WHAT

● Serves 3 functions namely: evacuation, stabilization, and redistribution.

● It is set to deliver both basic life support (BLS) and Advanced life support to a patient
to promote healing and prevent risk for danger in life and limb.
● Moves following the fundamentals of first aid, which is "Preserve Life, Prevent Further
Injury, and Promote Recovery".
● EMS responds to emergency cases like natural and man-made disasters, sicknesses,
diseases and even terrorist activities. These cases rise which also equates to an
increasing number of needs from the hospital.
● Thus, there is a need to professionalize and control the practice of this
profession, as this will go a long way toward lowering the country's death rate
as well as the number of impairments caused by a lack of or inefficient
emergency medical care services delivery to our people.
Includes Hospital Incident Command System (HICS)
● within a hierarchical organization chart, an emergency management system
assigns functional roles for specialized catastrophe response.
● Key Features:
■ Chain of Command
● One incident commander will be assigned. This individual is in
charge of the incident's overall management, and the employees
are aware of who reports to them and to whom they report.
■ Use of same standards
● For command staff jobs, all agencies that adopt Incident
Command System employ the same names and functional duties.
■ Flexible Organization
● The team that is only needed in the incident will be the only one
to be activated
■ Incident Action Plan
● Activated when different sectors of authorities are needed.
■ Facility Action Plan
● Holistically entails the hospital’s actions
■ Unity of Command
● All units must report to a single individual (Incident
Commander)
● "Emergency Medical Services Systems Act of 2009. ": AN ACT
INSTITUTIONALIZING AN EMERGENCY MEDICAL SERVICE SYSTEM,
PROVIDING FOR THE ESTABLISHMENT AND REGULATION OF
 PROFESSIONAL EMERGENCY MEDICAL TECHNICIAN STANDARDS IN THE
COUNTRY, AND FOR OTHER PURPOSES.

Mass Casualty Incident vs Disaster vs Catastrophe

If the EMS emergency or the sources of the local and surrounding emergency departments are
overburdened, MCI is considered. The same event of the same severity might be deemed
routine, necessitating more transport units and patient dispersal to other hospitals in certain
EMS but not to the point where the system is overwhelmed. As a result, the same incident
impacts two EHS systems differently, yet neither is a "disaster." As a result, the declaration of
MCI is reliant on the system that is managing it.
● Paralytic Disaster: Several injured individuals may require medical attention;
nevertheless, because the healthcare infrastructure may have been shattered, the event
may necessitate outside aid to address the community's healthcare needs.
● As a result, it has the potential to obviate the EHS's capacity to react to any
need for services, much alone additional demands for care as a result of the
incident.
● A third level of crisis—a catastrophe
● A catastrophe is considered a disaster in which the community and hospital are
overwhelmed and isolated for 3 or more days.
With this, the EHS system must be prepared for both MCIs and catastrophes. Hence, the
preparation for both is similar since both are considered a disaster. The EHS catastrophe plan
must account for many forms of disasters and be adaptable to the situation. Yet, some
variances and variables are to be considered like the treatment and transportation of infectious
patients, for example will necessitate considerably different resources than victims of a
building collapse.

WHO

Dispatcher:
● Dispatchers have special training and follow protocols to triage patients’ acuity and
provide the appropriate resources given the complaint.
● EMS professionals vary from first responders to emergency medical technician-
paramedic and provide care at two levels: basic life support (BLS) and advanced life
support (ALS)
● BLS providers can provide extrication, immobilization, and bleeding control
while assisting a patient in taking their medication (nitroglycerin, for example)
or administering oxygen.
● ALS providers can perform several skills, including intubation, needle
thoracostomy, defibrillation, and cardiac pacing, while administering a wide
variety of pharmacotherapy, including advanced cardiac life support
 medications.
Patients:
● Upon presentation, each of the patients must be rapidly triaged.
● The proper distribution of patients is required to ensure that specialized and needed
interventions can be delivered to patients requiring those services
● With the objective of "clearing" all patients from the site as fast as possible, there may
be an issue since promptly transferring all patients, even non-critical patients, may have
the effect of merely relocating the disaster from the site to the emergency departments
(EDs).
● EMS planning efforts should include consideration of these effects

Dealing with influx:

● The actual number of patients will most likely be determined by the nature of the
tragedy and the emotional impact it has on the patient group. Thus, proper EMS
resource allocation must be addressed. All patients are unlikely to require an EMS
response right away. All patients do not need to be sent to the nearest hospital for
immediate care.
● Satellite EDs have been used successfully while physician’s offices and
urgent care centres may be appropriate alternatives during a disaster.
● Additional treatment space is also needed in the ED to deal with the influx of patients.
● When patients are being transported:
● The proper distribution between all of the hospitals in the system must be
considered, particularly hospitals with specialized resources
● Systems monitoring the availability of beds and resources and directing the
flow of patients should be devised to help the response.
● Solutions to consider include cancelling elective admission, including surgery:
● When cancelling operations to make space for the EMS, financial implications
must be addressed, since some hospitals are weighing on this factor. Other
alternatives discussed include shifting non-emergent hospital patients to nursing
homes or lower-acuity hospitals to better accommodate those who require the
greatest care.
● In the event of a chemical, biological, or infectious exposure, it is critical to
segregate potentially contaminated patients from non-contaminated patients
● During a disaster, hospitals must anticipate how to decontaminate themselves
and should not solely rely on the fire department or HAZMAT (hazardous
materials) team because such assets will be on the site reducing the incident's
impacts.
● 50%of patients are overtrained
● OVERTRIAGE: unnecessary deployment of the trauma response team for
patients who do not have extensive injuries.
 ● This overtriage rate is concerning because the triage process exists to distribute
resources optimally.
● The first wave of the influx will present in two ways:
● One group of first-wave patients
● will be cared for by EMS when they respond to the scene of the incident
and will be transported to health facilities.
● The second group of first-wave patients
● Directly present to EDs by foot, personal vehicle, or nonmedical public
transport such as bus or taxicab.
● The second wave of patients will usually follow
● Patients in the second wave are usually worse than the first wave who
can walk into the hospital; since they need to be extricated and assisted.
These may take time to be transported.
● Reverse triage
● may become part of the initial management of a large-scale disaster
● Those with less severe symptoms should be treated first since they have
a greater chance of survival after being exposed to the toxin or injury,
much as the least injured are treated first to allow them to return to the
battlefield. It is done because treating the most badly injured patients
may be futile and squander too many valuable resources.
● Even during a disaster, individuals still access the EHS system for routine
conditions unrelated to the disaster.
● Ensure that ill patients continue to access care
● Accurately triage these requests for assistance to provide care to patients in an
optimal time frame at the optimal site

WHERE

● Emergency Departments (EDs) are the usual route for patients from incidents or
emergencies.
● Beyond this, Emergency Departments have differing capabilities in terms of diagnostic
tools and treatment capabilities
● Although emergency department functions are critical, not all hospital units provide the
same consult services and support staff; some may be sporadic or completely absent.
This can be exemplified by a tiny community hospital that cannot provide specialist
treatment.
● Alternative sources of emergency care can come in two general forms:
● Urgent care facilities were designed to treat minor diseases and injuries. Some
can do laboratory tests, radiography, and other sophisticated therapy.
 ● Physician offices are also an alternate source of emergency care.
● They can care for acutely ill patients on-site.
● should be considered part of the EHS system because they possess
tremendous resources that may be accessed in times of increased patient
demand
● Satellite EDs
● These sites could include schools, arenas, stadiums, jails, or fairgrounds.
Depending on the resources invested, satellite EDs can provide a level of
service ranging from simple first aid to advanced life support care, including
radiographic and surgical capabilities
● To prevent unnecessarily clogging EDs: some disaster plans employ alternate resources
for healthier patients, reserving EDs as primary resources for critically ill patients.

HOW

Entry to EHS→911 or other municipal hotline systems can be used to request assistance
from the authorities. Patients may also bring themselves to emergency rooms or urgent
care centers→ Patients are taken to emergency departments for additional examination and
treatment. Patients may get initial treatment on-site or en route to the ED, where they are
checked, assessed, and treated for unstable or potentially hazardous disorders. → Patients
presenting to EDs with limited capabilities or urgent care centers may also be transported
to other sites for additional or specialized care when needed---> Patients Exit →being
discharged from the hospital, admitted to an inpatient unit (including observation units), or
admitted to a skilled care facility→ If unable to exit: problems can develop as bed space and
resources required for new, acutely ill patients are diverted to caring for stabilized and
admitted patients. This “exit block” can then cause an “entry block,” limiting the ability of
EHS to respond to the disaster.