The Secondary Device You May Not Have Planned For

My initial EMT class in 1990 had a very perfunctory lesson on scene safety, one we’ve all heard before—specifically, asking yourself “is the scene safe” and, if the answer is no, going no further. Clearly, with the Nunn-Lugar-Domenici Domestic Preparedness Initiative and the attacks on Sept. 11, as well as other factors, our take on scene safety has been modernized.

One of the elements we now focus on is the issue of a secondary device—one specifically designed to harm first responders. We saw a secondary device used in an abortion clinic bombing in Atlanta, and Israel has had similar experiences in a number of suicide bombings. But is it possible for a secondary device to lack intent, but still be harmful to EMS providers, such as a weather-related incident? That’s exactly what emergency responders in the northeastern U.S. were faced with in early November, as a nor’easter brought rain, snow and high winds to an area already devastated by Hurricane Sandy just a week before. Clearly, this type of nontraditional secondary incident presents unique challenges.

Those challenges could include patient evacuation from large acute care facilities, EMS personnel handling multiple 12- or 24-hour shifts, or the need for Medical Reserve Corps (MRC) activation. Both New York and New Jersey requested ambulances through the Emergency Management Assistance Compact (EMAC) and activated the FEMA National Ambulance Contract. Additional issues can include statutory waivers, patient tracking, resource management and financial reimbursement. And if that weren’t enough, there are public health issues to consider, including the need for potable water, the possibility of food-borne illness, environment concerns and even the possibility of sewage back-up.

In the Northeast, many responders were fatigued after working 12- or 24-hour shifts in austere conditions, all while facing the storm’s impact on their own homes, or those of loved ones. The gas situation got so bad in New Jersey that lines for fuel—which had to be rationed—were often hours long. Governor Chris Christie even resorted to an odd/even license plate system to determine who could get gas. Clearly, this impacted operations.

Lessons Learned

One of the primary lessons is to ensure your plans look at incidents realistically. Do you have areas for staff to sleep and eat—and are these areas capable of being accessible and maintained for days, if not weeks, in case of a prolonged incident or event? Have you considered how to respond to a fuel shortage when it affects your staff’s ability to get to work? How would your EMS agency operate with limited staff? Do you have a co-op plan? Has it ever been exercised? Every incident and event is an opportunity to update your contingency plans based on lessons learned. The fact that this storm changed direction, made landfall, maintained its strength and caused the destruction in the way it did should be lost on no one, and these lessons should be incorporated into contingency plans. Additionally, the aforementioned issues—from MRC activations to EMAC requests—must also be incorporated, if they weren’t previously.

Another lesson learned is the importance of cooperation. A wise man once said you should not be giving out your business card on game day, which means you should know all of the players (your health department, emergency management officials, law enforcement officials and more) before an incident occurs and understand their capabilities. This also means accepting that, when your resources are reaching their limits, it’s time to bump things up to the next level—state or federal—for assistance. This also means you need to know who to go to when things need to be “bumped up.”

One of the last lessons is the importance of the hotwash and after action report (AAR). It’s imperative that you have an opportunity discuss all the issues—what went well, as well as what didn’t, and what your agency can do differently in future events/incidents—at the hotwash, and just as imperative that these thoughts go into the AAR. The Eastern Seaboard hasn’t seen a weather-related incident of this magnitude in some time and the lessons learned need to be captured to benefit future responders.

Finally, it’s critical to understand how to present the realities of an incident—good and bad—and how your agency responded to elected officials. This can impact future funding for your agency and cannot be overstated.


As we reflect on these recent weather-related events, we’re reminded of our most important EMS resource—our personnel. As we’ve seen time and again, EMS providers overcome incredible challenges to get the job done. Learning from incidents, like the storms that ravaged the East Coast, prepares providers that much more for the next challenge to come.

Raphael M. Barishansky, MPH, is director of EMS for the Connecticut Department of Public Health. A frequent contributor to and editorial advisory board member for EMS World, he can be reached at