Rhode Island disaster initiative

Medicine and Health Rhode Island, Jul 2003 by Williams, Kenneth, Suner, Selim, Sullivan, Francis, Woolard, Robert

The Rhode Island Disaster Initiative (RIDI),1 is a federally funded research project focused on improving emergency medical response to disasters. The focus of the project is emergency medical services (EMS), first responders and emergency department (ED) staff during the first few hours of a disaster event. Project planning began in 1999, and congressional funding was released early in September 2001. There are three RIDI project phases. In phase 1 we determined the extent of current knowledge, assessed vulnerabilities, and planned future activities. In Phase 2 we will perform a series of disaster drills, testing equipment and response. In Phase 3 we will demonstrate best practices for disaster response. In this article we report on Phase 1.

The RIDI Principal Investigators, Drs. Sullivan, Suner, and Williams, examined three main areas: readiness, training, and technology during Phase 1. Various federal agencies have supported the RIDI effort, including the Department of Health and Human Services (Phase 1) and the Office for Naval Research (Phases 2 and 3). The RIDI project investigators collaborate with other Rhode Island state agencies, such as the Emergency Management Agency, Department of Health, and others who receive federal funds for disaster preparedness.

The Chemical-Biological Information Analysis Center (CBIAC) and Battelle Memorial Institute coordinate administration and funding for the project. Charles Seekell, Battelle Principal Research Scientist, is the Battelle On-Site Project Manager in Rhode Island. In RIDI Phase 1, the tasks completed include the vulnerability assessment, literature review, technology evaluation, training program development, and multiple expert panel discussions.

READINESS AND VULNERABILITY ASSESSMENT

The RIDI investigators define readiness as the ability to perform specified tasks upon request, in a timely manner. In drills and in actual events, many disaster responses fail to meet readiness challenges posed by the situation. These failures are noted in the medical literature, popular press, and anecdotal reports from actual events. Recurring failures include unfamiliarity with the disaster plan, failure to follow the plan, improper or inadequate equipment for responders, logistic and communication failures, difficulties controlling access to the disaster scene, delays in treatment, contamination of the hospital and EMS equipment, and a variety of other issues. While some of these fail-ures can be attributed to the challenges disasters pose, many are embarrassingly common and recurring.

Disasters can overwhelm local ability for rescue and recovery. Worldwide and nationwide, disasters are common. However, because they are widely distributed geographically, individual EMS systems and EDs infrequently experience a disaster. Consequently, many systems are not ready to respond to a disaster. The threshold that separates manageable tragedy from disaster is variable. The death of a single important individual may lead, through psychologic impact, to disaster for a company, school, or hospital. A large number of people may be killed in an event, but, because no survivors need medical care, the local medical system may not be overwhelmed. An incident that is easily managed within a busy city health care system may overwhelm the rural emergency care system a few miles away. Thus, the number of injured or killed persons necessary to constitute a disaster varies widely.

Most systems have planned, to some degree, for multiple casualties from locally anticipated natural disasters (hurricanes, floods, forest fires, etc.) and transportation accidents. These plans typically activate assets, provide resources, and invoke procedures in use daily. However, these plans traditionally do not consider epidemics, weapons of mass destruction (WMD), internal disasters at facilities, and other currently contemplated scenarios. Rhode Island is more prone to hurricanes than tornados, although the latter are possible. Some disasters are more threatening for some types of responders than others. A flu epidemic raises more concern for hospitals than for snowplow operators, while a blizzard has the opposite impact.

During RIDI Phase 1, an external analysis of Rhode Island first responder readiness was conducted. This analysis determined the number of personnel, hospital beds, ambulances, police cruisers, and hazardous material (HAZMAT) response teams within the state. Assumptions made included limited aid from other states and an ability to focus all available state resources on the disaster at hand. Fifty-one potential disaster scenarios were modeled with variations in type of disaster (biological, chemical, explosion, radiation, electromagnetic pulse, and natural), location (indoors, contained, outdoors) and environmental conditions (wind, geography). The casualty load was matched against available medical resources. Again, assumptions were made to determine the resources available, such as the number of casualties transported in each ambulance, and the number of patients each emergency physician could treat during one episode. Based on these scenarios and assumptions, the analysis determined whether available resources could manage the casualty load.