From EMT History to Disaster Medicine

1
From EMT History to Disaster Medicine

• Wang, Tzong-Luen, MD, PhD
• Shin-Kong Wu Ho-Su Memorial Hospital
• Taiwan Society of Disaster Medicine

2
EMT History
3
CPR Cardiopulmonary Resuscitation
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4
CPR Comprehensive Practice of Resuscitation
EMT
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Fifteen Required Components of the EMS System

1. Manpower
2. Training
3. Communications
4. Transportation
5. Facilities
6. Critical care units
7. Public safety agencies
8. Consumers

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Fifteen Required Components of the EMS System

1. Access to care
2. Transfer of patients
3. Medical record-keeping
4. Consumer information and education
5. Review and evaluation
6. Disaster linkage
7. Mutual aid

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EMT History

• 1958 Dr. Peter Safar demonstrates the efficacy
  of mouth-to-mouth ventilation.

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EMT History

• 1960 Cardiopulmonary resuscitation (CPR) is
  shown to be efficacious.

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EMT History

• 1967 Dr. Eugene Nagel trains Miami firefighters
  as "paramedics" at the University of Miami School
  of Medicine.

10
EMT History

• 1968 The American Telephone and Telegraph
  Company designates "911" as the universal
  emergency telephone number.

11
EMT History

• 1969 The USDOT and NHTSA develop the basic
  training course for EMTs.

12
EMT History

• 1969 The Committee on Ambulance Design develops
  Ambulance Design Criteria, a report to the USDOT
  and the NHTSA to complement the NASNRC's Medical
  Requirements for Ambulance Design and
  Equipment(1968). This document recommends
  ambulance design standards and emergency
  equipment. The NHTSA agrees to issue matching
  federal funds to states that purchase vehicles
  meeting these standards.

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EMT History

• 1970 The National Registry of Emergency Medical
  Technicians (NREMT) is organized to standardize
  education, examinations, and certification of
  EMTs on a national level.

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EMT History

• 1972 President Nixon directs the U.S. Department
  of Health, Education, and Welfare to develop new
  ways to organize EMS, which results in 8.5
  million in contracts being awarded to develop a
  model EMS system.

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EMT History

• 1972 The University of Cincinnati establishes
  the first residency program to train new
  physicians exclusively for the practice of
  emergency medicine.

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EMT History

• 1973 The "Star of Life" is adopted as the
  official symbol for EMS.

17
EMT History

• 1974 President Gerald Ford proclaims the first
  National EMS Week.

18
EMT History

• 1975 The National Association of Emergency
  Medical Technicians (NAEMT) is founded.

19
EMT History

• 1975 The American Medical Association (AMA)
  accepts and approves the EMT-Paramedic role as an
  emergency health occupation.

20
EMT History

• 1977 More than 40 EMT training agencies
  throughout the United States develop and test the
  national training standards for the paramedic for
  2 years.

21
EMT History

• 1980 The USDHHS releases the Position Paper on
  Trauma Center Designation, which describes trauma
  centers within EMS systems. Facilities are also
  categorized

22
EMT History

• 1984 The EMS for Children program, under the
  Public Health Act, provides funding for enhancing
  the EMS system to better serve pediatric patients.

23
EMT History

• 1986 The 1979 Public Safety. Officer's Act (SB
  1479) is amended to expand the 50/000
  compensation to include survivors of rescue
  squads, ambulance crew members, and public safety
  department volunteers killed in the line of duty
  (amended in 1990).

24
EMT History

• 1990 President George Bush signs the Trauma Care
  Systems Planning and Development Act (HR 1602),
  which provides for annual grants to states based
  on geographical and population size to help
  establish and improve trauma systems. In 1995,
  Congress does not reauthorize funding for this
  act.

25
EMT History

• 1991 Occupational Exposure to Blood-Borne
  Pathogens Final Rule (CFR 29 1910.1030)
  establishes standards for workplace protection
  from blood-borne diseases.

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Emergency Medical Services System
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EMT History in Taiwan
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EMT History in Taiwan

• 1968 First Ambulance as a Taxi
• 1981 Ambulance Governing Rules
• 1989 EMS developed (two-tier)
• 1990 2nd EMS Enhancement Plan
• EMT 1 and EMT 2
• 1995 Emergent Medical Law
• 1998 one-tier EMT in Tauyuan
• 1999 one-tier EMT in Taipei
• 2002 Paramedics in Taipei

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EMT History in Taiwan
Long long ago
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EMT History in Taiwan
1999. 6.
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EMT History in Taiwan
1999. 9. 21
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EMT History in Taiwan
2000 Taipei USAR
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EMT History in Taiwan

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EMT History in Taiwan

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• 2003. 7. 15

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EMT History in Taiwan

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• 2003. 8. 31
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Disaster Medicine
37
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38
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Hurricane Mitch
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Earthquakes
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Volcanic hazards
43
Windstorms
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Flood
45
Tsunami
46
Instability-related hazards
47
Hazard and risk
48
Risk perception
49
The effects of disastersMontserrat volcanic
crisis
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Natural disasters in time space - I

• Major natural disasters are strongly constrained
  in space and time
• The bigger the event, the lower the FREQUENCY and
  the longer the RECURRENCE INTERVAL (return time)
• MEGADISASTERS are very rare none experienced in
  modern times

51
Natural hazards in time space - II
52
Triggering of a disaster

• Whether a hazard triggers a disaster depends on
  the SENSITIVITY of society/community to the
  hazard
• Sensitivity is a combination of two factors
• Exposure the range of potentially damaging
  hazards their frequency
• Vulnerability degree of social and economic
  tolerance to such hazards

53
Sensitivity trends

• Sensitivity of much of human society is on the
  increase due to
• rapidly increasing population growth in
  vulnerable areas
• increasing urbanisation and the growth of
  megacities
• increasing frequencies of climate-related hazards

54
Natural hazards versus natural resources - II
55
Numbers affected by geohazards and other
disasters 1968 - 1992
Earthquakes
Floods
Windstorms
Landslides
Volcanic activity
Drought famine
Technological hazards
20
40
60
Millions
56
Is the world becoming a more dangerous place?

• Rapidly growing populations (especially in large
  urban concentrations) in hazard prone areas
  (particularly coastal areas susceptible to both
  tropical cyclones and earthquakes)
• Poor planning and construction in high risk
  regions
• Poor enforcement of building codes
• Inadequate public awareness and education
• Limited financial and technical resources
• Environmental degradation climate change

57
Natural disaster trends
1998
events
58
Some worrying facts figures

• During 1970s and 1980s geohazards claimed 3
  million lives and affected 820 million people
• Population in 2020 is likely to be between 7 and
  8 billion (6 billion today)
• 16 of the worlds population currently live in
  MEGACITIES (populations in excess of 1 million)
• By 2020 this figure could top 30
• Most megacities will be in developing world
  countries - especially ASIA - one of the most
  hazard prone regions on the planet

59
Where do geohazards occur?
Alaska 1964
Tokyo 1923 Kobe 1995
Lisbon 1755
Izmit 1999
Mount St. Helens 1980
Tangshen 1976
Caribbean
Pinatubo 1990
Northridge 1994 Loma Prieta 1989
Montserrat 1995-present
Rabaul 1994
Toba 73ka
Tambora 1815
Ring of Fire
S. E. Asia
Chile 1960
Principal earthquake zones and explosive volcanoes
Tropical cyclone zones
60
1998 natural disasters by region
Oceans space
Oceania
Africa
Japan
Asia
USA
America
UK
Europe
140
100
60
20
61
Natural disasters by type 1998
Windstorms (240)
Floods (170)
Earthquakes volcanic eruptions (110)
Other (190)
62
Geohazard economic losses 1998
63
Extreme events

• Majority of hazards have return periods on a
  human time-scale
• Extreme events have very low frequencies but very
  high magnitudes in terms of destructive capacity
• Asteroid/comet impact
• Super-eruption
• Megatsunami

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World War II
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Nazi Camp
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911????????
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• Crisis Management
• Consequence Management

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Interest in Disaster Preparedness
DISASTER
Time
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DOE
USDA
DOT
Energy
Food
EPA
NCS
Transportation
Hazardous Materials
12
11
1
Communication
10
2
Urban Search and Rescue
ESF
9
Public Works (USACE)
3
FEMA
DOD
8
4
7
Health and Medical
5
6
Firefighting
HHS
USDA FS
Resource Support
Information Planning
Mass Care
USDA AID DOJ ARC DVA EPA DOD FEMA DOT GSA USPS NCS
GSA
FEMA
ARC
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Local First Responders
County Executive
Disaster Occurs
Alert
Governor
Requests Aid From
FEMA Regional Director
Informs
Field Operations
THE FEDERAL RESPONSE PLAN
Declares Disaster
Advises
FEMA Director
Requests Assistance
Contacts
12 Emergency Support Functions (ESFs)
President
Declares Disaster
Provides
Sets Up
Emergency Response Team
Federal Coordinating Officer
Disaster Field
Office
Appoints
Joins
State Coordinating Officer
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Energy
Food
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Transportation
Hazardous Materials
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Communication
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2
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Urban Search and Rescue
ESF
9
Public Works (USACE)
3
8
4
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Health and Medical
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Firefighting
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Resource Support
Information Planning
Mass Care
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