Mass Casualty Incident Management: Part 12

Throughout this series we’ve discussed tools you can use to prepare for, manage and teach other responders about mass-casualty incidents. In this final installment we detail the resources available in the Operational Templates and Guidance for EMS Mass Incident Deployment document released by FEMA in July 2012.

Prepared by an expert review panel with input from partner organizations including the National EMS Management Association, NAEMT, IAEMSC, IAFC, IAFF, NVFC, NFPA, NAEMSP, NHTSA, U.S. Fire Administration, U.S. Department of Health and Human Services and Department of Homeland Security, this document, in the words of U.S. Fire Administrator Ernest Mitchell, “will lead to a better prepared EMS deployment to mass-care incidents."¹

The document can help agencies prepare for a full spectrum of mass-gathering and mass-casualty deployments without having to reinvent the wheel. Recognizing the tremendous diversity in the types of communities in the U.S. as well as the EMS models that protect them, this document provides “ready-to-use” templates, concrete guidance and real-life case studies to help any agency take immediate steps to better prepare for large-scale incidents. With the increase in both man-made and natural disasters,² along with a lack of EMS representation in many local, regional and state emergency plans,³ this document is a long-overdue step in the right direction.

Operational Templates begins with the introduction of a simple emergency operations plan framework to serve as a guide, overview and centerpiece in the emergency management and MCI preparation processes. Following that is a comprehensive template for performing a hazard vulnerability analysis (as discussed in Part 3 of this series, “Preparation”). Even if you are not involved in emergency management in an official capacity, considering the hazards and vulnerabilities in your response area will make you a better emergency responder.

The next template is for incident and event plans. Here again, preparation is improved as much by the thought that goes into answering the template’s questions as it is by actually having the template on-hand at any given emergency.

The fourth template contains a number of incident deployment checklists. Designed for large-scale incidents, these not only provide standardized Incident Command System forms and to-do lists, but describe their use and purpose. If you are looking for a checklist of job duties for the triage or treatment group supervisor, you will find it here.

The next section in Operational Templates is the mass-care coordination toolkit. This contains a number of outlines that can assist in preparing for things like local sports events, residential medical facility evacuations, political gatherings and weather emergencies. While these templates don’t cover every possible emergency, going through one can help you plan for and respond to a similar event, and going through all of them will help you consider aspects of emergency response beneficial to the many types of incidents in between.

Section III covers recent mass-care incidents from across the country and lessons learned from them. Each case study presents unique problems (e.g., shelter requirements, high security events, wide geographic scope) that you should review in the context of the types of incidents likely to occur in your jurisdiction.

Sections IV and V provide procedural guidance for your agency, including some great advice for policies on any topic: “Plans for an MCI should be simple and straightforward. Experience demonstrates that the more complex a plan is, the less likely responders are to follow it.” More than simple diagrams and checklists, these sections offer a commonsense walk-though of preparation for planned and unplanned (though expected) events and pose pertinent questions to consider about how you will meet the kinds of challenges encountered by other responders in previous incidents. Communication and practice before the incident are key, so it isn’t just top brass who know the plan. These sections emphasize that it is vital for first-due crews to understand their role in the big picture: “Unless carefully coordinated, these responding resources are going to establish their own on-scene command structure.”¹

This section also includes special considerations for infrequent issues such as active shooter scenarios, as well as frustratingly common issues such as freelancing and mishandling of equipment and supplies.

The final section discusses mutual aid agreements and memoranda of understanding that are crucial to  management of any large-scale incident and provides an excellent guide to establishing new (or revising existing) agreements to ensure that help arrives when and how you need it.

Additional resources and references are included in the many annexes that accompany Operational Templates, including sample mutual aid agreements, EMS operational plans, after-action reports and incident action plans.

The resources in Operational Templates will help you ensure a thoroughness and consistency in preparation that will quickly become evident during your responses to high-profile events, whether you are the most senior member of your organization or its newest recruit. Using these templates and the articles in this series will ensure that each and every first-due crew is ready to respond.

References

1. FEMA. Operational Templates and Guidance for EMS Mass Incident Deployment, www.usfa.fema.gov/downloads/pdf/publications/templates_guidance_ems_mass_incident_deployment.pdf.

2. Arnold A, Dilley M, et al. Natural Disaster Hotspots: A Global Risk Analysis. Washington, DC: World Bank, 2005.

3. Berger E. Crossroads: Report calls for EMS standards of care. Ann Emerg Med, 2006; 48(2): 142–43.

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 a career fire lieutenant, EMS coordinator and American Heart Association national faculty member.