The House Fire MCI

WHAT WE LEARNED

ON AUGUST 14, 2022, at 1047 hours, the Garland (TX) Fire Department (GFD) responded to an incident involving a house explosion. Multiple callers reported people still trapped inside. The house was a single-story, wood-frame structure built in 1955. Dispatch sent updated computer-aided design notes that read, “Some got out, others still trapped.” The next note read “stating a kid is on fire.” The last update note listed “two kids, one teen, and two adults are burned.” When the first-due units arrived on scene, they found that a bystander had run into the house and pulled out six critically burned patients, including three adults and three children. The adults were 27, 29, and 54 years old. The children were 3, 5, and 15 years old. With the total number of burned patients, the incident qualified as a mass casualty incident (MCI) (photo 1).

Arrival of Crews and Tactics

Ambulance 8 arrived first on scene and gave a radio size-up of a single-story house showing heavy fire from the A-B side, a partial building collapse, and a report that at least two people with burn injuries had been evacuated. Ambulance 8 requested one additional ambulance.

A Garland police officer, who arrived onscene shortly before Ambulance 8, carried a small child to the back doors of the ambulance. The bystander who pulled the victims out of the house also started bringingpatients to the back of Ambulance 8. All six patients were brought to Ambulance 8, with the three children and one adult placed in the back of the ambulance and the other two adults standing at the back doors. With the additional patients, Ambulance 8 contacted dispatch and requested five additional ambulances. The two paramedics on Ambulance 8 began triaging all six patients, attempting to secure airways and obtain intravenous lines (photo 2).

Engine 8 arrived second, with three personnel. The captain of Engine 8 took command and found the B-side wall tilted outward with heavy fire. No one reported an odor of natural gas on arrival. With reports that all victims were out of the house and with the structure showing significant instability from the explosion, Command declared the incident a defensive fire and personnel were told to stay out of the collapse zone. Command requested three additional ambulances and asked the power and gas companies to secure utilities for the house. Firefighter 1 of Engine 8 stretched a 1³A-inch line to the B side of the house to fight the fire and protect the B-side exposure, which consisted of another house close to the flames lapping out of the tilted wall. With a hydrant close to the house, the driver of Engine 8 established his own water supply (photo 3).

For GFD, the first alarm on structure fires contains two ambulances on the initialdispatch. Ambulance 9, the second ambulance dispatched, read the dispatch notes and requested two additional ambulances before arriving third on scene. Daily staffing for all GFD ambulances consists of two paramedics.

Ambulance 9 arrived on scene with three firefighters, due to a GFD paramedic student assigned to them that day as part of the ride-out portion of his class. The third firefighter allowed Ambulance 9 to arrive with a dedicated driver, which enabled the other two paramedics to treat patients in the back of the ambulance during transport. The two adult patients standing at the back doors of Ambulance 8 were the 27- and 29-year-old patients. Ambulance 9 quickly transported both to a burn center.

Battalion Chief 2 arrived and took command from Engine 8, reassigning Engine 8 as “Bravo Exposure” (side B). Battalion Chief 1 arrived on scene and Command assigned him as “Charlie” (side C). Command recognized early that responding units needed to come to the scene from the west side, as the first arriving units had begun to stack up on the east side of the street. GFD enacts Level I staging on structure fires, so all units responding stage approximately a block from the incident until called to the scene. From the units staged, Command assigned Engine 1 to side C, Engine 4 as “Delta Exposure” (side D), and Truck 9 (a quint) to lay a supply line and set up the aerial master stream in front of the house.

Truck 9 caught the hydrant at the next intersection located 10 houses away and laid a supply line. Command noticed that the five-inch supply line stretched from the hydrant through the middle of the street, which would block access to the scene. Command quickly instructed personnel to move the supply line out of the way before it was charged. Aerial operations were never initiated for this incident, just set as a precaution. With all exposures protected around the house, defensive operations fighting the house fire, and an aerial master stream set, Command turned his attention to creating an emergency medical services (EMS) group.

For GFD, EMS-1 is a captain position that becomes the designated incident safety officer (ISO) on arrival to a working structure fire or a major event. EMS-1 arrived on scene and checked in as “Safety” over the radio. Command immediately reassigned Safety as the EMS group supervisor. The incident started on the fire channel “Ops 1.” Command instructed EMS-1 to move all EMS traffic to “Ops 3.” Command requested EMS-1 to switch back to Ops 1 if he required anything. Command and EMS-1 cleared up with dispatch the exact number of ambulances needed, which was five additional units. All ambulances currently with patients, staged, and still responding moved their traffic to the new designated EMS channel on Ops 3.

The EMS group supervisor requested three ambulances from staging, which were Ambulance 2, Ambulance 11, and Ambulance 5. With space limited on the street, only two of the three ambulances could maneuver down to the triage area in the back of Ambulance 8. The second unit to receive a patient from triage was Ambulance 2. After receiving the dispatch tone at the station, the driver of Ambulance 2 quickly read the notes and proactively asked his captain if he could take a firefighter from Engine 2 to respond to the MCI. The captain agreed, giving Ambulance 2 an extra member to act as a dedicated driver for transport on arrival. Ambulance 2 transported the 15-year-old to a burn center.

Ambulance 11, the third unit to report to triage, also arrived with a dedicated driver as another GFD paramedic student was riding out that day. Ambulance 11 transported the 54-year-old patient. Ambulance 5, the fourth unit to report to triage, took two firefighters from a staged apparatus and transported the 3-year-old patient. Ambulance 8 took a firefighter from another apparatus on scene to be the driver for transporting the 5-year-old patient. All patients were transported to a burn center 23 minutes 21 seconds after the arrival of Ambulance 8.

For the house explosion, the B-, C-, and D-side crews extinguished the fire and ensured all exposures were protected from fire extension. With the threat of fire gone, the crews waited for investigators to arrive before attempting overhaul. Ambulance 3 treated two bystanders on scene who had helped pull victims out of the house, but both refused transport to the hospital. Command reassigned Ambulance 3 as rehab until the termination of the incident.

GFD conducted a full post-incident assessment on the incident.

Post-Incident Assessment

Command initially wanted to raze the house for safety reasons. Ultimately, decision makers halted this due to the potential for a lengthy investigation into the incident. Razing the house could have interfered with the investigation into the possible cause of the house explosion. With the incident resulting in an MCI, crews erected a chain-link fence around the home to preserve evidence.

The exact cause of the explosion remains unsolved. A family member stated she turned the oven on when the blast occurred. An investigation into the incident showed an unusually high usage of natural gas in the house for the summer before this incident occurred. Investigators conducted tests on the natural gas pipes and found no leakage after pressurizing the pipes.

Investigators also discovered a sewer pipe that terminated in a wall space without any ventilation to the outside. The termination appeared to result from remodeling work done several years earlier. Several investigators from multiple agencies, including ones representing the family, examined the home. The Texas State Fire Marshal’s Office also investigated the incident. Investigators found that neither the higher gas usage nor the sewer pipe could be identified as the definitive cause of the explosion. They found no other obvious signs as a possible cause for the incident during the investigation (photo 4).

Multiple requests for ambulances made by the first-arriving units confused the dispatch center in determining exactly how many ambulances to send to the incident. Dispatch received four requests for one, two, three, and five additional ambulances from different crews. Before accountability could be obtained by Command for the EMS side of the incident, ambulance crews started communicating with each other about a patient transfer location. Command ordered the ambulances to stay staged until he could set up someone to direct traffic and create the EMS group. Communications for EMS were moved to a different ops channel with an EMS group supervisor established, which helped control the communications confusion.

Early recognition of the direction of travel from responding units allowed Command to prevent units from stacking up on one side and created an ambulance corridor used for patient transport later in the incident.

For the fire portion of the incident, resources were effectively deployed to protect exposures and contain the fire to the original structure. The incident started defensively. Command reminded all units on scene that the incident remained a defensive fire and that all personnel needed to pace themselves. With resources stretched thin fighting fire and treating patients, Command could not establish a formal rehab assignment until he received confirmation of all patients treated and transported to a burn center (photo 5).

Two ambulances arrived with GFD paramedic students already onboard. Another ambulance proactively asked to take another firefighter with them to the scene after reading the dispatch notes, which allowed for three of the five transporting ambulances to arrive on scene with designated drivers. Fortunately, Command and the EMS group supervisor did not need to further deplete on-scene resources to find drivers for three of the ambulances.

A staging area manager (STAM) was not assigned since the units responding followed Level I staging protocols of stopping approximately a block away from the incident. (For Level II staging, a STAM is appointed.) The EMS group supervisor’s span of control was four, with Ambulance 8 as triage and the three other ambulances responding from staging to transport patients. Some confusion arose in the EMS group with tracking the ambulances, patients transported, and hospital destinations. But, ultimately, the group now had accountability.

Considerations and Lessons Learned

The GFD learned the following considerations and lessons at this response:

• Be sure that all communications for an incident flow through the proper chain of command. Any requests for more units should only be relayed to dispatch by Command or someone designated by Command.
• Review the expansion of the incident command system (ICS) to include a group/division, branch, or section. Ensure all personnel understand how this expansion sets up the chain of command and how communications should flow through a group/division supervisor, branch director, or operations chief.
• Declare a defensive fire at the start of an incident to help set the tone. Reminding units working on scene that the fire is still defensive can help prevent injuries from occurring.
• Declare an MCI over the radio. Ensure dispatch knows the approximate number of patients so they can initiate an appropriate response based on the MCI protocols of your area. Depending on your staffing levels, an officer at a station can allow an ambulance to take a firefighter off another apparatus and proceed to the scene with three personnel. The third member gives the ambulance a designated driver, allowing the other two personnel to treat a patient during transport.
• Remember that an incident can quickly turn into an MCI. Review your department’s triage procedures to ensure personnel understand the tagging and documentation functions for triage.
• Ensure your department implements staging protocols. Staging allows you to gain control of incoming units, decrease freelancing, and maintain better accountability. Review your department’s staging procedures to ensure personnel know how to respond accordingly.
• Appoint a STAM for any MCI. Command or, in this incident, the EMS group supervisor only needs to request a type of unit, such as an ambulance. The STAM can acknowledge the request and state which ambulance number will respond to the scene. Does everyone in your department know how to function as a STAM? Depending on the resources available when the incident occurs, you may be required to initially appoint a relatively new firefighter as the STAM to track staged units until more resources arrive.
• Assign a crew to control traffic to the scene of major incidents. A fire department can manage its response to scenes by implementing, practicing, and enforcing staging protocols at different incidents. Early recognition of the direction of travel of responding units can limit stacking up on one side. The fire department does not have control over how police and other entities respond to the scene. Many times, these agencies park and leave their vehicles unattended. Assigning someone early to help control traffic is imperative during major incidents to help ensure lanes are cleared for ambulances and proper access is granted for units requiring closer access to the scene.
• Notify the units in staging as to what type of scenario they might be responding to or whether they may receive a patient. The house explosion involved three severely burned children. A heads-up to the units in staging on the potential patients can allow personnel to prepare mentally, such as reviewing pediatric protocols or making a game plan for the type of equipment to bring. Giving staged units this information early can also allow them to prepare emotionally, possibly leading to better patient outcomes.
• If resources allow, appoint scribes to assist the lead positions as the ICS expands to different groups/ divisions, branches, or sections. Scribes help track information that could be missed while a lead communicates on the radio or to someone else on scene.
• Establish a transport officer to track all the patients transported, the transport times, and the hospital destinations. The transport officer or an appointed hospital liaison in the transport area can coordinate with the hospitals and your medical control regarding hospital capabilities and space available.
• Ask: Can we move the triage area? In this situation, the two ambulatory patients were quickly transported by Ambulance 9. With four patients still inside the back of Ambulance 8 and limited access to the scene, the triage area could have been relocated to the staged ambulances at the next intersection. The new triage area would have allowed more room for the additional ambulances to pull up, obtain their patient, and move out of the way to stabilize the patient for transport. Moving the triage area might have decreased the on-scene time for all ambulances and allowed for faster patient transport. Ambulance 8 could not transport the last patient until the other ambulances with patients cleared the road. Once the triage, treatment, and transport areas are set up, they are difficult to move, but consider moving the triage area if it is in the best interest of the patients.
• Incorporate an MCI into your live burn training scenario. Staging; optimum resource allocation for fire and EMS; and establishing the triage, treatment, and transport groups can all be practiced simultaneously for an incident like this house explosion.
• Remember that laying a supply line properly can be as important as the initial attack line layout. The old saying “the fire goes as the first line goes” also applies to the supply line. Unless no other option exists, take time to ensure the layout of the supply line does not impede access for other responding units. Try not to stretch the supply line around an apparatus or an ambulance, which could block them in and prevent them from leaving or repositioning if needed. Before charging your supply line, size up the layout for other issues that might significantly reduce or block your overall intake. Issues can include kinks or the hydrant pressure causing the hose to move under the tire of your apparatus.
• Consider the potential for future investigations before overhauling a structure, especially in situations such as this incident, which resulted in an MCI. Preserving evidence can also help with closure for the family involved after the incident.
• Ask: Should the triage team transport a patient? In this scenario, Ambulance 8 initially triaged and helped treat all six burn patients until they transported the last patient, a 5-year-old child, to a burn center. The total on-scene time for Ambulance 8 was 23 minutes 21 seconds. After making patient contact, many first responders establish a rapport with their patients, and most would probably want to transport and finish what they started. With mental health in mind, you also need to consider whether a triage team is mentally fit to transport a patient based on the conditions of the incident. Check on the triage crew to see how they are doing and check on all crews after they experience a significant call. GFD’s peer support team checked on all personnel involved with this incident and counselors were brought in for a nonmandatory session for anyone who might need to talk to a professional.

MICHAEL K. CLARK is a 20-year veteran of the Garland (TX) Fire Department and a captain/paramedic assigned to Truck 9. He served three years as the lieutenant over fire training, responsible for training all new hires and helping deliver training to operations. He is state-certified as a master firefighter, incident commander, instructor III-master, fire officer II, and incident safety officer.