The Great Shakeout After Action Report Commentary

excerpt taken from DMS After Action Report:

DMS participant commentary

Kim Kirchberg-Schmitt
Strike Team Leader, LAFD Project Manager

The goal of this exercise for me was to get the units in the hands of a few of the members of the department, and to expose the LAFD to the EPTS they have invested in. This project I expect will be an ongoing effort of several members of both the department, as well as DMS. With the recent fires and train disasters, it seems that the natural progression would be to slowly expand the awareness of the system first, and then attempt to install and deliver it to those who will be ultimately responsible for patient tracking.
I was extremely pleased with the LAFD’s involvement and commitment to this test of the system, and felt that the drill was a success from both a technology perspective as well as a human one. Without the support of key individuals who were obviously prepared ahead of time with information and an objective, I don’t believe the test would have been met with such enthusiasm and acceptance. All of the patients that were appropriately funneled through the choke point created at the East Gate area were scanned and tracked using the system, and even those who were not given a bar-coded tag were able to be tracked with ease by rapid manual entry of their triage tag ID.
The drill was intended to have an element of surprise for many of the responders and I felt this contributed to the ultimate success of the test. The natural flow of an incident is never one without bottlenecks, but the ability to identify those bottlenecks and put them to productive use (gathering more specific patient data such as name, gender, DOB, and photos) was one that evolved as the exercise progressed.
At the end of the incident, being able to give the total counts to the PIO staff within a few minutes was clearly representative of the hard work and dedication of the participants, as well as the functionality and usability of the system overall.

Tags: After action report, California, disaster, Disaster Management Solutions, Drills, EMS, EMT, Fire Department, Golden Guardian, Great Shake Out, kirchberg-schmitt, LA Fire Department, LinkedIn, mass casualty, MCI, Paramedic, Patient Tracking, response, strike team, tracking, train crash, transport, treatment, Triage

Golden Guardian 2008 and the Great Shakeout

FOR IMMEDIATE RELEASE
__________________________________________________
FirstTrak Patient Tracking System Tested During Great Shakeout
Torrance, CA - November 20, 2008 – Disaster Management Solutions
(DMS) achieved continued success working with four separate public safety
agencies and numerous hospitals simultaneously during the largest disaster
exercise of its kind in California last week. The Great Shakeout simulated a 7.8
earthquake and saw over 5 million participants across the state. Of
those that participated, the DMS First Trak Patient Tracking System
successfully tracked well over 500? (need actual number or ballpark
here) individuals (need the from where to where here).
“We are very pleased with the feedback we heard from our customers
during the exercise. Four separate public safety agencies of considerable
size in Southern California utilized the system and the response was
very positive,” said DMS President Jay O’Donnell. Riverside County,
Kaiser Bellflower, the Los Angeles County Coroner and the Los Angeles Fire
Department all utilized the FirstTrak system as part of the
exercise. DMS staff were on-hand at the Mission Hills school that the Governor
personally attended and spoke at and were excited to be able to showcase the system
to him.
“Being a local company, we have an added interest in disaster
preparedness in Southern Cal and we are delighted to have quite a
footprint established in the area and to be able to make a
difference,” commented O’Donnell.
Located in Southern California, Disaster Management Solutions and
their First Trak Suite enables multiple uses for multiple purposes
and applications. First Trak has been utilized by hospitals, EMS
agencies, fire departments, public health agencies, the National
Guard and the Red Cross. Disaster Management Solutions has over 25
regional engagements across the country covering over 400 individual
entities.

Tags: California, drill, earthquake, EMS, First Responder, FirstTrak, kirchberg-schmitt, LA City Fire Department, Linked In, O'Donnell, Paramedic, Patient Tracking, preparedness

Memphis Training

Memphis and Shelby County used the First Trak system during Gustav to track the evacuees they recieved from New Orleans. The system worked well and was easy to train the First Responders on in less than 10 minutes. This week, the Shelby Co. MMRS group was able to train a new group of trainers within their response system from many different agencies. The Memphis Fire Department sent a large continigent of Battalion Chiefs and Trainers as well as Paramedics, The Red Cross was very well represented, and numerous local hospitals and EMS agencies. Germantown Fire Department and Bartlett Fire/EMS were represented. I was honored to meet staff from Tenet Healthcare’s St. Francis- Bartlett, Methodist, The Med, LeBonheur, the Memphis VA, and Delta Medical Center.

ProMed sent representatives from Knox County (Eastern Tennessee also has the system) as well as their Memphis operation. Also represented were Emmact, Abundant Care, and the Memphis/Shelby County EMA. The Office of Preparedness sent representives as did the Tennessee Department of Health-Division of EMS.

This is exactly the kind of multi-agency trining that is need to ensure a seamless integration of an EPTS in a community or region. No longer do you need a subject matter expert in the MAC or in your EOC to know how the tracking system works! When all levels of response are trained, as well as all agencies, the system can be expanded and utilized to it’s fullest capacity.

I work with a lot of communities, and I can say without a doubt that Memphis and Shelby County have certainly risen to the occasion with this training. I was proud to be a part of their learning process. This group proves to me that when people are motivated by one common goal and unified in their efforts towards reaching that goal, anything can be accomplished and agency lines can disappear, leaving one whole that is by far greater than the sum of it’s parts.

Tags: EMS, kirchberg-schmitt, LinkedIn, Memphis, mmrs, Paramedic, patient tracking system, ProMed

Why on Earth is Patient Tracking Important, you ask?

Tags: 911, disaster, EMS, fire, kirchberg-schmitt, Patient Tracking, police

The Aftermath of Gustav and Ike

As posted on the The Military Health System Blog

Tuesday, September 30, 2008 - Hurricanes Ike and Gustav
Posted by: Colonel Donald L. Noah

In the wake of hurricanes Gustav and Ike, Air Force Col. Donald L. Noah, chief of staff for Force Health Protection and Readiness, weighs in with lessons learned from the military’s response to these storms.

Hurricanes Ike and Gustav:
Real-Life Application of the Joint Force Health Protection CONOPS

The winds of hurricanes Gustav and Ike have died down but work in the aftermath goes on. Part of that work is assessing what assistance was provided by the Military Health System (MHS), what went right and wrong with that assistance, and how we can do better in the future. One thing is for sure, in addition to all the other missions of the MHS, hurricanes will keep coming and we will keep being requested to assist.

What does hurricane response have to do with the Joint Force Health Protection concept of operations (JFHP CONOPS)? Plenty! Although I’ve only recently studied the JFHP CONOPS, I’ll bet very few of you have—largely due to the fact that it was only recently drafted and published. As a very brief primer, JFHP is organized into six functional focus areas:

1. Human performance enhancement
2. Health surveillance, intelligence, and preventive medicine
3. Command and control
4. Patient movement
5. Casualty management
6. Medical logistics and infrastructure support

Simply put, the JFHP CONOPS examines the future warfighting context and characteristics of the future joint force in order to characterize future required medical capabilities. As I read through the CONOPS document, having recently returned from an on-site visit to the hurricane response area, I saw how effectively the document is organized and how it lays out a process for continual improvement for all types of missions, from the War on Terror to responding to disasters in CONUS.

Alright, enough of the CONOPS lead-in—back to the hurricane situation. Here is a summary of what we did, how well we did it, and how we can do better in the future:

What the MHS provided

· Leadership advice and guidance. Through the NORTHCOM Surgeon’s office, we have a nationwide array of 14 Joint Regional Medical Plans officers (JRMPOs). All available JRMPOs were mobilized to coordinate and synchronize state and Federal ESF-8 capabilities.

· Patient movement. Both within and without the National Disaster Medical System (NDMS), aeromedical evacuation units from Active Duty and Air National Guard units moved approximately 473 non-ambulatory patients out of harm’s way.

· Medical support to general evacuation effort. The Air Force’s San Antonio-based 59th Medical Wing provided medical screening and emergent care to the thousands of people evacuated from the landfall areas.

· Medical logistics. Through the ARNORTH emergency operations center in San Antonio, the right military medical materiel was provided to the right place at the right time.

What went right

· The JRMPOs provided the unique “glue” that bound the interagency effort. During my trip to Texas between the hurricanes, every single agency representative I met requested more of these valuable officers.

· The Texas Military Forces, ably led in the medical context by Joint Surgeon Colonel (Dr.) Connie McNabb, proved capable of augmenting—and in many cases, replacing—Federal response assets.

· Personal initiative at all levels effectively erased policy shortfalls and ensured that patients were moved safely and quickly.

· Operational communication between military medical response experts at all levels (e.g., OSD, NORTHCOM, ARNORTH, and Texas Military Forces) provided effective situational awareness.

What went wrong

· The NDMS does seem adequately user-friendly to state and local medical officials. Additionally, it does not apply to non-ambulatory patients in facilities other than hospitals (e.g., nursing homes and hospice care). Therefore, I believe we dodged a bullet so far in this hurricane season; our success is as much due to the relatively small numbers of patients requiring evacuation rather than to the effectiveness of the system.

· Medical response policies of certain interagency partners (e.g., DoD/TRANSCOM, HHS/NDMS, and DHS/FEMA) are not sufficiently interoperable to ensure seamless operations.

How can we improve?

· First, and perhaps most important, we need to ensure that our DoD response policies are coordinated with all agencies, both internal and external to DoD.

· We also need to lean forward to proactively work with our interagency partners on improving Federal policies. A salient example is patient movement. Whether by air, rail or bus, and whether by NDMS or non-NDMS assets, we need to do a better job of preparing to respond.

As of this writing, we are already taking steps to move out on plans improvement. Dr. Casscells and Ms. Embrey have empowered us to host several meetings to lead this process of policy integration. The first will be an After-Action Review of senior action officers of the MHS to identify issues and workable solutions, whether in the domains of doctrine, policy, operational guidance, or training. The second meeting will include our intergovernmental partners to review, revise, and integrate Federal policies and guidances to operationalize those improvements before the next hurricane season.

To conclude, I must briefly return to the JFHP CONOPS document. Its central theme is Protect the Force, Enhance the Mission. That’s a deceptively simple statement—one that elegantly sums up the strategic objective of all military medical forces. If I’ve been successful in anything during this blog entry, it’s that 1) the MHS provides a unique and vital service to our country—as was demonstrated during our response to the hurricanes, 2) no matter how good we are at providing that service, we can always do better, and 3) the Joint Force Health Protection CONOPS document is an excellent reference in understanding your role in the MHS and how you can contribute to its improvement. I’m attaching the document for those who are (or should be) interested.

Tags: Ambulance, Disaster Management Solutions, Disaster Response Team, DMS, EMS, EMT, Gustav, hurricane, Ike, Katrina, Paramedic

Peter Canning

I have been reading Peter Canning’s books and blog for years, and I always enjoy his perspectives on this job we do.

http://medicscribe.blogspot.com/

He wrote several excellent blogs after he was deployed to Gulfport, Mississippi in 2005- I will attempt to link to them here on their own page.

Tags: Disaster Response, DMS, EMS, hurricane, Katrina, Paramedic, Peter Canning

We Have Met the Enemy & He is Us

springer science journal

We Have Met the Enemy & He is Us: Another Perspective
Reprinted with Permission, as written on Nov 1, 2007 by by Bryan E. Bledsoe, DO, FACEP

There was a cartoon series entitled Pogo that was popular during the Vietnam War. Pogo was a possum that lived in a Georgia swamp. Life in the swamp satirically represented society. One of the most popular quotations that came from the widely read cartoon was the phrase “We have met the enemy and he is us.” The phrase subsequently became the mantra for Earth Day and reflected the fact that pollution and similar environmental issues are largely the responsibility of humankind. Unfortunately, the same phrase can be easily applied to EMS.

Lately, I have noticed three issues that illustrate how we are our own worst enemy. These three issues affect everybody who is or has been a part of the EMS community in the United States. Now, I don’t think anybody is consciously trying to hurt the profession, I believe it is occurring because of generalized apathy or ignorance. In addition, sometimes we place our own interests in front of those of the profession.

First, any profession needs a unified voice to represent the interests of the profession in society as a whole. The American Medical Association (AMA) represents physicians in general while the American College of Emergency Physicians (ACEP) specifically represents the interests of emergency physicians. The strength of a professional organization, such as the AMA or ACEP, lies in the membership. The more members, the more influential the organization.

The organization for EMS is the National Association of Emergency Medical Technicians (NAEMT). This organization was founded in 1975, and I was a charter member. While NAEMT has had its ups and downs, it still remains the only unified voice for EMS in the U.S. Furthermore, in recent years, NAEMT has cleaned up their act and have become duly focused on the issues facing the profession. The dues are inexpensive. The organization is sound. Yet, very few EMS people are members. Why do people not join? Unfortunately, some in EMS don’t feel they are a part of the EMS community. All of us, whether we work for a private EMS service, fire department, governmental entity, hospital or similar operation are all EMS providers. NAEMT is devoted to protecting the interests of EMS providers regardless of the employer or EMS delivery model. Likewise, many state EMS associations exist yet are also poorly supported by EMS providers. In the U.S., EMS is a local governmental responsibility. Because of this, representation of the profession at the state level is very important — yet almost nonexistent!

If you are not a member of NAEMT and your local EMS association, it is time to join. I joined both NAEMT and the EMS Association of Texas (EMSAT) although, technically, I am not a prehospital provider. Interestingly, I just recently read an email thread about the Johnson & Johnson television ad that supports nursing as a profession. EMS providers were angry that the entire ad showed nurses working in the prehospital setting. I completely understand. They complained like typical keyboard warriors. But that was it. Little did they know that NAEMT had already addressed this ad with Johnson & Johnson. If they were members, they would have known.

Second, EMS is one of the few public service professions without a national memorial that honors our colleagues who have fallen in the line of duty. We, as a profession, have an ethical duty to assure that our fallen brothers and sisters are forever remembered. There has been an EMS Memorial Service each spring in Roanoke, Va. While the need for a memorial and the memorial service are different issues, this is something each of us should be involved in. There is presently an ongoing controversy about where the memorial should be and who should be responsible for it. Different groups come to the table with different ideas and agendas. Instead of dividing the profession we should unite and work together to assure that a bona fide memorial is placed somewhere in this great land where people can come to reflect and remember those who have made the ultimate sacrifice. If we are all on one page, instead of the usually divided image, then we will attain our goal. If we are united, major sponsors will follow and make the national EMS memorial a reality.

Third, there has been a recent interest in preserving our legacy through a National EMS Museum. Many people have put in many thankless hours to get the museum up and running. NAEMT has provided some seed money. But, like everything in EMS, we are again divided. There is a push to have the national EMS museum at the Los Angeles County Fire Museum — not a bad idea. There is also a push to have a pure EMS museum at some location in the country — also not a bad idea. But, like usual, we have two to three entities trying to achieve the same goal that appear to be competing with each other. As well, personality issues now appear to be affecting the National EMS Museum project. We will never get the needed major sponsors for this project unless we put petty personality issues aside, stop bickering and have an organization that is squeaky clean and fiscally transparent. Again, we are our own worst enemy.

It is time for EMS providers to join our professional organizations and speak with a unified voice. Each EMS provider, whether volunteer or career, should join their state EMS organization and NAEMT. They should also belong to organizations that represent their other work interests (e.g., International Association of Fire Chiefs, International Association of Fire Fighters, International Association of Flight Paramedics, etc.). The dues are tax-deductible, and the benefits far outweigh the costs. Likewise, EMS organizations must work hard to be totally transparent and solely represent the interests of the membership. NAEMT has done a great job in addressing this problem. The National Association of EMS Educators (NAEMSE) appears to be trying to become more transparent. People will only join an organization if they feel their voice is heard by the officers, the organization does not misuse their dues, and the organization presents an image and voice that totally represents the profession.

So, can the apathy! Quit being EMS keyboard warriors! Join the organizations of the profession that pertain to your work. The future of EMS is dependent upon such actions.

Tags: Brian Bledsoe, EMS

How to Properly Document and EMS Call

skin changes

Timothy J. Perkins recently wrote the article for EMS Responder Magazine entitle, The Importance of Documentation (for EMS Responders).

Documentation is an important but often overlooked part of every EMS call. How much time does an EMS provider put into documentation? How much time should an EMS provider put into documentation? How detailed should the reporting be? Would your reports hold up in court? The answers, and some additional points as well, are important for every call you respond to. …. read the full article here

Tags: EMS, Patient Tracking, Tutorials

NEMSIS Update - Aug 2007 PowerPoint Presentation

Disaster Management Solutions strives to keep you informed about relevant updates.  Click here to view a NEMSIS, as found at nemsis.org.

Tags: DMS, EMS, NEMSIS, Standards

NEMSIS Webcast - History and Progress of NEMSIS

 MCHB/EMSC’s National EMS Information System (NEMSIS) Webcast Archive Wednesday, September 28, 2005
Dan Kavanaugh, Moderator
Susan McHenry, Moderator

• Greg Mears, M.D., Presenter : History and Progress to Date of the NEMSIS Project
• Clay Mann, PhD, MS, Presenter : Future Direction of the new NEMSIS Technical Assistance Center
• Rick Alcorta, MD, Presenter : State EMS Director’s Commitment to NEMSIS and Participation in the National EMS Database

Tags: EMS, NEMSIS, Standards