Ep 69: What About Hospitals?
Episode 69
Published Feb 26, 2024
Last updated Feb 18, 2026
Duration: 41:23
Episode Summary
In a mass casualty event, your hospital may be overwhelmed. When they call for help are you going to make it better or worse? In today’s episode, we look at several issues you should anticipate and how you can respond.
Episode Notes
Patient distribution, security concerns, reunification, media handling and even parking can easily overwhelm a hospital during a mass casualty event. Can we integrate our training and provide assistance? On this week’s podcast we’ll discuss how we, as Public Safety Officers, can assist our hospitals in the challenges they may encounter if faced with an active shooter incident.
View this episode on our YouTube channel at https://youtube.com/live/U19VnL3eFk4
Transcript
Bill Godfrey:If your community experiences an active shooter event that's a true mass casualty incident, your hospital may become overwhelmed. Problems with inability to take care of the, a number of people, security issues, reunification, media management, and it's really easy to say that those are hospital problems, but who are they gonna call? And when they call you, are you gonna make it better or worse? That's today's topic. Stick around.
Welcome to the Active Shooter Incident Management Podcast. My name is Bill Godfrey. I am joined here by my good friend Ron Otterbacher, sitting next to me. Pete Kelting across the table and Adam Penley with us in the house as well, all of us part of the instructor cadre here at C3 Pathways, and today's topic, we're gonna talk about some of the special considerations that need to be thought of for hospitals when you have a mass casualty that goes beyond the typical. So that you know, for those that aren't aware, the median number shot is three, and of those three shot, one is killed, and that is not typically a mass casualty incident, as we all know, but when you have one of these events that's a true mass casualty incident, 15, 20 people shot, that can be very overwhelming for small community.
And in some cases, even metro communities can get overwhelmed as well, and it creates some unique circumstances and challenges for the hospitals, and so we're gonna talk today about some of the things that will come up that you should anticipate and some of the things that you may not have thought of, and it may technically be a hospital responsibility. Well, we might be in a position to really help out. Let's start with the basics of, the hospital is overwhelmed to the point that they're unable to care for patients. Pete, you want to start us off a little bit? Talk a little bit about, you know, you were mentioning earlier, right before we went off air, the example of the one police officer that got shot. Talk a little bit about some of the things that can lead to a hospital being so saturated that they can't care for any more patients.
Pete Kelting:
Bill, just by mere proximity to the event potentially where you have, you know, the response of EMS bringing patients there and then self-transportation. You know, we have several events unfortunately across the country that we can point to with self-transportation with a police officer to get shot, you know, that we bring a, you know, an officer to that location. It just brings a whole lot of challenges to the hospital when they immediately are seeing that patient surge.
Adam Pendley:
Yeah, we actually, one of our other instructors can tell a story about an officer that was taken to a hospital that was quite overwhelmed and they had to turn him away. You know, imagine that, a police officer's shot on your incident and not that the hospital, they want to, you know, be there for us, obviously, but they've just been so overwhelmed with patients that they have to send that officer with a gunshot wounds maybe to somewhere else, and I know we're gonna get into it as we continue to talk, but, you know, integrating with your fire, EMS folks that typically do have some sort of system in place to understand the distribution of the hospitals, they might be able to help with that, but to Pete's point, your system where you know what hospitals have received which patients might not catch up with the fact that there's been so many self-transports as well. So it just requires a lot of recognition that they're gonna potentially have a problem with patient overloading and it's gonna be police and EMS working together to make sure that we distribute patients and people are going to the right place.
Bill Godfrey:
Ron, opening thoughts on patient overload.
Ron Otterbacher:
It can happen very easily, depending on who's moving the people. You look at some of the events we've been involved with that, you know, the number of people that are moved, the number of people that are unaccounted for that move, like Pete said. You know, we can account for the ones we touched, but we can't account for the others and the hospital's still receiving them anyway, so they may have put themselves on divert and if we're not in that system to understand what they've diverted, we just continue slapping on other victims to the diversion and they can't handle it, they're overwhelmed, we've gotta have a better way of communicating and make sure we're assisting in the situation instead of rendering it.
Bill Godfrey:
I think it, I think it's really important to take a moment and talk about in a perfect world how the system is supposed to function. EMS has mass casualty plans that they lay out and generally speaking, as the, one of the duties of the transport officer is to communicate with the hospital or hospitals that are targeted for transports and to fairly evenly distribute the patients to those various hospitals. So if they've got three or four hospitals that they're transporting to, you don't send all the reds to one and all the greens to another one. You try to distribute 'em out, you know, red, yellow, green to this one, red, yellow, green to this one, red, yellow, green to this one. Now that's perfect world, pie in the sky, and that doesn't always pan out that way. Sometimes you have to transport two reds at a time or a red and a yellow and you may not have the right balance.
The other factor to consider a lot of communities will poll the hospitals to find out what they feel like they can take, what can they manage? How many reds, how many yellows, how many greens? And so now you're trying to distribute 'em evenly, but you're trying to match up with what the hospitals can take, and that's where the other piece of this, the wheels start to come off the bus, so to speak, is that doesn't account for self-transports, you know, people who have fled the scene, either of their own power or somebody has transported them in a private vehicle to the hospital. It doesn't account for any law enforcement transports that may have been done. Most law enforcement officers that end up transporting patients, that's not their normal mode of action. Something in their mind has gone wrong, and they've concluded that the best way to try to save this patient's life is for them to transport it, and they have no real awareness of how a hospital can become oversaturated, and it's really easy to think, but yeah, that's really the hospital's problem. Well, what is in the best interest of the patient?
Adam Pendley:
Right.
Bill Godfrey:
You know, Adam, to your example about the police officer that was shot, he was actually shot in the neck, which is a, was a fairly serious injury. However the bleeding was controlled and the hospital that he initially was transported to by his partner looked at it and said, he is going to get better care by taking him further down the road to another hospital. We are completely overloaded, and I think sometimes we have to kind of remember at the end of the day, our focus is supposed to be on survivability of the patient, what's in the best interest of the patient, you know, whether that hospital was fully prepared, fully staffed, whether they've done this, done that.
Okay, we can hash that out after the fact, but right now, what is in this best interest of the patient? There's been examples of hospitals that had a very large number of patients transported 'em because they were very close to the incident and they stabilized those patients, but they weren't able to take care of, surgically care for those patients, and those patients then had to be transported by helicopter and by ground ambulance to other hospitals that were further away that could actually care for 'em. So I think it's important to keep in mind the way the system is intended to work, but when we get true mass casualty events where, you know, the chaos is raining, that system tends to break down and we don't have a good answer for it, I don't think, and how to accommodate for all those people that self-transport.
Pete Kelting:
So, I mean we gotta look at, you know, when does the hospital's problems become our problems from our active shooter, right?
Bill Godfrey:
It's a good point.
Pete Kelting:
So I mean, most jurisdictions here locally, we all know that we train once a year with our local hospitals across three to four counties of MCI training. When do we, they all stand up normally their own incident command systems within their structure. When do we step in to be a part of that? Or when do we request somebody from them to be a part of ours? So we have to see when we integrate that response together with ours.
Adam Pendley:
Sure, and I, and you hit on a great point. I mean, one of the first tools in the toolbox is this integrated training, so just to get law enforcement to understand that, the fire EMS interface with the local hospitals and their distribution system, that that exists and that it is possible for a hospital to get overwhelmed and just getting law enforcement to recognize and understand that's the first thing, but now imagine that in addition to the kind of the three normal scenes you're used to, the crisis site, what transportation the suspect used, where they came from, their home address, that sort of thing, but now you have these additional locations that you're, you know, you mentioned, it just made a light bulb go off, you mentioned that, hey, this hospital may have taken too many patients, stabilized them and now they're transporting 'em to other places. So even, you know, are we talking about traffic routes and traffic control and you know, your urban hospitals that are your level I or level II trauma centers, oftentimes they have a higher level of security. They might hire hire off-duty law enforcement officers.
Bill Godfrey:
Or they might have their own police department.
Pete Kelting:
Right, right.
Adam Pendley:
Yeah, yeah, but then the third or fourth down the line hospital that's a little further out, that is typically a community hospital, but now they're taking more patients than they're used to, they're gonna be calling for help and the only people they know to call are gonna be, you know, local law enforcement. So it does become a point at which all of those things, you know, circle together, but again, kind of the tools in the toolbox, the first thing is to understand that those kind of things can happen in a complex incident, and getting law enforcement to understand that your day in and day out, you know, when I was an officer, I knew that if I had this type of patient, you know, maybe a, you know, a drunk who's been injured or something, I knew that it, to go to this hospital 'cause they handled it really well. Well some of that stuff, you know, you might have to work around knowing that the system is under a strain.
Bill Godfrey:
I think it's also really important to talk about from an incident management perspective, our responsibility for accounting for all of the patients that came from our scene, and I think that's something that we forget about. If we've transported them through the EMS system, the transport group supervisors should have a log of each ambulance that left, how many patients that they took, what the color of those, the severity of those patients, red, yellow or green, and what hospital they went to. They're probably not gonna have a name to go with it. I mean, that's just the reality. We hope that they get a triage tag number, but the truth of the matter is, that's probably not gonna happen either.
You're gonna know that Ambulance 42 went to Memorial with a red and a yellow, and that's about it, and so trying to match that up after the fact can be a challenge, but then when you factor in the people who self-evacuated and transported on their own. So I do feel like there's a part of this in our planning for community MCIs where we haven't as EMS fully wrapped our arms around, how do we close the loops with the hospitals on accounting for the patients? Who did you receive? How many did you receive? And of course the first time you call over there, they're gonna tell you HIPAA, we can't, you know, tell you a damn thing, and I'm sure we'll talk a little bit more about that, but I feel like just on the not overloading on a severity level, there's a couple of basic gaps that we have in the fundamental planning and assumptions that we've made over the years, and not just even in active shooter events, but just in really any mass casualty incident where you're gonna have some component of self-evacuation. How do we account for everybody, right?
Ron Otterbacher:
The key is understanding the capabilities. You know, if you are around a level I trauma center, they may be as in central Florida, the only level I trauma center in 10 county area, this incident is probably gonna be their focus, but understanding what their capabilities are and understanding that as you see all these people going, we don't have to, we're not like fire rescue where we have to have direct conversation, but we're gonna end up sending from law enforcement someone there to start tracking where these patients are going and understanding that they may have to, like we said, transport some of these people off to another facility for surgery or something like that. The big thing is with this integration is having an understanding of what each other does, what their capabilities are, who do we talk to when we get to the hospital, right? Knowing where to go to say, hey, can you help me? I'm looking for this information, and that's a key thing.
Pete Kelting:
Yeah, I mean at a minimum our logistics of our event is gonna operate in their backyard in the hospital. We have, you know, potential evidence to collect off the patients being transported.
Bill Godfrey:
Yes.
Pete Kelting:
We have witness interviews to conduct. Probably our family reunification may involve finding individuals at that hospital. There's, you know, several logistics and then, you know, we hope, what if that hospital actually then has to incorporate a potential threat? You know, have we transported a bad actor, you know, unknowingly or is that hospital actually picked out as another soft target of the attack for whatever the motive is of that attacker, so.
Bill Godfrey:
Which is a perfect tangent to take us to our next component of this, which is the security issue of that hospital. You know, I, Ron, I think you said it, if they're a big level I urban trauma center, they're gonna have some level of security. I mean frankly, this day and age, even most community hospitals have some security on staff, though it may only be one or two people, but what are we gonna have to do to assist in securing the facility from threats, securing the patients that we've transported, providing traffic control, crowd control? Isn't security going to be something that's gonna end up on our backs?
Ron Otterbacher:
And again, a lot of hospitals have limited search capacity, so the only search capacity they're gonna get is from local law enforcement until they can get either contract security to help come augment them or move people from other facilities within that organization to there, but usually it's gonna fall back on local law enforcement, whether it be for traffic control, whether it be for protection at the ED right then because we don't know where, you know, what the status of the bad guy is, and so there's a lot of things that they're thinking about too that we've got to be a partner with because they don't have the resources to expand out to that. Where's media gonna go? Where are all the people looking for their loved ones, where are they gonna go? Who's gonna help them? You know, who are, like we said initially, who are they gonna call for help? It's gonna be us and we've gotta be prepared for that call, right?
Adam Pendley:
Absolutely, and I think, and I look at it as that the people that were potentially injured in the active shooter event, they're now our responsibility, right? They've already been traumatized once and the hospital's gonna do their level best to provide the best medical care they can, but if now they're also, again, there's may still an unknown threat. There may be media that's trying to get in to do interviews at an inappropriate time. There might be family members that are otherwise estranged day to day, but now they're showing up at the hospital 'cause they've heard that this event has happened. So even though it's, again, it's a lot of times a hospital responsibility, once we are managing the larger event, they kind of fall under our umbrella too. You know, I think we have a responsibility to those that have been injured that are at the hospital and we especially have a responsibility to the families to try to piece together quickly, like Pete was saying, who was, who is where, you know, so, 'cause reunification is part of the response. It is a response function and we have to get it set up quickly and we talk about, you know, accounting for folks so we can, you know, give families the best information we can right at the scene.
Bill Godfrey:
It's interesting that you mentioned that element, Adam, of getting at the media and the hospital. There was a sad, I would almost say despicable incident where media pretended to be a family member of a minor to try to gain access to the child's bedside to get video, and presumably if the child was able to talk, try to get an interview but may mainly just get video of a hurt kid and they were not successful, but it to me, that just points to the need for uniformed law enforcement presence to be at every hospital that receives patients from an event we had, and I'll, I'm, I won't forget this, we were doing some training in an area that happened to be fairly resource rich and they said, "Look, we've, we'll have enough, "10 minutes in, we'll have enough cops. "Is there any reason why we can't send "a cop with every ambulance?" And we said, "No, you know, of course not, "and but tell us why," and he said, "Well, if there's dying declarations, "if there's comments, witnesses, things like that, "that officer can document that during transport.
"If there's an opportunity to secure their clothing "and evidence, the officer can do that. "If there's information about who they are and a name or ID, "the officer can get that, and then the officer "arrives with the patient and can continue to, "with the patient into the ER and stay at "the patient's bedside to provide that protective element, "but it also becomes the access point for information "for us on the public safety side to reach back out "and say, who was it that you transported, "and to get those names without having to put the hospital "in the position of, well, you know, we want to tell you "but we can't tell you because of HIPAA, "and you're like, you know, screw your HIPAA. "I've got a criminal investigation I'm working here." So I thought it was a really fascinating idea. Now again, this particular community happened to be very resource rich and so that was something that they could afford to do. I'm not sure how many communities that extends to, but maybe 20, 30 minutes into the event, you do have enough officers.
Adam Pendley:
Sure. I think oftentimes you see at some of these events because we all, all your public safety agencies want to respond and help and I think more often than not, you have resources that are looking for a job to do, and it's, part of our earlier conversation that you know, you gotta have resources that you can carve out other jobs that need to get done, and even if you can't send an officer with every transport unit, all those tasks that you just set are something that needs to get done and most of them need to get done fairly quickly. So as more people come up and you have additional officers at staging, I wanna help, what can I do? I wanna help, what can I do? This is an important consideration, like hey, have we thought about the hospitals yet? And if you have extra resources, start getting 'em out to the hospitals.
Bill Godfrey:
All right, so let's bullet point off some of the security tasks that need to be done at at a hospital. So obviously securing ingress and egress, is that on the list?
Ron Otterbacher:
Yes.
Pete Kelting:
Absolutely.
Bill Godfrey:
Okay. What else? Crowd control.
Everyone:
Right.
Adam Pendley:
Traffic control.
Bill Godfrey:
Traffic control.
Pete Kelting:
Media.
Bill Godfrey:
Media control. What about inside? You secured ingress and egress, but don't we need some?
Ron Otterbacher:
Just the presence puts ease of mind for the people that are there.
Bill Godfrey:
Uniform presence.
Ron Otterbacher:
I think it's important to understand that we're not there, it's the hospital's responsibility for patient care. No doubt it's our responsibility to provide a safe environment for them to provide that patient care.
Adam Pendley:
Absolutely.
Ron Otterbacher:
Whether that's ease of mind on them that they're not gonna be attacked while they're trying to provide patient care. You look at all those situations we talked about. You know, we're limiting access into it. You know, there, those are all responsibilities that can often overwhelm the security component of the hospital and it's our job to reinforce that, to give them a safe environment, do everything they can to save these patients.
Bill Godfrey:
So here's a question I'm gonna throw, and Pete and Ron, you guys both have or are doing hospital work. So let me put this one to you specifically. Let's use a fairly typical community hospital, 150 to 200 bed community hospital, and they've received half a dozen to a dozen patients from an active shooter event that may have had 30 or 40 shot. So they've got a load but not all of 'em. What's the, in your mind, the minimum number of officers that you're gonna need to send over there to supplement whatever security they have to secure it, provide traffic control, crowd control and to be a visible presence and deterrent? What are you thinking in numbers?
Ron Otterbacher:
I think the squad level size, eight to 10 people, and the reason I say that is some of the community hospitals, depending on the number of fixed posts they have at the hospital, they may only have five security officers with two fixed posts. That means they got three people that can provide all these other resources. That's just not enough in these types of situations. So it would be probably a squad level response, or once that squad arrives and they determine we could probably handle it with five, then they can cut it back, but I always go on the auspice, I'd rather have more and turn them away than need more and have to wait for them to respond so.
Pete Kelting:
I agree. I was gonna say eight to 10 and we gotta remember, the hospital was already in operation with hundreds of other patients and depending on the time when.
Bill Godfrey:
And may still be receiving patients from other events.
Pete Kelting and Ron Otterbacher:
Right.
Pete Kelting:
Other events. The active shooter event took place during the day, you know, definitely higher concern. Nighttime, a little bit later in the morning, maybe not, but who knows, on a weekend. So there's a lot of variables that the hospital has to deal with, and I just circle us back to, you know, your relationship in your own jurisdiction of how you train with your hospitals during their MCI events. Are you a part of their instant command when it stands up? Are they a part of your monthly EOC briefings and emergency management exercises that we train together with so that when we walk in the door it's not the first time looking at a face on game day? You know, hey I'm so-and-so. Can I, you know, come into your incident command and they have no idea who we are so.
Bill Godfrey:
And so, before we leave the squad size, 'cause I want to do a follow on that. So the squad size of eight to 10, how many supervisors are we sending? One sergeant or a couple sergeants?
Ron Otterbacher:
I think initially start off with one and then make a determination if you need to scale up from there because that one can direct again span of control and you need a command are both important so they can control that number, but if it's a more dynamic situation you may have to send more squads and more supervisors.
Bill Godfrey:
Well, that was gonna be my next question. So let's now scale up to a large metro hospital, 500 plus beds. How many are you gonna need then? And they got 30, maybe 40, 50 patients. 500 bed hospital.
Pete Kelting:
I think he's gonna say the same thing I am is you know, we're moving to double that initial response. Two supervisors probably, you know, 10 to 15 officers, somewhere in there, maybe upwards as 20, just depending on what's going on at the time, you know.
Ron Otterbacher:
Remember we're supplementing their ongoing processes. Are they already screening everyone that's coming in? I know that, you know, when we screen patient or patient visitors, we're using x-ray and we're using metal detectors. That's gonna continue. All we're doing is supplementing what they've already got in place. We're not taking over what they're doing. We're simply there to add a more robust response to their situation.
Adam Pendley:
And I would say the reason you need more is, you may not even be supplementing that much inside.
Ron Otterbacher:
Right.
Adam Pendley:
But I can tell you that whether it's on social media or one family member gets word that their person was transported there, the cars that arrive, you know, if you've ever been around.
Bill Godfrey:
And where they park.
Adam Pendley:
And right, if you've ever been in a hospital parking lot, they're full all the time. So if 30 extra family members are arriving, 60, 100 extra family members are arriving and they're panicked and they're pulling right up to the emergency department and they're parking wherever they can stop. So I think helping on the outside is a supplement that we would probably need to do even before we try to go inside and help with some of the existing processes.
Ron Otterbacher:
And that 30 that Adam talked about may be in fact 30 for a family.
Adam Pendley:
Right.
Ron Otterbacher:
You know, we got one victim, you got 30 people showing up 'cause they all knew and everyone's going 'cause they need to be there, and that can quickly overwhelm the system.
Pete Kelting:
That's just from the logistics standpoint of it with saying the hospital doesn't have any type of threat issue with it. We had a local incident here where the bad actors showed up at the hospital, you know, trying, it was a domestic incident that, you know, showed up at the hospital. Now everybody there became a threat. So what officers were on scene to be able to respond to a threat, still handle the logistics of what's going on at the hospital.
Adam Pendley:
And then, I don't wanna go too far on a different tangent, but if you did have an injured police officer transported there, now you're dealing with multiple law enforcement officers showing up to show their support, which is the brotherhood of the police is, you know, and same thing with the fire department. So now you need somebody of a significant rank there, you know, in any, and again this is kind of a different tangent, but just managing, you know, those types of folks that are coming to the hospital as well to support, you know, their brother in arms or their fellow firefighter or EMS person, right?
So it's an additional management issue at the hospital that falls back on us completely, and from a management perspective we now have to ask ourselves, is this too much for the incident command of the active shooter event itself? And how do they section that off? Does it become just a branch and you call the next arriving supervisor of good rank to say, "Hey, you're gonna be in charge of the hospital branch "and you need to start thinking about divisions "or groups of each hospital, right?" Or is, does it become a command all on its own? You know that my, I think my preference would be because there's so much information you still need from the hospital at the original scene, I would just make it a branch. I would immediately delegate it as a hospital branch, and let somebody be in charge of all things hospital.
Bill Godfrey:
Yeah, and Adam, I would tend to agree with you. It was with, it was, it's funny that you went there as I was just thinking about bringing up the management component of this conversation, 'cause the numbers you guys are talking about are not small numbers.
Ron Otterbacher:
No.
Bill Godfrey:
And in fact for some communities it could be quite a strain to have a presence at the scene and at two or three different hospitals as they need to do this, but I think that that management piece, I would agree with you in simplest terms it would be nice to have it a branch and have it roll right under and we have consolidated communications, we put it on a different radio channel, all that kind of stuff. That makes a lot of assumptions about the size of the jurisdiction, the capabilities of the systems. If those hospitals are in somebody else's jurisdiction, it may make practical sense from a just a getting it done thing to have that split off and have them establish their own command that we coordinate with an area command.
Do, at what point does it trip into, we're gonna manage it under the umbrella of the scene's incident management versus, okay I think this has gone big enough with the investigation, coordination, reunification, which we haven't talked about yet and all of that, that maybe we do need to overlay an area command which could also coordinate with the hospitals, each of the hospital's incident command system, 'cause hospitals, God love them, you know, you ask 'em and they'll tell you they use HICS, Hospital Incident Command System. Great, you know, how do you use it? Yes, we use it. Yeah, but how do you? We use it and we all know from exercises we participated in, their understanding of how that functions is a little bit limited and can cause some operational challenges when we're trying to manage all that, but to me I think it becomes a function of, how big is the event? How many sites or facilities are involved? How many jurisdictions are involved? Are they all in my jurisdiction or is every one of 'em in somebody else's jurisdiction?
Adam Pendley:
Sure.
Bill Godfrey:
'Cause I'm a small city, and I think all of that plays into the decision making. I also think you shouldn't be afraid to change gears.
Ron Otterbacher:
Right.
Bill Godfrey:
If you do it as a branch and about the time you stand up the third hospital's worth of security, you realize that this is becoming difficult to manage, you're having radio problems, you can't quite control it, it's just getting too much, then maybe you do, you know, by that point the police chief, the fire chief, the rest of the backup has showed up.
Pete Kelting:
Your EOCs are starting to stand up.
Bill Godfrey:
EOCs are standing up, get an area command stood up.
Adam Pendley:
Right, and Pete took the words right outta my mouth. That's a great opportunity for your emergency managers at the county level, 'cause they have some plans in place for those types of MCI or surge events that maybe they can implement some of that, but I'm a big fan of delegating big parts of your incident off to someone else to be in charge of that so you're not overwhelmed trying to think about.
Bill Godfrey:
Agree.
Adam Pendley:
Too many things at one time, and if you have, that's even a job you could call a neighboring county for and say you know what, we don't need any more help with the scene, however, if you can send your ranking person and about 25 officers over here, please help us at the hospitals, and you're now just delegating it off to some follow on resources.
Ron Otterbacher:
And again, to hit on what Bill said in his comments was, we're there to support the hospital at the time. You know, they've got their HICS stood up, we need to make sure we integrate with their HICS. That's why I always go back to, training ahead of time is the critical part. They may have a different view of what we're gonna provide and do once we get there than we actually have, and when the incident's happening is not the time to, for them to find out. Nah, we're gonna go in there, we're running roughshod or we're gonna sit back and wait for the hospital to tell us what to do. They need to know what our capabilities are. We need to know what theirs are. We need to talk about expectations on both sides, and then we need to share the responsibility for this incident because we don't want them to think that, hey we're just coming in to run this thing, and you know, it's, I go back to the old days when the fire department was well versed and well practiced in incident command and law enforcement wasn't, and then you figure fire department's just gonna come over and take over the scene. That's not gonna happen, but it's the same way with the hospital. You know, although they may run things different, they run it the way that it serves the hospitals and we've gotta have that understanding.
Adam Pendley:
Sure.
Ron Otterbacher:
We've gotta support their efforts.
Pete Kelting:
Yeah, I mean, Ron, you and I have been a part of the planning of the hospitals over the last 10 years or so here in central Florida, and we've seen where we used to what maybe with MCI training events, two or three hospitals now, we're three and four counties.
Ron Otterbacher:
Right.
Pete Kelting:
15 hospitals all playing in in the event for the day
Ron Otterbacher:
Sure.
Pete Kelting:
It's, they've really come around.
Bill Godfrey:
All right, so I'm gonna move us on to our final. I wanna talk about reunification and we've already hit our 30 minute mark. So let's talk a little bit about reunification and then we'll wrap this one up. What role does the hospitals play in reunification with us when we're standing up reunification as part of our incident?
Ron Otterbacher:
I think the important thing is understanding that reunification is gonna occur. If we control it from the onset, we may be able to save not only our efforts but the hospital efforts at that time, and the reason I say that is because if we don't designate a reunification location, then everyone that doesn't know where to go is gonna go to the hospital. I can tell you from experience.
Bill Godfrey:
That's true.
Ron Otterbacher:
That's where they're gonna show up. So if we can set a reunification and then we can get them on the front side with us, then we can work out how to do that reunification that still complies with their HIPAA responsibilities and everything else. They want the same thing that we do in public safety. They want these people to reunite with their family. They want someone there that can help them make medical decisions during that time, and it's critical for them. What we can do is again initially set a reunification area and get them worked in with us, 'cause we're already involved in their incident command system so we can get someone from the hospital there so we can work it out so we have plans ahead of time instead of having, you know, 5,000 people show up front door of the hospital.
Adam Pendley:
Sure, and as we've seen in other incidents though, let's say everything does go according to plan. We have a really good reunification set up at or near the scene and we go down our list and we find, oh well Mr. Smith, your son was transported to Memorial Hospital, he was one of the injured. We may not want Mr. Smith to jump right back into his car and try to drive to the hospital.
Ron Otterbacher:
Right.
Adam Pendley:
And we want to know who he should see when he gets there, right, so he can get, so reunification involves some people learning that their family member has been transported to a hospital and then they want to go there, right, rightfully so. So now how do we, you know, keep doing our part to make sure that that connection happens effectively?
Bill Godfrey:
I think the success of reunification all comes down to the power of information. If we do our job, you get everybody transported off of the scene. Once the injured are taken care of, that next priority is to clear it, but while you've got contact teams and tactical working on the clearing operation, fire and EMS job is not done. They should immediately begin circling back with law enforcement and the investigative team and trying to put names to every patient that was transported into the ambulance, because if we're doing our job, we should be the focus of the information so that when little Johnny's dad shows up or Sandy's, you know, mom shows up, we've got answers for them about where they are and what the situation is. One of the things that has frustrated me to no end is this talk about how you can't call it the reunification center because not everybody gets reunified, and I think not only is that super shortsighted and just a ridiculous talking point, but it's absolutely false.
Everybody does get reunified one way or the other. Everybody gets reunified. Whether they're uninjured, injured, or tragically a fatality, we gotta get 'em reunified and we have to have answers for all those questions, and to your point, Adam, you know, somebody's injured, okay Mr. Smith, let me take you to the hospital. Well, I don't wanna leave my car. I'll get somebody else to drive your car right behind us. I'm gonna walk you in through security. I'm gonna introduce you to somebody that's gonna be able to give you answers and hopefully take you to, you know, little Johnny's side or you know, the flip side of that is, is you gotta do a death notification and it's a horrible thing to do.It's a horrible thing to do, but it doesn't end with just telling 'em that.
There's a lot of questions that come up and we need to be prepared, just as if we're taking them to the hospital and guiding them, we need to be prepared to answer those questions and guide them through the other thing, hence the family assistance center. So I think it's a, I think it's incumbent upon us as public safety to do our job, to initiate when it's needed, those reunification elements quickly, early, and to take it very seriously and to realize that it's still a very integrated team effort between law enforcement, fire/EMS, and the hospitals, and Ron, to your point, if you haven't planned and worked it out ahead by policy, which by the way some communities have done, right, they have done interlocal agreements.
Ron Otterbacher:
Sure.
Bill Godfrey:
That have been signed off, all legal, through the contract review that allows the hospital to provide names to law enforcement and fire/EMS for the accountability and these types of events, and if you haven't done that ahead of time, that's one to put on the list 'cause you should do it ahead of time, but if you haven't done it ahead of time, get a uniformed cop over there to start getting answers.
Adam Pendley:
Sure, and just to extend on what you're saying, again, that's a place where emergency management can also help as well, your local emergency managers. So there's two things there and I think to your frustration, sometimes they're conflated into thinking that it's one thing. Reunification is very much a response issue. Family assistance is part of recovery, but we know that response and recovery overlap, especially early on.
Bill Godfrey:
Yes.
Adam Pendley:
In these incidents and they should overlap, but planning ahead for what happens with those that have been transported, what happens with those families that are getting the most terrible news of their lives, and how emergency management can help bringing those resources simultaneously. Your scene may still be working, but if you make that one call to a plan that's already in place, you can get those, this second part of it rolling already.
Pete Kelting:
Yeah, Bill, we talk about our two priorities, right, the bad guy and the clock. Well, the hospital is a part of that clock. It, the end of that clock could end at the hospital either saving that patient's life or them passing away, and our response and responsibility is to help hospitals be as successful in the event also, could be as simple as keeping an emergency lane open. The ambulance can even get there from over convergence of people trying to find out about their folks, you know, being transported to a hospital. So, you know, it's important that we look at that as a full on responsibility as a, of our event.
Ron Otterbacher:
And maintain the understanding that reunification is not only a function, it's also a location, and if you set a reunification location, it allows you to have a controlled method of bringing those people into their loved ones instead of just mass chaos where everyone shows up. Now you got, what do I do now?
Bill Godfrey:
Yeah, indeed, and it's a difficult topic, no question about it. I think it's very personal and passionate to all of us 'cause we've all been one form or another in those shoes, but a very, very difficult topic. So, you know, at the end of the day, we can't assume that our job is over just because the ambulance has left the scene and gone to the hospital. There may be more needed from us. Now in the smaller events, when it's three or four people shot, that's a lot easier to manage, but in the larger events where you do have a true mass casualty incident, the hospital may need assistance from us in ways that we hadn't thought about ahead of time, and Adam, to your point, does emergency management even know to bring that up and coordinate that planning? Because if there's one thing EMS is really good at doing is pulling people together to lay out the plans and to have those conversations, and I think that can save a lot. Well gentlemen, thank you very much for.
Everyone:
Thank you.
Bill Godfrey:
The time and the passion on this topic. I wanna say thank you to our producer Karla Torres, and if you haven't liked or subscribed to the podcast, please do so wherever you consume podcasts or if you're watching on YouTube, give us the subscribe thing. If you have some questions for us or topics that you'd like to suggest, please email them to info@c3pathways.com. So it's info, I-n-f-o, @c3pathways.com. Thank you guys for being here. Again, please tell everybody that you work with about this. This doesn't work unless we get the message out. So pass it along, include people you know, send the links out, and until next time, stay safe.