In a time where high-tech air-conditioned classrooms are taking over most training divisions in the fire service, we must recognize there are times when this approach simply won’t serve our members in the best way possible. Nothing beats realistic hands-on training when preparing our members for a mass-casualty incident (MCI). There is literally no comparison.
Just as fire service organizations vary in size, equipment and capability, MCIs can vary in scope and require different response models. No single response works for all organizations or incident types. The only true way to know if your command officers, company officers and crewmembers are prepared is through realistic training and drills.
Two types of MCIs, one solution
There are two types of MCI events – the ones you can plan for and everything else.
The ones you can prepare for include events like the Super Bowl or World Series. You have time to arrange resources, like an area command, and have a medical sector pre-staged. Then there are those spontaneous events, such as chemical plant explosions, plane crashes, train accidents and mass shootings that are unexpected. Regardless of which scenario we are dispatched to next, training is key.
To make an MCI run smoothly, you need to conduct large-scale drills – as realistic as possible and as many drills as your members can handle. Training will certainly differ agency to agency. Same with the response approach.
For example, I work in the fourth-largest fire department in the nation. I also work for a much smaller organization with only two stations and six members per shift. Obviously, these departments are going to have different approaches to an MCI, as the larger department will have more resources. But contrary to what you might think, smaller departments also require complex MCI plans and training, as their resources will be strained faster than a larger department.
Assessment time
It’s sometimes hard to know where to begin with planning for an MCI. The first step is typically to assess your current situation:
- Do you think your organization is prepared for a large-scale MCI?
- Has training been sufficient?
- Are members mentally prepared for this type of event?
- Do they have the resources necessary for a successful outcome?
If you answered yes to all of these questions, I will just assume you are fooling yourself, your entire organization and the public. Yes, many organizations have guided an MCI to a conclusion, but they most always had a long list of items that they wish they had had available or actions they wish they had done differently. No MCI goes perfectly. There’s always more we can do to improve. Many of these issues come up during post-incident debriefings, but others may only be acknowledged through personal evaluation.
MCI realities
We must be realistic about these responses and our training for them. Yes, we need a starting point when we arrive on location, but this starting point shouldn’t default to an IC standing Side Alpha with a checklist in their hands. And this really shouldn’t be the default starting point if the actual incident occurred on the fourth level of the Charlie side of a football stadium with 50,000 spectators, some of whom are panicked and have lost all common sense in their effort to escape whatever the event may be. Let’s also not forget that an active shooter on the run will widen your incident footprint.
Unless you have a bonified plan for every single potential occupancy and every single large-scale event that occurs within your response territory, which is highly unlikely and highly impractical, my suggestion is that you focus on the basics and communications. Unless your resources are sitting in staging for the entire event, you should expect a certain level of confusion, chaotic radio traffic and slowed progress for the first 20 minutes.
Whatever resources you have available, whether local, regional of state assets, include them in your next MCI drill. This will give everyone a good idea of what the working relationships are, the reflex time required to place the asset in operation, and the opportunity for everyone to become familiar with each other’s operations and capabilities.
Photos/Houston Fire Department Training Academy – Facebook
A more focused training
Unless we focus all our time and effort on MCI training, which is obviously not feasible, the only thing we can expect for certain is confusion. It might be controlled, but it’s still confusion.
To help limit this confusion, we should focus our MCI training and drills on the following: ICS; dispatchers and call-takers; strict radio communications; response avenues; staging operations; triage, treatment and transport operations; working with additional agencies; and, for a realistic experience, how to manage confusion – a lot of confusion. Let’s review each.
ICS: Not many events will test your understanding and use of the ICS – and your ability to remain calm – more than a large-scale MCI. Training and drills need to be an in-person, physical event, not merely studying a guideline, a PowerPoint presentation or table talk.
When an IC participates in a drill, regardless of what the scenario may be, they will gain a better understanding of the ICS, become more fluid with radio traffic and learn how to better organize such events to bring them to a more controlled end. Further, MCI drills give the IC a rare opportunity to expand the ICS beyond that of our daily structure fire framework. The IC will realize the importance of assigning and communicating with the operations section, plus additional branches and divisions, if they actively participate in the drill.
Dispatchers and call-takers: Questions for the callers should be focused on the type of event, exact location (not just an address) and number of victims, as well as whether the scene is still active in some manner. They also need to continue pressing for additional information as the companies are responding. This information must be passed onto the responding companies quickly, and it must paint a picture and make sense. The information transmitted to incoming companies should lead them directly to or very close to the heart of the MCI until resources are in place for a formal staging location.
Radio communications: Radio communications must be condensed and limited when necessary but still effective enough to get the message across in a calm voice. Every department has members who are yellers and air-time hogs. These folks are counterproductive during an MCI and need to be controlled from the beginning to limit the chaos that could ultimately prevail. Realistic training drills will improve this aspect of our MCI response.
Response avenues: Once command has been established by the first-arriving company or chief officer, a single response avenue should be determined. That way, resources are assigned from staging to the treatment/transport area, they use a single known route instead of coming from multiple directions. This plan should be incorporated into your response guidelines to help limit the confusion of responding and staged companies. Realistic training drills will improve the coordination of this aspect of an MCI and make all vehicle traffic more fluid.
Staging operations: Incorporate staging into your next MCI drill. The lack of a formal staging area and officer could lead to congestion and an uncoordinated response into the MCI area. Appoint a formal staging officer, and add additional channels to limit the chaos created on the operational channels. Understanding this aspect of response and actually drilling on this prior to an event will provide an additional level of competency for the real deal.
Triage, treatment and transport: This always been a difficult and time-consuming aspect to MCIs. There is either too much time spent on triage or on locating the actual victims that require medical attention.
In your next drill, add participants who do not require medical attention. A realistic number would be 1,000 to 1 but, of course, it’s not realistic to find that many willing participants. However, the more you can add, the more realistic the event would be for your triage, treatment and transport crews. Requiring them to wade through a sea of uninjured panicked participants to find the actual patient and begin the triage process is about as realistic as one could get.
Additional agencies: Most MCIs will involve outside agencies beyond fire/EMS. We almost always work side-by-side with law enforcement, but how often do we work with our appointed officials, elected officials, public works or mutual-aid companies. Our drills should include them as well to help us gauge and plan where we are with our MCI response.
Dealing with confusion and chaotic radio traffic: Dispatchers and ICs need to be prepared for chaotic radio traffic. They also need to understand that unless they have unlimited resources pre-staged, there will be a reflex time that needs to be incorporated into their decision-making and orders given to individual companies. Where an order may be given for a crew to respond to an injured patient, depending on the patient’s injuries, the actual location may change prior to the crew’s arrival. If the incident is on upper floors or several parking lots away from the responding apparatus, it is going to take time for the companies to get to the actual incident or patients. The IC needs to remain calm and understand that it could take some time.
Some tips:
- ICs should have a shared radio channel with law enforcement. This will improve communications and ease reflex time and confusion.
- If sharing a command post, which is highly advisable, use face-to-face communications as much as possible to illuminate unnecessary radio traffic.
- Incorporate law enforcement in your training and large-scale MCI drills. This is critical, even if it is as simple as traffic control or as significant as an active shooter in a large sports complex.
Realistic drills
Throughout my career, I have been a small part of several MCI drills and have observed and compared actual MCIs and MCI drills. One thing stands out every time: They rarely, if ever, go as we trained for, which suggests that we do not drill enough and that most MCI drills are not bringing enough reality into the drill.
I have observed many MCI drills take place in an empty field where responders only have to deal with a few actual patients from something like a bus accident – no real example of a large-scale incident in a large building or involving a massive crowd. These types of drills could lead us into a false impression that we can handle an MCI, assuming we can get the resources we need.
All incidents do come to an end – eventually. It’s how we performed from the beginning to end that will leave an impression on patients, citizens, neighboring organizations and, if it’s a large enough event, the media. Did we live up to our training? Did we live up to our own expectations?
I, like many others, am a firm believer in realistic training. Realistic training is a critical aspect in gaining a full understanding of why, when and how we implement tactics and tasks. For your next MCI drill, plan to incorporate some reality. Truly test your guidelines, your organization and its understanding of the ICS and mutual-aid departments.
Try to find a large complex that would allow you to use their facility for your next MCI drill. Bring in law enforcement, mutual aid, public works and any other potentially concerned entities, and ask either high school or college students to participate to add to the realism. This is the real test that can provide you and your organization with the best results and information to improve.
Final thoughts
Remember, ongoing training and focusing on our basics will always lead us to a relatively good outcome. It’s when we fail in our most basic job functions that things start to unravel. A confident IC can bring those basic mistakes back on track and keep the incident flowing, but confidence can only be obtained through realistic MCI drills that truly test the system.
Realistic training breeds confidence. Confidence produces results.
Realistic training makes us really good at what we do and is a safety net that no online training or guideline can replace.
Train for reality.
- 8 individual IFAKs each contain the essential tools to address severe bleeding
- Instruction card for quick and easy component identification
- QuikLitters are also included
This article, originally published on March 22, 2022, has been updated.
