Emergency

Paramedics treating a woman who has collapsed in the street in New York. Dangers to life and health are serious enough that emergency response systems are considered vital.

An emergency is a situation that poses an immediate risk to health, life, property, or environment.^[1] Most emergencies require urgent intervention to prevent a worsening of the situation, although in some situations, mitigation may not be possible and agencies may only be able to offer palliative care for the aftermath.

While some emergencies are self-evident (such as a natural disaster that threatens many lives), many smaller incidents require that an observer (or affected party) decide whether it qualifies as an emergency. The precise definition of an emergency, the agencies involved and the procedures used, vary by jurisdiction, and this is usually set by the government, whose agencies (emergency services) are responsible for emergency planning and management.

Defining an emergency

An incident, to be an emergency, conforms to one or more of the following: if it:

• Poses an immediate threat to life, health, property, or environment
• Has already caused loss of life, health detriments, property damage, or environmental damage
• has a high probability of escalating to cause immediate danger to life, health, property, or environment

In the United States, most states mandate that a notice be printed in each telephone book that requires that someone must relinquish use of a phone line, if a person requests the use of a telephone line (such as a party line) to report an emergency. State statures typically define an emergency as, "...a condition where life, health, or property is in jeopardy, and the prompt summoning of aid is essential."^[2]

Whilst most emergency services agree on protecting human health, life and property, the environmental impacts are not considered sufficiently important by some agencies. This also extends to areas such as animal welfare, where some emergency organisations cover this element through the "property" definition, where animals owned by a person are threatened (although this does not cover wild animals). This means that some agencies do not mount an "emergency" response where it endangers wild animals or environment, though others respond to such incidents (such as oil spills at sea that threaten marine life). The attitude of the agencies involved is likely to reflect the predominant opinion of the government of the area.

Types of emergency

Dangers to life

Many emergencies cause an immediate danger to the life of people involved. This can range from emergencies affecting a single person, such as the entire range of medical emergencies including heart attacks, strokes, cardiac arrest and trauma, to incidents that affect large numbers of people such as natural disasters including tornadoes, hurricanes, floods, mudslides and outbreaks of diseases such as cholera, Ebola, and malaria.

Most agencies consider these the highest priority emergency, which follows the general school of thought that nothing is more important than human life.^[3]

Dangers to health

Some emergencies are not necessarily immediately threatening to life, but might have serious implications for the continued health and well-being of a person or persons (though a health emergency can subsequently escalate to life-threatening).

The causes of a health emergency are often very similar to the causes of an emergency threatening to life, which includes medical emergencies and natural disasters, although the range of incidents that can be categorised here is far greater than those that cause a danger to life (such as broken limbs, which do not usually cause death, but immediate intervention is required if the person is to recover properly). Many life emergencies, such as cardiac arrest, are also health emergencies.

Dangers to the environment

Some emergencies do not immediately endanger life, health or property, but do affect the natural environment and creatures living within it. Not all agencies consider this a genuine emergency, but it can have far reaching effects on animals and the long term condition of the land. Examples would include forest fires and marine oil spills.

Systems of classifying emergencies

Agencies across the world have different systems for classifying incidents, but all of them serve to help them allocate finite resource, by prioritising between different emergencies.

The first stage of any classification is likely to define whether the incident qualifies as an emergency, and consequently if it warrants an emergency response. Some agencies may still respond to non-emergency calls, depending on their remit and availability of resource. An example of this would be a fire department responding to help retrieve a cat from a tree, where no life, health or property is immediately at risk.

Following this, many agencies assign a sub-classification to the emergency, prioritising incidents that have the most potential for risk to life, health or property (in that order). For instance, many ambulance services use a system called the Advanced Medical Priority Dispatch System (AMPDS) or a similar solution.^[4][5] The AMPDS categorises all calls to the ambulance service using it as either 'A' category (immediately life-threatening), 'B' Category (immediately health threatening) or 'C' category (non-emergency call that still requires a response). Some services have a fourth category, where they believe that no response is required after clinical questions are asked.

Another system for prioritizing medical calls is known as Emergency Medical Dispatch (EMD).^[6][7] Jurisdictions that use EMD typically assign a code of "alpha" (low priority), "bravo" (medium priority), "charlie" (requiring advanced life support), delta (high priority, requiring advanced life support) or "echo" (maximum possible priority, e.g., witnessed cardiac arrests) to each inbound request for service; these codes are then used to determine the appropriate level of response.^[8][9][10]

Other systems (especially as regards major incidents) use objective measures to direct resource. Two such systems are SAD CHALET and ETHANE,^[11] which are both mnemonics to help emergency services staff classify incidents, and direct resource.^[12] Each of these acronyms helps ascertain the number of casualties (usually including the number of dead and number of non-injured people involved), how the incident has occurred, and what emergency services are required.

Agencies involved in dealing with emergencies

Most developed countries have a number of emergency services operating within them, whose purpose is to provide assistance in dealing with any emergency. They are often government operated, paid for from tax revenue as a public service, but in some cases, they may be private companies, responding to emergencies in return for payment, or they may be voluntary organisations, providing the assistance from funds raised from donations.

Most developed countries operate three core emergency services:

• Police – who deal with security of person and property, which can cover all three categories of emergency. They also to some extent deal with punishment of those who cause an emergency through their deliberate actions.
• Fire service – who deal with potentially harmful fires, but also often rescue operations such as dealing with road traffic collisions. Their actions help to prevent loss of life, damage to health and damage to or loss of property.
• Emergency Medical Service (Ambulance / Paramedic service) – These services attempt to reduce loss of life or damage to health. This service is likely to be decisive in attempts to prevent loss of life and damage to health. In some areas "Emergency Medical Service" is abbreviated to simply EMS.

In some countries or regions, two or more of these services may be provided by the same agency^[13] (e.g. the fire service providing emergency medical cover), and under different conditions (e.g. publicly funded fire service and police, but a private ambulance service)

There may also be a number of secondary emergency services, which may be a part of one of the core agencies, or may be separate entities who assist the main agencies. This can include services providing specialist rescue (such as mountain rescue^[14] or mine rescue),^[15] bomb disposal^[16] or search and rescue.^[17][18][19]

The Military and the Amateur Radio Emergency Service (ARES) or Radio Amateur Civil Emergency Service (RACES) help in large emergencies such as a disaster or major civil unrest.

Summoning emergency services

Most countries have an emergency telephone number, also known as the universal emergency number, which can be used to summon the emergency services to any incident. This number varies from country to country (and in some cases by region within a country), but in most cases, they are in a short number format, such as 911 (United States and many parts of Canada),^[20] 999 (United Kingdom),^[21][22] 112 (Europe)^[23][24] and 000 (Australia).^[25]

The majority of mobile phones also dial the emergency services, even if the phone keyboard is locked, or if the phone has an expired or missing SIM card, although the provision of this service varies by country and network.^[24]

Civil emergency services

In addition to those services provided specifically for emergencies, there may be a number of agencies who provide an emergency service as an incidental part of their normal 'day job' provision. This can include public utility workers, such as in provision of electricity or gas, who may be required to respond quickly, as both utilities have a large potential to cause danger to life, health and property if there is an infrastructure failure.^[26][27]

Emergency action principles (EAP)

Emergency action principles are key 'rules' that guide the actions of rescuers and potential rescuers. Because of the inherent nature of emergencies, no two are likely to be the same, so emergency action principles help to guide rescuers at incidents, by sticking to some basic tenets.

The adherence to (and contents of) the principles by would-be rescuers varies widely based on the training the people involved in emergency have received, the support available from emergency services (and the time it takes to arrive) and the emergency itself.

Key emergency principle

The key principle taught in almost all systems is that the rescuer, be they a lay person or a professional, should assess the situation for danger.^[28][29]

The reason that an assessment for danger is given such high priority is that it is core to emergency management that rescuers do not become secondary victims of any incident, as this creates a further emergency that must be dealt with.

A typical assessment for danger would involve observation of the surroundings, starting with the cause of the accident (e.g. a falling object) and expanding outwards to include any situational hazards (e.g. fast moving traffic) and history or secondary information given by witnesses, bystanders or the emergency services (e.g. an attacker still waiting nearby).

Once a primary danger assessment has been complete, this should not end the system of checking for danger, but should inform all other parts of the process.

If at any time the risk from any hazard poses a significant danger (as a factor of likelihood and seriousness) to the rescuer, they should consider whether they should approach the scene (or leave the scene if appropriate).

Managing an emergency

A graphic representation of the four phases in emergency management.

There are many emergency services protocols that apply in an emergency, which usually start with planning before an emergency occurs. One commonly used system for demonstrating the phases is shown here on the right.

The planning phase starts at preparedness, where the agencies decide how to respond to a given incident or set of circumstances. This should ideally include lines of command and control, and division of activities between agencies. This avoids potentially negative situations such as three separate agencies all starting an official rest centre for victims of a disaster.

Following an emergency occurring, the agencies then move to a response phase, where they execute their plans, and may end up improvising some areas of their response (due to gaps in the planning phase, which are inevitable due to the individual nature of most incidents).

Agencies may then be involved in recovery following the incident, where they assist in the clear up from the incident, or help the people involved overcome their mental trauma.

The final phase in the circle is mitigation, which involves taking steps to ensure no re-occurrence is possible, or putting additional plans in place to ensure less damage is done. This should feed back in to the preparedness stage, with updated plans in place to deal with future emergencies, thus completing the circle.

State of emergency

In the event of a major incident, such as civil unrest or a major disaster, many governments maintain the right to declare a state of emergency,^[30] which gives them extensive powers over the daily lives of their citizens, and may include temporary curtailment on certain civil rights, including the right to trial (for instance to discourage looting of an evacuated area, a shoot on sight policy, however unlikely, may be in force)

See also

• Certified first responder
• Emergency medical technician
• First aid
• Emergency medical service
• Natural disaster
• Emergency Communication System
• Emergency Response Information Network
• Prevention
• SWAT
• Maritime emergency
• Universal healthcare

References

1. "UK Government Advice on Definition of an Emergency" (PDF). Retrieved 2007-05-30.
2. Some examples of state statutes defining emergency for this purpose: California Penal Code, Sec. 384
3. "UK Government document stating that life-saving activity is the highest priority in an emergency" (PDF). Retrieved 2007-05-30.
4. "Tampa Fire Department EMS dispatch details". Archived from the original on May 5, 2006. Retrieved 2007-05-30.
5. "London Ambulance Service details of AMPDS use". Archived from the original on 2007-01-30. Retrieved 2007-05-30.
6. "EMD Resources". Retrieved 2007-07-07.
7. "EMD Training Guide" (PDF). Utah Bureau of Emergency Medical Services. January 2005. Retrieved 2007-07-07.
8. "DEMSOC Annual Report - 2005". Delaware Emergency Medical Services Oversight Council. 2005. Retrieved 2007-07-08.
9. Brian Dale. "Using the ECHO Determinant". Archived from the original on September 4, 2004. Retrieved 2007-07-08.
10. Jeff J. Clawson. "EMD: Making the Most of EMS". Retrieved 2007-07-08.
11. "Patient Plus reference to CHALET and ETHANE systems". Retrieved 2007-05-30.
12. "London Emergency planning committee use of CHALET". Archived from the original on 2007-06-26. Retrieved 2007-05-30.
13. "New York City Fire Department is the largest combined Fire and EMS service in the United States". Retrieved 2007-05-30.
14. "Mountain Rescue Association (US)". Retrieved 2007-05-30.
15. "United States Mine Rescue Association". Retrieved 2007-05-30.
16. "British Army Bomb Disposal Engineer Career Page". Archived from the original on April 5, 2007. Retrieved 2007-05-30.
17. "Maritime Search and Rescue Agencies in the UK (at the MCA)". Retrieved 2007-05-30.
18. "CANIS specialist search dog charity in the UK". Retrieved 2007-05-30.
19. "Search and Rescue service in Essex, UK". Archived from the original on 2007-09-29. Retrieved 2007-05-30.
20. "US National Emergency Number Association". Retrieved 2007-05-30.
21. "History of the 999 System". Archived from the original on 2007-05-28. Retrieved 2007-05-30.
22. "Metropolitan Police advice on using 999". Archived from the original on 2007-06-09. Retrieved 2007-05-30.
23. "UK government advice on the use of 112 alongside 999". Archived from the original on 2007-04-03. Retrieved 2007-05-30.
24. "European Commission document on the Implementation of the Single 112 emergency number" (PDF). Retrieved 2007-05-30.
25. "Australian Government Advice on Emergency Calls". Retrieved 2007-05-30.
26. "UK National Gas Emergency Number". Retrieved 2007-05-30.
27. "UK Government Gas and Electricity National Emergency Plan" (PDF). Retrieved 2007-05-30.
28. "UK Health and Safety Executive publication on dealing with emergencies - Danger assessment is the first point" (PDF). Retrieved 2007-05-30.
29. "St John Ambulance UK Primary Assessment guide". Retrieved 2007-05-30.
30. "UK Government Civil Contingencies Act, giving powers to declare a state of emergency". Retrieved 2007-05-30.