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PUB DATENOTEAVAILABLE FROM

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ABSTRACT

DOCUMENT RESUME

CE 057 708

Rescue Manual. Module 1.Ohio State Univ., Columbus. Instructional MaterialsLab.

89

51p.; For related modules, see CE 057 709-717.Instructional Materials Laboratory, Ohio StateUniversity, 842 West Goodale Blvd., Columbus, OH43212 ($5.50; set of 10, $33.00).Guides - Classroom Use - Instructional Materials (ForLearner) (051)

MF01/PC03 Plus Postage.Accidents; *Emergency Programs; *Emergency SquadPersonnel; First Aid; Learning Modules; *NaturalDisasters; Occupational Safety and Health;Postsecondary Education; Recordkeeping; *Rescue;Safety; Safety Education

This learner manual for rescuers covers the currenttechniques or practices required in the rescue service. The first of10 modules contains 9 chapters: (1) introduction; (2) occupationalstresses in rescue operations; (3) size-up; (4) critique; (5) reportsand recordkeeping; (6) tools and equipment for rescue operations; (7)

planning for emergency operations; (8) incident command system; and(9) dealing with natural disasters. Key points, an introduction, andconclusion accompany substantive material in each chapter. (NLA)

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Reproductions supplied by EDRS are the best that can be madefrom the original document.

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INN III MN =III Mimi New MIN NMI

U.& DEPARTMENT OF EDUCATIONOffice of Educational ReSelitCh and Improvement

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

/This document has been reproduced asreceived from the person or organilationoriginating it

C' Minor changes have been made lo improvereprOductiOn quality

points of view or opiiiions staled in this document do not neceSsanly represent OficialOERI position or poiicy

/67/IN

"PERMISSION TO REPRODUCE THISMATERIAL HAS BEEN GRANTED BY

Cfc4TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)."

MODULE 1Introduction Tools and Eqiipment for Rescue OperationsOccupational Stresses in Rescue Operations Planning for Emergency OperationsSize-up Incident Command SystemCritique Dealing with Natural DisastersReportings and Recordkeeping BEST COPY AVAILABLE

INSTRUCTIONAL MATERIALS LABORATORYTHE OHIO STATE UNIVERSITY

COLUMBUS, OHIO 432102

Copyright 1989 by The Ohio State University. All rights reserved.

Edited and distributed by theInstructional Materials Laboratory

The Ohio State UniversityCollege of Education

Columbus, Ohio 43210

"CAUTION: Rescue operations routinely subject the rescuer to the very real probability of death or seriousinjury. Rescuers must understand the nature and effect of each attempt and each technique. In addition, practicecontinuing education and safe materials are necessary to insure all potential safety in extrications. The materialsand information presented here are intended only as a learning aid, and are no substitute for training. Expertopinions, recommendations, and guidelines change as research and experience refine procedures. This text includesthe most up-to-date information from rescuers working in the field. When applicable, the standards of the NationalFire Protection Association (NFPA) and Occupational Safety and Health Administration (OSHA) have been

followed for this text.

Specialized procedures require demonstration and training by subject-matter experts. It is not likely that arescuer will become proficient in all rescue operations. Most rescuers develop proficiency in only a few areas butmay be familiar with several others. You are assuming the risk of injury if not proficient in a rescue technique.

This text suggests procedures and explains how to do them. The techniques given are guidelines only. Each

department should incorporate its own procedures and address local needs.

Nondiscrimination Policy The policy of The Ohio State University, both traditionally and currently, isthat discrimination against any individual for reasons of race, color, creed, religion, national origin, sex, age,handicap, or vietnam-era veteran status is specifically prohibited. Title IX of the Education Amendments of 1972prohibits sex discrimination and Section 604 of the Rehabilitation Act of 1973 prohibits discrimination on the basisof handicap in education programs and activities. Accordingly, equal access to employment opportunities,admissions, education programs, and all other University activities is extended to all persons, and the Universitypromotes equal opportunity through a positive and continuing affirmative action program.

3

RESCUE MANUAL

INSTRUCTIONAL MATERIALS LABORATORYTHE OHIO STATE UNIVERSITY

COLUMBUS, OHIO 43210

RESCUE MANUALACKNOWLEDGMENTS

The Rescue Manual is a culmination of the combined efforts of many people who are dedicated to therescue service. Special acknowledgment is extended to the following personnel for coordinating thedevelopment and production of the publication.

Ronald J. Slane, Technical ConsultantJoyce Leimbach, Curriculum ConsultantJeanne Desy, EditorDar lye Oakes, PhotographerAndrew Eastwood, Computer IllustrationsTom Hindes, Director, Instructional Materials LaboratoryJohn Adkins, Attorney-At-Law

The development of this publication is the result of the expert guidance and advisementpersonnel who served as members of the Rescue Editorial Board.

of the following

James Bartholomew,D.D.S.

Assistant Director, PublicSafety Services

Ohio Department of Education,Division of Vocational and

Columbus, Ohio

Career Education

Thomas Beverly Lieutenant Columbus Division of Fire Columbus, Ohio

Russ Born Master Scuba Diver W. Born & Associates Millersport, Ohio

Jeff Corder Firefighter Coshocton Fire Department Coshocton, Ohio

Lee Curry Lieutenant Columbus Division of Fire Columbus, Ohio

Robert Featheringham Public Safety ServicesConsultant

Ohio Department of Education,Division of Vocational and

Columbus, Ohio

Career Education

Gary Fellows Fire Protection Engineer Wheeling Pittsburgh Steel Co. Steubenville, Ohio

William Fibich Public Safety ServicesConsultant

Ohio Department of Education,Division of Vocational and

Columbus, Ohio

Career Education

Charles Foster Manager Ohio Department of Natural Columbus, OhioResources, Division of Forestry

Emily King Special Programs Ohio Department of Natural Columbus, OhioAdministrator Resources, Division of

Watercraft

Terry Kirkpatrick Public Safety ServicesConsultant

Ohio Department of Education,Division of Vocational and

Columbus, Ohio

Career Education

Greg Lash Firefighter Columbus Pivision of Fire Columbus, Ohio

John Mason Emergency Medical Technician Medina, OhioConsultant

Dory le Oakes Technical Consultant Columbus, Ohio

Bob Pettit Assistant Chief of Stafffor Planning

Ohio Emergency ManagementAgency

Columbus, Ohio

Albert R. Pugh Professor Emeritus The Ohio State University Columbus, Ohio

Willis Troy Public Sakw ServicesConsultant

Ohio Department of Education,Division of Vocational and

Columbus, Ohio

Career Education

Louis Vargo Fire Chief Mt. Pleasant Fire Department Mt. Pleasant, Ohio

Mike Warner Firefighter-Paramedic Medina Fire Department Life Medina, OhioSupport Team

ii

RESCUE MANUALACKNOWLEDGMENTS (cont.)

Contributing Authors

Glenn E. Alexander Chief Dayto. Fire Department Dayton, Ohio

Dave Bowman Hazardous MaterialsTJchnician

Hazardous Materials Bureau Reynoldsburg,Ohio

Tom Forbes Technical Consultant Bureau of Underground StorageTank Regulations (BUSTR)

Reynoldsburg,Ohio

Catherine A. Heaney,Ph.D., M.P.H.

Assistant Professor The Ohio State University,Department of Preventive

Columbus, Ohio

Medicine

Dan Hoffman Paramedic-Firefighter Liberty Twp. Fire Department Powell, Ohio

Cheryl Kimerline Watercraft Volunteer Ohio Department of Natural Columbus, OhioResources, Division ofWatercraft

Debra Kra 11 Watercraft Volunteer Ohio Department of Natural Columbus, OhioResources, Division ofWatercraft

Lawrence Kra 11 Watercraft Officer,Specialist

Ohio Department of NaturalResources, Division of

Columbus, Oh io

Watercraft

William Lee Assistant Chief Cleveland City Fire Department Cleveland, Ohio

Ralph Leen Watercraft Officer,Specialist

Ohio Department of NaturalResources, Division of

Columbus, Ohio

Watercraft

Steve Parsons Hazardous Materials Technician Hazardous Materials Bureau Reynoldsburg,Ohio

Douglas A. Rund, M.D.,FACEP

Associate Professor andDirector

The Ohio State University,Division of Emergency Medicine

Columbus, Ohio

William Staiger Watercraft Officer,Specialist

Ohio Department of NaturalResources, Division of

Columbus, Oh io

Watercraft

Marc Theodore Watercraft Officer,Specialist

Ohio Department of NaturalResources, Division of

Columbus, Ohio

Watercraft

James Tippett Captain Columbus Division of Fire Columbus, Ohio

Larry Young Aviation Management Training U.S. Department of the Boise, IdahoSpecialist, and the Officeof Aircraft Services

Interior

Using the Brake-Bar Rack for Rope RescueThe part of this module titled Using the Brake-Bar Rack for Rope Rescue is from the copyrighted works titledUsing the Rappel Rack copyrighted 1982, revised 1986, by Steve Hudson, Diane Cousineau Hudson, and ToniWilliams and is used with their permission

Others acknowledged for their contributions and assistance are:

Ashland Chemical Company, Ashland, OhioBacharach, Inc., Pittslwrgh, PennsylvaniaCity of Ashland, Fire Division, Ashland, OhioColumbus Division of Fire, Columbus, OhioCommunity Ambulance, Garretsville, OhioGlobe Safety Equipment, Dayton, OhioHazardous Materials Bureau, Ohio Department of

Commerce, Division of State Fire Marshal,Reynoldsburg, Ohio

Lorain Community Hospital Ambulance, Lorain, OhioMedina County Career Center, Medina, OhioMine Safety Appliances, Pittsburgh, PennsylvaniaNational Fire Protection Association, Quincy,

MassachusettsNational Draager, Inc., Pittsburgh, Pennsylvania

iv

Northeast Regional Agriculture Engineering Service,Ithaca, New York

Office of Aircraft Services, U.S. Department of theInterior, Boise, Idaho

Ohio Fire Academy, Reynoldsburg, OhioOhio State University, Columbus, OhioOtis Elevator Company, New York, New YorkPigeon Mountain Industries, Inc., Lafayette, GeorgiaScott Aviation, Lancaster, New YorkUnited States Coast Guard, Marine Safety Detachment,

Cincinnati, OhioWesterville Fire Department, Westerville, OhioWheeling Pittsburgh Steel Company, Wheeling, West

Virginia

FOREWORD

The intent of this manual for rescuers is to provide the latest instructional content and serve as an up-to-date, comprehensive source of information covering the current techniques or practices required in therescue service. To help in this endeavor, an instructor's manual has been developed to be used in conjunctionwith this learner's manual. The manual has been produced in a series of modules to facilitate future revisionsmore rapidly and cost effectively.

The instructor's manual follows the key points identified in the text. Chapters have been included in thetext which exceed those printed in any other resource. These include managing and operating the emergencyvehicle, rope rescue techniques, industrial rescue, farm accident rescue, and various water emergency procedures,among others.

That the rescue profess:on is a dangerous and challenging career is a recognized fact. It is our hope thatthis tc..t will help the rescuer meet the challenges of the rescue service in a safe and professional manner.

Tom HindesDirectorInstructional Materials LaboratoryCollege of EducationThe Ohio State University

8

PREFACE

The Ohio State University Instructional Materials Laboratory has played a major role in the training ofpublic safety personnel through the development of text materials for many years. Due to the advances inthe rescue techniques, it became apparent that the existing text was obsolete. Upon the advice of manyknowlegeable people in the rescue service, the Instructional Materials Laboratory initiated the developmentof a new text that would be easily updated, and address the needs of the rescuer. To this end, an editorialreview board representing a broad spectrum of individuals in the various phases of the research professionwas convened to determine what topics this text should address. The culmination of this effort is the RescueManual. It is hoped that this text ran be useful to not only the new rescuer but will serve as a referencesource for the experienced rescuer.

Joyce LeimbachCurriculum ConsultantCollege of Education

The Ohio State University

vi

9

Ronald SlaneTechnical ConsultantCollege of Education

The Ohio State Univereity

MODULE 1

TABLE OF CONTENTSIntroduct ion 1

Occupational Stresses in Rescue Operations 3

Size-up 7

Critique 11

Reporting and Recordkeeping 17

Tools and Equipment for Rescue Operations 23

Planning for Emergency Operations 25

Incident Command System 33

Dealing With Natural Disasters 37

MODULE CONTENTS

The 1989 Rescue Manual has been grouped into tenfrom the Rescue Editorial Board.

Module 1IntroductionOccupational Stresses in Rescue OperationsSize-upCritiqueReporting and RecordkeepingTools and Equipment for Rescue OperationsPlanning for Emergency OperationsIncident Command SystemDealing with Natural Disasters

Module 2Patient Care and Handling TechniquesRenue Carries and DragsEraergency Vehicle OperationSelf-Contained Breathing ApparatusProtective Clothing

Module 3Forcible EntryStructure Search and RescueRescue Operations Involving ElectricityCutting Torches

Module 4Construction and Characteristics of Rescue RopeKnots, Bends, and HitchesCritical AnglesRaising SystemsRiggingUsing the Brake-Bar Rack for Rope RescueRope Rescue TechniquesAerial Ladder and Aerial Platform Rescue

modules in accordance with the recommendations

Module 5Hazardous Materials

Module 6Industrial RescueRescue From a Confined SpaceExtrication From Heavy EquipmentRescue Operations Involving Elevators

Module 7Extrication From Vehicles

Module 8Trench RescueShoring and Tunneling TechniquesFarm Accident RescueWilderness Search and RescueAircraft RescueHelicopter Information

Module 9Ice CharacteristicsRiver Characteristics and Tactics for RescueWater Rescue TechniquesWater Rescue/Recovery OperationsDive OperationsWater Rescue EquipmentWater Rescue Safety Tips

Module 10Glossary'Appendix

PUBLIC SAFETY SERVICES PUBLICATIONS AVAILABLEFor ordering and pricing information contact:

Instructional Materials LaboratoryThe Ohio State University842 West Goodale BoulevardColumbus, Ohio 43212Phone (614) 221-4950

vii 1 0

MODULE 1ACKNOWLEDGMENT

Acknowledgment is extended to the following persons for their willingness to share their knowledge andexpertise and for authoring information presented in this module:

IntroductionDan Hoffman, Paramedic-Firefighter, Liberty Twp. Fire Department, Powell, Ohio

Occupational Stress in Rescue OperationsDouglas Rund, M.D., FACEP, Associate Professor and Director, The Ohio State University, Divisionof Emergency Medicine, Columbus, Ohio

Size-up, Critique, and Reporting and RecordkeepingGlenn Alexander, Chief, City of Dayton Fire Department, Dayton, Ohio

Tools and Equipment for Rescue OperationsMike Warner, Firefighter-Paramedic, Medina Fire Department Life Support Team, Medina, Ohio

Planning for Emergency Operations and Dealing with Natural DisastersBob Pettit, Assistant Chief of Staff for Planning, Ohio Emergency Management Agency, Columbus,Ohio

Incident Command SystemGary Fellows, Fire Protection Engineer, Wheeling Pittsburgh Steel Co., Wheeling, West Virginia

1 1

viii

INTRODUCTION

To date there has been little rescue material avail-able that addresses a multitude of rescue techniquesin one collective effort. The Instructional MaterialsLaboratory at The Ohio State University has de-veloped instructional manuals and audiovisuals forpublic safety services for many years and continuesto address the needs seen in emergency efforts.

This rescue manual represents an immense un-dertaking. It provides suggested procedures andtechniques that can be used in many emergencysituations. It was authored and reviewed by manysubject-matter experts. Rescue operations often in-volve risk-taking procedures. Rescuers must alwaysremember safety first, that is, the safety of therescuers and bystanders, as well as that of the victimsinvolved.

Throughout the development of this document, itwas readily evident that many emergency situationsare unique, and there was no textbook to be con-sulted, nor is there time during an emergency toresearch techniques to be used to execute a rescue.Successful rescue operations often involve on-siteimprovisation. The ideal rescue situation seldom ex-ists. It is necessary to be able to use the equipment,materials, and personnel that are readily available.Rescue personnel sometimes place their own liveson the line. The degree of risk is high; however,sharing of information and rescue techniques, alongwith training and practice, should reduce the risk.The concern for liability is also high; but the bottomline is that someone has to do the job.

It is important for people involved in rescue op-erations to maintain as calm an attitude as possible.It is often necessary to work quickly, and clear, calmthinking usually produces the best results. Team-work and communication between the rescuers areboth important to executing a safe rescue. Whensizing-up an emergency situation, procedures to beused should be discussed among the rescue teammembers. Successful rescues usually involve the co-operation and effort of the total team. It is alsoimportant for individual rescuers to be receptive toothers' suggestions and not feel rejected if someoneelse's idea is adopted.

Training enables rescuers who are confronted withemergencies in the field to better provide adequatecare to victims. Trained safety service personnel areoften the best suited for emergency rescue work. Itis strongly recommended that rescuers be trained inmore than one rescue procedure, i.e., in emergency

1

medical technician and water rescue procedures, firefighting procedures and hazardous materials han-dling, farm and trench rescue procedures, or othercombinations. Cross-training enables a rescuer toassist in more than one kind of emergency, and tofill in for othell. when necessary. It also allows op-timum use of personnel. There is no way for oneperson to train for every type of rescue. Every rescueoperation is diffei ent, but most rescues have somecommonalities.

Training and actually performing rescue opera-tions gives personnel experience in techniques andprocedures. Preplan and discuss potential "what if"scenarios. With this information, an emergency res-cue plan can be designed for potential incidents.Each completed rescue should be followed by acritique.

N o one group can handle every type of rescueemergency. It is often necessary to call on helpoutside the local departments for specific assistance.A list of current resources complete with names andphone numbers should be kept on file.

Each community's public safety service agenciesshould develop a plan for interagency action in theevent of an unforseen disaster. This allows for agreater workforce, adequate backup for the localteam, and a contingency for any communityemergency.

It is common for rescue personnel to be emotion-ally and physically exhausted once a rescue is com-pleted. The tension and stress encountered whenworking under adverse conditions is intense. Workingagainst the clock, along with the concern for humansafety, creates an extremely tense environment.

Everyone reacts to stress differently. It is impor-tant for rescuers to acknowledge that everyone doesreact. Some people may become extremely chattyand need to talk, while others may withdraw andtry to block out the details, especially when involvedin an unpleasant situation.

Following a rescue operation, all equipment, ma-terials and supplies must be cared for and main-tained in a condition ready to address a futureemergency. Review what happened, what procedureswere implemented, what worked and what did not,and actually critique the entire operation.

Rescue operations are very important to humanlife. Procedures are often challenging and successfulrescues fire rtwarding. In a time of need rescuersare greatly appreciated.

OCCUPATIONAL STRESSES IN RESCUE OPERATIONS

INTRODUCTIONOccupational stress and its potential effects on

health are of much concern to all workers. The term"occupational stress" describes a process wherebyindividual employees appraise and react to job con-ditions and demands. The amount of stress thatemployees experience is determined both by thenature of their jobs and the extent of each employee'scoping abilities. Employees in some occupations ex-perience more stress than employees in others. Res-cue seems to be one of the high stress occupations.This chapter describes the stressful aspects of rescueoperations, the adverse effects of stress on healthand job performance, and strategies for reducing theamount of stress experienced by rescue workers.

Jobs in rescue operations and emergency medicalservices can be exciting, challenging, and deeplyrewarding. However, they can also be very stressful.The aspects of rescue jobs that are challenging andrewarding are also those that make the job stressful.When the rescue team is alerted, there is a highprobability that some serious human emergency hasoccurred. The salvage of human life or limb mayinvolve a precise series of life-saving steps conductedin exactly the correct order in a brief time. Timeseems to vanish while rescuers try to perform com-plex motor tasks under less than ideal conditions.

The other important feature of stress generationis the inescapable demand to make a decision onthe basis of incomplete data. Life and death decisionmaking under such uncertain conditions can generate

emendous stresses within rescue workers.The rewards of doing the job well, however, are

immensely satisfying. The salvage of human life andhealth has to be one of the greatest satisfactions forany professional health-care worker or rescue worker.

SOURCES OF STRESSThe work schedule of rescue workers is a potential

source of both pleasure and stress. Many workersenjoy working long (24-hour) shifts in order to havesubstantial stretches of time between shifts to spendin leisure-time activities and/or with their families.However, long shifts can also cause stress. The body'snatural biorhythms are not in harmony with such aschedule.

3

Rescue work can be physically demanding, espe-cially when rescuers re3pond to calls throughout mostof the work shift. The body's energy and resourcesare quickly depleted under these circumstances. In-stead of spending days off pursuing hobbies or so-cializing, rescuers may devote time off to resting upfor the next shift. Some workers feel that insteadof allowing for more time with their family andfriends, the 24-hour shift schedule actually interfereswith their family life and social life.

Rotating shifts and frequently working overtimeoften aggravates this situation. Research has dem-onstrated that employees who work nonstandardshifts are more at risk for illnesses. Again, the body'sability to resist disease is adversely affected by long,constantly-changing work hours.

For some rescue workers, the critical incidents oftheir work days are not as stressful as the minor,daily hassles. Good teamwork and supportive su-pervision are essential for effective rescue teams. Acritical and punitive supervisor or an uncooperativecoworker can create much stress for the rescue worker.

Bureaucratic battles and unending paperwork canalso cause frustration and tension. The small ailyhassles are particularly stress-involving because somuch of a rescue worker's energy has to be directedtoward dealing with the life-and-death situationsthat arise. Few resources remain to deal with theother, srna-er hassles of the job, and thus there islittle tolerance for them.

The ups and downs of a routine shift can also betaxing. Rescue work is not characterized by an evenwork flow. Long periods of "down time" are punc-tuated by immediate calls to critical action. A rescueworker must have personality characteristics thatallow sufficient flexibility to accommodate this un-evenness in the work day.

Another aspect of rescue operations that can causestress for rescue workers is the lack of opportunitiesfor advancement. The system is relatively new andis still developing; however, at this time, surveys ofrescue workers suggest that they are frustrated bythe lack of a career ladder.

Given all of the potentially stressful aspects ofrescue operations, it is normal for rescue workers tosuffer from stress-related symptoms. Some peopleare more vulnerable to stress than others. Researchshows that those who dwell on the negative aspects

3

VICTIM RESCUE

of events and those who blame themselves for fail-ures or negative occurrences on the job are moreprone to stress-related symptoms. Those with TypeA personalities are also more vulnerable to stressthan others. Type A personalities are characterizedby an impatient and aggressive approach to theirwork. They hate to wait, and experience feelings ofanger when their progress is delayed.

Everyone experiences some degree of stress atone time or another. The worst thing that a personcan do is to try to deny the presence of stress orfeign invulnerability to stress. Uncontrolled, chronich;gh levels of stress can have dire results.

RESPONSES TO STRESSRescue workers may experience several immediate,

short-term physiological responses to stress. Thebody's response to stress includes a release of cate-cholamines such as epinephrine. This results in el-evations in blood pressure and heart rate, increasedserum glucose levels, and decreased gastric move-ment. People may also experience cold hands andfeet and profuse sweating.

Stress may also result in more enduring outcomes.Research has now documented many adverse healtheffects of high levels of stress. Highly stressed rescueworkers may suffer chronic exhaustion. Even afterlong periods of rest, they may not feel that theyhttve regained their energy and strength. Severalmental health effects of stress are evident. Depres-sion, anxiety, tension, and extreme irritability canbe stress-related. Stress has been implicated as oneof the many causes of cardiovascular disease andcertain gastrointestinal disorders. There is also evi-dence that stress, through impairing immunity,weakens the body's defenses so that cancers canmore easily develop. Finally, stress can lead to skininflammations, allergies, certain types of sexual dys-function, and headaches.

Stress is not related to disease in the same directard disease-specific way as a bacteria or other dis-ease-causing agent. Rather, responses to stressfulsituations in the environment alter the body's en-docrine balance, thus increasing the susceptibility tophysiochemical or microbiologic disease agents.Therefore, people manifest a wide variety of symp-toms and syndromes as a result of high levels ofstress.

Stress can also contribute to a deterioration of jobperformance. An exhausted and despondent rescue

worker may be more likcly to exercise poor judge-ment during a call or may be slower to respondappropriately. Such a worker may begin to sufferfrom chronic tardiness or absenteeism. Often, highlyiressed workers turn to alcohol or some other sub-stance to alleviate stress-related symptoms. Alco-holism and substance abuse may develop, resultingin further impairment of job performance.

Unrecognized and untreated stress will result indecreasos in job satisfaction and may lead to workersleaving their jobs and the field of rescue operationsaltogether. Rescue occupations have a high rate ofturnover, which is detrimental to the provision ofhigh-quality care.

COPING WITH STRESSDenying the presence of stress serves no one's

needs, and threatens rescue worker's personal mentaland physical health. The probable accompanying fallin job performance makes the job more difficult forcoworkers and puts victims more at risk.

Stress that is ignored impairs the vitality of therescue operations system as a whole. High turnoverand low morale erode the effectiveness of the systemand cause it to expend much energy on refilling theflagging ranks of workers by training new men andwomen rather than on improving the skills and abil-ities of current rescue workers.

There is no need to be fatalistic about stress.Many strategies can be employed, both by the in-dividual rescue worker and by the rescue operationssystem, to reduce stress and its negative conse-quences. The first step for both the worker andmanagement is to acknowledge the presence of stressand the need to deal with it.

Each rescue worker has unique coping mechanismsthat work best for him or her. Some may attemptto focus on the positive aspects of work. For example,in the face of an unsuccessful rescue attempt, theymay consciously try to remember and celebrate suc-cessful saves.

Others succeed in coping with their stress by de-personalizing relations with their patients. This cop-ing strategy should be implemented cautiously.Depersonalization that is carried too far may be asymptom of uncontrolled stress, said can impair ratherthan enhance job performance.

Others cope by talking about their actions andfeelings with others. Open communication with co-workers and others facir g similar stresses may be

1 4

OCCUPATIONAL STRESSES IN RE3CUE OPERATIONS 5

invaluable and should be encouraged in rescue sys-tems. Coworkers, family members, and friends mayprovide much-needed support for dealing with adifficult incident or a string of daily hassles.

Some workers may prefer to release stress throughphysical activity. This strategy actually serves twopurposesit releases the tension due to stress andalso enhances overall good health and resistance todisease.

Some workers manage to control their stress re-sponses by setting aside time to relax, preferablyaway from work. (Beware the rescue worker whospends much of his or her free time lounging aroundthe workplace.) Sometimes special procedures canbe used to help workers relax. Relaxation techniques,such as guided imagery and meditation, are a stand-ard component of any stress-management training.

In addition to using stress management tech-niques, individual workers can actively try to reducethe stressful aspects of the job. An important stepin this process is to bring problems to the attentionof management. Often, the best solutions to problemsare arrived at when the workers and managementwork together. Workers can also organize supportgroups for rescue workers. A support group oftenprovides unders if.ig and helpful advice from peo-ple who experienot milar concerns and issues.

Management has a very real responsibility to helprescue workers avoid unnecessary stress and manageunEvoidable stress. Providing adequate staffing andproper schedules, and distributing the workload eq-uitably can reduce some of the stress encounteredon the job. Some prehospital emergency systems areexperimenting with innovative schedules and rota-tions in an attempt to find the most efficient, yetnonstressful, strategy. Management should seriouslyconsider offering stress management training andthe opportunity for to workers to debrief after en-countering critical incidents. These efforts will helpprotect the health and well-being of rescue workers.

CONCLUSIONStress is inevitable in rescue work. The demands

of rescue work, both physical and emotional, areconsiderable. If ignored, the resulting stress can leadto ill health, substance abuse, depiession, poor jobperformance, and high turnover. These adverse out-comes can be avoided if both management and in-dividual workers recognize the stresses inherent inrescue work and actively attempt to reduce them.Through identification of potential stressors and en-hancement of coping skills, rescue workers can re-duce their stress levels, be more satisfied with andrewarded by their jobs, perform their duties morecapably, and enjoy life more fully.

1 5

7

SIZE-UP

KEY POINTS

The importance of size-upEvaluation and translationFactors to consider during size-up

INTRODUCTIONThe success or failure of a rescuc operation hinges

on the judgments made by the incident commanderat the scene. A command decision i based on theinformation gathered by the supervisors on the sceneand then related to the incident commander. Theincident commander needs to have an understandingof the elements that can affect the desired outcomein order to make the critical decisions necessary toassure a successful rescue. Decisions must flow froma systematic process and be easily understood. Size-up points out the proper tactical and strategic ap-proach to the rescue.

DefinitionSize-up is the thought process built around eval-

uation of information available at the emergencyscene, and the translation of that information intoa plan of action to assure the successful executionand control of the incident. Size-up is done to predictthe outcome of an incident or situation. In otherwords, the incident commander tries to envision allof the things that could possibly happen in theimmediate future that could affect the outcome ofthe operation.

The major goal of the size-up is to avoid anunsuccessful rescue attempt. For example, if peopleare trapped in a vehicle lying on its top, the incidentcommander must make sure that the vehicle is sta-bilized so that it is not in danger of moving whilethe injured are being treated and extrication pro-cedures are being done. The incident commandermust continually size up the operation to determineits success and to anticipate the resources and meth-ods required for the .next phase of the operation.

Evaluation and TranslationEvaluation and translation are the major com-

ponents of a size-up, and are the basi of command

decisions. Size-up is a process that starts with thefirst supervisor to arrive at the scene and continuesthroughout the incident. The evaluation providedby the initial supervisor is often the foundation forevery command decision that follows throughout theincident. If the evaluation is accurate, the size-upwill lead to a quick and effective outcome. If theevaluation is flawed, the decisions that follow willbe flawed, and can lead to poor performance orconfusion at the scene until orders are modified toaccommodate the corrected size-up.

The Game PlanMaking an accurate size-up is not enough. The

size-up must lead to a master plan with specificstrategies that are conveyed to the rest of the su-pervisors and personnel on the scene. A simple de-scription of what is seen and how the situation isto be attacked is sufficient. It is important that thesize-up and resulting game plan be conveyed tohigher-ranking supervisors upon their arrival. Anaccurate discussion of what was seen and what isbeing done assures a smooth transfer of command.

Size-up is not limited to the decision made uponthe arrival of the first crew or the first supervisor.Many components of a size-up can be done in ad-vance of an incident. For example, a snowy, sleet-filled day predictably leads to rescue activity becauseof the numerous accidents caused by vehicles slidingoff the road and pectc.. slipping and falling on ice.It is also logical to piedict that severe cold weathermay cause cases of frost bite and hypothermia.

The realization that certain incidents may demandcertain rescue activities begins the process of size-up. This type of assessment does not have to waituntil the alarm sounds. The obvious conclusion isthat size-up involves as much preplanning as actualreaction at the scene of the emergency. Effectivepreplanning signals the personnel, tools, and equip-ment that are going to be needed to complete theoperation.

1 6

8 VICTIM dESCUE

FACTORS TO CONSIDER INTHE SIZE-UP

Of all the factors to consider in size-up, weatherconditions are the most obvious. The weather createsemergency rescue situations. The high temperaturesof July and August often cause the elderly, athletes,and playful youngsters to suffer heat exhaustion and/or heat-stroke related problems. If a marathon raceis scheduled lnd the temperature is 80°F at eighto'clock in the morning, that is a pretty good indi-cation of what the day is going to be like, at leastduring that race.

Another factor to consider is the organization'slimitations. If the local service can staff only tworescue units, and a marathon race has 1500 entrants,the possibility exists that the service lacks the re-sources needed to cover that race and the rest ofthe community at the same time. The size-up ofthat situation would indicate a need for mutual-aidassistance or extra personnel. To assure that thecommunity will be supplied with sufficient resources,assistance will have to be provided.

The limitations of the available tools and person-nel is another factor to consider. If a unit lacks theability to perform rope rescue or dive rescue activ-ities, it is importar.t to know where personnel withthose capabilities are available, and how they willbe notified if the need arises. Rescuers must also beaware of the capabilities and limitations of the toolsand equipment available.

General information such as the time of day isalso important in size-up. A classic example of anincident in which time of day is an important factoris an alarm indicating that a truck has hit a schoolbuilding. This will lead to a different kind of reactionat nine o'clock in the morning on a Saturday in Julythan at nine o'clock in the morning on a Tuesdayin March. A response to an alarm can be altered bythe time of day and also by traffic conditions.

During the rush hour, alarm responses are slowed.A critical situation requiring extrication will demandmore equipment during rush hour. Additional equip-ment may be needed, and the incident commandershould call for the extra equipment as soon as thecall is dispatched, since the traffic congestion willrequire more travel time. If the equipment is notneeded it can be sent back. If it is needed, valuabletime is saved if assistance is enroute. When livesare at stake, delay can be the difference betweensuccess or failure.

VIINISIMPIIL111111.

SIZE-UP BASED ON THESITUATION

The type of rescue problem can be dictated bythe particular situation found. For example, in asituation where victims are trapptm in a house fireand the structure is relatively sound, the rescueproblem becomes one of finding the victims andremoving them from the building to a safe atmos-phere so treatment can begin in a safe environment.

In a high-rise building, on the other hand, movingoccupants to a safe environment does not necessarilymean removing them from the building. Rescue canbe simply directing them to a safer zone four or fivestories below the fire. It may also mean that fullyprotected fire personnel should do the search andbring the individuals to a safe zone where paramedicswho are not dressed in full turnout clothing canbegin medical treatment. Size-up also indicates thata high-rise fire requires more personnel than a housefire.

A second kind of rescue problem occurs when thebuilding itself is unstable. For example, when anearthquake or fire results in a collapsed roof withpeople trapped, the situation becomes dramaticallydifferent. Above all, the incident commander mustbe concerned for the safety of the rescuers. Withoutthe rescuers the trapped individuals have no chanceof being rescued.

The incident commander must consider shoringup portions of the building so that the rest of thebuilding does not collapse on people trying to effectthe rescue. The problem may be compounded if theenvironment in which rescuers are working demandsspecific protective clothing. If paramedic crews arenot cross-trained ar 1 not required to wear fire fight-er's clothing, they cannot be ordered into the im-mediate fire zone.

A rescue involving tunneling, trenching, or a cave-in is different than any kind of structural rescue.In these situations, material is usually packed aroundthe victim. Consequently, these rescues require atremendous number of personnel who understandthe need for shoring-up and doing longittidinal orsecondary tunneling, and who have other types ofskills as well. In this type of emergency there is theadditional need to direct a supply of air or oxygeninto the area to assist the victim's breathing. If theearth or soil is packed around the victim, the victim'sability to expand the lungs is greatly diminishedand the victim usually needs respiratory support. 41

SIZE-UP 9

A hazardous environment is another gituation thatrequires a knowledge of size-up procedures. The size-up must indicate the proper reaction to a rescueinvolving such contaminants or hazards as a radio-active leak, a toxic by-product of combustion, anammonia or chlorine-type gas leak, or a downed liveelectrical wire. Certain guidelines must be followedin any hazardous environment. Crew members mustmaintain a safe, clear working zone. Potential windshifts within the hazardous area must be carefullymonitored. A hazardous atmosphere requires res-cuers to approach a scene with caution. The rescuemust be planned around taking charge and controlof the safe working areas.

Water and ice rescues can also be preplannedthrough size-up. If a community lacks a river orlake, the most common water iescue will be in aswimming pool. The most common swimming poolrescue is one in which a person is found unconsciousin the pool. The procedure requires a rescuer tojump into the pool upon arrival at the scene andrescue the individual, or to start CPR on the victimwho has been removed from the pool. Safe waterrescues in other configurations such as fast water orlow dams require a tremendous amount of training.(For further information see the module on wateremergencies.)

A final size-up situation to be considered is ex-trication from vehicles. This type of rescue situationis the one most familiar to all public safety personnel.Extrication requires the use of spreading jaws, airbags, shoring blocks, air chisels, and an entire in-ventory of tools and equipment normally associatedwith performing this task. Size-up along with train-ing allows rescuers to identify the needed equipmentquickly. (For further information see the chapter onextrication from vehicles.)

Unstable situations require an in-depth knowledgeof advanced rescue techniques. The size-up processcan predetermine which resources have specific res-cue capabilities and whether or not they are available.

1 6

CONCLUSIONCareful size-up is essential for a successful rescue.

The incident commander must relay the plan ofaction as quickly as possible, so that rescuers canreact. If specific situations dictate a change in aplan, the change must be communicated quickly toeveryone.

The plan that evolves from a size-up is not etchedin stone. It is place to start; an idea to send to allinvolved personnel. The incident commander needsto be constantly aware of the progress of a rescueand changes in action required by a changing sit-uation. If the situation changes, the plan must change.Once again, that change must be communicated toeveryone involved in the rescue.

KEY POINTS

The importance of a critiqueThe components of a critique

1 1

CRITIQUE

INTRODUCTIONGood rescue performance is built upon training

and the knowledge learned from past experiences inrescue operations. An analysis of the positive andnegative aspects of each rescue experience is im-portant for deveioping good performance and safe,effective rescue operations. To assure that the pos-itive aspects are reinforced and the negatives areeliminated, a thorough review or critique of theactivities of a given rescue operation must beconducted.

Incidents that involve serious injuries with a po-tenUal for casualties, and multiple-casualty incidentsmust be critiqued with meticulous attention to thefacts. An incident that is exceptional and rare, suchas a window cleaner trapped on the side of a tallbuilding, would probably require a formal critiqueto provide a standard in case of a repeat occurrence.

A good critique can lead to improvement in policiesand procedures or reinforcement of procedures thatare in place. The critique needs to be an open,honest, and fair evaluation based upon facts, withan understanding of the emotions surrounding thesolution. The only way a critique can lead to suc-cessful problem-solving is if it is based on facts.

DefinitionA critique is simply a review of an incident, de-

signed to analyze the events that occurred whiledealing with the situation. The two primary reasonsfor conducting a critique are, (1) to improve theefficiency of the operation, and (2) to provide anaccurate record of the sequence of events, shouldthere be litigation associated with the accident.

Psychological BenefitsRescue personnel often encounter horrendous

emergency situations which can pose emotional andphysical health hazards to all personnel at the scene.

1 ;)

Such stress can be transferred to the rescuer's familysetting and thereby can affect overall performance.

In terms of psychological treatment, or outcomes,it is important that an operation centered around agruesome incident or one that is heavily chargedwith emotion be followed up with a critique. Sucha critique assumes a unique character. It may beformal or informal. Besides acquiring the facts, ifdone properly, this type of critique can become thetool that relieves stress for the crew members andprovides an opportunity to release emotions or opin-ions that affect the performance of the crew membersand their ability to work together. While it is im-portant to record a distressing situation, it is moreimportant to perform the critique from a psycho-logical perspective.

Many public safety departments have professionalguidance available for their personnel through emer-gency assistance programs, a chaplain corp, or a staffpsychologist who can work with staff members at amoment's notice. A good critique with the psycho-logical impact in mind can spare the departmentthe loss of personnel from burnout and emotionaldistress.

TYPES OF CRITIQUESA critique should be conducted as soon after the

incident as possible. The magnitude of the incidentwill dictate whether or not the critique will be aformal, full-scale review or an informal, simple re-view. A large-scale incident, or one that might leadto litigation, requires a formal, full-scale critique.

Formal CritiqueA formal critique necessitates collecting all of the

run reports and audio tapes surrounding the inci-dent, from the original telephone call reporting theincident to the dispatch center, to the last rescuer'sinput upon returning to headquarters. It is prudent

12 VICTIM RESCUE

to secure copies of all the TV tapes, including boththe edited and unedited news coverage. The infor-mation should be compiled in chronological orderfor presentation.

Informal CritiqueMost emergency incidents simply require the re-

calling of events from run reports and an analysisby members at the scene of the incident. The reviewis usually short and informal, requiring an exchangeof facts with the incident commander or the crewsupervisor conducting the exercise. The focus of theinformal critique is to provide an overview of theoperation to make sure it followed standard oper-ating procedures and accomplished the expectedoutcome.

COMPONENTS OF A CRITIQUEThe person conducting the critique needs to de-

termine as many facts as possible about the incident.The facts collected begin with the time of the firsttelephone call and conclude when the last personnelreturn to headquarters. In most cases, the personconducting the critique should be looking for ex-ceptions to normal activities.

As with size-up, if a subject or activity is notunusual, then it is not stressed in the presentation.For example, if the alarm is given in a clear concisemanner within acceptable time limits and is docu-mented in the transcript of the exact conversationduring alarm transmission, there is no need to dwellon it in the critique (see Figure 1).

TRANSCRIPT OF TELEPHONE TAPE

FOR DROWNING INCIDENT

- Windsor Emergency OperatorDispatcher 132855

Caller 1328:57

Dispatcher 1329:02

Caller 132904

Dispatcher 1329:18

Caller 1329:20

Dispatcher 1329:29

Caller 1329:42

1329:46

A neighbor boy has fallen throughthe ice in mv pond. I need helpright away.

Can You see the boy?

Yes, he's hanging on a spare tireat the edge of the ice. His headand shoulders are out of the water.I tried to get him, but the icekeeps cracking under my weight, soI threw him the spare out of mypick-up truck.

What's your address and telephonenumber?

- It's the Shaus Farm, Box 128,Chapman Roads that's between KuckRoad and McClintock Road. Mytelephone number is 555-1212.

OK, we'll send somebody out. Inthe meantime you can qo out andhelp keeP the boy calm. Let himknow help is on the way. If youcan, get somebody out at the end ofthe driveway to flag down theemergency crews and direct them tothe pond.

- Right - I'll have my son out by theroad. (Disconnect)

- Conversation completed.

Figure 1. Transcript

CRITIQUE

A narrative report for a situation without com-plications would simply include the following infor-mation: the response route, the action taken on thescene, and the number of personnel used in con-trolling the incident. If the action involved a stand-ard operating procedure and nothing new was learned,or no unique situation was encounterei, a formalcritique is not necessary. However, if a situation outof the ordinary forced a reaction from the rescuersthat is not part of standard operating procedures,include a review of this action in a critique.

Every organization has a standard run report form.Usually the form is standardized for each region orstate. The run report should be completed by thecrew commander, the incident commander, or both.It usually includes basic information such as thename, age, and sex of the rescued person, whetheror not the rescued person was the owner/occupantof the vehicle or building, and the nature of theemergency. A run report commonly provides infor-maCon like the alarm time and response time, thehe ipital to which the victim was transported, and6.0 medical treatment given both enroute and atftte scene (see Figure 2). The run report should besed as an outline and generally plays a major rolein the informal critique.

ITEMS FOR THE CRITIQUE

Diagrams and DrawingsA general diagram or map of the incident area iB

important and should include relevant geographicinformation, such as street locations, items that helpprovide reference to the scene, and obstacles en-countered during the course of the rescue operation.If the rescue involved a building, include a diagramof the structure showing the distance to the groundor any intersection area. Make the drawings to scaleif possible. It is important to understand the rela-tionship of infrastructure items, such as wires, sew-ers, water mains and other building attachments, tothe incident, and to make sure they are Included inthe drawing.

If rescue activities involve the interior of a struc-ture, include a separate drawing that notes the im-portant structural characteristics of the building,such as doorways, stairwells, and fire escapes. Avoidnoting light fixtures if they were not part of therescue operation. The basic structural diagram thatis of most value is the site plan of the structure. It

-MOM.

13

is wise to assume that every map or drawing madewill be transferred to an overhead transparency ora slide if the critique becomes formal (see Figure3).

Written ReportsInformation necessary for the crit'que includes any

written reports completed, including unit reports andthe summary incident report done by the incidentcommander on the scene. All reports must becomepart of the information gathered. The run or incidentreport is probably the most important documentdealing with the incident and should contain themost precise information.

The information gathered becomes the basis forthe narrative of a critique, even though it may notbe put on a transparency or slide for the graphicpresentation. The incident commander will be ex-pected to provide a summary of all the activitiessurrounding the incident, as well as a pertinentdiagram of critical features mentioned in the textof the report.

Interview InformationAnother factor to consider in a critique is infor-

mation gathered from personnel interviews. Once thebasic information has been gathered, the individualresponsible for the critique should interview theincident commander (if the incident commander isnot doing the critique) to review the basic strategythat was employed in handling the incident. Theinterviews should then proceed down the chain-of-command until the commander and crew membersof the first arriving piece of equipment have providedcomplete information about what was observed andwhat action took place.

Interviews should not be restricted to the super-visors and crew members; however, it is importantto interview only individuals present at the incident.Important information can often be collected bytalking to bystanders, such as the citizen who calledin the incident or the mutual-aid crew members. Inorder to understand what was seen and what infor-mation was relayed the individual responsible forthe critque should be sure to interview all individualswith relevant information.

Final PresentationThe next step in the critique process is to review

all the information collected. The presenter of the

1 4 VICTIM RESCUE

EMS SERVICE'

COUNTY:

LOCATION OF CALL:

NATURE OF CALL-

NAME:

ADDRESS.

AGE: SEX L/ M

RUN REPORT FORM

PHONE:

CITY;

LI F HOSPITAL:

TIME HIP PULSE FIESP AVPU (4)NI1 OR RHYTHM

DATE

RUN NUMBER

CALL REC 0

BLSTOSCNE

ALS TO SCENE

ATBLS SCENE

ALS AT SCENE ..................

?4,

7TO HOSPITAL ::::::.... ..AT HOSPITAL ...::.'::i.:.::::. ....:.:.....:.;.;.:/.:::-.... .

IN SERVICESTART FINISH TO AL

AT OuARTERS

CHIEF COMPLAINT/ASSESSMENT.

RUN PIPE: LI EME RGE NT LI NON-EMERGENT U SCHEDULED/TRANSFER U NO REMOVAL

SEVERITY OF CONDITION 'J MINOR J SERIOUS U CRITICAL J APPARENT DOACOMMUNICATIONS: j TELM L.I BLS j ALS j PHONE j DISPATCH

SIGNIFICANT HISTORY

ALLERGIES

U ABDOMINAL PAIN

ALCOHOL.RELATED

U ALLERGIC REACTION

LI ANXIETY

U ASSAULTU BEHAVIOR DISORDER

BLEEDING/LACERATIONS

LJ BURNS

'J AIRWAYJ ORALU NASALU EO 'J'J EGTA 'Ju ET T

ORAL

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LI BANDAGEU BURN CARE7..) CARDIAC MONITORLI CONTROL BLEEDING

SKIN

NORMAL

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DRY

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WARM

PUPILS

RESPONSIVE

UNEOUAL

DILATED

CONSTRICTED

NON.REACTIVE

R LRLR L

R L

BREATH SOUNDS

CLEARRALES

WHEEZES

DIMISHEDABSENT

SUSPECTED NATURE OF PROBLEM h

CARDIAC

DEAD ON ARRIVAL

DIABETIC

FEVER

FRACTURE/SPRAIN

HEAD INJURY

MULTIPLE COMPAINTS

NAUSEANOMITING

O MULTIPLE TRAUMA

( ) BLUNT ( ) PENETRATING

011GYN

OVERCOSE

C..1 POISONING

U RESPIRATORY

LI SEIZURE

C.1 SHOOTING

TREATMENT GIVEN

C.J CPR TIME

LI SQUADLI BY.STANDERDEFIBICARDOVERTEXTRICATION

KED/XPI

C.1 SBB

OTHER--ICE PACK

1 IMMOBILIZATONLJ CERVICAL

LI EXTRICATE

U FOAMLJORTHOPED

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C.J SPINALLI BACKBOARDU REEVESLI SCOOPL I OTHER

Li EXTREMITYAIR

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LI

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LI

PHYSICIAN:

U SPINAL CARD

U STABBINGLI STROKE

LI SUICIDE ATTEMPT

LI UNCONSCIOUSNESS

WEAPINESSRARAYSIOMUMBN

7J OTHER:

INFANT DELIVERYTIME

IV THERAPY

NO ATTEMPTSMAST

LI INFLATEDRGHT LEG

LI LEFT LEG'J ABDOMINAL

PSYCHOLOGICALRELIEF TENSION PNUMOSUC PONJ NASALLI ORALLI TRACHEALTRANSPORT ONLY

itANI

JUSTIFICATION CODES: POS.PHYSIC AN ON SCENE,BQ.BTANpINg Q_RDE,R . E . PHY oCIAN

NAME OR SIGNA U E PH SICIAN:

CHF W Mf MBE RS DESI(.NATE A EMT AAA E MI-AA P FF,lT.P D DRIVI R 0.0TIAFFI

POLICE

,1111Nk

Figure 2. Sample Run Report

BEST COPY AVAILABLE 2 2

CRITIQUE 15

THIRD PARY BILLING INFORMATION

MEDICARE NO:

.... ADDITIONAL EQUIPMENT USED

MEDICAID NO:

BLUE CROSS & BLUE SHIELD NO:

WELFARE NO:

OTHER INSURANCE:

INSURANCE NO:

NEXT OF KIN:ELATIONSHIPR

ADDRESS:.

... , ?.. SQUAD NARRATIVE

PHONE

PERSONAL EFFECTS

X XSOUAD SIGNATURE WITNESS SIGNATURE

REFUSAL STATEMENT

refuse to allow thePATIENTS NAME

to give me emergency care and to remove me to a hospital.

I have been advised of the risks invulved in making such a refusal.

I hereby release the

liability and claims which could arise from the consequences of this refusal of emergency care and/or

transportation to a hospital.

from any

X

WITNESS

X

WITNESS

DATE SIGNED:

XPATIENT SIGNATURE OR IF A MINOR, PARENT OR LEGALGUARDIAN

AGE OF PATIENT AMBULANCE REPORT NO

Figure 2. Sample Run Report (cont.)

23

16 VICTIM RESCUE

6 PP'S

'.-reata Pari. t

136

1.tt'rt;.rg

132

Fmci, Flortit

128

S!.

121

V14,,

1441,11dare

116

0High Street

Ran MEI! 'III

INMAN" II

nSUE Ift /El

Mane ! ,uthatde 0111.5Barber Shop Market Lat.udry

6« oil*

Scale 1"t, 20'

Multiple casualty Incident Scene132 High Street - January 3. 1969

I.

Figure 3. Critique Diagram

critique must compare the transcript, diagrams, andrun reports te check for discrepancies. Any discrep-ancies must be corrected. Once the information isin place, a visual presentation should be prepared.

The initial alarm information is of extreme im-portance in a final formal presentation. A transcriptor tape of the alarm provides a basis for under-standing how the alarm was received, what initiatedthe type of response, and why the situation mayhave demanded additional equipment. Although thetranscript may not be part of the formal graphicpresentation, in terms of slides, overheads, or othergraphics it will definitely be the basis of the chro-nological accounting of the incident.

With a clear understanding of what transpiredduring the incident, the individual presenting thecritique should be prepared to make a verbal pres-entation. A written narrative should be provideddescribing the general action taken, along with ref-erences and a copy of the visuals used in the critique.The initial presentation should be conducted in thepresence of the incident commander or the chief tomake sure that the presenter (if it is not the incident

commander) is in agreement with the person incharge. The critique should then be presented to allcommand personnel and any others who might con-front a similar incident.

The information gained from a critique is oftenthe basis for a change in policies or standard op-erating procedures within an organization. It is im-portant that all of the policy or operationalramifications be mentioned, particularly in a formalcritique, so that everyone has an understanding ofthe need for any change suggested by the critique.

CONCLUSIONIt is important for a critique to provide infor-

mation that can be shared with an entire rescueservice as soon as possible after an incident occurs.A good organization has the ability to correct pasterrors and build on the positive efforts detailed ina good presentation. Developing and presenting agood incident critique provides a strong self-im-provement tool for everyone involved.

24

41

17

REPORTS AND RECORDKEEPING

KEY POINTS

The importance of reporta and recordkeepingReporting responsibilitiesThe incident reportMiscellaneous reporta

INTRODUCTIONAccurate reporting and recordkeeping are crucial

to analyzing an emergency response. Records andreports are important components of an effective,efficient response system. They provide an organi-zation with a base for productivity analysis and iorthe measurement of rescuers' performance levels.They also provide an indicator of the seveety of anactivity and of the probability that a situation willbe ongoing or recurring.

An incident report provides critical informationfrom the legal viewpoint. Assuming that the partic-ular organization is not involved in a lawsuit, a filedreport can be used by both parties. Informationcontained in an incident report is almost always thefoundation of any lawsuits or investigations of auincident.

Activities such t , the training of involved person-nel also need exact ,:eporting. The information gath-ered from these rr,ports can appear in court two andthree years later.

REPORTINGRESPONSIBILITIES

Usually, the responsibility for collecting and filingreports is placed in the highest office of a depart-ment. When a rescue service is part of a fire de-partment, the chief is responsible for reports.

In an independent rescue service, such as a county-wide or a regionally-operated service, the chief ofthat service is responsible for seeing that reports arecompleted and properly filed. The individual unitreport, however, is the responsibility of the officerin charge of the crew or vehicle. This run reportincludes documentation of all of the activities of thecrew while working at an incident. In cases where

several units are sent, the crew commander of eachunit completes a report and sends it to a centrallocation where the reports are assembled, and anoverall incident summary is completed by the in-cident commander. Multiple reports from one inci-dent are kept together and filed in one location.

THE INCIDENT REPORTEach report must include the name of the de-

partment generating the report. The report mustalso include the following: the incident location, de-tails of the call, the times associated with the call,the time the alarm was received, the time the alarmwas transmitted, the time rescuers arrived at thescene, the time enroute to the hospital or to head-quarters, the time the unit was in service, and adescription of the situation encountered (see Figure4).

Critical information such as the address of theincident, the name of the victim, and the owner ofthe property is listed. Other information documentedon the report is how the alarm was received, whetheror not the police were called, and whether policewere on the scene (see Figure 5).

The report also documents pertinent details aboutthe situation found, the care or treatment of thevictim, and an assessment of the victim's conditionat the time of the rescuers' arrival. It must alsoinclude data about the nature of the suspected prob-lem and about any medication administered to anyvictim by a paramedic. Treatment provided to vic-tims such as splinting and oxygen administrationmust also be described.

Actions Taken by RescuersThe information provided in the action taken sec-

tion will vary with each situation and with each

25

18 VICTIM RESCUE

EMERGENCY MEDICALINCIDENT REPORT

Rtin Numb*,

1 Date7 0 A/R 0 M/A 0 Columbus 0 Washington

0 To 0 From 0 Perry 0 Westerville

2 Location8 Medic Time LogDispatch Time

9 Dispatch Message:

3 Patient Name Arrive/SceneTo HospitsL 10 SuPPorting Units

4 Address At Hospital

6 City Stat. In Service 11 Call Received By:0 P.A. 0 Police 0 Walk In0 Radio 0 Phone 0 GUBE

In Station6 Age M.I. Female

12 Medic No. Unit hl; 14 Location of Run0 Doctor Office0 Highway Acc,0 Job Site0 Nursing Home0 Office0 Public Place0 Residence0 Other

15 Disposition0 Cancelled Call 0 Childrens Hosp.0 Service Call 0 Doctors Hosp. N.W0 Not Trans. Advised 0 Grant Hosp.

0 Mt. Carmel Hosp. CITransported BY 8 Riverside Hosp.

0 Private Auto St. Ann's Hosp.0 Supporting Sqd. 0 University Hosp.0 Private Ambulance 0 Co. Morgue0 Sharon Medic 0 Other

In Chg

AfiAtt.

13 Refused Aid

olon 44444

Date 19

16 Type of Injury or Inners 0 D.O.A. 0 Heart Attack 0 Poisoning0 Animal Bite 0 ,;u tsiiiruises 0 Electric Shock 0 H.morrhage 0 Psychiatric0 Burn riCVA 0 Fainting 0 Illness-General 0 Seizures0 Chtst Pain 0 Diabetic 0 Fracture 0 Intoxication 0 Suicide-Attempted0 CHF 0 Din. Breathing 0 Internal Bleeding 0 OB-GYN 0 Unconscious0 Choking 0 Drowning 0 Gun Shot 0 Overdose-Possible 0 Other

g )lebsaanrvedalvyloounin(:lease checks rill that aspply) 11111and Advised k \IS \ I \IS r r

Open Wounds

Fracture S/C

Burns (note degree)

Pain

Cut/Bruises

18 Pre Hospital Emergency Care 0 Long Backboard0 % Backboard0 Cervlcal Coller0 Sand Baps

0 Airway Inserted 0 Spinal Immobilization0 False Teeth Removed0 Suction Used0 Oxygen LPM

0 Oral0 Nasal 0 Bleeding Controlled0 EsoPhalisal 0 Cold Application0 Endotrecheal * 0 Restraints Applied 0 Blanket/Cravats

0 Nasal Cannula 0 Face Mask 0 Limb Immobilization 0 SU,/ No Splint0 Artificial Ventilation 0 Mouth to Mouth 0 Vomiting Induced B.4 :olint0 CPR Given 0 BagNalve/Niask Time

8Traction

0 Patient Vomited 0 Demand Valve 0 Rotating Tourniquets 0 Air Splint

0 Other 0 Thumper Time 0 Antishock Trousers

19 Physical Condition

Status Skin Color Respirations Pulse Pupils

20 Peet History0 Allergy0 CVA0 Diabetes0 Hvoertension0 Seizures0 Previous Angina0 Previ011s Heart

0 Conscious0 DisorientedC unconscious0 Convulsing0 Unruly

0 Normal0 Cyanotic0 Pale/Ashen0 Flushed0 Moist

0 Normal0 Labored0 Shallow0 NoisyC., Absent

0 Regular8 Irregular

Thready0 Absent

0 Responsive0 Equal0 Unequel0 Dilated0 NOn ReKtive

21 Drug Therapy

Atropine_

Ti me 23 Vital Signs Time Time TimeGiven

Amount

MG

_Blood Pressure 11 / 21 31 //Respirations 11 /Min 21--/Min. 31 /Min.Pulre 11 /Min 21-___/Min. 31--_/Min.1 mipereture 1) _____F 21____F 31 FCalcium Chloride CC

Decedron M(DIMINO 50% CC 24 Defibrillation

Watt Sec ResultDopamine MCG/MinEpi. 1:1000SC MG

Tim,Result

Epi. 1.10.000IV MGTime Watt Sec

ResultTime Watt SecIsuprelLox

WA/MinMG 25 ECG 0 B Lead 0 12 Lied 0 Monitor Only

0 NSR 0 Atrial Fib. 0 PVC Per Min.Lidocaine, Bolus MGLidocacm, Drip MG/Min. 0 Sinus Arrhy. 0 Atrial Flutter 0 Vent. Tech.

U Sinus Brady 0 Junctional 0 Vent. Fib.0 Sinus Tact, 0 1.. ..led T la,,..4 0 Asystole0 PAC 0 kmi ) .1 Soc. 0 iwoventricular0 AV Block 1.2.3 0 0 Waves Present 0 ST Elevation0 PAT 0 Pacemaker 0 ST Depression

Nitroglycerin labSodium Blurb CC

IV 5% D/W CC

IV Ringers CC

Other (specify)

22 IV Therapy 26 Remarks0 Successful GA Angio.0 Unsuccessful GA. Scalp

0 Blood Sample

fund OvVONTII - STAMM COPY PILLOW - Fee COPY oni:4 - HOSPITAL COPY

Figure 4. Sample EMS Report

BEST COPY AVAILAB15

0114.014011,

REPORTS AND RECORDKEEPING 19

1-I I INCIDENT REPORT D"171

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Figure 5. Sample Incident Report

7

BEST COPY AVAILABLE

20 VICTIM RESCUE

responding agency. Depending on the situation, apreviously described condition or the victim's chiefcomplaint at the time rescuers arrived at the scenemay be the basis for the narrative of the actiontaken section. In any case, the mRjority of the datain the report will describe the treatment of thevictim.

Treatment includes the use of splints, bandages,and dressings; placement of a cervical collar; use ofa backboard; and any other action taken during thevictim's treatment. If activity centered aroundsearching for the victim or releasing the victim fromsome type of entrapment, the description explainsin detail what was seen upon arrival, what kind ofaction was taken to prevent further injury to thevictim, what method was used to free the victim,and other specific details. It is critically importantto note if there were other medically trained per-sonnel on the scene, specifically if a physician or aregistered nurse treated to the victim.

Handling of ValuablesIf a victim's valuables such as a billfold, purse, or

jewelry were removed for safekeeping, indicate clearlyon the report how the items were handled. If itemsare given to a police officer, include the police of-ficer's name and badge number; if items are givento the commanding officer, indicate his or her nameon the report; if the items accompanied the victimto the hospital, indicate how valuables were handledonce the victim was at the hospital.

If in the process of performing a rescue valuableitems are noticed and not handled, note this on thereport. For example, if there are sterling silver itemsdisplayed in a home, indicate where they are locatedand their condition.

Personnel SectionReports should note the number of rescuers sent

to a scene and each rescuer's name. Note whetheror not additional assistance was requested. Indicatenotification of other authorities. For example, if thereis a fatality associated with the incident, note thatthe local law enforcement agency and county coronerwere notified, and note the time of notification.

The SignatureFinally, on every incident report, ther, is a place

for the signature of the person filing the report.Remember, legal documents require signatures to

complete the transmittal of information. Do not al-low another person to sign your ;lame. Allowingsomeone else to sign the report carries the risk thatthe report may be both inaccurate and forged. Beforesigning a report, make sure it reflects exactly whatwas seen and known about the incident.

OTHER REPORTS

The Maintenance ReportReports also include the maintenance report as-

sociated with vehicle usage (see Figure 6). A checklistof regular maintenance and inspection items can beused. A vehicle inspection includes attention to howthe vehicle handles, and to the brakes, the warningsystems, and other systems. The report should alsoindicate fuel and oil usage, and the number of milestraveled.

RECORD OF MUNT/DIANCE TO APPARATUS

DATE RE P A I Rs OR MAINIFENNICE PERFORMED HI LEAGEWHERE

PERFORMBY

VAIC+1

COMPANY TAG KRIM

Figure 6. Sample Maintenance Report

The maintenance report must be filled out everytime the vehicle travels any significant distance. Ifit is driven from headquarters to the training grounds,document the mileage even though it is not anemergency run. Mileage figures are used to determinethe vehicle's average fuel consumption and to cal-culate miles expended on emergency activities andmiles used for other activities.

Items noted in the remarks section include no-tations that tools were broken or left at the scene,medical-treatment equipment such as splints wereleft at the hospital, supply trays are empty, etc.When the report is completed, review it and obtainthe necessary signatures before filing.

-=111110=110.,REPORTS AND RECORDKEEPING

The Tre;ning ReportAnothet report necessary for a rescue operation is

the training report (see Figure 7). This report in-cludes a summary of the monthly training sessions.List each training activity by subject. Include thelength of time spent on a subject and a list of namesof the people who attended the session.

Most organizations provide an annual guide fortraining, transmitted by the chief of the organization.The annual guide reflects the minimum training

:hedule of all materials to be covered throughoute year. An officer can look through a report andil whether or not a unit is meeting the expectations

ot the aepartment.

CONCLUSIONMany kinds of reports can be generated by a rescue

21410111INNO

operation. The types and number of reports aredictated by the size of the organization. Reportingand recordkeeping are not exciting activities. Whena report is generated, it is for a specific purpose. Itmust reflect information that is noteworthy and nec-essary for the organization. Likewise, it must becompleted accurately. Reports do not take prece-dence over victim care, but they are as important.

If a report has to be amended because of additionalinformation, indicate that it has been amended andattach the additional information to the originalreport. Ft:ports must be accurate. It is important toremember that a report subpoenaed into court mayhave been generated by someone who is no longeralive to defend an action or a statement. Medicalreports are subject to subpoena years after an in-cident. Court decisions have extended the statutesof limitations for medical records to years beyondthe seven-year mark. For this reason, a report mustbe properly completed so that it is self-explanatory.

TRAINING REPORT

Date Starting TM Ending Time___/___/

Total Time Unit Task Number,

Division Level CoSpany Level Other

Officer. Instructor(s)

Topic(Describe instructional activity in detail or attach a lesson plan.)

The firefighters who participated in this act!.vity, slash (/) theappropriate number(e).

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 4041 42 43 44 45 46 47 48 49 50 51 52 53 54 SS 56 57 58 59 60

If you were unable to have a training session today, briefly describe below.

Officer/111c Making Report

Training Officer

Dace , 19

Date , 19

Figure 7. Sample Training Report

P9

23

TOOLS AND EQUIPMENT FOR RESCUE OPERATIONS

KEY POINTS

The need for a community hazard surveyThe need for basic and specialized equipment and toolsFactors to consider before purchasing a tool or piece of equipment

INTRODUCTIONThe ideal rescue service has all the tools, equip-

ment, and trained personnel needed to extricatevictims from potential hazards within its service area.This ideal is seldom realized, but measures can betaken to preplan for needs. Each community shouldconduct a hazard survey to identify potential prob-lems and determine local needs. With the infor-mation and data gathered from a hazard survey,preplanning can be done, equipment and tools canbe obtained, and resources can be identified thatwill enable a rescue service to deal with emergencysituations.

Some basic rescue and extrication equipment iscommon to the rescue service such as tools for ex-trication, lighting equipment, and items required forroutine rescue procedures. The need for specializedequipment can be determined as potential hazardsare identified. For example, a waterfront communitymust have rescue boats and self-contained under-water breathing apparatus available, while a highlyindustrialized area needs to invest in equipment andtools to deal with hazardous materials incidents.

Factors to consider when ordering equipment andtools include the following:

Department needs. The equipment selectedshould be based on the hazard survey andpreplanning.Effectiveness of the item. Be sure to purchasethe right tool for the job.Safety concerns. Consider the safety of the res-cuer as well as that of the victim.Simplicity and ease of operation. Consider equip-ment and tools that are easy 3 operate.Serviceability. Be sure replacement parts arereadily available and that the equipment can beserviced in the field.

30

Versatility. The equipment or tools must be us-able to perform many different tasks.Reliability. Be sure the equipment and tools arereliable.

Durability. The item must be capabk of oper-ating efficiently in extreme environmentalconditions.

Compatibility. Equipment must be compatiblewith existing equipment.Size, weight, and storage requirements. Depart-ment facility and management requirements inthis area must be considered.Cost. The most cost-efficient equipment for thejob to be done should be purchased.

Each section of this manual will discuss differentrescue problems and recommend equipment andtechniques necessary to perform specific rescue ev-olutions. It is the responsibility of each rescue serviceto identify local hazard situations and the equipmentand tools that will best suit its needs. In many rescueoperations techniques and tools and equipment mustbe improvised, so it is important for rescuers tobecome familiar with the capabilities of the equip-ment available. During preplanning rescuers alsoneed to become familiar with equipment and toolsavailable from cooperating agencies.

CONCLUSIONTo execute safe, effective, and efficient rescue

operations, each community must assess its potentialhazards and identify the tools and equipment it mayneed. Once the items have been obtained, rescuepersonnel should develop training procedures andpractice mock situations to become proficient withthe use of each tool and piece of equipment.

25

PLANNING FOR EMERGENCY OPERATIONS

KEY POINTS

The importance of emergency readinessPlanning for a mass casualtyCoordination of local personnelThe requirements for emergency readinessThe importance of emergency operations plansThe planning processThe basic plan and its annexesManaging an emergencyImplementing the planReviewing the planThe functions of an emergency management agency

INTRODUCTIONThe emergencies addressed in this section apply

to specific situations when government agencies mustcoordinate and direct the operations of the emer-gency services that are available in or to a com-munity. The need for coordinated emergencyoperations distinguishes a major disaster or emer-gency from an emergency that local fire and policeforces, or hospitals and doctors deal with daily.Emergency management operations leader-ship roles may differ depending on state orlocal protocal.

EMERGENCY READINESS"Emergency readiness" means that a community

is prepared to react promptly to save lives andproperty if threatened or hit by a disaster or majoremergency. Preplanning must take place before anemergency arises.

A community must plan in advance how to dealwith evacuation, temporary housing, search and res-cue, providing immediate medical care, and otherspecialized needs that arise during an emergencydisaster. During a hurricane or flood, it may benecessary to evacuate many people from low-lyingareas, and then feed them and provide temporaryhousing until the danger is over. When a river isrising to flood stage a massive effort may be neededto strengthen dikes or levees. If a tornado or earth-

21

quake hits, the damaged area must be searched forinjured people; the injured must be given first aidfollowed by professional medical attention aspromptly as possible. In addition, the homeless mustbe fed and housed.

If a plane crashes into a town, an explosion occurs,or a large building collapses it is necessary to getfire and medical unite into the damaged area asquickly as possible. In addition to providing all theemergency services, it is important to have crowdcontrol to keep curious spectators out of the area.

Similar emergency operations on a larger scale willbe required if the United States ever encounters anenemy attack. In such a situation there may be anadditional need to protect people from radioactivefallout.

The rescue, law enforcement, fire, engineering, andpublk health department personnel, doctors, andother health-care professionals are the front-lineforces to take the lead in conducting lifesaving andproperty-preserving operations. State law enforce-ment, fire department, and other public service agen-cies from neighboring communities are often calledfor assistance.

In addition, citizen-volunteers are used for manyservices. For example, crews may be needed to fillsandbags and strengthen levees during a flood threat,or to help police and fire personnel search an earth-quake-damaged area to rescue injured survivors.Crews are also needed for clean-up and other or-ganized restoration activities after a tornado, hur-

26 VICTIM RESCUE

ricane, or other major emergency.Emergency readiness can be summarized by saying

that during an emergency mission government agen-cies and other rescue personnel must be able to dothe right thing at the right time. This includesprocedures for coordinating the operations of res-cuers, law enforcement officers, fire fighters, EMTpersonnel, hospitals, medical personnel, and all oth-ers with resources for helping during a large-scaledisaster. (See the Incident Command System chapterfor further information.)

MASS CASUALTY PLANNINGTriage, treatment, and transport of emergency vic-

tims are of utmost concern to the public safetyservice agencies in the event of a mass casualtyincident. The terminology, responsibilities, and an-nexes must be milmon to all participating agencies.The designated incident commander will be coor-dinated with the nature of the disaster, i.e., a civ".disturbance that ends with mass casualties shall beunder the responsibility of the law enforcementagency in charge of the area.

A preplan must be developed for protocol of ac-tivating local, county, and mutual-aid resources. Eachcommunity needs to establish a plan of action fora mass casualty incident and determine local protocolfor potential disasters.

Types of IncidentsA mass casualty incident refers to an incident

where the number of victims exceeds the number ofrescuers and the required resources to immediatelytriage, treat, and transport the victims.

A limited-victim incident refers to an incidentwhere a full activation of the mass-casualty plan isnot necessary; the number of victims indicates on-the-scene control and a limited amount of triage isnecessary. Triage tags may be used if necessary. Thelimited number of victims is usually five and themaximum number for this type incident is approx-imately 20.

Wandby NotificationStandby notification may be necessary for an in-

cident where there may be a mass casualty incidenteven though it has not actually happened. The in-cident commander may choose to announce standbynotification to rescuers who will be called if the mass

41116.

casualty incident occurs. The emergency networkincludes emergency responders, cooperating hospi-tals, disaster services, The Red Cross, coroner, andother local public assistance agencies. Standby no-tificatiun allows responders time to prepare for amass casualty incident.

Hospital Care FacilitiesCooperating hospital. This hospital receives

victim information and relays the information on tothe receiving hospital. This facility also coordinatesmental health counseling for all bystanders and per-sonnel assisting with the rescue operations.

Receiving hospital. This hospital receives andcares for the victims. Information about each victimis relayed on to the American Red Cross and healthand welfare agencies when necessary. Most hospitalshave an internal disaster plan established by localprotocol.

Children's Hospital. When an incident involvesa large number of children who are injured or burned,these victims are sent to a children's hospital unlessotherwise designated.

Coordination of Local PersonnelDuring a large-scale disaster an individual de-

partment must be aware of all the instructions issuedby other agencies or departments. For example, dur-ing a fire emergency the water department can issuea call to the citizens to hold the use of water to aminimum so that water pressure can be maintainedfor the fire department. At the same time, fire of-ficials may instruct citizens via the media to wetdown their roofs with garden hoses. Such specialefforts must be coordinated and prioritized.

REQUIREMENTS FOREMERGENCY READINESS

Specific requirements for emergency readiness in-clude the following:

An emergency operating center where local of-ficials can direct and control emergency opera-tions. The mayor, chief of police, fire chief, civildefense director, and other officials located atthis center must each have the same informationabout the emergency situation in order to co-ordinate decisions rapidly.

32

PLANNING FOR EMERGENCY OPERATIONS 27

Local government officials and community lead-ers should preplan what emergency actions areto be taken if the community is threatened orhit by a disaster. Different types of disastersshould be simulated to test the plans.Community leaders must be ready to give emer-gency instructions and information to the citi-zens. People must be given practical informationabout how to deal with a disaster. Citizens seekinstruction so that they can avoid injury andminimize damage to their property. People wantdown-to-earth advice from the government andtend to panic less when they are prepared.

Use the local warning system to alert the pub-lic before a disaster occurs. Do not wait toolong to broadcast reliable and official informa-tion. If a storm is threatening, alert the peoplewho may be affected. Information and instruc-tions must be broadcast repeatedly.

EMERGENCY OPERATIONSPLANS

An emergency operations plan contains informa-tion regarding protection for citizens and their prop-erty in the event of a disaster or a disayter-threateningsituation. It describes actions required to handle anyhazard, natural or technological, including the effectsof a nuclear attack. It addresses the tasks to beconducted by specific agencies and organizations atspecific places and projected times. It is based onestablished objectives, assumptions, and a realisticassessment of the capabilities of the respondingagencies.

A local plan describes a community's approach toemergency planning, organization, and operations.The plan provides an emergency management systemtailored to the particular needs of the jurisdiction,and the responsibilities generated by a large-scaledisaster or disaster-threatening situation. It ad-dresses an evacuation plan and identifies a specificshelter already in place that can be used to protectthe population. The plan identifies resources andprovides a system to ensure the orderly use of re-sources during a disaster.

Commonalities exist in the approach to emergencymanagement for all hazards. This should be reflectedin the emergency operations plan. Plans developedfor one specific type emergency may be extremelyuseful for other emergency situations. A level ofemergency operations capability is established by

addressing general functions such as direction andcontrol of the incident, the warning system, com-munications, evacuation routes, and shelter-provisions.

An emergency operation plan is a preplan thattreats emergency management activities genericallyand can be used for a multitude of hazards, disasters,or emergencies. The plan provides general applicableinformation without referencing a particular hazard,disaster, or emergency. Unique characteristics andcapabilities of the individual disaster agent are in-cluded in a hazard-specific appendices.

The Planning ProcessEmergency planning is based on the principle that

people support what they help to create. The planshould evolve through an organized process con-ducted by a team. The team includes representativesfrom each local government and agency with anemergency mission and from each nongovernmentalgroup with an assignment, for example, the newsmedia, the Red Cross, the Salvation Army, and others.

Comprehensive emergency management planningrequires the government to mitigate, prepare for,respond to, and recover from a disaster. Such plan-ning gives a community a sense of security.

As shown in Figure 8, the inner ring includes themayor, city council members, the city manager, countycommissioners, county judges, legal authorities, andother local personnel. The emergency manager's co-ordinating responsibilities are identified in the lowerhalf of the ring. Various local departmenta surround-ing the center or hub of the figure must take specificresponsibility for parts of the comprehensive emer-gency management program. The local emergencymanager coordinates the various department's emer-gency plans and functions.

The first two tasks are (1) to conduct a hazardanalysis, or review and update the existing hazardanalysis to identify the hazards that could affect thejurisdiction; and (2) to assess the jurisdiction's ca-pabilities and resources available in the event of anemergency or disaster. Once these steps are com-pleted a draft plan can be initiated.

The local plan may be simple or complex de-pending on the potential hazards in a community,the population at risk, and a community's resourcesand capabilities. A community with a large chemicalmanufacturing firm needs to draft a more detailedplan than a rural village with no industry. All plansshould follow the same format. The basic plan is

:43

28 VICTIM RESCUE

Plan Format

DEPARTMENTS OF LOCAL GOVERNMENT

Fire 1 PoliceDepartment Deportment

/ Departmentol Public

Works

SchoolSystem

\

Public Safely

May OrCity Council City Meneger

Of

CounlyCommismoners

Emergency Manager(Coordinator h3r Elected Authority)

Emergency Operating CenterMedia Training

Figure 8. Plan Format

Finence(Treasury) ;

PublicHealth

EmergencyHealth

Services

usually no longer than 10-15 pages with approxi-mately 14 appendices. The appendices coincide withthe local jurisdiction's needs.

The Basic PlanThe basic plan provides an overview of each ju-

risdiction's approach to emergency management (seeFigure 9). It is an umbrella plan that covers thegeneral organizational and operational details. Theplan establishes the structure reflected in the ap-pendices to the plan.

The basic plan identifies the incident commander,summarizes the potential hazardous or emergencysituations, explains the emergency operations, anddescribes the organization and details of the re-sponsibilities for emergency planning operations.

The AnnexesThP annexes are the parts of the plan that provide

specific information and direction. They focus onoperations and identify each function and who isresponsible for carrying out each function. While thebasic plan provides information relevant to the plan

BASIC

PLAN

cceeourrs OP

AM EMERGENCY OPENATIONS PLAN

Contains General Plan Information

FUNCTIONALANNEXES

Direction and controlCommunicationsWarningEmergency Public InformationEvacuationReception and CareSheltering and Hass CareHealth and Medical ServicesLaw EnforcementPublic WorksFire and RescueRadiological ProtectionHuman ServicesResource ManagementDamage Assessment

Each contains

JONT&INS

HAZARD SPECIFICAPPENDICES

1F---

TABS for Work Aids,orms, Charts, Tables

Specific InfoLuNtion

CONTAINS GENERAL ORGANIZATIONALAND OPERATIONAL COIWOMENTS

Introduction (not required in annexes)PurposeSituation and AssumptionConcept of OperationsOrganization and Assignment of

ResponsibilitiesDirection and ControlContinuity of GovernmentAdministration and LogisticsPlan EPrelopment and MaintenanceAuthorIcies and ReferencesDefinitions of TermsTabs (Maps-Organizational Charts)

Figure 9. Components of an Emergency Operations Plan

BEST COPY AVAILABLE1 4

PLANNING FOR EMERGENCY OPERATIONS 29

as a whole, the annexes emphasize responsibilities,tasks, procedures, and operational actions. Theyidentify activities to be performed by anyone withassigned responsibility explained under the identi-fied function. They identify actions that not onlyensure an effective emergency response but also aidin preparing for an emergency.

To be usable, the annexes must clearly define anddescribe the policies, procedures, and roles and re-sponsibilities inherent in the various functions be-fore, during, and after an emergency. To ensureadequate planning for all possible contingencies itis necessary to spend time projecting the conse-quences of various emergencies.

This activity should not be restricted to the haz-ards identified as the most threatening during thehazards analysis, but for any hazard. For example,an airplane crash can occur anywhere with little orno warning. Generic annexes are important parts ofthe plan since they are applicable to any unforeseenemergency.

The organization of the annexes should parallelthat of the basic plan. Specific sections should bedeveloped to expand uponbut not to repeat in-formation contained in the basic plan.

Functions to Include as AnnexesOne of the most important things to be done early

in the planning process is to identify the functionsfor each separate annex. The choices are influencedby factors such as the organizational structure ofthe state and local government, the capabilities ofeach jurisdiction's emergency service agencies, andestablished policies with respect to the concept ofoperations.

No single listing of functional annexes can beprescribed for all jurisdictions. The primary concernis that all activities are covered in a plan. Thecategorization of the activities is of secondary im-portance; however to facilitate coordination a juris-diction should strive for consistency among itsdepartments and the local agencies.

Generic AnnexesFollowing are brief explanations of important

emergency management functions.

Direction and Control. The direction and con-trol of an incident involves the use of a centralizedmanagement center (the emergency operations cen-ter) to facilitate policy-making and the coordination

and control of operating forces in the event of alarge-scale emergency. This annex must address theprocess of obtaining and analyzing emergency man-agement information to provide a basis for decision-making. It should describe the use of an alternateemergency operations center, mobile emergency op-erations center, and a field-command post. (For fur-ther information see the chapter Incident CommandSystem)

Communications. Communications deals withestablishing, using, maintaining, and providingbackup for all channels of communication neededfor an emergency response and recovery. This is acritical management function.

Warning. Warnings must be sent to the appro-priate government officials and then to the generalpublic in order to timely forecast all hazards thatmay require emergency preparedness or responseactions. Existing warning systems must be identifiedand coordinatoed, and provisions must be made toimplement them as needed.

The government unit must be able to obtain timelyinformation with regard to impending threats to thejurisdiction and to transmit the information rapidlyto local officials and citizen§. It is especially im-portant that clear directions be provided for the useof the Emergency Broadcast System (EBS) to warnthe public. A backup system must also be in place.For example, a telephone network initiated at themanagement center can be used to confirm thatschools have received the weather warnings issuedby the National Weather Service as well as any otheremergency warning issued. Descriptions of the warn-ing systems that are in place within the jurisdiction,and the responsibilities and procedures for using thesystems management functions.

Emergency Public Information (EPI). Thegoal of the emergency public information system isto increase public awareness of hazards and to pro-vide active channels for informing and advising thepublic on appropriate actions before, during, andafter an emergency. It provides for effective collec-tion and dissemination of information to controlrumors and to minimize dysfunctional public re-sponses. It describes policies, roles, responsibilities,and procedures for communicating with the generalpublic during several phases of emergency manage-ment, preparedness, response, and recovery.

Plans for developing and disseminating public in-formation materials or preparedness and evacuation

30 VICTIM RESCUE

procedures should be in place along with informationabout handling communications with the mass mediaduring an emergency. Special attention must be givento ensure the proper use of the emergency broadcastsystem. Technical aspects of communicating withthe public may be included. For example, a provisionfor remote transmission to the radio or televisionstation from the emergency operations center.

Evacuation. The purpose of the evacuation pro-cess is to relocate people to a safe area when anemergency or the threat of an emergency occurs.Detailed procedures must be established for carryingout complete or partial evacuation of the peoplefrom the jurisdiction. Focus on movement by defin-ing areas to be evacuated and designating safe areaswhere people are to go. Outline the approach forcontrolling the flow of traffic, and for ensuring anorderly return.

Reception and Care. Reception and care refersthe designation of a location to care for the peoplewithin the boundaries of the residential jurisdictionin case of a partial evacuation. This location mayalso be used to provide care for people from otherjurisdictions who may be directed to the area duringa contingency plan.

This annex states the policies, procedures, androles and responsibilities associated with providinghousing, food, clothing, and other essentials to alarge number of people who are displaced from theirhomes by a disaster. It also addresses problemsinherent to establishing a sufficient number of cen-ters, and activating a sufficient number of resourcesto care for people in need.

Inplace Protective Shelter. An inplace shelteris a designated location that provides appropriateshelter to protect people from the after-effects of adisaster. Use of shelters located in or near homes,schools, or places of work may be the most effectiveway to protect people and it may be the only al-ternative available. Address the conditions underwhich people should be placed in protective sheltersand how a plan for their use can be implemented.Describe shelter facilities, their capacities, and othercharacteristics. Delegate the responsibility for sheltermaintenance.

Health and Medical Care. This annex includespolicies and procedures for i..obilizing medical re-sources during a disaster and providing medical carefor the population during emergency conditions. At-tention must be given to public health problems in

major emergencies, especially within a mass-care fa-cility. Establish a mortuary facility for casualties.

In addition provisions must be made for portabletoilet facilities and an emergency fresh water supply.

Law Enforcement. Law enforcement agenciesshould provide for sufficient resources to maintaincivil order during an emergency situation. Respon-sibilities and procedures for maintaining security andorder must be addressed during a crisis situationand the eventual recovery. Describe procedures foraugmenting existing forces during an emergency.

In some localities it may be necessary to establisha proced,.,e for animal control. Animals often be-come a problem during a storm, flood, or whentraumatized.

Public-Works Operations. The public worksfunction provides for emergency-response capabili-ties for the engineering, construction, and repair andrestoration of essential public facilities and services.This includes the utilities that may be under controlof private businesses. A means for debris clearanceand post-disaster safety inspections of damagedstructures must be included.

Public works personnel can provide for heavy-rescue operations and are responsible for establishingmultipurpose staging areas. Effective public-worksoperations requires several detailed hazard-specificpreplans.

Fire and Rescue. The fire department providesfire fighting and search and rescue services duringand after an emergency. This annex addresses thepolicies, procedures, and responsibilities of fire pre-vention and fire fighting during a potential crisissituation. Also, roles and responsibilities must beclarified for search and rescue operations.

Procedures for implementing the use of fire andrescue resources must be identified. When rescueoperations are not the responsibility of the fire de-partment, the resource to be used must be identified.

MANAGING THE EMERGENCY

Radiological Protection

A means for radiation detection and the moni-toring and controlling exposures in any emergencyinvolving radioactive materialsincluding a nuclearpower plant accident, a hazardous-material incident,or a nuclear attack must be identified in a preplan.

PLANNING FOR EMERGENCY OPERATIONS 31

Human ServicesIdentify the delivery of human services such as

counseling during a disaster situation. Also identifyprovisions for housing, food, and clothing during adisaster situation that does not require a mass-caresystem.

Resource ManagementResource management involves the coordination

and use of personnel, equipment, supplies, facilities,and services during a disaster response and recovery.It must deal with the allocation of resources thatmay be scarce during an emergency situation. Emer-gencies usually restrict the normal flow of people,goods, and services. Also, address the jurisdiction'sparticipation in resource clemency during a nationalemergency.

Damage AssessmentA plan for damage assessment ensures that per-

sonnel and procedures are available to provide pre-liminary estimates and descriptions of the extent ofdamage resulting from a large-scale disaster. Policies,procedures, and roles and responsibilities are usuallydefined in a disaster plan for situations that wouldcall for a declaration of disaster by a state Governoror the President of the United States.

Implementing the PlanOnce a plan for a community's disaster prepared-

ness system has been developed, it should be vali-dated through a mock exercise. This allows thecommunity officials to evaluate the capability of theemergency-management function. It also evaluatesthe validity of a plan, along with a jurisdiction'scapability to deal with a large-scale emergency. Dur-ing a mock exercise, the emergency operations centeris activated and all participants, including electedofficials and agency and department heads are alertedand assigned to respective positions. Communica-tions are established where response forces actuallyparticipate. Time frames are established for com-pletion of the actions and orders which generate asense of urgency and add realism to the exercise.

A mock exercise reinforces established policies andprocedures, helps with hospital accreditation, testsdeployment of resources, and evaluates the availableresource capabilities.

R 7

Reviewing the PlanContinuous review and revision of the plan is

necessary to incorporate changes that may take placein the potential hazards in a locale, available re-sources, or local, state, or federal policies. It is ad-visable to do a post critique of any emergency serviceprovided and evaluate how suggestions can be ap-plied to, or affect the basic plan.

An Emergency Management Agency(EMA)

Usually an emergency management agency is gov-erned under regulations promulgated by a state'sGovernor. It coordinates all activities of the statedepartments and agencies when responding to a stateof emergency is declared by the Governor. Upondeclaration of such an emergency, the Governor orhis or her representative, and the agency's directordirect emergency operations from a state emergencyoperations center.

Depending upon the magnitude and severity ofthe emergency, state departments and agencies withan emergency assignment are notified to furnish aliaison officer to the state's emergency operationscenter.

Communications SystemsRadio and telephone communications must be in

place at the center and each state agency must havean assigned position and telephone number in thecenter. The statewide disaster radio frequency shouldbe made known to all participants.

A state usually has a four-fold mission during adeclared emergency: (1) to warn the public, (2) toenact timely and effective employment of state re-sources in support of local government, (3) to co-ordinate and direct of restoration and recoveryoperations in the disaster area when such operationsare beyond the capability of the local jurisdictionor when requested by proper local government au-thority, and (4) to assess damage and procure sup-port and assistance from the federal government.Specific emergency management assignments andfunctions for the departments, agencies, and bureausof the state are usually assigned by the Governor'soffice.

The state disaster plan, outlines guidelines for fire,police, and hospitals and emergency medical services.It discusses the coroner's responsibilities and au-thority, the funeral directors' plan for multiple-cas.

32 VICTIM RESCUE

ualty deaths, and outlines criteria for hospital disasterplans. It also contains a listing of the special emer-gency radio frequencies.

When a disaster occurs, it is usually the policy ofthe state to respond using local and state resources,quasi-public resources, and resources of the federalgovernment which can be provided without a Pres-idential-declared emergency. However, if the size andseverity of the disaster warrants, the state's Governormay request the U.S. President to declare that anemergency or major disaster exists.

To obtain significant state assistance (primarilyfrom the National Guard), the chief executive of ajurisdiction must submit a request for such aid di-rectly to the Governor along with advance infor-mation concerning the situation. Depending on theurgency of the situation, a telephone request is suf-ficient to initiate preiiminary state actions, but itmust be immediately followed by a written or tel-egram request. All requests should include the fol-lowing information:

Natural or caused disastersSpecific type of help needed

Name and title of individual making the request

Description of disaster

Estimate of number of persons affected andproperty damage

Action taken by local authorities

Civil disturbances

Name and title of individual making request

Estimated number of persons involved and iden-tity of each group

Number of law enforcement officers availableand dedicated to scene

Statement of action taken

Minor emergencies take place throughout thecountry nearly each month in which some state aidis needed. However, whenever the National Guardis called, the governor must issue a signed procla-mation declaring that an emergency exists and au-thorize the use of the National Guard for assistance.This proclamation is necessary for the protection ofthe individual guardsman or guardswoman.

CONCLUSIONThe steps required to complete an emergency op-

erations plan include the following:

Form a planning team with representation fromthe local government, agencies, and organizationswith emergency management assignments orroles. Do not work in a vacuum.

Complete a local hazard analysis and assess localresource capabilities.

Develop a basic plan that includes policies, iden-tification of legal authority, concept of opera-tions, and the structure and tasks for anorganization.

Select the functions to be addressed in the an-nexes of the plan.

Implement the basic plan through a mockexercise.

Review and revise the plan.

The key to a successful emergency preparednessprogram is to gain the support and have activeparticipation of the local officials. The degree ofconcern and the leadership exercised by the localofficials dictates the level of effort and readiness acommunity has to meet an emergency.

33

INCIDENT COMMAND SYSTEM

KEY POINTS

iMiortince of an incident conummd eystemsionVOntents of an Incident coinmand system

How to WO/0ot en incident commend system

INTRODUCTIONDisaster situations and large-scale emergencies

happen more frequently each year. With today'ssophisticated communications systems and rapidly-changing technology, it is possible to save more livesand property than ever before. A major componentof a safe, effective rescue department is its man-agement system.

The incident command system (ICS) is a system-atic approach to identifying responsibilities and thechain of command. The ICS provides a method foreffectively controlling rescue personnel, equipment,and communications simultaneously during an emer-gency. The ICS can be implemented during an emer-gency of any size, ranging from a single-unit responseto an individual emergency to a large-scale disaster.An effective incident command system must havethe following components:

PreplanningOrganizationThe Hierarchy of CommandThe Communications SystemDesignated FacilitiesManagement of Resources

ORGANIZATIONAs the size of an emergency situation increases,

the need for organization of the personnel increases.Likewise, the size of the command staff must in-crease in proportion to the size of the rescue staff.An incident commander needs to assign responsi-bilities as necessary (see .Figure 10).

The incident commander should appoint threeofficers to report directly to him or her; a safetyofficer, a liaison officer, and an information officer.The safety officer is responsible for the safety of

Incident ,ImmAnler

Safety Offic rtialson Officerinformation Officer

Section Chief

Prdnrn officer Offi,pr

Chlvf eprtin "hinf

n iv i,inq of f iree 9i.t,fen,1 pffi,,,

Unit lommander Unit commander

Figure 10. The Organizational Chart

the personnel involved in the rescue operation. Thisofficer evaluates the safety issues of the evolutionsas they are performed, and has the authority to haltany activity when an unsafe environment or haz-ardous condition exists.

The liaison officer is responsible for coordinat-ing the activities of the agencies assisting with theincident. He or she acts as the point of contact forthe designated representative of each agency.

The information officer is responsible for gath-ering all information pertaining to the incidentthecause, the agencies responding, the activities un-dertaken, and other details. This officer has directcontact with the media and is the only person otherthan the incident commander who makes publicstatements about the status of the incident.

In addition, the following personnel should beidentified as needed.

Section chief. A section chief is assigned foreach specific entity as required by the size of theemergency. For example, a section chief is neededto coordinate public safety services (fire, emergency

34 VICTIM RESCUE

medical service, and law enforcement); another chiefis needed to coordinate ground support services (fueland food provisions, sanitation provisions, etc.); anda third is needed to handle the logistics of theincident (equipment needs, Red Cross involvement,communication bases, etc.). It is important to re-member that section chiefs have the authority todelegate and that the number of section chiefs re-quired is dictated by the size of the emergency.

Branch officer. Branch officers are appointedby the section chiefs as needed. A branch officer isthe person who reports the activities of assignedagencies to the specific section chief. A section chiefin charge of public safety services may have a branchofficer for each servicethe emergency medical serv-ice, the fire service, and the law enforcement agencies.

Division officer. A division officer may be as-signed to oversee each law enforcement agency, eachfire service involved, etc.

Unit commander. The unit commander is theperson in charge of each unit performing a job.

A given incident may need only a section chief tohandle all the operations; the incident commandershould assess the situation and delegate assignmentsand authority as necessary. The number of officersdepends on the size of the emergency. Additionalpositions are delegated only when the size of theincident requires additional command positions.

The span of control for the incident commanderis determined by the size and scope of the incidentand the concern for safety. The average commandstaff has five to seven people. Limiting the span ofcontrol assures the incident commander that morecontrol can be maintained and that personnel willbe functioning in their assigned roles.

The Hierarchy of CommandAdvance planning must be done by agencies that

may be called upon to assist in a large-scale emer-gency. This requires a cooperative effort among allagencies that may have a role in an emergency. Theoverall commander of a specific incident should bethe person from the agency with the greatest in-volvement in the emergency. It is important for allpersonnel from all agencies responding to the emer-gency to recognize who the incident commander isand agree to his or her appointment.

Planning and decision making are the responsi-

bility of the incident commander and the commandstaff. The personnel involved in these processes willbe rep-esentatives of the organizations responsiblefor the rescue operation at the location of the in-cident. The fire department, the emergency medicalservice, the rescue unit, and representatives frominvolved public utility companies might all be in-cluded in the planning.

It is recommended that a joint effort be madeamong potentially involved agencies to discuss andpreplan any foreseeable emergency. Objectives andstrategies can be developed prior to any emergency.Conducting a disaster drill allows a community tobe prepared for an incident and also test the readi-ness of the personnel involved.

PreplanningPreplanning is a must. Effective preplanning and

the development of standard operating proceduresallow a predetermined course of action to take placewhen responding to an incident. Such a plan beginswith the first responding unit and all involved (agen-cies) through the completion of the rescue operation.

Preplanning can involve establishing a simple op-erating procedure or a complex written plan of actionfor a large-scale emergency. Items to be addressedduring preplanning include the span of control limits,potential staging areas, resources available, identi-fication of hazard areas, and identification of agen-cies available to respond and the service each agencycan provide.

The Communications SystemAll working units at an incident must have access

to integrated radio communications. On-site tele-phone units and a public address system with allradio frequencies predetermined should be availableto the rescuers.

Communications at all incidents should be keptat a minimum to avoid tying up phone lines andavailable frequencies. Rescuers must limit radio useand speak only in conversational English, avoidingthe use of codes and signals.

In the event of a large-scale disaster, a centralpoint should be established for all communications.The central point may be in a centrally-locatedvehicle, a building, or a nearby open area. To fa-cilitate more accurate communications, locate thispoint at or near the command post.

INCIDENT COMMAND SYSTEM 35

Designated FacilitiesAn effective incident command system must have

designated facilities on-site at each emergency. Theseshould include the following:

The command post. The command post is astation from which all operations can be directed.This post is the central location for the commanderof the incident and all immediate staff. All respond-ing organizations and agencies report to this post,and it is the center for communications. The com-mand post should be located in close proximity tothe incident scene, and at a point with easy access,away from the noise of the incident, and away fromthe direct route of the rescuers.

The staging area. The staging area is a des-ignated area where all equipment is kept until ac-tually needed at the scene. This area may be threeto five minutes away from the incident scene, withadequate space for parking and maneuvering ofequipment. A staging officer must be assigned tomanage equipment and maintain constant contactwith the incident commander.

In the case of a large-scale emergency, it mightbe necessary to have a prestaging area to avoidcongestion at the main staging area. A second stagingofficer will be needed to supervise activities at aprestaging area. This person must be in direct con-tact with the first staging officer. During preplanningactivities it is often possible to determine stagingarea sites for target hazards.

Management of ResourcesIt is often more effective and efficient to respond

to an emergency as one combined unit rather thanas separate resource units. A single resource isany individual piece of equipment that responds toan incident. This may be a heavy-rescue unit, anambulance unit, or a fire engine or ladder truck. Atask force may consist of a combination of rescuers,ambulances, or other safety service units.

The task force should share a common radio fre-quency and have a command structure and a pre-determined leader appointed to be responsible forthe operations of all the units in the task force. Thetask force allows the incident commander to usespecialized groups of resources to execute specifictactics. Using the task force concept removes theincident commander from the responsibility of man-aging any single resource unit, and provides for amore efficient operation.

41

IMPLEMENTATION OF THEINCIDENT COMMAND SYSTEM

To assure that an incident command system isimplemented within an agency the following stepsshould be followed:

Analyze the command systemDetermine objectivesDevelop a training programImplement the systemEvaluate the system's effectivenessReview and revise the system

An incident command system cannot be put intoplace overnight. Such a system is most effective whenan agency develops and implements it for day-to-day operations.

Analyze the Command SystemTo establish a command system for an emergency,

analyze past incidents and determine what commandsystem was the most effective. The anal is mustbe done objectively by a cross section of personnel,with representation from each responding organi-zation, not just by the chief officers andadministrators.

Gather information by interviewing members ofeach organization from each agency involved in theincident. After the data is collected, divide the mem-bers ,,f the organization into groups by category(organization, communications, command structure,preplanning, span of control, facilities, and manage-ment of the resources) and evaluate the system.

Determine ObjectivesAfter the initial listing and classification of prob-

lems has been completed, establish a committee todetermine the objectives of the ICS prcgram. Whendeveloping a program, attempt to define proceduresto address the problems already identified. Solvingproblems not only allows the organization to makeimmediate improvements to standard operating pro-cedures, but also proves that the ICS program iseffective, thus gaining support for the system.

The program objectives should address all thecomponents of the ICS system and give considerationto the various types of applications. The ICS systemis designed to work for a small or large incident andthe involvement of many different organizations. The

36 VICTIM RESCUE

objective statements (1) explain how the ICS isexpected to work within tile organization and (2)strategies for implement;Aig an ICS training program.

Develop a Training ProgramA training program must be developed to imple-

ment an effective incident command system. An ICSis integrated into the daily operations of an orga-nization. The training should explain the history ofthe system, why ICS is being developed, and whatit will do for an organization. The training programmust stress that the ICS is to be used for everyincident, regardless of its size. (If all departmentmembers are familiar with the ICS process, when alarge-scale incident does occur, a larger commandstructure and a communications network can beeffectively implemented.) Training should also stressthe importance of preplanning and show how itrelates to effective incident management.

The actual content and delivery of the training isat the discretion of the organization. Training shouldbe reviewed regularly and supplemented by outsidetraining, either at the state level, such as at seminarspresented at a state-sponsored fire school, or at thefederal level, at seminars conducted by the NationalFire Academy. The purpose of training is not onlyto teach the members of the organization about theincident command system, but also to help themintegrate it into daily operations.

Implement the SystemThe ICS should be used daily. During the initial

implementation, conduct at least two disaster drills,with multiple agencies responding, to determine theeffectiveness of the system. Involve any agency thatis normally used during a large-scale incident. Thetype of incident simulated for the drill should beone that requires maximum interaction of all of theagencies involved.

Evaluate the System's EffectivenessComplete an evaluation form after every run that

requires the response of more than one unit. Thisevaluation gives those in charge an opportunity toevaluate how the ICS is being used and whether itis effective. Conduct written and oral critiques aftereach incident to ensure that information is availablefor evalub tion. Evaluate the activities for 50 to 200calls. This is a sufficient number of runs to determineif the system is working.

*WORN

Review and Revise the SystemReview the information gaired from the evaluation

of the system and revise as necessary to ensure thesystem's effectiveness. In addition conduct ongoinganalyses of command problems so that new problemsencountered can be dealt with effectively and ex-pediently. Emergency service organizations are facedwith constant change, which makes continuous re-view and revision necessary.

CONCLUSIONThe incident command system is not intended to

solve all the management problems of an emergencyservice, but it does serve as a management tool forcontrolling operations at the scene of an emergency.Regardless of the size of an organization, the incidentcommand system allows for orderly control and themanagement of a large number of personnel andmany pieces of equipment. The system requircls ex-tensive planning before it is put into use, and regularreview to remain current with new procedures andequipment.

4 2

DEALING WITH NATURAL DISASTERS

KEY POINTS

Winter stormsPreparing for a winter stormTornadoesSafety precautions prior to and during a tornadoAfter a tornadoForest and wildland firesEarthquakesAfter an earthquakeFloodsBefore, during, and after a flood

37

INTRODUCTIONThe information presented in this section provides

suggestions to local officials in small communitiesand rural areas to deal with natural disasters. In-cluded is basic information about several civil emer-gencies that can occur in many communities.

Dealing with natural disasters is handled differ-ently for different communities and in the variousareas of the country. The information provided in-cludes some basic detail about each type of disaster,and precautions and suggestions about how to dealwith a situation in advance of, during, and after anincident. Many of the suggestions should be dissem-inated to the general public through public agenciesor during mock disaster operations. This informationis noted in the text.

Winter Storms

Warning ResponsibilityThe National Weather Service is responsible for

the timely issuance of weather warnings to the pub-lic, including the approach of a winter storm.

Winter Storm TerminologyFreezing rain or drizzle is called an ice storm,

i.e., moisture that falls in liquid form and freezesupon impact. The term heavy is used to indicatean ice coating sufficiently heavy to cause significantdamage to trees, overhead wires, and similar objects.

An ice storm is sometimes incorrectly referred toas a sleet storm. Sleet is easily identified as frozenrain drops (ice pellets) which bounce when hittingthe ground or other objects. Sleet does not stick totrees and wires; however, sleet in sufficient depthcauses hazardous driving conditions.

When the word snow is predicted in a weatherforecast, without a qualifying word such as occa-sional or intermittent, means that the fall of snowis of a steady nature and will probably continue forseveral hours.

Heavy snow warnings are issued to the publicwhen a snow fall of four or more inches is expectedwithin a 12-hour period, or a snow fall of six ormore inches is expected within a 24-hour period.Some variations of these rules may be used in dif-ferent parts of the country. In an area where a four-inch snowfall is common, the emphasis on heavysnow is generally associated with six or more inchesof snow fall. In other parts of the country whereheavy snow falls are rare, or in a metropolitan areaw.th heavy traffic, a snowfall of two or three inchesjustifies issuance of a heavy-snow warning.

Snow flurries are defined as snow falling for ashort duration at intermittent periods; however,snowfall during flurries may reduce visibilities to aneighth of a mile or less. Accumulation from snowflurries is usually small.

A snow squall is a brief, intense fall of snowaccompanied by a gusty surface wind that is com-parable to a summer rain shower.

Blowing snow and drifting snow result from

38 VICTIM RESCUE

the combination of strolig winds and falling snowor loose snow lying on the ground. Blowing snowis defined as snow lifted from the ground surfaceby the wind and is blown about restricting horizontalvisibility.

Drifting snow indicates that strong winds areblowing fallen or loose snow lying on the groundsurface into significant drifts. In the northern plainsof the United States the combination of blowing anddrifting snow after a substantial snowfall is calledas ground blizzard.

A blizzard, the most dramatic of all winterstorms, is characterized by low temperatures andstrong winds bearing large amounts of snow. Mostsnow accompanying a blizzard consists of fine, pow-dery snow particles which are whipped in great quan-tities and limit visibility to only a few yards.

A blizzard warning is issued when winds at 35mph or more are accompanied by falling or blowingsnow and temperatures of 20°F or less, and theconditions are expected to prevail for an extendedperiod of time.

A severe blizzard warning is issued when ablizzard with wind speeds of at least 45 mph isex, xted and is accompanied by a dense falling orblowing snow and a temperature of 10°F or lower.

A cold-wave warning indicates an expectedrapid drop in temperature within a 24-hour periodand requires substantially increased protection toagricultural, industrial, commercial, and social ac-tivities. Temperature drops and minimum temper-ature readings required to justify a cold-wave warningvaries with the changing of the seasons and thegeographic location. Regardless of the month of theyear or the section of the country affected, a cold-wave warning flags an alert that a change to verycold weather requires greater protective measures.

A hazardous-driving (traveler's) warning is

11112111MM "M.

issued to indicate that falling, blowing, or driftingsnow, freezing rain or drizzle, and sleet or strongwinds will make driving conditions difficult.

A stockmen's warning alerts ranchers andfarmers that livestock will require protection froma large accumulation of snow or ice, a rapid dropin the temperature, or strong winds.

A strong wind speed calculated with a low tem-perature is referred to as the wind-chill factorand causes the rapid cooling of exposed surfaces.Unprotected portions of the body such as the faceor hands chill rapidly and must be protected duringa low wind-chill temperature. In some areas of theU.S., the National Weather Service continuously is-sues the wind-chill index. The following descrip-tive scale compares a 20°F temperature calculatedwith different wind speeds (see Figure 11).

PREPARING FOR A WINTERSTORM

Rescue personnel can prepare for a winter stormby checking to the latest National Weather Servicewarnings and bulletins given on the radio or tele-vision. Warn residents to make necessary trips forsupplies before a storm develops, not dring thestorm.

The following information should be pro-vided to the general public.

Check battery-powered equipment beforea storm arrives. A portable radio or televisionmay be the only contact with the world outside thewinter storm. Also check emergency cooking facilitiesand obtain working flashlights.

Check the supply of heating fuel. Fuel carriers may not be able to move if a winter stormburies an area in snow. Arrange for emergency heat

Wind Combined WithTemperature

20° F

Wind-Chill Index(EquivalentTemperature)

ForecastDescriptive

Term

10 mph 2° F Very cold20 mph F Bitter cold35 mph -20° F Extreme cold

Figure 11. Wind Chill Index

=NWDEALING WITH NATURAL DISASTERS 39

supply in case of power failure. Be sure camp stovesand lanterns are filled with fuel.

Check the food supply. Supplies should includefood that requires no cooking or refrigeration in caseof a power failure.

Be watchful of fire hazards. Overheated coal-or oil-burning stoves, fireplaces, heaters, or furnacescan cause a fire.

Stay indoors during a storm or cold snapunless in peak physical condition. If it is necessaryto go outside, avoid overexertion. Do not overdoshoveling snow. This is extremely hard work foranyone in less than prime physical condition andcan bring on A heart attack.

Dress to fit the season. If necessary to spendtime outside in the weather wear loose-fitting, light-weight, warm clothing in several layers. If necessarylayers can be removed to prevent perspiring and asubsequent chill. Wear outer garments that are water-repellent, and have hoods to protect the head. Coverthe mouth to ensure warm breathing and protectthe lungs from extremely cold air. Remember, en-trapped, insulating air, warmed by body heat is thebest protection against the cold. Layers of protectiveclothing are more effective and efficient than a singlelayer of thick clothing. Mittens that are snug at thewrists provide better protection than fingered gloves.

An automobile can be a best friend or worstenemy during a winter storm, often depending onthe care it is given. Have each vehicle winterizedbefore the storm season begins. The following itemsshould be checked before the winter storm season.

Ignition systemBatteryLightsCooling system

Fuel systemLubricationDefrosterExhaust systemSnow tires and/or chainsHeaterBrakesAntifreeze

Wiper bladesWinter-grade oil

4 5

Winter Storm Car KitThe following information should be pro-

vided to the general public.Be equipped for the worst. Carry a winter storm

kit in the car, especially if cross-country travel isanticipated or if residing in the Northern States.

Items to consider for a travel kit include thefollowing: blankets or sleeping bags, matches andcandles; an empty coffee can Nith a plastic cover;extra clothing; high-calorie, nonperishable food; acompass and road map; a knife; a first aid kit; ashovel; a container of sand; a flashlight or signallight; a windshield scraper; booster cables; tow chains;a fire extinguisher; and an axe.

Winter travel by automobile is serious business.Keep the following suggestions in mind during asevere storm.

1. If the storm exceeds or even tests a person'slimitations, seek refuge immediately.

2. Plan the travel route and select a primary andan alternate route.

3. Check the latest weather information.4. Try not to travel alone.5. Travel in convoy with another vehicle if possible.6. Always fill the gasoline tank before entering

open country, even for a short distance.7. Drive carefully and defensively.

Tips if Trapped in a Vehicle During aBlizzard

The following information should be pro-vided to the general public.

Avoid overexertion and exposure. Exertionfrom attempting to push a vehicle, shoveling heavydrifts, and performing other difficult chores duringthe strong winds, blinding snow, and bitter cold ofa blizzard may cause a heart attackeven Far peoplein good physical condition.

Stay in the vehicle. Do not attempt to walkout of a blizzard. Disorientation comes quickly inblowing and drifting snow. Being lost in open countryduring a blizzard can mean certain death. A personis more likely to be founi and is better shelteredin a vehicle.

Do not panic.Keep fresh air in the car. Freezing wet snow

and wind-driven snow can completely seal the pas-senger compartment. Beware the gentle killers, car-bon monoxide and oxygen starvation. Run the motor

40 VICTIM RESCUE

and heater sparingly, and only with the downwindwindow open for ventilation.

Exercise by clapping the hands and movingthe arms and legs vigorously from time totime. Do not stay in one position for a long periodof time.

Turn on the dome light at night to makethe vehicle visible to work crews.

Keep watch. Do not permit all vehicle occupantsto sleep at one time.

Precautions for Livestock CareA blizzard takes its toll on livestock. For both

humane and economic reasons farmers must be no-tified to take necessary precautions to care for live-stock in advance of a severe storm.

Move livestock, especially the young, into shelteredareas (frequently called shelter belts). A shelterbelt provides better protection for range cattle thana shed-type shelter which may cause cattle to over-crowd and cause the animals to overheat and haverespiratory problems.

Range cattle are hardy and can survive extremewinter weather if some nonconfining type of shelterfrom the wind is available and feed is provided atfrequent intervals. Autopsies done on cattle killedby winter storms have shown the cause of death tobe dehydration, not cold exposure or suffocation.Haul extra feed to feeding areas before the stormarrives. Storm exposure of long duration is the largestcause of livestock loss. If a storm lasts more than48 hours, provide emergency feed.

Since cattle can seldom lick enough snow to satisfytheir thirst, heat the water tanks to provide waterand feed during prolonged exposure to stormconditions.

TORNADOESA tornado is viole -it local storm with whirling

winds of tremendtus sijeed. A tornado appears as arotating, funnel-shaped cloud which extends towardthe ground fiutn tole base of a thundercloud (seeFigure 12). It mies from gray to black in color.The tornado spins like a top and may sound like aroaring airplane or locomotive. These small short-lived storms are the most violent of all atmosphericphenomena and in a small area the most destructive.

Notification of tornado conditions are issued in twostatements.

A tornado WATCH means tornadoes are ex-pected to develop.

A tornado WARNING means a tornado hasactually been sighted or indicated on radar.

WarningsThe National Weather Service issues severe weather

warnings to the public over radio and televisionstations. In addition some communities have a localalarm system.

Radio and television stations broadcast the latestsevere weather warnings and tornado watch infor-mation. Local advice and instructions for safety arealso issued over these stations.

Knowing what to do when a tornado is approachingmay mean the difference between life or death. Ifa revolving, funnel-shaped cloud is seen on a cloudyday call the local police department, sheriff's office,or National Weather Service office immediately. Donot use the phone to obtain information and advice,listen to the radio or television station.

Safety Precautions Prior to and During aTornado

The following information should be pro-vided to the general public.

When a TORNADO WATCH is announced:Listen to a radio or television station for theLtest weather warnings and advisories. If powerfails use a portable battery-powered radio orcar radio.Watch the sky, especially to the South andSouthwest. When a tornado watch is an-nounced during the approach of a hurricane,remember a tornado may move from an East-erly direction.

When a TORNADO WARNING is announced:Move to an underground shelter or cave, or asteel-framed or concrete building. If such ashelter is not available take refuge in otherplaces. If there is no basement, take coverunder heavy furniture on the ground floor inthe central part of the building, or in a smallroom on the ground floor away from outsidewalls and windows. As a last resort, go outsideto a nearby ditch, excavation area, culvert, orravine.

DEALING WITH NATURAL DISASTERS 41

'ilsak.ititakitt.

A A'

;

Figure 12. Typical Funnel-Shaped Tornado

- Open doors and windows on the side of ahouse away from the tornado to help reducedamage to the building. Stay a safe distanceaway to avoid flying debris.

- Do not remain in a recreation vehicle, or mo-bile home if a tornado is approaching; moveto shelter.

4 7

- If located directly in the path of a tornadoand if time permits, shut off electricity andfuel lines.

- If driving in open country, drive away fromthe tornado's path and at a right angle to it.If there is not time to leave the area takecover or lie flat in the nearest depression such

42 VICTIM RESCUE

as a ditch, culvert, excavation, or ravine.- If in a school building made of steel or rein-

forced construction remain near an inside wallon the lowest floor away from the windows.Avoid an auditorium or gymnasium with alarge, unsupported roof span. Move occupantsfrom a rural school or one that does not havereinforced construction to an area providingthe best possible protection.

- Move occupants in an industrial facility tosections offering the best possible protectionin accordance with advance plans. Shut offelectrical circuits and fuel lines.

- Move occupants in a shopping center to adesignated shelter area, NOT to a parked car.Move occupants in an office building to aninterior hallway on the lowest floor or to adesignated shelter area. Stay away from win-dows and doors.

Safety Measures Atter the TornadoThe following information should be pro-

vided to the general public.

Use extreme caution when entering or workingin a building that may have been damaged orweakened by the disaster. Also, watch for gasleaks or shorted electrical circuits. Stay awayfrom fallen electric wires.Do not take lanterns or torches into buildingsthat have been damaged by the disaster, theremay be leaking gas lines or flammable materialspresent.Check for leaking gas pipes in homes. Do thisby smell, do not use a match or cendle. If gasis suspected, open all windows and doors, turnoff the main gas valve at the meter, leave thehouse immediately, and notify the gas company,law enforcement personnel, or fire department.Do not re-enter the house until it is checked.If any electrical appliance is wet, turn off themain power switch, unplug the wet applianceand dry it out (Caution: Do not do this whilestanding in water.) If fuses blow when the electricpower is restored, turn off the main power switchimmediately and inspect the building for shortcircuits in the wiring, appliances, and equipment.Check food and iter supplies before using.Foods that require refrigeration may be spoiledif electric power has been off.Stay away from disaster areas. Sightseers inter-

fere with the rescuer's work.Do not drive unless necessary. If necessary todrive watch for hazards and report them to thelocal law enforcement personnel or firedepartment.Report broken sewer or water mains to the localwater department.Stay tuned to a radio or television station foradvice and instructions from the local officialsregarding the following:a. Where to obtain necessary medical care in

the areab. Where emergency assistance for housing,

clothing, and food can be soughtc. Ways to help the community to recover

FOREST AND WILDLANDFIRES

Forest fires can occur at any time of the year butmostly during dry, hot weather of long &ration.Most forest fires are caused by human carelessness,negligence, or ignorance. Forest-fire prevention re-quires an understanding of the importance of theforests, an awareness of the danger of fire in awooded area, and a sense of personal responsibilityto safeguard the forests.

Forest fires can start without warning. The federaland state government offices maintain a surveillancesystem of watch towers and aircraft to monitor po-tential or active fire locations. Personnel in theseoffices determine the location of fires, issue warnings,and initiate emergency actions. Many localities havea prearranged warning system to network advisorymessages.

In Case A Forest Fire ThreatensThe following information should be pro-

vided to the general public.In the event a forest fire threatens a community

follow the suggestions listed below:

maintain a close watch of the fire by listeningto the local radio or television station. Knowingwhat to do when a forest fire threatens maymean the difference between life or death. Ifsuch a threat is noticed, report it immediatelyto the local law enforcement department, firedepartment, or fire officer. Do not use the phoneto obtain information.

DEALING WITH NATURAL DISASTERS 43

Check garden hoses and water supplies for pos-sible use in wetting down roofs if necessaryExtinguish all fires in homes and other structuresExtinguish all camp firesClear all combustible materials, specifically pilesof brush that may be hazardous to homes orother structuresIf time permits, clear flammable vegetation awayfrom up to 30 feet of homes or other structuresClose all windows (cover if possible), removecombustibles near windows and other openings,and protect and secure livestock and petsBe prepared to assist in constructing communityfirebreaksObtain complete information on exit routes andrelocation areas if evacuation is necessary

Community Involvement in Dealing witha Forest Fire

Citizens must cooperate with authorities and beaware of the progress of the fire by listening to thelocal radio or television station. During an evacuationeveryone must follow directions for safe exit routes.Do not use fire fighting entrance routes reserved foremergency service only. All people not involved inthe rescue operations must keep clear of fire area.All volunteers assisting with the rescue must beunder the supervision of a designated fire fighter.All safety precautions must be followed to preventgetting trapped. Ground winds can cause shifting.Follow instructions to the public and keep informed.Know where the fire is active and know the escaperoutes. Rescuers must maintain communication withthe incident commander and stay calm.

EARTHQUAKESAn earthquake is a shaking or trembling of the

crust of the earth caused by underground volcanicforces or by breaking and shifting of rock beneaththe earth's surface.

Many natural hazards can be detected before thethreat to life matures; however, this is not true foran earthquake. The U.S. Geological Survey Depart-ment monitors global earthquake activity and crustalmovements, measures earthquake effects on build-ings, and seeks to learn advance signals an earth-quake may produce. The National Oceanic andAtmospheric Administration detects and warnsagainst Pacific tsunamis (tidal waves generated bysome earthquakes).

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Dealing with an EarthquakeThe actual earth movement during an earthquake

is seldom a direct cause of death or injury. However,this movement causes collapse of buildings and otherstructures. Most casualties result from the following:

Falling bricks or wallsSplintering glassToppling furniture, collapsing walls, or fallingpictures and mirrorsRock slides on mountains or hillsidesFallen power linesSea waves generated by earthquakesFire resulting from broken gas lines and spillageof gasoline or other flammablesa danger whichmay be aggravated by lack of water due to brokenwater linesDrastic human actions resulting from panic

Before an EarthquakeThe following information should be pro-

vided to the general public.Check for earthquake hazards. Bolt down or pro-

vide other strong support for water heaters and gasappliances. Fire damage can result from toppledappliances and broken gas lines caused by earth-quakes. Place large, heavy objects on lower shelvesof closets and storage areas. Brace or anchor highor top-heavy objects. Wire or anchor overhead light-ing fixtures.

During an EarthquakeRemain calm. Think through the consequencesof any actions and try to reassure others.If indoors, watch for falling plaster, bricks, lightfixtures, or other building rxtures. Watch forhigh bookcases, china cabinets, shelves, or otherfurniture which might slide or topple. Stay awayfrom windows, mirrors, and chimneys. If in dan-ger, move under a table, desk, or bed located ina corner away from windows, or in a strongdoorway. Do not use candles, matches, or otheropen flames during the tremor. Extinguish allfires.If outside, avoid high buildings, walla, powerpoles, or other objects that could fall. If possible,move to an open area away from all hazards. Ifin a vehicle, stop in the safest place available,preferably an open area. Stop as quickly as safetypermits but stay in the vehicle for shelter.

44 VICTIM RESCUE

After an EarthquakeCheck victim's for injuries. Do not attempt tomove the seriously injured unless they are inimmediate danger of further injury.Check for fires.Wear shoes in areas near debris or broken glass.Check utility lines and appliances for damage.If gas leaks are found, shut off the main gasvalve. Shut off electrical power if there is damageto wiring. Do not use matches or lighters untilthe area has been checked for gas leaks. Do notturn light switches on and off. Sparks can ignitegas from broken lines.Clean up spilled potentially harmful chemicalsand materials immediately.Draw a moderate quantity of water in case thewater supply should be disrupted. If water isturned off, emergency water may be obtainedfrom hot water heaters, toilet tanks, melted icecubes, or bottled water. If water pipes are dam-aged shut off the water supply at the main valve.Check to see that sewage lines are intact beforepermitting toilets to be flushed.Do not eat or drink anything from open con-tainers that have been near shattered glass.Check chimneys for cracks and damage. Unno-ticed damage can lead to a fire. Approach eachchimney with caution. An initial visual inspec-tion should be made from a distance.Check closets and storage areas for disruption.Open closet and cupboard doors carefully toguard against falling objects.Check individual residences and apartmentbuildings for structural damage and if necessaryevacuate occupants to a safe area. Stay out ofseverely damaged buildings, aftershocks canshake them down.Do not spread rumors or speculate conditions.This often causes great harm following a disaster.Stay off the telephone except to report an emer-gency. Stay tuned to a local radio or televisionstation for the latest emergency bulletins.Do not go sightseeing, particularly in beach andwaterfront areas or in areas where buildings havecollapsed and electric wires may be down. Keepthe streets clear for emergency vehicles. Be pre-pared for additional tremors.Respond to requests for assistance from law en-forcement, fire fighters, and public assistanceorganizations. Do not go into a damaged area

unless assistance has been requested. Cooperatewith local authorities.

FLOODSThe National Oceanic and Atmospheric Admin-

istration (NOAA) via the Weather Service's RiverForecast Centers and River District offices issueflood forecasts and warnings when rainfall is suffi-cient to cause rivers to overflow their banks or whenmelting snow combines with rainfall and producesa similar effect.

Flood warnings and forecasts of impendingfloods, are announced on the radio and televisionstations and through local emergency agencies. Thewarning message predicts the expected severity offlooding (minor, moderate, or major), the affectedbody of water, and when and where flooding isexpected to begin. Careful preparation and promptresponse can reduce property loss and ensure per-sonal safety.

Flash flood warnings are the most urgent typeof warnings issued. They are transmitted to thepublic over the local radio and television stations orby other local warning signals.

Local InstructionsArea radio and television stations broadcast the

latest flood information and warnings; however, thelocal officials usually provide more specific adviceand instructions over local stations. This is prefer-ably done by a local chief executive or an emergencypublic information representative.

Suggested Safety InstructionsThe following information should be pro-

vided to the general public.

Before a floodFind out how many feet a residence is locatedabove or below the possible flood level so thatwhen predicted flood levels are given, it is pos-sible to determine if an area is in danger. Thisinformation may be obtained from the local en-gineering department or a civil defense office.Identify the locatiori of the nearest safe area.Stock food which requires little cooking and norefrigeration in case of a power failure.Keep a portable radio, emergency cooking equip-ment, lights, and flashlights in working order.

DEALING WITH NATURAL DISASTERS 45

Keep first aid and medical supplies (prescrip-tions, insulin, etc.) on hand.Keep fuel in vehicles, if electric power is shutoff, fuel stations may not be able to operatepumps.Keep emergency materials on hand (sandbags,plywood, plastic sheeting, and lumber) for emer-gency waterproofing.

When a flood warning is issuedMove essential items and furniture to the upperfloors if time permits.Move to a safe location before access is cut offby flood water if forced to leave an area.Shut off all electric circuits at the fuse panel ora disconnect switch. If this is not possible dis-connect all electrical appliances. Store drinkingwater in closed, clean containers since waterservice may be interrupted. Shut off the waterservice and gas valves. Before shutting off gasvalves check the local gas company policy.

During a floodAvoid areas subject to sudden flooding.Do not attempt to cross a flowing stream wherewater is more than knee high.Do not attempt to drive over 2.` flooded road.If a vehicle stalls, abandon it immediately andseek higher ground.

After a floodDo not use fresh food that has come in contactwith flood water.Test drinking water for potability; wells mustbe pumped out and the water tested beforedrinking.Do not visit the disaster area, extra vehicles canhamper rescue operations.Do not handle live electrical equipment in a wetarea; electrical equipment should be dried andchecked before returning to service.Use flashlights, not lanterns or torches, to ex-amine buildings.Report broken utility lines to law enforcementpersonnel, fire fighters, or the appropriateauthority.Stay tuned to the radio or television station foradvice and instructions from local officials. i.e.,Where to go to obtain necessary medical care.:where to go for emergency assistance such ashousing, clothing, food, etc.; and ways to helpthe community recover from the emergency.

51

CONCLUSIONThe chapter dealing with natural disasters pre-

sents some interesting information. Not all areas ofthe country are faced with the same natural disasters;however, that is not to say that an area is nevergoing to experience an earthquake or tornado. Manyof the suggestions presented in this chapter can beapplied to other mass disaster situations. A keyfactor in any large-scale disaster is to have a masterplan to organize rescue efforts, to have an agencyin charge, and to have an incident commander. Mostdisasters result in a total community being affectedand involved in the after effects.

Much of the information presented must be sharedby rescuers and other emergency p,_rsonnel to thecitizens.