Disaster Response Practices: Guide to Mass Casualty/Mass Fatality Management Planning (Management for Professionals)

Preface
Contents
About the Author
1: Introduction
2: Mass Casualty
	2.1	 Mass Casualty Incident
	2.2	 Declaration
		Initial Size-Up
		Scene Size-Up
			METHANE Method
	2.3	 Agencies and Responders
		Emergency Medical Services
		Fire and Rescue
		Public Safety
		Specialized Teams
		Public Services
		Hospitals
			Trauma Centers
	2.4	 Mass Casualty Decontamination Line Flow
		Triage
	2.5	 Example Triage Tags
		Treatment
			On-Site Morgue
		Transport
	2.6	 Definitive Care
		Interim Care Center
		Mass Casualty Event
	2.7	 Demobilization
	2.8	 Activating a Mass Casualty Response (System Example)
	2.9	 Preresponse Element Setups
	2.10	 Functional Areas
	2.11	 Functional Roles
	2.12	 Mass Casualty Incident (MCI) Demobilization
	2.13	 Summary
3: Decontamination for Mass Casualty/Mass Fatality
	3.1	 Methods
	3.2	 Mass Decontamination/Mass Fatality
		Mass Hysteria and Security Aspects
		Mass Decontamination Equipment
	3.3	 Contamination Control
		Function of Decontamination Activities
		Usage
		Types of Contamination
		The Effects of Contamination
		Types
	3.4	 Human Decontamination of Injured Victims
		General Principles
	3.5	 Decontamination of Injured Victim
		Hospital Decontamination
		Decontamination Exercises
		Collection of Personal Belongings for Evidence
		Handling Uncooperative Victims
		The Belfast Telegraph Describes Such a Situation (Example)
		Internal Human Contamination
	3.6	 Summary
4: Civil Support Team Decontamination Operations
	4.1 Decontamination Planning
	4.2	 What Is the Terrain?
	4.3	 Decontaminating Personal Protective Equipment
	4.4	 Decontamination Process
	4.5	 Decontamination Steps (Example Template)
	4.6	 Casualty Decontamination
	4.7	 Casualty Decontamination Considerations
	4.8	 Site Location and Layout
	4.9	 Mass Casualty Decontamination
	4.10	 Decontamination Procedures for Ambulatory Casualties
	4.11	 Decontamination Procedures for Nonambulatory Casualties
	4.12	 Decontamination Cleanup
	4.13	 Summary
5: Mass Casualty Incident Plan Template
	5.1	 Template Instructions
	5.2	 Acknowledgments
	5.3	 Table of Contents
	5.4	 Acronyms
		Overview
		Purpose
		Scope
		Assumptions
	5.5	 Pre-Incident
		Training and Exercise Schedule
		Supplies and Equipment
	5.6	 Activation
		Authorization to Activate
		Notification
		Coordinate Staffing and Prepare Staff for Activation
		Deploy Supplies and Equipment
		Hospital Command Center
	5.7	 Operations
		Triage
		Treatment
		Security
			Traffic Control
			Internal Security
			Law Enforcement Coordination
		Patient Processing
		Communications
		At-Risk Populations
			Family Information Center (FIC)
			FIC Activation
		Mental and Behavioral Health
		Staff Support Services
	5.8	 Transition
		Authority to Transition
		Notify Stakeholders
		Transition Operations
	Appendices
6: Triage
	6.1	 Triage Types
	6.2	 Simple Triage
	6.3	 Triage Tags
	6.4	 Advance Triage
	6.5	 Continuous Integrated Triage
	6.6	 Reverse Triage
	6.7	 Undertriage and Overtriage
		Outcomes
			Palliative Care
			Evacuation
			Alternative Care Facilities
			Secondary (In-Hospital) Triage
		Specific Systems
			Practical Applied Triage
			Scoring Systems
			START Model
			Hospital Systems
		Conventional Classification Different Countries
			Australia and New Zealand
			Canada
			Japan
			Spain
			United Kingdom
			United States
				US Military
		Limitations of Current Practices
		Ethical Implications
	6.8	 Summary
7: Guidelines for First Responders to a Mass Casualty CBRN Incident Euro-Atlantic Partnership Council (EAPC)
	7.1	 Introduction
	7.2	 Summary
8: Mass Fatality
	8.1	 Response Functions
	8.2	 Mass Fatality Management Resources
	8.3	 Disaster Mortuary Operational Response Teams
		DMORT Organizations
		Identification of Remains
	8.4	 Disaster Mortuary Operational Response Teams (DMORTs)
	8.5	 Disaster Medical Assistance Teams (DMAT)
	8.6	 Disaster Portable Morgue Units (DPMU) Team
	8.7	 National Nurse Response Team (NNRT)
	8.8	 National Pharmacy Response Teams (NPRT)
	8.9	 Veterinary Medical Assistance Teams (VMATs)
	8.10	 Critical Infrastructure Protection
	8.11	 Logistics
	8.12	 Operations
		Secretary’s Operations Center
		Response Operations
		Training, Exercise, and Lessons Learned (TELL) Programs
	8.13	 Preparedness Planning
	8.14	 Manmade Disasters
		Bioterrorism
	8.15	 Chemical Agents and Hazardous Materials
	8.16	 Pandemics and Diseases
	8.17	 Radiation Emergencies and Event Management
		Terrorism
		Natural Disasters
		Earthquake
		Fire and Wildfire
		Flood and Dam Failure
		Hurricanes
		Landslide
		Thunderstorm
		Tornadoes
		Tsunami
		Volcano
		Extreme Cold and Winter Storm
		Extreme Heat
	8.18	 Summary
9: Mass Fatality Planning: Emergency Preparedness
	9.1	 Mass Fatality Management
	9.2	 Mass Fatality Checklist
	9.3	 Mass Fatality Management Plan Template
	9.4	 Overview
	9.5	 Plan Maintenance
	9.6	 Activation
	9.7	 Operations
	9.8	 Demobilization
	9.9	 Public Information Officer
	9.10	 Safety Officer
	9.11	 Liaison Officer
	9.12	 Operations Section
	9.13	 Planning Section
	9.14	 Logistics Section
	9.15	 Finance and Administration Section
	9.16	 Summary
10: Mortuary Logistic Challenges of Mass Fatality Incidents
	10.1	 The Complex Problem
	10.2	 Decedent Remains Planning and Educational Resources
	10.3	 Summary
11: Defense Support to the Civil Authorities
	11.1	 Military Aid to the Civil Power
		DSCA Authority
		DSCA Activation
		FEMA
		DSCA History
	11.2	 Summary
12: General Guidelines for Hospital Mass Casualty/Mass Fatality Decontamination Procedures
	12.1	 Procedures
		General Procedures: Five-Step Process
	12.2	 Decontamination Corridors
	12.3	 Safe Refuge/Observation Area
	12.4	 Medical Triage Area
	12.5	 Cold Weather Considerations
	12.6	 First Responder Considerations
	12.7	 Exiting the Hot Zone
	12.8	 Infants, Children, and Adolescents (Pediatric) Considerations
	12.9	 Elderly, Pregnant Women, and People with Chronic Medical Conditions: Considerations
	12.10	 Recent Planning Guidance
	12.11	 Summary
13: Animal Decontamination: Natural and Manmade
	13.1	 Animals and Disasters
	13.2	 Animals and Disasters: Concerns
	13.3	 Owners’ Concern for Animals
	13.4	 Animal Care and Incident Management 1
	13.5	 Animal Care and Incident Management 2
	13.6	 Emergency Operation Plans and Animals
	13.7	 ESF #11 – Agriculture and Natural Resources
	13.8	 Safety and Well-Being of Household Pets
		Response Policies
	13.9	 Disasters and Readiness
	13.10	 Farms and Natural Disasters
	13.11	 Protection: Veterinary Care
	13.12	 Response: Disease
	13.13	 Response: Hazardous Materials
	13.14	 Summary
Case Study 1 Mass Casualty Management (Rana Plaza Tragedy) in Secondary Military Hospital: Anesthesiologist Experience
	1.1	 Case Presentation
	1.2	 Hospital Resources/Execution of Services
	1.3	 Discussion and Evaluation
	1.4	 Summary
Case Study 2 Mass Fatality
	1.1	 Methods and Findings
	1.2	 Background
	1.3	 Purpose of the Study
	1.4	 Body Recovery and Storage
	1.5	 Identification of Victims
	1.6	 Coordination and Preparedness
	1.7	 Discussion of Actions
	1.8	 Storage, Identification, and Burials
	1.9	 Coordination and Preparedness
	1.10	 Summary
Case Sudy 3 Mass Casualty Events Involving Chemical, Biological, Radiological, or Nuclear Incidents
	1.1	 Chemical, Biological, Radiological, or Nuclear (CBRN) Challenges
	1.2	 Decontamination Considerations
	1.3	 Responding to a Chemical, Biological, Radiological, or Nuclear (CBRN) Event
	1.4	 Scene Management
	1.5	 CBRN Casualty Management Zones
	1.6	 Personal Protective Equipment
	1.7	 Hazard Monitoring Strategies
	1.8	 Mass Casualty Triage
	1.9	 Triage Zones
		1.9.0.1	 On-Site Triage Hot Zone (Level 1)
		1.9.0.2	 Medical Triage Cold Zone (Level 2)
		1.9.0.3	 Evacuation Triage-Loading Zone (Level 3)
	1.10	 Triage Tags
	1.11	 Summary
Lessons Learned 1 Challenges of the Management of a Mass Casualty Event: Lessons Learned from the Jos Crisis of 2001
	1.1	 Introduction of the Event
	1.2	 Methodology of the Event
	1.3	 Results of the Event
	1.4	 Lesson Learned and Discussion of the Event
	1.5	 Summary
Lesson Learned 2 International Lessons to Improve Mass Fatality Management During a Pandemic Influenza Event December 8, 2008
	1.1	 Introduction
	1.2	 Methodology
		1.2.0.1	 Analysis Review of Mass Fatality Events
		1.2.0.2	 Major Events Selected for Key Informant Interviews and Literature Review
	1.3	 Review of Benchmark Countries
	1.4	 MFM Planning in the United States at the State and Local Levels
	1.5	 Summary
	1.6	 Appendix 1: Acronyms
	1.7	 Appendix 2: Questionnaire
	1.8	 Mass Casualty Mass Fatality Challenge Scenario Questions
		1.8.1	 Scenario 1
		1.8.1.1	 Scenario 2: Part A
		1.8.1.2	 Scenario 2: Part B
		1.8.1.3	 Scenario 3
		1.8.1.4	 Scenario 4
		1.8.1.5	 Scenario 5
		1.8.1.6	 Scenario 6
	1.9	 Answers to Scenario Questions
Glossary
Bibliography
Index