New York City EMS (Emergency Medical Services) has long used the term “planned MCI” – i.e., a planned Mass-Casualty Incident – to refer to special events. That seemingly ambiguous description reflects both sides of the dilemma that describes such “special” events: on the one hand, that the responses to such incidents are or should be planned well in advance, and should therefore be carefully controlled; on the other hand that the outcome of such an event is as unpredictable as it would be of any other event requiring an emergency response. And, of course, such events generate real patients.
Smaller events such as a well attended concert can be viewed as a training ground for the intangible skills required to manage and carry out incident-command, logistics, and other basic ICS (Incident Command System) functions that can be initiated and completed in real time. The practice gained in receiving this type of experience in a controlled environment becomes invaluable if and when those in charge of the simulated incident are later called on to lead a response in a completely uncontrolled environment.
A major benefit of practicing the appropriate responses to various special events is that those involved learn from practical experience the meaning and use of such intangible but vitally important ICS concepts as chain of command, span of control, and resource management. The chain of command at the concert just mentioned might have only a few “patients” to deal with, but the communications requirements would be similar, and the incident commander would have to organize his or her subordinates in much the same way he or she would at and during a real-life MCI. And, of course, even a relatively small non-simulated event such as a “rock” or “rap” concert might in fact generate a large number of patients, yielding a different and probably even more valuable type of experience.
In some cases, one of the advantages provided by working at a real-life special event is that it provides MCI leaders with a ready pool of patients as well as a venue to test various plans, theories, and systems. Here, a prime example is the annual Boston Marathon, which for a number of years has been used to test patient-tracking software in real time – while simultaneously dealing with a varying number of real patients. Last year alone, more than 4,000 patients were seen either at hospitals or in any of several temporary healthcare field stations strategically positioned at various points along the marathon course.
Capitalizing on the Inherently Unpredictable
Perhaps the biggest advantage to using a special event such as a marathon as a full-scale exercise is that the patients and bystanders are equally unscripted, and as a result can be counted on to do the same unpredictable things that most humans do in their everyday lives.
The 2007 Boston Marathon was used, for example, as a full-scale exercise of the Massachusetts Department of Public Health’s (MDPH) Hospital Capacity Website hospital resource tracking system, which allows hospitals to report – directly to the MDPH, and through a web-based system – the number of beds and other resources currently available in each healthcare facility in the area.
Because all hospitals in the area potentially could receive patients – but the reality of which hospitals would receive patients is unpredictable – the system could not be front-loaded with data; as a result the data stream coming in through the system in 2007 generated all of the same difficulties that would be encountered in the real-life reporting of such data.
A footnote of special importance to emergency managers: Many federally funded grant programs require that exercises be carried out as the final proof that the taxpayers’ money has actually paid for a demonstrably improved response capability. Many of these same programs, however, allow grant recipients to use real-life response events in place of exercises. Which means, of course, that the grant-savvy manager may be able to save the cost of an exercise while at the same time providing the responders with a more substantial real-life experience.
For additional information: Click on either or both of the following links: https://hd.dph.state.ma.us/changes_2_07_bed_counts%5B1%5D.htm
Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.