Mass Casualty Incident Management: Part 3

“Now is the time to inventory lessons learned from previous disasters and use them to plan together.”

-George Buck, Preparing for Terrorism: An Emergency Services Guide

In this series we have discussed the importance of identifying and declaring mass- or multi-casualty incidents (MCIs), along with reasons responders may be reluctant to do so. In this article we will consider the preparation and training that should be in place to maximize performance at the MCI itself.

Pre-incident planning is the key to success for any MCI operation. While we may not know the exact who, what or when of the next MCI, we can identify key hazards and resources and the methods to bring them together before the next “big one” happens.¹ While the exact level of preparation will vary greatly from service to service, the following components should be included in all preplans.

Hazard assessment: Consider the types of mass-casualty incidents most likely to occur in your area. This should include both low-impact MCIs such as motor vehicle accidents and high-impact possibilities such as large-scale industrial accidents, mass gatherings, etc. Assessments should be realistic and exclude incidents that are unlikely to involve your community.

Resource assessment: Consider potential resources that will be available during normal operations as well as reserves that might be brought in to deal with increased patient loads. Such resources may include reserve supplies and equipment as well as mutual aid from surrounding communities.

Deployment: While it is one thing to preplan resources to meet potential hazards, it is quite another to do so in such a way that available responders will be able to deploy those resources properly. Once components of your MCI preplan have been identified, gather stakeholders (including first responders, fire, EMS, law enforcement, emergency management, public health, etc.) and begin to train with your MCI management system.²

Education: Information about preplanned hazards, resources and deployment, as well as the general roles, responsibilities and procedures of the agency’s chosen MCI management system must be distributed to emergency responders and other stakeholders.

Training: This is where the rubber meets the road. If education is cognitive preparation for MCIs, then training is the psychomotor, hands-on component. It may involve large-scale simulations, tabletop exercises and everything in between. What is certain is that, again, all stakeholders should participate together.

Culture change: Some stakeholders may have difficulties when these training exercises challenge their preconceptions of MCI management and their roles in it. These will not be overcome by a single education session or training exercise, no matter how comprehensive. True and functional preparation for effective response to mass-casualty incidents takes long-term organizational commitment. Luckily, this commitment will yield payoffs in operational improvements not only during MCIs, but also in daily operations.

ICS and NIMS

While some components of an education and training program are specific to a community’s preplan and selected MCI management system, other components are unified across the United States to help in the management of all large-scale and multijurisdictional incidents.^3–5 The Incident Command System (ICS) and National Incident Management System (NIMS) are different but complementary systems that create a framework for your service’s operations at an MCI or large-scale incident, as well as for all local, regional, state and federal agencies. ICS and NIMS share 10 key features that make them vital for the management of any MCI or large-scale incident. These are:

• A standard structure for all agencies to use;

• Expandability to match evolving incidents;

• Contractibility as incidents de-escalate;

• Modularity, so users can pick and choose the components needed for their incident;

• Chain of command, so the reporting line is clear to all involved;

• Unity of command, so responders always know to whom they directly report;

• Span of control, so those in authority don’t have too many people reporting to them;

• Standardized communication across agencies;

• Accountability for responsibilities and actions;

• Finally, the last word in any conversation, money. Not only is most ICS and NIMS training free, but as of Homeland Security Presidential Directive #5 in 2003, ICS and NIMS training is mandatory before your service can utilize any federal grant funds.

ICS/NIMS core classes are available online at no charge through the FEMA Emergency Management Institute Independent Study Program.

Yet the best reason to learn, love and live ICS and NIMS is that they emphasize the coordination and cooperation that must be achieved for the smooth and efficient management of any multivictim/multiagency emergency—which is, of course, the very nature of the MCI. Education and training based on a solid preplan will not only improve your readiness to deal with the “big one,” but improve your day-to-day operations as well.

In next installment: different agencies, different MCI systems, one approach.

References

1. Buck G. Preparing for Terrorism: An Emergency Services Guide. Delmar Cengage Learning, 1997.

2. Bullock J, Haddow G, Coppola DP. Introduction to Homeland Security: Principles of All-Hazards Response. Butterworth-Heinemann, 2009.

3. American Academy of Orthopaedic Surgeons. Emergency Care and Transportation of the Sick and Injured, 10^th ed. Jones & Bartlett, 2006.

4. Limmer D, O’Keefe MF, Dickinson ET. Emergency Care. Pearson Education, 2011.

5. Mistovich JJ, Karren KJ, Hafen BQ, Werman HA. Prehospital Emergency Care. Pearson/Prentice Hall, 2008.

An emergency responder for more than 20 years with career and volunteer fire departments, public and private emergency medical services and hospital-based healthcare, Rom Duckworth is an internationally recognized subject matter expert, fire officer, paramedic and educator. He is currently a career fire lieutenant, EMS coordinator and an American Heart Association national faculty member.