Mass-Casualty Exercise Design for EMS Agencies

Communities of all sizes require disaster planning, and exercises are a fundamental part of ensuring preparedness for emergencies. Over the past six years or so, the largest cities in the United States have received substantial amounts of anti-terrorism and disaster-preparedness funding through a variety of federal programs. These initiatives have, among other things, afforded certain jurisdictions the opportunity to receive exercise support from federal contractors, including expert assistance in developing and executing tailor-made exercises. These opportunities have allowed EMS agencies in these cities to assess personnel, procedural, equipment, supply and training needs, as well as to practice dealing with interagency operations and unfamiliar scenarios. For the many smaller jurisdictions that have not yet received federal support, valuable exercises can be designed and implemented using many of the same principles followed by the experts in this area. This article provides conceptual guidance for local EMS agencies regarding the design of effective mass-casualty exercises.

It is important to note that many federally supported exercises are required to involve weapons of mass destruction (WMD). However, even in a post-9/11 world, not every mass-casualty exercise needs to involve WMD. Any opportunity to stage an exercise dealing with large numbers of patients and/or hazardous materials increases an EMS agency's preparedness for hazards of all types, including those posed by potential terrorism. By the same token, a WMD exercise yields benefits in terms of preparation for garden-variety mass-casualty and hazmat incidents.

A realistic and challenging, but not overwhelming, scenario often proves the best course of action. Planners should avoid the standard bus accident drill and consider the unique possibilities within a community for disaster, including transportation hubs, industrial facilities, hospitals, nursing homes and schools.

Types of Exercises

A comprehensive exercise cycle usually involves four types of exercises: drills, tabletop exercises, functional exercises and full-scale exercises, each successively increasing in complexity and scope of activities.

1. A drill is conducted on the individual agency level, and allows for practice in one particular aspect of disaster response, such as triage, the use of a new piece of equipment or the setup of a treatment area.

2. A tabletop exercise allows responders to think through a paper scenario without actually practicing the response itself. The scenario may gradually unfold over a period of time, requiring participants to adapt their responses to a dynamic situation. While tabletop exercises can prove useful for an individual EMS agency, they are even more valuable when conducted community-wide. This allows members of various agencies to practice working together and coordinating their respective emergency operations plans.

3. A functional exercise involves a live response to a simulated emergency in real time, testing one specific function. These exercises are often used to test the operations of state and local emergency operations centers (EOCs) in coordinating emergency responses.

4. A full-scale exercise usually involves multiple agencies, real time, real equipment, real personnel, mock victims and other steps to create as much realism as possible. They aim to provide the closest possible simulation of an actual disaster and provide an excellent opportunity to assess many aspects of an EMS agency's and an overall community's respective preparedness. Full-scale exercises involve a great deal of planning and coordination, and some expense.

It is vitally important that appropriate training precede any type of exercise. The exercises should assess the efficacy of training programs and reveal unanticipated operational weaknesses.