One of the most essential principals of mass casualty incident (MCI) management is the establishment and operation of vehicle staging areas. Yet, this is usually one of the first areas that break down at large scenes (second only to communications).
You have to wonder why this occurs when, in reality, our lives are “staged” from birth.
When we arrive in this world, the hospital staff places a uniquely numbered ID band on a specific wrist and places us in a standardized “vehicle” that allows us to be easily observed and monitored. They then carefully position those carriers in an orderly manner so we don’t get lost and can be easily “dispatched” to our moms to obtain nourishment and expedite our growth.
It’s organized “staging” and it’s a time-proven practice.
The same thing happens when children go to elementary school for the first time. I remember the first time my oldest son waited at the edge of our driveway for his school bus to arrive. My wife was in a panic, worried that he’d get lost in the maze of 75 other 6-year-olds being dropped off in unfamiliar territory.
Thankfully, we had attended an orientation in advance of that first bus pick-up where we watched the carefully planned and executed process that would manage and ensure his every move from the time of his arrival until his eventual return home at a designated time.
Everything was planned out. First there was the easy-to-see Disney character on the front window of his bus that enabled him to remember the vehicle that would deliver him to and from school.
Upon arrival at the school, his teacher was waiting to meet the bus, line up all the students in a specific formation, check off their presence on a standardized log sheet and direct them into their classroom.
At the end of the day, when my son had his assignments for the next day, a teacher made sure he packed up all his clothes, books and supplies and was properly positioned outside the school in a designated location where he would be efficiently loaded into his transport unit for the preplanned trip back to the safety of our home.
Because of advanced notification of the time his bus would depart the school, and the carefully calculated time the return trip would take, we knew almost to the minute the time he would arrive.
By the time my second son was ready to take the school bus for the first time, we were well-practiced, aware of and comfortable with the transportation process.
As my sons got older and began to play organized sports, they learned that they had to report to a specific location at the massive sports complex where hundreds of kids were converging for practice and games.
There were assigned gathering points, rows they had to position themselves in and organized activities that had to be followed to get the maximum outcome in a limited amount of time.
In baseball, they were taught there could only be one batter in the batter’s box, and one batter on-deck at one time. They were also instructed that all base runners had to advance when a batter walked or got a hit, to keep the game flowing.
The Real Message
The same planning, practice, principals and pearls of organized events apply to MCIs. You have to know what’s expected of you and your vehicle before you arrive on scene, and you have to know what process and actions you’re expected to follow once you’re there.
You can’t just arrive at a big incident without a specific position, posting or staging location or you’ll freelance, park your rig in an inappropriate spot or, worse yet, create congestion or delay the access of important resources or the departure of ambulances with carefully triaged patients who have to get to specialty centers to survive.
The loading zone should have easy access to the vehicle staging area, but be sure vehicle exhaust doesn’t asphyxiate patients in the patient treatment areas.
Scene managers also frequently forget to designate vehicle approach routes and set-up staging until it’s too late. They have to be thought of and initiated early into a big incident.
Rapid Determination of Staging Locations
As soon as you arrive on scene and realize the situation or patient volume requires resources beyond the initial dispatched vehicles, requires the response of mutual aid ambulances and resources, or requires pre- arranged task forces or “waves” of units, the need for staging should pop into your head.
Look over your scene, determine a safe, easy-to-access location near where patients are being treated or evacuated to, and pick a spot where ambulances can enter, load and exit easily.
Once you determine that location, pick a person to meet ambulances on their arrival. This will be your staging officer. Tell them to await the arriving ambulances, get the attention of their drivers, position them for crew and equipment debarkation and deployment, and inform the driver to stay with their ambulance and be ready to leave as soon as patients are loaded.
Allowing drivers to leave their units can be a fatal mistake, particularly if their ambulance blocks in other units and prohibits them from leaving the scene rapidly.
Unless drivers are trained in MCI operations, they often don’t understand why the staging officer is directing them. They may want to disobey the request and start to walk away with the crew.
This can’t be allowed and must be firmly reinforced with a statement like, “Stay with your unit. We’re going to be loading at least one patient onto your unit in a minute and we need you to go to the hospital we assign you to. You can’t leave your unit.”
Once your staging area is identified, you must transmit that location to your communications center to ensure incoming units are alerted of the staging locations–there may be a need for more than one at complex or expansive scenes–before they arrive on scene.
Give direct locations to the communications center but don’t be overly specific because too much specificity can be confusing to incoming units. For example, telling all drivers to “proceed to 5th and Main and meet a staging officer” is better than saying, “Proceed on Broadway to 5th Street, then north on 5th Street to Main Street and park on the northwest corner of 5th and Main.”
Primary & Secondary Staging Areas
If you have large open areas like shopping centers or church parking lots, or streets that police can secure for you to stage and position multiple ambulances, you can get away with designating a direct/primary staging area. But, if you’re in a tight inner city or remote area where access is limited, tell the communications center to send the first 3–5 ambulances directly to your primary staging area at (location) and to have all other ambulances report to a secondary staging area (specifying that location).
Then tell the staging officer to request additional units from the secondary staging area as they’re needed. The staging officer can then say something to the effect of, “staging officer to secondary staging location, send me three more units please.”
Keep Stretchers Close to Ambulances
It may seem like a basic statement, but your Ferno stretcher won’t fit in an ambulance that has a Stryker mounting bracket. So allowing your stretcher to be taken away from your ambulance at an MCI may mean you’ll be delayed unnecessarily in leaving a scene or forced to get creative with straps or duct tape–both of which are a lawsuit waiting to happen.
If at all possible, drivers should position their unit’s primary stretcher just outside the rear doors of their ambulance when positioned in staging and guard it.
If the MCI managers have their act together and have patients flowing through the transportation branch and to the staging area for rapid loading, there shouldn’t be a problem doing this. You’ll be in staging less than five minutes when a patient is transferred to your wheeled stretcher, the stretcher is placed in your ambulance and you’ll be told to transport the patient to a designated hospital. When you return, you’ll drive to the same staging location and simply repeat the process.
Practice Makes Perfect
Staging is a process that becomes second nature once it’s learned and practiced. The best way to accomplish this is through a structured training program for your staff. But it can also become second nature if you institute staging whenever you arrive on scene and realize that the situation or patient volume requires resources beyond the initial dispatched vehicles, requires the response of mutual aid ambulances and resources, or pre-arranged task forces or waves of units.
Simply tell the communications center you’re instituting staging, assign a staging officer and give the staging location to the dispatcher. Believe me; you won’t regret it and the dispatcher will thank you for adding this important vehicle organization and positioning to your incident.