In a recent poll, we asked the FireRescue1 community, “Has your department conducted interagency MCI training in the past year?” An astounding 69% responded “no.” Only 19% responded “yes,” and another 12% were unsure – not promising.
Before we delve into why this training isn’t prioritized, it’s important to understand what constitutes a mass-casualty incidents (MCI). An MCI is an incident that overwhelms the local EMS system. That might be five patients for your agency, 10 for your neighboring jurisdiction – or even less or far more for other agencies. For this to make sense in the context of interagency training, you need to understand the differences around you.
All-hazards service doesn’t stop at the fire engine
When I deliver leadership training, talking to departments about their operational paradigms, I often ask how often they train on hoseline placement, ladder-throwing or even roadway incident response. Almost universally, hands raise for the hoseline and ladder training, but quickly drop when we talk about roadway incidents or medical training.
We tend to spend lots of time stretching attack lines, throwing ground ladders, driving around cones, studying mayday incidents and practicing response to active shooter events – all important operational functions. While active shooter training may touch on MCI strategies most of these exercises focus more on security, assailant neutralization and victim retrieval. Officers will tell me, “We have to train more on those critical elements so we get them right while ‘under fire.’” Of course, but there’s so much more to tackle in training.
I’m reminded of Gordon Graham’s series on risk reduction in the fire service, specifically his article “High-Risk, Low-Frequency Events in Public Safety” in which he states: “Rarely do we make mistakes on the high-frequency events, even when you factor in complacency, fatigue, distractions, hubris and risk homeostasis. Mistakes in any occupation or profession are more likely to occur on low-frequency events.”
Why then do we continue to practice much more on the higher-frequency events, and pay little if any attention to many low-frequency events? I suggest two basic theories:
- MCIs generally aren’t the “sexy” fire side of what we do; and
- Not many people have the operational experience to feel comfortable leading such an exercise at the station or company level – so we avoid the discomfort of those topics.
The common denominator to the two theories seems to be operating outside of our comfort zone. The funny thing to me is that we routinely operate out of comfort zone in a chaotic state of energy surrounding many of the incidents to which we respond. So, let’s try to solve the comfort zone drama if we can.
3 groups to protect
I recall a time when we “made up” the station training regimen daily with little coordination beyond the academy walls. Fortunately, most organizations have progressed beyond this ad hoc approach, utilizing organized online training platforms and NFPA standards as benchmarks for improvement and completion.
MCIs need to be a part of that routine rotation – at all levels, particularly the street and command operational levels. Online training for MCIs is OK as a primer; however, hands-on training is essential to improving operational success.
Recognizing the difficulty in identifying and prioritizing everything in an all-hazards approach, let’s focus on the “high-risk” discussion. In any discussion about risk, we must acknowledge both operational and administrative risk, whether for our providers, our organizations or the communities we serve. In the case of MCIs, we must practice limiting risk for all three groups:
- Reducing risk to providers: Any opportunity to practice low-frequency skill allows for performance improvement through tactical and experiential learning. In the case of the provider, performance improvements are measured by fewer provider injuries and swifter operational prowess as the comfort zone expands.
- Reducing risk to the organization: Organizational risk is measured in many ways, not the least of which should maximize the standard of care you provide to patients with whom you interact. Further, organizational risk is evaluated by systemic capacity to support ongoing operations. Improving operational prowess can reduce potential organizational and personal liabilities, but also stands to expedite units returning to service, supporting the organizations’ ability to maximize operational capacity.
- Reducing risk to the patients: This area applies no matter whether it’s an MCI or not. The faster and more efficiently we isolate and deal with the patients, especially high-priority patients, the faster they make it to appropriate and definitive care, reducing cascading medical failures.
Make “all-hazards” meaningful
Let’s make sure we’re including MCI training as part of our recipe for success. Online MCI training monthly and some level of operational MCI training on a quarterly or biannual basis should be achievable for most fire departments. After all, we need to ensure “all-hazards,” whether in training or operations, is more than just a catchy political descriptive used to justify more staffing or the acquisition of more stuff – your life may just depend on it!
Listen to more from Chief Bashoor on training for MCIs:
