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					DISASTER LESSONS
DL43 AMBULANCE LESSONS 9-11

The following article is from the Journal http://www.jems.com/jems/news02/0910a.html

of

Emergency

Medical

Services,

POST 9-11 EMS IN NEW YORK & ARLINGTON, VA.
By Kim Oriole, JEMS Reporter
Two EMS leaders who dealt directly with last year's terrorist attacks in New York and Arlington, Va., have different post-Sept. 11 priorities for improving their departments, but they agree planning is at the top of the list.

NEW YORK
At NYU Downtown Hospital in lower Manhattan, the biggest change is a new focus on everyone using the incident command system, according to Peter Fromm, NYU Downtown Hospital's director of Emergency Services and an EMS responder for 14 years. "We've stepped up training in incident command," he says. "We're improving implementation of our ICS under extraordinary circumstances. People didn't realize how important it was." At NYU Downtown Hospital, every person in the hospital—from the highest administrators to the aides and housekeeping staff— now has to receive training in emergency management and the incident command system (ICS). Fromm says hospital staff learned how crucial the command system was when the planes hit the World Trade Center just blocks away, sending 500 patients into their emergency department within hours and pushing their usual number of onduty ambulance crews from two up to five. "Incident command won't work unless everyone knows how to use it," Fromm says. "Systems collapse without the support personnel. By improving our use of the incident command system—managing people, locating people, keeping people safe—we can make big changes."
Disasters mean that normal responses don’t work. Who would have expected electricity to be out in NY, NY for six days? Page 1
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Another example of people who use ICS in real life swear by it. Here, the lesson was so impressive that even the housekeepers are trained in it. Yet, we have amateur radio clubs that still don’t even have the basic ICS-100!

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DISASTER LESSONS
DL43 AMBULANCE LESSONS 9-11

The hospital was without electricity for six days and ran on its auxiliary generator, designed to operate for just 24 hours, for all six days, Fromm says. Telephones were also out, and doctors and emergency crews had to rely on cell phone systems, which also were jammed and often proved useless. Downtown Hospital operates its own ambulance service with allALS units dispatched through the FDNY system. Fromm says Downtown Hospital units were the first to respond to Ground Zero on Sept. 11 because they were closest. And they learned some frightening lessons. "The radio was absolutely useless," Fromm says. "There was mostly silence punctuated by Maydays. The radios were completely overwhelmed." NYU Downtown Hospital has improved its communication system by buying more radios, new satellite phones and new cell phones for all ambulances. The next challenge is to improve interagency cooperation. "We've learned that the unthinkable is possible," Fromm says. "Hopefully, it will never happen again. But I think there's a lot to be done. It's challenging working in such a big system. Improvements in our citywide incident command system would be my No. 1 issue."

ARLINGTON COUNTY EMS
In Arlington County, Va., Fire-EMS Capt. Ed Blunt says his department learned a new respect for the ability to communicate with hospitals during a crisis. "We are basically the eyes and ears for the hospital centers' ability to respond," Blunt says. "At the Pentagon, I was constantly calling different hospitals and seeing what they could take. They were calling me to see what was coming." There was a lot of confusion. "For our communications with the hospitals, we've had two major drills since the Pentagon incident," Blunt says. "It's far better today than it was on the 11th, but there's still room for improvement." After the confusion of Sept. 11, Blunt says the Fire-EMS Department quickly convinced its main hospital, Fairfax Hospital, to create a medical command system (MedCom) to communicate with responders and coordinate patient dispatch to area hospitals
Hospital communications are often overloaded during the initial phase of a disaster. Few people remember to actually tell the hospitals what is happening! As a result, hospitals are often left guessing. Ham radio could fill a huge role here in giving an over-all picture and ensuring back-up communications.

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DL43 AMBULANCE LESSONS 9-11

with appropriate resources. The MedCom system includes a fulltime, dedicated communications staff member. "Now, when I first recognize we have a mass-casualty incident, I call [MedCom]. They're on the phone with the incident commander, and they stay on the phone and relay information to all other [area] hospitals," says Blunt. He says that led to another important change: Arlington is now working on using the mass media, especially TV, to deal with the public during crises. Communications were a problem on Sept. 11 when radios failed, but the problem was compounded because cell phones systems were so jammed they were useless to emergency personnel. "The public needs to know [that] when a large-scale incident like this happens, they need to get off their cell phones and leave the channels open for emergency workers," Blunt says. He says the county government is also studying a new communications system and new radios for the department. And they've already ordered mass-casualty trailers that will carry all kinds of emergency supplies, from small bandages to burn treatment kits to drop packs to give people who can treat themselves. Blunt says all metro Washington, D.C., departments are now developing mass-casualty units. Arlington also learned the importance of getting hospitals to plan for large emergencies. "You need to expect the hospitals to take a lot more responsibility for patients who self-transport," Blunt says. The department transported 42 of approximately 100 patients on Sept. 11, he says. The others self-transported or went to the Pentagon's own clinic—the DiLorenzo TRICARE Health Clinic, which set up its own triage and EMS transport stations, unbeknownst to the county. Blunt says his department set up its triage and transport area on the Pentagon's west side, nearest the crash, but learned that site should be farther away from the disaster and in a more neutral area. "If the building's on fire, which direction are you [the victim] going to go? Not toward the fire."
Self transport is common during disasters. Emergency rooms quickly overflow into the nearest parking lot which becomes the hospital triage. Hospitals don’t normally communicate with their parking lots and triage communications usually breaks down. If this happens almost 100% of the time, why don’t hospital emergency plans include some communications plan for the parking lot? Amateur radio is often told ―Don’t set up with the media – only the Incident Information Officer should ever talk to them. Yet, communications to the media is almost invariably stated as a communications priority after the event. Does he think people will actually turn off their phones or stop trying to get hold of their family? Even if some people stay off, do you think getting even 20% of cell phone users to turn off their phones on 9-11 would have made ANY difference to the overloaded communications? This type of wishful thinking means that the problem will not be addressed and will happen again next time.

Another common comment after disasters – ―We set up too close to the event‖. The result is often having to move, or in the case of 9/11, having your entire ICS command killed or incapacitated.
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DL43 AMBULANCE LESSONS 9-11

Arlington County government commissioned an After-Action Report on the response to the terrorist attacks. The report's many recommendations include:   Every firefighter and EMS responder should have a pager to receive dispatch notices, whether on- or off-duty; All deploying units must strictly follow instructions from the Emergency Communications Center until they reach the scene and get other instructions from the incident commander; All building entrances must be secured and controlled for accountability; EMS must establish treatment and transport control for the entire perimeter to get control and accountability in masscasualty events; and EMS must integrate all treatment providers into a single EMS structure.

 



(For more detail on the After-Action Report, see the Arlington County Fire Department's Web site at: www.co.arlington.va.us/fire/edu/about/after_report.htm

Blunt says his biggest national concern now is that many EMS providers don't seem to take the terrorist threat seriously. "I've been all over the country speaking in the past year," he says. "I could go back to maybe a third of [the places I've been], and they haven't made any changes. It didn't strike home to them. I think we're all guilty of that. An earthquake in California doesn't make me earthquake-sensitive in D.C. "But if I was a terrorist and I really wanted to shake up America, I'd hit the Midwest. That would really damage the psyches of Americans," Blunt says. "It can happen anytime, anywhere."
Is your radio club equally guilty? You can hear all the lessons you want; unless you change your operational guidelines (SOPs) to reflect the lessons learned in 9/11 and all other disasters, you will make the same mistakes. When was the last time you took even ONE disaster debriefing report and compared it with your SOPs to make sure your SOPs would work? Did you discuss the pros and cons of various responses or changes? Then why do you think your plan will work? EMS providers aren’t the only ones sticking their heads in the sand.

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