Fire & EMS in the Post-9/11 World
Recently I was asked at one of our area hospital’s quarterly employee meeting. The hospital‘s CEO gave a “state of the hospital” briefing, and I followed with my presentation on fire and EMS response in the post-9/11 world.
Obviously there always will be natural and intentionally caused disasters that will produce injury and death and require the services of a hospital. These include an airplane crash, bridge collapse, fires, floods, tornadoes, and hazmat and mass-casualty incidents. A disaster also may involve a pandemic with response currently being preplanned by the Centers for Disease Control and others in public health and the threat from both domestic and foreign terrorism.
My discussion centered on recent events with common threads that could be relevant when discussing what hospitals might expect in the future. I drew on such attacks as the Oklahoma City bombing, the Sept. 11 multi-pronged attacks, bombings in Malaysia and Madrid, the London bus and subway bombings, the failed London car bombs, and the Glasgow Airport attack. The common denominator in these incidents was the terrorists’ desire to cause a maximum number of casualties and disrupt a normally safe environment. In several cases, the attacks included a small detonation designed to draw the crowd into the path of a secondary and much larger explosion.
These incidents produced an overwhelming number of walking wounded who found their way to the nearest hospitals on foot or by public and private transportation, reserving ambulances, medic units and onsite triage for the most critical patients. My discussion with the hospital staff included how to deal with this surge of wounded, including the gross decontamination of potential patients before they could enter a medical facility. If, for example, local fire and EMS resources are dealing with the most critical injuries, rescue and extrications, who is left to set up any decontamination? Alternate means might be needed to treat the masses.
The discussion then turned to the order of any emergency response activation. Unless there is a prestaged event such as an impending hurricane or the Super Bowl, the order would most likely be:
- Local fire/EMS responders and initial mutual aid departments: up to 12 hours
- Regional and intrastate mutual aid: four to 24 hours
- EMAC activation: 24 to 72 hours
- Federal resources: 72 hours to demobilization
The bottom-line discussion determined that the hospital staff needed to be self sufficient for at least 72 hours with food, fuel, decontamination equipment and supplies, as well as manage the schedule of their professional and support staff to avoid burnout. If this sounds familiar, it should; This is what FEMA has begun asking the fire service to do when it is deployed to other locales. The final discussion points included the need to consider revising their plan and practice for future events including those of longer durations caused by both natural disasters and terrorist attacks.
What‘s in the future is anyone‘s guess, but preparing for emergencies of longer durations with more casualties is probably a good guess.








