Long Island first responders simulate emergencies to test response, part of national trend of mass-casualty training

Matthew Pasieka spent five months preparing to simulate a disaster that could claim lives in a matter of minutes.

Pasieka, the vice president of the Islip Ambulance Chiefs Association, will join about 250 first responders Saturday morning for a mass-casualty incident training exercise at the Sayville Ferry Service. Local police, fire and EMS officials will have to save around 70 "victims" of a simulated explosion onboard a ferry following a boat collision, he said. When first responders climb aboard the stranded, smoking ferry from their rafts, they will tend to seemingly bloodied, prosthetic wounds of screaming, crying actors.

First responders and emergency medicine officials agree that it's not a matter of "if" they will encounter a mass-casualty incident — it’s a matter of "when."

"It’s inevitable. These things are happening," Pasieka said. "There are mass shootings, there are so many different things ... whether nefarious or by accident. We are taking our own initiatives to prepare to keep our communities safe."

Mass-casualty simulations, which range from school shootings to train derailments, occur several times a year in both counties, as well as throughout the country, at the request of first-responder agencies and hospitals. While some do it to fulfill accreditation requirements, others aim to ensure their teams understand their priorities and command structures during real-life cataclysmic events, experts said.

One of their challenges is making sure the community knows it's not real.

"We did personally go and knock on a couple hundred doors of the community and handed out letters explaining what's going on: ‘Don't be alarmed,’ ” Pasieka said of preparations for the exercise. "We're hoping nobody's calling 911 saying that there's a boat on fire out in the water, but it's almost inevitable."

Learning from simulations

While the Sayville Ferry Service routinely trains with local first responders for dangerous situations, from someone falling overboard to an active shooter, fifth-generation ferry service president Ken Stein III said a mass-casualty simulation is "the last thing that we haven’t done yet."

"We expect to learn something from this," Stein added. "Having one of this caliber will be sure to make us much better — God forbid something did happen."

Across Long Island, first responders and hospitals have been gearing up for mass-casualty incidents since before the real-life disaster that occurred on Jan. 25, 1990, when Avianca Airlines Flight 52 from Colombia crashed on the North Shore, according to Dr. Thomas Kwiatkowski, the assistant dean for simulation for Zucker School of Medicine at Hofstra University and Northwell Health.

Kwiatkowski, the chairman of emergency medicine at Long Island Jewish Medical Center when the 1990 crash occurred, said the hospital had trained for such an incident and successfully pulled extra staff and supplies into the emergency department to help several of the 85 survivors of the crash.

For the past four years, Kwiatkowski has sent first-year Zucker students to the Nassau County Fire Service Academy in Old Bethpage for a five-rotation gauntlet of mass-casualty simulations. While the training is not a requirement for students to earn their EMT credentials at the end of their first year, Kwiatkowski said it is the program’s "crowning achievement" that trains medical students for "what happens in the real world."

In one day, Zucker students rotate through active shooter, train collision, bus bombing, automotive entanglement and hazardous materials simulations, according to Paul Wilders, the chief instructor of the fire academy.

"What’s happening now in today’s climate ... we feel it’s our job to do whatever we can to review case studies, learn from them, create curriculum around it and deliver that message to as many of our volunteers in Nassau County," Wilders said.

While first responders prepared for mass-casualty events such as natural and transportation disasters for several decades, the April 20, 1999, Columbine High School shooting "changed the way we do things," said Brian Kohlhepp, an adjunct lecturer at John Jay College of Criminal Justice.

"From that, a lot of training rolled out for police departments on how to respond to active killer scenarios," said Kohlhepp, who also is deputy chief of the Ross Township Police Department in Pittsburgh. "Departments realized not just the importance of doing training, but doing mock scenarios and using large scale facilities, be they schools or shopping malls."

NYU Langone Health has incorporated lessons learned from the 2016 Pulse nightclub shooting in Orlando, Florida, and the 2017 Las Vegas mass shooting, according to Kelly McKinney, the network’s vice president of emergency management and enterprise resilience. During a mass-casualty simulation, emergency department staff are reminded that they must follow "a different way of working," he said. They cannot tend to each patient fully as they arrive and must make victims who are "not seriously wounded" wait.

"You get all these people and they’re all screaming and crying and moaning and they’re bloody," McKinney said. "The mission is to find the ones who are what we call a red tag, or a critical, who are bleeding to death, and get them upstairs and get them into surgery and save their lives."

Sharing critical information

When the EMTs from the five EMS agencies under the Islip Ambulance Chiefs Association arrive at the ferry station Saturday, they will train with firefighters from Sayville and other local departments, Suffolk police and state health, homeland security and police officials, Pasieka said.

Suffolk police will establish and lead an incident command center, just as they would during a real mass-casualty incident. From these stations near incident sites, police, fire and EMS leaders can receive radio transmissions from their respective boots on the ground and share critical information with one another.

"Generally ... it's impossible for the police to talk to fire, to talk to EMS, on the same radio channel," Kohlhepp said. This limitation, as well as a scarcity of communications equipment and the confusion of responsibilities among different agencies, were all critiques of the response to the Avianca crash, Newsday reported one year after it.

"You make mistakes and you learn from those, or things work out really well and it reinforces that as a positive behavior," Kohlhepp said. "When it comes to mass casualty or any sort of critical incidents, the best thing we can do to get better at it is to simulate it."

Many of the first responders gathered on Saturday will tend to actors onboard the ferry, while others will help actors who swam to shore or rescue mannequins stranded in the middle of the bay. Chiefs and medical directors will evaluate how EMTs at the scene triage and treat patients with "impalements, burns, blunt injuries, traumas," he said.

"When you do a big thing like this, there's many things that you test out," Pasieka said. "It's very complex and it gives a lot of opportunities for personal evaluation and individual agency evaluation."