The timing was uncanny. The coordinated response that ensued was practiced in a Mass Casualty Incident Command System (MCICS) training just the day prior to the incident, when those same responders were educated using an active shooter model. The training was applied to the mine incident in a structure that can be generalized to almost any mass casualty incident.
At the Revenue-Virginius mine, the county established a transportation unit leader and group for the first time to accurately track who was coming and going during the emergency.
In total, 30 responders navigated a snowy, narrow terrain to reach miners exposed to high levels of toxic carbon monoxide gases. The transportation leader and group helped especially to track and triage the miners and ensure quick treatment at three regional hospitals.
If not for the training, said Kim Mitchell, Ouray County chief paramedic, the miners who needed help would have likely left the scene without being accounted for or treated because the scene would not have been controlled. All miners exposed to carbon monoxide gases were sent to be evaluated by physicians.
Emergency responders applied the staging concepts they learned from the training to set up an area for resources to converge and to act as a casualty collection site, about five miles down the steep dirt road. Ambulance, fire and extraction crews waited there until needed. Responders also set up a mechanized shuttle using mine vehicles to taxi miners to the area.
This is a change from responders’ usual reaction to rush to the scene when a mass casualty incident happens, potentially choking up the area.
Effective Response
Mitchell sought out the MCICS training with assistance from the Western Regional Emergency Medical and Trauma Advisory Council in Colorado, which supports the delivery of emergency medical and trauma care. About 75 participants from Ouray County and the surrounding counties of Hinsdale and Montrose as well as the cities of Ridgway and Telluride attended.The training teaches the components of ICS, which standardizes response, roles and communication under one system. The MCICS training also helps responders to compartmentalize a mass casualty incident into chunks that are easier to deal with than thinking about the whole incident at once, according to John Putt, president and partner of the Operational Consulting Group, which put on the training prior to the incident.
The two-day course is given by instructors representing the various disciplines, working right alongside responders. The last day is all hands-on, scenario-based training. The training focuses on the pre-hospital side, ensuring that law enforcement, fire and EMS collaborate in a structured and standardized way, akin to the well honed hospital side, said Kelly Victory, chief medical officer and partner of Operational Consulting Group. This is doable, she said, because 80 percent of what needs to be done during any mass casualty event is the same.
“All these events are relatively similar, and they need to be structured in such a way that people do it as rote as they do the ABCs,” Victory said.
Active shooter mass casualty training is a shift in thinking because it asks EMS and fire to go with law enforcement into an active scene to address casualties immediately. EMTs have been historically trained to wait until a scene is safe before entering.
The emergency management community has learned during shootings that if medical responders wait, it might be too late, according to Putt. “Ultimately, success in the field is dependent on how fast you get patients to the surgeon.”
Operational Consulting Group has offered these comprehensive trainings throughout Colorado in cooperation with the Hospital Preparedness Program in the state’s Department of Public Health and Environment, with additional grant funding from the U.S. Department of Health and Human Services. Going forward, the group is interested in taking the trainings out of state, seeing a need for other agencies to learn from the structured, hands-on training.
Though MCICS covers high-level concepts by PowerPoint, the critical piece is practicing the response with all the stakeholders at the same time to develop muscle memory, Victory said. “That is why I believe Ouray had the outcome it did in dealing with the mine incident. They had practiced it; they had done it.”
There was also a 100 percent participation rate in the training from county and city law enforcement, fire departments and EMS, Mitchell said. “It brought all the different players together.”
Glenn Boyd, Ouray County emergency manager, said that was significant because the county’s entire fire department and all but three EMTs are volunteers. And many of them had never experienced in-depth, hands-on training before.
And that’s the goal of the training, Putt said: To get people confident in dealing with mass casualty incidents but also confident in responding to them while working together.
A Unified Effort
An essential thing the county learned from the training was to call for help early.
As it happened, Mitchell was the medic on call when she got pages around 7:20 a.m. that told her at least one person was in the mine unconscious, but possibly as many as six. Mitchell responded to the messages along with law enforcement and the fire department, and also called on mine rescue teams. Once at the mine, which is located about a half hour outside of town, Mitchell learned that two miners were more than a mile inside.
In coordinating the safety of the miners, emergency responders worked together with law enforcement, much like how the active shooter training required collaboration so that fire and EMS would have protective detail during a shooting.
In applying the training, the sheriff’s office worked with responders to protect the area from miners attempting to return to the area for rescue attempts, according to Mitchell. “Eventually we just had to seal it off because very distraught miners were trying to go down.”
In addition to the sheriff’s office assuming incident command at the scene, agencies established a unified effort at the emergency operations center in town to direct media, family and resource collection. This unified effort is something the county has attempted before, but this time it worked, Boyd said.
Because all of Ouray’s resources were focused on the mine site, the county called on its mutual aid partner, Montrose County, to cover fire and EMS calls. Montrose covered three calls for the county, including an avalanche and an auto-pedestrian fatality, Putt said. The regional effort also included emergency resources from Ridgway and the counties of San Juan, San Miguel, Gunnison and Delta.
The rescue team drove 19 miners and flew one by helicopter via TriState CareFlight to three hospitals, with the farthest hospital located more than two hours away. Four miners were treated overnight.
Meanwhile, the rescue effort waited at the scene for two four-person mine rescue teams to drive several hours to retrieve the individuals who were still inside. Mine rescuers are the only responders who can rescue people inside mines, following technical rules established by the Mine Safety and Health Administration.
Though the administration has not released its conclusive report as to what happened that day, Ouray County Sheriff Dominic Mattivi ruled out a mine explosion or collapse as the cause of the incident. A preliminary report notes that the men were found in the area where mine operations had detonated explosives the day before, potentially leaving behind carbon monoxide as a byproduct.
‘Better Learning’
Even in the face of loss, an effective response can help a community bounce back because emergency crews know their response was as effective as possible.
Not only did the training help bolster resilience, but the mine incident itself also reinforced the lessons Ouray and other responders learned from the MCICS training simply because the community used what it learned during the response.
“You can learn a lot from having a big incident like that and failing,” Mitchell said. “But if you can practice and then have mostly success, it’s better learning.”
And the lessons are sticking. Before the Fourth of July weekend — the community’s busiest holiday — sheriffs along with police, fire and EMS chiefs gathered to make an incident action plan to anticipate resources and situations. Boyd said that would have never happened even five years ago.
