Transcript Slide 1

Mass Casualty Management
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Learning Objectives
At the end of the session the participants will be able to:
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Explain the concept of Mass Casualty
Define Mass Casualty Management System
Describe Field Management
Elaborate the management of victims
Elucidate the concept of transfer organization
Be familiarized with the concept of Surge Capacity
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Overview of Mass Casualty
Mass Casualty Incident
• Produces several patients
• As few as six or as many as several hundred
• Affects local hospitals
• Patients are greater than resources of the initial
responders
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Overview of Mass Casualty
Preparation for Mass Casualty
• Pre-planning and training are critical
• Establish guidelines and procedures
• Early implementation of Incident Command
• First five minutes will determine next five hours
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Overview of Mass Casualty
Response Categories for Mass
Casualties
• Mass Casualties can occur in a variety of ways
• Effect on emergency response and community impact
• Include transportation, violent crimes and building
collapse
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Overview of Mass Casualty
Response Categories of Mass Casualties
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Hazardous materials incidents
Civil disturbances
Natural disasters
Major fires
Terrorist attacks
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Overview of Mass Casualty
Problems in Mass Casualty Incidents
Most common being:
• Who is in command of the incident
• Location of the Command Post
• Lack of communication between agencies leading to
conflicting priorities and orders
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Overview of Mass Casualty
Problems in Mass Casualty Incidents
• Perimeter establishment delayed or not done at all
• Large crowds of people
• Media involvement
• Political involvement
• Inadequate resources
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing Mass Casualty
Management System
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Mass Casualty Incident
 Any event resulting in a number of victims large
enough to disrupt the normal course of emergency
and health care services
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Mass Casualty Management
• Management of victim of a mass casualty event
• Objective is to minimize loss of life and disabilities
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Mass Casualty Management System
The group of Units, Organizations, Sectors which work
jointly during a mass casualty event
Based on:
- Pre-established procedures
- Maximization of use of existing resources
- Multi-sectoral preparation and response
- Strong pre-planned and tested coordination
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Different Approaches to MCI
1. “Scoop and Run”
2. Classical Approach
3. Mass Casualty Management System
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Scoop and Run
• Most common
• Does not require specific technical ability from
rescuers
• Justified for small numbers occurring near a hospital
• May just transfer problem to the hospital
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Classical Approach
• First responders are trained (basic triage and field
care)
• Disregard the receiving hospitals from the field
• Quickly result to chaos
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Mass Casualty Management Approach
• Most sophisticated approach includes preestablished procedures for:
a. resource mobilization
b. field management
c. hospital reception
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Mass Casualty Management Approach
• Training of various level of responders
• Incorporates links between field and health care
facilities
• Command Post
• Multi-sectoral Response
• Dependent on the availability of large amounts of
human & material resources
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Problems in Developing MCM
• Limited human resources
• limited material resources
– facility
– transport
– communication
• Poor communication
– topography
– isolation
• Political
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Activities at various levels of responses:
alerting process
‘E’/Disaster
Site/Scene
initial assessment
command / control / coordinate
manage information
search/rescue
field care-- mostly health activities
transport/traffic control
facility reception at ER / A&ED
hospital mass casualty mgt. & command
system
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
Field Management
Definition:
Encompass procedures used to organize the disaster area in order to
facilitate the management of victims
Components
Alerting Process
Search and Rescue
Pre-identification of
Field Areas
Field Care
Safety/ Security
Command Post
Evacuation
(EMC) Emergency
Management Center
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Establishing a Mass Casualty Management System
RESCUE CHAIN---SECTORAL
Impact Zone
Command Post
*SEARCH*
*RESCUE*
*First Aid*
Triage
Stabilization
Evacuation
Traffic Control
ER
Regulation of Evacuation
or
A&ED
CP / AMP
Pre-Hospital Organization
Hospital Organization
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Field Organization
Alerting Process
Definition: Sequence of activities implemented to
achieve the efficient mobilization of
adequate resources
Aim:
- Confirm the initial warning
- Evaluate the extent of the problems
- Ensure that appropriate resources are informed
and mobilized
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Field Organization
Alerting Process
Dispatch Center:
• Core of the Alerting Process
(Operation/Communication Center)
• Functions:
– receives all warning messages (radio/phone)
– mobilize a small assessment team (Flying Team)
from police, fire or ambulance services
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12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Initial Assessment
• Precise location of the event
• Time & type of the event
• Estimated number of casualties
• Added potential risk
• Exposed population
• Resources needed
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Pre-Identification of Field Areas
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Impact Zone
Command Post
Collecting Area in unstable location
Advance Medical Post Area (3-T Principle)
Evacuation Area
VIP & Press Area (Information Officer)
Access Roads (geographical presentations if available)
Check point for resources (Staging Area)
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Safety
• Best practice technique to protect victims, responders
& exposed population: immediate/potential risk
• Measures:
Direct action:
- risk reduction - fire fighting
- contain hazardous material
- evacuation of exposed population
Preventive actions: establish field areas
- primary- impact zone
- secondary- rescue/ICP/AMP
- tertiary-“buffer zone”; tri-media
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Safety
• Personnel: fire services; specialized units hazardous
materials & explosives (bio-nuclear and
radioactive materials) experts, etc.,
airport manager, chemical plant expert
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Security Measures
• Non-interference of external elements:
- crowd/traffic control
• Contribute to safety:
– protect workers from external influence; additional
stress
– free flow: victims/resources
– protect general public from risk exposure
• ensured by police officers / special units (security:
airport/building/hospital/establishments, etc..)
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Command Post ( CP / or ICP)
Multi-sectoral control unit to:
• Coordinate sectors involved in field/scene management
• Linked w/ back-up system: provide information &
mobilization resources
• Supervise victim management
REQUISITE: radio communication network: main
criterion to be effective
Purpose: coordination / communication hub of people who
don’t work routinely (pre-hospital setting)
Location: external boundary of restricted area (impact zone)
close to AMP/ Evacuation Area/ accessible/easily identified
* should accommodate: com./visuals/maps/boards
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Personnel
• High ranking officer (government police, fire, health,
defense)
- plant manager/ airport manager/ chief security, etc…
- fire officer / police officer skilled in ICS / MCM
• Identified by name/position, coordinator / commander
• May depend on what type of incident
• Must be familiar with each other’s roles during previous
meetings/ drills/ simulation exercises (policy)
• This core group cooperate with volunteer organizations
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
METHOD
• The communication / coordination hub of the prehospital organization. By constant re-assessment,
CP will identify needs to increase / decrease
resources:
o organize timely rotation of rescue workers exposed to
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stressful/exhausting conditions in
close coordination
w/ back-up system
ensure adequate supply of equipment / manpower
ensure welfare / comfort of rescue workers
provide info to back-up system, other officials, and
tri-media thru an Information Officer
release as soon as situation allows “E” staff and reestablish normal operations
determine termination of field operations
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
MANAGEMENT OF VICTIMS
• Search & Rescue
- locate victims
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remove victims from unsafe locations – collecting area
assess victim’s status (on-site triage)
provide first aid , if necessary (no CPR on-site in MC Event)
transfer victims to AMP thru entry triage (medical triage)
under supervision of the CP/ IC/ or Commander/Coordinator
may in special situation, require medical personnel (trained)
to stabilize/resuscitate/amputate (trapped) victim before
extrication.
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Management of Victims
• Field Care
- Pre-established capabilities / inventory: pre-planning
- Integrated community plan: practiced w/ policy
support
- The “Golden Hour” Principle
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Recent progress in pre-hospital
emergency / disaster medicine
Establish AMP with specially skilled /trained ---“disaster field medical teams”
- good triage / stabilization capacity
- specifically trained / up-skilled medical teams
- good (radio) communications between the field
scene & medical facility
“ Don’t transfer chaos in the scene,
to the hospital……”
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
TRIAGE
Basis: urgency (victim’s status)
survival (chance or likelihood)
care resource availability and capability
Objectives:
Quick identification for immediate stabilization
for life-saving (measures) and surgery
Levels:
On-site–----- ‘where they lie’
Medical ----- at Advance Medical Post
Evacuation --- transport
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
On-site T:
Acute
Non-acute
Red:
Medical T:
Red
Yellow
Green
Black
Yellow: after evacuation of Red,
without life-threatening
problem
Evacuation T - transport:
transferred as soon as
possible to tertiary facilities
in an equipped ambulance
with medical escort
Green: ‘walking wounded’-to
AS/OPD
Black: to morgue Forensic Services
Public Health & Psycho-Social
interventions to relatives/kin
Red
Yellow
Green
Black
First
National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
First Aid
Personnel:
– volunteers, fire, police staff, special units, EMT’s,
and medical personnel
Location:
– on-site, before moving victim
– at collecting point/ area in an unstable
environment.
– “Green Area” of “AMP”
– ambulance in transit to facility
Action:
– primarily to transfer with consideration of the
ABC’s order of priority
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Advance Medical Post (AMP)
Purpose:
• reduce loss of life & limb - save as many as possible in
the context of existing & available resources/ situation
• victim’s status; chance of survival; resources
Location:
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50-100 meters from Impact Zone (walking distance )
direct access to: Evacuation Road. / Command Post
Clear Radio-Com Zone… and SAFE (Upwind)
tent / bldg / open / mobile field hospital..??
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Advance Medical Post (AMP)
Role:
• Provide “entry” medical triage
• Effective stabilization for victims of a MCI/Situation
– intubation, tracheostomy, chest drainage,
– shock mgt , analgesia , fracture immobilization
– fasciotomy, control external bleed & dressing
• Convert red to yellow category as maybe possible
• Organize patient transfer to designated care facility/ties
• AMP 3-T principle: Tag – Treat – Transfer….
Personnel:
• ER (A&ED), physicians/ nurses (trained & skilled)
• support: Anesthetists / Surgeons / EMT’s / Nurses / Aiders,
etc.
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
AMP
NON-ACUTE
TRIAGE
Black
Green
NON-ACUTE
C
P
evacuation
ACUTE
Red
Yellow
ACUTE
C P– Collecting Point
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
COLLECTION AREA
(in unstable condition)
TRIAGE AREA
(color tagging of victims)
COMMAND POST
TREATMENT
AREA
(management and stabilization)
1st
3rd
PRIORITY III
2nd
PRIORITY II
T R A N S P O R T
PRIORITY I
A R E A
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Field Management Plan: Diagram
Working
Area
Triage
Evacuation
AMP
Impact Zone
T
r
a
f
f
i
c
C
o
n
t
r
o
l
Command Post
Strictly Restricted
Restricted
Access Route
Traffic
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Transfer Organization
• Procedures used to ensure that victims of a MC
situation is safely, quickly, and efficiently transferred by
appropriate vehicles to the appropriate and prepared
facility
• Preparation for Evacuation:
1. Single Reception Facility
2. Multiple Reception Facilities
* type of vehicle required
* type of escort required
* destination
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Transfer Organization
• Preparation for Transport
Evacuation Officer reporting to ATM:
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assess patient’s status: vital signs, ventilation / hemostasis
check security of equipment / & accessories
ensuring efficiency of immobilization measures
ensure triage tags: secure/& clearly visible
• Evacuation Procedures: Regulation
Principles
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not to overwhelm care facility
- avoid spontaneous evacuation of unstable patients.
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Transfer Organization
• Evacuation Procedures: Regulation
Rules:
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victim is in most possible stable condition
victim is adequately equipped for transfer
receiving facility correctly informed and ready
the best possible vehicle and escort– available
Victim Flow
- “Noria” Principle, Spanish word from Arabic--… ”wheel”
WW I Battle of Chemin de Dames, Verdun, France
* conveyor belt’ flow from first aid to the most
sophisticated care level..
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Victim Flow : “Conveyor Belt” Management Diagram
Triage
3-T
Triage
Tag
Treatment
Evacuation
Treat
and
Transfer
Impact
Zone
Collecting
Point
AMP
TRANSFER
HOSPITAL
Victims Flow
Transport Resource Flow
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Victim Flow
- Ambulance Traffic Control
Radio Links:
*Transport Officer at AMP
*Hospital Admission / ER Department
*Command Post
*Ambulance Headquarters
Responsibility of Ambulance Driver
*takes order from the Transport Officer
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Victim Flow
Road Control:
Police Officers ----- crowd and traffic control
• Evacuation of Non-Acute Victims
- use available mass transport
- as much as possible, to primary care centre
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Establishing a Mass Casualty Management System
Field Organization Checklist
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Situation Assessment
Report to Central Level
Work Areas Pre-identification
Safety
Primary Area: Impact Zone
Secondary Area Units: CP/AMP/EVAC/TRANSFER
Radio Communications
Crowd & Traffic Control
Search and Rescue
Triage & Stabilization
Controlled Evacuation
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Fallacy
“IT CAN’T HAPPEN
TO US”
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Thank you
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Incident Command
System
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Performance Objectives
• Discuss the advantages of using the Incident
Command System
• Discuss the two types of command
• Discuss the Incident Command Process
• Discuss Incident Priorities
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Performance Objectives
• Discuss the components of the Incident Command
System
• Discuss the Incident Command System organization
• Discuss the use of the Incident Command checklist
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Incident Command System
• Developed in the 1970’s during the California
wildfires
• Business management practices of planning,
directing, organizing, coordinating, delegating,
communicating and evaluating
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Incident Command System
• Framework necessary to manage resources,
personnel and equipment
• Designed to be flexible and can be used in large or
small incidents
• Creates a safe environment for all involved
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Benefits of Incident Command
• Common terminology
• Position titles and Chain of Command for decision
making
• Responder accountability
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Basic Command Types
• Single Command
• Unified Command
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Single Command
• Based on first arriving emergency units
• Initial Incident Commander begins assessment of
incident
• Rescue, Triage, Treatment, Transport
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Basic Command Structure
Single Command
INCIDENT
COMMANDER
RESCUE/
EXTRICATION
TRIAGE
TREATMENT
TRANSPORT
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Unified Command
• Incidents that involve jurisdictions or agencies
involved in the decision making and planning process
• Ensures plan is communicated and supported by all
resources assembled
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12 – 23 March 2011. Muscat, Oman
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INCIDENT COMMAND SYSTEM
INCIDENT
COMMAND
SAFETY OFFICER
LIAISON OFFICER
PUBLIC INFORMATION
OFFICER
OPERATIONS OFFICER
FIELD MEDICAL COMMANDER
STAGING OFFICER
MEDICAL GROUP
SUPERVISOR
PLANNING OFFICER
TRANSPORT GROUP
SUPERVISOR
RESOURCES
ADMINISTRATIVE OFFICER
LOGISTICS OFFICER
SERVICE
SUPPORT
SITUATION
TREATMENT TEAM
LEADER
TRIAGE TEAM
LEADER
GROUND AMBULANCE
PROCUREMENT
COMMUNICATIONS
SUPPLY
MEDICAL
FACILITIES
FOOD
GROUND SUPPORT
DOCUMENTATION
AIR AMBULANCE
TREATMENT MEMBERS
IMMEDIATE
TREATMENT MEMBERS
DELAYED
TIME
COMPENSATION
TRIAGE MEMBERS
DEMOBILIZATION
COST
MORGUE MANAGER
TREATMENT MEMBERS
MINOR
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Overview of Incident Command Process
Process is based on:
• Size up
• Setting Incident Priorities
• Predicting incident course and harm
• Strategic goals and tactical objectives
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Size Up
• Rapid mental evaluation of factors influencing an
incident
• Must continue throughout incident with ongoing
evaluation
• Incident situation, incident cause and incident status
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Incident Situation
May be one or combination of:
•
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•
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Biological
Nuclear
Fire
Chemical
Explosion or natural event
Natural disaster with MCI
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Incident Cause
• Incident Cause is important because additional or
specialized resources may be needed
• The Incident Commander must determine if the
incident was accidental or intentional
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Incident Status
Is the incident:
• In a somewhat controlled state or
• Does it remain uncontrolled
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Setting Incident Priorities
• After size up of the incident a course of action is
determined
• High priority is life safety for the public and
responders
• Incident stabilization
• Protection of critical systems
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Estimating Potential Incident Course
and Harm
• Responder is making a prediction on what will likely
occur during the incident
• Based on available information
• Responder’s experience
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Strategic Goals
• Broad general statements of desired outcome of the
incident
• Example:
mass casualty overturned school bus
- extrication, triage, treatment,
transport
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Incident Command System
Organization
•
Comprised of two major categories which assist in
organizing functions into an effective design:
- Command Staff
- General Staff
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Command Staff
Consists of the :
•
•
•
•
Incident Commander
Safety Officer
Liaison Officer
Public Information Officer
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Incident Commander
INCIDENT
COMMANDER
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Incident Commander
• First person on the scene with communications
capability
• Remains in command until transferred or incident is
terminated
• Complete authority and responsibility
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Incident Commander
• Must assume and announce command, rapidly
evaluate incident, identify resources on hand, request
additional resources and establish incident action
plan
• Fill command staff and functional areas
• Must approve all information releases to the media
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Transfer of Command
• Based on the initial responders experience and comfort
level
• Higher ranking officer does not need to assume
command
• Transfer procedures should be predetermined
• Detailed briefing is required
• Face to Face is best method
• Include: current status, strategies and tactics employed,
progress, safety, accountability and resources assigned or
needed
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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General Staff
Consists of:
•
•
•
•
Operations (includes staging)
Planning
Logistics
Administrative/Finance
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Operations Section
INCIDENT
COMMANDER
OPERATIONS
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Operations Section
• Operations officer functions under direction of the
Incident Commander
• Deploys tactics to control and resolve the incident
• Responsible for execution of the incident action plan
• Makes recommendations for changes to plan based on
incident status
• Oversees and is in direct contact with the staging
manager
• Task supervisors report to Operations not Incident
Command
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Planning Section
INCIDENT
COMMANDER
OPERATIONS
PLANNING
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Planning Section
• Responsible for collection, evaluation, distribution and
use of information about the incident
• Forecast and develop plans to contain and resolve
incident
• Communicates with logistics section
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12 – 23 March 2011. Muscat, Oman
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Logistics Section
INCIDENT
COMMAND
OPERATIONS
PLANNING
LOGISTICS
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
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Logistics Section
• Responsible for providing facilities, services and
materials in support of incident
• Includes equipment, personnel and associated
materials and tools
• Support branch and Services branch
First National Course on Public Health Emergency Management
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Administrative / Finance Section
INCIDENT
COMMANDER
OPERATIONS
PLANNING
LOGISTICS
ADMINISTRATIVE
FINANCE
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Administrative/Finance Section
• Generally not located at incident site
• Responsible for financial, administrative and cost
analysis
• Divided into four units: time, procurement,
compensation/claims and cost
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Summary
• Incident Command created to deal with any incident in
an organized manner
• Manages resources, personnel and equipment to
mitigate the incident
• Builds from first responder
• Expandable to manage hundreds
• Implementation is critical for safe and effective
operation
• Allows for multi-agency operations and response based
on incident type
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Thank you
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CRITICAL INCIDENT
MANAGEMENT
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Performance Objectives
• Discuss critical incident stages
• Discuss decision making in a critical incident
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Critical Incident Management
Characteristics
• Demands a coordinated response to prevent incident from
getting worse
• This includes unresolved element of danger such as
additional bomb, a threat to citizens and responders or an
unusual incident
• Often random in nature and disrupt normal life
• Terrorist organizations use opportunity as a tool for civil
disturbance
• A mass casualty is a critical incident
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Mass Casualty Incident Overview
• Produces several patients
• As few as six or as many as several hundred
• Affects local hospitals
• Patients are greater than resources of the initial
responders
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Preparation For Mass Casualty
• Pre-planning and training are critical
• Establish guidelines and procedures
• Early implementation of Incident Command
• First five minutes will determine next five
hours
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Functional Systems Approach
• Three levels of function: strategic, tactical and task
(operation)
• Management is strategic
• Team leaders are tactical
• Resources not involved in supervision are task
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Critical Incident Stages
They consist of:
• Initial Response
• Incident Control using the Six Step Response
• Recovery Stage
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Initial Response Stage
• Ability to establish command and control
• Faced with confusion and panic
• Crucial to develop a team and place a plan in
action
• Protecting citizens and rescue of victims
• Limit incident growth
• Protect arriving responders
• Identify ingress and egress routes
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Initial Response Objectives
As soon as possible:
• Gain control of
the scene
• Restore order
• Prevent target
opportunities
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Incident Control Using The Six-Step
Response
The Six-Step response is based on the Incident Command
System. It includes:
1.
2.
3.
4.
5.
6.
Assume Command,
Situation Assessment,
Identify and Set Perimeters,
establish Command Post,
assign Safety Officer and
establish Staging Area and assign a Staging Officer
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# 1 – Assume Command
• Must advise incoming responders of incident
location
• Secure tactical frequency
• Request supervisory support
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# 2 – Situation Assessment
• Size up of the incident that includes the type of
threat, approximate number of injured, size of
threatened area and possibility of secondary event.
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# 2 – Situation Assessment
In simple terms the
assessment describes:
• What do you have
• What are you doing
• What do you need
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# 3 - Identify and Set Perimeters
• Divide the incident into manageable divisions
(geographical areas)
• Allows command to provide resources where they are
needed
• Critical incidents have three standard perimeters. All
perimeters are divisions
• Expand perimeters based on weather
• Perimeters are the hot zone, inner perimeter and
outer perimeter
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The Hot Zone
• Area in which the incident has occurred
• May be a street corner or spread over a large
area
• Secured by placing responders in positions of
controlling ingress and egress
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Inner Perimeter
• Protects responders in hot zone
• Uniformed personnel only
• Used as decontamination area, treatment area and
evacuation area for walking wounded
Outer Perimeter
• Provides last line of defense from internal incident
acceleration
• Provides first line of defense from external acceleration
• Secure area for command post, resources and control of
the media
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Perimeter Placement Illustration
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# 4 – Establish Command Post
• Typically begins at first responders vehicle
• Incident dynamics will require Incident Commander
to shift to a fixed command post
• Must be away from hot zone
• The command post will
ensure support for field
personnel, create a
controlled environment
and improve
communications
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# 5 - Establish Safety Officer
• Should be filled as soon as possible
• Officer selected on operational experience and ability
to recognize acceptable and unacceptable risk
• Operations can be stopped or modified
# 6 - Establish Staging Area
• Effective tool in correct and safe deployment of resources
• Staging Supervisor must track, rotate and relieve
resources as appropriate
• Area established within inner or outer perimeter. Avoid
congestion
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Inter Agency Planning
• Failure to include all agencies during planning
process may compromise responders
• Identify and establish liaisons with all agencies and
coordinate tactical operations
Secondary Incidents
• May be more destructive and damaging than initial
incident
• World Trade Center crashes were primary incident
with collapse of the towers as secondary incidents
claiming more lives
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Recovery Stage
• Begun when aggressive threats of incident are
neutralized
• Incident is not over when last patient is transported
• Recovery must be managed aggressively
• Planning Section of incident command is
responsible for initial recovery
• Typically the longest and most poorly managed
part of the incident
• May require months to years
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Goals in the Recovery Stage
• Most important goal is document collection
• Information can assist in Post Incident Analysis, cost
recovery and tracking responder injuries or deaths
• Provide critical incident stress management for
responders
• Collect and properly dispose of used medical supplies
and biohazard waste from the incident
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Post Incident Analysis
Critical for operational review. Benefits include:
• Operational performance
• Organizational needs
• Procedure modification
• Additional training
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Summary
• Critical Incident Management can place a heavy burden
on responders
• Requires a coordinated response from all agencies
involved
• Mass casualty incident is a critical incident, terrorist
related or not
• Identifying critical stages will give the responder a
better chance of dealing with the incident
• Six – Step response is a tool for incident management
• Humanitarian Assistance
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9-11-01
9-11-01
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TRIAGE
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Description
• This lesson provides participants with methods of
prioritizing care delivery in mass casualty situations.
• The decision- making process is explored with the
goal being the maximum positive effect for the
greatest number of patients.
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QUESTION 1
What is the meaning of Triage ?
What is the basis of triage ?
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QUESTION 2
In the MCMS, how many times do you triage
and where ?
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Objectives
• Describe the basic concepts of sorting and allocating
• treatment
Describetothe
basicinconcepts
of sorting and
patients
a triage situation
allocating treatment to patients in a triage
• Demonstrate
situation the decision-making process in
determining priority of care
• Demonstrate the decision-making process in
determining priority of care
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3
What is Triage ?
• French word meaning to “Sort”
• Utilized to identify treatment priorities
• Process by which a decision is made on which victim
receives treatment and which does not
• Four basic priorities of patient treatment and
transport
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Priorities
Highest Priority
• Patients that require immediate care and
transportation
• Patients receive treatment at the scene for life
threatening injuries
• First to be sent to available medical facilities
Intermediate Priority
• Patient treatment and transport can be
delayed
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Priorities
Delayed or Low Priority
•
•
•
•
Referred to as “walking wounded”
Injuries require medical care at some point
Treatment and transport can be delayed
Monitor patients and reassess
Lowest Priority
• Patients have either died or are near death
• If still alive they have suffered severe or serious
injuries with little chance of survival
• When resources are limited, patients must be ignored
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Initial Triage Officer
• Must size up situation
• Ensure safe approach and scene survey
• Activate additional resources
o Number of victims
o Size of the incident
o Better off requesting more equipment and
personnel than not enough
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Simple Triage and Rapid Transport System
This system focuses on three areas :
1. Respirations
2. Pulse Rate and Quality
3. Mental Status
System requires first responders to have tags,
ribbons or tape in four colors
Priority One (Highest Priority )
Red – Immediate care : Life threatening
injuries
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Simple Triage and Rapid Transport System
Priority Two (Intermediate Priority)
 Yellow – Urgent care: delay treatment
and transport up to one hour
Priority Three (Delayed or Low Priority)
 Green – Walking wounded: delay
treatment and transport up to three
hours
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Simple Triage and Rapid Transport System
Priority Four (Lowest Priority)
• Black – No care required: patient is dead or
near death
• Hardest priority to deal with emotionally
• Necessary for others to survive
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Simple Triage and Rapid Transport System
• First Step is to make an announcement for all people
able to get up and walk to specific area
• Allows responder to focus on injured
• People who successfully move should be tagged
“Green”
• Tell people to look out for each other and notify
responders of any significant changes
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Simple Triage and Rapid Transport System
• Second step is to conduct an orderly survey of
remaining victims
• Decide how to move through area
• Perform quick assessment on each person and label
or tag
• No more than 10 seconds per patient
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Simple Triage and Rapid Transport System
• Correct life threatening : airway or breathing problem
and profuse bleeding
• The objective is to: locate, identify and tag priority one
patients who require immediate care and transportation
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Patient Assessment
Respiration
Assess breathing rate
• Greater than 30 per minute, patient is priority one
and tagged red
• Less than 30 per minute, move on to assessing pulse
and mental status
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Patient Assessment
Not Breathing
Quickly make sure mouth is clear
Open airway with head tilt method
During mass casualty incident, cervical spine
immobilization may not be able to be done
• Open patients airway and position so it remains
open
• If patient does not start to breath with simple
airway maneuvers, tag priority four - black
•
•
•
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Patient Assessment
Pulse Rate and Quality
•
•
•
•
•
Check radial pulse
No more than 5 second check
Pulse is weak or irregular - Red Tag Priority One
If pulse is strong, move on to assess mental status
If there is NO pulse, Black tag priority four
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Patient Assessment
Mental Status
•
•
•
•
Breathing and pulse should have already been
checked
Have patient respond to simple commands such as
“open your eyes” or “squeeze my hand”
If patient can perform this function, is breathing
and has a pulse, yellow tag priority two
If patient is unresponsive and cannot follow simple
commands, red tag priority one
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START TRIAGE
all walking wounded
MINOR
RESPIRATION
YES
NO
Position Airway
over
30/min
under
30/min
YES
IMMEDIATE
NO
DECEASED
IMMEDIATE
PERFUSION
Radial Pulse Present
Radial Pulse Absent
Capillary Refill
Over
2
Secs
Control
Bleeding
IMMEDIATE
Respirations
30/min
Perfusion
2 secs
Mental Status
can do
Under
2
Secs
MENTAL STATUS
Can’t Follow
Simple Commands
IMMEDIATE
Can Follow
Simple Commands
DELAYED
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First National Course on Public Health Emergency Management
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Thank You
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