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CRITICAL INCIDENT CRITICAL INCIDENT MANAGEMENTMANAGEMENT

Dr Praveena AliDr Praveena AliPrincipal Medical OfficerPrincipal Medical Officer

Ministry of HealthMinistry of HealthFijiFiji

Performance ObjectivesPerformance Objectives

Describe critical incident characteristicsDescribe critical incident characteristics

Discuss the characteristics of a mass Discuss the characteristics of a mass casualty situationcasualty situation

Discuss common problems associated Discuss common problems associated with a mass casualtywith a mass casualty

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Performance ObjectivesPerformance Objectives

Discuss critical incident stagesDiscuss critical incident stages

Discuss decision making in a critical Discuss decision making in a critical incidentincident

Discuss critical incident case studiesDiscuss critical incident case studies

Discuss the process for Humanitarian Discuss the process for Humanitarian AssistanceAssistance

Bus AccidentBus Accident

Bus Accident ScenarioBus Accident Scenario

School bus with 60 Girl ScoutsSchool bus with 60 Girl Scouts

Lost control and landed in ravineLost control and landed in ravine

MultiMulti-- agency responseagency response

Write down good points and bad points Write down good points and bad points

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Critical Incident Management Critical Incident Management CharacteristicsCharacteristics

Demands a coordinated response to Demands a coordinated response to prevent incident from getting worseprevent incident from getting worse

This includes unresolved element of This includes unresolved element of danger such as additional bomb, a threat danger such as additional bomb, a threat to citizens and responders or an unusual to citizens and responders or an unusual incident incident

Critical Incident Management Critical Incident Management CharacteristicsCharacteristics

Often random in nature and disrupt Often random in nature and disrupt normal lifenormal life

Terrorist organizations use opportunity Terrorist organizations use opportunity as a tool for civil disturbanceas a tool for civil disturbance

A mass casualty is a critical incident A mass casualty is a critical incident

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Mass Casualty Incident Mass Casualty Incident OverviewOverview

Produces several patientsProduces several patients

As few as six or as many as several As few as six or as many as several hundredhundred

Affects local hospitalsAffects local hospitals

Patients are greater than resources of Patients are greater than resources of the initial respondersthe initial responders

Preparation For Mass Casualty Preparation For Mass Casualty

PrePre--planning and training are criticalplanning and training are critical

Establish guidelines and proceduresEstablish guidelines and procedures

Early implementation of Incident Early implementation of Incident CommandCommand

First five minutes will determine next five First five minutes will determine next five hourshours

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Response Categories Of Mass Response Categories Of Mass CasualtiesCasualties

Mass Casualties can occur in a variety of Mass Casualties can occur in a variety of waysways

Effect on emergency response and Effect on emergency response and community impactcommunity impact

Include transportation, violent crimes and Include transportation, violent crimes and building collapse building collapse

Response Categories Of Mass Response Categories Of Mass CasualtiesCasualties

Hazardous materials incidentsHazardous materials incidents

Civil disturbancesCivil disturbances

Natural disastersNatural disasters

Major firesMajor fires

Terrorist attacksTerrorist attacks

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Problems In Mass Casualty Problems In Mass Casualty IncidentsIncidents

Most common being:Most common being:

Who is in command of the incidentWho is in command of the incident

Location of the Command PostLocation of the Command Post

Lack of communication between Lack of communication between agencies leading to conflicting priorities agencies leading to conflicting priorities and orders and orders

Problems In Mass Casualty Problems In Mass Casualty IncidentsIncidents

Perimeter establishment delayed or not Perimeter establishment delayed or not done at alldone at all

Large crowds of peopleLarge crowds of people

Media involvementMedia involvement

Political involvementPolitical involvement

Inadequate resourcesInadequate resources

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Functional Systems ApproachFunctional Systems Approach

Three levels of function: strategic, Three levels of function: strategic, tactical and tasktactical and task

Management is strategicManagement is strategic

Team leaders are tacticalTeam leaders are tactical

Resources not involved in supervision Resources not involved in supervision are task are task

Critical Incident StagesCritical Incident Stages

They consist of:They consist of:

Initial ResponseInitial Response

Incident Control using the Six Step Incident Control using the Six Step ResponseResponse

Recovery Stage Recovery Stage

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Initial Response StageInitial Response Stage

Ability to establish command and controlAbility to establish command and control

Faced with confusion and panicFaced with confusion and panic

Crucial to develop a team and place a Crucial to develop a team and place a plan in actionplan in action

Initial Response ObjectivesInitial Response Objectives

Protecting citizens and rescue of victimsProtecting citizens and rescue of victims

Limit incident growthLimit incident growth

Protect arriving respondersProtect arriving responders

Identify ingress and egress routesIdentify ingress and egress routes

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Initial Response ObjectivesInitial Response Objectives

As soon as possible:As soon as possible:

Gain control of the sceneGain control of the scene

Restore orderRestore order

Prevent target Prevent target

opportunitiesopportunities

Incident Control Using The SixIncident Control Using The Six--Step ResponseStep Response

The SixThe Six--Step response is based on the Step response is based on the Incident Command System. It includes: Incident Command System. It includes: Assume command, situation Assume command, situation assessment, identify and set perimeters, assessment, identify and set perimeters, establish command post, Safety officer establish command post, Safety officer and staging areas and staging areas

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# 1 # 1 –– Assume CommandAssume Command

The first responder is providing order to The first responder is providing order to the incidentthe incident

Prevents independent action and Prevents independent action and multiple commandsmultiple commands

Reassures responders that someone is Reassures responders that someone is in charge in charge

# 1 # 1 –– Assume CommandAssume Command

Must advise incoming responders of Must advise incoming responders of incident locationincident location

Secure tactical frequencySecure tactical frequency

Request supervisory supportRequest supervisory support

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# 2 # 2 –– Situation AssessmentSituation Assessment

Size up of the incident that includes the Size up of the incident that includes the type of threat, approximate number of type of threat, approximate number of injured, size of threatened area and injured, size of threatened area and possibility of secondary event.possibility of secondary event.

# 2 # 2 –– Situation AssessmentSituation Assessment

In simple terms the assessment should In simple terms the assessment should describe:describe:

What do you haveWhat do you have

What are you doingWhat are you doing

What do you needWhat do you need

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# 3 # 3 -- Identify And Set Identify And Set PerimetersPerimeters

Divide the incident into manageable Divide the incident into manageable divisions (geographical areas)divisions (geographical areas)

Allows command to provide resources Allows command to provide resources where they are neededwhere they are needed

# 3 # 3 -- Identify And Set Identify And Set PerimetersPerimeters

Critical incidents have three standard Critical incidents have three standard perimeters. All perimeters are divisionsperimeters. All perimeters are divisions

Expand perimeters based on weatherExpand perimeters based on weather

Perimeters are the hot zone, inner Perimeters are the hot zone, inner perimeter and outer perimeter perimeter and outer perimeter

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The Hot ZoneThe Hot Zone

Area in which the incident has occurredArea in which the incident has occurred

May be a street corner or spread over a May be a street corner or spread over a large arealarge area

Secured by placing responders in Secured by placing responders in positions of controlling ingress and positions of controlling ingress and egressegress

Inner PerimeterInner Perimeter

Protects responders in hot zoneProtects responders in hot zone

Uniformed personnel onlyUniformed personnel only

Used as decontamination area, Used as decontamination area, treatment area and evacuation area for treatment area and evacuation area for walking woundedwalking wounded

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Outer PerimeterOuter Perimeter

Provides last line of defense from Provides last line of defense from internal incident accelerationinternal incident acceleration

Provides first line of defense from Provides first line of defense from external accelerationexternal acceleration

Secure area for command post, Secure area for command post, resources and control of the media resources and control of the media

Perimeter Placement IllustrationPerimeter Placement Illustration

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# 4 # 4 –– Establish Command PostEstablish Command Post

Typically begins at first responders Typically begins at first responders vehiclevehicle

Incident dynamics will require Incident Incident dynamics will require Incident Commander to shift to fixed command Commander to shift to fixed command postpost

Must be away from hot zoneMust be away from hot zone

# 4 # 4 –– Establish Command PostEstablish Command Post

The command post will ensure support The command post will ensure support for field personnel, create a controlled for field personnel, create a controlled environment and improve environment and improve communications.communications.

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# 5 # 5 -- Establish Safety OfficerEstablish Safety Officer

Should be filled as soon as possibleShould be filled as soon as possible

Officer selected on operational Officer selected on operational experience and ability to recognize experience and ability to recognize acceptable and unacceptable riskacceptable and unacceptable risk

Operations can be stopped or modifiedOperations can be stopped or modified

# 6 # 6 -- Establish Staging Area Establish Staging Area

Effective tool in correct and safe Effective tool in correct and safe deployment of resourcesdeployment of resources

Staging Supervisor must track, rotate Staging Supervisor must track, rotate and relieve resources as appropriateand relieve resources as appropriate

Area established within inner or outer Area established within inner or outer perimeter. Avoid congestionperimeter. Avoid congestion

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Inter Agency Planning Inter Agency Planning

Failure to include all agencies during Failure to include all agencies during planning process may compromise planning process may compromise respondersresponders

Identify and establish liaisons with all Identify and establish liaisons with all agencies and coordinate tactical agencies and coordinate tactical operations operations

Secondary IncidentsSecondary Incidents

May be more destructive and damaging May be more destructive and damaging than initial incidentthan initial incident

World Trade Center crashes were World Trade Center crashes were primary incident with collapse of the primary incident with collapse of the towers as secondary incidents claiming towers as secondary incidents claiming more lives more lives

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Recovery StageRecovery Stage

Begun when aggressive threats of Begun when aggressive threats of incident are neutralizedincident are neutralized

Incident is not over when last patient is Incident is not over when last patient is transportedtransported

Recovery must be managed Recovery must be managed aggressively aggressively

Recovery StageRecovery Stage

Planning Section of incident command is Planning Section of incident command is responsible for initial recoveryresponsible for initial recovery

Typically the longest and most poorly Typically the longest and most poorly managed part of the incidentmanaged part of the incident

May require months to years May require months to years

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Goals In The Recovery StageGoals In The Recovery Stage

Most important goal is document Most important goal is document collectioncollection

Information can assist in Post Incident Information can assist in Post Incident Analysis, cost recovery and tracking Analysis, cost recovery and tracking responder injuries or deaths responder injuries or deaths

Goals In The Recovery StageGoals In The Recovery Stage

Provide critical incident stress Provide critical incident stress management for respondersmanagement for responders

Collect and properly dispose of used Collect and properly dispose of used medical supplies and biohazard waste medical supplies and biohazard waste from the incident from the incident

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Post Incident AnalysisPost Incident Analysis

Critical for operational review. Benefits Critical for operational review. Benefits include:include:

Operational performanceOperational performance

Organizational needsOrganizational needs

Procedure modificationProcedure modification

Additional trainingAdditional training

SummarySummary

Critical Incident Management can place Critical Incident Management can place a heavy burden on respondersa heavy burden on responders

Requires a coordinated response from all Requires a coordinated response from all agencies involvedagencies involved

Mass casualty incident is a critical Mass casualty incident is a critical incident, terrorist related or not incident, terrorist related or not

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SummarySummary

Identifying critical stages will give the Identifying critical stages will give the responder a better chance of dealing responder a better chance of dealing with the incidentwith the incident

Six Six –– Step response is a tool for incident Step response is a tool for incident managementmanagement

Humanitarian Assistance Humanitarian Assistance

9-11-01