Until the Real Thing Conies Along
The potential for mass casualty incidents is in every community. Philadelphia’s mock drill not only improved existing procedures, but developed new ideas for dealing with “the real thing. ”
A MASS CASUALTY incident could occur within Philadelphia’s boundaries at any time. The Philadelphia Fire Department, recognizing this, firmly believes that mock casualty drills provide the realism that’s needed to deal with this type of emergency. With this need established, a drill, under the direction of then-Fire Commissioner William Richmond, was planned for an aircraft disaster last May at the Philadelphia International Airport. It was approached not as a test to he graded on, but as a method to improve existing procedures and, hopefully, develop new ones.
The airport covers about five square miles in the southwest portion of the city. In a year, there are more than 400,000 flights at the airport, and in excess of 14 million people pass through its portals.
The drill scenario involved an Epex Airlines’ Hoeing 727 with 88 passengers and crew aboard. The aircraft overshot the runway and crashed upon landing at the far end of the field. A bus was used to represent the main section of the plane. “Victims,” volunteers from the U.S. Navy, were placed on the bus and scattered throughout the surrounding area. To make the exercise more true to life, controlled fires were set and handled by tlie airport’s crash/fire/rescue units. A fire simulating a section of the tail that separated from the plane on impact was placed in an area remote from the crash site. This necessitated that the CFR units split their forces to deal with the fires.
At 1055 hours, a full first-alarm assignment consisting of four engines, two ladders, one advanced life support rescue squad, two battalion chiefs, and one division chief was dispatched. To make this evolution more accurate, all units responded from their stations with lights and sirens. This gave the incident commander a feel for the amount of response time that would occur during an actual incident.
Upon confirmation of a crash by the first-arriving CFR unit, a second alarm was requested at 1057 hours. Five additional engines, one ladder, three rescue squads (two advanced life support, one basic life support), two battalion chiefs, and an F-100 (communications van) were dispatched.
A command post was established and identified upon the arrival of the first-in battalion chief, and our airport SOP was pul into operation. This SOP deals w ith fire attack tactics and mass casualty considerations.
Under the SOP, the Philadelphia Regional Multiple/Mass Casualty Operation Plan (PREMDOP RED) was activated. This is a regional mass casualty plan; the red alert signifies that an actual emergency situation exists and that the hospital is to mobilize its disaster plan. We’re able to specify which of the area’s 30 nonprofit general hospitals and 25 other specialty hospitals are to respond by using HASTE, or the Hospital Alerting System, Tone Encoded. The Fire Communications Center, through HASTE, alerts the selected emergency rooms of Philadelphia and nearby suburban hospitals simultaneously.
As the incident progressed, all arriving units were placed in a staging area, where fire apparatus and rescue squads were separated. Emergency medical technicians, whose expertise would be needed in the triage operation, were segregated from firefighters, who were used as litter bearers. Police established a security perimeter, which prevented unauthorized entry and interference in the disaster site operations.
Tlie second-in battalion chief assumed the duties of triage coordinator. Along with the emergency medical services officer (triage officer), the coordinator supervised the primary survival scan and triage operations and established a Casualty Collection Center. The primary survival scan is a quick medical scan of all casualties to locate those in life-threatening situations that require simple aid: clearing an airway, stopping hemorrhaging, or preventing additional injury from the immediate environment. Casualties that require a considerable time commitment—for example, those with major multiple injuries or major internal bleeding—are not given more definitive treatment at this time.
(All photos by Jim Wynne.)
The Casualty Collection Center, designated by a green strobe light on top of a van, was established in a safe area where all casualties were moved for further medical evaluation and eventual transport to a hospital best suited to the injury, for example: severe burns to a burn center, spinal injuries to an approved spine care center, and severe trauma to trauma centers.
After the primary survival scan was complete, triage and tagging was begun. A colored, numbered tag designating the patient’s condition was applied to his or her clothing. (See page 54.) Red tag casualties (immediate care, first priority) were dispersed to various hospitals rather than overloading one particular hospital. Green tag casualties (third priority) were transported to hospitals further away so that closer hospitals could use their resources to treat the more serious red and yellow category injuries. Deceased victims were not moved until approval was received from the Medical Examiner’s Office and the Federal Aviation Administration.
The first-in battalion chief on the second alarm was designated as the casualty transportation coordinator. He was charged with the orderly transportation and accountability of all victims that left the scene, as well as determining which hospital they were sent to. He also coordinated the availability of hospitals, keeping in mind the level of care that was available at them.
The casualty transportation coordinator’s assistant, a company officer, was assigned to a predetermined checkout point through which all rescue squads had to pass before departing to assigned hospitals. Maps providing directions to specific hospitals were prepared in advance, carried on the casualty carts (which also carried wooden backboards, bandages, oxygen, and assorted first aid supplies) and given to the driver. This checkout point proved to be invaluable in performing the accountability check on the victims. All casualties were actually taken to the hospitals, whose abilities to cope with a mass casualty incident were also tested.
Four passengers could not be accounted for based on the number that was transported and the number of deceased. These four had wandered away from the crash site and were found in a terminal by police. A touch of realism was provided when an airport employee was reported missing. He had been last seen driving his truck in the area where the tail section fire occurred. Companies were dispatched from the staging area to search this area. An injured person was found, treated, and transported to a hospital.
The second-in battalion chief on the second alarm was designated as logistics officer His duties included water supply and foam replenishment of the crash trucks.
Communications between the various agencies operating on the incident scene were carried on two bands— casualty transportation and triage on F-5 and all other operations on F-4. Periodic progress reports were given to the Fire Communications Center on the F-2 band. Had there been an actual emergency, the phrase “Urgent, Code Real” would have been used. Fortunately, there wasn’t a need for that precaution to be exercised.
UNTIL THE REAL THING COMES ALONG
The incident was placed under control at 1225 hours, and the drill was completed by 1300 hours. The PREMDOP white alarm was given at 1245 hours, indicating that the mass casualty situation had passed or diminished to the extent that affected hospitals could demobilize their disaster plans.
Immediately upon deactivation of the drill, the Philadelphia Fire Department and Delaware County stress debriefing teams went into operation. Although no actual debriefings took place, instructional material was given to everyone that participated in the drill. The material explained what the symptoms of stress are and what the teams would have done had it been an actual emergency. The PFD realizes the importance of stress debriefing when its members are confronted with a disaster that could carry many emotional ramifications. This drill provided the arena to put the wheels into motion.
A formal postincident analysis was held after the drill with all the agencies that participated, including fire, police, emergency management, the Department of Aviation, the Federal Aviation Administration, Epex Airline representatives, the American Red Cross, and the Medical Examiner’s Office, just to name a few. In addition to the PFD rescue units, five BLS and two ALS rescue units from Delaware County, nine private and three volunteer ambulances, and helicopter support from an area trauma hospital participated in the drill. Comments, both positive and negative, were invited and received, and a formal written response was requested from each agency. Chief fire officers who participated in the drill held their own critique several days later, after soliciting feedback from their members and all aspects of the exercise were reviewed. One tool used in the review was a video recording of the drill. Several firefighters were designated as videomen and recorded activities as they unfolded. These videos were an important tool in our postincident analysis.
The drill served many purposes: We were able to test and reinforce our ICS and mass casualty procedures; the hospital emergency system and the fire department’s triage system were tested and evaluated; and interaction between the necessary ancillary agencies was also tested and evaluated.
Until the real thing comes along, mock drills are an invaluable tool to use to test the leadership ability of your department and the feasibility and viability of your written operational procedures.
See “CFR Responders” on page 56.