This is the html version of the file http://mediccom.org/public/MMRS/plans/seattle.PDF.
G o o g l e automatically generates html versions of documents as we crawl the web.
To link to or bookmark this page, use the following url: http://www.google.com/search?q=cache:1KF-ZQtiajcC:mediccom.org/public/MMRS/plans/seattle.PDF+seatac+decontamination&hl=en&ie=UTF-8

Google is not affiliated with the authors of this page nor responsible for its content.
These search terms have been highlighted: seatac decontamination 
City of Seattle
Page 1
City of Seattle
November 8, 1998
Se
attle Fire Department
Metropolitan Medical
Metropolitan Medical
Strike Team
Strike Team
Operations Plan
Operations Plan
...
to respond to and assist with the management and mitgation of the medical
and public health consequences of nuclear, biological, and chemical incident...
For Details,
Contact:
Chief A.D. Vickery
Seattle Fire Dept.
(206) 386-1895
Page 2
Primary Participants
:
SEATTLE FIRE DEPARTMENT
SEATTLE POLICE DEPARTMENT
SEATTLE/KING COUNTY
DEPARTMENT OF PUBLIC HEALTH
HARBORVIEW REGIONAL MEDICAL
CENTER
UNITED STATES PUBLIC HEALTH SERVICE
Written By:
Deputy Chief A.D. Vickery, Seattle Fire Department
Battalion Chief Rich Schultz, Seattle Fire Department
Captain Randy Hansen, Seattle Fire Department
Captain Bryan Hastings, Seattle Fire Department
Fire fighter Venice Turner, Seattle Fire Department
Acknowledgments:
Michael Copass, MD, Harborview Medical Center
Chief Ed Joiner, Seattle Police Department
Sergeant Grant Tietje, Seattle Police Department
Sharon Stewart-Johnson, Seattle/King County Department of Public Health
Steve Marten, Seattle's Office of Emergency Management
Tom Harmon, Washington Department of Health
Steve Scott, MD, MPH, U.S. Public Health Service
Seattle MMST Development
Page 3
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
preface
PREFACE
The MMST Plans Section will complete the annual update of this plan. It will be
reviewed annually by the team members for revisions.
The City of Seattle's Department of Emergency Management and the Washington
State Department of Health, Risk and Emergency Manager have reviewed this
plan to ensure its compliance with City and State disaster plans.
The Seattle MMST can be requested regionally as a part of those disaster plans.
Page 4
03/17/01
1
1.
Emergency Transportation of Patients
The Seattle Fire Department and the City of Seattle has long been
recognized as providing one of the finest EMS systems in the world. This
system consistently delivers superior: service, resuscitation rates,
response times, and a successful hospital control network that operates
out of the Pacific Northwest Level One Trauma Center, Harborview
Medical Center.
a)
Existing Ambulance Service
(a) The capacity for medical transportation in the City of Seattle
includes:
*
Fifteen (15) Seattle Fire Department aid/medic units; with
both BLS and ALS capability;
*
20 private ambulance units; with BLS capability only;
*
City Metro Bus lines, single and articulated buses;
*
City of Seattle School Buses
(b) There is a mutual aid mass casualty transportation plan. This
plan incorporates county personnel and resources to move
victims throughout the county. The countywide system
includes:
*
27 Fire Districts
*
3 private ambulance companies
b)
Onboard Staffing of Ambulance
*
An effort will be made to transport all patients with the minimum
of an ALS and BLS attendant. In the event of diminished
resources, it may be required to staff with only two (2) BLS
attendants, (EMT-level, minimum 100 hours of EMS training).
*
The Seattle Fire Department will do all of the ALS transport,
(Seattle-trained paramedics have received over 2000 hours of
training under the direction of the Hospital Control Medical
Director, through the University of Washington School of
Medicine).
Page 5
03/17/01
2
c)
Augmentation to Handle Mass Casualties
*
In the event of an incident, local fire resources are utilized on-
scene. Once these resources are depleted, a countywide
mutual aid system is implemented, to include:
- 27 Fire Districts
- 3 private ambulance companies
d)
Integrate Ambulance Service into the MMST Response
*
Patient transportation is a part of the existing incident command
system and structure. The MMST will be integrated into the ICS
structure and the mass casualty procedures. Within this
structure:
1. The Incident Commander will assign a triage, treatment and
transportation officer.
2. The MMST Hospital Liaison Officer will interface with these
three ICS components and, in coordination with the MMST
Medical Director, will develop the transportation plan for the
incident.
e)
Medical Treatment Requirements Enroute to Hospital
*
Medical personnel will be working under current Seattle Fire
Department field medical instructions and directed by the
Hospital Control Medical Director, (who is also the MMST
Medical Director).
f)
Decontamination Requirements for Vehicles
*
Patients will be decontaminated prior to transport.
*
At the conclusion to the incident, MMST and local fire
department hazardous materials personnel will bring all vehicles
used for transportation to a designated collection point, (as
determined by the IC) for evaluation.
1. Any vehicle knowingly used to transport a contaminated
patient will be immediately placed out-of-service and brought
to the collection point for evaluation.
Page 6
03/17/01
3
2.
Forward Movement of Patients
a)
Extension of Existing NDMS Patient Transportation and
Treatment.
*
After the local resources are expended, the City of Seattle's
Emergency Operations Center will access state resources,
which can then access federal resources. There currently exist
a local, regional and federal disaster response plan. These
plans would be exercised upon notification of the event.
b)
Adaptation to a Mass Casualty Situation
*
There is a mass casualty plan that would be implemented once
the event is made known. The plan exists in the City of Seattle
Disaster Readiness and Response Plan, the Seattle Fire
Department Operating Instructions and the Seattle Police
Departments Policies.
*
There are pre-established shelter areas and designated Points
of Departure (POD) for mass casualty victims, such as Boeing
Field or Seatac International Airport that will be exercised in the
event of a mass casualty incident.
*
There is a Seattle-based DMAT team, available once federal
assets become attainable.
c)
Integration into the MMST System Response
*
The MMST system and resources will be integrated into the
functioning incident command system and the mass casualty
plans at the event.
Page 7
03/17/01
4
3. Hospital Emergency Medical Services
a)
Mass Casualty Treatment Capability Considerations
i.
Incident Action Plan- Regarding Pharmaceuticals
*
The Seattle Fire Department will carry the medicines to
treat first responders and initial patients.
*
A countywide mutual aid response will support continued
patient care.
*
Hospital Control Medical Director will be assessing
pharmaceuticals from commercial and military vendors,
based on projected needs. The medicines will be
brought to the Incident Command Post upon receipt.
ii.
Pre-stocked NBC Pharmaceuticals
*
The Fire Department will carry limited stores of
WMD/NBC medicines. The MMST will maintain a larger
inventory of WMD/NBC medicines. Local hospitals are
being encouraged to increase their stocks of pre-
identified pharmaceuticals. Hospital Control will be
contacted for pharmaceutical needs. There are
additional commercial and military sources outside of the
MMST System but within the Seattle-area for possible
pharmaceutical replenishing.
iii.
Integration into the Incident Action Plan
*
The Incident Command System and the Mass Casualty
Plan will be the operating systems and the MMST
System will be integrated into their systems and plans.
iv.
Incident Action Plan for Transportation
*
The transportation plan has 35 ambulances capable of
patient transport. When additional assets have been
authorized, the mutual aid, government and military
options will include numerous patient transport vehicles.
Page 8
03/17/01
5
b)
Hospital Emergency Medical Services
*
The selection system for patient destination is controlled by the
Hospital Control Medical Director, (this position is also the EMS
Medical Director of Harborview Medical Center and the MMST
Medical Director.)
c)
WMD Medical Treatment Protocols
*
Each of the receiving hospitals will be operating under agreed upon WMD
treatment protocols as established by the Hospital Control Medical Director,
the Seattle/King County Medical Director and the Director of Seattle/King
County Public Health.
d)
Decontamination Capability
*
The WMD plan includes the establishment of a large perimeter
to contain potentially contaminated patients and restrict access
to the incident site, thus avoiding further contamination.
Emergency decontamination would be implemented
simultaneously with the establishment of hot, warm and cold
zones. Decontamination corridors will also be implemented.
*
It is anticipated a large number of walk-in non-transported
patients will require decontamination PRIOR to them entering
the hospitals. Therefore, the Seattle Fire Department will deploy
exterior emergency decontamination corridors to area hospitals.
*
The Seattle Fire Department will deploy their decontamination
trailer to the incident site for secondary (definitive/technical)
decontamination capability, (the system affords specific
decontamination solutions, warm water and privacy). Our goal
would be to provide this level of decontamination to patients
prior to being transported to minimize the possibility of cross
contaminating transport resources and personnel.
-
This trailer may also be deployed to local hospitals as a
remote technical decontamination station, which will
supplement the exterior emergency decontamination
corridors previously established by the Seattle Fire
Department.
f)
WMD Emergency Medical Response Training
Page 9
03/17/01
6
*
The DoD has conducted the WMD-training. Designated
regional hospital personnel attended these train-the-trainer
classes. In cooperation with Seattle/King County Public Health
and the Washington State Hospital Association, they are
conducting their in-house training, which includes an annual
refresher.
g)
Integration into the MMST System Response
*
The MMST system and resources will be integrated into the
existing incident command system.
4.
Mental Health Services
Page 10
03/17/01
7
a)
Existing Community Mental Health Services
*
The City of Seattle and Seattle/King County Public Health are
responsible for the mental health portion of the medical
response for both first responders and victims.
b)
Mental Health Service in a Mass Casualty Situation
*
The incident commander will activate the Emergency
Operations Center. Within the EOC, the Health and Hospital
ESF-8 Coordinator (see chart 3-4) would make available to the
Incident Commander local and regional mental health
professionals for treatment. The ESF-8 Coordinator would
ensure the development of the mental health treatment plan.
c)
Mental Health Services for First Responders, Victims, Families
and the Local Community
*
A joint CISM system exists for Police and Fire responders and
their families. Police psychologists and a team of trained Police
and Fire personnel staff it. The incident commander, 9-11-
dispatch center, or any ranking officer that identifies the need
can access it.
*
The ESF-8 Coordinator will develop an overall strategy for
providing mental health counseling to the affected community.
There is a federal team of mental health professionals that may
be utilized once federal assets become available.
*
All aid and medic units carry referral cards for mental health
assistance, to be provided to the general public, as needed.
d)
Integration into the MMST System Response
*
The ESF-8 portion of the EOC will operate within the ICS
structure during the incident.
5
.
Plans for Disposition of Non-Survivors
Page 11
03/17/01
8
a)
Based on Existing Mortuary Service
*
The Seattle/King County Medical Examiner will be the lead for
the development of a temporary morgue site(s) and developing
the plan for the disposition of the deceased. The Seattle/King
County Medical Examiner will work under the direction of law
enforcement.
b)
Adaptation to a Mass Casualty Situation
*
The mechanism for dealing with a mass casualty incident is
included in the Mass Casualty Incident Plan. The priority for
resources will be to control access to the non-survivors until the
incident has stabilized.
-
Resources needed to properly decontaminate the non-
survivors will be identified during this phase of
Operations.
c)
Crime Scene Considerations
*
Law Enforcement and the King County Medical Examiner will be
responsible for the official determination of the time and cause
of death.
*
The Seattle Police Department bomb technicians on the MMST
are trained at the MMST-technician level and will be responsible
for initial evidence collection.
*
Decontamination of non-survivors will be facilitated under the
direction/assistance of military/federal assets, which may
include:
-
A DEMORT Team.
d)
Integration into the MMST System Response
*
The Seattle/King County Medical Examiner will work within the
framework of the on-site Incident Command Structure.
Page 12
City Of Seattle
Seattle Fire Department (SFD)
_________________________________________Metropolitan Medical Strike Team (MMST)
03/17/01
1
INTRODUCTION
HEALTH AND MEDICAL SERVICES RESPONSE
TO
NUCLEAR/BIOLOGICAL/CHEMICAL (NBC) TERRORISM
A.
OVERVIEW
The U.S. Department of Health and Human Services (USPHS), in its role as the nation's health
department, is implementing a systems approach for health and medical services response to
acts of domestic terrorism involving weapons of mass destruction (WMD).
The USPHS strategic national plan concept has two major tenets: first, to assist State and local
governments and key private sector assets to gain the additional necessary capability to
effectively and appropriately initially respond in a coordinated manner to a local nuclear,
biological, or chemical (NBC) terrorist incident; and, second, to significantly improve Federal
capability and capacity to rapidly augment State and local governments in responding to a major
terrorist incident.
Building enhanced State and local capability is centered on the implementation of the
Metropolitan Medical Strike Team (MMST) system development in the most populous
metropolitan areas of the United States.
B.
BACKGROUND
Recent events, such as the World Trade Center and Oklahoma City bombings, should be a
wake-up call to all personnel working in the public safety arena. The idea that ``it can't happen
here'' is at best a dangerous assumption. The use of WMD is no longer relegated to use by
nation states during war.
The February 26, 1993, bombing of the New York World Trade Center killed six persons and
more than 1,000 people were injured, most due to smoke inhalation.
Although it was never confirmed that they actually used cyanide in the World Trade case, the
presiding judge at the defendants' sentencing hearing believed their intention was to use cyanide
with the explosive.
Page 13
City Of Seattle
Seattle Fire Department (SFD)
_________________________________________Metropolitan Medical Strike Team (MMST)
03/17/01
2
More than 50,000 people were believed to be in the 110-story building at the time of the
explosion. One can only imagine what would have happened if a chemical attack had been
successful.
In short, the threat to the public, and to public safety agencies responding to incidents involving
NBC materials, is very real. It is no longer a question of ``if it happens,'' since it already has.
The real question is when and where the next incident will occur.
C.
NUCLEAR MATERIALS
The most likely scenario facing public safety agencies would be an accident involving the
transportation of nuclear materials within their jurisdictions. While a nuclear power plant may
not be next door, materials used to operate that plant are transported throughout the United
States. For the most part, such incidents would be considered a HAZMAT issue and dealt with
on that basis by first responders.
Radiation is defined as high-energy particles or gamma rays that are emitted by an atom as the
substance undergoes radioactive decay, which is the process in which a radioactive nucleus
emits radiation and changes to a different isotope or element. The types of radiation are in the
following forms of energetic particles:
*
Alpha particles
*
Beta particles
*
Photons (gamma rays and X-rays)
*
Neutrons
Particles lose their energy by depositing it in the material they move through, whether that
material is air, water, people, or lead. Alpha particles deposit all their energy in a very short
distance; very little protective material is required from alpha particles. Beta particles require
slightly more shielding; gamma rays and X-rays require much more shielding. Neutrons react
with matter differently than do most other kinds of radiation. They are more easily ``stopped''
by materials with low atomic numbers or ``low Z materials'' like carbon, lithium, or water.
The problem with radiation is that it is an invisible hazard. Unless the responding public safety
agency has radiological detection equipment, or the nuclear material at issue is clearly marked
and identified, there is a strong chance that the initial identification of a radiological or nuclear
hazard will go unnoticed. Additionally, there is no one piece of equipment available on the
market to meet all detection requirements; however, there are separate detectors for each type
of radiation. An additional concern would be the availability of protective clothing and breathing
gear, in sufficient quantities, to protect first responders.
Page 14
City Of Seattle
Seattle Fire Department (SFD)
_________________________________________Metropolitan Medical Strike Team (MMST)
03/17/01
3
Radiation sickness is similar to any other illness in the body. The ``disease'' is just radiation.
It
should be noted that individuals who have been properly decontaminated and are
suffering from radiation injuries are NOT radioactive!!
D. BIOLOGICAL AGENTS
Once the subject of movies like
Outbreak
or
The Andromeda Strain,
the use of biological
agents is the oldest of the NBC triad. Biological agents are more deadly than chemical agents
and occur in nature as well as being developed. Large numbers of naturally occurring poisons
have also been examined to determine their value as chemical warfare agents; these include
capsaicin (an extract of cayenne pepper and paprika), ricin (a toxic substance found in the
castor bean), and saxitoxin (a toxic substance secreted by certain shellfish). Of the many natural
toxic materials, none has received more attention than the toxin of the common bacterium
clostridium botulinum, which is sometimes ingested from food that has been improperly canned
or preserved. A tiny quantity can produce death. Sprayed in the air or introduced into a water
system, it might prove to be a highly effective agent. Of nuclear, biological and chemical agents,
biological agents are by far the cheapest to produce.
Governments have used biological warfare as long as civilization has depended on agriculture.
Today, various governments continue to research the development of poisonous toxins that are
far more deadly than chemical warfare agents.
The most practical method of initiating infection using biological agents is through the dispersal of
agents as minute, airborne particles (aerosols) where finely divided particles of liquid or solid
suspended in a gas are sprayed over a target where the particles may be inhaled. An aerosol
may be effective for some time after delivery, since it will be deposited on clothing, equipment,
and soil. When the clothing is used later, or dust is stirred up,
responding personnel may be
subject to a ``secondary'' dispersal
.
Biological agents may be able to use portals of entry into the body other than the respiratory
tract. Individuals may be infected by ingestion of contaminated food and water or even by
direct contact with the skin or mucous membranes through abraded or broken skin. This makes
the use of protective clothing a must, along with protection of the respiratory tract through the
use of a mask with biological filters or SCBA.
Page 15
City Of Seattle
Seattle Fire Department (SFD)
_________________________________________Metropolitan Medical Strike Team (MMST)
03/17/01
4
Exposure to biological agents, unlike chemical agents, may not be immediately apparent.
Casualties may occur minutes, or hours to days or weeks after an incident has occurred. There
are currently no effective monitoring devices available for first responders for use in determining
whether they are involved in an incident involving biological agents. The precautionary use of
the appropriate PPE would be prudent given the lack of detection equipment.
Some clues may be present that could be indicators that an NBC incident involving biological
agents has taken place.
*
Unusual numbers of sick or dying people and animals are present. For example, all the
birds that are usually present at outside trash bins are dead, there are no insect sounds,
etc.
*
Reported illness reflects an unusual or impossible agent for the geographic area or there
is an unusual distribution of the disease (i.e., the casualties are aligned with the wind
direction outdoors).
*
Biological attacks will be different from natural outbreaks of disease, i.e., a steady
stream of patients to medical facilities instead of peaks and valleys, or the illness may
occur in an unusual environment or time of year (i.e., cases of anthrax show up where
none have occurred before).
Early warning and rapid identification of biological agents is of primary importance. Early
warning can sometimes be supplied by intelligence sources, but early warning is not usually
available. The following are some rules of thumb for defense against biological agents.
*
Maintain current threat information. Once a threat is known, personnel should review
information on biological agent capabilities, symptoms, etc.
*
Alert all personnel to the possibility of an attack involving biological materials based on
intelligence information (if any).
*
Identify backup supplies of antidotes, etc., and their location.
Page 16
City Of Seattle
Seattle Fire Department (SFD)
_________________________________________Metropolitan Medical Strike Team (MMST)
03/17/01
5
*
Get medical evaluation to identify the biological agent.
-
Pending identification of the agent, measures should be taken to prevent epidemics
as soon as possible after initial exposure. These measures include isolation,
quarantine, and restriction of personnel movement. After identification of the agent,
and if it is not capable of producing an epidemic, these restrictive measures can be
relaxed. This applies not only to the victims at the incident, but to all first
responding personnel as well.
*
If the incident involves a few exposed persons, then transportation from the scene to a
medical facility may be reasonable. The facility to which casualties are transported must
be alerted, and the facility should be capable of isolating the patients when they arrive.
-
When large numbers of exposures are involved, a quarantine should be imposed
and victims treated on site.
*
Depending on identification of the agent, medical treatment in the form of antibiotics,
antitoxins, or antiviral agents to persons exposed to the biological agent should be
administered by appropriate medical authorities.
*
Destroy all exposed food and water. Some biological agents cannot be destroyed by
normal water purification techniques.
*
Collect and destroy all waste products, including human waste products of victims and
possibly contaminated first responders. This is done to ensure that the agents are not
spread through normal waste handling procedures.
E. CHEMICAL AGENTS
Chemical agents are compounds that, through their chemical properties, produce lethal or
damaging effects on man.
Chemical warfare agents designed to incapacitate by entry through the skin are probably best
exemplified by the well-known mustard gas and Lewisite (chlorovinyl dichloroarsine). These
agents severely burn or blister the skin and may cause permanent damage to the lungs, if
inhaled. Mustard gas was especially feared during World War I, and large stocks are still held
by some countries, including the United States. Harassing agents, such as tear gas, have been
developed to produce a less severe effect.
Page 17
City Of Seattle
Seattle Fire Department (SFD)
_________________________________________Metropolitan Medical Strike Team (MMST)
03/17/01
6
The groups of toxic substances receiving the greatest attention are the organ-ophosphorous
nerve agents. The German product Tabun was only the first in a series of these compounds,
which now include the U.S. standard nerve agent Sarin (methyl-isopropoxy fluoro-phosphine
oxide) and the United Soviet Socialist Republic's (USSR's) Soman (methyl pinacolyloxyfluoro
phosphine oxide). All these nerve agents produce the same basic physiological effect: they act
upon enzymes at the myoneural (muscle-nerve) junction, causing immediate convulsions,
paralysis, and death. They are capable of entering the body either through the lungs or the skin
and are deadly in very small quantities.
Chemical agents are defined as any chemical substance intended for use in military operations to
kill, seriously injure, or incapacitate humans because of its physiological effects. Chemical agent
symbols usually consist of two letters that are used as a designation to identify chemical agents
(e.g., GA = Tabun) and have nothing to do with the chemical formula of the agent. Unlike
biological agents, the onset of medical symptoms is measured in minutes to hours instead of
days. Additionally, easily observed signatures such as colored residue and dead foliage, insects,
and animals are present.
PERSISTENCY-An expression of the duration of effectiveness of a chemical agent. The
level of persistency is used to describe the tactical use of chemical agents and should not be
used as terms to technically classify the agent:
*
Nonpersistent Agents-Remain in the target for a relatively short period of time. The
hazard, predominately vapor, will exist for minutes or, in exceptional cases, hours after
dissemination of the agent.
As a general rule of thumb, nonpersistent agent
duration will be less than 12 hours.
*
Persistent Agents-Remain in the target area for longer periods of time. Hazards from
both vapors and liquids may exist for hours, days, or in exceptional cases, weeks after
dissemination of the agent.
As a general rule of thumb, persistent agent duration
will be greater than 12 hours.
Page 18
City Of Seattle
Seattle Fire Department (SFD)
_________________________________________Metropolitan Medical Strike Team (MMST)
03/17/01
7
There are many factors that will affect the persistency of chemical agents.
*
Type of Agent-Different agents have various consistencies or viscosities, ranging from
rubbing alcohol to motor oil, and will evaporate or dissipate at approximately the same
rate.
*
Amount of Agent-Different amounts and dispersal of agents also impact the
persistency of an agent.
*
Terrain-The terrain will also affect the duration of an agent (open area, vegetative,
urban, soil composition, etc.). For example, terrorist use of a chemical agent would be
most effective in enclosed spaces such as building entrances or underground subway
platforms.
*
Weather-Wind, temperature, humidity, precipitation-all impact on the duration of an
agent.
The following information is provided in order to give a general overview of chemical agents.
*
NERVE AGENTS-Chemical agents that affect the transmission of nerve impulses by
reacting with the enzyme cholinesterase, permitting an accumulation of acetylcholine and
continuous muscle stimulation. The muscles tire due to overstimulation and begin to
contract. Nerve agents are colorless to light-brown liquids, some of which are volatile.
Toxic liquids are tasteless. Nerve agents may be absorbed through the skin, respiratory
tract, gastrointestinal tract, and the eyes; however, significant absorption through the
skin takes a period of minutes, and prompt medical treatment and decontamination are
imperative.
*
CHOKING AGENTS-Chemical agents that irritate the alveoli in the lungs. This
irritation causes the alveoli to constantly secrete fluid into the lungs. The lungs slowly fill
with this fluid (called pulmonary edema), and the victim dies from lack of oxygen (also
known as dry land drowning).
*
BLOOD AGENTS-Chemical agents that act upon the enzyme cytochrome oxidase.
This allows the red blood cells to acquire oxygen, but does not allow them to transfer
oxygen to other cells. Body tissue decays rapidly due to lack of oxygen and retention
of carbon dioxide (first the heart and then the brain are affected).
Page 19
City Of Seattle
Seattle Fire Department (SFD)
_________________________________________Metropolitan Medical Strike Team (MMST)
03/17/01
8
*
BLISTER AGENTS-Chemical agents that affect the eyes, respiratory tract, and skin,
first as a cell irritant and then as a cell poison. Blister agents initially cause irritation of
the eyes (and respiratory tract, if inhaled), erythema (reddening of the skin), then
blistering or ulceration, followed by systemic poisoning. There are three types of blister
agents: mustards, arsenicals, and urticiants.
*
INCAPACITATING AGENTS-Agents that cause physiological or mental effects
that lead to temporary disability lasting from hours to days after exposure to the agent
has ceased.
*
VOMITING AGENTS-Compounds that cause irritation of the upper respiratory tract
and involuntary vomiting.
*
IRRITANT OR TEAR AGENTS-Compounds that cause a large flow of tears and
intense (although temporary) eye pain and irritation. The effects are immediate but
transient.
Many highly technical defense systems against chemical agents have been developed.
Protective gas masks combine particulate filters with substances that absorb gases and can
remove a variety of toxic agents. Other protective devices include chemically treated clothing
and suits with portable ventilating systems and sealed and air-conditioned tanks and personnel
carriers. In recent years chemical agent detectors have been developed that readily identify
whether some agents are present.
The availability of antidotes and training of medical personnel to handle casualties are important
defensive measures. Most are reasonably effective if some early warning is possible. In the
absence of warning, a successful chemical attack would have an immediate impact on the
jurisdiction of the affected area.
The possible mixing of chemical agents presents an additional concern to first responders in that
it will be difficult to identify (by symptoms alone) which type of chemical agent is being used.
Another concern is that without advance warning, first responders may not be aware that they
are dealing with a chemical incident. As a result, first responders may initially become part of
the victims in such an incident.
Page 20
City Of Seattle
Seattle Fire Department (SFD)
_________________________________________Metropolitan Medical Strike Team (MMST)
03/17/01
9
Some clues may be present that could be indicators that an NBC incident involving chemical
agents has taken place.
*
Unusual numbers of dying animals are present. For example, all the birds that are
usually present at outside trash bins are dead, there are no insect sounds, etc., not just
an occasional roadkill, but numerous dead animals.
*
Lack of insect life. If normal insect activity (ground, air, and/or water) is missing, then
check the ground, water surface, or shoreline for dead insects.
*
Numerous individuals are experiencing unexplained water-like blisters, wheals (like bee
stings), and/or rashes.
*
Numerous individuals are exhibiting serious health problems ranging from nausea, to
disorientation, to difficulty breathing, to convulsions, and to death. It is apparent that a
mass casualty incident exists.
*
There is a definite pattern of casualties (i.e., the casualties are aligned with the wind
direction outdoors). Casualties are distributed in a pattern that may be associated with
possible agent dissemination methods (i.e., a lower number of ill people working
indoors versus outdoors, or outdoors versus indoors).
*
Unusual liquid droplets are present. Numerous surfaces exhibit oily droplets/film;
numerous water surfaces have an oily film. (No recent rain.)
Early warning and rapid identification of chemical agents are of primary importance. Early
warning can sometimes be supplied by intelligence sources, but early warning is not usually
available. The following are some rules of thumb for defense against chemical agents.
*
Maintain current threat information. Once a threat is known, personnel should review
information on chemical agent capabilities, symptoms, etc.
*
Alert all personnel to the possibility of an attack involving chemical materials based on
intelligence information (if any).
*
Identify backup supplies of antidotes, etc., and their locations.
*
Take steps to identify the chemical agent used, either through local HAZMAT teams or
military resources.
Decontaminate victims prior to transporting them to local medical facilities.
Page 21
City Of Seattle
Seattle Fire Department (SFD)
_________________________________________Metropolitan Medical Strike Team (MMST)
03/17/01
10
F. HAZMAT/NBC TERRORIST INCIDENT CONSIDERATIONS
An NBC terrorist incident is, inherently, a HAZMAT incident. There are, however, significant
differences between the two types of incident that influence a civil jurisdiction's response
planning, organization, training, equipment, operational procedures, and coordination
requirements. An NBC terrorist incident may be characterized by:
*
The use of WMD designed to inflict mass casualties.
*
The high lethality of biological or chemical agents.
*
The extremely toxic environment resulting from NBC WMD.
*
The relative ease and inexpensive manner for NBC WMD production.
*
The significant legal implications due to the fact it is a crime scene and must be treated
appropriately.
*
The initial ambiguity in determining what type of NBC weapon or agent is involved, or,
in the case of biological agents, if a terrorist incident has occurred;
*
The potential for a combination of weapons/agents each presenting different response
requirements, i.e., explosives and chemical agents or simultaneous explosives, chemical
agents, and radioactive material dispersal.
*
The narrow window-of-response time to administer lifesaving antidotes for chemical
agents and antibiotics for biological agents.
*
The NEED for immediate medical treatment for mass casualties.
*
The NEED for transportation of mass casualties to appropriate medical facilities.
*
The NEED for immediately available specialized pharmaceuticals.
*
The NEED for specialized NBC detection equipment.
*
The NEED for a timely, efficient, and effective mass decontamination system.
Page 22
City Of Seattle
Seattle Fire Department (SFD)
_________________________________________Metropolitan Medical Strike Team (MMST)
03/17/01
11
*
The NEED for an organized, trained, and equipped health and medical services
emergency response unit to immediately augment the local HAZMAT/EMS response.
*
The NEED for precoordination with hospitals and medical treatment centers to establish
medical treatment protocols, stock appropriate pharmaceuticals, and determine
treatment procedure requirements; and
The NEED to accomplish advance planning and coordination to respond to each of the
NEEDS identified above.
Page 23
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
03/17/01
i
METROPOLITAN MEDICAL STRIKE TEAM
OPERATIONAL SYSTEM DESCRIPTION
TABLE OF CONTENTS
Introduction Health and Medical Services Response to Nuclear/Biological/Chemical
(NBC) Terrorism
Section 1
Metropolitan Medical Strike Team (MMST)
Section 2
MMST System
Section 3
Team Operations and Field Operations Guide
Section 4
Training Requirements
Section 5
Health and Medical Services
Section 6
Law Enforcement Function
Section 7
Public Information Media Relations
Section 8
Equipment Cache Requirements
Section 9
Communications Group
Section 10 Pharmaceutical Support
Section 11 Recommended Medical Surveillance Guideline
List of Acronyms
Glossary
References
Page 24
City of Seattle
Seattle Fire Department (SFD)
_________________________________________Metropolitan Medical Strike Team (MMST)
11/07/98
i
METROPOLITAN MEDICAL STRIKE TEAM
CHAPTER ONE
TABLE OF CONTENTS
PART I
Page
Metropolitan Medical Strike Teams Mission Statement ............................... 1-1
MMST Scope of Operations ................................................................................................ 1-2
MMST Concept of Operations ................................................................................................. 1-2
MMST Management Structure ................................................................................................. 1-5
MMST Management Roles and Responsibilities ........................................................................ 1-6
MMST Membership/Organizational Structure ........................................................................... 1-7
MMST Members Roles and Responsibilities ............................................................................. 1-7
PART II
MMST Role in Supporting First Responders ............................................................................ 1-11
MMST Activation ............................................................................................................... 1-12
MMST Deployment ............................................................................................................. 1-13
MMST Predeployment Actions 1-17
Cancellation of an MMST Deployment .................................................................................... 1-17
NBC Agent Detection and Identification ................................................................................. 1-18
MMST Extraction and Antidote Administration Activity ........................................................... 1-19
MMST Triage and Decontamination Activity ........................................................................... 1-21
MMST Field Casualty Collection Center ................................................................................. 1-22
MMST Field Medical Operations (treatment/transportation) .................................................... 1-23
Page 25
City of Seattle
Seattle Fire Department (SFD)
_________________________________________Metropolitan Medical Strike Team (MMST)
11/07/98
i
MMST Pharmaceutical Cache and Concept of Operations ...................................................... 1-26
Page 26
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Diagram 2
1-7
METRO MEDICAL STRIKE TEAM
Seattle Washington
ORGANIZATION
Risk & Emergency Mgr.
WA State Dept. of Health
COMMAND STAFF
OPERATIONS
PLANS
LOGISTICS
MEDICAL
TASK FORCE LEADER
METROPOLITAN MEDICAL
STRIKE TEAM
MMST
MMST PROGRAM
MANAGEMENT TEAM
PMT
SEATTLE DISASTER MANAGEMENT COMMITTEE
DMC
MAYOR
&
CITY COUNCIL
Page 27
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-3
DIAGRAM 1 CITY OF SEATTLE - MMST OPERATIONAL CONCEPT
SFD
MEDICAL
SFD MMST
30 Minutes
Operational
10 Minutes
SFD HAZMAT
LOCAL
INCIDENT
SFD
MARINE
SFD
TECHNICAL
RESCUE
10 Minutes
MMST
STAGING
SFD MMST
PERSONNEL
SPD MMST
PERSONNEL
4-6
Minutes
SFD OPERATION'S
SPD OPERATION'S
10
Minutes
Page 28
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-1
METROPOLITAN MEDICAL STRIKE TEAM
CHAPTER I, PART 1
MISSION, CONCEPT OF OPERATIONS,
AND TEAM ORGANIZATION
I.
INTRODUCTION
A. Purpose
Chapter 1, Part 1 will:
*
Define the Metropolitan Medical Strike Team (MMST) mission
*
Describe the MMST scope of operations
*
Describe the MMST concept of operations
*
Describe MMST management structure
*
Describe MMST management roles and responsibilities
*
Describe MMST membership/organizational structure
*
Describe MMST members roles and responsibilities
B. Mission Statement
It is the mission of the MMST to respond to, provide support for, and render assistance to
local and regional jurisdictions to effectively address responder safety issues, incident
management, and public health consequences of WMD incidents that result from accidental
or deliberate acts.
The MMST is a key component of the MMST System and operates within the City of
Seattle's Disaster Management Plan. The MMST system and Management plan provide
for decontamination of victims, pre-designated hospital and emergency medical services,
definitive care of patients, mental health services, disposition of non-Survivors, and plans for
appropriate staging areas and evacuation points should the Regional medical care
infrastructure be overwhelmed. These activities will be conducted in collaboration with and
consistent with existing Local, Regional, State, and Federal response plans.
Page 29
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-2
C. MMST Scope of Operations
The MMST response, assistance, and support includes:
*
Responding at the request of local and/or regional jurisdictions with existing Mutual Aid
agreements
*
Providing medical management and/or medical assistance and support of WMD
incidents
*
Providing training and response planning assistance to Team response personnel
*
Providing technical assistance in the identification of agent and management of WMD
incidents
*
Supporting coordination and interaction with designated Local, Regional, State, and
Federal WMD incident response authorities
D. MMST Concept of Operations
The MMST is a technical-professional team that provides assistance to local and regional
responders. This assistance may be by way of a response to an incident site or may be by
way of consultation by telephone. If a Local response is required, the team will be
operational within 30 minutes of notification. If a regional response is required, the team will
be operational within 60 minutes of notification, (see next page, Diagram 1).
Page 30
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-3
Pg1-3 goes here, Make sure it is called diagram 1
Page 31
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-4
D. MMST Concept of Operations (cont.)
Once on site, the Task Force leader will report directly to the Incident Commander to
advise of the team's arrival and to be briefed on what has occurred and what action plans
are currently in place. If no formal incident command has been established, the Task Force
leader will take the necessary steps to establish an incident command system. During an
incident, operational direction for the MMST will be taken from the Incident Commander
who will coordinate through the TFL to determine how best to deploy team resources. As
soon as practical, the Task Force leader in communication with the Medical Director will
begin assessing the probable agent involved using victim symptomatology, clinical
examination information, and environmental sampling.
In addition, the team will contribute to mission completion by:
*
Hospital/Public Health Coordination-Coordination with local public health officials and
hospitals that includes professional medical guidance on agent identification, mass triage
and decontamination, victim intake, and treatment for specific agents.
*
Medical Treatment/Management-Direct field medical intervention in WMD incident
consequences.
*
Incident Command Liaison-Liaison and coordination with the local incident
commander that includes advising on technical and medical professional issues,
establishing an Incident Command System (ICS) if none has been established, and
establishing and deploying MMST resources into the existing ICS.
*
Decontamination-Coordination with the existing ICS to establish mass
decontamination facilities.
*
Pharmacology-Maintenance, distribution, and administration of appropriate
medications for WMD incidents, maintaining an inventory of medications and monitoring
the medications' shelf life to ensure they remain current.
*
Communications-Maintenance and inventory of communications equipment and
coordination with the local ICS to establish common communications capabilities.
*
Public Information Officer (PIO)/Media Relations-Coordination with the local PIO to
establish information parameters and determine the appropriate information releases to
avert further casualties due to mass hysteria.
Page 32
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-5
*
Law Enforcement Coordination (Intelligence/Security)-Coordination with local law
enforcement officials to brief them on the potential impacts of the incident and courses
of action to take.
II.
MMST MANAGEMENT STRUCTURE
A Program Management Team (PMT), which is a subcommittee of the Seattle Disaster
Management Committee, organizationally directs the MMST. The PMT consists of the Seattle
Fire Department's Assistant Fire Chief as the Chair and a representative from the Seattle Police
Department, the Seattle Office of Emergency Management and the Seattle/King County
Department of Public Health.
MMST MANAGEMENT STRUCTURE
Seattle Washington
Risk & Emergency Mgr
WA State Dept of Health
Advisor
COMMAND STAFF
OPERATIONS
PLANS
LOGISTICS
MEDICAL
TASK FORCE LEADER
METROPOLITAN MEDICAL
STRIKE TEAM
MMST
MMST PROGRAM
MANAGEMENT TEAM
PMT
SEATTLE DISASTER MANAGEMENT COMMITTEE
DMC
MAYOR
&
CITY COUNCIL
Page 33
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-6
A. MMST Program Management Team - Roles and Responsibilities
The Program Management Team (a subcommittee of the Seattle Disaster Committee)
consists of a committee composed of a Chair, (Seattle Fire Department Assistant Fire
Chief) and a representative from the Seattle Police Department, the Seattle Office of
Emergency Management and the Seattle/King County Department of Public Health. This
group will utilize a subgroup composed of subject experts from the field to accomplish the
functions/tasks below:
*
Response Team
*
Ambulance Transport
*
Hospital Treatment
*
Mental Health
*
Non-Survivors
*
Forward Movement of Patients
*
Crime Scene
*
Inter-agency Coordination
The responsibilities of the Program Management Team are to:
*
Represent Seattle at national meetings
*
Coordinate team activities on a Local, State and Federal level
*
Ensure the MMST response plan is kept current, that all medical and training
requirements are met, and that all required forms are current
*
Coordinate the development and scheduling of exercises and teamwide training sessions
*
Assure training programs are devised and presented for area first responders (police,
fire and EMS) as well as the local medical community
*
Coordinate the development and distribution of educational materials concerning the
MMST
*
Coordinate with Federal agencies and DoD units for sharing information, for establishing
joint exercises, and for other purposes found in the MMST mission statement, (see
page 1-1)
Page 34
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-7
*
Keep the Mayor, City Council, Fire Chief and Police Chief apprised of team status and
pertinent operational and training issues through the Disaster Management Committee
III.
MMST Membership / Organizational Structure
The MMST is organized into a Task Force consisting of 62 personnel. It is a multidisciplinary
team drawn from Seattle/King County law enforcement, fire, Hazmat, medical, and public health
professionals. Team members are organized under a Task Force Leader (TFL) using an
Incident Command (IC) model, (See Diagram 2).
A. Roles and Responsibilities of the MMST Members
1. Task Force Leader.
The MMST Task Force Leader will be a Seattle Fire Department
Officer. The TFL is responsible for managing and supervising all team activities.
2. Law Enforcement Liaison.
The Law Enforcement Liaison will be a law enforcement
officer, usually of Lieutenant rank or higher. The Law Enforcement Liaison will
coordinate the following functions:
*
Intelligence
*
Police logistics
*
Team/scene security
*
Evidence control
3. Safety Officer.
The Safety Officer will be a Seattle Fire Department Officer. The
Safety Officer will ensure the following functions are established:
*
Decontamination operations are in place
*
Safety zones are established
*
Site safety plans are developed and in place
*
Evacuation parameters are established and in place
Page 35
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-8
Seattle Fire Department
METRO MEDICAL STRIKE TEAM
(Proposed 62 Person Team)
Security
Law Enforcement
Liaison
Safety
Officer
Medical
Director
Hospital
Liaison
FM - Unit 1
1 Unit Leader
5 Specialists
FM - Unit 2
1 Unit Leader
5 Specialists
Field-Medical (FM)
Group
Supervisor
FH - Unit 1
1 Unit Leader
5 Specialists
FH - Unit 2
1 Unit Leader
5 Specialists
FH - Unit 3
1 Unit Leader
5 Specialists
FH - Unit 4
1 Unit Leader
5 Specialists
Field-HazMat (FH)
Group
Supervisor
OPERATIONS
SECTION
CHIEF
Intelligence
Info - Specialist
(Law Enforcement)
HazMat
Info - Specialist
(Chemist)
Medical
Info - Specialist
(Toxicologist)
Plans
Group
Supervisor
PLANS
SECTION
CHIEF
Comm Unit
1 Specialist
Communications
Group
Supervisor
Log. Unit 1
1 Unit Leader
1 Specialist
Log. Unit 2
1 Unit Leader
1 Specialist
Logistics
Group
Supervisor
LOGISTICS
SECTION
CHIEF
TM - Unit 1
1 Unit Leader
1 Specialist
TM - Unit 2
1 Unit Leader
1 Specialist
TEAM-MEDICAL
SECTION
CHIEF
TFL
Diagram 2
Page 36
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-9
4. Medical Director.
The Medical Director will be a physician and will oversee all
medical operations of WMD incidents and coordinates the following functions:
*
Pharmaceutical and antidote
*
Medical elements of product/agent identification
*
Team members medical and health records
*
Hospital and medical facility coordination
*
Public health issues
*
Liaison regarding medical issues
5. Hospital Liaison.
The Hospital Liaison will be a Health Care Professional from
Hospital Control who oversees the following functions:
*
Hospital communication/liaison
*
Medical information sharing
*
Patient disposition tracking
*
Hospital resupply and pharmacology
6. Field Operations.
A Seattle Fire Department Officer directs the Field Operations
Section in the role of Operations Section Chief. The Operations Section Chief will
coordinate the following functions:
*
Reconnaissance (See Page 19)
*
Detection/Identification (See Page 18)
*
Patient Extraction (See Page 19)
*
Decontamination (See Page 21)
*
Field Medical Operations
(1)
Treatment (See Page 23)
(2)
Transportation (See Page 23)
Personnel for this section include a Field HazMat Supervisor and twenty-four
Hazardous Materials Specialists and a Field Medical Group Supervisor and twelve
Field Medical Specialists
.
Page 37
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-10
7. Plans Section.
A Seattle Fire Department Officer in the role of the Plans Section
Chief directs the Plans Section. The Plans Section Chief will assume the role of the
Team PIO. The Plans Section Chief will coordinate the following functions:
*
Develops Incident Action Plan
*
Documents Team Activities
*
Intelligence Information and Exchange
*
Hazmat Information
*
Toxicological Information
Personnel for this section include a Plans Group Supervisor and three Technical
Information Specialists.
The MMST Plans Section will complete the annual update of this plan. It will be
reviewed annually by the team members for revisions.
8. Logistics Section
. A Seattle Fire Department Officer in the role of the Logistics
Section Chief directs the Logistics Section. The Logistics Section Chief will oversee the
following functions:
*
Inventory Control
*
Communications Hardware
*
Equipment Maintenance
*
Equipment Supply
Personnel for this section include a Logistics Group Supervisor, four Logistics
Specialists, a Communications Group Supervisor and a Communications Specialist. It
is expected that the Communications Group will be reassigned to the Plans Section
during a deployment.
9. Team Medical Section.
A physician will direct the Team Medical Section and will
oversee the following functions:
*
Team member medical issues
*
Supervise the team medical monitoring program
*
Be available for on-site consulting and treatment of team members
Personnel for this section include four Team Medical Specialists. Their primary function
will be the treatment of MMST Team members.
Page 38
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-11
METROPOLITAN MEDICAL STRIKE TEAM
CHAPTER I, PART II
MMST TEAM OPERATIONS
I.
INTRODUCTION
A. Purpose
Chapter 1, Part II will:
*
Describe the MMST role in supporting first responders
*
Describe MMST activation
*
Describe MMST deployment
*
Describe MMST predeployment actions
*
Describe the cancellation of MMST deployment
*
Describe MMST NBC agent detection and identification
*
Describe MMST extraction and antidote administration activity
*
Describe MMST triage and decontamination activity
*
Describe MMST field casualty collection center
*
Describe MMST Field medical operations (treatment/transportation)
*
Describe the MMST pharmaceutical cache and concept of operations
B. MMST's Role in Supporting First Responders
In most WMD incidents, initial recognition of an unusual event is likely to be done by local
providers. Therefore, until the MMST can be activated, first responders will be the initial
lines of defense and action. All first responders have received training in proper control and
approach of a MCI scene, methods of recognition, and protective actions to take in the
event of a suspected WMD incident.
The MMST will have the capability of supplementing first responders, including HazMat
teams. This will include site entry, agent determination, drug administration, victim retrieval
and treatment, and victim and rescuer decontamination procedures.
It shall be recognized that the MMST has limited law enforcement capabilities, and acts as a
support to law enforcement, in the crime scene management phase of an incident.
Page 39
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-12
II.
MMST ACTIVATION
There are different levels of Team Activation depending upon the magnitude of the incident.
A. Emergency Call-Down Lists
1.
MMST Task Force Leader is responsible to initiate the notification of the MMST.
2.
It is the responsibility of the MMST Program Director
(Seattle Fire Department's
Assistant Fire Chief
)
to ensure call-down list remains current.
B. Types of Activation
1. Alert
Upon the occurrence of a WMD incident or the possibility of an impending WMD
event, the Seattle Fire Alarm Center will issue an advisory alert to the MMST Task
Force Leader. This alert will be channeled through a pager/call back system. The
MMST Task Force Leader, upon review of all available information, and taking into
consideration the confidentiality of the intelligence information, will initiate notifications to
MMST personnel. All appropriate information related to the event, such as type of
event, location, magnitude, weather conditions, etc., will be provided. The alert is
intended only to apprise MMST members of the occurrence of an event and does not
constitute a directive to begin any activation or deployment activities.
a)
Alert notification message shall include procedures and communications methods for
alerted MMST personnel to acknowledge the alert message.
b)
The Mayor and other appropriate officials
(e.g., Director of Emergency
Management Division, Fire Chief, and Police Chief
) shall be expeditiously
apprised of the alert notification from the Emergency Management Staff Duty
Officer.
Page 40
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-13
2. Activation
Upon the occurrence of an WMD incident or the possibility of an impending WMD
event, the Seattle Fire Alarm Center, in coordination with the MMST Task Force
Leader, may issue an activation order for emergency or deliberate deployment of
certain or all MMST components. All MMST members will be advised, including those
components not activated. An activation order is intended to have MMST members
report to a mobilization area prior to deployment as a group and to await a
determination on deployment or cancellation.
a)
MMST members in their role with the local jurisdiction affected by an WMD
incident and already on scene at the incident site will not be required to report to a
mobilization area prior to deployment but will stay on scene awaiting the arrival of
the MMST.
b)
The Emergency Management Staff Duty Officer shall apprise the Incident
Commander of the activation notification.
c)
The Mayor and other appropriate officers
(e.g., Director of Emergency
Management Division, Fire Chief, and Police Chief)
shall be expeditiously
apprised of the activation notification from the Emergency Management Staff Duty
Officer.
3. Mobilization Center Locations
Locations of mobilization centers are to be determined by the MMST Task Force
Leader with consideration as to the incident site of the affected jurisdiction.
III.
MMST DEPLOYMENT
Deployment is used when there is a need for the MMST to be on scene at the incident site. The
MMST Task Force Leader must establish contact with the appropriate local official as soon as
arriving at an assigned locality. This may be a designated position within the Incident Command
System (ICS) structure responsible for receiving and briefing the incoming force(s) or it may be
the on-site local Incident Commander at the Incident Command Post.
Page 41
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-14
A. Types of Deployment/Technical Assistance
There are four types of deployment of MMST assets:
1. Emergency Deployment
involves the limited or substantial release with no warning of
suspected WMD materials resulting in injuries or death.
2. Deliberate Deployment
involves the confirmed or suspected presence of WMD
materials without an actual release. A deliberate deployment could also be the result of
a scheduled field training exercise of MMST assets or a determination by the MMST
Program Director
(Seattle Fire Department's Assistant Fire Chief)
that the
deployment of certain or all MMST components may be advisable due to:
*
Individuals or groups working in a defined area pose a risk of a release.
*
A scheduled event where a threat assessment indicates an increased risk.
3. Technical Assistance
involves providing technical advice to responders in the
management and consequences of a WMD event.
B. Information Required for Deployment.
When deploying the MMST the following information, as a minimum, should be identified:
1. Specific work location and a safe access route to the incident
.
2. Relevant security issues to be addressed.
3. Location of base of MMST operations
(if identified or established).
*
Inner Perimeter
*
Staging Areas
*
Treatment Areas
*
Public Information Areas
*
Decontamination Areas
*
Outer Perimeter
Page 42
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-15
4. Current situation report to include but not limited to the following
:
*
Magnitude of event, i.e., number of victims, etc.
*
Suspected material involved
*
Location of material or device
*
Weather conditions at incident site
*
Phone number and location of Incident Command Post
*
Other pertinent tactical information
5. Tactical assignment
.
6. Immediate supervisor
(Incident Commander/Operations Officer, etc.).
7. Personnel/cache movement requirements
.
8. On-site transportation requirements
.
9. Communications frequency
(ies).
10. Shelter and support facilities
.
11. Reporting requirements
(type/location/frequency).
12. Availability of maps
.
C. Procedures for Types of Deployment
1. Emergency Deployment
a)
Incident occurs and local responders
(Hazardous Materials, Law Enforcement,
etc.)
become notified, determine, or otherwise suspect the use of WMD materials.
b)
Emergency notification will be requested by utilizing the designated contact point
(Seattle Fire Alarm Center)
. See the above Section,
Information Required for
Deployment
.
c)
The Seattle Fire Alarm Center will contact the MMST Task Force Leader and
relay all available information.
d)
MMST Task Force Leader activates the team notification process.
Page 43
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-16
2. Deliberate Deployment
a)
Local Incident Commander believes a WMD release is possible either through
direct evidence or threat assessment.
b)
To preserve secure communication channels, notification will be routed directly to
the MMST Task Force Leader and to law enforcement.
3. Technical Assistance
a)
Requests for technical assistance are directed to the Seattle Fire Alarm Center.
b)
Seattle Fire Alarm Center will relay requests for consultation to the MMST Task
Force Leader, the Law Enforcement Liaison, and the Emergency Management Staff
Duty Officer who jointly will determine one of the following actions:
*
Provide MMST consultation
*
Assist with coordination effort
*
Activate MMST
Page 44
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-17
IV.
MMST Predeployment Actions
A. When deployed, a MMST briefing will be conducted. The Task Force Leader will brief the
appropriate Section Chiefs. Each Section Chief will then brief their assigned personnel.
1. Depending on the type of notification initiated by the MMST Task Force Leader, the
following notification information (if available) will be relayed to all MMST members as
listed in the following table:
Alert
Activation/Deployment
Cancellation
Type of event
Event location
Magnitude of event
Weather conditions
Current situation
(Security
considerations may
require the
modification of this
list.)
Type of event
Event location
Magnitude of event
Weather conditions
Current situation
Mobilization center location
Time of departure to incident
MMST radio frequencies
Anticipated length of mission
Time of official activation
Person initiating activation
Reason for cancellation
Person initiating cancellation
Time of cancellation
Procedure acknowledging
cancellation.
V. Cancellation of Deployment
When an
alert has been issued, and subsequent information indicates that the mobilization of
MMST is not warranted, the local designated contact point will issue a notice of stand down to
the MMST Task Force Leader and provide related information regarding the reason for the
stand-down notice.
After an
activation or deployment cancellation the following actions should be taken:
*
The TFL shall communicate with the Incident Commander to confirm the stand down.
*
The TFL shall communicate with the Emergency Management Staff Duty Officer to
confirm the stand down.
Page 45
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-18
*
The Emergency Management Staff Duty Officer shall apprise appropriate senior level
officials from the affected jurisdiction of the stand down.
VI.
NBC AGENT DETECTION/IDENTIFICATION
Agent detection under the Seattle MMST Plan is the responsibility of the Field Operations
Section, (
See Roles and Responsibilities of MMST Team Members
,
Page 1-7). This section is made up of:
*
Operations Section Chief
*
Field Medical Group Supervisor
*
Field HazMat Group Supervisor
*
Medical Specialists (12-Paramedics)
*
Field HazMat Specialists (24-Specialists)
A. Agent Identification
Training has been conducted with the Field Operations Section (FOS) in Agent
Identification procedures. The Seattle MMST will possess the following equipment for
identification capabilities:
1. Nerve Agents
*
M8 Paper ­ liquid nerve agent
*
M90 CAD ­ aerosol/liquid nerve agent
*
M256A-1 Chemical Detection Kit ­ nerve agent
*
SAW MiniCAD ­ aerosol/liquid nerve agent at low concentrations
2. Blister Agents
*
M8 ­ liquid blister agent
*
M90 CAD ­blister agent
*
M256A-1 - Chemical Detection Kit ­ Lewisite/blister agents
*
SAW MiniCAD ­ blister agent at low concentrations
3. Blood Agents
*
M90 CAD ­ blood agent
*
M256A-1 Chemical Detection Kit ­ blood agent
4. Radiation (Alpha, Beta, Gamma)
Page 46
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-19
*
Ludlum 2241 meter ­ detects alpha/beta/gamma
*
Thermoluminescent dosimeters (TLDs)
*
Self-reading dosimeters (SRDs)
5. Chemicals (e.g., Phosgene, Chlorine, etc.)
*
Draeger Kit
6. Biological
*
Smart Cards (e.g., Anthrax, Botulinum, etc.)
The current state-of-art for field biological detection is crude therefore; the MMST
capacity for detecting a biological agent is focused on proper collection and transport to
an appropriate laboratory facility (State lab, CDC, USAMRID, etc.). Within Seattle,
detection of a biological agent attack would most likely occur based on shifts in
morbidity and mortality patterns. As part of their flu-monitoring program, the
Seattle/King County, Department of Public Health collects patient morbidity trends from
sentinel infectious disease specialist and targeted emergency rooms in the city. In
addition, Seattle Fire Department, EMS, track EMS ambulance runs to local
emergency rooms on a daily basis.
VII. EXTRACTION OF VICTIMS / ANTIDOTE ADMINISTRATION
Extraction of victims from the hot zone of a WMD event is the responsibility of the MMST
Field Operations Section. Field Operations members designated for hot zone entries have been
trained in WMD symptom recognition, antidote administration, and WMD HazMat issues.
A. Hot Zone Entry ­ Extraction/Reconnaissance
Hot zone entry and/or extractions/reconnaissance will be done under the following
guidelines:
1. No rescue is to be attempted without appropriate PPE. The PPE appropriate to the
situation will be determined by existing standard operating procedures (SOP's). Where
questions exist regarding appropriate PPE, the TFL is responsible for determining the
appropriate level of PPE.
2. For rescuer safety, entry/rescue attempts will not be initiated until decontamination is
established.
Page 47
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-20
3. In a multiple victim scenario, ambulatory patients will be removed first, followed by near
ambulatory patients, then unconscious patients.
4. In victim extraction from a confined space or other entrapment situation, rescue will be
coordinated with input from local HazMat Team/Fire Department confined space
experts.
5. Field HazMat Supervisor will designate team personnel to don the appropriate level of
personal protective equipment (PPE) to assist the MMST in reconnaissance work,
including gathering specimens for laboratory analysis.
6. Where appropriate, initial treatment and emergency decontamination procedures will
begin by the MMST entry/extraction team prior to passing a patient off to the
Decontamination Team
7. The MMST TFL in cooperation with the Team Medical Section Chief is responsible for
establishing safe work/rest intervals for team members in Level A, B, and C PPE.
B. Antidote Administration
All MMST members, Paramedics, and targeted health care providers responsible for
antidote administration have attended training in NBC symptom recognition and antidote
administration. Guidelines for symptom recognition and antidote administration have been
approved and provided to each pre-designated hospital
.
1. MMST entry/extraction team members have the capability to begin antidote
administration in the extraction/hot zone.
2. Capacity to provide antidote administration has also been established with the MMST
Decontamination Team, MedicOne transportation units, pre-designated hospitals, and
at all casualty collection centers.
Page 48
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-21
VIII. TRIAGE / DECONTAMINATION
Triage is the process of doing the most good for the most victims. In WMD incidents, there
may be few viable victims within the hot zone and increasing numbers of viable victims near the
outer perimeter where the agent is less concentrated.
A. Triage
1. The Fire/Paramedic members of the MMST Field Operations Section are responsible
for victim triage within WMD event hot and warm zones. Ambulatory victims who have
left the warm zones will be directed to the decontamination entry points for appropriate
triage and decontamination.
2. If victims overwhelm the decontamination or transportation lines, holding areas will be
established (casualty collection centers) at both the entry and exit to the
decontamination alley. Field Operation's personnel in appropriate PPE to ensure
victims are provided appropriate field treatment and re-triage prior to decontamination
will staff the entry casualty collection center. Casualty collection centers at the end of
the decontamination alley will hold "clean" victims and will be staffed by Seattle Fire
Paramedics. Clean victims will be provided appropriate treatment, antidote
administration and be prioritized for transportation to pre-designated hospitals.
3. Victims outside the warm zone who have not been decontaminated will be directed to
the closest decontamination entry point for appropriate triage, treatment, and
decontamination.
4. Victims will be triaged using a four-color triage rating (Black = Dead and Non-
salvageable, Green = Non-injured or Walking Wounded, Yellow = Delayed Care,
Red = Urgent care) based on the Seattle Fire Department's Simple Triage And Rapid
Treatment (S.T.A.R.T.) System. See Appendix J for explanation of the S.T.A.R.T.
system
B. Decontamination
1. All WMD victims will receive emergency decontamination prior to being transported to
medical facilities.
Page 49
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-22
2. Victims who have completed on-scene emergency decontamination will be identified
with white flagging tape, preferably on an upper extremity.
3. To facilitate documentation of onsite treatment and decontamination a "punch card"
care tag will be attached to each victim when triaged. Treatments given, type of
decontamination, and decon solution used will be noted (punched) on each tag prior to
transport.
4. Emergency decontamination procedures will be immediately initiated when MMST
personnel are injured and/or have a PPE failure.
5. Victims who continue to deteriorate after emergency decontamination and treatment
should undergo repeat decontamination. This definitive decontamination should be a
more intensive scrubbing/cleansing of the patients and may have to be completed at
receiving medical facilities.
IX.
MMST Field Casualty Collection Center (CCC)
Post event, casualty collection centers may be needed in areas where patient flow is slowed
because of transportation delays, resource limitations, medical intensive procedures (i.e.,
decontamination), or delays in admission to definitive care (e.g., hospitalization). Properly
staffed CCC's ensures triage, continued medical treatment, re-evaluation, and prioritization of
patient care and movement.
*
At the incident site, if delays are encountered in decontaminating victims or transporting
decontaminated victims to definitive care, a CCC(s) will be established near the
decontamination entry site(s) and exit site(s) to ensure medical treatment until transportation
of victims is completed.
*
At the definitive care site, if delays are encountered in hospital admission of decontaminated
victims, alternate CCC(s) may be established away from the incident site to ensure
continued medical treatment and avoid cross contamination until appropriate definitive care
(e.g., hospitalization) can be established. At the CCC, patients will be re-triaged and
prioritized for hospital transport.
*
Within the warm zone, the MMST Field Operation Section will maintain staffing of the
CCC. Outside the warm zone, staffing of the CCC will be by Seattle Fire Department
Paramedics or appropriately trained mutual aid EMT/Paramedics. Additional staffing
Page 50
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-23
support will be coordination by City of Seattle ESF-8, (See Chapter II Emergency
Operations Center).
*
If the incident size and scope overwhelms local/regional hospitals, then CCC(s)will be
established for staging victims for possible evacuation out of the affected area. Within
Seattle, public facilities and community centers have been pre-designated for disaster
sheltering/CCC(s) points.
*
Delegation of appropriate staffing for the CCC will be the responsibility of the Incident
Commander.
*
Individuals who die while being treated at the CCC will be relocated to the designated
temporary morgue site, as directed by the Medical Examiner.
*
The Law Enforcement Liaison will coordinate with the primary law enforcement agency to
ensure security issues at CCC(s) are addressed and proper evidence handling procedures
are being practiced.
X.
FIELD MEDICAL OPERATIONS
A. Field Treatment
1. All health care providers providing field treatment have received training in WMD
symptom recognition, antidote administration, and initial treatment of WMD victims.
2. In the hot/warm zones, only MMST Medical Specialist provides field care. Once
victims have been decontaminated, any Seattle Fire Paramedic Unit at the scene can
provide field care.
3. Treatment protocols have been established and adopted for field medical care, (See
Appendix I).
4. On-site treatment will include ability to provide basic and advance life support.
5. Communication linkages will be established between field-treating units and recognized
local medical experts.
Page 51
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-24
a)
The Poison Control Center will be used as a resource for product identification and
determining treatment regimens not covered by MMST protocols.
B. Field Transportation of Patients
The Seattle/King County emergency medical system is a regional partnership of 35 fire
departments, five paramedic providers, mutual aid cities, the county, the University of
Washington Medical Center, Airlift Northwest, and private ambulance companies
1. Patient transportation is a part of the existing incident command system and structure. It
is the responsibility of the Incident Commander to assign a transportation officer. The
transportation officer coordinates onsite transportation resources with incident
transportation needs.
2. The MMST Hospital Liaison Officer interfaces with this ICS component and, in
coordination with the MMST Medical Director develops the patient transportation plan
for the incident.
a)
As part of the patient transportation plan, the first line of emergency transportation
of victims to definitive care will be the Seattle Fire Department, Emergency Medical
Services (EMS). The Seattle Fire Department, EMS Division, provide BLS/ALS
transport. Further transportation needs will be augmented by the Seattle/King
County emergency medical system.
*
Seattle Fire Paramedics have over 2000 hours of training under the direction of
the Hospital Control Physician
b)
When patient transportation resources are overwhelmed the City's mass casualty
transportation plan is activated. The plan augments Seattle Fire Department's first
responder medical units (15 Aid Units) with 35 ambulances from immediate local
jurisdictions. In addition, it adds pre-identified mass transit vehicles within the
public and private sector to allow for victim movement. Additional transportation
assets are available by requesting mutual aid from neighboring county and local
military support.
Page 52
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-25
C. Transportation Protocols at the Scene
1. All victims transported by EMS will be decontaminated prior to transportation. A
contaminated victim may be transported at the request of the MMST Medical Director
under the following situation:
a)
The life of the victim is in danger and more definitive care is required to save their
life.
b)
EMS/transportation personnel have the proper PPE available and been trained in its
use.
c)
Definitive care requirements are available at the receiving facility and provisions
have been made for proper decontamination once the victim arrives.
d)
Vehicles used to transport a contaminated patient will be immediately placed out-
of-service and brought to the collection point for evaluation.
e)
Vehicles and personnel used for transport that become contaminated must be
decontaminated before returning to service. First responders using a contaminated
vehicle will be decontaminated and evaluated for treatment by the MMST Medical
Director designate.
2. Unconscious victims will be transported to definitive care facilities using an emergency
vehicle and staff capable of providing continuous treatment and/or antidote
administration.
3. An ALS and BLS attendant will transport all patients to definitive care (e.g., hospital).
In the event of diminished resources, staffing for EMS transportation will be by two (2)
BLS attendants, (EMT-level, minimum 100 hours of EMS training).
4. A minimum BLS medical support will be provided on all public mass transit vehicles
used to move large numbers of asymptomatic or psychologically affected victims.
D. Decontamination of Transportation Vehicles
Page 53
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-26
1. At the conclusion of the incident, MMST and local fire department hazardous materials
personnel will bring all vehicles used for patient transportation to a designated collection
point, (as determined by the IC) for evaluation.
2. Vehicles used to transport a contaminated patient will be immediately placed out-of-
service and brought to the collection point for evaluation
3.
Seattle Fire/HazMat is responsible for determining if vehicles suspected of
contamination can be re-commissioned.
4.
Vehicles and personnel used for transport that become contaminated must be
decontaminated before returning to service. First responders using a contaminated
vehicle will be decontaminated and evaluated for treatment by the MMST Medical
Director designate.
XI. MMST Pharmaceutical Cache
A complete list of the MMST pharmaceutical cache can be found in Section 10-A-1. The
rationale for selecting the quantities and types of drugs is as follows:
A.
Background / Development of Pharmaceutical Cache
This section discusses the Metropolitan Medical Strike Team's (MMST's) role in providing
pharmacological support to the first responder community, on-scene patient care, and
support for hospitals providing primary care to the victims of these incidents. Magnitude and
depth of the Seattle MMST pharmacological cache has been determined based on the
MMST concept of operations (i.e., potential NBC agent, operational manpower, response
time, personnel training, etc.) and contract requirements for access to sufficient quantities of
antidote to handle an estimated 1,000 affected victims. The pharmaceutical cache will be
developed with the following goals:
*
Each member of the MMST will be issued appropriate antidotes against known agents
for self-administration in the event of exposure.
*
On scene MMST pharmaceutical cache will provide sufficient quantities of antidotes to
support the members of the MMST, emergency responders, support personnel, and
initiate treatment of 1000 victims.
*
Where necessary, MMST pharmaceutical cache can be made available to support the
receiving medical facilitates.
Page 54
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-27
To better determine the type and quantity of MMST Pharmaceuticals, the MMST Program
Management Team considered input from local experts in the areas of: emergency
response, mass casualty events, and uncontrolled chemical releases. Based on this
information and projected impact on 1000 victims, the following estimates and triage
classifications have been made by the MMST Medical Director to assist in making
judgments on the depth of he pharmaceutical cache.
Projected Number of Patients Requiring Treatment in Field
(Sorted by Triage Color)
10 Black
No Treatment
100 Red
3 Doses/ patient
300 Yellow
2 Doses/patient
600 Green
+/- 1 Dose/patient
This is a conservative estimate. In an actual WMD chemical event which impacts 1000
victims, it is expected that the number of patients triaged to the "black" category would be
considerably higher.
B. WMD Chemical Event - Concept of Operation for Pharmaceutical Need
In a WMD chemical agent release, Seattle anticipates that the agent will have an immediate
health affect on the impacted population. Signs and symptoms, size of the event, and
indications of an unknown "chemical exposure" would result in early deployment of the
MMST. In a chemical event, the MMST pharmaceutical cache will provide a critical key in
victim survival.
*
Priority use of the MMST pharmaceutical cache will be MMST members, emergency
responders, support personnel, field victim care, and hospital resupply.
*
In the event MMST pharmaceutical caches are depleted, the MMST TFL will assist
impacted health care sites with identifying and accessing alternate sources of medication.
Using the "Projected # of Patients Requiring Treatment in the Field" chart (see previous
page) to estimate severity and dosage requirements for pharmaceutical support in the field,
the MMST cache will include the following chemical antidotes:
1. Nerve Agent Antidotes
Page 55
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-28
a) MMST Pharmaceutical Cache
(1)
Mach-1 Auto-injectors (Atropine/2-PAM) =
1,500 doses
*
100 Red Patients = 300 doses
*
300 Yellow Patients = 600 doses
*
600 Green Patients = 600 doses
*
Atropine Preloads
= 150 doses
1,650 doses
(2)
Diazepam 10 mg =
750 doses
Expectations are that only patients who are moderately (yellow) or severely
(red) affected by nerve agent would require therapy for seizures. All will
require decontamination therapy.
b) Seattle Hospital Supplies
=
~1,000 doses
Telephone survey of Seattle hospitals show in-hospital atropine range between 60-
180 mg (30-90 doses). Seattle has 11 hospitals/ King County has 19 hospitals.
c) Alternate sources of Atropine
(3)
Veterinary supply houses =
4,000 doses
There are 4 distribution centers within one hour of Seattle each with on-the-
shelf supply of veterinary atropine ranging between 1500-2500 mg.
C.
WMD Biological Event - Concept of Operation for Pharmaceutical Need
Given the nature of biological agents and their inherent incubation period, it is unlikely that
the release of a biological agent would be immediately recognized. Within Seattle, detection
of a new biological agent would most likely occur in health care facilities through shifts in
common morbidity and mortality patterns.
The role of the MMST in a biological incident will be to assist and support the Public Health
efforts at patient identification, technical assistance, and evidence collection. It is likely, initial
care of victims of a biological agent will seek care through traditional health care access
Page 56
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-29
points (i.e., private physicians, hospital emergency rooms, infectious disease specialist, etc.),
not the MMST.
Given this scenario, priority use of the MMST pharmaceutical cache will continue to be
MMST members, emergency responders, support personnel, field victim care, and then
hospital resupply. In a suspected biological event, antibiotics in the MMST cache will be
used primary for prophylaxis or immediate treatment of responders.
1. Biological Antidotes
a) MMST Pharmaceutical Cache
*
Ciprofloxocin 500 mg
= 750 doses
D.
WMD Radiological Event - Concept of Operation for Pharmaceutical Need
In a radiological release, the role of the MMST will be to assist and support the Public
Health efforts at identify exposed populations, disseminating information to care providers
and the public, and assisting the law enforcement community in determining the site of
release and in collecting evidence.
While there is no effective treatment for radiation poisoning, early intervention with
potassium iodine can reduce the incidence of some long-term health effects, especially in
children. An organized distribution of medication to the general public is the responsible of
local public health authorities and private health care providers. The MMST, as directed by
public health authorities, could augment the quick dissemination of potassium iodine to
Seattle children and the general population.
Priority use of the MMST pharmaceutical cache will be MMST members, emergency
responders, support personnel, field victim care, and hospital resupply.
In a suspected radiological event, potassium iodine in the MMST cache will be used to
provide prophylaxis or immediate treatment of responders and targeted distribution to the
general population as directed by local Public Health authorities.
1. Radiological Prophylaxis
a) MMST Pharmaceutical Cache
*
Potassium Iodide
= 10,000 doses
Page 57
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
11/07/98
1-8
Seattle Fire Department
METRO MEDICAL STRIKE TEAM
(Proposed 62 Person Team)
Security
Law Enforcement
Liaison
Safety
Officer
Medical
Director
Hospital
Liaison
FM - Unit 1
1 Unit Leader
5 Specialists
FM - Unit 2
1 Unit Leader
5 Specialists
Field-Medical (FM)
Group
Supervisor
FH - Unit 1
1 Unit Leader
5 Specialists
FH - Unit 2
1 Unit Leader
5 Specialists
FH - Unit 3
1 Unit Leader
5 Specialists
FH - Unit 4
1 Unit Leader
5 Specialists
Field-HazMat (FH)
Group
Supervisor
OPERATIONS
SECTION
CHIEF
Intelligence
Info - Specialist
(Law Enforcement)
HazMat
Info - Specialist
(Chemist)
Medical
Info - Specialist
(Toxicologist)
Plans
Group
Supervisor
PLANS
SECTION
CHIEF
Comm Unit
1 Specialist
Communications
Group
Supervisor
Log. Unit 1
1 Unit Leader
1 Specialist
Log. Unit 2
1 Unit Leader
1 Specialist
Logistics
Group
Supervisor
LOGISTICS
SECTION
CHIEF
TM - Unit 1
1 Unit Leader
1 Specialist
TM - Unit 2
1 Unit Leader
1 Specialist
TEAM-MEDICAL
SECTION
CHIEF
TFL
Page 58
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-1
METROPOLITAN MEDICAL STRIKE TEAM
CHAPTER II
MMST SYSTEM
I.
INTRODUCTION
A. Purpose
This chapter will
:
*
Provide an overview of the Seattle MMST System
*
Define the critical components of an MMST System
*
Describe each critical component as it applies to the City of Seattle
*
Describe required actions or remaining gaps for each component
B. Overview of the Seattle MMST System
Like it or not, WMD weapons are not limited to the battlefield. When used on a city,
these weapons can quickly overwhelm a community health care system and cause
widespread psychological impact on the population. In the last few years, civilian
experience with WMD events has demonstrated that an effective response requires
timely, appropriate, and well-coordinated community actions beyond most local
capabilities. The need to close this gap in community preparedness has been the drive
for developing a "
Metropolitan Medical Strike Team System
" in Seattle.
What is Seattle's MMST System? Part of the MMST System is a new
professional/technical strike team that trained, equipped, and is prepared to work safely
in a nuclear, biological, and chemical environment. The remaining parts of the System
are enhancements of several existing City response agencies, such as; Law
Enforcement, HazMat, Fire, EMS, Public Health and City hospitals. These agencies
alone don't have the training, equipment, antidotes, or strong interdepartmental
linkages necessary for an effective response to a NBC incident. All must act together
in a coordinated, multi-agency response. From the initial 911 call to patient evacuation
out of the City, the MMST System coordinates scene control, agent identification,
victim extraction, field treatment and decontamination, patient transportation, definitive
hospital care and coordination with National Disaster Medical System. Each
component of the MMST System is an interdependent link that --taken together--forms
a "chain of survival" for victims in a WMD event. Each link in the chain is one
component in a cascading system that coordinates many agencies; providers,
Page 59
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-2
responders, and resources needed to manage the human health consequences of a
terrorist incident in Seattle. If any link in the chain is weak, survival rates will be
reduced.
To mount an effective WMD response, the City has nurtured and built stronger
communication linkages between departments, conducted multi-disciplinary planning
and exercises, developed specialized training, and begun procuring needed equipment.
To ensure our activities are cost-effective, Seattle has focused the MMST System
Development on four principal areas
:
*
Identifying "components" (i.e., Fire, EMS, etc.) in the City that would normally
respond to WMD event
*
Augmenting those "components" to meet the additional demands of a WMD event
*
Developing new "component(s)" (i.e., Metro Medical Strike Team) that would
improve our response to a WMD event, and
*
Strengthening communication and planning linkages between all the critical
components
Today, are all links in Seattle's "
chain of survival
" as strong as they should be? No. Is
additional funding of critical components needed? Yes. Do current public and private
funding levels adequately support all the essential links in the chain? No. Gaps still
remain. Funding for private/public hospitals to prepare for a WMD event (e.g., hospital
decontamination equipment, hospital PPE, etc.) remains weak. Some private health
care facilities are struggling to survive, facing strong competitive pressures in the
marketplace. Because of these economic conditions, WMD preparation remains a low
priority with many hospitals. These political and funding challenges should not
discourage or dissuade the community from getting prepared but it has produced
barriers to each link in the "
survival chain
" reaching full potential at the same time.
Over the last year, WMD awareness has been raised at all levels in the City. Strong
partnerships have been built that will significantly improve the City's response to a
WMD event. However, wherever the Program Management Team's influence and
authority have been limited, commitment of resources has lagged and WMD
preparedness has been slower than hoped.
What has been accomplished in less than one year? Communication and planning
linkages between City/County departments, State/Federal public health, and private
industry have significantly improved and public interest and commitment have taken a
positive turn. The City of Seattle has committed 1000's of hours in training, and
planning for a WMD event. Tremendous strides have been made at bridging several
strong departments (i.e., EMS, Fire, Hospital, Public Health, etc.); into one "response
army" --- an MMST Response System. These initial actions make a strong foundation
Page 60
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-3
for the MMST System. It has placed the goal of an effective response within grasp, but
more training, more equipment, and more planning remain to be done.
The remainder of this chapter highlights each of the critical components in the Seattle
MMST System, outlining what has been accomplished, what needs to be accomplished,
and our plan for closing any preparedness gaps.
MMST Critical Components
II.
MMST System ­ Critical Components
The critical components and systems that make up Seattle's MMST System are:
1. Metro Medical Strike Team
M M S T S Y S T E M
M M S T S Y S T E M
2. Health Care System
3. EMS System
4. Mental Health System
5. Disposition of Non-Survivors
6. Emergency Operations Center (EOC)
7. Forward Movement of Patients
EMS
System
Non-
Survivors
MHS
EOC
Health Care
System
MMST
Patient
Movement
Page 61
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-4
EMS
System
Critical Component # 1
A. Metro Medical Strike Team
The Metro Medical Strike Team (MMST) is a technical-
professional team that provides on-scene assistance and
telephone consultation to local and regional responders
in the event of a WMD threat. The MMST is a key
component of the overall MMST System and
operates within the City of Seattle's Disaster
Management Plan. The organization and concept
of operations for the MMST is thoroughly
discussed in Chapter I, Part 1 (see page 1-2). A short
overview of the MMST capabilities is discussed here.
For a more detailed discussion of the actions,
operations, and organization of the Metro Medical Strike
Team, see Chapter I, Part 2 (see page 1-11).
To ensure an effective WMD response, the Seattle MMST performs the following
essential actions
:
*
Reconnaissance
*
Agent identification
*
Victim rescue/extraction
*
Antidote administration
*
Decontamination
*
Triage
*
Field medical care (Primary Care)
*
Preparation for victim transport
*
Technical assistance (e.g., HazMat, toxicology, etc).
In addition to the activities listed above, the MMST maintains several linkages
throughout the MMST System that facilitate communication, patient tracking, field care,
and patient flow. These linkages are through the following team positions: Hospital
Liaison, Law Enforcement Liaison, and the MMST Medical Director.
MMST SYSTEM
EOC
MHS
MMST
Non-
Survivors
Health Care
System
Patient
Movement
EMS
System
EOC
Patient
Movement
MMST
Non-
Survivors
MSH
Page 62
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-5
MMST
EOC
Patient
Movement
Non-
Survivors
Health Care
System
MHS
EMS
System
Critical Component # 2
B. Health Care System
M M S T S Y S T E M
M M S T S Y S T E M
The Health Care System within the City of Seattle
consists of 12 hospitals (1 level-1 and 11 level-2) with
over 3100 beds. Within the immediate King County
area, there are an additional 19 primary care
hospitals (4900 beds) to support the existing
health care system. The cornerstone of the
Seattle/King County Hospital System network is
the University of Washington Medical
Center(UWMC). Conducting world-renowned
research, UWMC includes three of the largest area
hospitals; University of Washington Hospital, the
Children's Orthopedics Hospital, and Harborview Medical
Center (Trauma center). These three hospitals support and train all Seattle Fire
Department paramedics. This arrangement facilitates the MMST System's need for
strong field-hospital communication, standardized treatment protocols, and an effective
interaction between the EMS and Hospital Systems.
Normally, patient entry into the Hospital System is by EMS transport or through self-
referral (walk in, private transport, etc.). In a WMD event, patients transported to the
hospital by Seattle EMS will have been decontaminated and directed to definitive care
through Hospital Control.
However, WMD events which occurred in Oklahoma City and Tokyo suggest that as
many as 80% of affected victims may circumvent our EMS system and self-refer
themselves to a medical facility. Therefore, a WMD incident has a high potential to
disrupt the community Health Care System.
To ensure an effective WMD response, the Seattle Health Care System must
successfully address the following key areas
:
*
Hospital control
*
Hospital decontamination/cross contamination
*
Provider WMD training
*
Hospital security/crowd control
*
Hospital supply
*
Public health/Patient tracking
1. Hospital Control
Without proper casualty distribution, self-referred victims may overwhelm the
nearest hospitals while nearby facilities remain available and underutilized. The
Page 63
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-6
City of Seattle hospital network distributes casualties through one
communication central point called "Hospital Control." Based out of
Harborview Medical Center, Hospital Control serves as the "disaster
coordination hospital," redirecting EMS transportation and medical resources to
ensure continuity of emergency care
.
During periods of peak usage (i.e., disaster), Hospital Control collects
information from the area hospitals regarding their capacities and capabilities.
This system promotes inter-hospital communication --- reducing hospital peak
usage overloads, while ensuring patients are directed to the most appropriate,
timely care.
Communication between area hospitals is maintained using a radio system
(Medcom). This system is exercised daily, with each hospital reporting bed
availability and critical care status. Alternate back-up communication networks
are in place and practiced (
cell phones, faxes, pagers, and runners
). These
back-up systems ensure continued hospital communication and the exchange of
critical information (e.g
., patient loads, agent identification, toxicity profiles,
treatment modalities, etc.
), should the primary communication infrastructure
collapse.
1.1 Remaining Gaps in Hospital Control
None. The system is well designed and needs no augmentation at this
time. The Hospital Control Physician collects information on area
hospital capacity and casualties from the scene then uses this information
to direct ambulances to a destination for the most appropriate care and
timely care.
2. Hospital Decontamination / Cross Contamination
Victims who circumvent decontamination at the incident site, risk contaminating
valuable medical resources (
e.g.,
medical facilities and staff). Contamination of
hospital facility or staff will reduce critical health resources and expand the
WMD incident scene and hot zone
.
2.1 Remaining Gaps in Decontamination
Generally, health care facilities in the City of Seattle have limited
capabilities to perform decontamination (
1-2 patients)
. Many of these are
dedicated indoor showers with no water capture or separate HVAC
system. This capacity not robust enough to provide effective hospital
decontamination for large numbers of patients. Few hospitals in our area
have shown the will/motivation to plan, budget, or allocate resources that
would provide 1) robust patient decontamination, 2) provider WMD
training or, 3) appropriate PPE to support a WMD event.
Page 64
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-7
2.2 Plans for Improvement for Decontamination
Our long-range plans to correct these gap are:
*
Continue to educate and inform the medical community
*
Promote and participate in appropriate hospital planning
*
Partnership with Washington State Hospital Association to move area
hospitals toward development of a greater capacity at outside triage
and decontamination.
*
As an interim step, the Seattle Fire Department has trained and is
capable of establishing decontamination alleys outside of hospitals.
Consideration is being given to how the SFD might provide gross
decontamination support to critical hospital facilities without
negatively impacting other areas of the response.
3. Health Care Provider Experience/Training
Health care providers who are untrained or inexperienced in WMD patient
recognition, treatment, management or use of PPE will reduce survival of WMD
victims and increase health provider injuries from cross-contamination.
News events, participation in area conferences, and personal contacts made by
members of the MMST and MMST Medical Director over the last year have
significantly raised WMD awareness levels among Seattle health care
professionals and facilities. Over 2,400 fire, police, and health care
professionals have completed WMD Training.
3.1 Remaining Gaps in Health Care Provider Training
Area hospitals and health care providers have had limited experience with
WMD patients. While training classes have been highly successful with
non-hospital based care providers (EMS/Paramedic), physician
attendance has generally been disappointing.
3.2 Plans for Improvement of Health Care Provider Training
*
Members of the Project Management Team, in collaboration with the
Washington Hospital Association are identifying ways to better
influence area hospitals and hospital-based physicians to the
importance of WMD training.
*
As an interim step, WMD treatment protocols have been approved
and distributed to all area hospitals to provide guidance to treating
physicians who have not yet completed WMD training.
4. Hospital Security - Crowd Control
Page 65
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-8
Site security is directly related to site safety. Fear, anxiety, and large crowds
(i.e., patients, media, family, etc.) may overpower established hospital security
procedures. Keeping unauthorized persons out of the treatment area will
improve rescue efforts by; decreasing congestion, reducing patient looting, and
minimizing injuries from cross-contamination. Lack of preplanning for victim's
family members, mishandling of ambulatory contaminated crowds, or failure to
control media convergence will reduce the hospital's effectiveness and may
extend hazardous contamination into the hospital.
4.1
Remaining Gaps in Hospital Security
It is not clear how many area hospitals have effective lock down policies,
traffic control procedures, or media plans. General consensus is that
hospital security has been given very little attention.
4.2
Plans for Improvement in Hospital Security
*
To better define the problem, Region X Emergency Coordinator, US
Public Health Service, Office of Emergency Preparedness is
conducting a telephone survey of all area hospitals. Information from
this survey will be used to develop a better understanding of the gap in
preparedness and assist us in developing possible solutions.
*
As an interim step, we will work with the Area FCC Coordinator to
ensure these issues are addressed in the annual NDMS hospital
exercise in March, 1999.
5. Hospital Supply
Hospitals are the first fortified defense for patients in a biological/chemical
attack. As victims are moved to a hospital, critical medical resources such as
pharmaceuticals (
antidotes/antibiotics
), specialized equipment (
ventilators
), and
physicians will quickly be exhausted. Failure to address these supply limitations
will increase victim morbidity and mortality.
5.1 Remaining Gaps in Hospital Supply
*
Limited Pharmaceutical Supply
Each of Seattle's hospitals have limited supplies of antidotes (~100 ­
150 doses of atropine) and antibiotics that could be used in a WMD
event. In a large-scale event, these supplies would not sustain the
hospitals for a 24-hour period.
*
Ventilators
The 30 hospitals within Seattle/King County maintain approximately
275 in-house ventilators. Most of these ventilators are consolidated
in the 4-5 largest hospitals. At any one time ~50% of these
Page 66
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-9
ventilators are in use. During periods of high ventilator demand,
some hospitals have informal loan agreements to share ventilators and
supplies. An alternate source for ventilator support is through a
national rental company (MedicPRN 800-222-4776). They maintain
40 ventilators in Seattle, with an additional 3,000 ventilators
warehoused in California. Turn-around time for these warehoused
ventilators is approximately 24 hours. There is an additional supply
of ventilators available through three home health care agencies in the
city.
5.2 Plans for improvement of Hospital Supply
*
Limited Pharmaceutical Supply.
*
Area hospitals have been slow to adopt the value of an in-house
WMD pharmaceutical cache. It is anticipate, as greater numbers
of hospital administrators and physicians are WMD-educated,
funding for in-house drug caches may increase.
*
As an interim step, the MMST has developed policies,
procedures, and priorities to guide transfer of unused MMST
drugs stores to depleted heatlh care facilities. In addition, we
have identified several alternative distribution sources to procure
nerve agent antidote (~4000 doses) and antibiotics within one
hour of Seattle. The MMST Workgroup will continue to
investigate ancillary networks (
veterinarian, military, and
commercial vendors
) to augment available hospital supplies.
*
Ventilators
*
There are over 300 ventilators in Seattle with a large ventilator
pool in California. No additional action is needed at this time.
6. Public Health / Patient Tracking
Local health departments are charged with preventing the spread of
communicable diseases in the community.
Within Seattle, detection of a biological agent attack would most likely occur
based on shifts in morbidity and mortality patterns, first identified by local
health care providers (e.g., primary care, infectious disease, emergency
medicine, etc.). Appropriate surveillance and rapid physician reporting are
critical to the process of identifying exposures, particularly common-source
exposures, and implementing interventions to reduce or eliminate infection.
As far as patient tracking goes, the demands for insurance reimbursement have
caused health care facilities to develop sophisticated patient tracking systems.
However, there is no integrated tracking system that has been universally
adapted to a WMD event. A tracking system that will track a victim from initial
Page 67
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-10
triage/treatment, through the EMS system, continuing throughout admission to a
local hospital and, finally into forward movement by NDMS.
6.1 Remaining Gaps in Public Health/Patient Tracking
*
Mass Casualty Incident Plan (MCI)
An MCI plan has been adopted and agreements are in-place between
the hospitals to control patient flow, redistribute patients to the most
appropriate facilities for definitive care, and provide for disposition of
non-survivors. While the plan is comprehensive, some gaps remain in
citywide planning for a biological event. The MCI plan fails to
address contagious infections, quarantine issues, and mass vaccination
or drug distribution. The MCI plan will be updated in 1999.
*
Mass Vaccination/Prophylaxis
Seattle/King County Department of Health, Prevention Division, has
the responsibility for routine and emergency immunization programs.
Sites for vaccinations are situation-dependent (
public health centers,
schools, etc
.) and would be determined by the scope and magnitude of
the infection. Emergency vaccinations would be provided at the ten
(10) County Public Health Centers, then expanded to area satellite
clinics, and then community shelters.
*
Community Surveillance
Community Surveillance for communicable disease is the
responsibility of Seattle/King County Department of Health.
Communicable diseases are monitored using a duel
physician/laboratory reporting system. Physician/laboratories are
legally mandated to report some biological WMD agents (anthrax,
botulism, brucellosis, and cholera) within two days. Other biological
WMD are not reportable. One-day reporting requirements are also in
place for case clusters and unusual communicable diseases.
Page 68
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-11
EOC
Non-
Survivors
MHS
Patient
Transport
MMST
Hospital
System
EMS
System
6.2 Plans for Improvement in Public Health/Patient Tracking
*
Members of the MMST have met with the Department of Health,
Division of Epidemiology to discuss community surveillance,
quarantine, and mass prophylaxis issues. Future meetings have been
planned to clarify which data elements (e.g., EMS runs, daily mortality
counts, or trends) could be used as "triggers" for the early recognition
of a WMD biological event. The goal is to develop a sentinel system
that would effectively detect and report disease clusters, unusual or
heavy usage patterns, or unanticipated deaths.
*
The County Disaster/MCI plan will be updated in 1999. The goal is to
raise awareness of WMD events with City planners and integrate
appropriate WMD contingencies as plans are updated,
Critical Component # 3
A. EMS System
M M S T S Y S T E M
M M S T S Y S T E M
The next critical link in our MMST system is the EMS
transportation system. The Seattle/King County
emergency medical system is a regional partnership of
35 fire departments, five paramedic providers,
cities, the county, the University of Washington,
Airlift Northwest, and private ambulance
companies. As a direct result of this integrated
partnership, Seattle/King County's emergency medical
system maintains a better survival rate for out-of-
hospital heart attacks than anywhere in the United States.
Paramedics trained by Harborview Medical Center operate
from
five paramedic provider agencies around the county ­ Seattle Fire Department,
Shoreline Fire Department, Evergreen Medic One, Bellevue Medic One, and King
County Medic One.
To ensure an effective WMD response, the Seattle EMS System must successfully
address the following key areas
:
*
WMD Training /Advance life support
*
Antidote administration
*
Safe, fast transportation
Page 69
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-12
*
Patient tracking
1. WMD Training / Advance Life Support
As part of the patient transportation plan, the first line of emergency
transportation of victims to definitive care will be the Seattle Fire Department,
Emergency Medical Services (EMS). The Seattle Fire Department, EMS
Division, provides BLS/ALS transport. Seattle Fire Paramedics have over
2000 hours of training under the direction of the Hospital Control Physician.
All personnel have completed WMD training and refresher training has been
integrated into the EMS training schedule.
1.1.
Gaps in WMD Training/Advance Life Support
None. There is no additional augmentation necessary at this time. Staff
is well trained and the System is a nationally recognized first responder
program.
2. Antidote Administration
EMS personnel have been trained in antidote administration and the EMS
Medical Director has approved WMD treatment protocols. Some transport
vehicles have begun stocking a limited number of WMD pharmaceutical
(Marc-1 auto-injectors and diazepam). A MMST pharmaceutical plan has
been developed. This drug cache will augment existing EMS antidote
supplies.
2.1. Gaps in Antidote Administration
Pharmaceutical cache remains to be approved and procured.
3.
Safe, Fast Transportation
Seattle emergency medical system is nationally recognized as one of the best
in the United States. It maintains a better survival rate for out-of-hospital heart
attacks then anywhere in the United States and has an under four-minute
response time anywhere in the City of Seattle.
3.1.
Gaps in Fast Transport
There is no need for changes in this system. The response times are
efficient.
4. Patient Tracking
A Mass Casualty Incident Plan has been adopted and exercised by the City and
area hospitals to address standardized triage, patient flow, patient tracking, and
safe transportation of patients to definitive care facilities. The current tracking
system uses a sequential numbering system, via an ID tracking number written
in indelible ink pen on the patent's forehead.
Page 70
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-13
EOC
Non-
Survivor
Patient
Movem
MMST
Hospital
System
EMS
MHS
4.1. Remaining Gaps / Plans for Improvement in Patient Tracking
Patient tracking tags are being designed to better maintain information
on patient location and routing. An NDMS exercise planned for April
1999 will focus on improving patient tracking between
EMS/Hospital/NDMS.
Critical Component # 4
A. Mental Health Care System
M M S T S Y S T E M
M M S T S Y S T E M
Disasters often cause behavioral changes in adults and
children. Many react with fear and show signs of anxiety
about
recurrence after a WMD event. Some will experience
psychosomatic illnesses. During the recovery, most
victims will display periods of anger, mood swings,
suspicion, irritability, and/or apathy. Increased levels
of
stress can worsen pre-existing physical problems such
as
heart trouble, diabetes, and ulcers. In addition, victims
and
responders may develop decrements in performance
because
of inadequate rest, stress, or concerns about family and friends. Long after the disaster
has resolved, both responders and victims may feel haunted by visual memories of the
event. For this reason, ensuring victims and responders are provided early critical
incident stress debriefing and long-term psychological support is crucial to the mental
health of citizens in the community.
To ensure an effective WMD response, the Seattle Mental Health Services must
successfully provide:
*
Early critical incident stress debriefing
-
For first responders
-
For victims, families, and the community
*
Long term psychological support
1. Early Critical Incident Stress Debriefing
*
First Responders
A joint Critical Incident Stress Management Team (CISM) exists for Police
and Fire responders. It is staffed with police psychologists and a cadre of
trained Police and Fire personnel. The incident commander, 911- dispatch
center, or any ranking officer can request this team.
Page 71
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-14
Should additional services be needed, the Emergency Medical Services
Division of the Seattle/King County Health Department will coordinate with
the Seattle Police Department (SPD), Seattle Fire Department (SFD), and
the Washington CISM Net to provide additional counselors from across the
State of Washington.
*
Victims, Families, and Community
In a disaster, Mental Health Services are requested through the City of
Seattle-EOC ESF-8 Coordinator, through the Seattle/King County
Department of Human Services, Mental Health Division, and the American
Red Cross (ARC).
The Mental Health Division is responsible for providing mental health crisis
response, involuntary detention services, and outpatient mental health
services for persons who suffer from reactions to the disaster.
The American Red Cross will provide disaster mental health services to
citizens as outlined in ARC Disaster Services Regulations and Procedures,
and is dependent on volunteer staffing allowances.
1.1 Remaining Gaps/Plans for Improvement in MHS
*
Responder Mental Health Services
. No additional action is needed.
The mental health services available to first responders are
comprehensive, well designed, easily accessible, and effective.
*
Victims, Families, and Communities.
System is generally adequate.
Long term mental health services can be delivered at several
neighborhood clinics and emergency services could be provided onsite
or in treatment facilities. The Seattle/King County Department of
Health, Division of Mental Health is meeting to improve the existing
response plans related to victim and community intervention.
*
Division of Mental Health personnel has not been trained in WMD
awareness. Members of the Program Management Team will discuss
the need for the Department of Health to develop a training plan and
offer appropriate assistance with training materials and expertise.
Page 72
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-15
Patient
Movement
EOC
MHS
Non-
Survivors
MMST
Hospital
System
EMS
System
Critical Component # 6
A. Disposition of the Non Survivors
M M S T
M M S T S Y S T E M
S Y S T E M
In Seattle, the Medical Examiner's Office (ME) is a unit of
the Prevention Division of the Seattle/King County
Department of Public Health. The Medical Examiner's
Office has five autopsy specialists and eleven
investigators. Their office is located at Harborview
Medical Center (which serves as Hospital Control in
a WMD event). Causes of death, which come under
the jurisdiction of the Medical Examiner's Office,
include:
*
Unknown or obscure causes
*
Deaths caused by any violence
*
Deaths from a contagious disease
In the field, the Medical Examiner works in coordination with law enforcement and is
integrated into the on-site Incident Command System.
Mass handling of the dead creates unique problems. In a WMD event, contamination of
the body and personal effects may make routine handling impossible. Events of this
nature are national in scope frequently generate a deluge of queries from concerned
relatives, politicians, and media about the non-survivors. Collecting information for
these queries can be more different than in routine fatalities. Plans should address the
need for an information officer.............
In a WMD disaster, special materials may be needed for the recovery, identification,
and care of fatalities. For example, special markers may be needed to indicate where
the bodies were found, photographs taken before bodies are moved, special body
pouches or other containers may be required, and exceptional provisions (e.g.,
refrigeration trucks) may be needed to store large numbers of bodies. This all has to
happen in a manner that is culturally sensitive and respectful.
Page 73
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-16
To support an effective medical response to a WMD event, several areas need to be
address by the Medical Examiner's Office. These areas include:
*
Mass fatality management
*
WMD training/experiences.
*
Decontamination policy/procedures
*
Personal Protective Equipment (PPE)
*
Evidence collection/preservation
In an NBC mass fatality incident, the ME's team is faced with the enormous challenge of
establishing temporary morgue site(s) in or near contaminated environment. For this
reason, it is anticipated the ME will require immediate State or Federal assistance (i.e.,
National Guard, DoD Decontamination Teams, DMORT, DMAT, etc
.)
1. Mass Fatality Plan (MFP)
1.1. Remaining Gaps
A mass fatality management plan has been written and is currently being
revised to address disposition of non-survivors in a WMD event. Items that
have or will be addressed are:
*
Establishing a control element to coordinate ongoing activities and
release information updates.
*
Securing the area and limiting access to nonessential personnel (e.g., law
enforcement, National Guard, etc.).
*
Establishing communications between areas and to higher headquarters,
if possible.
*
Establishing the triage, decontamination, and holding areas.
*
Establishing a traffic pattern, which provides for the smooth flow of
bodies and vehicles in and out of the affected area.
*
Organizing medical personnel for staffing of the different areas.
Organizing nonmedical personnel for litter bearer duty messengers
restocking supplies, and other nonmedical functions.
*
Develop procedures that ensure timely, respectful, and culturally
sensitive evacuation and final care.
*
A temporary morgue site maybe established in proximity to the incident
site. If so, the location will need to be protected from the elements and
ensure appropriate security of the non-survivors.
*
The non-survivors personal effects will need to be removed, tracked, and
secured.
1.2. WMD Training/Experience
*
Gap in WMD Training
Page 74
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-17
Patient
Movement
MMST
MHS
Non-
Survivor
EOC
Hospital
System
EMS
System
Some personnel within the ME's Office have completed WMD training
however, several key members need to complete WMD training. At this
time, the ME's office does not plan to send additional staff for training.
1.3. Decontamination Policy/Procedures
*
No written policy or procedure regarding care, safe handling, storage,
decontamination, and final disposition (cremation, burial, etc) has been
developed.
*
The ME's Office is responsible for managing descendant's personal
effects. No policy has been written regarding safe handling (i.e., double
bagged, etc.), decontamination, destruction, or final disposition of
personnel effects.
*
Contacts for up to twelve refrigerated storage trucks have been
established and signed.
1.4. Adequate PPE
*
While it is planned, the ME's Office has not procured a PPE specific to
safe handling of a contaminated WMD victim.
2. Plan for Improving Non-Survivor
While the ME's office has discussed and begun planning for a WMD event. Many
of the policies and procedures regarding the care, safe handling, evidence
collection, decontamination, and final disposition of contaminated bodies have not
been formalized. Discussions have been held with members of the ME's Office
which suggest there is little interest in formalizing many of these procedures. As an
interim action, we will invite the ME's office to participate in upcoming
WMD/MCI exercises to better illustrate the benefits of formalized procedures. In
regards to training, we will continue to encourage participation and suggest
employees already trained provide in-service to those employees who have not
attended WMD classes.
Critical Component # 5
A. Seattle Emergency Operations Center (CS-EOC)
MMST SYSTEM
The primary responsibility for maintaining "the peace
and
order" in the City of Seattle is vested in the Mayor by the
City
Charter. All operational and service department heads
are
appointed by the Mayor, work directly for the Mayor,
and have been delegated the day-to-day authority to
administer their respective departments. Should a
situation be serious enough to warrant the use of any of
the
Page 75
City of Seattle
Seattle Fire Department (SFD)
Metropolitan Medical Strike Team (MMST)
Ll/07/98
2-18
Mayor's "emergency powers", the Mayor will activate the City's Emergency Operations
Center (EOC) and declare a "Civil Emergency".
In Seattle, day-to-day emergencies do not require activation of the EOC. All of the
City's operations departments operate using "control centers". During routine operation
these centers dispatch and support field personnel and their equipment. In a low-level
emergency, an IC can request support directly from the individual department control
center. If mass transportation is needed on scene, the IC request is routed directly to the
responsible department's control center for action. It is the responsibly of the department
control center to 1) notify key department official, 2) call off-duty personnel and arrange
additional workforce requirements, 3) monitor and keep records of departmental support
and costs, and 4) call the EOC Staff Duty officer for assistance if resources become
scarce. In additional, there IC can request the EOC Staff Duty Officer to activate the
EOC when an emergency is of such magnitude it will require significant manpower or