Post Severe Storm Response

[Rcoddington]

On April 27th 2011 my area was hit by a series of very strong tornados (including several F5s). The storms hit from early morning to late afternoon. Reports were coming in over radio that different areas were requesting all available resources. This is the day that basically the :censored: hit the fan. All power was down including radio repeaters and cell towers. (Later learned over 250 people died that day in our state)

So scenario is you are an EMT with a well stocked Med kit and are familiar with areas worst hit. Would you go out and help as much as possible? Or take it easy?

**Also realize that ambulances were to the point of self dispatching because of complete lack of COMs, and people couldn't call 911 and 911 couldn't dispatch.**

 

[DrParasite]

how are you self dispatching? meaning, how do you know where the sick and injured are?

If I was in your position, i would not take my jump kit and help people. I would get on the ambulance and help people. Staff 3 or 4 person crews, and realize your on your own, and no M/a is going to come. Also remember, many people will need an ambulance to take them to the hopital, not a self dispatching EMT with a stocked jump kit. freelancing is generally frowned on, especially when you need help and no one know where you are.

do the best you can with limited resources. that's what happens., and i hope you have a plan for it.

Durring Superstorm Sandy, everyone was told "there would be NO mutual aid provided", so make proper arragnement. just remember, it's a severe storm, so calling for all available resources isn't going to help, since there is a good chance everyone is calling for all additional manpower.

 

[DesertMedic66]

If you are employeed with an ambulance company then being at work is where you will do the most good. If they need you to dispatch then they will place you there. If they need you responding then they will put you there.

One of the hardest hit areas in NY during Hurrican Sandy was actually having people who lived there helping out. I had an unemployed NY EMT and a laid of NYPD officer come up and ask for help. The area they were helping with had 0 running ambulances. They were using their personal 4x4 vehicles to go door to door and help people out (the areas they were going needed a 4x4 vehicle).

 

[Rcoddington]

how are you self dispatching? meaning, how do you know where the sick and injured are?

If I was in your position, i would not take my jump kit and help people. I would get on the ambulance and help people. Staff 3 or 4 person crews, and realize your on your own, and no M/a is going to come. Also remember, many people will need an ambulance to take them to the hopital, not a self dispatching EMT with a stocked jump kit. freelancing is generally frowned on, especially when you need help and no one know where you are.

do the best you can with limited resources. that's what happens., and i hope you have a plan for it.

Durring Superstorm Sandy, everyone was told "there would be NO mutual aid provided", so make proper arragnement. just remember, it's a severe storm, so calling for all available resources isn't going to help, since there is a good chance everyone is calling for all additional manpower.

In the beginning of the day communications were still up and everyone was aware of the hardest hit areas. After all power went down there was still some FM radio stations that would tell people to shelter when another tornado was inbound, but in the early afternoon. The Doppler radar they were using was destroyed. So even early warning was no longer existent, but interestingly the majority of the tornados followed the same paths so a few single areas just were pounded and pounded (that's how you knew where todo).

I believe this to be different from hurricane Sandys response because we had almost no warning this storm was going to hit, and y'all had quite awhile to get assets in place.

Also it was to the point that just hopping on an ambulance doesn't really help when your going to fill up the entire ambulance with patients. There weren't enough trucks to transport everyone so people were actually driving down there interstate I'm pickup trucks with wounded in the back on the way to the hospital. Several patients were transported on doors (as makeshift backboards).


Just to give you an idea this is a picture of an ambulance transporting as many backboards as possible to one of the areas.

The ambulance company couldn't place you where they needed you because all the trucks were out and there was no communications to tell you where todo anyway.

 

[Veneficus]

The picture of the ambulance with so many backboards tells me that agency has no idea how to handle a disaster.

Disaster response and operations (and by extension war and austere medicine) are well researched specialty fields with lots of around the world experience.

All disasters are mitigated by logistics, not by response to to individual treatments.

The first step in disaster response is to understand and plan for the conditions.

There are actual published medical guidlines on who should receive care and how much because of the limit and lack of resources. While some of those guidlines are really difficult decisions to stand by, they are for the good of everyone.

As any experienced person can tell you, the normal civilian EMS response, treatment, and transport model does not work. (One of the reasons nobody wants EMT volunteers post incident)

There are numerous accounts of destruction of facilities, or facilities with limited staffing and capabilities. If you or your agency didn't understand this basic concept, I hope you are volunteers because certainly there is no level of professional knowledge.

Additionally, in multiple recent disasters it was determined that often EMS changes from a transport mode to a shelter and care in place operation. Particularly for those triaged as less urgent.

In disasters and "refugee conditions" as the phrase is used, there are 2 main types of diseases which become cyclical. Acute trauma during the initial event, followed by basic health problems (chronic condition management and public health issues) then acute trauma becomming prevalent again during reconstruction efforts.

Was your agency really planning on putting dozens of people on backboards and flooding an ED with them?

Most EMS treatments will be of little use. The few that are will be in short supply. Medications and devices generally used to prevent acute exacerbations of chronic events are not carried by EMS.

Organization is another major part of disaster response. It is better to have a central area where care is directed from than people wandering around doing their own thing. Safety issues aside, basic needs like toilet, sleep, food, water, etc. all have to be managed. (As well as an influx of selfdispatched volunteers who add to the logistical problems)

Anyway, the best and nicest advice I can give you is, get some knowledge of disaster response before you try to decide what your role in it is going to be.

 

[RocketMedic]

If that truck had been loaded with water bottles, a portable generator with space heater (or use the truck...) and linens/MRE/extension cords, you'd be like Disaster Jesus.

COPD, CHF, and "Odd Cardiac Dysrhythmias" are generally fatal conditions in a true disaster-type situation. These are people best managed by a designated evacuation asset. Outfitting everyone to take care of them is redundant, to say the least. (I know, but politically, it's hard to leave Grandma Bradycardia or Great-Uncle Wheezer at home in the mess of things.)

You say you lost all communications- did your agency have a generator for its radios? What about the trucks? If your truck runs, you've got a radio. Heck, loot some walkie-talkies.

Regardless of level, showing up to a destroyed neighborhood with a plan, a bright flashy ambulance, clean water and hot food and as much power as you can push out (power strips and extension cords) is a better response than strapping everyone you could find to a backboard and flooding the local ED. People are animals with a thin veneer of 'civilization' and revert quickly to unpredictability when they lose comforts; I like keeping them comfortable and not-dangerous. (Note, in something like this, it may be more appropriate to use POVs or buses or a designated evacuation truck than to pull your unit out of the Triage Nest).

Politically, an excellent disaster response is a great tool to avoid future budget cuts. It's way better to be remembered as "those awesome guys from CXZT who made it all better" than "what did they do for me?"

 

[Rcoddington]

If that truck had been loaded with water bottles, a portable generator with space heater (or use the truck...) and linens/MRE/extension cords, you'd be like Disaster Jesus.

COPD, CHF, and "Odd Cardiac Dysrhythmias" are generally fatal conditions in a true disaster-type situation. These are people best managed by a designated evacuation asset. Outfitting everyone to take care of them is redundant, to say the least. (I know, but politically, it's hard to leave Grandma Bradycardia or Great-Uncle Wheezer at home in the mess of things.)

You say you lost all communications- did your agency have a generator for its radios? What about the trucks? If your truck runs, you've got a radio. Heck, loot some walkie-talkies.

Regardless of level, showing up to a destroyed neighborhood with a plan, a bright flashy ambulance, clean water and hot food and as much power as you can push out (power strips and extension cords) is a better response than strapping everyone you could find to a backboard and flooding the local ED. People are animals with a thin veneer of 'civilization' and revert quickly to unpredictability when they lose comforts; I like keeping them comfortable and not-dangerous. (Note, in something like this, it may be more appropriate to use POVs or buses or a designated evacuation truck than to pull your unit out of the Triage Nest).

Politically, an excellent disaster response is a great tool to avoid future budget cuts. It's way better to be remembered as "those awesome guys from CXZT who made it all better" than "what did they do for me?"

Communications were down for a few days. It took time to deploy generators to the repeater sites. The crews had their personal and truck radios, but those weren't strong enough to reach dispatch because of the lack of repeaters.

I know this may seem like every patient found were just strapped to a backboard and transported, but there were a huge amount of high priority trauma patients. Just to give you an idea 238 people died, and if thats the amount of fatalities just imagine the number of injured patients that survived. Obviously only the critical patients were immediately transported.

Another issue was you'd have 20 *yellows* on scene and by the time an ambulance got through the roads (which were blocked by debris and fallen trees) half of them had progressed to red.


(To Veneficus) At the time this happened disaster procedures were not well known by the truck crews or command. Our area had never experienced an incident on this scale.

In the beginning i was mainly speaking about the day of and after the storms when getting patients to the hospital was the big priority.

It really was amazing to see how everyone adapted to the situation. The emergency personnel did a phenomenal job at working with what they had. especially with the lack of direction everyone had.

On the day after the storms supplies were brought by volunteers from the supermarkets. The next day the red cross and national guard arrived further distributing supplies.

Back to the EMS response. The care of *greens* were mostly taken care of on scene. Obviously the people and crews used common sense in all of this.

Also the need for all the backboards were to secure the patients with possible spinal injuries. When the patients were found or pulled from the debris. Would you want somebody to sit there and hold C Spine until transport arrived? No you wouldn't, hence all the backboards so you can at least secure the patient on scene.

Our state has done a fantastic job since in planning for future disasters. Including beginning the process of switching radios over to a state wide network so that multiple agencies can communicate together over the same type of network, started hands on courses that teach citizens how to react to a disaster, and started multiple public campaigns including a few days where there's no sales tax on emergency goods.

 

[Handsome Robb]

If you are employeed with an ambulance company then being at work is where you will do the most good. If they need you to dispatch then they will place you there. If they need you responding then they will put you there.

This.

/thread.

If you're freelancing I'm sure you'll end up getting booted by some government agency eventually. Plus you don't have any ability to transport or medical direction. I guess theoretically you could go pass out band-aids somewhere?

Not trying to be a ****, sorry if it comes off that way but the fact of the matter is that you're not going to be able to help from an EMS standpoint by wandering around with a jump bag. Not saying there aren't other aspects in a disaster zone you can't help with but if your goal is EMS you need to go through the proper channels, whether it be going into work to help staff units, aid centers, where ever they need you or volunteering through an organization like the ARC.

 

[Veneficus]

This is going to be harsh, sorry...

Not trying to be mean, but your reply to mine just restates the obvious. Nobody knew what they were doing.

People (especially managers) probably should have lost their jobs for such ignorance, incompetence, and short-sightedness. I hope they did for the benefit of future generations.

From tsunamis to earthquakes, to powerful storms, to subway bombings, the rest of the world seems to have educated themselves and prepare for disaster response.

"It never happened to us before" is not an excuse, and since there are people specifically educated, trained, and paid, to plan for and mitigate disasters. The idea that "it never happened to us before" just means that everyone had their head burried in the sand and wasn't even aware of what was going on outside of your little area. Hardly a sign of engaged pros.

It may seem like I am being overly critical, and truthfully I am. I hate small town, good old boy networks, who measure their ability by "it never happened and somehow we survived, so it must have been a good job."

It wasn't a good job. Since the 1980s it was highly publicized it will take 24-48 hours with an intactinfrastructure for federal help to arrive. You didn't know? You had no preperations? You were surprised? Where has your agency been?

Your description simply describes amateurs masquerading as professionals, or maybe even heroes.

Did they give out awards for this cluster after too?

Communications were down for a few days. It took time to deploy generators to the repeater sites. The crews had their personal and truck radios, but those weren't strong enough to reach dispatch because of the lack of repeaters.

Of course it did, backup generators prestaged for communication didn't seem important prior to a disaster?

Maybe the money was spent buying backboards?

I know this may seem like every patient found were just strapped to a backboard and transported, but there were a huge amount of high priority trauma patients.

So what? What did the backboard help with? Did it magically increase surgical capability for them? Hospital space? What made anyone think it was helping or doing anything at all?

It sounds to me they didn't know what to do so they did what they knew, even though it was pointless and may have harmed people.

Just to give you an idea 238 people died, and if thats the amount of fatalities just imagine the number of injured patients that survived. Obviously only the critical patients were immediately transported.

Sorry, that is not that much. It is probably just the largest your area ever saw. Inexperienced, unprepaired is an excuse. Who cares if you had 10,000 dead, they are dead, they require no treatment. They should not be taking up treatment resources at all. Including things like putting sheets over them.

Another issue was you'd have 20 *yellows* on scene and by the time an ambulance got through the roads (which were blocked by debris and fallen trees) half of them had progressed to red..

Again, not many at all. That is not even a busy night in many EDs I have seen that a staff of roughly 8-10 handle regularly. Did they progress to red because you lacked the ability to treat them or did they progress because you are not used to taking care of patients long term and were scared?

We have a word for people who rapidly deteriorate in a disaster, we call them "expectant."

I am also going to just guess not all of your "criticals" wound up in surgery or an ICU. Which means they were in fact, not really critical.

Unless your treatments made them that way.

(To Veneficus) At the time this happened disaster procedures were not well known by the truck crews or command. Our area had never experienced an incident on this scale...

Regretably, that is obvious.

In the beginning i was mainly speaking about the day of and after the storms when getting patients to the hospital was the big priority..

As I said, transporting to the hospital in a disaster is not a reasonable goal. It was all you knew, so it is what you did.

When you take a large disaster and transport it to the hospital, you do not help mitigate it, all you do is move it from one location to another. You know what happens to sick people in a hospital when resources run out? They die there.

Whether a person dies with no care in the rubble or dies with no care in the hospital, they still die. You don't win any awards for driving people around and wasting fuel.

Of course the the infrastructure was destroyed, that is part of disasters. It happens in all of them.

It really was amazing to see how everyone adapted to the situation. The emergency personnel did a phenomenal job at working with what they had. especially with the lack of direction everyone had.

From your description, it doesn't sound amazing, it sounds like self praise for muddling through no better than any other person who is not a "professional" responder.

On the day after the storms supplies were brought by volunteers from the supermarkets. The next day the red cross and national guard arrived further distributing supplies..

As scheduled. I am sorry you seem surprised.

Back to the EMS response. The care of *greens* were mostly taken care of on scene. Obviously the people and crews used common sense in all of this..

I can only hope with more ability than the other treatment and transport details you described.

Also the need for all the backboards were to secure the patients with possible spinal injuries. When the patients were found or pulled from the debris. Would you want somebody to sit there and hold C Spine until transport arrived? No you wouldn't, hence all the backboards so you can at least secure the patient on scene.

So you took people who were going to have delayed treatment/transport and put them on a board to help them, despite well known harmful effects of that, and ED policies around the world designed to remove people from boards as soon as possible?

You don't hold c-spine in a disaster. You let the person lay there and self splint. You don't strap people to boards that causes harm, inhibits breathing, and requires you to spend resources to monitor their airway. In a disaster, c-spine precautions are not a priority at all.

Perhaps if one vomited on that board and nobody was monitoring them and they died from a FBAO they will be very greatful you did your best to prevent secondary spinal injury.

Our state has done a fantastic job since in planning for future disasters. Including beginning the process of switching radios over to a state wide network so that multiple agencies can communicate together over the same type of network, started hands on courses that teach citizens how to react to a disaster, and started multiple public campaigns including a few days where there's no sales tax on emergency goods.

Lol, they couldn't do much worse. But it is typical to upgrade communications after a disaster, it makes it look like it will solve all the problems and the leaders know and are doing something. It is also a good PR tool, because it is hard to show off your knew knowledge but not your new electronic toys.

The rest of that is just useless fluff. Like hiding under your school desk in a nuclear attack with a burn kit.

Sorry for my curt and candid response, but like I said, this level of ignorance from those who claim to be "professional" really pisses me off. They should be embarassed everytime somebody looks up to them.

Nobody in an emergency agency should be proud of having no insight and no idea how to handle a disaster. It means they didn't know or care enough to do their job before it happened.

Especially then congratulate themselves on a job well done when they really weren't doing anything and the situation resolved itself.

Like I said, I have no mercy and no tolerance for these types of people. What were they doing instead of planning for disasters everyday? Trying to organize where they were in the next parade line-up?

We sometimes make fun of it, but every emergency organization I have ever been part of, visited, or have only ever talked online around the world plans for "the big one" both formally and informally on a regular basis.

What you described here wasn't a good job. It was garbage. Understanding that is the first step to improvement.

 

[DesertMedic66]

The best way to respond to a major incident like that is to prepare. Have everything needed before it is needed. Once something does happen you should have a plan (general plan) and vital supplies to keep you working.

I'm in Cali so I don't have to worry about tornados, hurricanes, floods. Our main concern from the earth is earthquakes (still haven't figured out a way to predict them). So our main station and dispatch center (60 miles away) both have back up generators (not the small portable ones). We also have a mobile communications rig with the ability to dispatch from inside. We also have a MCI trailer with everything from backboards to duodote kits. We also have a "DemCo" Uhaul type vehicle (it's got flashy lights and the woo woos) with cots, portable showers, portable toilets, and other non medical equipment. And this is all for a private company.

Now the fire department has a good amount of goodies as well.

As for location that should play a lot into what stuff and how much you need. I'm not familiar with your area so I can not speak of it. As for us here in Cali, while I may be in a semi isolated region, the pure amount of resources available is jaw dropping. So it won't be extremely long before we are getting aid from other agencies.

To recap the best way to respond to a disaster is to prepare before a disaster occurs... Long before it does occur.

 

[Rcoddington]

**veneficus**
You must have a fantastic set of departments where your from, and have responded to a lot of disasters personally. You seem to not give any helpful advice, but purely tell me that we did the worst things possible. There is literally not a single thing I have said that you have then said is wrong.
Very helpful...

 

[RocketMedic]

Rcoddington, Veneficus has been working in the fire service and emergency medicine since I was in grade school, but his expertise is not unique. There are quite a few experts in disaster planning and plenty of cheap or free resources. That your agency failed to take advantage of those resources is criminal, in my opinion.

Heck, a junior-enlisted medic could have shot holes in the disaster response plan y'all used.

 

[MrJones]

Rcoddington, Veneficus has been working in the fire service and emergency medicine since I was in grade school, but his expertise is not unique. There are quite a few experts in disaster planning and plenty of cheap or free resources. That your agency failed to take advantage of those resources is criminal, in my opinion.

Heck, a junior-enlisted medic could have shot holes in the disaster response plan y'all used.

Regardless of whether he's done it a day or a decade, his decision to criticize every aspect of the OP's experience was everything except helpful. It's one thing to use one's training and experience to point out ways in which improvements can be made; it's another thing entirely to use them to belittle others. And, like it or not, that's pretty much all I've gotten out of Veneficus' posts in this thread.

 

[Veneficus]

Regardless of whether he's done it a day or a decade, his decision to criticize every aspect of the OP's experience was everything except helpful. It's one thing to use one's training and experience to point out ways in which improvements can be made; it's another thing entirely to use them to belittle others. And, like it or not, that's pretty much all I've gotten out of Veneficus' posts in this thread.

Maybe I should be more specific on why this upsets me so much?

It will probably help you take something important away from this.

What was demonstrated here is that the "leadership" of this department did not have even the most basic of knowledge of a topic (disaster response) that is directly in the realm of what is expected in their industry.

That is a very poor quality leader.

Now I don't know if this is a fire agency or an EMS agency or even both, but it doesn't matter. These people who bestowed these titles upon themselves with obviously no merit are making life and death decisions.

Not only for patients, who deserve more, but of their very people. Who as you can see from the poster, hold them in high regard as both teachers and role models.

Dumb decisions can get people killed in such an environment and these "leaders" didn't bother to even get some basic information on their industry in order to make these decisions.

Just like most EMT students probably don't know a good instructor from a bad one, members of the mentioned department thought they did good!

That is like being asleep at the wheel and bragging you survived the accident.

People like the poster should take away what a farse their leadership is. So they can make an informed decision on whether they want to stay involved.

I wonder, if they didn't have the insight or basic knowledge is such a widely known topic, what other basic knowledge are they lacking in?

When fire and EMS people are killed, the loss is collectively mourned, they get a flag, a wreath, and some flowers. But it doesn't bring back mothers, fathers, kids, lovers, etc.

When they get killed needlessly, because of a flawed system or leadership, it makes it even worse. Especially when those in command don't even know it was their fault and preventable.

Look at your leadership with a critical eye, not blind admiration. The life that might be saved could be yours.

 

[MrJones]

Maybe I should be more specific on why this upsets me so much?

It will probably help you take something important away from this....

Oh, I took something important away long before you decided to be "more specific". But thanks for taking the time to expand on your position.

 

[RocketMedic]

That MrJones is too arrogant to learn from other people's mistakes in the mistaken "noble belief that it is wrong to insult someone by criticizing them because you weren't there in that position"?

Constructive criticism forgets that construction requires destruction, regardless of whether it's a house going up on a field or a real concept of how to handle something replacing improvisation.

 

[Rcoddington]

Constructive criticism is one thing, but if your close minded enough to put down basically every single thing I put up. Then you either you misunderstood, or you need to pull you head out of your ***.and realize that I AM NOT management, and I and every other first responder did the best with what they had (whether you think they did or not). Maybe you should take all your criticism and write a letter to Alabama EMA. I'm sure they'd enjoy it as much as I did.

 

[usalsfyre]

I and every other first responder did the best with what they had (whether you think they did or not).

The problem is "what you had" was caca. Horse puckey. Bull Scat.

Rather than stand around and pat yourselves on the back you should think long and hard about both your and other's role in how this went bad. You muddled through it, got lucky no one got died with EMS assistance and that none of your people were killed due to lack of communications, building collapse, flying debris or any other number of things that will reach up and bite you in this environment.

I like Veneficus have grown really tired of seeing deaths due to lack of preparation and failure to recognize and acknowledge standard hazards.

I'll leave you with this quote, source unknown

"An amateur relies on luck as a factor, a professional seeks to eliminate it as a factor"

 

[shfd739]

Constructive criticism is one thing, but if your close minded enough to put down basically every single thing I put up. Then you either you misunderstood, or you need to pull you head out of your ***.and realize that I AM NOT management, and I and every other first responder did the best with what they had (whether you think they did or not). Maybe you should take all your criticism and write a letter to Alabama EMA. I'm sure they'd enjoy it as much as I did.

You're in north Alabama and I can probably guess who you work for.

No surprise to me what you dealt with and the lack of preparation.

Tornados happen up there and should be something that a 911 company is ready for. Yes it costs money and eats away at profit but as a 911 responder the community depends on it as necessity.

I feel fortunate that none of my family were affected (too close for comfort,but not affected) and were not subject to the lack of response capability.

 

[Chimpie]

Constructive criticism is one thing, but if your close minded enough to put down basically every single thing I put up. Then you either you misunderstood, or you need to pull you head out of your ***.and realize that I AM NOT management, and I and every other first responder did the best with what they had (whether you think they did or not). ....

That may be true, but...

The problem is "what you had" was caca. Horse puckey. Bull Scat. ...

Now it's time to move forward. Instead of asking the question...

...
So scenario is you are an EMT with a well stocked Med kit and are familiar with areas worst hit. Would you go out and help as much as possible? Or take it easy?

... the question should be, "What can we do to improve so this situation doesn't happen again in the future?"

You can even start with the final part of your first post...

**Also realize that ambulances were to the point of self dispatching because of complete lack of COMs, and people couldn't call 911 and 911 couldn't dispatch.**

So maybe comms will be one area that you can look on improving.

We're quickly coming up on the two year anniversary of April 27. By now there should be some serious improvements. If not, maybe you should approach management and start creating some chat sessions where you all you can reflect on what happened that day and how you can prevent it from happening again.

It's called a hot wash. It's where members of the response team, at all levels (management and downward), get together and talk about the response. What worked and what didn't. You write everything down and the start prioritizing what can be fixed and who can fix it.

For what it's worth, I was deployed there with the Red Cross, arriving on April 30. I was operations management for two counties in the northeast corner of the state. Six tornadoes including two EF-4 and one EF-5 went through the area causing tremendous damage and over 40 deaths. I recognize that the area was devastated and that everyone was doing the best they could until additional resources arrived. I also recognize that when there are long periods of 'peace time' (no disasters), interest in preparing goes away, as well as the money. But after April 27, money was flowing like the <insert the name of a local river here>. All of the local EMAs, FDs, PDs, EMS agencies, etc. should have had lists ready of the items needed to improve their preparedness. This should have also been followed up by training and drills.

So, to answer your question...

...
So scenario is you are an EMT with a well stocked Med kit and are familiar with areas worst hit. Would you go out and help as much as possible? Or take it easy?

No. An MFR/EMT/Medic/Whomever who works with a department/agency should not be self deploying. They should be part of a well prepared, well trained, well exercised department and respond as one.