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.
The overall exercise is generally coordinated by an exercise director and/or senior controller, who takes responsibility for keeping time, interacting with the functional controllers and making global decisions about exercise conduct. It is important that a dedicated safety officer assist this person, just as he or she would assist an incident commander in any large-scale event.
Exercise Administration
The delivery of any type of exercise involves a number of special concerns related to administration and logistics. One concern is the response of vehicles to the site of an exercise involving actual responses. As running lights and sirens cannot be justified for a simulated emergency, vehicles must either respond from their home stations in nonemergency mode or respond from a staging or assembly area. The latter option often proves most effective, especially when units are held at that location from the time of dispatch for the duration of a pre-established "response time." Such an area also facilitates the pre-briefing of participants regarding exercise rules, artificialities and safety concerns.
Ambulance transport is another area of concern for a full-scale exercise. If an exercise will involve hospital play in addition to field play, either two sets of victims can be used or scene victims can be transported to the hospital. The former keeps more personnel at the exercise site to practice those activities, as victims pre-staged at the hospitals can be injected into play according to a timeline of "ambulance" arrivals.
Ambulances can also transport victims to a notional "hospital" elsewhere on the exercise site. This option better assesses the actual turnaround time of ambulances transporting patients.
One of the most complex logistical concerns, seen mostly in full-scale exercises, is the use of actors to play mock victims. The effective use of victims greatly enhances the realism of an exercise, especially if moulage is used and victims are well instructed on their roles. Victims can come from many sources, including schools, nursing and EMT programs, military bases, the American Red Cross, the Salvation Army, auxiliary groups and scouting organizations. It is best to present a variety of age groups reflective of the scenario, and incorporate special challenges such as elderly victims or victims with disabilities. To drive the responses of emergency personnel, victim injuries and vital signs can be conveyed using a combination of moulage and printed tags. However, it is important that responders understand that such tags may be consulted only following triage assessment of the patient. It often works well for the victim to hide a single-sided information tag and reveal information only when an EMS provider assesses for it.
Planners should also note that use of volunteer victims presents a liability concern for the sponsoring jurisdiction and ensure these individuals are covered by insurance policies should they be injured or killed in the exercise. "Victims" should generally sign a waiver of liability and exercise administrators should provide for their comfort and safety with dedicated victim controllers, food, water and restroom facilities. An appropriate number of actor controllers should be recruited to give direction to and ensure the safety of this group. The victims should be protected from any dangerous actions by responders and monitored for the effects of environmental conditions, such as extremes of heat or cold.
Safety is paramount in any type of exercise. Possible hazards should be anticipated ahead of time and addressed. For example, cold weather conditions warrant supplies of blankets to protect victims, while hot weather requires provision of water and sunscreen. Controllers should watch for, and correct, hazards throughout the exercise, such as patients carried on stretchers or backboards without straps. For any large exercise, a dedicated ambulance should stand by for actual emergencies at the exercise itself and a code word should be developed to indicate that such a problem is a real emergency and not part of the scenario.
Follow-Up Activities
