By Sarah-Maria Marchegiani

– Executive Summary –

Mass casualty incidents (MCIs) present substantial challenges to emergency response systems, demanding coordinated actions across multiple agencies and jurisdictions. Hospitals are becoming secondary MCI scenes as patients flee the incident location and self-present at the closest hospital with no medical care. Although hospitals have emergency plans to increase their capacity, the rapid influx of patients often outpaces the time it takes to implement these plans. Consequently, fire and emergency medical service (EMS) agencies are adapting their approach to MCI response by deploying personnel directly to hospitals to assist in managing the surge of patients. This thesis investigates collaborative strategies that support this paradigm shift in MCI response by identifying and examining regions where successful policy development has facilitated the integration of fire-EMS with hospitals across different jurisdictions. By analyzing these collaborative efforts, the study uncovers potential barriers and drivers that could support similar integrated response strategies within the National Capital Region (NCR). Ultimately, this research aims to bolster the effectiveness and efficiency of MCI responses in the face of evolving challenges.

This study employed a qualitative research methodology to better understand the changing state of MCI response. Semi-structured interviews with leaders from fire and EMS departments, hospitals, and emergency management agencies revealed valuable insights into their experiences, challenges, and perspectives on collaboration and integration in MCI response. Seven participants from two geographic regions, southern Nevada and the Phoenix metro area, were interviewed. Thematic analysis applied to the interview data uncovered four key themes: interagency collaboration, overcoming challenges, policy development, and continuous reevaluation and refinement.

Further examination of the NCR’s diverse characteristics and collaborative history revealed additional challenges in creating a regional framework for MCI response. Synthesizing the effective strategies observed in other regions with a deep understanding of the NCR’s unique context facilitated the formation of recommendations to strengthen interagency collaboration and improve MCI response within NCR. To establish a cohesive regional response strategy, the research recommends creating a training plan to support the implementation of the revised MCI response plan in northern Virginia, enhancing stakeholder identification and engagement, conducting a comprehensive gap analysis, developing a flexible framework, and maintaining ongoing training and collaboration.

1. Develop a Training Plan to Implement the Revised MCI Response Plan

Northern Virginia’s initiative to revise its shared MCI response manual integrating fire-EMS with hospitals signifies a critical advancement requiring interagency cooperation. The research underscores the need for a strategic training plan to ensure effective implementation of the new response policy and to maintain its usefulness. Initial agency-specific training is essential to thoroughly familiarize personnel with the new procedure and their individual responsibilities. Additionally, regular interagency training and exercises based on real-world scenarios is needed to ensure a cohesive response and foster an environment of ongoing improvement. This approach allows for the refinement of strategies based on hands-on experiences, the adoption of emerging best practices and continued collaboration. To sustain the advancements in MCI response, agencies in northern Virginia must commit to training and collaborative efforts across jurisdictions and agencies.

2. Identify and Engage Stakeholders to Expand the MCI Response

Expanding this MCI response model across the broader NCR remains challenging due to the inherent complexities of managing such incidents in a region marked by varied legal regulations, operational protocols, and administrative structures. Identifying and actively engaging a broad spectrum of stakeholders is essential for fostering multidisciplinary support. Stakeholders should include the traditional fire-EMS and hospital agencies as well as other entities involved in MCI response, such as law enforcement, state and district health departments, local public health officials, and emergency managers. Each stakeholder brings unique perspectives, resources, and challenges, making their early involvement vital in the planning process. Leveraging existing collaborative partnerships and strategically building stakeholder support requires effective communication and the ability to proactively address each agency’s concerns. Achieving consensus among a diverse group may require an incremental approach to change, necessitating stakeholder buy-in individually and then collectively.

3. Conduct a Comprehensive Gap Analysis

A thorough gap analysis will identify disparities and areas requiring improvement in resources, training, policy, and overall response readiness across participating jurisdictions. The accuracy of this assessment hinges on active participation from stakeholders and their willingness to honestly evaluate existing plans and operational realities. Building trust among stakeholders through a collaborative approach is key to ensuring their full participation in the process. A comprehensive assessment of current response realities and planning assumptions lays the foundation to collectively enhance response strategies.

4. Develop a Flexible Regional Framework

Adopting an inclusive approach is key in developing MCI response strategies suitable for the varied jurisdictions within the NCR. The regional framework must be cohesive yet flexible to ensure a unified response and address the specific needs of each jurisdiction. Instead of prescribing particular tactics or resource allocations, the framework should outline overarching strategies and goals. This approach allows for local autonomy and permits individual jurisdictions to customize the specific implementation details according to their needs.

5. Sustain Collaboration Through Training, Meetings and Planned Events

Maintaining the momentum and adapting the framework to emerging trends and challenges requires ongoing dialogue and collaboration. Regular meetings, exercises and planned events serve as vital platforms for continuous communication, allowing for the exchange of ideas, refinement of strategies, and strengthening of the regional MCI response framework. Through such collaborative efforts, the NCR can continue to evolve and develop a more cohesive, effective, and adaptive response to MCIs, ultimately enhancing the region’s overall emergency preparedness and response capabilities. This thesis underscores the limitations of traditional approaches to MCI response and examines innovative solutions implemented in other regions. The study examines successful models that integrate fire-EMS resources with hospitals, offering valuable insights into tackling the complex challenges of building a cohesive and efficient regional response framework. By advocating for enhanced stakeholder identification and engagement, a thorough gap analysis, the development of a flexible framework, and continuous collaboration, this research provides a foundation for significant improvements in MCI preparedness and response within the NCR.