1. 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

2. 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."

4. September 11, 2001- NYC

5. September, 2002 - Jerusalem

6. 2003-Toronto

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

8. Natural disaster

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

10. Technological disaster

11. 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

12. Man-made disasters Anthrax envelope - 2001

13. 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

14. 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 www.ceep.ca

15. What are the characteristics of disasters?

16. A disaster can have multiple settings

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

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

20. The Setting: Community Warren Leonard, Toronto OEM Potential HazMAT incidents: –In transit or fixed sites –Toronto - 1991 – 2.2/day - 2000 – 4.2/day Pickering nuclear generating station?

21. 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

22. A disaster often has multiple patients

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

25. A disaster always has multiple players

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

27. A disaster can have variable timelines

28. Static timeline

29. Dynamic timeline

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

31. 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

32. Because without a system we look like this….

33. IMS is the system

34. 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.

35. History of IMS

36. 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

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

38. The Eight Components of Incident Command Systems

39. 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

40. IMS Basic Structure

41. 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)

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

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

44. 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

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

46. 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

47. Job Action Sheets

48. IMS Structure

49. IMS Expanded Structure (1)

50. IMS Expanded Structure (2)

51. 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

52. 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

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

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

55. Summary

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

57. There are common threads in all disaster responses

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

59. IM Systems have standard components

60. IM Systems have a standard command structure

61. IMS will have job action sheets and a planning cycle

62. Do it right and you will become the…

63. www.ceep.ca