Disaster in the Desert: Rotunda Thunda `05

The daytime temperature in Las Vegas that July Monday was 115ºF. Tourists filled the hotels and swarmed the Strip, and the nearly two million residents of the metro area went about their business.

Then disaster struck. A chemical bomb detonated during a concert at the Thomas and Mack Center, a sports and entertainment arena, killing 500 and injuring 1,500. At almost the same time, a bomb exploded at a large hotel casino. Then the local Emergency Operations Center (EOC) reported anthrax on the Strip. Later, a 6.7-magnitude earthquake hit the valley, and in the subsequent days, several other disasters followed, taxing Las Vegas' first responders and healthcare facilities to the limit.

Was it the end of the world? It may have seemed that way as bloodied citizens streamed into the casualty collection point and the coroner's office decontaminated the dead. But none of it was real. The roaming and panicked injured were actually actors and volunteers sporting moulage wounds. Store manikins represented the dead.

Rotunda Thunda '05
The preceding scenario was part of Rotunda Thunda '05, a mass-casualty preparedness exercise funded by a $500,000 grant from the Department of Homeland Security's Office for Domestic Preparedness. It was the culmination of nearly a year of planning by 78 different local, state and federal agencies--planning that began when Nevada Homeland Security Commission Chair Dr. Dale Carrison determined it would take only 200 critical patients from a terror attack to disrupt the Las Vegas Valley's trauma system. What would happen if there were more?

Previous exercises had involved individual links in the area's emergency response system, but the entire system--from first responders to hospital trauma units-had never before participated collectively in a sustained, coordinated exercise. Rotunda Thunda gave them a blind exercise--none of the responders knew what was going to happen ahead of time. Primary players included various Clark County first responders, staff at eight hospitals and 11 University Medical Center Quick Care facilities, EMS providers, ambulance companies, Clark County Health Department personnel and 180 volunteer "victims."

There were several goals for the 54-hour, around-the-clock exercise. They included discovering how long, in real time, it would take to set up a system to deal with mass casualties; testing a response under realistic conditions such as the desert heat of Las Vegas; improving communication and coordination among medical agencies under pressure; and seeing if agencies would rely on and follow the disaster plans they had established. Some of those disaster plans included the Clark County Emergency Operations Plan, Clark County Health District Emergency Plan, Terrorism Response Plan, Convention and Visitors Authority Response Plan and Metropolitan Medical Response Plan for Las Vegas.

At the Clark County Government Center
As the exercise began, the Emergency Operations Center (EOC) was activated as a multi-agency command facility. Representatives from various agencies monitored events on several television screens and received and confirmed data through contact with their agencies' incident command members on site.

Confirmed information was sent to the Joint Information Center, which was staffed by public information officers (PIOs) from the various agencies. (The single exception was the PIO of the lead agency, who was at the site of the disaster.) These PIOs, in addition to monitoring news stations, met with and coordinated news releases for the media. In this way, they all provided the same information, preventing confusion and ensuring that the information would be accurate. These news releases were kept for easy reference on individual agency clipboards on a large table.

In the Policy Room, agency heads and others such as county commissioners and the sheriff were kept informed about what was happening. Mock press conferences took place in the Media Room, with volunteers acting as reporters and concerned citizens. Outside, the Salvation Army brought mobile feeding units from Reno and two Arizona locations. They also sent a team of counselors to support mental health activities and activated an incident command post. They utilized amateur radio operators for communication between the command post and the mobile feeding units.

As part of the exercise, veterinarians offered free microchip implants to pets to test the capacity of the new Regional Mobile Emergency Animal Shelter, a converted Featherlite trailer. Hurricane Katrina, which devastated New Orleans the next month, proved how important the microchips can be in identifying pets and matching them with their owners. In the 47 continuous hours that the veterinarians worked, they implanted microchips in more than 750 animals, including everything from dogs and cats to parrots and fish.

At the Casualty Collection Point
The Las Vegas Convention Center was a predetermined casualty collection point (CCP) that already had setup guidelines in place. It was chosen because it was a large building with plenty of parking, and was equipped with bathrooms, chairs, tables, forklifts and air conditioning.

It was also used for several other reasons. First, the Las Vegas Convention and Visitors Authority could test whether it would be able to support a community disaster response by providing direct logistical support to fire command. Also, the exercise offered an opportunity to evaluate the Las Vegas Metropolitan Medical Response Plan, test the setup of the CCP using fire department playbooks, and evaluate the ability of local public health to operate the center. Finally, it made sense logistically to combine various activities and test the different plans in one location.

Another terrorist bombing exercise, Loaded Dice, was scheduled to take place in the Las Vegas area several months later. Since that exercise would be geared toward prehospital triage and treatment/transport of casualties, those functions were kept to a minimum during Rotunda Thunda. Rather, the main prehospital emphasis at the CCP was on design, setup and staffing of the facility by fire/EMS, public health, Medical Reserve Corps, CERT, etc.

Early the first morning, as the reports of disasters came into the EOC, fire and rescue companies were briefed at their locations and began to assemble at the casualty collection point. Once there, they received a more formal briefing.

Las Vegas Fire and Rescue and Clark County Fire Department each provided a one-alarm assignment that included three engines, a truck and rescue, battalion chief and EMS supervisors to assist Incident Command in setting up the CCP. Ambulance companies provided support staff and half a dozen units for patient transport. Community Emergency Response Teams, Medical Reserve Corps and other volunteer groups provided additional personnel and staffing to operate the CCP, all under direction of the Clark County Health District.

The casualty collection point was organized into several divisions, each under the control of a division leader and having a different function. One area had the morgue and a refrigeration truck. Coroner's office and Army personnel decontaminated bodies there. Another section contained fast-pack equipment. Nearly 250 cots and accompanying basins, sheets, etc., were put into service. There was also an area for the veterinary duties.

Small meeting rooms within the convention center provided space for an incident command post and related functions. Only division leaders had access to the command post; in an actual emergency, it would contain communication equipment and plans. Other rooms were designated for meetings, debriefings and mental health activities, and equipment and supply storage.

Outside, the Mobile Command Center bus supported the casualty collection point.

Results, Insights and Solutions

• From fire, EMS and public health: According to Assistant Chief Russ Cameron of the Clark County Fire Department and representatives of the Clark County Health District, Las Vegas Fire Rescue and Medic West Ambulance, the hands-on scenario allowed personnel to experience what they had only known in theory before. For example, it was the first time personnel had physically used the fast-pack equipment in setting up the 250 cots and related materials.

While working closely with public health, fire and EMS learned valuable lessons in point-of-distribution management, and both realized the need for more personnel in an actual disaster. In addition, public health personnel now understand the Incident Command System regarding crew organization and prioritization when setting up a CCP.

Some confusion by the crews about the right location to send the injured demonstrated a need to clearly define--and for personnel to understand--the differences between the terms casualty collection point, alternative care site (ACS) and point of distribution (POD). A casualty collection point is a location generally at or near the scene of the incident for casualties produced by the incident. Alternative care sites are for long-term patient care after incidents. These sites would be necessary because an overwhelming community disaster would require care facilities other than the CCP or local hospitals. Points of distribution are for mass prophylaxis of citizens. Fire department playbooks were edited to clarify these definitions.

It was discovered that even with volunteer groups, there would not be enough personnel to staff more than one POD or ACS in a disaster. Solutions for this problem are being developed. And while Incident Command training previously focused on training just public health managers, it was decided that it would be better to give it to all employees.

The exercise also pointed out the need for designated physician-nurse Metropolitan Medical Response System (MMRS) strike teams. This would prevent lost time that could be better spent doing patient evaluations, ordering treatments and releasing victims who don't need help.

Another finding was that animal control duties should take place in areas separate from the rest of the center, and that the location of the morgue should be carefully considered.

Since Rotunda Thunda '05 took place, a fire department mass-casualty working group has been established to further refine MCI plans and examine communication issues. Also, plans are being developed to increase the frequency of tabletop sessions, and to conduct a large incident scenario once a year.

• From emergency management: According to Clark County Emergency Manager Jim O'Brien, Rotunda Thunda '05 met and sometimes surpassed its objectives.

For example, the capabilities of the convention center exceeded expectations. With more than three million square feet under one roof, it has the capacity to support the local community in the event of a disaster. One of the exercise's goals was to discover how long it would take to set up a CCP to process the injured who arrived there. It took just five hours from first notification to completion, and this was accomplished in the off-season, when fewer staff were on duty and some equipment was in storage. It was estimated that in season, a CCP could be set up in half that time if the center were not occupied by a convention.

Communication among the various agencies, the convention center and the drill sites was successful. It was accomplished through use of telephones, cell phones, fax, e-mail, radio and Web EOC, a Web-based emergency management communications system.

When the county e-mail system shut down during the first two days of the exercise, amateur radio operators transmitted messages. In fact, these operators already have places at each hospital, and antennas for their use are mounted outside the buildings. One area found through the exercise to need improvement, however, was the two-way communication between the EOC and the hospitals. Corrective action has been taken by placing a hospital trauma manager at the EOC.

The ability to respond effectively under several different plans carried out by different agencies worked because Las Vegas already has a blend of agencies working together to provide an all-hazards response when needed. ARMOR, the All-Hazard Regional Multi-Agency Operational Response Unit, consists of police, fire, EMS, hazmat, narcotics and other agencies that work together, depending on the incident.

The National Incident Management System (NIMS) and National Response Plan were used and generally implemented successfully. A few departments, such as purchasing, do not use them regularly throughout the year, so those personnel will need to practice more to become familiar with these plans and retain the information therein.

Plans called for 200 public health nurses to be assigned to the casualty collection point to supplement the first responders. However, it was found that public health nurses were not equipped to handle trauma cases, and another solution needs to be found.

Other lessons learned were that it took longer than originally thought to get emergency equipment to locations and to brief emergency crews, and longer for other events to take place. Had the exercise not been conducted in real time, this would not have been discovered.

• From the EOC: Samantha Charles, PIO of the Clark County Manager's office, says it's important to keep the language barrier in mind when disseminating emergency information. This information--and especially instructions for the public--is important to all citizens, many of whom may not speak English. Translators for German, French, Spanish and other, less-widespread languages should be available. EOC staffers had arranged to use interpreters from the Clark County Courthouse. They came to the information center to translate and were available for television interviews. This relationship with the interpreters must be established well in advance of any disaster.

Overview
O'Brien says he's a big advocate of unscripted, long-duration multi-agency disaster exercises, for several reasons:

• Most health agencies hold field drills during normal workweek, daytime hours, so only those on duty at that time are able to participate. But since this was an around-the-clock mass-casualty exercise, fire and rescue, for example, continued to deliver patients to the ED during the swing and night shifts when staffing was low. These personnel learned in a graphic manner that they needed to call for support early and often.

• Since the 54-hour exercise continued through all shift changes and over several days, it stressed the system, leading to discovery of which processes and procedures were inaccurate or faulty, and where such weaknesses existed. It exposed what needed to be practiced and where personnel should be brought up to speed. It found the points where information fell through the cracks.
• It took nearly a year to plan Rotunda Thunda '05.O'Brien says the planning process was just as important as the execution. The planners learned as much as those involved in the exercise, especially in areas such as which duties other agencies could perform and which ones they could not.

Even if officials don't think their city needs a disaster plan because it is in a "safe" location, it does. A disaster does not have to take place within a jurisdiction to impact it. After Hurricane Katrina hit New Orleans, nearly 4,700 evacuees were displaced to Las Vegas, all arriving within a very short period of time.

What are the chances that Las Vegas--or any city, for that matter--would be hit by an earthquake that causes a train derailment that releases sulfuric acid, a bomb at a concert, the release of anthrax in an area filled with tourists, and several other disasters, all within 54 hours? Hopefully zero. But a well-planned, continuous multi-agency exercise, followed by careful evaluation--and fixe--of any problems that crop up would prepare an area for just about anything.

Information for this article was provided by Jim O'Brien, Clark County Emergency Manager; Assistant Chief Russ Cameron, Clark County Fire Department; Assistant Chief Mike Myers, Las Vegas Fire Rescue; Rory Chetelat, EMS Manager, Clark County Health District; Mary Ellen Britt, EMS Quality Assurance Coordinator, Clark County Health District; Deb Dailey, Supervisor and Training Officer, Medic West Ambulance; and Samantha Charles, Public Information Officer, Office of the Clark County Manager.

Jim Weiss and Mickey Davis are writers specializing in Safety Forces issues and technology, and have had over 100 articles published in law enforcement and emergency services magazines. Jim is a retired lieutenant from the Brook Park, Ohio, Police Department and former State of Florida Investigator. Mickey is a Florida-based writer and author of an award-winning novel.