A series of powerful earthquakes on January 7, 2020 destroyed or damaged many buildings and knocked out power across the island. As a result, at least one hospital and several nursing homes had to be evacuated.

During a major disaster, the pool of available ambulances is usually completely engaged in responding to emergency medical incidents. This makes the problem of safely evacuating large numbers of patients extremely problematical.

In widespread disasters such as the Puerto Rico earthquakes, additional ambulances from mutual aid partners may not be available for days. Even if some ambulances are available, they are typically designed to handle one or two patients per trip. This ties up both the vehicles and a significant number of EMTs.

A solution to this problem is to have one or more permanently equipped AmbuBus Conversion Kits installed in a school or metro bus. An AmbuBus can typically handle 12 supine patients and is flexible enough to accommodate, a mix of supine, seated, or wheelchair-bound patients.

An AmbuBus can also serve as a highly functional mobile triage unit. It can be equipped with an AmbuPower self-contained battery and inverter which replaces the need for a generator. This is extremely handy in situations like Puerto Rico when there are widespread power outages.

A Multiple Patient Monitoring System (MPMS) can be used with any portable computer and can capture up to 4.5 hours of patient data wirelessly for 12 or more patients.

The Mass Casualty Oxygen System (MCOS6) is a completely portable oxygen distribution that mounts to the AmbuBus frame. It enables delivery of individually metered oxygen for up to six people.

MCI Blocks which are a modular storage, transport, and deployment system that are color-coded to triage standards for easy identification. First Line Technology can pre-fill them with your desired contents to simplify triage and emergency medical treatment.

After the multiple patient transport phase of the disaster response, the AmbuBus frame kit can quickly and easily be removed from the bus and set up free-standing in a safe facility for patient or responder sleeping quarters.

Additional AmbuBus kits can be stored in or near a hospital and quickly set up in areas such as hallways or cafeterias to accommodate a surge in patients.

An AmbuBus equipped properly can greatly simplify medical evacuations and mass casualty medical response.

Freestanding AmbuBus kits can be set up in airport terminals, hangars, or even on the tarmac to serve as staging areas for large scale medical air transport operations.

Get more information on the AmbuBus and optional accessories and equipment.

Read the original article.

There are more than 90,000 dams in the United States. On average, the nation’s dams are over 50 years old.

“A more than two-year investigation has found scores of dams nationwide in even worse condition, and in equally dangerous locations. They loom over homes, businesses, highways or entire communities that could face life-threatening floods if the dams don’t hold.”

A review of federal data and reports obtained under state open records laws identified 1,688 high-hazard dams rated in poor or unsatisfactory condition as of last year in 44 states and Puerto Rico. The actual number is almost certainly higher: Some states declined to provide condition ratings for their dams, claiming exemptions to public record requests. Others simply haven’t rated all their dams due to lack of funding, staffing or authority to do so. Associated Press “At least 1,680 dams across the US pose potential risk” by David A. Leib, Michael Casey, and Michelle Minkoff, November 11, 2019

According to the Association of State Dam Safety Officials (ASDSO), the cost to rehabilitate the nation’s federal and non-federal dams would exceed $70 billion. Even if the money was available, over half of the dams in the United States are owned by a private entity.

While the majority of state-regulated dams Emergency Action Plans (EAP), it is unclear how many privately-owned dams have EAPs.

All these factors create a massive problem for emergency managers and disaster response stakeholders. This problem is exacerbated by the frequency of severe weather events that we have experienced in recent years.

According to the ASDSO Incident Database, over 60% of dam failure incidents were triggered by heavy rains, excessive water runoff, or other weather events. There are increasing efforts to monitor excessive ground water levels around dams during storms to identify unsafe conditions.

Emergency response planners should connect with their state dam safety official, the US Corps of Engineers, utilities and other private sector dam owners and operators regularly to ensure they have updated EAPs relating to areas that could be impacted by a dam failure.

In areas where dams are considered at risk during severe weather events, special consideration should be given to evacuating schools, hospitals, nursing homes, and homebound at-risk individuals before conditions reach unsafe levels.

Get more information on multi-patient evacuation transport.

Read the original article.

California Post-Fire Audit Shares Important Lessons

The recent devastating wildfires in California have created a greater awareness of the problem of evacuating vulnerable individuals during fast-changing disaster situations.

A new report from the Auditor of the State of California examined some of the factors that hampered county and state emergency managers in evacuating access and functional needs individuals. While the report focused on three counties as well as the California Office of Emergency Services (CAL OES), the problems cited will be familiar to emergency managers everywhere.

Among the findings of the report were:

• None of the counties had completed an assessment of their populations to determine the needs that their communities will have during an emergency.
•  In developing emergency plans, the counties did not involve community representatives of people with a variety of access and functional needs to provide insight.
•  The counties did not assess the resources needed to assist people with access and functional needs during a natural disaster, such as accessible transportation and shelter resources.

While the report cites these deficiencies, it generally fails to recognize many of the underlying factors that contribute to the problem. It is easy to find fault but much harder to address the resource issues that could improve our response efforts.

Among the underlying causes are:

• Staffing and Funding – Most emergency management agencies are underfunded and understaffed. Every aspect of our emergency response efforts require enough trained people and enough investment to accomplish the task at hand.
• Developing and Maintaining Registries – While most OEMs have relatively up-to-date registries of patients in hospitals and nursing homes, maintaining lists of homebound patients and other vulnerable citizens is difficult and time-consuming.
• Lack of Omnichannel and Multilingual Communications – Many elderly, physically-challenged individuals, and economically disadvantaged people are unable or unwilling to stay informed through TV, radio, and the internet. Even if messages go out on all these channels, they are generally broadcast only in English.
• Limited Availability of Ambulances –Most ambulances are designed for single patients and require two to three EMTs. Few communities have enough available ambulances to handle both the regular level of medical incidents and surge capacity during a disaster. In addition, the equipment and storage in a typical incident mean they can’t accommodate multiple wheelchairs.
• Mutual Aid Agreements aren’t much use in a large-scale disaster – Incidents like Hurricane Katrina and Superstorm Sandy pointed out the glaring weakness of relying on mutual aid agreements for medical transport assets. When the disaster is so widespread, the partner you are counting on may not have enough assets to handle their own problems.

It has often been said, “Never let a crisis go to waste.” Emergency managers, public health professionals, and first responders should recognize the findings of the California Audit for what they should be; grant and business case justifications.

When a report like this comes out, use the findings as evidence that jurisdictions should invest more funding in staffing, public outreach and multilingual communications, and flexible, multi-patient transport vehicles.
Unless we educate the legislators who fund us, and convince them that more citizens could be saved with adequate staffing and evacuation assets, we will be reading reports like these every year.

(Photo: Chris Caldwell / The Spectrum & Daily News)

Mass casualty incidents in rural areas pose unique challenges. 

In September of 2019, a tour bus carrying 30 Chinese nationals traveling to Bryce Canyon National Park rolled over and crashed into a guard rail. Four people died and at least twelve other people with injuries that ranged from serious to critical.

Mass casualty incidents caused by bus crashes in rural areas often lead to more fatalities than similar crashes in urban areas.

“A National Highway Traffic Safety Administration (NHTSA) study published in 2005 found that nearly 60 percent of fatal crashes occurred on rural roads, despite the fact that rural roads incur only 39 percent of the total vehicle miles traveled and less than 20 percent of the US population lives in rural areas. The frequency of fatal crashes involving large buses, often referred to as motorcoaches, was documented through the NHTSA Fatal Accident Reporting System (FARS) as occurring an average of 137 times a year during the period from 2000 to 2007, with less than 25 percent of these occurring in rural areas. Despite comprising less than a quarter of those fatal crashes, the rural incidents accounted for 56 percent of the fatalities and 72 percent of the non-fatally injured victims.”
(NASEMSO Rural Highway Mass Casualty Guidelines, November 2011)

There are a multitude of factors contributing to the disparity in casualty figures between rural and urban area bus crashes. EMS system subject matter experts assert that rural areas of the United States suffer from a lack of adequate prehospital response capacity.

In many rural areas, few ambulances are available to respond at any given time due to limited funding and qualified staffing. Ambulances may have to travel many miles to reach the scene over difficult terrain and in bad weather.

Open reaching the scene, there are not enough qualified EMTs and doctors to handle triage and immediate care for all the victims. With not enough ambulances available, patients may be waiting by the side of the road for extended periods of time.

While grant funds to rural areas such as the Supporting and Improving Rural EMS Needs (SIREN) Act are available, the funding levels are inadequate for most jurisdictions to purchase, equip, and staff a turnkey, custom-build Medical Ambulance Bus (MAB) to serve as a mobile treatment center. These special purpose vehicles can cost between $500,000 and $1,000,000.

Some rural communities have begun to adopt innovative solutions to improve their prehospital triage, treatment, and transport capabilities.

Utilizing a surplus school or metro bus, and a bus stretcher conversion kit like the AmbuBus developed by First Line Technology, they can deploy a multiple patient transport vehicle at the Basic Lifesaving (BLS) level that can accommodate 12 supine patients for under $50,000.

With additional grant funding in subsequent years or financial assistance from regional coalition partners, they can upgrade the AmbuBus to Advanced Lifesaving (ALS) level complete with power, heating and air-conditioning, wireless multiple patient vital signs monitoring, oxygen flows, and other capabilities.

First Line Technology can also supply customized and pre-filled Multiple Casualty Incident Blocks. MCI Blocks are a modular storage, transport, and deployment system that are color-coded to triage standards for easy identification.

With an ALS equipped AmbuBus and easy to deploy MCI Blocks, rural EMS units can greatly improve their response to mass casualty incidents.

Get more information on the AmbuBus.

Read the original article on the Bryce Canyon bus crash.