Major Incidents, Operations

N.J. EMS Task Force Provides Relief to Hurricane-Ravaged U.S. Virgin Islands

Issue 3 and Volume 43.

 

The New Jersey EMS Task Force provided relief to EMS providers in the U.S. Virgin Islands as well as all-terrain mini-ambulances and other equipment to help gain access to areas of the islands that were inaccessible to regular ambulances. Photos courtesy New Jersey EMS Task Force (NJEMSTF)

Steve Cicala, a task force leader with the New Jersey EMS Task Force (NJEMSTF), questioned why a specialty EMS group from the Northeast would be deployed for hurricane relief in the U.S. Virgin Islands.

“Why were we chosen out of all the 50 states?” Cicala recalls wondering.

He found an answer quickly.

The U.S. Virgin Islands had been devastated by not one, but two powerful Category 5 hurricanes—Maria and Irma—and was in need of the specialty equipment and personnel the NJEMSTF could provide. In addition to extensive training and experience in responding to storms, the NJEMSTF also had equipment to self-sustain for extended periods of time, and a cache of all-terrain mini-ambulances that could respond to areas unreachable by U.S. Virgin Islands EMS crews.

Based upon their identified needs, officials in the U.S. Virgin Islands requested the NJEMSTF through an Emergency Management Assistance Compact (EMAC), a mutual aid agreement that allows states and territories to share resources in response to manmade and natural disasters.

Long Way from Home

The NJEMSTF was the primary component of a team of 59 people deployed on Oct. 1, 2017, to the U.S. Virgin Islands to help the devastated region. All totaled, there were 30 members of the NJEMSTF, 25 New Jersey State Troopers and four Disaster Mental Health Counselors from the New Jersey Department of Health.

What started out as a two-week mission was extended to three weeks. That deployment was quickly followed by a second two-week mission that put 26 members of the NJEMSTF there for a period that included the Thanksgiving holiday.

“We saw a lot of devastation from the storm,” Cicala says of arriving in the region. “My first reaction was, OK, we’re going to have a lot of work to do.”

“It was bad,” says John Grembowiec, chairman of the NJEMSTF who was part of the first deployment. “People were pretty desperate and trying to get the basic necessities.”

The NJEMSTF was also in a unique position to help. The organization was created in the wake of the 9/11 terrorist attacks and consists of 250 career and volunteer EMS professionals who are trained to respond to disasters and provide EMS support at preplanned events.

The organization has been integral to the responses of such natural events as Superstorm Sandy, Hurricane Irene and blizzards, as well as preplanned events such as Super Bowl 2014, the New Jersey Marathon and more.

Since its formation, and given New Jersey’s history of natural disasters, the NJEMSTF has developed, tested and reworked a variety of plans for hurricanes and tropical storms.

Indeed, conceptual conversations about the NJEMSTF someday being called to respond to the U.S. Virgin Islands began about five years before the actual deployment. The idea was raised as a possibility by former NJEMSTF planner Devin Kerins, now an individual and community preparedness officer with FEMA’s Region 2, who had created plans for hurricane responses in the region.

Kerins was serving as the emergency services group supervisor for FEMA on St. Thomas when the first and second storms hit the islands. Because New Jersey was out of the path of the multiple hurricanes that hit the United States in 2017, deploying the NJEMSTF to the U.S. Virgin Islands made sense. Kerins helped the territory’s officials with the EMAC request, coordinating a military flight down for the New Jersey-based first responders, and was key in integrating them into the local systems.

“Every disaster and response is unique,” says Christopher Rinn, former acting commissioner of the New Jersey Department of Health. “This was the first time the team was deployed outside of the continental U.S. to a region as hard hit with back-to-back hurricanes.”

Deploying so far away from home created some new challenges that the organization hadn’t faced before—especially in such a short period of time. Although the NJEMSTF trains for longer deployments, the team had never actually done so to a region where they were expected to survive and operate solely on what they brought with them.

“Normally in EMS, we don’t think of the response as a challenge,” Rinn says. “Getting to a hurricane-ravaged area was a challenge.”

“Deploying outside of the continental U.S. is significantly different than deploying state to state. There are built-in delays, such as arranging air or maritime transport and assuring that you’re bringing what’s absolutely needed and leaving behind those items and personnel who aren’t absolutely essential to the core mission. There’s not an option of driving home for personal issues, nor even calling home for much of the time,” says Michael Bascom, NJEMSTF leader and incident commander for the first deployment.

Task Force Leaders Michael Bascom (left) and John Grembowiec (right), along with Devin Kerins of FEMA (center), deliver specialized baby formula donated by McCabe Ambulance Service in New Jersey.

“It was not difficult finding personnel who were willing to make the commitment to deploy, the difficulty was in leaving behind team members who were eager to help.”

There’s also the personal side, Rinn says. Sending people into such situations puts them at risk, and takes them away from their families and regular work commitments.

“I’m mindful of [the danger] and I’m also mindful of the personal sacrifice,” says Rinn. “Many did that—putting the mission first.”

That mission started with identifying assets and people to make the trip. Because they would be deployed using military airplanes out of Joint Base McGuire-Dix-Lakehurst, N.J., each item carried aboard would have to go through the process of being certified to fly.

“It was, in my career, the toughest thing I’ve ever had to plan,” says Joe Grassi, who handled logistics for the deployment.

The challenge, Grassi says, “was being so far from home and having nowhere to turn if you needed equipment, food, water or housing.”

That meant shipping enough supplies to get by—and then some. Grassi and the logistics team coordinated the delivery of one refrigerated box truck, a skid steer, four tents, four pickup trucks, one SUV, seven all-terrain mini-ambulances, four towable generators, two flat-bed trailers, a logistics trailer, 10 Western Shelter tents, 10 HVAC units, two 1,200 gallon per hour water purifiers, two 500 gallon water tanks, satellite communications, radio repeaters, 40 portable radios, 1,700 gallons of bottled water, more than 3,700 meals ready-to-eat (MRE) and three weeks’ worth of BLS and ALS supplies.

“We went in recognizing what they were going to need in the short term, and the mid-range term,” says Bascom. “We were well prepared.”

Task Force Leaders Michael Bascom (left) and Louis Raniszewski (center) and Safety Officer Robert Contreras (right) work from within the Western Shelter system to develop a work schedule for deployed personnel.

Arriving On Scene

The New Jersey deployment arrived in the U.S. Virgin Islands at night. As the sun began to rise, they were able to get a real sense of the disaster zone they would face. Power was out in the entire region, meaning there were no traffic signals or communications. Some roadways were washed out or blocked. Homes were destroyed. And the EMS system they were there to help had been serving their communities since the first storm, with little time to address the damage that their own homes had sustained.

For many of those on the two deployments, the response was reminiscent to their work during Superstorm Sandy, which hit the New Jersey coast in 2012, and damaged the homes of some responders. Though their scenarios were different, the contingent from New Jersey knew all too well what it was like to respond in their home area, knowing that their own families and property were at risk.

“Having Sandy really prepared us mentally for that trip,” says Grembowiec, whose New Jersey home was surrounded by water during Sandy.

“After Sandy, I didn’t get to my house for 14 days,” says Bascom, whose home was also flooded and uninhabitable for months after Sandy. “I knew the impact that had on my family. We were insistent when we got there that they take a break and get home. We also took time to sit with them and talk about their recovery.”

Indeed, part of the mission was to provide some relief to local EMS providers, many of whom had their homes severely damaged, yet continued to respond to emergency calls in the aftermath of the record storms.

“For a lot of us, having lived through Sandy, it made us more empathetic and more understanding of their situation,” says Grembowiec. “I think as we related our stories to the people working on the Virgin Islands it helped them understand where we were coming from. It was personal for us, too. For us, we were paying back a little bit.”

Before they could do that, however, members needed to make sure their lives at home were settled. The first deployment was set for two weeks and extended to a third.

In the days leading up to the trip, members were told there could be times when they might not have contact with home and it was unlikely that they could get back quickly in an emergency.

Task Force member Robert Contreras understood that well. As the father of a young daughter, he must always be conscious of a backup plan for child care. A multi-week deployment into a new region exponentially increases the need for outside help at home.

“I think because the nature of our jobs and what we do, we always have to have a type of plan in place,” Contreras says, adding that he’s fortunate in that regard. “I think if you wait until the disaster, it doesn’t work.”

Among the many challenges facing out-of-area deployment is fitting seamlessly into local operations. Communications systems may be different. Local customs may require adjustments. Local protocols for emergency medical systems can vary widely—and that’s on top of the challenges of simply getting to the region.

The first task when the team arrived was getting good situational awareness of the geography where they’d be operating.

“When the task force mobilized for Superstorm Sandy, it was a ‘home game’ for us,” says Neel Mehta, a planner with the NJEMSTF. “We knew the state and the majority of the stakeholders we would work with. In the U.S. Virgin Islands, we were dealing with two islands, 24-hour operational periods, new emergency response personnel to interact with, establishing two bases of operations, and adapting to the environmental obstacles with working in a disaster zone.”

Mehta adds, “The moment we exited the back of the U.S. Air Force C-17, it was game on, and all lessons learned through the years of exercise/training, in state deployments, supporting high profile events was going to be put to use over the next few weeks.”

Bascom says learning local customs right away was critical to that process.

“One of the things we did as soon as we got there was to have a conversation with their leadership about local customs, for example, how they greet each other,” says Bascom. “Getting to know the customs is a big thing, it helps us to better understand the expectations of those we were working with as well as the community that we were there to serve.”

Grembowiec agrees, saying it was important to understand the group dynamics, and getting to know those providers they would be working with side-by-side.

“I wanted them to see us as help and not a threat,” Grembowiec says.

They also needed to adjust to the heat and high humidity, taking care of themselves while also getting used to the hilly terrain, destroyed roads and driving on the left side of the road.

Once settled, NJEMSTF members rode on EMS calls with local providers, and responded to a variety of illnesses and injuries on St. Johns and St. Thomas, two of the three U.S. Virgin Islands. A tent, initially set up to provide housing, became a makeshift care center for locals, who thought it was a medical tent. During the first deployment, the team responded to more than 200 calls, ranging from severe cardiac issues, motor vehicle crashes, broken bones and lacerations.

Patients were transferred to the ED of Schneider Regional Medical Center. In one instance, crews had to reach a patient in a severely damaged home on the top of a mountain, only accessible with multipurpose vehicles.

On another call, crews responding had to lower the patient in a stretcher down a driveway using ropes because the incline was too steep and the roadway conditions didn’t allow closer access. More critical patients were stabilized and often transferred to the mainland U.S. via helicopter.

Large washouts plagued the main roadways of St. Thomas and St. John, making many inaccessible to full-size ambulances.

Members of the task force worked with U.S. Virgin Islands EMS personnel to transport patients via ambulance boat from St. John, where there’s no hospital, to St. Thomas.

Lessons Learned

Though the NJEMSTF was initially there to help provide the all-terrain mini-ambulances to gain access to areas of the islands that were inaccessible to regular ambulances, the mission was expanded to allow EMS providers in the U.S. Virgin Islands to get some rest and return to normalcy.

The NJEMSTF members who worked the deployment say there were many lessons learned that will help them on the next mission, and will also be brought back home to be adopted by their organization and in their local communities.

“The success of these deployments was because of the dedication and commitment to complete mission by the leadership and most importantly the men and women of the NJEMSTF,” says Mehta.

“Just operating in such an austere environment with the incident command structure,” says Grassi. “It was really imperative to stick to it there. There was no freelancing. It was doing what you were told and answering up the chain. Communications issues, too. I’d never been in an environment where communications were wiped out for such a long period of time.”

Grassi adds that had the task force not gone through Sandy, responded to Hurricane Irene, or provided onsite care for marathons and participated in major drills like Gotham Shield at MetLife Stadium in New Jersey, the team wouldn’t have been as well-prepared for the trip to the Virgin Islands.

“Every event, whether it be a preplanned event or an actual emergency, you get lessons learned,” says Grembowiec. “That’s why we do the after-action reports. Each time it happens, we learn from it. We get ideas for new equipment, new protocols, and how to do things more efficiently. Everything leads to a better performance for the next one.”

When planning for another similar mission, Cicala suggests, when possible, send an incident advance team in first to get a good sense of what supplies will be needed and what the working conditions may be. The tendency, he says, is to bring too many supplies.

Planning ahead in terms of what to bring on a deployment and how to get it home is key, according to Bascom. The NJEMSTF team took a military transport to the U.S. Virgin Islands, but flew on commercial airlines back home, which meant they faced different rules in terms of baggage and what they could bring home.

“Also,” Bascom says, “bring enough of a crew so that you can give your people down time. They’ll work to exhaustion. They’re there because they’re needed. No one wants a break. Safety was important, too.”

“Our team and the community benefited from the presence of our New Jersey State Troopers who not only provided a law enforcement presence, but conducted community outreach, responded with us on every EMS call on St. Thomas and in the Coral Bay area of St. John and helped us to build relationships and identify helpful resources within these communities,” Bascom says.

Bringing crisis counselors is also key to such a mission, says Bascom. “The crisis counselors were deployed to provide support to responders and officials in the U.S. Virgin Islands, and to train community groups to provide similar services to their constituents, but their presence amongst our team and belief in what they’re doing led them to provide similar services to our responders, who benefited from the stress relief without knowing that they were being counseled. They will now be a part of any future deployment we do.”

“There’s always room to grow and learn from our experiences,” says Mehta. “The one thing is how can we better train ourselves to provide excellent medical care in an austere prehospital setting? You’re in an absolute disaster zone. There’s nobody going to help you. You’re the help. You’re the final answer.”

Task force officials as well as the state’s top health executives view the two deployments as successes, given how quickly the trips came together, the use of the EMACs, how everyone overcame logistical hurdles and the sheer number of responses on the ground—which was more than 400.

“It’s more than numbers, it’s people,” says former acting N.J. Department of Health Commissioner Rinn.

“You have to remember, at the end of the day, you have to pay attention to the success stories, the personal impacts on the lives that were touched throughout the deployments, those are the stories that need to be told to quantify the success,” Rinn says. “Those who braved danger going up a mountainside to rescue someone who was disabled and needed care. … Those are the stories that a lot of the members of the team will carry with them and that’s where the rubber meets the road.”

Task Force leadership and crews worked from a 19′ x 35′ Western Shelter tents at the base of operations located just outside of Schneider Regional Medical Center on St. Thomas.

All-terrain miniature ambulances proved to be the appropriate resource for the challenging terrain and washed out roads in the U.S. Virgin Islands.

Conclusion

Despite some minor challenges with getting there and completing the mission, it did have a lasting impact on those who participated.

“I think it makes everybody a better person,” Contreras says. “I think it’s life-changing in that, you know, we sign up to help people. We change peoples’ lives every day. But when you can do it on a larger scale, it changes everybody.”

“It is actually a life experience, without question,” says Bascom, adding he learned patience and resilience through the experience. “I was amazed by the understanding of the process and the acceptance of how they live on an island—and while most were without electricity and running water. They accepted it and figured out how to deal with it.”

“I’ve been in EMS well over 30 years and it was probably one of the most rewarding large-scale incidents I’ve ever been on,” says Cicala, whose son participated in the second deployment to the U.S. Virgin Islands.

“Just being able to help your EMS family, and the people down there. The residents came up and thanked you, not even knowing who you are.”