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DISASTER MEDICINE EXAMINATION BLUEPRINT DETAILED INFORMATION

Structure of the Incident Command System:

Participates as a member of the disaster team under the structure of the Incident Command System

The candidate will understand:

• The structure of the Incident Command System (Logistics-Operational-Financing-Planning); the organization of the Emergency Operations Center; the ICS table of organization and the role and responsibilities of the public information officer (PIO), the safety officer, incident commander, liaison officer, communications, and related topics such as NIMS and HEICS; and the chain of command and chain of responsibility



• The basic concepts related to command location, gathering sites (Red, Yellow, Green), site control, span of control, site safety, stockpile issues (strategic, primary loads, local/ community, pharmacy), contracting/ re-supply



• How to establish the site perimeter and subdivide into hot, warm, and cold zones as appropriate

Preparation and Mitigation:

Works in planning for disaster preparation and mitigation

The candidate will have:

• The knowledge and skills to serve a major planning role in areas related to PHS, immunization, health/nutrition, sanitation/water, special populations (pediatrics, geriatric, mobility issues, pregnancy)



• The knowledge and skills to participate in the setup and supervision of disaster planning/exercises/training in a variety of settings (hospitals, community/schools, regional/state, federal, and personal)



• The understanding of the basic concepts of credentialing/education, funding/granting, interagency agreements (mutual aid, EMTALA Transfer), re-supply contracting, EMS/alternate transportation, and shelters

Triage:

Performs triage as appropriate in the disaster environment

The candidate will have:

• The understanding of the role and implementation of triage and can differentiate between disaster and non-disaster triage



• The basic operational knowledge of the major disaster triage systems (START/PRM, iSTART, MASS) and can use one of these methods to perform triage that results in appropriate tags and records

Public Health and Safety:

Advises on and coordinates aspects of public health and safety throughout the disaster life cycle

The candidate will have knowledge and skills:

• In environmental aspects of public health and safety, including sanitation, water, nutrition, immunization, voluntary and compulsory evacuation, scene control, shelters, weather monitoring and modeling, and dispersion modeling and monitoring



• In aspects of public health and safety related to disease, including immunization/prophylaxis, surveillance/epidemiology, emerging disease modeling, vector control, lab/path services and treatment



• Related to complex humanitarian disaster, including issues related to pharmacy services, refugee/evacuees, physical recovery, special populations, and morgue services

Psychosocial Considerations:

Provides psychosocial support as appropriate throughout the disaster life cycle

The candidate will:

• Recognize, assess, and develop a treatment plan for incident-related stress for responders and their team members and families as well as community/victims through the disaster life cycle



• Understand the role of groups such as clergy, NGOs, volunteers, and grief counselors in CISM



• Understand the psychosocial needs of special populations, especially pediatric



• Understand Psychological/Psychiatric Trauma- Acute Stress Rxn vs Acute Stress Disorder, Acute Stress Disorder vs Post Traumatic Stress Disorder, Community Psychological Issues, Psychology of Recovery (Community), Critical Incident Stress Management

Support/Assistance:

Works with various groups and organizations (governmental, community, non-governmental, volunteers) to optimize support for disaster planning, response, and recovery

The candidate will:

• Understand the roles and the integration of groups such as:



• NDMS (DMORTs/ME, IMSURTS, DMAT, VMAT, NMRT)


• Community (Law Enforcement, Fire/Rescue, EMS, Public Works)


• NGOs, Military/National Guard/Coast Guard


• FEMA


• FBI


• CERTs


• Public Health personnel


• CDC


• USAMRICD


• WMD-CSTs


• Poison Control


• Vendors


• Other specialists (e.g., medical, nuclear)


• Understand issues related to the use of volunteers (training, handling, appropriate use, liability, and responsibility)

Communication/Documentation:

Maintains necessary communication and documentation

The candidate will:

• Understand the chain of communication and role of the PIO



• Understand basic vocabulary, as well as acronyms, used in disaster operations



• Know basic procedures for medical record-keeping (including data capture and banking and the role of toe tags)



• Know basics of evidentiary documentations (crime scene evidence)



• Understand basic types of communications equipment (primary/backup) and the need for and application of basic technical communications security procedures (encryption, varied frequencies)

Regulatory/Legal/Ethical Principles:

Complies with regulatory and legal as well as accepted moral and ethical principles

The candidate will:

• Understand regulatory and legal landscape, as well as moral and ethical issues as they impact disaster medicine



• Have sufficient knowledge to operate in compliance with regulatory and ethical principles related to the following:



• HIPAA


• EMTALA/COBRA


• Stafford Act


• JACHO


• Federal Response Plan


• OSHA


• NIOSH


• ADA/Access


• Licensing


• Sovereign Immunity


• Good Samaritan Doctrine


• Federal Tort Claims Act


• Expectant Patient Issues (dying not yet dead, DNR)


• NRC


• CDC


• FDA


• EPA


• Confidentiality


• Consent


• Withdrawal of Care


• Refusal to assume risk


• AMA/Refusal of Care


• Privacy/Decontamination


• Profiling


• Legal rights of responders


• Professionalism


• Public Health and Legal Considerations - Immediate and Long Range

Assessment and Treatment:

Assesses and treats injuries resulting from natural/non-natural and incidental/intentional causes in a variety of environments (urban, rural, and austere)

The candidate will have the knowledge and skill to assess and treat injuries related to the following:

• Electrocution - including High Voltage/ Low Amperage, High Voltage/High Amperage, Low Voltage/High Amperage, Low Voltage/Low Amperage, and AC vs. DC


• Resuscitation Protocols – ACLS, BCLS, PALS, APLS, ALSO, NALS, NRP


• Infection - including Bio weapon, epidemic, emerging illness, and vaccination needs


• Toxin - including natural vs. synthetic, nerve agents, cholinergic, anticholinergic, biologic, blister agents, and enzymatic


• Blast trauma -including physics of explosives; primary, blast trauma affecting gut, lung, ear, eyes; bullets, thermal and radiation burns, secondary blast trauma (smash, spear, gas, glow), and tertiary blast trauma (crush, traumatic or emergency amputation)


• Ionizing/Non-Ionizing Radiation - including physics, toxicity, exposure rates and times, iodine prophylaxis, pregnancy risks, and treatments/antidotes


• Burns – including thermal, Parkland Formula, BSA burned, chemical, radiation, environmental, and special population considerations


• Penetrating/Ballistic - including physics, mechanisms of injury, yaw, pitch, sprawl, deformation, velocity, and kinetics


• Crush Injuries - including rhabdomyolysis, compartment syndrome, compartment pressure measurement, fasciotomy, crush injury/release syndrome, hyperkalemia, myoglobinuria, and washout (to prevent ARF), entrapment, and field amputation


• Submersion/Drowning - including dry vs. wet drowning, salt vs. fresh water drowning, submersion injury, diving reflex, cold water considerations, treatment, and surgical airway


• Inhalational - including smoke, chemical, drowning, biological, and radiation


• Exposure Effect - including hypothermia, rewarming, hyperthermia, and cooling (mist and fan)


• Dehydration/Starvation – including mechanisms of dehydration (Type 1 vs. Type 2), mechanisms of rehydration (Oral vs. IV), rehydration solution, re-feeding, culturally sensitive diets, special needs diets, refugee/evacuee feeding, special populations


• Blunt Trauma – hollow/solid organ injury, intracranial blunt trauma, bony trauma, neurologic trauma


• Special Populations

Pathology

The candidate will have knowledge of:

• The identification of remains (DNA, forensic odontology, and forensic anthropology)



• The visual observations of trauma or infectious disease



• Electrocution


• Infection


• Toxin


• Blast trauma


• Ionizing/non-ionizing radiation


• Burns


• Penetrating/ballistic


• Crush injuries


• Submersion/drowning


• Inhalational


• Exposure effect


• Dehydration/starvation


• Psychological/psychiatric trauma


• Blunt trauma


• Autopsy findings and clinical-pathological correlations



• The collection, testing, and preservation of biological materials for future medical and legal concerns and inquiries

Decontamination/PPE:

Follows appropriate decontamination principles and procedures

The candidate will have:

• The knowledge of what comprises levels A, B, C, and D and can determine the level of PPE required for each



• The knowledge and skills to perform Level C decontamination

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