Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Disaster Response and the Disaster Response and the Respiratory TherapistRespiratory Therapist

Preparation for Disasters is Preparation for Disasters is prudent and necessary. One prudent and necessary. One

must RELENTLESSLY Prepare!must RELENTLESSLY Prepare!

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Why ?Why ? Why? Disasters can occur seemingly Why? Disasters can occur seemingly

randomly and at the most inopportune randomly and at the most inopportune times.times.

Why? One must provide continuing Why? One must provide continuing care for the pre-disaster patient care for the pre-disaster patient population despite infrastructure population despite infrastructure disruption and a surge of new disruption and a surge of new patients.patients.

Why? Because Murphy Law is Why? Because Murphy Law is optimistic.optimistic.

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

What is a disaster?What is a disaster? Natural: Natural: A local event that disrupts the normal, A local event that disrupts the normal,

fundamental community services that fundamental community services that associated human and environmental losses associated human and environmental losses exceed the capacity of local emergency exceed the capacity of local emergency management. Example: Tornados, Hurricanes, management. Example: Tornados, Hurricanes, Earthquakes, Eruptions, Regional fires, Earthquakes, Eruptions, Regional fires, Mudslides, Floods, etc.Mudslides, Floods, etc.

Manmade: Manmade: Accidents (Industrial, Community) Accidents (Industrial, Community) and Terrorism (domestic and foreign)and Terrorism (domestic and foreign)

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Problem Areas in Disaster Problem Areas in Disaster ManagementManagement

Lack of common organizationLack of common organization Inadequate Inadequate communicationscommunications on- on-

scene and intra-agencyscene and intra-agency Inadequate joint planningInadequate joint planning Inadequate valid and timely Inadequate valid and timely

intelligenceintelligence Inadequate resource managementInadequate resource management Limited prediction capability based Limited prediction capability based

on research or experience.on research or experience.

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Nomenclature: Prevention *& Nomenclature: Prevention *& MitigationMitigation

Prevention:Prevention: actions that one takes actions that one takes to decrease the likelihood that an to decrease the likelihood that an event or crisis will occur.event or crisis will occur.

Mitigation:Mitigation: actions that one can actions that one can take to eliminate or reduce the loss take to eliminate or reduce the loss of life and property damage related of life and property damage related to an event, particularly those events to an event, particularly those events that cannot be prevented.that cannot be prevented.

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Establishment of an ICS and EOCEstablishment of an ICS and EOC

Incident Command System (ICS) Incident Command System (ICS) should be consistent with the should be consistent with the National Incident Management National Incident Management System for organizing personnel and System for organizing personnel and services response to an emergencyservices response to an emergency

Emergency Operations Center (EOC) Emergency Operations Center (EOC)

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Hazard IdentificationHazard Identification Frequency of occurrenceFrequency of occurrence Magnitude and IntensityMagnitude and Intensity LocationLocation Geographical extentGeographical extent DurationDuration Seasonal patternSeasonal pattern Speed of OnsetSpeed of Onset Warning and warning timeWarning and warning time

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Experience – Oklahoma City April 19, Experience – Oklahoma City April 19, 19951995

Mean Arrival time at ED (13 Mean Arrival time at ED (13 hospitals) 91 minutes after the hospitals) 91 minutes after the explosion – most within 3 hours/.explosion – most within 3 hours/.

56% self-evacuated56% self-evacuated 33% EMS transported33% EMS transported 11% by Police and POV11% by Police and POV Extrication of only 9.7% of victimsExtrication of only 9.7% of victims Rescue phase over in 3 hoursRescue phase over in 3 hours

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Oklahoma City Experience – Pre-Oklahoma City Experience – Pre-hospital treatments*hospital treatments*

71% spine immobilization71% spine immobilization 44% field dressing44% field dressing 36% IV access36% IV access 3% endotracheal intubation3% endotracheal intubation 3% ACLS medication3% ACLS medication 2% tourniquet application2% tourniquet application 1% field amputation1% field amputation* Note that some victims required several * Note that some victims required several

treatment modalities prior to evacuation treatment modalities prior to evacuation from the scene.from the scene.

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

World Trade Center Experience: World Trade Center Experience: 09/11/0109/11/01

Access to flashlights was deemed Access to flashlights was deemed ““InvaluablInvaluablee ”” by survivors. by survivors.

““Clearly many building occupants did not Clearly many building occupants did not take preparedness seriously.take preparedness seriously.””

Evacuees were stymied by stairway Evacuees were stymied by stairway deviations and smoke doors.deviations and smoke doors.

Software failure resulted in no access to Software failure resulted in no access to computer locked door.computer locked door.

Lack of information for decision makingLack of information for decision making Lack of Protocol for Rooftop RescuesLack of Protocol for Rooftop Rescues

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Emergency Response at the Emergency Response at the Pentagon: September 11, 2001Pentagon: September 11, 2001

Successful for three reasons:Successful for three reasons:1.1. Strong professional relations among Strong professional relations among

emergency responders.emergency responders.2.2. Adoption of Incident Command Adoption of Incident Command

SystemSystem3.3. Regional responseRegional response

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Joint Commission on Accreditation Joint Commission on Accreditation of Healthcare Organizationsof Healthcare Organizations

Under JACHOUnder JACHO’’s section of Management of the s section of Management of the Environment of Care, a plan must address Environment of Care, a plan must address four phases of disaster management:four phases of disaster management:

1.1. MitigationMitigation2.2. PreparednessPreparedness3.3. Response Response 4.4. RecoveryRecovery (See Bellevue, Coney Island and (See Bellevue, Coney Island and

Manhattan VA post-Superstorm Sandy)Manhattan VA post-Superstorm Sandy)

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Five Common Procedures Five Common Procedures

1.1. Wound careWound care2.2. Tetanus ImmunizationTetanus Immunization3.3. Intra-venous line placementIntra-venous line placement4.4. Pulse oximeter usePulse oximeter use5.5. Analgesic administrationAnalgesic administration

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Mass Casualty Incident (MCI)Mass Casualty Incident (MCI) An MCI produces a number of victims An MCI produces a number of victims

that disrupt the normal course of that disrupt the normal course of emergency and healthcare services emergency and healthcare services in a community. Casualties will in a community. Casualties will include psychological, surgical and include psychological, surgical and medical.medical.

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Classification of DisastersClassification of Disasters Level 1: Level 1: Disaster can be managed within Disaster can be managed within

an region/ locality – emergency medical an region/ locality – emergency medical services are adequate for the event.services are adequate for the event.

Level 2:Level 2: The Disaster The Disaster exceedsexceeds the regional the regional’’ local medical response capabilities – local medical response capabilities – additional aid is required.additional aid is required.

Level 3:Level 3: The Disaster The Disaster overwhelmsoverwhelms local local and regional resources – state and federal and regional resources – state and federal aid is required.aid is required.

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

The Stafford ActThe Stafford Act The Robert T. Stafford Disaster Relief The Robert T. Stafford Disaster Relief

and Emergency Assistance Act gives and Emergency Assistance Act gives the federal government an the federal government an operational mandate and a budget operational mandate and a budget with which to execute a disaster with which to execute a disaster response.response.

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Twelve Emergency Support Twelve Emergency Support FunctionsFunctions

1.1. Transportation Transportation (EMS / National (EMS / National Guard)Guard)

2.2. CommunicationCommunication3.3. Public works Public works

engineering (ConEd)engineering (ConEd)4.4. Information Information

disseminationdissemination5.5. Mass careMass care

6.6. Rescue supportRescue support7.7. Urban S & RUrban S & R8.8. Hazardous Material Hazardous Material

ManagementManagement9.9. Food and WaterFood and Water10.10. Energy (gas & Energy (gas &

electric)electric)

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Disaster TeamsDisaster Teams DMAT: Disaster Medical Management DMAT: Disaster Medical Management

TeamsTeams DMORT: mortuary teamsDMORT: mortuary teams DVAT: Veterinary teamsDVAT: Veterinary teams USAR: Urban Search and RescueUSAR: Urban Search and Rescue

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

Transport VentilatorsTransport Ventilators

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

The ChallengeThe Challenge ““Because no one believes that every Because no one believes that every

conceivable forma of attack can be conceivable forma of attack can be prevented, civilians and first prevented, civilians and first responders will again find responders will again find themselves on the front lines. We themselves on the front lines. We must plan for that eventuality.must plan for that eventuality.””

The 9/11 Commission Report 2004 The 9/11 Commission Report 2004 W.W. Norton & Co. p. 323W.W. Norton & Co. p. 323

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

New York CityNew York City Office of Emergency ManagementOffice of Emergency Management Department of Heath and Mental Department of Heath and Mental

HygieneHygiene Medical Reserve Corps Medical Reserve Corps

www.medicalreserve.org or 866-NYC- or 866-NYC-DOH1 DOH1

Health Alert Network Health Alert Network han@health.nyc.gov

Prof. Thomas J. Johnson, MS, RRT Prof. Thomas J. Johnson, MS, RRT

On-Line ResourcesOn-Line Resources CDC CDC www.cdc.gov Department of Homeland Security Department of Homeland Security

www.dhs.gov U.S. Army Research Institute of U.S. Army Research Institute of

Chemical Defense http://www. Chemical Defense http://www. apgea.army.milapgea.army.mil

U.S. Army Medical Research Institute U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) of Infectious Diseases (USAMRIID) www.usamriid.army.milwww.usamriid.army.mil