Professional responders who are first to arrive at a mass casualty incident (MCI) face a complex and potentially overwhelming challenge. It’s possible the first to arrive may be an inexperienced responder who will have to make decisions quickly and may lack mental models to help drive their behaviors. Even in a well-coordinated response, the professional responders may not be able to treat all the injured at the same time, and so they must triage and prioritize the victims.
Spontaneous volunteers often heroically step in to fill the gap without being asked, but their courage and commitment often adds complexity to an already chaotic and challenging situation. Recent MCIs demonstrate that volunteers are often willing to help in a variety of ways. The additional support can make a significant difference in the response, and can help saves lives. Current policy and training don’t encourage professional responders to engage and leverage the public in this manner.1
The initial professional responder (IPR) is defined as “the initial professionally trained and legally recognized responder to arrive at the scene of an event.” It is usually a member of the police, fire or EMS. An IPR arriving on scene at any complex event is often the immediate center of attention for volunteers and victims. The IPR is seen as the legitimate authority and expert to turn to.
This can create a significant amount of stress on the IPR, as well as providing the IPR with an important amount of informal power. The IPR is expected to take charge, make decisions and provide information under the most challenging of circumstances. A simple and straightforward method of trying to bring order to the chaos is needed to allow the IRP to make decisions and manage the incident effectively.
Recognition of the capacity for volunteers to help has led to a number of new initiatives aiming to train and empower volunteers. Simple yet effective medical techniques and initiatives have been developed, such as Stop the Bleed, Be the Help,2 and Until Help Arrives.3
Current training for professional responders focuses on reducing the complexity and liability of a response to an MCI by “clearing” the scene of spontaneous volunteers and bystanders. This approach doesn’t recognize the reality of spontaneous volunteers, nor does it allow the IPR to take advantage of the skills and potential support spontaneous volunteers can provide.Volunteers are critical to the initial response in many types of emergencies, from terrorist events to vehicle accidents to mass evacuations.4 In these events, the professional responders need to understand “who can help.”
Protocol for Volunteer Support
A team from the National Preparedness Leadership Initiative (NPLI) at Harvard University studied the problem of volunteers at emergencies. They believe if IPRs are trained in using a simple protocol to better control and leverage the capacity and support of “spontaneous volunteers,” it will lead to better outcomes. These outcomes could be fewer deaths and injuries, faster casualty evacuation, and more effective scene control at MCIs and other emergency events. The success of this initiative is the development of a protocol and supporting training that allows professional responders to be knowledgeable and effective in coordinating the support of volunteers.
Volunteers assist on-scene for a variety of reasons, but regardless of their motivation, there will be a wide variance in skills, abilities and willingness to undertake certain tasks. A “spontaneous volunteer” (SV) is already helping in some regard when the IPR shows up. A “willing volunteer” (WV) may be in close proximity, but is waiting for a social cue or leadership from someone to help engage and direct their support. There will be those individuals on scene that are unable or unwilling to support the efforts, and they are classifi