The Boston Fire Department lost two of its members last week when an intense fire swept through a Back Bay row home, injuring 18 others. The loss is tragic and a reminder that our jobs come with risk of injury and death. We mourn for the fallen, their families and the department.
Incidents like these can blow up quickly, taxing EMS systems to the limit. Fortunately, Boston EMS (BEMS) prepares for these types of incidents regularly and was prepared to handle the worst.
Events like last year’s Boston Marathon bombing has kept providers on their toes. Like the other events, the Back Bay fire incident resulted in several observations and lessons that reinforce how EMS manages mass casualty incidents.
Experienced EMS providers will tell how crucial it is to manage a potentially large-scale incident right from the start. Neil P. Blackington was the BEMS incident commander.
“We set up a unified command presence with Boston Fire Department, and eventually the police department in the front of the building,” he said. Doing so improves communications tremendously, and offers situational updates to spread very quickly through the on-scene staff.
Keep plans flexible
Most of us have been through tabletop exercises where MCI medical resources and locations are neatly set up. Real-life situations are rarely that simple. For the fire, BEMS set up primary and secondary treatment areas around different building exposures.
“One got moved once, when the 40-plus mile-per-hour winds took a slight turn and showered folks with smoke, embers and second hand water,” Blackington said.
One part of the building backed up against a very heavy-use roadway; with no room to maneuver in the narrow alleyway between the building and the main roadway, BEMS and the state police closed down one lane to create a safe area to work.
Fire operations can get messy fast.
“Fires, especially 9-alarms worth, quickly end up being stretcher transports to ambulances not blocked in by later-arriving apparatus and big hose lines,” Blackington said. Because of that, the staging area was located a block from the fireground, and staging and transport areas were combined to allow easier access by crews to extricate patients from the treatment areas.
Settle in for the long run
Incidents such as these can blow up very quickly. They can also run for some time — hours, days, even weeks. Commander Blackington reported that while there were 18 patients, they came into the system over a period of several hours.
“The incident started around 14:35 and the last patient [was transported] at about 20:00 hours,” he said. “We had firefighters transported to the hospital, and then they showed up back at the scene working again before it was all wrapped up.”
For incidents that go longer than a couple of hours, make sure that crews get the nourishment, hydration and rest needed to avoid becoming ill or injured. Plan for crews to rotate out of assignments to reduce fatigue. For inclement weather, having shelters to protect responders from the elements is important.
Consider transport decisions
It’s important to keep other essential resources related to the incident in mind. BEMS used several hospitals to receive the less critically injured patients, but kept the closest one as available as possible.
“We tried to leave the closest hospital out of the loop to citywide transports, so they could take [any] cardiac arrests/critical patients, and then later the taxis and the ‘walk-ins’” Blackington said.
Incidents such as the Back Bay fire can get out of control quickly, which generates a lot of stress for the responders. Sometimes we’ll shoulder more risk than needed, exposing us to possible exposure and injury.
Blackington emphasized, “Strict discipline about PPE is imperative. I don’t think there’s a news shot that doesn’t show [BEMS personnel] in full turnout gear. In fact, several news outlets usually confuse us with the fire department, even though we wear khaki and they wear black.”
Remember that when everyone starts to run around, scream and shout, first responders move more slowly and deliberately, and stay in control.
