Ready for Anything: Emergency Response Teams Prefer Training at Air Shows

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Anything can happen at an air show. It covers a huge expanse, with thousands of people from all walks of life crammed together under the hot sun, stumbling over anchor ropes, bumping into plane propellers and tripping over other obstacles. That’s precisely why many federal-level disaster response teams choose to stage their training operations at air shows. 

The Rhode Island Disaster Medical Assistance Team (RI DMAT), the North Carolina State Medical Assistance Team (NC SMAT), and a Unified Command team consisting of nearly a dozen local, state and federal emergency response departments in Sacramento County are just a few such examples.

Much like the reputed Marines in battle, these teams are the first on the ground to respond to large-scale domestic emergencies — terrorist attacks, hurricanes, earthquakes, floods, ice storms — and national events such as State of the Union addresses, state funerals, and presidential inaugurations. They also provide coverage for major athletic and entertainment venues, including the Olympic Games, marathons, Mardi Gras, and Capitol Mall 4th of July celebrations, to name a few.

In every case, the key word is coordination, that painstaking process of cooperating with fellow professionals with different areas of expertise to deliver the highest level of emergency care to all  those who need it.

Perhaps the most impressive part of this arrangement is that emergency response teams provide world-class medical, transportation, law enforcement and crowd control services at virtually no (or nominal) cost to the air show or the public, simply because it’s all part of their field training exercise.

It’s a win/win proposition for all involved; that is, as invaluable as these teams are to the show organizer, they are as excited to participate in the air show as the show is to have them there.

Rhode Island National Guard Open House & Air Show

RI DMAT is a non-profit organization established in 1999 which recruits and trains volunteer health professionals to respond to in-state public health emergencies. Staffed with doctors, nurses, emergency medical technicians, pharmacists, other medical staff, plus logistics and support personnel, RI DMAT is integral to both the state’s and the nation’s emergency preparedness.  Their annual training exercise has been staged at the Rhode Island National Guard Open House & Air Show for the past 15 years.

“We plan for one-quarter to one-half of the event population to require treatment for dehydration and other heat-related emergencies; drug and alcohol trouble; sprained ankles and pinched fingers, sunscreen in the eyes; cardiac, stroke and pregnancy issues,” says RI DMAT Operations Section Chief Brooke Lawrence.

“Someone who was predisposed to having a heart attack anyway that day — then exacerbates the situation by exposure to the sun, noise, exertion and excitement of an air show – will most certainly have that heart attack at the show; not at home,” says Lawrence. “And we’re ready for them.”

RI DMAT invests ten hours of logistical preparation for every hour at the air show; then commits another 1,400 man hours at the show itself. The team sets up a robust field hospital comprised of three self-contained, air-conditioned, fully-equipped two-bed, two-bay critical care treatment centers in yurt-like tents, which provide certified emergency room services along the flightline. (Additional units stand ready on a Coast Guard cutter just offshore.)  From Band-Aids to digital X-rays, these treatment centers offer all the amenities of a conventional emergency room, and none of the angst associated with getting there and waiting for treatment while the day wastes away.

Patients can be treated and released on site so they can return to the air show. More serious cases are transported to the main field hospital on the National Guard base. Each patient is wrist-banded with a bar code-based tracking system, so all of their pertinent information is transferred to the hospital before they’re transported there.

Of the 60 patients who came to the treatment centers during the 2012 air show, only four had to be transferred to the brick-and-mortar hospital. Most received the treatment they needed right on the flightline, and then were able to take in the rest of the show.

In addition, RI DMAT takes a proactive approach, deploying bicycle and walking patrols for surveillance. “We watch folks,” Lawrence says. “If they don’t look good, they probably don’t feel good.” With just a few questions, the patrols can identify and address medical issues that patients haven’t even recognized. The team also sets up water buffaloes to provide free, potable water to people who can’t afford the sometimes high price of bottled water for everyone in their family.

And that’s just the medical side of things. RI DMAT also has sophisticated treatment and evacuation plans in place in case of a weather emergency, aviation-related accident, terrorism attack, or other mass-casualty event.

RI DMAT is one of 90 response teams that comprise the National Disaster Medical System (NDMS).  DMATs provide triage, primary and acute care, initial resuscitation and stabilization, advanced life support, and preparation of the sick or injured for evacuation during a disaster or other emergency event involving a large number of casualties.

The basic deployment configuration of a DMAT consists of 35 professionals who can be mobile within six hours of notification and arrive at a disaster site within 48 hours. They can sustain operations for 72 hours without external support. DMATs establish an electronic medical record for each patient to facilitate tracking throughout the NDMS.

Other DMATs across the country also integrate air shows into their training exercises. These include The Dayton Disaster Medical Assistance Team in Ohio (DMAT OH-5), which assists the Vectren Dayton Air Show, supplying medical treatment for air show participants while training DMAT personnel. They set up a complete base with five tents: medical, command and communications, training, food, plus housing and air show viewing tents. Training includes how to use various medical equipment and practicing medical procedures.

The Missouri-1 Disaster Medical Assistance Team (MO-1 DMAT) has staged live training deployments at the now-defunct St. Louis County Fair and Air Show and the Scott Air Force Base Air Show.

Over a seven-year period, the Virginia-1 Disaster Medical Assistance Team (VA-1 DMAT) has conducted field training exercises in five states at various venues including four air shows, two airlift staging exercises, and six conferences.

Since 1988, Metro-Boston MA-1 Disaster Medical Assistance Team (MA-1 DMAT) has responded to disasters and provided medical support to presidential inaugurations, Sail Boston, the Boston Marathon, the Olympic Games, and Hanscom Air Force Base air show, among other events.

With 1,600 medical volunteers on their rolls, RI DMAT functions both as a federal disaster response team associated with the Health and Human Services Department, and as a not-for-profit Rhode Island Reserve Corps responding to statewide emergencies. They have responded to several federal emergencies, including the terrorist attacks in New York City and Hurricanes Ike, Irene and Katrina. Locally, they provide field hospitals for the America’s Cup, Tall Ships, and the Iron Man competition.

As Lawrence says, “Our field training exercise at the air show prepares us for the real-world events no one can predict.”

RI DMAT raises funds to stage its annual training exercise — free of charge — at the Rhode Island air show. Other events that contract out RI DMAT services are charged a flat fee on a per-diem basis.

Marine Corps Air Station Cherry Point Air Show in North Carolina

Local emergency managers from the North Carolina State Medical Assistance Team first offered medical assistance to the MCAS Cherry Point Air Show in 2007. At the time, the air show operated a basic first aid station staffed by U.S. Navy medical personnel.

“This provided a very basic level of care and required ambulance transport to the hospital for most patients,” explains Cherry Point Fire and Emergency Services Chief Kenneth Lavoie. “With only a minimum number of ambulances available to us, this system severely taxed our ability to handle even a small amount of patients. Contributing to this situation is the long transport distance of 18 miles to the nearest hospital.”

Through a partnership with the Eastern Regional Advisory Committee, NC SMAT now provides an onsite medical base of operation for participants, spectators, and responders during the MCAS Cherry Point Air Show.

According to NC SMAT Regional Emergency Response Coordinator Chris Starbucks, SMAT brings its own doctors, nurses, paramedics, and other medical providers to the air show. They work with the local emergency medical services (EMS) director to coordinate onsite care for patients requiring anything from minor procedures to an advanced level of care. Patients having a critical emergency (heart attack, labor and delivery, or severe trauma) can be stabilized and treated by SMAT, but emergency transport is also arranged.

Additional resources from local EMS, Mass Evacuation Ambulance Bus (Morehead City Fire), Vidant Medical Transport, Cherry Point Fire and Rescue, and Cherry Point Naval Clinic all work together under the Incident Command System (ICS) to provide medical care plus patient identification, movement, treatment and transport.

Best of all, MCAS Cherry Point is not required to supply funding or in-kind support other than rooms for NC SMAT personnel during their stay, Lavoie points out.  Medical services are provided gratis as an exercise for NC SMAT.

Up to this point, this arrangement sounds almost too good to be true. But it’s no cakewalk. Logistics are key to many inherent challenges.

“We have greatly improved the entire SMAT operation at our show through the years by trial and error and lessons learned,” says Lavoie. “The SMAT footprint is very large and can present a problem if you have limited space for the air show. We eventually settled on a site just off the flightline which provides the required space and utilities to operate. This is the best option, as it provides a secure location that’s isolated from the crowd but within easy transport distance of patients.”

Other logistical challenges involve finding lodging for SMAT members and providing for their security. Lavoie credits the utilization of the National Incident Management System with ensuring an overall smooth-running operation.

From the perspective of NC SMAT, Starbucks says, “Any time you deploy 50 people and four trailers out of town for three days, it’s a challenge. You have to transport, feed, sleep and equip these people. Finding volunteers to provide medical coverage can be a major challenge. With this event being on a military base, team members have to be on the gate roster, receive passes to get on base, and SMAT must coordinate and rely on base security and not bring its own force protection.” 

So what’s in it for NC SMAT? Starbucks says the exercise provides the opportunity to deploy its assets and team members over a three-day period on a real-world practice run. A typical deployment for a team member is seven days. The air show provides each member with experience exercising their plans, eating and sleeping within the base of operation as they would on a real deployment. “Deploying under these conditions only better prepares us for the next disaster mission and teaches us to adapt to the mission,” he says.

SMAT also likes to exercise its ability to bring everything it needs to sustain an operation for three days without impacting the local community. So they bring (or contract) all the food, water, medical equipment and supplies, communications equipment and generators they require (again relieving the show of those burdens). This allows SMAT to integrate into a local ICS structure.

“This idea is highly recommended as it greatly enhances our medical treatment capability and provides for state-of-the-art medical treatment on site,” says Starbucks. “Lessons learned from this event allow SMAT to improve its plans for disaster-related missions.  And that’s invaluable.”

California Capital Airshow in Sacramento

The coordinated emergency response exercises at the California Capital Airshow (CCA) are even more complex and wide-reaching, says the show’s executive director, Darcy Brewer. With safety being their priority since the inception of the show seven years ago, their public safety plan continues to evolve and broaden in scope.

With the help of Alan Sernholt, Battalion Chief of Sacramento County Airport System’s

Aircraft Rescue & Firefighting; along with Scott McCartney, CCA Incident Commander of Sacramento County Sheriff’s Department and Rancho Cordova Police Department; and Rick Griggs, Battalion Chief at Sacramento Metro Fire, Brewer explains that eleven allied public safety agencies* cooperate to manage command and control,  aircraft emergencies, emergency medical services, emergency egress and ingress to the air show area, fires (including inspection and prevention), Mass Casualty Incidents, hazardous materials response (Haz-Mat), emergency communications, security, traffic management, crowd control, and lost or missing persons.

With so many agencies from different areas of expertise involved, their overall approach integrates “post orders,” which are standard practice in law enforcement, military, private security, and sporting venues for staff and volunteers. These post orders help define job functions, giving personnel important information about the show, who is in charge of what, and instructions regarding what means of communication to use when addressing a problem.

A Unified Command is formed utilizing the ICS, consisting of the two fire agencies responsible for crash/fire/rescue/Haz-Mat/special hazard and EMS planning and management; dedicated event emergency communications frequencies; and law enforcement responsible for overall security, crime scene management, crowd control, traffic management, VIP security, threat assessment, and lost or missing persons assistance.

Other local agencies provide real-time intelligence on traffic patterns along highways leading to the air show. The Sacramento County Office of Emergency Services can call in additional regional assets as needed. Further coordination is made with city and county officials to manage the air show’s impact on roadways and community services.

“All the stakeholders in this event are dedicated professionals — many who have worked together each year since its inception,” says Sernholt. “Those of us who have dedicated ourselves to the CCA each year return the specialized knowledge and expertise it has taken years to learn and assemble the right team and resources, tailoring the emergency services needs based upon the types of performers participating at the event. This professional relationship has forged longstanding friendships as well, which affords better communication amongst the entire CCA group.”

Since the beginning, participating agencies have shared resources, including using motorcycle officers from neighboring police forces, at their cost. Because most performers fly over numerous geographical areas and jurisdictions, it’s sensible to involve multiple agencies… and it reduces overall costs.

Airport fire resources are provided at no cost to the air show by using on-duty staff. Other agencies’ personnel rates have been discounted, so those working at the show volunteer several hours of their own time. Some professionals receive no pay whatsoever for their service.

“The emergency responders are generous with their time because the air show provides them the opportunity to work together in a unified command structure with other emergency service personnel from different agencies across Sacramento County,” Sernholt says. Such inter-agency cooperation on this scale is rare, except in large-scale emergencies.

“The CCA is a planned event, and while the possibility of an emergency exits, the air show is a very safe and fun environment for the public to experience,” Sernholt adds. “The emergency services personnel enjoy broad support from one another, including the CCA staff, volunteers and board members. We would highly recommend exercising an ICS for any air show. Involving all the players that form together to make the air show happen has created a tremendous success and a safe, clean place for families to visit, enjoy and return every year.”

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Estelle R. Brown
Estelle Brown is a freelance writer and independent public relations specialist based in northeast Ohio.