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How to set up guideline for MCI 
Pre-hospital & In-hospital 
Asst Prof Prasit Wuthisuthimethawee 
Attending physician, Department of Emergency Medicine, Faculty of 
Medicine, Prince of Songkla University, Hatyai, Songkhla 
Adjunct faculty of BIDMC Disaster Medicine Fellowship Program, Beth 
Israel Deaconess Medical Center, Harvard Medical School, 
Boston, MA, USA
รถโดยสารสาธารณะ 137,609 คัน 
รถโดยสารสาธารณะเกิดอุบัติเหตุ 5,019 ครั้ง 
รายงานการวิเคราะห์อุบัติเหตุบนท้องถนน ประจา ปี 2555 กระทรวงคมนาคม
Leader 
Data 
Coordination 
Committee/unit/organization 
Budget HVA 
Strategy
Plan 
Do 
Check 
Act
4 C’s 
• Collaborate 
• Communicate 
• Coordinate 
• Capitalize
Hazard Vulnerability Analysis 
• Knowing your risks and preparing of them 
• Disaster guideline or plan is based in result of 
HVA 
• All data gathering: past and present
Hazard Vulnerability Analysis 
• Events 
• Probability 
• Effect and impact 
• Current capabilities 
• Ranking
Campus Safety 
Landscape
Risk = VCP 
• Vulnerability 
• Consequence 
• Probability
Hazard Vulnerability Analysis 
Disaster Management 
DETERMINATION OF POTENTIAL RISK OF THE HAZARD OCCURING 
HAZARD LOW MODERATE HIGH 
Natural Disasters 
Ice/Snow/Blizzards 
Flooding 
Earthquakes 
Fire 
Outbreak/Epidemic 
Resource/Utility Disasters 
Loss of Power/Electric/Generator 
Communication/Telephone 
Failure 
IT Failure 
Loss of Water 
Fuel Shortage 
Fire- Internal 
Medical Gas Shutdown 
Staff Unavailability 
Mass Casualty Accidents 
Bus Accidents 
Train Accidents 
Airplane Accidents 
Hostage Situation 
Industrial Accidents 
Fires 
Chemical 
Hazmat 
Weapons of Mass Destruction 
Chemical Weapons 
Biological Weapons 
Nuclear Weapons 
Radiological Weapons 
High Explosive Devices 
Bomb Threat
earthquake in the lower mainland because it is more likely and will have 
considerable damage even though the extent of damage will be considerably 
less than the strongest earthquake possible. 
Hazard Groups Hazard 
Accidents • Air crashes 
• Marine accidents 
• Motor vehicle crashes 
Atmosphere • Snow storms 
• Blizzards 
• Ice storms and fog 
• Hailstorms 
• Lightning 
• Hurricanes 
• Tornadoes 
• Heat waves 
Dam failure • Dam failure (includes foundations and abutments) 
Disease and epidemics • Human diseases 
• Animal diseases 
• Plant diseases 
• Pest infestations 
Explosions and emissions • Gas and gas leaks (pipeline) 
• Gas and gas leaks (gas wells) 
• Mine 
• Other explosions 
Fire - urban and rural • Fire (urban and rural - excludes interface fire) 
Fire - wildfire and interface • Wildfire (includes interface fire) 
Geological • Avalanches: 
- highways 
- other 
• Debris avalanches and debris flows 
• Landslides: 
HRVA Tool Kit 4-5
Hazard and Vulnerability Identification 
- highways 
- other 
• Submarine slides 
• Land subsidence 
Hazardous materials • Hazardous spills 
- general (on site or transport routes) 
- radiation 
- infectious materials 
Hydrologic • Drought 
• Erosion and accretion 
• Flooding 
• Ice jams 
• Storm surges 
Power outage • Electrical power outage 
Riots • Riots/public disorder 
Seismic • Ground motion effects 
• Tsunamis 
Space object • Space object crash 
Structural • Structural collapse 
Terrorism • Terrorism (hostile act against state) 
Volcanic • Ash falls 
• Pyroclastic flows 
• Lava flows 
• Mudflows 
There may be other hazards. Do not limit yourself to this list, however, you may 
with to constrain the scope of risk analysis work to the highest risks. If so, include 
those hazards with a potential to have at least an occasional possibility of 
occurring and a high level of impact.
RISK ANALYSIS Date: APRIL 21, 2003 
No HAZARD SCIENTIFIC DETAILS INCLUDING IMPACTS & 
VULNERABILITY 
LIKLIEHOOD CONSEQUENCE 
SEVERITY 
1 FLOODING FRESHET FLOODING IMPACTS 
VILLAGES AND FAMRS CAUSING 
LOCALIZED AND SEVERE 
PROPERTY DAMAGE. 
VULNERABILITIES: 
SCHOOL, STORM CREEK BRIDGE, 
AND NO EVAC PLAN 
4 3 
2 INTERFACE 
FIRE 
WILDFIRE THREATENS VILLAGE 
AND FORCES EVACUATION. 
VULNERABILITIES: SMOKE 
IRRITANT, ACCESS CUT OFF TO 
NORTH, EVAC TO SOUTH OK BUT 
NO ARRANGEMENTS IN PLACE FOR 
EVAC AND SHELTER TO NEAREST 
TOWN. 
3 3 
Impacts: 
Fatal 1 
Injury 1 
Crit. Inf. 2 
Lifeline 2 
Property 3 
Envir. 2 
Econ./Soc. 2 
LIKLIEHOOD 
6: Frequent or Very Likely 
5: Moderate or Likely 
4: Occasional, Slight Chance 
3: Unlikely, Improbable 
2: Highly Unlikely (Rare Event) 
1: Very Rare Event 
CONSEQUENCE: 
IMPACT AND VULNERABILITY 
4: Very High 
3: High 
2: Low 
1: Very Low
FREQUENCY OR 
PROBABILITY 
INCREASING RISK 
CONSEQUENCE: 
IMPACT & VULNERABILITY 
6 
5 
4 
3 
2 
1 
1 2 3 4 
VERY HIGH 
CONSEQUENCES 
FREQUENT OR 
VERY LIKELY 
6: Frequent or Very Likely 
5: Moderate or Likely 
4: Occasional, Slight Chance 
3: Unlikely, Improbable 
2: Highly Unlikely (Rare Event) 
1: Vary Rare Event 
4: Very High 
3: High 
2: Low 
1: Very Low
HAZARD AND VULNERABILITY ASSESSMENT TOOL 
NATURALLY OCCURRING EVENTS 
SEVERITY = (MAGNITUDE - MITIGATION) 
EVENT 
PROBABILITY HUMAN 
IMPACT 
PROPERTY 
IMPACT 
BUSINESS 
IMPACT 
PREPARED-NESS 
INTERNAL 
RESPONSE 
EXTERNAL 
RESPONSE 
RISK 
Likelihood this will 
occur 
Possibility of 
death or injury 
Physical losses 
and damages 
Interruption of 
services 
Preplanning 
Time, 
effectiveness, 
resources 
Community/ 
Mutual Aid staff 
and supplies 
Relative threat* 
SCORE 
0 = N/A 
1 = Low 
2 = Moderate 
3 = High 
0 = N/A 
1 = Low 
2 = Moderate 
3 = High 
0 = N/A 
1 = Low 
2 = Moderate 
3 = High 
0 = N/A 
1 = Low 
2 = Moderate 
3 = High 
0 = N/A 
1 = High 
2 = Moderate 
3 = Low or none 
0 = N/A 
1 = High 
2 = Moderate 
3 = Low or none 
0 = N/A 
1 = High 
2 = Moderate 
3 = Low or none 
0 - 100% 
Blizzard 0 2 2 3 2 2 3 0% 
Drought 1 2 2 2 2 2 2 22% 
Dust/Sand Storm 1 1 2 1 3 3 3 24% 
Earthquake, >6 
Local 
3 3 3 3 3 3 2 94% 
Epidemic/Natural 2 3 2 3 3 3 2 59% 
Flood, Local 2 3 3 3 3 3 2 63% 
Hurricane 0 0 0 0 0 0 0 0% 
Ice Storm 1 3 2 3 3 3 3 31% 
Infectious Disease 
(SARS, etc.) 
1 3 3 3 3 3 2 31% 
Landslide 1 1 2 2 3 3 2 24% 
Severe 
Thunderstorm 
1 1 1 1 2 2 2 17% 
Snow/Ice/Hail Storm 2 2 2 2 3 3 3 56% 
Temperature 
Extremes 
1 1 1 1 2 2 2 17% 
Tsunami - 
Tidal Wave 
0 0 0 0 0 0 0 0% 
Tornado 0 0 0 0 0 0 0 0% 
Volcano 0 0 0 0 0 0 0 0% 
Wild Fire 2 3 2 3 3 3 2 59% 
AVERAGE SCORE 1.06 1.65 1.59 1.76 2.06 2.06 1.76 21% 
*Threat increases with percentage. 
* Events in Bold have occurred previously 
18 RISK = PROBABILITY * SEVERITY 
185 0.21 0.35 0.60 
Notes 
Natural Hazards : HVAlDetailedHM.xls
Guidelines for community disaster 
preparedness plan 
• Aims of the plan 
• Assessment of community 
– Strength VS Weakness 
– Risk, Vulnerability, Resources 
• Relationship with government 
• Warning system 
• Evacuation procedures 
• Emergency shelters 
International Federation of Red Cross and Red Crescent Societies
Guidelines for community disaster 
preparedness plan 
• Search and rescue 
• Damage/Needs assessment 
• Road cleaning/Debris clearing 
• Communication 
• Law and Order/Security 
• Transport 
• Repair of community services 
International Federation of Red Cross and Red Crescent Societies
Guidelines for community disaster 
preparedness plan 
• Health 
• Personal support 
• Welfare 
• Relief supplies 
• Outside assistant 
• Testing plan 
• Revision and update plan 
• Aware of plan 
• Risk reduction activities 
International Federation of Red Cross and Red Crescent Societies
International Federation of Red Cross and Red Crescent Societies
74
Phonetic Alphabet 
Alpha Juliet Sierra 
Bravo Kilo Tango 
Charlie Lima Uniform 
Delta Mike victor 
Echo November Whiskey 
Foxtrot Oscar X-ray 
Golf Papa Yankee 
Hotel Quebec Zulu 
India Romeo
?
Summary
Leader 
Data 
Coordination 
Committee/unit/organization 
Budget HVA 
Strategy
Plan 
Do 
Check 
Act
Preparedness cycle 
Plan 
Organize & Equip 
Train 
Evaluate/Improve 
Exercise 
Preparedness cycle
ขอบคุณครับ
Email: prasit0552002@yahoo.com
Disaster and Emergency Medicine 
Research workshop 
• Professor Marvin Birnbuam 
• Former president of WADEM 
• 7-9 December, 2014 
• Royal Phuket City Hotel
ACTEP2014: How to set up guideline for MCI
ACTEP2014: How to set up guideline for MCI
ACTEP2014: How to set up guideline for MCI
ACTEP2014: How to set up guideline for MCI

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ACTEP2014: How to set up guideline for MCI

  • 1. How to set up guideline for MCI Pre-hospital & In-hospital Asst Prof Prasit Wuthisuthimethawee Attending physician, Department of Emergency Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla Adjunct faculty of BIDMC Disaster Medicine Fellowship Program, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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  • 5. รถโดยสารสาธารณะ 137,609 คัน รถโดยสารสาธารณะเกิดอุบัติเหตุ 5,019 ครั้ง รายงานการวิเคราะห์อุบัติเหตุบนท้องถนน ประจา ปี 2555 กระทรวงคมนาคม
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  • 14. Leader Data Coordination Committee/unit/organization Budget HVA Strategy
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  • 18. 4 C’s • Collaborate • Communicate • Coordinate • Capitalize
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  • 20. Hazard Vulnerability Analysis • Knowing your risks and preparing of them • Disaster guideline or plan is based in result of HVA • All data gathering: past and present
  • 21. Hazard Vulnerability Analysis • Events • Probability • Effect and impact • Current capabilities • Ranking
  • 23. Risk = VCP • Vulnerability • Consequence • Probability
  • 24. Hazard Vulnerability Analysis Disaster Management DETERMINATION OF POTENTIAL RISK OF THE HAZARD OCCURING HAZARD LOW MODERATE HIGH Natural Disasters Ice/Snow/Blizzards Flooding Earthquakes Fire Outbreak/Epidemic Resource/Utility Disasters Loss of Power/Electric/Generator Communication/Telephone Failure IT Failure Loss of Water Fuel Shortage Fire- Internal Medical Gas Shutdown Staff Unavailability Mass Casualty Accidents Bus Accidents Train Accidents Airplane Accidents Hostage Situation Industrial Accidents Fires Chemical Hazmat Weapons of Mass Destruction Chemical Weapons Biological Weapons Nuclear Weapons Radiological Weapons High Explosive Devices Bomb Threat
  • 25. earthquake in the lower mainland because it is more likely and will have considerable damage even though the extent of damage will be considerably less than the strongest earthquake possible. Hazard Groups Hazard Accidents • Air crashes • Marine accidents • Motor vehicle crashes Atmosphere • Snow storms • Blizzards • Ice storms and fog • Hailstorms • Lightning • Hurricanes • Tornadoes • Heat waves Dam failure • Dam failure (includes foundations and abutments) Disease and epidemics • Human diseases • Animal diseases • Plant diseases • Pest infestations Explosions and emissions • Gas and gas leaks (pipeline) • Gas and gas leaks (gas wells) • Mine • Other explosions Fire - urban and rural • Fire (urban and rural - excludes interface fire) Fire - wildfire and interface • Wildfire (includes interface fire) Geological • Avalanches: - highways - other • Debris avalanches and debris flows • Landslides: HRVA Tool Kit 4-5
  • 26. Hazard and Vulnerability Identification - highways - other • Submarine slides • Land subsidence Hazardous materials • Hazardous spills - general (on site or transport routes) - radiation - infectious materials Hydrologic • Drought • Erosion and accretion • Flooding • Ice jams • Storm surges Power outage • Electrical power outage Riots • Riots/public disorder Seismic • Ground motion effects • Tsunamis Space object • Space object crash Structural • Structural collapse Terrorism • Terrorism (hostile act against state) Volcanic • Ash falls • Pyroclastic flows • Lava flows • Mudflows There may be other hazards. Do not limit yourself to this list, however, you may with to constrain the scope of risk analysis work to the highest risks. If so, include those hazards with a potential to have at least an occasional possibility of occurring and a high level of impact.
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  • 28. RISK ANALYSIS Date: APRIL 21, 2003 No HAZARD SCIENTIFIC DETAILS INCLUDING IMPACTS & VULNERABILITY LIKLIEHOOD CONSEQUENCE SEVERITY 1 FLOODING FRESHET FLOODING IMPACTS VILLAGES AND FAMRS CAUSING LOCALIZED AND SEVERE PROPERTY DAMAGE. VULNERABILITIES: SCHOOL, STORM CREEK BRIDGE, AND NO EVAC PLAN 4 3 2 INTERFACE FIRE WILDFIRE THREATENS VILLAGE AND FORCES EVACUATION. VULNERABILITIES: SMOKE IRRITANT, ACCESS CUT OFF TO NORTH, EVAC TO SOUTH OK BUT NO ARRANGEMENTS IN PLACE FOR EVAC AND SHELTER TO NEAREST TOWN. 3 3 Impacts: Fatal 1 Injury 1 Crit. Inf. 2 Lifeline 2 Property 3 Envir. 2 Econ./Soc. 2 LIKLIEHOOD 6: Frequent or Very Likely 5: Moderate or Likely 4: Occasional, Slight Chance 3: Unlikely, Improbable 2: Highly Unlikely (Rare Event) 1: Very Rare Event CONSEQUENCE: IMPACT AND VULNERABILITY 4: Very High 3: High 2: Low 1: Very Low
  • 29. FREQUENCY OR PROBABILITY INCREASING RISK CONSEQUENCE: IMPACT & VULNERABILITY 6 5 4 3 2 1 1 2 3 4 VERY HIGH CONSEQUENCES FREQUENT OR VERY LIKELY 6: Frequent or Very Likely 5: Moderate or Likely 4: Occasional, Slight Chance 3: Unlikely, Improbable 2: Highly Unlikely (Rare Event) 1: Vary Rare Event 4: Very High 3: High 2: Low 1: Very Low
  • 30. HAZARD AND VULNERABILITY ASSESSMENT TOOL NATURALLY OCCURRING EVENTS SEVERITY = (MAGNITUDE - MITIGATION) EVENT PROBABILITY HUMAN IMPACT PROPERTY IMPACT BUSINESS IMPACT PREPARED-NESS INTERNAL RESPONSE EXTERNAL RESPONSE RISK Likelihood this will occur Possibility of death or injury Physical losses and damages Interruption of services Preplanning Time, effectiveness, resources Community/ Mutual Aid staff and supplies Relative threat* SCORE 0 = N/A 1 = Low 2 = Moderate 3 = High 0 = N/A 1 = Low 2 = Moderate 3 = High 0 = N/A 1 = Low 2 = Moderate 3 = High 0 = N/A 1 = Low 2 = Moderate 3 = High 0 = N/A 1 = High 2 = Moderate 3 = Low or none 0 = N/A 1 = High 2 = Moderate 3 = Low or none 0 = N/A 1 = High 2 = Moderate 3 = Low or none 0 - 100% Blizzard 0 2 2 3 2 2 3 0% Drought 1 2 2 2 2 2 2 22% Dust/Sand Storm 1 1 2 1 3 3 3 24% Earthquake, >6 Local 3 3 3 3 3 3 2 94% Epidemic/Natural 2 3 2 3 3 3 2 59% Flood, Local 2 3 3 3 3 3 2 63% Hurricane 0 0 0 0 0 0 0 0% Ice Storm 1 3 2 3 3 3 3 31% Infectious Disease (SARS, etc.) 1 3 3 3 3 3 2 31% Landslide 1 1 2 2 3 3 2 24% Severe Thunderstorm 1 1 1 1 2 2 2 17% Snow/Ice/Hail Storm 2 2 2 2 3 3 3 56% Temperature Extremes 1 1 1 1 2 2 2 17% Tsunami - Tidal Wave 0 0 0 0 0 0 0 0% Tornado 0 0 0 0 0 0 0 0% Volcano 0 0 0 0 0 0 0 0% Wild Fire 2 3 2 3 3 3 2 59% AVERAGE SCORE 1.06 1.65 1.59 1.76 2.06 2.06 1.76 21% *Threat increases with percentage. * Events in Bold have occurred previously 18 RISK = PROBABILITY * SEVERITY 185 0.21 0.35 0.60 Notes Natural Hazards : HVAlDetailedHM.xls
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  • 63. Guidelines for community disaster preparedness plan • Aims of the plan • Assessment of community – Strength VS Weakness – Risk, Vulnerability, Resources • Relationship with government • Warning system • Evacuation procedures • Emergency shelters International Federation of Red Cross and Red Crescent Societies
  • 64. Guidelines for community disaster preparedness plan • Search and rescue • Damage/Needs assessment • Road cleaning/Debris clearing • Communication • Law and Order/Security • Transport • Repair of community services International Federation of Red Cross and Red Crescent Societies
  • 65. Guidelines for community disaster preparedness plan • Health • Personal support • Welfare • Relief supplies • Outside assistant • Testing plan • Revision and update plan • Aware of plan • Risk reduction activities International Federation of Red Cross and Red Crescent Societies
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  • 71. International Federation of Red Cross and Red Crescent Societies
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  • 92. Phonetic Alphabet Alpha Juliet Sierra Bravo Kilo Tango Charlie Lima Uniform Delta Mike victor Echo November Whiskey Foxtrot Oscar X-ray Golf Papa Yankee Hotel Quebec Zulu India Romeo
  • 93. ?
  • 95. Leader Data Coordination Committee/unit/organization Budget HVA Strategy
  • 97. Preparedness cycle Plan Organize & Equip Train Evaluate/Improve Exercise Preparedness cycle
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  • 105. Disaster and Emergency Medicine Research workshop • Professor Marvin Birnbuam • Former president of WADEM • 7-9 December, 2014 • Royal Phuket City Hotel