critical incident management - world health organization phemap... · 3 critical incident...
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CRITICAL INCIDENT CRITICAL INCIDENT MANAGEMENTMANAGEMENT
Dr Praveena AliDr Praveena AliPrincipal Medical OfficerPrincipal Medical Officer
Ministry of HealthMinistry of HealthFijiFiji
Performance ObjectivesPerformance Objectives
Describe critical incident characteristicsDescribe critical incident characteristics
Discuss the characteristics of a mass Discuss the characteristics of a mass casualty situationcasualty situation
Discuss common problems associated Discuss common problems associated with a mass casualtywith a mass casualty
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Performance ObjectivesPerformance Objectives
Discuss critical incident stagesDiscuss critical incident stages
Discuss decision making in a critical Discuss decision making in a critical incidentincident
Discuss critical incident case studiesDiscuss critical incident case studies
Discuss the process for Humanitarian Discuss the process for Humanitarian AssistanceAssistance
Bus AccidentBus Accident
Bus Accident ScenarioBus Accident Scenario
School bus with 60 Girl ScoutsSchool bus with 60 Girl Scouts
Lost control and landed in ravineLost control and landed in ravine
MultiMulti-- agency responseagency response
Write down good points and bad points Write down good points and bad points
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Critical Incident Management Critical Incident Management CharacteristicsCharacteristics
Demands a coordinated response to Demands a coordinated response to prevent incident from getting worseprevent incident from getting worse
This includes unresolved element of This includes unresolved element of danger such as additional bomb, a threat danger such as additional bomb, a threat to citizens and responders or an unusual to citizens and responders or an unusual incident incident
Critical Incident Management Critical Incident Management CharacteristicsCharacteristics
Often random in nature and disrupt Often random in nature and disrupt normal lifenormal life
Terrorist organizations use opportunity Terrorist organizations use opportunity as a tool for civil disturbanceas a tool for civil disturbance
A mass casualty is a critical incident A mass casualty is a critical incident
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Mass Casualty Incident Mass Casualty Incident OverviewOverview
Produces several patientsProduces several patients
As few as six or as many as several As few as six or as many as several hundredhundred
Affects local hospitalsAffects local hospitals
Patients are greater than resources of Patients are greater than resources of the initial respondersthe initial responders
Preparation For Mass Casualty Preparation For Mass Casualty
PrePre--planning and training are criticalplanning and training are critical
Establish guidelines and proceduresEstablish guidelines and procedures
Early implementation of Incident Early implementation of Incident CommandCommand
First five minutes will determine next five First five minutes will determine next five hourshours
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Response Categories Of Mass Response Categories Of Mass CasualtiesCasualties
Mass Casualties can occur in a variety of Mass Casualties can occur in a variety of waysways
Effect on emergency response and Effect on emergency response and community impactcommunity impact
Include transportation, violent crimes and Include transportation, violent crimes and building collapse building collapse
Response Categories Of Mass Response Categories Of Mass CasualtiesCasualties
Hazardous materials incidentsHazardous materials incidents
Civil disturbancesCivil disturbances
Natural disastersNatural disasters
Major firesMajor fires
Terrorist attacksTerrorist attacks
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Problems In Mass Casualty Problems In Mass Casualty IncidentsIncidents
Most common being:Most common being:
Who is in command of the incidentWho is in command of the incident
Location of the Command PostLocation of the Command Post
Lack of communication between Lack of communication between agencies leading to conflicting priorities agencies leading to conflicting priorities and orders and orders
Problems In Mass Casualty Problems In Mass Casualty IncidentsIncidents
Perimeter establishment delayed or not Perimeter establishment delayed or not done at alldone at all
Large crowds of peopleLarge crowds of people
Media involvementMedia involvement
Political involvementPolitical involvement
Inadequate resourcesInadequate resources
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Functional Systems ApproachFunctional Systems Approach
Three levels of function: strategic, Three levels of function: strategic, tactical and tasktactical and task
Management is strategicManagement is strategic
Team leaders are tacticalTeam leaders are tactical
Resources not involved in supervision Resources not involved in supervision are task are task
Critical Incident StagesCritical Incident Stages
They consist of:They consist of:
Initial ResponseInitial Response
Incident Control using the Six Step Incident Control using the Six Step ResponseResponse
Recovery Stage Recovery Stage
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Initial Response StageInitial Response Stage
Ability to establish command and controlAbility to establish command and control
Faced with confusion and panicFaced with confusion and panic
Crucial to develop a team and place a Crucial to develop a team and place a plan in actionplan in action
Initial Response ObjectivesInitial Response Objectives
Protecting citizens and rescue of victimsProtecting citizens and rescue of victims
Limit incident growthLimit incident growth
Protect arriving respondersProtect arriving responders
Identify ingress and egress routesIdentify ingress and egress routes
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Initial Response ObjectivesInitial Response Objectives
As soon as possible:As soon as possible:
Gain control of the sceneGain control of the scene
Restore orderRestore order
Prevent target Prevent target
opportunitiesopportunities
Incident Control Using The SixIncident Control Using The Six--Step ResponseStep Response
The SixThe Six--Step response is based on the Step response is based on the Incident Command System. It includes: Incident Command System. It includes: Assume command, situation Assume command, situation assessment, identify and set perimeters, assessment, identify and set perimeters, establish command post, Safety officer establish command post, Safety officer and staging areas and staging areas
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# 1 # 1 –– Assume CommandAssume Command
The first responder is providing order to The first responder is providing order to the incidentthe incident
Prevents independent action and Prevents independent action and multiple commandsmultiple commands
Reassures responders that someone is Reassures responders that someone is in charge in charge
# 1 # 1 –– Assume CommandAssume Command
Must advise incoming responders of Must advise incoming responders of incident locationincident location
Secure tactical frequencySecure tactical frequency
Request supervisory supportRequest supervisory support
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# 2 # 2 –– Situation AssessmentSituation Assessment
Size up of the incident that includes the Size up of the incident that includes the type of threat, approximate number of type of threat, approximate number of injured, size of threatened area and injured, size of threatened area and possibility of secondary event.possibility of secondary event.
# 2 # 2 –– Situation AssessmentSituation Assessment
In simple terms the assessment should In simple terms the assessment should describe:describe:
What do you haveWhat do you have
What are you doingWhat are you doing
What do you needWhat do you need
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# 3 # 3 -- Identify And Set Identify And Set PerimetersPerimeters
Divide the incident into manageable Divide the incident into manageable divisions (geographical areas)divisions (geographical areas)
Allows command to provide resources Allows command to provide resources where they are neededwhere they are needed
# 3 # 3 -- Identify And Set Identify And Set PerimetersPerimeters
Critical incidents have three standard Critical incidents have three standard perimeters. All perimeters are divisionsperimeters. All perimeters are divisions
Expand perimeters based on weatherExpand perimeters based on weather
Perimeters are the hot zone, inner Perimeters are the hot zone, inner perimeter and outer perimeter perimeter and outer perimeter
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The Hot ZoneThe Hot Zone
Area in which the incident has occurredArea in which the incident has occurred
May be a street corner or spread over a May be a street corner or spread over a large arealarge area
Secured by placing responders in Secured by placing responders in positions of controlling ingress and positions of controlling ingress and egressegress
Inner PerimeterInner Perimeter
Protects responders in hot zoneProtects responders in hot zone
Uniformed personnel onlyUniformed personnel only
Used as decontamination area, Used as decontamination area, treatment area and evacuation area for treatment area and evacuation area for walking woundedwalking wounded
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Outer PerimeterOuter Perimeter
Provides last line of defense from Provides last line of defense from internal incident accelerationinternal incident acceleration
Provides first line of defense from Provides first line of defense from external accelerationexternal acceleration
Secure area for command post, Secure area for command post, resources and control of the media resources and control of the media
Perimeter Placement IllustrationPerimeter Placement Illustration
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# 4 # 4 –– Establish Command PostEstablish Command Post
Typically begins at first responders Typically begins at first responders vehiclevehicle
Incident dynamics will require Incident Incident dynamics will require Incident Commander to shift to fixed command Commander to shift to fixed command postpost
Must be away from hot zoneMust be away from hot zone
# 4 # 4 –– Establish Command PostEstablish Command Post
The command post will ensure support The command post will ensure support for field personnel, create a controlled for field personnel, create a controlled environment and improve environment and improve communications.communications.
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# 5 # 5 -- Establish Safety OfficerEstablish Safety Officer
Should be filled as soon as possibleShould be filled as soon as possible
Officer selected on operational Officer selected on operational experience and ability to recognize experience and ability to recognize acceptable and unacceptable riskacceptable and unacceptable risk
Operations can be stopped or modifiedOperations can be stopped or modified
# 6 # 6 -- Establish Staging Area Establish Staging Area
Effective tool in correct and safe Effective tool in correct and safe deployment of resourcesdeployment of resources
Staging Supervisor must track, rotate Staging Supervisor must track, rotate and relieve resources as appropriateand relieve resources as appropriate
Area established within inner or outer Area established within inner or outer perimeter. Avoid congestionperimeter. Avoid congestion
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Inter Agency Planning Inter Agency Planning
Failure to include all agencies during Failure to include all agencies during planning process may compromise planning process may compromise respondersresponders
Identify and establish liaisons with all Identify and establish liaisons with all agencies and coordinate tactical agencies and coordinate tactical operations operations
Secondary IncidentsSecondary Incidents
May be more destructive and damaging May be more destructive and damaging than initial incidentthan initial incident
World Trade Center crashes were World Trade Center crashes were primary incident with collapse of the primary incident with collapse of the towers as secondary incidents claiming towers as secondary incidents claiming more lives more lives
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Recovery StageRecovery Stage
Begun when aggressive threats of Begun when aggressive threats of incident are neutralizedincident are neutralized
Incident is not over when last patient is Incident is not over when last patient is transportedtransported
Recovery must be managed Recovery must be managed aggressively aggressively
Recovery StageRecovery Stage
Planning Section of incident command is Planning Section of incident command is responsible for initial recoveryresponsible for initial recovery
Typically the longest and most poorly Typically the longest and most poorly managed part of the incidentmanaged part of the incident
May require months to years May require months to years
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Goals In The Recovery StageGoals In The Recovery Stage
Most important goal is document Most important goal is document collectioncollection
Information can assist in Post Incident Information can assist in Post Incident Analysis, cost recovery and tracking Analysis, cost recovery and tracking responder injuries or deaths responder injuries or deaths
Goals In The Recovery StageGoals In The Recovery Stage
Provide critical incident stress Provide critical incident stress management for respondersmanagement for responders
Collect and properly dispose of used Collect and properly dispose of used medical supplies and biohazard waste medical supplies and biohazard waste from the incident from the incident
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Post Incident AnalysisPost Incident Analysis
Critical for operational review. Benefits Critical for operational review. Benefits include:include:
Operational performanceOperational performance
Organizational needsOrganizational needs
Procedure modificationProcedure modification
Additional trainingAdditional training
SummarySummary
Critical Incident Management can place Critical Incident Management can place a heavy burden on respondersa heavy burden on responders
Requires a coordinated response from all Requires a coordinated response from all agencies involvedagencies involved
Mass casualty incident is a critical Mass casualty incident is a critical incident, terrorist related or not incident, terrorist related or not
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SummarySummary
Identifying critical stages will give the Identifying critical stages will give the responder a better chance of dealing responder a better chance of dealing with the incidentwith the incident
Six Six –– Step response is a tool for incident Step response is a tool for incident managementmanagement
Humanitarian Assistance Humanitarian Assistance
9-11-01