INTERHANDS III June 2003 Miami, FL Initial Medical (Health) Assessment

1. INTERHANDS IIIJune 2003Miami, FLInitial Medical (Health) Assessment United States Southern Command Col. Miguel A. Montalvo USAF MC FS Command Surgeon

2. Assessments(Defining How Bad Is Bad)

3. When does the assessment process begin??? Right Away

4. Decision Makers On-scene Military Commander U. S. Ambassador Combatant Commander National Command Authority Considerations Requirements Resources Available National Interests Legal Authority Funding Disaster Assessments Purpose: To provide decision makers the information they require to determine the appropriate USG response

5. Objectives • Recognize the wide variety of resources available to support assessments • Understand the criticality of gathering political, economic, military, cultural, engineering, health and other essential information • ID the capacity and status of the HN • Everyone is responsible for gathering information

6. United States AmbassadorRoles and Responsibilities Role: The U.S. Ambassador to the affected nation is responsible for declaring the occurrence of a disaster or emergency in a foreign country that requires U.S. foreign humanitarian assistance support. Responsibilities • Declaration via Cable to DoS • Recommends appropriate USG response • Focal Point for USG agencies responding to disaster Considerations • Country desires U.S. assistance • Capability of the country to respond is exceeded • Impact of disaster

7. Combatant CommanderRoles and Responsibilities Role: The combatant commander establishes theater strategic objectives required to transform national strategic policy and guidance into operational level activities. Responsibilities • Transform policy and guidance into operational plans and activities • Structures the force necessary to conduct and sustain HA operations Considerations • Immediate employment of intra-theater assets • Mission and magnitude of the response • Force Protection • Logistical Support

8. On-Scene Military CommanderRoles and Responsibilities Role: A military commander at the immediate scene of a foreign disaster may undertake prompt relief operations when time is of the essence and when humanitarian considerations make it advisable to do so. Responsibilities • Report action at once • Request guidance • Track costs • Request reimbursement IAW DoDD 5100.46 Considerations • Immediate threat to life • U.S. Military response required • Reimbursement not assured

9. Spectrum of HA Operations Natural Disasters: hurricanes, floods, earthquakes, volcanic eruptions, drought, fire Man-made Disasters: civil violence, CBRNE incidents and accidents Types of Aid Provided • Immediate response to save life/prevent destruction • Shelter, clothing, bedding • Food and water • Medical care, sanitation • Transportation, communications Types of Missions • Immediate disaster assistance • Dislocated civilian support • Security missions • Technical assistance and support • Consequence management

10. Initial AssessmentWhat Happened? What Does it Mean? Description of the event: type of incident, location, time, cause, casualties, ongoing threat Magnitude of the event • Area affected • Number of people affected • Damage to infrastructure Immediate Needs • Most vulnerable population • Emergent requirements • Chronic vs. acute needs Impact of the event • Baseline capabilities • Remaining capabilities • Response of other nations, IOs, NGOs Other Considerations • Ethnic • Religious • Political • Economic

11. Initial AssessmentPlanning Considerations Force Deployment • Available food, water, sanitation • Displaced civilian population and location • Disease risk assessment • Local medical capabilities • Status of roads and bridges • Available logistic facilities for air and sea-lift • Threat and security requirements Coordination • Status of host nation government • Host nation relief efforts • Outside relief efforts • Points of contact • Continuously update as situation and information requirements change

12. Intelligence and Information Gathering in Foreign Humanitarian Assistance Operations Intelligence and Information Gathering Politics Religion Military Ethnic Business Economic Criminal Medical Environmental Infrastructure

13. How do YOU define “BAD”???? Baseline Data

14. Baseline Data • Population • Infrastructure • Water • Electric Power • Communications • Roads • Bridges • Food • Health Statistics • Assets • Public • Private • Distribution capabilities • Agriculture • Industries • Ports • Transportation

15. Baseline Data • Economy • Communications • Telephone • Cellular • Radio • TV • Internet Service Providers • Climate • Terrain • Natural Hazards • Environmental issues • Government • Type • Leaders • Ministries • Relationships

16. Where do I find the information I need?

17. SOURCE

20. Needs Assessment • Identifies resources and services for immediate emergency measures to save and sustain the lives of the affected population. It is conducted at the site of a disaster or at the location of a displaced population. • Quick response based on this information should help reduce excessive death rates, and stabilize the nutritional, health, and living conditions among the population at risk. • A quick response to urgent needs must never be delayed because a comprehensive assessment has not yet been completed.

21. Assessment Goals • Provide timely and comprehensive information on the scope and impacts of a disaster • Support effective emergency decision making at local, state and federal levels • Keep the public accurately informed • Develop and support requests for disaster resources and recovery assistance

22. Provide information so that timely decisions can be made • Impact a disaster has had on a society and its ability to cope • Most vulnerable populations that need to be targeted for assistance • Most urgent requirements • Levels of response by affected country (by other players) • Make recommendations

23. Keys to a Successful Assessment • Identify who needs your data • Potential users will specify their data requirement • Identify the information needed to plan specific action • What information is vital • Best method for collecting • How detailed does the information have to be useful • What is your mission, task (implied or specified)

24. Keys to a Successful Assessment • Consider the Timing • May effect the accuracy since situation and needs can change dramatically from day to day • Determine the best place to get accurate information • Distinguish between emergence needs and Chronic needs

25. Situation/Disaster Assessment • ID areas affected (size/location) • Numbers affected by the disaster • Mortality / Morbidity rate • Characteristics and condition of the affected population • Emergency • Medical / Health / Nutrition / Water / Sanitation • Levels of continued / emerging threats (natural and human)

26. Priority Health Status Assessment • How many deaths have occurred • From the Disaster • From Diseases • Children/Adults/Gender/Age • Main cause of death for each group. • Vaccinations (measles) have been or will be provided Determine the incidence of diarrhea among adults and children. • Determine the most common diseases among children and adults.

27. Priority Health Status Assessment • Affected Country(s) • Population at risk • Health Infrastructure • Clinics, Dispensaries, Hospitals • Supportive: Roads, Shelter, Water, Food Sanitation • Medicines • Health Care Workers

28. Providing Water • Information you might need • What is the demand • What are the sources • Road network like • Transportation availability • Fuel • Storage

29. Tools of the Trade • Field Operations Guide • Camcorder • Digital Camera • Camera • Access to a computer • Maps

30. Main Points • Only a “snapshot in time” • Information changes over time • The significance of the information changes over time • What you can’t see is often more important than what you can see • Goal: to save and sustain the lives of the affected population

31. Main Points • Vital to use the first assessment to establish an ongoing data collection and analysis system • The initial assessment should provide information that feeds directly into the program planning process • Timing is vital – without a point of reference most assessments data is of little value • Disasters are traumatic events to individuals – Mental Health intervention will be needed

32. Hurricane Mitch - Overview THE MOST DEVASTATING STORM TO HIT CENTRAL AMERICA IN OVER 200 YEARS. Guatemala City Tegucigalpa Eastern San Salvador Dead: 8,209 Missing: 9,397 Displaced-Homeless: 2,747,640 Bridges Damaged: 356 Managua

33. Phase I - Emergency Life saving missions and emergency delivery of relief supplies and medical assistance 26-Nov-98 2,102 San Pedro Sula La Ceiba Guatemala City 39 A/C 440 Sorties 1686 hrs Soto Cano 6 A/C 200 Sorties 385 hrs Lives Saved 1,052 Food Distributed 3,245,100 Lbs Medical Supplies Distributed 131,000 Lbs Water Distributed 120,000 Gals Managua $42,500,000

34. Roads Medical Bridges Power Structures Wells Phase II - Rehabilitation Repairs to infrastructure required to reestablish national capabilities to provide for health and basic welfare of the populace 5,400 + San Pedro Sula La Ceiba 219 (Sorties) Guatemala City 11 Soto Cano Comalapa 53 Managua 10 $112,500,000 4

35. Phase III - Restoration Long term effort to permanently repair infrastructure, rebuild economies and fully mitigate storm damage. 12 / 39 Clinics and Medical Outreach 27 Wells 33 Roads Bypasses and Bridges 90 km / 26 / 2 Schools $70,000,000

36. Medical Priorities in Phase I • Safety of rescuers • Saving of life • Distribution of water & food

37. Medical Priorities in Phase II • Force health protection • Controlling disease outbreaks • Vector control consultation • Food and water surety • Sanitation consultation • Restoration of general public health measures • Consultation on the disposal of remains • Epidemiological surveillance • Functional HN medical infrastructure

38. Lessons Learned • Early and accurate assessments a must: • Infrastructure needs • Size and type of units • Deployment priorities • Regional disaster office overwhelmed • Disaster relief often creates competing priorities • Military Support to Civil Authorities is a different animal--Training a must… • SOUTHCOM both a supported and supporting Command • Knowledge of ground rules-- Imperative!!!

39. Finding a Balance Balanced Surge Capacity Scale Efficient Effective

40. Rhode Island Nightclub FireThe Facts • 20 Feb 03, West Warwick, RI • “The Station” nightclub caught fire with 250-300 people inside • Results: • 99 dead • 150+ injured • Deadliest U.S. nightclub fire since 1977

41. Rhode Island Nightclub FireMedical Response • Burn patients sent to 11 regional hospitals including • Rhode Island Hospital, RI • Kent Co. Memorial Hospital, RI • Mass. General Hospital, MA • Response teams delivered on scene medical care • EMT • Fire • Off-duty doctors/nurses

42. Rhode Island Nightclub Fire • Validated theory of “Surge Capacity” • Local hospitals overwhelmed • Patients sent to other states for care • Tested response plans to possible terrorists attacks Source: Boston Globe, The Phoenix

43. Rhode Island Nightclub FireLessons Learned • Patient surge must be addressed! • Can happen in peace time • Terrorist attack is not only cause • Use of all available resources is a must! • Hospital beds • Response personnel • Bottom Line: We must prepare for all possible disasters. We should organize, train, and equip to meet the surge dilemma in any crisis!

44. The Dilemma! • No solution currently exists to meet a surge in patients during crisis! • 2001 Presidential Inauguration -- 7 ICU beds in DC • Demolition of Mile High Stadium Exercise -- 7 ICU beds in Denver • 2002 weekend in Dayton and Cincinnati -- 1 ICU bed in area • Hospitals face fiscal constraints in national crisis • Limited resources and manpower • Fear factor • Who will arrive for second shift once bio/chem has been detected?

45. Preparation for the NationMaking the Pieces Fit First Preparers General Population City Planners Disaster Planners National Planners First Receivers Hospitals Clinics Health Facilities FP FR First Responders Police Fire EMS City and County Health Officials FRd Source: Dr. Paul K. Carlton

46. QUESTIONS?