Letter from America: Training Hard and Fighting Easy
Rob Lawrence is chief operating officer of the Richmond Ambulance Authority. Before coming to the USA, he held the same position with the English county of Suffolk as part of the East of England Ambulance Service. He writes a regular "Letter from America" column for the UK publication Ambulance Life.
It’s not unusual these days for visitors to stop by the Richmond (VA) Ambulance Authority (RAA), but a few weeks ago Steve Kanarian came by. Steve is a retired EMS officer from the Fire Department of New York (FDNY). He was an urban search and rescue paramedic based in the Bronx, and like many EMTs and firefighters from FDNY, his world literally came tumbling down on September 11, 2001.
Steve’s account of that day, and the days, weeks and months in the aftermath of the Twin Towers collapse, are recounted in his book The Downwind Walk. He left me with a copy, and by the end of the next weekend it was read and passed on to another member of my team with a two-thumbs-up recommendation. Even before I got to the point in the book where Steve and many like him were scouring the “pile,” looking for any sign whatsoever of a life that hadn’t suffered the crushing blow of that terrible day, I was impressed by the way he captured the essence of the EMS worker, the camaraderie, the shared adversity and, yes, the gallows humor. His words clearly demonstrate that the lot of American medics is exactly the same as paramedics and EMTs in the U.K. and beyond. That’s why I suspect every time we have ambulance visitors from anywhere on the planet, an immediate rapport, familiarity and mutual respect are instantly established.
What I didn’t realize in reading Steve’s book was that only a few days before September 11, members of FDNY took part in a plane crash mass casualty exercise at New York’s La Guardia Airport. Triage and treatment of multiple casualties was the order of the day, and while they never imagined in their wildest dreams the size of the disaster population only a few days later, training nevertheless occurred.
Having spent my first career as a soldier, the phrase “train hard, fight easy” was a mantra we always followed. I distinctly remember a moment in Bosnia, where I commented that the rigors of the “battle day” resembled an exercise we had conducted before deploying. In fact, it wasn’t like the training; the training mirrored the operation and we were all the better prepared because of it. Later on in my National Health Service life, I had the privilege (and the blessing of the chief constable) to be chairman of the Suffolk Strategic Coordination Group (SCG), normally the preserve of senior police officers. We certainly lived by the “train hard, fight easy” rule; in fact, no sooner had we exercised a scenario than it happened!
Not long after an H5N1 table top, the Bernard Matthews turkey factory had a massive outbreak of bird flu. The SCG suddenly had to worry about everything from parking for huge TV trucks from the world’s media around the leafy lanes of Suffolk, to immunization and barrier treatment of exposed workers. Training made the day easier. An SCG coastal flood exercise was followed not long after by the highest surge tides and flood potential seen on the east coast since 1953. Again, training at all levels of the Gold, Silver and Bronze command structure bred familiarity—with each other and the plan—and was a force multiplier that eased operational pressure considerably. The day a 500 pound WWII bomb washed up on Felixstowe beach and placed half the town within the blast radius was dealt with in a cool, calm, collected and rehearsed way by a joint service team that trained, operated and thought as one.
The ways in which EMS agencies respond to major incidents—whether it’s the classic “rising tide” event, where a degree of notice allows for preparation, or the “big bang” theory, where zero notice requires immediate and decisive action—needs to be rehearsed. Last year in Richmond, the rising tide of Hurricane Irene and the big bang of a magnitude 5.9 earthquake hit us in the same week. Thankfully, we were able to joke by the end of the week about scoring a hat trick when President Obama made a whirlwind visit through town. Just like during my U.K. experiences, the emergency operations center (EOC) team produced a well-executed product, born out of training, which in turn developed trust and confidence to deliver each day we were needed.
Now that London has bade farewell to a successful and memorable Olympics, Diamond Jubilee and even Mayor Boris Johnson’s zip line incident (they all received equal media coverage over here), we can surmise a multitude of scenario-based exercises, involving everything from the Community First Responder to the Hazardous Area Response Team (HART) and the Territorial Army to the Special Air Service (SAS), preceded them. As another old Army adage states, “prior preparation and planning prevent poor performance”—and readiness through training and rehearsal, whether it’s in New York, Richmond, VA, or Richmond on Thames, is the only way to go. Just like the Olympians on the field, positive results come from dedicated and focused training.
Rob Lawrence is chief operating officer of the Richmond Ambulance Authority. Before coming to the USA three years ago to work with RAA, he held the same position with the English county of Suffolk as part of the East of England Ambulance Service. He is a graduate of the Royal Military Academy Sandhurst and served in the Royal Army Medical Corps. After a 22-year military career in many prehospital and evacuation leadership roles, Rob Joined the National Health Service, initially as the Commissioner of Ambulance Services in the East of England. He later served with the East Anglian Ambulance Service as director of operations.
