I thought you all might find this interesting.  The National Emergency
Management Resource Center (NEMRC) is a subscription service that is
dedicated, in part, to distributing information about folks with special
needs during regional and national emergencies.  It costs a pretty penny to
join as an individual, but you can still get their digest at www.nemrc.net.
The following is a feed I pulled off their website that was posted last
Monday in preparation for Gustav.  As the brief indicates, the e-bands
didn't work out (I think it was a network problem) so they reverted to the
old paper manifest that accompanies each patient.

Rumor is that my little "Band of Brothers (and Sisters)" might be headed to
the Houston area by way of Arkansas to assist in building damage assessment
post-Ike.  In addition to medical supply staging (what we're doing now), we
do have specialized training in BDA. We also assist in evac and Search and
Rescue (SAR) on a block-by-block basis.  We are some of the folks that go in
and put the "tic-tac-toe" symbols on buildings to indicate they've been
searched, how many injured folks were found, how many bodies, etc.  We don't
pull people from buildings as we don't have any transport equipment at all,
but we do assist in Immediate Critical Care and triage.  Mostly that means
we prioritize those folks that have the best chance of surviving the next
sixty minutes.  If our nurses think a patient can survive an hour "in
place", then we direct our resources toward them.  If the charge nurse
doesn't think they'll make it and treating them would deprive another
patient who has a better chance of surviving, then we mark them "expectant"
and go on to the next.  The vast majority of expectants are unconscious--or
so I hear.  My group has never done this for real, but our team has ER
nurses and paramedics in civilian life and they know what they're doing.  My
primary job in all of this is to coordinate what we're doing with local
First Responders and FEMA's Disaster Medical Assistance Teams (DMATs) and
the Disaster Mortuary Teams (DMORTS).  The first is made up of medical
professionals who have volunteered through FEMA, and the latter is comprised
of morticians and funeral directors who have also volunteered.  Handling the
deceased appropriately and respectfully, for forensic reasons and otherwise,
has to be emotionally exhausting.  These folks aren't trained soldiers who
deal with carnage on a large scale.  Many are small town funeral directors
who have gone through intensive training and volunteer for the job.  I know
I couldn't do it.  I hope we don't have to do it for real--ever.

This is only my opinion, but I think we've really come a long way in how we
deal with the disabled regarding evacuation and shelter.  Nobody had really
given it much thought before Hurrican Andrew.  Even though we had procedures
in place by the time Katrina/Rita came 'round, folks were still, in many
cases, treated like cordwood.  I haven't seen the After-Action Reports
(AARs) on "our" performance during the midwest floods a couple months back,
but I hope we're getting in the groove of things.  The training staff (folks
like me) had been instructing our folks to "toe tag" or "necklace" cards on
everyone who was either "walking wounded" or non-ambulatory.  Trouble is,
many folks who were non-ambulatory were not wounded.  The tags are
color-coded from black (dead) to green (not injured or only slightly
injured) and they have little animals stamped on the codes--"rabbits for
green" down to "turtles for red".  If a patient's condition worsens, the
idea is that you can start tearing the perforated color strips off (starting
at green) to indicate the triage status at a glance.  If someone had a
speech or hearing issue, the soldier might just hang a tag around their neck
with no attempted explanation as to what it meant or what was going on.
They got about as much communication as someone who was semi-conscious.
Sometimes less.  You can imagine what people must have thought when they got
an "expectant" tag just because they didn't respond verbally.

The After-Actions on Katrina were pretty brutal regarding our performance
with the disabled, so we learned some really valuable lessons we're passing
on to our soldiers.  One lesson we learned from our ER/Paramedic liasons was
to speak to EVERYONE in the same way, no matter the perceived level of
non-communication.  Unless someone is in shock, or in danger of going into
shock and losing consciousness, we don't speak loudly and we don't discuss
their medical condition without actively putting them in the loop.  If we
have to discuss grave concerns, we discretely pass a little whiteboard back
and forth with cryptic notes.  The watchword is "reassurance", no matter
what you really think.  None of my non-medical folks are in a position to
pass judgement on a patient's condition, so we communicate with them through
the entire process.  We have a couple of ASL-certified soldiers in the
Company, so they're a real help too.  Everyone has learned simple phrases
like, "Blink your eyes if you understand signing".  If they blink, then the
soldier signs they are going to radio for an interpreter.

We haven't tried any of this out for real in my little piece of the Big
Green Machine, but I think our people are highly trained to assist PWDs.
We've really ratcheted up the concern for modesty among the disabled and
elderly in our exercises.  That was one area that was found lacking.  Again,
it goes back to the practice of treating these demographics like so much
cordwood.

At any rate, I thought you might find the following report interesting.

Kyle


**
*NEMRC Alert - Notes from GUSTAV FEMA Update from 1510 ET
Mon 01/09/2008 16:14*

Briefing from FEMA HQ at approximately 1510 this afternoon:




Vice Admiral Johnson- FEMA has done a good job of preparing and responding.
Federal family had a "positive" Video Conference demonstrating the good
coordination helped with the fact that the Storm dropped to Cat II.
Priorities continue to be (1) Life saving and (2) Life sustaining.

Tried to use "Phoenix" electronic system of wristbands to register those
leaving with transportation assistance.  System bogged down, but went to a
"low tech"system (per VADM Johnson) of paper manifests, but it's working and
it's able to track family members if needed.



To reach families that have relocated using the Federal transportation
options of trains, busses, etc from New Orleans, details can be found at:
National Emergency Family Registration and Locator System 1-800-588-9822  or
at www.FEMA.gov <http://www.fema.gov/>

First priority for housing is to rehab the original home; next is trailers.
Used successfully in the Floods of the Midwest.

Special Needs issues:
Nat.l Guard (Major Bill Etter- National Guard)
indicated that they evacuated 600 Special Needs patients
Health & Human Services- (Rear Adm. W. Craig Vanderwagen; Asst. Sect. for
Preparedness & Response- HHS)
9000 medical needs patients (8K of those were nursing home patients)
evacuated 400 by air
8600 by ground using the 1000 ambulances participating.
40 of those were ventilator dependent
Used an electronic medical record system that will help track where patient
ended up

There were 3 confirmed deaths in transporting critical patients. Deaths will
be investigated by LA Medical Examiners.  There are still plenty of beds
available at the 6 Federal Medical Stations (3 in Texas and 3 in another
state )

Already part of the pre-planning for Hanna

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