Why Existing Protocols Have Failed

• 2008 May 1

Existing protocols for major incident response deployment and operations are inadequate. It’s assumed that the individuals responsible for implementing these protocols will function at the same levels they function at during training. Such personnel usually train after getting eight hours of sleep and a good breakfast, so their performance level is at its highest. 

However, during a disaster, it’s not uncommon for deployed personnel to arrive on scene after having little or no sleep for 24 hours. They may also experience a high level of stress if worried about the welfare of loved ones left behind. The performance of these individuals is therefore compromised, and the situation going forward will deteriorate since sleep deprivation and stress only compound as the length of deployment increases. 

To add to the stress level on scene, assumptions made about the resources that will be available to assist in scene set-up are often inaccurate, as are assumptions about the condition of the region’s infrastructure where the major incident has taken place. 

During disasters, such as earthquakes, hurricanes, tornadoes and terrorist events, the existing health-care infrastructure is either overwhelmed or destroyed, and the need for outside help is immediate. Within 72 hours following a disaster, local health-care resources begin to recover and become operational, and the flow of walk-in/drive-in patients begins to subside.

Traditionally, it has taken 72, 96 or 120 hours for substantial medical resources to arrive and become capable of patient care.   Disaster management officials must therefore improve their capabilities not only for hurricanes and earthquakes, but also terrorist attacks, tsunamis, floods, pandemic influ-enza, loss of a hospital due to an incident and large public gatherings, such as state fairs, the Olympic games or political conventions. 

The traditional health-care response that provides large, multi-bed resources to major disasters from outside agencies and national stockpiles, which are essential after an incident, is often described as slow and cumbersome. This description does not reflect in any way on the health-care professionals involved, but on the nature of the tools with which they respond.

Deployments with large shelter facilities that take days to deploy and many hours to erect impede the process and delay the care and services desperately needed soon after a major event. 

Equipment that takes several hours to set up also delays the readiness of the deployed facility. To add insult to injury, teams arriving to set up operations are often left to fend for themselves.

Two factors that greatly affect the amount of time needed to set up deployments are the weight and bulk of much of the traditionally deployed equipment, which requires significant physical effort to move and position. This results in personnel becoming physically exhausted, stressed and diverted from delivering medical care to those in need. Their exhaustion is compounded by the very nature of the events they’re deployed to, putting them under added undue stress. 

The usual response teams, such as DMAT, can provide assessment, triage, minor surgery and the equivalent of sick-call care, but they don’t have the equipment or capability to perform major surgery or ICU patient management. 

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