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					 DISASTER LESSONS
 DL43 AMBULANCE LESSONS 9-11




The following article is from the Journal             of   Emergency     Medical      Services,
http://www.jems.com/jems/news02/0910a.html



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         Another example of people who
the highest administrators to the aides and housekeeping staff—     use ICS in real life swear by it.
now has to receive training in emergency management and the         Here, the lesson was so
                                                                    impressive that even the
incident command system (ICS).                                      housekeepers are trained in it.
                                                                    Yet, we have amateur radio
Fromm says hospital staff learned how crucial the command           clubs that still don’t even have
system was when the planes hit the World Trade Center just          the basic ICS-100!
blocks away, sending 500 patients into their emergency
department within hours and pushing their usual number of on-
duty 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
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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 all-
ALS 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       Hospital communications are
                                                                          often overloaded during the
different hospitals and seeing what they could take. They were            initial phase of a disaster. Few
calling me to see what was coming." There was a lot of confusion.         people remember to actually tell
"For our communications with the hospitals, we've had two major           the hospitals what is happening!
drills since the Pentagon incident," Blunt says. "It's far better today   As a result, hospitals are often
than it was on the 11th, but there's still room for improvement."         left guessing. Ham radio could
                                                                          fill a huge role here in giving an
                                                                          over-all picture and ensuring
After the confusion of Sept. 11, Blunt says the Fire-EMS                  back-up communications.
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


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with appropriate resources. The MedCom system includes a full-
time, 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           Amateur radio is often told
                                                                         ―Don’t set up with the media –
working on using the mass media, especially TV, to deal with the         only the Incident Information
public during crises. Communications were a problem on Sept. 11          Officer should ever talk to them.
when radios failed, but the problem was compounded because               Yet, communications to the
cell phones systems were so jammed they were useless to                  media is almost invariably
emergency personnel.                                                     stated as a communications
                                                                         priority after the event.

"The public needs to know [that] when a large-scale incident like        Does he think people will
this happens, they need to get off their cell phones and leave the       actually turn off their phones or
channels open for emergency workers," Blunt says.                        stop trying to get hold of their
                                                                         family? Even if some people
                                                                         stay off, do you think getting
He says the county government is also studying a new                     even 20% of cell phone users to
communications system and new radios for the department. And             turn off their phones on 9-11
they've already ordered mass-casualty trailers that will carry all       would     have      made     ANY
                                                                         difference to the overloaded
kinds of emergency supplies, from small bandages to burn
                                                                         communications? This type of
treatment kits to drop packs to give people who can treat                wishful thinking means that the
themselves.                                                              problem will not be addressed
                                                                         and will happen again next time.
Blunt says all metro Washington, D.C., departments are now
developing mass-casualty units.
                                                                         Self transport is common during
Arlington also learned the importance of getting hospitals to plan       disasters.     Emergency rooms
for large emergencies. "You need to expect the hospitals to take a       quickly overflow into the nearest
lot more responsibility for patients who self-transport," Blunt says.    parking lot which becomes the
The department transported 42 of approximately 100 patients on           hospital triage. Hospitals don’t
                                                                         normally communicate with their
Sept. 11, he says. The others self-transported or went to the            parking      lots   and     triage
Pentagon's own clinic—the DiLorenzo TRICARE Health Clinic,               communications usually breaks
which set up its own triage and EMS transport stations,                  down. If this happens almost
unbeknownst to the county.                                               100% of the time, why don’t
                                                                         hospital      emergency     plans
                                                                         include some communications
Blunt says his department set up its triage and transport area on        plan for the parking lot?
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]   Another common comment after
going to go? Not toward the fire."                                       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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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 mass-
           casualty 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.        Is your radio club equally guilty?
                                                                            You can hear all the lessons
"I could go back to maybe a third of [the places I've been], and            you want; unless you change
they haven't made any changes. It didn't strike home to them. I             your    operational guidelines
think we're all guilty of that. An earthquake in California doesn't         (SOPs) to reflect the lessons
make me earthquake-sensitive in D.C.                                        learned in 9/11 and all other
                                                                            disasters, you will make the
                                                                            same mistakes. When was the
"But if I was a terrorist and I really wanted to shake up America, I'd      last time you took even ONE
hit the Midwest. That would really damage the psyches of                    disaster debriefing report and
Americans," Blunt says. "It can happen anytime, anywhere."                  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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