Emergency Response Search and Rescue

Experience

My role in FEMA Urban Search and Rescue (US&R) eventually developed to the point that I began FEMA US&R Medical Team Specialist training in 2016. My mentor, Scott McKenney at the time, had led these courses since the late 90s and had trained most of the US&R medical personnel across the country. I worked with Scott for years to ensure our team’s commitment to the System (National Urban Search & Rescue) and that our responders did not stop training with his departure. His lessons of service, semper gumby, and always leaning forward inspired me step forward to take over the program once he left.

When this course was first developed, it was by doctors and paramedics who responded to major earthquakes domestically and internationally. Each subsequent year and disaster added to the lectures and skill stations of the course. My first 50+ hour, 5-day course in 2003 focused on treating victims trapped under a collapsed building, how to ensure team health, and attending lectures on bomb blast injuries. By 2005, lectures included chemical, biological, radiological, and nuclear materials. We were taught to recognize potential agents by identifying signs and symptoms. Additionally, each new year brought new information pertaining to team health and patient management.

An updated course was rolled out in 2016—but was not without controversy. With over 20 years of adding lessons learned from the major disasters which now included Hurricane Katrina, and the international responses of Haiti and Fukushima, the members of the rewrite committee were challenged to reduce the heft of the course while retaining the most important information. Lessons deemed “less important” were moved to an online pre-course. The committee also wanted to ensure that all vital medical team information continued to be taught. During the committee’s debates, I witnessed firsthand the passion, heard the arguments, and watched multiple members walk away or be replaced.

This project had a budget and a deadline through Texas A&M Engineering Extension Service (TEEX) contracted by FEMA US&R Branch. Three US&R members were selected for the rewrite with three reviewers. The parameters of the class were clear: 13 hours online of pre-course work and 46 hours of in-class sessions over the course of four-and-a-half days. Instructors were directed to utilize the power points provided. They could add to them, but not delete any information.

As the lead, one of my roles is to select an instructor cadre. I aim to choose seasoned SMEs and urge them to continue developing their lectures. In my view, it is critical to shorten the learning curve of our newest members in the System by giving them lessons which have been in use for over 25 years. Awareness of best practices and how to avoid the pitfalls of disaster response is crucial in developing 28 teams across the nation who can be expected to operate seamlessly.

Two Medical Team Specialist courses are sponsored annually with a $90K grant each to cover costs of expenses. TEEX and two other providers offer this course on an equivalency status to paying students. This course has a very high instructor to student ratio ensuring student safety, as many of the manipulative skills are completed under live rubble piles. To maintain consistency of the course, I utilize instructors who teach with the other programs.

Due to the needs of the System and other US&R teams, we have permission to allow non-FEMA US&R team members in class. With the class designed to have 3 groups, our class doubles this to 6. This adds to the complexity of four hours on a travel day and four days with 10.5 hours of structured time for 46 hours of instruction. To support trainers and trainees and staff, we provide breakfast, lunch, and dinner on site to keep the classes moving.

I have led four of these sponsored courses since the rewrite and have taught four equivalent courses. As we have a new rewrite in the works, this is the feedback I provided:

· Students are not retaining the online material. My instructors have relayed they spend time reteaching material from the online portion.

· Put back the full extra day due to students needing time to absorb information. A 10.5-hour instructional day is a 15-hour day to include breaks and meals. Extremely long days do not allow the students to decompress at the end of each day and network, a critical component for success for future missions.

· Add continuing education module to include skills refresher and latest deployment lessons

· Add a module for Medical Team Managers and coordinators. Currently, this course does not cover medical cache maintenance, day to day operations, and deployment management.

Given the physical and mental difficulty of this training, it is rare to get complaints. The students understand the relevancy of the material and witness the round-the-clock efforts of the instructors while being rewarded with a new set of skills for medical disaster response. They leave with a sense of accomplishment and appreciation of the facts and issues regarding an entrapped patient. My own understanding of how much I did not know after my first class is what prompted me for years to shadow this course on my own. I have opened this course to 4-6 volunteers a year to shadow. I cover their room and board. This has allowed me to continue developing instructors while being cost effective with the budget.

Earlier this year after the pandemic hiatus, we hosted a course. I received multiple complaints this time. It quickly became apparent that the main issue is that our equipment is outdated. To run a high-level course, the best tech should be available—especially for a tech-savvy generation. So trainees had a very valid point. We do need to keep up with training equipment that models our front-line cache. Unfortunately, the $90K does not stretch far enough to cover durable equipment replacement. To address windfalls like this, course funding has been supplemented with cooperative funds thanks to the support of my team, CA-TF4. The previous Program Manager stated he was willing to utilize training funds from our team because we need other disciplines to assist with course management. We developed our own opportunity to train our logisticians in cache transport, base of operations set-up, and equipment accountability. Communications brings radios and develops a comms plan. Canines are involved in being treated and locating victims during the night exercise. Team members volunteer to be victims on the night exercise. And the night exercise developed into a coordinated effort to have a Disaster Medical Assistance Team on-site to receive patients. Still, the bottom line remains: we need additional funding to ensure this course remains relevant.