Personnel Staffing in Times of Disaster

There are really only three operational states for an Emergency Medical Services (EMS) system: (a) Normal operations, during which the resources of the EMS system are responding to emergencies as part of the normal flow of business; (b) Times during which a multi-casualty incident (MCI) – a train or plane crash, for example – occurs, causing the normal operations of the EMS system to be disrupted and requiring that additional resources be employed to bring the situation under control; and (c) Finally, when a major disaster, such as Hurricane Katrina, strikes, or an influenza pandemic breaks out that threatens to overwhelm the system.These operational states are separated by how quickly additional resources are or might be available. During normal operations, additional resources usually would be brought into the system by requesting them from surrounding communities, probably under mutual-aid agreements; during an MCI the additional resources would come from more distant communities, but for practical purposes would still be immediately accessible.   During a disaster, however, there usually would be no outside resources immediately available, either because the route of travel to the disaster scene is blocked – e.g., during and immediately after Hurricane Katrina – or because there is no unaffected area to draw on, as during an influenza pandemic. Even during the 11 September 2001 attacks on the World Trade Center there were resources available, from as far away as Canada, that were on the scene within eight hours, and adequate EMS resources were actually on the scene even earlier – almost immediately, in some cases; in other instances within the first few hours after the attacks.EMS staff and Visiting Nurses Association (VNA) staff are among the more convenient talent pools to call on during and/or immediately after a disaster strikes – for a number of reasons: Their people are trained in many medical procedures; they have been pre-screened by their employers to work with the public; many possess advanced skills of various types; and they can monitor sick patients to determine if a change of status is warranted.Possible Options, Plus One Important Non-OptionOne important question that must be asked before these or similar groups are included in a strategic plan as potential personnel resources during times of disaster is “Who would be carrying out the duties they would otherwise be assigned?” The answer to that question seems obvious when one considers the Even during the 11 September 2001 attacks there were resources available, from as far away as Canada, that were on the scene within eight hours example represented by an influenza pandemic. One seemingly attractive option at such a difficult time would be to use VNA nurses to staff a field hospital (set up in a gym, perhaps), but taking that approach would mean that many other people – senior citizens, perhaps, or handicapped persons who could not take care of themselves under normal conditions – would be left to fend for themselves under much more difficult conditions. Clearly, using the VNA staff would not improve the surrounding community’s overall situation. There are, however, a number of other trained personnel who can be accessed during a disaster – school nurses and teachers are perhaps the best examples. The value of using school nurses as an emergency nursing staff is self-evident. While schools are closed, as they would be in many if not all disasters, they would not be carrying out their usual everyday responsibilities for their normal patient population – i.e., the school children in their home communities.Most teachers, of course, usually do not possess medical skills per se, but most school systems are governed by strict screening rules requiring fairly extensive background checks before teachers can work with students. If nothing else, therefore, teachers can be assigned tasks in times of disaster that require contact with at-risk populations. Teachers usually if not always would be qualified to carry out these tasks because of their clearances, experience, and demonstrated ability to work with children.In short, contingency planners at any level – state, county, or local – cannot count on staffing to meet emergency medical needs in times of disaster by stripping other essential services of their personnel without taking into account the “normal” everyday tasks the emergency workers would otherwise be carrying out. The accounting process may take the form of stretching other resources to cover the emergency tasks that suddenly develop, or making the difficult decision that the normal everyday tasks must be lower in priority – for as short a time as possible, of course. The one option that is totally unacceptable is to ignore the problem until it is too late.

Joseph Cahill
Joseph Cahill

Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.



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