url?sa=t&source=web&cd=1&ved=0CCQQFjAA&url=http://www.integratedtrainingsummit.org/presentations/2008/main_training_summit/course_18_-_tale_of_two_cities_and_the_running_of_a_planned_mass_casualty_event_-_serino_richard

Presentation Overview• Planned Disaster Concept• Groundwork• Collaboration•Planning•Execution• Evaluation and Analysis

Special Events as Planned DisastersCONCEPT

ConceptSpecial Events: Sharing the Characteristics of a Major Incident• Special Events (“High Threat Incidents”)– Draw large crowds– Require above normal resource commitments byemergency responders– Special circumstances, such as heat, cold, exertion,substance abuse, and others present responders withreal (not simulated) opportunities to performinterventions on a large number of patients– Frequently result in a high number of casualties– Excellent opportunities to exercise disaster, largescale,and mass-casualty incident plans

Special Events asPlanned DisastersGROUNDWORK

Groundwork• Plans must be in place– Communications– Notifications– Operations• Mass-casualty• Mass-evacuation• Pharmaceuticals/Prophylaxis Distribution• Fire suppression• Other consequencemanagement• Partnerships need to bedeveloped

Special Events as Planned DisastersCOLLABORATION

Collaboration• During an actualmajor incident, no oneagency works alone• Agencies have uniqueresponsibilities• Agencies must knowhow cooperatingagencies will respond

CollaborationWorking TogetherUtilize special events and drills asopportunities to plan & train together sothat you may institutionalize ‘workingtogether’.People and agencies will fall back on what they knowduring emergencies. Through building necessaryactions and protocols into regular operations, webecome better prepared.

CollaborationUnified Command• Jurisdictions talkabout unifiedcommand often• Plan to implementa unified commandstructure for yourplanned disaster• Consider opening aunified commandcenter

CollaborationWorking with the MediaTheir mission is to get a story. Building alongstanding relationship with journalistsand reportersensures thatthey get theright story andthat they serveas a resourcewhen needed.

Special Events asPlanned DisastersPLANNING

Planning•Interface andintegrate with theevent organizers• Bring the right peopleto the table• Develop a mission• Develop specific andmeasurable objectives• Decide the elementsof your plan you wantto focus on exercising•Determine whatpartners you want toinclude in yourexercise• Be ambitious, but berealistic

PlanningAssess Potential Threats• Determine what could go wrong and whatwould be done to minimize risk, injury,and/or damage.• Ex: How would you shelter marathonrunners if there was a hurricane?

PlanningSpecial Operations

Boston EMS – Tango Trucks (3)•Tyvek Suits•Backboards•Stretchers• Defibrillator• Ladder•Blocks•O2 Tanks• Multilators•Mark 1•etc….

Boston EMS – Gators & Golf Carts

Boston EMS - Bicycles

PlanningIncident CommandIncident Command System (ICS)– Incident Commander– Command staff– General staff– Appropriate branches– Pre-designated task forces– De-escalation– Call sign usageUnified Command– Develop structure in advance– Explain the concept– Build relationships withcooperating agencies

PlanningCommunications• Interoperable communication acrossagencies & jurisdictions• Consider a tactical frequency• Dedicate a dispatcher for largeevents•Utilize earpieces

PlanningAccess and Egress• Cordon-off evacuationroutes around congestedareas• Make use of aerial views forplanning• Escalate resourcecommitments around busyevent periods

PlanningEvent Escalation• Assign personnel to busy areas but bearaccess and egress in mind• De-mobilize resources as the event deescalates• If there is a mass exodus, considerimpact units around heavy exoduszones• Delicate balance: maintaining citywidecoverage during major events• “Life goes on…” while “everyone” is atthe event

EXECUTIONSpecial Events as Planned Disasters

Execution• Proactive action (for heat orcold)– Mount a coordinated riskcommunication campaignusing media outlets beforeand during the event– Encourage runners &revelers to wearsunscreen, stay hydrated,etc.– Develop hot-weathersafety tips pocket cardsand magnets

Execution• Incident Action Plandeveloped in advance• Mobilization details, demobilizationdetails• Coverage assignments• ICS call signs, grid maplocations, contingencyplans, pertinentappendices• BEMA and BFoJ or BAAcoordinate inter-agencyplanning

Mapping• Scaled maps for theevent, specialized fora specific purpose–Improved upon eachyear• All maps are based onconsistent gridcoordinates– Makes dispatchingsimple and efficient– Zone designations forincident reporting

MappingBoston Marathon

Mapping Boston Marathon

Medical Response• Much of the care renderedis the result of patients selfdeliveringto medical tents• Large crowds presentaccess issues for rapidresponses for patients thatcannot self-deliver• Solution: Proceed Out andRapid Response Teams– Gators– Bicycles– Fully staffed and equippedmedical tents

Medical Response• All tents can functionnear the capacity of anemergency room– Assorted medical supplies– Pharmaceuticals– Defibrillators– Re-hydration solution– Disaster supplies• Physicians present atmedical tents for closemedical oversight andcritical patients• WMD CST and BFDpartnered with forHazMat/MCIdecontamination

Medical ResponsePatient Tracking• Using MMRS & UASI funding,Boston EMS has developed aPatient Tracking System for theMetro Boston Region.• Patients tracked with uniquebarcodes on a web based system.– Location , status & unique ID arerequired fields.– Registered runners are preloaded inthe system• Special Events have been utilizedto trial and evaluate the system.

CredentialingFor all Exercises & Special Events• All personnel pre-screened• All personnel must gothrough credentialingprocess• All personnel (evenuniformed) must displaycredential at all times

Transferable Lessons•Boston Marathonofficials observeBoston Fourth of Julyoperations (vice-versa)•Over the years,lessons have beenlearned on both sidesas to how to enhanceoperations safety

Logistics Needs• Food, ice, and waterwill all be neededduring a majorincident – specialevents are no different• Distribution can betricky, given all of thepersonnel to feed• EMS cordons off ourown logistics center

Special Events as Planned DisastersEVALUATION ANDANALYSIS

Evaluation and AnalysisAfter every major special event or incident,there are formal and informal discussionsevaluating the response, what went welland areas for improvement.

Evaluation and Analysis• Each year is a learningexperience• Essential to takelessons learned fromthe planned disasterand integrate theminto operationalplanning• Analysis should beongoing• After-action reportsare essential toeffectively capture thesuccesses and failures• Develop action items

Evaluation and AnalysisDue to the inherent similarity between the medicalresponse for special events and disasters, wehave seen a continual improvement in ouremergency response capabilities as we preparefor and execute plans for special events.For that reason, we consider any weakness in ourresponse to a special event to be a weakness inour emergency preparedness capabilities, takingthe utmost care to address such issues as soon aspossible.

Thank YouRichard SerinoChief, Boston EMS617-343-2367serino@bostonems.org