By Randall Hanifen
Contributor, EDM Digest
This article is the second in a series.
In an earlier blog post, I examined the need for triage and the use of ambulances in an efficient, taxi-style transportation configuration after a mass shooting event. But how do we organize an incident command system to create this efficiency?
First, it’s important to understand the working relationship among the fire, EMS and police departments in the community. That understanding of each others needs and goals facilitates the creation of a unified command.
The Necessity of Unified Command
The idea of a unified command is nothing new and is taught at nearly every level of Incident Command System (ICS) training. However, in the initial response phase, it’s rare that the ICS concept is taken into consideration.
Part of the problem is that fire departments are accustomed to working in groups and utilizing the incident command system in a regimented fashion. Police, however, are used to responding as individuals when neutralizing suspects.
These conflicting philosophies can initially create discord between first responder agencies, which hampers a good unified command structure. Additionally, fire departments, police departments and emergency medical services (in some communities) operate on different radio channels.
Creating a successful command can be accomplished only through planning and when all agencies respond on the same channel. A unified command must be established as soon as the first responder team arrives at an emergency.
While this concept might seem radical to some people, I suggest that the fire commander should serve as the incident command for both fire and police. I am not proposing that the fire commander tell police officers how to do their job. Instead, I suggest that a fire incident commander should inform the first police unit on the scene where the firefighters will be and then create a joint fire and police task force.
This way, the rescue team and medical responders can care for the wounded and injured while police in the task force provide them with protection. Although many fire and EMS responders wear bulletproof vests, most are not armed with weapons. The inclusion of police in a rescue task force is imperative for the safety of all responders.
The premise here is that the EMS is part of the local fire department and that state laws designate a fire official as the leader in charge of any incident. Nevertheless, all planners should check their state laws related to which officials are charged with acting as leaders during specific types of incidents.
The EMS is the branch that can triage, remove, treat and transport patients in the most efficient manner. A key element in training paramedics is the need to remove patients in a timely manner.
As we increase the level of training and education for paramedics, we are continually adding the number of procedures carried out in the field. But it’s important to remember that we cannot do surgery on scene.
An EMS Branch Director Controls Successful Outcome of a Mass Shooting Incident
The success of a mass shooting response is heavily dependent on the EMS branch director (EBD) who manages the EMS portion of a mass casualty event. He or she must understand the triage, treatment and transportation of patients and have a strong, commanding presence, as well as great organizational skills
Even if a mass shooting event does not involve multiple responder branches, it is best to establish one person in this position. The incident commander may be quickly overwhelmed with ordering resources, communicating in a unified command and dealing with the media.
First, the EBD should establish a layout for the event response and organize the scene logistically. The layout should consist of three different treatment areas and a transportation network to remove the victims of a shooting attack.
The EBD must think of the big picture. If the incident occurs at a school, for example, the EBD must know the logistics of treating and transporting injured children to a hospital.
The second task of the EBD is to actually determine the degree of patient injuries based on the initial triage. The EBD and the initial triage crews must remove “green” (no significant injury) patients from the scene as quickly as possible.
These “green” victims should not see others getting medical attention because they might come to believe they have similar symptoms and need to be treated similarly. Removing the slightly wounded from the triage area leaves the scene clear to attend to seriously injured or wounded victims.
In the next blog post, we will discuss the specific group supervisors of the triage, treatment and transportation groups and how proper planning and training for these group supervisor positions is valuable in the first hour of a mass casualty incident.