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When Did 'Mass Casualty Event' Become a Term?
Very recently the term ‘mass casualty event’ has tragically become part of society’s lexicon. Specific wording and phrases have significance and meaning, especially for emergency managers.
“Police declared Astroworld ‘mass casualty event’ half-hour before Scott left stage” – New York Post
“5 fatalities, at least 40 injured after Waukesha mass casualty event” – gmtoday.com
“Did quick-thinking taxi driver prevent mass casualty event in Liverpool blast?” – The Daily Beast
Very recently the term ‘mass casualty event’ has tragically become part of society’s lexicon. I cringe when I hear/read ‘event’ made synonymous with ‘incident’. There are words and phases which have significance and specific meaning, especially for emergency managers.
Case in point is how the very legal term of terrorism is applied or mis-applied, depending on who is asking or telling. Does your organization have a different set of plans for the adverse impacts of Foreign Terrorist Organizations versus Domestic Violent Extremists? Does it really matter to the people who were hurt or worse?
An event should be defined as something planned and scheduled. The 2021 events in Houston, Texas and Waukesha, Wisconsin quoted above were a scheduled concert and parade, respectively. The Liverpool, England incident involved a quick-thinking taxi driver who locked a suicide-bomb wearing suspected terrorist in his vehicle, keeping the explosion within – rather than going off at the hospital where they were most likely going to detonate it. There was not even a scheduled event at the hospital that day.
Are you enjoying reading this? Maybe your friends (or even your foes) would, too.
The incidents are what happened (or might happen) at those events or situations. It is doubtful either of the concert or parade event organizers were planning on having mass casualties on their itineraries, unlike for example, the annual running of the bulls at Pamplona, Spain. That may be the only event to come to mind which really is a Mass Casualty Event. Any mass casualty incidents should have been part of the consequence management planning, as, for example, it is already established for most acute care hospitals, especially those designated as trauma centers. In my opinion, no ethical emergency manager should be scheduling mass casualties: however, they must be planning for mass casualties, as part of their consequence management planning for any event – including both how to protect and prevent them, as well as respond to and recover from them.
Emergency Management is all about consistent understanding and usage of policies and procedures, including that of systems and acronyms. Plain language is a key tenet to the U.S.’s National Incident Management System (NIMS). Incidents can be designated as different levels for events and types (size and scope, plus resources needed and duration of the incident). In our profession, we need to define and promote these terms as standards:
Events are planned, with notice. The U.S. Department of Homeland Security already has a leveling scale, called the Special Event Assessment Rating which can be used to identify needs for federal and other resources.
Incidents can occur anywhere, including at events. Incidents occur as a change to what is normal. They can have notice like a winter storm or a hurricane, or no-notice like a cybersecurity breach or a tornado. And the U.S. Federal Emergency Management Agency has a set of typing for incidents as well, through the NIMS Incident Complexity Guide. Multiple operational periods and greater levels of staffing are both hallmarks of higher incident types.
Emergencies engage more resources than the original plan anticipated. These can be thought of as incidents where the current plans are insufficient for what is actually happening, or the incident has escalated beyond the capacity of the current resources available. This is also the level when legal authorities and extra-ordinary powers can be triggered - as in when an authority having jurisdiction “declares an emergency”.
Disasters should be designated for those incidents when those additional resource needs cross major jurisdictions (such as across multiple states, territories, and/or tribal entities), or have national impacts. These are Type 2 and Type 1 Incidents.
Catastrophes should be reserved as a term for when all of the possible available systems fail to cover the unmet needs – up and down the chain of command – and our nation does not have enough capacity to properly respond. In my opinion 9/11 was a catastrophe, and so was our response in and around New Orleans during Hurricane Katrina. 2011’s Fukushima, Japan earthquake, tsunami, and then nuclear power plant disaster was a complex and cascading catastrophe. These may all be incidents when one nation needs help from others.
Finally, if you are a true consequence management planner, you will always consider the “what if it was worse?” scenarios. And yes, it can get worse than a Catastrophe. When the whole world is figuratively going down the drain, and there is real possibility of a Mass Extinction of humans anywhere and everywhere, there’s a term for that type of incident. Unfortunately, many scientists have already described this as an event – an Extinction Level Event (ELE). Think along the lines of a meteor striking the earth, a nuclear war, or maybe an unchecked worldwide pandemic. This has also been called a Type 0 incident by some. There’s not much emergency management planning for an ELE – it is really the stuff of science fiction and the movies, in reality. [I wrote a piece advocating for Emergency Management not to be the sole management structure for Type 0 incidents, for Pracademic Affairs, using COVID-19 as my use case example.]
This post, authored by Michael Prasad, was originally published in the IAEM’s Bulletin, in January 2022. Used with permission. This monthly newsletter is one of the benefits of IAEM membership. Learn more at https://www.iaem.org/resources/newsletter. The author is an IAEM member, and frequent contributor to the Bulletin, as well.