ems and civil unrest - code 3 conferencecode3conference.com/.../ems-and-civil-unrest.pdf · ∗low...

EMS and Civil Unrest Shannon Watson, CCEMT-P Community Health Supervisor Christian Hospital EMS

Nathan Woltman, MD EMS Fellow Washington University

∗ Describe the preparation needed for civil unrest

∗ Recognize the changes to practice with civil unrest

∗ Acknowledge the focus on provider safety

∗ Understand the emotional wellbeing of your providers

Objectives

∗ Paramedic 10 years

∗ Onslow Co EMS, CHEMS, MIH

Background

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCJ2S8szcksgCFUnUgAod_UoOZQ&url=http://www.worklooker.com/nc-onslow-county-jobs.php&psig=AFQjCNG7_UesTE2GlEBTdD9yMnTzoT9lWA&ust=1443288953607872

∗ August 9th 2014 ∗ 21 days of civil unrest

∗ November 2014 - Grand jury decision ∗ 7 days of civil unrest

∗ 1 year anniversary ∗ 7 days of civil unrest

CHEMS & Civil Unrest

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCL7IkIPjksgCFcuVDQodxb4ALQ&url=http://www.ksdk.com/story/news/local/ferguson/2015/08/01/michael-brown-sr-piece-me-gone/30979205/&psig=AFQjCNHq6B-tjgYWehUojTgZdtQUP-GAYQ&ust=1443290691063183

∗ 250 EMS calls dispatched to the hot zone ∗ Trauma, sick cases, maternity

∗ Resources Used ∗ Medications, trauma dressings, vehicles

∗ Staff ∗ 2500 additional hours overtime

CHEMS Total Civil Unrest

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCI6F-6XJq8gCFYuODQodW1AEQg&url=http://www.emsworld.com/article/10732855/pulmonary-edema-and-heart-failure&psig=AFQjCNF7eAPXrPS3d6jLrFcmvDiWnRPnKA&ust=1444142740767271

∗ Nathan Woltman, MD ∗ EMS Fellow, Washington University in St Louis ∗ Instructor of Emergency Medicine, Johns Hopkins School

of Medicine ∗ Deputy Medical Director, USDOJ (USMS, BATF) ∗ Deputy Medical Director, USDHS (USSS, ICE)

Background

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCNnwoOaXwsgCFcaVDQodWnQOwg&url=http://www.hopkinsmedicine.org/emergencymedicine/residency/people/2015_alumni_graduates.html&bvm=bv.104819420,d.eXY&psig=AFQjCNFCJuC_uvPsnt7QzsZOLPP2xompUA&ust=1444919778701875

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCKbS6fiXwsgCFYyggAodCZoLxQ&url=https://wuphysicians.wustl.edu/for-patients/find-a-physician&bvm=bv.104819420,d.eXY&psig=AFQjCNFCJuC_uvPsnt7QzsZOLPP2xompUA&ust=1444919778701875

∗ Fire/Medic Fort Collins, CO; Great Falls, MT ∗ Post Certified 2003 ∗ Rocky Mountain Rescue Group ∗ Emergency Physician ∗ Physician-US Army Medical Corps ∗ Law Enforcement Medicine Fellowship ∗ Emergency Medical Services Fellow

Background

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCKOTgNzcksgCFUTPgAodMWwD-A&url=http://www.angelfire.com/nc3/dcems/isabel.html&psig=AFQjCNG7_UesTE2GlEBTdD9yMnTzoT9lWA&ust=1443288953607872

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCLvZs8eYwsgCFQGFDQodHMsAcA&url=http://www.rockymountainrescue.org/prospective_intro_series.php&bvm=bv.104819420,d.eXY&psig=AFQjCNGjBJlKEYsccLoTGLOSZi1xrwyOhA&ust=1444919981759153

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCOyZsfeYwsgCFUqGDQodOXoDhg&url=http://www.amazon.com/Army-Flag-Black-Gold-Crest/dp/B0026BVKY6&bvm=bv.104819420,d.eXY&psig=AFQjCNGoXR6PuqkhGuPG4lAfrqgKSV3uUQ&ust=1444920067190105

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCLnA9JWZwsgCFUGYgAodZVgEig&url=http://www.tacticalmedicine.com/about-us/&bvm=bv.104819420,d.eXY&psig=AFQjCNEtwrimYQ86NIRB3lHK1q1PC1PB5Q&ust=1444920133311567

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCNyLotCZwsgCFcavgAodxScF6g&url=http://www.iuhealthrecruitment.org/Physician_Job/Details/Emergency-Medicine-Opportunity-IU-Health-Ball-Memorial-Hospital-ED/8147&psig=AFQjCNGNWrQKP_BLJBzb1VelQCUhmxGCgQ&ust=1444920275272603

City of Baltimore

∗ Largest independent city

in the United States, founded 1729

∗ 622,000 people ∗ 2.7 million person

metropolitan area

Baltimore and Civil Unrest

∗ April 12 2015 ∗ Freddy Gray arrest

∗ April 19 2015 ∗ Freddy Gray dies in

hospital ∗ April 27 2015 ∗ Protests spread across

the city

Baltimore Unrest

Baltimore

∗ Baltimore police command center ∗ Middle of downtown

Baltimore at a confluence of the interstate and several major roads

∗ Homeland Security and

MSP command ∗ Camden yards parking

lots

∗ Why is it important? ∗ Communication on all levels

∗ Challenges we encountered ∗ No communication – fear of unknown ∗ Lack of intel ∗ Reactive

Unified Command

Baltimore

∗ Two methods of EMS response ∗ Baltimore city Fire/EMS

∗ Priority calls in Baltimore city ∗ Calls in hot zone

∗ Tactical Medics ∗ Maryland State Police ∗ Johns Hopkins Center for Law

Enforcement Medicine & USDOJ

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCL2IqZzK08gCFQWsPgodq4YBtg&url=https://www.flickr.com/photos/triborough/9481082621&psig=AFQjCNHAJonLBZqEGoKBu9hTBlvy2qg5Lw&ust=1445517391970839

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCIG9hrPK08gCFUUVPgodiYwPOQ&url=http://weblogs.baltimoresun.com/news/crime/blog/2010/09/&bvm=bv.105454873,d.cWw&psig=AFQjCNEZWnXGq-PQS6joIj_OXf7q7ERY2w&ust=1445517481375214

Baltimore-Tactical Medics

∗ MSP trains state troopers to work full time as paramedics on helicopter

∗ Federal agencies train federal agents to work part time as medics, mostly for special teams

∗ Physicians trained in tactical medicine attached to federal teams

∗ Tactical medics responded in medically equipped black low profile SUVs rather than ambulances ∗ Could be confused with low

profile law enforcement vehicles

∗ Very little protection for driver/occupants

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCNvr0JXGwsgCFUGMDQod_SMM0Q&url=http://www.cnn.com/2015/07/08/us/baltimore-fop-police-riot-response/&psig=AFQjCNGObOFAi5ualUlmatN5fnVgL59laQ&ust=1444932187053638

Baltimore Riots

∗ Riots covered a geographical area comparable to downtown St Louis to Forrest Park

∗ Riots initially isolated to

pockets but then spread across the city, passing through commercial center and a major medical campus

Baltimore - Challenges

∗ Large geographic area ∗ Low situational

awareness ∗ Radio chaos

∗ Vulnerable medic units ∗ Blocked thoroughfares ∗ 600,000 Baltimore

residents needing care

∗ Bystanders effected ∗ Inability to obtain

medications from pharmacies ∗ Diabetics ∗ Coumadin

∗ Breakdown in social services ∗ Shelters, Mental Health,

Dialysis

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCIKt4uDGwsgCFQmZgAod30QH9A&url=http://www.cnn.com/2015/07/08/us/baltimore-fop-police-riot-response/&psig=AFQjCNGObOFAi5ualUlmatN5fnVgL59laQ&ust=1444932187053638

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCMmzxO7GwsgCFcvwgAodK64NoA&url=https://electronicintifada.net/blogs/rania-khalek/israeli-trained-police-invade-baltimore-crackdown-black-lives-matter&psig=AFQjCNGObOFAi5ualUlmatN5fnVgL59laQ&ust=1444932187053638

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCKOo56fHwsgCFQmVgAodhUkEFg&url=http://www.baltimorepolicehistory.net/technology/34-security/218-tactical-section.html&psig=AFQjCNGObOFAi5ualUlmatN5fnVgL59laQ&ust=1444932187053638

Changes to Practice

Baltimore Fergusson

∗ Casualty collection

∗ Location of command

∗ Resources

∗ Crew Communications

∗ Initial EMS responses with police escort

∗ PD & EMS restricted to life threats in riot area

∗ Many calls pending for >30 minutes

∗ Physical safety / Fatigue / Mental Health

∗ Hospital Staff Safety

∗ Short scene times

∗ Discontinued services

∗ Two people per vehicle

Crew Safety

∗ EAP &CISM ∗ Mandating vs. Offering

∗ PTSD ∗ Common

∗ Overworking ∗ Crews felt obligated to support their community & coworkers

Fatigue & Mental Health

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCJiTvPfnksgCFUOagAodCMcNHQ&url=http://thechampagnesupernova.com/2015/01/new-years-resolution-simplify-overextend-authentic-authenticity-just-say-no/&psig=AFQjCNGe_knPQkCFp5KS0qWAtxCcudk-9A&ust=1443292017405746

∗ Have strong relationships with local agencies

∗ Don’t be too proud

∗ Identify additional resources early

Asking for Help

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCNjE3p3sksgCFQTSgAodFqkMGw&url=http://www.cbsnews.com/news/police-fire-tear-gas-as-protests-turn-violent-in-ferguson-missouri/&psig=AFQjCNHsne6QsmclPx8jXEXbMIgi1CnL9Q&ust=1443293156942288

∗ Disaster planning

∗ Treating everyone

∗ Communication with crews

∗ Social Media

∗ Mandating ∗ CISM ∗ EAP ∗ Safety Gear

∗ Sustainability with response

∗ Rebuilding relationships

Lessons Learned

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCJGv9cXuksgCFRDugAod7xcLCg&url=http://www.scienceforwomen.org/2014/08/compassion-versus-competition-what-does.html&psig=AFQjCNGS4QriBTmONdtZBhLRjGpS_3kPyg&ust=1443293800580768

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCOqWm9PuksgCFUqggAodaTENAw&url=http://technmarketing.com/&psig=AFQjCNGv4rBCueZ_ZQjCWvvKk5mVfvxgCA&ust=1443293828982708

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCOqWm9PuksgCFUqggAodaTENAw&url=http://technmarketing.com/&psig=AFQjCNGv4rBCueZ_ZQjCWvvKk5mVfvxgCA&ust=1443293828982708

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCLWB09_uksgCFQGPDQodFtgAyA&url=http://technmarketing.com/&psig=AFQjCNGv4rBCueZ_ZQjCWvvKk5mVfvxgCA&ust=1443293828982708

Questions

Shannon Watson [email protected] 314-653-5271

Nathan Woltman [email protected]

mailto:[email protected]

mailto:[email protected]

ems and civil unrest - code 3 conferencecode3conference.com/.../ems-and-civil-unrest.pdf · ∗low...

Documents