Letter from America: Training Hard and Fighting Easy

Just like the Olympians on the field, positive results in emergency response come from dedicated and focused training


Rob Lawrence is chief operating officer of the Richmond Ambulance Authority. Before coming to the USA, he held the same position with the English county of Suffolk as part of the East of England Ambulance Service. He writes a regular "Letter from America" column for the UK publication Ambulance Life.

It’s not unusual these day days for visitors to stop by the Richmond (VA) Ambulance Authority (RAA), but a few weeks ago Steve Kanarian came by. Steve is a retired EMS officer from the Fire Department of New York (FDNY). He was an urban search and rescue paramedic based in the Bronx, and like many EMTs and firefighters from FDNY, his world literally came tumbling down on September 11, 2001.

Steve’s account of that day, and the days, weeks and months in the aftermath of the Twin Towers collapse, are recounted in his book The Downwind Walk. He left me with a copy, and by the end of the next weekend it was read and passed on to another member of my team with a two-thumbs-up recommendation. Even before I got to the point in the book where Steve and many like him were scouring the “pile,” looking for any sign whatsoever of a life that hadn’t suffered the crushing blow of that terrible day, I was impressed by the way he captured the essence of the EMS worker, the camaraderie, the shared adversity and, yes, the gallows humor. His words clearly demonstrate that the lot of American medics is exactly the same as paramedics and EMTs in the U.K. and beyond. That’s why I suspect every time we have ambulance visitors from anywhere on the planet, an immediate rapport, familiarity and mutual respect are instantly established.

What I didn’t realize in reading Steve’s book was that only a few days before September 11, members of FDNY took part in a plane crash mass casualty exercise at New York’s La Guardia Airport. Triage and treatment of multiple casualties was the order of the day, and while they never imagined in their wildest dreams the size of the disaster population only a few days later, training nevertheless occurred.

Having spent my first career as a soldier, the phrase “train hard, fight easy” was a mantra we always followed. I distinctly remember a moment in Bosnia, where I commented that the rigors of the “battle day” resembled an exercise we had conducted before deploying. In fact, it wasn’t like the training; the training mirrored the operation and we were all the better prepared because of it. Later on in my National Health Service life, I had the privilege (and the blessing of the chief constable) to be chairman of the Suffolk Strategic Coordination Group (SCG), normally the preserve of senior police officers. We certainly lived by the “train hard, fight easy” rule; in fact, no sooner had we exercised a scenario than it happened!

Not long after an H5N1 table top, the Bernard Matthews turkey factory had a massive outbreak of bird flu. The SCG suddenly had to worry about everything from parking for huge TV trucks from the world’s media around the leafy lanes of Suffolk, to immunization and barrier treatment of exposed workers. Training made the day easier. An SCG coastal flood exercise was followed not long after by the highest surge tides and flood potential seen on the east coast since 1953. Again, training at all levels of the Gold, Silver and Bronze command structure bred familiarity—with each other and the plan—and was a force multiplier that eased operational pressure considerably. The day a 500 pound WWII bomb washed up on Felixstowe beach and placed half the town within the blast radius was dealt with in a cool, calm, collected and rehearsed way by a joint service team that trained, operated and thought as one.

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