1
Q
Define a major incident
A
- Complex scene
- Not routine and requires specialist skills or organisations
- May include multiple casualties, multiple agencies, protracted/complex incidents, or even just an incident attracting public interest
- Major incidents will generally be managed using an Emergency Response Plan (ERP)
2
Q
What are the differences in clinical leadership at major incidences?
A
- Must adopt a more management role as opposed to a clinical one
- Must assume control of the situation to reduce chaos and confusion and increase efficiency and outcomes
- Ensure that appropriate resources are requested and that these are activated early
- Above all ensure scene safety for yourselves and other emergency workers on scene
3
Q
What are the 3 Rs of incident management?
A
Recognition
o Alert and escalation phase
o Commences when initial call is received
o Activation of crews signals the beginning of the response phase
Response
o Commences when first resource arrives on scene and finishes when the last resource has left the incident
o Allows response level to be reassessed by using a windscreen sitrep
Recovery
o Where the organisation restores and replaces resources and accounts for all the actions that were taken in response to managing the incident
o Occurs concurrently with the response phase
4
Q
What are the different categories of a METHANE sitrep?
A
M = Major incident confirmation E = Exact location T = Type of incident H = Hazards on scene A = Access and egress for resources N = Number of patients E = Emergency services required
5
Q
Describe appropriate situational awareness at a multi-casualty incident
A
Hazard identification o Pause and plan o Defer to experts where appropriate SES, fire services, policies o Use all sense and instincts including sight, sound, smell and motion o Never put yourself in harms way
Patient identification
o May be spread over large distances
o Try to limit patient movement
o Gather info to determine likely number of patients on scene
Resource requirements o Begin resource planning early o Keep up to date with MDT o Communicate team strategy and roles o Windscreen assessment on arrival
6
Q
What are the roles and responsibilities of the Triage Officer?
A
- Provide initial scene leadership
- Ensure patients are triaged and tagged using Smart Pac triage cards
- Provide direction for incoming resources
- Ensure timely and accurate sitreps are provide
- Establish scene layout including Casualty Clearing Point, Loading Point and Holding Point
- Reports to incoming incident health commander when established
- Direct transport officer
7
Q
What are the roles and responsibilities of the Transport Officer?
A
- Support triage officer in management of the scene
- May undertake some patient management
- Coordinate transport vehicles to ensure appropriate transfer of patients
- Commence and maintain casualty movement log
- Ensure appropriate access and egress for responding vehicles
- Supervise Casualty Clearing Point
8
Q
What is included in a casualty transport log?
A
o Patient name/triage card code o Brief description of injuries o Triage category o Destination o Name of transporting ambulance
9
Q
What are things to consider for a casualty clearing point?
A
o Safe distance from scene
o Appropriate size for no. of patients
o Provides shelter
o Attempt to separate patients according to priority
10
Q
What are things to consider for an Ambulance Loading Point?
A
o Identified and managed by the Transport Officer
o Located near CCP for efficient casualty loading
o Clear access and egress
o Crews are called from Holding Point to Loading Point by Transport Officer
11
Q
What are things to consider for an Ambulance Holding Point?
A
o Identified and managed by Transport Officer
o Used when Loading Point has poor access
o Crews remain here until summoned by Transport Officer
12
Q
What is the role of the Emergency Response Plan?
A
- Helps to identify and separate the management and coordination of major incidents from normal business
- Provides staged and scalable approach to incidents
- Structured processes across all types of incidents
13
Q
What are the two key criteria in determining the scale of a major incident?
A
- Number of patients
- Severity of incident
14
Q
What is the management summary for a white level of response?
A
- Handled as normal business
15
Q
What is the management summary for a green level of response?
A
- Health Commander responded
- Regional HC managing
- State HC advised
16
Q
What is the management summary for a orange level of response?
A
- Health Commander responded
- Regional HC advised
- State HC managing
- AEOC stood up
17
Q
What is the management summary for a red level of response?
A
- Health Commander responded
- Regional HC advised
- State HC managing
- AEOC and AV regions stood up
18
Q
What other resources are available to help manage a major incident?
A
- Urban Search and Rescue
- Aquatic and Wilderness Response
- Chemical, Biological and Radiological
- Police
- Fire services
- Rescue
- Armed forces
- Hospitals
19
Q
What may be the roles of the second and subsequent crews?
A
- Transport of casualties to definitive care
- Sectorisation of scene if required (taking up TO/TO roles for another sector)
- Patient management (if further backup is far away and patients well outnumber the crew)
- Taking control (if initial crew is struggle/self-identify as not suitable)
- Safety officer (oversee safety of overall scene, patient management and OH&S)
20
Q
What is the role of the Health Commander?
A
- Undertaken by the first manager on scene
- Provides regular sitreps to control centre
- Scene control
- Represents ambulance resources on scene in Emergency Management Teams (EMTs)
- Responsible for the distribution of patients
21
Q
What specific challenges are faced in rural and remote settings?
A
o Resources may be further away/fewer for longer
o Crew configurations may be different (ACOs)
o Access to appropriate hospitals may be limited
o CFA may be volunteer service with delayed or limited response
o Locating and accessing the patients and scene
22
Q
What could be described as complex locations?
A
o Entrapment o Unstable locations o Mountains, cliffs, mineshafts o No access by road o Bushfire affected o Flood affected
23
Q
What resources are provided by DoH for major incidents?
A
Field Emergency Medical Coordinator (FEMC)
- Medical practitioner inside ambulance control centre
- Coordinates dispatch of VMAT
Field Emergency Medical Officer (FEMO)
- Dispatches to scene and manages VMAT
- Reports to HC
24
Q
What is the purpose of the IHR?
A
• International Health Regulations
o Legally binding agreement
o International public health security
• To prevent, protect against, control and provide a public health response to the international spread of disease commensurate with public health risks, and which avoid unnecessary interference with international traffic and trade
25
What are the aims of the SHERP?
o Reduce preventable death
o Reduce permanent disability
o Improve patient outcomes
- Match patient level of injury with treatment option
- Safely and timely manner
26
What are the purposes of the SHERP?
o Safe, effective, coordinated health and medical response
o Outlines arrangement for escalating the health response
o Describes how available clinical resources are organised
27
What are the 3 Cs laid out in the SHERP?
Control
• Legislates who is in control
Coordination
• Involves bringing together agencies and resources to ensure effective response to and recovery from emergencies
Command
• Relates to an agency and acts vertically within an agency
28
What is the role of ambulance crews as outlined in the SHERP?
o Triage casualties
o Provide first aid and advanced treatment
o Provide most effective transport
o Provide health support for other agencies
29
What is the role of the health commander as outlined in the SHERP?
o Reports to Regional HC
o Directs health emergency operations at scene
o Usually a senior ambulance manager
30
What is the role of ambulance commander as outlined in the SHERP?
o Senior paramedic then senior manager
o Manages ambulance resources on scene
o Reports to HC
31
What is the role of duty manager as outlined in the SHERP?
o Coordinates initial response
| o HC and ambulance response
32
What is the role of the Regional HC as outlined in the SHERP?
o Responsible for regional implementation of ERP
33
What is the role of the State HC as outlined in the SHERP?
o Overall responsibility for ERP
34
What is an Incident Control System (ICS)?
* Scalable management tool
* Integrates personnel, procedures, facilities, equipment and communications into a common organisational structure
* Provides clear delegation of responsibilities
35
What are the 3 key principles of the AIIMS?
Management by objectives
o Detailed as desired outcomes and implemented in management plans
Functional management
o Control – management of all activities
o Planning – development of plans to achieve resolution
o Operations – understanding resources required
o Logistics – acquiring the resources required
Span of control
o Number of agencies or people that can be successfully supervised by one person
o When the incident is large enough the incident controller must delegate responsibility
36
What is a high threat environment?
• Any incident that involves the potential or actual risk of physical harm to responders as a result of dangers inherent at the scene
37
What should you do if you find yourself in a high threat environment?
* Retreat to a safe space
* Activate duress alarm
* Only provide basic assistance to injured people which will not delay your withdrawal
* Provide sitrep ASAP
38
What is a Public Health Emergency of International Concern (PHEIC)?
* Extraordinary public health event which is determined to constitute a public health threat to other states through the international spread of disease
* Potentially require a coordinated international response
* E.g. SARS, Ebola, Polio, COVID 19
39
What things can trigger escalation of the SHERP?
o 000 calls to AV
o Multi agency dispatch requests to AV
o Warnings and advice from control agencies
o Planning and arrangements for major public events
40
What is the level of escalation of the SHERP influenced by?
```
o Location (region/remote, proximity to hazardous facility)
o Agency involvement
o Political sensitivities/complexities
o Media interest
o Public awareness
o Risk environment
```
41
What are planning considerations for public events under SHERP?
* Hazard analysis of the area
* Geographic location
* Entry and exit for emergency vehicles
* Crowd movement
* Type of spectators
* Time of year and weather conditions
* Public health issues
* Availability of food and water
42
What are the options for dealing with risk?
* Avoid the risk
* Reduce the likelihood of harmful consequences occurring by modifying the source of the risk
* Reduce the consequences by modifying susceptibility or increasing resilience
* Transfer the risk
* Retain the risk
* Prevention
* Planning
* Response
* Recovery
43
What is a code brown?
• Used by health services and facilities to plan, prepare, respond and recover from an external emergency
o E.g. transport accidents, chemical spills, natural emergencies such as fire and flood
44
What is a disaster?
o Serious disruption to community life
o Threatens to cause death and injury or damage to property
o Beyond day to day capacity of prescribed statutory authorities
45
What are some public health consequences of disasters?
```
o Water quality
o Sanitation
o Infectious disease
o Hospitalisation
o GP/outpatient attendance
o Long term health effects
o Long term physiological effects
```
46
What is involved in a SMEAC action plan?
Situation
- What has happened?
Mission
- What do we need to achieve?
Execution
- How are we going to achieve it?
Administration
- What are the details?
Command and Communication
- Who is doing what and how will we communicate?
47
What is the communicable disease triad?
Host
- Intrinsic
- Behaviours/extrinsic
Agent
- Pathogenicity
- Infectiousness
- Infective dose
- Virulence
- Immunogencity
- Drug resistance
Environment
- Physical
- Social
48
What is the chain of infection?
```
o Infectious agent
o Reservoir
o Portal of exit
o Mode of transmission
o Portal of entry
o Susceptible host
```
49
What are the common themes of surveillance?
o Collection
o Analysis and interpretation
o Communication
o Action
50
What are the purposes of surveillance?
o Determine the magnitude of a disease
o Examine trends over time
o Examine differences in different settings
o Identify risk factors
o Identify cases that require defined responses
o Detect outbreaks
o Monitor impact of health interventions
o Facilitate future planning, interventions
51
What are the 5 moments of hand hygiene?
```
o Before touching the patient
o Before antiseptic procedures
o After body fluid exposure/risk
o After touching a patient
o After touching patient surroundings
```
52
What is the definition of endemic?
disease that occurs in the community with incidence falling within an expected range
53
What is the definition of epidemic?
occurrence of disease in the community/region clearly in excess of the normal expected incidence
54
What is the definition of pandemic?
occurrence of a disease over a whole country or the world
55
What is the defintion of outbreak?
first cluster or epidemic cases
56
What is the risk communication paradigm?
Precautionary advocacy
- People are insufficiently alarmed about a serious hazard
- Task is the increase their concern and motivate them to take appropriate actions
Outrage management
- People are excessively alarmed about a small hazard
- Task is to diminish their concern and deter them from unnecessary and potential harmful actions
Crisis communication
- People are justifiably alarmed about a serious hazard
- Task is to harness their concern and guide their actions
57
What are the characteristics of CBRN events?
o Potential for mass casualties, loss of life or long term effects
o Creation of extremely hazardous environment
o Similar signs and symptoms
o Initial ambiguity/delay in determining type of material involved
o Narrow time frame for admin of life saving interventions
o Need for immediate medical treatment and specialised pharmaceuticals
o Need for timely, efficient and effective mass decontamination systems
58
Which agency is in control for each type of CBRN event?
```
o Chemical = fire services
o Biological = DHS
o Radiological = DHS
o Rescue and decontamination = Fire services
o Explosion = police
```
59
What is the role of the ambulance service in CBRN events?
o Provision of appropriate skills and equipment for CBR emergencies
o Triage of casualties
o Provision of most effective transport
o Coordination of medical teams
o Provision of support to other agencies
o Assist with decontamination of casualties
60
What are some examples of protracted incidents in Australia?
```
o Floods
o Heatwaves
o Fires
o Bushwalkers
o Missing persons
```
61
How can AV manage a situation where demand for services outweighs resources?
```
o Response to code 1 and 2 only
o Provide options such as refcom and local clinics
o Activate extra resources
Calling on extra staff
Extending hours
o Treat at scene
o Care by family at home
o Continue with prescribed medication
o NEPT
```
62
What alternate health resources can be available on scene?
```
o Field medical response officer
o VMAT (Victorian Medical Assistance Team
Doctors and nurses
o Other agencies
Red cross
Salvation army
St johns
```
63
What are the 3 levels of situational awareness?
Perception
- Registering of info and ability to see the information the is provided to you and gather it
Comprehension
- How people combine, interpret, store and retain the info that is gathered during the perception phase
- Integration of multiple bits of info and determination of their relevance to the goals
Projection
- The ability to forecast future situation events and dynamics
64
What are strategies to optimise situational awareness?
o Communicate
o Have a plan
o Listen to all team members
o Take control
65
What are some barriers to effective communication?
o Poor verbal skills such as being unclear and body language
o Perceived barriers regarding rank of the individual
o Use of jargon
o Lack of attention/interest
66
What strategies can improve effective communication?
```
o During a case
Verbally identify clinical problems
Consider clinical flags
Pause and plan
Seek feedback
o Clinical approach
o Guidelines that support good clinical decision making
o Developing critical thinking skills
o Dynamic risk assessment
```
Emergency Management
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