WARRENTON, Ore. – Members of the Oregon Air National Guard’s 142nd Fighter Wing Medical Group, along with civilian medical first responders from Oregon Disaster Medical Team (OMDT) and other military and government agencies, took part in the annual Pathfinder Exercise held at Camp Rilea Armed Forces Training Center from June 11-14, 2019.
The scenario for the event began 36 hours after an earthquake and tsunami have overwhelmed most coastal communities in the region. As in past years, the exercise site for the four days of training was at Camp Rilea in Warrenton, Oregon, the mid-point between the two popular west coast tourist destinations of Astoria and Seaside.
The Cascadia Subduction Zone (CSZ) is more than 620 miles long, stretching from Northern Vancouver Island, in British Columbia, Canada, south along the Washington and Oregon coast to Cape Mendocino in California. Because of the fault line’s excessive length and sloping plates, the CSZ has the potential to produce an enormous earthquake and subsequent tsunami along the Pacific Northwest coastline. The annual Pathfinder Exercise generates a variety of scenarios for first responders to encounter when faced with the devastating effects of a CSZ event.
Oregon Air National Guard Capt. Kevin Lindsey, a medical plans officer with the 142nd Fighter Wing Medical Group and Chemical, Biological, Radiological and Nuclear Defense (CBRNE) Enhanced Response Force Package (CERFP) briefed all the first responder’s teams on the situations they would encounter for the final day’s assessment.
“We begin the exercise at the point where resources are spread thin, many of these smaller towns and cut off areas have become overwhelmed with difficulties so you’re going to encounter victims that could be very distraught,” he said.
Responding to individuals in the disaster zone is the major challenge, both for the search and rescue teams finding casualties in cut-off areas to the patient care and medical groups triaging, treating and transporting them to available hospitals.
Addressing this point, Lindsey emphasized to the groups that they should work together and take care of themselves in the field and not take unnecessary risks. “It’s important to remember, work closely together, practice safety and think about what is ‘closest, easiest and fastest’ to solving situations you encounter.”
“Often this means thinking outside the box,” Lindsey reiterated. In stressing the need for consistent communication, he explained that the Incident Operations Center will regularly make decisions, such as moving strike teams from one area to another, but will get questioned from the field coordinators about why resources are being moved.
In an exercise training scenario the day before, Lindsey role-played a strike team leader in the field, calling into the operations center for answers. “I wanted to see what that ‘better answer’ was, so I pushed back on some of these demands being made,” he said.
“In the end, the solution was to move resources that were not in play and ultimately it was determined that those recourses should be moved into that critical area,” Lindsey summarized, crediting the operations team members working the problem together for an improved result.
Bobbie O’Connell, working in a dual status with OMDT and with the National Director Medical Systems (NDMS) on this exercise, echoed this need for clear and concise communication.
“Communication is always first,” as she described the significance of collaboration with other team members in mass casualty events. “Getting people activated, getting people to interact, and getting people to respond. Communication is the biggest challenge not only here but in my full-time job in the hospital environment too.”
Terminology is critical. Bridging the gap between military and civilian first responders lingo is vital. Confusion can lead to delays, or not providing the correct resources where they are desperately needed.
“The communication piece is not only for common up-to-date information, but understanding a common language,” O’Connell said. “There’s ‘hospital speak,’ ‘military speak,’ ‘fire and rescue speak’—each has its own language. But here, we have broken it down and find a common vernacular.”
In years past, civilian response teams like ODMT drove the exercise, but for Pathfinder 2019, the military took the lead role. This flexibility is nothing new for O’Connell, a full-time nurse and trauma operations officer when not volunteering her time for training and real-world relief missions.
“Just like in real life, somebody has to jump-start the process,” she said. “Brokering relationships and wanting to work with multiple partners is really the goal of the whole operation.”
In a disaster scenario, any organization could end up leading the response effort. The exercise allowed teams to take on various responsibilities and build best practice solutions.
Leading up to the final day’s exercise, a variety of specialized teams broke out into training groups or attended forums to share past experiences and real-life lessons learned. This included members from the U.S. Navy, Coast Guard, local law enforcement, fire and EMT providers and agencies outside of the Pacific Northwest.
Last September, when Hurricane Florence impacted the Atlantic coastline of the Carolinas, it also tested first responders' capabilities over a prolonged period. Kimberly Clement, a Health Preparedness Program Manager from North Carolina, briefed key leaders on the response effort as part of the Pathfinder Exercise.
“The storm just sat in place for what seemed a month,” describing the massive volume of rain. “It depleted not only the resources but the plans for dealing with a storm that lingered far beyond practiced scenarios,” she said.
In detailing the timeline of the storm, she interjected the issues that hampered pieces of the recovery. As difficult as the nature-made obstacles were to surmount, staffing was also a concurrent problem.
“Often it was not the plan or the resources, but we found that we had human issues,” she explained. “At some of our emergency shelters it was the role someone had, other times it was leadership or having ‘too many leaders’ coming to a head.”
Overall she said the people affected by the storm were well taken care of but having the right balance of specialties on teams was one of the biggest lessons learned.
Using a well-trained and equipped Medical Rapid Response Team (MRRT), the Nevada Air National Guard’s 152nd Air Lift Wing helped bridge some of those gaps. Maj. Bruce Gallio, a physician assistant (PA) with the unit, was making his third trip to Oregon in support of the Pathfinder Exercise.
“This year the lead is more military driven,” he said. “The exercise, for military members feels more familiar with the organization and chain of command structure already established.”
This is one of the built-in advantages with the hierarchy recognized within the military structure, Gallio explained. “For other military units outside of Oregon, jumping in with support roles for Pathfinder, the leap (as military members) was much easier to make.”
Nevada is in FEMA Region II and typically partners with National Guard units in California and Hawaii. The Pathfinder Exercise allows neighboring states to build in rapid flexibly to assist within hours.
“With the MRRT concept, we think we can get out the door in four hours unlike the CERFP element, which has 72 hours to respond,” Gallio described. “We’re prepared, but the biggest question is how to get here in an actual emergency, whether it is vehicle, helicopter, airplane… when it happens we’ll figure that (part) out.”
In a CSZ event, Oregon and other West Coast regions will be looking for help from a variety of places. Units like the 152nd Air Lift Wing could be relied upon for their air transport mission and medical services.
“Nevada is close and we can inject as a strike team or medical team. And the way our teams are constructed, we can arrive with a larger group or just as a 12-member team,” said Gallio.
The team’s make-up is established with military members working in partnership with their civilian counterparts, Gallio reiterated, describing the makeup of team leaders working together during the exercise.
“A well-organized team will have a variety of skill sets in each group, to include search and rescue specialist, medical staff, and often radio and security personnel,” he said.
This is the type of flexibility that Lindsey described in thinking ‘outside the box,’ in the aftermath of an actual emergency.
“We teach each other in these types of exercises; we’ve learned some best practices from our civilian partners, even in command and control--which is something we do really well in the military,” said Lindsey.
Overall the exercise tested what team leaders set up to achieve: combining multiple first responder groups, partner them in teams, and challenge them on those ‘best practice’ and time-saving solutions.
“Ultimately the only way we can work together (in mass causality conditions) is to break down some of the problems and look at them through different points of view, this is how we’ll ensure successful outcomes,” said Lindsey.
“When time is of the essence, the established support structure with flexibly built-in, can drive resources and help save lives.”