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Southern Oaks House and Gardens 1246 Richburg Rd Hattiesburg, MS 39402 Enhance your medical surge response capabilities. Registration Starts: 8:30 A.M. Training: 9:00 A.M. - 4:30 P.M. February 11, 2020

February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

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Page 1: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Southern Oaks House and Gardens

1246 Richburg Rd

Hattiesburg, MS 39402

Enhance your medical surge response capabilities.

Registration Starts: 8:30 A.M.

Training: 9:00 A.M. - 4:30 P.M.

February 11, 2020

Page 2: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Healthcare Medical Surge

Burt SchmitzMSDH Emergency Planner

Page 3: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Objectives

• Define Medical Surge Capacity and Capabilities

o Identify Triggers

• Utilization of NIMS

• Identify Planning Assumptions

• Identify Appropriate Actions that will Improve Preparedness

• Benefits of surge management planning

Page 4: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Medical Surge

Medical Surge is the ability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community.

Page 5: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Definition of Capacity and Capability

• Medical surge capacity refers to the ability to evaluate and care for a markedly increased volume of patients—one that challenges or exceeds normal operating capacity.

• Medical surge capability refers to the ability to manage patients requiring unusual or very specialized medical evaluation and care.

Page 6: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Why do we need medical surge training ?

• All potential situations demanding a surge response are unique. Incident specific surge plans should be included in your emergency operations plan to ensure preparedness.

• A high degree of internal self-sufficiency and self reliance is important in any surge event.

Page 7: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Why use the Incident Command System?

Burt SchmitzMSDH Emergency Planner

Page 8: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

National Incident Management System

(NIMS)

• A consistent nationwide approach for all levels of government to work effectively and efficiently together to prepare for and respond to domestic incidents

• Core set of concepts, principles and terminology for incident command and multi-agency coordination

Page 9: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Homeland Security Presidential Directive 5

• Requires all Federal Departments and Agencies to adopt the NIMS and the NRP

• Requires state and local NIMS compliance as a condition for Federal preparedness assistance

Page 10: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

NIMS Key Concepts

• Framework for interoperability and compatibility

• Flexibility

o Consistent, flexible, and adjustable national framework

o Applicable regardless of incident cause, size, location, or complexity.

• Standardization

o Standard organizational structures

o Key to interoperability

Page 11: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Key Components of ICS

ComprehensiveResource

Management

Pre-designatedIncidentFacilities

UnifiedCommandStructure

IncidentActionPlan

ManageableSpan-of-Control

Common Terminology

Modular organization

Page 12: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

ICS Command and General Staff Titles

Incident Commander

Operations Section Chief

Planning Section Chief

Logistics Section Chief

Finance/Adm Section Chief

Safety Officer

Public Information

Officer

Liaison Officer

Command Staff:The Command Staff

provides Information,Safety, and Liaison services for the entire organization.

General Staff:The General Staff are assigned

functional authority for Operations, Planning,

Logistics, and Finance/Administration.

Page 13: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Training: Who needs to take what?

• IS-700 NIMS: An Introductiono All personnel with a direct role in emergency preparedness, incident

management, or response

• IS-800 NRP: An Introductiono All Federal, state, territorial, tribal, and local emergency managers or

personnel whose primary responsibility is emergency management

• ICS-100: Introduction to ICSo All Federal, State, territorial, tribal, local, private sector and non-

governmental personnel at the entry level, first line supervisor level, middle management level, and command and general staff level of emergency management operations

• ICS-200: Basic ICSo All Federal, State, territorial, tribal, local, private sector and non-

governmental personnel at the first line supervisor level, middle management level, and command and general staff level of emergency management operations

Page 14: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Use of NIMS for Resource Management

• Identifying and Typing Resources

• Certifying and Credentialing Personnel

• Inventorying Resources

• Identifying Resource Requirements

• Ordering and Acquiring Resources

• Mobilizing Resources

• Tracking and Reporting Resources

• Recovering Resources

• Communications

• Reimbursement

Page 15: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

ICS Training

• The Emergency Management Institute (EMI) has several ICS-100 and ICS-200 level courses that can be taken online as interactive Web-courses. These course materials may also be downloaded and used in a group or classroom setting. Answer sheets may be obtained from the Emergency Management Institute by calling the EMI Independent Study Office at 301-447-1256. To complete the courses or download the course materials go to http://training.fema.gov/emiweb/IS/crslist.asp

Page 16: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

ICS Training

• ICS 100, 200, 300, and 400 level training equivalencies can be met by following the guidance outlined in the NIMS National Standard Curriculum Training Development Guidance (October 2005).

• It is not necessary that the training requirements be met through a federal source. ICS training developed by state, local, and tribal agencies and private training vendors can “qualify” as NIMS compliant training if the training meets or exceeds the ICS objectives outlined in the NIMS National Standard Curriculum Training Development Guidance (October, 2005) and is adopted for use by the sponsoring training organization (i.e. State Emergency Management Agency, State Fire Training Academy, etc.).

Page 17: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

NIMS Training GuidelinesEntry Level First Responders & Disaster Workers

Audience

• Emergency Medical Service Personnel

• Firefighters

• Healthcare Facility Staff

• Law Enforcement Personnel

• Public Health Personnel

• Public Works/Utility Personnel

• Skilled Support Personnel

• Other emergency management response, support, volunteers' personnel at all levels

Required Training

• FEMA IS-700: NIMS, An Introduction

• ICS-100: Introduction to ICS or equivalent

Page 18: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

NIMS Training GuidelinesFirst Line Supervisors

Audience

• First line supervisors, single resource leaders, field supervisors, and other emergency management & response personnel that require a higher level of ICS/NIMS Training

Required Training

• FEMA IS-700: NIMS, An Introduction

• ICS-100: Introduction to ICS or equivalent

• ICS-200: Basic ICS or equivalent

Page 19: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

NIMS Training GuidelinesMiddle Management

Audience

• Middle management including strike team leaders, task force leaders, division/group supervisors, branch directors, and multi-agency coordination system/emergency operations center staff.

Required Training

• FEMA IS-700: NIMS, An Introduction

• FEMA IS-800: NRP, An Introduction

• ICS-100: Introduction to ICS or equivalent

• ICS-200: Basic ICS or equivalent

• ICS-300: Intermediate ICS or equivalent

Page 20: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

NIMS Training GuidelinesCommand & General Staff

Audience

• Command and general staff, select department heads with multi-agency coordination system responsibilities, area commanders, emergency managers, and multi-agency coordination system/EOC managers.

Required Training

• FEMA IS-700: NIMS, An Introduction

• FEMA IS-800: NRP, An Introduction

• ICS-100: Introduction to ICS or equivalent

• ICS-200: Basic ICS or equivalent

• ICS-300: Intermediate ICS or equivalent

• ICS-400: Advanced ICS or equivalent

Page 21: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Interaction with Community Response Organizations

• Identify Roles and Responsibilities

• Common Terminology

• Resource Management

• Patient Tracking

• Communications

• Joint Exercises/Training

Page 22: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Resources you can use!

• Training Opportunities

• Forms

• Position Specific Job Aids

• HICS NHICS

• ASPR TRACIE

• NIMS Implementation Guide

• EMA / Healthcare Coalitions / LEPCs

Page 23: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Communications /MEHC / EEIs

Lillie BaileyMSDH Healthcare Coalition Coordinator

Page 24: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Communications: MEHC

The Mississippi Emergency Support Function 8 Healthcare Coalition

Mission Statement

The mission of the Mississippi

Emergency Support Function 8

Healthcare Coalition (MEHC) is

to reduce the burden of illness,

injury, and loss of life in the

event of an emergency or

disaster through coordination

and communication regarding

emergency preparedness,

mitigation, response, and

recovery.

Communication is a vital part of any response!!

The MEHC helps to provide a two-way communication process for creating and sustaining a common operational picture

for all MEHC partners and their stakeholders.

Page 25: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Knowledge Center Incident management software

Helps to build a common operating picture during a critical event in order to save lives

and mitigate risk. Incident management technology platform that is a mission-ready. Provides wide visibility and interoperability from a comprehensive, integrated platform

with a single-sign-on.

• Access and share real-time bed data

• Save time and improve decision making

• Enhance patient care coordination

• Better utilize staffing resources

• Standard ICS/HICS forms

• SitReps and IAPs

• AARs, HSEEPs, Joint Commission 6 Critical Element Evaluations

• MS Point of Contact for KC Users – Jamie Wilson

[email protected]

Communications: KC

Page 26: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Essential Elements of InformationExamples of EEIs include, but are not limited to:

• Healthcare facility information

• Healthcare facility operational status

• Healthcare facility security status

• Healthcare facility staffing availability

• Emergency Department status

• Bed availability

• Location and medical needs of every home-bound patient in an affected area

• Availability of respirators and/or powered medical supplies

• Alternate means of power

• Vehicles for patient movement

• Identified health issues

• Inventory of available counter measures

• Strategic National Stockpile

• Morgue operations

The need to have accurate information in

a timely manner is critical in making decisions during

disaster response.

Communications: EEI

Page 27: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Surge Capacity

The ability to expand care capabilities in response to prolonged demand

• Potential patients' beds

• Transportation

• Available space for:

o Triage

o Incident Command / EOC

o Patient Management

o Volunteer Management

o Vaccinations

o Decontamination

o Medications, supplies and equipment

o Security

o Traffic flow

Page 28: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Lillie Bailey

Page 29: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:
Page 30: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:
Page 31: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:
Page 32: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:
Page 33: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Supply Chain

Christy HooverMSDH Emergency Planner

Page 34: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Developing and Maintaining Resources

• What is needed?

• Food, Water, Fuel, Critical Supplies (medical, laboratory), Medication, Oxygen/Medical Gas, Transportation, Others

• What can you not do without?

Page 35: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Developing and Maintaining Relationships

• Who do you need relationships with?

• Emergency Management, Fire Department, Law Enforcement

• Think outside of the boxo Neighboring Facilities & Transport Agencies

(Church vans, tour buses, school buses, etc.)

o Medical/Urgent Care Clinics

o Home Health/Hospice Agencies

o Local businesses (Wal-Mart, Dollar General, Walgreens, etc.)

o Places of Worship

o Community Centers

o Electric & Water Companies/Cooperatives

Page 36: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Supply Chain Integrity

• Definition of Integrity

o The condition of being unified, unimpaired, or sound in construction.

• Definition of Resilience

o The capability to recover quickly from difficulties; toughness.

Page 37: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Supply Chain Resilience

Supply chain resilience is the ability of a network, or portion of a network, to continue moving goods and services even when important elements of the network are no longer operating. For example, the continued flow of water, food, and fuel while the electric power grid is not operational.

Supply Chain Resilience Guide

Page 38: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Supply Chain Integrity

Issues• Equipment/Power Failure(s)/Communication Loss

• Loss of Facility Capability

• Staff Shortages

• Loss of Supplies

• What happens when your first supplier is unavailable?

• Shortage due to compromised/contaminated supplies

o Saline

o Drug shortages/recalls

o Flu Vaccine

Page 39: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Supply Chain Integrity

• Developing and Maintaining Supply Chain Integrity

• Prioritizing supplies/resources

• Do you have a 72-hour supply?

• Complex Emergencies – what if you run out sooner

than expected?

• Backup plano Orders of Succession

Page 40: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

What is EMS?

Alisa WilliamsMississippi Director of EMS

Steven JonesState EMS Director of Education and Certification

Page 41: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Introduction

The EMS system is constantly evolving.

• Originally, the primary role was transportation.

• Today it provides advanced medical care. © Mark C. Ide

Page 42: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Introduction cont…

The public’s perception is based on:

• TV and articles

• Treatment of theirloved ones

Page 43: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

The History of EMS

1485’s

• First use of an ambulance

• Transport only

1926’s

• Service started similar topresent day

1800’s

• First use of ambulance/ attendant to care for injuries on site

1940’s

• EMS turned over to fire and police departments

• No standards set

Page 44: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

The 20th Century and Modern Technology

EMS made major strides after WWII.

• Bringing hospital to field gave patients a better chance for survival

• Korean War

o First use of a helicopter

o M*A*S*H units

Page 45: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

The 20th Century and Modern Technology

• 1965: “The White Paper” released

o “The White Paper” findings outlined 10 critical points for EMS system

▪ Led to National Highway Safety Act

▪ Created US Department of Transportation

• 1968

o Training standards implemented

o 9-1-1 created

Page 46: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

The 20th Century and Modern Technology

• 1969

o First true paramedic program

o Standards for ambulance design and equipment

• 1970s

o NREMT began Courtesy of Eugene L. Nagel and the Miami Fire Department

Page 47: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

The 20th Century and Modern Technology

• 1970s (cont’d)

o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS

o 1973: Emergency Medical Services System Act

o 1974: Mississippi Emergency Medical Services System Act

o 1977: First National Standard Curriculum for Paramedics developed by US DOT

Page 48: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

The 20th Century and Modern Technology

• 1980s/1990s

o Number of trained personnel grew

o NHTSA developed 10 system elements to help sustain EMS system

o Responsibility for EMS transferred to the states

o Major legislative initiatives

Page 49: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Licensure, Certification, and Registration

• Certification examination:

o Ensures all health care providers have the same basic level of knowledge and skill.

• Licensure:

o How states control who practices

o Also known as certification or credentialing

o Unlawful to practice without licensure

Page 50: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Levels of Education

EMS system functions from a federal to local level

• Federal: National EMS Scope of Practice Model

• State: Licensure

• Local: Medical director decides day-to-day limits

Page 51: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Emergency Medical Responder (EMR)

• Formerly “first responder”

• Requirements vary by state

• Should be able to:

o Recognize seriousness of condition.

o Provide basic care.

o Relay information.

© Matt Dunham/AP Photosages

Page 52: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

EMT

• Primary provider level in many EMS systems

• EMT certification precedes paramedic education

• Most populous level in the system

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Page 53: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Advanced EMT (AEMT)

• Formerly EMT-I

• Initially developed in 1985

o Major revision in 1999

• Trained in:

o More advanced pathophysiology

o Some advanced procedures

Page 54: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

• Highest level to be nationally certified

o 1999: Major revisions to curriculum greatly increased level of training and skills

• Even if independently licensed, you must:

o Function under guidance of physicians.

o Be affiliated with a paramedic-level service.

Paramedic

Page 55: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Lillie Bailey

Page 56: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Medical Direction

• Paramedics carry out advanced skills

o Must take direction from medical directors

• Medical directors may perform many roles:

o Educate and train

o Recommend new personnel or equipment

o Develop protocols, guidelines, and quality improvement programs

Page 57: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Roles of the medical director (cont’d):

• Provide input for patient care

• Interface between EMS and other agencies

• Advocate for EMS

• Serve as “medical conscience”

Medical Direction

Page 58: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Medical DirectionMedical directors also provide online and off-line medical control.

Online

• Provides immediate and specific patient care resources

• Allows for continuous quality improvement

• Can render on-scene assistance

Offline

• Allows for the development of:

o Protocols or guidelines

o Standing orders

o Procedures

o Training

Page 59: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Evidence-Based Practice

• Care should focus on procedures that have proven useful in improving patient outcomes.

o Evidence-based practice has a growing role in EMS.

• Mississippi utilizes this model.

• Research determines the effectiveness of treatment.

o Can help identify which procedures, medications, and treatments do and do not work

Page 60: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

•What is EMS in Mississippi?

Page 61: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

By the Numbers

EMS Personnel

• MFR – 15

• EMT – 2,063

• AEMT – 15

• Paramedics – 1,679

• Critical Care - 32

Page 62: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

By the Numbers

EMS Services

• Air - 33

• ALS - 46

• BLS - 5

• Invalid - 1

Page 63: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

By the Numbers

EMS by county

• Rural Area

o 1-2 ambulances

• Urban Area

o 15-20 ambulances

Page 64: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

911: Send an Ambulance!

What to do in Med Surge situation?

• Call local ambulance service and advise of situation.

• Local service may have limited resources even with mutual aid.

Steps to ask for more resources

• EMS or Facility contact EMA Director

• EMA will contact MEMA

• MEMA will contact State EMS to obtain and deploy additional resources.

What we do to help

• Coordinating resources

• Assisting with evacuation of facility on request.

Page 65: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

• Ambulance corps were developed during World Wars I and II to transport and rapidly care for soldiers.

• Helicopters were used to rapidly remove soldiers from the battlefield during the Korean and Vietnam Wars.

SUMMARY

Page 66: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

• In 1966 the National Academy of Science and the National Research Council released “The White Paper” outlining 10 points.

o The National Highway Safety Act and the US Department of Transportation were created as a result.

• EMS Personnel must be licensed (also known as certification or credentialing) before performing any functions.

SUMMARY

Page 67: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

• Standards for prehospital emergency care, and the people who provide it, are regulated under state law by a state office of EMS.

• There are four levels of training: emergency medical responder, emergency medical technician, advanced emergency medical technician, and paramedic.

SUMMARY

Page 68: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

• A physician medical director authorizes EMS providers to provide care in the field through off-line or online medical direction.

o Standing orders or protocols

• Some of the primary ems responsibilities include preparation, response, scene management, patient assessment and care, management and disposition, patient transfer and report, documentation, and return to service.

SUMMARY

Page 69: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Triage

Alisa WilliamsMississippi Director of EMS

Steven JonesState EMS Director of Education and Certification

Page 70: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

What is Triage?

• French verb trier

• To sieve / to sort

• Medically:

o The process of applying medical priority based on needs, available resources, and situation

o Assign priority when resources limited

o Someone has to go last

Page 71: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

What is a Mass Casualty Incident?

• A MCI is any incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties.

Page 72: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

What is a Disaster?

Needs > Resources = Disaster

When the need for resources is (or is

anticipated to be) greater than the

resources available, you have a

disaster.

Page 73: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Situation

Day-to-day emergencies

• The greatest good for each individual patient

Disasters/Mass Casualty

• The greatest good for the greatest number of potential survivors

Page 74: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Available Resources

Do we have enough?

• Medical supplies & equipment

• Trained medical personnel

• Transportation

• Beds available at definitive care centers

Page 75: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Needs

• Lifesaving interventions

• Casualties greater than available resources

• Scene hazards (austere environments)

• Incident command

• Communication

• Multi-jurisdictional/multi-agency response

Page 76: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

General Principles of Mass Casualty Triage

• Separate-those requiring minimal or no treatment and get them to safety

• Treat first-those most seriously injured who have a reasonable possibility of survival

• Treat last-those who have the lease severe illnesses or injuries or are very unlikely to survive

Page 77: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

General Concepts of Mass Casualty Triage

Mass Casualty Triage

• Systematic method

• Organization of casualties

• Begins on the scene

• Continues throughout incident until the last patient treated at hospital

Page 78: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Mass Casualty Triage Decision Making Encompasses:

• Presence of life-, limb, or vision threatening condition

• Available lifesaving interventions

• Availability of transportation assets

Page 79: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Triage tools

Intended use:• Hospital vs. Pre-hospital

• Day-to-day vs. MCI

• Trauma vs. Other

• Adult vs. Child

Types:• Tags

• Tape

• Tarps

• Flags

Page 80: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

What’s Unique About Disaster Triage?

Needs > available resources

• Number of patients

• Life Saving Interventions (LSI)

• Spinal immobilization

• Extended extrication

• Entrapment

• Specialized rescue

Page 81: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

S-A-L-T Triage

• New National Standard

• Evidenced Based

• A non-proprietary free system, was developed from available research, widely accepted best practices of existing mass triage systems, and consensus opinion from the workgroup.

Page 82: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

AND it looks like this…

Page 83: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

And this…..

Page 84: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

And this.

Page 85: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

S-A-L-T TriageSort – Assess – Life Saving Interventions –

Treatment/Transport

• Simple

• Easy to remember

• Groups large numbers of patients together quickly (15 seconds vs. 60 seconds with START)

• Applies rapid life-saving interventions early

85

Page 86: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

SALT/MCI General Principles

• Move as quickly as possible

• Begin transports of red patients as soon as feasible

• REMEMBER: don’t neglect other MCI processes (Command, Communication, etc.)

Page 87: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

SALT Triage Methodology

• Global Sorting

• Individual Assessment

• Life Saving Interventions

o Control major hemorrhage

o Open airway (if child, consider 2 rescue breaths)

o Chest decompression

o Auto-injector antidotes

• Treatment / Transport

Page 88: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

SALT Mass Casualty Triage

Step 1 – Sort:Global Sorting

WalkAssess 3rd

Wave/Purposeful MovementAssess 2nd

Still/Obvious Life ThreatAssess 1st

Step 2 – Assess:Individual Assessment

LSI*

– Control major hemorrhage– Open airway (if child,

consider 2 rescue breaths)– Chest decompression– Autoinjector antidotes

Breathing

– Obeys commands or makes purposeful movement?

– Has peripheral pulse?– Not in respiratory distress?– Major hemorrhage in control?

Minor injuries only?

MinimalDelayed

Yes

No

All YesYes

Dead

No

Likely to survivegiven current resources

No

Expectant

ImmediateYes

No*LSI: Lifesaving Interventions

Page 89: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

SALT TriageStep 1: Global Sorting

Global Sorting

If you can walk, get up and go to _____ = Assess 3rd

If you cannot walk, wave your arm or leg = Assess 2nd

If not compliant with either, possible life threat = Assess 1st

Rapidly identify most at-risk by sorting into groups!

Limitations: Many… hearing, language, fear, injured family…

Page 90: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

L S I *

– Control major hemorrhage– Open airway (if child,

consider 2 rescue breaths)– Chest decompression– Autoinjector antidotes

Breathing?

– Obeys commands or makes purposeful movement?

– Has peripheral pulse?– Not in respiratory distress?– Major hemorrhage in control?

Minor injuries only?

Minimal

Delayed

Yes

No

Yes

Dead

No

Likely to survivegiven current

resources?

No

Expectant

Immediate

No*LSI = lifesaving interventions

AllYes

SALT TriageStep 2: Individual Assessment

Yes

Page 91: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Individual Assessment What can I do?

Lifesaving interventions

Control major hemorrhage

Open airway

Decompress chest

Autoinjector antidotes

Page 92: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Casualties overwhelm available resources

Goal of disaster triage:

Do the greatest good for the greatest number of potential survivors

IMMEDIATE DELAYED MINIMAL DEADEXPECTANT

I D M E

Individual Assessment Triage Category Assignment

Page 93: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Response to interventions

Breathing?

Responds to commands?

Peripheral pulse?

Respiratory distress?

Bleeding stopped?

Individual Assessment Triage Category Assignment

Page 94: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

ImmediateRequires immediate care for a good probability

of survival

DelayedRequires care that can be safely delayed

without affecting probability of survival

MinimalSick or injured but expected to survive with or

without care

ExpectantAlive, but with little or no chance of survival

given current available resources

Dead A fatality with no intrinsic respiratory drive

Page 95: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

IMMEDIATE

Highest priority of casualties to receive care

• Immediate, life-threatening conditions

• Require immediate management in order to survive

• Response to lifesaving interventions:

o Any NO answer + resources are available

Page 96: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

DELAYED

Require prompt medical attention for survival

• Condition can tolerate a short delay in treatment

• Expected to survive despite that short delay

• Response to lifesaving interventions:

o All YES answers + does need access to additional or definitive health care

Page 97: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

MINIMAL

• Minor injuries or illnesses

• Expected to survive even if medical treatment not received

• Response to lifesaving interventions:

o All YES answers + does NOT need access to additional or definitive health care

Page 98: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

EXPECTANT

Casualties with low probability of survival

• Not expected to survive given available medical resources

• Response to lifesaving interventions:

o Any NO answer + resources are NOT available

Page 99: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

DEAD

Casualties with complete absence of life

• Not breathing after basic airway-opening maneuvers, including two rescue breaths if a child

• Attempt basic life-sustaining efforts only if sufficient personnel available

• It is important to NOT move dead casualties, unless the remains are blocking access to live casualties

Page 100: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Do NOT relocate the disaster to the hospital!!

Page 101: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Triage Tag Characteristics

Two Sided Basic Components:

• Tear off sections

• Main Body

o Patient information

o Patient vital signs

o Patient treatments

o Special Fields

o Triage aides

• Tracking Number

Page 102: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

TRANSPORT, TRANSPORT, TRANSPORT

1st EMS transport unit(s) arrives on sceneSets up Triage & Treatment

Subsequent EMS transport unit(s)load and go!

Move – Move – Move those RED patients

Page 103: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Patient Tracking

In a rapidly evolving incident, critical Red Tag patients may bypass Treatment Area and be

taken directly to Transport.

Page 104: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

AMBUS

AMBUS is a mass casualty transport system for hurricanes and other disasters

• No-Notice (Permanent): A permanently installed AmbuBus Kit that allows a mass transit vehicle to be converted into a turnkey mass casualty transport system for earthquakes and other no-notice disasters.

• On-Demand (Temporary): A temporarily installed AmbuBus Kit that allows for the use of an everyday vehicle to be converted on-demand into a mass casualty transport system for hurricanes and other disasters.

Page 105: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

AMBUS

Page 106: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Mississippi

Ambulance

Bus (AmBus)

Mass

Evacuation

Transport

Program

Page 107: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Mississippi MEDCOM

Page 108: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Mississippi MEDCOM

Mississippi MED-COM is designed to function as a service to the emergency response agencies, hospitals and first responders of Mississippi. The communications center is located on the campus of the University of Mississippi Medical Center and serves many functions.

Page 109: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Mississippi MEDCOM

• Provides a point of contact for referring providers statewide to facilitate timely acceptance of their critical patients. Mississippi MED-COM also assist hospitals in arranging out-of-state transport of burn patients to burn centers

• Acts as the access point to Medical Control physicians for those EMS agencies that have Medical Control through UMMC.

Page 110: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Mississippi MEDCOM

MED-COM Communications:

• Averages 6,000 calls for assistance a month and provides a single point of contact for almost 1,000 emergency transfers into the University of Mississippi Medical center and other tertiary care facilities in Mississippi and neighboring states.

• Strategically placed emergency direct dial phones across the state in hospitals and dispatch centers for use with day-to-day operations as well as for disaster support situations.

• Monitors radio frequencies for fire departments and law enforcement agencies in the regional area around University of Mississippi Medical Center. This enables the first responders to have ready access to UMHC's AirCare 1,2,3 and 4

Page 111: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Recovery Planning

Lillie BaileyMSDH Healthcare Coalition Coordinator

Page 112: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Recovery Planning

Picking up the pieces

Page 113: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Recovery planning piece is as essential as planning for the response

• Safely continue care provided to the community

• Help in maintaining financial viability

• Caring and retaining staff

Page 114: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Lillie Bailey

Page 115: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Checklist Ideas for Recovery Planning:

• Access

• Buildings

• Communications(Internal & External)

• Dialysis

• Dietary

• Electrical Systems

• Emergency Department

• Equipment/Supplies

• Facility Maintenance

• Infection Control

Page 116: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Checklist Ideas for Recovery Planning:

• Medical Records/IT

• Laboratory

• Management Staff

• Morgue

• Sterile Procedures Support Systems

• Surgical Services

• Vendors

• Waste Management

• Water Systems

Page 117: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Lessons Learned

Page 118: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974:

Coronavirus 2019-nCoV

MSDH Interim Guidance for Assessing a Person Under Investigation (as of 1/31/2020)

• Identify

• Isolate

• Call

Page 119: February 11, 202020Surge%20Training...o 1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS o 1973: Emergency Medical Services System Act o 1974: