Emergency Medical Teams (EMTs)

National EMTs Orientation

Workshop
Gaza 2021

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Emergency Medical Teams (EMTs)

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Workshop overview
• WHO EMT initiatives
• EMT standards and principles
• MCM overview
• EMT structure and equipment
• EMT organogram and tasks distribution
• EMT SOPs/Red and Blue books overview
• Working groups
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Introduction and WHO EMT
initiatives

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Introduction
• Gaza Strip has been exposed frequently to emergencies in the last years
and the context is considered as a protracted emergency crisis.

• The need for national EMTs was well-addressed by MOH and WHO to
alleviate the direct impact of the emergencies, capitalizing the TSPs success
story
• EMTs have a long history of responding to sudden onset disasters (SOD).

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WHO EMT initiatives

• The WHO EMT initiative assists organizations and

countries to build capacity and strengthen health systems

• The EMT initiative places focus on helping countries

develop national teams

• The WHO has certified Emergency Medical Teams

(EMTs)

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Why in Gaza?

TSPs were a national successful

emergency response during GMR
in 2018 to alleviate the burden and
overload over a fragile health
system in Gaza.

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TSPs video show

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TSPs
• TSPs are the 1st stop on the referral pathway.
• TSPs are a special form of EMT Type I (outpatient).

TSPs EMTs
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EMTs Definition
• EMT refers to groups of health professionals providing
direct clinical care to populations affected by disasters,
outbreaks, and/or other emergencies as a surge
capacity to support the local health system.

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Types of EMTs
• The WHO categorizes the EMTs into three types:
EMT type 1

EMT type 2

EMT type 3
• For Gaza we had chosen:
– EMT type1, mobile
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Type 1 EMT (Outpatient Emergency Care)

Provides outpatient initial emergency care of injuries

and other significant health care needs. EMT type 1
could be Mobile or Fixed.

The type 1 EMT must be capable of treating at least

100 outpatients per day

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 Trauma
Pathway

OVERALL
OBJECTIVE:
Support the
continuum
of care

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 Trauma
Pathway

EMTs CAN BE
POSITIONED IN
DIFFERENT POINTS
ALONG TH E
TRAUMA
PATHWAY

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EMTs steering committee formation

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EMTs steering committee formation

Series of committee meetings

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EMT standards and Principles

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EMT standards and principles

EMT core
standards

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EMT standards and principles

EMTs THE OVERALL OBJECTIVE OF HAVING A NATIONAL

EMT IS TO BE HAVING A DEPLOYABLE TEAM, ALWAYS
overall READY, WITH EQUIPMENT AND SUPPLIES, ABLE TO

objective RESPOND TO ANY SUDDEN ONSET DISASTER DURING

THE FIRST GOLDEN HOURS

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EMT standards and principles

• Standard A: GLOBAL & NATIONAL COORDINATION

– National: Standardise coordination through the EMT CC
– Through EMT CC the EMTs must be connected to the
Health System, as well as other partners, nationals and
Internationals
• Standard B: GLOBAL CLASSIFICATION
– Report on arrival what type, capacity and services they
can offer based on the international EMT classification
system. (International EMTs)
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EMT standards and principles

• Standard C: REPORTING
– Report at regular intervals
during response, and prior to
departure, via MOH & WHO
using the identified national or
international reporting format.

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EMT standards and principles

• Standard D&E: MEDICAL RECORDS

– Keep confidential medical records.
– Provide patient with individual record of treatment performed
& referral for follow up.
– Clinical care documentation records.
– Discharge & referral documentation.
– Clinical documentation Informed consent.

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EMT standards and principles
• Standard F: REFERRAL CAPACITY
• Standard G: QUALIFIED & CREDENTIALLED
– All staff must be registered to practice in their home
country.
– All staff must have licence to practice for the work
they are assigned to by the agency

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EMT standards and principles
• Standard H: TRAINING & SKILL MIX
– Effective standby personnel roster system (e.g.. excel
or database; 5:1 ratio availability.
– Compliant Standard Team composition & ratios with
minimum skill criteria requirements by profession
• Principle E: ACCOUNTABLE CARE
All EMTs are accountable to:
– The patients’ communities they assist; MOH, Own
organization & donors
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 EMT standards and principles
• Standard I: INTERNATIONAL PHARMACEUTICAL STANDARDS
– EMTs will ensure that all pharmaceutical products and
equipment they bring complies with international quality
standards and drug donation guidelines.
• Standard J: SELF-SUFFICIENCY
– EMTs are self-sufficient and not put demand on logistic
support from the affected country, unless agreed otherwise
before deployment.
– We prepare ourselves for 3 days of self-sufficiency.

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EMT standards and principles
• Standard K: SANITATION & WASTE MANAGEMENT
• Standard L: INDEMNITY & MALPRACTICE
• Standard M: TEAM HEALTH & WELFARE
– EMTs must have arrangements in place for the care of their
team members’ health and safety including exit strategies if
required.
– COVID-19 CONSIDERATION
– Consideration for the number of uniforms to maintain
personal hygiene and allow for washing and drying time
– Clarity in organogram of responsible people
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EMT coordination platforms and modalities

Coordination is of even more

paramount importance for medical
teams operating in conflict where
coordination carries an additional
weight and a specific purpose.

EMT Coordination Cell (EMTCC)

at MOH supported via WHO

ICRC and the International Red Cross Red

Crescent Movement (the Movement)

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Video show / 1ST WHO classified EMT

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Mass Casualty Management
(MCM)

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Most common triggering incident in the recent
Gaza history?

– Clashes on the fence (GMR)

– Escalation with Israel

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Mass Casualty Management (MCM)
– A mass casualty (MC) refers to a combination of patient numbers
and care requirements at one time that exceed the system’s usual
capacity, disrupt routine procedures, and require additional
resources.

– A mass casualty incident (MCI) has the potential to quickly exhaust

available resources and undermine the response

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Mass Casualty Management (MCM)
– Definitions:
• Casualty - Any human accessing health or medical services, including mental
health services and medical forensics/mortuary care (for fatalities), as a
result of a hazard impact.
• Green Zone - The area outside of the EU to which all patient initially triaged
as green are taken to. This will be the site of treatment for walking/ minor
patients.
• Red Zone - The area within an EU to which all patients not initially triaged as
green are taken to. This will be the site of secondary triage and emergency
life and limb saving interventions.
• Mass Casualty Incident - An incident which generates more patients at one
time than locally available resources can manage using routine procedures. It
requires exceptional emergency arrangements and additional or
extraordinary assistance.
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Mass Casualty Management (MCM)
– Definitions:
• Mass Casualty Management System - is a set of established procedures,
policies and plans, coherent and interrelated, whose main objective in the
context of the emergency unit is to optimize the unit’s capacity to manage a
large number of patients in a short period of time.
• Mitigation - Structural and non-structural measures undertaken to limit the
adverse impact of natural hazards, environmental degradation and
technological hazards.
• Recovery - Decisions and actions taken after a disaster with a view to
restoring or improving the pre-disaster living conditions of the stricken
community, while encouraging and facilitating necessary adjustments to
reduce disaster risk.

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Mass Casualty Management (MCM)

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Mass Casualty Management (MCM)
While you are planning for MCM, think about:

Staff and patient

MCM plan
safety
Identify a threshold
for activation Supplies

Invest in routine
preparedness Communication

Incident command
team Triage IPC

Crowd Control Clearly defined roles

Zones
and staff visibility

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EMT structure and equipment

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Video show

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TSPs structure

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 EMT structure and equipment

The main building blocks of the EMT structure are:

1 .Triage area
2 .Pre-management waiting area
3 .Walking patients’ area
4 .Non-walking patient’s area
5 .Post management waiting area
6 .Administration area
7 .Storage and inventory designated area
8 .Waste management area
9 .Free time, praying, and sleeping area
10 .Ambulance parking area
11 .Mortuary area

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EMT Zones
Waiting Area

Rest
Waste

Waiting Area

Ambulance
Parking

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EMT structure and equipment
# Product Name Unit QTY
1 D/C shock Defibrillator PIECE 2
2 Automatic External Defibrillator (AED) PIECE 8
3 Dressing Emergency Trolley PIECE 14
4 Electric sphygmomanometer adult and child cuffs PIECE 50
5 Fingertip pulse oximeter incorporated display PIECE 50
6 Laryngoscope set ,McIntosh blade 0.,1,2,3,4 PIECE 10
7 Non Folding traditional cot PIECE 10
8 Stretcher Trolley Folding PIECE 20
9 Emergency resuscitation cart PIECE 10
10 emergency cot PIECE 20
11 Electric suction machine PIECE 10
12 Mobile screen PIECE 40
13 Monitor, vital signs PIECE 8
14 Otoscope-ophthalmoscope (SET) PIECE 4
15 O2 Concentrator (Min 8 L/min). 220-240V - 50Hz + accessories PIECE 30
16 Stethoscope, duplex, Adult, (dual-head chest piece) PIECE 30
17 Glucometer - battery operated with strips PIECE 10
18 IR Thermometer- non-contact PIECE 10
19 Thermometer, non-electrical, mercury-free PIECE 20
20 ECG Machine PIECE 4
21 Overhead light with chargeable batteries PIECE 20
22 Portable ventilator PIECE 6

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EMT structure and equipment

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EMT structure and equipment

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EMT structure and equipment

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EMT organogram and tasks
distribution

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EMT organogram and tasks distribution

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EMT organogram and tasks distribution
EMT staffing
EMT1 EMT2 Total Backup

12 H 24 H 12 H 24 H 24 H

Doctor 4 8 4 8 16 48

Nurse 9 18 9 18 36 108

Pharmacist 1 2 1 2 4 12

EMS 4 8 4 8 16 48

Admin 1 2 1 2 4 12

Total 19 38 19 38 76 228

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EMT organogram and tasks distribution

EMT director TD

• He Takes orders from the high level committee of emergency in Ministry of

Health.
• General supervision on EMT.
• Informs the EMT manager to prepare the EMT.
• Contacts with the security and ambulance to go to the EMT manager.
• Responsible for solving any problems or shortages related to the employees.
• Gives order to the manger to terminate the EMT at the end of the event.

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EMT organogram and tasks distribution
EMT manager TD
• He is under the EMT director
• In the emergency situations he contacts with the EMT team to inform them to
move to the specified location.
• He reports and supervises the administrator to bring all the medical tent and
supplies.
• He is responsible for supervising the installation and deployment of the tents
and the placement of all equipment in the specified locations.
• He has to run all the EMT departments including the security and ambulance.
• He supervises the transfer of the wounded by signing the medical shunts on
papers and electronic.
• Coordination with the hospitals if needed and contacts with the director of all
EMTs in case of any problem or shortages or a new reserve staff. Media
communication is done only by him.
• At the end of the work, the administrator has to supervise returning the
medical tents and other supplies back to the stores.

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EMT organogram and tasks distribution

Doctor TD
• Receives instructions from the EMT Manager to come to the EMT and
distribute the work within the EMT.
• Treats all the cases that enter the EMT and fill the medical sheets.
• Transferring the cases to the hospital.
• Request any medical needs or supplies from the EMT manager.
• At the end of the events he collects the medical devices with the EMT
manager and admin.
• Takes the instructions to leave from the EMT manager.

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EMT organogram and tasks distribution
Nurse TD
• An EMT Nurse is a trained nurse who operates as part of an emergency medical
team and provides emergency care to patients experiencing trauma, severe injury,
or illness that requires immediate emergency care.
• Assess a patient’s condition and perform various medical treatments based on the
injury or illness the patient is dealing with.
• EMT Nurse perform various non-invasive treatments to assist their patients and
improve or stabilize their condition and referral of severe trauma and no-trauma
emergencies until they reach the emergency care facility.
• The primary purpose of the EMT nurse is to provide nursing care to patients. This
care may include: triage, assessment, performing basic airway management
treatment, providing CPR & AED to non-responsive patients, first aid, applying
splints, administering basic medications, pain relief, intravenous infusions and
checking/monitoring vitals.
• Coordinate and Liaise with the emergency medical team leader to escalate care
needs as required and communicating effectively with patients and their relatives.

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EMT organogram and tasks distribution
Pharmacist TD
• He receives instructions from EMT manager.
• He is responsible for the medicines and medical supplies in EMT stores.
• He should have an electronic program for all existing items with an expiration date.
• He is on contact with the general director of pharmacy and pharmacy stores in
case of changing any item according to the medicines expiration date.
• During the event he must be available in the EMT stores to provide any shortage.
• Pharmacist who will work during the events in the EMT.
• He must monitor and provide any shortage in the EMT store officer.
• At the end of the event he must collect the medicines and supplies.

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EMT organogram and tasks distribution
Admin TD

• The administrator receives all comments and orders from the EMT manager.
• The administrator is responsible for all EMT supplies in the stores.
• The administrator responsible for bringing all the EMT supplies to be installed in
the place specified by Ministry of Health under the supervision of EMT manager.
• All medical tent contents are arranged under the supervision of EMT manager.
• The administrator responsible for providing logistical support of water and food
from MOH.
• The administrator responsible for registering the cases inside the medical tent on
paper and electronic under the supervision of EMT manager.
• The administrator responsible for the medical tent maintenance and supplies.
• At the end of the EMT work, the administrator is responsible of disassembling and
collecting all EMT contents and returning them to the stores under the supervision
of EMT manager.

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EMT organogram and tasks distribution
EMS officer TD

• Providing EMT's with EMS (services) 24/7 whenever needed in timely manner
through a Well-prepared & equipped Vehicles and well-trained, equipped Staff
who are capable of providing the services safely with high level of performance
within the expected standards (SOP's).
• Response to Emergency Events.
• Clear roles & responsibilities.
• Communication.
• Providing Backup.
• Co-ordination.
• Staging area.
• Transportation & evacuation.
• Ambulance Cleaning, Restocking Infection control.
• Documentation, Reporting & Auditing.
• Evaluating events outcome (+/-).

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EMT Standard Operational
Procedures (SOPs)

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EMT Standard Operational Procedures

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EMT Standard Operational Procedures

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EMT Standard Operational Procedures

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EMT Standard Operational Procedures

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EMT Standard Operational Procedures

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EMT Standard Operational Procedures

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EMT Standard Operational Procedures

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EMT Standard Operational Procedures

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EMT Standard Operational Procedures

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EMT Red and Blue books

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EMT Red and Blue books

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 EMT Red and Blue books
Blue Book Red Book

Initially published as: Classification and Introduces additional verification

Minimum Standards for Foreign Medical
Teams (FMT) in Sudden Onset Disasters,
has been updated as the main reference
document for EMTs, inclusive of both
national and international teams
responding to disasters and outbreaks
requirements for EMTs preparing for or
involved in responding to health
emergencies in armed conflict and
other insecure environments

The baseline requirements of a response captured in the Blue Book and the additional
requirements of a response in armed conflict and other insecure environments captured
in the Red Book

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 EMT Red and Blue books

The Blue Book and Red Book are complimentary and designed
to be used together by EMTs responding to health emergencies
in armed conflict and other insecure environments.

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Red book in Summary:

Do No
International humanitarian law (IHL) Harm!
and core humanitarian principles in
action IHL–
accepta IHL –
nce security
Regardless of national or organizational IHL –
affiliations, medical teams should be access
guided in their mission by the legal
frameworks of the Geneva Conventions,
and IHL more broadly.
Imparti
ality

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Safety and security Risk management

Medical MHPSS
evacuat Patient
for the
ion safety
team

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Sexual and gender-based violence and protection

Highlight the importance and specific roles of

medical teams to manage SGBV.

Special considerations
for children

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Clinical considerations in pre-hospital

• Trauma care
• Outbreak
• Mass casualty incidents (MCI)
• Rehabilitation
• Mental health and psychosocial support (MHPSS)

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The road is long, we are going to be on it
together

Thank you all for your willingness and your

work!
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Thank you
Thanos GARGAVANIS
Emergency Care Technical Officer
gargavanisa@who.int

Ahmed ABOUTEIR
Hospital Technical Officer
abouteira@who.int

Husam ABUOLWAN
Prehospital Technical Officer
abuolwanh@who.int

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