EMS World

SEP 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | SEPTEMBER 2018 27 tive. However, anticipatory planning also requires data and information to make informed decisions. EMS can use intelli- gence operations to bolster preparedness efforts. EMS agencies should avail themselves of bulletins issued from partners in the intel- ligence community, such as federal entities like the Department of Homeland Security, state-level fusion centers, and local intel- ligence centers. While a bulletin may not indicate a specific threat, it can commu- nicate trends or developments that could have a negative impact, providing space for the recipients to implement protective measures. 3 This situational awareness could allow EMS agencies to lean forward by using a dynamic intelligence-led model rather than a standardized and static plan. It is also important for EMS leaders and frontline personnel alike to understand national and international events and trends and their local security implications. This goes beyond crime and terrorism. The heroin epidemic is one example of a prob- lem affecting many areas of the country that has an impact on every level of public safety and the community as a whole. Surge Capability Operationally one of the greatest vulner- abilities EMS systems face is a lack of surge capacity. 4 Imagine the unthinkable occur- ring during the busiest hour of the day. How will your EMS system respond to an event requiring an unfolding incident command structure with a large demand for transport units in a short period of time? One solution could be for the system to monitor available resources, includ- ing designating a frontline supervisor to ensure timely transfers of patients at EDs, prompt units at hospitals to clear as quickly as possible, guide communication centers to hold lower-priority calls during times of high volume and low resources, and con- sider mutual aid from surrounding jurisdic- tions. These steps could assist day-to-day operations, minimizing the impact of call volume influx. Another, more complicated solution is establishing a bed-monitoring system with a real-time ability to reconcile available beds regionally across all hospitals. Other Advantages Regionalization has other advantages as well. These plans improve communications across jurisdictional lines and promote a better understanding of available resourc- es. For example, if one area agency has a mass-casualty response unit and another maintains a command post while a third has a mobile hospital for deployment, com- bining assets and personnel could improve a major response. The importance of getting ahead of events and establishing contingencies allows for, at a minimum, an opportunity to think of those earlier-mentioned "what ifs" and improve our ability to adapt to the situation. Some examples include hav- ing secondary and tertiary staging areas; establishing multiple routes to trauma centers; and developing deployable strike teams to surge particular areas. Teaming with agencies such as public health is also critical for many missions. Paramedics and EMTs can act as work- force multipliers during biological incidents, responding to overt attacks and recognizing trends of sick patients early. Additionally, EMS can be worked into previously devel- oped plans to assist with mass prophylaxis and vaccination clinics, as well as overall pandemic preparedness and response. Operational Security Operational security needs to be embed- ded into the culture of EMS organizations. Simple measures such as securing vehicles and stations, ensuring accountability of equipment and uniforms, recognizing suspi- cious activity, and sharing information with the right people can elevate our posture and ensure our ability to provide service. Ways to harden operational security include: • Securing ambulances when unoccupied, including on emergency scenes; • Avoiding leaving identification or uni- forms in personal vehicles; • Installing kill switches in response vehi- cles so ambulances can be left idling but unattended; • Installing station security systems with automatically closing bay doors and badge access for crew areas; and • Having a method for disposing of old uniforms. Recognizing attempted elicitation of information from responders is another important way to lean forward. Elicitation is a technique to gain information about operations, capabilities, or personnel through subterfuge. Elicitation attempts may be made by mail, e-mail, telephone, or in person. By training to understand sus- picious activity or indicators, we can avoid inadvertently sharing sensitive information, making it more difficult for those seeking to carry out nefarious acts. Elicitation is one of the eight signs of terrorism used as indicators to recognize a potential threat. 5 Making Smarter Decisions Leaning forward provides multiple ben- efits for operationally progressive EMS systems. First, enhancing our planning process improves our strategic posture. Second, having improved plans enhances our comfort levels tactically with the ability to fall back on a dependable structure for all levels of the system. Further, through better planning and exercises, personnel are empowered to make smarter decisions, especially in high-risk, high-consequence environments, which results in improved operational tactics. EMS has a responsibility to lean forward alongside other public safety disciplines. By evaluating the "what ifs" and having a comprehensive understanding of the threat environment, risks can be mitigated and negative outcomes minimized. REFERENCES 1. Bradner E. Washington Metro police up security after Paris attacks. CNN, www.cnn.com/2015/11/16/politics/washington- metro-police-increase-security-paris/index.html. 2. Shapiro E, Sands G. How U.S. Is Stepping Up Security in Wake of Paris Attacks. ABC News, https://abcnews.go.com/US/ us-stepping-security-wake-paris-attacks/story?id=35231459. 3. Department of Homeland Security. NTAS Frequently Asked Questions, www.dhs.gov/ntas-frequently-asked-questions. 4. Barishansky RM. Surge Capacity. EMS World, www. emsworld.com/article/10320478. 5. State of Rhode Island Fusion Center. 8 Signs of Terrorism, http://fusioncenter.ri.gov/terrorism/index.php. ABOUT THE AUTHOR Seth J. Komansky, MS, NRP, is deputy director and chief of operations for the Wake County Department of EMS in Raleigh, N.C. He manages the Wake County EMS Medical Intelligence Unit and serves as the statewide EMS field liaison of ficer coordinator at the North Carolina Information Sharing and Analysis Center, the state fusion center. He holds a master's degree in homeland security management from the Homeland Security and Terrorism Institute at Long Island University. ISSUE FOCUS: MANAGEMENT & OPERATIONS

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