My mind is constantly pondering the what-ifs of life, especially if it involves Emergency Response. I have been blessed in my life to be a part of just about every type of agency that provides services to people in crisis. They all differ greatly from one another, but have internal pieces that are the same between them that have to fit together like a puzzle in the face of disaster. All of these duties fall into the scope of a well organized incident command.
My description is in itself an Oxymoron, in the fact that well organized, and incident command do not go together real well. You can plan and train and hope that all goes well in a mass casualty incident, but it is rare that the real deal goes off without a hitch. As responders, we are all trained in the art of incident command and the need for it on scene. I call it an art, because it is open for interpretation. The idea is to have structure. A structure that is fluid and dynamic so to adapt to any situation. To provide a sense of calm and organization to an otherwise nightmare. Its like trying to put an egg back together.
I personally have been involved in many calls in which triage and incident command were needed. I personally find it to be one of the most difficult things to do when arriving at a multi-casualty scene. When there is a situation that is going to involve multiple agencies, using multiple resources, incident command is imperative.
To roll up to where people are screaming, and shouting for help, reaching out for you and you just have to walk past them to access the scene is tough. Triage is hard but effective. To do the most good, for the most people, with the least effort. We have always been trained to respond to the call, arrive on scene, get out and help the victim, that is impossible when there are 10, 20, or 100 patients. Here is a little tip to the non medical readers of this blog that may one day find themselves in a mass casualty event....If your sitting up and screaming at us for help, we are going to walk right by you..congratulations, your a green tag. Its the quiet ones we have to worry about.
Large agencies that have a heavy response load, are better at dealing with incident command and triage than smaller, ill equipped agencies. That being said, lets think about this..If we had to pick a department that we thought would be the best at it, who would it be? Lets say good ol' FDNY. Huge department, unlimited resources, vast experience, good command structure right? Do you think they ever planned on the events of September 11, 2001? Could you ever be ready for that? I figure they did the best anybody could do in that situation and they still had a ton of problems. A total breakdown of command at times with no accountability. Rogue responders roaming around doing their own thing, should we run? should we dig?
All of this to bring me to my real point of this rant.The Aurora Colorado theater shooting. A nut walks into the dark theater and opens up with gas grenades and bullets from an assault rifle. Just in that sentence alone, we know we need the response from 3 agencies. Law enforcement for an active shooter, fire department because of need for breathing apparatus, and EMS because we know we will have casualties, and probably a lot. A total of 70 to be exact with 12 that ended up dying. This was a true nightmare for responders.
I have listened to the full dispatch recordings and this is my opinion. A lot of people are saying that an awesome job was done by reponders, but there were a bunch of problems that I heard that I am sure they have addressed. I am not one to go behind people and second judge things, or armchair quarterback, but this is why I chose to mention it. Several people involved in the response have complained about the other agencies publicly, and the media has run with it.
First off, I know the dispatchers did an awesome job keeping things together and being professional. They received incoming calls and got the responders on the way, updating them every few seconds. There was an Engine company on scene really quickly, really before they had the info of the number a patients involved. They struggled to sort things out at first, and make a decision on where staging and command would be. This is time critical. That has to be determined quickly because that info has to go out with dispatch as additional units are assigned. Make your decision and stick with it, only move if it becomes a safety risk. responding units need to approach the scene from the same general location, and not get caught up by passing through the scene to get to staging. Ambulances were showing up on all sides of the mall and being flagged down by victims and officers to stop and take on patients, this was a major problem. Command could not keep up with resources, because they were not coming to staging. Command was trying so hard to wrangle these "hi-jacked" ambulances, that they lost the ability to send available units in from staging, they were just sitting there.
Now, as for law-enforcement. This was a tough one. They are charged with being the only ones that can really enter the scene. Active shooter protocol prohibits rescuers from entering the scene I am sure. Officers were encountering multiple victims with all sorts of injuries and calling them out. Without a secure scene, the medical help isn't coming. It ended up with officers trying to bring medics in, officers screaming on the radio over and over again for medics, and officers just giving up and putting victims in cars and racing them to the hospital. This probably saved lives, but was very problematic in the grand scheme of things as far as command goes. There was an incident command structure up and running, the only problem was that each agency was running their own. Numerous times, out of frustration, I heard a ranking police officer demand that the Fire captain in command meet him ASAP, almost like calling him out for a duel.
So they had command, but not a unified command. The commmanders of all 3 agencies should have been together so the left hand knew what the right hand was doing and so forth. I heard a lot of problems that could have been solved if just 3 people could have talked to one another. Pointing fingers at each other in the media is a mistake, and hurts your people. Get together, learn from it, fix it. It was a tremendous tragedy that is hard to manage in any aspect, but everyone in this business can learn from the mistakes.
So as we go forward in our day as rescuers, we quietly sit in our stations and read our books, watch our TV's, read training manuals and think about what we will do tomorrow when we are off. Remember this, there were responders doing just that on September 11th,2001, at 08:45am not knowing the world was about to change. Many of which did not come home that night.
Triage in the field is a nasty beast. While there, you fight a battle between emotions, knowledge, reality, and spiritual belief. It is only natural, on the day after, to start second guessing decisions made in the blink of an eye. You need to have faith in yourself and the people working with you and not dwell on the what-ifs, because that is where the demons live. Do your best, pray a lot, and stay strong because today is a new day and someone out there needs you.
