The Big One

Is your service ready for “the big one?”You know what I’m talking about: that big call that we all dread, that MCI to beat all MCIs, the one that no matter how much you train for it, you never will be completely prepared.What can you do though to help make the day that your department is faced with a disaster you never expected?A lot of the steps are simple, but because of that, we might be more apt to overlook them.

1.Review your disaster protocols.If you’re on the streets that day, where will you fall in the chain of command?What will the Fire Department’s responsibility be?How about PD?You don’t need to know every move that everyone is supposed to make all the time, but knowing peoples rolls will let you know who to ask when you need something.

2.Make sure your vehicles start!I know this sounds silly, but imagine getting to that moment when someone tells you to “roll the MCI Truck,” and you go turn that key and . . . NOTHING.In my department, our MCI truck is constantly plugged in to keep it charged, but it’s lets face it, it’s a 12 year old ambulance with close to 200,000 miles on it.Once she gets going, she’ll go forever, but to help make sure that she can run, I try to start her at least once or twice a week.

3.What level of certification do you have in Incident Command?Everyone here is required to have 100 and 200, but because of my position, I have to take extra classes, assuming that I will be wearing a vest and hold some sort of authority if things ever went bad.Some might think of ICS classes as dry content, but if you ever need it, you’ll appreciate having taken the classes.

4.Run through scenarios in your head.At my part time job, we have a jar, and on the outside of it, it says “What if, right now?”When things are slow, we pull two different colored pieces of paper from the jar, and one of them will have a location, and the other a situation.An example would be pulling “Big Roller Coaster’s lift hill” and the other saying “Person in cardiac arrest.”Its then your responsibility to decide where you’d bring your ambulance in from, how you’d get the person off the Roller Coaster, and how you’d handle crowd control, transport and notifications.

We find it to be a useful tool, simply because it makes you think.Take a look around the area that you cover.Find those high risk locations, and ask yourself “What if, right now?” and see what you can come up with.Look at your access points, and staging areas, and any potential problems that you could run into and how you would handle them if they did.

5.Treat drills as more than just a chance to get a “free lunch.”Ask your counterparts questions about their rolls, and make sure they know they can ask you questions.This is a great chance for multiple departments to get together and not only work through scenarios but also learn what we are capable of.

Nothing is more frustrating to me then when people make assumptions about what another’s job is, and give uninformed orders based on those assumptions.Here’s a perfect example:

We had a motor vehicle accident with one patient that required a door pop from the Fire Department.A very capable crew responded, assessed, and gained access to, packaged, and transported a patient that met trauma criteria based solely on mechanism.Based on that assessment, they decided to transport that patient “lights and sirens” to the hospital, a tactic that is not often used within my system.During the extrication, one of the police officers noticed another ambulance close by who had pulled into a parking lot nearby at their assigned posting location.

The officer was furious, and couldn’t understand why this crew didn’t drive down the street and offer their assistance knowing that there was an accident.The crew that was on the call was oblivious to the other truck, and it really didn’t matter to them because they had the patient and the scene well under control, but the officer’s observations prompted an angry call to me.I had to cool him down and explain to him that more hands aren’t always the answer inEMS.Sometimes two, or even one, paramedic is plenty, especially when there are two fire crews and four police officers there with them.

In order for a disaster to be managed effectively, especially from theEMSside of things, people need to understand the concept of triage, which is often overlooked.The first unit on scene might not grab the first patient they find and rush them to the hospital.They need to prioritize their patients, call for the right amount of trucks and get things organized.We try to live by the “First in, last out” rule in most scenarios, and often get a lot of push back when the perception is that the first crew there “isn’t doing anything” when they are, in fact, sizing up the scene, requesting resources and determining what they have for injuries, and in a large scale incident, this is even more important.We need to let the scene progress and evolve into well organized chaos, which is an oxymoron, I know.

I feel very fortunate in the setting where I work, because I have a number of employees who spent time in the South on deployment during the Hurricanes we’ve had over the last couple of years.They have a great deal of respect for the power of mother nature, and have been put in situations where they’ve had to make those tough “black tag vs red tag” decisions.Now, we just need our counterparts who might not have the medical training that we do to understand why we make those decisions.That burden ultimately falls on us,EMS, to make sure that everyone understands OUR roll, and when the time comes, we need to make the decisions that we know are right, and stick by them.

I’ve been in some pretty serious situations during my time inEMS, both as a provider as well as on command staff.Thankfully, things have never gotten to the level where my available resources couldn’t handle it, but I feel that if they did, I would have a good grasp on my responsibilities.My recommendation: think about it, preplan, drill, and you will make yourself as ready as you can be.