Specialized Vehicles in EMS: MCI Vehicles

Mass-casualty incidents, or MCIs, present EMS providers with unique operational and logistical challenges. These can include multiple patients with varying degrees of injury or illness; NBC (nuclear, biological, chemical) agents; the possibility of adverse weather conditions; scenes with multiple emergency agencies; difficult access and egress routes; and prolonged medical operations. Various EMS systems have seen that a large-scale emergency--medical or traumatic--can deplete significant resources in a short time. In response to this, as well as to the common issues highlighted above, they have developed specialized MCI vehicles to meet their needs.

Some of these units respond to urban areas, some to suburban areas and some to rural areas. Some are staffed by volunteer EMS workers, some by paid EMS personnel, and some by a mix of the two. Whether they can be driven to the scene or just towed, whether they are transport-capable, what equipment each holds and what each is capable of doing are just some of the distinctions between these vehicles. This article highlights MCI-specific vehicles used by two EMS systems, with a focus on their diverse capabilities.

University Hospital EMS, Newark, NJ

Across the river from New York City and its specialized vehicles, in the "little big city" of Newark, NJ, University Hospital EMS (UH-EMS) operates its Mass Casualty Response Unit, or MCRU. This vehicle was originally intended as a one-size-fits-all approach to the special-operations needs of UH-EMS, and it has lived up to this and more. The MCRU is an extremely specialized non-transport vehicle equipped with essential supplies needed to manage a mass-casualty incident. This cache includes: backboards, bandages, floodlights, airway supplies, blankets, portable generators, triage tags and additional triage tools, colored cones that correlate with triage tags and tarps, incident command vests, intravenous solutions, situation status boards and markers, an onboard multilator oxygen system capable of treating 56 patients on high-flow oxygen simultaneously, and a special ALS pack with additional supplies such as advanced airway management adjuncts, additional intravenous supplies, etc.

In regard to operational advantages, the MCRU allows responding ambulances to keep much of their equipment in the vehicle for safe transport and care of patients. It is also a portable VHF base station.

The MCRU doesn't only stay within the confines of Newark itself. UH-EMS has a unique deployment strategy which dictates that the MCRU is only dispatched to far distances if the number of patients, or potential patients, deems it necessary. In the years since its development, the MCRU has answered calls all over the state of New Jersey for incidents including high-rise fires, multiple-patient accidents, hazmat events and others. It was also pressed into service at both World Trade Center attacks (1993 and 2001).

Currently, UH-EMS is developing a new MCRU that is slated for delivery in approximately nine months.

Toronto EMS, Toronto, Ontario

Toronto EMS in Canada operates what is known as Emergency Support Unit #6, or ESU #6. ESU #6 was specifically designed to address triage and mass-casualty scenarios such as large fires and multiple-patient accidents, and has even been put on standby duty at building demolitions with a potential for mass casualties.

Built on a bus chassis, ESU #6 has the capacity for 10 stretchered patients--five on standard patient-transport stretchers and five on portable-type stretchers. There is room for several ambulatory-care patients as well. Additionally, it is outfitted with a hydraulic ramp to allow for the rapid loading and unloading of patients on stretchers. Supplies on board include defibrillators, oxygen, basic bandaging supplies and oxygen supplies.

This specialized unit also boasts an extensive communications system and a dedicated 6,000-watt diesel generator. These features all increase its potential for use as a mobile command center. It is standard practice for ESU #6 to be dispatched to major emergencies along with another specialized Toronto EMS unit, ESU #8, a specially designed Freightliner truck capable of providing medical supplies for mass-casualty situations and specialized equipment to assist with special teams, as well as emergency lighting and power. This vehicle can restock up to 20 ambulances on scene.

"The goal of ESU #6," says Peter Rotolo, Toronto EMS's special-operations manager, "is to increase the availability and flexibility of primary response units by treating low-acuity patients on scene and transporting them all in one vehicle. By utilizing a multi-patient vehicle for these types of patients, we save the EMS system time and resources in the long run. Toronto EMS has seen the benefits of this approach time and time again, including on a commuter train crash with 54 patients transported--which, without the utilization of ESU #6, would have required many more ambulances and overall resources."

Conclusion

We've all heard that it's not a matter of if, but rather when, we will respond to the next large-scale incident. When that time comes, MCI-specific vehicles like the ones highlighted in this article may be the difference between a well-managed scene and a not-so-well-managed scene. These vehicles offer many resources--including supplies, communications equipment and the possibility of additional transport capabilities--that, when incorporated into MCI response plans and regular training regimens, may greatly affect emergency scenes.