Dr. Chamberline Ozigbu MD Walden University November 16, 2014 MANAGEMENT OF MASS CASUALTY INCIDENTS IN NIGERIA: AN INTEGRATED APPROACH Dr. Chamberline Ozigbu MD Walden University November 16, 2014 Good morning everyone. My name is Chamberline Ozigbu, you are all welcome to this presentation. Make yourself comfortable, grab some coffee, tea, or juice and relax as I talk about the integrated approach to manage mass casualty incidents in Nigeria. Please feel free to let me know if I am talking to fast and don’t hesitate to stop me when necessary. All questions will be answered at the end of the presentation. Thank you. Okay, let’s begin with the outline of this presentation

PRESENTATION OUTLINE Overview of Mass Casualty Incidents (MCI) Types of MCI Agencies and responders Elements to consider in a MCI Components of Effective agencies and responders Preparing for MCI Management of MCI Conclusion Here is the presentation outline, I will be going over these objectives in my presentation. These will help educate the general public and also emergency personnel on effective management of MCI. I will start by giving a brief overview of MCI I will then talk about types of MCI Next, I will breakdown some key players in response We would then look at components to consider when faced in an MCI Then the components of effective responders. Preparing for MCI The Management of MCI And finally, the Conclusion Let’s take a look at the overview of MCI

OVERVIEW OF MCI So what exactly is Mass casualty incident (MCI)? Mass casualty incident is an event with injuries that may exceed the normal response capability of an emergency care provider agency. In the recent decades, major emergencies, disasters and crisis have become more recurrent. These casualties affects more and more people and puts a strain on health sectors and resources. MCI can overwhelm most individuals, and even the most experience individuals gets overwhelmed. Educating the general public and also emergency response personnel on how to be better prepared, with an organized response system in place, could help save more lives. A simple first aid practice can be beneficial before a medical personnel arrives. With that in mind, lets look at various types of MCI Reference: Emergency operations plan (2011). Utah department of health. Retrieved on October 16, 2014 from https://health.utah.gov/ems/op/mci_plan.pdf

TYPES OF MCI Terrorism Motor Vehicle Collision Airplane Crash Bomb Blast Weather Disasters (earthquakes, hurricanes, tornados) Politico-Ethnic Violence War/Conflicts Infrastructural Decay Mass casualty incidents can range from a natural disaster to a man-made disaster. Some natural weather diseases would include- earthquakes, hurricanes, and/or tornados. Man-made disasters would include terrorism or war. Terrorism- is a systematic use of terror especially as a means of coercion or violent acts which are intended to create fear or are perpetrated to achieve religious, political or ideological goal and deliberately target or disregard the safety of non-combatant (Moeller, 2011). For example, the Nyanya bomb blast in Abuja, Nigeria would be considered an act of terrorism. So what are some key responders/ agencies in MCI? Reference: Sun News, (2014): Nyanya bomb blast: Nigeria going through trying period. Retrieved on October 16, 2014 from http://sunnewsonline.com/new/?p=60355

AGENICES AND RESPONDERS Hospitals Emergency Medical Services (EMS) Fire Service Security Agencies ( Nigerian Police, Army, Department of State Services, Civil Defense) The Media Ministries (Health, Information, Transport) Federal Road Safety Commission Agencies and responders are key players in MCIs. They work intensively to make sure that lives are saved and peace is restored. Their roles are interrelated, indispensible and invaluable in controlling and managing the incidents. Hospitals - receive and treat the injured, discharge stable patients in order to make room for those involved in MCI. At times, hospitals may send doctors to the scene of the incident to help with triage, transport, and first-aid treatment. EMS & Fire Service - at times, they might be the first responders on scene of the incidents. They may perform initial rescue and provide medical care Security Agencies- will help secure the scene Media- informs the public about the magnitude of the incidents Ministries- provide valuable assistance, for example food, staff, transport, shelter and many more for those involved. Federal Road Safety Commission- controls the traffic around the scene Now, lets take a look at the elements to consider in a MCI. Reference: WHO, (2007): Mass Casualty Systems; strategies and guidelines for building health sector capacity. Retrieved on October 16, 2014 from http://www.who.int/hac/techguidance/MCM_guidelines_inside_final.pdf

ELEMENTS TO CONSIDER Type of Event Transport Response Time Professional Capabilities Equipment Experience Communication Some of the elements to consider in a MCI are; type of event. Depending on the event, difference protocol will be taken. Rapid evacuation of casualties remains invaluable in ensuring timely definitive care for injured victims. Professional Capabilities/ Experience- each medical personnel should be assigned tasks within their scope of practice Communication is very important because it keeps everyone on the same page. Whether it is communication with personnel's on scene or telephoning a near by hospital or Emergency Department (ED). Reference: WHO, (2007): Mass Casualty Systems; strategies and guidelines for building health sector capacity. Retrieved on October 16, 2014 from http://www.who.int/hac/techguidance/MCM_guidelines_inside_final.pdf

COMPONENT OF EFFECTIVE RESPONDERS Preparation Establish Command and Control Patient Evacuation Transportation of casualties Patient Discharge and Return In order for responders to successfully and effectively manage MCI, these components must be met. A variety of agencies and responders have roles to play in emergencies. The first order of business is preparation; one must first establish a baseline- a comprehensive analysis of relevant healthcare resources available should be ascertained. This will help assess and map both the quantity and quality of available healthcare facilities, personnel and equipment. Establishing command and control using a joint communication system-According to WHO, the most commonly cited problem in disaster management is invariably communication breakdown. Emergency activities, and decision-making are seriously affected as a result of a loss or delay of information dissemination at such times. To resolve this problem, systematic communication plans between and among health and emergency management agencies must be established. We must also evacuate stable patients, in order to treat those who are injured; transport those who needs medical attention to receive treatment, and discharge them with follow-up instructions. Reference: WHO, (2007): Mass Casualty Systems; strategies and guidelines for building health sector capacity. Retrieved on October 16, 2014 from http://www.who.int/hac/techguidance/MCM_guidelines_inside_final.pdf

COMPONENTS OF RESPONDERS TO MCI: COMMUNICATION The figure above shows the communication between responders. The primary triage is where the casualty occurred, The two arrows shows where the victims are going to be transported to depending on their injury. The black arrow illustrates transport to urgent hospitals and the grey shows transport to non-urgent institute. Reference: Raiter, Y., Farfel, A., Lehavi, O., Goren, O. B., Shamiss, A., Priel, Z., ... & Bar-Dayan, Y. (2008). Mass casualty incident management, triage, injury distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a suicide bomber attack in downtown Tel Aviv. Emergency medicine journal, 25(4), 225-229.

PREPARING FOR MCI Public, Local, State, Nationwide knowledge Training/ Drills Human and Material Resources Strong Political Commitment Not Relying on Foreign Aids The government is responsible for providing emergency relief and safety to the public, but that does not mean that the public should not be knowledgeable on how to prepare for MCI. It is important for public health professionals to get involved and educate the public, by initiating trainings and drills for schools, organizations and establishments among others. This would strengthen the ingenuity and resilience of the communities while equipping them for the skills needed for MCI preparedness. Reference: Green W.C, (2000): Mass Casualty Incident Management; the Virginia model. Retrieved on October 16, 2014 from https://facultystaff.richmond.edu~wgreen/conf7.pdf

MANAGEMENT OF MCI S- Safety S- Size-up S- Send S- Set up S- Start The management of MCI is crucial. A stitch in time saves nine; early intervention becomes the rule. Like I said in the previous slide, simple interventions like first-aid can have a huge impact. There are 5 simple “S” acronym to remember the initial intervention during MCI. The first “S” is SAFETY- you want to first assess the scene to determine and to make sure it is safe for you and other responders to enter. The Second is “S” stands for SIZE-UP, you want to size up the characteristics of the incident; you want to assess the severity and access routes. Next “S” is SEND; you want to notify (send) the receiving hospital of the casualty and also request for more resources. The next “S” is SET-UP; you want to establish a chain of commands. The final “S” is to START; you then start providing care using the triage tag chart shown above. The chart is color-coded, black tags means victims are dead, the red tag means victims are critically injured and should be seen first. The yellow means victims treatment can be delayed, while the green means victims only suffered a minor injured and may or may not need medical attention. When providing care, always remember the ‘ABC’ of resuscitation = Airways, Breathing, Circulation. First assess their airway, and check their breathing, and then circulation like peripheral pulses and capillary refill. Reference: Raiter, Y., Farfel, A., Lehavi, O., Goren, O. B., Shamiss, A., Priel, Z., ... & Bar-Dayan, Y. (2008). Mass casualty incident management, triage, injury distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a suicide bomber attack in downtown Tel Aviv. Emergency medicine journal, 25(4), 225-229.

CONCLUSION Disaster reduction is an integral part of sustainability development of any nation. With the current global trend and emerging global threats, there is obvious need for key players in the management of MCI to have a comprehensive response doctrine and effective cooperation at incident scenes. Despite the controversies surrounding the place of preparedness in management of MCI; preventive measures, and preparedness remains fundamental in containing the aftermaths of incidents. Rapid increase of Emergency Medical Services’ vehicles, efficient primary triage between urgent and non-urgent casualties and primary distribution between hospitals will enabled rapid conclusion of any MCI, both at the scene and at the receiving hospitals (WHO, 2007). Therefore, all hands must be on deck to make sure MCI is tackled whenever it occurs. Reference: WHO, (2007): Mass Casualty Systems; strategies and guidelines for building health sector capacity. Retrieved on October 16, 2014 from http://www.who.int/hac/techguidance/MCM_guidelines_inside_final.pdf

CLOSING REMARK Thank you so much for your time. Hope all of you enjoyed the presentations? It is time now to take some questions, comments and feedbacks.

ONCE MORE, THANK YOU

REFERENCES Emergency operations plan (2011). Utah department of health. Retrieved on October 16, 2014 from https://health.utah.gov/ems/op/mci_plan.pdf Green W.C, (2000): Mass Casualty Incident Management; the Virginia model. Retrieved on October 16, 2014 from https://facultystaff.richmond.edu~wgreen/conf7.pdf Raiter, Y., Farfel, A., Lehavi, O., Goren, O. B., Shamiss, A., Priel, Z., ... & Bar-Dayan, Y. (2008). Mass casualty incident management, triage, injury distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a suicide bomber attack in downtown Tel Aviv. Emergency medicine journal, 25(4), 225-229 Sun News, (2014): Nyanya bomb blast: Nigeria going through trying period. Retrieved on October 16, 2014 from http://sunnewsonline.com/new/?p=60355 WHO, (2007): Mass Casualty Systems; strategies and guidelines for building health sector capacity. Retrieved on October 16, 2014 from http://www.who.int/hac/techguidance/MCM_guidelines_inside_final.pdf