Catastrophic Health Incident

Response Planning

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Catastrophic Incident Response Community

Fire

Hospitals

PublicAdministration

Public Health

Emergency Operations

Public Works

CitizenVolunteers

LawEnforcement

EMS

HighImpactIncident

3

Catastrophic Incidents

TIME (min) 0 15 30 45 60 90 >120

EMS

Approx. 20%of causalities

PublicSafetyArrival

Source: Davis, 2004

“Upside down triage”

Bystanders transport 80% of casualties (11% of admits)

EMS transports 20% ofcasualties (88% of admits)

Self-evacuee’s

50 - 80% bypasspublic safety

4

Catastrophic Incidents

TIME (min) 0 15 30 45 60 90 >120

EMS

Approx. 20%of causalities

PublicSafetyArrival

Source: Davis, 2004

“Upside down triage”

Bystanders transport 80% of casualties (11% of admits)

EMS transports 20% ofcasualties (88% of admits)

Self-evacuee’s

50 - 80% bypasspublic safety

GOAL - Protect The Hospitals

5

Psychological vs. Medical “Footprint”

The size of the psychological “footprint” greatly exceeds medical “footprint”

psychological “footprint”

medical “footprint”

> 4:1

“Not all victims should beevaluated in theemergency department”!

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Statewide Catastrophic Health Incident

Response Plan (CHIRP)“Chance favors the prepared mind.”

Louis Pasteur

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CHIRP Scope

A catastrophic incident may result from:

natural events (hurricanes, floods, etc.)large-scale accidents such as a plane crash manmade/terrorism events

Size of incident is not the determining factor, capacity and capability to respond is most important factor

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CHIRP Provisions

Provides for:Incident response strategy• Preparedness, prevention, response, recovery

Roles and responsibilities

Coordination of regional response

Alternate Care Sites• Expansion of medical care capacity and capability

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Statewide CHIRP

All hazards plan utilizing principles from;

National Response Framework (NRF)National Incident Management System (NIMS)National Preparedness Guidance (NPG)

Incorporate plans and resource from regional:

Law enforcement, emergency management, EMS, fire/rescue, hospitals, and public health

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Statewide CHIRP

Concept of operationsDevelop, exercise and maintain regional catastrophic response plans which support local plans, and draw on regional, state, and federal assets

Catastrophic Incident Response Plansreside at the regional level

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Regional CHIRP Provisions

Incident management priorities

Protect, restore critical infrastructure, resourcesConduct law enforcement operationsProtect property, mitigate impactsFacilitate recovery

Source: FEMA Photo Library

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Operational Goals

Provide chain of commandAttend to all victimsMinimize injury/illness, damage/loss of property & recordsProvide maximum safetyIntegrate with community emergency plansMaintain and restore normal servicesProvide supportive action

All operational goals are built into the Emergency Operations Plan (EOP)

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Concept of Operations

Statewide and Federal Assets

Regional Catastrophic Incident Response Plans

Local/County

CommunicationsRisk/Public InformationSpecial Needs PopulationsVolunteer CredentialingPatient TrackingAlternate Treatment SitesTraining/Exercises

Local/County EmergencyResponse Plans

Enhances

Coordinates

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Concept of Operations

StatewideAmbulanceResponse

Plan

HospitalResponse

Plan

PublicHealth

ResponsePlan

BehavioralHealth

ResponsePlan

MassFatality

ResponsePlan

RegionalCatastrophic Incident Response Plans& Multi-Agency Coordinating Teams

Local

CommunicationsRisk/Public InformationSpecial Needs PopulationsVolunteer CredentialingPatient TrackingAlternate Treatment SitesTraining/Exercises

Local EmergencyResponse Plans

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Planning Targets

Rural AreasMinimum 100 total casualties

per incident

Smaller Urban AreasMinimum 250 total casualties

per incident

Major Urban Areas500 casualties per million

population

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Planning Assumptions

CHIRP will knit together existing plans, not replace them.

Agency Mass Casualty Plans• Fire Departments and EMS Agencies• Hospitals• Law Enforcement Agencies

Field Operations Guide (FOG)Medical Examiner Disaster PlansMMRS Regional MCI Plans

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Assumptions

Triage / Treatment Basic Principles of Disaster Medicine must applyLevel of care will be less than day to day medicine as we know it

StandardsWill see and care for larger patient / staff ratios

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Regional Catastrophic Health Incident Response

Plan ComponentsPrehospital (MCI) Response PlanAlternate Medical Treatment Site Plan Hospital Response PlanMass Fatality Plan (FEMORS)Lab Surge Capacity PlanHealthcare Professional Surge Capacity PlanDisaster Behavioral Health Plan

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Injury Severity

10 percent immediate deaths

Of those surviving:20 percent emergent (severe multi-system injuries)30 percent urgent (able to defer definitive treatment once stabilized)50 percent mild or moderate (the “walking wounded’)

1

2

3

4

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Practical Options

Expand via

Mobile facilities-expand in place or deploy to incident siteConvert existing buildings to temporary hospitalsUse of shuttered hospitals [closed, obsolete,mothballed, bankrupt, etc.]Add beds to existing facilitiesBuild temporary facilities Develop protocols addressing emergency standard of care procedures

Alternative Care Sites Plan

Region 5 Domestic Security

TaskforceCentral Florida MMRSCentral Florida UASI

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Funding Sources

State Homeland Security Grants (DHS)

Centers for Disease Control Grants (CDC)

DHHS – ASPR Grants (ASPR)

Urban Area Security Initiative Grants (UASI)

Metropolitan Medical Response System Grants

(MMRS)

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ACS Cache Locations

12

4 5

6

7

3

ASPR Funded

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MCI Cache LocationsMCI

MCI

MCI

MCI DHS Funded

100 Pt Caches

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MCI Cache LocationsMCI

UASI

MCI

MCI

UASI

MCI

100 Pt Caches

26

All MCI Cache LocationsMCI

UASI

MCI

MCI

UASI

UASI

MCI

250 Pt Cache

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Hospital Cache Locations

Hospital

Hospital

Hospital

Hospital

Hospital

HospitalHospital

Hospital

MMRS Funded

Speedway

Cruise ship Port

Spaceport

ThemeParks

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County Cache Locations

Region

County

County

County

County

UASI Funded100 Pt Caches

&EnhanceRegional

500 Pt Cache

County

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All Cache Locations

UASI

MCI

UASI

MCI

UASI

Region

County

County

County

County

County

Hospital

Hospital

Hospital

Hospital

Hospital

Hospital

Hospital

MCI

MCI

Region 5MedicalSurge

StrategyRequired Capacity Surge500 Pt / Million Pop.

Regional Population

≈3 million population1500 Pts.

1 Regional Cache – 500 pt

5 County Caches – 100 pt

8 Hospital Caches – 100 pt

6 Sm MCI Caches – 100 pt

1 Lg MCI Cache – 250 pt

Total Surge – 2,650 pt

Hospital

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Alternate Care Site Cache Trailers

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First Aid and Casualty Collection Points for Mass Gathering Events.

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State Medical

Response Team

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35

36

ZUMBROAir InflatableQuad Tents

Temps CotsWestcots

carts, tables & chairs

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State Medical Response Teams

Florida has Three Mobile Field Hospitals and One Rapid Response Hospital

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State Medical Response TeamSet-up

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Leveraging Our Assets

Pandemic Influenza Caches

Points of Dispensing Caches

Special Needs Shelter Caches

Mass Casualty Caches

Local and Regional AMTS Caches

State Medical Response Team Cache

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Questions?

Discussi

on?

Federal Health and Medical Response

Technological Disasters

Terrorism

Transportation Disasters

Natural Disasters