Incident Command

Small Town Rescue Squad, to which I belong, has been doing an awful lot of training over the past two months. Actually, STRS has been doing so much training that I haven’t been to a Tae Kwon Do class in the past two months because, for some reason, training can be scheduled only on those days I take Tae Kwon Do classes I am paying for, and not on any other days of the week. Fine. Training is good and training is needed.

Among the classes we have recently taken has been a class given by Dr. J, our medical control doctor and one of the Emergency Room physicians at our local hospital. Dr. J is a fantastic doctor and he’s a pretty darn good teacher as well, which is probably why he’s a fellow at the Academy of Emergency Medicine. So, when Dr. J gives a class, you’d think people would take a little something away from the class. And, if you took anything away from Dr. J’s class on Multiple-Casualty Incidents, or MCI’s, it should probably have been the fact that the first unit on scene becomes Incident Command upon arriving at the scene of an MCI.

True to Dr. J’s fashion, he didn’t just teach us this in the classroom, but he also had us try the concept out at our large, once-annual MCI training scenario at the local high rise. This year, the Medical Simulation Training Center at the local Army base did the moulage kits on our casualties, who were volunteer students from the local high school, which added a heck of a lot of realism.

But the problem with a canned MCI scenario like this one is that everyone knows what they’re supposed to be doing. “Wait,” you wonder, “Isn’t the whole point of this training to ensure that everyone knows what they’re doing? So how can that possibly be a bad thing?” Well… here’s why.

When you run a canned MCI scenario, everyone knows what they’re supposed to be doing because it’s discussed in great detail before we’re ever paged out to participate in the scenario. We know who’s going to be running triage and who’ll be rehab. We know who’ll be at Incident Command and where our ambulances will be staged. Which is great. Except for the fact that you don’t know any of those things when you’re responding to a real MCI.

Cue a real MCI.

Coming back from Search-and-Rescue training with the local K-9 team in Fulton, we were just outside of Small Town when I was passed by MC’s truck, running blue lights and going about 80 in a 55. “Funny,” I thought as I pulled back onto the road, “I didn’t get a page. Maybe it’s just a fire department thing.” After checking CAD Page my phone, I find that the Rescue Squad has been paged out along with the fire department for a structure fire. Hum. That’s a pretty routine thing and usually requires an ambulance to stand-by somewhere while firefighters do their thing. It’s not usually something that requires extra hands.

Just as I was about to turn into the main street, about a mile from the Squad, I got a phone call from KB. KB knew that we were close by because I’d asked hubby to text him when I turned off Route 11 to ask him what the turn was to get to 126 – the one I always miss but that we usually take returning from transports to Syracuse in the ambulance. So he knew I was only a few minutes out. He sounded frantic and wanted to know if I could come into the squad right now because there was a fire in a building with a central oxygen system and one firefighter was already down and the Lifeflight was in the air.

So I headed to the Squad, grabbed my stethoscope and reflective vest from the back of the Jeep, handed hubby the keys so he could drive it home, and hopped into the ambulance, all under the calls of “HURRY UP!” from inside. I saw that one of our rigs was already out and the third was still in the bay, with neither crew nor EMT ready to take it out, which was a little surprising since we usually don’t have a problem getting drivers or EMTs to crew all three rigs when there’s a big incident. (But a lot of our people are also firefighters and went on this call with the fire department, rather than the rescue squad, I assume.)

On the way, KB filled me in on the fact that, apparently, the building on fire was our local hospital – more specifically, our local Emergency Room. That’s not a good thing. At all.

As we pulled up on the road overlooking the hospital, just prior to our turn, I saw that a ton of equipment was already in place. The entire parking lot in front of the Emergency Department was flashing and blinking lights on fire trucks, ambulances, police vehicles, volunteer firefighters’ personal cars, and so on. Two fire trucks were right in front of the ER’s entrance and our other ambulance was backed in to the left of those. We had no ability to join them there with other vehicles and fire hoses blocking the way, so we looped around and staged in the adjacent parking lot, then jumped out to locate command to find out what we were going to be doing or whether they wanted to stage us elsewhere.

As it turned out, the crew of our first rig was comprised of our Squad’s president (and Chief 2), an EMT, and her driver, also an EMT. They were inside, caring for a firefighter who’d been injured in some way and for whom the Lifeflight had originally been called but had since been cancelled. Eventually, Chief 2 came outside to ask for a c-collar and tape, which we handed her from her rig, and a short while later, her driver came outside to inform us that mutual aid was coming but the EMS coordinator had not yet arrived, so he didn’t know where they needed to go or where we needed to go.

Stepping back here a second …

We’re at a scene now with the Fire Department, police, and EMS. Other agencies are on their way for mutual support and there is NO Incident Command framework, at least for EMS, because “the EMS coordinator isn’t here”. What is wrong with this picture?

Meanwhile, we can see four other ambulances from surrounding departments on the high road, about ready to turn toward the hospital and we’ve got no place to direct them to. KB and I looked at each other and told MB, the driver – “You were first on scene, YOU are the EMS coordinator. Make a decision.” KB suggested staging them in the parking lot where we were staged, as it would be easy for them to load and go from there, and once we got a sort-of-committal from MB, I headed down to the police road block at the entrance to the parking lot to direct those rigs into the upper parking lot where we were, which is where they went.

A short while later, which everyone staged nicely and ready to go, MB showed up and told us that we should stage behind the hospital, at the rear entrance, so we all lined up and drove around the building. Only problem being that there isn’t any damn room back there, so having pulled two rigs up to the building, the rest had to be quite a ways back and taking any of the rigs out of there to transport would have required tight, 3-point turns past other rigs, a fire truck, and various dumpsters. And, obviously, this literally put us up against the building … probably not the best place to be, necessarily, in a structure fire. But, we were sent, so we went.

That is, until our Chief came around the building and told KB that he was now EMS command because nobody else more qualified, such as the EMS coordinator, had arrived yet and she “was busy” on the other side of the hospital doing whatever it was they were doing over there that didn’t include becoming EMS Command on arrival as the first rig on scene. With KB becoming EMS command, of course, that also meant I was now out a driver. Another little detail nobody seems to have considered.

In the end, none of the ambulances were needed – luckily. The firefighter injured was treated at the hospital, and the structure fire everyone was looking for had turned out to be “a strong odor” pulled in from outdoors by the ventilation system, possibly from people starting up their wood fireplaces for the first time this season, or someone being dumb enough to burn their trash and plastics in said fireplace (which is not particularly uncommon in these parts, especially now that burning trash outdoors happens to be illegal). The mutual aid rigs were sent home and we stayed on scene for a while longer until we, too, were released. (KB was surprised they didn’t end up forgetting about us.)

Overall, I think it was a lesson learned in how not to handle Incident Command at an MCI. And a lesson learned regarding the fact that taking the classes and required tests (such as all the FEMA classes we have to complete online) does not equate actually know what the heck you’re supposed to do when placed in that situation. It was disappointing to see. Fortunately, nobody got hurt but I don’t think it should have gone the way it did. (But it’s not my place to point that out.)

Advertisement