Public Health Emergency - Leading a Nation Prepared
The following example demonstrates how the concepts presented in this chapter may be applied during an actual incident response. The various phases of response (as described in Chapter 1) highlight when critical actions should occur; however, the example extends only as far as incident operations, since this is the focus of the MSCC Management System.
While the following example demonstrates Tier 2 addressing specific activities, it should be noted that in some jurisdictions, many of these activities are addressed by Tier 3.
Background and Incident Description
Incident recognition is provided across the Tier 2 coalition by EMS dispatch. Multiple 911 calls describing "a large explosion with casualties" trigger a pre-determined threshold, and the EMS dispatcher notifies coalition hospitals as EMS units are sent to the scene. Almost simultaneously, initial media reports describe an explosion with casualties. Subsequently, the hospital closest to the blast site notifies the Tier 2 coalition that they have already received several walk-in burn patients from the event.
Notification/activation of the Tier 2 coalition occurs immediately and is accomplished by the initial EMS dispatch communication. The initial notification is sketchy and states only that an explosion has occurred at or near Station X, many casualties are expected, and EMS scene officers will call back shortly for an HCO bed availability count. Because of preparedness planning and training, the Tier 2 coalition partners know to immediately survey their HCO's bed availability and categorize additional patient capacity according to a predetermined format.
Mobilization involves the initial staffing of the Tier 2 call center (MACC), as well as the gathering of initial information from the various Tier 1 assets. This includes determining which Tier 1 assets are activating their respective EOPs. In addition, the coalition begins to gather additional incident information from Tier 3 for dissemination to the Tier 1 assets. Participating Tier 1 HCOs appoint a liaison from their organization as their primary contact with the MACC component of the Tier 2, and appoint a senior executive to participate in any potential MAC Group activities in Tier 2.
Incident operations begin within minutes, as initial bed counts are reported by each HCO. The Tier 2 information clearinghouse function collects and aggregates the data, and provides a composite of the data to EMS for use by triage and transport officers, and to the DoH communi-cations officer for jurisdictional (Tier 3) planning. Moreover, the composite is immediately distributed to all coalition HCOs and is used by hospital incident managers to anticipate surge needs for direct patient care or potential support needs for their partner HCOs.
Through the Tier 2 communications mechanism, coalition HCOs (with DoH participating) receive an incident update from an assistant EMS Chief at the blast site. The total number of victims is unclear because underground areas have not been fully accessed by rescuers. The Tier 2 coalition decides to implement a formal reporting mechanism to facilitate distribution of incident information to the HCOs and to jurisdictional health authorities (Tier 3). The Tier 2 clearinghouse function provides an electronic reporting format for hospitals to use and initially requests submission on an hourly basis. Information from the reports is collated by the Tier 2 clearinghouse function and redistributed back to the HCOs to give them a more comprehensive perspective of the response. Essential elements of information in the reports include:
The Tier 2 coalition coordinates various services among the HCOs. For example, staffing agencies that supply healthcare personnel to more than one HCO are coordinated through the Tier 2 coalition to prevent serious shortages at any one facility. In addition, the coalition sends a liaison to the jurisdiction's EOC to convey the collective issues and concerns of the HCOs to the EOC management team and appropriate Emergency Support Functions (ESFs). For example, the liaison to the EOC informs the jurisdiction that law enforcement activities (e.g., street closures) have hindered the ability of off-duty staff to return to the hospitals to assist with the surge in patient volume. This problem is rapidly addressed.
The blast caused a significant number of eye, burn, and respiratory injuries, which severely challenge the response capability of several HCOs. The Tier 2 coalition assists in coordinating medical mutual aid to these facilities:
As the blast scene is cleared of victims, the jurisdiction's defined "incident" transitions from focusing on fire/EMS rescue at the site to supporting HCOs as they surge to meet victims' medical needs. Medical representatives from the Tier 2 coalition are appointed as senior advisors to the Tier 3 incident management team. Input from these advisors to jurisdictional incident management will promote optimal support of the local HCOs in their efforts to address evolving surge demands.
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