Friday, November 8, 2013

CERTs in Charge: Lessons Learned From the Final Exercise

Hopefully, you saw yesterday's recap of the November 2 final exercise for CERT classes 73 & 74. This post will highlight some things I saw as a controller in Building 25, and some conversations I had with CERTs in Command, Medical, and Accountability.

Note that these are just my personal opinions and observations: If you have feedback from the exercise you'd like to share, please leave a comment here or on the Facebook page; you can also send feedback directly to your instructors.

 Command and Control 

IC Brian Aiello (in green
helmet), coordinates with
Fairfax County Fire & Rescue.
Under ICS, the rescue effort is led by an Incident Commander (IC), who takes overall command of a chaotic situation and assigns the other roles for the Command staff.

CERT Brian Aiello from Class 73 started out as Incident Commander. When I asked Brian about his impressions serving as IC, his key takeaway was that the Incident Commander bears a lot of responsibility and has a lot to organize, but that the task is made easier by identifying good people to fill key roles.

ICs also have to maintain flexibility and adapt to the changing conditions and uncertainty present in all disasters. In this scenario, exercise controllers added complexity by requiring all CERTs, including the Command staff, rotate over to the lifting and cribbing skills test station, meaning that command was transferred more than usual.

IC Andrea Borelli
directs efforts.
CERT Andrea Borrelli (also Class 73) was there to pick up command responsibility. While finding the initial handover "really confusing," Andrea ultimately found her stint as IC not as complicated as she'd expected.

She attributes this to having worked in prior CERT training activities with her Accountability lead, Ken Lucas, which illustrates another aspect of the benefits of training exercises: Increasing familiarity and developing the working relationships responders need in a real emergency.

(There's a saying among emergency managers: "You don't want to be exchanging business cards during a disaster.")

Despite challenges, both ICs were pleased by the helpfulness of their fellow CERTs, with Brian lauding CERTs' readiness to accept assignments, and with Andrea glad to see that CERTs had no problem following orders from a young person (something she'd had concerns about before taking command).

Coordinating Rescuers

Before Rescue teams can be sent out, Command staff first have to assess the situation, set priorities, allocate resources, and issue orders. And as the operation develops, teams often face waits to check in or be redeployed, since the IC and Accountability are trying to simultaneously handle multiple problems.

For rescuers, the wait can be agonizing; IC Andrea noted that one of the challenges of Command is the need to rein in the impulse of CERTs on rescue teams to run off and go do something outside the scope of their orders.

For example, in one instance, an exercise controller (experienced Fairfax County CERTs can probably guess who) set off a smoke bomb to simulate a fire in an already-cleared building. A CERT, on his own initiative, started heading to the building with fire extinguisher in hand to perform fire suppression, until the IC stopped him and pulled him back, noting that the fire provided no immediate threat to the operation.

Rescuers don't always understand that they only see a small piece of the overall picture, and that in theory, Command will have a broader picture of the entire situation.

This is easier said than done. Within the friction of a disaster response, there are always challenges, bottlenecks, and information gaps. To help manage the information flow, Accountability went low-tech, using a large piece of cardboard and a black Sharpie marker:

Command staff coordinate in front of the Accountability board.
Using the board, the Command staff was able to track team status, and keep a tally of actions taken, buildings searched, and victims rescued, to better inform Command's decisions. Though it wasn't always easy: Accountability Ken noted his biggest challenge was getting teams to maintain consistent numbering of victims on tags and dashboards. Similarly, IC Brian noted several instances where CERTs got separated from their partners, against the precepts of the buddy system.

(I only saw activity at the Command Post towards the end of the exercise; if folks have comments from earlier in the day, please share in the comments.)

Rescuers in the Field

Once the disaster scene is cleared for rescue teams to begin work, CERTs often feel impatience to deploy, especially when they can see and hear victims in the immediate vicinity of the Command Post.

Victims, too, can feel impatience or frustration, especially when they can see or hear CERTs waiting at the Command Post to be deployed:

The view of the Command Post from inside Building 25.

Of course, impatience at initial inaction can often be followed by the feeling of being overwhelmed once a rescuer comes face to face with the number of victims at a mass casualty scene.

The CERTs I witnessed were pretty good at using the triage techniques they were taught to assess patients for breathing, bleeding, and shock, as well as mostly good at wearing their Personal Protective Equipment (PPE).

Another thing that was a pleasant surprise to see -- the Rescue team I witnessed remembered to mark the building -- both on entry and exit -- which is something CERTs often forget to do.

CERTs marked the entrance to Building 25.

Caring for Patients

For CERTs working at Medical, the tempo is slightly different. Initially, activity at Medical is slow... until CERTs begin bringing in rescued victims, and activity surges.

Carlos Santiso, overseeing Medical, also found the experience somewhat overwhelming. As CERTs are told in training, patient demand can often threaten to overload capacity, until resources start to shift from search-and-rescue operations to patient care.

CERTs and EMTs assess and treat patients in the busy Medical area.
The diversion of CERTs to the lifting and cribbing station also affected Medical, causing a loss of resources just when they were needed to scale up. However, challenges like these simulate the kind of pressures CERTs would face in a real response, and provide lessons learned for future situations.

According to Carlos, one other lesson he learned was to leave more room to expand the areas for Red-, Yellow-, and Green-tagged patients in Medical, to avoid having patients spread across multiple locations.

Logistical Support

The role of Logistics can be easy to overlook... until Rescue and Transport teams start calling for stretchers and cribbing material, and Medical teams run low on splint material and dressings.

Logistics team members find, gather, and distribute vital supplies. (And steal our water.)
Logistics team members were particularly aggressive; I had to stop one team from taking the bottled water set aside for victims in Building 25, only to find that a few minutes later that another Logistics team had gotten to it.

Transfer of Command

Coordinating counts of patients and their status provided a challenge, complicated by the prior transfer of Command, as well as having patients in the same category spread across multiple locations.

CERTs coordinate with Fairfax County Fire & Rescue to transfer command.
Towards the end of the exercise, it seemed like everyone -- CERTs and victims -- was crowded around Medical. Some of our victim actors had moved around, making it particularly difficult for IC and the Fair Oaks EMTs to get an accurate tally of the number and type of victims.


Here you can see one of the Incident Command Boards used by the Fairfax Fire and Rescue folks (click to zoom), compared to the big piece of cardboard Accountability was using. The goal is to make sure that by the Transfer of Command, CERTs can boil down the info from that big board, down to the boxes on that little board:

IMG_2732 IMG_2713


The purpose of a full-scale exercise is to challenge CERT responders, to make them think as they use their training, and to give them a chance to learn what they do well, and what they can do better. The CERTs from classes 73 & 74 did a great job, and I hope to see them at future training exercises and activities.

Thanks to all the CERT instructors, staff, and victim actors, and congratulations to our new Fairfax County CERTs!

If you have thoughts or feedback you'd like to share, please leave a comment below.

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