  • A unified command structure

  • Common terminology

  • Modular organization

  • Integrated communication

  • Consolidated action plans

  • Manageable and sensible span of control

  • Designated facilities

  • Comprehensive resource management


Designated Facilities

  • Emergency Operations Centre (EOC)

  • On-site Command Post

  • Staging Areas

  • Triage Area

  • Resource Storage

  • Morgue


Primary Response Command

(Initial Command Centre)

On-site Command

(Secondary)

EOC

Off-site Command

(Final)


Summary


We need to formally review our disaster risks in order to prepare a plan


There are common threads in all disaster responses


IMS is the system used for command and control of a disaster response


IM Systems have standard components


IM Systems have a standard command structure


IMS will have job action sheetsand a planning cycle


Do it right and you will become the…


www.ceep.ca


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