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When the MCI hits close to home

The Colerain Township (Ohio) Department of Fire and EMS was prepared to respond when an MCI occurred in their service area


Don’t wait! Be prepared for your MCI, for it will come when you least expect it.

Image courtesy Twitter ahuguelet

I’ve written previously about how our neighboring Cincinnati Fire Department seamlessly responded to the mass casualty shooting at the Cameo Nightclub.

The Cameo MCI took place on March 26, 2017, and resulted in 17 casualties, including two fatalities and 15 wounded.

Following that incident, my home department, the Colerain Township (Ohio) Department of Fire and EMS, initiated two action steps to prepare for any similar incident in its response area:

  1. The first was participating in a full-scale triage training exercise for our tactical medics conducted in conjunction with the University of Cincinnati Medical Center.
  2. The second was conducting an extensive study, including ballistic testing, of various tactical vests for our own personnel with a recommendation report due for inclusion in the next year’s budget. However, no one expected we’d have our own MCI just months later.

It was a nearly perfect July evening, with an occasional firecracker discharging and most neighborhoods holding one or more cookouts. In one of those neighborhoods, 20 to 25 invited guests gathered at a party.

As the party was winding down, with most of guests gone by 11 p.m., those remaining (including several children), settled in to watch the movie “Spiderman.”

Partway through the movie, at least two gunmen from among the invited guests started shooting at the other individuals in the front rooms of the dwelling. The attack appeared premeditated, as the subsequent investigation found multiple connections between individuals attending the party and three different drug circles. Once the gunmen had finished, nine victims lay dying or wounded.

Mounting a mass casualty incident response

Almost immediately, 911 calls to the Hamilton County Communications Center (HCCC) were received from individuals inside the house, as well as neighbors and bystanders in the vicinity of the location. The calls from within the home were frantic, with crying and shouting in the background.

However, the calls from neighbors and bystanders gave the first clues that this was to be no ordinary emergency call. Callers indicated that several people were laying in the front yard and appeared bleeding or injured. They had heard what at first sounded like firecrackers, but then realized that these had been gunshots.

Simultaneously, the HCCC dispatched both Colerain Fire/EMS and Colerain Police units to the scene. The first fire dispatch indicated that there was one person shot, but almost immediately, additional information received at the HCCC upgraded that number to three people. Engine and Medic 25, the units initially dispatched, requested three additional medic units to respond. Subsequently, Medic 225, Engine and Medic 26, and Medic 102 were dispatched.

Prior to their arrival, the first police officer on the scene notified the HCCC that he had several – at least six – gunshot victims, and he had yet to secure the residence. The HCCC then put out an “officer needs assistance” call on the West area police channels.

Hearing this information, the Colerain Fire shift supervisor, District Chief Tim Beech, called for four additional medic units, and the HCCC dispatched Colerain Engine 103 and medic units from Green, Springfield and Whitewater Townships, along with a medic unit from the City of Forest Park. Chief Beach, aware the address was on a dead-end street, had all units stage on a nearby cross street in order to keep access available while he initiated command with the police supervisor.

Quickly assessing the scene, he assigned Engine 25’s Firefighter Joe Grayson, a tactical medic, to assume triage; Engine 25’s Captain Chris Ruwe as treatment, and Engine 103’s Lieutenant Dave Simonson as the transport officer.

MCI triage, treatment, transport

Triage quickly determined that there were at least nine victims, including one deceased at the scene, as well as five adults and three children being treated prior to transport

As the scene was secured, and the more critically wounded were removed from the home, the HCCC opened the Greater Cincinnati Hospital Net and separately started to inventory which hospitals had critical care capacity.

Due to the severity of the injuries and wounds, the decision was made to transport all of the adults to the University of Cincinnati Medical Center, a Level 1 Trauma Center; and the three children to the adjacent Cincinnati Children’s Hospital. Both hospitals had indicated they had the capacity and trauma teams available for this push.

Colerain’s Medical Director, Dr. Donald Locasto, also affiliated with the University of Cincinnati Medical Center, had frequently discussed with our personnel how the hospital reacts to an MCI in order to augment staffing in the ER to handle the increased surge. The patient assessment went quickly, with those most critically wounded taken immediately to surgery.

All eight viable patients were transported to these two area hospitals within 28 minutes of patient contact and survived their trauma wounds.

MCI hot wash

Upon clearing the scene, District Chief Beach and Assistant Chief Will Mueller began a hot wash debriefing process to assess if any of the personnel in attendance wanted to talk to a critical incident counselor that night. Another debriefing, held by Assistant Chief Allen Walls, was performed at shift change the next morning.

Perhaps it was fate, luck or coincidence, but less than an hour after clearing the MCI and returning to their separate quarters, these same department personnel almost to an individual firefighter were dispatched to a working structure fire about three miles from the MCI’s location. This turned out to be a smoky basement fire that required about two hours on scene for extinguishment, overhaul and investigation, but it immediately gave these men and women a break from continuing to dwell on the trauma they had witnessed. The success story to this fire was that all six family members residing in the home had been alerted by smoke alarms and made it safely outside prior to the arrival of Engine 103.

Captain Shane Packer, the Department’s EMS supervisor, subsequently wrote up an after-action report that documented the steps taken and lessons learned. Assistant Medical Director, Dr. Michael Spigner, reviewed each patient’s care for quality assurance, and led a discussion on the essentials of rapid triage, initial critical patient care and prompt transport using the example of this MCI response during department in-service EMS training.

This MCI response went as well as it did because of years of training, preplanning and networking among several strategic partners: the Colerain Police, the Hamilton County Communications Center, our automatic aid Fire/EMS departments, and the University of Cincinnati and Cincinnati Children’s Hospitals.

Don’t wait! Be prepared for your MCI, for it will come when you least expect it.

Chief Robert R. Rielage, CFO, EFO, FIFireE, is the former Ohio fire marshal and has been a chief officer in several departments for more than 30 years. A graduate of the Kennedy School’s Program for Senior Executives in State and Local Government at Harvard University, Rielage holds a master’s degree in public administration from Norwich University and is a past-president of the Institution of Fire Engineers – USA Branch. He has served as a subject-matter expert, program coordinator and evaluator, and representative working with national-level organizations, such as FEMA, the USFA and the National Fire Academy. Rielage served as a committee member for NFPA 1250 and NFPA 1201. In 2019, he received the Ohio Fire Service Distinguished Service Award. Rielage is currently working on two books – “On Fire Service Leadership” and “A Practical Guide for Families Dealing with a Fire or Police LODD.” Connect with Rielage via email.

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