Get `Em Out Alive: Evacuation Considerations for EMS

     Nearly every community in America could face an emergency evacuation. All it could take is a single rail line and derailed train, or a lone highway and overturned tanker. Hopefully, you know what those threats are in your community. But does that mean you're ready to handle the medical aspects of a large-scale citizen relocation?

     "Evacuations could be either mass-casualty or mass-care kinds of events, and EMS needs to be prepared to provide healthcare and prehospital care," says Chase Sargent, president of Virginia-based Spec Rescue International, which offers training, consulting and search services for emergency-response organizations.

     But the challenges for EMS begin long before evacuees congregate at their destination. Especially with the elderly, infirm and special populations like hospital patients and nursing-home residents, if they're not sheltering in place, EMS will be a large part of getting them where they're going.

     "EMS is going to take the brunt of people who can't get out under normal methods," says Mike Fagel, PhD, CEM, a 30-year fire/EMS veteran who has served as emergency management director for the North Aurora (IL) Fire Department and now provides technical support for federal, state and local disaster-response projects. "And a lot of EMS agencies don't have the staffing and equipment they'll need to do that."

     Think New Orleans, where some nursing homes and care facilities were never evacuated because the buses and ambulances contracted to do so were occupied elsewhere. There's also the matter of staffing-in a disaster, public-safety providers will be affected too; some may choose to stay with their families.

     "Even though we're fire, EMS or the police, we're still part of the population," says Sargent, a retired division chief and special-operations battalion officer with Virginia Beach Fire and Rescue. "We could find ourselves victims as well."

     This means you need extremely robust, interregional mutual aid. Don't rely on your next-door neighbors; they could be swamped too. Know where to get manpower and supplies from unaffected areas.

     This ties into perhaps the most important weapon any department can have in its pre-evacuation arsenal: communications.

     Here, communications doesn't just mean radios on the fireground. It means all the meeting, planning, talking and problem-solving you've done with your full range of colleagues and cohorts before an event happens.

     "Communications is you and I talking back and forth," says Fagel, who offers training, assessment and support services through his company, Aurora Safety. "It's me saying 'These are the issues I see. What can you offer to help me?' and you saying 'Here's what I think we can do.'"

     Other issues involved in an evacuation include:

• Predisaster vs. postdisaster evacuations-Pulling people out on the back end-when resources are stressed, roads potentially blocked and victims are suffering event-related injuries and exacerbated conditions-is much harder, and will require more, and potentially different, resources.
• Long-term situations-Caring for people over days or weeks is different than caring for them for hours. You may be in a Superdome-type situation where care has to be bare-bones. Evacuees may need nonurgent or ongoing care; some may not have had any medical care in years.
• Personnel problems-Providers may be double- or triple-counted among disaster-response resources. Consider the full-time medic who's also a volunteer firefighter and DMAT member. He may be counted as three responders in your disaster plans-he's not. This could create an unanticipated shortfall.
• Public education-Help your citizens help themselves. Offer as much information as you can about emergency supplies and the basics of first aid and trauma care. They should know their prescriptions and keep copies of their medical records with a distant relative or in another secure place.

     The Emergency Film Group (www.efilmgroup.com) offers a new training product for emergency personnel who might be involved in carrying out evacuations. Protective Actions: Evacuation/Shelter in Place covers issues to consider and steps to take for both, and includes a instructor's PowerPoint presentation.

     "You have to know the hazards and plan for them," says Sargent, who was part of the technical committee advising the project. "Five minutes before the ball is not the time to learn to dance."