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."
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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.