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U.S. Department of Health and Human Services

Illustrative Example

The following example demonstrates how the concepts presented in this chapter may be applied during an actual incident response. The various phases of response (as described in Chapter 1) highlight when critical actions should occur; however, the example extends only as far as incident operations, as this is the focus of the MSCC Management System.

Background and Incident Description

  • A large chemical factory that produces plastics resides in the far eastern corner of State Alpha. State Beta is adjacent to State Alpha and is "downwind" of State Alpha.
  • An explosion occurs at the factory, starting a fire that is difficult to control. Victims are coughing and complaining of breathing difficulties.
  • Large clouds of smoke, possibly containing combustion products, such as phosgene and other pulmonary irritants, are released into the atmosphere and carried downwind toward State Beta. The local fire service and a hazardous materials (HAZMAT) team respond to the scene.

Incident recognition at the State level occurs for State Alpha (where the explosion occurred) when the responding jurisdiction reports the findings of an initial HAZMAT scene survey to the State's Environmental Protection Agency (EPA) HAZMAT reporting center. State Alpha begins staffing its State EOC and notifies participating agencies that the State EOP is activated. The initial HAZMAT report forms the basis of State Alpha's notification of EOP activation.

For State Beta, incident recognition occurs when State Alpha's HAZMAT responders notify the fire service/HAZMAT team in the adjoining jurisdiction of State Beta using tactical channels established in preparedness planning. They decide that unified command should be set up to coordinate the evacuation of the at-risk population.

Notification/activation of the interstate response occurs through the aforementioned tactical coordination between local fire/HAZMAT units from State Alpha and State Beta. In addition, State Alpha directly notifies State Beta's Emergency Communications Center (ECC), which serves as the pre-event baseline operating entity for State Beta emergency management. State Beta immediately activates its State EOC and notifies participating agencies in its State EOP.

Mobilization of the interstate response occurs as State Alpha and State Beta activate and ramp up staffing at their respective State EOCs, and activate their State-level unified command teams.

Incident operations are characterized by initial reports from the affected jurisdiction in State Alpha of large numbers of respiratory injuries that have overwhelmed the local healthcare organization (HCO). Fortunately, this HCO is upwind of the area of concern and does not need to evacuate or consider sheltering in place. The HCO has activated its EOP and requested and received assistance from community medical providers, as well as from its mutual aid agreement with a hospital located ten miles away. The local MMRS plan is also activated and used to coordinate the metropolitan healthcare response.

State Alpha provides regular updates to State Beta's EOC regarding firefighters' progress in suppressing the fire and smoke, in determining the exact contents of the noxious smoke, and in plotting plume models as wind conditions at the scene change. In addition, State Alpha provides information to State Beta on the conditions of patients presenting at State Alpha hospitals, including symptoms correlated with positions where the victims were exposed. When State Beta requests to send its HAZMAT experts to the scene, State Alpha's EOC arranges for an escort from the fire marshal's office in State Alpha to facilitate scene evaluation by State Beta experts.

The heavily affected jurisdictions in State Alpha and State Beta decide to continue with a unified area command[4] to tactically manage joint issues caused by the smoke. State Alpha supports this initiative by supplying a command vehicle and medium-range communications equipment for use in the affected areas. This is closely coordinated with command staff in State Beta's EOC. Strategies and tactics, such as decisions to evacuate or shelter-in-place, are also coordinated between State Alpha and State Beta to avoid conflicting recommendations. Any differences are explained to the public in simple terms to prevent confusion. Similarly, medical evaluation and treatment protocols for victims are coordinated with input from both States' public health agencies. As the situation improves, recommendations for repopulating evacuated areas or ending shelter-in-place are consistently developed and applied across State boundaries.

State Alpha requires additional assistance for the local hospital that is caring for the majority of incident victims. It is determined that healthcare assets in State Beta can actually provide the necessary help faster than assets that could be obtained through intrastate mutual aid. Therefore, State Alpha's EOC asks for assistance from State Beta for critical care personnel and ventilators. This is accomplished using protocols and procedures developed during preparedness planning (through MMRS and other initiatives) and based on EMAC authorities.

State Beta notifies its Medical Reserve Corps and hospitals near its border with State Alpha. The requested resources are located and dispatched. The strategic mutual aid agreement between State Alpha and State Beta provides for:

  • Waiver of licensure and certification requirements in State Alpha for State Beta responders who are appropriately credentialed in State Beta
  • Extension of liability coverage by State Alpha to State Beta for workers as long as they operate within their defined scope of practice
  • Extension of worker compensation coverage by State Alpha to healthcare workers who respond from State Beta.

  1. The definition of an Area Command (Unified Area Command) is provided in Appendix D.

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  • This page last reviewed: February 14, 2012