Think Big

Training that simulates mass-casualty events is easier than you think, even for volunteer fire departments

Have you ever watched the evening news and longed for the opportunity to stage a major disaster scenario in your area? Only a firefighter would dream of a homegrown calamity. Luckily, with planning, cooperation and a little hard work, you too can bring mayhem to your neighborhood! I know, because my department did. With help from the local school, several citizens and multiple local agencies, we staged a mass-casualty incident (MCI), complete with moulaged victims, over-zealous parents and members of the press.

At the time, we had approximately 25 volunteers, though only half of those members were active. Our longtime chief had recently retired, so the planning of this project rested on the interim chief and training officer, which just happened to be me. This project was as much about training as it was building the pride of a small volunteer department that was taking on a challenge usually undertaken by training councils, or at least a career department around tax levy time.

Training Goal
Our first goal: to test our ability to handle an MCI. Even though the local school is several miles away, school buses regularly traverse our often-treacherous mountain roads. In fact, as a child in the community I got to experience firsthand our school bus sailing off an icy road one winter morning. Fortunately, there were no major injuries, as the fire department at the time wasn’t equipped to cope with an MCI. As son of the assistant chief, I had a pretty good idea of what the department could do and could not handle. Perhaps this is why, 30 years later as the department’s training officer, I spearheaded this training.

The Activity & Anticipated Outcome
To test our abilities, we planned to have a major motor vehicle accident (MVA) with more victims than our 10 EMTs and first responders could handle. Once we decided on the incident, we discussed what the ideal outcome would look like and set our goals accordingly. Because our district had only a couple of MVAs annually and because there had been only one MCI in the past 30 years, which involved a load of partygoers in an overturned hay wagon, we felt that throwing our volunteers into a major disaster unprepared would totally overwhelm and discourage them. Our intention was not to set up our volunteers to fail, so we gave them the tools to succeed.

After briefing our members on our plan, we picked a date and got an attendance commitment. Once we knew how many volunteers to expect, we determined the scope of the scenario. Our volunteers’ MVA experience levels varied greatly. Many of our volunteers, especially the non-EMTs and newer firefighters, had never been on an MVA, let alone an MCI. So we started from scratch by reviewing the MCI protocols, ensuring that everyone would be on the same page. Given our background, we specifically outlined the duties of the EMS personnel and firefighters.

The final preparation was a tabletop exercise that mimicked the big event. You may think that rather than providing training, we were doing the work for our volunteers. Remember, however, that many of these firefighters had never been on an injury MVA, and it’s unlikely that any had ever been on a true MCI. Keep in mind that our goal was to give our firefighters not only the necessary tools but also the confidence to use those tools without hesitation under pressure. Even classroom-ready firefighters can learn a great deal from a field exercise.

Lining Up Other Players
Once we had properly prepared our volunteers, our next step was to locate patients. Since our scenario involved a school bus crash, we went straight to the source: our local school. Our victims were middle school students who were looking for a community service project. Perfect! The school district was more than willing to provide a bus and driver for our Saturday training at no cost to the fire department.

To make the exercise more realistic, we enlisted the cooperation of the county sheriff, state patrol, ground and air ambulance services and other fire districts. All of these agencies were delighted to participate, especially since nothing like this had been attempted in our area.

Adding to the mayhem, we recruited several parents to act the part of over-zealous citizens and distraught parents. We were fortunate enough to have a local first aid training company offer its services to moulage the victims.

Finally, much to the consternation of many of our firefighters, we invited the press. One of our secondary goals was to improve our public image. While we realized inviting the press could backfire, it was a gamble we were willing to take. After all, it was the only way our citizens would see the sacrifices we were making to improve their service.

The Big Day
On the day of the exercise, our volunteers met at the station to get their final tasks and crew assignments. To simulate volunteers responding to the call from home or work, we instructed them to stagger their responses. To add to the confusion of the scene and to make the event more realistic, some volunteers were instructed to arrive in their personal vehicles. Arrival of police, ambulance and mutual aid would mimic average response times for our area.

While the firefighters prepared, the first aid training company applied makeup to our victims (some of the kids looked pretty disgusting), who were then positioned at the accident.

To test the entire emergency response system, once the “accident” occurred, the bus driver radioed her dispatcher, who called 911 and got the ball rolling.

The first responding personnel rolled up to a chaotic scene of screaming kids and were immediately overwhelmed, just as we had hoped. They quickly stepped back to assess the scene, called for additional units and went to work triaging the patients. Even though the firefighters thought they were ready, we provided enough realistic surprises to make the morning very challenging. Our volunteers had no prior knowledge of the realistic-looking injuries, the French-speaking exchange student, the not-so-innocent bystanders or the irate parents. One of the parents, a 45-year-old, 5' 3" mother of seven, was so into her role that she prompted a 6' 6" state patrol sergeant to chase her down the street at a dead run. I don’t think he ever caught her.

Initial Debriefing
After a couple of hours of frenzied action, we had all the patients at the hospital or safe at home. I am happy to say the exercise turned out as we had hoped: With the help of the community, we successfully staged an MCI, and our responders reacted appropriately. Once we were back at the station, we critiqued the scenario with all the participants. We took great pains to get input from victims, bystanders and responders.

That evening we watched a very favorable story detailing our activities on the local news. The news station even ran the story again as a feature on the Sunday morning show.

Detailed Review
At our next training, we reviewed the activity in great detail, incorporating the news footage and a video that was taken by one our retired firefighters. We found plenty of little things that we could improve upon, but, all in all, our volunteers did a great job. Even though we determined that we did not need to change any policies as a result of the exercise, we identified deficiencies in our training regime. We determined:

• Our EMTs needed to train more on MCIs and MVAs.
• Our EMTs needed to hone their basic trauma skills.
• Our medical training was too classroom-oriented. We needed to spend more time developing practical skills.
• Our firefighters needed to learn how to assist in medevac helicopter landings.

Final Assessment
Though this exercise took quite a bit of effort to accomplish, the results were well worth it. Here’s what we achieved:

• Our volunteers learned a great deal about MCIs, trauma care, incident command and teamwork.
• Our personnel learned how to work with and utilize the resources of our neighboring agencies.
• Our local citizens, neighboring agencies and the TV-viewing public learned that our volunteers are professional firefighters.

• Our personnel and crew gained the confidence necessary to handle a big call, which, in turn, caused our morale to rocket to new heights. For a small fire department, this was the most significant gain.

Finding the time required to successfully pull off a training exercise of this magnitude is no easy task. However, with the support of your community and your crew, big training sessions can be a huge success.

Bob Kolva is the former chief and 18-year veteran of the Newman Lake (Wash.) Volunteer Fire Department. Bob currently serves the department as a volunteer firefighter and EMT.