Man with headset sitting at a desk in front of computers
Centers for Disease Control and Prevention activated its emergency operations center to assist public health partners in responding to the novel coronavirus outbreak, February 4, 2020 (Source: CDC/Unsplash).

Interoperability During Mass Casualty Incidents

When two pressure cooker bombs exploded at the Boston Marathon in 2013, three people died, and hundreds more were injured. The death toll would likely have been much higher if it were not for the swift actions of the boots on the ground, the 911 operators’ effective handling of the calls, and the utilization of the Disaster Radio Network to facilitate patient care and inter-facility communications between the scene and medical receiving facilities.

The District of Columbia’s Homeland Security and Emergency Management Agency (HSEMA) hosted its fifth annual Interoperability Summit in September 2023 to review the lessons learned from that 2013 attack. The discussions at the summit spurred key action items to help participants close interoperability gaps within their jurisdictions. Three of the 10 items focused on communications planning with hospitals and other medical systems:

  • Ensuring that third-party and private services such as emergency medical services and security have direct interoperability capabilities with local first responders; 
  • Incorporating the often overlooked “responders” in the planning process (e.g., 911 call centers, hospitals); and
  • Planning for the unique issues regarding patient data and transfer of care.

Learning what worked, what did not work, and what communities still need to do is only a start. The real work begins when participants use that information to take actions that reduce the likelihood of repeating mistakes or not closing known gaps.

Setting the Stage for Effective Communications During Active Assailant Incidents

Using the action items from the Interoperability Summit, HSEMA hosted a workshop on January 10-11, 2024. The “Effective Communications During Active Shooter Incidents” workshop brought together DC-area communications supervisors, dispatchers, law enforcement, fire and EMS supervisors, radio technicians and information technology support, emergency management, hospitals and mutual aid partners, and public information officers. The discussion focused on three primary objectives for addressing mass casualty incidents:

  • Identify interoperable emergency communications lessons learned in hospitals and healthcare systems;
  • Learn how national gaps relate to local medical system capabilities; and
  • Develop actions to resolve locally identified capability gaps in communications.

Because this event included some the often overlooked responders, Day 1 began with an overview of the basics about the statewide interoperability coordinators’ (SWIC) roles, defining interoperability, and describing the emergency communications ecosystem and PACE plans. Since Washington, DC, has some interoperability gaps that would need to be addressed to effectively coordinate patient transfers – as needed after the Boston Marathon bombing – it was critical to include the medical community in working through a mass casualty scenario.

Assistant Chief Rodney Reed of the Harris County (Texas) Fire Marshal’s Office set the stage for an active assailant scenario by describing trending gaps in interoperability during the Christopher Dorner manhunt in California in 2013, the Paris terrorist attacks in 2015, the Pulse nightclub attack in Florida in 2016, and the Route 91 Harvest Festival shooting in Nevada in 2017. Such incidents create an influx of calls to 911 call centers that can overwhelm dispatchers and delay aid to those who are critically injured. Hospitals experience sudden patient surges, but the medical staff may not have all the pertinent information about the threat, the extent of injuries to expect, and the resources to keep up with the patient flow.

Source: District of Columbia Fire and EMS Department (2018).

Interoperability Challenges

Any incident that results in large numbers of casualties has the potential to overwhelm the response efforts. However, there often are opportunities to save more lives during crises. As Reed noted during the workshop, injuries are not always life-threatening, but some fatalities may be preventable with swift action and solid communication. When emergency medical services, hospitals, and other healthcare facilities are included in communications plans, close coordination and improved interoperability capabilities can reduce response and treatment delays.

Simply conveying messages to other agencies through dispatchers is not true interoperability. However, some current equipment may have the ability to become interoperable if users know how to engage it. It is important to note that even if a radio can be interoperable, it not necessarily should be used in that manner. Training is a key component for any communications system, especially units that are not used daily. The middle of a crisis should not be the first time someone uses the equipment.

When large-scale incidents occur, the equipment also can become overwhelmed. Computer-aided dispatch (CAD) systems can be pushed to the limit by off-duty responders logging in. People who do not have new information about an incident can tie up 911 lines and delay or prevent critical calls from getting through. Family and friends who are trying to obtain information about their loved ones may make repeated calls to emergency services.

Closing the Gaps

Planning and collaboration with hospitals and other medical facilities can increase interoperability and improve patient care during a disaster. For example, first responder agencies could stage equipment in hospitals and train personnel on its use to ensure the medical staff is alert to potential patient surges. In addition, dispatchers could deploy first responders to medical centers nearest the incident to assist with overflow and increase interoperable communications.

Events like the Interoperability Summit bring together key stakeholders to share lessons learned and best practices. So, talking about issues and plans is a good first step. The next step would be follow-up. Workshops like the one in January on effective communications during an incident go beyond talk to create action items for the stakeholders who will be involved in the response. It is not enough to simply identify a problem and talk about what should be done. Take the next step to close the gaps. Collaboration and effective communication with other key stakeholders cannot wait till the next critical incident.  

Planning has begun for HSEMA’s 6th Interoperability Summit, to be held on September 4th and 5th.  The 2024 theme will be “Preparing for the 60th Presidential Inauguration; Interoperability Is Our Common Language.”

Charles Guddemi
Charles J. Guddemi

Charles Guddemi is the District of Columbia’s Homeland Security and Emergency Management Agency’s (HSEMA) statewide interoperability coordinator (SWIC). He is responsible for coordinating interoperability and communications projects involving voice, data, and video. He chairs the District’s Interoperable Communications Committee and Cellular Industry/WiFi Provider Working Group. He serves as the secretary for the Statewide Interoperability Executives Council, is a member of the National Council of Statewide Interoperability Coordinators and current co-chair of FEMA’s Region III Regional Emergency Communications Coordinators Working Group. He also participates on several Metropolitan Washington Council of Governments (MWCOG) committees and working groups. He joined HSEMA after a 25-year career with the United States Park Police (USPP). His assignments included working in Washington, D.C., New York Field Office, San Francisco Field Office, and the National Park Service Northeast Regional Headquarters in Philadelphia, Pennsylvania. He achieved the rank of deputy chief serving as the commander of the Services Division.

Catherine L. Feinman

Catherine L. Feinman, M.A., joined Domestic Preparedness in January 2010. She has more than 35 years of publishing experience and currently serves as editor of the Domestic Preparedness Journal,, and The Weekly Brief. She works with writers and other contributors to build and create new content that is relevant to the emergency preparedness, response, and recovery communities. She received a bachelor’s degree in International Business from the University of Maryland, College Park, and a master’s degree in Emergency and Disaster Management from American Military University.



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