FIELD TREATMENT SITES

1. FIELD TREATMENT SITES Another PIECE of the PUZZLE Presented by: Doug Buchanan www.DisasterDoug.com

2. OBJECTIVES 1- WHAT? 2- WHY? 3- WHO? After this course, you should be able to answer… What Are They?Identify several resources available to help augment current Treatment Facilities Why Do We Need Them?Describe the purpose and function of a Field Treatment Site. How Do We Activate an FTS?Outline the Activation and Set-up Process for an FTS. Where Do We Get the Equipment/Supplies ?Describe the Logistics and Support Process for an FTS. What Happens at the End of 3 Days? List the options for Demobilization of an FTS. Who Decides When We Need to Activate an FTS?Describe the Decision Process for Activation of an FTS. 4- HOW? 5- WHERE? 6- WHEN? www.DisasterDoug.com

3. What is an EMS Field Treatment Site? • An EMS Field Treatment Site is a temporary facility, designed to provide Triage and Treatment of patients awaiting transportation, for up to 72 hours. How does this relate to other facility types? www.DisasterDoug.com

4. Don’t We Already Have Options?.. like: Mobile Field Hospitals Alternate care sites • The California EMS Authority currently has three 200-bed Mobile Field Hospitals available for deployment. • Many Operational Areas have already developed plans for establishing Alternate Care Sites as part of the local Medical Surge plan. www.DisasterDoug.com

5. YES. Local and State Government agencies currently have Assets and Plans to help augment Treatment locations during a Medical Surge. • However… most of these plans require a minimum of 72 hours to fully activate. • An EMS FTS is designed to use Paramedics, EMTs, and EMRs to provide care up to 72 hours. www.DisasterDoug.com

6. Field Treatment Sites Filling in the Gap. • Establishing an EMS Field Treatment Site to fill in the gap between the onset of a local Medical Surge event, and the time it takes to activate a Mobile Field Hospital or an Alternate Care Site is one possible scenario (i.e. Medical Surge). • Another reason why an EMS Field Treatment Site may be activated is that Transportation of patients to definitive care is not possible, due to: • Unavailable Transportation Routes • Unavailable Transport Resources www.DisasterDoug.com

7. TEST YOUR KNOWLEDGE Let’s examine what we’ve learned so far… • Scenario: A bridge on the local highway had partially collapsed during a mud slide earlier today. At 6pm, a 50 passenger bus and several automobiles didn’t notice the problem… until it was too late. This highway is the primary route to local hospitals. Taking alternate routes could take hours. You now have 58 patients, and the weather forecast is calling for freezing temperatures tonight. You anticipate that getting adequate transport resources here could take until morning. You decide to… • Request a Mobile Field Hospital • Request an Alternate Care Site • Request a Field Treatment Site www.DisasterDoug.com

8. TEST YOUR KNOWLEDGE Let’s examine what we’ve learned so far… • If you answered “C. Request a Field Treatment Site,” you’re correct. • Our problem is not places to send our patients, it is that the transportation routes are significantly affected, and transport resources are significantly delayed. • Requesting an FTS should allow us to getpatients out of the environment, andprovide facilities to maintain patients overnight. www.DisasterDoug.com

9. Deciding to Activate Requests for FTS Activation come to the MHOAC from a local Incident Commander or the OA EOC. • An Incident Commander may decide to contact the MHOAC to request an FTS Activation when it appears that patients will have to be cared for greater than 12 hours on scene. • T he OA EOC may elect to activate an FTS due to a Healthcare Surge event. • The MHOAC may use the FTS Decision Checklist and tools found in the FTS Planning Guide to: • Evaluate Resource Options • Determine number, type, and locations of FTSs • Sign an FTS Activation Order • Appoint an FTS Activation Team Leader • FTS Activation Team Leader oversees the Activation and set-up of the FTS. www.DisasterDoug.com

10. FTS Decision Checklist Designed for use by the MHOAC A Medical / Health Technical Advisory Committee may be convened to help assess the available alternatives or Medical Surge strategies, prior to FTS activation. www.DisasterDoug.com

11. Assessment Factors To assist the MHOAC or the EOC MH Branch in evaluating the need for an FTS, many factors should be considered. This tool is available in the FTS Planning Guide. www.DisasterDoug.com

12. FTS Options Considering what is available. Pre-Surveyed Facility:  If the County has a pre-designated FTS within the area , this location should be considered first. A list of Pre-designated sites can be found in the Appendix of the FTS Planning Guide. Non-Surveyed Facility:  If no pre-designated sites in the target area are available, other non-surveyed facilities should be considered, such as halls, community centers, etc. Non-Fixed Site:  If there are no targetable facilities within the area, an FTS will need to be identified and established in close proximity to the incident, which may require assets such as tents, portable water / sanitation, and generators, etc. www.DisasterDoug.com

13. FTS Activation Order After Identifying the Site This is the first part of the form, designed to be used by the MHOAC or Med/Health Branch Director at the EOC. www.DisasterDoug.com

14. FTS Activation Order After Identifying the Site The second portion of the FTS Activation Order is designed to list the Team Leader, appointed by the MHOAC or Med/Health Branch Director of the EOC. www.DisasterDoug.com

15. Decision to Demobilize or Transition Thinking ahead… The MHOAC or MH Branch needs to consider when, and how the FTS might be demobilized. Planning must begin as early as possible to ensure a smooth transition. The options for consideration may be: • Maintain the FTS until all patients are disbursed, then demobilize the site. • Utilize the FTS for initial care and treatment, then transition the care of patients to an FTS or ACS at different location. • Utilize the FTS for initial care and treatment, then transition the FTS into an ACS at the same location. www.DisasterDoug.com

16. Decision to Demobilize or Transition Thinking ahead… The following graphic provides examples of transitioning an on-scene Treatment Area to an FTS and transitioning an FTS into an ACS for longer term care. www.DisasterDoug.com

17. Decision to Demobilize or Transition Once an FTS is Activated… www.DisasterDoug.com

18. Activating an EMS Field Treatment Site FTS Activation Team Leader Checklist • Once the decision has been made to activate a Field Treatment Site (FTS), and an FTS Activation Team Leader has been assigned, the team leader is responsible to: • Assign the Activation Team staff, • Secure the selected FTS location, • Acquire the necessary resources to staff and equip the site, and • Set-up the site. www.DisasterDoug.com

19. Activation Team Leader Checklist This tool from the FTS Planning Guide is meant to assist the FTS Activation Team Leader. Additional supporting tools are listed in the column to the right. www.DisasterDoug.com

20. FTS ACTIVATION TEAM Planning Tool This tool is intended to give the FTS Activation Team leader an overview of the tasks and responsibilities involved in the FTS activation process, and shows how these tasks may be assigned to various Section Chiefs and Unit Leaders. Team Leader(Command and Control) Logistics Section Chief • Facility Procurement Unit (Select and Secure a Site) • Staffing Unit: (Establish Initial Operational Period Staffing) • Equipment / Supply Unit: (Order of Equipment and Supplies) • Communications Unit: (Establish Communication Systems) Operations Section Chief • Staging Manager: (Receive and inventory incoming equipment / supplies) • Site Set-up Unit: (Site Set-up) • Security Unit: (Establish Site Security Plan) www.DisasterDoug.com

21. FTS Activation Org Chart Example of how the Activation Team may be organized. This chart utilizes Smart Art which is feature in PowerPoint 2007. If you wish to make charts like this and don’t have PPT 2007, we have provided the graphical elements to help you build this yourself. Here is the description of the chart. You may change or delete this text as you wish. FTS logistics will by managed by, or in cooperation with, the OA EOC www.DisasterDoug.com

22. Job Action Sheets The right tool for the right job. Job Action Sheets are included in the FTS Planning Guide for each position on the FTS Activation Team. In addition to the Job Action Sheets, the supporting tools, such as the ICS Forms, can be found in the Attachments section. www.DisasterDoug.com

23. FTS Equipment / Supplies Tool And Recommended Quantities for a 50 patient FTS www.DisasterDoug.com

24. FTS Equipment / Supplies Tool How do we use this form? • Example: Available in Local Cache?This is designed to be filled out in advance, based upon known local assets. PHD 50 PHD 150 PHD 200 OES 100 OES 200 www.DisasterDoug.com

25. FTS Equipment / Supplies Tool How do we use this? • Example: Select for OrderingThis is designed to be filled out to reflect the actual need during an incident (e.g. if your incident requires care for only 30 patients, the column should reflect that.) PHD 50 PHD 150 PHD 200 OES 100 OES 200 30 90 30 6 20 www.DisasterDoug.com

26. FTS Equipment / Supplies Tool How do we use this? • Example: Have – Need These columns are designed to indicated what items we already HAVE, versus what we still NEED (e.g. We have 10 cots, 2 Tables, & 2 Chairs; we need everything else). PHD 50 PHD 150 PHD 200 OES 100 OES 200 30 90 30 6 20 10 0 0 2 2 20 90 30 4 18 www.DisasterDoug.com

27. FTS Equipment / Supplies Tool How do we use this? • Example: Requested – Order FilledThe last two columns are meant to help us track what has been requested, and if an order has been filled. PHD 50 PHD 150 PHD 200 OES 100 OES 200 30 90 30 6 20 10 0 0 2 2 20 90 30 4 18 20 90 30 4 18 www.DisasterDoug.com

28. FTS Layout Sample Layout of a Field Treatment Site www.DisasterDoug.com

29. TEST YOUR KNOWLEDGE Let’s examine what we’ve learned so far… Portable toilets. Storage area for medical supplies. Nothing. • Scenario: You have been assigned as an FTS Activation Team Leader, and are tasked with activating this facility for 50 patients. Besides patient cots, bedding, and food, what additional items might need to be considered? www.DisasterDoug.com

30. TEST YOUR KNOWLEDGE Let’s examine what we’ve learned so far… • If you answered “C. Nothing,” you might need to restart this lesson. • If you answered “A. Portable toilets,” you have begun thinking like an FTS Activation Team Leader. • Caring for 50 people will likely require more than one toilet. You might also consider additional handwash stations.A good rule of thumb is: 20/1 www.DisasterDoug.com

31. FTS Operations The FTS Organization Chart is largely modeled after the current FIRESCOPE MCI organization chart. www.DisasterDoug.com

32. FTS Operations Job Action Sheets, Forms, & other Tools Job Action Sheets are included in the FTS Planning Guide for each position in the FTS organization. In addition to the Job Action Sheets, the supporting tools, such as the ICS Forms and FTS Report Forms can be found in the Attachments section. www.DisasterDoug.com

33. FTS Tools Several forms have been developed to assist the personnel with FTS operations, including the: FTS Report Form FTS Staffing Roster FTS Time Sheet FTS Patient Record www.DisasterDoug.com

34. FTS Site Surveys/Diagrams Developed through HPP Grant Funding In addition to the county –specific FTS Surveys and Site Diagrams, a generic FTS Diagram has been included in the Appendix of the FTS Planning Guide that demonstrates an FTS set-up at or near the site of an incident, using Tents, Cots, etc. • Most Operational Areas in California have had the opportunity to conduct FTS Assessments on local target facilities. • The FTS Assessment allows us to identify in advance what services or features already exist at a target facility, and what will likely need to be brought in to make a facility functional as an FTS. www.DisasterDoug.com

35. You have completed the FTS Overview. -Thank you. Field Treatment Sites Another piece of the puzzle. www.DisasterDoug.com