Jump to content


Photo
- - - - -

Aeromedical Response To Mass Casualty Care


  • Please log in to reply
9 replies to this topic

#1 Richard

Richard

    Advanced Member

  • Members
  • PipPipPip
  • 102 posts

Posted 02 August 2007 - 10:54 AM

Greetings Flt RCPs, Nurses and Paramedics..

As I become more involved with AEMS, I am going to put forth some notions and suggestions regarding another hot RCP topic. Disaster/Pandemic/Bioterrorism Response. Take your pick.

In the last two years, I have done a bit of work in this area, and I have concluded that transport services are uniquely suited for extensive and early involvement is mass casualty care for any particular cause, whether natural, (hurricane, pandemic flu) or man-made, (nuclear, biological or chemical).

One of the puzzlers regarding mass casualty response is who will act as front line providers and trainers in any event where the affected institution, local or region has to care for itself until a federal, (24-72 hours) can be organized and deployed. Surge capacity ventilators cannot be "airdropped" to confused and fearful practitioners who have never used them without a guide/instructor attached.

I would like to entertain some serious and prudent discussion and some fringe left field possibilities.

AEMS personnel, whether RCP, RN or FP-C already provide care in the same cut as would be required. If several teams were available to fly into a bioterrorism event, an infectious agent would preclude evacuation. The only possibility is to treat in place and a surge beyond the local capacity could be mitigated by flying resources, (surge equipment and personnel) in. Charity hospital COULD have been relieved with additional pneumatic ventilators and critical care personnel. The staff suffered needlessly.

I work with other groups besides RCPs and HCWs, including Disaster Planners, Risk Assessors, physician and nursing groups and some folks in the GWNorth. This idea has had some momentum.
  • 0
Richard P. Mitchell, RRT-NPS
Pediatric Respiratory Therapist
Vidant Medical Center, Greenville, NC and
HHS/OS/ASPR/OPEO/NDMS/DMAT-NC1 & MAC-ST

#2 Terry24

Terry24

    Newbie

  • Members
  • Pip
  • 6 posts

Posted 02 August 2007 - 01:48 PM

What kind of discussion and fringe possibilities are you referring to? My facility and I are working on this very subject.









Greetings Flt RCPs, Nurses and Paramedics..

As I become more involved with AEMS, I am going to put forth some notions and suggestions regarding another hot RCP topic. Disaster/Pandemic/Bioterrorism Response. Take your pick.

In the last two years, I have done a bit of work in this area, and I have concluded that transport services are uniquely suited for extensive and early involvement is mass casualty care for any particular cause, whether natural, (hurricane, pandemic flu) or man-made, (nuclear, biological or chemical).

One of the puzzlers regarding mass casualty response is who will act as front line providers and trainers in any event where the affected institution, local or region has to care for itself until a federal, (24-72 hours) can be organized and deployed. Surge capacity ventilators cannot be "airdropped" to confused and fearful practitioners who have never used them without a guide/instructor attached.

I would like to entertain some serious and prudent discussion and some fringe left field possibilities.

AEMS personnel, whether RCP, RN or FP-C already provide care in the same cut as would be required. If several teams were available to fly into a bioterrorism event, an infectious agent would preclude evacuation. The only possibility is to treat in place and a surge beyond the local capacity could be mitigated by flying resources, (surge equipment and personnel) in. Charity hospital COULD have been relieved with additional pneumatic ventilators and critical care personnel. The staff suffered needlessly.

I work with other groups besides RCPs and HCWs, including Disaster Planners, Risk Assessors, physician and nursing groups and some folks in the GWNorth. This idea has had some momentum.


  • 0

#3 Mike

Mike

    Member

  • Members
  • PipPip
  • 10 posts

Posted 02 August 2007 - 04:02 PM

Interesting thoughts. A few comments...

I see the interest in bringing a specialized level of care to an environment that needs additional resources and trained people to care for them/assist with the technology. A few problems arise, and I will try and use current examples to illustrate. However, first, let me be clear, I am a true belilever that our best funciton in any MCI is rapid transport, sometimes multiple times. In general, we are not a "front line' resource. We are called to help evacuate the sickest people quickly, and to return and repeat until we need to refuel. There have been exceptions, of course, and there will continue to be (IMHO)

- New Orleans - From what i understand (not there, so really this is third/fourth hand), civilian HEMS crews were transporting patients during daylight hours for safety precautions, over multiple days/weeks. Crews would work 12 hour shifts, basically flying most of the time, then sleep/whatever at night. I totally agree that an influ of peopel would have helped many people in those hosptials. However, at the same time, by you not being on the helicopter, you are removing yourself from the flight rotation, where you were intially called to serve. You are putting more of a burden on your co-workers, decreasing everyone elses's amount of rest by being short one able body. If your company were in a position to send crews for flight and crews to augment hospital staffing...well, there wouldn't be a HCP shortage wuld there?

- NYC 9/11 - Understandably, HEMS didn't have much of a role, as it was downtown NYC. And, many were DOAs with many walking wounded, an MCI nightmare if it were a poisonous/biological attack. In that situation sure, augment hosptial staffing as needed, but then you have issues of licensure and hospital liability. While nice to think we are all banding together in an emergency, I assure you adminstrators will have to account for provider actions during those times of crisis. So, logistaically while there is a potential positive point, liability rears its ugly head.

- Pentagon 9/11 - Again, from what I understand there were multiple aircrews performing missions. AMTC that follwoing year had some good presentations on the topic. One crew stayed to provide on scene support to USAR teams. From what I unerstood, not actively involved in searching, but to provide on site medical care for the rescuers, and I would imagine, anyone else who wandered by needing care. Again, from what I understood, as is shown on the recurrent shows, there was a national grounding of flights during that period until the 4th aircraft (PA) could be located. So, maybe while the ground support crew, while there, realized they couldn't go anywhere, and decided to stay. A great utilizaiton of resources, especially to protect those people climbing around in the building.

- Tahoe wildfires - How about dropping crews off to help with smoke inhalation and burns? I have no idea if there are any, but again, dropping you off with a surplus of vents (who has that anyway?) to help care for patients would be great, if it didnt take you out of the role of transporting to a speacialy facility.

Let's not forget the all important rule of EMS... a dead paramedic (interchange provider here) doesn't provide care to anyone (paraphrasing).

So you want to drop into an area to assist in onsite care until people are de-conned and hosptials can treat and manage the first wave of patients, that's great. However, you now take yourself out of caring for patients in the role that you now specialize in (i.e., HEMS). you also put yourself at risk for exposure to said chemical/biological, etc... and are now considered, even though you are caring for those in the "red/yellow/green" zone, another patient who in the end needs to be evaluated.

I see what you are saying, and you have some great ideas. However, I think that your specialty best serves your patients in the environment where you are... in the air. I know states have disaster teams... maybe evaluating some kind of continued training for them, to an increased level of care, so that in the event of an emergency, they were to respond to a location to be coordinated in advance, then to act as a rapid intervention team for teh medical side of the disaster, with a surplus of equipment. Again though, you hae a specific function. If the "disaster" is so short lived that rapid transport accomplilshes the goal, then you are where you need to be... in the helicoppter. If the "disaster" is so lengthy that it requires continuous HEMS operations or additional medical staff, you will be needed to help relieve flight crews as you are specialized... so you are where you need to be... on a helicopter.
  • 0
Mike RN NREMTP etc...
"Just do your job"

#4 Richard

Richard

    Advanced Member

  • Members
  • PipPipPip
  • 102 posts

Posted 03 August 2007 - 09:07 AM

Interesting thoughts. A few comments...

I see the interest in bringing a specialized level of care to an environment that needs additional resources and trained people to care for them/assist with the technology. A few problems arise, and I will try and use current examples to illustrate. However, first, let me be clear, I am a true belilever that our best funciton in any MCI is rapid transport, sometimes multiple times. In general, we are not a "front line' resource. We are called to help evacuate the sickest people quickly, and to return and repeat until we need to refuel. There have been exceptions, of course, and there will continue to be (IMHO)

- New Orleans - From what i understand (not there, so really this is third/fourth hand), civilian HEMS crews were transporting patients during daylight hours for safety precautions, over multiple days/weeks. Crews would work 12 hour shifts, basically flying most of the time, then sleep/whatever at night. I totally agree that an influ of peopel would have helped many people in those hosptials. However, at the same time, by you not being on the helicopter, you are removing yourself from the flight rotation, where you were intially called to serve. You are putting more of a burden on your co-workers, decreasing everyone elses's amount of rest by being short one able body. If your company were in a position to send crews for flight and crews to augment hospital staffing...well, there wouldn't be a HCP shortage wuld there?

- NYC 9/11 - Understandably, HEMS didn't have much of a role, as it was downtown NYC. And, many were DOAs with many walking wounded, an MCI nightmare if it were a poisonous/biological attack. In that situation sure, augment hosptial staffing as needed, but then you have issues of licensure and hospital liability. While nice to think we are all banding together in an emergency, I assure you adminstrators will have to account for provider actions during those times of crisis. So, logistaically while there is a potential positive point, liability rears its ugly head.

- Pentagon 9/11 - Again, from what I understand there were multiple aircrews performing missions. AMTC that follwoing year had some good presentations on the topic. One crew stayed to provide on scene support to USAR teams. From what I unerstood, not actively involved in searching, but to provide on site medical care for the rescuers, and I would imagine, anyone else who wandered by needing care. Again, from what I understood, as is shown on the recurrent shows, there was a national grounding of flights during that period until the 4th aircraft (PA) could be located. So, maybe while the ground support crew, while there, realized they couldn't go anywhere, and decided to stay. A great utilizaiton of resources, especially to protect those people climbing around in the building.

- Tahoe wildfires - How about dropping crews off to help with smoke inhalation and burns? I have no idea if there are any, but again, dropping you off with a surplus of vents (who has that anyway?) to help care for patients would be great, if it didnt take you out of the role of transporting to a speacialy facility.

Let's not forget the all important rule of EMS... a dead paramedic (interchange provider here) doesn't provide care to anyone (paraphrasing).

So you want to drop into an area to assist in onsite care until people are de-conned and hosptials can treat and manage the first wave of patients, that's great. However, you now take yourself out of caring for patients in the role that you now specialize in (i.e., HEMS). you also put yourself at risk for exposure to said chemical/biological, etc... and are now considered, even though you are caring for those in the "red/yellow/green" zone, another patient who in the end needs to be evaluated.

I see what you are saying, and you have some great ideas. However, I think that your specialty best serves your patients in the environment where you are... in the air. I know states have disaster teams... maybe evaluating some kind of continued training for them, to an increased level of care, so that in the event of an emergency, they were to respond to a location to be coordinated in advance, then to act as a rapid intervention team for teh medical side of the disaster, with a surplus of equipment. Again though, you hae a specific function. If the "disaster" is so short lived that rapid transport accomplilshes the goal, then you are where you need to be... in the helicoppter. If the "disaster" is so lengthy that it requires continuous HEMS operations or additional medical staff, you will be needed to help relieve flight crews as you are specialized... so you are where you need to be... on a helicopter.


  • 0
Richard P. Mitchell, RRT-NPS
Pediatric Respiratory Therapist
Vidant Medical Center, Greenville, NC and
HHS/OS/ASPR/OPEO/NDMS/DMAT-NC1 & MAC-ST

#5 Richard

Richard

    Advanced Member

  • Members
  • PipPipPip
  • 102 posts

Posted 03 August 2007 - 09:30 AM

Sorry about the choppy edit. Very good points. Mike. I would not suggest that the transport/HEMS tram compromise it's primary role. I do suggest there are functions wholly suited to AEMS in disaster response that could be either directed or directly supported by AEMS. For instance, there is probably no group better to become a primary education/training resource in mass casualty ventilation methods and mechanics. The LTV1000/1200 is fast becoming the vent of choice for most states and there are many RCPs/Critical Care RNs not familiar with it. As an educational resource and a group in touch with institutions through out the service area, this could come in handy.

I did say you won't be moving anyone if an infectious agent is the issue. Care will have to be provided in place and it may well be that AEMS will be ask to transport NDMS or MRC personnel to the scene/location for that purpose. This could be done with limited materials, as well. Again, rapid and timely support of the logistics will be essential. FYI, there are several available texts on NBC/Mass Casualty Care and they're all written for EMS. None for RCPs or Nursing.

I would suggest that all who have not studied the paradigms of Mass Casualty Care in either the Natural or Unnatural version, do so, and then consider what expertise and skills could be brought to bear on them. I have been writing materials for two years and worked to improve awareness for RCPs and have been very disappointed in the lack of interest and the lack of natural aptitude. Anyone can intubate a patient in an OR with Enya singing background. It takes extra to do it in the dark, in the rain, upside down. Mass Casualty Care will be everything more like the latter than former.

Don't compromise the mission, but get involved. There is much that could be contributed from here.
  • 0
Richard P. Mitchell, RRT-NPS
Pediatric Respiratory Therapist
Vidant Medical Center, Greenville, NC and
HHS/OS/ASPR/OPEO/NDMS/DMAT-NC1 & MAC-ST

#6 flightnursesarah

flightnursesarah

    Advanced Member

  • Members
  • PipPipPip
  • 113 posts

Posted 03 August 2007 - 07:34 PM

With the August 31st deadline approaching for federally-funded hospitals to become NIMS and HICS compliant, I have been actively involved in educating our regional hospitals about such topics. With disasters happening everyday, unfortunately, we have to be prepared!

As the only aeromedical transport operation in our EMS region, our role in disaster is to transport patients. We actually have two huge bags of disaster supplies that we have on hand to take to such event. This gives the ground crews extras of a lot of "stuff."

As for our role in a biological disaster, our program has an isopod. All of our region hospitals have at least one as well, and our home hospital has two of them. I don't know if anyone else has them, but from the training we have done with them, I believe they are a good tool for transport (--maybe better in a ground rig than in our space-confining aircraft). This does not protect the caregiver from chemicals, only biological, agents.

On a different note, is anyone else a member of your local medical disaster team? Our region has a medical disaster team compromised of nurses, medics, physicians from all of our regional hospitals. We meet every-other month for training and set up at large events in our region. We are also on call 24/7 in the event of a large-scale disaster. We have been activated multiple times in the last few years for tornados, large-scale power outages during an ice storm, etc. We have ICS and hazmat/decon training, as well as START triage, and all of that other "large-scale badness" education.


Just wondering!
Sarah :)
  • 0
Sarah RN BSN CFRN
Two things are infinite: the universe and human stupidity; and I'm not sure about the universe.
Albert Einstein

#7 Terry24

Terry24

    Newbie

  • Members
  • Pip
  • 6 posts

Posted 10 August 2007 - 05:25 PM

With the August 31st deadline approaching for federally-funded hospitals to become NIMS and HICS compliant, I have been actively involved in educating our regional hospitals about such topics. With disasters happening everyday, unfortunately, we have to be prepared!

As the only aeromedical transport operation in our EMS region, our role in disaster is to transport patients. We actually have two huge bags of disaster supplies that we have on hand to take to such event. This gives the ground crews extras of a lot of "stuff."

As for our role in a biological disaster, our program has an isopod. All of our region hospitals have at least one as well, and our home hospital has two of them. I don't know if anyone else has them, but from the training we have done with them, I believe they are a good tool for transport (--maybe better in a ground rig than in our space-confining aircraft). This does not protect the caregiver from chemicals, only biological, agents.

On a different note, is anyone else a member of your local medical disaster team? Our region has a medical disaster team compromised of nurses, medics, physicians from all of our regional hospitals. We meet every-other month for training and set up at large events in our region. We are also on call 24/7 in the event of a large-scale disaster. We have been activated multiple times in the last few years for tornados, large-scale power outages during an ice storm, etc. We have ICS and hazmat/decon training, as well as START triage, and all of that other "large-scale badness" education.
Just wondering!
Sarah :)


Sarah, did you get the message I sent you yesterday?


  • 0

#8 flightnursesarah

flightnursesarah

    Advanced Member

  • Members
  • PipPipPip
  • 113 posts

Posted 10 August 2007 - 06:18 PM

No, sorry, I didn't.
  • 0
Sarah RN BSN CFRN
Two things are infinite: the universe and human stupidity; and I'm not sure about the universe.
Albert Einstein

#9 Terry24

Terry24

    Newbie

  • Members
  • Pip
  • 6 posts

Posted 11 August 2007 - 02:42 PM

Sent you one this morning.
  • 0

#10 flightnursesarah

flightnursesarah

    Advanced Member

  • Members
  • PipPipPip
  • 113 posts

Posted 12 August 2007 - 02:49 AM

Got it! Thanks. It is glad to know there are other people as paranoid as I am about the world!
  • 0
Sarah RN BSN CFRN
Two things are infinite: the universe and human stupidity; and I'm not sure about the universe.
Albert Einstein