Daniel Kollek, MD, CCFP(EM)Director, Centre for Excellence in Emergency PreparednessChair – CAEP Disaster CommitteeAssociate Professor, Division of Emergency Medicine, McMaster University

Definitions, Classification and Response Structure

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."

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 Electrical failure Generator failure Transportation

failure Fuel Shortage Natural gas failure Water failure Sewage failure Steam failure Structural damage

• Fire alarm failure• Communications failure• Medical gas failure• Medical vacuum failure• Info. systems failure• Fire – internal• Flood – internal• Hazmat exposure –

internal• Supply failure

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

Whatever the case, and despite the range of possible

events, disaster response has more commonality than event specific characteristics.

What do you need in a disaster?

A system to deliver this to you in a useful fashion

• Information• Guidance• Money

and……

• Supplies• Equipment• Human Resources

IMS is the system

IMSIncident Management System

Incident Management System is a method of coordinatingmethod of coordinating parts of

one agency or many agencies in a

unified command structureunified command structure to use all available resourcesuse all available resources in the effective and efficient

response to an emergency.

The Eight Components of Incident Command Systems

IMS - Components

1. A unified command structure2. Common terminology3. Modular organization4. Integrated communication5. Consolidated action plans6. Manageable and sensible span of

control7. Designated facilities8. Comprehensive resource

management

IMS Basic Structure

Incident Commander

Operations Planning Logistics Finance

Incident Commander

1. Most senior trained responder2. As incident develops, falls back to

established command on-site3. Eventually may fall to Senior

Command off site (Emergency Operations Centre)

Incident Commander

Operations Planning Logistics Finance

Operations

1. Implements response activities as determined by Incident Manager

2. Maintains communication between Command and site

3. Requests and assigns resources as directed

Incident Commander

Operations Planning Logistics Finance

Logistics

1. Support Operations2. Allocate resources and provide

all materials, equipment, and personnel required

3. Application of additional resources provided by Mutual Aid

Incident Commander

Operations Planning Logistics Finance

Planning

1. Control and flow of all information

2. Data collection, analysis and forecasting

3. Development of response and recovery objectives and strategies

4. Mutual Aid Requests

Incident Commander

Operations Planning Logistics Finance

Finance

Tracking of expenses Funding Government Financial Aid

requests Financial Aid distribution

Incident Commander

Operations Planning Logistics Finance

IMS - Components

1. A unified command structure2. Common terminology3. Modular organization4. Integrated communication5. Consolidated action plans6. Manageable and sensible span of

control7. Designated facilities8. Comprehensive resource

management

Job Action Sheets

IMS Structure

Incident Commander

Operations Planning Logistics Finance

Security TransportationData collection& forecasting

StaffingEquipment &

Supplies

IMS Expanded Structure (1)

Incident Manager(CEO / designate)

Operations Planning Logistics Finance

Public Information Officer

Liaison Officer

Health & Safety Officer

Medical Officer

Incident Manager(CEO / designate)

Operations Planning Logistics Finance

Public Information Officer

Liaison Officer

Health & Safety Officer

Medical Officer

Facility Treatment areas Operational Services Support Services

IMS Expanded Structure (2)

BO ARD

Execuitve O fficer (s)(O ther Executives, M edical D irectors )

Liaison O fficer (s )(R isk M anage r/Em ergenc y P reparedne ss M anager)

F acilities O ffice r(Security, Facilit ies )

Safety O fficer(Liase w ith Infection Control, O cc. Health & Safety )

Public Inform ation O ffice r(Internal/External)

D iagnostic Im agin g

Pharm acy

Cardio Respiratory T herap y

Infection P revention& Contro l

LaboratoryService s

C linical Suppor t

Psych Suppor t

S taff Suppor t

Depend ant Care

O cc Health

Hum an R esource s

T riage (Patie nt T racking )

Im m ediate Care

Delaye d Care

M inor Care

D isch arg e

M orgu e

Docum en tion (Reg istration )

Decon/HAZM AT (Perim eter)

Em ergency T reatm ent A reas

Critica l Care

Surgical Services (O .R.'s)

Inpatient Care

M aternal/Child Care

Am bulatory Care

Inpatient A rea s

M edic al CareD irecto r

O peration s

Patient T rackin g

S ituation S tatu s(Continge ncy plans )

Dem obilization/Recovery(Recovery plan )

Research/Scie ntific Expertis e(Data colle ction and analysis )

M edical S taffin g

Nursin g

Labou r Poo l

F am ily Info Services Centre

P lan nin g

F acility O perations(Security, Dam age Assessm ent,

Sanitation, A ir )

Nutrition Se rvices/F oo d

T ransportatio n

M aterials M anagem en t(M edical Supplies )

Inform ation T echnolog y(T elecom m unications )

B io M edic al Device s

Logistics /Suppor t

Com pensa tion/C laim s

Cost

P rocurem en t(Equipm ent, m aterial/supplies )

T im e(S taff, Agency, etc.....)

F inanc e

Incident M anager (CEO or Senior Adm inistrator )

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

Proposed Hospital IMS Structure For Ontario Hospitals

IMS - Components

1. A unified command structure2. Common terminology3. Modular organization4. Integrated communication5. Consolidated action plans6. Manageable and sensible span of

control7. Designated facilities8. Comprehensive resource

management

Designated Facilities

1. Emergency Operations Centre (EOC)

2. On-site Command Post3. Staging Areas4. Triage Area5. Resource Storage6. Morgue

EOC

Primary Response Command(Initial Command Centre)

On-site Command(Secondary)

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