Exercise After Action Report

Exercise After Action Report

County:

Exercise Location:

Exercise Name:

Date/s of Exercise:

Hazard:

Please enter only one (1) P for the Primary Hazard and, if needed, one (1) or more S’s for Secondary type(s) of Hazard(s) Natural (P or S) Technological (P or S) National Security/Terrorism (P or S)

Avalanche Dam Failure Biological

Drought Hazardous Materials – Fixed Facility

Chemical

Earthquake Hazardous Materials – Transportation

Civil Disorder

Flood Power Failure Cyber

Hurricane Radiological – Fixed Facility Explosive P

Landslide Radiological – Transportation Hostage

Subsidence Structural Fires Nuclear/Radiological

Tornado Transportation Accidents (Air/Rail/Highway/Water) Tsunami Volcano Wild Fire Winter Storm

Type of Exercise:

Actual Occurrence:

If Yes, Local

State Federal

Exercise Focus

Indicate Number of Participants in each Category:

Number Number

Number

Appointed Officials Law Enforcement 3 Search and Rescue

Civil Air Patrol LEPC Utilities

Communications Private Industry Volunteer Agencies

Emergency Management 2 Public Information

Finance Public Participants 18 Federal

Fire 11 Public Works State

Health and Medical 25 Radiological Military

Human Services School Personnel Other

Breakdown of Participants in Selected Categories:

Federal Agencies Number

State Agencies Number

Military Groups Number

Volunteer Agencies Number

Other Groups Number

Members of Grant County 4-H 18

Executive Summary

Provide a 1 to 2 page summary of the exercise highlighting the scope, participants, key successes, and most significant areas for improvement.

The scope of this exercise was to determine the capabilities of the Mass Casualty Trailers and the preparedness level of responders to a WMD mass casualty event. Since these

trailers were completed in the fall of 2004, very little time for training has been

available. Grant County Emergency Management conducted this exercise to determine if the equipment on each of the two trailers available was adequate to handle a mass casualty response. It was also conducted to determine what additional training needed to be done for emergency responders so they felt confident in requesting the trailers and using the equipment once the trailer arrived on scene at an MCI incident. It was the purpose of Grant County Emergency Management to train emergency responders on the availability of the MCI trailers, the equipment housed in the trailer and what types of situations would

necessitate the request and response of these trailers prior to the exercise.

Prior to the exercise, participants were given instruction on a basic mass casualty triage system using the triage bags containing triage tags and a marking system. The system also involves triaging patients by injury severity and using a series of different colored tarps to determine transportation order. During the exercise, responders would need to follow the protocol for requesting the trailer and once it arrived, putting the triage system to use. Responders would need to use the equipment to sucessfully triage, scene treat and transport multiple victims of a mass casualty incident.

Most of the emergency responders attending the exercise were EMS and Police and Fire from the City of Cuba City, Village of Hazel Green and from Jamestown. It was decided during the training that many of those present would certainly be called to help handle a mass casualty situation under the mutual aid agreements in place in Grant County. Approximately 100 emergency responders from fire, EMS, First Responders and Law Enforcement were invited to attend. Unfortunately, only about 40 were able to participate. It was sucessful that we trained and exercised that many, but a larger turn-out would have expanded the training experience for more of the area departments. Since the planning committee had requested 20 victim volunteers and received 18, the volume of injured overwhelmed the responders.

Obviously that is a realistic event, but for training purposes, it cause some issues. Most of the 18 victim-volunteers were members of Grant County 4-H Clubs. They played their parts very well and they can be considered a credit to their club. Their behavior and excellent theatrical skills were without fault and greatly added to the realism of the exercise.

Training enhancements were created with the use of Moulage and rescue manikins. Moulage was applied by Jerry Crotsenberg, Public Health Preparedness and Response Coordinator for Region #9. His efforts increased the reality of the exercise and provided EMS and other emergency responders with realistic injuries to deal with. The responders were quite

surprised and pleased with the fact that they actually had injuries they could see to treat as opposed to pretending the injuries. The manikins were used to simulate patients who would be found trapped or in a position or situation that a human volunteer would prefer

not to be in Responders had to triage and rescue the manikins as they would have any other patient/victim involved in a mass-casualty incident.

With the WMD twist of the exercise, the police department had to use some of their

investigative skills to determine the cause of the explosion. Upon realizing that this was a deliberate act when additional IED's were found in the vicinity, they acted appropriately by requesting assistance from other agencies including the Sheriff's Department and the FBI. Unfortunately, they were unable to continue to participate when they were called to an actual situation and left the exercise.

The fire department chief maintained control of the situation throughout the exercise. He established this using ICS and then switched over to Unified Command when the EMS Chief reported to him. The fire chief appointed a safety officer who was sent directly to the scene to maintain safe operations. The fire department assisted with patient removal and equipment set up assistance. They worked along side the EMS and it was a good situation. The Safety Officer determined that there were unexploded IED's and reported back to the chief about half way through patient triage and removal. The fire chief requested

immediate evacuation until it was determined that the building was safe. Not one of the EMT's or fire fighters left the scene. This was discussed at the critique. The

overwhelming majority of responders felt that it was more important to remove the victims, most of them children, than it was to evacuate the building. This is hard to argue, but the proper response would have been to evacuate the building and return when deemed safe. EMS response was a bit uncontrolled in the area of triage. It started out with a the crew chief taking a brief walk-through of the scene. She began requesting additional EMT's and equipment be brought to the scene. She was eventually requested to report to the outside temporary Command Post and someone else was assigned the triage officer duty. This person made it about half way through the patients when he discovered a critically wounded patient under a pile of debris. He stopped all triage activities and began to field treat this patient who had injuries that would eventually become fatal. All the triage fell apart at that point.

Another EMT came into the scene and immediately began shouting orders to other EMT's and fire fighters. (He was not directed to be the replacement triage officer.) There was no control or order in this. He approached one victim who was screaming for help and told her to stop screaming or they would not be paying any attention to her. He eventually left the scene and went to the staging area with a patient. His approach was deemed as unacceptable by the evaluators and the victim. It was discussed at the critique that it is important to keep a calm and cool head on scenes such as this and that if a responder becomes

overwhelmed with the daunting task, they should step out and request to be reassigned. Yet another EMT was assigned the task of triage officer and proceeded to triage some of the remaining patients. (There were still 10 left to be triaged.) While examining one, the call went out to evacuate the building because additional IED's were discovered in the immediate vicinity of some of the patients. The triage officer and another EMT refused to leave and were caught in the blast of an IED and became a fatality. Following that

simulated explosion, the remaining fire fighters and EMTs who reentered the building

without permission from the IC put victim removal regardless of injuries into motion. They packaged the remaining 4 patients and removed them the building.

All living patients were moved to the staging area using the tarping system. This portion of the exerise went well. All victims were treated with care and concern and constant monitoring by the EMT's assigned to the staging area. They comforted the patients and covered them with blankets when it was determined that many of them were cold. The transportation of patients brought an interesting issue to light. Because we only had 3 rescue squads and 21 patients, most with critical injuries, additional means of

transportation needed to be figured out. The group worked together to discuss this issue and determined that the use of the fire department equipment truck would be sufficient for the transporation of at least two more victims. Those involved in the discussion worked well together and came to a perfectly reasonable solution to a common problem.

Because of the number of EMT's who were able to participate, this exercise went very well in terms of keeping track of victims especially the ambulatory ones who tried to get back into the building or wander away. They handled the critical patients quite well. During the critique, it was discussed that most of the victims ended up on the red tarp which signifies immediate transport to hospital. It was discussed that perhaps emotion brought them to determine that some of the patients who really could have been sent to the delayed or yellow tarps were sent to red. The yellow tarp was almost used as the overflow for the red tarp. A discussion ensued that perhaps someone was almost needed to reassess the patients as they came out of the scene to determine exactly which color they should be marked. During the staging period, some of the patients were moved around in order of transport. This was properly done to assure that the most critical and yet viable patients would be transported first.

Additional improvement comes in the need for additional training for those who were unable to attend the exercise. Spring doesn't seem to be a good time to conduct exercises of this scope. We had good response from EMS, but the exercise proved how important participation by and training of fire departments really is. They were essential for manpower and

lifting.

Exercise Overview

Provide an overview of the Exercise Scenario and a description of the evaluation process.

A man is angry over a zoning issue. He is in a dispute with the township board members who won't rezone his property to commercial and stands to lose a lot of money when a

corporation can't build their new business on his land. He feels no one is listening to him and he is going to make them listen. By hurting a group of people he is sure he will get some attention for his cause. He finds out the township chairperson will be attending a play in a school gymnasium. He sets a backpack in the bleachers before the play begins. During the performance, an explosion occurs. Several students and adults are critically

injured. Some of the injured are found wandering around the grounds of the school. Others are found buried under piles of debris.

Evaluation was conducted by one law enforcement officer, one EMT and one fire fighter. Each were given the tasks and objectives within their area of expertise to watch for and make evaluations and observations on. A final critique was held following the close of the exercise. Each of the evaluators reported their findings.

Exercise Goals and Objectives

List the goals and objectives for the exercise.

The Exercise Goals:

1) To understand the process of responding to a mass casualty incident where responders would be faced with some crucial decisions regarding triage and transportation.

2) To understand the use of and equipment housed in the Mass Casualty Trailers owned by Grant County Emergency Management.

3) To properly assess the mass casualty incident and respond using the MCI trailers provided by Grant County Emergency Management.

4) To determine if first responders will invoke mutual aid agreements requesting additional assistance from area responders.

5) To determine if a WMD incident in Grant County would immediately overwhelm law enforcement when asked to respond to an incident outside their normal response calls.

6) To ensure that the equipment housed on the MCI trailers is adequate and if other equipment should be on the trailers.

The Exercise Objectives:

1) Alert Notification: To demonstrate the ability to alert, mobilize and activate the personnel, facilities and systems required for emergency response.

2) Communications: To determine the ability to establish, use, maintain and manage communications essential to support response to an incident/accident.

3) Direction and Control: To determine the level of cooperation and coordination between agencies, departments and organizations of the jurisdiction in responding to problems associated with a major emergency or event.

4) Health & Medical: To determine the preparedness of local responders to respond to a mass-casualty incident using the MCI trailer housed in Hazel Green.

5) Transportation: To determine the ability to alert, mobilize and activate mutual aid response to a mass-casualty event.

6) Resource Management: To determine the effectiveness of procedures for deployment of emergency personnel and equipment during a major emergency or disaster

Exercise Events Synopsis

Provide a synopsis, by time, of the major actions that were taken during the exercise.

10:00 a.m. The exercise is scheduled to begin. At this time, a discussion has insued by local responders on the facility and how a mass casualty event could occur and trigger a MCI response. The facility is the world-wide headquarters for the Dominican Order and

known as Sinsinawa Mound. This deeply political organization is housed within a huge

complex of interconnected, multi-story buildings. There are 375 permanent residents living at this facility, many of whom are elderly and would need assistance to evacuate the

building. On a normal day, including weekends, nearly 500 additional visitors and guests can be found on the grounds interacting with the nearly 300 staff. Annually over 32,000 people come to Sinsinawa Mound for meetings and retreats and educational opportunities. An incident, whether intentional or accidental could cause the need for response by many

departments and resources within Grant County and the surrounding counties which include those in the states of Iowa and Illinois.

10:45 a.m. Hazel Green Fire and EMS, officers from the Grant County Sheriff's Department and the Hazel Green PD are paged to an explosion in the gymnasium at Sinsinawa Mound. There are no details on the cause of the explosion and no fire or smoke is showing. 10:50 a.m. Hazel Green EMS arrive on scene and report that they have approximately 20 victims and Hazel Green fire will need to bring the MCI trailer to the scene. They also request mutual aid assistance from Cuba City Rescue, and Jamestown First Responders. (These additional units were staged on scene in the necessity of time. Actual response time would be 15-30 minutes.) Hazel Green PD arrives on scene and the two officers begin to assist with scene assessment. They begin an investigation into the cause of the

explosion.

10:52 a.m. The Fire Chief establishes himself as IC. An EMT is assigned as Command and Unified Command is established. Two others are assigned as Transportation and Triage Officers. Initial triage begins. It is determined that there are 21 patients and only 3 of them are ambulatory.

10:55 a.m. The MCI trailer arrives on scene. Fire fighters and extra EMT's are assigned to set up the staging area using the tarp system. A location is determined and work begins. Additional fire fighters are assigned by the IC to assist with victim removal from the scene. Fire fighters are given spine boards and work in pairs to assist with victim removal in the order that is determined by the triage officer. Triage begins.

11:00 a.m. Victim removal in progress. Triage officer distracted by seriously injured patient. All patient removal to this point stops. Member of EMS crew takes over and begins moving from patient to patient without tagging and giving direction. He yells at one victim and then leaves the scene with another patient he determines to be next to remove. Several of the victims have yet to be triaged. Victim transportation to area hospitals is in progress in the tarp staging area.

11:10 a.m. Another EMT on the scene and within the building self assigns after realizing what is happening and becomes triage officer. She begins to move from victim to victim triaging and tagging and directing victim removal.

11:15 a.m. Approximately 7 victims are left to be removed. One victim has yet to be triaged and is lying under the bleachers and hard to see. Hazel Green PD finds two unexploded IED's and informs dispatch and the fire chief. The fire chief orders the immediate evacuation of the building. Not one of the fire fighters or EMT's leave the scene as directed but continue with victim triage and removal. PD Chief requests that contact be made with the Sheriff. (The HGPD chief is new to the department and fairly new as a law enforcement officer and correctly requested assistance from a senior officer. At that time, he was paged away for an actual situation within his juridiction. He left one officer to assist with perimeter control. He did not return to the exercise.) The Safety

Officer reports to the fire chief that none of the responders have left the scene and that several unexploded IED's have been identified in the direct vicinity.

11:17 a.m. The call for evacuation is made again. By this time, several more of the victims have been removed. The single victim that has not been triaged continues to wait for discovery. Most of the fire fighters move into rushed evacuation without concern for stablization. Victims are strapped to spine boards and carried out.

11:18 a.m. A single IED explodes in the middle of the scene (simulated) killing the triage officer and one additional EMT. This incident is reported to the IC/Unified Command. Evacuation of the scene is ordered again. Finally, the single victim is removed quickly without regard to immobilization. The remaining victims were determined by triage to be unviable and had been black-tagged.

11:20 a.m. A lack of rescue squads leaves EMT's to determine how to transport patients. Transport Officer requests assistance from the fire chief. Through a lengthy and well thought out discussion, several options are determined which include the use of a school bus and the use of the equipment van belonging to the fire department.

11:30 a.m. Patient care continues on the tarps. Patients are well cared for and

comforted. Several of the patients are moved in the transportation order as it is deemed necessary.

11:35 a.m. One patient is removed from the staging area as she becomes a fatality. She is moved to a tarp away from other patients and covered. Exercise called to an end.

Analysis of Mission Outcomes

Provide an analysis of how well the participating jurisdictions as a whole (i.e., across disciplines and across jurisdictions) achieved the expected mission outcomes in their response to the simulated event.

All in all this exercise was considered a success. There were a few problems with personalities and the response was not as large as anticipated. Additional assistance would have been necessary from other fire departments had this been an actual event and would have been requested. A greater response within each department would have occurred had this been an actual event. The volunteer departments in this area and their employers are dedicated to public safety and often make accomodations to allow for response to

emergency situations. The fire chief took control of the incident and worked well under the Unified Command structure. The EMT's handled patient and victim care correctly and used great care and concern. They talked to the victims and reassured them. The use of equipment from the MCI trailer was astounding. They used much of the equipment and determined that additional equipment would be helpful added to the trailer. Even though the police department was only able to participate in a limited capacity, and had just begun to participate when called away, they were going in the right direction to determine that this was infact a deliberate act. The Chief's request for assistance from the

Sheriff's Department was correct and leading in the correct direction. Hopefully in the future, the new Chief will be able to participate in another exercise fully.

Analysis of Critical Task Performance

Each task identified by the exercise planning team as critical to the response required by the scenario should be discussed. Tasks that were performed as expected require only a short writeup that describes how the task was performed. For tasks that were not performed as expected, you should include 1) an issue statement; 2) references to plans, procedures, and evaluation guides; 3) a brief summary of the

issue; 4) the consequence of the issue on the response; and 5) an analysis of what happened or did not happen and the root causes for the variance from the expected outcome. Recommendations for improvement should be presented to address identified issues.

Task # 1: To identify the need for the MCI trailer and follow the proper proceedures for requesting the trailer be brought to the site for an MCI situation. This task was

performed as expected. The request for the trailer was made by the EMS Chief through the fire department and the fire department correctly and quickly responded with the trailer. The proper request was made as had been established in the training and in the guidelines established by Grant County Emergency Management.

Task # 2: Proper use of the MCI trailer and the equipment on board belonging to Grant County Emergency Management during a mass casualty incident. After the trailer arrived on scene, the EMS IC designated a triage area and members of the EMS crew set up the area while initial victim triage was being conducted both in the gymnasium and on the grounds by the assigned EMS Triage Officer. The crew properly set up the triage/transportation area using the colored tarps. They unloaded the necessary emergency equipment and staged it so it was immediately available for arriving patients. The IC properly assigned one EMT to each of the tarps and one as a combined transportation/communication officer. This went very smoothly.

Task# 3: Proper triage and transport of patients using equipment found on the MCI trailers owned by Grant County Emergency Management. As discussed, the triage portion of the

exercise had room for improvement. Additional training will be necessary for this task to be accomplished with confidence and accuracy. The plans exist for this proceedure and were not followed. The first triage officer after only triaging approximately 5 victims was distracted by a critically injured victim and stayed with that person to the detriment of the other victims. An EMT came onto the scene and immediately took over but did not provide direction to other EMT's and fire fighters. He triaged a couple patients, took over care of one and insisted that that victim be carried to the staging area immediately. He left with the patient. Finally, after about 10 minutes of confusion another EMT stepped up and took the role. She continued with the triage. She did a good job until by order of the fire chief the scene was to be evacuated, and she failed to follow through with this directive. An IED exploded near her and she and another EMT were fatally wounded. The entire process of triage will be discussed again at length with area responders. Failure to properly triage all patients in a timely manner and using the process of triage would jeopardize victims lives. Failure to follow directives from the Incident Commander leaves responders in situations that the command feels are dangerous to personnel. A review of ICS training and the consequences of failing to follow the system needs to be reinforced with area responders.

Conclusions

Provide a brief summary of the major conclusions from the exercise.

This exercise provided emergency responders with the opportunity to better cope with a very real situation that could occur in our county or anywhere in our area. This situation could be a bus accident, bleacher collapse, plane crash, school shooting or anything that would trigger the need for a mass casualty response. The responders were trained on the use of the MCI trailer and most of them knew how to use the equipment inside the trailer.

Their response was professional and they showed great concern for the patients even though this was not an actual situation.

The use of Moulage in any full-scale exercise is a must. It adds so much to the exercise and gives emergency responders the visual aids they need to keep a focus on the exercise. By practicing for a WMD event, we are prepared should a situation involving terrorism actually occur. We have several high-profile targets in our county and we need to be sure our emergency responders are ready to assist residents and visitors with the best equipment available. People expect to be cared for in times of emergency. Grant County Emergency Management is dedicated to protecting and ensuring public safety whether it be from a natural disaster or a man-made one.

Additional training in the use and deployment of the MCI trailers will ultimately continue to benefit the residents of Grant County. Emergency responders can respond to a situation knowing they have equipment enroute and on scene within a matter of a few minutes in most of Grant County. This gives them the confidence and the skills to handle a large situation where saving the biggest number of lives is the goal. Practice makes confidence and

offering training opportunities will be a major focus in the many months to come to ensure that all responders, including fire, EMS and law enforcement are familiar with the