Disaster Response Patient Care Guidelines Pierce County EMS (7/2009) Disaster Response Patient Care Guidelines Pierce County EMS (7/2009) Table of Contents Disaster Response Notification Guideline .............................................................................. 1 ICS Considerations ............................................................................................................... 3 Triage Process Overview ....................................................................................................... 4 START Guideline ................................................................................................................... 6 Jump START Guideline .......................................................................................................... 7 Burn Treatment Protocol ...................................................................................................... 8 Carbon Monoxide Treatment Protocol ................................................................................ 10 Blast Injuries: ....................................................................................................................... 11 Lung Injury ............................................................................................................. 12 Abdominal Injury .................................................................................................... 12 Extremity Injury ...................................................................................................... 13 Ear Injury ............................................................................................................... 13 Eye Injury ............................................................................................................... 13 Crush Injury/Crush Injury Syndrome ........................................................................ 14 Geriatric Patient Considerations .............................................................................. 15 Pediatric Patient Considerations .............................................................................. 16 Bombing: Injury Patterns and Care Pocket Guide ..................................................... 17 WMD/All Hazards Events: Chemical Agents .................................................................................................... 19 Incapaciting Agents ............................................................................................ 19 Choking Agents ................................................................................................. 20 Blister Agents .................................................................................................... 22 Nerve Agents .................................................................................................... 27 Arsine ............................................................................................................... 29 Cyanide ............................................................................................................. 30 Ricin .................................................................................................................. 32 Bioterrorism Agents ............................................................................................... 33 Radiological & Nuclear Illness/Injuries ..................................................................... 36 Communicable Disease Events ............................................................................................ 41 Natural Disaster Considerations .......................................................................................... 51 Mental Health Guidelines ................................................................................................... 53 Deviation from PC Patient Care Protocols/Disaster Response Guidelines ............................... 55 Disaster Worker Considerations: ........................................................................................ 59 Attachment A- National EMS Core Content Attachment B- National EMS Scope of Practice Model Disaster Response Patient Care Guidelines Disaster Response Notification Guideline 1. Introduction a. The Pierce County Disaster Response Patient Care Guidelines are a separate document from the Pierce County Patient Care Protocols, but use the latter as a foundation for patient care during a mass casualty disaster event (MCDE). All EMS providers must act within their scope of practice. b. The Pierce County Fire Chiefs’ Association Mass Casualty Incident Plan is the guiding document for incidents that occur in Pierce County and are considered ‘manageable’ by routine mutual aid/response activities for a multiple patient event. It is, as well, the guiding document for initial response to what will eventually be declared a disaster emergency by some entity. c. The intent of these Disaster Response Patient Care Guidelines are to provide guidance for events that are expected to overwhelm county pre-hospital and hospital entities in a short time or over an extended period of time. d. Examples of the type of disaster events that may require activation of these guidelines: Natural Hazards- avalanche, earthquake, flooding, urban/wildland interface fires, landslides, severe storms, tsunamis & seiches, and volcanic hazards. Technological Hazards- abandoned underground mines, civil disturbance, dam failure, energy emergency, epidemic, hazardous materials, pipelines, terrorism, and transportation accidents. 2. Notification and Activation of these Disaster Response Patient Care Guidelines a. EMS agencies are expected to notify Good Samaritan Hospital Emergency Department, the Disaster Medical Control Center, in the event of a potential or actual disaster. Madigan Army Medical Center Emergency Department is the back-up DMCC if Good Samaritan is non-functional. It is anticipated that in many instances related to the type of events listed in these guidelines, notification to/from the DMCC has already occurred, but it is still important for each EMS agency to notify the DMCC of the need for use of these guidelines in their jurisdiction. When contact is made with the DMCC, request “activation of the Disaster Response Patient Care Guidelines”. This will put into affect a cascade of other hospital and EOC notifications. b. When contacting the DMCC, the following information will be needed: i. Name of agency making notification ii. Name of person doing the notification iii. Call-back number for person doing the notification and/or Incident Command iv. Type of disaster (i.e. What caused it?) v. Location of the disaster as it related to your jurisdiction and beyond as necessary vi. Number of injured/ill involved (approximate) 1 vii. Types of injuries/illness (burns, respiratory, etc.) viii. Route of entry into the disaster area (if applicable) ix. Known hazards to responding units x. Any other pertinent information deemed necessary xi. Get the name of the person at the DMCC this information was reported to c. The Pierce County Emergency Operations Center (PCEOC) will be activated at some level in response to an event referred to in these guidelines. In the initial phase, the Pierce County Duty Officer will react to the DMCC activation and be available to EMS agency requests for assistance above dispatch center capabilities. Once the PCEOC is activated, requests for resources, equipment, supplies, and other support should be directed to the ‘EMS Liaison’ in the PCEOC. d. It is imperative that you contact the DMCC when the event has concluded for your agency, even if the event never moved out of the ‘potential’ phase. This allows the DMCC to deactivate the other hospital and EOC notifications that occurred at the outset of the event. 2 Incident Command System (ICS) Considerations 1. Responsibility a. The use of ICS is expected for all disaster responses, and it is anticipated to have integration of EMS into Unified Command (UC) regardless of the number of EMS response vehicles/personnel. b. The Pierce County Fire Chiefs’ Association Mass Casualty Incident Plan is the guiding document for incidents that occur in Pierce County. It contains the information regarding Incident Command/Unified Command and all other key functional roles EMS personnel may be asked to fulfill. c. The Pierce County EOC will stand up in a support role to field operations, to include an EMS Liaison for EMS resource/support requests. All requests for assistance from the field should be funneled through the on-scene Medical Group Supervisor or Operations Section Chief. d. Pierce County Medical Examiner’s office is the lead agency for activities concerning the deceased including temporary morgue, identification, and disposition of the deceased. 2. Accountability a. If the declared disaster is of a “scene response” type such as a bombing, etc access to the scene will be restricted to those individuals possessing appropriate identification. All EMS personnel should have in their possession their Washington State EMS provider certification card as well as any agency identification. b. Individuals that arrive on scene with an ambulance for the purposes of transporting patients, but which will not be staying on scene, must remain at or near their vehicle. It is important that crew members do not leave the immediate vicinity of their ambulances if they are transport units. c. Individuals that arrive at the scene as part of a non-transport asset, but was requested to report to the scene must check