NEWS

Mass casualty exercise helps to promote
collaboration between different agencies

By Sheila Bigelow


A member of the Kwajalein Fire Department gives aid to ‘victim’ Coleen Engvall during the mass casualty exercise that was held May 13 in the downtown area. A member of the Kwajalein Fire Department gives aid to ‘victim’ Coleen Engvall during the mass casualty exercise that was held May 13 in the downtown area. (Photo by Dan Adler)

Members from the Joint Task Force-Homeland Defense visited Kwajalein May 11-14 to conduct a Field Training Exercise. The purpose of the exercise was to promote collaboration and cooperation between Kwajalein Hospital, the fire department, the police department and other agencies on island in dealing with a mass casualty event. The Joint Task Force members, Mike Machado, Maj. Stanley Garcia, and Master Sgt. Paul Price worked with medical and first responder personnel to identify resource requirements and deficiencies in Kwajalein’s mass casualty response capabilities.

The full scale mass casualty exercise was conducted May 13. At approximately 9 a.m., there was an ‘explosion’ in front of the beauty salon in the downtown area initiating the exercise. The ‘blast’ site was littered with injured ‘victims’ who were Kwajalein high school students and volunteers from the community. Prior to the exercise, the volunteers were told what their ‘injuries’ were and what to do during the event. They were also made up with fake blood and limbs to add reality to the exercise.

According to Lt. Chris Ramsey of KPD, the response began when, “An anonymous individual called into the police department saying they heard a loud explosion downtown. From that point, the desk officer dispatched KPD officers to the scene. KPD also has a direct line to the Fire Department and they were notifi ed as well.”

Ramsey explained that on Kwajalein, 911 calls go directly to the fire department. “Normally the fire department is the first responder and they contact us to inform us of the incident. In the case of this exercise, it happened the other way around. Either way, we work very closely together on all calls.”

After notifying the proper agencies, KPD quickly responded to the scene. “The day that it happened we had a recall of all of our officers and accounted for them and that’s where it started here for us,” explained Ramsey. “The majority of our involvement was setting up TCP’s (traffic control points) and just keeping the public away from the incident. On Kwaj, first responders are the fire department, so we do mostly traffic control or crowd control. Obviously all of our officers are trained in CPR and First Aid so should we need to render aid, the officers are all aware that’s what they need to do.”

KFD personnel tends to ‘victim’ Kaitlynn Phillips, after the ‘explosion’ during a mass casualty exercise May 13.
KFD personnel tends to ‘victim’ Kaitlynn Phillips, after the ‘explosion’ during a mass casualty exercise May 13. (Photo by Dan Adler)

Once notified that there was an incident happening in downtown, the Kwajalein Fire Department initiated their response. “We received a 911 call saying that there had been an explosion in the downtown area, in front of the salon area,” stated Fire Chief Michael Diehl. “When we got there, we set up. The first thing is to stage all of our equipment and try to see what the scenario is. We try to get a number of victims, try to identify any potential hazards that may be down there.” KFD personnel took note of the boxes near the explosion site and got reports from eye witnesses on what had happened.

“Once we noticed it was a hazmat (hazardous materials) incident and it was going to be a mass casualty, we recalled all the fire department personnel and we called for our fire department hazmat trailer to respond to the scene. We called for the hospital to be notified and for them to come pick up the mass casualty [decontamination tent]. Also, we called to make a recommendation to the Provost Marshall to set up the EOC (Emergency Operation Center),” said Diehl. The Emergency Operation Center is held off-site from the incident and is where all the key players go during an emergency. It is used by personnel that are on-site of the emergency to call for additional resources if needed.”

Once the site had been surveyed and hazards had been identified, KFD personnel entered the scene and began to triage victims using a color code system. Colored tags indicate the extent of patient’s injuries. Black means dead or dying. Red means ‘priority one’ and immediate assistance is required. Yellow indicates that a patient may have bad injuries, but might not require immediate assistance. Green means ‘walking wounded’ or minor injuries.

While some KFD personnel tended to the victims, others were busy setting up decontamination areas for patients to pass through before they were transported to the hospital for further treatment. “Our EMT’s are also firefighters,” Diehl said. “So it’s kind of a dual role. Some of them were taking care of going down and getting the victims, triaging the victims and some of them were taking care of [decontamination]. We had other personnel that started setting up the technical [decontamination]. They take all the victims to a staging area where we have them all identified and then we transported them to the hospital.”

A firefighter/EMT from Kwajalein Fire Department checks on a ‘victim’ after an ‘explosion’ went off in downtown Kwajalein May 13 during a mass casualty exercise. A firefighter/EMT from Kwajalein Fire Department checks on a ‘victim’ after an ‘explosion’ went off in downtown Kwajalein May 13 during a mass casualty exercise. (Photo by Dan Adler)

When patients arrived at the hospital, they were put through another decontamination tent before they were admitted into the hospital to keep any harmful agents from contaminating the staff and facility. The hospital staff was divided into color-coded groups, each one associated with the colored triage bands put on the patient by the fire department personnel.

While the patients in this exercise had already been triaged at the scene by the fire department, Dr. Cory Mazour, who was the hospital’s lead triage doctor at the decontamination tent during the exercise, pointed out that in a real mass casualty, patients’ symptoms and conditions can change in a matter of minutes, so the hospital staff was sure to re-check patients as they moved them through the decontamination tent.

“In this case it seemed to be important to separate out potentially contaminated patients and workers,” Mazour said. “The more people that cross the line into the contaminated zone, the more you take out as a health care worker and turn into a patient. It doesn’t take too long with too many people making that mistake that you run out of workers.”

Safety and patience is key, Mazour explained, and it is important to keep the lines between contamination closed off so the health care workers do not contaminate themselves and become patients also. “It can be frustrating; the instinct is to go to the injured people and help them. It takes some discipline to tell yourself and tell your people that it is important to set up the layers of protection and layers of treatment for people so you can do your job efficiently when patients get there.”

Colored ribbons are attached to the victim’s arms indicating the severity of their injuries.
Colored ribbons are attached to the victim’s arms indicating the severity of their injuries. (Photo by Dan Adler)

After going through the exercise, Mazour was able to refl ect on how things went and where there were areas for development. “That’s why you do one of these, so if you ever had to do it for real, it’s good to get these things worked out and kind of know what types of problems are likely to come up and know how people react and know what you can do.” Improvement, he says, probably involves slowing the process down to some degree. “It seems counterintuitive on everyone’s level; even with this just being a drill, you certainly felt pressure to try to get everyone going and start doing your job. But you’ve got to make sure you’re doing the right thing and take the time to get everything set up.”

Mazour thought everyone did a good job keeping their goals and priorities in line. Had this been an actual mass casualty, he says, he feels confident that the hospital staff would be able to assess the situation and do the best job possible. “Granted it was a drill, but I feel like the communication went well; I feel that everyone filled their role well. From my perspective, I think not only the fire department and hospital staff, but all of the safety people, Community Services and the other peripheral people who performed other tasks and were involved with the nuts and bolts of the drill really chipped in.”

Overall, the mass casualty exercise was a success and helped to facilitate a positive interagency working relationship that will increase their effectiveness and efficiency and validate and enhance their level of response support.

“It went very smooth on our end,” said Ramsey of the KPD. “Obviously, even though we are a civilian contractor, all of our officers have previous law enforcement experience, either civilian or military or both. So at some level, they’ve all been involved in this somewhere down the road. There’s always ‘what if’s’ and unknowns and you never really know. Again, being a contract job, I’ve worked with some of these officers for a year, a little more and some of them for just a couple months; you never know the response time or their reaction, and I’m very impressed with the way KPD responded. The officers were just spot on about everything. So for our involvement here...I was amazed with how they handled themselves. We’re looking forward to the next exercise; who knows what they’ll throw in there and maybe they’ll involve us a little more.”

Members of the Kwajalein hospital staff help to decontaminate
‘victim’ Carrie West during the mass casualty exercise that was conducted May 13. Members of the Kwajalein hospital staff help to decontaminate ‘victim’ Carrie West during the mass casualty exercise that was conducted May 13. (Photo by Dan Adler)

According to Diehl, things went smoothly for the fire department as well. “It’s our guys’ job to know how to do each of these things so it’s nothing that’s really out of the norm for them from what their daily procedures are supposed to be. They had a really good, quick response. They had a good set up and size up of the emergency. As far as getting [to] the victims, everything was done timely with the amount of personnel that we had. All the different agencies worked well together and the EOC activation went well too.” Diehl thinks the mass casualty exercise helped his personnel become better at their jobs. “It helps with the confidence; it helps knowing that you are prepared to handle a situation like this if it comes up.”

JTF-HD will continue to monitor, assess and return to Kwajalein when requested to foster a close working relationship and preparation between the agencies which would be involved in a mass casualty situation and which would be responsible for responding to and recovering from any such event. Those agencies include the Department of Defense, Kwajalein Hospital, Kwajalein Fire Department, Kwajalein Police Department, Security Forces and various supporting agencies such as transportation and logistics.