Special events give Boston’s response agencies great opportunities to make sure their mass-casualty and other disaster plans are good to go
When thousands of runners line up next April 17 for the start of the annual Boston Marathon, some people will view the event as 26.2 miles of mass lunacy.
The 2005 Boston Marathon begins.
Richard Serino, however, sees it as the start of a mass-casualty incident.
He knows chances are good that between the times the race begins in suburban Hopkinton and the last runner staggers across the finish line near downtown five-plus hours later, the emergency responders he directs as head of Boston EMS will attend to hundreds of patients requiring treatment for everything from dehydration to heat exhaustion to hypothermia, depending on weather conditions.
But there is an upside, Serino says. “How often do you get to test your mass-casualty plan with 1,400 patients?”
Police, fire and EMS units nationwide routinely deploy to work events that range from Friday night football games to 4th of July celebrations. Responders often end up watching the game or enjoying the fireworks display, ready to respond but relaxed.
Mass opportunities In Boston, the practice increasingly is for the city’s emergency response agencies to use high-profile events to practice elements of their disaster plans. The advantages are several:
The events typically draw large crowds,
action can be unpredictable and
the presence of an array of electronic gear, everything from cell phones to satellite tv trucks, can disrupt responder communications.
During a live event, responders can familiarize personnel with 911 call signals. Planners can learn which radio frequencies disappear when command posts sit adjacent to one another. They can test incident command protocols and engage in a little interagency bonding.
They can even test new equipment and response strategies. In the early 1990s, Boston EMS tested and demonstrated the effectiveness of using bicycles to move through large crowds at the marathon and bring assistance to pooped-out runners.
“I can’t think of an event in the past two years where we have not done this,” says Dist. Chief Bart Shea of the Boston Fire Department’s training division.
When the Rolling Stones played Fenway Park last August, fire department decontamination units practiced their response for a chemical or biological agent attack. Responders carried nerve agent antidotes as they circulated through crowds, and incident planners studied access points to identify the best locations to stage equipment and supplies.
Training also included setting up mass-decon units outside nearby hospitals, extending the exercise to simulate how potentially contaminated victims would pass through shower tents before entering emergency rooms.
Drill drawbacks Most planned disaster training drills provide valuable insight into a plan’s strengths and limitations, says Carlo Boccia, who head the Boston Mayor’s Office of Homeland Security. One drawback is that despite efforts to make the exercise appear as real as possible, everyone knows it’s still a drill.
One of six small medical stations setup by Boston EMS at the 2005 Marathon.
He recalls fire drills during his student days at Our Lady of Grace School in the Bronx and how orderly the evacuation would be when the nuns pulled the fire alarm. He says he always wondered if the reaction would be as calm should an actual fire break out. Probably not.
“There would be panic with people running around,” he says.
Carrying that philosophy forward to the world of disaster training, he says it’s important to “see how we operate in real time.” Mass-casualty incidents are rare enough that Boston has determined to take advantage of live events to more closely approximate the stress, confusion and crush of crowds that accompany a real disaster.
Boston hosts New Orleans New Orleans may be 1,500 miles from Boston, but a week after Hurricane Katrina’s devastation, Beantown prepared to greet some 2,500 Big Easy residents displaced by the disaster. Not surprisingly, the event was turned into an opportunity for Boston first responders to train and evaluate.
Emergency coordinators were tasked with setting up a reception area that would not only welcome the 2,500 as tourists rather than as refugees, but also would be able to provide medical aid and transport to hospitals for the sick and injured. They also needed to provide mass transit to locations around the city where people would set up temporary living quarters. And they needed to address issues such as how to provide clothing and banking services to the new arrivals.
And, Boccia says, all this was done in a real-time, real-incident environment that included stress, uncertainty and communication lapses. Unfolding events were observed by agency coordinators, who, in addition to their normal duties, kept an eye on what Boccia calls a “50,000-foot view” of their particular agency’s response. In some cases, redundant teams were deployed to observe what their colleagues were doing. These teams later took part in after-action debriefs involving all agencies to assess what worked and what needed improvement.
Results were still being discussed when Boccia spoke with hpp, but early evaluation showed that prepositioning equipment and resources would have been beneficial. Issues also arose around helping people depart the airport terminal quickly. And more extensive medical facilities could have been deployed at the airport to enhance triage.
A major glitch The New Orleans disaster also pointed to a flaw in Boston’s own disaster planning, Boccia says. Boston, like New Orleans, was unprepared for the possibility that people would be unable or unwilling to leave town during a mandatory evacuation.
Boston EMS evaluate an elderly patient.
“We didn’t think of that,” Boccia says. “We would never have drilled our evacuation plan and thought that we couldn’t get people out.” New Orleans exposed that “glitch” in the evacuation plan, he says.
Efforts are now under way to study facilities in and around Boston that can accommodate people in the event of an “evacuate in place” emergency.
“What New Orleans tried in the Superdome wasn’t a terrible idea,” Boccia says, referring to the decision to offer shelter of last resort in the city’s covered sports facility.
ProblEMS arose, however, because the Superdome lacked the appropriate infrastructure to support the mission it was assigned. Drawing on that lesson, Boston emergency planners are evaluating sites with an eye toward issues such as security, refrigeration, plumbing, heating and air-conditioning, vehicle access, capacity to hold prepositioned supplies, and ability to accommodate a field hospital.
“We don’t depend on our own incidents” for lessons, Boccia says. “We utilize and look at [places like] New Orleans and pick out lessons learned.”
“Don’t strip the city” One of the biggest annual events where disaster plans can be tested is the annual 4th of July celebration along the city’s Charles River. Drawing as many as 500,000 people, the event brings together some two dozen agencies that include police, fire, EMS, the Coast Guard, environmental authorities, transit police and even college police forces from Boston and neighboring Cambridge.
Training includes identifying staging areas and access and egress to and from main venues, techniques in escalating and de-escalating emergency deployment, and ensuring that adequate emergency coverage exists for the remainder of the city.
“You don’t strip the city to cover a special event,” says Serino. After all, “Mrs. Smith will still have a heart attack” and need transport to an emergency room.
Bart Shea says that such live incident training is “a wise thing to do” and is “becoming expected.” He’s mindful, however, that the fire department and other agencies must also keep current on routine and technical training exercises. With current budget constraints, he wonders, can the city afford to pay for overtime to potentially provide more staffing at live events? Budgets for routine training can be stretched thin as extra demands are added.
Boccia acknowledges the reality of budget constraints in every emergency response agency. He weighs that against the advantages of having multiple agencies test thEMSelves under real-time, stressful conditions as well as testing their ability to work cooperatively.
Budget constraints might limit the extent to which live events can be used to practice broad disaster plans, but Boccia rejects the idea that such opportunities be passed up. “That’s fool’s thinking.”
David Wagman is a freelance writer in the Denver area.
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