Taking Another Look at Mass Casualty Incidents

In case you missed it, the NTSB issued their findings and recommendations relative to the derailment of Amtrak 188 in the City of Philadelphia last May, which resulted in the loss of eight lives and injuries to over 200 other passengers.

The NTSB surmised that the engineer was distracted by reports over Amtrak’s radio of a nearby train having rocks thrown at it, which is apparently a common occurrence on a certain stretch of tracks through Philadelphia.  His distraction resulted in him speeding up the train, rather than slowing it prior to heading into a curve.  Taking the curve at high speed led directly to derailment of the train.  It has been pointed out that the presence of an automatic Positive Train Control system, not installed on many trains, would have slowed the train and likely prevented the derailment.  A rail industry union consortium indicated that the presence of two engineers on the train may have also mitigated this incident.

What I found most interesting in the report was that after listing findings and recommendations related to the derailment itself, the NTSB report identified issues beyond the crash.  The report states that

“…as a result of victims being transported to hospitals without coordination, some hospitals were over utilized while others were significantly underutilized during the response to the derailment.  The NTSB further found that that current Philadelphia Police Department, Philadelphia Fire Department, and Philadelphia Office of Emergency Management policies and procedures regarding transportation of patients in a mass casualty incident need to be better coordinated.”

Why is the NTSB providing recommendations on how mass casualty incidents are handled?  These recommendations are, in fact, fully within the scope of their mission statement as they address, ultimately, how victims are cared for.  The NTSB has also brought us best practices that extend beyond crashes, such as Family Assistance Centers.

The recommendations the NTSB provides in this report are spot on.  Mass casualty incidents MUST be coordinated.  Triage, treatment, and transport.  We’ve all heard of these three key activities.  Yes, it’s excruciatingly difficult to not ‘Scoop and Run’ when we encounter an injured victim, but let’s consider a few reasons why we shouldn’t:

  1. Patients with certain injuries, such as those to the cervical spine, are not being stabilized, and could have their injury worsened.
  2. A patient could ‘crash’ from a multitude of causes, which require the resources of an ambulance and paramedic to address, absent being in a hospital.
  3. Scoop and Run violates the concept of triage, which is intended to provide care and transport for the most critically injured first.
  4. The emergency personnel and vehicles involved in Scoop and Run may be otherwise needed at the scene.
  5. Depending on the incident, victims may be contaminated. Scoop and Run can endanger personnel who are not aware of this.
  6. Scoop and Run circumvents patient tracking and accountability, which is important for on-scene operations, liability and insurance, post-incident medical monitoring, and investigation.
  7. Scoop and Run, as the NTSB report pointed out directly, doesn’t account for spreading patients among receiving hospitals, meaning that some patients can end up at hospitals unequipped for their type of injury as well as overcrowding of hospitals.

While the City of Philadelphia did a great job overall, this gave them cause to take another look at their mass casualty plans and procedures; resulting in Philadelphia Office of Emergency Management asking for better coordination of the multiple entities involved in a mass casualty incident.  While this incident provided some great lessons learned for the City of Philadelphia, it also provides lessons learned for all of us.  It’s a good opportunity to convene your mass casualty planning group and give a review of your plan.  Any jurisdiction can be susceptible to a mass casualty incident.

In need of a structured plan review, planning, training, or exercises involving mass casualty incidents?  Emergency Preparedness Solutions can help!  Contact us now!

© 2016 – Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLCYour Partner in Preparedness!

A Decontamination Game Changer

Last week, the way we remove chemical contamination from victims of a terror attack or chemical accident has changed… well, not quite yet, but it should soon.  A partnership between the US Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) and the University of Hertfordshire in England and Public Health England found that “…removing clothes removes up to 90 percent of chemical contamination and wiping exposed skin with a paper towel or wipe removes another nine percent of chemical contamination.  After disrobing and wiping with a dry cloth, showering and drying off with a towel or cloth provides additional decontamination, bringing contamination levels down 99.9 percent.”

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Essentially, what they discovered was that despite recommendations for doing so, victims have often not been required to disrobe for decontamination.  When victims would progress through a decontamination (water spray down), much of the chemical they have been exposed to remains in the clothing and trapped against the skin.  Clearly this is not effective.

I see this new methodology being a significant change to how we decontaminate victims.  As the study hypothesizes, decontamination is much more effective when the chemical is wiped from the body after the victim disrobes.  Following this, they may progress then through a water spray.  This, essentially, adds a step to the typical protocols used in North America, Europe, and other locations.  I’m told the wipe methodology has been used in Japan for some time now.  I also believe that wipes have been in use by the US (and other) military forces for units in the field.

Links of interest:

HHS Press Release on the study.

Implementation of new protocols in the UK and other European nations

Many thanks to my colleague Matt for passing this information on to me.

As with any new procedure, the devil is in the details.  Standards must be established and adopted, supplies and equipment must be identified and obtained, personnel must be trained, and exercises must be conducted to validate.

I’m interested to hear opinions on these findings and recommendations, as well as thoughts on implementation in the US and abroad.

© 2016 – Timothy Riecker, CEDP

Emergency Preparedness Solutions, LLC Your Partner in Preparedness

 

Battling Wild Fires and Perspectives

Hello readers!  Apologies for my absence over the past couple of weeks.  I’m grateful, especially as a founder and company partner, that we’ve been so busy as of late.  The design, conduct, and evaluation of a couple of great exercises for one client; the design of several impactful training courses for another; along with preparations for two new contracts have had our small business buzzing with activity.  We will be recruiting a lot of people for one of those contracts, so stay posted on the blog (www.triecker.wordpress.com), my LinkedIn profile, and both my personal (@triecker) and our company (@epsllc) Twitter accounts, as well as the company website (www.epsllc.biz) for more info.

Although I’ve not been blogging for the last couple of weeks, I’ve still been keeping up on current events.  The wildfire in Fort McMurray, Alberta, Canada has been consistently one of the biggest stories as the fires still continue to spread, having caused massive devastation to property and the environment, and having displaced around 100,000 people.  Hundreds of vehicles were abandoned during evacuations, either due to mechanical trouble or lack of fuel.  The Canadian Red Cross, partnering with federal and provincial governments, is providing tens of millions of dollars in direct aid to impacted individuals and families.  Thousands of workers are being evacuated from the oil sands area north of the Fort McMurray, stalling more than a million barrels of production each day.  Firefighters, law enforcement, military personnel, and other resources are battling dry conditions, high temperatures, and winds in this massive and constantly shifting fire.  Other provincial and local governments and even citizens are helping to shelter and care for evacuees, many of which have lost much of their property.

One thing I often find interesting is the difference between perspectives, especially between public safety and citizens.  While our focus in public safety is… well… to make sure the public is safe, we always have to keep tabs on perception.  Take the seemingly conflicting reports of these two articles, for example.  The first article, published Thursday May 5, tells the story of residents evacuated from an area who are questioning the organization of response efforts and general preparedness of officials.  One individual tells of no police officers to guide evacuees out of town.  The second article, published on Saturday May 7 tells of military and police overseeing evacuations across the incident.  I believe I read these two articles back to back, causing the dichotomy of the two to really jump out at me.

Truth, of course, likely lies in both articles.  Yes, thousands of public safety and military personnel are involved and doing what they can.  Some evacuation orders, as indicated in the first article, are sudden, based upon rapidly changing factors, giving public safety little time to mobilize to the new area.  There must also be a consideration that evacuation orders may have been issued without proper coordination of resources.  Any of these things are possibilities, especially in the fast moving environment of wild fires.  Still, they provide opportunities for us to learn and improve.  Not knowing the details of what may or may not have transpired, I am always reluctant to speculate.  As with all incidents, events, and exercises, however, once the work is done, we have an excellent opportunity to review and evaluate information in a collaborative manner to identify strengths and areas for improvement.  Organizing these notes creates a corrective action plan, the implementation of which will, over time, make us better at what we do.

© 2016 – Timothy Riecker

Several New CyberSecurity Efforts in the News

Over the past few days, there have been media releases about several new cybersecurity initiatives that should have broad reaching benefits.

Timothy Riecker

First, Govtech.com reported on New Jersey’s consolidated fusion center-style approach to cybersecurity.  About a year ago, the New Jersey Cybersecurity and Communications Integration Cell (NJCCIC) was formulated, following the model of the National Cybersecurity Communications Integration Cell (NCCIC).  Co-located with the NJ State Emergency Operations Center and with support from the NJ Office of Homeland Security and Preparedness intelligence resources, the NJCCIC is keeping a watchful eye on cybersecurity matters internal and external to state government and sharing information with the private sector. This is a model effort that will hopefully grow and change based on identified opportunities in both New Jersey as well as other states who have yet to build such a capability.

EDM Digest recently reported on an initiative from the National Governor’s Association to form a multi-state working group, or academy as they are calling it, to create strategies to fight the evolving cybersecurity threat.  States contributing to this effort include Connecticut, Illinois, Louisiana, Nevada, and Oregon.  While not states we would usually think of as being on the forefront of cybersecurity issues, each does have significant business and industry which will hopefully serve as partners and resources in this endeavor.

Lastly, US Representatives Richard Hanna (R-NY) (who represents my district) and Derek Kilmer (D-WA) introduced the Small Business Cybersecurity Act to help American entrepreneurs protect themselves from cybercrimes and create cybersecurity plans that meet their business’ needs.  Co-sponsors of the bill included a range of Representatives of both parties from across the nation.  The release states that three out of every five cyberattacks target small businesses, and with small businesses making up a significant portion of the US economy, it is vital to help protect them.  I couldn’t agree more!  The intent of the bill is to create no-cost legislation to leverage the expertise of Small Business Development Centers (SBDCs) around the nation as an information distribution point for cybersecurity preparedness.  Let’s hope this one passes!  Express support for the bill to your Congressional Representative!

All in all, it’s encouraging to see continued effort toward cybersecurity protection, preparedness, and response.  As with the preparedness efforts we see in emergency management, I hope soon these efforts in cybersecurity will become more unified and closely knit.  While they all technically fall under the President’s Cybersecurity Strategy, we need to ensure connectivity of these efforts to help prevent duplication of effort and minimize holes.  We also want to ensure that access to services and resources that are available are comprehensive and streamlined to the greatest extent.  Let’s keep cybersecurity in mind and continue this work!

© 2016 – Timothy Riecker, CEDP