Dose EMS need a Strike team

Kavsuvb

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I saw this in JEMS and it ask, dose EMS Need a Strike team and I say NO because we already have a National Medical response system such as DMAT's, CERT's, FEMA Medical Reserve Corps, Air National Guard Medevac teams, Army National Guard Medical brigades, US Coast Guard, USPHS Commissioned Corp, State Guards and State Militias. It's gona overlap what the Feds already have and here's the link to the article;

Why Ambulance Strike Teams Will Improve Homeland Security Response
 

NPO

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You're asking the wrong question. ASTs and MTFs already exist in several states (including California) and at the federal level with FEMA. Yes, we do need them.

The question should be, how do we more appropriately utilize these resources?

You mention things like DMAT. State DMATs have been less and less used for operations every year, mostly being logistical support. Federal teams have more flexibility and have been used more in recent years.

CERT isn't medical. Things like the Coast Guard are big asks, and inefficient. They do have benefits, like they can get in places other helos cant. However resources like the USGS or national guard have to be requested by the Governor. For a local or regional incident, that won't happen.
 
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Akulahawk

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I'm going to say that we DO need EMS strike teams. That's a resource. As already stated, the better question is how do we most appropriately utilize the resources we have? For smaller incidents that are more local/regional, EMS strike teams can be an excellent resource for rapidly increasing local system capacity. Think SURGE. If something big happens in my county, the system can become quite overloaded. Activate both mutual aid from neighboring counties and bring in strike teams from elsewhere and within a couple HOURS the system can go from overloaded to being able to manage operations relatively easily. Give it a few days and .mil field hospital units can increase system capacity dramatically on that end but they have to be requested, units activated, and all their personnel/equipment all has to be mobilized appropriately, and setup before they can begin operations.

Certain federal or federalizble assets do have great flexibility and capability but those assets take time to mobilize. Being able to use .mil resources for SAR and medical evac is great but it takes time for those assets to mobilize and arrive on station to begin their work. Yes, I'm including USCG in this. I would also counter in stating that we really do NOT have a national medical response system. What we have is multiple assets with overlapping capabilities at multiple levels of government that all take time to mobilize, organize, and deploy to where they are needed. Given an appropriate amount of time, sure, all can be organized and deployed in a unified manner but all that does take time. Once all those assets are available, they then have to be integrated into the local and regional systems.

You might say that we do this on a semi-regular basis and in a way, we do. It's called "Hurricane Season." What we see is the system working somewhat well when we can anticipate a large regional disaster coming. It's possible with hurricanes. How quickly do you think we could effectively respond to a large earthquake or volcano eruption in the Pacific Northwest? I use those because those are "surprise" events...
 

DrParasite

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You know, you listed several groups, but none of them are EMS centric groups.....

While I think we should have AST, we need to remember what the roles of an AST is, and considering many/most agencies are already short staffed, we might not have the available staffing for an AST.

The shooting in Orlando is a great example of when an AST is NOT needed. They needed their local OEM to get them 20+ ambulances, to a staging area, not 4 5-unit strike teams under a leader. After all, the AST might be good to go in 4 hours.... can I really wait 4 hours?

Further, what is the roles of an AST? meaning, am I getting 7 strike team units under the supervision of a strike team leader, of 7 single resources designed to answer EMS calls in a disaster affected system?

As a former EMS employee who frequently worked hand-in-hand with NJ's EMS task force, I can tell you I worked many disasters, events, and drills, and for most of them, I wasn't on an ambulance. I did logistics, communications, provided medical support for a shelter, and had coworkers who set up hospitals. We also provided MCI vehicles (with a bunch of equipment), and provided ICS command staff. When New Orleans was hit by a hurricane, my coworkers went down as part of the AST; but once they were there, did they function with a common goal, or did they break up to answer their individual calls?

If I have a building collapse, I might call for an AST. I will need EMS resources there for hours, if not days, providing medical coverage to the responders. If I have USAR or rescue medics, I might even have personnel who can assist with the search operations. Ditto a 3+ alarm fire; I need units assigned to the incident, and they will be there for hours, all under the supervision of a team leader.

While an AST is typically 5 units with 2 people each, the question I would ask is do I need EMS personnel, or ambulances to transport people? If I need EMS personnel, I might request 2 units and put 5 people in each truck (using the ambulance as a transportation vehicle, giving me 6 personnel to provided medical coverage for a scene and scene and 4 to transport if needed), instead of everyone bringing minimum staffing and trying to find a parking spot for all units.

Personally, I think an EMS Task force is more useful than an ambulance strike team, unless I have a long term or preplanned MCI and can wait a few hours until all of my resources are assembled.

@Kavsuvb, here are some additional information for you about ASTs

and for an EMS Task force:
 
OP
Kavsuvb

Kavsuvb

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Well Some states like Texas, California, Georgia and New York have State Guards and State Militias. Within the State Guard and State Militia's they have a Medical brigade or Medical battalion that can respond to Medical crisis in the state.

Texas State Guard; https://tmd.texas.gov/state-guard

New York State Guard; https://dmna.ny.gov/nyg/

Georgia State Defense Forces; http://paonews.net/
 

CCCSD

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Taking up to 24-72 hrs to deploy. Your arguement isn’t structured on facts, just your opinions, which are running 99% incorrect.
 

Phillyrube

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We had a strike team in SE Virginia for some time. DMAT is great, did that as well but takes time to gear up. Local teams much quicker.

 

NPO

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Well Some states like Texas, California, Georgia and New York have State Guards and State Militias. Within the State Guard and State Militia's they have a Medical brigade or Medical battalion that can respond to Medical crisis in the state.

Texas State Guard; https://tmd.texas.gov/state-guard

New York State Guard; https://dmna.ny.gov/nyg/

Georgia State Defense Forces; http://paonews.net/
Your idea for what an AST is, seems to be misplaced.

The militia and things like that are for moving bodies (dead or alive) triage and management in a CCP.

ASTs are for transport. Be it from an extended scene or evacuated nursing homes, hospitals, etc...
 

NPO

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Your idea for what an AST is, seems to be misplaced.

The militia and things like that are for moving bodies (dead or alive) triage and management in a CCP.

ASTs are for transport. Be it from an extended scene or evacuated nursing homes, hospitals, etc...
And I'll add, that on am AST, you do very little if any treatment in most circumstances. Your role is transport.
 

Akulahawk

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Well Some states like Texas, California, Georgia and New York have State Guards and State Militias. Within the State Guard and State Militia's they have a Medical brigade or Medical battalion that can respond to Medical crisis in the state.
Taking up to 24-72 hrs to deploy.
The Medical Brigate/Battalion assets are completely fabulous and wonderful once they're setup. Those assets are for ASSESSMENT and TREATMENT of illness and injury. That's all they do. Consider those to be essentially a mobile HOSPITAL that cannot simply move at the drop of a hat. Once emplaced, they MUST be completely cleared out of all patients before they can be moved to another physical location. Because of this, such units will be emplaced at a safe distance away from an incident so they can be both relatively safe from the hazards of the site while still being reasonably accessible to the personnel at the incident. State Guards/Militia/NG assets are GREAT for manpower.
ASTs are for transport.
This is 100% correct. The AST is strictly for transport. This is why ASTs don't have to be anything special. Their job is simply to MOVE patients from point A to point B. That can be from an incident site (or decon site) to the Field Hospital or from the Field Hospital to a permanent hospital or from a permanent hospital to a SNF hospital. Remember folks, in a MAJOR disaster that goes beyond a regional level, all those SNF hospitals won't be doing rehab, convalescent, or custodial care. They'll have to shift quickly over to doing basic Med/Surg care as the Acute Care hospitals will be doing the immediate care and then cycling those patients out quickly. All those patients need TRANSPORT and that's where the AST (and there will be MANY called in those instances) comes in. Actual CARE in an ambulance will be minimal as the ALS resource will have to be conserved as much as possible. Lots of EMT and EMR personnel will be needed for such transports. One ambulance I used to work in was setup for this kind of work: it could take 4 patients. One on the cot, one on the bench, and two suspended on flats from the ceiling. Ambulances set up that way would be what's needed during massively large incidents.
 

CCCSD

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I brought up the four pt set ups in my old rigs, and that it is still military standard, in a recert class. The instructors were horrified that I would even consider transporting more than two pts at a time...

Im aghast at what “paramedics” think is a standard of care now. How will they ever cope in a real MASCAL.
 

FiremanMike

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Taking up to 24-72 hrs to deploy. Your arguement isn’t structured on facts, just your opinions, which are running 99% incorrect.
My state came up with a USAR strike team concept shortly after 911.. The mission/goal of the strike team is to be on scene within an hour (there are 5 throughout the state) and work the incident until up to 24 hours when the FEMA team arrives.

In this model, we really have 3 phases of the incident, 0-1 hour managed by local resources, 1-24 hours managed by the strike team, and 24+ hours managed by the FEMA team..

I realize this is USAR and not EMS, but the concept isn't necessarily completely out of the realm..
 

CCCSD

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We have strike teams as well. The OP doesn’t seem to understand HOW this works. Sure, you can, possibly, get a bunch of rigs rolling in a few minutes to a few hours, however, you can’t strip all of them. That takes time to organize. It’s in just about every EMS policy I’ve read.

The OP seems to think these rigs and staff will magically appear or can be hired and kept on standby.

BTW, “dose“ is an amount of something, usually medication. Does is a question.
 

FiremanMike

EMS Coordinator
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We have strike teams as well. The OP doesn’t seem to understand HOW this works. Sure, you can, possibly, get a bunch of rigs rolling in a few minutes to a few hours, however, you can’t strip all of them. That takes time to organize. It’s in just about every EMS policy I’ve read.

The OP seems to think these rigs and staff will magically appear or can be hired and kept on standby.

BTW, “dose“ is an amount of something, usually medication. Does is a question.
In fairness to the OP's point, I think the question is "could we create something".. Could we have a mass casualty trailer stocked and stored with non-perishable EMS supplies and a team of folks who could respond and bring that equipment, similar to how we run our USAR strike teams..

It's an interesting idea, although I'm not sure about the feasibility and cost/benefit. While our USAR strike team has been activated a handful of times over their history (approx 15 years I believe), the number of times nationwide when a mass casualty response could be utilized seems dramatically lower than that..
 

NPO

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In fairness to the OP's point, I think the question is "could we create something".. Could we have a mass casualty trailer stocked and stored with non-perishable EMS supplies and a team of folks who could respond and bring that equipment, similar to how we run our USAR strike teams..

It's an interesting idea, although I'm not sure about the feasibility and cost/benefit. While our USAR strike team has been activated a handful of times over their history (approx 15 years I believe), the number of times nationwide when a mass casualty response could be utilized seems dramatically lower than that..
Many states have exactly that.

I believe the OP is in California, so I'll answer with that relevant information, although I could be mistaken on that.

CA EMSA has 26 DMSUs (Disaster Medical Supply Unit) throughout the state. These function very similar to OES fire engines in that the state can request them. Additionally, many ambulance operations have their own MCI equipment.

My agency (not California) maintains 2 MCI trailers, one with medical supplies, one with operational supplies (Stokes, cots, backboards, etc). We also have a "MMU" (Mobile Medical Unit) which is like a small urgent care on wheels, expandable to a 50+ bed hospital for very large events. That's more on the Nationwide taskforce deployment level. We don't use it locally.
 

akflightmedic

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I brought up the four pt set ups in my old rigs, and that it is still military standard, in a recert class. The instructors were horrified that I would even consider transporting more than two pts at a time...

Im aghast at what “paramedics” think is a standard of care now. How will they ever cope in a real MASCAL.

LOL....I have students who do not believe we routinely transported three patients on a regular basis "back in the day", sometimes four!!

MVC...1 patient on stretcher, 1 patient on bench seat and the third back boarded patient was hooked above the bench seat. Yep, there were hooks on the wall to secure a third patient on a board. I have even placed a 4th either in CPR seat or Captain's chair...maybe thrown one in front passenger seat who was low acuity for partner to keep an eye on!

Fun times then!! LOL
 

FiremanMike

EMS Coordinator
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LOL....I have students who do not believe we routinely transported three patients on a regular basis "back in the day", sometimes four!!

MVC...1 patient on stretcher, 1 patient on bench seat and the third back boarded patient was hooked above the bench seat. Yep, there were hooks on the wall to secure a third patient on a board. I have even placed a 4th either in CPR seat or Captain's chair...maybe thrown one in front passenger seat who was low acuity for partner to keep an eye on!

Fun times then!! LOL
It's so much easier now that pretty much no one is on a backboard :)
 

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