Franklin County Multi-Casualty Incident Seminar and Drill After Action Report May 11, 2016 The After-Action Report aligns exercise objectives with preparedness doctrine to include the National Preparedness Goal and related frameworks and guidance. Exercise information required for preparedness reporting and trend analysis is included; users are encouraged to add additional sections as needed to support their own organizational needs.
This page intentionally left blank. i For Official Use Only
EXERCISE OVERVIEW Exercise Name Exercise Date April 1st and 2nd, 2016 Scope This event was a seminar scheduled for 4 hours on April 1, 2016 and a drill planned for eight hours at the Deerfield Railyard located at 95 McClelland Farm Road. Drill play included exercising portions of the Franklin County MCI Plan; especially triage procedures. Mission Area(s) Core Capabilities Response Public health and medical services Situational Assessment Operational Communications Objectives Threat or Hazard Scenario Sponsor Participating Organizations Point of Contact To increase the capability of first responders to respond to a multi-casualty incident. Train versus bus accident At approximately 9:10AM a transit bus carrying 20 adults was lodged on a railroad track and struck by an oncoming passenger train. All 20 passengers and the bus driver along with persons on the passenger train are injured and need to be transported to nearby hospitals. Some of the passengers are elderly and have mobility challenges. Franklin County Regional Emergency Planning Committee Franklin County Regional Emergency Planning Committee Community 911Training Franklin County EMS Franklin County Fire Departments Franklin and Hampshire County Police Departments Northwest Massachusetts Incident Management Team PanAM Railways AMTRAK Greenfield Community College Turners Falls High School Daniel Nietsche, Emergency Preparedness Coordinator, FRCOG, dnietsche@frcog.org, 413-774-3167x105 Exercise Overview 2 For Official Use Only
ANALYSIS OF CORE CAPABILITIES Aligned exercise objectives and core capabilities provide a consistent taxonomy for evaluation that transcends individual exercises to support preparedness reporting and trend analysis. Table 1 includes the exercise objectives and aligned core capabilities that were assessed during the exercise. Exercise Objective Increase the knowledge base of first responders in the areas of triage procedures, the Incident Command System, Franklin County Multi- Casualty Plan, and communication standard operating guidelines in a seminar format. Increase the capability of first responders to respond to a multi-casualty incident using the incident command system and communication systems and protocols in a drill format. Core Capability Public health and medical services Situational Assessment Operational Communications Public health and medical services Situational Assessment Operational Communications TABLE 1. Exercise Objectives and Associated Core Capabilities The following sections provide an overview of the participants discussion related to each exercise objective and associated core capability, highlighting strengths and areas for improvement. Objective 1: Deliver a seminar which increases the knowledge base of first responders in the areas of triage procedures, the Incident Command System, Franklin County Multi-Casualty Plan, and communication standard operating guidelines. Core Capabilities: Public health and medical services Strengths Strength 1: The speakers were very knowledgeable about the topics assigned to them. They were all dynamic speakers who were successful in getting participation and keeping the audience s attention. Strength 2: The seminar was able to train and increase awareness of the topics to forty (40) first responders. Strength 3: The logistics for the site at Greenfield Community College was perfect for this seminar. GCC provided and operated all the audio and visual equipment. This equipment ran smoothly throughout the night. Analysis of Core Capabilities 3 Western Region Homeland Security For Official Use Only
Areas for Improvement Area for Improvement 1: Allow for different teaching formats to increase the effectiveness of the training. Analysis: The seminar was delivered in a lecture type format only. While the lecturers presented a great deal of information, it was expressed via the students, that including hands-on training or demonstrations would have helped to increase the attendees level of understanding. Recommendation: When discussing a concept that requires people to judge the severity of injuries it may help to show or demonstrate the type of injuries that fall into the classifications. This is true especially for new first responders who may not have seen a wide variety of injuries. Additionally, the equipment being discussed should be demonstrated or allowed to be handled. Appendix A: Feedback Form Results A-2
Objective 2: Increase operational experience for first responders responding to a Multi-Casualty Incidents. Core Capabilities: Medical Services, Situational Assessment, Operational Communications Strengths Strength 1: Stakeholder involvement during the planning process was enthusiastic. The planning meetings were well attended by a wide variety of stakeholders. Strength 2: The drill site worked very well for this event. PanAm Railways was able to provide a spur rail, which is an offshoot of a main rail line, allowing for a large and safe area for participants. The site also included room for parking and a command and control area that the Northwest Massachusetts Incident Management Team could use. Strength 3: The event staff, volunteers, and the Northwest Massachusetts Incident Management Team, played multiple logistics, emergency management, and victim roles during drill day. Their participation allowed the drill participants to use radio communications, utilize staging area supplies, lend logistics expertise, and roleplay as victims for the first responders. Areas for Improvement Area for Improvement 1: Improve the accuracy of assigned triage levels. Analysis: The data collected during the evolutions showed first responders over triaged patients 30% of the time and under triaged by 11%. The group assigned the correct level of triage 58% of the time. In total there were 115 attempts recorded. Recommendation: Perform additional training in identifying what types of injuries correspond to what level of triage. The training should include discussion along with visual media to help responders to quickly identify injuries. Ensure triage algorithm sheets are included as part of an MCI kit. Continue to train first responders on the algorithms and are encouraged to use them. Area for Improvement 2: Incident commanders had difficulty managing the scene. Analysis: In the afternoon sessions, the incident commanders had a difficult time trying to keep track of their teams accountability while reporting back to dispatch with resource requests and reports on casualty counts. The unfamiliarity of scene management led to one train passenger car not being triaged at all. Recommendation: Teach and drill responders on proper scene management under the incident command structure and department protocols. Appendix A: Feedback Form Results A-3
Area for Improvement 3: Increase the amount of leadership and teamwork training provided to all levels of first responders during drills and exercises. Analysis: First responders were hesitant to designate the incident commander/team leader. Once the incident commander was selected, that person took some time to assign the remaining team members into groups and designate the location where they should begin the triage process. This was especially true during the morning sessions. It took some players time to get past the uneasy feeling of working with new teammates. Unfortunately, there were only a few evolutions in the afternoon that tested the incident commander in a situation of having to manage more than one team. Recommendation: Chiefs and supervisors should continue to allow all levels of first responders to practice in the role of incident commander under varying situations and with teams of people they may not know well. Area for Improvement 4: Improve the level of instruction to facilitators and evaluators. Analysis: During the course for the day the facilitators had a difficult time understanding their role pertaining to the schedule. This issue was exasperated by the drill having no official time keeper, which led to less instruction time due to the facilitator having to stop and figure out exercise logistics. The evaluators had a difficult time keeping track of what level triage type each victim had. This led some evaluators to question the accuracy of some of the data being collected. Recommendation: There should be a separate briefing and materials for the evaluators and facilitators to become familiar with each other and the procedures. Each victim should have a nametag. The evaluators should have a prepopulated list of the victim s injuries and triage level. Appendix A: Feedback Form Results A-4
Appendix A: Feedback Form Results Appendix A: Feedback Form Results A-5
Appendix A: Feedback Form Results A-6
Appendix A: Feedback Form Results A-7
Appendix A: Feedback Form Results A-8
Do you have any suggestions for making future drills/exercises/seminars better? What kind of improvements would you include in the next event? A bit more clarity and communication with the event staff on their roles. More clear training agenda and timeline for both sessions. The exercise could have used heated tents to keep victims and players out of the elements from first arrival 0730 hours to the end of the day, I was dismayed there was not a standby ambulance or means for warming the attendees, given the weather conditions. Study types of injuries in passenger cars. The makeup was great, but a train vs bus scenario would transfer more momentum to the bus, and triage would focus more heavily injured there. Most people on train would not be bleeding, except from head but would be concussed. Make it a full scale exercise. Fire, Police and medical facilities needed to participate to evaluate their operational capabilities. The EMS Friday evening training was excellent and the Saturday sessions were well done. Appendix A: Feedback Form Results A-9
The registration/wait list was confusing to some people. Folks that signed up in February were left on the wait list although as of March 14, 2016 there were still 20 openings per Dan. Although the flyer went out to heads of departments, I don't think that they passed on the information to their departments because a County Wide Drill should have had a lot more interest and participation. I also think there were more facilitators than were required. Some of the younger EMT facilitators could have certainly participated as first responders and practiced a plan that many of them have never been involved in before. It felt odd to have been an EMT for 23 years and have some EMT with very little experience telling you what you were doing wrong or could have done better when they probably have not practiced the MCI plan ever. Start with smaller, more controlled instructional time. Then gradually combine the smaller events to the next levels before going with a full blown MCI, with all the supporting pieces. Instructions to the patients and first responders could have been clearer. Perhaps some time could have been spent explaining or actually demonstrating extraction of injured people from a passenger rail car. a quick group briefing just prior to the exercise. i.e. after being tagged, please exit toward the front etc. in other words, give specific directions as to what to expect as a volunteer. I guess the only thing would be when we do this type again, (better weather) we practiced getting the patients out which I imagine will take longer considering the space. Have a larger planning team. Areas for improvement would have included perhaps bringing in a decon tent or the state rehab vehicle to keep responders and participants warm, and dry, The unheated train car was the last one to get serviced, The next step would be Tactical Ems for things like active shooter drills Please consider including how to work with folks with disabilities, the elderly...this might be an upcoming training. Nametags or numbers on the victims would make the evaluators lives easier. Appendix A: Feedback Form Results A-10
Please provide comments on the seminar and/or the drill which were not covered above. Kudos for those who prepared the exercise and those who participated under less than ideal weather conditions. This drill is a true possibility in the area and was way over due. This should be done more often. I would like to see a full scale MCI drill take place similar to the ones done many many years ago. Not just triage and extrication. Work the plan from start to finish. Include the dispatch center and the hospital and the ambulance services etc. The facilitators were amazing, and were great at explaining incident management and triage. Too bad more people didn't attend it. I thought the drill/exercise was very good and just concentrating on triage, because by the time the last of the drills came about it was easier to sort patients. The drill was over all very well structured, the local police department was unaware of the drill the morning of the drill, the dispatch center did not get much guidance into the role it would play if at all in the exercise, all are just areas for improvement the drill itself went ok. Someone should have the role of making sure safety of those who can't "jump" from a distance of a few feet to the ground. There could have been many added injuries that while not life threatening could be very serious and would have complicated the recuse efforts (broken hips..) Thank you for allowing the GCC nursing students to be apart of the drill. We all thoroughly enjoyed it and it was a wonderful experience for us as well. Appendix A: Feedback Form Results A-11
APPENDIX B: EXERCISE PLANNERS Organizations Federal AMTRAK State/Regional Massachusetts Emergency Management Agency Northwestern Massachusetts Incident Management Team Private Sector Baystate Franklin Medical Center Pan Am Railroads Local Franklin Regional Emergency Preparedness Council Franklin Regional Council of Governments Appendix B: Exercise Planners B-1
APPENDIX C: EXERCISE PARTICIPANTS Organizations Federal AMTRAK Emergency Management State/Regional Franklin County REPC Franklin Regional Council of Governments Massachusetts Emergency Management Agency Massachusetts State Police Massachusetts State Police- Shelburne Control Northwestern Massachusetts Incident Management Team Mass Department of Public Health Private Sector Baystate Franklin Medical Center Pan Am Railways Community 911 Training, Inc. Cooley Dickinson Hospital Highland Ambulance Local Ashfield EMS Colrain Ambulance Deerfield Fire District Dept. of Early Education and Care Easthampton Police Department Erving Fire Department Franklin County CERT Franklin Regional Council of Governments Greenfield Community College Greenfield Community College RN Program Greenfield Community College Service Learning Montague Center Fire Department Northfield EMS Shelburne Control Shelburne Falls Ambulance Shelburne Falls Fire/Rescues/EMS Shutesbury Fire Department South County EMS South Deerfield Fire District Town of Buckland Town of Deerfield Appendix C: Exercise Participants C-1
Town of Heath Board of Health Town of Shelburne Town of Sunderland Fire Department Turners Falls Fire Department Umass - Amherst Whately Fire Department Organizations Appendix C: Exercise Participants C-2
APPENDIX D: IMPROVEMENT PLAN This IP has been developed specifically for western Massachusetts first responders as a result of the conducted on April 1 and 2, 2016. These recommendations draw on information from the After Action Conference. Capability Observation Title Recommendation Corrective Action Description Capability Element Primary Responsible Agency Agency POC Start Date Completion Date Deliver a seminar which increases the knowledgebase of first responders in the areas of triage procedures, the Incident Command System, Franklin County Multi-Casualty Plan, and communication standard operating guidelines. 1.0 Allow for different teaching formats to increase the effectiveness of the training. 1.1 When discussing a concept that requires people to judge the 1.2.0 Demonstrate the tasks and severity of injuries it may help concepts being taught to show or demonstrate the type of injuries that fall into the classifications. This is true especially for new first 1.2.1 Continueto have professional responders who may not have development lessons on triage seen a widevariety of injuries. Additionally, the equipment being discussed should be 1.2.2 Use visual materials to allow demonstrated or allowed to be first responders to see thelevels of handled. injuries. Medical Services Medical Services Medical Services Franklin County REPC Chair 1-Jun-16 Ongoing Franklin County REPC Chair 1-Jun-16 Ongoing Franklin County REPC Chair 1-Jun-16 Ongoing Increase operational experience for first responders responding to a Multi-Casualty Incidents. 1. Improve the accuracy of assigned triage levels. 2. Incident commanders had difficulty managing the scene. 3. Increase the amount of leadership and teamwork training provided to all levels of first responders during drills and exercises. 4. Improve the level of instruction to facilitators and evaluators. 1.1 Perform additional training in identifying what types of injuries correspond to what level of triage. The training should include discussion along with visual mediato help responders to quickly identify injuries. Ensure triage algorithm sheets are included as part of an MCI kit. Continue to train first responders on the algorithms and are encouraged to use them. 2.1 Teach and drill responders on proper scene management under the incident command structure and department protocols. 3.1 Chiefs and supervisors should continue to allow all levels of first responders to practice in the role of incident commander under varying situations and with teams of people they may not know well. 4.1 Thereshould be a separate briefing and materials for the evaluators and facilitators to become familiar with each other and the procedures. Each victim should have a nametag. The evaluators should have a prepopulated list of the victim s injuries and triage level. 1.2.0 Demonstrate the tasks and concepts being taught 1.2.1 Use visual materials to allow first responders to see thelevels of injuries. 1.2.2 Ensure triage algorithm sheets are included as part of an MCI kit. Continue to train first responders on the algorithms and are encouraged to use them. 2.2.1 Include scene management training to all levels of staff 2.2.2 Continue to teach and drill on ICS procedures especially during MCI incidents. 3.2.1 Incorporate leadership and teamwork specific trainings into the training schedule. 3.2.2 Drill with people form other departments and services to facility relationship building. 4.2.1 During the planning process ensure the needs of the facilitator and evaluator is included. This may include having them be part of the planning team. Medical Services, Situational Assessment, Operational Communications Medical Services, Situational Assessment, Operational Communications Medical Services, Situational Assessment, Operational Communications Medical Services, Situational Assessment, Operational Communications Medical Services, Situational Assessment, Operational Communications Medical Services, Situational Assessment, Operational Communications Medical Services, Situational Assessment, Operational Communications FRCOG, FCEMS Chair 1-Jun-16 1-Aug-16 FRCOG, FCEMS Chair 1-Jun-16 1-Oct-16 Franklin County REPC Chair 1-Jun-16 1-Oct-16 Franklin County REPC Chair 1-Jun-16 1-Oct-16 Franklin County REPC Chair 1-Jun-16 1-Oct-16 Franklin County REPC Chair 1-Jun-16 1-Oct-16 Franklin County REPC Chair 1-Jun-16 1-Oct-16 Planning Franklin County REPC Chair 1-Jun-16 Ongoing Appendix D: Improvement Plan D-1
APPENDIX E: ACRONYMS Acronym AAR DHS EDT EMS HazMat HSEEP IP JIC MOUs NIMS SitMan SMEs WRHSAC Term After Action Report U.S. Department of Homeland Security Eastern Daylight Time Emergency Management Services Hazardous Materials Homeland Security Exercise and Evaluation Program Infrastructure Protection Joint Information Center Memoranda of Understanding National Incident Management System Situation Manual Subject Matter Experts Appendix E: Acronyms E-1