Ambulance services incidents

See, for example the discussion on the London Ambulance Service incident discussed in Section 10.4. 

All hospital plans should include provisions for a proportionate response to the arrival of contaminated casualties, with procedures for rapid lock-down and establishing entry and exit restrictions. Most ambulance service plans already provide for sending an immediate alert to all hospitals designated to receive casualties whenever a major incident is declared. Although patients may have already self-evacuated before the emergency services arrive, ambulance plans should also provide for warning all... 

MOAs are required with local MTFs, local emergency medical services, ambulance services, and regional or state emergency medical services officials. The MOAs and frequent coordination with these agencies are necessary to ensure that appropriate off-post resources will be available for support during a chemical accident or incident. 

CPR alone does not replace defibrillation in an SCA incident. CPR merely gives a person precious time until medical help arrives. Yet, many ambulance services arrive several minutes after the call. According to the American Heart Association, the chance of survival decreases 10 percent with each passing minute that the heart beat is not returned to normal. Very few people have survived after 10 minutes. Unfortunately, experts can t tell you why SCAs occur nor how to prevent them. They can, however, tell you the best known way to fix them — AEDs. 

Box 5.2 Mnemonics used by ambulance services for reporting a HAZMAT incident METHANE ... 

One of the main difficulties of a chemical incident is obtaining rapid information on the identity of the chemical or mix of chemicals involved and their health hazards. Disseminating this information is vital and allows medical management to proceed on an adequately informed basis. Evidence of the nature of the released chemical will come from the detection equipment deployed by the fire and special ambulance services and also from the primary assessment of the signs and symptoms of casualties to try and identify characteristic toxidromes. These are considered in Chap. 6. 

The transfer of casualties to the hospital will depend on the type of emergency medical service deployed. Some countries such as France deploy medical personnel with the ambulance response teams, and these can provide definitive early life-support and antidote treatment whilst delaying transfer. Other paramedically operated ambulance services have an early transfer to the hospital as a priority, delaying treatment until reaching the emergency department. Factors affecting transfer include the number and severity of contaminated casualties, location of the incident, weather conditions, distance to the appropriate medical facilities and the resources available. 

The equipment officer appointed by the ambulance service is responsible for the provision and resupply of medical equipment at the scene of an incident. 

The responsibilities of the ambulance service at a major incident include ... 

A Category 2 incident is one clearly recognizable from the outset as beyond the capability of the forces to hand. The emergency services should be informed immediately of the magnitude of the incident and the specific location. The resources sent in response, e.g. the number of fire appliances, ambulances, police, need to be predetermined by good pre-planning. 

The availability of capital resources is equally important. As mentioned, the current health care system— including the emergency, acute, and chronic care components—are all operating at maximal capacity. However, EMS vehicles, ED and hospital beds, and operating rooms will be needed in differing levels based on the incident (Auf der Heide, 2006 Pesik et al., 2001). For the EMS system, planners must know and address mutual aid issues. In upstate New York, Rural Metro Medical Services provides EMS in many cities and has a plan to shift resources between cities in event of crisis. Thus, additional ambulances, communications equipment, and maintenance facilities can be deployed throughout the region. In other areas, mutual aid compacts must be in place to allow for the immediate recruitment of as many additional EMS units as are needed (Auf der Heide, 2006). 

Victims of chemical contamination need prompt and effective treatment, both at the scene of the incident and in hospital. Ambulance or emergency medical services and hospital emergency rooms provide the front line health response and most will already have tried and tested contingency arrangements for accidental chemical releases - often referred to as HAZMAT or HAZCHEM (hazardous materials and hazardous chemicals) protocols. Whether for an accidental or deliberate chemical release contingency arrangements need to address the following key objectives ... 

First responder—Personnel who have responsibility to initially respond to emergencies. Some examples are firefighters, HAZMAT team members, law enforcement officers, lifeguards, forestry personnel, ambulance attendants, and other public service personnel. In the case of hazardous materials incidents, these personnel typically respond at the site where the incident occurred. 

Collisions and derailments, especially those involving hazardous materials usually require the attendance of emergency services. At the very least, ambulances and the fire department will attend. If an evacuation is necessary, police will be called to help in the evacuation and provide security for the affected area. Assistance of the state police or the national guard may be necessary in major incidents. Local schools may have to be opened to provide temporary accommodations for those displaced, and the Red Cross may be called to provide bedding and food service for the residents and emergency workers. 

The emergency services response at the scene of an incident is controlled by the joint emergency services control centre which consists of the silver-level commanders of each emergency service. The fire, jx)lice and ambulance commanders will be recognisable by their identifying tabards. Within the bronze area each service has a forward commander who is responsible to the commander at silver level. 

The emergency services responses at the scene are controlled by the individual service commanders, who together comprise the joint emergency services control centre or silver command. The silver commanders report to their gold command. Ambulance, police and fire commanders will usually be appointed. A medical incident commander will be appointed in incidents involving significant numbers of live casualties. 

---