elow is a conversation with Paul M. Maniscalco, an adjunct assistant professor at the School of Medicine and Health Sciences at George Washington University. He is the past president of the National Association of Emergency Medical Technicians, and currently serves as a deputy chief in the Bureau of Emergency Medical Services for a large urban EMS system.
Mr. Maniscalco has consulted with many federal agencies and organizations on issues related to the response and management of emergency incidents, disaster and terrorism, as well as pre-hospital care and safety. He is the author of the textbook, The EMS Incident Management System - EMS Operations for Mass Casualty and High Impact Incidents, and Understanding Terrorism and Managing its Consequences.
In your estimation, how are we doing with the tracking of survivors and tracking of the deceased?
The tracking of patients resulting from a mass casualty incident is usually an easy task when the event involves less than one hundred patients. Those types of incidents usually involve a response from a limited number of jurisdiction emergency response organizations and result in transportation of the injured by ambulance to a small number of hospital facilities.
In the present situation in New York City, the scenario currently being played out is extraordinary. There are thousands of injured that were treated and transported by many different emergency response agencies to hospitals throughout New York and New Jersey.
The information is compiled from all sources, reviewed to the best possible levels for accuracy and then released. The accuracy of information is critical, and it is essential to avoid errors. But being accurate will of course delay access to information, and many times this frustrates concerned families and friends. But simple things like misspelling a name, for instance "Smith" being spelled "Smyth", could result in horrible misunderstandings. The system in place is very sophisticated and is designed to provide the best possible information in a timely manner.
How is this terrorist crisis different, qualitatively, from the Oklahoma City bombing?
While all of these events have left unimaginable death and destruction in the aftermath, this latest barbaric act is truly unprecedented in all aspects. The size of affected area, technique employed, numbers of patients, number of rescuers, fiscal impact and length of time to manage the aftermath are historically the largest of their kind.
Health
The Murrah Federal Building in Oklahoma City was a federal building while the World Trade Center was Port Authority. The World Trade Center had a significant transportation hub (PATH & subways) and a shopping mall and the Oklahoma City building had neither. The World Trade Center was integral to the operation of the world economy, housed state and federal agencies, businesses and foreign government offices - The Murrah Federal Building housed federal offices. Both experienced a tremendous loss of life, and both incidents changed us, and the United States as a country forever.
What are the safety precautions being used by rescue workers at the Trade Center site in New York?
Clearly the women and men that operate at these scenes are required to take extra precautions to protect themselves from injuries. This is a critical function for each and every member operating at the scene. No one wants to become injured and deter from the overall goal of saving those entrapped in the wreckage. Steps that are taken to ensure the health and safety of rescuers include but are not limited to:
- Helmets - Protect the workers from injuries by falling or being hit directly by kicked-up debris.
- Eye protection - Protects the rescuer from injuries to the eyes from airborne debris and dust.
- Protective coats and pants - Provide the rescuer with protection from contamination and, to a limited level, puncture injuries from sharp debris.
- Hearing protection - The noise levels at these scenes can be deafening. Prolong exposure to loud noises and vibration can cause serious hearing damage or hearing loss.
- Leather protective gloves - Protect the rescuers hands and also provide a better grip when moving debris while searching for entrapped people.
- Steel toe/shank boots - Walking around the rescue scene can be very dangerous to the rescuer. Proper footwear is important because it provides good footing grip as well as helps to protect the rescuer from crushed toes or punctures to the foot from debris, which might penetrate the soles of their boots.
- Respiratory protection - Protects the rescuer from inhalation injuries due to the high levels of dust and smoke, and possibly asbestos.
- Medical gloves - Usually worn under the leather protective gloves as an added level of protection due to the frequent contact with blood and body fluids encountered while treating patients.
The need to assure that all rescuers are monitored for increased levels of stress is a critical task. Rescuers, by nature, are not quitters and as such will push themselves to the limits to get the job done - Save Lives. These scenes can be extremely stressful in physical, mental and emotional ways. The stress levels are amplified and compounded when you are faced with the loss of your fellow emergency response members.
As soon as workers arrive on the scene, Incident Commanders are taught to monitor their members for stress and also for exhaustion (which contributes to the stress experienced). Crews are rotated at regular intervals to provide proper rest time with fresh crews rotating in to the site to continue the work at hand. After the scene is secured, all rescue personnel have the opportunity to take advantage of a variety of programs to assist them with their feelings and with sadness. These include the Critical Incident Stress Debriefing program, access to licensed mental health professionals, organization-affiliated chaplains/clergy and employee/member assistance programs (EAP/MAP).
Is there anything else you'd like to add?
It is essential that we take care of the family members of rescuers who may be away from home for an extended period of time. While not soldiers in the literal sense, the emergency medical technicians, paramedics, firefighters and police officers are "America's First Line of Defense." We are on the frontlines daily, working, to the best of our ability, for the safety of individual citizens as well as for public safety and national security.
Our families also participate in this noble calling by having to endure prolonged absences in times of emergencies and disaster, worrying about our well being and having to fend for themselves while we are out serving others. They are truly the "unsung heroes" of the emergency response world.
