Biomedical Engineering Reference
In-Depth Information
providers. Also the feedback that can be brought
about by real world problems are not necessarily
encountered either. There is less realism in the
scenario.
As an example; one area that is often overlooked
during this table top type of exercise is the trans-
port and turnaround time of ambulances used to
transport casualties from the scene to the hospitals.
The second option to practice the plan is to have
a full scale drill with live patients and involving
EMS providers, Fire Service, Law Enforcement
and Hospitals. Actually handling patients, pack-
aging them and transporting them can be an eye
opening experience for management, hospital, and
street level personnel. A paper drill may have one
ambulance crew transport three critical patients,
the real drill may have the paramedic balk at taking
more than one critical patient.
Unforeseen difficulties that only come about
because of the live drill are also found. For
example, many disaster plans call for closing local
highways to all but emergency traffic. When put
into practice you may find that natural choke points
develop on the highway on-ramps, and the roads
that lead to them. What happens then is that ambu-
lances find it easy to transport patients into the
hospitals, but they are unable to easily get back
on the highways when the leave the hospital to
return to the incident site. Grid-lock can occur
from the hospital to the highway and therefore
the plan should allow for such blocks, e.g., the
access to the emergency scene was blocked by the
plan that meant to allow for clear traffic patterns
(Downtown Pittsburgh during the crash of flight
411 in September 1995 is a good example of this
happening).
Of course, with any large exercise like this
there are difficulties. This includes having active
participation by as many providers as possible.
This may mean overtime costs for many munic-
ipal departments. Cooperation with other public
safety services as well as that of the various hospi-
tals that may or may not wish to be involved in
the exercise can be a difficult job to coordinate.
Also the job of making up and programming of the
multiple patients that are needed to truly tax the
system.
8.8 Patient Transportation
When it is time to transport, there is little informa-
tion available as to the recommended number of
ambulances to be used. As a rule, patients triaged in
the lowest category could be transported en masse
by bus or other modes of transport, with an appro-
priate number of EMS providers who are properly
equipped. It is probably a good idea to have at least
1 EMS provider for every 5-7 non-urgent patients.
Dead patients will often be left for placement
in a temporary morgue for the local coroner or
medical examiner.
This will then leave the urgent and critical
patients to be transported by ambulance. While our
first instinct often is to transport as many critical
patients as possible, providers who have actually
been in this situation will tell you that actively
caring for more than one critical patient at a time
properly is difficult at best.
An example of a good solution to this dilemma
is to transport only a single critical patient or a
single critical patient with a single moderate/urgent
patient per ambulance. Establishing and staffing a
treatment area on scene in the green zone can help
to organize the effective transportation of patients
by providing on scene care until transportation is
available.
Another reason to have an organized trans-
portation system is the danger of contamination
of the ambulances involved in transporting the
patients. While decontamination should be (and is)
done on the scene prior to transport, with a large
number of patients and a large number of “walking
wounded” it is possible and likely that at least one
will be transported by ambulance prior to being
decontaminated.
The best defense against this will be the estab-
lishment of strong perimeters and making certain
that all patients are decontaminated before being
placed in a transporting unit.
Should an ambulance or other transporting
unit become contaminated, three issues become
important. First the patient must be decontaminated
prior to entering the hospital. Second, the crew may
need to be decontaminated depending on the type
of contaminant. Third no further “clean” patients
