Community Emergency Response Teams- CERT -

A National Strategy for Haiti

Aldy Castor, M.D.

President, Haitian Resource Development Foundation HRDFDirector, Emergency Services, Association of Haitian

Physicians Abroad (AMHE), Haiti Medical Relief Mission

Prepared for the National Haitian American Health Alliance

7th Annual Conference, October 20-23, 2010Karibe Hotel, Port-au-Prince, Haiti

“When you’re out there lying dead on the road, you’ll want a coroner you can trust!”

Old campaign slogan from Arkansas, USA where county coroners are elected officials.

Modern society requiresSAFETY - SECURITY - TRUST

Background

The Haitian Resource Development Foundation (HRDF) was founded in 1987:

- In the US, as a 501(c) 3 non-profit organization, with a United States Federal Tax I.D. Number

- In Haiti, as a nongovernmental organization (NGO) that is registered in the archives of the Ministère de la Planification et de la Coopération Externe.

Since 2008, HRDF and its partners have trained Haitians in emergency medicine, primarily in the capital city area.

Among the students have been medical and nursing emergency room staff of the Hôpital de la Communauté Haitienne [HCH] and emergency units of Haiti State University Hospital. Port-au-Prince firefighters have also received training.

COMMUNITY EMERGENCYRESPONSE TEAMS (CERT)

The Creation of HRDF-CERT In 2009, HRDF began to create its own Community Emergency Response Teams (CERT) training program for Haitians. Four purposes of this program are to:

1. Educate communities about disaster preparedness for hazards that may impact their area, and trains them in basic disaster response skills, such as fire safety, search and rescue, team organization, and disaster medical operations.

2. Use the training learned in the classroom and field to assist others in their neighborhoods and workplaces following an event when professional responders are not immediately available to help.

3. Encourage teams to complement emergency response agencies by taking a more active role in emergency preparedness projects in their community.

4. Inform their communities about the existing emergency services.

The Setting and the Need

Community Emergency Response Teams are needed all across Haiti. The initial location for HRDF’s program was the south-central coastal community of Aquin, population approx. 100,000.

History

For twenty-three years, HRDF has had a strong presence in civil defense and emergency response training, health and environmental research and development in Haiti’s southern peninsula.

Like many Haitian coastal cities, Aquin’s coastal zone is relatively narrow, only a couple of miles wide from the water’s edge to the deforested hills and mountains that rise above and surround the city.

Rivers, streams and storm water ravines flow steeply from the mountains to the sea. Because of this, cloudbursts and seasonal storms often cause flash floods, with consequent loss of life and property.

Severe Mountain Trail Erosion

Severe Riverbank Erosion

The Flooding Consequence

And while there is a moderate-quality coastal road, it is not to highway standards. Thus, vehicular accidents are frequent, especially with trucks and buses, and evacuation routes during storms are few and far between.

Aquin-Miragoane Road

Four elements of a CERT program forHaitian communities are:

1. An academic and practical curriculum,2. A training process,3. Methods and operations that integrate with Haiti’s civil protection system for disaster preparedness, and4. Adequate equipment and supplies, safely warehoused, to meet community emergency response needs during disasters.

The need is for local, first-responsecapabilities that include:

- highly-trained and equipped staff and volunteers, - first aid supplies, - search and rescue tools and procedures, - all-terrain vehicles and boats, - communications equipment, - hand and power tools and electricity generators, - evacuation plans, - warehousing for equipment, supplies and inventory - planning, management and budgeting for comprehensive prevention, response and recovery.

The recommended training program:

Duration: 3-4 consecutive monthsOne three-day session every month

The training program includes:- Safety- Search and rescue operations- Accidents - Basic medical care and CPR- Principles of organization:

prevention, early alert,disaster management, mitigation

- Simulation of disasters

Objectives:

Community Emergency Response Teams will learn how to prevent and manage disasters and will be able to apply their expertise to:

Support people in their neighborhood whenprofessionals are not immediately availableto assist them.

Assist in various activities, such as publicsafety.

Educate their community on how to preventand manage disasters.  

Inform their communities on the existingemergency services

Serve as a support organization for theDirection of the Protection Civile, which isHaiti’s focal organization for emergencyresponse.

Participants:

Young residents of from 18 to 30 years old. The students will be recruited among these who had actively participated in social activities that had positively and objectively affected their community.

Beneficiaries:

The populations of Haiti’s communes [townships] who are chronically exposed to disasters, such as hurricanes, floods, drought, urban violence, etc.

Anticipated Results:

To train fifty young Haitian men and women who, in turn, will serve as monitors to other local youth of the community to integrate a growing CERT team.

Graduation and certification:

At the completion of the course, an examination will be given. The passing students will be given a certificate recognized by the Ministry of Public Health and the Ministry of Interior.

Cost

HRDF prefers that CERT training be offered at no cost to participants. By experience, each training program cycle (three, 3-day sessions) has cost HRDF approximately US$15,000, including staff expenses, teaching material, travel and student meals. These were paid for by tax deductible contributions and grants to HRDF.

Expansion potential

With existing HRDF staff and format, sixteen training cycles a year are possible at a cost of approx. US$200,000. Additional teams can be formed to offer even more programs per year.

Limiting factors

Proximate limiting factor - HRDF is willing and capable of conducting more CERT training, both in the southern region where it began and around the country if funds were available.

US$ 200,000 would be enough to a) fully employ current staff, and b) graduate approx. 800 students per year.

The investment is approx. US$250/student.

Ultimate limiting factor – Imagine a team of fifty HRDF-CERT graduates with the knowledge toprotect their community, but without the requisite equipment, supplies, tools and replacement necessary to go into action. This is the ultimate limiting factor.

Therefore, HRDF recommends adding a fourth session to its program cycle where the CERT team assembles, tests, uses and repairs a variety of vehicles, search and rescue equipment, emergency communications, computers, boats, earthmovers, bridges, drains, water filtration and sanitation apparatus, shelters, body bags, identification, etc.

This requires capital investment that is not only used for education purposes but also becomes lifesaving assets in the community. HRDF cannot turn a blind eye to this ultimate limiting factor.

And as most emergency equipment and supplies are not manufactured in Haiti, another source can be through in-kind gifts, such as from the surplus and excess property of foreign governments and aid agencies.

Instructors:

Qualified, candidate instructors may include:

- HRDF volunteer physicians , nurses and volunteer firefighters from the United States, France and Haiti,- Instructors from Haiti’s Ministry of Health and from the Direction of Protection Civile of the Ministry of Interior.

After graduation

The graduates will be able to support the Direction of the Protection Civile Office throughout Haiti in a program of prevention and management of disasters, and also assist their community in related activities.

Selected Components ofHRDF’s CERT Training Curriculum

1. Search and Rescue

Search and Rescue is a broad topic that covers everything from searching for lost children to transporting disaster survivors to a treatment area. Every aspect of CERT training is used in Search and Rescue.

Search and Rescue involves three distinctly different actions:

Scene Size Up – Assess the situation and build a safe plan of action.

Search – Locate and document the location of survivors, or other items of interest.

Rescue – Safely remove survivors from danger.

2. Triage and Trauma

Disaster medical assistance is based on two assumptions:- the number of victims will exceed the capacity for traditional response and treatment, and that- survivors will assist others.

CERT increases the knowledge base to allow survivors to render additional assistance and possibly save lives while conserving community resources in time of disaster.

HRDF’s CERT teams are trained to provide:

- Treatment for life-threatening conditions such as airway obstruction, bleeding and shock, and for other less-urgent conditions.

- The greatest good for the greatest number of survivors by conducting simple triage and rapid treatment.

3. Triage

In a disaster, there will be more victims than rescuers, and immediate help may not be available. Haitian CERTs must be able to function quickly and efficiently to save lives.

“Triage” is a French word that means “to sort.” During triage, survivors are evaluated, sorted by the urgency of the treatment needed, and classified as Minor (green), Delayed (yellow), Immediate (red), or DeadDead (black).

Triage has proven to be effective when

- There are more survivors than rescuers

- There are limited resources

- Time is critical

4. Medical Treatment After survivors have been triaged and taken to the medical treatment area, basic medical evaluation and treatment can begin.

- Assess – head to toe- Alert - communicate with other rescuers, helpers and professionals- Attend – begin basic treatment, stabilize

5. Disaster Psychology

Disaster psychology is much more than caring for your victims. You will need to care for yourself and your team members as well. Know your limitations.

Access - Scene size-up. “Are you in danger?” Alert - Prepare family and prepare to respond. Only respond if requested and if there is no danger to you, e.g. chemical, biological, radiological, geological.Attend - Be prepared to assist survivors.

6. Organization

Organization is a necessity in a mass-casualty situation. Organization is needed for every aspect of Haitian CERT, from the team approach to search and rescue to the organization of volunteers that show up on the scene.

Being organized will keep rescuers and victims safe, provide clear leadership on the scene, and provide valuable information when professional responders arrive.

HRDF’s National Plan forCommunity Emergency Response Teams

Matthew Marek, International Federation of the Red Cross

Time Magazine

Time Magazine

Crew of 42

International Federation of the Red Cross

After the earthquake struck, Port-au-Prince firemen, police and civil defense personnel, many of whom had received thorough training in emergency training from HRDF over the years, were suddenly reduced to helplessness. Why?

Because, of the hundreds of millions of dollars of foreign aid and gifts that donors have annually poured into Haiti, the necessary backup emergency response equipment and operating systems that ought to have been priorities were never purchased and safely stored.

Over the years, HRDF members and partners have witnessed "mass casualty" events such as hurricanes, floods and, recently, the January 12 earthquake that caused terra firma to give way under several Haitian cities at once.

Even ladders, the most rudimentary of rescue tools, were in short supply or lacking or inaccessible or broken, not to mention the paralysis of fire engines trapped under collapsed roofs, and the inability to pump fuel because of electrical outages.

What’s the reason?

Factors such as number of victims, failure of communications, roads and vehicles, inaccessibility of buildings, neighborhoods and regions, limit failures, and road blockages will prevent people from accessing emergency services.

People will have to rely on each other for help in order to meet their immediate life saving and life sustaining needs.

Under these kinds of conditions, family members, fellow employees, and neighbors will spontaneously try to help each other.

This was the case following the Mexico City earthquake where untrained, spontaneous volunteers saved eight hundred people. However, a hundred lost their lives while attempting to save others. This is a high price to pay and is preventable through training.

Against this void, HRDF and colleagues from countries where CERT has long ago proved its weight in gold, were left to their own devices (and scarce funds) to start helping a few Haitian communities study and practice large-scale emergency response methods. Among them is was Aquin. Last year, HRDF began teaching CERT to approximately fifty Aquin volunteer residents.

The CERT course of study emphasizes helping community members develop a team mentality, then recognize and act out their roles and responsibilities as if a natural or manmade disaster had struck or was about to strike.

HRDF - CERTNational Disaster Preparedness Strategy

“Powers of Ten”

Based on success up to now, HRDF wants to train a corps of 100 CERT teachers who will then be grouped and dispatched to all of Haiti's ten departments where they will conduct CERT training commune-by-commune.

The training program will include:

- Safety- Search and rescue operations- Accidents - Basic medical care and cardiopulmonary resuscitation- Principles of organization: prevention, early alert, disaster management, and mitigation - Simulation of disasters

The program will be modeled on Aquin, namely:

1. At least three, 3-day sessions, taught over three successive months = nine total days.

2. Among those especially recruited will be young Haitians who positively and actively participate in their communities.

3. The objective will be to train fifty young Haitians, male and female, in each of the country’s 140 communes, who in turn will serve as mentors to other community youth concerned about disaster preparedness.

Partners

HRDF seeks and welcomes partners in the CERT training program. In addition to existing international expert instructors, HRDF has been offered the assistance of the State of Florida Division Emergency Management Division. This is particularly significant because it lives up to the spirit and letter of the Haiti Advisory Task Force of the Governor of Florida, 2005.

Governor’s Advisory GroupRecommendations 3 and 11

Recommendation 3: “The State of Florida should provide resources for the creation of a dedicated Florida-Haiti Professional Exchange and Training Program with the Government of Haiti. This would allow Florida volunteers to travel to Haiti to provide in-country technical assistance and /training and for Haitian officials to travel to Florida to receive longer-duration off-site training.”

Recommendation 11 - “The State of Florida should employ its expertise and experience with natural disasters to provide technical assistance to the Republic of Haiti’s Bureau of Civil Protection, in order for this agency to develop appropriate disaster management infrastructure and training.”

Technical training provided through the Florida Division of Emergency Management, as well as appropriate surplus equipment donated from other State and local agencies, could be utilized toward this end.

The objective will be to attract and certify at least fifty Haitians in each of the country’s 140 communes by the year 2015. This will make a corps of 7000 strong...residents from all walks of life.

Cost, 5-year National CERT Program

a) Teaching Corps - $330,000:

- 20 master teachers of various specialties @ $10,000 compensation = 200,000

- 10 days travel/lodging/meals per instructor @ $150 per day x 20 instructors = $30,000

- principal instructors' materials, including expendables = $50,000

- long distance and overseas travel, shipping, miscellaneous = $50,000

b) CERT Training - $7,550,000:

- 70 part-time CERT instructors @ $3,000 per year x 5 years = $1,050,000

- $50,000 teaching materials x 10 teams, including expendables, sufficient for each to conduct training in approx. 15 communes = $500,000

- $40,000 minimum, team equipment and supplies x 140 communes = $5,600,000

- 30 days travel./lodging/meals per instructor @ $150/day x 100 instructors = $450,000

c) HRDF Coordination - $1,730,000:

- 3 staff @ $30,000 x 5 years = $450,000

- 3 part-time advisors @ 30,000 x 5 years = $450,000

- $1000 per month office expenses x 60 months = $60,000

- $50,000 per year vehicles, fuel and maintenance x 5 years x 2 vehicles = $500,000

- 10 person-days/month x $150 in-country travel, lodging, meals x 60 months = $90,000

- $3000 international travel/month x 60 months = $180,000

Therefore, the total estimated cost for a five-year CERT nationwide training program in Haiti is $9,910,000.

Using the assumption that a Haitian life may be worth $100,000, the return on investment to save approximately a hundred lives from community-scale disasters over a five-year period seems a good return on investment.

Outreach

This year, HRDF members have convened, attended and participated in a variety of conferences, including at the Organization of American States [OAS] to convey priority concerns and request that foreign aid donors include Diaspora medical professionals in the reconstruction, re-equipping and re-staffing of Haiti's health sector.

HRDF stresses that Diaspora professionals have the credentials, culture, connections, motivation and opportunity to be of invaluable assistance throughout the country, and many years' productive experience working with major international responders such as the U.S. Southern Command.

CERT instructors - physicians, nurses, therapists, rehabilitation specialists, students, etc. - will be offered compensation for their time. In turn, they will be free to accept all or a portion of the offer, depending on need.

HAITIAN RESOURCE DEVELOPMENT FOUNDATION

www.hrdf.org

Aldy Castor, M.D., President

United States:854 Marina Drive, Weston, Florida 33327

ph 954.659.7953. 954.873.0064fax 954.659.7957 aldyc@att.net

Haiti:17, 2ème ruelle Wilson, Pacot, Port-au-Prince ph

509.3.443.3703 25, Rue Sténlo Vincent, Aquin ph/fax 509.245.4117