Boston's hospitals couldn't have known Monday morning that dozens of people would pass through their doors that afternoon in need of immediate medical care for injuries sustained in a bombing at the finish line of the Boston Marathon.
Readiness is the watchword, and improvements over the last decade in the ability of the health care system to react swiftly and effectively were evident in the aftermath of the catastrophe, said Christopher Colwell, the director of the Department of Emergency Medicine at the Denver Health Medical Center, who spoke to emergency medical personnel in Boston on Monday. Colwell was on the scene after the shootings at Columbine High School in 1999 and oversaw the treatment of 11 victims of last year's mass shooting at a movie theater in nearby Aurora, Colo.
From those tragedies emerged a new way of thinking that forced the health care system to acknowledge that large-scale events are a fact of life, Colwell said. In Boston, what happened was twin explosions of improvised explosive devices hidden near the finish line of the marathon that killed at least three and injured more than 170. Colwell said hospitals need to treat their real-life experiences as opportunities to better understand their capabilities and limitations.
Hospitals write detailed action plans, stage mass-casualty drills and maintain constant communication with emergency responders and other medical facilities to prepare for major events, said Georges Benjamin, the executive director of the American Public Health Association in Washington, D.C. A key development over the last decade or so has been better coordination among hospitals and others involved in emergency planning and response, like ambulance services, Benjamin said. Large cities like Boston are especially well-positioned to react to mass-casualty events because there are more hospitals and more surgeons, with greater experience dealing with violent trauma, Benjamin said. Broader pressures on the health care system also weaken the nation's emergency preparedness and response, Benjamin said. BOSTON - APRIL 15: Police officers with their guns drawn hear the second explosion down the street. Based on the new National EMS Education Standards and endorsed by the American Academy of Orthopaedic Surgeons, the Fifth Edition of our core first responder textbook offers complete coverage of every competency statement with clarity and precision in a concise format that ensures student comprehension and encourages critical thinking. Interactive resources, including online testing and assessment materials, learning management system, and eLearning student resources, allow you the flexibility to build the course that works best for you and your students. Concept Reinforcement: The Fifth Edition is built on the premise that students need a solid foundation in the basics and then appropriate reinforcement. More than one in four Americans have bone or joint health problems, making them the greatest cause of lost work days in the U.S. You Make the Call —Scenarios help you develop your decision-making skills by describing emergencies and challenging you to come up with solutions. Labeling—Reinforce your mastery of difficult concepts with illustration and photo labeling activities.
Page references to Emergency Medical Responder, Fifth Edition are provided for every question in the Student Workbook.
The Ontario Mass Evacuation Plan is a supporting plan to the Provincial Emergency Response Plan (PERP).
For more information on the legislative framework and authorities, see the PERP available on the EMO website. This plan supports the agreement between the Governments of Ontario and Canada (through the Department of Aboriginal Affairs and Northern Development Canada) to provide emergency response support to First Nation communities in the province. An EMO planning team in consultation with non-governmental organizations, provincial and federal partners developed the plan.
This plan is meant to be used to respond to a request for a partial or complete evacuation from one or more communities to one or more host communities.
Provincial coordination will involve the evacuating community, host communities, relevant Ontario ministries, federal departments, non-governmental organizations, and others, as required.
This plan is for Ontario’s far north, encompassing municipalities, unorganized territories2 and First Nation communities. This is an overarching plan for carrying out mass evacuations and as such, many aspects are general in nature4. The Far North of Ontario spans the width of the province, from Manitoba in the west, to James Bay and Quebec in the east. The far north is subject to several hazards covered under Ontario’s Hazard Identification and Risk Assessment.
The geography of the far north may complicate evacuations or efforts to manage or suppress the hazard. Maintain family and community unity, which is integral to maintaining community cohesion and supports.
Potential threats to the communities and emergency responders are critical in determining the urgency of the evacuation and for planning resource mobilization.
Real-time threat assessment should be ongoing and coordinated among partners, particularly ministries with relevant OIC responsibilities and the community(ies) at risk.
An OIC ministry or the PEOC may recommend evacuation, or that it is safe to return, based on a real-time threat assessment.
The availability, duration, type, and location of host community facilities affect planning for the evacuation.
Consideration should be given to maintaining the readiness of host communities for future hosting. Evacuating communities should identify Community Evacuation Liaisons for each host community.
The decision to deploy is typically based on requests from impacted communities, the mandate of the organization deploying staff, and staff member’s level of expertise.
Depending on the scale and complexity of the operation, a senior provincial official may be deployed to coordinate the provincial response and to liaise with community and other deployed officials. Situational awareness requires continuous coordination to help collect, collate, evaluate, and disseminate information. When planning for the return of evacuees, the number and location of host communities, and the distance to evacuated communities are key planning considerations.
Roles and responsibilities may pertain to transportation hubs, host communities, support from ministries or the federal government, or responsibilities of evacuating communities. Determine the financial and legislative roles and responsibilities for the evacuation and comply with applicable policies, agreements, procedures, etc. Emergency information needs to be coordinated among the affected communities, province, and federal government.
Once it has been decided that a community needs complete or partial evacuation, the parties involved must establish who the evacuees are, where the host locations are, and what the means of evacuation will be. Following the judgement of the authorized entity that it is safe for evacuees to return, the order of return and the methods of transportation must be established using an inclusive planning process that involves affected communities, provincial and federal partners, and other partners (i.e.
Real-time threat assessment is a critical component of evacuation operations and should be ongoing. All responders involved in managing the hazard or participating in the evacuation must regularly communicate situational awareness information to those conducting real-time threat assessments and must report a changing situation as soon as feasible. OIC ministries are responsible for assessing the threat for the types of emergencies they have been assigned.
EMO is responsible for real-time threat assessments for hazards that have not been assigned to an OIC ministry. The PEOC is responsible for assessing the threat based on the real-time threat assessment and characteristics of the community(ies) or region under threat. During routine monitoring, the PEOC duty officer performs the function of real-time threat assessment.
OIC ministries routinely monitor conditions in the province according to their assigned type of emergency. Uncertainty in real-time threat assessment is unavoidable, which is why persons with appropriate knowledge of the threat causing the emergency should be involved in the assessment. During emergencies, the PEOC links with the local community and the OIC ministry acting as provincial lead to coordinate real-time threat assessment information.
Emergency managers must understand the makeup of the population who are to be evacuated before they can make key decisions about transportation modes, route selections, hosting destinations, and the many other elements of an evacuation.
Medevac is used for those individuals receiving home care or residing in a health-care facility in the evacuating community that qualify for medical transfer as per the Ambulance Act (evacuation by emergency medical services (EMS) or Ornge).
This stage is typically orchestrated through the existing health procedures used in the community. This includes persons with disabilities, seniors, children, pregnant women, and those with medical conditions.
Among these, some require attendant care, which means both the caregiver and the Stage 1 evacuee they care for should be on the Stage 1 evacuation list.
The designation of evacuees into the different stages will be determined by the First Nation Chief and Council, Head of Council, or appointed person, with the assistance of the on-site health care organization. Different types of hazards may dictate variations in the criteria for these categories (e.g.
The decision to evacuate a community is the responsibility of the First Nation Chief, Head of Council, or appointed person.
For First Nations communities, AANDC and PS approve federal assistance to support an evacuation. The urgency of an evacuation is determined based on the immediacy of the threat to the community (life, safety, health, and welfare), the resilience of the community, and (depending on the nature of the threat) the availability of resources for evacuation or shelter-in-place10. Evacuations may take place prior to (pre-emptive), during, or after an incident has occurred. Given adequate warning about a hazard, adequate resources, and the likelihood of the threat actually impacting a community, it is advisable to conduct pre-emptive evacuations.
If adequate resources are not available to conduct a pre-emptive evacuation, it may still be possible and necessary to carry out an evacuation even while a threat is already affecting a community. If recommending enhanced monitoring or activation of the PEOC, consider what positions must be staffed to conduct the evacuation.
Alert PS of the situation and advise them if Government of Canada support may be required to assist. Establish a regular information cycle and contact for evacuating communities, host communities, and other parties assisting with the evacuation. Consider requesting additional host communities stand-by to receive evacuees if the situation appears likely to escalate rapidly. Establish the PEOC Command, and if it is an area or unified command, consider including additional organizations in the command meetings to better inform and coordinate the response. Determine financial accountabilities in consultation with partners and communicate the information. Determine at the outset of the operations which organization will be responsible for information management and the manner in which information will be shared. Initiating media contacts or directing the appropriate position to do this according to established plans and procedures (e.g. Adopting an extended operational cycle in which extra positions are staffed beyond the normal working day.


Alerting other emergency responders in the province, including non-governmental organizations, that they may be requested to provide assistance.
Marshalling transportation resources, including the recall of deployed resources in preparation for redeployment. Collecting and analyzing the data necessary to fully understand the potential impact and threat.
Weather, resource availability, and the scale of an incident can significantly affect the time required to mobilize resources. Emergency information is primarily the community’s responsibility, but may be supplemented by the province according to the provisions of the Provincial Emergency Information Plan. Communications between the field and the PEOC, between the PEOC and partners, and within the PEOC is critical. The PEOC (or other EOC) may request deployments to fulfil specific incident management functions, as needed (e.g. Where the scale of the incident, evacuation timeline, or availability of staff prevents the physical deployment of staff, relevant incident management functions may be performed remotely using available technology. Information technology in the far north is not universally accessible and may be further compromised by the nature of the emergency. All partners (but with specific reference to PEOC) should recognize the potential limitations to information technology in these regions of the province.
The priorities for evacuation will be determined by the Chief and Council (for a First Nation), the Head of Council (for a municipality), or an authorized entity. Transportation planning for the evacuation will be undertaken by a joint planning team as described in Annex 7.
The evacuating community should identify community evacuation liaisons at each of the host community sites to support evacuees. If an evacuation involves a First Nation community, the JEMS Service Level Evacuation Standards provides a sample flight manifest.
Service Level Evacuation Standards11 are in place for hosting First Nations community members in the event of an evacuation. Through the PEOC, EMO works with the evacuating First Nation to identify a host community or communities for its evacuees. The selection and preparation of host facilities should be driven by the needs of the evacuees.
Another key consideration is the availability of personnel and other resources to support the host facilities. Potential conflicts with the longer-term use of accommodations in the host community should be considered and mitigated if possible (e.g. The PEOC should begin contingency planning with partners for longer-term evacuations if it appears likely that evacuees will be displaced from their community for longer than the period discussed below. When evacuees are members of a First Nation, the use of any facility that was used as, or could evoke comparisons to, residential schools should be avoided. Communities considering acting as a host community during an evacuation should identify emergency shelter facilities. Short-Term Basic Shelter Services: for a period of 1-14 days, in arenas, gymnasiums, recreation halls, etc. Special Accommodations: to address the requirements of medically vulnerable individuals or those with special needs. Host communities may be limited in the types of accommodations that they are able to provide. Planning for hosting evacuees builds on information already available (typically from the manifest).
Host communities are responsible for registering evacuees that are entering into their care.
Registration records should only be shared with organizations providing services to the evacuees (e.g. Before the return of evacuees, the evacuated community should be in a safe and ready state. Services have resumed and are sufficient to support returning evacuees – for example, power, water, sanitation, security, food and essential supplies, and medical services.
If a community was completely evacuated it may be advisable to begin the return of evacuees with essential workers to restart systems and assess the readiness of the community to receive other returning evacuees. Once approval has been given for all or a part of the population to return home, community leaders, working with community evacuation liaisons, will develop priorities and manifests for the return flights. Ground transportation arrangements may be made by the host community or the provincial government. The evacuated community will take the lead for communicating re-entry procedures, with assistance from partners as required.
What media sources can evacuees use for the most up-to-date information on re-entry procedures? Following a regional evacuation, multiple communities may decide at the same time that they are ready to return evacuees.
The PEOC and partners will commence demobilization as host communities are cleared of evacuees. The Quick Reference Guide is a condensed version of the Ontario Mass Evacuation Plan Part 1: Far North.
When someone has a medical or traumatic event that affects his or her ability to breathe or heart to function, seconds count. Through the GoodSAM Smartphone app, trained first responders (who may be off duty) including doctors, nurses, firefighters, paramedics, medics, police officers and medical students can register to be alerted to incidents in their surrounding area and could be on scene within minutes.
Tom Aczel of Emergency Medical Response said: “GoodSAM is set to revolutionise our ability to get help immediately to a patient and improve outcomes.
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Emergency Response Systems Ltd (ERS) is reacting to the increasing demand for Ambulance provision to NHS, Public and Private Sector persons who require transportation for Emergency, Urgent and High Dependency patient transfers.
ERS is able to provide Cost Effective ambulance transport for both NHS and private persons, by offering Trained, Qualified and Well Equipped ambulance crews for this aspect of seamless clinical care ambulance provision throughout the UK and Europe. Facilities including Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Tufts Medical Center, Massachusetts General Hospital and Boston Children's Hospital saw between eight and 31 patients, each suffering from a variety of wounds caused by the blasts.
Evaluating responses to smaller events, such as car crashes with multiple victims, can inform how a hospital deals with a larger-scale disaster, he said. Hospitals prepare for this," said Benjamin, a former emergency room physician who previously ran the health departments in Maryland and the District of Columbia. Hospitals now share information about what resources they have available, enabling ambulances and police to deliver patients to the most appropriate location, he said. He noted that rural areas and even some urban areas remain underserved by the trauma and emergency medical systems, and pediatric trauma care isn't available widely enough. Hospitals seeking to cut costs may contract for "just in time" delivery of medicines and vital supplies, and nurses may work for more than one facility, for example. The experienced author team and the AAOS medical editors have transformed the Education Standards into a training program that reflects best practices in prehospital medicine. The Fifth Edition is the only way to prepare law enforcement personnel, fire fighters, rescue squad personnel, athletic trainers, college students, and laypersons for the challenges they will face in the field.
For example, the Patient Assessment chapter fully details every step of the patient assessment process. Orthopaedic surgeons and the Academy are the authoritative sources of information for patients and the general public on musculoskeletal conditions, treatments and related issues.
When orthopaedic surgeons restore mobility and reduce pain, they help people get back to work and to independent, productive lives. In addition, this plan references the Service Level Evacuation Standards1 developed by the Joint Emergency Management Steering (JEMS) Committee.
Updates to the plan will be undertaken as required based on lessons learned from exercises and incident responses.
It is a provincial coordination plan outlining how Ontario would coordinate its response and collaborate with federal and municipal governments, First Nations, non-governmental organizations, and ministry partners.
It is not intended for internal evacuations of one part of a community to another part of the same community. This plan does not replace a community’s own emergency response plans, which should contain provisions for evacuations if they consider evacuations likely. A detailed action plan that addresses the specific scenario, hazard, and threat will still be required. Evacuations are most frequently caused by forest fires and flooding (most often from spring break-up along the James Bay coast). Communities in the far north may be located significant distances from communities with road access or from regional centres where services may be available (e.g. Damage to property or the environment may also trigger an evacuation if it poses a risk to the safety, health, and welfare of people. It also dictates what level of activation, and how many and what type of resources will be required for the evacuation. If the evacuation is for one or a few communities, planning may be restricted to movements within the same general geographic area. Therefore, planning should include post-hosting needs, such as financial reconciliation, demobilization support, and reports on issues to be resolved before hosting evacuees in the future.
This allows the incident management team, and all partners, to take informed, effective and consistent actions in a timely manner.
However, as the level of activation increases, the PEOC duty officer transfers this function to a technical specialist or team, if available.
These ministries have processes in place for transferring the responsibility for real-time threat assessment to specialists within their ministry when required. All activities and efforts should be focused on moving these people from the at-risk area to places of safety in a timely manner. This list should contain the names of persons needed to restart systems that must be in place before evacuees can return home (e.g. If an authorized entity decides on a partial or complete community evacuation, the community should declare an emergency. A pre-emptive evacuation may be undertaken when it is clear that if delayed, conditions (weather or other hazard) would impede evacuation.
Evacuations of this nature are done when life safety is at extreme risk and a rescue becomes essential. For example, evacuations of large populations to one or more host communities may require logistics support to secure modes of transportation from a receiving aerodrome or transportation hub to the host community.


Communities are encouraged to make the decision to evacuate as soon as a significant or imminent threat is identified. In widespread evacuations, emergency information may need to be coordinated amongst all involved partners. To assist with streamlining communications, an operational cycle should be established and communicated by the PEOC to partners so they know when they are expected to provide updates on the situation from their perspective.
Partners should have back-up technologies available, particularly for their deployed staff.
It is preferable to host community members together, even if it means hosting them farther away from their home community.
Evacuation liaisons represent the needs of evacuees when attending meetings with the host community and other agencies. If the information is not collected on the manifest, registration services can collect and provide this more detailed information.
Depending on the scale of the incident, and the numbers and locations of persons to be evacuated, the needs may exceed the capacity of available resources.
The Standards provide guidance on allowable expenditures, hosting arrangements, health services, emergency social services, etc.
If requested, the PEOC could assist other communities in identifying potential host communities. It is worth noting that community health services and hospitals in the host community may experience an increased demand for their services. Representatives from provincial (through the PEOC) and federal organizations may be available to assist a host community in providing services to evacuees.
It is generally understood that time of year may affect the host community’s ability to provide accommodations during an evacuation. This allows the host community to better coordinate services and seek reimbursement for expenses incurred due to hosting. The recommendation and the decision to return should be based on the results of the ongoing real-time threat assessment, plus a determination that the home community is ready to support the returning evacuees.
This may involve the coordination of an advance team that is given sufficient time and other resources to return the community to a pre-evacuation state. It is critical that at the end of an evacuation, there is a full accounting of the operation in the form of after-action and financial reports.
Paramedic response times varies around  Central Goldfields Victoria (from minutes, to over an hour!). There are thousands of “Good Samaritans” around the world with these life saving skills – there might be someone less than a few hundred feet from you now who could help – if only they knew that help was needed.
With a built-in Defibrilocator function, app users can also easily identify registered public access defibrillators.
In a life threatening or time critical Medical Emergency please call: 000 or 112 from your mobile for an Ambulance. Previously, provision was met by regional NHS Ambulance Services, who now, due to the current climate, find themselves committing their resources to patients requiring transportation via the 999 emergency systems. All vehicles compliment current practices and are targeted specifically to react appropriately and effectively to demand requirements.
11, 2001, changed the way hospitals and others responsible for responding to mass casualties think about preparedness. Current, state of the art medical content has been incorporated along with new cognitive and didactic material, and skills and features, to create a robust and innovative training solution for your course that will engage student’s minds. As many of the communities in the far north are First Nations, coordination with the federal government is crucial. Two communities falling within the focus area have road access (Mishkeegogamang and Pickle Lake) and there is a rail link to one municipality (Moosonee). However, the evacuation of multiple communities due to an area-wide emergency is likely to require out-of-area movements for hosting, particularly when the goal is to keep families and communities together. The size and demographics of the population are significant factors in determining how to conduct an evacuation.
This would include: scheduling such that staff do not become overly fatigued by the operation and providing as much advance notice of scheduling as is possible given the nature of the incident. In addition, up-to-date contact lists should be maintained by all organizations for use in an emergency. Alternate technologies that may be utilized in an evacuation include satellite phones and amateur radio.
They should also be identified to the host community as resources that may be called upon to assist evacuees. This mitigates the risk of families being separated and makes the return of evacuees less complicated. Evacuation liaisons also assist with creating manifests and determining the order of the return of evacuees in consultation with the Chief, Head of Council, or appointed person from the home community.
Once a flight manifest is prepared, it should be sent to the PEOC, which can in turn forward it to other organizations that require the information.
Receiving the information in advance can help ensure that needed services are delivered quickly.
In this situation, evacuations may need to be prioritized and contingency plans implemented. While the Standards provide guidance on hosting First Nations, they may also be applied to municipal or unorganized territory evacuations as they pertain to hosting arrangements.
While agreements may exist between EMO and a host community, the community retains the option of not hosting during a particular evacuation. Emergency planners should assess proposed facilities based on location, capabilities, capacity, accessibility, and resources, as well as how they would route evacuee traffic.
Municipal departments involved in the development of the host facility plan may be able to provide resources to support the set-up and operation of a host facility. Registration involves creating a municipal record, which is covered under municipal privacy legislation.
Since the degree of damage will likely vary within the affected area, it might be beneficial to initiate a phased re-entry process. In most instances, people are returned in the reverse order of when they were evacuated (i.e. As with the initial evacuation, numerous resources, especially personnel and transportation related resources will be required to return evacuees to their home community.
It also shows the various partners likely to be involved in an evacuation, broadly reflecting the actions that fall within their jurisdiction. Maryborough has some of the fastest times with 50% of immediate life threatening incidents beings responded to within 13 minutes; but even 13 minutes could be too late in such circumstances. That’s where the GoodSAM App comes in … download the GoodSAM Alerter from your App Store or Google Play now and register. Effectively what the app does is enable someone to shout for help, really loudly – even through walls – so a responder in the car wash will know that the man in the coffee shop next door is having a cardiac arrest. Then call: 0438 580 426 or use your GoodSAM Alerter as soon as possible for FREE Volunteer Pre-ambulance Emergency Care from Emergency Medical Response (if available) while waiting for the Ambulance to arrive in areas surrounding Bealiba, Dunolly, Moliagul, Tarnagulla, Emu, Archdale and Natte Yallock in Central Goldfields Victoria. This approach makes it clear how the information learned in the chapter will be used to help patients in the field.NEW! This plan supports the activities being undertaken related to mass evacuation planning for ministry and community emergency management programs. There are two municipalities that fall within the focus area (Moosonee and Pickle Lake) plus more than 30 First Nation communities. This is facilitated through liaison that may be in place between OIC ministries and federal departments - for example, between the Ministry of Health and Long-Term Care, Health Canada and Local Health Integration Networks (LHIN). Alternatively, the Chief of the First Nation, Head of Council, or an appointed person may decide to conduct a complete or partial evacuation based on an assessment of the threat to area residents. This approach minimizes potentially having people in harm’s way and enables a more controlled evacuation and optimization of resources. Where possible, identify the positions, rather than individuals who may be involved in the operation. Notwithstanding this recommended practice, a host community’s capacity may be such that it is unable to accommodate an entire community. In the event that the list of potential host communities is insufficient for the size of evacuation pending, the PEOC will solicit additional host communities. Details on the set-up and operation of the shelter should be provided in the community’s emergency response plan. Each municipality has the responsibility for managing the record in accordance with the applicable legislation and their municipal policies.
The Chief of a First Nation, Head of Council of a municipality, or appointed person, will decide when to allow evacuees to return to the community.
A full chapter on Environmental Emergencies addresses response to heat, cold, and drowning emergencies. It draws linkages to various hazard management plans and procedures developed by ministries.
The exact population at any one time is difficult to report as people who are recorded in the census may be away from the community and some who are not recorded may be in the community. Unorganized territories, fly-in lodges and camps, and mining operations also fall into the plan area. The seasonal roads cannot be relied on for evacuation operations given the short and sometimes unpredictable length of time that they are available. Local populations often provide the best information on the threat to their community and the region. Emergency responders may require personal protective equipment, as responder safety will be critical. Where an entire community may not be hosted together in close proximity to the home community, and if the situation allows, the community’s preference should be discussed with the Head of Council, First Nation Chief, or appointed person. The primary reason for returning the most vulnerable people last is to help ensure that support services are in place when they return.
For example, there may be people staying at fly-in lodges that do not report year-round population. Similarly, there may be community events that draw tourist and other visitors to the community.



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