Daniel Kollek, MD, CCFP(EM) Director, Centre for Excellence in Emergency Preparedness Chair – CAEP Disaster Committee Associate Professor, Division of Emergency Medicine, McMaster University Definitions, Classification and Response Structure

Disaster  The Merriam-Webster dictionary definition of disaster is: "a sudden or great misfortune."  The Medical definition if a disaster is: "when the destructive effects of an event overwhelm the ability of a given area or community to meet the demand for health care."

September 11, NYC

September, Jerusalem

2003-Toronto

What kind of disasters might we face and how do we assess our risk?

Natural disaster

Natural Events  Hurricane/Tornado  Severe Thunderstorm  Snowfall  Blizzard  Ice Storm  Earthquake  Tidal wave Drought Flood - external Wild fire Landslide Volcano Epidemic Extreme temperature

Technological disaster

Technological events  Electrical failure  Generator failure  Transportation failure  Fuel Shortage  Natural gas failure  Water failure  Sewage failure  Steam failure  Structural damage Fire alarm failure Communications failure Medical gas failure Medical vacuum failure Info. systems failure Fire – internal Flood – internal Hazmat exposure – internal Supply failure

Man-made disasters Anthrax envelope

Human events  MCI – Trauma  MCI - Medical  MCI – Hazmat  Hazmat – external  Terrorism – chemical  Terrorism – biological  Terrorism - radiological VIP situation Infant abduction Hostage situation Civil disturbance Labor action Forensic admission Bomb threat

For each event you must assess risk  What is the probability of occurrence?  What impact would it have?  What is your preparedness? A formal risk assessment tool is available at

What are the characteristics of disasters?

A disaster can have multiple settings

The Setting: Hospital  K wing fire, Sunnybrook, 1997  ED flood, Sunnybrook, 1999  Transformer fire, HSC, 2000  SARS, 2003

The Setting: Community  Plane crash, 1977  Chemical spill, 1979  Subway crash, 1995  SARS 2003

The Setting: Community Warren Leonard, Toronto OEM Potential HazMAT incidents: –In transit or fixed sites –Toronto – 2.2/day – 4.2/day Pickering nuclear generating station?

The Setting: International  WTC bombing, 1993  Tokyo sarin gas release, 1995  Anthrax hoax, Queen’s Park, 2001  WTC disaster, 2001  Maryland snipers, 2002  SARS, 2003

A disaster often has multiple patients

The Patients: Tokyo Sarin attack 1995:  >5800 victims  12 deaths  17 critical patients  37 severe patients  984 moderate patients  4793 “worried well”

A disaster always has multiple players

The Players:  Police  Fire  EMS  Hospitals  Volunteers  Public health  Elected officials  Civil servants  Utilities  Transit  Provincial / Federal agencies  Media

A disaster can have variable timelines

Static timeline

Dynamic timeline

Whatever the case, and despite the range of possible events, disaster response has more commonality than event specific characteristics.

What do you need in a disaster? A system to deliver this to you in a useful fashion Information Guidance Money and…… Supplies Equipment Human Resources

Because without a system we look like this….

IMS is the system

IMS Incident Management System Incident Management System is method of coordinating a method of coordinating parts of one agency or many agencies in a unified command structure unified command structure to use all available resources in the effective and efficient response to an emergency.

History of IMS

There were a variety of reasons for IMS to be implemented Different terminologies between allied agencies Difficulty in allocation of resources and utilization Lack of central communication Inability to coordinate unified actions towards objectives (leading to duplication of response) Disorganized approach to an incident leading to loss of life and destruction of property IMS History

IMS – Two key concepts Components of Incident Command Systems and Concepts of Command in IMS

The Eight Components of Incident Command Systems

IMS - Components 1. A unified command structure 2. Common terminology 3. Modular organization 4. Integrated communication 5. Consolidated action plans 6. Manageable and sensible span of control 7. Designated facilities 8. Comprehensive resource management

IMS Basic Structure

Incident Commander 1. Most senior trained responder 2. As incident develops, falls back to established command on-site 3. Eventually may fall to Senior Command off site (Emergency Operations Centre)

Operations 1. Implements response activities as determined by Incident Manager 2. Maintains communication between Command and site 3. Requests and assigns resources as directed

Logistics 1. Support Operations 2. Allocate resources and provide all materials, equipment, and personnel required 3. Application of additional resources provided by Mutual Aid

Planning 1. Control and flow of all information 2. Data collection, analysis and forecasting 3. Development of response and recovery objectives and strategies 4. Mutual Aid Requests

Finance  Tracking of expenses  Funding  Government Financial Aid requests  Financial Aid distribution

IMS - Components 1. A unified command structure 2. Common terminology 3. Modular organization 4. Integrated communication 5. Consolidated action plans 6. Manageable and sensible span of control 7. Designated facilities 8. Comprehensive resource management

Job Action Sheets

IMS Structure

IMS Expanded Structure (1)

IMS Expanded Structure (2)

Legend: The Colour Code Triage (Yellow, Red, Green, Black) is universally accepted and consistent with Triage Codes used by EMS in the field when addressing large scale emergencies Proposed Hospital IMS Structure For Ontario Hospitals

IMS - Components 1. A unified command structure 2. Common terminology 3. Modular organization 4. Integrated communication 5. Consolidated action plans 6. Manageable and sensible span of control 7. Designated facilities 8. Comprehensive resource management

Designated Facilities 1. Emergency Operations Centre (EOC) 2. On-site Command Post 3. Staging Areas 4. Triage Area 5. Resource Storage 6. Morgue

EOC Primary Response Command (Initial Command Centre) On-site Command (Secondary) Off-site Command (Final)

Summary

We need to formally review our disaster risks in order to prepare a plan

There are common threads in all disaster responses

IMS is the system used for command and control of a disaster response

IM Systems have standard components

IM Systems have a standard command structure

IMS will have job action sheets and a planning cycle

Do it right and you will become the…