Keep Calm and Collaborate

As high-profile mass-casualty incidents (MCIs) continue to afflict communities across the country, first responders continually need to enhance their response efforts to efficiently de-escalate and manage these events. 

Louisiana State University’s National Center for Biomedical Research and Training/Academy of Counter-Terrorist Education (LSU-NCBRT/ACE) aims to fulfill that need by holding incident management courses designed for first responders. EMS World recently attended two of these courses held in New Jersey: “Critical Decision Making for Complex Coordinated Attacks” (CCAs) and “A Prepared Jurisdiction: Integrated Response to a CBRNE Incident” (CBRNE).

Paul Maniscalco, MPA, EMT-P, and James Covington, emergency services trainer and lead instructor for LSU, were among the instructors who led the CCA course, which focuses on training first responders in resource management, incident command, and interagency collaboration during complex coordinated attacks.

According to the LSU-NCBRT/ACE CCA participant guide, a complex coordinated attack is defined as an event that “involve[s] multiple threats that often exceed conventional response tactics” and “require[s] a joint response involving members from various disciplines and jurisdictions.” 

The main objective of the course is to emphasize resource management rather than focusing on individual performance. “Because it is a complex coordinated incident, it’s absolutely crucial that resources become managed as early as possible so we’re putting the right resources in the right places,” says Covington.

A Collaborative Effort

While most public safety agencies are capable of handling incidents in their own capacities, they often don’t rehearse their plans with other disciplines or plan for multiple concurrent attacks, resulting in a lack of interagency cohesion during MCI operations. 

“This course was designed to help remedy a gap that exists across the emergency services world,” says Maniscalco, “and that is having the experience and confidence to function at that ICS 400 level to coordinate resources in cross-functional areas and in a stressful environment in which resources become scarce pretty quickly.”

The two-day course helps participants develop their decision-making skills and situational awareness. On the first day instructors teach participants about the characteristics of a CCA, interagency coordination, how to gather and share intelligence, and resolutions for potential problems that may arise. For the remainder of the course, the class splits up into groups to participate in simulated tabletop exercises.

The exercises feature a city named Metropolis that faces multiple attacks requiring specialized resources from different agencies that participants must learn to manage. If resources are delegated too quickly to one incident, it’s more difficult to reassign them to subsequent incident sites in greater need. “It becomes a logistical nightmare,” says Covington. 

Maniscalco says if responding agencies don’t properly manage catastrophic incidents, “the fabric of society and the ability to get back to normalcy is going to be altered.” To ensure participants feel more confident about their abilities to do so, instructors stress the use of operational and theoretical applications, noting the skills learned in the course can be utilized for both day-to-day and large-scale operations.

“The foundation that we drive aggressively is the intersection of theory and operations so they become comfortable and better oriented on how to employ it,” says Maniscalco. “These skill sets…are transportable. They’re not only resonant at the catastrophic event, but they’re transferable to everyday operations in terms of managing your systems.”

The tabletop exercises are designed to help participants become innovative in their approach to problem-solving, Maniscalco says. For example, if a participant decides to move 100 patients to a hospital that can’t handle an influx of that number, an algorithm will lock up those resources and determine how that decision affected the mortality rate of the event. The participant must then decide how to adapt and change course in a safe and efficient manner.

Instructors are interactive throughout the exercises to both challenge and guide participants. To simulate a real city, the exercise provides participants with a limited pool of resources, but with the ability to request more if necessary.

“We’re not there to give them additional problems, we’re there to make them think about the possibilities of the problems arising at these incidents,” says Covington. “We can give them problems based on how the incident is going, but if they’re doing very well, we have a tendency to let them do very well.”

Considering every agency has different resources available, the instructors remind the class that what they teach is only one way to handle these incidents. They don’t ask participants to change their current protocols but to keep an open mind and apply what they learn according to their local needs and resources. 

“The fundamental skill sets we seek to provide through this program will allow each jurisdiction on a regional basis to determine how they will best respond to these events with the resources they have,” says Maniscalco. “Classes like this help us deal with decision-making, respect for roles and responsibility, and how we assimilate all of that into a coherent response strategy.”

It’s important first responders are mindful of each other’s different roles to maintain a unified effort. It’s not a chain of command, says Maniscalco, but rather an incident command. Because the most damage is inflicted in the first 30 minutes of an incident, instructors stress that command must be established within that time frame to limit the number of casualties.

Covington notes that this collaboration between agencies is one of the most difficult parts of handling large-scale incidents. With this in mind, the instructors recognize the significance of participants from both management and street levels interacting with each other during the tabletop exercises—they require both a tactical and a resource-management response. 

“When representatives from these agencies are talking in class face to face, you see [them gain] a new appreciation for the support other agencies can give,” Covington says. “We’ve been really excited to see so many people understanding the need to work together between agencies.”

Work Smarter, Not Harder

The LSU-NCBRT/ACE’s three-day-long “A Prepared Jurisdiction: Integrated Response to a CBRNE Incident” course largely focuses on improving this interagency response. Multiple agencies from one jurisdiction participated in a large-scale MCI response drill, requiring EMS, firefighters, law enforcement, hazmat, and SWAT crews on scene.

Three incidents occurred, beginning with a van fleeing a mock gas station where it had spilled an unknown chemical substance. The van then drove through a crowd of pedestrians before being stopped by law enforcement. The third incident involved an active shooter in a nearby building. EMS crews triaged and tended to the victims (played by Community Emergency Response Team members) while a hazmat team analyzed the substance left by the two passengers in the van.

Once the suspects from the van were confronted by the police, they engaged in a shootout. One of the suspects then took his partner hostage, threatening to shoot him in the head (participants used blank rounds in the guns). 

“I’m not looking at their ability to shoot, I’m looking at their decision-making,” says Detective Raymond McPartland of the New York City Police Department, one of the instructors assessing the participants’ actions during the drill.

Meanwhile, the same chemical substance left at the gas station was leaking from the back of the van, but the hazmat crew was busy handling the initial spill. The officers’ next moves depended partially on the resources tied up at the first incident. Officers couldn’t advance on the suspect without clearance from the hazmat crew regarding the second chemical spill, McPartland explained, and there was a potential need for medical aid from EMS in the event of injury during the shootout. 

McPartland says the instructors observe the decisions made during these roadblocks in the drill so they can offer constructive criticism in class the next day.

“Divvying up resources isn’t easy for a lot of organizations to do,” says McPartland. “They train specifically for one issue, so we’re just trying to get them to think about the worst-case scenario.”

The worst-case scenario certainly got worse: The hostage came into contact with the chemical spill and began convulsing on the ground, though he continued engaging in the shootout with officers until the effects of the chemical rendered him too disabled. 

The officers decided to call in SWAT members for assistance since they have basic hazmat training and could approach the van with the protection of their BearCat (Lenco’s Ballistic Engineered Armored Response Counter Attack Truck). The team slowly moved in on the suspect, ordering him to drop his weapon. 

“They know enough to protect themselves and still do their level of work, but it has to be done safely and quickly to mitigate and get out,” says McPartland. “That’s the idea with [agency] integration.” 

The SWAT team apprehended both suspects and inspected the inside of the van, which contained explosives. Such details are not provided to participants ahead of time, encouraging them to think on their feet.

Utilizing the convenience of modern technology, the crews decided to send a drone to investigate the bombs more closely and direct a remote-controlled robot to test a sample of the leaking agent. This allowed participants to assess the scene from a safe distance. 

“They have the ability to gather intel about all of this and send it back in real time” to the command post, says McPartland. “They don’t have to bring in a bomb technician.”

After the van scene was cleared of all hazards, the SWAT crew successfully took down the active shooter during the last incident, and EMS crews treated his victims. Participating agencies then convened for a debriefing, discussing their shortfalls and achievements in the drill and what participants thought they could improve in the event of a real mass-casualty incident. 

“Work smarter, not harder,” McPartland says.

To participate in upcoming LSU-NCBRT/ACE courses, visit www.ncbrt.lsu.edu/courses. 

Valerie Amato is assistant editor at EMS World. Reach her at vamato@emsworld.com.