BY DENNIS R. KREBS
It’s a bright, sunny weekend with temperatures just above 907F. Nearly 10,000 people have gathered in your district for a two-day country music festival. Your station sends an engine company and an EMS unit to this annual event. The afternoon hours are generally profitable for donations to the burn center or apparatus fund.
By midafternoon, the heat is taking its toll, and you are overrun with heat exhaustion cases. You quickly begin calling for help, but the next-due station is out of service for training at an out-of-county site. In addition, a heavy call volume in your area now means an extended ETA for those resources you desperately need.
EMS PREPLANNING
For years the fire service has conducted prefire planning and preincident surveys. The local engine company visits a target hazard to conduct a detailed assessment of the structure. Information is gathered from building occupants and design engineers regarding air handling systems, building contents, elevators, exit locations, fire protection systems, and so forth. The fire department then attempts to project the potential for fire spread and smoke travel. The company officer formulates a plan of action in case he should have to respond to this address in the middle of the night.
 Preplanning an event, whether it be a triathalon or a demonstration, allows for a variety of specialized resources to be incorporated into the plan. (Photos by author). |
In recent years, tactical EMS providers, EMTs, and paramedics assigned to provide medical assistance to law enforcement SWAT teams have conducted their own style of preincident planning. This threat assessment or mission plan is conducted prior to a known incident (e.g., a raid or executive protection detail). Personnel gather a variety of information and formulate a written plan. Similar planning could have benefited our crew at the country music festival.
Such planning is beneficial for any type of unusual or special event and should begin as soon as your agency is notified. Many jurisdictions require permits for any large gathering. Make sure your agency is on the notification list when permits are issued.
Event date and anticipated size. The process begins with date, time, and type of event. The latter will affect the remainder of your plan. Is the event an air show, a white supremacist or similar demonstration, a triathlon, or a line-of-duty funeral for a fallen police officer? How many people are expected? This may range from 1,000 to 2,000 for an officer’s funeral to 20,000 for the air show. As seen in Washington, D.C., some events may have between 200,000 and 250,000 attendees.
Site visit and preplan. Visit the site and, if necessary, draw a site map. The situation will dictate the map’s required detail, ranging from a generalized plot plan for an outdoor event to one that closely resembles a prefire plan, with floor plans and exit locations for an indoor event.
Designate landing zones (LZs). While on-site, designate landing zones (LZs) for any air evacuations that may be necessary. This may seem foolish when planning for some events, but we should always plan for the unexpected.
In one recent incident, a planner felt it was foolhardy to include LZs in the plan for a police officer’s funeral. Yet, many police departments deploy SWAT teams as security during these funerals. Where better for someone to ambush a large number of law enforcement officers at one time? Prepare for the worst and hope for the best.
If a global positioning system (GPS) unit is available, note the latitude and longitude for each site on the plan. In one instance, a potentially violent demonstration by a white supremacist group was planned at the state capitol. The primary LZ closest to the site was designated “hot,” since the site would not be secured by law enforcement and might be compromised if tensions escalated. The secondary LZ was designated as “cold,” since the site was on a secured military installation and would be used should the primary site be compromised. This portion of the planning necessitates meeting with the agency or company providing the aeromedical service.
Meet with involved agencies. In the example of the event at the state capitol, it may be wise to meet with the commanding officer (or his designee) of the military installation. The installation may not appreciate unknown aircraft landing there, and the helicopter pilot may not be familiar with the tactic of dodging antiaircraft fire. Landing a medevac helicopter in the middle of an air show may also present a few challenges. Include the route of travel and travel time to each LZ in the plan. This is necessary to avoid any conflicts with road or bridge closures and so forth. Also, the scene units may be from a distant response district and might not be totally familiar with the area. If necessary, provide a map in the final document.
Medical facilities and personnel. Identify and plan which medical facilities will be used, including primary and secondary hospitals, a trauma center, a burn center, and a pediatric center. Other specialty facilities can be added as needed. Document the address of each facility, the route of travel, and travel time from each event site. If units unfamiliar with the area are assigned to this detail, this information will assist in their response to the facility.
Meet with at least the primary and secondary hospital staff. Generally, emergency department administrators are good contacts. Medical facilities usually receive very little event information in advance; they find out about such an event at the time the first of many patients begins flooding the emergency department. They will appreciate the advanced information. Share with them the specifics of the upcoming event, including details on anticipated problems or hazards.
If you are planning for a potentially violent rally or dem-onstration, consider including a law en-forcement representative when meeting with hospital personnel. Certain information may be sensitive, and law enforcement may wish to restrict its dissemination. At the demonstration at the state capitol, the closest hospital was only one block from the event site. The emergency department, the entry doors of which opened onto the main thoroughfare, could be overwhelmed with walk-in patients if the situation exploded. The law enforcement official’s meeting with the emergency department staff enabled them to identify some potential problems at the facility and provide suggestions for minimizing or alleviating certain risks. With sufficient advance information, the hospital can conduct its own assessment, devise an appropriate plan to deal with the situation, and provide valuable input and resources for your own plan.
Learn from past experience. In gathering information, consider the following. Has this type of event (country music festival or air show) been held in previous years? What problems were experienced? Has this environmental group held demonstrations in other jurisdictions? What problems did public safety officials experience, and how did they address them? For example, the Seattle public safety agencies could provide tips on strategies, tactics, and pitfalls on handling particular demonstrators protesting at the World Trade Organization conference.
Check out the weather. Could the weather (an often overlooked factor) affect the number of sick and injured that emergency responders might have to treat? Recall our experience at the country music festival at the beginning of this article. Extreme heat, humidity, and cold can have a major impact. When Pope John Paul II visited Colorado several years ago, hundreds of young people succumbed to the heat at that event. Visit the many Web sites providing short- and long-range weather forecasts, such as www. weather.com. These sites also have heat indexes and windchill charts, allowing you to anticipate extreme conditions and note them in the written preplan.
Other event-related hazards. At a particular type of event, what hazards can you anticipate? At an air show, maybe a plane crash! At a protest, someone might inadvertently get pepper spray in his eyes. What about a high-speed boat race? One team of fire department divers standing by at a boat race was surprised when someone attempted suicide by jumping off a bridge above.
Identify resources. Start identifying resources that will be needed, and don’t limit yourself to handling problems by just adding additional units, engine companies, and officers. Be imaginative! Would it be more appropriate to have two transport units supplemented by bicycle units? Is a specially equipped golf cart useful? If an engine company is needed at the scene, could a paramedic engine company be used? Are other agencies besides fire/EMS personnel (e.g., the Red Cross) available to assist?
At a country music festival, if the temperature is expected to reach 100°F and the humidity is to be high, strategically located water stations may be appropriate. Perhaps the on-scene engine company can deploy a misting fan, which is also useful for cooling marchers at the end of your next summer parade. The misting fan, supplemented by public address system announcements on the importance of continued hydration, can significantly reduce the number of potential heat exhaustion cases.
The rally at the state capitol may require a decontamination station. After demonstrators are exposed to tear gas or pepper spray, officers can bring detainees to the decon station prior to sending them on for medical treatment. We may need to deploy tactical medics and designate separate secure areas for treating police officers and demonstrators. Keep treatment areas for police and detainees separate from one another, and designate separate hospitals for treating police and demonstrators.
Some groups have thrown vials of red liquid, dung, and other substances at demonstrations. If this type of group is expected to participate in a demonstration, the local EMS service or tactical medics assigned to the incident should preplan for such an eventuality. Some teams have merely taken a small sample of the liquid and examined the material on-site under a microscope. If intelligence shows that this tactic is used, responders should be warned to have sleeves rolled down and all body surfaces covered. For protection against HIV/AIDS and hepatitis C, standard body substance isolation equipment, including eye protection, is appropriate. For police, this means using gloves and helmets with shields lowered.
Once you are confident that all potential problems have been identified, reexamine your planning material. You want to avoid any surprise visits from Mr. Murphy, of Murphy’s Law. Although you can’t have resources on-scene for every potential problem, anticipating them will ensure your planning document is not myopic. Undoubtedly, your call for additional resources will be quicker and more appropriate in size and structure.
Compile your planning material into a comprehensive document. Meet with representatives of associated agencies, including responders from your own agency, in the planning process. They oftentimes have unique solutions to complicated problems.
Fire and EMS personnel are routinely called on to provide services at nontraditional venues. Having a written plan to disseminate to those involved provides quicker, more appropriate service to the community and reduces the overall impact on sometimes-beleaguered delivery systems.
DENNIS R. KREBS is a captain and ALS provider with the Baltimore County (MD) Fire Department. He is the founder of International Survival Systems (ISS), which teaches survival skills to firefighters and paramedics. Krebs is a faculty member of Counter Narcotics Terrorist Operations and Medical Support (CONTOMS), funded by the Department of Defense, which trains paramedics and EMTs assigned to SWAT teams. He is the author of When Violence Erupts: A Survival Guide for Emergency Responders (Mosby, 1990), and Tactical Medical Support Field Guide (ISS, 2000).
