Disaster Evacuation Detailed at EMS Expo

DALLAS, TEXAS -- The concept of disaster evacuation is pretty simple -- move a group of people, large or small, out of harm's way and take care of them. However, although the concept may be simple, the logistics of the process require planning of even the smallest details such as sending drinking water with the evacuees as they travel 10 hours on a school bus.

"If you start planning for disaster evacuation when it happens, it's too late, you're already behind the game," said Warren Porter of Garland, Texas, who is the director of clinical education for South Region American Medical Response.

"People get on a bus and they might be diabetic and they have had no food, no water and no medication for 10 hours," said Porter, as he spoke Thursday at EMS Expo in Dallas, co-located with Firehouse Central and Enforcement Expo. "It's a little short-sighted to not worry about negative outcomes in that situation."

View more EMS Expo 2010 coverage at EMSWorld.com/expo.

Porter, who is also a paramedic, was speaking from first-hand experiences he had as one of the supervisors in Dallas who received evacuees from hurricanes Katrina and Rita. The title of his presentation was, "EMS Disaster Evacuation Response."

When developing a plan for evacuating people, or receiving them, simple, repeatable plans need to be developed because there could be thousands of people in need of transport and it's impossible to make plans for each individual, he said. Additionally, people can't work 24 hours a day, seven days a week.

"The plan has got to be repeatable so when you go off shift, everything continues," Porter said. "It's the old KISS method, 'keep it simple, stupid.'"

Porter also recommends a model of triage be used when dealing with evacuees. Most people, as much as 75 percent, will be "greens" requiring little or no care and can be sheltered or transported without much intervention, Porter said, adding that the rest of the population will require some specialized care ranging from bandaging to life support.

Regardless of the kind of care an individual requires, it's critically important to keep track of each patient, he said. In virtually all emergency and disaster evacuations, people get lost in transit. "UPS does it, FedEx does it with packages," Porter said. "But we don't do it with people. We need to develop systems for keeping track of bodies as we move them."

One way to do that is to make full use of cell phones and radios, and have checklists with protocols and resource information distributed to caregivers and providers who need the information.

So, when a bariatric patient with congestive heart failure starts to crash on an evacuation bus, people will know what to do and where they can call for the help they need to deal with that individual, Porter said.

More importantly, they may have the protocol suggesting that that person probably shouldn't get on the bus, and should rather be evacuated by some other means, he said.

EMS systems can be quickly overwhelmed when thousands of patients need care for trauma and sickness and providers shouldn't "be afraid to pull the trigger" and declare a mass casualty incident and get more help quickly, he said.

"The thing about buses and ambulances, there are a lot of them out there," Porter said. "And when you call for them, they'll come. And when you call for more still, you'll get those too... Don't be afraid to call for extra help."

Managing all that help will require coordination and a command system that will shepherd resources as needed. Mutual aid will bring in additional EMTs and paramedics and even doctors when necessary, Porter said, and someone has to be ready to take charge and direct people where they can be most effective. Doctors and residents will often want to take charge of clinics or evacuation hospitals, but they probably don't have the skills it takes to do emergency medicine outside of their environments, Porter said. It will require someone with experience in triage and emergency medicine to keep things organized, at least initially.

Porter cautioned that with a large influx of patients, providers will need to keep in mind that they need to remain human.

"They need to be able to talk to the patients," Porter said. "Often, it becomes an assembly line of care and the people don't know what's happening, or what's going on with them and it can be a very scary time."

Even the smallest courtesies will be appreciated by the evacuees and shouldn't be overlooked. For example, Porter said a group of evacuees from Hurricane Katrina arrived in Dallas after spending time in sewage water.

"Do we think about decontamination in situations like that?" Porter asked. "We should have. They arrived here and they smelled like poop and we gave them blankets and sent them on their way. We should have set up a decontamination area, just a simple one, no suits or anything, given them soap let them wash up and give them clean clothes on the other side...We need to think about the small things."

Then, there are the special needs patients who require care or evacuation. Dialysis patients who haven't had treatments for a couple of days can present as sick people, he said. A recovering burn patient requiring dressing changes twice daily, needs extra care, as do day-old babies and their moms, Porter said, noting that he received all of those patients when they were evacuated to Dallas.

A clinic was set up in the Dallas Convention Center, just a few hundred yards from where Porter was now giving his presentation.

Depending on the size of the disaster and the evacuation effort, providers should be prepared for intervention from state and federal agencies. In Porter's case, the Federal Emergency Management Agency (FEMA) dropped off supplies for a 250-bed hospital, unhitching the trailers and taking off.

"They dropped everything off, but they didn't drop any help off," Porter said.

That's why Porter said each evacuation is a local emergency that should be planned by local people.

"You know the resources, you know what you need," Porter said, encouraging attendees to write down protocols that can be distributed when needed. "Your plans need to be simple and scalable depending on the size of disaster. But don't wait until it happens. It's too late then."