As best as I can recall, some fire department out in California is credited with devising the system we currently use for managing multiple casualty incidents (MCIs) in EMS. The Incident Management System (IMS) and the Simple Triage and Rapid Transport (START) have been adopted worldwide. But a quick review of history reveals that an incident command system was developed as early as the late 1890s. Although we give the credit for development of the MCI system to that fire department out on the left coast, in reality, it was the quintessential American humorist Mark Twain who described, in detail, the first IMS.
In a manuscript that was published after his death, a collection of his works titled Letters from the Earth: Uncensored Writings by Mark Twain, he describes the appropriate method to rescue people from a burning boarding house. Written in his humorous style, using the language of the day, Twain recommends the following procedure:
In assisting at a fire in a boarding house, the true gentleman will always save the young ladies first making no distinction in favor of personal attractions, or social eminence, or pecuniary predominance but taking them as they come, and firing out with as much celerity as shall be consistent with decorum. There are exceptions, of course, to all rules; the exceptions to this one are:
Partiality, in the matter of rescue, to be shown to:
1. Fianc es
2. Persons to whom the rescuer feels a tender sentiment, but has not yet declared himself.
6. First cousins.
8. Second cousins.
10. Young-lady relations by marriage.
11. The Unclassified.
Parties belonging to these twelve divisions should be saved in the order they are named.
The rescuer must keep himself utterly calm and his line of procedure constantly in mind; otherwise the confusion around him will be almost sure to betray him into very embarrassing breaches of etiquette. Where there is much smoke, it is often quite difficult to distinguish between new Relatives by Marriage and Unclassified young ladies.
Twain goes on to state, Other material in the boarding house is to be rescued in the following order:
13. Children under 10 years of age.
14. Young widows.
15. Young married females.
16. Elderly married females.
17. Elderly widows.
19. Boarders in general.
20. Female domestics.
21. Male domestics.
Twain s attention to detail is evidenced by his description of how the rescuer should approach the party to be rescued. He writes that the rescuer should offer the following form of tender of rescue to a young lady entrapped in the fire:
Although through the fiat of cruel fate, I have been debarred the gracious privilege of your acquaintance, permit me Miss [here insert name, if known], the inestimable honor of offering you the aid of a true and loyal arm against the fiery doom which now o ershadows you with its crimson wing. [This form to be memorized, and practiced in private.] Should she accept, the young gentleman should offer his arm bowing, and observing Permit me and so escort her to the fire escape and deposit her in it (being extremely careful, if she have no clothes on but her night dress, not to seem to notice the irregularity). No form of leave-taking is permissible, further than a formal bow, accompanied by a barely perceptible smile of differential gratitude for the favor which the young lady has accorded this smile to be completed at the moment the fire escape stairs start to slide down, then the features to be recomposed instantly.
If the victim happens to be a chambermaid, Twain recommends the following offer: There is no occasion for alarm, Mary [insertion of surname not permissible]; keep cool, do everything just as I tell you, and I will save you. He goes on to say, Anything more elaborate than this, as to diction and sentiment, would be in extremely bad taste. Such expressions as Come, git! should never fall from the lips of a true gentleman at a fire.
Further clarifying his system, Twain specifies how the various victims should be removed. He writes, Observe: 1's, 2's, 3's, 4's, and 5's may be carried out of the burning house, in the rescuers arms permission being first asked. 7's and 9's may be carried out without the formality of asking permission. The other grades may not be carried out, except they themselves take the initiative. In that case, they should make their request in the following form: Form of response to Indication on the part of a 2, 6, 8, 10, 11, or 12 that she Desires to be Carried Out of a Fire in Arms of a Young Gentleman.
The speeches to be used at a fire may also, with but slight alteration, be wielded with effect upon disastrous occasions of other sorts. For instance, in tendering rescue from destruction by hurricane, or earthquake, or runaway team, or railway collision (where no conflagration ensues), the rescuer should merely substitute fatal doom for fiery doom ; and in cases of ordinary shipwreck or other methods of drowning, he should say watery doom.
He summarizes, Offers of marriage to parties being carried out of a boarding house fire are considered to be in questionable taste. Offers of marriage, during episode of runaway team, are to be avoided. A lady is sufficiently embarrassed at such a time; any act tending to add to this embarrassment is opposed to good taste and, therefore reprehensible.
Well, I m glad I cleared up that bit of historical perspective for you. And I feel it s my duty to report that some hospital in Newport Beach, Calif., is still inaccurately reported to have developed the incident management system instead of Mark Twain (or even Samuel Clemens for that matter). I ll be speaking with Mr. Twain later this evening and will make him fully aware of this transgression. Be alert for the next installment that will describe the history of fire department rescue of endangered arboreal felines.