Great Preparations

A mass-casualty incident can happen in a million different ways, but odds are, you know the most likely threats your community faces. If you're smart, you've prepared accordingly. Having the right plans in place can make a huge difference in the toll a disaster takes-not only in lives, but in dollars and your ability to function in its aftermath. There's no one-size-fits-all formula for this, but there are some principles and approaches that bear recognizing. Here we present snapshots of the measures taken by some EMS systems to prepare for specific MCI scenarios. Think about how what they've done might be adapted to your jurisdiction.

Taking the Care to the Patient
     May 24, 1981: A storm that would be remembered as the Memorial Day Flood pummels the Austin, TX, area, with some areas receiving more than 10 inches of rain in four hours. One urban creek with an average flow rate of 90 gallons a minute peaks at a staggering six million gallons a minute. Flooding kills 13 and causes $36 million in damages.

     If your community is prone to floods, it makes sense to develop your emergency medical and rescue capabilities accordingly. Austin/Travis County EMS began doing so under municipal mandate following the '81 flooding, but it's a charge they fully embrace today.

     "We talk about golden hours, yet often EMS will just stand by the ambulance and wait for the patient to be brought to them," says division commander Casey Ping, who heads A/TCEMS' special operations. "Many times, EMS could be caring for a patient as rescue is occurring. That may not be in the river, but once that patient gets to the bank or into the boat, why not be able to start caring for them?"

     A/TCEMS trains its paramedics and district commanders to the swiftwater rescue operations level and its special-ops team members to the technician level at a minimum; some are specialists. It can deploy up to five special-ops ambulances with water-rescue equipment such as PFDs, helmets, ropes and floating litters. It also has five swiftwater-capable boats and two helicopters.

     The ambulances are part of the normal response matrix, making them readily deployable for sudden flood events both locally and as mutual aid. As a state, Texas has numerous top-flight water-rescue resources, including Texas Task Force 1, the nation's first statewide water rescue team. When authorities know an event is coming-like, say, a hurricane-those resources can be prestaged.

     "The intent is to get the capability placed at least 24-48 hours in advance," says Ping. "We'll typically go in and set up a base of operations somewhere like a high school, because they'll have things like Internet and showers. The key is to be close enough to do some good, but not close enough to be in harm's way."

     There was plenty of water in Texas this summer, with severe rains and flooding stretching from the Oklahoma border all the way to Mexico. At one point Austin got 19 inches of rain in two days. A/TCEMS provided resources to affected areas first as mutual aid, then at home under state task force activation, performing several rescues.

     A state review of the response was scheduled for August (shortly after press time), but Ping says one lesson was abundantly clear.

     "The biggest thing is that you really have to have things in order and ready to go," he says. "With these evolving events, you're calling people at home; if they don't have their bags packed and gear ready, it really takes hours just to get out the door. And anyone who's in the water is going to live or die within hours.

     "On-duty units probably aren't configured to go be self-sufficient for 24-72 hours. So we have to do a better job of having folks who are rapidly deployable and able to be self-sufficient. The last thing a devastated community needs is another 50 or 100 people to take care of."