BRATTLEBORO — It's the scenario that every emergency responder trains for, and hopes never happens - an accident scene with dozens of people in need of immediate help.
“I can barely imagine what it's like to be a patient on a scene. Must be pretty unnerving,” said Brian Richardson, assistant chief of operations at Rescue Inc. in Brattleboro. “People are moving quickly sorting it all out, triaging those hurt [using] colored tags to let other responders know the level of their patients' injuries quickly and easily.”
Those tags, Richardson said, “are based on how fast we need to get you to the hospital. It's always the balance of injuries versus the resources we have on hand. We do this because we want to make the best possible use of our resources. It's not like visiting your doctor's office, where there is all the time in the world. We have to evaluate, in about 30 seconds per person, the most critically injured patients.”
“It might appear as organized chaos,” said Brattleboro Fire Chief Michael Bucossi. “But it isn't.”
The secret, said State Police Lt. Kraig LaPorte, commander of the Brattleboro barracks, is something called the Incident Command System, or ICS.
ICS, a hierarchy of procedures, instructs emergency personnel from law enforcement, firefighting, and emergency medicine so that when agencies need to respond together at the scene of an emergency of any kind, they can adhere to a pre-established hierarchy and authority.
“In training, all our local emergency agencies work together using ICS,” LaPorte said. “Once trained in this system, any of us could go anywhere in the United States, and participate in an emergency, and know what to do.”
LaPorte, Richardson, and Putney Fire Chief Tom Goddard had this training put to the test on Dec. 3 during a bus accident on Interstate 91 in Putney. They worked together at the command post and coordinated the other agencies that were called to assist, including road crews from the Vermont Agency of Transportation and other ambulance services from New Hampshire and Vermont.
More than 100 people were involved at one point or another during the accident. From the doctors, nurses, and technicians at several hospitals waiting for the patients to arrive, to the helicopter that took patients with the most injuries to Dartmouth-Hitchcock Medical Center, to those covering fire, rescue, and police operations while the emergency played out, the bus accident gave these workers an opportunity to use the training they had practiced for years beforehand.
ICS in practice
“The [response to] the bus accident went like clockwork,” said Bucossi.
“The accident was in Putney, so Chief Goddard was in command of the scene,” he said. “Our department had less time on the scene itself and more time providing support. I had four people who set up the landing zone for the helicopter. I went up to Brattleboro Memorial Hospital with a liaison from Rescue Inc., and we worked with the emergency department staff at BMH.”
Bucossi said he thought there would be an onslaught of patients.
“Chief [Eugene] Wrinn of the Brattleboro Police Department came in with extra officers. I brought in all of my career staff. BMH had the Emergency Department set for all the critical patients, the lobby set up for [those with] intermediate wounds that are not as serious but needing a higher level of care than the walking wounded, who were sent to the new Richards building.”
As it turned out, Bucossi said, “we didn't need all of this, but we were ready if the need was there.”
The speed and depth of the response, Bucossi said, was all due to the preparation for such an event.
“It's all about the training,” he said. “That's exactly why we train. We all worked together, and the department heads supported each other. Everybody had a job to do.”
Part of the training, said Richardson, is learning to recognize things that his department does well.
“We can each handle the everyday calls, but through training, all of us also know what our agency's limits are,” he said.
“A mass casualty incident is defined as anything above the ability of the agency to handle it alone,” he added. “For Rescue Inc., that means if the scene has six or seven patients that have serious or life-threatening injuries, we call in for more help right away.”
The scale of an event totally dictates the response, he said.
“It's a totally different circumstance if the scene was an accident that had seven patients who had minor injuries and one with a critical injury. That kind of scene we can handle ourselves,” Richardson said.
“As I approach a scene, one of the first things I will do is call out to everyone to walk towards me if they are injured,” he added. “That helps me see where we are right away. If a patient can stand, think, and understand a direction like that, I know that they are my least anxious category of patients. We can give them shelter and warmth until we can get them off scene.”
Running the show
All agencies train and practice ICS on their own almost every single day.
“Let's say there is a bank robbery,” said LaPorte. “Law enforcement units will train together on that scenario, and maybe that's the Vermont State Police alone, or with another law enforcement agency, like the Brattleboro Police Department. On the other hand, law enforcement would not train the same way as the Fire Department for a house fire. Likely, we wouldn't be involved during that emergency. The fire department would train alone on that scenario.”
It would be the same way with emergency medicine, said LaPorte. “If there was a person rock climbing and that person fell off a cliff, Rescue Inc. might train for that eventuality.”
But when an event involves all the needs of multiple agencies, LaPorte said everyone comes together, “bringing with us our expertise in our individual area. Then each commander works with the agencies involved to make decisions for the group.We also organize this way throughout New England.”
For example, LaPorte said, the Vermont State Police were called in to assist the Massachusetts State Police with security at the Democratic National Convention in Boston in 2004.
A long history
ICS was developed more than 30 years ago after a series of massive wildfires in California. As fire began to spread from the wilderness to urban areas, more agencies became involved.
A committee studying those fires determined that because agencies had been training in isolation, a lack of systematic planning hampered efforts when working together on a large multi-agency scale. Because a system had not yet been developed, efforts during multi-agency emergencies were sometimes at cross purposes. Consequently, property damage ran into the millions, and many people died or were injured.
Eventually, the ICS system was designed, and national laws required each individual agency to learn, train, and teach the same information to every emergency responder.
As ICS evolved, it incorporated town, state, and national government, and then moved to include the private sector. By 2003, a new version of the law became national, mandating all federal, state, and local agencies to learn the National Incident Management System and to have a plan in place unique to each agency, town, or business.
How are the scenarios of training decided?
LaPorte suggests it can be specific to an area of the country.
“We look at what the possibilities are for our area, or we emulate a disaster from another area of the U.S.,” he said. “We could look at a tornado scenario, but that's unlikely in Vermont, so we consider what real life is for us.”
Last spring, State Police did an emergency training in Windsor County with a much broader scope, he said. “We pretended that Moore's Dam in St. Johnsbury had failed and flooded the Connecticut River.”
LaPorte said that the exercise included TransCanada, since that firm manages the dam.
“There is a lot to consider during that type of disaster, as it would affect all the towns along the river, south of the dam,” he said. “How much water would it take to down power lines? What types of businesses might flood? Do those businesses use chemicals that would turn the situation into one that included hazardous materials?”
Over on Elliot Street, the Brattleboro Fire Department trains as an agency and in consultation with other agencies, just as the State Police do.
“Like all the other agencies in town which work together during emergencies, the Brattleboro Fire Department takes pride in all that we do. We know there are many times when you only get one shot to do it the right way and that lives can be on the line when we get called out,” said Bucossi. “Even though the guys are a playful bunch, and we're in Small Town USA, that one shot - we take that very seriously.”
Bucossi explained that all three shifts of the career firefighters are required to train at least one hour of every day. The topic could be fire-related, or they could train for a technical rescue, a medical emergency, or anything else they choose.
A training committee meets monthly to identify topics, set up a series of trainings, or bring in outside instructors. “One of the things that is common is to do a once a month get-together with Rescue Inc.” he said. “On that day, all three shifts will meet with whoever is on duty with Rescue over the 24-hour period.”
The Brattleboro Fire Department has 15 volunteer fire fighters on their roster as well.
“It is mandatory that all career firefighters be certified to Level 1, which is an entry-level type of training - how to run pumps, stretch hose, wear an air pack, that sort of thing. But all our staff is trained to at least Level 2, which gets into more extrication, ropes, knots, etc.,” said Bucossi.
There is another level of training that teaches and prepares a firefighter for administration, “and our captains and lieutenants are also trained to that level,” Bucossi said.
“That's a lot of personnel training, and we don't stop there,” he added. “Brattleboro has always had the identity of being a very efficient and well-trained fire department. We have a long tradition of training and leadership in which we take pride. All the agencies in Brattleboro - from the Department of Public Works, led by Steve Barrett, to the Police Department, Rescue, and BMH - work hard to support one another. We have each other's backs.”
Practice makes perfect
This week kicks off a three-month series of trainings on water awareness. A state instructor will meet once a month for three months with several emergency agencies in this area.
The first meeting is a four-hour classroom session where many parts of water rescue will be discussed and various methods of rescue will be identified, with a special focus, as always, on safety, command, and control.
In session two, personnel from all the agencies will meet at the pool at the Colonial Motel on Putney Road, where they will talk about and work on self-rescue, along with other rescue techniques.
In the spring, when the water levels rise, the same participants will return for a swift-water rescue. High lines will be installed from shore to shore, and as they enter the cold, fast spring waters, they will design a scenario.
“You see a lot on television what happens during a severe flooding circumstance. We'll act out a scenario that is realistic for our area based on that idea,” said Bucossi.
“The inter-agency workings in our area are stellar,” he said. “There is a sense of wanting to do the very best work we can to serve the public under any circumstances. In this case, we are acting out a scene, as we did last month with a drill surrounding a shooter at the high school.”
At other times, agencies meet together for “table talk training.” At these events, responders from each agency are seated at a table. Everybody huddles up and decides how they each want to handle the circumstances. A question will be posed to the assembled groups.
“We might ask each agency to get together and decide what they need to do in the first five minutes of the emergency,” said Bucossi.
“No matter what scene we come up with, it bleeds over to another agency, so we make the invitation for all departments to come and interact with one another,” he said. “We all come back and read what we decided we would do.”
The drills - which Bucossi said are designed to be as realistic as possible - make those associated with the various agencies “work together to solve certain problems that might be issues to us all, and to anticipate circumstances that might come up during that particular emergency,” he said.
During these exercises, “the chiefs step out and let the captains practice their skills,” he added.
A lot of training available to the town of Brattleboro's emergency services comes from the National Fire Academy in Maryland or the Vermont Fire Academy in Pittsford.
“At least twice a year, we'll have an instructor in here from the National Academy,” Bucossi said, describing the free- or low-cost programs as “excellent quality training.”
Rescue Inc. takes a nod from the National Incident Command Training Group.
“We do all the training that is required by federal mandate, and often times, much more,” Richardson said. “ We use ICS every single day, practicing things on the small scenes so that when we have a bigger scene, we just expand it as needed. We do a lot of classroom time, we do seminars, and we work with Brattleboro Memorial on communications, often with Brattleboro Fire joining in.”
Richardson said that this training “helps with emergency preparedness, to be sure, but these exercises also build and raise community among the agencies. The emphasis on the relationship is tremendously important. It's always a group effort. We all support each other; our staffs work really well together. We strive to work even better together every single day. It's about how we can better serve the folks in our community.”
All three agency heads agree that volunteers, funding, and town support are also crucial.
“'None of what we do would happen without the support of the town administration, the Selectboard, and the town,” said Bucossi. “My budget is $1.4 million. It takes a lot of money to maintain any municipal departments, and it's gratifying to get the support,” he said.
At Rescue, the number of career staff is about equal to the number of volunteer staff.
“I started out as a volunteer at Rescue, before I went on to college,” said Richardson. “I know how much time and training it takes to keep your license, how much time away from the family our men and women give to us. We also rely on the public for donations for a lot of our budget, and it always gives me a big smile to think of the numbers of people who help us at Rescue, both volunteers and donors.”
LaPorte, Bucossi, and Richardson have a combined total of over 70 years of experience in their areas of expertise.
“I can't imagine doing anything else,” said Bucossi.
Richardson agrees.
“The relationships that we've built are strong, and I know how well we all work together,” he said. “I know what to expect from them. They know what to expect from me. We just go to work and get the job done. It's a beautiful thing.”