Pre-Planning and Preparedness Pay Off

New Jersey EMS Response to US Airways Hudson River Crash

 

 
 
 

Devin Kerins, BA, MICPHenry P. Cortacans, MAS, CEM, NREMT-P | | Tuesday, January 20, 2009


When the news hit the wire on January 15 that a plane had crashed into the Hudson River, a multitude of people held their breath. Was this a repeat of the 9/11 attacks? How many people were on board? Giving the freezing temperatures of the afternoon, people wondered if any of the passengers would freeze to death awaiting rescue.

The major media outlets converged on the piers of New York City to cover the response. Praise was doled out to the actions of the pilot, crew, and New York City's emergency services. Similarities were drawn to the 9/11 events and people initially speculated whether this was a terrorist attack or wildlife mishap.

Once again, the world's attention was drawn to New York City. Little attention was being paid to the efforts and successes taking place across the river in Hudson County, N.J.

What the nation did not see was the dozens of ambulances from all over northern and central New Jersey responded to assist Weehawken EMS at the Port Imperial Ferry Terminal. Specialized equipment from the New Jersey EMS Task Force was requested to provide logistical, staging, and operational support. Numerous medevac aircraft were mobilized and moved forward.

The coordinated effort of these agencies resulted in the successful disposition of 58 passengers who were evacuated to the New Jersey side of the Hudson, with patients treated andtransported to five New Jersey hospitals, mostly with hypothermia and minor injuries.

This success can be attributed to three major factors: Pre-planning, agency buy-in and training. These factors are important to how New Jersey EMS responded to the incident and came together to successfully respond to the US Airways crash.

Pre-Planning: More than Just Words on Paper

President Dwight D. Eisenhower was credited with saying, "ll plans fall apart when the first shot is fired." And EMS responders frequently hear, ˙No one is going to follow that plan," "People will just do what they want to anyway" or, "You can_t plan for everything." These are poor excuses not to pre-plan.

The biggest benefit to pre-planning is relationship building. It's always better to know who will be helping you before you need them. It's equally important to know what their capabilities, limitations and policies are beforehand. The best way to develop this knowledge is to sit down and meet with them ahead of time, drill together and really get to know how they can help you.

It's also important to identify what presents potential and realistic disasters within your response area. Approach this task from the perspective of"All-Hazards," meaning that you should plan for anything to happen. Since 9/11, we focused a lot of attention on preparing for terrorist attacks. So much so, that we have often drawn ridicule from our peers, who may say such things as"Why would terrorists strike here?" or, 'It'll never happen here."

The truth is, they're probably right; terrorist attacks are infrequent and may never occur in many of the country's smaller communities. However, no community, regardless of size or location, is immune from disasters. Fires, floods, hazardous materials spills, even extreme weather, can create chaos, confusion and casualties in any town. By developing flexible plans to respond to any disaster, you're doing a major service to the citizens of your community.

Agency Buy-In: You'll Get Nowhere Without It

Planning and plans that are developed mean nothing if the individuals that run your agency don't support the effort. If you're in a leadership position with your agency, you're doing a disservice to your staff and community by just paying lip-service to pre-incident planning. Although not every plan can adequately cover every nuance of a response, you_ll ensure a more organized operation if you provide a flexible foundation for your responders to follow.

Leadership must show a willingness to change and embrace these new plans. There's a saying in the planning community, "If you always do things the way you have always done them, then you'll always end up with what you always got." Although we often manage to get by during chaos ofmajor operations for which there is no pre-plan, the optimal approach is to have adaptable preplans that will fit almost any situation. Things often need to change, and that change starts with planning.

Once you've decided to embrace these planning efforts, you must create a culture of change within your agency. You must convince the membership and staff that the planning effort is important. Discuss the planning required with your people, and, most importantly, involve them in the planning process. Give them a sense of ownership so they feel like they were involved in something important.

After you've adopted these new plans, make a concerted effort to periodically review and update them. Review each plan with your team whenever you update them and at least annually.

Training:Practice, Practice, Practice

It's critical that training extend beyond sitting in classrooms listening to lectures. Personnel must utilize the skills they've learned frequently or they will not feel comfortable with them when they are needed. If crews begin to feel uncomfortable or unsure of themselves, they'll revert back to those bad habits they had before.

Training can be divided into two main areas: individual and agency. Individuals should be encouraged to attend as much training as possible. Your agency and your disaster response will truly benefit from having well educated and well rounded individuals on your ambulances.

Agency training should include drills and exercises. Make your training as realistic, relevant and energetic as possible. Although some skills need to be practiced over and over again on your training schedule, such as lifting and moving and extrication,be sure to include at least one yearly refresher on your disaster response plans. Your plans can't sit on a shelf simply collecting dust.

In addition to monthly drills, work with the other agencies in your response districts (law enforcement, fire, public works and theemergency mManagement) and have at least one joint major disaster exercise each year. This is the best way to test your skills and determine your agency's breaking points. Don't be afraid to fail in these exercises, because here's a little known secret:the best exercises are the ones you fail in. That's the only way you learn, and it's certainly better to fail in practice then during a real event.

The Success of the US Airways Response

By now you may be asking, what does that have to do with the Hudson River plane crash response? Let's take a look at the planning points made earlier and see how they're applied to the response to US Airways Flight 1549 crash.

The N.J. EMS Response

The EMS response on the New Jersey side was initiated by the Weehawken EMS. Weehawken EMS is a combination paid/volunteer service that provides round-the-clock emergency medical coverage to the geographically small and densely populated towns in Hudson County. Weehawken typically staffs one BLS ambulance, but it can and does frequentlyplace up to two additional BLS units in service. Weehawken EMS has been an active partner in regional planning, because itcovers two major commuter ferry terminals to New York City and the Lincoln Tunnel. On this afternoon, Weehawken responded and initiated an EMS branch within the incident command system established at the Port Imperiale Ferry Terminal. Weehawken EMS remained in control of EMS assets at the scene and coordinated their requests through the Hudson County Office of Emergency Management (OEM) EMS Coordinator.

Although additional information was being gathered at the scene, Weehawken EMS and the Hudson County OEM EMS Coordinator set into a motion a system of requesting resources from all across the state of New Jersey. Within minutes of sending out the request,six NIMS Type IV Ambulance Strike Teams (each containingfive BLS ambulances) andfour NIMS Type I Ambulance Task Forces (each containingfive BLS ambulances and one advanced life support unit) were being assembled and dispatched from counties in northern and central New Jersey. The New Jersey Department of Health and Senior Services' EMS Task Force responded withthree mass care response units (capable of treating more than 100 patients each), a special operations vehicle for logistical support, two staging area management trailers to assist with check-in and demobilization, and several specialists in operations, logistics and planning to assist the Weehawken EMS. The Hudson County Waterfront Strike Team, formed after 9/11 to respond to incidents along the Hudson River, responded by sendingthree mass casualty response trailers capable of treating 25 patients each. The New Jersey State Police Aviation Bureau established an EMS Helibase at Morristown Airport to supportthree medical evacuation helicopters that had been requested.

In total, more than 200 EMT-Bs and paramedics responded to aid Weehawken EMS. While only 58 patients were evacuated to the shore of New Jersey, the cooperation Weehawken received in managing the incident ensured they were prepared to handle even more had the incident been worse.

Pre-Planning: Statewide & Regional Impacts

Three major planning efforts came together to provide a coordinated response when the US Airways jet made a controlled landing in the Hudson River. They were:

  1. The New Jersey Ambulance Strike Team/Task Force Deployment Strategy for EMS;
  2. The New Jersey Statewide EMS Staging Area Management Plan, and
  3. The Port Security EMS Annex.

Each of these planning efforts assisted the Weehawken EMS and Hudson County OEM EMS Coordinator in providing a more organized response to the event.

The Ambulance Strike Team/Task Force Deployment Strategy for EMS was developed by the New Jersey Department of Health and Senior Services' EMS Task Force in conjunction with the NJ County OEM EMS Coordinators. This document sets up the mechanism for coordinating the requests and responses of large numbers of ambulances and EMS resources to an event. The plan is compliant with the principles issued by the Federal Emergency Management Agency on NIMS Resource Typing. Rather than sending a large number of individual ambulances to a disaster, they're now grouped into teams of ambulances (strike teams) or teams that consist of resources with different capabilities (task forces).

The plan also provides guidelines and training standards for strike team/task force leaders, as well as how leaders should manage the team and integrate into the overall response. Ambulances and paramedic units that responded to the Hudson River plane crash were organized into strike teams and task forces at the county and regional staging areas.

The Statewide EMS Staging Area Management Plan was also developed by the N.J. EMS Task Force in conjunction with the County OEM EMS Coordinators. This plan pre-identifies a location in each of New Jersey's 21 counties that are to be used as a county staging area for organizing resources. These county staging areas serve as 'jumping off' points from which county resources will respond as a team to another county's disaster.

A staging plan is imperative for the successful management of EMS resources for large disasters. The N.J. Statewide EMS Staging Area Management plan also pre-identifies four regional staging areas that can accommodate a large number of ambulances. From these regional staging areas, a large number of ambulance strike teams and task forces can be deployed to a disaster.

Counties sending their resources to the plane crash established county staging areas to organize arriving strike teams. From there, these teams were deployed to the regional staging area at the New Jersey Sports and Exhibition Authority Meadowlands Sports Complex. This provided a control point for traffic flow.

The area around the Port Imperial Ferry Terminal was considerably congested with emergency vehicles, media, government officials and on-lookers. Utilizing the regional staging area allowed Weehawken EMS to stage EMS resources a few minutes away and call them to the scene in a more orderly fashion.

The most proactive of the plans utilized in the response was the Port Security EMS Annex. This plan was the product of a landmark planning effort which has been called a model of regional collaboration" by New Jersey's Office of Homeland Security and Preparedness and honored with an award by the International Association of Emergency Managers.

The Port Security EMS Annex

In late 2007, the New Jersey EMS Task Force planners were tasked with developing EMS pre-plans for the vulnerable chemical facilities, transportation facilities, and other points of interest along the New Jersey side of the New York Harbor. The New York Harbor was designated by the Coast Guard as a Tier One Facility, meaning that a disaster in the harbor would have high potential for casualties and far reaching economical implications. The planning process was recognized by New Jersey's Office of Homeland Security and Preparedness as being an example of how to conduct interagency planning. In addition, the state planners were acted as project managers were recognized by the International Association of Emergency Managers for their work in Interagency Disaster Preparedness in 2008 for their work on this plan.

The key to the success of this planning process was the division of the work into manageable sections and the inclusion of all relevant agencies. The project was first separated into five phases.

  1. Phase I addressed the five most vulnerable chemical facilities on the New Jersey side.
  2. Phase IIhandled the 14 commuter ferry terminals between New Jersey and New York City and included a popular dinner cruise that tours the harbor.
  3. Phase IIItackled the monumental task of planning for a mass casualty incident on the cruise port in Bayonne, N.J. This phase was subdivided to address a traumatic mass casualty in port, a biological outbreak on board, and a coordinated sea and air evacuation of a cruise ship in distress off the coast of N.J.
  4. Phase IV addressed the four bridges and two tunnels that connect New York City and New Jersey.
  5. Phase V, the final phase, established a multi-agency coordination system for coordinating requests for EMS resources in response to multiple concurrent or large scale incidents on the waterfront.

Once the work was divided, the relevant partners were identified. This included more than 40 local, county, state, federal and private agencies. Each phase had a kick-off meeting where the planning partners were introduced to each other. The partners were then separated into working groups for each facility and presented with a facilitated discussion to lead them through the plan development. The working groups returned home to work togetheron a rough draft, which would then be presented to everyone at a follow up meeting.

In total, more than 10,000 man hours were logged in developing the document which contained more than 27 individual emergency operations plans. These plans provide responders with a flexible framework of the actions and objectives for the first 90 minutes of a response, which are notoriously the most confusing and chaotic of the response.

Each plan provides information on available resources, mutual aid procedures, staging areas, casualty collection points, helibases and helispots, local and regional hospital capabilities and notification chains. The plan was signed by the associated jurisdictions during a signing ceremony aboard the Royal Caribbean Explorer of the Seas cruise ship in the Cape Liberty Cruise Port in Bayonne, N.J.in October, 2008.

Weehawken's Port Imperial Ferry Terminal was identified as one of those vulnerable facilities. And while a plane crashing into the Hudson River wasn't exactly what the planners had in mind, the flexibility and concept of the plan allowed the plan to be rapidly adopted to meet the incident's needs.

Agency Buy-In

One of the keys to the success of the Hudson River response was that, from the beginning of the planning process, all of the major players for a response in Weehawken were included in the meetings. These agencies included Weehawken EMS, Weehawken Police and OEM, Jersey City Medical Center EMS (ALS for Hudson County), the Hudson County OEM EMS Coordinator, and the N.J. EMS Task Force. Each agency discussed the response from their perspective, including their resources, capabilities, policies, and concerns. Each agency showed a commitment to a successful response in Weehawken.

Specialized Training & Exercises Pay Off

After several large New Jersey events, such as the Somerset County flooding and Warren Grove Wildfire in 2007, it was identified that there was a lack of training in key EMS ICS positions. One such position was the Ambulance Strike Team/Task Force Leader. The EMS community found that it was doing a good job of organizing resources into strike teams and task forces, but it failed to tell the leader of these teams what was expected of the role.

The N.J. EMS Task Force responded by developing an eight-hour Ambulance Strike Team/Task Force Leader course to be compliant with the NIMS standard for the position. More than 130 Strike Team Leaders have been trained so far, with more classes planned. Lists of trained strike team leaders have been provided to each of the County OEM EMS Coordinators, and several of those coordinators have reached out to the trained leaders and requested them for responses and exercises. For the response to the plane crash, several of these trained leaders were utilized to assist in managing the Ambulance Strike Teams.

Following the completion of the Statewide EMS Staging Area Management Plan, the N.J. EMS Task Force began offering classes throughout the state on how set up a staging area and begin checking in and accounting for resources at a disaster. Many of the students in these classes have been utilized on exercises and responses to fill in the positions of the staging area management team, gaining real-world experience to supplement the classroom knowledge. Some of these former students were utilized in the plane crash response to manage county and regional staging areas and to assist in directing resources at the scene itself.

In November, 2008, the Atlantic Highlands First Aid Squad staged a full scale exercise to test the portion of the Port Security EMS Annex that covered its ferry terminal. Several of the participants also responded to the Hudson River plane crash. Lessons learned from the after action review of the exercise helped make the response in Weehawken more organized.

Best Practices & Lessons Learned

Although any response where lives are not lost, injuries are successfully managed and patients are seen and transported rapidly is considered a great response, a successful response is also one that teaches us something about ourselves and how we operate. Here are some take away points from the US Airways Flight 1549 response that may help you better prepare for your next disaster:

1. Interoperable communications is essential in disaster response. Municipalities, counties, states, private and other organizations may operate on a variety of channels and frequencies. By utilizing the National Interoperability frequencies into base, mobile, and portable radios-- incident communications will allow for better coordination. Alternatively, communication caches should be pre-packaged to allow for such provisions. In the N.J. EMS response, radio caches of interoperable radios were deployed; however, the extreme cold reduced the effectiveness of the radio battery storage. Recent freezing temperatures in the region had reduced the power being stored in many of the batteries in the radio caches. Additional batteries were quickly located through the Hudson County OEM. However, this is why contingencies should be in place for critical resources. For this response, the initial cache limitations were replaced by the backup-- allowing almost seamless continuity of operations.

The lesson learned here was that additional measures and care should be taken when storing batteries/radios in extreme temperatures (in our case, it was unusually bitter cold) variations and the best practice is to have a contingency in place for critical resources.

2.The state of New Jersey and the city of New York have a memorandum of understanding (MOU) between the EMS services. Although not activated for this emergency, it's critical for states to develop such compacts to allow for interstate assistance. The MOU spells out liability, responsibilities, procedures, reciprocity, and other items, all ahead of the emergency. Alternatively, the Emergency Management Assistance Compact (EMAC) can be implemented; however, several additional layers of authorization and approval would need to be made Ï delaying theimmediate response of critical resources to neighboring states. MOUs supersede EMAC the process.

Had assistance been necessary for New Jersey or New York to cross into states, the MOU would have outlined all the procedures in advance. The interstate MOU was first developed after the 1993 World Trade Center bombing, and implemented for the9/11 attacks and the 2003 New York Cityblackout.

3.Developing pre-plans mean nothing if the end-users are unaware of those plans. Agency and organization leaders must share the plan with their entire staff. For large organizations, this can be accomplished during mandatory inservice training sessions or through an online education tool. Medium- or smaller-size organizations can discuss the plans, actions and objectives at monthly meetings. You never know when disasters will strike, and who will be on duty to respond to them. All personnel, regardless of experience, level of training, should be familiar with the plans and procedures within the document(s). For this response, the organizations impacted by the disaster were familiar with the plan.

Summary of Initial Response in New Jersey

  • 50 BLS Ambulances
  • 6 ALS Units
  • 3 Mass Casualty Response Trucks (each is 100-patient capable)
  • 3 Mass Casualty Response Trailers (each is 25-patient capable)
  • 2 Staging Area Management Trailers (to support various EMS staging operations)
  • 1 Logistical Support Unit (Special Operations Vehicle)
  • 3 Medevac Aircrafts
  • More than 200 NJ EMTs and paramedics

About the Authors

Devin Kerins
, BA, MICP, is the Resources Unit Leader for the FEMA Region II Incident Management Assistance Team and a New Jersey State certified paramedic. He was formerly a State Planner on the EMS Task Force and assisted in the development of Statewide EMS Emergency Operations Plans.

Henry P. Cortacans, MAS, CEM, NREMT-P, is the State Planner of the New Jersey Emergency Medical Services (EMS) Task Force. He' responsible for the development and implementation of Statewide EMS Emergency Operation Plans, and provides administrative and operational support to the organization.




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Extrication and Rescue, Leadership and Professionalism, Operations and Protcols, WMD and Terrorism

 
What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS





 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

Simulation-Based Assessment Facilitates Learning & Enhances Clinical Judgment

Simulation is an educational tool that can be used to develop and refine clinical skills of the student in a controlled environment before they progress to becoming practicing clinicians.
More >

Multimedia Thumb

NYC September 11 Commemoration

Tolling of the bell begins the anniversary ceremony.
Watch It >


Multimedia Thumb

Wrong Fuel Cited in New Mexico Air Ambulance Crash

Plane received jet fuel instead of aviation fuel.
Watch It >


Multimedia Thumb

Wake County EMS PAT

Physical ability test demonstration.
Watch It >


Multimedia Thumb

NYC Sept. 11 Anniversary

View images from the ceremony at Ground Zero.
More >


Multimedia Thumb

13th Anniversary of Sept. 11 Terror Attack

The nation remembers the fallen.
More >


Multimedia Thumb

Building Explosion, Collapse in Paris Suburb

Death toll rises to eight after blast in Rosny-sous-Bois.
More >


Multimedia Thumb

Braun Ambulances' EZ Door Forward

Helps to create a safer ambulance module.
Watch It >


Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >


Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >


More Product Videos >