Introduction to Disasters

1. Daniel Kollek, MD, CCFP(EM) Director, Centre for Excellence in Emergency Preparedness Chair – CAEP Disaster Committee Associate Professor, Division of Emergency Medicine, McMaster University Definitions, Classification and Response Structure Introduction to Disasters

2. 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."

3. How have health care systems dealt with disaster in the past?

4. September 11, 2001- NYC

5. September, 2002 - Jerusalem

6. 2003-Toronto

7. What kind of disasters might we face and how do we assess our risk?

8. Natural disaster

9. Natural Events • Hurricane/Tornado • Severe Thunderstorm • Snowfall • Blizzard • Ice Storm • Earthquake • Tidal wave • Drought • Flood - external • Wild fire • Landslide • Volcano • Epidemic • Extreme temperature

10. Technological disaster

11. Technological events • Fire alarm failure • Communications failure • Medical gas failure • Medical vacuum failure • Info. systems failure • Fire – internal • Flood – internal • Hazmat exposure – internal • Supply failure • Electrical failure • Generator failure • Transportation failure • Fuel Shortage • Natural gas failure • Water failure • Sewage failure • Steam failure • Structural damage

12. Man-made disasters Anthrax envelope - 2001

13. 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

14. 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

15. What are the characteristics of disasters?

16. A disaster can have multiple settings

18. A disaster often has multiple patients

20. The Patients: Tokyo Sarin attack 1995: • >5800 victims • 12 deaths • 17 critical patients • 37 severe patients • 984 moderate patients • 4793 “worried well”

21. A disaster always has multiple players

22. The Players: • Police • Fire • EMS • Hospitals • Volunteers • Public health • Elected officials • Civil servants • Utilities • Transit • Provincial / Federal agencies • Media

23. A disaster can have variable timelines

24. Static timeline

25. Dynamic timeline

26. and despite the range of possible events, disaster response has more commonality than event specific characteristics. Whatever the case,

27. What do you need in a disaster? • Information • Guidance • Money • Supplies • Equipment • Human Resources and…… A system to deliver this to you in a useful fashion

28. IMS is the system

29. IMSIncident Management System Incident Management System is a method of coordinatingparts of one agency or many agencies in a unified command structureto use all available resources in the effective and efficient response to an emergency.

30. The Eight Components of Incident Command Systems

31. IMS - Components • A unified command structure • Common terminology • Modular organization • Integrated communication • Consolidated action plans • Manageable and sensible span of control • Designated facilities • Comprehensive resource management

32. IMS Basic Structure

33. Incident Commander • Most senior trained responder • As incident develops, falls back to established command on-site • Eventually may fall to Senior Command off site (Emergency Operations Centre)

34. Operations • Implements response activities as determined by Incident Manager • Maintains communication between Command and site • Requests and assigns resources as directed

35. Logistics • Support Operations • Allocate resources and provide all materials, equipment, and personnel required • Application of additional resources provided by Mutual Aid

36. Planning • Control and flow of all information • Data collection, analysis and forecasting • Development of response and recovery objectives and strategies • Mutual Aid Requests

37. Finance • Tracking of expenses • Funding • Government Financial Aid requests • Financial Aid distribution

38. IMS - Components • A unified command structure • Common terminology • Modular organization • Integrated communication • Consolidated action plans • Manageable and sensible span of control • Designated facilities • Comprehensive resource management

39. Job Action Sheets

40. IMS Structure

41. IMS Expanded Structure (1)

42. IMS Expanded Structure (2)

43. Proposed Hospital IMS Structure For Ontario Hospitals 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

44. IMS - Components • A unified command structure • Common terminology • Modular organization • Integrated communication • Consolidated action plans • Manageable and sensible span of control • Designated facilities • Comprehensive resource management

45. Designated Facilities • Emergency Operations Centre (EOC) • On-site Command Post • Staging Areas • Triage Area • Resource Storage • Morgue

46. Primary Response Command (Initial Command Centre) On-site Command (Secondary) EOC Off-site Command (Final)

47. Summary

48. We need to formally review our disaster risks in order to prepare a plan

49. There are common threads in all disaster responses

50. IMS is the system used for command and control of a disaster response