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Mass Casualty Response

At the 2005 annual conference, the national MRC program office recruited volunteers for a working group on mass casualty incidents. Dr. Heather Shover presented their findings at the next year's conference (April 18-21, 2006), in a talk entitled "National MRC Mass Catastrophic Event Working Group."

This report summarizes the Region I participant's perspectives for the Bay State, as discussed in a con-call for MA MRC representatives the following week.

MCI Response Differs From PH Emergencies

The national MRC program is a public health initiative. Volunteers in most units across the nation are particularly well suited for response to public health events.

Public health emergencies could involve the MRC in vaccinations, distribution of medication, procedures for isolation and quarantine, and other measures to prevent the spread of disease. If an Emergency Dispensing Site must be set up and staffed in a day or two, units can complete their deployment procedures by taking member photos and printing badges, running license and CORI checks, and other tasks. While the pace for such activities must be accelerated, the requirements of organizing a clinic allow for some flexible scheduling.

By contrast, a mass casualty incident demands immediate response. The focus is to save lives and alleviate suffering; usually due to injuries, rather than a disease outbreak. Any credentialing - badges, background checks, assignment of uniforms, distribution of go-kits - must have been handled in advance.

An MCI demands prompt response, often to triage and treat injured victims, who may be transported to hospitals for definitive care.

One example of an MCI is a fire or building collapse at a large nursing home or sporting event. This type of situation could require members to report to the scene, show their ID to the operations chief or delegate, and be waved on to a staging area to perform triage and treatment on vast numbers of victims. Trauma skills would be paramount: splinting and bandaging, airway support, monitoring of vital signs, and other urgent tasks. Non-medical members could help in traffic management, patient records, distribution of supplies, and other assignments.

In summary, MCI response differs from public health deployments in two key areas: (1) The need to arrive on scene and work with patients immediately, and (2) The primary focus on trauma skills.

Units can prepare their members for mass casualty response through:

• Advance credentialing - providing badges and uniforms, running background and license checks ahead of time - for rapid deployment
• Training classes - such as triage, first aid, and stress management (which also apply to many public health events)
• Drills (tabletops and full-scale exercises) - to ensure that both individual skills and interactions with response partners are effective

Training with affiliates, such as fire and hazmat shown here, help MRC members know how to interact with responders at a disaster scene.

Meeting the Charge from the White House

The purpose of the working group was to assist the MRC program office in meeting the charge from the White House Homeland Security Council, to the Department of Health and Human Services. HHS was chartered to establish systems to:

• Pre-enroll, organize, and credential volunteers
• Train, equip, and activate MRC personnel for MCI response

The working group identified issues and made recommendations to meet the charge.

Working Group Procedures

The MCI working group was comprised of one representative from each of the ten regions across the U.S. The group held three conference calls, with activities and research between sessions.

The August 15 kickoff identified goals and approaches, with much lively discussion about the options. The December 19 con-call focused on lessons learned through response to hurricanes Katrina and Wilma, which had ravaged the gulf coast. The March 22 session allowed members to provide updates and progress.

Recommendations and Local Impacts

There was much discussion of first-hand experiences of deployed members; to disaster sites that had been devastated by hurricanes, as well as for less cataclysmic events. Through lessons learned and additional research, the working group identified several areas of focus to meet the charge for HHS.

1. Pre-enrollment and ID - All MRC leaders should pre-identify members who would be willing to serve outside their jurisdictions.

   This suggestion was immediately applied by the UMV MRC unit, by including an extra question on its new application form. Members are now asked to specify their preferred realm of service: national, statewide, regional, or strictly their town of residence. (Service across the region is encouraged, though deployment limited to a member's own town remains an option, as the focus of MRC units is "local, local, local.") Even while supporting the national call for deployment to Katrina, the UMV MRC emphasized its local commitment, as national calls are beyond our official service area.

2. License and Certification - Leaders should verify that the licenses and certifications of members are current and unencumbered. Preferably, the unit would also re-run verifications on occasion, to ensure that the information remains up to date. Members who are being deployed should also have recent verifications.

   The size of the unit, availability of staffing, and nature of the deployment are factors that would determine the feasibility of running multiple verifications on each member, and at what intervals. Furthermore, the methods of data storage and access would impact the ability to monitor the timeliness of these verifications.

3. Training - Units are encouraged to adopt the MRC core competencies as part of their training plans, and track members' attainment of these competencies.

   
   

   Students talk through patient assessment, triage, and extrication before taking action.

   As these specifications were introduced for the first time at the 2006 national conference (as the result of a separate MRC working group), units may need some time to integrate core competencies into their programs.

   Leaders are encouraged to consider MRC-TRAIN as a resource. (Again, the national roll-out of this resource took place at the national conference, and will take time for units to learn and apply.)

   Members should meet these competencies to deploy outside of their jurisdiction.

4. Activation - Units should be integrated with local and state response plans, according to the Incident Command System. Leaders must ensure that deployments outside their jurisdiction do not jeopardize local needs.

   Most likely, these policies are already being addressed by MRCs within MA. Some units have established liaisons with Local Emergency Planning Committees (LEPCs) and other affiliates, to ensure MRC integration within existing response plans.

   When possible, members from the same unit should be deployed together. (For the UMV MRC unit, two members tried to apply as a team for Katrina response, though our efforts to support this excellent approach were unsuccessful. The designated national affiliate was able to process applicants for deployment strictly as individuals.)

   Federal response efforts should follow a chain of command from Federal, to State, and eventually to Local response agencies. Non-affiliated volunteers should sign up on the HHS website to support the federal mission by joining their local MRC unit. In the long run, operational models for local, state, and national activations should be developed.