--· - • I TO V Hitherill Director N T S O FROM M Rogers NEST Paramedic Coordinator SUBJECT MIGHTY DERRINGER MEDICAL EMERGENCY RESPONSE 6 December 1986 The MIGHTY DERRINGER exercise includes personnel from a variety of organizations many of whom are unfamiliar with their present working environment To avoid confusion in the event of an actual emergency it is necessary to delineate areas of responsibility and identify those assets available both personnel and material for the purpose of this plan only potentially serious medical emergencies requiring definitive treatment in Las Vegas hospitals will be addressed This plan is for utilization in a real world situation though its elements could be utilized in a role playing scenario if desired i I f SITUATION The MIGHTY DERRINGER exercise is being enacted in A-ZS of the Nevada Test Site approximately 90 road miles from the nearest definitive care hospital ' Approximately ill personnel will be working and residing within the DOE area of responsibility during the course of the exercise The majority of these people will be working long hours under considerable stress to support a critical mission This factor combined with exercise elements that include several potentially hazardous activities produce a situation with a greater than routine potential for serious illness or 1nJury To effectively address this situation firm guidelines for Command and Control and utilization of 1 resources mu5t be enacted I i I MISSION I To comply with current national standards for prehospital care it is I essential that any victim of life threatening trauma be delivered to a definitive care facility within one hour from time of injury While this oal is difficult to attain in the relatively remote environs of N T S effective utilization of key components of the N T S • emergency medical response plan will minimize this critical time period I I These key elements are I Effective Dispatch of Emergency Assets - In this context the REECo NEST paramedics will be the primary respondents Ground transport via ambulance is the expected method •• helicopter availability is yet to be determined and is weather dependent Paramedics are available 24 hours a day for the duration of the exerciae and can be accessed immediately on Net 14 or the exercise net frequency D-2 --- u 'I ' · 'I '• I 1 1• UNCJ D --- MIGHTY DERRINGER EXERCISE 1 6 December 1986 V Hither ill MIGHTY DERRINGER MEDICAL EMERGENCY RESPONSE Page 2 Evaluation and Communication - This is the single most important phase in the evolution of an emergency response Upon arrival at the scene the paramedics will as»e»s and prioritize all victim and rapidly communicate the total number of victims their treatment prioritiea and any additional transport personnel or material required The as essment phase hould require approximately 30 seconds per victim with communication following immediately Command and Control - In the event of a multiple casualty incident an effec tive centralized Command and Control structure is imperative for rapid t resolution of the problem The Command and Control element for MIGHTY DERRINGER is ideal for cutting across jurisdictional boundaries and maximizing utilization of all resources It is essential that the incident commander the senior paramedic have direct communication with the Command and Control element to avoid dilution or misinterpretation of vital information The jincident commander will request all assets necessary for an ideal response jand will realize that any compromises are the result of a cognizant deci ion iand not expediency I Transportation - All conventional H T S transport will be available as well as military helicopters as dictated by their mission It is suggested that a REECo NEST paramedic familiar with Las Vegas hospitals and staff accompany any critical injury during transport to avoid any inadvertent disclosure of sensitive information and to present the patient as a victim of routine activities 1 L- Resources Personnel Area ZS - 1 NEST MD Dr Mcindoe Z REECo NEST paramedics 1 REECo support paramedics •o• cleared Mercury - 3 REECo paramedics N T S Fire Department Equipment Area ZS - Advanced life support equipment o Cardiac Monitor Defibrillator o Endotracheal Intubation and ventilatory support equipment and oxygen o Complete inventory of essential cardiac drugs o Intravenous crystalloid volume expanders o Spinal immobilization apparatus -•- - MIGHTY DERRINGER EXE 1i Ul l UNCLASSIFIED I • I J MIGHTY DERRINGER EXERCISE v- -- i the rill f 6 December 1986 MIGHTY DERRINGER MEDICAL EMERGENCY RESPONSE Page 3 Area 25 continued o Complete inventory of splints dressings and bandages o Military Anti-Shock Trousers MAST suit o Portable tracheal suction equipment o A limited amount of rescue equipment is carried by REECo NEST paramedics o One ambulance CAPABILITIES REECo NEST paramedics operating under protocols for the N T S are authorized to perform all procedures and techniques concurrent with national standards for Advanced Cardiac Life Support and Advanced Trauma Life Support The para medics assigned to this mission are trained and experienced in all phases of rescue anticipated in this environment and are experienced multiple casualty incident commanders Military Assets - yet to be determined -- MR eai I ' t •j I - I •• l MIGHTY DERRINGER EXERCISE