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Military Spin: Mass Casualties–Planning to Succeed

By Lt. Col. Steve Colby, USAF | October 1, 2004
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Today's array of natural and terrorist disasters makes it imperative for states and municipalities to plan for and exercise mass casualty incident management. Planning must be specific enough to ensure that healthcare, first-responder, helicopter and fixed-wing agencies are identified and tasked or invited in a formal planning document according to capacity, availability, and capability.

The planning process must begin with a tool that allows simple process analysis. The tool should fall somewhere in complexity from a simple flowchart decision sheet that directs crisis management actions to a complex computer model that might include city infrastructure and traffic management analysis.

Planning elements must include facility, personnel, transportation, communications, command and control, supplies, interagency coordination, and victim/patient prioritization. A sample triage method can be found at


Some folks say, "Amateurs talk tactics and procedures: experts talk logistics." In that mindset, individual patient treatment exercises can be minimized to increase the opportunity for exercising the operationally difficult patient/medic movement logistics. Moulage is great training for paramedics but can add a burden of time and coordination that will detract from the logistical focus of these exercises.

Facility assessment must entail a detailed look at hospital/clinic capacity and throughput. The exercise must be designed for a realistic number of victims. That number should exceed local capacity and drive the operation toward ground and air medevac to regional or field hospitals. Arenas or stadiums work well for these types of field operations and make security easier.

Personnel qualifications, equipment and training must be assessed to ensure that the right folks are assigned to the right exercise nodes. The plan should include transportation of those personnel to the field hospitals that will invariably pop-up to handle overflow capacity. The transportation plan must include critical analysis to preclude bottlenecks at road chokepoints.

A well-thought-out plan will have maps, routes (air and ground), trans-load locations (for ambulance to helo and helo to ambulance, and helo to airplane), and mass briefing locations. There must be an accurate manifest system to account for patients and medics departing and arriving at hospitals and field hospitals. This must be accountable through the command and control network.

There must be a communications plan that employs landline phones, wireless phones, and amateur and line-of-sight radios. This plan must have a graceful degradation communications scheme to handle downed telephone or cellular nodes. Translators are always a good idea for multiethnic metro areas.

Exercising must be a crawl, walk and run transition. Planners should exercise individual plan elements, such as casualty collection or ground/air transport. The exercise scenario should be based on a logical event like an earthquake in California or terrorist event in a major metropolitan area.

It must include complications like major thoroughfare blockages that will force the exercise to exploit alternative patient and medic transportation. However, rules and limits with local authorities are critical to avoid setting up real-world traffic problems.

Iceland conducts biannual exercises with Partnership for Peace countries called Cooperative Safeguard. These exercises test and refine Iceland's and its partner countries' abilities to respond to natural disasters, such as volcanic activity or earthquakes. Countries from Europe, Scandinavia and Asia attend to polish their international assistance skills. The template of these Cooperative Safeguard exercises is an excellent blueprint for similar events conducted on various scales here in the States.

Lastly, regional military organization integration with local civilian first responders closes the interagency cooperation loop and will greatly benefit both the civil and military contributions to the plan. Closing the gap between emergency management system lingo, radio configurations, procedures and plans with these military agencies will be the grease on the axles of crisis management cooperation and should begin by contacting them directly.

Expect to work with the Rescue Coordination Center at Langley AFB, Va. (1-800-851-3051) as well as the Federal Emergency Management Agency (FEMA). Getting the military committed to exercises early (three to six months out) is the key to improving the chances of their participation. Late invitations often conflict with long-range training and deployment plans. Combat is their primary training emphasis and they have to prioritize their resources to make these types of exercises happen.

Military personnel turnover presents continuity issues mandating some form of continuity development as part of the planning and exercise process.

Lastly, exercises require critical debriefing to catch and document problem areas needing updates or changes to the plan. These "hotwashes" are essential to fix the future for success. Planning ahead is planning to succeed in mass-casualty evacuation. Exercising those plans is key to refining and improving them.

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