Ep 82: Transport Group Supervisor
Episode 82
Published May 27, 2024
Last updated Feb 18, 2026
Duration: 20:51
Episode Summary
Having ambulances to transport patients is just one job of the Transport Group Supervisor. Working shoulder to shoulder with Tactical and Triage, Transport is a vital component of saving lives.
Episode Notes
The Transport Group Supervisor is responsible for more than just calling ambulances and getting them to the scene. In today’s episode we discuss the issues that arise when considering ambulance exchange points and transportation and the need for collaboration with tactical and triage.
View this episode on YouTube at https://youtu.be/GwRFhW7yHrg
Transcript
Adam Pendley:You know in our active shooter incident responses that we are going to have to have ambulances on the scene to transport patients, but there's more tasks that need to be done in the importance of the transport group supervisor. That's what we're gonna talk about next.
All right, welcome to the National Center for Integrated Emergency Response. My name is Adam Penley, I'll be hosting our podcast today. With me today is Bruce Scott, welcome to the studio.
Bruce Scott:
Thank you, Adam.
Adam Pendley:
Yeah, Bruce has got over 30 years in the fire service
Bruce Scott:
Yep.
Adam Pendley:
and will be able to add some to the conversation, I hope. And Kami Maertz, law enforcement background.
Kami Maertz:
Yes.
Adam Pendley:
Yeah, and so welcome back.
Kami Maertz:
Nice to be here. Thank you so much.
Adam Pendley:
Yeah, nice to be back. So we're gonna talk a little bit about, as we go through the checklist on the active shooter incident management, in this process, we know that as we build the response, we get those contact teams in there, they push towards the active threat. At some point we're building a casualty collection point, and we have the fifth officer concept or the fifth man concept, where you have that tactical group supervisor that gets close to the scene enough to control what's going on, to give direction to those follow-on resources. But then we talk a lot about tactical, triage, and transport. So that triage group supervisor and that transport group supervisor come down range, and they work shoulder-to-shoulder with tactical. And we kind of have talked a lot about the importance of tactical and triage working together. But let's talk a little bit about the transport group supervisor. Bruce, what do you think?
Bruce Scott:
I can tell you that I think that having the transport group supervisor co-located with triage and transport is critically important. Oftentimes it gets overlooked, if I can be honest, it's one of the last positions filled, it seems like, if people are doing it right. But they have a lot of responsibility to make sure that we're getting the wounded off to a medical facility pretty quick, right? Responsible for coordinating the ambulance movement, if you will.
Adam Pendley:
Very good, so if you're working that tactical position on a critical incident or an active shooter event, what's some of the information you would look to your transport group supervisor to help you with?
Kami Maertz:
So I'm gonna wanna know, obviously, what's gonna be an ideal situation or ideal location for the ambulance exchange point, and where that's gonna be is going to determine how many security element I need and all of those kind of things. What I'm gonna need for a corridor possibly, depending on the location to the casualty collection point to the ambulance exchange point. And also how many ambulances we have on standby to come and pick up patients to know that, what is the recall on that? How many do we have going down? How many do we have coming back?
Adam Pendley:
Excellent, so, and I think, you know, we talked about those contact teams that come in, and I know one of the things they initially report is how important that injury count is. And it doesn't necessarily have to be exact, and it doesn't have to necessarily even be whether they're serious or minor or red or green at this point, but saying that you have 8 or 10 down and then five more down as you continue to move through the building from a fire EMS perspective, how important is that early intelligence?
Bruce Scott:
Adam, that falls directly on law enforcement to give us an idea of the amount of resources we are gonna need to not only treat but also transport, right? If you start stacking a lot of patients in one ambulance, the paramedic in the back can only take care of one critical patient most likely. But we have a habit oftentimes, because we want to get 'em off the scene, that we stack too many folks into an ambulance, if you will.
And so I think it's really important that we understand that, to Kami's point, that you, number one, know the count, right? And then that law enforcement gives us that count pretty quick. And then lastly, from law enforcement as a transport group supervisor, I would want to know, does she have security elements in place at our ambulance exchange point before we ever move an ambulance?
Adam Pendley:
Absolutely, so if you look at the checklist, I mean, most of our areas, the different jobs that have to be done, always start with that, get a verbal briefing. And it's likely that triaging and transport group supervisor may be moving downrange together to meet with tactical, or they may come separately. If they're first arriving, what are some of the things you're gonna brief them on?
Kami Maertz:
To let them know at least, what are our patient numbers? What are our, like Bruce mentioned, it's gonna be important for how many critical patients to go into each ambulance. And so they, depending on the numbers, depends on the amount of ambulances. They can't put too many reds inside one ambulance. So that number's gonna be very important for them to know so they can start making the hospital counts and everything. So that's gonna be the first thing that I'm going to do, is let them know where the casualty collection point is so they can start getting an idea of where a good ambulance exchange point's gonna be and also what type of patients that we're looking at currently.
Adam Pendley:
Absolutely, and I think we've hit on this already, is that they have to be co-located, right? I mean, tactical triage and transport have to be standing side by side.
Bruce Scott:
100%. You mentioned that they may be going down range at the same time. So your initial briefing will come from your tactical group supervisor, right? So not necessarily your triage group supervisor giving you the latest intel, but law enforcement's first contact teams giving us an estimated account of injured people would be what we would need during that briefing.
Adam Pendley:
Absolutely.
Kami Maertz:
And with the tactical group and the transport, another good thing that I forgot to mention earlier is that when we're talking about that kind of tag and go response, that's a really good thing for the tactical and transport group to be saying, "I have an ambulance going down," so that tactical response can relate to the RTFs, so that we're not just stacking patients at an ambulance exchange point, that we're holding them in casualty collection point until that ambulance exchange or that ambulance is on the way, and we're moving that patient at the time. Because we often see in trainings especially that people like to just stack everybody at the ambulance exchange point. Now we've created a second casualty collection point really there.
Bruce Scott:
Another security issue.
Kami Maertz:
Absolutely, and so that's another important thing for our tactical and transport to be talking about.
Adam Pendley:
Yeah, absolutely. And we know in many of the agencies that we see the fire service and the medical part might actually be part of the same agency. And so these might be two officer types that work together a lot. But we go to a lot of areas where EMS is a third service, right? So what are the challenges of getting co-located and getting that work together started in those areas that you've seen, Bruce?
Bruce Scott:
Anybody that's ever heard me talk on a podcast or anywhere else will tell you that I preach you do training beforehand, right? You have had to have those previously established relationships, and that makes things go a lot simpler. If I'm trying to meet you at an incident, there's a good chance that our policies conflict, right? So we need to have those conversations, we need to have a policy in place, and we need to have trained to that policy.
Adam Pendley:
Right, and I think, unfortunately, we have seen in some instances where, an EMS service, they set up their own kind of little command area and their own staging and they're separate from the rest of the response because maybe they're just pushing ambulances. But again, it's just one part of the checklist, but really driving home the idea that tactical, triage, and transport have to be co-located in the same way that you have to have representatives from law, fire, and EMS even in the command post a little further up range, but you need them down range working together to make those critical decisions. Because I think you already hit on it, Bruce, but like, just something as simple as determining routes. What does that mean?
Bruce Scott:
Yeah, I mean, if you're not careful, you could send ambulances to the wrong place, through a potential hot zone. We need to have those conversations with our tactical group supervisor. "Hey, what's the best way?" Not only where the ambulances are going, but how they get there, right? We wanna make sure that we're not putting those ambulances unnecessarily into harm's way.
Adam Pendley:
Right, absolutely, and then this idea of a separate radio channel. You know, we were kind of chatting about that earlier, like what are the advantages and disadvantages of potentially putting transport on their own radio channel?
Bruce Scott:
Well, anytime you split channels for any reason, it just becomes a little more complicated, right? Somebody's got, your command post needs to be listening to multiple channels. Obviously your staging needs to be listening to multiple channels. So it adds just an extra degree of difficulty. However, if you feel like you need to split channels, Adam, I think honestly that's your low hanging fruit, your transport group supervisor. Flip over to channels, he can give direction to the ambulances, and that takes him out of the conversation of what moving the rescue task forces, and those conversations that are happening real time, right?
Adam Pendley:
So I think, Kami and Bruce both, kind of in the area that we're familiar with, there are kind of a lot of hospitals to choose from. We have a lot of medical facilities to transport people to. But the next thing on the checklist is to get those hospital counts, and not all, you know, I think we've told the story before of one of our other NCIER instructors whose brother was in injured in an active shooter response. And because of just the number of patients that were being transported, I think if we remember the story correctly, they got him into a police car and got him to a hospital, but he was turned away because they just didn't have the capacity to help address that injury at the moment. Now, that officer ended up being fine and everything else, but you know, what are some, how does that work in the hospital world?
Bruce Scott:
Alright, well first off, we need to find out what our hospital availability is, but keep in mind that's just a moment in time, how many patients they can take and the severity of those patients. However, that can change minute to minute, and our goal realistically is to get patients to the most appropriate medical facility.
So to your point, Adam, what happened there was they thought they were doing the right thing, they put him in an ambulance or put him in a police car, drove him to a hospital, and that place was already filled up with patients, right? So think about that. They've turned away a law enforcement officer that's shot in the neck and say, "Hey, you're gonna have to take him somewhere else." So we're trying, as a transport group supervisor, oftentimes that's your responsibility to try to get folks, for the most part, to the most appropriate medical facility.
Adam Pendley:
Right, so we've talked about this part already just in the conversation so far, but this idea of transporting patients from the ambulance exchange point, and you've talked a lot about like helping, the RTFs may help pick out a location, but you're also working directly with transport to understand the security needs and the routes to get to that ambulance exchange point. But from a law enforcement perspective, why can't we just send all 10 ambulances down to the ambulance exchange point right now?
Kami Maertz:
Well, 'cause obviously at this point we've created a warm zone pocket area, right? So we're still at a hot zone capacity, and anything could break into a second incident. We're still considering this area a hot zone. So what we don't wanna do is send all of our ambulances down and take the risk of an active situation happening and all of our ambulances being down range. It is gonna be the safest, and even for security to be able to meet the needs is to do it at least one at a time or as minimal as possible to get them in and out.
Adam Pendley:
Sure, one or two at a time. And now I've heard of best practice, Bruce, I wanna get your thought on this of, I know we have a staging area, that hopefully the staging area is fairly close, but can you start getting them, you know, can they start moving forward just a bit so that one or two in and out goes quicker?
Bruce Scott:
Yeah, I think that that's another instance that comes down to training and practicing with each other. I can honestly tell you that we talk about beating the clock, beating the clock, beating the clock, and they feel like if they stack those ambulances up in the ambulance exchange point, it's beating the clock. Where it's the seconds it really don't, can I say that don't really matter at this point. But to your point, if we could stack 'em close, where law enforcement has told me that it is somewhat safe, and then as one ambulance leaves, you bring another ambulance in. So getting 'em in and out quickly.
Adam Pendley:
Well, I think what what we're trying to say is that ambulances piling up on each other can actually add seconds. You know, like that those are the seconds that you're actually losing, you're not really saving them. So those are the, and I think there's some, and I like that you remind us all that, you know, that we're fighting two things, the criminal and the clock, and we do a pretty good job of addressing the criminal, but then things can sometimes bog down and we lose lives because of the clock. So, you know, always beating that time.
Alright Bruce, so now this might get into some different people's policies and medical directors' guidance and stuff, but on the checklist it says target three per ambulance, one red, one yellow, one green. Let's talk about that a little bit.
Bruce Scott:
Yeah, I think I mentioned it earlier that, you know, I was a paramedic for a long time. If you put more than one critical patient in my ambulance, that at that point, all my attention's gonna be focused on them. You put two, we're really not doing them any service at all. You know, we're giving them both a little bit. But it is a habit that we do because it's clock, clock, clock, we're just gonna stack 'em into an ambulance and get 'em off the scene, but we're not doing what's appropriate.
So, you know, what we teach in our text is put a red patient on the stretcher, take a yellow that's, you know, moderately hurt, that is stable, put them on the bench seat of an ambulance, and then a green patient, somebody that's just, you know, just a little bit injured, you could put them in the right front seat. Where I came from, our medical director refused to have anybody sit in the right front seat. And I believe that's what you're referring to, Adam, with policy.
So you need to think about patient care and think about policy and how you can merge those two things together. Are there exceptions to the rules at certain periods of time?
Adam Pendley:
Sure, absolutely, and again, that's all part of that pre-planning and training sort of thing. And you have to ask yourself, if you had an incident with 20 or more patients, and you know, and you're in an area that doesn't have a steady flow of transport vehicles that can get in there quickly, maybe you are going beyond the normal day to day, you know, standards if you will. But again, patient care and getting them to hospitals' the primary thing, because we talk a lot when we introduce this topic that, you know, a good paramedic can do a lot to extend someone's life on the scene, but at the end of the day, if you're shot in the main part of your body, you're gonna need surgery. You're gonna need to be in a hospital.
Kami Maertz:
Absolutely.
Bruce Scott:
Neck to navel, you need to be in the surgical suite.
Adam Pendley:
And again, we talked about this distribute to the hospitals, you know, again, once you have that hospital count, you're getting the patients where they need to be, but then this might often be overlooked as well. But from a law enforcement perspective, keeping a good transport log, maybe, if possible, even including the patient names, but at a minimum knowing exactly where all the hospitals that they were transported to, why is that so important to us on the law enforcement side?
Kami Maertz:
Well, for one thing, this is an investigation. So all of those people are witnesses. All of those people have been involved in this crime and are are victims or witnesses to this incident, and it's also going to change. We're gonna need security elements at each hospital that they were brought to. And so that's gonna be, for how many resources we have left are going to be distributed among those hospitals. And that's gonna be a big component for us.
Adam Pendley:
Absolutely, and in many instances that transport group supervisor is gonna get that call that we now have the suspect that needs to be transported. What are you looking for in that situation, Bruce?
Bruce Scott:
If I'm the transport group supervisor, I'm gonna turn around to my, you know, tactical group supervisor. I say we need a law enforcement officer to be with that ambulance when they're being transported. And another thing we could do, is it okay if we hook them up in staging? You know, in the staging area, Kami, is it all right if we take a law enforcement officer outta staging, put 'em in that ambulance, and let him move him or her move forward to that scene beforehand, again, help him beat the clock, but also provide for the security of our crews.
Adam Pendley:
Because you know, interestingly, and I understand why it happens a lot of times when, you know, when we're in training, we'll see downrange someone from that initial contact team wants to ride with a suspect. Well, the investigator might have an issue with that. If you've been involved in the officer involved shooting aspect, you probably shouldn't be riding to the hospital with the suspect. Remember that we have all those resources at staging that we can put a law enforcement officer in the transport unit and send them down range.
Bruce Scott:
And you know, another, excuse me, Adam, I think it's also important to note we would try to avoid having the suspect go to a hospital where any of our patients are if at all possible, right? Obviously for, you know, a lot of reasons.
Adam Pendley:
Absolutely, so I think, you know, as we start to wrap this up, the idea that it's more than just calling for the ambulances and getting them sent to the scene. I think the tasks, that if you're just looking at the checklist, the tasks the transport group supervisor has to do is more robust than that. But again, tactical, triage and transport working together I think is really the key.
Kami Maertz:
Yes.
Bruce Scott:
I would say, I'm sorry.
Kami Maertz:
No, go ahead.
Bruce Scott:
I was just gonna say we've preached this from day one. The only way we're ever gonna be successful on a critical incident is to be integrated. We have to be working together, and if you look through the way we do things with our checklist, at every position there's a fire, law enforcement, potentially an EMS person with them at every location. And we're not talking to each other on the radio, we're talking with each other face to face. And if you really want to talk about being successful, that has to happen.
Adam Pendley:
Absolutely.
Kami Maertz:
And having those resources not only at the tactical, triage and transport, but having it staging too, that triage, transport, and law enforcement personnel also at staging, those personnel represented there to be able to coordinate together of how many resources are on scene and reminding their tactical, triage, and transport how many resources they have and that flow. And to just make sure that you remember that that transport is such a vital component of saving lives. That it's not only just triage and tactical, that that transport is really who's going to save the majority of the lives, getting them in an off scene.
Adam Pendley:
Absolutely, and it should all happen in rapid succession.
Kami Maertz:
Yes.
Adam Pendley:
If you train to this process, you have those contact teams that go in, they address the active threat, then they identify casualty collection points. Shortly thereafter, triage should be, should understand where the RTFs are needed, that the RTFs need to go to these casualty collection points. Shortly thereafter, the RTF should be talking to triage about potential locations for a good ambulance exchange point. Transport should then be talking to staging about getting some transport units down this route into the ambulance exchange point, getting them off the scene.
And if you're in one of the management positions where you're cross-checking that these things are happening and you're not hearing those things happen in rapid succession, that's something you need to jump in and start getting fixed now, because we have seen too many times where, again, law enforcement, they want to get in there and deal with the active threat. You have the triage that's, for a variety of reasons, they're trying to understand where their more serious patients are. So a lot of talk about red and yellow and green patients and where they're located at, but then it stalls a little bit. That's oftentimes where we see the gap is between law enforcement and triage figuring out where the patients are located, getting the RTFs there, but then there's some lag time between getting that transport started.
Bruce Scott:
Right, and I think that kind of falls under the kind of responsibilities of the rescue task force that are in that space, right? If I was on a rescue task force, I would look to my law enforcement partners, "Hey, we need to be thinking about an ambulance exchange point that you can secure or law enforcement can secure that we can bring our ambulances in and out." And the faster we do that, and you know, downrange, I believe it makes all of that that you just mentioned go quicker.
Adam Pendley:
Absolutely.
Kami Maertz:
I think it's one of the biggest things that we see, especially in training, is that there is always that delay, that RTFs get on scene, they start treating, and then they consider the ambulance exchange, and it really should, as soon as they get on scene, you have created enough of a warm zone at that point to start that ambulance exchange process. And so that's when you do turn to your tactical guys and say, "We're here, we're ready, we have these to treat." They can start looking at the numbers, but get that ambulance exchange point started early, early on.
Adam Pendley:
Absolutely.
Bruce Scott:
100%.
Adam Pendley:
So let's wrap up, Bruce, what are your final thoughts?
Bruce Scott:
You know what I'm gonna say already, right? I mean, I say it all the time. Develop a policy. Whatever that policy looks like. Follow our checklist or not, but develop a policy, train all your partners to that policy so everybody's using the same policy, and then practice it, right? Because the only way we're ever gonna be successful really is if we do that, we have to practice.
Adam Pendley:
Absolutely.
Kami Maertz:
I think the main thing is just to remember that, you know, tactical's gonna do their job, triage is gonna do their job, but don't forget the element of transport. Don't let it be a second thought, it is just as important as the other components to get it all working in unison together.
Bruce Scott:
Well said.
Adam Pendley:
And again, I'm just gonna extend what we've said already is it's got to be co-located. Like all the other parts of the active shooter incident management process, we have to be co-located, shoulder to shoulder, working together.
So thank you very much for joining us today.
Kami Maertz:
Thank you so much.
Bruce Scott:
Thank you Adam.
Adam Pendley:
If you have not liked or subscribed to our podcast, please do so. We have multiple topics, we bring out new content every week. And again, I wanna thank our guests for joining us, and I wanna thank Karla Torres, our producer, for getting this all done. And until next time, thank you very much.
Bruce Scott:
Thank you.
Kami Maertz:
Thank you.