Raritan Valley Emergency Services Consulting & Education

Every EMS call is subject to review. Multi-casualty incidents (MCI), like the recent ditching of a US Airways jet into the Hudson River, are no exception. Because MCIs involve many victims and a host of first responder agencies, MCI “after action” meetings are essential.  Following the Hudson River incident, the EMS responders – local, county and state – shared several meetings to discuss the MCI and how plans and procedures worked – or didn’t.

The incident could have been catastrophic. On January 15, minutes from take-off at LaGuardia Airport in New York City, a US Airways pilot made a perfect landing into the Hudson River after losing power in both jet engines due to bird strikes. The plane ditched in the water adjacent to Weehawken, NJ, carrying 155 passengers and crew.  Because the airplane did not break apart, it floated twisting and drifting south in the current. Within minutes, passengers were evacuating the plane, climbing onto the wing to await rescue.

The airplane landed in the backyard, so to speak, of Gio Ahmad, captain of Weehawken EMS, who immediately established the EMS Branch.  His protocol was to notify Mickey McCabe, the Hudson County OEM-EMS Coordinator. In addition, Ahmad ordered all Weehawken ambulances to stage and establish a casualty collection point at the Port Imperiale Ferry Terminal at the waterfront. Arthur’s Landing, a restaurant situated downriver, was established as another staging area.

Following protocol, McCabe activated the County OEM Coordinators and the NJ Department of Health & Senior Services EMS Strike Team asking for six strike teams, four task forces and three MCRUs or mass care response units. (The strike teams, organized by the County OEM-EMS Coordinators comprised five BLS ambulances; the four task forces comprised four BLS ambulances and one ALS unit. Each MCRU can treat 100 patients.) McCabe soon joined Ahmad at the ferry terminal.  Because of the scope of the incident and initial thoughts that it was going to require a large EMS response, the regional staging areas at the NJ Meadowlands (north) and the PNC Arts Center (central) were activated. Within minutes, strike teams and task force assets were dispatched, some directly to the scene and others to the two staging areas. Units in other counties were ordered to convene, but stay in their respective coverage areas. (McCabe ordered responding agencies to ensure coverage of their areas while they were out of town.)

So far, so good. The plan was working. All three tiers of response were in play: Local, county and state. But minor glitches immediately beset the players, causing some surprises and challenging the plan.

Luck Plays A Hand

ICS is a structure which all first responders should know like the back of their hands. It’s a simple principle: a chain of command with specific jobs.

But the outcome of this disaster did not depend entirely on ICS. In fact, luck played a strong hand. Fortunately there was:

• A crackerjack pilot with years of experience who carefully executed a perfect touchdown into the icy Hudson River, bringing the 50-ton airliner in on a soft, nose-up landing. Consequently, the airplane did not break apart, but floated more or less intact long enough for passengers to get out alive.

• An older, well-seasoned airline crew who executed the emergency evacuation plan with tremendous skill.  As water flowed into the airplane floor, passengers were directed to grab seat cushions (floatation devices), put on life vests and move toward the front of the airplane where emergency exits were opened and life rafts were deployed. Others stepped out onto the wings. As one passenger said afterwards: “It was a mess, but it was incredibly orderly.”

• An instant marine response by skilled captains and crews: An ad hoc flotilla of ferry boats, tugs, charters, tour boats all immediately maneuvered their way to the downed jetliner. 
  NY Waterway captains had been preparing to make the 4 p.m. run when the airplane ditched and they spotted it. “We made a beeline,” said one captain. The first ferry reached the floating jet within four minutes of its landing. The airplane’s front doors had blown out and passengers were scurrying out onto the wings. Deckhands on the vessels immediately began hoisting people from the water, all the while coping with the river’s shifting current. “You train so much, you don’t have to think about it,” said one boat captain. Other vessels included the NYPFD, the Port Authority of NY/ NJ, the NY Circle Line, commercial tugs, private boats and the US Coast Guard.
• The incident had a relatively short duration: The entire rescue operation – getting passengers and crew off the airplane and on to shore – took no more than 90 minutes. Everyone was off the airliner and on dry ground by 5:30 p.m.  “We couldn’t fully ‘stand-up’ because we were immediately ‘standing- down,’” quipped McCabe.

EMS Response: Good, But…

Now what about NJ EMS and its response? Did plans and procedures work? 

“Things went very well,” said task force coordinator Henry Cortacans during an after action meeting in Bayonne ten days later, “but we get no High Fives.” The players present – state task force, county and local EMS responders – concurred.

What went wrong and how could those pitfalls be averted next time?

The strengths of the rescue were obvious: an immediate response by local, county and state EMS. The state’s Emergency Support Function #8, (ESF#8), which provides for the coordination and direction of EMS resources in large scale incidents, was activated and EMS resources were coordinated through county OEM-EMS coordinators.

In addition to ESF#8, three major plans were activated. They were:

• The NJ Ambulance Strike Team/Task Force and its Deployment Strategy for EMS strategy calls for customized response teams, e.g., task forces, strike teams, or single resources such as MCRUs, which meet the specific needs of the incident.
• The Port Security EMS Annex: A two-mile stretch from Newark Airport to Port Elizabeth (adjacent to NYC) has been designated by terrorism analysts as “the most dangerous two miles in America.” Three months before the landing in the Hudson, the NJ EMS Task Force had reviewed this annex to address the objectives for EMS during the first 90 minutes of a response. This entailed bringing agencies together which operated from both sides of the river and the agencies operating on the river, such as the US Coast Guard. In addition, part of the plan had been tested in November at a drill in Atlantic Highlands. One scenario in the plan: A catastrophic event taking place in the water which called for the Imperiale Ferry Terminal in Weehawken as an area to be used for EMS operations. 
  “On January 15, everything Weehawken EMS did was written and executed in the plan,” said Henry Cortacans, complimenting the volunteer squad.
• The NJ Statewide EMS Staging Area Management Plan identified a location in each of Jersey’s 21 counties for staging areas. Written by the NJ EMS Task Force, this plan also developed training for Jersey EMS providers, both BLS and ALS. (Printed in the 2008 fall issue of The Gold Cross. )

The response plans had credibility, i.e., they made sense for buy-in from different EMS agencies.  They were flexible and allowed for deviation, like an algorithm. “...the optimal approach is to have adaptable preplans that will fit almost any situation,” wrote Henry Cortacans and former task force planner Devin Kerins.  “For this response, the organizations impacted by the disaster were familiar with the incident plan,” said Cortacans. 

Many of the ambulances that responded were volunteer. (See page 21) “We couldn’t have done it without them,” said Mickey McCabe later.  “In operations like this, our relationship is essential.”

“The response went well,”concurred Dave Schimmel, NJSFAC Mobilization Director. “We dodged a bullet. There were no critical patients.”

Time For Fine-Tuning

Incredibly, no one died, and injuries were minor. Between the local, county and state EMS agencies all the victims coming to New Jersey were well taken care of: 22 were transported to local hospitals primarily for mild hypothermia and some minor injuries including lacerations, bruises and broken bones. (HERN or the Hospital Emergency Response Network was used to notify northern area hospitals in order to account for hospital bed availability.) The other victims, not really considered “walking wounded,” were persons without complaints (other than being wet and cold) who just wanted to go home. (In the triage system these victims would not be tagged “green” but “white.”)

But no plan is perfect and the after action meeting provided the opportunity for fine-tuning. What improvements would strengthen the plan for the next disaster?

Communication, as always, was a major glitch.

• Within minutes of being contacted, REMCS, the state’s northern regional EMS communication system, put in a call to New York City OEM for more information. The problem that afternoon was no one picked up the phone. “New York took a lot of time to acknowledge,” Joe Burlew, the REMCS EMS Coordinator said. “There was a lack of information coming from them.”

Subsequently it was learned that NYC OEM was overwhelmed, hampered by a large call volume coming  all at the same time. New York had its hands full and couldn’t answer the phone.

• There was also a disconnect between rescuers on the shore and rescuers in the boats, e.g., the US Coast Guard, NY Waterway, etc. 
  Almost every city, state and federal agency that works the waters around NYC was involved plus the commercial ferries. Subsequently there was a flotilla of rescue boats delivering patients to three different locations:
• Approximately 40 patients were delivered at the Port Imperiale Ferry Terminal in Weehawken. The NJ EMS community was there to meet them.
• Because of radio problems, (see below), NJ EMS Incident Command was unaware that the US Coast Guard had taken a group of uninjured victims to the staging area at Arthur’s Landing. Chilled victims there were wrapped in cooks’ aprons and tablecloths which were appropriated from the restaurant. The owner served hot soup and coffee. Strike team ambulances and task force resources were there within minutes of notification.
• In the middle of the rescue, NYC OEM notified the Hudson County EMS Coordinator that 80 patients were being taken to a staging area in Manhattan!
•  
  The Remedy: Review radio and communication protocols with the US Coast Guard, which has jurisdiction in the harbor, to assure standard communication in future incidents.

However, some communications worked well and should be validated. The newly-deployed 800 MHz radios of the NJ EMS County Coordinators and the NJ EMS Task Force allowed for seamless communication using the NJ State Police radio network. This allowed the county coordinators to relay their needs to REMSC as well as effectively coordinate needed EMS resources.

• Because of the geography of the area where the airplane ditched, VHF from point-to-point radio transmission between responders at Arthur’s Landing and the Imperiale Ferry Terminal inside the response area was poor. Weehawken is situated on the Palisades of the Hudson River, opposite midtown Manhattan, to which it is connected by the Lincoln Tunnel. The town is divided into uptown, downtown and the waterfront, all at different elevations. The rocky cliffs provide an approximate 300 foot difference between the highest and lowest elevation. Due to the proximity of the rocky cliffs and the body of water, radio wave transmission was poor for direct point-to-point communication.
• The Remedy: The NJ EMS Task Force recommended that a communications specialist be assigned to the advance task force team. That person would immediately facilitate communications for the incident which in this case would have required boosting the power and increasing the range of the radios. This incident would have had better communication early on had a mobile repeater on a portable trailer been parked at the terminal.
• There was a cache of portable radios stored by the task force in a vehicle kept outdoors at UMDNJ in Newark. The cache consisted of compatible systems supporting VHF, UHF and 800 MGHz radio communications for immediate use. The problem: the radios were dead, their batteries not functioning because of the persistent cold snap they had been exposed to this winter. But a back-up plan already existed with another cache in Hudson County. “This is why contingencies should be in place for critical resources,” said Henry Cortacans.
• The Remedy: Besides the aforementioned contingency cache, the UMDNJ radio cache has been moved indoors and will be placed on the response vehicles.
• Another communications problem endemic to disasters: Radio chatter. 
  Too many people were talking on the radio who had too little to do with the ICS structure.
• The Remedy: “Talk less!” suggested Kevin Hayden, NJDH&SS EMS Task Force Director. “Maintain radio discipline. Only incident commanders should be communicating with the dispatch centers during a disaster.”

• Access. Another common pitfall at disasters and now one being acknowledged in disaster plans. At the waterfront, ambulances had limited access to the Port Imperiale Ferry Terminal transport staging area as fire, police, onlookers, and the media had blocked the route with their vehicles. 
  “We couldn’t get an ambulance to the front of the building,” said Mickey McCabe. To make things worse, “everyone had locked their vehicles and walked away,” he said.  Because ambulances had to park outside the pack of fire and police vehicles, EMS providers had to “hump” equipment further than they would have as well as load patients further away from the terminal entrance.
• The Remedy: “Valet parking,” McCabe joked later.
• Better yet, keep responding ambulances at the staging area and send only what is needed. The staging plan had already taken that into account and when ambulances got to the terminal, they had limited access to patients, but access nonetheless.

• Unified Command: One problem which beset the operation was the lack of immediate unified command. ICS calls for heads of police, fire and EMS to be physically in one place. 
  “We were dealing with unknown entities,” said McCabe later, “and initially we needed to get a grasp on the situation. We then needed to get everyone out of the water. Effectuating unified command was postponed while rescue was carried out and passengers and patients were accounted for. Then we were downsized and the operation was over.”

• Patient Resources: Wool blankets were needed for hypothermic victims and some squads were carrying caches. (Reflective blankets were found to be ineffective.) The US Coast Guard and other rescue boats distributed what they had stored onboard. Many victims walking off the ferries were barefoot because they had shed their sodden shoes and socks. (Several EMTS gave victims their own socks.) The after action group addressed the need for caches of patient care items for cold water rescues, such as blankets and slippers.

The Importance Of Relationships

At the end of the after action meeting, Mickey McCabe emphasized the importance of not only practicing the plan, but knowing the players.

“In this incident, knowing one another was vital,” he said. “The chain of command was easily followed because each person in the link knew one another and trusted each other.

“It was also a great relief to know that we had the plan and more importantly, the resources to meet the challenge and everyone knew his part.”

He also emphasized the importance of drills.  “Although it can be argued that these drills sometimes fail to accomplish our goals, the interaction with other rescue personnel from other agencies is invaluable. Putting names to faces, especially when in a command position, is priceless.”