Q&A: Fire chief who responded to Las Vegas shooting shares advice on MCI planning
Chief Greg Cassell underscores the importance of interagency relationships in planning and staging for mass gatherings
The FireRescue1 Academy features the course “Mass Casualty Incidents for EMS,” including multiple videos, as well as the single-video course “Remember 2 Things: Triage for Small-Scale MCIs.” Visit the FireRescue1 Academy to learn more and to schedule an online demo.
Chief Greg Cassell is one of a small group of firefighters with an unfortunate distinction: responder to the site of the deadliest mass shooting committed by an individual in the history of the United States.
Cassell is fire chief of the Clark County (Nevada) Fire Department, which includes in its response area the Las Vegas “Strip” and the site of the Route 91 Harvest festival. On Oct. 1, 2017, Stephen Paddock opened fire on this crowd of concertgoers, killing 58 people and wounding more than 400. The members of the Clark County Fire Department were the first responders facing a mass-casualty incident (MCI) of unimaginable horror. They were joined in their efforts by Las Vegas Fire and Rescue, the Henderson Fire Department and the North Las Vegas Fire Department with whom Cassell says they have a great working relationship.
Fire Chief spoke with Chief Cassell about a new program his department has implemented since the shooting, managing mental health issues that stem from such events, as well as how to plan for and stage an MCI event response.
Fire Chief: While it’s impossible to know when an MCI will happen – or what type of MCI (shooting, structural collapse) – where should fire departments begin when planning for such events?
Chief Cassell: It’s critical to have relationships established with law enforcement, EMS, communications centers, hospitals, local health departments and similar agencies well BEFORE an event occurs.
Train on the basics of potential responses, such as the incident command system and EMS response. Identify resources for various scenarios, local SMEs like crane operators, various trade groups, behavioral health professionals, etc., and coordinate with them ahead of time. Identify key staff positions and staff them with competent personnel. Also, have a plan for establishing and operating a Family Assistance Center. This was a huge challenge for us and one area that strongly suggests that every municipality should consider before an event happens.
Is there a checklist of potential hazards or issues that fire personnel should walk through prior to their jurisdiction hosting a large event?
With solid preexisting relationships, broadly share pertinent information with all partners in the operation, have an incident action plan (IAP) with input from all involved. Local ordinances or state laws that dictate the number of resources for the type and size of an event should be established and followed.
We have hundreds of special events every year in our jurisdiction, and we learn something from each one. I don’t recommend making hard rules that limit flexibility. General guidelines (ordinances, laws or otherwise) need to provide a jurisdiction with the ability to adapt from one event to another given a wide range of influences.
How can public safety coordinate among themselves (fire, police, EMS) for these events? What about coordinating with other agencies, such as the Red Cross?
Again, having the relationships and knowing what each group brings to the table and what support is needed to make things happen. This does not happen overnight; it takes years to solidify.
How can dispatch centers and private ambulance companies be worked into training and planning for MCIs?
This is important, as they are key players. Have them in the planning phases for planned events and have them as part of table-top exercises and after-action reports for all events. This will identify opportunities to get better as a group.
Should a command post be set up in advance of a major event and, if so, are there special considerations for how to manage the Command Post at an event?
Yes – access and egress before, during and after the event under regular operations. Consider where people will flee if an incident happens at the event. Generally, the bigger the event, the farther away the incident command post (ICP) should be. Consider the type of facilities to include food, water, restrooms, communication systems, breakout rooms/areas for critical decision-making and perimeter security.
What is the appropriate training in the use of Rescue Task Forces (RTFs) for fire and EMS, and how can departments implement such training?
This is driven by local policies and available resources. Those relationships and training on the basics of RTF ahead of time are critical. Even if the scenario you practice is not the incident you face, having trained together and understanding the basics of working together is imperative.
How do the preparations change as the event size grows? Are there tips or recommendations for how fire and EMS can scale their response efforts, from small events to large-scale gatherings?
Planning time increases, as do all factors like logistical support, incident complexity, number of pre-event meetings and table-top exercises. Notify other entities that are not involved in the event and share the IAP with them just in case they get drug in for some reason.
Having recently marked the two-year anniversary of the Las Vegas shooting at the Route 91 Harvest Festival approaches, what new initiatives or lessons can you share about planning and training for these events?
We have established a plan called “Hospital Area Command.” This is intended to support the area hospitals, as so many people will self-transport, even critical patients, to the closest hospital located by using their phone.
This plan has five unassigned engine companies going to the five closest hospitals to the address of the MCI. The captain of the engine meets up with the charge nurse of the ER and from there they help the charge nurse with whatever they need (triage, IVs, intubations, chest decompressions, etc.).
An unassigned battalion chief manages these engines, which assume a division call sign on their arrival at the hospital like Sunrise Division (Sunrise Hospital) or Desert Springs Division (Desert Springs Hospital). The battalion chief is the incident commander (IC) for hospital area command.
In 2018, I sat in a presentation you and Kevin McMahill gave at a fire service trade show, covering response efforts and lessons learned from the Las Vegas shooting. You noted in that presentation that the PTSD from such events is very real. How are you doing now? What can you share with first responders about the impact of responding to these events, and is there anything they can do in advance to mentally prepare themselves for these types of calls?
We are holding our own on this front for now. Hopefully nothing will change.
On the front end, I recommend that the providers in the area, especially the ones on an insurance plan, are vetted to make sure they can actually help with traumatic debriefings/counseling. For us that was four out of the 10 on the list. The other six were more like marriage or teenage counseling and would not have been useful for the trauma we had that night. We learned this from the IAFF national crisis team that arrived to help us.
Also, develop a relationship with a counselor before you have a problem. Think of it like a dentist. You don’t want to try and find one you like and trust when you have a terrible tooth ache. Find a counselor that fits your needs and that you trust before you have a critical event.
Editor’s Note: What types of training have you coordinated with local agencies? Share you tips with firstname.lastname@example.org.