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MCI Management Has Evolved Since 9/11


Just as the world defines dates as B.C. or A.D., the world of EMS could describe part of our historical time-line as being B9 (Before 9/11) or A9 (After 9/11). The use of Sept. 11, as a pivotal reference point in history permeates many areas of our society, and EMS is one of them.

Despite the numerous references to how this event has changed our lives, there are still some results of 9-11 that remain unknown in the EMS community. For example, one area of EMS in particular that has seen a major change since 9/11 is the way we respond to mass casualty incidents (MCIs). Perhaps we're now more cognizant of the possibility of an MCI, but more importantly, 9/11 impacted how we train and respond to large-scale incidents.

Consider the following: Prior to 9/11, how much did we hear about MCI management or incident command systems for EMS? Magazine articles were less prevalent. Such EMS leaders as JEMS Editor-in-Chief A.J. Heightman and MCI author Alex Butman spoke at conferences and conducted classes on MCI management long before 9/11, but attendance at and access to such classes was limited. However, recently, concepts of MCI management have been more widely disseminated because they're now included in many terrorism response courses.

What about resources to allow us to better manage the MCI? Previously, MCI-response trailers were few and far between. Most were at airports and were "homemade" by the departments that operated them. The problem largely stemmed from a lack of funding for such a resource. Who had an extra $20,000 to $40,000 to spend on equipment for that occasional major incident when there wasn't enough money for personnel, a new 12-lead ECG monitor or a new biphasic defibrillator? But that changed after 9/11. Suddenly grant money was available not only for personal protective equipment (PPE) for chemical agent response units, bomb trucks and armored vehicles, but also for mass casualty trailers and Mark 1 kits.

Nevertheless, we shouldn't lose sight of the fact that MCIs have always been around. More importantly, that they aren't just related to terrorist events. Some make the national news, while others make only the local news. Either way, hardly a week goes by without a clip on CNN or Fox News about a bus crash or other MCI. Trust me -- ask my wife how often I have a news channel on the TV. Google "school bus crash" and you'll see many incidents. Most which are minor, but can remind us of the potential for an MCI in our own backyard. Now, add the potential for a natural disaster, airplane or train crash or school shooting. Even if terrorism went away, the need for MCI awareness and preparedness would not.

With this in mind, JEMS.com has decided to launch this new column to focus on MCIs. The column has a couple of goals.

One is to raise MCI awareness: As you read about different MCIs across the country, consider if it could happen in your area. What would you do if it did?

Another goal is to educate: We'll examine actual MCIs to see what worked and what didn't. We'll consider "lessons learned" and look at ways we can all improve our response to these infrequent, but high impact, calls. From time to time, we'll also look at "what's new" in the field of MCI management. This will include techniques or products that can help us do our job better and to better manager limited resources.

To make this column a success, we can't do it alone. Therefore, we're soliciting your assistance. So, if you've had a recent MCI in your community and have something you're willing to share, please contact us. For this column to provide the maximum benefit, we must have frank dialogue and share our successes and where we fell short.

Finally, keep in mind that the intent of this column isn't to tell its readers what to do. What works in an urban setting may not work in a rural one. What worked at one incident may not work at another. I like to think of the concepts of MCI management as being like tools in a toolbox. The more tools you have, the more likely you are to have just the right one when you need it. Likewise, the more we know about how our colleagues have met unique challenges, the more likely we will be prepared to handle future challenges. Hopefully, through this column, you'll be able to fill your toolbox, and then some.


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