Mass Casualty Management Participant Guide August 2017
The American Red Cross Mission The American Red Cross prevents and alleviates human suffering in the face of emergencies by mobilizing the power of volunteers and the generosity of donors.
Contents About This Course... 5 Unit 1: Setting the Stage... 7 Unit 2: Leadership on a Mass Casualty... 11 Unit 3: Overview of Standards... 15 Unit 4: Mass Casualty Sites and Procedures... 19 Sites and Procedures Worksheet Instructions... 20 References: s and Job Tools... 21 Sites and Procedures Worksheet: Scenario 1, Bus Crash... 27 Sites and Procedures Worksheet: Scenario 2, Active Shooter Incident... 30 Sites and Procedures Worksheet: Scenario 3, Plane Crash... 34 Unit 5: Transition to Recovery... 41 Unit 6: Readiness for a Mass Casualty Incident... 43 Unit 7: Next Steps/Course Conclusion... 47 Copyright The American Red Cross 3
About This Course About This Course Welcome to. This course is for all regional and divisional leadership. Participants should have a G/A/P of Supervisor or above. You have all had experience at incident responses, but mass casualty incident responses are far more complex and require a different approach. During this course, you will get hands-on experience to increase your proficiency in disaster leadership in managing a mass casualty incident response. The course will also present ways in which you can take steps to ensure the workforce is healthy physically, emotionally, and spiritually (workforce protection) and use appropriate job tools to do so. You will also learn ways you can assess the need for, request, and manage event based volunteers (EBVs). Course Purpose The purpose of the training is to describe the distinctive nature of mass casualty incidents and the adjustments to standard operating procedures during mass casualty incident responses. Although each mass casualty incident has characteristics that are unique to that event, this training provides guidance for leadership and instructions for actions that are common to the majority of mass casualty incidents. Best practices for each of the functions involved in these types of events are described, including suggestions for staffing and implementation. Course Objectives This course provides you with a better understanding of how to: Describe the multi-agency partnerships and collaboration necessary in the management of a mass casualty incident response. Identify the specific management responsibilities and challenges in a mass casualty incident response. Describe how workforce protection measures are woven throughout the response. Demonstrate skills identifying the job tools and the procedures specific to mass casualty incident responses. Course Design This course will be delivered within a 4-hour block of time. We will provide an overview of the schedule, describing the approximate duration for each unit, opportunities to take breaks, and descriptions of unit activities. The following seven units comprise this course: Unit 1: Setting the Stage Unit 2: Leadership on a Mass Casualty Unit 3: Overview of Standards Copyright The American Red Cross 5
About This Course Unit 4: Mass Casualty Sites and Procedures Unit 5: Transition to Recovery Unit 6: Readiness for a Mass Casualty Incident Unit 7: Next Steps/Course Conclusion Copyright The American Red Cross 6
Unit 1: Setting the Stage Unit 1: Setting the Stage Unit Overview and Purpose The purpose of this unit is primarily to preview this course so that you can be prepared to take full advantage of the learning opportunity before you. In addition, this unit will review mass casualty terminology. Unit Objectives When you have completed this unit, you should be able to: Describe the purpose and structure of this course. Define terms used around mass casualty incidents. What Is a Mass Casualty Incident? A mass casualty incident is any incident in which resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. Mass casualty incidents often have the following characteristics: The response involves multiple agencies or entities. The response requires the expertise of specially screened and trained responders. The incident has a widespread impact on the public and the community. What Are Types of Mass Casualty Incidents? Mass casualty incidents are clearly different from the types of incidents Red Cross normally responds to. Mass casualty incidents include: Active shooter Plane crash Gas pipeline explosion Earthquake Large scale fire Terrorist attack Etc. Copyright The American Red Cross 7
Unit 1: Setting the Stage Mass Casualty Incident Terms There are some terms you learned when you took Mass Casualty Basics. Legislated Transportation Incident The National Transportation Safety Board (NTSB), an independent federal agency charged with investigating and determining the probable cause of all civil aviation accidents in the United States and selected accidents in rail, highway, marine, and pipeline operations, will determine if a rail or aviation accident meets the federal requirements for invoking one of the three federal acts pertaining to such incidents. The Aviation Disaster Family Assistance Act of 1996 and the Foreign Air Carrier Family Support Act of 1997 apply to any domestic or foreign commercial aviation accident occurring within the United States, its territories, possessions, and territorial seas which result in a major loss of life. The Rail Passenger Disaster Family Assistance Act of 2008 only applies within the United States. Major loss of life is the key determination for activation of either legislative authority, is defined by the NTSB for each incident, and can be dependent on community characteristics and resources. Refer to the Transportation Disaster Job Tool for more information. Non-legislated Transportation Incidents Certain transportation incidents, such as bus crashes or small plane accidents, do not fall within the parameters of the Aviation Disaster Family Assistance Act or the Rail Passenger Disaster Family Assistance Act. An example of this is the Reno air show accident where a plane crashed into the viewing stands. Disability Integration Disability integration is providing ways to accommodate the special challenge for people with functional and access needs, including disabilities, that a mass casualty incident can present. It may be difficult for this population to access resources or act as disaster responders themselves. Also, a mass casualty incident may create new functional and access needs as a consequence of the event. The American Red Cross is firmly committed to serving the needs and interests of all people, including those with disabilities, throughout all lines of service, at all times, and in every way. This is evidenced by: Consistent use of inclusive, person-first language. An ability to assess and monitor all service delivery for physical access, programmatic access, and effective communications access. Appropriate referrals for equal access, disability accommodations, and access and functional needs support. Copyright The American Red Cross 8
Unit 1: Setting the Stage Integrated Disaster Care The functions of Disaster Mental Health, Disaster Spiritual Care, and Disaster Health Services all focus on the health-related needs of the client, from a perspective of body, mind, and spirit. During a mass casualty incident, the three functions work closely together to provide compassionate care and support to survivors, families, and others impacted by the incident. For ease of reference, the term integrated disaster care is used in this course to indicate situations in which all three functions are equally relevant. Refer to the job tools for each of the functions for specific information related to that activity. Integrated Care Condolence Team An integrated care condolence team is formed to deliver comprehensive services to families of deceased, injured, or unaccounted for loved ones. The team consists of two or more members from Disaster Health Services, Disaster Mental Health, Disaster Spiritual Care, and Casework and Recovery Planning. The intent is to provide a range of services with minimal intrusion into the family s grief. Visits are usually scheduled after the immediate response is concluded. Regions can benefit from standing up an ICCT for everyday events involving casualties. Having an ongoing ICCT cadre helps build readiness and capacity. Refer to the Mass Casualty Integrated Care Condolence Team Job Tool for more information. You Can Do It! Mass casualty incidents can be daunting. However, by embodying the skills you learn in this class, you will be ready to provide the assistance the victims and their families need. In addition, you will feel more confident making effective decisions in times of very high stress. Copyright The American Red Cross 9
Unit 2: Leadership on a Mass Casualty Unit 2: Leadership on a Mass Casualty Unit Overview and Purpose Strong leadership is necessary for a mass casualty incident response to be most effective and to have compassionate care available when it is needed. This unit focuses on how operations can be structured at a mass casualty incident and some of the special considerations for leaders. We also discuss several other roles that are specific to a mass casualty incident response. Unit Objectives When you have completed this Unit, you should be able to: Describe how operations can be structured at a mass casualty incident response. Identify special considerations for leaders. List roles that are specific to a mass casualty incident response. Special Considerations Mass casualty incident responses are different from others, and as such, they have a special set of requirements. The disaster relief operation (DRO) leadership must be acutely aware of and sensitive to the: Significant and widespread media coverage, including social media. Increased visibility and stress on partner relationships, which may foster challenges to successful collaboration. Crucial need for workforce protection and integrated disaster care support to staff and clients during and after the response. Applicable legislation, Memoranda of Understanding, etc. Need for coordination and collaboration with multiple law enforcement agencies, coroner or medical examiner offices, public health, local health care systems, other local service providers, local Office of Emergency Management, and other responding agencies that might include an air or rail carrier. Recognition of the National Transportation Safety Board as a public health authority. Copyright The American Red Cross 11
Unit 2: Leadership on a Mass Casualty Table of Organization This figure illustrates a sample organizational structure of a Level 3 operation, which is the majority of mass casualty incidents. In smaller operations, individual team members may be able to perform more than one function whereas in larger operations, the structure and level of staffing is expanded. If an operation is larger than a Level 3, other positions may be necessary. In all cases, the responsibilities listed here need to be covered. The roles specified in the Table of Organization are consistent with the positions described in the Concept of Operations. The following positions are required specifically for mass casualty incident responses: Family Assistance Center Lead Integrated Care Condolence Team Coordinator JFSOC Liaison Copyright The American Red Cross 12
Unit 2: Leadership on a Mass Casualty Family Assistance Center Lead The Family Assistance Center (FAC) Lead reports directly to the Assistant Director of Operations and is responsible for the Red Cross services at the Family Assistance Center. Family Assistance Centers offer mass care, disaster mental health, disaster health services, and disaster spiritual care. The Family Assistance Center Lead also ensures that Red Cross services are offered in collaboration with other agencies, avoiding duplication and gaps in service delivery. In some cases, the Family Assistance Center Lead may become the Integrated Care Condolence Team Coordinator when the Family Assistance Center closes and the Integrated Care Condolence Team begins providing outreach services to families. ICCT Coordinator The Integrated Care Condolence Team (ICCT) coordinator is responsible for coordinating integrated care condolence teams during a mass casualty incident response. An ICCT is typically composed of any combination of two or more members of integrated disaster care activities. The combination is based on the needs of the family being assisted. The coordinator may be a worker in any of the relevant functions. The ICCT coordinator reports to the Deputy Assistant Director of Operations for recovery. JFSOC Liaison The Joint Family Support Operations Center (JFSOC) liaison is an experienced government liaison with training and experience in mass casualty incident responses. He or she is responsible for collaborating with the other agencies that are present in the JFSOC. This role reports to the assistant director for External Relations with a consultative relationship (dotted line) to the Assistant Director for Operations. The JFSOC liaison needs to have the authority to make decisions on behalf of the Red Cross and must be familiar with relevant legislation and organizational agreements. Refer to the Joint Family Support Operations Center Job Tool for more information. Copyright The American Red Cross 13
Unit 3: Overview of Standards Unit 3: Overview of Standards Unit Overview and Purpose In Unit 2, you learned about specific leadership roles. In this unit, you will be introduced to the Fundamental Principles and standards that are most important in a mass casualty incident response. Unit Objectives When you have completed this unit, you should be able to: Identify the three Fundamental Principles most important in a mass casualty incident response. Describe the three standards that guide Red Cross operations and service delivery in a mass casualty incident response. Humanitarian Principles The American Red Cross response to mass casualty incidents is consistent with the mission, vision and Fundamental Principles of the global Red Cross network. These Fundamental Principles include: humanity, impartiality, neutrality, independence, voluntary service, unity, and universality. The three Fundamental Principles of humanity, impartiality, and neutrality are especially important during the organization s response to a mass casualty incident. Multi-Agency Collaboration and Cooperation A mass casualty incident response involves many governmental and non-governmental organizations. Generally, the American Red Cross is not the lead agency, but operates in a supportive role to law enforcement, local, state, or federal agencies, such as the Federal Bureau of Investigation (FBI) or the National Transportation Safety Board (NTSB). Because of the multi-agency nature of these responses, it is imperative that American Red Cross leadership and workers be aware of and attentive to: Communication among agencies is critical to provide accurate, credible, and timely information to survivors, families, and friends. Adherence to a strict chain of command prevents role confusion, duplication of efforts, and misinformation. Mass casualty incident sites are often crime scenes or investigation sites which will restrict movement by Red Cross personnel. Knowledge of relevant MOUs and legislation regarding the type of incident (e.g., transportation incident) is crucial for effective and efficient response. Copyright The American Red Cross 15
Unit 3: Overview of Standards Protecting Confidentiality and Privacy Standard: Confidentiality All American Red Cross disaster workers are required to comply with the organization s policy on protecting an individual s privacy and personal information. These protections are upheld during all processes of obtaining and releasing information about clients, with the understanding that such information is given to or obtained by relief workers as representatives of the American Red Cross, and thus, such information should be used only for the direct purposes of providing Red Cross services. The Red Cross should request no more information than is necessary to conduct service provision on behalf of the client. Assessments and care provided by Disaster Health Services, Disaster Mental Health, and Disaster Spiritual Care workers should be conducted in as private a manner as possible. All workers should advocate for needed client privacy where applicable and comply with mandated reporting laws when necessary. Procedure: Protecting Privacy Policy The Red Cross is committed to providing a confidential and private environment. The Red Cross Protecting Personal Information Policy can be found on The Exchange. All workers should read and familiarize themselves with this policy. Procedure: HIPAA The American Red Cross Office of the General Counsel has concluded that the American Red Cross is not a covered entity within the regulations of the Health Insurance Portability and Accountability Act (HIPAA), and HIPAA provisions are not applicable to American Red Cross services. Integrated Disaster Care workers will rely on professional principles of confidentiality when sharing client information. The HIPAA Clarification Letter that you can use to communicate about this issue with other community health or mental health care providers, medical examiners, coroners, hospitals, public health departments, or pharmacies is on The Exchange. Copyright The American Red Cross 16
Unit 3: Overview of Standards Workforce Protection The Red Cross role during a mass casualty incident response is to provide effective care to the survivors, families of victims, others directly and indirectly impacted, and the communities in which these incidents occur. Although stressful work environments are often part of disaster response work, mass casualties are often more demanding. All Red Cross workers need to assess their physical, emotional, and spiritual readiness before undertaking such an assignment. Maintaining fitness to perform one s function during a mass casualty incident response is the responsibility of the individual worker, the supervisor, and the Red Cross as an organization. All mass casualty incident response team members need to care for and be accountable to themselves and their team members. For more information on workforce protection measures, take a look at the Workforce Protection Checklist job tool. Copyright The American Red Cross 17
Unit 4: Mass Casualty Sites and Procedures Unit 4: Mass Casualty Sites and Procedures Unit Overview and Purpose Mass casualty incidents happen unexpectedly, evolve fast, and can have long-term implications for responders and communities. In order to function most effectively, you must be prepared to identify which response sites should be set up and when, and which procedures should be implemented. Unit Objectives When you have completed this unit, you should be able to: Identify sites to implement, activities to complete, and planning priorities for a mass casualty incident. Activity: Response Sites and Procedures In this activity, we will work together on identifying the sites you would establish, the procedures you would take, and the doctrine you would use during specific times in a mass casualty incident response operation for three scenarios of increasing complexity. We will begin with a school bus crash incident that we will work on together. After we ve completed this scenario we will break into groups which will be assigned a different, more complex scenario. Please complete the Sites and Procedures Worksheet for Scenario 1 as we go over it together. The instructions for completing the worksheet, as well as a list of toolkits and job tools, start on the next page. The description of the bus crash incident is on page 27. Be sure you select a scribe for your group activity. Copyright The American Red Cross 19
Unit 4: Mass Casualty Sites and Procedures Sites and Procedures Worksheet Instructions As the scenario unfolds, list the incident sites that you expect to be open. Use the list of sites and procedures accompanying this worksheet for suggestions. List at least three actions that are going on at that time. Indicate the specific job tools or doctrine used to inform the response at that time. Indicate the planning priorities in the last column. As the scenario continues to unfold, indicate in the actions column: The additional sites that are opening and note the sites that are closing. The function-specific procedures you would implement. For the function-specific procedures already selected, indicate for each interval when it will be discontinued. List of Sites Administrative Sites: Operation Headquarters (HQ) Joint Family Support Operations Center (JFSOC) Volunteer Intake Center (VIC) Emergency Operations Centers (EOC) Client Service Delivery Sites Survivor (Passenger) Gathering Area (Gathering Areas) Friends and Relatives Centers (FRCs) Family Assistance Center (FAC) Spontaneous Memorial Sites (Spontaneous Sites) Responder Service Delivery Sites Respite Centers for First Responders (RCs) Morgue and Other Body Recovery Sites (Morgues) Mass Casualty Incident Sites (MCI sites) Procedures Unique Mass Casualty Procedures: Interfaith Memorial Events Disaster Site Visits Home Region Support Procedures Interface with the Community Procedures Function-Specific Procedures: Logistics o Staffing o Workforce Protection o Material Support o Disaster Services Technology Operations/Integrated Disaster Care (IDC) o Disaster Mental Health (DMH) o Disaster Health Services (DHS) o Disaster Spiritual Care (DSC) o Integrated Care Condolence Teams (ICCT) Operations o Mass Care (Feeding, Sheltering, Distribution of Emergency Supplies, Reunification) o Casework and Recovery Planning (CRP) o Call Center Copyright The American Red Cross 20
Unit 4: Mass Casualty Sites and Procedures References: s and Job Tools The below table contains a list of toolkits and job tools used in mass casualty incident responses. You may refer to this table as you complete the Sites and Procedures worksheets. Location on The Exchange Casework and Recovery Planning Casework and Recovery Planning Casework and Recovery Planning Casework and Recovery Planning Casework and Recovery Planning Casework and Recovery Planning Disaster Health Services Name Casework and Recovery Planning Standards and Procedures Client Consent to Share Information Job Tool (English and Spanish) Meet the Client: What is a Family? Client Information in CAS 2.0: Appropriate Use and Sharing Direct Client Assistance Price List Mass Casualty Immediate DCA Roadmap Mass Casualty Disaster Health Services Standards and Procedures Description This document describes the activities, standards, control mechanisms, responsibilities, and authorities for providing Casework and Recovery Planning services to Red Cross clients. Together with the associated job tools, it includes the steps required for caseworkers and disaster action team responders to provide recovery planning services to support and promote client recovery, as well as direct client assistance. It also describes the program standards designed to ensure that clients receive services that are timely, relevant, and appropriate for their recovery needs. Standard text used to obtain client consent to share information. Covers the casework rules for creating a new case when meeting the client and identifying the numbers of cases to open based on a resident's recovery plan. Explains how to protect client information and how to handle requests to share client information. Price list used to provide direct client assistance Mass Casualty Incident Responses. Use this decision flowchart to determine and document the Direct Client Assistance portion of the initial client interview for Mass Casualty Incident Responses. The purpose of this document is to describe the activities, standards, responsibilities, authorities, and control mechanisms for providing Disaster Health Services to disaster-affected Red Cross clients. This document includes licensure requirements, scope of work assignments for responses varying from single-family disasters to large disaster relief operations, and information to support the volunteers who work with local, state, and federal agencies. It also describes the standards designed to provide timely and relevant services to clients. Copyright The American Red Cross 21
Unit 4: Mass Casualty Sites and Procedures Location on The Exchange Disaster Mental Health Disaster Mental Health Disaster Mental Health Disaster Mental Health Disaster Spiritual Care Integrated Care Condolence Integrated Care Condolence Name Disaster Mental Health Standards and Procedures Documenting Disaster Health Services and Disaster Mental Health Information in CAS 2.0 Job Tool: Staff Mental Health on a Disaster Relief Operation Job Tool: Client Consent to Share Information (DHS and DMH) Disaster Spiritual Care Standards and Procedures Integrated Care Condolence Team Standards and Procedures Working with Community Partners Job Tool Description The purpose of this document is to describe the process, activities, standards, responsibilities, authorities, and control mechanisms for the Red Cross Disaster Mental Health program. Disaster Mental Health interventions support individuals, families, neighborhoods, communities, and Red Cross workers across the continuum of disaster preparedness, response, and recovery. This job tool reminds Disaster Health Services and Disaster Mental Health responders how to document health and mental health services provided to clients in CAS 2.0. All cases must include all required CAS 2.0 fields. All standards are currently published doctrine for Disaster Health Services, Disaster Mental Health, and Casework and Recovery Planning. Use this job tool to learn about staff mental health on a disaster relief operation. This job tool should be used in conjunction with the Disaster Mental Health Standards and Procedures. The purpose of this form is to provide Red Cross Disaster Health Services, Disaster Mental Health Services, and Disaster Spiritual Care responders a signed form to use only when the standard verbal procedure is not appropriate or not acceptable to a third party. The use of this form is limited to situations in which an external organization or healthcare provider requires signed documentation from a client in order to work with Red Cross for specific response and recovery services. This may apply to entities that are required to follow HIPAA regulations, such as hospitals, mental health agencies, and pharmacies. The purpose of this document is to describe the process, activities, standards, responsibilities, authorities, and control mechanisms for Red Cross responders and employees fulfilling a role within the Disaster Spiritual Care function. The purpose of this document is to describe the process, activities, standards, responsibilities, authorities, and control mechanisms for the Integrated Care Condolence Team approach. Use the job tool to create a list of local partner resources. This job tool should be used in conjunction with the Integrated Care Condolence Team Standards and Procedures. Copyright The American Red Cross 22
Unit 4: Mass Casualty Sites and Procedures Location on The Exchange Mass Care Sheltering Mass Casualty Mass Casualty Mass Casualty Mass Casualty Mass Casualty Mass Casualty Name Sheltering Standards and Procedures Joint Family Support Operations Center (JFSOC) FAC/FRC Concept of Operations FAC/FRC Site Selection and Setup Mass Casualty Incident Feeding Job Tool Spontaneous Memorials Job Tool Interfaith Memorial Events Job tool Description The purpose of this document is to describe the process, functions, standards, responsibilities, authorities, and control mechanisms for the Red Cross sheltering program. Workers can use this to provide standardized service to clients, measure program effectiveness, and inform continuous improvement. The tactical howto work instructions are found in the job tools. This document defines a Joint Family Support Operations Center (JFSOC) and provides an overview of stakeholders, roles, and services coordinated through the JFSOC. The JFSOC is set up to coordinate, plan, execute, and monitor services for victims and families of victims of a mass casualty incident. This includes the families of perpetrators of a crime as well, although the services will be offered separately. During the immediate response to a mass casualty event, the Red Cross partners with government organizations and many other community partners to open and/or support reception and assistance centers for the families of victims and for the survivors of the event. This job tool will provide the basic information on the operation of these sites. Friends and Relatives Centers are opened in the immediate aftermath of mass casualty incidents to support survivors, family members, and friends. This job tool outlines the steps in acquiring and setting up a site. This job tool is intended to provide supplemental information regarding feeding practices during a mass casualty or mass fatality incident response. Use the Initiating a Feeding Checklist for basic feeding procedures. Spontaneous memorials will develop in areas close to the site of a mass casualty incident, and/or at sites that have an emotional connection to those impacted by the incident. Locations will be influenced by space constraints, public access, and law enforcement restrictions. The Red Cross role is one of support for the city or entity where the spontaneous memorial appears, as well as support for those who visit the site. The purpose of this tool is to assist the affected chapter or disaster response operation in successfully fulfilling their responsibilities. The information will provide an overview of the tasks required to develop and implement a memorial service. Users can adapt the information depending on the role of the Red Cross. Copyright The American Red Cross 23
Unit 4: Mass Casualty Sites and Procedures Location on The Exchange Mass Casualty Mass Casualty Mass Casualty Mass Casualty Mass Casualty Mass Casualty Mass Casualty Mass Casualty Mass Casualty Name Disaster Site Visit Job Tool Respite Center Site Selection and Setup Home Region Support Job Tool Mass Casualty Integrated Care Condolence Team Job Tool Morgue and Other Body Recovery Sites Job Tool Initial Chapter Response Job Tool Workforce Protection Checklist Disaster Mental Health Role in a Mass Casualty Disaster Health Services Role in a Mass Casualty Description A disaster site visit is an opportunity for the victims and families to get close to the site of the incident, with protection from the media, before the public has access to the site. This job tool describes the planning process for a disaster site visit. The Red Cross role in establishing Respite Centers varies from incident to incident. This job tool helps clarify possible Red Cross roles for site acquisition and setup. Sometimes, the Red Cross takes a leadership role, but often the Red Cross is one of many supporting partners in the operation. The purpose of this job tool is to assist chapters and regions in offering local assistance to those affected by a distant mass casualty incident at another location. This job tool provides guidance for the service strategy of deploying integrated care condolence teams during a mass casualty incident response. Generally, integrated care condolence teams are activated after the initial response has culminated. The purpose of this job tool is to clarify the role of the Red Cross in establishing and working in a morgue and/or other body recovery sites. As with other no-warning disasters, mass casualty incidents result in a real or perceived urgency in initiating actions. This tool will identify unique factors that may not be present in other types of disasters or are of greater impact in mass casualty incidents, and how they influence service delivery. Use this checklist to plan for and implement pre-deployment support, on-scene support, and staff orientation. Ensure that all workers have received proper training, pre-screening, on-scene support, and post-deployment support. These tasks are critical to maintain the wellness and efficacy of the workforce before, during, and after a mass casualty operation. Recognize that the stress and intensity of a mass casualty event is different than other types of disaster relief operations. This job tool is to be used to supplement the Disaster Mental Health Standards and Procedures. This job tool is to be used to supplement the Disaster Health Services Standards and Procedures. Copyright The American Red Cross 24
Unit 4: Mass Casualty Sites and Procedures Location on The Exchange Mass Casualty Mass Casualty Mass Casualty Mass Casualty Mass Casualty Mass Casualty Mass Casualty Name Disaster Spiritual Care Role in a Mass Casualty Caring for Children in a Mass Casualty Incident Community Mental Health Recovery Social Media and Public Affairs in Mass Casualty Incidents Local Regional Readiness Job Tool Staff Services and Volunteer Intake Center Job Tool Transportation Disaster Job Tool Description This job tool is to be used to supplement the Disaster Spiritual Care Standards and Procedures. Because the stresses on children are often extreme and sometimes unacknowledged during mass casualty incidents, this tool is intended to remind responders of special considerations that should be taken when working with children impacted by mass casualty incidents. Recovery following mass casualty incidents includes planning for the long-term needs of a community. Red Cross partners with government and non-government agencies to create a plan to bolster the long-term recovery resources. As in all other disasters, Red Cross helps to identify the needs and strategizes on how best to fill those gaps. This job tool provides guidance for public affairs and social media messaging during a mass casualty incident response. In the aftermath of a mass casualty disaster, the Red Cross may choose to take a less proactive posture with the media than during a typical disaster. Red Cross spokespeople should work with national headquarters to evaluate incoming media requests, but media activity should be reactive only. Because of the sensitive nature of these incidents, it is important to remember that victims and their families are the most important focus of the situation, not the Red Cross. All of the normal readiness activities that a chapter or region undertakes will also lead to a higher level of readiness for mass casualty incidents. This job tool assists users to identify the unique characteristics of mass casualty incidents that require additional readiness activities to ensure capability to initiate actions and services. This job tool will help impacted chapters and operations initiate and maintain staff services for mass casualty incidents. Unique aspects of transportation disasters, including our national agreement with the National Transportation Safety Board, require changes to our readiness and response roles. The purpose of this job tool is to provide guidance to Red Cross chapters and regions that will enable them to recognize these unique aspects and take actions that will enable them to successfully adapt their response activities for transportation disasters of all sizes. Copyright The American Red Cross 25
Unit 4: Mass Casualty Sites and Procedures Location on The Exchange Integrated Care Condolence Team Mass Casualty Mass Casualty Name Pre-Assignment Self-Assessment Job Tool Mass Casualty Staff Screening Questionnaire Mass Casualty Post- Response Stress Self-Assessment Description A self-administered tool that can help individuals determine if they are ready to deploy to a mass casualty incident response at this time. Screening tool administered by Disaster Mental Health at a mass casualty incident response to determine current fitness for assignment. This self-assessment tool is an optional, but highly recommended, tool to help disaster responders assess their level of stress after a mass casualty incident response. Copyright The American Red Cross 26
Unit 4: Mass Casualty Sites and Procedures Sites and Procedures Worksheet: Scenario 1, Bus Crash Monday 0845 Local media reports that a Barron County school bus with 35 students, four chaperones, and a driver in transit on a museum field trip was struck by a delivery truck. The bus left the roadway, striking several small trees before rolling onto its side. Initial reports indicate there are several fatalities and a significant number of injuries. First responders from Barron County are on-scene and en route. Access to the state road where the accident occurred is blocked; access is granted only for emergency vehicles. 1000 The Red Cross representative at incident command center states 28 confirmed injured, five critical. Critically injured airlifted to all three hospitals. Barron County EMA has contacted the Red Cross requesting canteening at the crash site and Red Cross assistance at the high school as family members are being directed to that location. 1015 The less critically injured begin arriving at all three hospitals. 0910 Local authorities have called the Red Cross, confirmed the accident, and requested support. They report at least four dead, including delivery truck driver, one chaperone, and two children. They have also requested response assistance from surrounding jurisdictions. 0920 Media reports that the first critically injured victims have been taken to Barron County General Hospital, and emergency rooms in two neighboring jurisdictions (Morrison City Hospital, Kirk County Hospital) are on standby. NTSB Transportation Disaster Assistance (TDA) has contacted the Red Cross Disaster Operations Coordination Center (DOCC), notifying them of the accident and requesting contact information for the Red Cross liaison in the area. 1145 All injured removed from the scene, removal of fatalities begins. 1700 All fatalities removed from the scene and taken to morgue for identification. 2130 Vehicles removed from crash scene, road reopened. Copyright The American Red Cross 27
Unit 4: Mass Casualty Sites and Procedures Time Sites Actions Job Tools/Doctrine Planning Priorities First 2 hours: 1. 2. 3. 2-6 hours: 1. 2. 3. 6-12 hours: 1. 2. 3. 12-24 hours: 1. 2. 3. 24-48 hours: 1. 2. 3. Copyright The American Red Cross 28
Unit 4: Mass Casualty Sites and Procedures Time Sites Actions Job Tools/Doctrine Planning Priorities 2-3 days: 1. 2. 3. 3-7 days: 1. 2. 3. Post 7 days: 1. 2. 3. Copyright The American Red Cross 29
Unit 4: Mass Casualty Sites and Procedures Sites and Procedures Worksheet: Scenario 2, Active Shooter Incident Wednesday 1100 Initial 911 calls report shots fired at the Grandview Hotel in the Midwestern city-suburb of Suburbiaville. Police say the shooting took place in a ballroom during a company holiday party and lasted only a few minutes before the suspects fled the property on foot. They had fired approximately 100 rifle rounds. 1107 Police, EMS, and firefighters arrive at the scene within 7 minutes of the first 911 calls. A perimeter of a half-mile around the hotel is established, blocking all entry to the affected area. Residents are instructed to shelter in place and secure their homes and businesses. 1140 Police begin reporting multiple victims shot at the scene. 1225 Police say they are looking for two shooters after sweeping the building and determining the suspects had fled on foot; they may still be near the scene. Emergency responders are treating people inside. Ambulances begin to take the injured to the closest hospital. 1305 Police confirm 10 people dead and 31 wounded, 8 critically. There were 164 people reported to be attending the company party. Area buildings are on lockdown as authorities search for the suspects. Local EMA request canteening services at the incident command site at the outer perimeter. An additional request has been made for Red Cross to open a reception center for individuals and families unable to return to their homes and for those awaiting information on loved ones. 1605 Police report a shootout with two suspects in an office park ¾ of a mile from the hotel. One suspect has been killed, and the second suspect left the scene by driving an off-road dirt bike into the woods behind the office park. The office park buildings and surrounding roadways are locked down by police. 1630 Police confirm second suspect sighted by helicopter emerging from the woods. Suspect was injured and incapacitated when the dirt bike collided with a civilian automobile as the suspect attempted to escape on surface streets. Two officers suffered non-life-threatening injuries during the shootout. 1705 Police confirm the second suspect was taken to a hospital for non-life-threatening injuries. All injured have been removed from the scene. Police indicate the primary scene at the hotel and the secondary scene at the site of the shootout will be closed off until crime scene processing is complete. The lockdown has been lifted, but police are continuing to interview people before releasing them. Copyright The American Red Cross 30
Unit 4: Mass Casualty Sites and Procedures 1940 Police release names of two of the deceased. Crime scene investigators are on the scene. The first police officer on the scene of the shooting rampage described a scene of carnage, detailing how officers had to make the difficult choice to pass by the wounded as they hunted what they believed were armed attackers still in the building. Police state that more than 50 local, state, and federal responders were involved with the response and investigation. 2315 Responders begin removing bodies from the scene. 2330 Police report the captured shooter admits there were only two shooters. No motive is known, but terrorism has not been ruled out. The FBI has been declared the lead investigator. Police also report that crime scene processing will continue. Roads surrounding the hotel have been opened, though the stretch between the hotel and office park remains closed. Thursday 0735 Suburban University Medical Center says of the four patients being treated at its facility, two remain in critical condition and two are in stable condition. Suburbiaville County Hospital says of the 11 patients being treated at its facility, three remain in critical condition and eight are in stable condition. Sixteen patients were treated and released. 0810 The FBI has its first press briefing and states that it s still unclear whether the shooting was either terrorismrelated or workplace-related. 0945 Suburban University Medical Center says one of the patients in critical condition has died. The overall number of wounded rises to 33 from 31, after two ambulatory victims treated at other medical facilities are reported. 1730 Police released the names of the remaining deceased. Of the 11 total deceased, six were company employees, three were spouses, one was a 17-year-old high school student working for the caterer, and one was a hotel front desk employee. FBI declares event terrorism-related. Friday 1200 FBI reports the crime scene has been released. Only one victim remains in critical condition. Copyright The American Red Cross 31
Unit 4: Mass Casualty Sites and Procedures Time Sites Actions Job Tools/Doctrine Planning Priorities First 2 hours: 1. 2. 3. 2-6 hours: 1. 2. 3. 6-12 hours: 1. 2. 3. 12-24 hours: 1. 2. 3. 24-48 hours: 1. 2. 3. Copyright The American Red Cross 32
Unit 4: Mass Casualty Sites and Procedures Time Sites Actions Job Tools/Doctrine Planning Priorities 2-3 days: 1. 2. 3. 3-7 days: 1. 2. 3. Post 7 days: 1. 2. 3. Copyright The American Red Cross 33
Unit 4: Mass Casualty Sites and Procedures Sites and Procedures Worksheet: Scenario 3, Plane Crash Wednesday 0815 Can-Express Air Flight 164 departed from a major Midwest airport and climbed to cruising altitude before suddenly dropping off radar about 45 miles south of the airport. The Canada-based airline was carrying 135 passengers and seven crew members. The debris field covers about 2 square miles and includes Deep Springs, a recreational camping, swimming, and diving area (a very deep former quarry where people learn to scuba dive). Witnesses report there are some survivors. They are unsure what may be in the water but there is oil or fuel on the surface. They do not believe any campers were injured. 0823 Local fire and EMS units converge on the scene and begin search and rescue operations. About that time, fire breaks out in The Lodge, a large, remote cabin that was hosting a family reunion of about 55 people. A flaming wing section apparently triggered the fast-moving blaze. One large section of the fuselage was found intact and surrounded by fire. There are three general hospitals, a regional trauma center, and a specialty burn unit in the area, and all five facilities are preparing to receive survivors. 0940 The fires are extinguished. At this point, there are 41 injured individuals receiving emergency medical care; 21 from the plane and 20 from the fire at The Lodge. There are many fatalities, including passengers and crew of the plane and people from The Lodge fire. There are also many people who witnessed the scene because they were either attending the reunion or simply enjoying time at the park. The first news chopper is already circling the area. Family members and friends who just dropped off loved ones to catch the flight are now returning to the airport or rushing to the scene in order to find out if their loved ones survived. The airline has established a Friends and Relatives Center (FRC) at the airport in their VIP lounge. 1015 The EOC reports that 41 people have been transported to the five area hospitals. However, NTSB and airline personnel are experiencing difficulty in determining who has been taken to the hospitals as well as patient conditions. Search and rescue teams are establishing a grid pattern and beginning the long and difficult task of finding those who are still missing and documenting and recovering parts of the plane. 1030 Rescue dive teams begin to explore the quarry. TV news vehicles and reporters are clogging all the local roads. Many have been broadcasting live for some time. Speculation has already begun in the Canadian media that terrorists may have placed a bomb on the plane. 1145 One of the black boxes is recovered from the quarry along with a section of the fuselage containing six passengers. Personnel from the NTSB, the Department of Homeland Security, the FBI/DOJ, Immigration and Customs, and Copyright The American Red Cross 34
Unit 4: Mass Casualty Sites and Procedures the airline are now on the scene. Representatives from the Canadian consulate and the Royal Canadian Mounted Police are en route. 1530 The local medical examiner has established a temporary morgue in a vacant warehouse near the crash site and has asked NTSB to request a Disaster Mortuary Operational Response Team (DMORT). There are a few local funeral directors assisting the medical examiner until the DMORT arrives. A Respite Center is now operating in the park s recreation center. At this point, 12 other park buildings and three private residences were damaged but there are no additional casualties. 1720 As darkness begins to fall, local authorities have secured the scene as best they can. There are discussions concerning transitioning from a rescue effort to one of recovery. As parts of the plane are recovered, they are being taken to an empty hangar at the airport where investigators will work to reassemble it as they search for clues to the cause of the accident. Operations will stop until daylight, but there will be regular security patrols overnight. NTSB and the airline are searching for a location to establish a Family Assistance Center (FAC). Airline care teams have begun to arrive to support passengers families. Thursday 0910 Teams continue to recover human remains, personal effects, and parts of the aircraft. This process will likely take several days. The FRC has closed and a FAC is now open at the Cypress Resort, 7 miles from the crash site. There is a main gathering area set up in the Great Hall room. The Joint Family Support Operations Center (JFSOC) is set up in another room nearby. These areas are secured and IDs are needed to enter. Planning begins for a site visit and a memorial service is tentatively scheduled for Monday. 1115 At the press briefing, NTSB officials reveal that the second black box was also recovered and both are being analyzed. So far, there is no definitive evidence that a bomb brought down the plane and no one has claimed responsibility for causing the accident. 1720 Again, as darkness begins to fall, recovery operations stop for the evening and will resume in the morning. 1800 First FAC Family Briefing is held. Family members have been arriving at the Cypress Resort and settling into their rooms. They are greeted upon arrival and briefed about the FAC gathering area and available Integrated Disaster Care (IDC) and airline support. Part of that orientation is an invitation to gather in the Great Hall at 0900 and 1800 for private briefings about the progress of the investigation and the recovery effort from the NTSB, FBI, coroner, etc. to receive factual information before it is released to the press. They will also receive updates on plans for the site visit and memorial service. Copyright The American Red Cross 35
Unit 4: Mass Casualty Sites and Procedures Additional information from the JFSOC includes: 15 families totaling 34 people have registered at the FAC, including eight children under the age of 10. Ten more families have confirmed they will arrive tomorrow. Eight families in four different towns will not be travelling to the site. The involved hospitals still are reluctant to provide NTSB or the airline with definitive information about crash-related patients. NTSB requests assistance from the Red Cross. Friday 0900 FAC Family Briefing #2 is held. Family members are told that the rescue efforts have ended and it is now a recovery effort. More passenger family members are arriving at the FAC. Members of the DMORT are beginning to meet with family members to gather and review identifying information (dental records, x-rays, DNA samples, etc.) They report that some of the families have become distraught during the meeting. 1150 The NTSB learns the black boxes contain voice recordings indicating the pilot and copilot had no indication there was any problem with the aircraft until a loud bang was heard and the recording abruptly ended. At that same time sensors indicated sudden loss of power everything seemed to stop functioning at one time as a result of an explosion. Information is beginning to flow from the hospitals. Five people from three families have been discharged. They, along with their families, have come to the FAC. Three additional individuals have been moved from ICU to regular rooms. 1720 Again, as darkness begins to fall, recovery operations stop for the evening and will resume in the morning. 1800 FAC Family Briefing #3. NTSB begins conversations with the families regarding a site visit and possible interfaith memorial service honoring deceased passengers. A majority of family members present express a desire for a service but feel that Monday is too soon. Saturday 0900 FAC Family Briefing #4. A decision is reached to hold the memorial service on Tuesday and the site visit on Monday. 1030 A site visit and a memorial service are held for the family and friends of those who perished in the fire at The Lodge. The memorial is held at their church since they lived in the immediate area. 1300 Some family members of the passengers and crew who came to the area were unable to stay until the planned site visit and memorial service. Arrangements were made to support them when they made their own private visits to the site. Those were timed and coordinated with recovery workers so that work would temporarily be stopped while the visits occurred. Copyright The American Red Cross 36