Dan Kaniewski: Welcome to the EIIP Virtual Forum Round Table! Dan Kaniewski: Today the Round Table is being sponsored by the Congressional Fire Services Institute and I am pleased to serve as your host. Dan Kaniewski: A couple of quick reminders for any first timers with us today- Dan Kaniewski: The session will consist of about fifteen minutes of introduction and overview, and then we will open it up to audience participation. Dan Kaniewski: Our topic today is Implications for Fire Based EMS during Disasters Dan Kaniewski: I represent the Congressional Fire Services Institute (CFSI), a non-profit organization charged with the task of educating Members of Congress on fire and life safety issues. Dan Kaniewski: Founded by Congressman Curt Weldon (R-PA) in 1989, CFSI together with the Congressional Fire Caucus (with over 300 Members of Congress, it is the largest Caucus on Capitol Hill) works with major fire service organizations (such as the International Association of Fire Firefighters, the International Association of Fire Chiefs, the National Volunteer Fire Council and the National Fire Protection Association) on fire and EMS issues facing the nation's 1.2 million emergency responders. Dan Kaniewski: As one can see, our membership includes all facets of the fire service. Dan Kaniewski: This assures the nation's leaders that they can rely on the objective information CFSI provides. Each year we host the National Fire and Emergency Services Dinner that draws in 2,000 fire and emergency services responders, chiefs, and leaders from across the country to Washington to hear from the Nation's political leaders. Dan Kaniewski: Joining us today is a special guest. Scot Phelps is a JD, MPH, NREMT-P who has 16 years of EMS experience (including 7 years as an instructor) in New York, New Jersey, and Connecticut. Scot is currently a full time assistant professor of emergency medicine at the George Washington University Emergency Health Services Program. Dan Kaniewski: Additionally, Scot works clinically at St. Vincent's Hospital (part of New York City's 911 EMS system) as a Paramedic. Scot also serves as a consultant for a variety of 3rd service EMS systems. Dan Kaniewski: Several topics are essential to consider when discussing fire/EMS roles during a disaster. Dan Kaniewski: Five of them are: Dan Kaniewski: 1. The Incident Management System (IMS) is a requirement in making disaster response successful Dan Kaniewski: establishment of a unified command structure (as opposed to several single commands for each agency) Dan Kaniewski: appointment of an Operations Section chief through mutual agreement of agencies Dan Kaniewski: 2. Multiple fire and EMS agencies must work together Dan Kaniewski: mutual aid preplanning Dan Kaniewski: communications is always a problem Dan Kaniewski: 3. Volunteer fire/EMS personnel will arrive on scene without being requested to do so. Dan Kaniewski: 4. Role of aeromedical operations Dan Kaniewski: not always appropriate because of lack of a LZ, noise, and debris kickup Dan Kaniewski: 5. WMD terrorism Dan Kaniewski: responders will become patients too if they enter the hot zone Dan Kaniewski: plethora of monies being appropriated for responding to WMD terrorism Dan Kaniewski: requires specialized equipment (usually provided by Fire Department HAZMAT teams) Dan Kaniewski: We now invite your questions or comments, however please first enter just a question mark to indicate you wish to contribute, prepare your comment, but wait until you are recognized by name -- then either hit the Enter key or click on the Send button. We will take comments in the order the question marks are submitted. We are ready to start now. Dan Kaniewski: Who wants to start with a question? Amy Sebring: ? Dan Kaniewski: Amy Amy Sebring: I have seen room for improvement in coordination between ... Kevin Farrell: ? Amy Sebring: on-scene, incident command and emergency operations centers ... Amy Sebring: what can be done to improve this coordination? scot phelps: Planning is the key, regular interface between scot phelps: both management and field operations is crucial... scot phelps: especially since management is usually not present for the... scot phelps: first hour of emergency operations... scot phelps: A bigger problem is the lack of coordination of radio frequencies between... scot phelps: EMS, police, and fire. scot phelps: In New York, for example, EMS cannot communicate with FD at all. Dan Kaniewski: Thanks Scot, Kevin, you have a question Kevin Farrell: A lot has been published about domestic terrorism and WMD. Which fire service agency is taking the lead in coordinating our role/efforts in the area? Kevin Farrell: that should be... in this area? scot phelps: In general, the fire department and police department has gotten the bulk of the money nationwide Dan Kaniewski: Good Question scot phelps: now, some of that money trickles down to EMS, but not much... Kevin Farrell: police maybe.... but not any FD I know. scot phelps: The problem is that most WMD incidents will have a primarily medical component... Jose Musse: ? scot phelps: and the money for mitigation and response needs to be increased... scot phelps: to provide for medical response to terrorism. Dan Kaniewski: At the federal level FEMA is supposed to be in charge of consequence message, but locally there is no one lead fire agency for WMD Avagene Moore: ? Kevin Farrell: Will the USFA or NFA take on this role, or will the CFSI? Dan Kaniewski: Fire departments do receive federal monies (in the form of grants and equipment) thanks to the DoJ and DoD Dan Kaniewski: CFSI is simply an educational organization....and we certainly advocate monies should be available for WMD Dan Kaniewski: IAFC (fire chiefs) and IAFF (firefighters) have it on their agenda Dan Kaniewski: Jose, you have a question Jose Musse: What is difference ICS and IMS? Dan Kaniewski: ICS is an older terminology, IMS is the newer, more comprehensive title Dan Kaniewski: Incident Management System Dan Kaniewski: Avagene go with your question Avagene Moore: In your part of the country and from research data, is EMS a part of exercise design for disaster exercises? Seems to me that EMS is not included as it should be at the table in planning, communications, etc. How can we change that? Amy Sebring: ? scot phelps: a more friendly term, sort of like the switch from "Medical Control" to "Medical Direction" Jose Musse: difference only terminology? Dan Kaniewski: Scot and I both feel that EMS should be more actively involved in disaster planning! scot phelps: As more FDs become more involved in EMS across the country, the national FD agenda should shift to become more inclusive of EMS concerns from the ground up. Dan Kaniewski: Jose, basically. ICS was created by the US Forest Service and it's now been adapted for fire/EMS/police in the form of IMS scot phelps: This will take time. We need to move up in the fire service command structure. Dan Kaniewski: Amy, your question Amy Sebring: Generally speaking, are formal mutual aid agreements between jurisdictions with respect to EMS fairly common, or is further work needed in this area? scot phelps: Mutual Aid agreements are common, in some areas, with common dispatch (county or regional) they seem to work more efficiently... scot phelps: but resource management is crucial in a disaster. You can't strip an area of all of its resources... scot phelps: in order to respond to one incident. But the reality is that at the "big one" EMS workers are not going to like to hear that they need to stay behind. ralph williams: In Massachusetts - state law apparently requires to have a written agreement with at least one backup EMS agency scot phelps: At the World Trade Center, we had hundreds of units from a 50 mile radius but still managed to answer the normal call volume... Avagene Moore: ? Dan Kaniewski: So, we see that preplanning and mutual aid agreements are essential- and luckily most EMS agencies are doing this Dan Kaniewski: Avagene Avagene Moore: Are you aware that a loosely formed group re: emergency medical issues meets at Boulder Co each year .... scot phelps: The key is to understand that at most disasters, there are a few critical patients for whom the ambulance may make a difference, and the rest are "walking wounded" Dan Kaniewski: What is the name of this meeting? Amy Sebring: ? Avagene Moore: the group includes hospital staff and researchers, etc. They have tried to address disaster management and other issues. Avagene Moore: Hazards Research Workshop. scot phelps: Never heard of it. Dan Kaniewski: Though I have not heard of it, I would be interested in finding out who participates Avagene Moore: Joanne McGlowen heads it up. I will provide contact info if you like. scot phelps: Great. Dan Kaniewski: Sure, which organization does she represent? Avagene Moore: She is a contractor with a hospital in Alabama. Dan Kaniewski: Does anyone attend workshops, conferences, etc. where EMS representation is present? Kevin Farrell: is that ? for everyone Dan?_ Dan Kaniewski: Amy, question Dan Kaniewski: yes Amy Sebring: Are EMS workers receiving any of the federally funded training for terrorist incidents? Dan Kaniewski: Yes, generally though it is part of the fire service allocations.... Dan Kaniewski: many training programs are currently taking place from DoJ, DoD, FEMA, etc.... Dan Kaniewski: the EMS training that stands out is the MMSTs Dan Kaniewski: tha's Metropolitan Medical Strike Teams... Kevin Farrell: Amy Sebring: ? Dan Kaniewski: who are groups of individuals who are medically trained (DRs, medics, etc) and WMD training Dan Kaniewski: Kevin, go Kevin Farrell: to answer your question Dan, Fire and EMS are 'joined at the hip' here, though I know that isn't so everywhere. Kevin Farrell: we don't separate the two Avagene Moore: ? Dan Kaniewski: A fire based system I assume Kevin Farrell: correct Dan Kaniewski: Amy, question Amy Sebring: Regarding terrorist incidents, are the regional medical caches, or stockpiles going pretty much according to plan? Dan Kaniewski: Well DC has a large cache... Dan Kaniewski: across the nation varies widely....and it depends who has access to them (local vs. federal) scot phelps: In theory, there are stockpiles, but that doesn't help the field units when the incident happens. Dan Kaniewski: Avagene Amy Sebring: / Amy Sebring: ? Avagene Moore: Following Kevin's comment: Is the current trend to have EMS co-located if not under the Fire Departments across the country? Locally, our are separate agencies, although there are several trained paramedics in the city FD. scot phelps: The national trend is toward fire service EMS for a number of reasons scot phelps: decrease in fires.... scot phelps: increase in EMS workload... scot phelps: and increased demands for cost savings by government... scot phelps: in general, in merged departments, EMS is between 70-80% of the call volume. Dan Kaniewski: (I am representing fire based systems...so I will defer from making a judgement. It is a local question to be decided by local governments) Dan Kaniewski: Scot, I know your area of interest is resource allocation during disasters... Dan Kaniewski: maybe you could give us some insight scot phelps: An important concern is that during the immediate response... scot phelps: you need to rely on current resources in the system.... scot phelps: since most systems are already working at high demand... scot phelps: you can face a shortfall in resources without a backup.... scot phelps: even mutual aid can be quickly deleted... scot phelps: leaving you without enough resources... scot phelps: but that is the history of EMS in this country! As an isolated resource from the rest of the.. scot phelps: health care system, the ability to mount a large scale response is severely limited in a short time frame. Dan Kaniewski: That's why preplanning (such as stocking a disaster trailer with supplies) and have additional personnel available through mutual aid agreements Dan Kaniewski: is important scot phelps: But it still doesn't address the people problem... scot phelps: you need trained people to care for those minor injuries once the critical patients are cared for by the staffed units. scot phelps: and that resource doesn't currently exist in most communities. Dan Kaniewski: That's one of the reasons the Fed. gov. is implementing National Guard response teams to be able to provide additional help during a WMD event and NDMS for large scale disasters.. Amy Sebring: ? Dan Kaniewski: NDMS (National Disaster Medical system) has DMAT (Disaster Medical Assistance Teams) to provide long term assistance scot phelps: An additional resource may be the Red Cross... scot phelps: who have volunteers trained in first aid, as do the Boy Scouts, etc Dan Kaniewski: Amy Amy Sebring: Is there not growth occurring in private ambulances? Outsourcing by local jurisdictions? If so, what are implications for disaster response? scot phelps: Generally positive, they often have both emergent and non-emergency units so they can shift units according to demand. Amy Sebring: Is there a trend toward privatization? scot phelps: but generally, outsourcing leads to decreased experience, lower staffing, etc. Dan Kaniewski: I see a big stumbling point with the fact that private companies providing EMS may not interact as regularly with the fire department and this could cause problems during a high impact incident such as a disaster scot phelps: actually, there is a trend away from privatization because of service problems. Dan Kaniewski: One of the major private EMS companies is in financial trouble now and is having to pull out of many cities scot phelps: the big national companies have a conflict between growth projections and service demands. Amy Sebring: Interesting, thanks. Amy Sebring: ? Dan Kaniewski: Amy Amy Sebring: Do you foresee any impacts on the demographics of an aging population? Avagene Moore: ? scot phelps: on disaster response or in general for fire service based EMS? Amy Sebring: I should have said "from" the demographics. Amy Sebring: On demands for services during disaster. Amy Sebring: (EMS services since that is our topic today) ralph williams: comment scot phelps: Yes, they often have more underlying medical problems that can make them more vulnerable in disasters... scot phelps: and more vulnerable in the intermediate time frame of " scot phelps: and in the intermediate phase of "slow" disasters like floods and tornadoes. Dan Kaniewski: Avagene Avagene Moore: I recently heard a researcher say that we are not heeding disaster data that shows that first responders are not really the normal infrastructure -- EMS, fire and police -- but private citizens. What are your thoughts on doing more basic first aid training, dos and don'ts of emergency/disaster situations, etc.? scot phelps: In some areas, like California, it is more the norm... Avagene Moore: Before the trained professionals get there? scot phelps: but that would require foresight by the public, which is sometimes a rare commodity. Avagene Moore: ? AmirJ: What if first aid training and foresight were taught to elementary kids? scot phelps: In many types of disasters, the "professionals" may face significant delays, especially in community wide disasters like earthquakes. .. IDER: ? scot phelps: neighbors need to help themselves and most had first aid (which is 95% common sense) at some point. Dan Kaniewski: Ralph, comment? Dan Kaniewski: Avagene Avagene Moore: Is it foresight of the public or the overall planning responsibility of the powers that be? scot phelps: Depends on the community- many high school health classes have some sort of first aid component, especially in wealthier communities Amy Sebring: ? scot phelps: In general, creating an environment where training is available is the first step- you can lead a horse to water but you can't make him drink... scot phelps: and government will quickly become frustrated if their offerings are ignored. Dan Kaniewski: IDER, your question IDER: it is more a comment from UK re first aid Dan Kaniewski: go ahead IDER: I was until recently involved with the UK's largest first aid training org scot phelps: St. johns? scot phelps: or red cross? IDER: the way we got the public and the govt. to realise the importance of learning first aid was through the media IDER: St. Johns scot phelps: but we need to rally the financial resources to support these kind of programs... IDER: we train about 1/2 million members of the public each year scot phelps: and they are not currently there... IDER: an scot phelps: don't forget, St John's has a 400 year history in the UK. scot phelps: so PR is not as much of an issue. Dan Kaniewski: Amy, your question Amy Sebring: We have had comments a number of times in this forum that hospitals don't perhaps take disaster planning as seriously as they should. What are your observations in this regard? IDER: we are just this year celebrating 900 years! sorry scot phelps: Hospitals go through the motions, but don't really invest the resources- how can they justify it in their bottom line... scot phelps: for instance, in Manhattan, even thought there is the money available, there are no real concrete plans. ralph williams: sorry - having big trouble using this chat - see www.gao.gov for multiple reports on WMD preparedness Dan Kaniewski: DC for example has an organization that coordinates area hospitals and they regularly train scot phelps: (That would really work) Dan Kaniewski: Good site for the "real story" on WMD preparedness. the General Accounting Office scot phelps: sorry, IDER, I underestimated.... Dan Kaniewski: Ok time for one more question Dan Kaniewski: anyone else? scot phelps: As a closing comment... IDER: ? scot phelps: As emergency managers you need to understand that you'll need to deal with the resources at hand during the first stages of any disaster... scot phelps: and you need to work with your responding agencies to brainstorm about the "second wave"... scot phelps: you need to be the leaders on this! Dan Kaniewski: Thank you audience for participating today and thank you Professor Phelps for taking time out of your busy schedule to address these important issues. I enjoyed fielding the thoughtful questions. Avagene Moore: Thanks, Dan. ... Dan Kaniewski: Ava, can you please tell us what is coming up in the Virtual Forum? Avagene Moore: Yes, forgive me for jumping the gun ... Avagene Moore: Tomorrow is a very special event. If you aren't familiar with sustainable development and disaster vulnerability, you have an opportunity to learn more about these terms from the global perspective. ... Avagene Moore: Tomorrow, Wednesday, June 16, 12: 00 Noon, we have a panel of experts with us to talk about global sustainable development. Last month, we discussed the same topic from the domestic perspective. ... Avagene Moore: Helena Valdes, IDNDR Secretariat, San Jose, Costa Rica, will be with us. ... Avagene Moore: Also Stephen Bender, Organization of American States (OAS), Washington DC .... Avagene Moore: and Ollie Davidson representing the World Bank, Washington DC. Avagene Moore: Please make plans to be with us then for this very important and informative panel session. ... Avagene Moore: Next week, the International Association of Emergency Managers (IAEM) hosts their monthly Round Table on Tuesday, June 22, 12: 00 Noon EDT. ... Avagene Moore: Wednesday, June 23, 12: 00 Noon EDT, Philippe Boulle, Director of the International Decade for Natural Hazard Reduction (IDNDR), Geneva, will be with us in a wrap up discussion of their ongoing Internet Conference (June 14-25). ... Avagene Moore: Mr. Boulle's topic will be " Disaster Reduction as a Central Element of Government Policy." Please support this discussion --- this is important both domestically and globally. ... Avagene Moore: Our time is up for today. Dan and Scot, thank you both for your time and good discussion today! Very lively dialogue - - we look forward to further CFSI-led Round Tables. .... Avagene Moore: Audience, thank you too. Without you, there wouldn't be much discussion. Very glad that we have expanded our international participation today with John Mills (IDER) from the UK. ... Avagene Moore: John, Isabel McCurdy is from Canada and Jose Musse is from Lima, Peru. They are regulars in our sessions. There may be other international attendees that I am not aware of today. We are glad to have you here regardless of where you are located. ... Avagene Moore: We will officially close for today but you are welcome to stay another minute or two to express appreciation personally to Dan and Scot. ... Avagene Moore: The Round Table is officially adjourned.