O Brother, Where Art Thou?

     The quiet of a sunny afternoon is shattered by the deafening roar of an explosion from a car bomb. As the dust clears, dozens of people are hurt, some severely, and there appear to be fatalities. EMS jumps into action, responding with multiple ALS and BLS units. They establish a command post, begin triage and soon have treatment and transport areas set up. As the incident grows in size, more and more responders arrive. Some were dispatched; others just showed up, looking to lend a hand. Paramedics and EMTS are assigned to various sectors as needed. Suddenly a secondary device explodes. There are more injuries, and now they include EMS responders. The EMS branch director is overcome with panic. How many EMTs were at the scene? Where were they assigned at the time of the explosion? Are there survivors? Are there more devices?

     Having an established accountability system in place at the time of this incident could have given this supervisor some peace of mind. Simply put, an accountability system is used to improve the overall safety of personnel responding to and operating at the scene of an emergency by keeping track of responders' assignments and locations. More specifically, an accountability system allows an incident commander to know exactly how many responders are on scene, whom they are and where they are assigned any given time. The fire service has utilized accountability systems for decades. Whether it was a riding assignment written on a blackboard or the tag systems now common in many departments, the fire service has long known the importance of keeping track of its members at the scenes of fires and emergencies. In fact, the National Fire Protection Agency, in its standard on emergency services incident management systems (NFPA 1561), requires that fire department accountability systems include a "means to specifically identify and keep track of members entering and leaving hazardous areas."¹

     While EMS generally does not operate in hazardous areas, there are times when patient care must be performed in dangerous conditions. Areas such as collapsed structures, fire scenes and other disaster sites where patients might be located can be hazardous areas.

     There are many types of accountability systems. They range from simple systems designed and produced in house to expensive electronic equipment. Not all systems mentioned in this article were designed specifically for the purpose of accountability, but they can be utilized to perform that function. Whatever the system used, one thing is for sure: The safety of personnel at emergency scenes will be improved. Let's examine some of the systems available.

     There are many styles of manual systems, including tag-based systems, dry-erase boards, even pen and paper. Tag systems have existed for some time. With this system, members are issued two or more plastic or metal identification tags. These generally have a member's name and agency/department engraved. The first tag is placed on a ring on the apparatus responding to an emergency. Once the unit arrives on scene, the ring of tags is brought to the command post and allows the incident commander to know who's there and what agency they're from.

     The second tag is used to "tag off" at particular work areas, such as the triage or treatment area. It is left with the section leader (e.g., triage area supervisor or an accountability officer whose only job is to track the whereabouts of rescuers on the scene). If personnel are reassigned, the second tag travels with them to the new work area.

     Other manual systems can include dry-erase boards or even just paper and pen. Using these technologies would involve simply writing down responders' names and agencies. Each sector would need to maintain its own personnel list in addition to keeping a master list with the incident commander. Although rudimentary, these technologies accomplish the task of recording who's operating in a particular sector. As personnel rotate out of an area or are reassigned, their names are simply erased or crossed out.

     The foremost advantage to these types of systems is cost. Others include the ease of expanding accountability to other agencies that might not use tags or other devices. This can ensure that all personnel operating at a scene will be integrated into an accountability system. Disadvantages are that these systems are vulnerable to the elements, might be hard to read if poorly written, or could get lost.

     Bar code technology is one type of electronic system that can be used directly at the scene of an emergency. Handheld bar code readers utilize existing wireless technology, have significantly decreased in size, and are less expensive than ever. They are used by some agencies to get personnel logged in and accounted for quickly and efficiently at scenes. Bar codes are placed directly on accountability tags or personnel identification cards. The on-scene accountability officer can scan each responder's ID card when they arrive in staging. As personnel move about, they can be scanned in and out of operational areas, allowing commanders up-to-the-minute information about the number and whereabouts of every member. The bar code can also contain more than just a name and agency affiliation; certification levels, special skills such as foreign languages spoken, and in some cases even photographs can be encoded and retrieved instantly by the bar code scanner. Photos can prove invaluable for security reasons.

     Vehicles are now being equipped with bar codes as well. Information about a vehicle's type, level of care (BLS, ALS, CCTU) and agency can all be embedded. Like personnel, vehicles can be logged into and out of scenes. Bar code IDs can even be printed out on scene, allowing mutual aid companies, contractors and volunteers to be integrated and tracked, even without their own IDs.

     New technology on the fire market can track both personnel and vehicles utilizing wireless networks. The equipment consists of wireless receivers and transmitters. All vehicles and responders are issued wireless tags that transmit information. These are powered by alkaline batteries, negating the need to be turned on and off. The tag can be programmed with data such as name, rank and certification level. Vehicle identification data can be loaded onto the mobile tags. Wireless receivers are located in command vehicles, and additional units can be strategically placed around a scene, much like wireless Internet hot spots. The receivers pick up the data from the transmitters and display it on a computer screen at the command post. The incident commander has every responder's name, location and assignment displayed. The software even can track the amount of time each responder has been on scene, and if they remain in the same location for too long, it sounds an alert.

     Essentially, this system allows the IC to track all personnel and equipment on scene in real time. It can split a scene into multiple sectors simply by adding additional receivers. The greatest advantage of this system is that it's automatic. Accountability no longer depends on rescuers remembering to drop and pick up tags as they move about—the computer does it for them. The largest drawback is the price, with systems starting at more than $30,000.

     The size and scope of an incident will dictate the level of accountability needed. For everyday medical emergencies and routine motor vehicle accidents, it's unrealistic to expect an accountability officer to be assigned, personnel and equipment checked in, and multiple ICS positions staffed. At the minimum, though, EMS agencies should know who's on their vehicles and where they're responding. Tag systems are especially useful in accomplishing this. Each EMT can "tag in" on the ambulance prior to responding. This allows everyone to know who's riding what. This concept is especially important in volunteer systems, where staffing can change from call to call and personnel aren't necessarily assigned to shifts or units. Imagine an ambulance involved in a motor vehicle accident. How would you know who's on board? The tag system solves this problem. Rostering the crew in a CAD system would add another layer of accountability, but not every municipality has a CAD system.

     Large-scale incidents most necessitate the use of accountability systems. These require "high levels of coordination and cooperation, and may potentially produce large numbers of casualties or cause significant damage or chaos."² They can include things like major traffic accidents, building collapses or weather-related disasters, but don't forget that the definition cites the potential for injuries, so events like concerts, sporting events and parades also fit it.

     At these major events, EMS branch directors and overall incident commanders must know what resources they have on scene, in the staging area and departing the scene. The most efficient way of accomplishing this is to institute a check-in point for all units arriving in the staging area. There are several tasks that can be accomplished in the check-in area, including personnel check-in and credentialing, equipment check-in and resource typing and tactical assignments.

     As units arrive, personnel must be logged into the accountability system and have their credentials checked. This helps create a layer of security to ensure that only certified and affiliated responders are operating, and will weed out freelancers who have responded on their own and potential criminals who may try to pose as responders. Check-in staff should utilize the ICS 211 form to log responders in. Responders should present photo ID, driver's license, certification card, agency identification and accountability tag. Verification should be done in the presence of law enforcement, if possible, in case security issues arise.

     No matter which system is used, an accountability officer must be assigned to keep track of all personnel entering and leaving a scene. If personnel are not logged in and out, tracking will obviously be inaccurate, which can ultimately lead to freelancing and the potential for responders to become lost or hurt.

     The personnel accountability report, or PAR, is a roll call of personnel operating at the scene of an emergency. Its purpose is to determine if all members are accounted for, or if someone is missing or lost. PARs can be conducted at set intervals, such as at the completion of operational periods. However, PARs are also conducted when emergencies take place. In the fire service, roll calls are commonly conducted after buildings are evacuated to ensure all personnel have gotten out. The same holds true for EMS. If EMTs and paramedics enter a scene to perform patient care, triage or other operations and the scene needs to be quickly evacuated, a procedure must be in place to verify that all members are present and accounted for. Typically, the incident commander will call each piece of apparatus over the radio, and the vehicle officer or crew chief will confirm whether all responders are present. If members are found to be missing or the officer does not answer, the accountability system can be utilized to determine who's missing and what their last known location was, so the area can be searched.

     As EMS systems become busier and operate in more congested cities and towns, the frequency of major incidents will continue to rise. In the last year alone, EMS agencies have responded to major incidents such as wildfires, crane accidents and bridge collapses. While our counterparts in the fire service are tracked and monitored while they operate at these large and dangerous scenes, EMS responders typically are not. EMS agencies must look at adopting accountability systems before the next tragic incident claims one of our own.

1. National Fire Protection Association. NFPA 1561 Standard on Emergency Services Incident Management System, 2002 Ed.

2. UMDNJ Center for BioDefense. EMS Response to the Large Scale Incident—Level 1 Awareness, 2003.

     Jeff Kaplan is a fire lieutenant with the Englewood, NJ, Fire Department. He has been a New Jersey-certified EMT-B for over 15 years, working with both career and volunteer EMS services. Reach him at kaplan@englewoodfire.com.