EMS OPS At Long-Duration Incidents

     EMS supervisory personnel and incident command staff should be familiar with strategic goals for medical operations at emergency incidents of extended duration that would not otherwise be defined as disasters, such as prolonged structural firefighting and special-operations incidents. While these events occasionally span more than single 8-, 12- or 24-hour duty shifts, few last longer than two. This topic is important because, although there has been no causal relationship established between event duration and the incidence of responder illness and injury, most experts argue that such a relationship exists.

What Is a Long-Duration Incident?
     Long-duration incidents can be defined in many terms, but there's a general consensus that any incident lasting longer than one work cycle or operational period is a long-duration incident. A work cycle, in turn, is usually defined in terms of shift length. Although many firefighters and EMS personnel are accustomed to working 24-hour shifts, a more typical work cycle is 8-12 hours. Incident work cycles should be set by the Incident Commander based upon a number of factors, including weather, workload and manpower availability. However they're formally defined, prolonged emergency operations exist de facto at a point at which personnel rotation becomes mandatory to reduce the possibility of physical and/or mental fatigue.

Medical Ops at Long-Duration Incidents
     There are several overriding goals and objectives that are essential to the success of medical operations at emergency incidents (see Table 1).

     Treatment and Rehabilitation sectors should be established and appropriately staffed as soon as possible into the incident. EMS providers should be aware of the chain of command, treatment protocols and SOPs, plus the anxiety that exists in the fire service whenever medical personnel evaluate a firefighter's health status during an incident. EMS managers should drill these concepts during preincident educational sessions.

     The National Incident Management System (NIMS) must be utilized as a framework to manage all major incidents. Within a purist model of ICS, patient care functions are located within the Operations sector, alongside fire suppression and rescue services. Rehabilitation and medical monitoring of emergency response personnel is located within the Logistics sector (Medical Unit Leader), as this is considered to be a function that supports the overall incident. Rehabilitation and medical monitoring is essentially a process designed to restore the physical and mental health of personnel back to baseline conditions prior to their return to a harsh environment.

     The EMS Agenda for the Future speaks frequently about the need to move from a reactive to a proactive stance in the delivery of emergency medical services. EMS personnel should have a visible presence at the incident scene even if dispatched for a standby at a dynamic and uncontrolled event. This presence must be at the command post and in the form of clearly marked or defined Treatment and Rehabilitation sectors. Managers should don incident command vests, set priorities and accomplish tasks using predefined checklists. They should also strive to address potential health and safety issues among their colleagues in such a way that it is clear that the goal is to prevent injury and illness, rather than to wait for such events to occur.

     EMS personnel must also be prepared to work jointly with the Safety Officer to address public-health issues, such as hand washing and food safety, and implement injury-and illness-prevention initiatives. Such issues can have a significant impact on emergency responder health and wellness, but are rarely addressed in EMS training courses.

Why Long-Duration Medical Ops May Fail
     The objectives of extended medical operations may be ignored for a variety of reasons (see Table 2). Principles of major incident management and occupational and preventive medicine are often not targeted toward EMS providers and aren't taught in-depth during initial training. National courses on these topics, such as the Incident Safety Officer and Health and Safety Officer courses offered by the U.S. Fire Administration, are geared primarily toward fire officers. In EMS systems that have inadequate availability of command staff and limited transport resources, dispatching additional ambulances in order to deliver "worker bees" to the scene may be frowned upon. Lastly, Incident Commanders do not always recognize the importance of a Rehabilitation sector, especially when there do not appear to be any ill or injured firefighters.

David Jaslow, MD, MPH, EMT-P, FAAEM, is chief of the Division of EMS, Operational Public Health and Disaster Medicine within the Department of Emergency Medicine at Albert Einstein Medical Center in Philadelphia. He is an active firefighter/paramedic, assistant chief for EMS, and EMS medical director for the Bryn Athyn Fire Company. He serves as medical editorial consultant for EMS Magazine.

Marc Calabrese, DO, is the chief resident in the University of Medicine and Dentistry of New Jersey School of Medicine's Emergency Medicine residency. He participated in the authorship of this article as part of his EMS rotation, which is required of all emergency medicine postgraduate training programs in the United States and Canada.