Bringing Communities Together

Call to Action

The First Call …

Need to provide Emergency Medical Assistance at Incident Sites- Road Accidents – Savings Lives- Homes – Bridging the gap between Hospitals and Patients

The Second Call …

Emergency Management• Emergency management (or disaster management) is the

discipline of dealing with and avoiding risks. • A discipline that involves preparing for disaster before it occurs,

disaster response (e.g. emergency evacuation in an accident, quarantine, mass decontamination, etc.), as well as supporting, and rebuilding society after natural or human-made disasters have occurred.

• Effective emergency management relies on thorough integration of emergency plans at all levels of government and non-government involvement. Activities at each level (individual, group, community) affect the other levels. It is common to place the responsibility for governmental emergency management with the institutions for civil defense or within the conventional structure of the emergency services.

How ? …What? ... • How?

– Bring likeminded participants together– Doctors, Individuals, Social Entrepreneurs, Government Institutions,

etc– Self Sustaining Structure

• Donor Aided• People Funded – Service Promise• Participant Driven• International Driven

• What?– Primary Premise to provide Accessible Emergency Medical

Assistance at Incident site– Subsequently to community action

• Provide homeless assistance • Healthy Nutrition to Orphanages• Education for all children (avoid Child Labour)

Where? … Why? …• Where?

– Initially Kolkata, India– Thereafter across the Eastern India and other Sister Cities– Replicate across the globe

• Why?– To be able to meet the need for “HELP” when required

Model Structure

MITIGATION

PREPAREDNESS

RESPONSE

RECOVERY

The How? …Common preparedness measures

include:1. communication plans

with easily understandable terminology and methods.

2. proper maintenance and training of emergency services, including mass human resources such as community emergency response teams

3. development and exercise of emergency population warning methods combined with emergency shelters and evacuation plans

4. stockpiling, inventory, and maintain disaster supplies and equipment

5. develop organizations of trained volunteers among civilian populations.

The response phase includes the mobilization of necessary emergency services and first responders in the disaster area. This will include a first wave of core emergency services, such as firefighters, police and ambulance crews.

When conducted as a military operation, it is termed Disaster Relief Operation (DRO)

A well rehearsed emergency plan developed as part of the preparedness phase enables efficient coordination of rescue Where required, search and rescue efforts commence at an early stage.

Depending on injuries sustained by the victim, outside temperature, and victim access to air and water, the vast majority of those affected by a disaster will die within 72 hours after impact

The aim of the recovery phase is to restore the affected area to its previous state. It differs from the response phase in its focus; recovery efforts are concerned with issues and decisions that must be made after immediate needs are addressed.Recovery efforts are primarily concerned with actions that involve rebuilding destroyed property, re-employment, and the repair of other essential infrastructure.An important aspect of effective recovery efforts is taking advantage of a ‘window of opportunity' for the implementation of mitigative measures that might otherwise be unpopular. Citizens of the affected area are more likely to accept more mitigative changes when a recent disaster is in fresh memory.

Real Assets …

Ambulance - Functional• Combining emergency ambulance care with patient transport• Emergency ambulance – The most common type of ambulance, which provide

care to patients with an acute illness or injury. These can be road-going vans, boats, helicopters, fixed-wing aircraft (known as air ambulances) or even converted vehicles such as golf carts.

• Patient transport ambulance – A vehicle which has the job of transporting patients to, from or between places of medical treatment, such as hospital or dialysis center, for non-urgent care. These can be vans, buses or other vehicles.

• Response unit – Also known as a fly-car, which is a vehicle which is used to reach an acutely ill patient quickly, and provide on scene care, but lacks the capacity to transport the patient from the scene. Response units may be backed up by an emergency ambulance which can transport the patient, or may deal with the problem on scene, with no requirement for a transport ambulance. These can be a wide variety of vehicles, from standard cars, to modified vans, motorcycles, pedal cycles, quad bikes or horses. These units can function as a vehicle for officers or supervisors (similar to a fire chief's vehicle, but for ambulance services).

• Charity ambulance – A special type of patient transport ambulance is provided by a charity for the purpose of taking sick children or adults on trips or vacations away from hospitals, hospices or care homes where they are in long term care.

Ambulance - Types• Ambulances can be based on many types of vehicle,

although emergency and disaster conditions may lead to other vehicles serving as makeshift ambulances:

– Van – A typical ambulance is of a van construction, based on a standard chassis, usually with a maximum road weight loaded of between 3.5 and 7.5 tonnes.

– Car/SUV – Used either as a fly-car for rapid response or for patients who can sit, these are standard car models adapted to the requirements of the service using them.

– Motorcycle – In developed areas, these are used for rapid response in an emergency as they can travel through heavy traffic much faster than a car or van. Trailers or sidecars can make these patient transporting units.

– Bicycle – Used for response, but usually in pedestrian only areas where large vehicles find access difficult. Like the motorcycle, a bicycle may be connected to a trailer for patient transport, most often in the developing world.

– All Terrain Vehicle – for example quad bikes; these are used for response off road, especially at events. ATVs can be modified to carry a stretcher, and are used for tasks such as mountain rescue in inaccessible areas.

– Golf cart – Used for rapid response at events. These function similarly to ATVs, with less rough terrain capability, but with less noise.

– Helicopter – Usually used for emergency care, either in places inaccessible by road, or in areas where speed is of the essence, as they are able to travel significantly faster than a road ambulance.

– Fixed-wing aircraft – These can be used for either acute emergency care in remote areas (such as in Australia, with the 'Flying Doctors' or for patient transport over long distances (usually a re-patriation following an illness or injury in a foreign country

– Boat – Boats can be used to serve as ambulances, especially in island areas or in areas with a large number of canals, such as the Venetian boat ambulances. Some lifeboats or lifeguard vessels may fit the description of an ambulance as they are used to transport a casualty.

– Ship– Ships can be used as hospital ships, mostly operated by national military services, although some ships are operated by charities. They can meet the definition of ambulances as they provide transport to the sick and wounded (along with treatment). They are often sent to disaster or war zones to provide care for the casualties of these events.

– Bus - In some cases, buses can be used for multiple casualty transport, either for the purposes of taking patients on journeys, in the context of major incidents, or to deal with specific problems such as drunken patients in town centres

Equipment• Two way radio – One of the most important pieces of equipment in modern emergency

medical services as it allows for the issuing of jobs to the ambulance, and can allow the crew to pass information back to control or to the hospital (for example a priority message to alert the hospital of the impending arrival of a critical patient.) More recently many services world wide have moved from traditional UHF/VHF sets, which can be monitored externally, to more secure systems, such as those working on a GSM system, such as TETRA

• Mobile data terminal – Some ambulances are fitted with Mobile Data Terminals (or MDTs), which are connected wirelessly to a central computer, usually at the control center. These terminals can function instead of or alongside the two way radio and can be used to pass details of jobs to the crew, and can log the time the crew was mobile to a patient, arrived, and left scene, or fulfill any other computer based function.

• Evidence gathering CCTV – Some ambulances are now being fitted with video cameras used to record activity either inside or outside the vehicle. They may also be fitted with sound recording facilities. This can be used as a form of protection from violence against ambulance crews, or in some cases (dependent on local laws) to prove or disprove cases where a member of crew stands accused of malpractice.

• Tail lift or ramp – Ambulances can be fitted with a tail lift or ramp in order to facilitate loading a patient without having to undertake any lifting.

• Trauma lighting – In addition to normal working lighting, ambulances can be fitted with special lighting (often blue or red) which is used when the patient becomes photosensitive.

• Air conditioning – Ambulances are often fitted with a separate air conditioning system to serve the working area from that which serves the cab. This helps to maintain an appropriate temperature for any patients being treated, but may also feature additional features such as filtering against airborne pathogens.

Modern Ambulance Equipment• Defibrillator/Monitor• Syringe driver• Suction unit• High Flow CPAP• Syringes and Needles• Drugs• Additional equipment (Infusions, Intubation equipment...)• Additional equipment (CPAP-Helmet, Immobilization

equipment...)• Medical gloves• Stretcher• Oxylog 3000 ventilator• Emergency suitcase and backpack

Functions

Incident Command System

I C S• The Incident Command Structure (ICS) is a standardized, on-scene, all-hazard incident

management concept. It is a management protocol originally designed for emergency management agencies in the United States which was later federalized there.

• ICS is based upon a flexible, scalable response organization providing a common framework within which people can work together effectively. These people may be drawn from multiple agencies that do not routinely work together, and ICS is designed to give standard response and operation procedures to reduce the problems and potential for miscommunication on such incidents. ICS has been summarized as a "first-on-scene" structure, where the first responder of a scene has charge of the scene until the incident has been declared resolved, a superior-ranking responder arrives on scene and seizes command, or the Incident Commander appoints another individual Incident Commander

• Incidents - are defined within ICS as unplanned situations necessitating a response. Examples of incidents may include:

– Emergency medical situation (ambulance service)– Hazardous material spills– Terrorist attacks– Natural disasters such as wildfires, flooding, earthquake or tornado– Man-made disasters such as vehicle crashes, industrial accidents, train derailments, or structural fires– Search and Rescue operations– Hostage crises

• Events - Events are defined within ICS as planned situations. Incident command is increasingly applied to events both in emergency management and non-emergency management settings. Examples of events may include:

– Concerts– Parades and other ceremonies– Fairs and other gatherings– Training exercises

Key Concepts• Unity of Command

– Each individual participating in the operation reports to only one supervisor. This eliminates the potential for individuals to receive conflicting orders from a variety of supervisors, thus increasing accountability, preventing freelancing, improving the flow of information, helping with the coordination of operational efforts, and enhancing operational safety. This concept is fundamental to the ICS chain of command structure.

• Common Terminology– Individual response agencies develop their protocols separately, and subsequently develop their terminology

separately. This can lead to confusions as one word may have a different meaning for each organization. When different organizations are required to work together, the use of common terminology is an essential element in team cohesion and communications, both internally and with other organizations responding to the incident. The Incident Command System promotes the use of common terminology, and has an associated glossary of terms that help bring consistency to position titles, the description of resources and how they can be organized, the type and names of incident facilities, and a host of other subjects. The use of common terminology is most evident in the titles of command roles, such as Incident Commander, Safety Officer or Operations Section Chief.

• Management by Objective– Incidents are managed by aiming towards specific objectives. Objectives are ranked by priority, should be as

specific as possible, must be attainable and if possible given a working time-frame. Objectives are accomplished by first outlining strategies (general plans of action), then determining appropriate tactics (how the strategy will be executed) for the chosen strategy.

• Flexible/Modular Organization– Incident Command structure is organized in such a way as to expand and contract as needed by the incident

scope, resources and hazards. Command is established in a top-down fashion, with the most important and authoritative positions established first (e.g. Incident Command is established by the first arriving unit). Only positions that are required at the time should be established. In most cases, very few positions within the command structure will need to be activated. For example, a single fire truck at a dumpster fire will have the officer filling the role of IC, with no other roles required. As more trucks get added to a larger incident, more roles will be delegated out to other officers and the IC role will probably be handed to a more-senior officer. Only in the largest and most complex operations would the full ICS organization be staffed. Conversely, as an incident scales down, roles will be merged back up the tree until there is just the IC role remaining.

• Span-of-control– To limit the number of responsibilities and resources being managed by any individual, the ICS requires that any

single person's span of control should be between three and seven individuals, with five being ideal. In other words, one manager should have no more than seven people working under them at any given time. If more than 7 resources are being managed by an individual, then they are being overloaded and the command structure needs to be expanded by delegating responsibilities (e.g. by defining new sections, divisions, or task forces). If fewer than three, then the position's authority can probably be absorbed by the next highest rung in the chain of command

Coordination• Coordination on any incident or event is possible and effective due to the implementation of the following

concepts:• Incident Action Plan• Incident Action Plans include the measurable strategic operations to be achieved and are prepared

around a time frame called an Operational Period. Incident Action Plans may be verbal or written (except for hazardous material incidents where it has to be written), and are prepared by the Planning Section. The IAP ensures that everyone is working in concert toward the same goals set for that operational period. The purpose of this plan is to provide all incident supervisory personnel with direction for actions to be implemented during the operational period identified in the plan. Incident Action Plans provide a coherent means of communicating the overall incident objectives in the context of both operational and support activities. The consolidated IAP is a very important component of the ICS that reduces freelancing and ensures a coordinated response. At the simplest level, all Incident Action Plans must have four elements:

– What do we want to do?– Who is responsible for doing it?– How do we communicate with each other?– What is the procedure if someone is injured?

• Comprehensive Resource Management• Comprehensive Resource Management is a key management principle that implies that all assets and

personnel during an event need to be tracked and accounted for. It can also include processes for reimbursement for resources, as appropriate. Resource management includes processes for:

– Categorizing resources.– Ordering resources.– Dispatching resources.– Tracking resources.– Recovering resources.

• Comprehensive Resource Management ensures that visibility is maintained over all resources so they can be moved quickly to support the preparation and response to an incident, and ensuring a graceful demobilization. It also applies to the classification of resources by type and kind, and the categorization of resources by their status.

• Assigned resources are those that are working on a field assignment under the direction of a supervisor.• Available resources are those that are ready for deployment, but have not been assigned to a field

assignment.• Out-of-service resources are those that are not in either the " available" or "assigned" categories.

Resources can be "out-of-service" for a variety of reasons including: resupplying after a sortie (most common), shortfall in staffing, personnel taking a rest, damaged/inoperable.

Coordination• Integrated Communications• The use of a common communications plan is essential for

ensuring that responders can communicate with one another during an incident. Communication equipment, procedures, and systems must operate across jurisdictions (interoperably). Developing an integrated voice and data communications system, including equipment, systems, and protocols, must occur prior to an incident.

• Effective ICS communications include three elements:– Modes: The "hardware" systems that transfer information.– Planning: Planning for the use of all available communications

resources.– Networks: The procedures and processes for transferring information

internally and externally.

Why will it work?• International Aid Support complementing Local Knowledge and

Drive

• International Best practices transferred via contractual exchange

• One of its Kind in India