Introduction to The National Ambulance Service Major...

Introduction to The National Ambulance

Service Major Incident Response Programme

Irish Major Emergency Response (iMER)

Introduction

Introduction

Overview of the Programme

iMER – SCAT3

Triage

Questions

Defining a Major Emergency

“A Major Emergency is any event which, usually with little or no warning, causes or threatens death or injury, serious disruption of essential services, or

damage to property, the environment or infrastructure beyond the normal capabilities of the

principal emergency services in the area in which the event occurs, and requires the mobilisation of

additional resources and activation of specific additional procedures to ensure effective, co-

ordinated response”.

Purpose of Framework

Set out arrangements to facilitate the Principal Emergency Services working together to manage large scale incidents, and to mobilise/ involve full resources of Principal Response Agencies

Provide overarching framework by which other services e.g. Defence Forces, Voluntary Emergency Services, utilities etc. can support and work with the Principal Response Agencies

Links Major Emergency Plans with other National

& Local EPs

Language and Terminology

Principal Response Agencies (PRA’s)

An Garda Síochána

HSE

Local Authorities

Principal Emergency Services

An Garda Síochána

Ambulance Service

Fire Service

Language and Terminology

External Resources

Defence Forces

Civil Defence

Irish Red Cross

Voluntary Emergency Services

Utilities; and

Private Sector

Format of New Framework

Hazard Analysis

Each PRA should, in association with its partner PRA’s

carry out a risk assessment in accordance with the procedures set down in this Section.

The initial risk assessment should be reviewed and updated annually, or as circumstances require

Plotting outcome on risk matrix

Using the risk matrix for mitigation, scenarios for preparedness

Risk Assessment

Mitigation

Risk Assessment process informs/prioritises mitigation Reducing the likelihood

Reducing the impact

Risk owners/ regulators

Promoting Resilience Communities

Services

CIP

Mitigation

Planning and Preparedness

Major Emergency Plans (MEP)

New format of Major Emergency Plan

Each PRA to have individual MEP

Linking MEP with other Emergency Plans

National Emergency Plans (NEPs)

Severe Weather

Site & Event Specific Plans

Ports & Harbours

Airports

Functions of PRA's

Identify the support roles and functions which the external resources may be call upon to provide

Headings in Co-ordinated Response

Declaration of a Major Emergency

Mobilisation of Resources

Command, Control and Co-ordination of Resources

Management of the Scene

Casualty Management

Protecting Exposed Populations

Information Management Systems

Public Information and Media

Command Arrangements On Site

Each emergency service exercises command over its

own resources in accordance with its normal

command structure, command systems and

arrangements

If ‘Danger Area’ is declared - services operating in

the danger area should continue to exercise

command over their own operatives activities

Ambulance Incident Commander or Designate

Control Arrangements

A nominated Controller of Operations for each of the three PRA's

Each PRA should exercise control over

its own services

services (other than the PRA's) which it mobilises to the site (e.g. VES, etc)

Control Arrangements for External Resources

Defence forces – An Garda Síochána

own command and control structure

Civil Defence – Local Authority

own command structure under control of LA

Red Cross – Generally HSE

own command structure under control of HSE

Voluntary Emergency Services –

Relevant PRA

Own command structure

Under control of relevant PRA

Assigning Responsibility for Co-ordination Function

Lead Agency Concept

Extending the “lead government department” concept to

operational response level

On-Site Co-ordinator (Convenor) from lead agency

Two mechanisms to determine lead agency

‘Pre-nomination’ for common incident types

‘Default’ arrangement where categorisation.

Co-ordination Structure and Architecture

On site Co-ordination Group

Lead agency provide On-Site Co-ordinator

Local Co-ordination Group (Off-site)

Pre-nominated centres, chaired by lead agency

Regional Co-ordination Group

National Co-ordination – “Lead Department”

Bottom-up or top-down link between lead agency and “Lead Department”

Crisis Management Teams

Senior staff within each PRA

Support the response of the PRA on site

Link to rep on Local Co-ordination Group

Ensure lead agency/ co-ordination role where appropriate

Maintain normal day-to-day services

Site Management Arrangements

Programme

Modules

iMER Programme – Module 1

Command Structure

Controller of Operations - HSE

Is a Small Green and White Battenberg over Green Tabard with White insert and black lettering to be worn over the PPE Jacket

Controller of Operations - HSE

Role:

Tactical Static Command of HSE Resources at the Scene of a Major Incident

Based in a Tent or Building at the scene of the incident

HSE – Controller of Operations

Ambulance Officer or Paramedic Supervisor

AGS – Controller of Operations

Superintendant

LA – Controller of Operations

Fire Officer – Assistant Chief

Report to the Local Coordination Centre

Ambulance Incident Commander

Is a Large Green and White Battenberg Tabard

with White insert and black lettering to be worn over the PPE Jacket

Ambulance Incident Commander

Role:

Tactical Operational Command of HSE/NAS Resources at the Scene of an Incident or Major Incident

Based at the Incident Command Vehicle/ or designate

Responsible for:

Tactical Operational Command of NAS /HSE Resources

Large Incident Commander of all NAS/HSE resources

Can be an Officer; Paramedic Supervisor;

Paramedic or Advanced Paramedic

Reports to the HSE Controller of Operations at a Major Incident

Large Incident - NEOC

Ambulance Medical Officer

Is a Green Tabard with White insert and Black Lettering to be worn over the PPE Jacket


Role:

Responsible for all HSE Medical Resources at the scene of an Incident.

Briefing of all Doctors and Nursing resources arriving at the scene.

Report to the Ambulance Incident Commander

Ambulance Communications Officer

Is a White Tabard

with a green band at the bottom

Black lettering to be worn over the PPE Jacket:


Role:

Command of all communications at the scene of the Incident

Major Incident

Communicates information to the On-Site Coordination Centre.

Incident:

Communicates Information to NEDOC

Reports to and takes orders from the AIC

Ambulance Safety Officer

Is a Yellow and White Tabard Battenberg Pattern Tabard with White insert and Black lettering to be worn over the PPE

Ambulance Safety Officer

Role:

Designated to look after the Safety ; Health and Well-being of all NAS/HSE resources at the scene of an Incident.

Major Incident/Incident

Briefing of HSE resource arriving on scene

Liaise with the Fire Commander on scene regarding safety of personnel and the scene

Communicates with the AIC


Ambulance Forward Incident Officer

Is Large Green and Yellow Battenberg Pattern Tabard with white insert and Black Lettering to be worn over the PPE Jacket.

Ambulance Forward Incident Officer

Role:

Designated to command all NAS/HSE Resources in the forward area of the Incident

Danger Area

Triage ; extrication and Treatment of casualties in the forward area

Liaise with the CCS Officer


Ambulance Parking/Loading Officer

Is a Yellow Tabard with White insert and Black Lettering to be worn over the PPE Jacket, These two Jackets are interchangeable with Ambulance Parking Officer and Ambulance Loading Officer Panels being attached by Velcro on the inside and outside of the jacket.

Ambulance Parking/Loading Officer

Role Parking:

Parking of Vehicles and Equipment Dump.

Designate which vehicles move to the CCS to transport patient’s

Liaise with the Ambulance Loading Officer

Role Loading:

Loading of Vehicles at the CCS to transport patient’s

Liaise with the CCS Officer and Ambulance Loading Officer

Reports to and takes orders from the AIC or designate

Ambulance CCS Officer

Is a Dark Green Tabard with White insert and black lettering to be worn over the PPE Jacket

Ambulance CCS Officer

Role:

Triage and Treatment of Patients at the Casualty Clearing Station (CCS)

Prioritising Of patients for Treatment and Transport from the CCS to designated facilities

Reports to and takes orders from the AIC/AMO

Ambulance Decontamination Commander

Is a Large Battenberg pattern tabard of Green and Orange with white insert with black lettering to be worn over the PPE Jacket:

Ambulance Decontamination Commander

Role:

Command of Decontamination resources at the scene of an incident where Decontamination is required.

Responsible for the setting up and running of the Decontamination Unit at the scene

Liaise with the Fire Incident Commander

Reports to and takes Orders from the AIC

Ambulance Decontamination Control Board Officer

Is an Orange tabard with a White insert with Black lettering to be worn over the PPE jacket.

Ambulance Decontamination Board Control Officer

Role:

Command of the Decontamination of Patients at the scene.

Control of Personnel in the Decontamination Tent

Reports to and takes orders from Ambulance Decontamination Commander

Command & Control of the

Scene

NASC - Irish Major Emergency Response

Command and Control of the Scene

We use the Mnemonic SCAT3

Safety x 3

Dynamic Risk Assessment Tool

Command x 3

Assessment x 3

Triage

Treatment

Transport


Safety x 3: Self

HSE/NAS Resources.

Scene

Liaise with the other PRA’s Incident Commanders

Survivors

Do they need immediate evacuation?

Do any survivors need to be treated on scene?

• Liaise with AGS regarding Survivor Reception Centre

Safety at the Scene

Dynamic Risk Assessment Tool (DRAT)

IAM2 PEER

Identification

Problem

Effects

Exposure

Risk

Assessment

Problem

Effects

Exposure

Risk


IAM2 PEER

Mitigation

Problem

Effects

Extended Exposure

Risk

Monitoring - Escalation or De-escalation

Problem

Effects

Extended Exposure

Risk


Responsibility for the safety of all Ambulance/HSE Personnel at the Emergency.

Delegation of a Safety Officer

If appropriate

To deal with all safety aspects associated with the incident.

This person can also act as the

Holding/ Parking and Loading Officer at the Scene.

• If appropriate

All personnel coming on scene Have and are wearing the proper PPE

Can bring any equipment required

Casualty Clearing Station

Specifically designated Area

• Equipment Dump.

Safety at the Scene


Incident Command SCAT3: Command

Liaise with the Ambulance/HSE - On-Site Coordinator

Take command of all Ambulance Assets at Tactical Scene

Make Key Appointments Ambulance Forward Commander

Ambulance Casualty Clearing Station Officer

Ambulance Loading Point Officer

Ambulance Parking Officer



Ambulance Decontamination Officer

Decontamination Board Control Officer

Wear the tabard to identify yourself as a Commander/Officer

Start a log of your actions – noting times of entries. Utilise the Command Pack Booklets

NASC - Irish Major Emergency Response Irish Major Emergency Response Training

Incident Command SCAT3: Communication (1)

Liaise with the other PRA’s Tactical Commander

Fire Service Tactical Commander

An Garda Síochána Tactical Commander

Brief all HSE/ Ambulance staff for duty on Arrival

Designate a Incident Medical Commander if Appropriate.


Incident Command

SCAT3: Communication (2) Update the HSE OSC regularly

Current Situation Reports (Sit-Reps)

Scene Casualty Number and Triage State

CCS Casualty Numbers and Triage

Information relating to Casualty Movements (Hospitals)

Requirements for Resources/Staff/ Equipment and any other requirements

Consider Communication on scene. Appoint a Communication Commander (if not already done so)

Aid the On-Site Coordinator/Media Liaison Officer with Media Briefings


Incident Command

SCAT3: Assessment (1)

Assess Areas for:

Casualty Clearing Station (CCS)

Ambulance Parking

Ambulance Circuit

Liaise with AGS

Area for Helicopter Landing Site

If appropriate

Reassessment for developing hazards (SSS)

Dynamic Risk Assessment Tool

Assess needs for additional resources

Liaise with the HSE – On-Site Controller of Operations

NASC - Irish Major Emergency Response Irish Major Emergency Response Training Irish Major Emergency Response Training

Incident Command SCAT3: Assessment (2)

Assess needs for additional resources

Liaise with HSE – On Site Coordinator

Liaise with Ambulance Medical Officer

Number and type of Medical resources required.

Assess need for:

Resting staff

Relieving staff

Feeding and Hydration of staff.



Incident Command SCAT3: Triage

Ensure triage is being carried out at point of contact

Primary Triage (Triage Sieve)

Ensure Triage is being carried out at the CCS • Secondary Triage (Triage Sieve/Sort)

Sectorise Incident if Required

Delegate task to Ambulance Forward Command

• Multiple Triage Officers – Section Command

Priorities Evacuation and Treatment at the Scene


Incident Command SCAT3: Treatment

Establish a Casualty Clearing Station Delegate

CCS Commander


Provide Personnel to treat casualties at point of contact Designate Medical Personnel from CCS for specific tasks

Aim to achieve Best Practice


Incident Command SCAT3: Transport

Liaise with Medical Officer; Loading Officer; Parking Officer to identify the specific needs and requirements of the patient.

Select appropriate transport for individual patients


Command & Control Aide Memoire


Operational Control Lay out


Incident Sketch/Key Tasks

SCAT3

1. Safety:

1. Self/Scene/Survivors

2. Command:

1. Scene/ Resources/ Communications

3. Assessment:

1. Area/ Hazards/ Resources

4. Triage

5. Treatment

6. Transport


Tactical Command Management Structure:

Tactical Command- Operations

HSE Controller of Operations: ________________________

Ambulance Incident Officer: _________________________

Medical Incident Officer: ____________________________

Tactical Area –Danger Area

Forward Incident Officer: ___________________________

Forward Medical Incident Officer: ______________________ (This post may not be required)

Forward Triage Officer: ______________________________ (This post may not be required)


Outer Cordon Management Structure: (HSE- Tactical Command Area)

Amb. Safety Officer: ____________________________

Amb. Communications Officer: ____________________

Ambulance Parking Officer: ______________________

Ambulance Loading Officer: ______________________


Identification

Problem: ___________________________________

Effects: ____________________________________

Exposure: __________________________________

Risk: ______________________________________

Assessment

Problem: ___________________________________

Effects: ____________________________________

Exposure: __________________________________

Risk: ______________________________________


Mitigation

Problem: ___________________________________

Effects: ____________________________________

Exposure: __________________________________

Risk: ______________________________________

Monitoring - Escalation or De-escalation

Problem: ___________________________________

Effects: ____________________________________

Exposure: __________________________________

Risk: ______________________________________


Adult Triage Sieve


Triage Sort


Casualty Count (Page 1) (Cross the next number in each row for each new casualty)

Priority 1 (P1)

IMMEDIATE

1 2 3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20

Priority 2 (P2)

URGENT

1 2 3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20

Priority 3 (P3)

DELAYED

1 2 3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20

1 2 3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20 DEAD


Casualty Count (Page 2) (Cross the next number in each row for each new casualty)

Priority 1 (P1)

IMMEDIATE

21 22 23 24 25 26 27 28 29 30

31 32 33 34 35 36 37 38 39 40

Priority 2 (P2)

URGENT

Priority 3 (P3)

DELAYED

DEAD

21 22 23 24 25 26 27 28 29 30

31 32 33 34 35 36 37 38 39 40

21 22 23 24 25 26 27 28 29 30

31 32 33 34 35 36 37 38 39 40

21 22 23 24 25 26 27 28 29 30

31 32 33 34 35 36 37 38 39 40


Communications Log:

Time:______ *From: ___________To:__________.

Message:_________________________________________________

Time:______ *From: ___________To:__________.

Message:_________________________________________________

Time:______ *From: ___________To:__________.

Message:_________________________________________________

Time:______ *From: ___________To:__________.

Message:_________________________________________________

Time:______ *From: ___________To:__________.

Message:_________________________________________________

Time:______ *From: ___________To:__________.

Message:_________________________________________________

Time:______ *From: ___________To:__________.

Message:_________________________________________________

Time:______ *From: ___________To:__________.

Message:_________________________________________________


Information Management System


Medical Personnel Record

Name:_______________

Qualification:___________

Area:__________________

Name:_______________


Area :__________________

Name:_______________


Area :__________________

Name:_______________


Area :__________________

Name:_______________


Area :__________________

Name:_______________


Area :__________________

Name:_______________


Area :__________________

Name:_______________


Area :__________________

Name:_______________


Area :__________________

Name:_______________


Area :__________________


Forward Area - Practitioner Log :

1. In: ______ hrs ;Call ______ Name:_________ Grade___/ Pin:_____ Out: _______hrs

2. In: ______ hrs ;Call______ Name:_________ Grade___/ Pin:_____ Out: _______hrs










Vehicle Log : Vehicle Type:____/Call sign______ Arrive: ______ hrs Depart: _______hrs

Crew 1:_____________/ Pin:______ Crew 2:__________)/Pin:_______

Vehicle Type:____/Call sign______ Arrive: ______ hrs Depart: _______hrs

Crew 1:_____________/ Pin:______ Crew 2:__________)/Pin:_______


Crew 1:_____________/ Pin:______ Crew 2:__________)/Pin:_______


Crew 1:_____________/ Pin:______ Crew 2:__________)/Pin:_______


Crew 1:_____________/ Pin:______ Crew 2:__________)/Pin:_______


Crew 1:_____________/ Pin:______ Crew 2:__________)/Pin:_______


Crew 1:_____________/ Pin:______ Crew 2:__________)/Pin:_______


Crew 1:_____________/ Pin:______ Crew 2:__________)/Pin:_______


Casualty Evacuation Record: Time: _____Casualty Name:______________ Priority: _______

Transport Type:____/Call sign____ Destination:_________ Time:______

Time: _____Casualty Name:______________ Priority: _______















NOTES: Time:____ *________________________________

_______________________________________

Time:____ *________________________________

_______________________________________

Time:____ *________________________________

_______________________________________

Time:____ *________________________________

_______________________________________

Time:____ *________________________________

_______________________________________

Time:____ *________________________________

_______________________________________

References:

A Framework for Major Emergency Management (2006)

A Framework for Major Emergency Management, Appendices (2006)

A Framework for Major Emergency Management, (2010) Guidance Document 4, A Guide to Risk Assessment in Major Emergency Management.

A Framework for Major Emergency Management, (2010) Guidance Document 6, A Guide to Motorway incidents

A National Risk Assessment for Ireland, (2012) Office of Emergency Planning, Department of Defence.

Campeau, A. (2009) Introduction to the Space Control theory of paramedic scene management: Emergency Medical Journal, Vol. 26; p 213-216

Drabek, T.E. (2004) Theories relevant to Emergency Management versus A Theory of Emergency Management, Management Higher Education Conference, National Emergency Training Centre, Emmitsburg, Maryland, USA.

Emergency Management Australia, (1999), Approaches to Emergency Management, Risk Management, Vol. 1.

Anthony Campeau (2009) Space-control Theory of Paramedic Scene Management

Gary Kreps – D-T-R-A Typology: 4 Structured Components to the Planning Preparedness & Response to Major Emergencies

D = Domain

Functions of an Organised Response

T = Tasks

How this Domain is accomplished

R = Resources

The People, Capabilities, Commodities and Equipment

A = Activities

Interdependent activities of Individuals, Groups and Organisations

Monitoring Assessment

Identification

Mitigation

PEER

PEER PEER

PEER

PEER = Problem; Effects; Exposure; Risk

Dynamic Risk Assessment Tool: I.A.M2 P.E.E.R.

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