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MAJOR INCIDENT
MANAGEMENT
EMERGENCY
MEDICAL
SERVICE
RESPONSE
DEFINITION
(Referring Directive 20, N.S.C)
A regional event that involves a large number of
casualties in a large geographical area that
overwhelms the available local resources & service.
DEFINITIONS
Mass Casualty Incidents (MCIs)
Disaster in which patient care resources
are overextended but not overwhelmed,
focus on most life threatening injuries
Mass Casualty Events (MCEs)
Disaster in which patient care resources
are overwhelmed and cannot be
immediately supplemented, focus on
identifying those patients with the greatest
possibility of survival.
DARK SIDE OF
MODERNITY
More complex, widespread &
with a larger scale of losses
due to:
Increased technology
Intensive urban
development
Greater area of habitation
Sophisticated
DISASTER
An interface
between an
extreme physical
event & vulnerable
human population
Susman et al
ANATOMY OF A DISASTER
The physical happening which is determined
by the geographical area, physical
structures, infrastructure of the area,
number of lives and the exact nature of
destruction
PHYSIOLOGY OF A DISASTER
The social occasion and mechanism of the
process of disruption which will determine
the consequence and impact of the event.
HYBRID
Ecological Balance
Disruption
Landslide
Flooding
Urban Oriented
Flash Flood
Storm and
Typhoons El Nino
Outcome
Mass Casualties
Psychological
Loss of Public Trust in Authorities
Economical
TYPES OF W.M.D.
Radiological
Biological
Chemical
Explosive and
Incendiary
Devices
W.M.D.
Similar to Hazardous Materials
events
Chemical, Biological, Radiological has
the potential for mass casualties
Chemical, Biological, Radiological
event is a crime scene
Widespread psychological impact
Emergency Medical Service and
hospitals and overwhelmed
W.M.D.
Psychogenic casualties predominate
Responding personnel are at risk for
personal injury
Criminal event - need for evidence
preservation
Number of victims and dead are
greater.
CHEMICAL TERRORISM
Copycat attacks in Japan using
cyanide, phosgene, and pepper spray
Possible sarin attack in Disneyland
1997 Sydney, Australia chlorine
bombs in shopping centers injure 14500 evacuated.
DIRECTIVE
20,
NATIONAL
SECURITY
COUNCIL
( N.S.C.)
DIRECTIVE 20 NATIONAL
SECURITY COUNCIL
DISASTER:
An event that occurs suddenly.
Complex in nature.
Loss of lives.
Destruction of property and/or environment.
Disruption of the community daily activities.
Divided into 3 main level of categories
depending on the management capability and
capacity
DIRECTIVE 20 NATIONAL
SECURITY COUNCIL (NSC)
LEVEL 1
Localized major incident
under control
not complex
small no. of casualties and property loss
minor disruption of daily community activities
manageable by the local authorities not
requiring multi sectoral involvement.
e.g. bus accident, train derailment, landslide.
Bencana
Tahap 1
LEVEL 2
Widespread over a large area but under
control
Complicated and complex
Large no. of casualties and property loss.
Affecting daily community activities
Not manageable by the local authorities
requiring assistance from other states or
National Authorities
Support required, Regional or National
Support
e.g.: Highland Towers Collapse, Greg
Storm Sabah, Bright Sparklers.
LEVEL 3
Involves a very large area.
Loss of many lives.
Total Destruction of infrastructure and public
facility.
Complicated and complex.
High risk to rescue workers.
Complete disruption of daily community activities.
Major destruction of resources.
All local resources destroyed and assistance from
external resources required.
e.g. Earthquake, typhoons, volcanoes, war.
APPROACH
PRINCIPLE OF DISASTER
MANAGEMENT
DO THE GREATEST GOOD FOR
THE GREATEST NUMBER
1.Preparation
2.Mitigation
3.Response
4.Recovery
CONTINGENCY
PLANNING
CONTINGENCY PLANNING
CONTINGENCY PLANNING
Risk analysis and assessment
Resource matrix preparation
Obligation of all
Director, HOD, Community Leader
Dynamic
Inter agency and multi sectored
ERP and alert system
Contingency Planning
COMMITTEE
General Committee
JKKD/ JKKN / MKN
Specific Committee
Radiation, Disease Outbreak, Petrochem, Flood
Contingency Planners
Political will
Expert group
Strategist
Financier
Technical group
Researcher
Analyst
Policy makers
Contingency Plan
Researcher
Industrie
s
Corporate
JKKN
Policy Maker
Law &
Enforcement
Public
Govt
Agencies
Medical
Fire &
Rescue
Police
INCIDENT SITE
MANAGEMENT
PRES
S
Medica
l Base
Family &
Relative
Incident
Area
High Risk
COMMAND CENTRE
Zone
(TACTICS
ZONE)
STRATEGY
ZONE
On Scene
Commander
POLICE ( OSC )
On Site Medical
Commander
( OMC )
Fire
Base
Station
Ambulance
HQ
Transportatio
n
Forward Field
Commander
BOMBA (FFC)
Incident Characteristics
Effect on First Responder
- Need for Protective Gear
- Constraints on Movement and
Communications
- Limitations on Duty Time
- Coordination Challenges
- Psychological
Decontamination Process
Sealing of Contaminant
Decontamination of Personnel
PITFALLS
Requires increased awareness and
training of Emergency Medical
Service personnel
Detection equipment is not available
Emergency Medical Service
personnel must depend on clues to
identify a Biological Warfare attack
Report concerns to officials
Protection Suite
KEY POINTS
Public Education
Helps alleviate public fears
Mechanism to teach protective
measures
Must include media and public
officials (centralize)
Educate the public
Hospital Activation
Phase
NGOs
MRCS
St.John
Fire &
Rescue
Civil
Defense
False
Alarm
Confirmatio
n
Hospital
Operator
Emergency
Dept.
Registrar
Director
of
Hospital
Yellow
Alert
Stand
Down
CALLER
Police
Confirmation
Head of
Dept.
Emergency
Services
Declare Red
Alert
Establishment of Chain of
Command
1. Interhospital
Primary responding hospital
Secondary responding hospital
2. Intrahospital
CHAIN OF COMMAND
Organizational
Aspect:
HAP
Coordinator
Hosp Director
Admin
Coordinator
Dep. Director
of Hosp
Dietici
an
Matro
n
Securit
y
Clinical
Coordinator
Senior Clinician
Supervis
or
Pharma
cist
SMA of
ED
HOD
Pharmac
ist
ED
Sister
Activate
Supporting Hosp
Liase with
Relevant
Agencies
HOSPITAL
COORDINA
TOR
HOSPITAL
DIRECTOR
Elect Administrative
Coordinator
Establish Control
Centre
Elect Clinical
Coordinator
Administrative Coordinator
Admin
Coordinator
Dep. Director
of Hosp
Dietici
an
Securit
y
MA
Supervisor
Pharma
cist
Matro
n
Traffic
Ward
Relativ
e Mx
Area
OT
Total
Securi
ty
Transp
ort
Contro
l
Centre
Logisti
cs
ESTABLISHMENT OF SPECIFIC
ZONES/CENTERS
1. Control Center/ Operation Room
Nerve center where all decisions and strategies are
discussed / issued.
Coordination of all activities
Act as main communication center & sources of all
information / press statements
Manpower For The Center
a. Members of Major Incident Mx Committee
b. Medical Director
c. Administrative Coordinator and his team of
supervisors
d. Other members identified by the medical director
3. Clinical Zones
- At the Emergency Department (ED)
- At designated treatment areas
a) Patient reception and triage area
b) Treatment area
c) Body holding area
d) Emergency department control center
b) Treatment areas
CONCLUSION
BE PREPARED!
THANK YOU!