School Bus MCI Drill

On May 8, 2010, Ouray County EMS (OC EMS) produced an MCI drill that simulated a school bus going off the side of an embankment with a drop-off of 50-60 feet with 20-30 patients and no fatalities. This article is a "blueprint" for that drill, outlining all the logistics and components involved in such an operation. Agencies are encouraged to use this as a template for similar operations in their jurisdictions. Please check back for reports from the actual drill.

BACKGROUND

According to a website for trial lawyers, "In 2000, there were 9,000 (school) bus accident injuries, including 16 fatalities. School bus injuries result from several different causes. For one thing, most full-sized school buses are not equipped with seat belts."

In April 2002, on page V in the Executive Summary portion of a 54-page report to Congress on "School Bus Safety: Crash Worthiness Research," the National Highway Traffic Safety Administration states that "Over the past 11 years, school buses have annually averaged about 26,000 crashes resulting in 10 deaths: 25% were drivers; 75% were passengers."

In response to those statistics, on Saturday, May 8, Ouray County (CO) EMS will conduct a MCI field training exercise simulating a school bus going off the side of CR 1 with an embankment drop-off of 50¡Ç-60¡Ç, 20-30 patients and no fatalities.

This FTX will be the second in a series of exercises designed to address what we have identified as "worst case" events that might actually occur in our jurisdiction. Our first FTX extravaganza occurred on May 18th, 2008, when we pushed a bus off the scenic overlook above the city of Ouray to tackle the very real concern of a tour bus going over the side on Red Mountain. The exercise was designed to test access, rough terrain vehicle stabilization and extrication, with the Ouray Mountain Rescue Team working in coordination with our vehicle extrication team to get equipment to the site and assist in vehicle stabilization.

Our upcoming FTX, will be not only to reaffirm the lessons and changes we implemented from the Red Mountain bus exercise, but to test, among other things, our Rural First Responder Corps' scene size-up and communications, multi-agency coordination, vehicle extrication, patient triage, treatment and movement. It is being designed to test our regional mutual aid system with our surrounding EMS providers, patient transportation in real time to our primary and new back-up "emergency" receiving facilities, patient tracking, the communications systems, law enforcement functions for scene control at the accident site and the receiving facilities, as well as any additional investigation training they wish to conduct. We will also be training two Rural Fire Protection Districts that would be the first and second due fire-rescue agencies to an accident of this nature.

OC EMS will train its members to properly fill out and run the various roles for ICS and MCI: Medical Group Supervisor, Triage Officer, Treatment Officer, treatment area leaders and members, Transportation Officer and Staging Officer. Through a series of lectures, TTXs and training scenarios, we will also cover the hows and what-to-dos in coordinating patient care in the treatment areas, including filling out information on triage tags; monitoring ongoing treatment; protecting patients from the elements; patient movement from triage to treatment areas and between treatment areas as a patient's condition improves or deteriorates; movement to the transportation area; and patient hand-off to transport ambulances. Caregivers will have to ask alert patients if they know the names of unconscious or altered mental status patients and record that information.

We will also train our EMS staff and volunteers in the proper use of various MCI forms/templates and get them comfortable in using them. In addition, we will have to develop a system to work with law enforcement for sharing names and patient tracking in compliance with HIPAA rules and regulations (see HIPAA section later in this document).

All patients will be transported to the Montrose Memorial Hospital ED to continue the drill as an in-house test of the hospital's external MCI plan or to the Mountain Medical Clinic to practice rural trauma training program skills.

Because this is a school bus "accident" involving 20-30 pediatric patients, plus the bus driver, scene security and patient tracking will be an especially serious issue. As most of us already know, word of the accident will rapidly spread via the "mountain telegraph" system that exists in all rural communities, and the scene and two receiving facilities will be inundated with relatives, caregivers and neighbors, all trying to learn about their children.

ADMINISTRATIVE TIMELINE

An initial proposal to produce this FTX was presented to the Ouray BOCC in November and permission was granted to proceed. The more formalized and in-depth scenario draft is scheduled for delivery to the BOCC on Monday, December 21, 2009, along with many of the invited and participating agencies for review and comment. OC EMS is requesting that suggestions, questions or issues not addressed by this document be sent back to us no later than January 21st so they can be evaluated and acted on in a timely manner.

THE SCENARIO

A school bus transporting 20-30 children swerves off CR 1 and rolls down a 50¡Ç-60¡Ç embankment, coming to a stop at the bottom of an arroyo. A passing motorist observes tire tracks leading off the road and discovers the school bus. Because there is no cell phone service in that part of the county, the driver leaves his passenger at the scene to wait for emergency vehicles and drives into the town of Colona, where he can get a cell phone signal and call the accident in to the CSP dispatching center in Montrose. The CSP dispatchers will then relay the information to the Montrose sheriff's dispatch center to dispatch the appropriate rescue, LE and EMS resources. Emergency responders will respond to the scene on a narrow, two lane-wide dirt road, which is the type of location that can easily become gridlocked by emergency vehicles if not adequately managed and staged.

FTX LOCATION

When we were originally scouting for a location for the Red Mountain Bus FTX in 2007, Ridgway's Marshal, D. Scott, suggested the county lot and Mall Road. While that was not a workable site to simulate a bus going off the Million Dollar Highway, it was perfect for simulating a bus going off CR 1 and down one of the arroyos. The Ouray BOCC and Chris Miller, director for Ouray County Road and Bridge Department, have given us permission to utilize this site.

OBTAINING A SCHOOL BUS

Ridgway bus supervisor Maggie Graff has facilitated donation of a surplus bus that is being decommissioned from the Ridgway School District. The bus has already been moved to the Ouray County Road & Bridge facility, and she is having the Ridgway School District sign the bus title over to Ouray County. (Maggie has also indicated that the district has two more buses that will be decommissioned over the next several years that may be available for donation for future FTXs/training scenarios.)

To make this FTX as "green" as possible and minimize any environmental impact, all fluids will be drained from the bus prior to rolling it down the training site. We do not want any fluids to leak or create any sort of negative environmental impact. We also want to eliminate/minimize the chance for any hazardous materials exposures to FTX participants and observers. Chris Miller has indicated that he will have his road and bridge mechanics take care of this so the bus is "dry" by the FTX date.

PARTICIPANTS

Participating agencies/stakeholders would include:

• Ouray County (OC) EMS - First Responder Corps, ambulances and EMS administrators/ALS
• OC EMS - Squad 11
• Montrose FD extrication team
• OC Sheriff's Office
• Ouray Mountain Rescue Team (?)
• OCSO's communications van/mobile command post
• Colorado State Patrol Troop 5C (Montrose post)
• Ridgway Marshal's Office
• Ouray Volunteer Fire Dept.
• Ridgway Volunteer Fire Dept.
• Log Hill Volunteer Fire Dept.
• Ridgway State Park LE rangers & EMTs (?)
• Mutual Aid Ambulances from: Montrose Fire & EMS, Telluride Fire & EMS, Norwood Fire & EMS, Silverton EMS, Montrose Memorial ED, The Mountain Medicine Clinic.
• 20-30 high school & middle school-age volunteers to be victims; 1 adult to role-play the injured bus driver; and 50-70 role-players to be parents/concerned relatives of the victims.
• Two school buses & drivers to retrieve the victims
• Careflight of Montrose will be invited to participate. The decision on whether to incorporate them into the FTX will depend on their willingness to participate and weather conditions on the day of the FTX.

CONTINUITY OF CARE

While OC EMS has two primary ambulances and two fully stocked reserve ambulances, we will only commit Ridgway's primary and the two reserve ambulances to this FTX. The Ouray primary ambulance will remain in service to cover any emergency incidents that may occur in the county while the FTX is being run.

THE FTX

All responders and participants will be staged at the Road & Bridge Department yards. Permission will be obtained to utilize the Land Use Office's event room as a feeding area for everyone. Several upper area observation points will be established for participants to observe the bus going over and subsequent rescue operations from a safe distance, yet available to respond as their time in the script comes up.

Several additional safe viewing areas will be established in the lower yard for the press and other observers to watch the FTX while clear of the operation. (This will include elected officials, agency representatives, interested invited observers like Ridgway and Ouray School District bus drivers, the media, etc.)

The bus will be rolled/tipped off Mall St. and roll down the embankment to the lower yard. All access to the bus by rescuers will be from Mall St. Several victims will be placed on the hillside and several more will be out and wandering around the bus to simulate injured children who were able to exit the bus on their own.

As with the Red Mountain bus exercise, a Rescue Randy manikin will be pinned in the driver's seat. For patients, we hope to obtain a series of pediatric manikins (see POSSIBLE BONUS TRAINING AND RESOURCES) that we will number and seat in the bus before we push it over the side. We will stage already-moulaged pediatric victims with corresponding numbers off to the side. As each pediatric manikin is rescued/extricated from the bus, the moulaged patient with the corresponding number will be brought from the holding area and secured to the backboard or rescue litter used to bring the manikin off the bus. The same will be done for the adult bus driver.

(By using manikins for the vehicle extrication portion of this FTX, we hope to appease the county's insurer and allow us to utilize real pediatric patients for the rest of the drill to make it as realistic as possible. Ouray's county attorney is discussing this issue with the insurer, and we are awaiting their decision.)

SAFETY OFFICERS

As in 2008, we hope to use the services of New Mexico-based vehicle extrication training specialists Pete Bellows and Rufus Campbell to oversee the vehicle extrication and patient movement portions of the FTX. OC EMS will send a copy of this proposal and request a bid for their services in this capacity so we can budget for their services and track down funding for the same. An EMS and technical/rope rescue safety officer will also be recruited from outside agencies to oversee those portions of the FTX.

TIMING

In an attempt to make this training exercise as realistic as possible, the arrival of emergency units will be scripted closely to calculated actual response times under daylight driving conditions in good weather. All units will be staged in the parking lot of the Land Use facility so responders can watch the bus going over the side and rescue efforts as they progress until it is their turn to "arrive on scene." This will obviously take some coordination and the efforts of a good staging officer.

The FTX will ignore the initial time from when the bus is discovered until the first emergency responders arrive on scene, so we will get a 15-20+-minute "jump" on the actual time it would take for a scenario like this to play out.

OC EMS Rural 1st Responders will be first to arrive on scene and will need to do a proper scene size-up, communicate what they have and begin START triage and treatment for those patients they can access (mainly those on the hillside and walking around outside the bus).

Next to arrive will be an OC sheriff's deputy, followed quickly by two units from the Log Hill Volunteer Fire Department. The Ridgway ambulance and two OC EMS ALS QRVs will arrive 15 minutes later.

10 minutes later, the Ouray Ambulance, Ridgway VFD, another OC EMS ALS QRV and Squad 11 will arrive on scene.

5 minutes later, additional LE officers will arrive on scene, as well as EMTs and LE rangers from Ridgway State Park, if they are interested in participating. (This would also be when the OC SO's Command & Communications van would arrive on scene and be set up, if that is written into the drill.) Additionally, a Montrose FD ambulance responding from Station 2 and the first units of the Ouray Mountain Rescue Team (OMRT) will arrive on scene.

5 minutes later Squad 11, Ouray's back-up ambulance, Telluride Fire & Rescue Placerville Ambulance, and the rest of the OMRT members will arrive.

3 minutes later, the first group of parents/guardians start to arrive and will continue to arrive in approximately 5-minute increments, interspersed with arriving emergency responders so they are not arriving on scene simultaneously. This will continue every 5-10 minutes until all 60-70 role-playing agitated and concerned relatives arrive on scene.

5 minutes later, Silverton EMS and a CSP unit(s) will arrive on scene.

10 minutes later, Telluride Fire & EMS ambulance and Norwood Fire & EMS ambulance will arrive on scene.

(Silverton EMS, Montrose FD, Telluride Fire & EMS, Norwood Fire & EMS and other selected agencies will be invited to have additional members attend to act as observers and participate in the after-action debriefing process.)

Once the bus been properly stabilized by Squad 11 and members of Log Hill and Ridgway VFDs, the remaining victims will be placed in the bus, if the plan to use manikins turns out not to be a viable option.

Patients will have to be triaged, initial treatment started as practical, extricated from the bus, packaged and transported up the hillside for re-triage, treatment and transportation to either Montrose Memorial Hospital (to serve as an external disaster/MCI drill) or to the Mountain Medical Clinic.

LE could also continue the FTX by interviewing the bus driver, accident scene investigation, etc. if they so desire. This would be up to the Ouray County sheriff and Montrose CSP accident investigation team.

A school bus will go to each location to retrieve student victims and bring them back to the County Land Use Office for debriefing, accounting and release.

POSSIBLE BONUS TRAINING AND RESOURCES

Ridgway School District Transportation Supervisor Maggie Graff has proposed getting the Colorado Department of Education (CDE) and/or the National Association of Pupil Transportation (NAPT) to fund a school bus seat belt study as part of this FTX. The proposal is to fund placing seat belts in every other seat on the school bus, obtain 30 pediatric-sized manikins, 15 to be seat-belted and 15 to be unbelted, and mount several cameras in the bus to film the action as the bus is pushed/rolled down the embankment.

Film footage would be made available to C-DOT, CSP and OC EMS for training and educational purposes. Additionally, the group that funds this program would provide a point of contact and a way for nonprofit groups like the National Association of EMTs (NAEMT) to obtain a copy of the footage for training EMS workers on what kinds of injury patterns to expect with this kind of accident.

If this is possible, it is hoped that this in turn will make us eligible for funding from the Tri-County Seat Belt Coalition and/or the Colorado Dept. of Transportation, C-DOT, to offset some of the FTX expenses.

STAGING

As mentioned previously, all participating units will be staged at the Ouray County Land Use Office and, for real response time increments, be held there until sent to the scene to stage and transport. Due to the nature of the two-lane road, staging will be of critical importance for the arriving units.

Several areas should be designated for different types of responding units, such as LE, fire suppression, vehicle extrication, ambulances, Mountain Rescue, etc. Drivers will either need to stay by their vehicles or leave the keys in the vehicles in case they need to be moved. In turn, this adds the need for staging area security so no one can walk in and pillage the vehicles while everyone is focused on the emergency response. This is an area that will need to be trained by chief officers and incident commanders and then put into practice at a TTX to be scheduled in March or April.

PATIENT TRACKING

One of the hot issues currently being addressed by the Department of Homeland Security Science & Technology's First Responder Working Group is how to make an accurate and easy-to-use system to track patient movement from initial extrication through triage, treatment and transportation to arrival at the receiving facilities--and do it all in real time.

The current "standard" is a paper-based system, using colored surveyor's tape and cardboard tags with tear-off, sequentially numbered segments, and transferring by hand the patient information and destinations on paper forms to go along with the respective number on the triage tag, and, from there, the numbers, patient name, age and destination to ICS for MCI patient transportation forms. This is a time-consuming system that is frequently short-changed due to failure to assign individuals to act as scribes for the medical group supervisor and, more importantly, the transportation officer.

Two years ago, the state of Colorado's Office of Emergency Management conducted a huge patient movement exercise called Operation Mountain Move. The FTX simulated a chemical attack on attendees at a music concert in Summit County. Large numbers of patients (in this case, triage-tagged Teddy bears) were moved by ground and air ambulances for distribution to front-range hospitals.

The FTX organizers deliberately "waylaid" more than 200 of the "patients" en route. These patients were never caught at the receiving end, and for all intents and purposes, disappeared into the void. Real-world examples of "losing" patients occurred multiple times during the response and recovery efforts for Hurricane Katrina.

To avoid this problem with OC EMS's paper trail method of patient tracking, we will need to pay close attention and make an effort to document patient identification and information, and share that information with law enforcement and emergency management. One suggestion is to have a law enforcement representative assigned to the transportation officer to assist with patient tracking and documentation, and to share that documentation with the IC and LE investigators. In turn, the IC, working with their staff and Public Information Officer, will be able to accurately notify the concerned parents/caregivers of the patients about their youngster's status and destination facility.

HIPAA IN DISASTERS

In the aftermath of Hurricane Katrina, some hospitals and agencies were reluctant to exchange patient information, fearing HIPAA-related repercussions. Upon learning this, the Federal Health and Human Services Agency's Office of Civil Rights issued two bulletins clarifying the legality of hospitals sharing patient information in emergencies. These HHS bulletins made it clear that patient information may be shared:

• As necessary to provide medical treatment.
• To identify and locate family members, guardians and others responsible for victim care. This includes giving information to the press, to law enforcement and to the public.
• To prevent or lessen a serious and imminent threat to the health and safety of a person or the public.
• As part of a directory of patients to answer inquiries about whether individuals are at a facility and their condition.

This legally allows OC EMS to share patient names, ages, injury status and patient transportation destinations with law enforcement and emergency management while maintaining full HIPAA compliance.

PATIENT TRANSPORTATION

Patient transportation will occur in real time, and all patients will be taken to one of two or possibly three destinations. Should Careflight of Montrose, our closest air ambulance provider, choose to participate and the weather cooperates, the bus driver, an adult scripted with critical, life-threatening injuries, will be transported down to the open field at the county fairground north of the 4-H Event Center. If there is an event scheduled at that facility, the alternate Ridgway LZ site will be the ReMax Field diagonally across the way from the fairgrounds. Whichever LZ is selected, it will require a LE officer and one fire-rescue unit for scene security and safety.

For insurance reasons, only the adult patient will be airlifted out, although, if this was an actual incident, the most critical patients would be airlifted as needed, and if air ambulance availability and weather conditions would allow. In the real world, if the patient was critical enough to require evacuation by air ambulance, they would most likely be flown to St. Mary's Hospital, a Level 2 trauma center in Grand Junction, CO. For this FTX, the patient will be flown to Montrose Memorial Hospital.

If Careflight of Montrose is unable to participate, the adult critical patient will be included in the pool of Red and Yellow category triaged patients to be transported by ambulance to Montrose Memorial Hospital. All Green patients, the walking wounded, will be transported either to Mountain Medicine Clinic or a treatment area the MMC has set up at the 4-H Event Center.

In April 2009, St. Mary's Hospital, through a state-funded grant, sent a team to Ridgway to put on a one-day Rural Trauma Training Program. This is a program specifically designed for rural/frontier clinics to evaluate and provide life-saving stabilization and treatment for trauma patients. The minor injured trauma patients can be treated and released, and the moderate to seriously injured patients can be appropriately evaluated, life-saving stabilization techniques administered, and the appropriate receiving facility notified to expect the patients with the right report given to the right individual.

This highly successful program has been taught to clinic staffs throughout the Western Slope area by the St. Mary's training team. OC EMS ALS providers took this course alongside the Mountain Medicine Clinic physicians, physician assistants, RNs and nursing assistants. This allowed both groups to learn the capabilities of the other and to facilitate working together even more smoothly should the need arise. (We enjoy a very good working relationship with the MMC.)

One of the suggestions that came out of the facilitated discussion led by Leslie Williams, trauma services coordinator for St. Mary's Hospital and course coordinator and instructor, was early notification of the MMC so they can assemble supplies and paperwork and move the operation to the 4-H Event Center if it's available. Regardless of whether we actually use the 4-H Event Center, the following need to be addressed:

• Who has a key to unlock the center?
• Who do we notify, and how?
• Where are the light switches?
• How do we get access to tables & chairs?
• Setting them up with the idea of patient privacy and accommodating the parents who will be descending on the clinic or 4-H Event Center in search of their injured children.
• Site security. Coordinating with the Ridgway Marshal's Office to have a deputy respond to either the clinic or 4-H Event Center for site security, as well as call off-duty deputies to assist/maintain patrol functions.

Regardless of the location for patient receiving, all ambulances will drive at normal speeds, observing all traffic laws. There will be no "Code 3" lights & siren transports to the hospital or clinic regardless of the patient's triage category!!!

COMMUNICATIONS

Communications has been the weak point for most moderate to major incidents in the United States. We hope to address a number of these issues and test the region's new Regional Communications Plan.

The initial page-out will be on Ouray County Primary Channel, announcing that this is only a drill. All additional communications will be done on the various tactical frequencies. Alan Staehle, the Ouray County Emergency Manager, has developed a county communications plan and has plugged this into an ICS Form 205 template, taking into account lessons learned from the Red Mountain Bus FTX.

We will also be exploring with the Susan Byrne, manager of Montrose SO communication, the concept of having a dedicated dispatcher for a large-scale event. It would most likely mean recalling an off-duty dispatcher or pressing into service an extra dispatcher to just staff the radio for MCI traffic or to back-fill for other radio traffic, since life does not come to a stop elsewhere just because a major event is occurring.

In addition, the West Region Emergency Planning Committee, of which Ouray County is a part, has been tasked with developing a regional communications plan for the state and the Department of Homeland Security to be submitted by June 1st, 2010. Rob Fiedler, the Delta County Emergency Manager and member of the Western RETAC, indicated during our discussions that the West Region Emergency Planning Committee would attempt to have its plan completed by April 29th to allow it to be beta-tested by our FTX. This would allow them to evaluate their plan and tweak it as needed before final submission.

As will be outlined in the IAP, a series of safety code words will be established to: halt the FTX until a safety issue can be resolved; to resume the FTX; to switch gears and indicate that an actual rescue is needed, such as for a traffic accident occurring near the FTX site; and to notify participants to listen up in the event an agency needs to pull out of the FTX to respond to a major incident in their own jurisdiction. If they are transporting a "patient" at the time this occurs, an intercept with an OC EMS administrative vehicle will be set up to retrieve the patient.

TRAFFIC AND TRAFFIC CONTROL

The FTX site, the county-owned flat below Mall St. and Mall St. itself are readily visible from Hwy 550, as is the county fairground and, to a lesser extent, the ReMax LZs. To address the "lookie loo" factor, we will adopt a three-pronged approach:

As with our Red Mountain FTX, we will petition the Ridgway C-DOT office to post portable traffic message signs north and south of the FTX site, advising the driving public that a training exercise will be or is occurring. We will request that these signs be set up several days in advance.

Several weeks prior to the FTX, a press release will be issued to area newspapers and radio stations notifying them of the event and requesting that they advise their respective readers/listeners.

In a December 18 briefing meeting with CSP Post 5C commander, Capt. Clark Bates, he indicated that he would detail a couple of additional officers for this FTX to manage traffic flow on Highway 550. He indicated that his major accident investigations sergeant would be participating as well.

REALISM

Every effort is being made to make this FTX as realistic and as safe as possible. One of those efforts will be researching school bus accidents to develop a realistic set of injured patients for this scenario. OC EMS Training Officer Stephen Lance is researching this and creating a list of realistic injuries that will be drafted and submitted to OC EMS supervisor Colette Miller, our moulage specialist, by January 21st. This will allow her to calculate what supplies will be needed, develop a budget for moulage supplies, train volunteers to apply moulage (she may be out of town the weekend of the FTX) and to start building/creating the injuries in a reasonable time frame.

By using manikins, Squad 11 and the Montrose Fire Department's vehicle extrication teams can go full speed under the watchful eye of safety officers at vehicle stabilization, access and patient extrication. Once a "patient" manikin is extricated, its number will be called and the moulaged victim with the corresponding number will be brought from a holding area and inserted into the scenario for completion of evacuation up the slope, treatment and transportation to a receiving facility.

TRAINING

OC EMS is requesting that all participating agencies look at their response capabilities and identify any areas they may need or want to train in. OC EMS Squad 11 will be conducting a school bus anatomy and stabilization/extrication techniques review in early to mid-April. It is hoped this can be done jointly with Montrose Fire Dept.

Some of the training points will include staging of apparatus and how to be a staging officer, leaving keys with units, site security, communications protocols, etc.

In conjunction with Gunnison Hospital EMS, OC EMS developed an 8-hour MCI management class that included lectures on ICS for MCIs and Simple Triage and Rapid Treatment (START), followed by group quiz, TTXs and then a mini FTX of an MCI event for the 2009 All Hazards Conference in Grand Junction. Using that experience, we have already begun the training process among our field providers with a review of START and mini TTXs utilizing START, then prioritizing patients for order of transport from the treatment areas. We plan to reinforce this training along with a series of trainings on how to perform the various MCI ICS positions and the forms that go with each position.

We will also be offering training assistance to our county fire protection districts and LE agencies if they desire it. This may be in the form of facilitating or putting on ICS 300 & 400 level courses for fire officers and chiefs who have not yet obtained this training, setting up a TTX for their respective departments to run a brief 1+-hr training module on the roles and responsibilities of a staging officer and how to do the job, including a check sheet and familiarization with the appropriate ICS forms.

We may also want to consider bringing back Todd Manns to do his one-day basic ICS forms class, especially since there will not be a 2010 All Hazards Conference. We will bring this all together in a meeting at the County Land Use Office and site walk-through in mid-April for all interested parties.

VICTIMS/ROLE PLAYERS

Depending on the county insurer's final ruling, we would like to recruit 20-30 adolescent victims from the Ridgway School District Drama Club and from the Ouray School District's Wilderness First Responder class that we conduct each winter semester. A common problem encountered at other FTXs utilizing adolescent role-players is that they sometimes go off script and even swap injury descriptor tags. We will need to take steps to ensure that the role-players selected stay on script and in role.

For the role of the injured bus driver, which may include a helicopter flight, the right of first refusal will be given to the Ridgway School District bus driver's corps. If none of the bus drivers elect to role play, BOCC Ouray County Clerk, Linda Munson-Haley, has offered to accept that role.

We will reach out to the parents of "student" role-players to play the parent roles, and Mary Rassmusson at Montrose Memorial Hospital has suggested we recruit nursing class students to role-play as parents. Finally, we will put out a film industry-type "cattle call" for role-players as concerned parents/relatives who will descend first on the FTX site and then on the clinic and hospital looking for their injured loved ones.

OBSERVERS/MONITORS

OC EMS will request observers from other EMS groups, like Gunnison Hospital EMS, to monitor the EMS portions of the FTX and submit comments during the debriefing session and a brief write-up within two weeks post-event. We will also invite observers from the receiving hospitals to give them a better understanding of the pre-hospital aspect of the MCI. The Montrose CSP and SO dispatch centers will be invited to send some of their members to observe operations in the communications van and for the IC so they can see how communications are handled at the other end of the radio. Hopefully, they might come up with suggestions for additional training, techniques or ideas to facilitate communications for us in the field as well. We will invite the St. Mary's Hospital Rural Trauma Training Team to send an observer down for the Mountain Medicine Clinic portion of the FTX.

WEATHER

The training exercise will take place regardless of the weather. Additional safety monitors will have to be available to monitor participants in the event of inclement weather. We will consult the NOAA weather station in Grand Junction for weather projections the week prior and the Friday before the FTX so arrangements can be made as needed.

EOC AND NOTIFICATIONS

Since this FTX will not exceed a single operational period, there is no need to put up an EOC, even in an observational/preparatory capacity; however, elected officials, the county administrator, and the managers for the city of Ouray and town of Ridgway need to be notified of an event like this, if for no other reason than the financial impact it will have on their respective jurisdictions due to overtime for the short-time recall of various key employees like law enforcement, public works, etc. This will keep them from being "blind-sided" by the public with questions about the event.

We have brainstormed several solutions and will be exploring them further for practice with this FTX. First is to take advantage of the REVERSE 911 System and assemble several pre-programmed lists, including cell phone numbers for the Ouray BOCC, county administrator and city and town managers so at the time of an event, the incident commander can simply select the designated program and send out a text message to alert these officials.

A second possible solution is a program called Web EOC. This is a web page that elected officials, administrators and mangers could log into and follow the incident response on-line. Steve Denny, Western Slope regional coordinator for the Colorado Office of Emergency Management will in-service Ouray County Emergency Manager Alan Staehle on this system.

Based on how it works, we will practice and train comm van staff on how to utilize the system. We will also provide training/orientation for members of the BOCC, the county administrator and city and town managers and their assistants on how to access and use this site. While there will probably be a moderate to somewhat steep learning curve, this should prove to be a useful tool to facilitate communications and monitoring of operations from the field for major incidents.

INCIDENT ACTION PLAN

A detailed IAP will need to be drawn up and vetted by March. By the second week of April, we will distribute it to all involved participating agencies, as well as to involved elected officials, administrators and managers whose agencies are involved.

DEBRIEFING AND AFTER-ACTION REPORT

A series of debriefings will be held at the OC Fairgrounds 4-H Event Center--the first with OC EMS First Responders and the second with the volunteer fire departments, Squad 11 and the Montrose FD extrication crew and LE.

Law enforcement will be encouraged to hold their own debriefing to discuss the event from their perspective and provide us with a summary for inclusion in the final report, as will the Mountain Medical Clinic and Montrose Memorial Hospital.

After the debriefing, all participating emergency units will be fueled from the county pumps and released to go home.

An after-action report will need to be assembled based on the observations of various chief officers and the debriefing process conducted in the field, as well as from the hospital and clinic. We anticipate that the report will be completed by mid- to late November and will be made available to all participants and the BOCC.

PUBLICITY

An event of this magnitude is an ideal public information event. A press release or series of press releases will be developed and area newspaper reporters will be invited to observe the FTX and report on it. This could also be an opportunity for emergency agency heads or PIOs to practice issuing timely statements to the media. We might also invite the TV stations out of Grand Junction.

For the Red Mountain bus FTX, we invited 5 individuals to photograph the event as they saw fit, as long as they heeded the safety officers. We also recruited the Ouray School Video Club to document the event. All photographers and videographers were issued safety vests and helmets for easy identification. We will approach the Ridgway School District's Photo/Video Club to see if they would be interested in documenting the FTX.

As in 2008, we will contact several of the commercial fire and EMS on-line and video/news organizations like 24/7 EMS to offer them the opportunity to film the event and/or access to footage from the video club, as long as they attribute the organizations and give video club members photo/video credit/byline for footage used.

INSURANCE

We will need county insurance in the very unlikely event that a participant should be injured and the county attorney will create a parental waiver explaining what we would cover for medical treatment, expenses not covered by the volunteer's own health insurance, and a release of liability.

FUNDING

A budget will need to be assembled by February at the latest. Anticipated expenses include, but are not limited to:

• Equipment purchases as indicated by Squad 11 from lessons learned at the Red Mountain FTX.
• A hundred gallons or so of diesel and unleaded gasoline to replace what participating agencies expend for the FTX.
• Funds to hire two vehicle extrication specialists/safety officers, whose expenses will include fee, mileage and two nights' lodging. In addition to their consultation and safety officer services, within one month after the exercise, they will also submit a written after-action report on how the FTX went from their perspective and suggestions for improvement. A bid request will go out over the Christmas holidays.
• Moulage supplies for up to 31 "patients."
• Food for the participants--pizza, coffee, other beverages and donuts--during the FTX and the debriefing afterwards.
• 16 cases of water for use during the FTX. One of the lessons learned from the Red Mountain FTX was that even on a moderately warm day (76 degrees F) with light variable winds, 12 cases of water for a 4-hour FTX was not enough.
• If possible, souvenir T-shirts for all participants. This would entail a design competition, bids and printing and transporting them to the debrief site for issue.

This will be submitted as a request for funding through various foundation or grant sources. The CO Rural Health Cooperative provides funding for rural health training activities, and this should fall within their guidelines. Another source might be the Western RETAC of which OC EMS is a participating member. Robyn Funk, the grant writer for Western RETAC, will be solicited to assist with this.

BUS RECOVERY AND DISPOSAL

One of the problems encountered with the Red Mountain Bus FTX was retrieving the bus and towing it away. The bus sat on the canyon side for 6 days post-FTX before being towed by a heavy-duty wrecker. During that time, the city manager and Ouray County sheriff received numerous phone calls from concerned citizens wanting to know when it was going to be removed. Once towed, the wrecker parked the bus at the scenic overlook above Ouray and went on to another job in the Durango area.

The bus remained in that parking area for an additional 3 days, where, at one point it served as inspiration for a 20-something female hitchhiking through the area. She was so inspired by the scenery, she climbed on top of the bus and took off all of her clothing to write poetry in full view of passing motorists. A sheriff's deputy had to "motivate" her to put on her clothes and climb down.

To avoid difficulties, we are proposing to contact a different towing company to provide a medium-duty wrecker to right the bus and tow it to Recla Metals for sale as scrap metal. We will establish a percentage to split with the towing company, say 40% of the salvage value of the bus for this service. (We will need to get the weight of the bus from Maggie Graff and contact Recla Metals to obtain an estimated salvage value.)

The full check will be made out to Ouray County EMS, processed through the County Treasurer's office and a check for their percentage will be issued to the towing company. The balance of funds would be put back toward off setting the expenses for putting on this FTX.

CONCLUSION

This is just a draft for this FTX. OC EMS would be very interested in your input and suggestions on how to make a FTX happen, specific suggestions on how to accomplish or improve on it, with the ultimate result of running a realistic test and training on a possible mass casualty/technical rescue incident for Ouray and our neighboring counties.

Norm Rooker recently retired as chief paramedic for Ouray County EMS in Ouray, CO, and is a frequent contributor to EMS World.