EMERGENCY RESPONSE STARTER’S ORDERS
Frank Rando asks if the emergency medical services are really ready for the CBRN threat
E
ssential to reducing morbidity and mortality in CBRN events is a keenly prepared, highly motivated and
properly equipped Emergency Medical Services System (EMSS) capable of conducting eff ective decontamination, triage, treatment and transport (DT3) of contaminated victims. The building blocks include proactive
citizen awareness and preparedness, eff ective, resilient and redundant communications capabilities and alert systems, highly trained and well equipped personnel, and a prepared and vigilant healthcare system. Regular training updates, exercises and emergency planning sessions are the cornerstones of successful all-hazards preparedness and are critical to eff ective CBRN emergency medical response. The EMSS is a critical component of a greater health care and public health system and serves as a crucial interface between the worlds of public safety and public health. The pre-hospital component of an EMSS can be crucial during an epidemiological investigation of a suspect bioterror event or an emerging infectious disease. EMS personnel may document a suspicious rash - or EMS ambulance run reports may indicate an unusual cluster of signs and symptomatology which seem to form a pattern.
Terror medicine The EMSS must be in a perpetual state of readiness and expected to perform in an exemplary fashion and with seamless integration into the Incident Command System (ICS), public safety sector and
the overall healthcare and public health infrastructure. The EMSS must be able to rapidly mobilise, eff ectively sort and treat mass victims, assess risks, and expand, as needed. It must be fl exible to readily adapt to dynamic and evolving events. Until fairly recently, EMSS, healthcare and public health systems were never considered as tactical stakeholders. Evolving threats taking the shape of tactical ultraviolence, such as the actual or threatened use of toxic agents, microbial and biotoxic weapons, radiological dispersal devices (RDDs) and improvised nuclear devices (INDs) have made it necessary
ACTION GUIDANCE FOR ALL EVENTS:
Approach cautiously from upwind Secure the scene/set-up perimeter
Establish ICS if fi rst responding unit or integrate into existing incident command structure
Identify the hazards - assess the situation
Obtain assistance - decide on site entry, stage as per protocol or Incident Commander; respond safely as needed
RAIN
Restrict entry Avoid contact, Assess scene Isolate area and contaminated victims
N otify command for additional resources and sitrep
78 | CHEMICAL, BIOLOGICAL & NUCLEAR WARFARE | 2012/02
for EMSS, healthcare organisations and public health entities to engage in ‘terror medicine’, ‘medical counterterrorism’ and ‘forensic epidemiology’. ‘Care under fi re’, once the domain of the military medic, has become an increasingly relevant paradigm of care for the civilian pre-hospital medical care provider. The tactical medic and tox-medic are now well- known additions to the world of pre-hospital medicine. In the US, the incorporation of emergency medical and public health planning elements into law enforcement-based intelligence networks, such as Terrorism Fusion Centers, attests to the evolving threat environment and the pressing need for public health intelligence and medical threat assessments once Force Health protection functions for the military on behalf of the US Armed Forces. The US Department of Homeland Security has designated hospitals and healthcare as critical infrastructure. The EMSS and other components of healthcare and public health fall under Emergency Support Function #8 (ESF-8) of the National Response Framework (NRF). The present-day EMSS is an integral part of America’s overall health and public health security strategy and forms a fi rst line of medical defense and response in communities around the globe.
CBRN scenarios Pre-hospital medical planning and operations must utilise an ‘all-hazards’ approach that encompasses a broad threat spectrum for all aspects and phases of emergency management.
Pictures: Brandon Baughn EMT, PCT
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