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CHAPTER 4

FIRST RESPONDERS
Dario Gonzalez

L OCAL RESOURCES, such as ambulance and fire services, as well as


specialized teams, are the first organized responders to arrive at a
disaster site. After the immediate actions provided by the citizens of the
affected area, the first responders provide the
initial medical care to the victims. First-responder tasks include removing the
victims from exposure to any hazardous materials or collapsed structures,
prioritizing those victims that are in need of medical care, and transporting them
to appropriate healthcare facilities. Depending on the magnitude of the disaster,
and despite their sometimes Herculean efforts to manage the scene, these services
quickly can become overwhelmed and depleted. Local emer-gency management
officials also assist by providing oversight to ensure coor-dination and
distribution of available local assets.

OBJECTIVES:

➣Understand the goals of emergency medical services activities at the disaster scene; ➣
Discuss the roles of the various first-responder agencies and teams;
➣Describe the five key pieces of information for the hospital nurse to obtain from the field; and Discuss local
emergency management’s disaster role, including its relation to health care.

Hospital staff require a clear understanding of prehospital operations to


ensure that their actions complement field activities. Also, in a disaster setting,
victims may self-present in mass to the hospital with minimal or no field assess-
ments or interventions. Nurses may respond to a disaster site to augment emer-
gency medical services resources and may provide the first and, for a period of
time, the only medical care that the victims receive; in this setting, basic knowl-
edge of prehospital operations and incident operations is critical. Furthermore,

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if the hospital becomes damaged during the event, the nursing staff may need to
lead or coordinate directly with field agencies in triage, assessment, evalu-ation
and evacuation of victims and staff.

EMERGENCY MEDICAL SERVICES


Ambulance services, called emergency medical services (EMS) in many parts of
the world, are responsible for the initial care of victims at the scene of an event
and their transport to healthcare facilities. There is considerable variability
among these services; they may be affiliated with community fire services or
gov-ernment entities, or they may be operated as private businesses. The EMS
staff may include various healthcare providers (physicians, nurses, paramedics,
or emergency technicians) with different skill sets; and they may be paid employ-
ees or volunteer staff. These trained healthcare providers can arrive on the scene
by a variety of methods, including ambulance, fast response car, bicycle, moped,
helicopter, fire engine, or even on foot.
The core role of EMS in the prehospital phase of patient care management
includes four basic functions:
1. Prevention of additional injuries;
2. Rapid transportation of the victims to the hospital (this does not
necessarily mean rapid treatment; delivery to the definitive care
setting is preferable);
3. Advance notification to the receiving hospital; and
4. Triage and emergency treatment (necessary life-saving and/or
stabilizing care).
EMS prehospital personnel are known by a wide array of titles throughout
the world. Basic care providers are known as Emergency Medical Technicians
(EMTs) in the United States, as Emergency Medical Responders (EMRs) in
Canada, as Rettungshelfers (RH) in Germany, and as Ambulance Officers in
Australia. Advanced care skills generally are provided by paramedics, although
some countries, such as Canada and Australia, have different levels of para-
medics, and in countries such as Germany and France, physicians or nurses
routinely provide advanced care in the ambulance setting. Specialized care, such
as administering thrombolytic drugs, is within the skill set of South Africa’s
Emergency Care Practitioner, and the United Kingdom’s similarly titled pro-
vider can perform minor surgical procedures in the field. Typically, first respon-
ders are fire personnel with limited basic care training.
Regardless of the particular title, ambulance systems are based on the
established skill levels of the accompanying staff. The differentiation of these
skill sets usually is based on advanced skills, i.e., Advanced Life Support (ALS),
vs. Basic Life Support (BLS). These skill sets are compared in Table 4.1.

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SKILL BASIC ADVANCED

Fire Responder Ambulance Staff


Airway Non-invasive method Non-invasive method Endotracheal/nasal
management (bag-valve-mask) (bag-valve-mask) intubation, needle
tracheostomy, drug-
assisted intubation
(Etomidate), chest
needle decompression
for tension
pneumothorax), CPAP

Intravenous No intravenous access No intravenous access Intravenous


access cannulation, saline
lock, intraosseous
infusion

Defibrillation Automatic External Automatic External Manual defibrillation,


and cardiac Defibrillator (AED), Defibrillator (AED), 3- and 12-lead ECG,
monitoring no rhythm monitoring no rhythm monitoring external pacemaker,
or assessment or assessment synchronized
cardioversion, rhythm
interpretation

Medication No medication Limited medication Most cardiac


administration administration other administration: medications:
than oxygen nebulizer for wheezing (Amiodorone,
(asthma), aspirin, Atropine, Diltazam,
nitroglycerin, oxygen Vasopressin,
Adenocard, Atropine),
Calcium Chloride/
Gluconate
Controlled
substances:
Morphine, Valium,
Lorazepam,
Midazolam, Steroids,
Magnesium
(Preeclampsia),
Pitosin

Training 40 to 50 hours Approximately 109 Varies according


to 300 hours; to program: 400 to
1,500 hours
CPR trained
Advanced Life Support
(ALS), Pediatric
Advanced Life Support
(PALS) or equivalent

Table 4.1: Comparison of Advanced Life Support (ALS) skills with Basic Life Support (BLS)
skills. (AED = automatic external defibrillator; ECG = electrocardiogram; CPAP =
continuous positive airway pressure)

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It is a common misconception that most prehospital EMS systems are ALS-


based; in fact, the more common model is a BLS-based system augmented with
varying ALS skills.

EMS Responses in a Disaster


In addition to their usual emergency responses, prehospital EMS provide the pri-
mary, official, medical responses to a disaster setting. The following describes the
different types of emergencies and disasters and their impact on EMS operations:
1. Multiple casualty incident (MCI):
a. An MCI involves >5 victims, requires a potential change in
routine daily operational procedures, and may impact other
local 911 EMS activities (i.e., ambulance availability).
Supervisory personnel are involved to assess the situation.
b. The system may be stressed, but is not overwhelmed.
An example of an MCI is a bus accident or a motor vehicle incident with mul-
tiple casualties.
2. Mass casualty:
a. The number and nature of presenting victims in a given time period
exceed the local EMS system’s capability to provide appropriate, usual
practices of time-sensitive care or the transport of victims.
Examples of a mass casualty include the collapse of a sports stadium with
multiple victims, a tornado in a rural community, or the bombing of a heavi-ly
occupied public building.
3. Medical disaster:
a. An event in which the immediate medical demands
(transportation or care) overwhelm the existing and/or
available emergency resources in the area;
b. External assistance, including state and/or federal resources. Examples
of a medical disaster include the situations following the Asian tsu-nami and
Hurricane Katrina.
The overall goals of EMS activities in a disaster are to:
1. Safely and rapidly evacuate casualties from a hazardous area to
a safe zone (may precede care delivery);
2. Safely and rapidly transport casualties from the incident site to a
definitive medical facility;
3. Effect an overall reduction in morbidity and mortality for injured
patients;
4. Provide safe, rapid, and effective evacuation with the lowest
possible victim mortality through appropriate transport priority
selection; and

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COLOR CATEGORY CLINICAL STATUS TRANSPORT STATUS

Black tag Category 0 Non-viable/ Do not transport or


Dead/Nearly dead provide care

Red tag Category 1 Most critical Immediate transport

Yellow tag Category 2 Not as severely injured Limited transport delay


acceptable

Green tag Category 3 Walking wounded Non-ambulance transport


acceptable

Table 4.2: EMS field triage descriptions

Casualty Treat &


Collection Release
Point
Treatment
Hot Zone Green Transportation

Incident Treatment Casualty


Triage Red Collection
Point

Yellow Treatment
Transportation
Black

Transportation Casualty
Collection
Point

FIELD TRIAGE PROCESS

Figure 4.1: Schematic depicting the field triage process and possible designated sec tors

5. Provide mass casualty disaster triage, which:


a. identifies the most salvageable victims;
b. varies according to the number of victims and availability of
medical resources;
c. requires frequent reassessments and reclassification; and
d. varies as a function of disaster site, scope, and magnitude.

Under normal circumstances, EMS staff initiate field triage and establish an
organizational command presence. The actions at the scene of a disaster or mass-

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SECTOR FUNCTION

Command post Area where Incident Command senior supervisors


manage the event

Staging location Destination point for arriving EMS services (not at the incident
site)

Transportation Location from which ambulances will depart with patients being
transported to the receiving healthcare facilities or other
designated receiving facilities

Treatment On-scene, safe area where medical care is rendered to victims


of the incident. (Normally on-scene care is provided by
prehospital personnel, but in the event of an overwhelming
event, assistance may be provided by hospital-based nurses
or doctors.)

Triage Location where patients are sorted according to their treatment


and transport priority classification

Medevac/Landing zone Designated location for helicopter operations

Casualty collecting point(s) Location(s) where victims are sequestered (after triage)
according to their triage level. Care may be provided in this
area and it can serve as a pre-transport staging victim
collection area as well. Ideally, the Red-tagged victims should be
removed immediately and not wait in a casualty collection area
(assuming sufficient transportation resources).

Morgue Designated, isolated area for the on-site collection of incident


fatalities. An isolated area allows for the initiation of on-scene
forensic examination without the need for immediate
transport from the scene.

Hot zone/Exclusion zone The incident exclusion zone where the potential for worker
injury or exposure is high.

Table 4.3: Designated organizational sectors and their prescribed function

casualty incident (MCI) are directed at establishing a command and control pro-
cess for all EMS activities. This process begins with the first arriving EMS unit,
which assumes the responsibility of establishing a triage area and communicating
with the on-scene emergency responder Incident Commander (e.g., fire or po-
lice). The goal of this initial triage is to determine or estimate the number of vic-
tims and potential victims, and their general triage categories (Table 4.2).
Field EMS triage is a process by which patients are categorized on the basis
of medical transport acuity (Figure 4.1). The purpose of this triage process is to
ration limited medical and transportation resources to effect the most good for the
greatest number of victims.
The initial EMS crew communicates with the dispatch system and pro-vides
an immediate, on-scene status report. This allows for the dispatching of
necessary EMS resources and additional administrative personnel. This also

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begins the process of assessing the current status and capabilities of the local
hospitals and specialty resources (i.e., burn and trauma centers).
It is not the function of the initial, responding EMS crew to begin the
transport or immediate treatment of on-scene victims. Their initial priorities are
administrative, providing triage and essential communications until addi-tional
resources arrive at the scene. Often, this is a frustrating time for EMS personnel
and other emergency response personnel whose natural reaction is to assist
victims; however, it is necessary to ensure that all patients are accounted for and
correctly triaged, and that command is established to coor-dinate other arriving
EMS units and resources.
Once other EMS resources have arrived at the scene, the organizational
process begins by establishing the required sectors to manage the situation. These
sectors are outlined in Table 4.3, and may vary depending on the scope and
nature of the incident.
Health care at the scene of a disaster normally is limited to basic life sup-port
services. Intravenous medications and endotracheal intubation are late treatment
options depending on the number and degree of injuries and the available
emergency care providers. This limitation of care requires that hos-pital
personnel be prepared to provide immediate and aggressive interven-tions of
transported victims.
Mass-casualty disaster triage has very specific, yet limited, goals: to iden-tify
the most salvageable victims and deliver them to definitive medical resources.
Additionally, the EMS system is responsible for the transfer of a large number of
victims to a limited number of hospitals. This may require the transport of
victims to facilities beyond the immediate region based on frequent hospital
status updates.

Scene Difficulties
Delays in the transportation of victims should be expected; the first patients
transported by EMS likely will begin to arrive at the hospital within 90 min-utes
after the event. Transportation delays are an inevitable consequence of standard
operating EMS procedures compounded by scene confusion, scene assessment,
and the establishment of safe areas of operation. Access to the immediate disaster
area and to the victims may be delayed due to physical barriers or distant
locations (e.g., subway or train tunnel), as well as concerns of potential,
secondary, explosive devices or structurally unsafe areas.
Other common problems at mass-casualty incident sites include:
1. Failure to organize and separate victims based on triage categories;
2. Failure to transport critical Category 1/Red tag victims as soon as
transportation resources allow;
3. Failure to establish a safe, efficient, and appropriate patient

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treatment area(s) that is out of the immediate hazard zone, yet


easily accessible to transportation resources;
4. Premature transport of stable (Category 3/Yellow tag) victims;
5. Delayed request for additional resources and failure to foresee
potential needs for specialty resources; and
6. Inadequate and inefficient communications from the disaster site —
a recurrent problem identified at every disaster critique.
Communications
One of the first systems to fail during a disaster is the communications system. All
hospital staff should work under the presumption that early and predictable com-
munications from the disaster site will not occur. Typically, notification of the event
becomes manifest with the first wave of arriving or transported victims to the facil-
ity. In a catastrophic event, prehospital EMS activities, such as developing a manage-
ment strategy and implementing organized rescue actions while trying to control the
scene chaos, may take priority over communication with local hospitals. In addition,
EMS systems possess limited capability to communicate by radio with other emer-
gency response agencies (i.e., fire and police) and may not be able to provide com-
plete information about the event to the hospital. The use of mobile phones also is of
limited value as the inevitable and consequential increase in mobile call volume by
the affected community overloads the system. Most EMS systems do not have emer-
gency priority, i.e., dedicated, emergency cell channels, and, thus, can become
blocked out by public cell phone overload at or near a disaster site.
From the hospital’s point of view, early and accurate information allows for
better hospital preparedness. When and if possible, the hospital staff should ask lim-
ited, but focused, questions of EMS personnel. Necessary information includes:
1. The type and location of event (i.e., explosion, fire, bus/train/plane
accident, hazardous materials, actual or potential terrorist incident);
2. The potential number of victims and their general categories
(i.e., critical, ambulatory);
3. The general type and nature of the injuries (i.e., burns, blast,
penetrating trauma, inhalation); and
4. The population demographics (i.e., pediatric, adult, elderly, dialysis,
special needs).
Hospital administration should provide a dedicated communication channel
through which the hospital can monitor the event. It is critical that the hospital’s
request for information be brief and specific with minimal repeated requests for
information. Emergency department nursing staff should not become frustrated
or demand further information from or periodic contact with EMS personnel. As
conditions become stable and safe, the information becomes more forthcoming
and at more frequent intervals. The key to field disaster communication is

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careful disaster planning and preparedness incorporating the EMS along with the
medical infrastructure.

FIRE DEPARTMENT FIRST RESPONDER ROLE


In a disaster setting, fire departments play a number of roles, although their
primary and immediate tasks are the mitigation and control of the immediate
consequences of the event. In the case of a terrorist bombing or industrial
catastrophe, this may involve fire suppression in order to make the environ-ment
safe for rescue operations. Their subsequent roles include the search for and
rescue of trapped and injured victims, and assisting in victim removal to
established medical facilities or treatment areas.
The Fire Department’s first response role is to support the field emergency
medical care providers (i.e., ambulance services) by providing additional per-
sonnel and resources that enable the emergency care providers to perform their
medically directed or basic triage functions. Typically, the firefighter’s medical
training is limited to basic medical skills, although some fire agencies have para-
medics on board the fire apparatus.
Traditionally, the transportation of patients to the medical facility occurs via
established ambulance providers, but in a catastrophic event with over-whelming
numbers of victims, firefighters may transport victims to healthcare facilities. In
this case, information from the transporters may be limited and medical insight as
to the victim’s clinical status may be lacking. The hospital receiving nurse should
be prepared to re-triage rapidly upon the arrival of crit-ically injured victims
transported in this manner.

HAZARDOUS MATERIALS (HAZMAT) TEAM


The response to hazardous materials at the scene is the responsibility of a Hazardous
Materials (HazMat) Team, comprised of specially-trained fire depart-ment personnel.
In general, hazardous materials are materials that are capable of causing injury to
individuals or to the environment. Decontamination is performed by the HazMat
Team to reduce or eliminate the danger(s) to exposed victims and personnel, and to
avoid spreading contamination beyond the immediate scene. The result of a natural
or terrorist event may require that the process of decontamina-tion or contamination
reduction be implemented immediately at the scene.
Upon arrival, the HazMat Team performs a scene evaluation during which they:
1. Identify any life threats to responding emergency personnel;
2. Identify any life threats to victims within the identified area;
3. Identify the offending substance, if possible;
4. Measure and monitor the levels of multiple gases: oxygen, com-
bustible gases (e.g., methane and propane), carbon monoxide, and
hydrogen sulfide;

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5. Measure and monitor radiation sources and the presence of suspicious


gases (e.g., organophosphates and chlorine);
6. Determine the appropriate type of protective respirator and chemical
suit required by emergency responders; and
7. Determine the need for decontamination, i.e., the removal of
contaminants by washing the victims prior to transport.1
Field decontamination procedures normally involve an unclothing process in
a privacy tent. Victims enter the decontamination zone, remove and bag all their
clothing, then proceed through the showering process. Thereafter, they can be
transported to a healthcare facility for assessment and definitive care.
In the event of a mass-casualty incident, in which large numbers of indi-
viduals are exposed to a chemical, biological, or radiological source, the field
decontamination process becomes more of a “contamination reduction” effort
rather than the complete removal of all contaminants from all patients; fire trucks
with spray hoses may be utilized to provide mass decontamination. Most
contamination can be reduced 85–90% by simply removing the outer clothing
2–5
from exposed victims. However, receiving hospitals must be pre-pared to
monitor the victims as well as the staff for signs of exposure, should the
contamination reduction not have been sufficient, or if a victim has some-how
eluded the contamination reduction process.
Theoretically, only fully decontaminated patients should be transported by
EMS. However, in the 9/11 terrorist attack in New York City, grossly “dust
contaminated” victims arrived at area healthcare facilities via EMS; victims had
not undergone any decontamination or contamination reduction process, re-
sulting in dust contamination of the receiving healthcare facilities. However, this
did not result in facility shutdown or known staff injury.6
Victims who are unable to remove themselves from the contaminated envi-
ronment will be removed by Fire Department personnel in the easiest and
quickest manner without immobilization or even the administration of oxy-gen.
This is under the premise that the best immediate medical care for these victims
is rapid removal from the contaminated environment.

URBAN SEARCH AND RESCUE TEAMS


Urban Search and Rescue (US&R) teams, also known as “USAR,” are rescue
specialists trained to work within collapsed zones and hazardous environ-ments
to recover victims. Additionally, team members have the training and capability
to operate in contaminated environments, e.g., a biological, radioac-tive, or
chemical incident.
Many countries have US&R teams with both national and international
deployment capabilities. Presently, within the United States, there are 28 deploy-

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NYC EMERGENCY MANAGEMENT


During the 9/11 terrorist attack, the New York City (NYC) Office of Emergency Management (OEM), located at

7 World Trade Center (WTC), was destroyed. The agency ultimately established its operations at a local

ship/passenger liner terminal (pier). The OEM continued to function out of this location and coordinated the

response to the NYC/WTC crisis and the subsequent anthrax events of 2001. The OEM provided medical

coordination with the NYC Commissioner of Health and served as the liaison between the city government and

the NYC healthcare system. In addition, it hosted, served as a link, and provided logistical support to a senior

medical advisory group composed of a cross-section of city healthcare providers, both for the Mayor and the

Commissioner of Health. The purpose of the group was twofold:

(1) to assist the city in developing an anthrax medical response plan; and (2) to provide public communica-

tion for the media. The OEM also assumed the role of assisting and facilitating the other emergency

response agencies in their activities.

One issue that was revealed in the aftermath of the 9/11 attacks was the need to address the concerns
and needs of the corporate sector of the community. The loss of this sector could have had devastating
consequences to the economy of NYC. It was necessary to coordinate and facilitate activities with the

corporate sector in order to reestablish vital city services and a sense of “normalcy” to the community.
Moves were made to assist the business sector in such a way as to allow them to re-establish the provi-
sion of their services and return to normal business activities.

In addition, the OEM was responsible for coordinating large numbers of volunteers and response
agencies and collaborated with other city agencies to create the Family Assistance Unit. The latter
provided families a single location from which to achieve information and assistance immediately following

the events of 9/11.

able teams operating under the direction of the Federal Emergency Management
7
Agency (FEMA). In Australia, there are US&R teams throughout the states and
8,9
territories. The Japan Disaster Relief Team’s Search and Rescue Unit has
responded to earthquakes in Indonesia, El Salvador, and Turkey.10
Due to the relatively late arrival of US&R teams, most disaster victims will
have been removed from a disaster site by local fire department personnel or by
citizens prior to first-responder arrival. However, US&R teams have evolved into
primary response groups for large-scale events, such as terrorist events and disas-
ters from natural causes, when there are long-term and/or overwhelming needs
for rescue teams. In the United States, US&R team deployments were involved in
the 2001 World Trade Center attack, the 1995 Oklahoma City bombing, the 2005
Hur-ricane Katrina disaster, and the 2003 Columbia Space Shuttle disaster.11–13

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Search activities are conducted by non-medical team members using search


dogs and infrared cameras. Once a victim is located, the medical members of the
team (typically two physicians and four paramedics) arrive to provide medical
care and support to the victim throughout the rescue process. Often, rescue
efforts are suspended in order to provide necessary emergency care. The rescue
paramedics and physicians are experts in the care and management of injuries
commonly encountered in victims of a collapse or crush, (crush syndrome,
compartment syndrome, and traumatic asphyxia). In addition to airway stabi-
lization, they can perform field blood chemistry analysis (e.g., potassium con-
centration), apply tourniquets, and, if needed, perform amputations. Under
extreme conditions, a member of the medical rescue group will accompany a
patient to the hospital and provide valuable information regarding the patient’s
status and scene situation. However, typically, hospital personnel will not inter-
face with members of the US&R teams.

EMERGENCY MANAGEMENT
Most governments have a designated department or agency that is responsible for
emergency or disaster management. Emergency Management (EM) involves
mitigating, preparing for, responding to, and recovering from major crises
14
through the coordination of available resources. Emergency Manage-ment is a
function of local, state, and national levels of government with organ-ized
responses beginning at the local levels and escalating up to higher levels of
responses if the local agencies’ resources become overwhelmed and unable to
effectively deal with the effects of the event.
Emergency Management reports directly to the governmental manager and
acts as his/her representative. The role of Emergency Management at the time of
a disaster is one of support and coordination of the responding agen-cies,
providing a single point of disaster management oversight. The specific degree or
scope of EM operations is determined by the particular jurisdiction.
The pre-event role of EM is to develop strategies for potential incidents
(based on their likelihood of occurrence and the potential impact), and to ensure a
degree of preparedness on the part of the local institution or munici-pality.
Emergency Management assists and facilitates the continued operation of the
municipal or state government in crisis resolution. The ultimate role of the
designated Emergency Management group is to ensure, or at least initiate, a
return of the impacted location (municipality), population, and health system
toward its pre-disaster state. This includes developing strategic plans that in-
volve multiple agencies and multiple jurisdictions.
Countries vary with regard to where the EM function resides. Within the
United Kingdom, the Civil Contingencies Secretariat, a department of the British
Cabinet, ensures the preparedness and resilience of responders at nation-

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al, regional, and local levels; further information is available at www.ukresili


ence.info. In Australia, Emergency Management Australia (EMA) assists the
states and territories with capacity-building and provides assistance when the
magnitude of an event overwhelms local resources; more information can be
found at www.ema.gov.au. Similarly, the US Federal Emergency Management
Agency (FEMA) coordinates response and assets in large-scale events (See
Chapter 16). Within other countries, disaster management is a function within a
department of a ministry, such as the ministry of Home Affairs in India, or the
Ministry of Health in Iran.
To provide disaster coordination, EM often establishes an Emergency Opera-
tions Center (EOC). The EOC is an identified location that coordinates event
information and resources to assist and support the overall incident management.
It is not the role of the EOC to assume direct operational control of a rescue and
recovery process. The direct operational responsibilities, i.e., Incident Command,
are those of the responsible responding public or private agencies. Day-to-day
operations are not conducted by the EM group, but may be coordinated within
the overall EM structure. The primary role of EM is to assist the Incident
Command System (ICS) to establish priorities, and mitigate the incident. The
ICS is utilized in the United Kingdom, New Zealand (Coordinated Incident
Management), Australia (Australian Inter-Service Incident Management System),
Canada (BCERMS), the United States, and other countries. The EOC allows for
representatives from different disciplines (fire, police, EMS, health, construction,
utilities, the media, and federal/state assets) to meet in an identified location for
interagency communication.
The EOC also coordinates the processing of tasks. For example, if the fire
department requires a heavy-duty crane for an operation, it does not contract out
or seek to obtain the needed equipment. It informs the EOC (via its EOC
representative) of the need; EM then contacts the EOC construction represen-
tative to attempt to meet this need. If the EOC construction representative
determines that traffic control assistance is needed to move the equipment, the
EOC requests traffic control assistance from the EOC police representative. This
allows for the administrative coordination and assignment of tasks and the central
control of incident needs and costs.
The regional Office of Emergency Management should participate with
hospitals in disaster planning, and hospital representation should be included in
the EOC during an event. EM can assist hospitals in facilitating communi-cations
with emergency resources from outside the local area, with obtaining necessary
assistance to ensure ongoing health care for the affected region, with overall
coordination of healthcare response and appropriate asset distri-bution, and with
communication and interaction with Department of Public Health authorities.

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CONCLUSION
During an emergency or a disaster, local first responders attempt to gain con-trol
of the scene, rescue victims, and provide prioritized medical care and
transportation. In general, the role of the first-response agencies is to effect an
overall reduction in morbidity and mortality of the victims. This is accom-plished
by an integrated and functional emergency response system that in-cludes active
nursing participation in disaster preparedness and response. Healthcare facilities
should be incorporated into the planning and prepared-ness efforts of local first
responders to ensure that there is a coordinated, seam-less flow of patient care
from the field into the hospital setting.

ISRAELI EMS RESPONSE TO TERRORIST EVENTS


Israel’s EMS practices a “scoop and run” philosophy in responding to terrorist bombings. The first
arriving ambulance crew performs a rapid triage, determines critically injured victims, and performs only
essential Basic Life Support interventions on-scene in order to expedite the movement of critical
patients. An ambulance arrives at the scene within an average of 4.6 minutes; and the first critically
injured victim patient is transported from the scene via ambulance within 11.5 minutes after the terrorist
event. All critically injured victims are removed from the scene and transported by ambulance within an
average time of 36 minutes after the explosion, and all other victims are removed from the scene within

an hour.15
Robert Powers

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