A number of my recent columns have focused on mass casualty incidents (MCIs) involving vehicle crashes. While gathering information for these columns, I noticed one thing in common: Whether done formally or informally, most of the incidents incorporated some type of staging operation in the overall incident management strategy. For example, in the multi-vehicle crash that occurred on a Virginia highway, formal and informal staging areas were established at various exit and entrance ramps onto the section of highway involved. In the case of the school bus crash in Missouri, ambulances were staged on an adjacent service road.
The staging area is more than just a glorified parking lot. It’s a place for holding, sorting and monitoring resources.
Staging may seem like a simple thing, but as we analyze it further, we can see that the presence of staging—or lack thereof—and the way it’s managed can significantly affect the success of the incident. In this column, we’ll specifically focus on the EMS section of the staging area, although many of the concepts apply to operating any staging area.
A number of advantages come from establishing a formal staging area.
First, it helps prevent scene congestion. The crash of an Avianca jet liner 20 years ago in Cove Neck, N.Y., is a prime example of the benefits of staging. Emergency responders arrived in department and personal vehicles, parked along the main road leading to the scene, which soon became clogged by the number of vehicles. This impeded access for other vehicles that were needed on scene.
Next, staging prevents freelancing. It’s easier to control personnel if they’re confined to an area outside of the immediate incident scene. There you can brief personnel on what they should expect and what to do before entering the incident scene. Some agencies use preprinted cards that are passed out to EMS units as they arrive. The cards outline generic “dos” and “don’ts” and have an area for writing special instructions.
Staging also places resources (e.g., vehicles, providers, equipment and supplies) close enough to the scene to allow quick access when needed. And it is easier to see when additional resources are needed.
Let’s look at some ways we can take advantage of this aspect of MCI operations.
Staging Area Considerations
In the event of an MCI, although they can be in the same general location, it may be advantageous to keep EMS vehicle staging separate from fire vehicle staging.
Vehicles in Staging Area
We mainly think of staging as a place to hold incoming ambulances. But other EMS related vehicles that aren’t immediately needed on the scene—such as non-transport first response units, additional MCI supply trailers or trucks and even personal vehicles of responding EMS agency members—should be directed to respond directly to staging.
Obviously, a major focus in staging will be on the ambulances. It’s advantageous to further subdivide staging into three areas so that ALS-, intermediate- and BLS-capable ambulances can be grouped together. This will make it easier for the staging area manager to send an ambulance capable of providing the appropriate level of care to the ambulance loading zone when requested. It will also make it easier for the staging manager to see when more ambulances are needed. This should trigger appropriate communications between staging and command to ascertain whether additional resources should be requested.
The staging area serves as a “personnel pool.” Available EMS providers can be sent to the scene to work in different functional areas of incident. Assign EMS providers with specific skills to appropriate tasks. For example, if providers are needed to work in the green treatment area, BLS providers may be assigned, thereby conserving ALS personnel (who may be of a limited number) for the red treatment area.
Personnel may be pulled from a variety of sources, including incoming ambulances. However, as a general rule, keep a driver from the responding department with the ambulance because they’re familiar with its specific operation. It’s even better if two EMS providers stay with their own ambulance. However, if necessary, the EMS provider(s) who will accompany the patient to the hospital may be from other agencies. The key is: Try not to strip all personnel from a single ambulance, thereby rendering the ambulance unavailable to provide transport for patients from the incident.
Equipment & Supplies
The staging area can become an equipment and supply cache. If such MCI response vehicles as trailers or trucks aren’t available to respond, or if they will arrive later in the incident, equipment and supplies can be pulled off the responding ambulances as they enter the staging area and placed in a specific section of the staging area.
The equipment and supplies can be shuttled from that section to the scene as needed to support treatment area operations. In particular, such equipment as cervical collars, backboards, backboard straps, cervical immobilization devices and trauma supplies are of little use sitting in a compartment of an ambulance in staging, but may be in demand in the immediate operational area. Once the incident response is complete, equipment can be sorted out and returned to its respective owner.
Staging Area Manager
Likewise, the staging area manager is more than just a glorified parking lot attendant. This task isn’t a popular one—admit it, we all want to be at the scene and “in the heat of the battle” if an MCI occurs. Nevertheless, it’s a vital position in our incident command structure because the staging area manager serves as the eyes of the incident commander and transportation group supervisor. The person assigned to this role needs to understand MCI management theory and anticipate the needs of the transportation group.
Because the position of staging area manager is so vital to the operation, the position shouldn’t simply be assigned to someone from the first arriving vehicle. Although they may be capable of getting staging established, it’s best to assign someone who’s capable of performing the task. As a courtesy, if the incident continues for a long time, command may assign another qualified EMS provider into the position, reassigning the initial staging area manager to a forward position that allows them to participate more directly in scene operations.
Generally, the staging area manager will communicate directly with someone in the transportation unit or group—in particular, the ambulance coordinator (if one is assigned). The staging area manager must constantly re-evaluate the available resources in staging and anticipate additional resources that are needed. To aid in evaluating whether sufficient resources are present, the staging area manager should be periodically advised of how many patients still need to be transported.
If it appears available or expected resources won’t be sufficient to meet the needs of the incident, other command personnel must be notified so additional resources can be requested. Or ambulances already involved can be notified to return to staging after dropping off their patients at the hospital.
There’s no doubt that staging is a key factor to successfully manage an MCI. But like any tool, it must be used properly to gain the best results. By enhancing our knowledge of staging operations and applying the basic concepts reviewed in this column, we can use staging to our advantage.