Emergency Management Paramedic - Essay Example

EMERGENCY MANAGEMENT PARAMEDIC INTRODUCTION Never before in the history of the United s has there been such an attack as there was on the morning of September 11th, 2001. For thousands of Americans their lives will forever be marked by that unforgettably horrific day. These terrorist attacks stand apart from other disasters for a multitude of reasons. The deliberately inflicted hard extended beyond the three airliner crash sites in New York City, Washington, D.C. and Somerset County, Pennsylvania to affect the entire nation. The live media coverage brought the immediacy and horror of the attacks into people’s homes like no other tragedy. American’s long held assumptions of security were shaken to the core, superseded by widespread feelings of person vulnerability and ushered in the era of homeland security. In New York City, the attack resulted in the collapse of the Twin Towers and killed 2756 civilians (Hirschkorn, 2003). These events have also had significant social and economic consequences, to include extensive property damage as well as serious and extensive financial disruption. 146,000 jobs were lost in New York City due to the attacks (Westfeldt, 2002). From the perspective of national healthcare, the events of September 11th generated public health, including mental health consequences of unparalleled proportions. RESPONDING TO DISASTER: INSTITUTIONS AND PUBLIC HEALTH Catastrophic events have far-reaching effects on social infrastructure. Disruption of life ways, vital resources, and services cause significant change in social system operations and behavior. Community disaster response may be organized and effective or disorganized and in some cases, nonexistent. Human resources are diverted from routine work functions to disaster relief operations. Disaster recovery, the long-term process of community restoration is a problem-solving process that includes not only planning for reconstruction and return to economic solvency, but also sustaining community health (Gad-el-Hak, 2008). Inequities in the distribution of social and material resources can adversely affect disaster recovery and community health. The 9-11 disaster posed unprecedented and unique challenges to the U.S. emergency management infrastructure. However, unlike less developed nations, the U.S. has the social and economic capital as well as the technology to build a defensive infrastructure for mitigation of disaster threats and provision for relief and recovery operations to its citizenry. The scope of involvement of American social institutions includes such activities as emergency preparedness, hazard mitigation, public alert systems, public health, rescue, relief, and recovery responses (Gad-el-Hak, 2008). Organizational interventions including emergency management and disaster relief may be critical for supporting the recovery of the community. A community with a disaster plan will be more resilient and effective in recovery efforts than a community without a plan. Public awareness campaigns and educational initiatives to inform populations at risk about disaster preparedness, evacuation and support services may mitigate stress. Population health is invariably at risk in a disaster. Crowding in shelters and refugee camps, exposure to bacteria from contaminated water and food, and absence of adequate sanitation increase the risk of infectious disease. Lechat (1990) summarizes the objectives of the public health system as to 1) prevent mortality; 2) provide care for casualties; 3) manage basic needs for food, water, and sanitation; 4) prevent disaster-related morbidity; 5) ensure restoration of community health; 6) reestablish health services; and 7) introduce services aimed at mitigation of disaster (preparedness education and vaccinations). Lessons learned from the terrorist attacks on September 11, 2001 included the need to strengthen the U.S. Public Health infrastructure. The public health infrastructure must expand its workforce, research, and public education. What is evident after 9-11 is the need to prepare the entire public health care system to respond in a coordinated manner to facilitate partnerships with other emergency response organizations. DESCRIPTION OF 9-11 TERRORISTIC ATTACK At 7:59 AM on the morning of September 11th, American Airline Flight 11 took off from the Logan International Airport in Boston, Massachusetts to Los Angeles, California. The plane is believed to have been hijacked at 8:14AM when it stopped responding to air traffic control and Federal Aviation Administration. At 8:46 AM, the plane crashed into the WTC 1 (the north tower) at a speed of 470 mph (Smith, 2002). It hit the building between the 95th and 103rd floors. With jet fuel capacities of nearly 24,000 gallons and weight of the plane greater than 150 tons, the aircraft was quickly turned into flying combustible bomb. At 9:03 AM, the second plane, United Airline Flight 175, also crashed into the WTC 2 (the south tower). There were 65 people on board. Approximately two hours after the impact at 10:05 AM, the south tower of the World Trade Center collapsed, killing by falling debris thousands of residents, firefighters, emergency personnel and rescue specialists (Gonzalez, 2004). At 10:28 AM, the north tower also collapsed. INCIDENT HAZARD ASSESSMENT As a result of the violent nature of the airliner impacts and the collapses of the towers, components of the two WTC Towers and the two Boeing 767 airplanes were pulverized and/or volatilized to create the dust cloud. Many of these components contain toxic or hazardous elements such as lead, mercury and asbestos (Landrigan et al, 2004). The dust cloud that was comprised of these particles was so expansive that it was visible on satellite images taken on September 11, 2001 and on following days as the dust inundated much of lower Manhattan. While heavier components of the dust settled closer to the WTC site, the lighter fraction had the potential to be carried for miles, indicating a wide area of environmental impact. As the dust cloud subsided, dust settled onto exterior and interior surfaces throughout lower Manhattan; its presence posed potential health threats to those who came in contact with it (Landrigan et al, 2004). Remediation procedures undertaken to remove the dust have been largely unsuccessful due to the lack of all-encompassing information about the WTC Dust, its constituents, its propensity for re-entrainment or recontamination, and the health hazards associated with human exposure to WTC dust (Landrigan et al, 2004). This deficit of information was generally a result of the lack of preparedness for a catastrophe of this magnitude and the crisis-modified environmental standards that were implemented to quickly address the aftereffects of the WTC Event. EVENT RISK ASSESSMENT The event occurred on September 11, 2001 yielded unforeseen financial and health consequences. More than 70,000 people from 47 US states had signed up to partake in the World Trade Center Health Registry in order to provide health organizations with a clear illustration of the health consequences of being present the site during the building collapse and the subsequent emergency response (NY CDHMH, 2010). In 2002, the US General Accounting Office indicated that in the New York City area alone, the attacks resulted in $83 billion dollars in direct and indirect economic losses (GAO, 2002). People and organizations responding to the World Trade Center catastrophe confronted many unanticipated risks, such as contending with the collapse of the city’s two tallest buildings, the deaths of thousands of people including hundreds of response workers, the waterborne evacuation of Lower Manhattan; the rerouting of major transportation corridors, the destruction of the City’s emergency operations center; the fire-related and environmental hazards as the impact site, the complex rescue, recovery and debris operations, the mass convergence of volunteers and family members, the site credentialing of response personnel, and the distribution of responsibility in this complex multi-organizational inter-governmental response (Wachtendorf, 2004, p.3). INCIDENT AFTERMATH: DAMAGE ASSESSMENT The data on injured, missing and dead victims of terrorist acts of September 11, 2001 have been gathered and published by several agencies, particularly the New York State Department of Health, the Centers for Disease Control, New York Department of Health and Mental Hygiene (DOHMH) and others. All agencies have published several reports, and the total number of dead and missing has been changing continuously as investigations were ongoing. As of August 2002, the State of New York issued 2,726 death certificates for victims of the 9/11 terrorist attack (Rosenthal and Schecter, 2003). According to data, the major cause of death was physical injury to the chest, head, etc (Acost and Levenston, 2002). Remains of victims have been identified primarily by methods of DNA analysis, fingerprints and dental records. The losses of the New York Fire Department constituted 343 firefighters and emergency personnel killed or missing (FDNY Deaths, 2002). The New York Police Department reported their 23 officers killed or missing in the incident (NYPD Deaths, 2002). Data on injuries received by the incident victims are less concrete than data on fatality due to the fact individuals being hospitalized in different facilities across three states and many victims were receiving medical help outside the hospital system. DOHMH reported on two major categories of complaints indicated in victims. Traumatic injuries such as blunt and penetration were caused by falling debris, crush, and fire. Most traumas received were qualified as laceration and sprain, both comprising 28% of total trauma numbers (Acosta and Levenston, 2002). Simultaneously, non-traumatic injuries such as respiratory and ocular irritation were far more common, 49% and 26% respectively (Acosta and Levenston, 2002). In the vast majority of cases, the eye irritation has been characterized as severe, virtually significantly compromising individual’s ability to see. Terroristic attack on the World Trade Center had significant consequences in terms of financial loss on New York and nation overall. The economic damage has been calculated not only in property damage and capital expenditures for rescue and cleanup operations, but also in damage done to local business and tourism industry. A total cost of damages estimated by the Federal Reserve Bank constituted $33-36 billion (Westfeldt, 2002). From the macroeconomic perspective, numbers estimating federal spending on improved national security and subsequent military campaign in Afghanistan and Iraq have not been calculated yet. EMERGENCY SERVICES RESPONSE ANALYSIS The New York City Fire Department is organized into 358 line units with approximately five firefighters and one officer (a lieutenant and/or a captain) per unit. There are three basic types of line units: engine companies that provide the water and pressure needed to suppress and extinguish the fire; ladder companies that primarily engage in search and rescue efforts; and special operations units such as Squad Companies, Rescue Units, and Hazardous Materials Units (Hazmat). The line units are organized into battalions, which consist of five to eight line units in a particular geographic area, and the battalions, in turn, are organized into nine divisions, which consist of four to seven battalions. The Fire Commissioner, who is appointed by the Mayor, administers the entire department, and the Chief of Department oversees all uniformed personnel (firefighters, officers and Emergency Medical Services (EMS) employees) (McKinsey & Company, 2002). The deployment of firefighters and officers to the scene of a fire depends on the level of alarm that is transmitted by the first officer to arrive on the scene. Each alarm rating corresponds to the number of units that are deployed to the site of an incident. For example, a second alarm signals FDNY Operations to send approximately 19 companies and 11 chiefs to the site of the incident. The higher the alarm, the more units are deployed (McKinsey & Company, 2002). A “total recall” is signaled when the department is in need of all its members, even those who are off duty. At 8:46 a.m. on September 11, 2001, American Airlines Flight 11 crashed into Tower 1. The FDNY immediately responded to the incidents activating a full five alarm, which was considered the highest level of response and according to protocols required minimum of 25 fire trucks and 125-150 fire emergency personnel directed to the incident scene (Smith, 2002). However, once the magnitude of disaster has been assessed, the FDNY triggered a “borough call,” which is referred to the highest level of emergency response (Smith, 2002). On September 11, 2001 “borough call” directed 121 engine companies, 4 rescue squads, over 60 ladder companies and other specialty units directly to disaster scene (Smith, 2002, p.12). The Battalion Chief who was first at the site transmitted a second alarm within minutes. Initially a command post was established in the lobby of the North Tower. The command post is the location where the Chief in charge assesses the incident and instructs the operational response. By 9:00 a.m., the command post had been moved across the street from the North Tower to West Street to provide protection from falling debris and the partial or localized collapse of the Tower that was anticipated (McKinsey & Co., 2002). At 9:03 a.m., 17 minutes after the first plane crashed into the North Tower, United Airlines Flight 175 crashed into Tower 2. Amid the confusion, units that arrived on the scene went directly into the lobbies of both the North and South Towers rather than reporting to the command post. Radio transmissions were problematic, because the portable radios used by the FDNY were unreliable in high-rise structures. T his caused the whereabouts of many units to be unknown (McKinsey & Co., 2002). “Chief officers ...had no reliable sources of intelligence and had no external information about the overall status of the incident area, the condition of the towers or the progression of the fires” (McKinsey & Co., 2002, p. 32). At 9:29 a.m., the Chief of the Department issued a total recall, directing all offduty personnel to respond. Although the procedure for total recall is included in the FDNY Operations Manual, it had not been administered for over 30 years. As a result, the recall was disorganized and many firefighters were left with little direction on where to respond. Many firefighters responded directly to the WTC site while others reported to their assigned firehouse, so there are no formal reports documenting which firefighters were at which sites. In addition to the disruption in recall procedures, the WTC attack occurred at the time of the change of tours, which caused both the night and day tour staff to respond to the event. Therefore, those firefighters who were ending their night tour and technically off duty were also involved in the operational response. This also impacted the ability to report who was officially “on duty” and responded to the WTC site on 9/11 (McKinsey & Co., 2002). At 9:59 a.m., the South Tower collapsed, killing many civilians and emergency workers. The collapse destroyed the West Street command post, leaving many firefighters and officers without specific direction. Many of the FDNY members who were stationed in the North Tower were unaware of the collapse of the South Tower and never heard an evacuation order (McKinsey & Co., 2002). At 10:29 a.m., the North Tower collapsed killing the Chief of the Department, Peter Ganci, Jr., and First Deputy Commissioner William Feehan as well as other members of the department (Golway, 2002). A few days later, reports were made that 343 were firefighters, fire officers and EMS personnel perished or were missing in the 9-11 catastrophe. The efforts of Emergency Medical Services (EMS) have been largely determined by three different waves of injuries. First wave occurred when aircrafts impacted both towers, resulting in hundreds of immediate causalities. Moreover, the majority of individuals injured during impacts was not able to receive medical or rescue assistance and died in the towers collapse. The first wave also was associated with numerous burn victims, suffered from ignited fuel during the impact. Because these individuals were located on lower floors and ground floor, they were able to present early to emergency medical personnel. Severely burned victims were immediately taken to St Vincent’s Hospital, located 5 quarters from the scene (McKinsey & Co., 2002, p.48). Individuals in critical condition were taken in emergency rooms, while moderately injured patients were treated outside. Patients were registered using disaster registration kits, having unique medical record number for every injured individual. Within the hospital facilities, all personnel followed disaster plan and performed functional responsibilities assigned by the plan. The second injury wave occurred during the collapse of towers. The evacuation of injured victims after collapse has been characterized with chaos and has been accompanied with additional injuries and causalities occurred during rescue efforts, which eventually formed the third injury wave. After the collapse communication between EMS personnel became ineffective, because roof antennas were destroyed. Communication with hospitals was also severely damaged, phone system has been characterized as unreliable and city’s disaster operations could not efficiently inform the receiving hospitals. As a part of disaster response strategy, Emergency Medical Services and the NYFD started utilizing field hospitals serving as triage aid stations, which were spread across the incident scene. Triage area consisted of emergency medical technicians, physicians, nurses, surgeons and other assisting personnel and volunteers. Triage area has been utilized primarily as victim’s screening method, in which patients with less serious injuries received yellow and green designations and were assessed and treated by medical personnel immediately (Acosta and Levenston, 2002). Red designated critical individuals after being stabilized were immediately transported to receiving hospital facilities. Critically assessing the effectiveness of disaster response by emergency services, communication has received a nearly universal expert agreement as the number one problem. Because UHF radios do not work in high-rise buildings, the FDNY lost track of their firefighters on the front line. Similar communication problem has been experienced by Emergency Medical Service. Besides radio transmission problems caused by antennas being destroyed in the collapses, radio communication has been heavily compromised because same broadcasting frequency was used for both dispatch-unit communication and for incident command. With hundreds paramedics responding simultaneously, radio traffic became chaotic and at some point incomprehensive (Acosta and Levenston, 2002). Experts on emergency response strategies point out the lack of communication between police and fire departments on September 11, 2001. From the moment disaster occurred and by the end of the day, the NYPD maintained a separate command structure and did not have their own representative at the NYFD command post. Practically, effective communication command between responding agencies during any incident is recognized as a mandatory prerequisite for successful rescue and relief efforts. From the array of communicative problems occurring during 9/11 disaster, the most ineffective communication was conducted between receiving medical facilities, dispatch and incident command. The immediate and inevitable result of this ineffective communication became the fact that the first receiving hospitals became immediately over-run and practically were not prepared for it. Simultaneously, those hospitals who were effective in their resource mobilization did not receive patients. At some points, the most effective communication with the scene, though still fragmentary was available only via hand-held radios (Levenston and Acosta, 2001). For Emergency Medical Service and receiving hospitals crowd control remained one the main challenges. In hospital facilities, all medical personnel focused heavily on emergency departments (Menlove, 2002). Over-triage also represented a significant challenge, as many receiving hospitals became overcrowded by with minor injured individuals (Hirshberg et al, 1996). Traditionally for disaster management, over-triage occurs when too many patients receive a high triage priority and are taken to medical facilities. Practically, during major incidents minor injured patients in big quantity over consume hospital’s resources and cause delays in care received by severely injured patients. On macro picture, it may have caused delay in emergency treatment of some critical patients. Effective scene control has been recognized as another critical problem in emergency response in the World Trade Center disaster. Because emergency units, including fire and medical services, were receiving chaotic and fragmented information on where to respond, many units chaotically flooded incident areas and in many case were completely blocking each other (McKinsey & Co., 2002, p.29). Furthermore, some units responded without appropriate direction, which eventually resulted in excessive traffic and vehicle flooding of important exit areas. REFERENCES Acosta, J.K. and Levenston, R.L. (2002). Observations from Ground Zero at the World Trade Center in New York City, Part II: Theoretical and Clinical considerations. International. Journal of Emergency Mental Health, 4(2), 119-126 FDNY Deaths.(2002). New York Times online. Retrieved from Sept, 29, 2010 Gad-el-Hak, M. (2008). 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