The fire department, the police department, and specialized anti-biological terror department
The fire department, the police department, and specialized anti-biological terror department (paramedics) will ensure the safety of the incident site. They will assess the scene for any possible detonation or secondary biological and other agent attacks to assure the emergency medical service team, and the ambulance incident team plus the victims of their safety as the rescue continues (Mlcak et al., 2018). The rescue team will use a seven model incident medical management, which comprises seven components including command, safety (which may include self, scene, and survivor), communication, assessment of the scene and survivors, triaging, treatment, and transportation of survivors. The teams will emphasize on the inter-agency communication and will receive instructions in safety first, catastrophic bleeding, and ABC.
The most experienced ambulance incident officer (the police incident commander) will be ensuring communication and coordination with emergency service teams and other parties at the site. The emergency medical service (EMS) team led by the most skilled emergency medical officer will command and control the incident site assisted with the most qualified personnel in the police and fire response team (Sjöberg, 2020). The most qualified medical officer incident commander will also ensure operational input and liaise with the emergency medical service, fire department, ambulatory incident service, police response department, and fire response department.
The Emergency medical service team plus the trained disaster community members will help in the quick assessment of both the burn and biological terror agents’ victims. The EMS and the trained disaster management community members will ensure their security and that of patients as they provide services to the victims and coordinate with the police and fire officers (Alpert & Grossman, 2018). They will use the THREAT acronym, which means threat suppression, hemorrhage control, rapid extrication, assessment, and transportation. The scene will be cordoned off into four zones (where casualty clearing will be stationed) comprising of the inner danger zone, a hot zone which is often referred to as a non-permissive zone, warm zone, and lastly, outer cold zone which is the permissive zone. Triaging will occur in both warm and outer cold zones separated into sections to isolate the smallpox patients from other victims.
EMS, with the assistance of the trained disaster community members and paramedics who would have receives pre-exposure prophylaxis, will help isolate patients infected with smallpox in a separate outer cold zone (Mlcak et al., 2018). The well-armed and protected EMS personnel will then decontaminate the scene. The skilled emergency medical practitioner incident commander will coordinate and liaise with the ambulance incident service team, to transport them in their isolated ambulances as immediate as possible and the Harborview Hospital, the receiving facility to ensure their accommodation in separate rooms with adequate countermeasures and restrictive movement.
The medical emergency management team will quickly assess the burn victim assisted by the trained disaster community members to safely remove the clothing and extinguish possible burning (Alpert & Grossman, 2018). The EMS will modify the rule of nines in burn assessment to accommodate both adults and children victims of burns. The head for toddler and infants will represent eighteen percent of the total body surface area as the legs represent thirteen percent. The medics will flush the victims’ skin with a copious amount of water in case of identified chemical burn. After this, they will proceed to initial assessment and treat any notable life-threatening conditions for the patients.
The initial assessment for both victims will follow the A (airway) B (breathing) C (circulation) and D (disability or deformity) model. The medics will assess the airway, listen to any respiratory noise, and carefully evaluating the possibility of respiratory involvement (Mlcak et al., 2018). Pediatrics often have smaller trachea, and those with possible airway obstruction just as adults will necessitate nasotracheal intubation using waveform capnography to secure the airway before transportation to the emergency units for advance care. Upper airway burns cause swelling in the upper airway, which may hinder the endotracheal tube. Thus, when an increased number of such cases are identified, the emergency medical service officer in command will allocate more emergency medical service personnel to promote quick nasotracheal intubation and transportation of such victims to burn units.
Vital signs for victims will be taken, and those with carboxyhemoglobin of twenty percent or higher will be ventilated (Sjöberg, 2020). The neurologic examination will be performing using AVPU to assess the mental status. The emergency medical service team will be keen on health, spine injury, and other medical conditions, which may complicate burn, biological injuries, and infections. They will take all the necessary precautions to protect the spine and instruct the ambulatory incident service team on proper management during transportation according to their evaluation of patients. The emergency medical team will obtain blood pressure. For those with circumferentially burned or damaged arms, they will protect victims’ tissues using sterile gauze between the blood pressure cuff and the victim’s arm. Besides, the electrocardiogram will be assessed, and for those with thoracic injuries, the emergency medical personnel will modify electrocardiogram lead placement.
After the correction of all possible life-threatening issues, the emergency medical response teams will focus on the burns and the biological agents themselves (Keating, 2017). They will remove jewelry, shoes, and other restricting objects from the injured or burned areas. However, they will not remove clothes that are stuck to the skin but instead cool the burn. Care will be taken to only cool burns for at most one minute to prevent possible hypothermia. The emergency medics will assess the extent of the injury and likely disability as well as the depth of the burn and classify them into first, second, and third degrees. They will also assess the total area of the injury using the rule of nines. Injured parts will be covered with a clean, dry dressing to prevent risk for hypothermia because they will have difficulty regulating their boy temperature.
The EMS professionals will attempt intravenous insertion for fluid resuscitation. They will administer adequate fluid to achieve a systolic pressure of at least 90mmHG for adults and 70mmHg for pediatrics as these patients are en route to the hospital. The possible injury, for instance, first and second-degree burns and disabilities are often painful. The emergency medical response personnel will administer narcotic analgesics like morphine or fentanyl to manage pain. Usually, fentanyl is administered intravenously or via nasal passages aided by the mucosal atomizer. One to two micrograms per kilograms of fentanyl is appropriate for prehospital care of both adults and pediatrics, while two to four milligrams of intravenous morphine if good for adults. For pediatrics, 0.1 milligrams per kilogram is appropriate.
The emergency medical service team and paramedics will use the SALT strategy to triage the survivors. SALT means to sort, assess, lifesaving interventions, treatment, and transport. Sorting: The patients will be rapidly prioritized using global sorting to promote efficient assessment, administration of lifesaving treatment, and transportation to the emergency units at the hospitals (Alpert & Grossman, 2018). A loud shouting or using a public address system will be used to tell everyone to move to the outer cold zone. First responders will be last to assessed and then tell those remaining to wave if they need help. Those who can wave and follow command will be the second lot to be assessed. The remaining patients will be given the first priority in the assessment. Assessment and lifesaving intervention will go hand in hand. The medics will offer any intervention as long as it takes the shortest time possible and does not require support from other practitioners. While assessing and providing lifesaving interventions, the emergency medics will categorize patients based on their priority as follows using SALT and model uniform core criteria (MUCC) triage (Alpert & Grossman, 2018). Black tag for dead or patients without spontaneous respiration, red for severely injured patients with higher chances of survival with emergency treatment. Gray tag will be for patients who respond ‘no’ to questions on the pulse, breathing, bleeding, and mental status but seems less likely to survive thus should be given treatment after the immediate patients. The yellow tag will be for patients with severe injuries but can wait for and lastly green tag for patients with minimal injuries such as lacerations.
The emergency medical service will treat patients for life-threatening conditions as they triage and eventual to ambulances for transport to Harborview Hospital (Alpert & Grossman, 2018). The treatment area, possibly the outer cold zone and partly warm zone, will be the destination for all incoming emergency medical service personnel and other departments and will as well hold patients temporarily as they are transported to Harborview Hospital.