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Training day: Disaster response, transporting patients from the scene
From full-scale to tabletop exercises, preparing for a mass casualty incident should be part of disaster management training
By Dan Greenhaus
EMS professionals have a strong history of leadership in disaster management, including preparedness planning, triage assessment, patient transport and care, and resource management. While the vast majority of our calls involve a single patient, when a major disaster or mass casualty incident occurs, EMS professionals are required to use scene and disaster management skills. The best way to ensure personnel are still proficient in these areas is by participating in training exercises.
Tabletop vs. full scale exercise
A tabletop exercise is conducted inside a training room using a large map of your coverage area – preferably laminated – placed over a table, simulating a disaster. During this exercise, use existing supervisory personnel in roles they would hold during an actual incident. I like to use matchbox ambulances and cars to represent units, describing where they can drive on the map. These exercises help gives people an idea of how many resources would be needed for an actual incident, are relatively cheap and easy to run, and can be repeated several times with different people in different roles.
A full scale exercise is much larger. It's expensive, requires a lot of planning and coordination among multiple agencies and is a true demonstration of how your system will handle a disaster. This type of exercise involves inviting all of your mutual aid agencies to participate, in addition to other local public safety agencies, as well as arranging to have actors portray victims. It's not easy to set up, and most agencies can only afford to do them once a year. However, these exercises are more beneficial, as they will showcase how effectively your system can handle an MCI or other major disaster.
Identify the ICS roles related to transport
Assign the following roles for patient assessment, treatment and transport:
- Triage officer – Obtains the number of patients, broken down into red, yellow and green triage designations. The information is relayed to the IC, who contacts dispatch to request appropriate number of resources to handle the patient count.
- Treatment officer – Establishes treatment areas, as well as identifies how patient will be transferred from the treatment area to the transport area.
- Staging officer – This person keeps the responding units out of the main scene, keeps track of how many resources are available and direct them to the scene when requested by the transport officer.
- Transport officer – Keeps track of which patients were transported to which hospital, notifies hospitals and is responsible for calling units from staging when treatment is ready to transport them.
- Communications/dispatch – Responsible for getting the resources that the IC needs, using preplanned mutual aid agreements, as well as ensuring coverage is maintained for the rest of your coverage area.
How to evaluate a full-scale training exercise
You need to have assigned observers and evaluators whose sole purpose at the exercise is to document and judge the actions of the participants. The evaluators may be senior personnel from your agency, or personnel from an outside agency. The advantage of using outside personnel is you can get a truly objective assessment on what went well and what did not go well at the incident, because they can objectively evaluate the operations without being influenced by your agency's SOGs.
Their job is to monitor and document what occurred, and not get involved unless there is a safety concern that needs to be addressed immediately to prevent an injury to one of the participants.
When evaluating an exercise, here are some of the many areas related to transportation that you can use to evaluate the agency’s performance:
- Was staging set up in a location that allowed easy access from the staging area to the treatment zone, as well as easy access out of the scene to the hospital?
- Once triage was completed, did the IC request the correct number of ALS and BLS resources?
- Prior to the first victim leaving the scene, did the IC contact dispatch and obtain a hospital bed status for how many patients they could accept? Were all the hospitals properly notified when they were to receive a victim? Were the patients equally distributed among the local hospitals, based on their capabilities?
- Were all transporting ambulances able to communicate with both the staging and transport officer via a common radio frequency?
- Were all patients transported safely, in an appropriate manner, based on their condition, with the appropriate number of patients in each vehicle?
- Was a school or transit bus requested to transport the ambulatory/green patients, along with the appropriate medical personnel aboard monitoring them?
- Were regional EMS disaster resources, such as medical ambulance busses, mass casualty response units and portable light towers for night time operations, requested early on in the incident? Were they integrated successfully with the operation, and were they beneficial to the EMS disaster response?
- There are also “lessons learned,” where the participants and evaluators can state what went well and what issues they encountered, so those issues can be mitigated before an actual incident occurs.
Prepare your crews to safely triage, treat and transport patients in the event of a MCI in your community by staging your own training day.