Table of Contents Dedication 11 Preface 12-16 Introduction 17-19 Author Biography 20-21 Chapter 1 Mass Casualty 22 Mass Casualty Incident 22 Declaration 22 Initial Size Up 23 Scene Size Up 23 M.E.T.H.A.N.E. 24 Agencies & Responders 24 Emergency Medical Services 24 Fire & Rescue 25 Public Safety 25 Specialized Teams 26 Public Services 26 Hospitals 27-28 Mass Casualty Decontamination Line Flow 29 Triage 30-32 Treatment 32-33 On-Site Morgue 33 Transport 33-34 Definitive Care 34 Interim-Care Center 34-35 Mass Casualty Event 35 Demobilization 35-36 Activating a Mass Casualty Response 36 Size-Up 1 36-37 Size-Up 2 37-38 Pre-Response Element Set-up 38-39 Functional Areas 40-41 Functional Roles 42-44 Mass Casualty Demobilization 45 Summary 46 Chapter 2 Decontamination for Mass Casualty/Mass Fatality Event 47 Decontamination 47 Methods 47 Mass Decontamination 48 Mass Hysteria & Security Aspects 48-49 Mass Decontamination Equipment 50 Contamination Run-Off Control 50 Functions of a Decontamination Activities 50 Usage 51 Types of Contamination 52-53 The Effects of Contamination 53-54 Human Decontamination of Injured Victims 54-55 Hospital Decontamination of Injured Victims 56 Decontamination Exercises 56-60 Internal Human Contamination 61 Summary 61 Chapter 3 Civil Support Team Decontamination Operations 62 Decontamination Planning 63 What is the Terrain? 64-65 Decontamination of personal Protective Equipment 65-67 Decontamination Process 67-70 Casualty Decontamination 70-71 Casualty Decontamination Considerations 71 Site Layout 71-72 Mass Casualty Decontamination 72 Decontamination Procedures for Ambulatory Casualties 72-73 Prepare Hypochlorite Solution 73-76 Decontamination Site Clean-up 76 Summary 77 Chapter 4 Template Instructions for Mass Casualty Incident 78 Acknowledgement 79 Table of Contents 80 Overview 81 Purpose 81 Scope 82 Assumptions 82 Pre-Incident Training & Exercise Schedule 83 Supplies & Equipment 84 Activation 85 Authorization 85 Authorization to Activate 85 Notification 86 Coordinate Staffing & Prepare Staff for Activation 87-88 Deploy Supplies & Equipment 89 Hospital Command Center 89 Operations 89 Triage 89-92 Treatment 93-94 Security 94 Traffic Control 95 Internal Security 95 Law Enforcement 96 Patient Processing 96-97 Communications 98-99 At Risk Population 99-100 Family Information Center (FIC) 101 FIC Activation 101 Sample FIC Checklist 102 Mental & Behavioral Health 103-104 Staff Support Services 104 Transition 104 Authority to Transition 105 Notify Stakeholders 106 Transition of Operations 107 Appendices 108 Chapter 5 Triage 110 Triage 110-111 Triage Types 111 Simple Triage 111-112 Triage Tags 112 Advance Triage 112-114 Continuous integrated Triage 114-115 Reverse Triage 115 Under Triage & Over Triage 115 Outcomes 116 Palliative Care 116 Evacuation 116 Alternative Care Facilities 116 Secondary (In-Hospital) Triage 117 Specific System 117 Practical Applied Triage 117-118 Scoring System 118 S.
T.A.R.T. Model 119-120 Hospital Systems 120-121 Conventional Classification from Different Countries 121 Australia & New Zealand 122 Canada 122-123 Japan 124 Spain 124 United Kingdom 125 United States 125-127 United States Military 127-128 Limitations of Current Practices 129-131 Ethical Implications 132 Summary Chapter 6 Guidelines for First Responders to a Mass Casualty CBRN Incident EURO-Atlantic Partnership Council (EAPC) 134 Introduction 134-135 Information Gathering Assessment & Dissemination 135 Scene Management 136 Saving & Protecting Life 136 Additional Specialist Support 136-137 Chart 6.1 Information Gathering 137-138 Chart 6.2 Scene Management 138-139 Chart 6.3 Saving & Protecting Life 140 Chart 6.
4 Additional Specialist Support 141-143 Summary 143-144 Chapter 7 Mass Fatality 145 Mass Fatalities Main Categories 145 Significant Mass Fatality Incidents 146 Response Functions 147 Mass Fatality Management Resources 148-149 Disaster Mortuary Operations Response Teams (DMORT) 150 DMORT Organizations 150-151 Identification of Remains 151-152 Disaster Mortuary Operational Response Team (DMORT) 152-153 Disaster Medical Assistance Teams (DMAT) 153-154 Disaster Portable Morgue Units (DPMU) 154-155 National Nurse Response Team (NNRT) 155-156 National Pharmacy Response Teams (NPRT) 157-158 Veterinary Medical Assistance Teams (VMAT) 158-159 Critical Infrastructure Protection 159-160 Sector Vision Statement 160 Healthcare & Public Health Sector Specific Plan 160-161 Logistics 161 Operations 162 Secretary''s Operation Center 162 Response Operations 163 Training Exercise & lessons Learned (TELL) 164 Preparedness Planning 164-165 Manmade Disasters 165-166 Natural Disasters 166-169 Summary 170 Chapter 8 Mass Fatality Planning 171 Mass Fatality Management 171 Mass Fatality Checklist 171 Mass Fatality Management Plan Template 172 Overview 172 Plan Maintenance 173 Activation 174-175 Operations 175-176 Demobilization 176 Public Information 177 Liaison Officer 177 Operations Section 177 Planning Section 177 Logistics Section 178 Chart 8.1 Example Complex Mass Fatality Operation 178 Mass Fatality management Adherence 179-180 Local Agencies/Jurisdictional Support 180 Summary 181 Chapter 9 Mortuary Logistic Challenges of a Mass Fatality Incidents 182 The Complex Problem 182-184 Decedent Remains Planning & Educational Resources 184-185 Table 9.1 Possible Options for Mortuary Operations 185 Summary 186 Chapter 10 Defense Support to Civil Authorities (DSCA) 187 Defense Support to Civil Authorities (DSCA) 187 Military Aid to Civil Power 187-188 DSCA Authority 188 DSCA Activation 189 FEMA 190 DSCA History 190-191 Summary 191 Chapter 11 General Guidelines for Hospital Mass Casualty/Mass Fatality Decontamination 192 Procedures 193 General Procedures 5 steps process 193 Step 1 Set up Decontamination & Support Areas 193 Decontamination Corridors 194 Decontamination System Design 195 Safe Refuge/Observation Area 195-196 Medical Triage 196 Step 2 Conduct Decontamination Triage 196-197 Step 3 Decontaminate Victims 197 Steps to take while Victims are waiting 197-198 If contamination is involved 198-199 Step 4 Segregate Victims for Observation/Treatment 199-200 Step 5 Release Victims 200 Cold Weather Observation 200-201 First Responder Considerations 201 Exiting the Hot Zone 202 Infant/Children & Adolescent (Pediatrics) Considerations 202-203 Elderly, Pregnant Women & People with Chronic Conditions 203 Recent Planning Guidance 203-204 Summary 204 Chapter 12 Animal Decontamination: Natural and Manmade Animals & Disasters Animals & Disasters Concerns Owners Concerns for Animals Animal Care & Incident Management 1 Animal Care & Incident Management 2 Emergency Operation Plans & Animals ESF#11 Agriculture & Natural Resources Safety & Well-Being of Household Pets Response Policies Disaster Readiness Farms & Natural Disasters Protection: Veterinary Care Response: Disease Response: Hazardous Materials Summary Animal Decontamination Flow Chart Case Study 1 Mass Casualty Management (RANA Plaza Tragedy) 205-207 Case Presentation 207 Case Study 1 Table 1 Patient Matrix Emergency Room 207 Hospital Resources/Execution of Services 208-209 Case Study 1 Table 2 Surgical Operative Procedures 210 Case Study 1 Figure 1 Patterns of Anesthetic Procedures 210 Discussion & Evaluation 211-214 Summary 214 Case Study 2 Mass Fatality Tsunami Disaster on 26 December 2004, Thailand, Indonesia 215 Methods & Findings 215-216 Background Information 216 Purpose of this study 217-218 Case Study 2 Table 1 Estimated Casualty/Fatality 218 Body Recovery & Storage 219 Case Study 2 Table 2 Number of Bodies Buried 219-220 Identification of Victims 220 Coordination & Preparedness 221 Discussion of Actions 221 Storage, Identification & Burials 222 Coordination & Preparedness 222 Summary 223 Case Study 3 Mass Casualty Event Involving CBRN Incidents 224-225 CBRN Challenges 225-226 Decontamination Considerations 226 The Principles of Decontamination 227 Responding to a CBRN Event 227 Scene Management 227-228 CBRN Casualty Management Zones 228-229 Personal Protective Equipment 229-230 Hazard Monitor.