In the aftermath of the tragedy of Asiana Airlines Flight 214 that crashed while landing at San Francisco’s airport in 2013, killing three and injuring 187, first responders and PSAP’s from the San Francisco Bay area learned some valuable lessons about what should be done during a mass casualty.

During the APCO International Conference & Expo, two people who were directly involved in that disaster shared lessons learned from that day that have led to changes in departmental procedures.

William Storti, Batallion Chief with the San Francisco Fire Department, and Michelle Geddes, who currently manages the Public Safety Communications Program for the San Francisco Department of Energy Management, each shared valuable lessons during a session entitled: “Communications and Operational Issues During a Multi-Jurisdictional, Large Scale Mass Casualty Incident.”

The immediate challenge was dealing with PSAP’s from the San Francisco Airport and other surrounding areas including San Francisco and the San Mateo County area, along with agencies from other countries because it was an international flight.
Among the major challenges:

• High stress situation
• Emergency response being handled via phone system
• Incomplete information being passed because of difficulty to communicate
• Information was delayed

Storti said what emergency supervisors learned that day, and in the ensuing analysis, is that often times procedures don’t translate well during an actual high-stress incident involving multiple agencies and many things had to be simplified.

Changes that have been implemented since the mass casualty incident:
Adding staff and equipment as standard procedure during initial dispatch. Among those: specialty medical equipment such as an MRI unit as a basic part of the response; adding an alarm level; adding an attached hose staffed by engine and truck on initial dispatch; adding a fire and rescue boat and Hazmat to initial dispatch and increasing personnel from 37 to more than 90 on initial dispatch.

Getting the information from the communications center to the responding units.
At one point air traffic controllers were reporting that there was no fire, while first responders on the scene were witnessing fire coming from the aircraft, and video of the aircraft showed the fire.

The city’s radios were not able to communicate with the airport system’s encrypted channels. Since then, audio in and around the airport is also available in the city of San Francisco without encryption.

“Units that are responding down at the airport now can switch to the channel and hear,” Geddes said. “And we’re also integrating the system into one large system, and all encrypted channels are available on one radio.”

PSAP to PSAP communication between three different communication centers.
In listening to the tapes and hearing the audio, it was clear there were delayed conversations between emergency responders who were forced to relay information by phone rather than receive it directly from the communications centers. The delays made it evident there was a critical need to have a direct link between responding emergency services personnel.

“We needed to look at how can we have a direct link, maintain that direct link, and share data and video over the same platform,” Geddes said. “So what we’re looking at is a system called MutualLink which is basically an intercom between the two dispatch centers, and also allows you to text and share files. So it becomes a file that is interactive and can be shared between agencies immediately. And there’s a video component where you can instantaneously take the video that you see at the scene and pull it directly at the dispatch center.”

Although the San Francisco Police Department and San Francisco Fire Department each were on the scene, they were utilizing two different PSAP systems that are not integrated.  “Ideally we would be able to integrate the two and share the calls going back and forth, but that’s in the future,” Geddes said.

“I kept saying it has to be simple because there’s a lot of stress,” Storti added. “I can have drills and I can have seven-point plans, but I’m never going to get to No. 2 because I’m always going to have to go and rescue someone. So it has to be simple.”

Triage, Treatment and Transport
In the chaos of the situation, with 307 people aboard the plane, it became difficult to keep track of where each passenger was. In the event of another disaster, a transport officer will be responsible for keeping communication with all ambulances, which won’t be allowed to leave without the knowledge of the transport officer. The transport officer will also select which Bay area hospitals patients should be transported to, based on injuries, and keep track of notification and how many patients are being sent to each hospital.