The United States Fire Service has seen many changes in the last century. The most recent positive changes are the development and production of new thermal-imaging equipment and personal firefighting gear that many users say is the safest money can buy. The principal effect of these equipment upgrades has been less economic damage and a drastic reduction not only in the number of fires that have to be fought but also in the numbers of deaths and injuries caused by fire. Those reductions are affecting the potential staffing of many fire departments that are not dual-trained to provide EMS (emergency medical services) transport. It is time, therefore, to take a close look at what seems likely to be the next big change for the fire service – namely, the gradual but increasing shift to all-hazards response capabilities, including but not limited to public-health emergencies.
The Town of Sandwich, Massachusetts, the oldest on Cape Cod, is about 60 miles south of Boston, the state capital. The Town’s fire department and local Board of Health agents were discussing a recent public-health emergency event at a local high school and started a dialogue about the planning needed for joint responses to future all-hazard public-health emergencies. The Sandwich Fire Department is a 40-member full-time organization that not only fights fires but also provides advanced life support EMS transport services for the Town’s 24,000 year-round and 55,000 seasonal residents. The land area of the Town includes the approximately 20 square miles that make up the Massachusetts Military Reservation, so military awareness is part of everyday life for the year-round residents.
The Town’s Board of Health Agent, David B. Mason, told Fire Department officials in June 2005 that a new federal mandate would soon be issued on the establishment of new Emergency Dispensing Sites (EDSs) that would be used to distribute various types of antidotes or vaccines during or in the aftermath of future public-health emergencies and/or WMD (weapons of mass destruction) terrorism attacks. Mason was aware of the National Incident Management System but did not know specifically how it would apply to EDS response operations. However, after Fire Department Chief George P. Russell was notified of this probable future need he detailed a fire prevention officer, John J. Burke [the author of this report], and a local EMS director, Jason Viveiros, to work with the Health Department in developing an All-Hazards Public Health Response plan that would include Fire Department and Police Department involvement.
PODs, EDS, NIMS, and a Drive-Thru Format An EDS working group was then formed and it was decided that the site used for the Town’s annual flu clinic would probably be the best venue to be used to test the pandemic-response plans. During that test, the Town’s citizens would come to the clinic to receive their annual flu vaccine (issued by the Board of Health); the EDS working group would be assigned full NIMS roles and operate as they would at a medical point of distribution (POD) site; and most of the shots would be administered in what is called the “Drive-Thru” format. The clinic site was selected and workable traffic and pedestrian plans developed. During this planning period the working group noticed a couple of areas of concern in the master plan. A unified-command post would be needed, for example, but the church that was being used for the dispensing of the flu vaccines did not have adequate command-post capabilities. The Town therefore had to find an alternate support facility to assist in the overall exercise.
The land area of the Town includes approximately 20 square miles that make up the Massachusetts Military Reservation, so military awareness is part of everyday life for year-round residents
A call was placed to the Massachusetts National Guard Bureau’s 267th Combat Communications Group to ask if assistance could be provided in the areas of command-post operations and communications interoperability. Colonel Anthony Schavi of the Massachusetts Military Reservation agreed to the request, and the exercise was given the name “Operation CAMCO” (Civilian and Military Cooperative Operation). Fortunately, the 267th CCG already possessed a JISCC (Joint Incident Site Communications Capability) system – which, it is worth noting, had been successfully deployed both during Hurricane Katrina and in Operation Iraqi Freedom.
The 267th CCG, which also has been assigned a domestic homeland-security mission, agreed in addition to provide not only the communications-infrastructure support needed but also the command-post quarters – at no cost to the Town of Sandwich. The JISCC system was funded in the aftermath of Hurricane Katrina, when millions of dollars of DHS (Department of Homeland Security) funds were allocated to the establishment of JISCC units throughout the country (there are 92 JISCC units operational throughout the United States, including at least one in every state). The units are sized and structuredentically, and operate under the same guidelines, so if any unit is deployed as a back-up in another area of the country already familiar with JISCC units there would be few if any interruptions in operations.
A full-scale exercise to test the CAMCO capabilities was scheduled for 14 November 2008. The command post was manned well ahead of time and at 12:00 noon the clinic opened. The clinic saw 1,000 residents come through in the following seven-hour period – about two thirds of them taking advantage of the “drive-thru” option. The ICS command structure was run by the Fire Department and Health Department, with their military counterparts “shadowing” the various ICS (Incident Command System) positions to learn the operational styles of the public-safety civilian components.
The local health agent served as the Unified Incident Commander, and received the full support of the public-safety chiefs. Because of my own affiliation with the Barnstable County Type III Incident Management Team, I was assigned as the Operations Section Chief (OSC). Members of the Public Health nursing staff who ran the various dispensing sites – including the drive-thru and indoor vaccination stations – served as division/group supervisors. The advantage of having a qualified Type III OSC is that the division/group supervisors could feel confident in trying out and testing the ICS terminology and their newfound supervisory status with the full knowledge that a qualified person was monitoring and advising so that no major mistakes would be made. The benefit provided by this close supervision turned out to be a key factor in the successful training of the public health staff.
Military Contributions Key to a Major Success The Military JISCC unit provided interoperable communication support and real-time video feedbacks both to the base and to George Mason University (GMU) in Virginia (just outside of Washington, D.C.), where a “Doc in the Box” scenario was established to have personnel at GMU evaluate the simulated flu-shot “victims.” This VTC (Video Transmission Capability) component was able to demonstrate the “reach back” capability of the JISCC unit and allowed the JISCC team to accurately test a real-world situation with real-time consequences. The JISCC unit set up the command post with 10 computer work stations, each of them with full internet capability, and provided fax and printing services as well. The incident commander thus was able to work in a secure and tech-savvy environment at the actual site of dispensation – remaining at all times, though, in full communication with the State of Massachusetts’s Emergency Management Agency and Department of Public Health.
The exercise proved to be a major success – on many levels. The exercise showed that military support components could fold into a civilian organizational response structure with relative ease and provide critical infrastructure support. The Public Health agents participating were able to practice their ICS roles in a real-time setting – with the full support of and backup from more knowledgeable ICS public-safety leaders. The Public Health responders said they were particularly appreciative of the opportunity to apply all of their own ICS training to a real-world situation. The Fire Service was able to almost literally reinvent itself by taking the lead on an All-Hazards Public-Health event and show the public that its time-honored role as a “hoses and band aids” department is rapidly and successfully evolving into a new role – as an agency fully qualified to meet the dangers of the 21st-century world of bioterrorism and weapons of mass destruction.
The members of the Sandwich Fire Department have a newfound knowledge and appreciation for the potentially disastrous events that could strike at any time. At the end of the day, it was encouraging to see a Unified Command truly live up to its name: unified not only in its title but also in the planning for and execution of an incident action plan. In short, the exercise proved to be a potentially historic turning point for the local fire service to evolve into much more of an All-Hazards-Response organization.
John J. Burke
John J. Burke, a longtime employee of the Sandwich Fire-Rescue Department, received a bachelor’s degree in Fire Science from Columbia Southern University. He is certified in all levels of the National Incident Management System and nationally certified as a firefighter I/II, a fire inspector I/II, and a hazardous materials operations and incident safety officer. He has many other professional qualifications in the same fields and serves as an adjunct professor at the Center for Health Care Emergency Management at the Boston University School of Medicine. He also is author of the Town of Sandwich’s Pandemic Preparedness Exercise.