Frank Patterson was one of the first responders on the scene of the West, Texas, fertilizer plant explosion and took command. He details how he navigated the chaos that night and what was learned.
We talked to John Pennington, director of the Snohomish County, Wash., Department of Emergency Management, whose eyes were forced to believe what he was seeing, and whose decisions helped guide the response and recovery efforts after a horrific mudslide.
Mark Spross directs the 911 center in Clackamas County, Ore. When a gunman opened fire in a local mall, it tied the county in knots. Much has changed — and improved — because of that day.
‘You Need to Take Command’
Frank Patterson recalls the aftermath from the West, Texas, explosion.The radio call on April 17, 2013, said “bombs going off, we need all the ambulances you’ve got.”
Frank Patterson, Waco-McLennan County emergency management coordinator, was on his way, but he was thinking it was a propane tank explosion.
When Patterson arrived on scene, he learned of the fire at the West, Texas, fertilizer plant and ensuing explosion and that people were dead. He asked about a command post. The response was, “You need to take command.”
He surveyed the area and saw doors blown off houses, windows blown out, collapsed houses. Debris was everywhere.
A call for mutual aid had already gone out and people were on the way. Patterson began setting up a command post at the dirt field. He asked a fire chief to take care of hazmat issues. He named a staging officer, a law enforcement person and a search and rescue person.
This emergency was a unique, no-notice event. There was no background on the situation, no warning. “None of us in command that night had any knowledge other than the plant was on fire,” Patterson said. “We are recreating the incident command structure based on what’s in front of us.”
The call about a fire at the plant had gone out at 7:29 p.m., and fire personnel arrived at about 7:39. The place exploded at 7:51. “In that 12 minutes, they had to make a lot of decisions, like whether to evacuate. That’s not a lot of time,” said Patterson.
During that time, there was an ammonium nitrate explosion that killed 15 people, including 11 firefighters, and injured more than 200. It also damaged or destroyed more than 150 buildings.
Patterson called it a CNN event — a flood of people from every direction to add to an already-chaotic scene. “The first thing we had was people flooding in from every open road,” he said. “Shutting down traffic became a priority, and it took 45 minutes to an hour to get our arms around that whole process.”
The challenge of the spontaneous responders, combined with inherent interoperability issues, made the situation overwhelming. “We had to patch people together. Some people had 800-megahertz systems, others VHF or UHF within our own county. So we’re patching and trying to convey that information, saying, ‘Hey, this is the frequency we’re going to operate on.’”
Over the years, the county has developed a system to patch all of that together. Patterson carries in his trunk a decade-old ACU-T Tactical Interconnect System. It’s become routine to patch in disparate systems, and they’ve developed templates for each system. The patching became second nature for locals.
“The issue here was, who was already on the scene, what were they operating off of and how do you talk to them if you don’t know where they are?” Patterson said. “There were 30 channels.”
The spontaneous responders kept coming and so did the wounded. Patterson had to stop the flow of responders and focus on the triaging process. He requested that the staging officer stop the traffic. “Just park them somewhere,” he said. “I just wanted them out of the way.”
Twice he called for resources to stop coming. Making decisions in the command post became chaotic with the presence of all the responders who wanted to help or to know something was being done.
“We made a lot of good decisions early on when nobody knew where the command post was because we were able to create the objectives, establish some strategies and start lining up people for the tactics,” Patterson recalled. “Once people realized where the decisions were being made, everybody wanted to be there.”
He realized that the command post had to be isolated, and if it’s not isolated, it needs to be controlled so that people can’t just walk up it to or through it. “We were trying to work on strategies, objectives — and people would just walk up and say, ‘Here I am.’ You’d have to stop, deal with that, then get back to business. Later we realized we should have had law enforcement barricade us in there, put tape around us or something to keep people from wandering in.”
Patterson finally requested a command trailer from which he would do briefings periodically, essentially yelling at the crowd. And that’s how it went for the rest of the night until all 262 patients had been transported.
“Until then I couldn’t even look up; the numbers were overwhelming,” he said. “That was the toughest thing. They just didn’t stop.”
The injured were transported in ambulances, helicopters, even buses.
Another lesson learned.
“We plan ways of notifying hospitals with the expectation that it’s all going to come from the hospital, but they’re going to present in different ways and that might be the first notice you get. An [injured] person might show up in an SUV.”
Social media was a problem and a lesson.
“We didn’t use social media. It ate us up,” Patterson said. “My wife, the next day, told me that if you’re not paying attention to social media, you need to. You need to get control of it.”
Information began circulating on social media about the number of dead and so forth. Reports were spreading of 60 to 70 dead and that plumes were moving toward Fort Worth 100 miles to the north. None of it was true.
Patterson said it’s vital for rural communities to have a public information officer on scene who is the face of the incident. In this case, the local mayor is also the PIO and a volunteer fireman. Command staff played musical chairs being the PIO.
It’s also important after the incident to have a PR person who becomes the voice of the command staff to blunt the criticism that will come.
Information Overload
Mark Spross, communications manager for Clackamas County 911 in Oregon City, Ore., said his 911 center changed the day of Dec. 11, 2012. At about 3:30 that afternoon, his dispatch center lit up as calls poured in about an active shooter at the Town Center mall near Macy’s.
The good news is that the sheriff’s department is located less than two blocks away and was on the scene quickly. Unfortunately it was too late for two mall shoppers. Cindy Ann Yuille, a 54-year-old nurse, died as fellow shoppers tended to her wounds. Forty-five-year-old Steven Forsyth died at the scene as well. Fifteen-year-old Kristina Shevchenko was lucky that she survived the impacts of the killer’s Bushmaster M4 Carbine rifle.
The word of an active shooter spread on social media and through other sources, and the call center was quickly overwhelmed. All 11 lines into the center were inundated.
Although the shooting at the Clackamas County mall lasted just 22 minutes, what followed was a communication system that was overwhelmed well after the incident was over. Photo: APImages.com
The protocol in the center is to answer: “911, what’s the location of your emergency?” and then go into specific questions. But every call was reporting an active shooter at the mall. It became impractical to follow procedure amid such a furious onslaught, so dispatchers set the book aside and answered, “911, are you calling about the mall shooting?”
“There comes a point where you’re so overwhelmed by incoming calls that you need to process them in and out as quickly as possible,” Spross said.
Furthermore, every off-duty police officer in the area wanted to respond. Many of them called an already-overwhelmed 911 center. “We told them to follow your procedures and we disconnected,” Spross said. “It turned out a lot of the departments didn’t have procedures prior to this on what to do and they needed people to come in.”
The shooting lasted just 22 minutes before the shooter turned the gun on himself, but everyone in the county — it seemed — got on their phone, knocking out service for hours. There were roughly 10,000 people in the mall that day, and as one officer put it as he arrived on scene, they were “on foot and bailing out like crazy.”
Police and fire soon set up incident command posts, and the chaos continued well after the shooter was dead, mostly as a result of miscommunication or a total lack of communication.
Among the calls to the dispatch center were those from inside the shopping center, where employees had followed mall policy and pulled every nearby shopper into a store, closed the gate, hid and called 911.
“Everything [mall employees] did saved lives that day,” Spross said. “However, we didn’t know that was their procedure, and knowing that would have been helpful so we could have said, ‘As long as you’re safe, don’t call 911.’ We want that information but maybe 10 minutes after the incident starts.”
The EOC acted quickly and rerouted traffic, without the knowledge of 911 dispatch. It didn’t occur to dispatch that it could be done so fast, Spross said. “If we’d have known, we would have requested it right away to make it easier for field responders to make traffic flow easier around there.”
Spross praised police and fire for setting up the command posts quickly, but they too struggled with communication. The fire department was getting reports of additional injured patients. And the police officers, not realizing that their frequencies were in fact the source of the fire department’s reports, were doubling back trying to find the additional injured people. “They recognize that they need to talk to each other faster and sooner, and have a joint command center,” Spross said.
That day set in motion policy changes on several fronts.
“One thing we learned is that we really don’t practice on a regular basis these high-stress events,” he acknowledged. “We don’t take it to the training room. Since then, we have done that. And staff understands they have a little more ability to work outside of the day-to-day structure.”
They’ve also worked with mall management to incorporate the 911 center into mall training and policy. And the mall and sheriff’s department have collaborated on communicating better, with the mall offering to pay for additional training for the department.
Another lesson according to Spross: “We learned we have to take better care of our staff in terms of mental health.”
‘We’ve Had a Mudslide’
John Pennington, director of the Snohomish County, Wash., Department of Emergency Management, remembers getting out of the shower at about 10:45 a.m. that day and seeing the light blinking on his BlackBerry. He remembers the uncertainty in the caller’s voice.“We’ve had a mudslide. Kind of scattered reports, but I think there’s a house that’s impacted or been pushed near the highway. I don’t have a good feeling about this.”
Early reports from the scene of the slide began to trickle in as first responders arrived. Then came reports of screams for help. There was no situational awareness for those on the scene, and conclusions from initial reports suggested a mudslide of 300 or 400 yards. The enormity of the incident started to take shape as air assets began plucking people out of the muck.
In February and March 2014, an unusual amount of rain had pelted Snohomish County. On March 22, a hill near the communities of Hazel and Oso gave way, pouring mud across the Stillaguamish River, suffocating an area of about a square mile and taking 43 lives with it.
“When I first got my eyes on the slide from a Black Hawk, I was mentally prepared because I had seen still photos and some video, but I was really focused on the dominoes downstream,” Pennington said.
The mudslide and ensuing debris had liquefied to the point where attempts to get on the pile were dangerous and nearly impossible. Photo: FEMA
Throughout that day and into the night, with no real situational awareness, it was difficult to measure the depth of the catastrophe, Pennington remembers. “There wasn’t really a strong ability for situational awareness. Because of the air assets, we would get a good visual that would be downloaded into our EOC, but we weren’t able to access any of that because we didn’t want to interfere with the fact that they were plucking people off the dirt. What we saw were spot checks of dirt.”
Looking back now, Pennington said if he had it to do again, he’d deploy additional air assets from either the state patrol or the federal government to get more video.
There are always lessons after the fact.
More reports began to trickle in about people yelling for help and the smell of natural gas and the depth of the mud mixed with power lines and jagged metal. The muck was everywhere, and it had collected ingredients that were harmful to search and rescue. The stuff was the consistency of pudding, The Seattle Times wrote later.
Pennington was uncertain if the debris would hold or break free and head down the river. “You’re talking 75 feet of mounds and water debris.” He evacuated the area downstream via the Emergency Alert System and upstream methodically with voice to text.
“The tactical commanders on the ground and I were talking a lot,” Pennington said. “It became problematic in that the debris was liquefied so much that any attempts to get on the pile were almost impossible and dangerous to the point where calls had to be made repeatedly to pull people back because of movement or just the complete uncertainty of what was happening.”
The search went on for days. More than a dozen people were pulled alive from the muck by the many who put their lives on hold to help. Nine days after the slide, just 24 bodies, or parts of bodies, had been found. The mud was so treacherous that searchers had to tape themselves into raincoats and pants to keep it out. The search continued for weeks.
Volunteers and agencies had flocked to the area wanting to help.
“My experience [with] the federal government and the state prior to that really helped me to understand that large-scale incidents, especially localized, had the highest potential for mission creep and federal takeover,” he said. “I knew what I was going to do.”
Pennington knew he had to “own” the incident. He made it clear with FEMA, for whom he had managed a Type II Incident Management Team (IMT), that everyone would work within the local system they had built and were building on the fly. “They were respectful of that.”
Pennington said the system in place worked because it was flexible, acting as more of a framework than a prescription. He was in the EOC for just three of the 37 days of the ordeal. The same went for his deputies and senior leadership.
“What we defaulted to was a system of emergency management in our EOC that would operate in times of crisis where we weren’t here, and that worked beautifully. But we had to inject ourselves into some tactical decisions knowing they impacted the larger strategy.”
It was a balance of tactical and strategic solutions that he hadn’t favored philosophically but was forced to practice in this event. A framework versus something too prescriptive allows for bending when the unexpected happens.
“We had this wonderful debris management plan that was recognized nationally and had been exercised, but what we had not accounted for in the plan was human remains,” said Pennington.
Another potential lesson involves the interface between the IMTs and the EOC. “What happens in an event like this one when you had huge IMT presence, but their reporting wasn’t to a county commission or council; instead they had to report to an aggressive, authoritative emergency operation center and emergency management function. Neither was prepared to work with the other,” Pennington said.
In the end, he said they made it work but that Oso is a microcosm of what a localized catastrophic incident will look like and will include the potential for EOC/IMT functionality. It will require looking more deeply at reporting requirements and integration between the two.
And lastly he remembered the 200 or so crisis managers on scene helping out. The message? “None of us are immune to human emotion.”
